The article written by myself, Peter Taylor, Geoff MacDonnell and Andrew Georgiou…..and published in the MJA in January  http://www.mja.com.au/public/issues/192_01_040110/bai10628_fm.html

has elicited a few private reactions.  Some of them from prominent health administrators in support, some of them  questioning by  clinicians ……… none that I’ve seen have yet made it to press (but if you  see one – please let me know as I am very interested in seeing the reactions !!)

………. has the 85% “myth “ been busted ………… or are those wedded to the notion of 85% as a blanket  rule for all settings  simply saving up their ammunition for rainy day ? J ………….. time will tell …………

In my new role at Ambulance Victoria I have seen some great work in action in operational planning and the embedded use of predictive software

http://www.theoptimacorporation.com/case-studies/optima-predicttm-to-the-rescue-in-melbourne_8

Interestingly it's 2 NZ companies with similar recent histories that are leading the way in embedding these tools into our health systems.......... something I have been keen to see in recent years

http://www.emendo.co.nz/case-studies/

Well ……….. it seems there’s no such thing as free speech around health IT …………….I’m sure you’d agree that this article makes interesting reading

http://www.smh.com.au/national/health-department-accused-of-censorship-20091127-jwwm.html

I’d have thought that all Cerner and NSW Health needed to do was to point to the reams of published, or at least public, examples of successes and business benefits that have been delivered by Cerner products – not quite sure why they would seek to censor or not respond ? Any thoughts ?

Victoria’s HealthSMART program has now been running for in excess of 5 years …..a number of wins have been had with implementations successfully undertaken in the PAS and financial spaces. Ask any clinician however ………… and all they care about  is having better tools with which to manage their patients and collect relevant  data related to their services.

We still do not have wins ……….or even visible implementations …….at key sites in the clinical space. More worryingly – we have very little indication to the broader clinical community, as to what is happening in this space, and what is and isn’t in scope – clinicians are left to wonder …………….and be cynical about the likely chances of success.

From a healthcare management informatics perspective – we remain  a long way from seeing the ways in which these clinical systems could or would support the improved provision of services to patients …………let alone actually being able to measure these benefits. I guess the key question is ……..how much longer will the sector need to wait ?...........as all the while,  clinical medicine increases in diversity and complexity,  and these tools to support the practice of that medicine fall further behind in relative terms.

Those of you who know me will recall that this is a favorite topic of mine ......... the question of what is a "bed" when talking patient care and hospitals … or more particularly ………. how do we define what a bed is ?

This is important to note for the development and use of operational IT systems that track usage and staffing of, and the need for, “beds” and also for those of us who develop computer or mathematical models of facilities and systems. Historically, blood has flowed – or at least many a nasty word said over “beds” - in the cut and thrust of hospital operations……….. so they are no trivial matter……………..and some would have us believe (with fair justification) that more of them is the answer to improved access to hospital care.  

Given some important realities however (see below), I think we need to explore a new concept for the 21^st century….can I submit to you for your consideration – the “patient treatment space” (the PTS) ……..as you know every new idea needs a new acronym J

The patient treatment spaces concept can encompass the same issues confronting “beds” – namely questions of – staffed (specialized vs generic) vs unstaffed; empty (transiently or temporarily) vs occupied ; gender specific or gender neutral; single room or multiple bed room; PPV vs normal; isolation vs non isolation; HDU vs ICU; ventilated vs non ventilated; physical bed vs trolley vs upright chair ……………..you get the idea……….

………whilst allowing for the fact that what is more important looking forward from  now with drivers to SD,  ambulatory and virtual care – that is the capacity of a “space” funded by an entity, to treat patients in a quality fashion whilst recouping expenditure ………… for example – if you run a GI service and the vast majority of your work happens to be endoscopy vs IP care …………… you are much more likely to be interested in available capacity to perform endoscopy (with the attendant implications) than access to vast numbers of IP beds

The work of Peter Pronovost 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61439-2/fulltext  is to be applauded.

Furthermore - we should certainly examine the ways that IT can support such simple aides-de-memoire and their implementation - in fact we must - as many healthcare workers will work off electronic work lists both now and in the future.

The "ticked off" part ?? - why has it taken our industry so long to do what others have being doing for decades (that's a PhD.......or a career...... not a blog entry :-) ) ........... one reason I would argue is (and I agree with Peter's 3 buckets idea) - that the 3rd bucket is neglected - health-mic is definitely focused on improving "the lot of the 3rd bucket" amongst its other roles.

I thought this was an interesting article for number of reasons.

http://arpa.allenpress.com/pdfserv/10.1043%2F1543-2165-133.4.601?bcsi_scan_455C35AC431ED0B8=Fsb3MH9X2bZWJ68iGk4fnw0AAADsXfAE&bcsi_scan_filename=10.1043%2F1543-2165-133.4.601

Delays in TAT in labs have an impact on system effectiveness and directly and adversely on patient care in some cases.  The paper also addresses the  issue of buy vs build in hospital information systems, an issue I have touched on in a previous AHR paper.

For those from an IS bent - in my current PhD research on technology ecosystems (Adomavicius et al) - I have identified an LIS as sitting in the same "technology layer" as a RIS and a PAS (all transactional systems)  - with the PAS as the focal technology

We recently chatted on our list serv re a "Virtual Hospital” or a “Virtual Healthcare system” - drawing analogies with the Virtual Physiological Human project and similar initiatives  - http://communications.nottingham.ac.uk/News/Article/Assembling-the-Virtual-Human.html

What I wrote at the time was: “So why not a virtual operational hospital (or a virtual operational health system) ...$$ are obviously one factor .......but is this something worth trying to drive as one activity of our research collaborative?  Consider the analogies with the complexities of health organizations of various kinds - their uniqueness (a-la  the personalized medicine concept) ...and the fact that many of us have already developed numerous models of parts of, or entire hospitals, or even broader health systems through various technological means. The end game can be a better understanding of the effects of localized interventions rippling through organizations or health systems facilitated  by interconnected tools and systems - which in turn can be linked to real time operational systems”

From where I sit I think we have a chance for a first ever international assault at this with links to Europe and the US – what are your thoughts ??

Let the blogging begin........... now that there have been some glitches ironed out - I thought I'd use the Health Hub to provide a blog for those who prefer this means of communication. I've also set up a Twitter site ........... so we can cover all horses and courses - you can find that under "healthmic" (no hyphen) on the Twitter site ............there is also a feed from that under my profile on Health Hub, and there will be on the SIG web page as well............I can put some of that spare time on the train (its the only time I get any  !!) to good use :-)