Status Review:
* Gerry: Tracked down Tringa, Virgil Sleeve, when you are using ICD, designed for pathology, you are not tracking illnesses in medical records, but several hierarchical categories above, e.g. west nile fever is grouped with , accession number. A new technique is to track the current coding and usages, to capture the item and physicians phrasing. Eg. HIV is coded as HTLV3, human xx lymphocyte virus 3, associated with t cells. The problem is that when an illness is not yet associated with its cause, it is an impedance mismatch, and are referred to a set of symptoms. There is no gold standard for reality in clinical diagnosis. No absolute reference standard. It is a record of physician perceptions. It should have a facility for natural language (for different meanings), open ended (for new discoveries), for trending you need an object that knows the coding standard used, real-time extensibility of the coding system including interim coding systems. Tringa (company in St. Paul MN) and Dr. Vergil Slee
* Chris Fuller: There are standards, ASTM E31.28 CCE standard, trying to integrate that with HL7, Solventus.com has a website has an example of a clinical care in open xml.
* Larry: Had another change to the Sphymochron program that handles the warning, Germaine has to review and run some other data files through, then he'll provide the final version, Germaine will post it with a user description and download instructions.
* Chris: Sent an email with suggested standards and desire for access and communication about them. I would like a slot on the agenda to talk about privacy requirements and I need at least a one-week notice. Many groups are planning to use 802.11
Bob: Comments. 1) Discussions on mass customization and project where you haven't done it before, don't work. 2) The diary process must collect events like: I just came out of a coma, eat, dropped unit in the sink. 3) Battery analysis has been a serious problem of error, we don't have the depth of knowledge in the product groups in the medical device industry so they are inventing their own processes that are error prone. 4) We need to assure the accuracy of the data provided to the doctor who is going to modify the medication. 5) The Joomla site provides legal advice for open source software. 6) My group at 3M wrote test scripts so that testing didn't have to reinvent everything. 7) ARM7 appear to have been clone from the Intel 8351, at least 30 years old. 8) We'll need a microprocessor-controller at the source because we can't store the data points, 25K points, so we can't eliminate the microprocessor from the wearable local subsystem. 9) Need to determine the outputs of the sensors, e.g. the piezo resistance sensor might provide a milli volt signal, an impedance sensor might be a micro volt, and larger signals are less expensive to measure.
* Germaine: Miguel Revilla is coming on Thursday, 4/13 and leaving on 4/16. He has been maintaining the Halberg Chronobiology Center website. The Cosinor sample analysis can only analysis 290 lines, and this isn't enough for realistic data, 48x7 =336 and increase number values.
Gerry Werth - Minitopic on Clinical Information Systems
Minitopic - Mass Customization
The Dynamic Stability Model
Doctors have always thought they were doing this, but it is very difficult to stabilize your inputs, there is no language or taxonomy, so it is difficult to discuss.
If you want mass customization, you must be a factory/
Outline
* Industrial Revolution
* Flatter, Information-Based Organization
* Assembly Line Health Care
* Dynamic Stability - second industrial revolution
* Mass customization and ITZZ
* Return-on-Management (R-O-M tm)
* Industrial Revolution
(dynamic change for customization)
- Craft Shop ;
-- Invention; made for each customer and customized.
* Mass production:
(stable change for standardization)
stabilize the product, same product for a large market.
- Factory
- Synergy between craft shop & factory. Invention isn't done
in the factory. Factory roles are divided between workers and
managers.
Flatter, Information-Based Organizations
* In 1988, Peter Drucker described three organizations; the hospital,
the university, the symphony orchestra.
- Info-based organization: knowledge will be primarily at the
bottom, int minds of the specialists.
- In each specialty, there is a head person wh9o is a working
specialist rather than a full-time manager.
Assembly Line Health Care
* Patient is personal, while the providers are impersonal. Each
patient has different risk taking profiles, even if they have
the same illness, they would want different treatments.
* Continuous Improvement
(Improve Process for stable product)
- ended with the demo product.
(Keep the product the same, improve the process).
-- team.
* Mass Customization
(custom product using stable process)
- Network Hub and Web
Dynamic stability: Network <-> Team.
- If you rotate a team you get a network.
- produce as network, create as team.
Mass Customization and IT
* Mass Customization (definition)
-- The use of loosely coupled networks of modular, flexible processing
units that apply reproducible, low-cost, high-quality processes
to create unique product value as perceived by each customer.
* True Network Organizations require:
- Communication among workers and with customers
- Communicate across Time: follow-up
- Coordination of Activities and Responsibilities
* Modern IT enables Mass Customization
- Internet Communications Technologies
- Object-Oriented Software's Self-Managing Objects
Return-on-Management (tm) (R-O-M tm)
* A dollar spent on management does not directly produce goods
and s3ervice for sale.
* R-O-M (tm) = Management Value-added /Management Costs.
(Strassmann PA, 1990, The Business Value of Computers, pp85 &
140.)
Of companies ranked by
R0OP-M, only those in the top 20% "Spend more of their total
information technol9ogy on mission critical Operations systems
than on Management information systems. This shows that information
technology should apply where it has a direct and favorable effect
on the generation of revenues."
* Health Care: invest information technology to support Mass Customization
of clinical services.
Picture
(walking around the circle)
[PROCESS, MODEL, CENTRAL ISSUE]
* Invention - craft shop - Dynamic change for customization
* Mass customization - Network Hub and Spoke - Custom product
using stable Process
* Mass Production - Factory - Stable Change for Standardization
* Continuous Improvement - Team - Improve process for stable product
See "Clinical Software Engineering", IEEE Computer
Magazine, April 2006,
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