Forgive me if I'm mistaken, but isn't this exactly what the FHIR standard is meant to address? Not only does it enable global inter-health communication using a standardized resource, but it's already adopted in several national health services, including (but not broadly), America. Is this not simply a reimplementation, but without the broad iterations of HL7?
Right, it would make more sense to use HL7 FHIR (possibly along with CQL) as a starting point instead of reinventing the wheel. Talk to the CodeX accelerator about writing an Implementation Guide in this area. The PlanDefinition resource type should be a good fit for modeling cancer guidelines.
You would aim to use CQL expressions inside of a PlanDefinition, in my estimate. This is exactly what AHRQ's, part of HHS, CDS Connect project aims to create / has created. They publish freely accessible computable decision support artifacts here: https://cds.ahrq.gov/cdsconnect/repository
When they are fully computable, they are FHIR PlanDefinitions (+ other resources like Questionnaire, etc) and CQL.
There's so much other infrastructure around the EHR here to understand (and take advantage of). I think there's a big opportunity in proving that multimodal LLM can reliably generate these artifacts from other sources. It's not the LLM actually being a decision support tool itself (though that may well be promising), but rather the ability to generate standardized CDS artifacts in a highly scalable, repeatable way.
Happy to talk to anyone about any of these ideas - I started exactly where OP was.
I downloaded and opened an CDS for osteoporosis from the link (as a disease in my specialty), I need an API key to view what a "valueset" entails, so in practice I couldn't assert if the recommendation aligns with clinical practice, nor in the CQL provided have any scientific references (even a textbook or a weak recommendation from a guideline would be sufficient, I don't think the algorithm should be the primary source of the knowledge)
I tried to see if HL7 was approachable for small teams, I personally became exhausted from reading it and trying to think how to implement a subset of it, I know it's "standard" but all this is kinda unapproachable.
You can register for a free NLM account to access the value sets (VSAC). HL7 standards are approachable for small teams but due to the inherent complexity of healthcare it can take a while to get up to speed. The FHIR Fundamentals training course is a good option for those who are starting out.
It might seem tempting to avoid the complexity of FHIR and CQL by inventing your own simple schema or data formats for a narrow domain. But I guarantee that what you thought was simple will eventually grow and grow until you find that you've reinvented FHIR — badly. I've seen that happen over and over in other failed projects. Talk to the CodeX accelerator I linked above and they should be able to get you pointed in the right direction.
It's not that hard a leap is it? For some reason it seems oblivious to non-sufferers that the idea of a physical treatment for a mental ailment is a given?
For most folks, that connection doesn't exist. Hell, I work out 3x a week and even I don't notice the obvious side-effects even though I'm certain they exist.
When we're dealing with ordinary people living their daily lives, the idea that something so "non-mental" - in the most literal sense "physical" can have an effect on the mental, is a really tough thing to swallow, understand and hell, even percept when things are going well?
Sorry. But I'm an avid gym-goer and even I have to remind myself of the positive it's doing. We're not all the same.
> Sorry. But I'm an avid gym-goer and even I have to remind myself of the positive it's doing. We're not all the same.
Maybe you're one of the people that for whatever reason exercise does nothing to - though I highly doubt it. I'm not sure what training you do exactly but to reap most of the benefits the workout should include moderate cardio work. I don't think going to lift weights for a 40-60 minutes with plenty of rest between sets will cut it. Running for 45+ minutes is what most people should aim for, of course beginners will do less.
Anyway I agree with you - for most folks the connection doesn't exist, perhaps its time this changed.
Hmm, I've never felt any "noticeable" positive effect of exercise either.
I didn't exercise basically at all for well over decade. But I felt fine, wasn't overweight or gaining weight or anything like that.
But I decided that I should probably exercise, so have been for awhile now. Fortunately I have what appears to be a very high amount of self control so I'm able to just force myself to go exercise even though I hate every second of it and it just feels like a waste of time.
I haven't noticed any changes to anything that I can think of since going from no exercise to 3-4 days a week of about 1 hour sessions of zone 2+ exercise.
I just keep waiting for this magical benefit that some people talk about, but I get nothing.
I'm only doing it because if I don't, supposedly "bad things" will happen to my body in the future.
Interesting. What kind of exercise do you do? and how do you define Zone 2 (there are many contradicting definitions out there)?
I would try going a bit to zone 3/4 at times (of course while being careful not to injure yourself) not only to get the 'noticeable' positive effect, but also because it seems like you get bored/frustrated a lot in your workouts and it doesn't have to be that boring.
Anyway keep at it, I hope you will enjoy it more and get that nice feelings everyone is talking about. Try noticing if your sleep is a bit deeper and better after hard sessions, how your energy levels are etc. For most people there will be improvement in those areas (you could be an outlier but I kinda doubt it).
Also - don't take it the wrong way but it's going to be very hard for you to notice anything positive about the whole thing if you're convinced you hate every minute of it. I'm not sure how you can get out of this mindset but I think it's important that you do. Or try different kinds of exercise that you don't hate.
Well aside from weight lifting I mostly use the stair machine because I feel that it best matches the activity that I do like to do sometimes (hiking).
I was defining zone 2 mainly by how it feels. Not too hard and where I can breathe fairly normally and easily have a conversation. But also by the heartrate being in the 65-75% range, so for age 36 I was keeping it around 125-130. My resting heart rate is 52 but not sure if that matters. It's always been that even when I was more than a decade of sedentary.
Another reason I was doing all zone 2 is because I thought that I had some sort of aerobic deficiency syndrome thing from being sedentary for so long. Basically my heart rate would shoot up into zone 3 with pretty minimal exercise, and I read that the only way to fix this was to do lots and lots of long zone 2 exercise for months.
I'm sure if I did more fun things it would be easier to be enthusiastic about it, but I am not even sure what active activity I would like. Sure I like hiking, but that's something I like to do on a trip somewhere exotic like a state or national park, not something I can easily do regularly locally.
My energy levels honestly feel somewhat more depleted when I am working out. Like I just want to take a nap after a workout and I feel like nodding off. Not like instantly, but maybe like an hour after or so.
I just haven't been able to understand or feel the connection people find with exercise. Like I said, I never felt any issue or lacking in my energy levels or mood, or sleep or focus when I was more or less completely sedentary, and I always watched what I ate so I was healthy in that regard (perfect scores on biometric blood tests), normal weight, etc.
So exercise just feels like a time waster, just an uncomfortable time sweating etc and overall possibly a little more tired and drained because of it.
My only motivation for keeping doing it is the prospect that it will help prevent some sort of future complications and health issues, and I guess that's good enough for me to convince myself to keep going.
Hating it is maybe too strong of a word, but I definitely don't look forward to it in any way and I just want to get it over with for the day so I can move onto something that I actually enjoy. It just feels like a chore. Something that we need to do to live a good life, so we do it.
Its possible your max HR is way above your age (the 220 - age thing is really inaccurate). You can buy a chest strap / get properly tested to find out.
I would try to make at least some of the workouts a bit more challenging - you can try pick up running. Or if you're working the stairs machine, do it faster and for longer for at least part of the time. This will not only make it more interesting for you - its also the only way to improve your vO2 max if all you're doing is 3 workouts a week (and a higher v02 max should be your goal is you're thinking about longevity / health).
As for energy levels - I meant in general. After hard workouts I can be quite exhausted for 24 hours sometimes. That's normal. But my sleep is usually higher quality and the day after I'm a bit more vital. My mood is more stabilized etc.
Anyway good luck! I hope you'll take away from this that its OK to change /mix things up and see what works for you.
I did always kind of wonder if i'm even using the right heart rate zones. But it's not like I am trying to train for any specific purpose. Just to be healthy, so I doubt I need to go to the level of doing a lab test to find that out.
I can definitely just increase the intensity.
Overall I don't feel like I have ever been in touch with my body or mood or things like that.
Like I don't know how I would judge how well I slept on a given night. I don't normally wake up in the middle of the night or anything like that. I don't really feel I can gauge my sleep quality by how I feel when I wake up because when I wake up for work on a weekday I am always tired. I just assume that's because I am not a morning person, and I only feel rested and good if I wake up more like around 10-11am on a day that I don't have to be up earlier.
As for mood, I rarely feel like I am in tune with that much either. Maybe it's a learned skill and I just never took the time to develop it or something. I feel more or less the same the vast majority of the time and that's about how well I can put it. If my mood is changing, it's not something I normally "notice" on its own I guess.
It's always a struggle for me to decide what exactly to do, because I feel like when looking up that information all you find is that it's all contradictory in some way the more you keep reading into it.
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