Phoenix Ambulatory Blood Pressure Monitor Project
10/9/2005 Meeting Notes




Michael Balow of Freescale joined us. Larry looking for software that can emulate a microprocessor or micro-controller, for test driven design and automated testing. Mike said he can provide it, any of 8 bit, 16 bit, or 32 bit processors. Also, he can provide emulators.

Dave Skramstad has built a piezo film blood pressure sensor, Dan Glumac and Mary Jo Rawson are building another two. Now, he is looking at using Labview to measure the time using cross correlation techniques where Labview is a virtual instrument for realtime digital signal processing. John suggested going to National Instrument's website and seeing their online tutorials and manual. John Gould suggested several contacts for people who are knowledgeable of Labview. By next meeting he hopes to investigate Labview.

Gerry is working on the minitopics on Clinical information systems. El will send the open source copyright text to use on his presentations so that they can be posted on the Phoenix website.

John has been working with Mike on the 3-D Star accelerometer. Then, he will have a board for testing. He is changing the software. He wants to work with Gerrmaine to determine sampling rates, output information, and perhaps activity, and especially wants to determine the precision needed.

Chris Adams led us in a requirements discussion. He talked about the subsystem requirements, especially the Diary Subsystem. His has a question for Gerry: we envision two software packages: 1) physiologists work on who populations with all data ever collected, exporting data that meet profiles structured by subject (e.g. patients, healthy subjects) characteristics. 2) Do clinical care support systems span patient support and decision support? Gerry says it is a decision support system for physicians caring for patients, so that they can identify the characteristics, with different modes, eg. population characteristics, compared with individual patients that help0 the clinicial and patient make a good decision in real time. We may have overlap of some functions across the interface between the Phoenix monitor and the clinical care support system.

We discussed the functions of signal, amplifier, A/D, analysis (e.g. labview), perhaps the interface between the local and remote subsystems are the A/D vs Analysis.

The data might look like:
T, A1, A2, x, y, z,
and then repeat,
where T is time, A1, A2 are amplitudes, and
x,y,z are the 3 d accelerometers coordinates.

Gerry presented on Clinical Information Systems, "How is it Different?" 1) Mobile workflow, 2) patient centered, 3) clinician-centered.

Traditional business workflow is often stationary, while clinician workflow is mobile. For example, there is no time to login.

Clinician workflow is mobile: local mobility: moving form room to room, patient to patient. Extended Mobility: physicians move from clinic to hospital and back.

Interacting with an informaion fountain: clinicians interact with a clinical computer like people interact with a drinking fountain: Walk up, Drink Briefly, and Leave.

Physicians were early adopters of telephones, they aren't adopting computers because it doesn't fit the workflow.

Patient-Centered Clinical Workflow:
* Schedule appointments
- leave time for Same-Day Urgent visits.
* Appointment Reminder
* Check-in
* Pre-Process
- Weight & Height, Vital Signs, ROS (review of systems), UA (urine analysis & routine bloodwork), rooming
* Clinician Encounter
* Post-Process
- Lab, X-rayl, Shots, Handouts, Re-Rooming & Re-Encounter
* Check-out
* In-Practice flow-up scheduling: appointments & phone calls.
* Outside referral and prescriptions.

Opportunities for change are integrating: medical records, patient historyy, lab results..

Clinician-Centered Workflow:
* Today's clnic patients
- Morning /afternoon/Evening ..
- Avoid clusters of complicated patients who will likely need more than average time: multiple chronic illneses, need interpreter, ...
* Curent Hospital Patients, by hospital and unit
* Recent Patients,
- Pending dictation and to do
- Pending Resutls aned consults
* Curent Results
- by urgency
- by patient

Work Smarter, Not Harder
* Learn from Experience
- Which clinicans work here
- Which inrformation is most used
* Pre-Fetch Information for each clinician
- Patients of Interest:
- Results of Interest.
* Track Patients Status while in Clinic
- Coordinate among physician and other staff
* Coordinate Flow-up
- In practice flow-up
- External Referrals and Prescriptions

- Doing what hasn't been able to do well before: tracking results & referrals coming back to the clinician, like lab results. It never gets back to the physician in time to be useful unless the patient carries it.



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