Thomas Clark wrote:
>>What was your study to do with? >> this is the meat of the problem... >STUDY: > >-several counties in California and Nevada ranging from agriculture to >forestry >and their current healthcare systems >-current budgetary constraints and potential for new funding >-can they develop county-wide and state-wide healthcare systems that >incorporate an OpenEHR-based system >-can they get support from the federal government >-how are they handling HIPAA >-can they integrate individual and small groups of Practitioners >-can they handle current levels of care for current populations >-are their open-source solutions currently available that could be used by >county personnel to introduce and maintain a EHR/EMR system > I certainly can't answer all these questions, and clearly answers would take time to emerge based on actually doing some trials there. However, I think we can say the following: - openEHR is certainly destined for regional EHR systems, with mixed users, including small providers (and big ones) - there are open source solutions which are leaning toward openEHR eventually becoming the EHR engine, including Torch (http://www.openparadigms.com/), Gnumed (http://www.gnumed.org/resources.html), openEMed (http://sourceforge.net/projects/openmed). A community worth belonging to is the Open Source HealthCare Alliance (OSHCA), see http://www.oshca.org/. - openEHR is an open community, and is essentially an open but disciplined software engineering enterprise, so people in the community can make changes and have influence. US govt support is always an interesting question - the US government is congenitally doomed to think that solutions from outside the US a) don't exist, b) are rubbish or c) should be secretly replicated and then badged as US innovations. This is not a point of view held by all experts or developers inthe health IT domain, particularly OS developers, but it is certainly entrenched. Breaking it requires internal advocacy on the part of the enlightened! >NOTE: >-restricted to individual counties and counties that have an established >inter-county organization > i.e. ones who can agree to set up compatible information governance and sharing agreements? >-homeless and transient healthcare a major problem and remains so. > I think that the approach of indexes/health resource location service + ad hoc requests/replies will be the go for transients. Homeless people is a challenge in the health system in general, and I suspect a lot of the problem is outside the realm of IT, i.e. identification, compliance, recalls etc. But we do need to design for the reality of processes which don't go according to plan - we certainly cannot design for perfect patients. Here in Australia dodgy/multiple patient identifiers are a big problem in rural & indigenous population, and somewhat so elsewhere. Connecting fragments of health information together form inside multiple patient contact points where the id information is unreliable is a known challenge, and I have seen some good work in France on this (based on the idea that even if you can't figure out who this person _really_ is, you don't care that much; what you do care about is determining if the various fragments of health inforation actually relate tothe same person, to give some hope of building a coherent picture of them). openEHR is trying to be cognisent of such problems - the EHR design makes nearly no assumptions about ids - that problem is outsoruced to the demographic system. Status/state of execution of treatment regimes, recalls etc we think will be pretty well handled by archetyped state machines and process models which are under development now in the workflow area. But - making sure this stuff works will of course be up to the whole community to be invlved in design, implementation testing and feedback. >-within each county there are major disconnects between different >departments >and services >-county healthcare services are over-burdened, under-funded, under-staffed >and in constant danger of closure > i think these points relate to deployment strategies (if you were ever to get that far;-) - don't change the work practices of clinical & allied health workers in a revolutionar way (make it evolutionary), and make sure the overall and ongoing costs can be met, including retraining etc. But the promise of clinician involvement in writing their own archetypes and templates could also have a benficial effect - this is where the health workers get to be inthe driving seat. Compared to the classic kind of IT in most current systems, this is one area we hope will drive engagement and positive reception of things like openEHR. >-governments seem to make matters worse >-charities and welfare agencies are unable to participate for a long list of >reasons >-in-place IT Departments are over-loaded > this last one could be radically changed it things moved to standards-based relatively lightweight back-end EHR components with a knowledge framework built around that, instead of enormous, unmaintainable databases and chaotic cross-feeds etc. >>can you define this role in more detail to do with EHRs? Do you mean >>senior medical staff? >> >> > >CREATORS > >The bulk of Patients are handled by staff, some untrained, e.g., admitting. >They >(admitting, etc) require automatic, form-based software applications and >lots of it. > >RNs and LVNs carry the load; fewer numbers of doctors do the major work, >senior medical staff, where present, and chasing funding and performing >administrative duties. A local county hospital can admit a Patient and setup >billing but does not know how long a Patient is resident or when they >actually >leave. The floor nurse has to check the beds and report on who is in and who >is out. > I guess this is really an argument for a proper analysis of time-wasting admin procedures, and how better IT systems can reduce the loss and get doctors back to working with patients. >Certainly better than nothing but needing considerably more. The hospital >Administrator was just involved in a serious controversy because of a budget >item for an ABSOLUTE BOTTOM-LINE Catscan system (first in the county). >There will be no computer system connection. > >This has been added to show that there are many Practitioners and staff that >SHOULD be CREATORS but cannot be because of UNAVAILABILITY. >A local county resident can travel globally with the assurance than NO >medical >record could be accessed by any regional, national or foreign Practitioner. > I would say that that is the situation for most patients globally... There is a lot of other interesting stuff in this post which I'm sure the list will be interested in chewing over... - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
