Hacking at 0300

Part of the drudgery of medicine is all the certification and paperwork, and the petty bureaucrats who need to constantly justify their existence by creating new rules. All the rules are well-intentioned, but taken together pave the road to hell—keeping us away from our patients and actually helping people. One such well-paved path is the American Board of Pediatrics which, over the past 20 years, turned board certification from "Take a test" to "Take a test at home every 7 years" to "Take a closed-book test in a secure environment because we can't trust you, every 7 years" to "Take a secured test every 7 years, keep your medical license (even losing it for not paying taxes means you lose your certification), do Board-approved CME, get patient-satisfaction surveys, and do Board-approved quality improvement projects, every 5 years." There's no reason to believe any of this makes me a better doctor but without it, what's the Board for? But enough griping, I may write about this more later.

One of the first things I tried to do when I started at the St. Lukes Pediatric Care Center this fall was improve our asthma management and follow up, so my Quality Improvement project will be the Board's Asthma Practice Improvement Module. It's no different from what I'm doing anyway, with the added fun of filling out data forms online for the Board to adjudicate.

Asthma Management

Asthma is a growing problem in the US, and the NIH has produced a huge (4 MB) report on managing it, with lots of its own jargon. Basically it's a chronic disease that comes in attacks, which can either be in control—only occasional symptoms—or not in control—frequent symptoms. Either way, attacks are treated with rescue medicines, usually an inhaler that relaxes the muscles in the lungs. If your asthma is in control without any other medicines, then you have intermittent asthma. If not, you have persistent asthma and need control medicines to take every day to prevent attacks. The report further divides persistent asthma into grades of severity, but judging severity is inconsistent and largely irrelevant: if your control medicines keep you in control, good; if not, do something more.

Continue reading ‘Better Asthma Care through Technology’ »

I use an AT&T 8525 smartphone (it's the HTC Hermes TyTN) that a friend recommended (some friend!). I've been pulling my hair out with its daylight savings bug—events have the correct time in Outlook on the computer, but are an hour off or worse on the phone. Outlook stores events in UTC and displays them in the local time zone. Events that take place during daylight savings time occur one hour earlier UTC, but Outlook knows that. Windows Mobile 6 doesn't. Why would a Microsoft programmer creating a calendar program care about daylight savings time? It only affects half the year! So all appointments during DST are listed on the phone as one hour earlier. Worse, all-day events are stored as midnight-midnight, with an extra flag marking them as all day long. The bug shifts the event to 11pm the day before, still marked as an all day event, so Easter Sunday falls on Saturday on my phone!

Solution: Follow the instructions at Microsoft's website: www.microsoft.com/windowsmobile/en-us/downloads/microsoft/daylight-savings-update.mspx. The phone resets itself without warning; that's OK. The times are still messed up. Open Outlook and make sure your contacts and calendar are correct. Now open Active Sync and select Delete Mobile Device from the File menu. This means that everything on the phone that syncs (Calendar, Contacts, etc.) will be erased and recopied from the computer (Microsoft neglected to provide a way to just sync with "computer overwrites handheld" for just the calendar, the way Palm does). Connect the phone. A "Connected" message appears in Active Sync, then the whole program disappears. Disconnect the phone and reconnect. A "Connected" message appears in Active Sync, then the setup wizard starts, and you can sync as usual. Pray that all your critical appointments will be copied correctly (this took 2 hours with my data). The phone calendar now has the correct days for all-day events, but the times are still off. Changing the date to a day in DST (under Settings/System tab/Clock and Alarms), however, corrects the times, both during DST and regular time. Changing the date to the correct date does not lose the correction. Restarting the phone makes it forget the correction, so you have to do the change date hack again.

Liberally mutter or curse while performing this arcane art.

Bottom Line solution:

1. Don't buy Microsoft products
2. If you must buy Microsoft products, don't depend on them
3. If you must depend on them, keep multiple backups and count the days until you can justify buying an iPhone

The yomim tovim are over, so I will hopefully have a chance to play with jQuery again. But on the programming side, one thing I had to do was turn a table of honors, something like this:

	Rosh Hashana 1	Rosh Hashana 2	Yom Kippur
Maariv	Person 1	Person 2	Person 3
Shacharit	Person 4	Person 5	Person 6
Musaf	Person 7	Person 8	Person 9

And turn it into this:

When	What	Who
Rosh Hashana 1	Maariv	Person 1
Rosh Hashana 1	Shacharit	Person 4
Rosh Hashana 1	Musaf	Person 7
Rosh Hashana 2	Maariv	Person 2
Rosh Hashana 2	Shacharit	Person 5
Rosh Hashana 2	Musaf	Person 8
Yom Kippur	Maariv	Person 3
Yom Kippur	Shacharit	Person 6
Yom Kippur	Musaf	Person 9

Continue reading ‘Turning a table into a list in Excel’ »

I just got a Windows Mobile smartphone to replace my Palm TX (screen digitizer died). It's an ugly, kludgy and slow operating system (even after upgrading to WM 6). There's nothing as elegant as Luach that integrates Jewish calendar data in the datebook. There's a Jewish Calendar that's nice, but I ended up writing my own program that generates a CSV file with Hebrew dates etc. It allows you to import candlelighting times, calendar info, and even all the Young Israel events into Outlook. It's at http://youngisrael-stl.org/articles/exportCalendarFull.php Next up for that program: Cardinals, Rams and Blues schedules!