On Wed, 11 Oct 2000 13:41:31   Alvin B. Marcelo wrote:
>He said: "All healthcare is local." 
...
>I expect the same will occur with 
>medical information systems. The information requirements of end-users 
>[except those required to be submitted by law] vary widely.
>
>Acknowldeging this, how then should we approach the work to be done by the 
>alliance? 
>Where is the common ground?
>alvin

Good question, and a question of pre-historic
proportions faced by all information scientists and
engineers since before the invention of language.
(perhaps first posed when intracellular communication protocols were being worked out 
- no, no, not cell
phones -- :->).

The answer is flexibility and ease of customization.
(with re-use and sharing of resources if possible).

Each organization and individual need to be able to
use the information system to collect and manage data
to answer the specific questions and information needs
that they have.  It is not possible to anticipate a
comprehensive list of all possible data items or
prepare answers to questions yet to be posed.

I think I used a printing press analogy several months
ago in another posting here.  It is human to look
for panacea in every new technology that comes along.
Unfortunately just as perpetual motion is hard to come
by, so is an information system that will fulfill all
possible information needs from now to eternity.  The
next best thing, in my view, is to have a system that
is less costly and painful to modify over time.

Again, the moving-type printing press comes to mind.
Sometimes you want to print the Bible,
sometimes you want to print a comic book.  It sure
is painful to have to carve brand new plates for each
page of every new book.  This is where we are at now
with our information systems that require costly
re-programming to customize and maintain over time.  
The OIO is the most "moving-type"/modular medical
system so far.  We will just have to see whether it
will catch-on like the moving-type printing process (after its inventor was bankrupt).

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org
Assistant Clinical Professor
Department of Psychiatry, Harbor-UCLA Medical Center
University of California, Los Angeles



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