Geoff Sayer wrote:
> Tim Churches said:
> 
> However, clinicians are poorly served by information tools in this
> respect, and there is also a lack of engagement between public health
> people and clinicians. But these things are changing, slowly.
> 
> Geoff Sayer response:
> 
> I would argue that the data that is used in aggregating has to be the same
> data that you can run the decision support systems with. Getting clinicians
> to capture data in the normal course of business should allow them to
> aggregate but also should then be the very same data that they use for
> initiating electronic "population/practice based initiatives". We often see
> a dissonance between population health strategies which relies on
> aggregation external to the clinical system without thought to effectively
> roll the findings back into electronic strategies that affect clinical care
> on single doctor-patient encounters (eg. generating recalls, prompts,
> implementing treatment pathways etc). Doctors are interested in populations
> but they care very well on a one to one basis.

Yes, I basically agree with all of that. I even agree with Geoff's point
 that population health strategies don't think through or make enough
use of electronic strategies that affect clinical care on single
doctor-patient encounters - that is a valid criticism of very many
population health efforts to date.

Mind you, I think that *every* health informatics project or product
and *every* deployment of a clinical information system in a hospital or
health system should have a population health and/or clinical
epidemiologist in a key role on the team to make sure that opportunities
for useful and valuable secondary, aggregate use of information are not
missed, as they routinely and repeatedly are at present.

Tim C
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