Arden W. Forrey PhD
Dept of Restorative Dentistry
University of Washington School of Dentistry
206-616-1875 Phone
206-543-7783 FAX
On Fri, 25 Sep 1998 [log in to unmask] wrote:
>
> > AR wrote:
> > >>It's the 'how' that's worrying me a lot. The documents don't actually
> > >>say where the money is coming from, unless I missed it!
> > JK wrote
> > It is not all clear that this
> > is a better way of spending money on patient care than leaving it up to
> > clinicians closer to the patient.
It has been enlightening to hear the perspectives on the common problem
also having to be faced in the US - namely how to place the incentives and
rewards for the market to drive the introduction the necessary mix of
capabilities. The AACC clinical laboratorians have the same dilemma as
their ACB counterparts but their options are a fragmented "I'm the
Greatest" market badly in need of common conventions to ensure the
interoperability implied by the "Information for Health" document.. Work
with the CEN TC-251 over the last nine years has taught me one thing -
that we have much to learn from one another, and we in the US have learned
much from TC 251 work. How much of what has been learned has been passed
on to the average clinical laboratorian is a good question. The lab
informaticians have not yet identified the strategy to convey the broad
range of issues that will be in the skills armamentarium of the coming
community of clinical laboratorians in order for the interoperability of
the integrated CLIMS/EHR environment to come to reality. We all need to
consider joint apporaches to the content and the implementation
conventions for the full evolutionary Life Cycle of system components of
that environment and how clinical laboratorians should interact with
software engineers with complementary capabilities strong in content where
as SEs are strong in implementation. We in the US do know SEs in the UK
with the needed skills and perspectives but like UK clinical laboratorians
do not yet have the right forums to produce synergism in complementing
disciplines. However the time is ripe and even modest joint efforts could
help each of us point in the right direction. In your email dialog we in
the US would be interested in ideas for modest efforts.
As a point of information the AACC, via its Lab Information systems and
Medical Informatics Division is currently represented on the American
National Standards Institute's Health Informatics Standards Board (ANSI
HISB) and works to involve all AACC Divisions in health
informatics standards activities that draw on their expertise so that that
expertise contributes to a focal capability and the common conventions
that can be documented and provided to industry to be incorporated into
products for the market that address system requirements serving both lab
care practitioner needs. It is embryonic, incomplete and still has many
hurdles - but it is a start. Joint work amongst clinical laboratorians in
other environments will create a posture that is recognized by vendors and
by govermental bodies in whatever setting. We work on issues with our
Canadian counterparts as diligently as we are trying with our UK
counterparts and those elsewhere such as Japan and Australia. We work with
NCCLS and their counterparts elsewhere. E-mail allows modular contribution
as time and effort allows but it is directed effort that adds up, as your
mail server exemplifies.
We do want to hear both the challenges you face
and your approaches to the solution of the problems. We try to focus our
efforts via Rick Jones and the ACB-IT group as part of that discipline. We
would like the UK members' participation in forums occuring in the US as
well as making the effort to see US partiticpation in forums occurring
elsewhere, drawing on the resources of those who might attend. Sharing
information on planned forums and potential attendees ahead of time can
help identify possible means to get participants to the forum. I can tell
you that in May 1996 at the Toward an Electronic Patient Record 96
Conference in San Diego we did have a session on the NHS interests and
challenges which was, to me, most enlightening. In subsequent occurances
of this event we have had further contributions. A lab issue track is
being prepared for 1999 and, judging from the NHS document and this
server, UK clinical laboratorians would be valuable contributions.
Similarly the TEHRE 98 Meeting in Nov in London might be a useful starting
point. Other forums, such as ACB Annual Meetings and others could be
useful targets. We would like to hear your ideas on these possibilities.
>
> The problem as I see it is that IS developments are breaking down all
> the old institutional boundaries or at least need to if the
> macro-economic benefits are to be realised. Unlike the internet where
> development can expand into areas where new alliances / institutions
> can be freely developed in health we have a mature institutional
> structure designed to be robust with well developed defensive
> reflexes which inhibit radical change.
I would offer, if it is any comfort, that the US has its attitudinal
lacunae where inhabitants curl in their mental Linus Blankets. It is not a
national but a worldwide hurdle - but also a challenge.
Paradoxically the
> introduction of market style micro-economic mechanisms into the NHS
> have probably made it more resistant to change than ever -
> necessitating more political pressure (ie financial manipulation) to
> drive through change.
Remember, the incentives/reward axis is the secret to escaping this
stasis.
>
> The question which we are presented with is to
> resolve the issues of necessary central control and direction (eg
> standards to allow interworking) with devolved ownership and
> delivery. All this in a situation when the number of people with the
> breadth of knowledge to understand the problem is probably
> in the order of a couple of thousand or so.
Leadership always resides in the minority, the issue is how to leverage
that talent by the incentive rewards to the various constituencies. It
never is (or has been) easy work. The prevalent unbiquitous saying "LEAD,
FOLLOW OR GET OUT OF THE WAY" is as relevant as ever. The challenge to
clinical laboratorians who wish to help show the way is how to do that.
>
> "I have yet to see any problem, however complicated which when you
> looked at it in the right way did not become still more complicated."
> Poul Anderson
>
>
> Life is going to be very interesting for eth next decade or so.
Amen!
>
>
> Rick
> Dr Rick Jones
> Director of Chemical Pathology and Immunology
> Institute of Pathology
> Tel:(44)-113-233-5677
> Fax:(44)-113-233-5672
> http://www.leeds.ac.uk/acb
> http://www.ifcc.org
>
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