Status Review:
* Dave Hendrickson: wants to work on sensors. Will meet with Dave Skramstad to select a project and get started.
* Larry: Nvu needed passive ftp, our ISP implemented it, and Nvu is working for Germaine, so that she can post the Sphymochron application, working on a tutorial on how to get started with Nvu to manage web pages.
* Dave Skramsted: Has been researching sensor technologies, recruiting sensor team members.
* Gerry: Working in pediatrics and building the clinical information group. People who are interested in what the clinician wants and needs, user interface and organizational interface, 1-10 clinicians, that scales up and is missed by other offerings, and there is a market niche for small practices where the physicians who do much of the management. There is anecdotal evidence that many clinicians would like to buy back their practices because practices with non-clinician managers often aren't profitable, and would be more profitable if the clinicians did the managing. The market niche for small practices is likely to be "outstate", e.g. small communities.
* Bob: Has been working on the technical requirements for hardware,
* Chris: Been investigating regulatory standards requirements, especially HIPAA. Also, has been reviewing an article in the Economist on the open source development model, "Open-Source Business", March 16, The Economist, www.economist.com.
The interface between the device and the analysis software seems to be a good candidate for the medical information bus, now ANSI 11073 (or 11037), a subset of the standards has been published on CD, Bob remembered that there is a rule that allows copyrighted material to be provided in an educational class, posted on a website with passwords for those who are registered in the class, and you cannot use a substantial portion of the copyrighted item. The Fair Use of Copyrighted Material allows one to make use of the copyright material; you can only use excerpts, for educational use, and not commercial use. This may be a way to make standards needed for Phoenix available to Phoenix members.
* Dennis: There has been no activity at SourceForge to make a top level category for medical devices.
* Germaine: There is interest from a small company in France
to use Phoenix. He is working as a software engineering, they
are interested in expanding to other monitors, to download data,
to use their software and work with any ABPM device, Laurent Gouthiere
at www.euroestech.net . Also, Miguel Revilla will visit the Chronobiology
Center from 4/13-16, leaving at 12 pm.
Gerry Wirth - Minitopic on Clinical Information Systems
* Success and Failure of Clinical Information Systems: A Case
Example.
How to assess where it is successful or not.
Clinical Information System
* Urban Teaching Hospital
- Very Political Organization
* Lab Result Reporting System
- Network of PC workstations
* Used by Resident and Attending (faculty) Physicians
- Afternoon Rounds
* Results served by Lab Computing system
Hospital IT
* System was building to meet Requirements
* within budget
* worked
* Assessment: Success
Internal Medicine Physicians
* System very slow to retrieve results
* Especially slow at peak demand times
- Afternoon Rounds
* System slowed physician work flow
* Assessment: Worse than useless.
Lab Computing
* System reduced phone calls to lab
* Lab Computer
- Controls auto-analyzer Instrument
- Server for results reporting system
* Instruments slowed at peak demand times
- Afternoon rounds
(Needed a data production & data delivery subsystem)]
* Assessment: significant burden on lab.
The organization didn't want to know the answer because it would make people look bad -- power and politics.
Success or Failure??
* Success or Failure varies by Stakeholder
- Recent AMIA work group discussions:
* success and failure are not dichotomous and static categories,
but socially negotiated judgments.
(Karl Weik)
* Even a supposedly successful implementation may only succeed
by reinforcing a "dysfunctional" operating environment.
Questions:
* Dave: Project management flaws: needed agreements with each
of the stakeholders -- clinicians, labs, IT, and manage the system
implementation to meet their needs and communicate with them.
Gerry: There are different cultures -- informatics (Extreme software
often assumes that requirements can't be explicit but emerge),
clinicians, labs, IT. This is an organizational culture and psychology.
It is hard to define good. In open source, the focus is meeting
federal requirements and being useful. In real clinical information
systems it often comems to meeting the power and politics issues
vs. helping the clinicians serve patients.
* Dave Henderson says from a Project Management perspective
there is: requirements and scope must be clarified and agreed
upon, then implement, then follow-up. Within budget, scope, time.
Requirements should be in scope.
Bob: You need a project architect.
* Dave Skramsted: How much interaction between requirements
and clinicians?
Gerry: Not a lot. Typically, the non-clinician business managers
are the go-between, and clinicians are kept at a distance. Because
they are busy, productive, not-involved. Historically, physicians
have been customers of the hospital or clinic and may work for
multiple facilities and not employees, and there are federal rules
to maintain this distance to avoid conflict of interests.
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