Phoenix Ambulatory Blood Pressure Monitor Project
2/12/2006 Meeting Notes




Chris Adams: We discussed setting Germaine up with AIM instant messenger for communicating. Then, we reviewed HL7 (healthcare level 7 for ISO's OSI 7 layer communications protocols) for healthcare interoperability into a standard information bus to reduce the clutter. We need to address communications protocols between Phoenix and other systems, and between the local subsystem and the remote subsystem or reference database. Do we need the reference database as part of Phoenix? Some said yes, others said no? We discussed the nature of the reference database, and that it may have fractal properties. Gerry will discuss this next meeting as a mini-topic as a required attribute of clinical information systems. Then we asked, does Phoenix need to have patient identities or is a temporary number sufficient, e.g. does Phoenix need to know about the unique person? At the time we provide the local subsystem device to the patient, it need not have patient information, merely device ID and session times. Chris thinks we don't need individually identifiable patient IDs. In practice, this information is used to create profiles, and establish reference norms for patients by gender, age, disease history, geography and other research useful parameters. Patient identity should remain with the clinician. Then, where does the reference database come from? There are data flows that flow from Phoenix and back to Phoenix. Now, how does Phoenix function if used by non-clinicians (non-physicians), perhaps by individuals or public health?

Larry Beatty: We looked at agile methodology, looked at bugs in the prototype application, and discovered that one of the bugs is actually a feature. We tried to set up test data and found that it doesn't seem to deal with data with gaps, eg. daytime, nighttime, between. Is it important to fix. Germaine said the system should parce them and analyze the global sphygmochron and provide warnings if there are gaps that overlap night and day, and not provide the daytime and nighttime analysis. Another question is, after we finish cycling, how do we document the webpage with this product created? We decided to set up Germaine with nVu so she can manage the webpage herself. Bob said we should add to the Phoenix release, "Application of these ideas and information for diagnostic purposes is the sole responsibility of the person doing it."

Dave Skramsted: He has been forming the sensor team, three engineers met, brainstormed current and other technologies, and is setting up the next meeting. He is looking for volunteers, and looked at the patents of the Tensys system to see how it is working,

Bob: He has been thinking about the device, selecting a particular active component and getting an emulator for it, e.g. TI8051. He found an article about it in Electronic Design, TI was doing the same thing. He'll provide the URL. He is worried about Franz's and Germaine's speculation that long term blood pressure changes may be due to fluctuations in solar magnetic fields, e.g. lack sunspots.

Gerry Werth's Mini-topic:
"Outpatient Clinical Process - Hiding in Plain Sight"

The Patient presented with chest pain. Procedure had the following steps.
CC: chief complaint, Chest Pain
DDX: (Differential Diagnosis)
PE: Physical Exam
Assessment: Called it an early pneumonia.

Finally, he discovered it was a bowl loop It helped to talk to the previous doctor, but there wasn't a lot of information. This case exemplified the description by:Nemeth & Cook, Journal of Biomedical Informatics 38 [2005], 262-263.

"healthcare work ... complex, poorly bounded, conflicted, highly variable, uncertain, and high-tempo work domain."

"Occasional visitors cannot fathom this demanding work, much less create IT systems to support."


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