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RESPONSE TO: Re: [Gnumed-devel] First-Time Patient-Practitioner Advocate


From: address@hidden
Subject: RESPONSE TO: Re: [Gnumed-devel] First-Time Patient-Practitioner Advocate (Karsten Hilbert)
Date: Mon, 24 Jan 2005 23:59:05 -0800
User-agent: Mozilla Thunderbird 0.8 (Windows/20040913)

Hi All,

This is a partial response; more to follow.

Regards!

-Thomas Clark

^^^^^^^^^^

Current projects include an 'EHR server' and a 'Patient Healthcare
Assistant'.

What is the scope/deployment target environment ?
^^^^^^^^^^
Response:
The 'EHR Server' grew from a system-level need to access, modify,
append and secure electronic records containing information on
Patients, Practitioners and Payers. An additional critical goal is
to build a 'baseline' system that will permit the development of
profiling applications for a three groups (i.e., the PPPs).

Very advanced, knowledge-based tools either exist or can be
developed to process information related to the relationships,
interchanges and processes between any two of the Ps or all of them.
Other advanced tools, e.g., 'data mining', can extract relevant,
credible information that can be further processed to make it
suitable for one or more recipients.

Information sources occur from three environment: Patient,
Practitioner and Payer. Other sources, such as Public Health,
Research and Government are included. Results and Outcomes are
achievable by all three Ps acting in synchronization, and in
some cases, in adverse positions. The Patient is, however, the
final Evaluator, unless the results/outcomes are fatal and then
the Evaluators may be survivors and the Government.

A problem that keeps appearing is security and in particular,
who has access, when and to what extent. A Security Officer
must provide a detailed 'paper trail' down to the individual
transaction level to survive audits and events. The task of
designing, developing and deploying the mechanisms, tests and
verifications rests with the IT groups.

Pushing the responsibility out to the Patient is a 'dead idea',
e.g., new borns up to mature adults have a hard time with this.

Pushing it out to the Practitioner is burdensome and overbearing.
The Practitioner must secure the information (not just the records)
that is involved. Facilities are grouped under this title. Hencae,
the Practitioner is one leg of the security task.

The Payer has a relationship with the other Ps but not the right
to access information held by both that does not relate to
financial issues.

All three Ps represent three separate groups controlling specific
information related to their participation. The Government enters
her to insure that privacy and protection for the Patient prevails
and that Common Law and appropriate legislations are effective,
e.g., 'informed consent' and where did this happen?

Presuming that three separate 'virtual' servers exist, where each
supports the tasks allocated to one of the Ps, communications can
be enabled and conducted through appropriate filters.

Basic structure aside, Outcome oriented Healthcare requires that
all parties interact now and in the future, the past included in the
historical record. The EHR Server is a good vehicle to perform this
task since even requests for paper records can be satified-on-demand
via the use of on-demand media conversions.

The future of Healthcare has interesting topics such as Genomics and
drug reactions, e.g.,


What is the scope/deployment target environment ?
^^^^^^^^^^
Response:
The 'EHR Server' grew from a system-level need to access, modify,
append and secure electronic records containing information on
Patients, Practitioners and Payers. An additional critical goal is
to build a 'baseline' system that will permit the development of
profiling applications for a three groups (i.e., the PPPs).

Very advanced, knowledge-based tools either exist or can be
developed to process information related to the relationships,
interchanges and processes between any two of the Ps or all of them.
Other advanced tools, e.g., 'data mining', can extract relevant,
credible information that can be further processed to make it
suitable for one or more recipients.

Information sources occur from three environment: Patient,
Practitioner and Payer. Other sources, such as Public Health,
Research and Government are included. Results and Outcomes are
achievable by all three Ps acting in synchronization, and in
some cases, in adverse positions. The Patient is, however, the
final Evaluator, unless the results/outcomes are fatal and then
the Evaluators may be survivors and the Government.

A problem that keeps appearing is security and in particular,
who has access, when and to what extent. A Security Officer
must provide a detailed 'paper trail' down to the individual
transaction level to survive audits and events. The task of
designing, developing and deploying the mechanisms, tests and
verifications rests with the IT groups.

Pushing the responsibility out to the Patient is a 'dead idea',
e.g., new borns up to mature adults have a hard time with this.

Pushing it out to the Practitioner is burdensome and overbearing.
The Practitioner must secure the information (not just the records)
that is involved. Facilities are grouped under this title. Hencae,
the Practitioner is one leg of the security task.

The Payer has a relationship with the other Ps but not the right
to access information held by both that does not relate to
financial issues.

All three Ps represent three separate groups controlling specific
information related to their participation. The Government enters
her to insure that privacy and protection for the Patient prevails
and that Common Law and appropriate legislations are effective,
e.g., 'informed consent' and where did this happen?

Presuming that three separate 'virtual' servers exist, where each
supports the tasks allocated to one of the Ps, communications can
be enabled and conducted through appropriate filters.

Basic structure aside, Outcome oriented Healthcare requires that
all parties interact now and in the future, the past included in the
historical record. The EHR Server is a good vehicle to perform this
task since even requests for paper records can be satified-on-demand
via the use of on-demand media conversions.

The future of Healthcare has interesting topics such as Genomics and
drug reactions, e.g.,

Dr David Mrazek, Mayo Clinic

http://www.mayoclinic.org/psychiatry-rst/13654331.html

Genetic tests help predict bad medication reactions
http://www.oregonlive.com/business/oregonian/index.ssf?/base/business/110648491561130.xml
Close cooperation between Patient and Practitioner is mandated in this field.

Other research by Dr Mrazek shows a close relationship betweenPsychiatry, Psychology and Medicine,
i.e., related information from multiple sources.

The EHR Server is a 'baseline' that supports information storage, retrieval and analysis.

The Patient Healthcare Assistant project is another 'baseline' product focused on supporting Patient information operations, e.g., information sampling and retrieval, Patient commanding and Practitioner-initiated procedures. Obviously a very complicated issue since the Patient can be involved in activities practitioners have no knowledge with results that can impact procedures.

What is the deployment?

After top-down design including Unix, Linux and Windows systems (LSM2005 Conference) an attempt to build a network of Patients and Practitioners willing to evaluate the products and
support further development.

Future plans?

Healthcare from the Patients perspective where the Practitioner becomes a 24/7 element in the Patient Healthcare. This includes items not currently in the mainstream practice of medicine in
specific locations, e.g., Gerontology (beyond warehousing).

Where does this fit within gnumed.org?

Beside the presence of drug-oriented projects, the integration with clinical systems goes well beyond the Patient-Practitioner interview. Having accomplished that, follow-ons should include advanced software agents, analysis applications and profiles that support the Patient 24/7 even when the Patient is 'unavailable' for a variety of reasons or is within a 'diminished state of mind'
due to a variety of reasons.

Obviously a complicated set of topics!















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