Phoenix Ambulatory Blood Pressure Monitor Project
7/9/2006 Meeting Notes




Status Review:

* Sensor Status from Dave Skramsted: The Sensor Team met last Sunday morning at the lab. Mary Joe is working on a calibration method for DPTT, Alex is building a piezo amplifier board, Carl and I are looking at applying ultrasound technology and have discussed alternative DPTT methodology. El & Dave are meeting with the Innovation Study Group next Thursday to recruit sensor engineers for Phoenix.
* Project status from Mary Jo: She ordered the software for the lab's oscilloscope and and is writing a summary of Chen's Patent.
* Larry: Fixing the bugs in the Sphygmochron prototype. One is straightforward and the second requires restructuring. He is investigating open source visual basic test frameworks, but hasn't found one that works in Excel. He would like from the project: 1) a way get revision control, e.g. SourceForge, 2) what kind of license. Chris suggested that we look at the various licenses and make a suggestion. Larry said that the GPL just discusses libraries. Chris said we need a written analysis of the licenses we choose and why we selected them. SourceForge has a selection of 60 licenses and you must select one. These licenses have been approved by .
* Chris: Working on his paper on low cost open source medical devices, citing the Phoenix project and ambulatory blood pressure monitors, on privacy requirements. Major sections will cover scenarios with communication diagrams including self-care and self-survillanence, internet care, etc. It will include public health, such as when will a public health worker hold the ABPM, what are they doing, and why are they doing it. It is written for the Halberg Chronobiology Center that will be presented to the Chinese in September and will be placed in a suitable journal from which the center typically receives offer for article placements. The second step after the paper is to present the Data Analysis Methods, which is higher priority that communities, investigating communication protocols, specifications for the devices.
* Bob: Let than one page long Sphygmochron quality system, and a quality system for the ABPM.
* Gerry: Continuing to work as a pediatrician, had lunch with Debra and Vergil Slee, who wrote "The Endangered Medical Record." Also, looking at the information that occurs around the clinical care process, the network of flows. Using the physical chart as a token of current status deals with which activity/pile it is, while the digital record can obviate this but these activities' status must also be maintained.
* Germaine: reviewed the book by Dr. Kane, and is writing a review. The book asserts that clinical medicine based on a single value assessment at a point in time doesn't affectively deal with chronic illnesses such as asthma, diabetes, and depression. You can't determine change over time - longitudinal information. You cannot involve the clinician continuously. You need a process that gathers this information over time, such as lung function communicated via telecommunication. Then, you are dealing with issues of privacy, Creating profiles, looking at change, medications, changing dosages. Change from acute care to chronic illnesses. Chris: When does the person on the internet become a care provider as defined by HIPAA. Germaine says that from the perspective of this book, HIPAA may be a hindrance. Chris: We need to determine when HIPAA is involved and not involve. HIPAA is triggered by specific conditions. For example, if you never submit an electronic insurance claim, HIPAA is not triggered. With the Phoenix ABPM, the working assumption is that the data is the patient's. Germaine: A letter from Halberg Chronobiology Center is being published in the New England Journal of Medicine.

Bob - Phoenix Sphygmochron Quality System. Bob submitted a draft quality system on paper, asked that it not be published to our website for the Sphygmochron and for the Phoenix Ambulatory Blood Pressure Monitor, and gave a paper copy to Germaine. This was provided to address possible FDA requirements of Phoenix Project activities with the Sphymochron program enhancements that will be used by the Halberg Chronobiology Center with their worldwide research.


Gerry Werth - Clinical Care MiniTopic

* Overview:
Information context: More than the Medical Record:
* Clinical Care context information:
- Clinical Focused List: Patients, Tasks, ...
- Process Focused Lists: Visits, Labs, Letters, Dictation, Phone Calls, ...
- Patient Focused Lists: What, When, Where, ...
* Clinical Workflow cycles
- Office Visit
- Prescription Refill
* Position-Coded context Information
- Overlapping workflow cycles
- Coding context by chart position
- In which stack is the chart
- Where is Process Context Information

Clinical Care Context Information
Clinical Workflow
* Clinician Focused Lists:
- Patients Today/Patients in Process/Tasks to do
* Process Focused Lists:
- Office Visits/Labs Pending/Labs to Review/Letters to Review/Dictations to do/Phone Calls to do/...
* Patient Focused Lists:
- What to do/When/Where, ...

Clinical Workflow Cycles
* Office Visit
- Schedule/Check-In/Room Patient
- Clinician Encounter/Lab and Radiology
- Check-Out/Schedule Follow-Up
- Pending Results/Review Results
- Contact Patient/Schedule Follow-Up
* Prescription Refill
- Verify Information in Chart
- Confirm with Clinician / Call to Pharmacy

Position-Coded Context Information
* Overlapping Workflow Cycles
- Office Visit:
-- Pending Results/Review Results
- Prescription Refill
-- Confirm Information in Chart
* Coding Context by chart Position- - In which process stack is the chart
* Where is Process Context Information?

Next Sensor Team meeting: Sunday, July 2 & 16 at 10:00 a.m. in ECE 2-110 (lab)

Next Phoenix Project meeting: Sunday, July 23 at 2:30 p.m. in Mayo 748



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