Regarding the nonstandard note titles and
the difficulties that poses … there have actually been some significant
peer-reviewed journal articles by some VA folks on that very issue. In fact,
standardization of note titles is one of the things currently in the queue to be
accomplished in VistA (I’m not sure but I believe it’s also part of the
CPRS-R work coming out very soon). A fair amount of automated matching to
standard titles will be performed (no doubt with some manual intervention and
checking). Once in place, new note titles would be quickly built up from a
compound set of expressions from the Enterprise Reference Terminology which would
cover virtually all of the useful note titles (excepting the odd and
uninformative ones such as “Dr Soandso’s notes”). That means
that both old and new titles can be sorted and searched in computationally meaningful
ways for quick and easy use.
-----Original Message-----
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Gillon, Joseph
Sent: Thursday, June 09, 2005 1:06
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
That’s an interesting problem you
pose. Did you ever see Euclid? It had a problem-centric UI that
apparently providers loved. I guess you would click on, say, diabetes,
and it would tell you what you should know about diabetes for patients of a
certain age, gender, ethnicity, whatever. It would offer recommendations
for meds and also check prescriptions for possible problems. It was
written by a doc who’s now in Reno. He just sent me the latest
which is now web-based and uses MDO, the middleware techonology that VW
uses.
A sort of related but not quite the same
feature is something VW will use soon, and that’s Up-to-Date and medical
dictionary searches. User highlights text, right clicks, picks the search
engine and gets info.
I’m saying all this just to indicate
there are efforts to get some AI into our EMRs. In fact, the CPRS-R folks
are going to use a lot of the old Euclid functionality. Oh, it has a
thing called Assist that helps write notes. Sorry I don’t know
exactly how…
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Sowinski, Richard J.
Sent: Thursday, June 09, 2005 3:51
PM
To:
'hardhats-members@lists.sourceforge.net'
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
It's good to see you on Hardhats. What
took you so long ?
Sorry about "hunt and peck"
analogy it's just the most apt description of what I see users doing when they
use these products.
It's just my bias, I think remote data
viewers fill an interim niche. But I have had busy docs tell me that
they don't have the time to sift through this data on most patients, unless
they are really, really curious about something. I think the same thing can be
said for Docs sifting through reams of CPRS data from their own site! Just no
time to do that: they see their patient, write their note,
write their prescription and any other orders, and get on to the next
patient.
This is no reflection on your VistaWeb
product. I think it's a great tool, faster than RDV's, and an accomplishment on
your part. It certainly helps alot when Docs really want to see that data.
I also think it is good that there is
such great interest outside of VA in some of the things VA has developed
over the past few years, including VistaWeb.
Joe, you are on the right track, I think
your VistaWeb product could be separated pretty simply from some of the
"complexities" underneath.
We can talk off-line if you want. I don't
want to burn anymore Hardhats bandwidth on this topic, especially considering
who is listening.
I have all the respect in the world for
the St Peterburg Times and their affiliation with the Poynter Institute, one of
the most respected journalism schools in the country, but I wish we could
"talk tech" here without worrying about being monitored or quoted.
After all, that's really
what this forum is for.
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]On Behalf Of Gillon, Joseph
Sent: Thursday, June 09, 2005 1:06
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
First, I should mention that if you are a
VA employee be careful what you say to this guy. He's a biased,
sensationalist reporter looking to make copy and not, IMHO, particulary
interested in veracity. More interested in uncovering another CoreFLS
than anything else.
On to Rich. And hi BTW, been a
while. Thinking just of implementing VW or RDV outside the VA, you hit on
one extremely important item, namely standardization of data. I disagree
with the "hunt and peck" label you're sticking VW with since it shows
all the data, collated, in seconds. However, due to the non-standard note
titles and stuff of that ilk, when you sort the titles you don't necessarily
get, say, all the cariology notes, in one place. Were I starting a new
multi-site VistA system I would really, really, really give some time and
effort to implementing standard note/report titles, lab panel titles, team
names, etc. All this stuff is a totally squirrelly mess in the VA after
years of each site doing whatever it pleased.
And I think Rich hits another nail on the
head with the MPI thing. If you are going to have distributed databases
you definitely need something central to figure out what sites to query.
Well, maybe if you only had half a dozen sites... Still. Rich, I
know that VistA kicks out an HL7 message on inpatient events (admit, discharge,
transfer). Does it do anything on outpatient visits? If it did you
could just set up an HL7 listener to catch these messages and put the relevant
data into an SQL database. Then, since VW can talk to SQL databases as
well as VistA databases, you could just replace the MPI RPC with a select
statement.
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED]
Sent: Thursday, June 09, 2005 1:45
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
----- Forwarded by Steve Nohlgren/News/Sptimes
on 06/09/2005 01:43 PM -----
|
[EMAIL PROTECTED]
Sent by:
[EMAIL PROTECTED]
06/09/2005
10:18 AM
Please
respond to hardhats-members
|
To:
hardhats-members@lists.sourceforge.net
cc:
Subject: RE: [Hardhats-members]
== VistaWeb Missing Apps ==
|
Mr. Sowinski's comments about the value of a central data repository or
repositories speaks to an issue we are wondering about at the St. Petersburg
Times--whether or not HealtheVet plans inject some unnecessary complexities
while upgrading VistA. As I understand it, the national HDR will be an Oracle
database that will merge clinical data real time and avoid this hunting and
pecking for remote info. It will also to allow for report writing and
queries to get a better handle on trends. Kaiser Permanente is splitting those
two functions in their Epic System. The clinical data is stored in a Cache
warehouse so everything pops up automatically no matter where the patient goes
for treatment, but that data also become input to an Oracle warehouse for
report writing and analysis. As I understand it, they figured that keeping both
functions in a relational database would require more CPU and slow down the
clinical side. Would such a divided s ystem make more sense for the VA's
centralized database. If anyone feels like responding to me directly, you can
use your home e-mail.
Thanks,
Steve Nohlgren
When
I speak of the "complexities" of the infrastructure I am speaking of
the MPI,
the updating of data across sites, etc. Initializing all patients with ICN's
etc.
Actually, I think that particular infrastructure could be simplified, and
probably should be
simplified, if one wanted to implement remote data viewing capability
outside of
VHA.
When you think about it, you really only need a list of sites a patient has
been
"registered at", and a good identifying scheme, to
"assemble" a patient's
record
from multiple sites.
But actually, the model I prefer is a centralized repository or
repositories.
The problem with apps like Remote Data Views and VistaWeb is, the physician
has
to "hunt an peck" for data. Physicians are expected to do 20-minute
appointments,
write their computerized notes and orders, and maintain 2000-patient panels.
Many Docs
simply do not have the time to look through this remote data.
Other issues are, you cannot run research-type queries across sites, to
identify cohorts
of patients meeting certain research criteria. Data is not standardized.
Your lab test name,
or lab test panel, may be different from mine.
With a data repository: reminders, alerts, etc can be run against a
standardized database,
and and data from many sites can be viewed via a common interface. A Doctor
can even be
paged automatically, if a patient's test data is outside normal ranges. Or
for any other
reason, specified.
But apps like RDV's and VistaWeb certainly fill a niche, for some Docs who
have smaller panels
or, who take the extra time, for now.
- Rich
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of Jim
Self
Sent: Wednesday, June 08, 2005 5:55 PM
To: hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Richard Sowinski wrote:
>The reason I have asked people on this list if they have VistaWeb up and
>running, is because I suspect
>they underestimate the infrastructure required "under the hood",
to make
it,
>or RDV run.
>
>I also suspect, some have misconstrued what VistaWeb is. I think some of
>them think it is a Web-based front-end
>to Vista, instead of a remote view-only application, used to view patient
>data at other sites.
I haven't tried to get VistaWeb running because of a lack of free time for
playing with
things dependent on M$ proprietary technology, but I have thought that the
source files in
VistaWeb might be helpful in defining some aspects of what a Web-based
front-end to VistA
should include.
>From reviewing the VistaWeb documentation a while back, it seemed to me that
it would be
quite easy using M2Web to improve upon the views of VistA data provided by
VistaWeb if
someone could take a little time just to specify what views are needed and
what data
fields should be included. I had the same impression from a health-e-vet
demo earlier, but
I haven't had the free time to pursue either very much so far. I have a good
understanding
of the underlying technology (MUMPS, Fileman, Web, etc.) but not of the
VistA EMR, so
someone with that knowledge and/or the time to gather it could help greatly
to move such a
project along.
---------------------------------------
Jim Self
Systems Architect, Lead Developer
VMTH Computer Services, UC Davis
(http://www.vmth.ucdavis.edu/us/jaself)
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