Hi Nandalal,
There was nothing personal in my message. I just wanted to point out
that time is probably come for "out of the box thinking".
You are probably aware that current standards in the medical domain are
all dedicated to "report making". It means that nothing exists to give a
proper vision of the patient's health project before this action.
Of course, you could imagine extracting this information from the amount
of previously received reports, but it would take a huge amount of time
and, as you said in a previous mail, it would necessitate that each and
every health professional work on a unique EMR. And to be able to read
hundreds of documents each time he sees a chronic patient.
This is an "in the box vision" : the HIS can grow and become a regional
or national system in order to address the continuity of care issue.
Now let's suppose you provide the patient with a personal health project
manager that lists health problems in a diachronic way (along time) +
pointers toward (main) existing documents + health goals ("follow up
colonoscopy every 3 years", "maintain BMI below 35"...) according to
health problems.
This way, you provide the customer with a tool for customers (with his
health as an asset to manage continuously over time), and service
providers keep their service provider's tool (with a specific issue to
address during a given period of time).
Philippe
Nandalal Gunaratne a écrit :
>Phillipe,
>
> I would like to know your approach to things, more clearly. The list I made
> is more in fun than an initiative for OSHCA!! My interest infact is in the
> use of IT for the area of Research, audit and CME for clinicians. The BIG
> jobof making those for administrators, managers, ministers, governments is
> far too complex.
>
> I think it has been clearly shown that the ability to communicate between
> different type of acpplications and to have an international standard on this
> may solve one major issue. Interoperability will stop here, most likely.
>
> How far will SNOMED go, in the worldwide context to standardize nomenclature?
> Let us wait and see.
>
> nandalal
>
>Philippe AMELINE <[EMAIL PROTECTED]> wrote: Joseph Dal Molin a écrit :
>
> > > I feel a partnership between a couple of IT savyy clinicians and expert
> > > programmers with a wholesome way of looking at things, can create the
> > > infrastructure of the future HISs.
> >
> >Nandalal, you have in one sentence described how VistA was first
> >developed and evolved for the better part of its history, all be it the
> >number of collaborators was much larger.
> >
> >So the real issue IMHO is not designing and building the perfect system
> >is but how to leverage the vast experience and knowledge that is imbeded
> >in VistA's DNA.
> >
> >Frankly speaking how many lives could be saved and improved by simply
> >implementing VistA as far and wide as possible and at the same time
> >engaging that community to improve the software? Is chasing perfection
> >by starting from a clean slate worth the human opportunity cost?
> >
> >Joseph
> >
> >
> Joseph,
>
> By "simply implementing VistA as far and wide as possible", do you mean
> that you want to provide the patients with Vista ?
>
> Because even if VistA is a very good system, it can't replace all
> existing systems (so you will have many discrepancies in the network)
> and beside, it is not possible to address the continuity of care issue
> through HISs (in the same way motion pictures and still images are
> different).
>
> Nandalal's point 5 : "5. Scale to a hospital/region/country/world!" is,
> from my point of view, a very dangerous feeling. It gives me the same
> feeling as if you would say : our aquarium architecture is made of a
> carbon filter and an air pump, and we want to scale it on a lake, a
> river, an ocean. A HIS is an "into the box" solution, don't even try to
> scale it in order to manage the open world.
>
> This sort of things makes me nervous because in France I am fighting
> everyday against HIS vendors selling their solution as "county wide
> scalable". Sometimes just because they can manage all Dicom modalities.
> I hope I can convince the people in charge of current national health
> record that a perfect HIS is a dangerous object in the landscape if it
> restricts its scope from in-patient to out-patient and doesn't have as a
> primary duty to contribute to a global patient health journey.
>
> As you know, "a single period of time, a single location, a single
> problem" is the usual architecture of... the classical tragedy.
>
> Philippe
>
>
>
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