Phoenix Ambulatory Blood Pressure Monitor Project
9/11/2005 Meeting Notes




Gerry Werth, Clinician Computing.EE, MD, PhD. Gerry presented on clinical information systems.

- Outline: engineering, primer, mass customizaiton, clinician computing, Information technologyg, Free or Open Source SW.

- Engineering Challenge: Healthcare is the most complex domain to model in software. Doctors think differently.

- Economic Stakeholders
-- vendors
-- customers (decisions)
-- consumers (quality)
-- wallets (money)

- Primary stakeholders
-- customer (clinician)
-- consumers (patient)
-- wallets (purchaser, insurance firms)

- Historically, the role of the healer was to 'name' the illness, so that they had power over it.

- "One reason it is so complex, is the customerr, consumer and wallets have no interests in common." Bob Lewis, InfoWorld, 2002.

* Mass customization.
-- Traditional model: invention - craft shop
-- Industrial model: Factory - mass production
-- Information model:

* Three organizations:
-- Hospital: has been a team, is trying to become a factory.
-- University: specialists are at the bottom.
-- Symphony: conductory coordinates specialists in a team-flat organization.

- Healthcare information systems should change towards mass customization via the network model.

* Chris Fuller, Open Source Medical Expert System.


- Current systems are inaccurate, unreliable.
- Problem: physicians are overwhelmed.
-- Costs are increasing.
-- Error rates in US are high
-- some people in 3rd world will never see a physician.

* Existing Medical DSS (Decision Support System) / Expert Systems
- 70 known systems
- most are proprietary.
* Proposed Solution
- Open Source DSS/Expert system.
-- more physician quaity time
-- improved care and accourace.
- allows verificaitni.
-- allows update
-- integration with CIS/EMR
-- reduction in overall cost per person-hour.

- Examples:

- Standards
-- ASTM E31.28, HLL7
-- ANSI grant to harmonize these standards, possible completion in 1-2 yrs.

- Features of Openm Source DSS/Expert Systems
-- ARDEN standardized syntax.

-- Ease interface with Clinicall Information Systems CIS, Electronic Heallth Record EHR, Hospital Information Systems HIS

- Simplified Graphjica;;l User Interface.

- Issues
-- Privacy (no code sharing)
--- viruses with mobile code
-- Clinical Trial Hurdles:
--- make recommendations, not diagnoses.

- Next Steps
-- Setup up IEEEE study group for open source CIS & DSS



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