[openhealth] Re: Demonstrations & Standards.

[Wayne Wilson]

This continues to be a good discussion.   I highlighted some small 
snippets of previous replys because I think they get at two of the other 
significant factors involved in uptake of systems.

Business models
Clinical care models

(My perspective is limited to the USA).
Whatever else we might think about it, there is a business model around 
how a patient get's moved around the health care system.  Usually 
changes in workflow (processes) change the resource (time, hardware) 
allocations for those processes.  Some processes get less, others get 
more, some new ones get more at the cost of existing or replaced 
processes.  Overall, the system may show a net gain, but if we have 
business models that separate financial (in general operational)  
accountability among the chain of care (most definitely true in the US, 
and I suspect elsewhere, the single payer does not lead to single 
operational accountability), it's very difficult to change the overall 
system and change proposals encounter stiff resistance.

In the clinical care model, at every process, I think the issue is not 
so much how much data is available or missing, but how much trust should 
be put in the data that is required for this particular encounter.  My 
personal observation in the US is that clinical staff just assume that 
critical data is missing and have built a care model and it's 
accompanying business models around that missing data.  Clinical staff 
are just as unhappy with systems that present 'everything' as they are 
of systems that don't have critical data, in fact, I think they dislike 
too data more than not enough.  That's because the system can easily be 
activated to make up the missing critical data (not all the time in 
chronic disease) but it's not so easy to pick out the relevant bits from 
the haystack of data.

 From my perspective, both of these issues are the behind the scenes 
landscape into which what I have called a practical demonstration of 
need will play out.  If you can demonstrate the need and the gain to 
most (maybe all?) of the people held operationally accountable, then 
your chances of changing technology increase dramatically.

>  From: "rschi2006" <[EMAIL PROTECTED]>
>Subject: Re: Demonstrations & Standards.
>
>... how a
>continuity of care for a patient is maintained so the patient gets
>to see the right doctors in the right order, etc.... often times
>this is supported by proper scheduling, data sharing and
>departmental communications.....
-------------------------------------

 >   From: David Forslund <[EMAIL PROTECTED]>
...
 >    Today
 > the clinician acts without
 > all the data in front of them, so providing more data than before should
 > hopefully improve (and not
 > confuse) things.

 > This
 > will require in the US incentive from the payer side of the house that
 > their costs will be reduced by
 > providing this and overseeing it even when the payer changes.

 > In the US one's PCP can change yearly if not more often. ............
  






 
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