Articles by James A Robertson and Associates

Cnf 053 Engineering Maintenance Management Methodology With Radical Rethink About Clinical Data Code Design
Created by James on 8/28/2014 1:37:43 PM

The current clinical data codes, ICD 10 and CPT 4 are exceptionally weak as information classification, management and analysis tools and massively inhibit the creation of clever clinical and medical software, there is a huge opportunity to redesign these codes and use the resulting intelligent codes to develop very sophisticated health management systems drawing on engineering maintenance management and other techniques in order to provide solutions for areas and countries with a limited number of healthcare practitioners


2nd Annual Clinical Data Management Symposium 2002 -- July 2002 

Some Thoughts on Is an Engineering Maintenance Manage­ment Methodology Coupled with a Radical Rethink about Clinical Data Code Design the Answer to Radically Improved Health Care in the New Millennium?

by Dr James A Robertson

We routinely travel in commercial aircraft for thousands of kilometres and view it as a major event when mechanical faults delay departure.  Mechanically related in-flight failures are major events in worldwide news reports since they are so extremely uncommon.

While the human body is immensely complex, it is arguable whether there are more discrete components and systems in the human body than in any of the modern generation of airliners.  Yet catastrophic failure of major human body systems is far more common than comparable system failure of aircraft, nuclear power stations and other comparably complex systems.

It can be argued that the level of variation between different human beings is greater than that between aircraft.  However consideration of the diversity of aircraft ranging from F15 fighter aircraft, through Boeing 747 Jumbo Jets to heavy lift transports such as the C130 Hercules and the wide diversity of helicopters in the air today, must indicate that the overall diversity of human form is FAR LESS than that of aircraft.

If we consider all aspects of the complexity and diversity of modern flying machines and the extremely low in-flight mechanical failure rate, we must surely ask ourselves whether modern human maintenance management lags seriously behind the standards of maintenance management applied to advanced engineering systems such as nuclear power stations, spacecraft and aircraft of all sorts.

An enormous amount of human maintenance management, that is medical care, is reactive in response to manifestation of symptoms of unwellness.  As much as the health care industry may strive to take measures to introduce preventative healthcare measures, honest introspec­tion must lead us to conclude that something is lacking.

An objective technical analysis of health maintenance manage­ment techniques compared to the highly sophisticated predictive maintenance management techniques applied in the aeronautical industry must lead to a conclusion that there is a major gulf between what is routinely successfully applied to keep aircraft from falling out of the sky or suffering crippling or disabling failures on the ground or in the air and the measures applied to managing the health of human kind!

The reason for this gulf, despite the massive investments and massive per capita expenditure on health insurance / medical aid is a fundamentally different approach.

From the inception of design throughout the operating life of any major commercial or military aircraft, sophisticated computerized risk management systems monitor operating conditions and other indicators which are applied to determine when repair, replacement or refurbishment of components is statistically required in order to meet the criteria of millions of event free air miles that are standard in the industry.

To the best of the writer's knowledge no comparable system is operating anywhere in the health care industry and there are fundamental factors which stand in the way of such an objec­tive.

It is the writer's contention that the factors which are preventing such a quantum improvement in health management are:

1) the lack of an industry vision that such an approach is possible.

2) the bias of the industry toward reactive health insurance instead of health management.

3) the lack of suitable structured data coding systems to make effective technical health maintenance management possible.

Given the trends in the health insurance industry in recent years and particularly developments in South Africa in the past three years, there must surely be those who would embrace a vision of effective health management were such a vision to be effectively presented within a set of parameters which indicate that it can be made to work.  In other words, factors 1 and 2 are relatively easily overcome by people with vision within the industry.

The major challenge facing the industry lies in point 3.

It is this point which makes this subject relevant and topical to a conference on Clinical Data Management.

On a technical level, viewed from the perspective of acquisition, storage, processing and interpretation of computer based data, the single biggest factor, and perhaps the last frontier in clinical computer application, is the lack of effective engineered data codes and data acquisition.

ICD9 and ICD10 while supposedly essentially diagnostic codes contain components which link back to the cause of injury, the type of vehicle involved and a wide diversity of other factors.  Collectively these represent literally dozens of different techni­cal data entities all lumped into one coding scheme.  The net effect is that any form of automated, reproducible interpreta­tion of clinical indicators based on ICD requires enormous technical complexity in the software which then becomes proprietary, copyright and inconsistent across the diversity of software applications available internationally.  The lack of congruency and conformity between ICD9 and ICD10 is a further indicator of the extremely unhealthy state of healthcare information coding, particularly when contrasted with the exceptionally high levels of standardization in component specification, classification and description that pertains in the Engineering industry.

CPT4 and CPT5 are supposedly essentially treatment and procedure codes to be used for billing but code components range over a diversity of factors which overlap with ICD and include variable parameters such as time embedded as code components.  Again dozens of individual technical data entities are lumped into one omnibus code system which defies simple, elegant and reproducible analysis directed at developing predictive measures of health condition that can be mobilized sufficiently early on to indicate preventative adjustment at a level that will prevent the occurrence of disabling or fatal conditions.

Going beyond the limitations of ICD and CPT as maintenance management software support tools the lack of industry standardization of available measurements further mitigates against effective human maintenance management.  For example, the ECG is a widely used device for measuring heart condition and performance and ECG response to stress is an important indicator of future heart attack.  However, following detailed research a few years ago, the writer was unable to locate any standard computer based techniques for describing in detail the wave form, amplitude pattern, frequency pattern and other characteristics of the ECG test result.  The sole data acquired from an average ECG is an overall, experience based, categorization of the resulting output into what amounts to categories of good, bad or imminently dangerous.  The reality must be that the use of digital ECG devices provides an opportunity for numerical acquisition and analysis of the ENTIRE wave form at a level of technical detail that will enable even the most minute aberration to be identified and tracked by computer thus permitting effective early diagnosis and prescription of correcting behaviour years before the deviation becomes visible to the naked eye of even the most experienced medical practitioner.

Armed with data acquisition tools such as these, harnessed to technically sound first principles design of structured codes which exactly capture all aspects of the human condition, effective probabilistic techniques linked to existing data ware­house and data mining technology have the potential to support a quantum leap in HEALTH MANAGEMENT techniques.

All that is lacking is for a significant player to seize the vision and finance the development work that is necessary to put together the solution.

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Business Systems NOT delivering?

Call the Business Systems Specialist

Dr. James Robinson

Dr James A Robertson -- has been involved in the effective application of Business Information Systems, including but NOT limited to ERP, since 1987 and in the profitable and effective use of computers in Business since 1981.

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Table of Contents

Home

About Dr James A Robertson PrEng -- The Business Systems Doctor -- and Other Topics

Catalogue of Major Business Information System Failures

About the Engineering Approach

James Robertson's Value Add

Attributes of a HIGH VALUE solution

Recognizing Business System Failure

The Critical Human Foundation

Old Software IS Viable

From South Africa

Competencies of Dr James A Robertson PrEng

About Professor Malcolm McDonald

Table of Contents

About my relationship with the Almighty Creator, Yah the Eternally Self-Existing

Comments relating to the Business Systems Industry and other topics

Testimonials and other positive material regarding James Robertson

Reference Articles

List of Articles

Article Catalogue

Achieving High Value Business Information System outcomes

Executive Custody -- What is it and HOW do you get it?

The REAL Issues in Integrated Business Information System Success

Part 1: Introduction

Part 2 -- Mythology and Lack of Executive Custody

Part 3 – Strategic Alignment and Precision Configuration

Why your ERP is NOT delivering and HOW to FIX it

IT Project Management

Pulse Measurement

CEO Anthony Lee Comments on his experience of the Pulse Measurement

No Charge Guarantee on the Pulse Measurement Service

Examples of Pulse Measurement Outcomes

Critical questions regarding the Pulse Measurement™

The Pulse Measurement Workflow

The Critical Factors for Business System (ERP+) Investment Success in the Pulse Measurement

Indicative Pulse Measurement Durations

What is a JAR&A Pulse Measurement?

Survival of the fittest – why it makes sense to measure the pulse of your business

Examples of Pulse Measurement Outcomes over 24 years

Sample Pulse Measurement Reports

Strategy

Strategic Essence: The Missing Link in Business Information Systems

Strategic Essence: Overview

Strategic Essence: Part 1 -- Strategy Defined

Strategic Essence: Part 2 -- Differentiation

Strategic Essence: Part 3 -- The Essence IS Different

Strategic Essence: Part 4 -- The Essence should be the Point of Departure

Strategic Essence: Part 5 -- Discovering Strategic Essence

Strategy -- the Essence of the Business: What is it and how do you develop actionable strategic plans?

Simple Steps to Increase the Strategic Value of your ERP Investment

Free Strategic Snapshot Toolset and Manual

A strategy focused planning system beyond traditional budgeting

Tough IT and ERP Procurement and Contracting that Works

Robust Business Systems Procurement

Part 1 -- Introduction

Part 2 -- Bill of Services, Laboratory, Go-live Certificate, etc

Part 3 -- Executive Engagement, Bid Compliance, Adjudication and other matters

Procurement Documents

Guidance and Advisory Services

The Art of Project Leadership

Why Regular Communication with the CEO is Vital

The Business Simulation Laboratory

Precision Configuration and Strategic Business Information Architecture

Precision Configuration based on Strategic Engineered Precision Taxonomies

The JAR&A Cubic Business Model

Highly Structured Strategic Chart of Accounts -- a Vital Element of your Corporate Information Arsenal

The Product Catalogue -- an Essential Element of any Precision Configuration

Attributes -- answers to the questions you have NOT yet thought to ask

Case Studies of Notably Successful Projects with high value Precision Configuration

092 Doing things differently and better -- ASCO Case Study 2-- BPM Summit 2013

088 Strategic ERP Invesment -- ASCO Case Study -- Service Management Conference and Exhibition Africa

026 Information Architecture and Design of FIS for Rennies Group -- Financial Information Systems Conf

018 CRM Risk Control: Designing and Implementing an Integrated Risk Mgmt Sys -- Integrated Risk Mgmt Conf

011 V3 Consulting Eng: Benefits of MIS to Professional Practice -- SAICE 15th Ann Conf on Computers in Civil Eng

Strategically Enriching your Business Information Systems

Part 1 -- Introduction

Part 2 -- Principles of Data Engineering

Part 3 -- Steps in applying these recommendations

Simple Steps to increase the strategic information value yield from your Business Systems Investment

The Full JAR&A Taxonomy Manual

Part 1: Introduction, Problem Statement, Definitions and Examples

Part 2: Why Use JAR&A, Required Knowledge and Experience, Cubic Business Model and Chart of Accounts and Taxonomy Software

Part 3: How to do it, Case Studies and White Papers and other References

Example General Ledger Manual

Business Process -- Irrelevant, Distracting and Dangerous

The RIGHT Approach

Custom Strategic Software Design and Oversight of Construction

Standards for Custom Software Specification

What IS Software?

IT Effectiveness

Organizing Outlook

Critical Factors for I.T. Success

A Moral and Ethical Dilemma -- Systems that Fail

Case Studies examining Business Information System failures

The BBC Digital Media Initiative Debacle

The Bridgestone -- IBM Conflict

Speaking and Training

Showcase of Conference Presentations

Most Viewed Presentations

Briefings and Seminars

Why your ERP/BIS is NOT delivering and HOW to FIX it

ERP and IT Procurement that Delivers Results

The Critical Factors for IT and ERP Investment Success

Other Seminars

Conferences and Public Presentations

Conferences 80 to 99 -- 2009 to Present

Conferences 60 to 79 -- 2005 to 2009

Conferences 40 to 59 -- 1996 to 2005

Conferences 20 to 39 -- 1994 to 1996

Conferences 01 to 19 -- 1989 to 1994

On-Line Seminars (Webinars)

Webinar on Preparing and Presenting Webinars

Contacting James A Robertson and Associates Limited