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Roger #33725 17/09/08 2:47 PM
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Yeah Roger you are right, acceptance has alot to do with it !

The reason for not developing in house is clear though. It is a specialist field, and Hospitals dont employ specialist in that field, and if they did it wouldn't be a permenant role, as that person would make more comercially, and the cost of that person would be considerable.

I mean Hospitals havent written their own operating system, havent written their own patient systems. These are all written externally then sold to the Hospital. It become too costly for an individual Hospital to do. They may have written something that sits on an SQL box, box thats about it. As soon as that person leaves, then theres no support.

I think the need is there, but you probably think I would say that. On the other hand, there are just some instances where there is no need, its just a want.

EBME is really one part of the puzzle that this technology fits into. Location based services in general fits across all the disaplines in one way or another. And having a solution that will fit most (as no solution fits all), is better than a solution that only fits one, from a cost perspective.

Jason G #33728 17/09/08 3:00 PM
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Some of the best (robust, easy to use etc.) hospital information systems, patient records, and maintenance systems, I have come across were indeed developed in-house! Not SQL ... but C. But that was back in the days when there were still some real programmers about. smile


If you don't inspect ... don't expect.
Jason G #33730 17/09/08 3:12 PM
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Originally Posted By: Jason G
EBME are responsilble for Medical Equipement
IT is responsible for computers
Finanace are responsible for money
Press office is responsible for publicity
Nurses are responsible for Patients

and never the twain shall meet.

discuss.... dont just dismiss

... OK, but doesn't twain mean two?

It can also stand for "Technology Without an Interesting Name" (so perhaps you're right, after all)!

But, anyway (and of course), I disagree with what you seem to be driving at there. The "Hospital as a System" is a theme that I've used before (and within it, all the staff working together as a team for the good of the patients).

In my "model", EBME is part of Technical Services, which encompasses biomed, "estates", IT and anything else of a technical nature. smile


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<----------Disappointed

did type something, but I deleted it. counted to 10 first

Shame on you "real programmers" tut

Im not a programmer, but I a know alot, and I know alot who wrote some of the old HIS systems, PAS systems, and many other clinical apps, however they all acknowledge the technology has moved on, and have adapted their skillset accordingly, and they have developed their original designs because the requirements change. Gone are old Acorn computer days etc.

rolleyes

Jason G #33732 17/09/08 3:27 PM
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Disappointed? In what way? Pity you can't hit the "undelete" button ... might have been something amusing.

Of course technology evolves. But my (oft stated) point is that we should take what we need, and discard what we don't. Just because something is (technically) possible, doesn't mean that we have to have it (... can someone please pass that message on to our so-called government ... if, that is, you can find anyone there with an ability to listen). smile

PS: I've got a couple of nice Acorn Electrons, if you're interested.


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Originally Posted By: Geoff Hannis
But, anyway (and of course), I disagree with what you seem to be driving at there. The "Hospital as a System" is a theme that I've used before (and within it, all the staff working together as a team for the good of the patients).

In my "model", EBME is part of Technical Services, which encompasses biomed, "estates", IT and anything else of a technical nature. smile


All departments in Hospitals should work together more effectively, but by the nature that they all have their own budgets already goes against the grain unfortunately.

Your model of EBME is what is happening in your site at the moment, and the model has differentt variantions in other sites.

And even if thats the model you would like to see everywhere, it would struggle to maintain stability and may not work effectively enough. The specialities are completely different.

In fact more common than not they are completely seperate. Other exmaples are IT is under finance, Estates and porters are together at other locations, and biomed and IT are together in others. So the model changes from location to location, which is why it is difficult to ever get a common working methodology under the NHS banner. and ultimately NHS is just a banner, and Hospitals are seperate businesses with a completely seperate speciality from each other. Which is why whats good for you, is not for another. Indeed Consultants work multiple locations day in day out, and are not tied to a Trust, and have no problem referring patients to and from their private practice so that they get more money from the government to treat said patient.

Jason G #33736 17/09/08 3:58 PM
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I don't have a "site", Jason. But I do have 34 years experience of the engineering support and maintenance of medical equipment, in many and various "scenarios". In which time I've seen (as in, been involved in) many hospital set-ups, and I know what works well, and what doesn't.

I'm not an NHS guy, but I do support the old-fashioned notion of a National Health Service, funded by the taxpayer, properly managed and and free at the point of need. I also advocate properly conducted equipment PM (not to mention treating people - patients and staff alike - with dignity and respect).

Mate, I've seen 'em come, and I've waived 'em goodbye ... and I shall still be here right until the end.

All this talk of budgets and getting "more money from the government" etc. doesn't really do a lot for me, I'm afraid. Frankly (to my mind), it misses the point (about being a biomed) by a long mile. If we were in it for the money, then we wouldn't be "in it" at all, would we? We would be in IT, or something like that. smile


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ah, I see...

I have to admit can never say what works well and what doesn't. As another "requirement" comes out from the Central office, you adjust the working practices to fit.

After the shambles of the patient data that was un-encrypted on disks came to light, every hospital got told that ALL data had to be encypted before it leaves site. Firstly data leaves site by many methods, and arrives by many methods. So each trust then have to spend hundreds of thousands, if not millions addressing all of these because of an unmanaged incident. However paper based medical notes cant be encrypted, so how do you address that?

Going at a bit of a tangent there, but the point is that Trust always have to change their working practices based on changes in the Worldwide Enviroment, and the new conditions and treatments that appear.

The way that Medical Engineers work now is by far different to that of 30 years ago, and different to 30 years from now. The requirements the top people in the Organisations want from their departments have changed, and the departments need to ensure they have the facilties to make these changes happen

I've seen HA's come and Go, the principle of PCT's come and go, Trusts status's changing to Universities, Foundations, Teaching Trust etc, and its clear that as the more this happens the more Hospitals will be looking to make cost savings and make money. This is the purpose of the Foundation status. They strive to get it so that they can roll their money over to the next financial year without having to start from stratch again.

Bottom line, the technology may not fit all, and you dont have to get it, but use what you can to ensure you are moving to provide better patient care with the appropriate reporting tools. If Biomed Engineers wish to remain as Engineers thats great, and I agree with that, however their Managers cant be, they have to think about the bigger picture rather than just fixing the kit.

RFID/RTLS can help the process that the managers and other staff need across the whole of the Hospital, and addresses patient care, asset management, waiting lists, bed management etc. But if the Hospital has a better processes and tools in place, then clearly RFID/RTLS isn't needed.

If you have these, or are aware of any site doing this well, then I am interested in understanding how they do this.

oh and on this "the old-fashioned notion of a National Health Service, funded by the taxpayer, properly managed and and free at the point of need"

dont get me started on that. So called "holiday makers" that utilise our "free" health care, then go back home. My ex-partner works in radiology and over 50% of the patients are "holiday makers". free for them at least, eh!

oh...rant...sorry

and IT-->Money. If that was the case they wouldn't be in the NHS smile


Jason G #33771 18/09/08 1:12 PM
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Originally Posted By: Jason G
Hi Das,

whats rubbish? capital/revenue? managment needing justification to employ more staff? can you explain please

Where do you get usage figures from? I honestly dont know.

Because a pump goes to a ward it doesn't mean it is in use permently. It just means its there. the ward may be storing it because they consider that there might be a shortfall in available equipement. If every ward is doing the same, surely your figures would then be in-correct, unless you walk the entire site every day checking to ensure all the assets are in use, oh and where you originally left them of course.

Do you have something that helps with this? to be honest this is not being pedantic, I am trying to understand the various processes.

As I have said, this type of technology may not be right for all, however dont shy away from it unless you have something thats concrete and have no problems with asset management and you have the right quantity of kit in the rights places accrodingly.

when I talk about usage btw, its not how many hours a IV pump for instance was in use, its more about ensuring that the IV pump is required at that location for that period of time. But you need to put the right process in place to manage it.

thanks for you comments



What's rubbish was your scenario 1.
I've no problem with justification etc.
As to equipment libraries and equipment going to a ward it's down to how the library is set up and managed. Last one I was involved with required the user to request a pump for a patient for a day. Only areas with own stock on hand were ICU & CCU. And yes we could work out the actual usage as pumps in question had a motor hour counter in the service menu, so was a simple task to take those hours & convert to a usage figure. Usage ranged from over 50% for ICU to under 1% for some wards. This was one of the reasons for setting up an equipment library. Some fairly hefty savings have been made on infusion pumps alone.

As for the technology. I love technology. Just in the right place though. I don't see much use for RFID for asset management. I refer you to Geoff's posts. I did look into it a while back and the expense far outweighed any possible advantages.


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DAS #33783 18/09/08 3:47 PM
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Time will tell how this technology influenced people in the healthcare sector (NHS in particular) and whether there is a real need.


Make the impossible POSSIBLE. I know we all can and it is the wisdom to distinguish one from the other.

My blog: http://biomedicalengineeringconsultancy.blogspot.sg/

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