Some thoughts on health and healthcare

Abstract Implementing a modern Electronic Health Record (EHR) in a hospital is fundamentally an exercise in representing, exchanging, and reusing clinical information safely across time, teams, and systems. This requires clarity about three related but distinct notions: syntax (how information is structured and encoded), semantics (what that structured information means), and ontology (a formal, explicit specification of the domain concepts and relations that underpin shared meaning and enable computational reasoning). In this essay I want to distinguish these concepts and demonstrates how their differences translate into concrete design, integration, governance, and patient-safety considerations in real-world hospital EHR implementations. 1. Introduction Hospitals depend on EHRs not only to store a longitudinal patient record, but to coordinate care across departments (e.g., laboratory, pharmacy, radiology, admissions), across professions, and often across organizational boundaries...

Abstract Healthcare quality measurement routinely relies on structure (resources), process (actions), and outcome (results) indicators, often combined into broader “quality indicator” systems. While foundational, each indicator type is vulnerable to confounding, weak causal interpretability, data artifacts, and behavioral distortion when linked to accountability or incentives. Building on Donabedian’s framework for evaluating quality and modern guidance on measure evaluation and lifecycle management, this essay proposes a practical governance approach: (1) mixed-method evaluation that triangulates quantitative signals with theory-driven and qualitative inquiry; (2) anti-gaming measure design that anticipates Goodhart/Campbell effects and reduces manipulability; and (3) periodic reassessment that treats measures as adaptive social instruments requiring continuous validation, recalibration, and retirement. The central thesis is that credible quality assessment is not achieved by “bet...