On Saturday 07 December 2002 23:59, Eric Browne wrote: > There is a huge leap in functionality
_And how_. Still, the story of Linux and of some of the classics of Open Source describe hackers thinking "It can't be that difficult to ..." and lo and behold 10 Christmases later there is an implementation that is getting common use. I'll pick out a couple of areas to comment on. 1. One of the workflow things is a "work token". This is a key to a general area of difficulty in moving medical systems from paper to computers but is also an obtainable advantage from doing so. In paper, if the patient record is no my desk then I have a job to do. The notes are being used as a work token, and until I have done that job and moved the result (the work token: the notes) on to someone else, the buck visibly stops with me. Electronic systems are easier for people to ignore, particualrly if thye have the option of some paper systems to concentrate on as well. Of course, the visibility of that work token is only moderate within the room in which I might work, if there were a dozen of me, and we each had a pile of 20 sets of notes and their sticky paper work tickets on them, then someone outside would have a hard time finding the notes or deciding who had the token: for whom we are waiting. And one can only work on one job at a time that way, hence the combinatorial explosion in delay generated by increasing sub-specialisation and team work. Eletronic work-token tracking can improve this... 2. I pick up from Andrew's posting a feeling that there is more "packaging" of medical services, than a full workflow system available in relatively short time here. Everyone who is referred with new central chest pain suggestive of Angina should have a Cardiology consultation, which should be preceeded by an ECG with that data presented at the consultation. These are likely in the same building... Everyone bar a few should go on to an exercise ECG, and everyone should have some of a set of drugs which are backed up by a set of knowledge resources for the dotor, and for the nurse, and for the patient. In other words, there is a single example of a fairly well-ordered set of ations that will improve the efficiency of the whole system if they can be grouped together and run in the right sequence, and which it hepls if we have in a _package_ rather than bokking individually. There are lots more, including things like the need to measure the blood pressure before deciding upon the anti-hypertensive medication and the time of the next review in general practice, or taking the blood and getting the results before the doctor review of Diabetes rather than at/instead of it or afterward. Both of these are more difficult to run _smoothly_ than they seem and both can generate benefits to patient and doctor. So in the same slightly sloppy way I think of expert systems (they are really hard to do, but I can run up an opinionatd system that'll give a hint on a certain area much more easily, and you na grow lots of those over time andrefine them) I think there is merit in generally understanding the workflow approach and concepts as Eric very kindly has appeared to contribute to and in using some of those to inform some work on a manageable scale wherever there is benefit from them. Trying to do an all-singing all-dancing system from scratch is very likely to result in a gargling stumbling system. -- From one of the Linux desktops of Dr Adrian Midgley http://www.defoam.net/
