As a boarded internist, intensivist, and pulmonologist, let me suggest a few things that are particularly useful in a networked clinic.
1) Security: Of course, access to the patient information should be restricted to the local network. Access from the Internet should be completely restricted except perhaps for SMTP. Furthermore, the user identity of all read, print, and write requests to the chart should be logged. Of course, any database is only as good as its last backup.
2) Database: Presumably, a RDBMS will be used to manage the information in the patients' charts. The database should of course meet all the ACID test requirements. See http://openacs.org/philosophy/why-not-mysql.html
3) Medication: While many pharmacies provide drug-drug interaction expert systems, many patients need to go to various pharmacies due to issues of reimbursement. For these patients, it is imperative and relatively simple to implement a meds list and cross check it with a drug-drug interaction table.
4) Patient Education: In these days of managed care and shortened facetime with patients, basic patient education is often delegated to a few minutes with the nurse, physician assistant, or the clinic assistant, if it is addressed at all. A list of printable materials and online movies can provide important instruction such as insulin administration, use of a metered dose inhaler or peak flow meter, or other medical devices. While these will never supplant F2F education, it allows the limited time with the patient to be used for issues specific to the patient.
5) Dictations: While dictating to the computer through a voice recognition system would be nice, it is much more important to keep track of procedure notes and consultations. These items already being transcribed to a digital system could be easily entered into the database from CD-ROM or, if the transcription service is unable to provide digital files, through OCR.
6) Level of Care/Billing: With Medicare recently increasing its attention to acuity/level of care, it is important to provide clear documentation to justify billing codes. Underbilling is being penalized just as aggressively as overbilling. Being able to document time spent with the patient, reviewing medications and notes, entering progress notes, and dispensing education materials is critical in justifying higher levels of care. Conversely, the system can be setup to prevent inadvertent underbilling for visits that require more than usual time with the chart.
7) Bells and whistles: While many bitheads may suggest that things like instant messaging, discussion forums and online appointment scheduling, these introduce security/reliability issues and furthermore are superfluous.
Although email/SMS/pager reminders of appointments might be useful for the chronically forgetful patient, they are probably for the most part unnecessary, if not outright intrusive. Several Usenet groups and WWW forums provide medical support groups with a larger audience than could be provided by the local MD. Electronic scheduling of appointments is not quite the same as purchasing airplane tickets. Especially in a busy practice where appointment slots (both new patient and follow-up) are at a premium, it is critically important to triage appointment slots to those that need to be seen immediately rather than later.
While not quite specifically in the sphere of outpatient clinic practice, the integration of a PDA in the inpatient setting would be fairly useful for purposes of billing for inpatient services and integrating the inpatient course into the outpatient chart.
In summary, a well-designed high tech medical clinic provides a secure and reliable way to administer and document patient care and education.
(1)ease of use+tech support=less trouble for newbies
(1a) less trouble for newbies = more newbies (2)more newbies =less newbies asking dumb questions EVERYWHERE (3)Equation solution: it is *you* who is saying bullshit.
yeah, more stupid questions everywhere including your dumba$$ irc channel, but I think RH is banking that they'll look for better help on their support plans. The free CD is a way of increasing support sales. It's all in "The Cathedral and the Bazaar", dude.
Slashdot Mirror
What is your view on the Microsoft .NET and its impact on Linux in general and RedHat in particular?
As a boarded internist, intensivist, and pulmonologist, let me suggest a few things that are particularly useful in a networked clinic. 1) Security: Of course, access to the patient information should be restricted to the local network. Access from the Internet should be completely restricted except perhaps for SMTP. Furthermore, the user identity of all read, print, and write requests to the chart should be logged. Of course, any database is only as good as its last backup. 2) Database: Presumably, a RDBMS will be used to manage the information in the patients' charts. The database should of course meet all the ACID test requirements. See http://openacs.org/philosophy/why-not-mysql.html 3) Medication: While many pharmacies provide drug-drug interaction expert systems, many patients need to go to various pharmacies due to issues of reimbursement. For these patients, it is imperative and relatively simple to implement a meds list and cross check it with a drug-drug interaction table. 4) Patient Education: In these days of managed care and shortened facetime with patients, basic patient education is often delegated to a few minutes with the nurse, physician assistant, or the clinic assistant, if it is addressed at all. A list of printable materials and online movies can provide important instruction such as insulin administration, use of a metered dose inhaler or peak flow meter, or other medical devices. While these will never supplant F2F education, it allows the limited time with the patient to be used for issues specific to the patient. 5) Dictations: While dictating to the computer through a voice recognition system would be nice, it is much more important to keep track of procedure notes and consultations. These items already being transcribed to a digital system could be easily entered into the database from CD-ROM or, if the transcription service is unable to provide digital files, through OCR. 6) Level of Care/Billing: With Medicare recently increasing its attention to acuity/level of care, it is important to provide clear documentation to justify billing codes. Underbilling is being penalized just as aggressively as overbilling. Being able to document time spent with the patient, reviewing medications and notes, entering progress notes, and dispensing education materials is critical in justifying higher levels of care. Conversely, the system can be setup to prevent inadvertent underbilling for visits that require more than usual time with the chart. 7) Bells and whistles: While many bitheads may suggest that things like instant messaging, discussion forums and online appointment scheduling, these introduce security/reliability issues and furthermore are superfluous. Although email/SMS/pager reminders of appointments might be useful for the chronically forgetful patient, they are probably for the most part unnecessary, if not outright intrusive. Several Usenet groups and WWW forums provide medical support groups with a larger audience than could be provided by the local MD. Electronic scheduling of appointments is not quite the same as purchasing airplane tickets. Especially in a busy practice where appointment slots (both new patient and follow-up) are at a premium, it is critically important to triage appointment slots to those that need to be seen immediately rather than later. While not quite specifically in the sphere of outpatient clinic practice, the integration of a PDA in the inpatient setting would be fairly useful for purposes of billing for inpatient services and integrating the inpatient course into the outpatient chart. In summary, a well-designed high tech medical clinic provides a secure and reliable way to administer and document patient care and education.
yeah, more stupid questions everywhere including your dumba$$ irc channel, but I think RH is banking that they'll look for better help on their support plans. The free CD is a way of increasing support sales. It's all in "The Cathedral and the Bazaar", dude.