Status Review:
* Larry: He's had discussions with Freescale and Microchip, looking for automated software testing for their chips, specifically to emulate their products. The software isn't free, especially the API. He wants to verify that their software does what we want. Then, we'll find a way to get it.
Then, he worked with Nvu. Its editing ability is adequate, but its website access capability has limitations, especially limited to passive FTP, requiring our website host to specially accommodate that.
We want to be able to do what agile software testers do, test each line of code, providing fine grained testing, and automate the resulting tests, often hundreds of thousands of tests.
* Gerry: He is monitoring the discussion on the working groups of the AMIA, the American Medical Informatics Association, monitoring failures. So, today's minitopic is professional cultures and how people don't communicate effectively.
* Chris: He is working on processing engineering framework. Hopefully, will have something to present on preprocess frameworks to building in enough so we know how systems engineering and process engineering fit in what roles are needed for each project, so we know what we need to ask for. He is continuing research into HL7 and Medical Information Bus, the likely standards that we will use.
* Dennis: Because of our request, there is some movement at Sourceforge to add a top level medical category. Currently, they have a category called medical science, while our project is medical engineering.
* Germaine: There is a group in the northern Italy, Mancia, that publishes journal articles on blood pressure variability.
Bob Schlentz - Data Analysis
Today, ambulatory blood pressure monitors cost so much they aren't used for preventative healthcare, just for clinical healthcare.
The Double Amplitude, 2A, is the meaningful BP variability, difference between the min and max of blood pressure.
We discussed how the data on slide 20 could be understood from engineering principles. We noted that the max occurred in the afternoon while the highest incidents of heart attacks occurs in early morning. However, from the second derivative, the highest acceleration of blood pressure occurs in early morning. We wondered what was the physical process that connected this acceleration to heart attacks, possibly through a force vector, at a time when total blood pressure was still small. Gerry said heart attacks are usually caused by a dislodged clot or vessel plaque that results in a blocked heart vessel causing loss of blood that damages a heart muscle. We remained curious about the physical process. Germaine thought it might be caused by several waking functions that cascade into a high force on the vessel wall.
We discussed whether the relevant data was the peaks or the intermediate points as well. The model comes from a nonlinear function. However, the period is assumed to be constant, which results in a linear function of M, beta and gamma in the normal equations, which can be fitted using least squares.
Then, we discussed the assumptions that of the normal equations and we realized we would like to see the detailed derivation of those equations so that we could connect the data to the equations.
Gerry Wirth - Minitopic
Professional Cultures
Outline
* Professional Cultures
* Professional Domains and Cultures
* The clinician "Lone Marshall" Culture
* "Failure" of Clinical Information Systems.
* Professional Cultures
- Shared basic assumptions form a culture.
- Individuals: Multiple Overlapping Cultures.
- Professional Cultures: examples
-- Healthcare: physicians, nurses, specialists, ..
--- even these are different, e.g. "doctors orders"
to nurses in US and others, vs "doctors requests" in
Britain.
-- Software: analysts, programmers, architectures,
- Adaptation precludes Adaptability - Clash of Professional Cultures
is Inherent
-- Value or Discard past experience. (Karl Weik, 1979, Social
Psychology of Organizing)
--- Organizations create environments that constrain them.
- Failed Cultural Assumptions may go Unrecognized.
(How you define the problem constrains they approaches and solutions
that are available to you?)
* Professional Domains and Culture
- Members of a professional culture
-- Share basic assumptions about their domain.
- Domain Systems: Complicated vs. Complex
-- Complicated System: Stable Domain.
-- Complex Adaptive Systems: Changing Domain
-- Grown, not built
-- Highly decentralized
-- Tolerate and Learn from errors
-- Maintain dynamic equilibrium
-- Exhibit emergent properties
* The Clinician "Lone Marshal" Culture
- An example of a clinician culture:
-- "Medicine is inherently chaotic"
-- Therefore: "All chaos in medicine in inherent"
-- The Lone Marshall: "I'm going to tame this ward single-handedly
with a stethoscope on each hip.!"
- Essential Chaos vs. Iatrogenic Chaos
- Essential Chaos: Each Patient brings Uncertainty
-- Not easily predicted for an individual
- Iatrogentic Chaos: Erratic Behavior of Clinical Organization
-- Results from Organizational structures and systems
-- Can be reduced by joint effort of clinicians (and others).
- However, a group of "Line Marshals" will not form
a "Posse", because joint effort is not in their culture.
* Failure of Clinical Information Systems.
- Recent AMIA discussions
-- AMIA, American Medical Informatics Association.
- Success and failure are not dichotomous and static categories,
but socially negotiated judgment.
- Even a supposedly "successful" implementation may
only succeed by reinforcing a "dysfunctional" operation
environment.
Question: As engineers, should we build what they want or what
they need?
Answer: Yes!! Use the solution as a way of educating them about
what is possible, because systems and needs evolve. Ask how they
do what they do and why they do it.
Question: Are you asking use to commit to changing the system?
Answer: Yes, you need to build into the process a mechanism to
continually evolve it. Like a vocabulary, you need to design the
system so that it is open ended. For example, there are serious
flaws in assuming a vocabulary can be closed ended.
Question: Are there any analysis methods suitable to complex
systems?
Answer: Are you thinking of patterns to discern complex systems
from complicated systems? There is a kind of synergy between software
and clinical diagnosis. Both deal with uncertainty, such as does
it fit what they are asking for, or are they asking for something
that isn't needed? You are continually trying to classify, such
as with illnesses, did they not come back because they got better?
Both domains could learn from each other. For example, patterns
in software analysis could be applied to clinical diagnosis.
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