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The 'crypto queen' listed among the FBI's 10 most wanted for defrauding investors and vanishing with their millions was allegedly killed on a yacht five years ago. Dr. Ruja Ignatova, a 42-year-old German citizen of Bulgarian descent, made headlines when she created the cryptocurrency OneCoin, which she marketed globally and attracted investors worldwide. Then, investors poured approximately €4 billion (£3.40 billion) into OneCoin before Ignatova vanished in 2017 with the entire sum. She was last seen in Athens, but on March 25, 2016, Lyubomir Ivanov, the 49-year-old head of the General Directorate of the National Police in Bulgaria, was shot in his home. After his death, investigators found records of taped conversations in his home and seized them. Two Bulgarian investigative journalists, Dimitar Stoyanov, and Atanas Tchobanov, have discovered and published online transcripts of these taped conversations. Ivanov was suspected of working for Hristoforos Amanatidis, also known as Taki, one of Bulgaria's most notorious drug lords. Ruja Ignatova, who was reportedly also closely connected to Taki, was allegedly murdered on the drug lord's orders to conceal his involvement in the OneCoin affair, according to the documents. According to the documents, the incident occurred on a yacht in Greece in November 2018, after which Ignatova's body was dismembered and thrown into the Ionian Sea. A man allegedly committed the murder named, Hristo Hristov, who was arrested after being caught with a large quantity of heroin in the Netherlands some time ago. The Bulgarian Ministry of the Interior has neither confirmed the authenticity of the documents nor issued an official statement. Despite rumors, Dr. Ignatova remains on the Interpol and Europol wanted lists in 194 countries, as she and her accomplices allegedly stole over €88 million (£74.9 million). Since October 25, 2017, when she boarded a plane from the Bulgarian city of Sofia to the Greek capital of Athens, her whereabouts have been the subject of rumors.

Today we’re going to talk about something that some doctors say is ruining medicine. We’re going to talk about something that doctors complain about almost as much as they do medical billing. We’re going to talk about EHR encounters. Encounters are the workhorse interface of the EHR. It’s intimidating, chaotic, unintuitive, and generally unpleasant. Late-career physicians who come to ParkHealth are often the only ones at their practice still using paper, which is surprising when you consider that these physicians are often the chief executives of their organizations. Unfortunately, by the time they come to us, they’d been accumulating stress and friction for so long that, sadly, many exhibit diagnosable anxieties. But like any other chaotic mess inherited as scientific investigators, physicians, and clinicians, we always return to the basics. Granted, we’ve been at this a while, so we’ve developed a bit of a repertoire about working with more senior physicians and getting them online. Well, like I mentioned. We return to the basics. We think fundamentally about what the EHR is and what the encounter is. Over the years, we’ve developed OERs specifically tailored to medical specialties that utilize metaphors and analogies that latch onto processes in respective medical fields. In pediatrics, we talk about a schedule, like the Periodicity Schedule. But instead of simply “growing,” we physicians have to direct ourselves to meet periodic developmental milestones. We have such schedules on our website, so check those out when you get a chance to. They’re OERs, so they’re published to the public domain and free to use. In our OERs on healthcare literacy, we talk about how the best way to universally frame things at the practice is by understanding that every new system is simply a language. And the way that Americans, especially Californians, pick up Spanish, is they toe into it, with a word or two here and there—then phrases. Then eventually, clumsy fluency develops into something that resembles Spanglish. We do the same thing with late career physicians that are struggling with the EHR. We discuss priorities and having to choose or designate the most important things during the patient visit, and relate that back to the encounter. We arrange these priority concerns about the visit into workflows, and arrange the workflows in order of difficulty and importance. When we atomize things this way—by the way, please do check out our OER on healthcare systems thinking where we talk about healthcare information atomization. When we atomize things this way, we’re able to clump together workflows that are “easy wins.” Easy wins in any digital transformation process is a key to beating inertia. With pediatrics, we usually find that we have to prioritize the parts of the encounter that are evaluated by billing first. With encounters that take up that old 1970s paradigm of SOAP, we start with the encounter’s assessment and planning notes. On our website, you’ll find examples of common workarounds to EHR templates and shortcuts. Many EHR systems for instance, require unique keyboard shortcuts be assigned to template items. But when lists have to be prioritized, this is where a common and universal system for serialization comes into play. This sort of looks like and behaves like the CPT coding system, where each subsequent digit demarcates a category and sub-category. For the learning materials mentioned and a few helpful narratives to help contextualize these things, please visit www.park.health/basics.

Healthcare is highly interconnected, and the degree to which healthcare providers are interconnected is only increasing. In the early 2020s, health security was pushed to the fore when the World Health Organization designated a coronavirus, COVID-19, a pandemic. At the top level of things, security is what's at stake. The World Health Organization and the Centers for Disease Control in the United States surveil and monitor the planet for health security threats. The most threatening feature of viruses and pandemics is infectiousness. Infections occur at a rate that's often described as exponential growth. So long as there is at least one infected person, regular contact between infected and uninfected members of the population occurs, and there are large numbers of uninfected potential hosts among the population. Whenever you have exponential growth, whatever it is that's growing will double its presence or population in a given amount of time. Let's say you start with a population with just one infected person on January 1, and the number of infected people doubles every three days, how many people will be infected by January 31? If the exponential nature of the infection transmission isn't stemmed in any way, there will be 1024 infected people on January 31: about a thousand times as many as you began with. That's a lot. But remember that this continues to double every three days as long as this growth remains exponential. On February 3, there will be twice as many: 2048 infected. On February 6, that rises to 4096. By the time you get to March 19, which is 78 days after the initial infection, some 67 million people will be infected. The role that private practices play in health security is critical. But because of how interconnected all of healthcare is, private practices must use the correct terminology, codes, standards, and technical specifications. This is where Private Practice Basics come into play. Private Practice Basics is a system of OERs. OERs are a kind of open-source information resource. Physicians access OERs through open-source communities and platforms such as the OER Commons. Because OERs are modular and granular, practices pick and choose the parts they need to prioritize. The program improves patient outcomes by increasing the degree to which doctor offices are integrated and interoperable. A byproduct of increasing the private practice's healthcare integration and interoperability is the increase in evidence that practice's use in the evaluation and management of disease.   Learn more at www.park.health/basics.

Paper Paradigms, the Private Practice, and Resource Chains Today we want to talk about a number of updates to our open educational resources on healthcare literacy. As you may know, we have been producing these OERs for private practices for over a year. And over that time, it's become apparent that there is a cultural and generational gap in medicine. And this gap divides parties from resources that they need from each other. And the worst is that the parties don't seem to realize that. The healthcare literacy effort is about bridging and connecting participants to existing resources. We have developed an index and table for organizing all the resources. The resources are atomized and stratified by medical and non-medical operations in private practice. In the 1980s, the private practice consisted of a front office, a back office, and a billing office. The front office was what you would expect. It was the receptionist, scheduler, and point of sale that patients passed through when they entered the waiting room door and exited. In the back office was where medications such as vaccines were stored. This is where the exam rooms were. Now for many younger residents just coming into private practice today, the terms front and back are not as relevant. These young physicians intuitively know that it doesn't make sense to organize by geography like this. Granted, there certainly is a function and place in the office for paper, especially considering how much time our eyes spend staring at computer monitors. But this "dimensionality of paper," which is a kind of self-inflicted confinement to the paradigm of "front" and "back," perpetuates the kind of red tape that has suffocated health care for years. This self-inflicted confinement is called the paper paradigm. Paper paradigms in late-career physicians present considerable challenges. It is psychologically frustrating considering that solutions are so readily available, just waiting for them to be put to use toward unlocking the potential and value that only senior physicians present. We have published considerable material on this topic. After all, there is no shortcut to fermenting knowledge into wisdom. With this in mind, we restructure the organization of the educational resources. Private Practice Basics now features an entire section on building literacies. The evolving hypothesis is that sustainable knowledge development, and metacognition skills in medicine and healthcare, is best framed within the context of learning new words and developing new languages. As you can see in our materials, Private Practice Basics OERs are codified. The 0101 series deals with Healthcare Literacies that form the "knowledge kernel" for private practice team members. In the later series, series 0201, we discuss Care Coordination. In series, 0301, we discuss Clinical Operations. We are currently focusing on developing the series on EHR Encounters, series 0350, and have opened up our EHR Encounter workshops on Asana to Patreon supporters and other donors. In news outside of the Private Practice Basics OERs, we are making inroads on drafting the models for resource chains. Recall that resource chains are, unfortunately, layer-2 blockchains whose ERC tokens and currencies are monetary units but also functional units—in the same way that neurons are functional units. Please visit our website for those updates.

ParkHealth is a tax-exempt educational nonprofit in the United States. Please consider supporting our OER efforts by visiting www.park.health/support or by visitng our Amazon or Patreon page. -- Private Practice Basics is an OER series on healthcare literacy. OERs are open-source educational resources. Though the series is written with pediatricians in mind, the OERs are used by physicians of all specialties. The OERs are used not just for onboarding or orienting but also for maintaining currency in healthcare literacy. We write with pediatricians in mind because of the sheer quantity of work they have to contend with, relative to other specialties. Primary care physicians, such as pediatric practices, are largely an endeavor of preventive medicine, the prioritization of preventing disease, instead of waiting for the disease to present itself. Consequently, a considerable percentage of the hours spent at the practice, are appropriated toward preventative clinical and medical schedules. One such schedule is the Periodicity Schedule in pediatrics. Another is the Immunization Schedule, which is compulsory for school admissions, and is published by the CDC. The schedules of requirements, compounded by the occasionally incompatible requirements of health insurance companies and even Medicaid, often breed a bit of disdain among PCPs. Common adages or refrains in healthcare are: "There aren't enough doctors." Or, "Healthcare economics are perverse." There's some truth to these gross simplifications. But the problem of "not enough doctors" can be alleviated by "altering a few lines of code" in the overall healthcare system. This is what Basics does. Private Practice Basics is a core curriculum that establishes building blocks private practices use to develop unique languages and language learning systems. Organizations that connect the largest number of people are the definition of impact. Unfortunately, especially for pediatric practices, this impact goes unseen and unappreciated. The aforementioned "perverse economics". Invariably, unseen and unrewarded doctors drop out of the medical labor market. But like unemployment numbers that don't "tell the full story," it could be said that we don't have as few doctors as we might be tallying--though we certainly could use more doctors. Though seemingly farfetched, private practices present the most potential for impact in healthcare. In Basics, we explore how language is at the heart of exercising this potential, which humans are uniquely capable of developing an overarching culture by--like we do online. Basics open source the code for practices to use to establish universal compatibility and interoperability, so that their work is seen, intelligible, and appreciated. Especially reimbursable. Basics doesn't add work to an already overwhelmed practice. Instead, it consolidates work. We start by simplifying the work at the practice into two broad operational areas. Please note that what we talk about in our podcasts is for informational purposes only. The information is general in nature and can never substitute for the advice of a medical professional, like your doctor or nurse practitioner. Listening to a podcast or commenting on podcast media never establishes privileged patient relationships. Though we discuss healthcare and medicine, no warranty is made that any information is accurate. Even if a statement about medicine is accurate, it may not apply to you or your symptoms. ParkHealth cannot take any responsibility for the results or consequences of any attempt to use or adopt any of the information presented. For more information on this legal notice and other disclaimers, see park