I am using the SIU^S12 segment and I need to indicate the financial entity (IN1). But IN1 is not allowed in segment SIU^S12. Has anyone ever experienced this?
You're right that financial information is not included in the SIU^S12 message, nor is it in the entire HL7v2 scheduling domain. I can't really attest to the "why" behind this, but only share my experience in the US domain.
From a very high level, in the United States, scheduling HL7v2 interfaces are used almost exclusively before the patient arrives, and ADT (HL7v2 Chapter 3) is used almost exclusively once the patient arrives. This is not ideal, and sometimes bears extra licensing costs in terms of getting two HL7v2 interfaces.
From a design perspective, I it makes sense to have a separation of concerns - SIU^S12 is chiefly concerned with scheduling resources - even treating patients as resources. SIU^S12 can have multiple patients in its schema, whereas ADT^A01 must have exactly one. While it would be possible to attach GT1, IN1/2/3 to each potential patient in SIU, it's easier to wrap your head around when only one patient is in play.
From a workflow perspective, insurance/payment information is typically verified with the patient in person once they arrive, so the majority of use cases won't need or more importantly trust insurance information were it to be sent by a scheduling system.
Related
In International Patient Summary (IPS), how is it expected to uniquely identify a cross-border Patient?
To elaborate, IATA has a way to track all passengers across the globe. How can the healthcare systems do that?
I'm unable to figure this from hl7 documentation and implementation guides. Any help is appreciated.
That's a good question. There certainly isn't anything like a "global MPI" that's available, of course, and I think your question fairly points out that we haven't explicitly provided a solution for this in the IPS and our other HL7 specifications. For "international" use in the patient summary and specifically for supporting cross (national) border patient care, I don't think that we can give an absolutely definitive answer, but I think that there are some reasonable ways that we should be able to deal with this issue. I'm thinking of two in particular at the moment. The first is that in cases where there is dedicated organization and infrastructure (I'm thinking of something like the European cross-border services) then it may well be possible to provide some type of MPI service(s) that can establish and verify identity across the jurisdictional boundaries (and I'm not saying that for sure this actually exists in Europe or anywhere else, but just that it may be possible to do). The second, which I expect will turn out to be the more common and useful case overall, is that the patient is the ultimate owner of his or her data, so if the patient transports and provides the data directly to the receiving clinician (e.g., via their mobile device) then that should be more than sufficient to establish the identity. In that case the provenance and reliability of the data may still need to be considered, but that is a different question. Hopefully that may help a little! It is something that I agree we probably will need to address further in future versions of the IPS.
Rob
While the public hospitals are trying to adopt FHIR as soon as possible this seems to not be the case for private entities. I heard that private entities are less likely to adopt FHIR due to the cost of transition and the fear of losing clients. I understand the cost reason, but the other one doesn't seems right. I chose a clinic based on the doctor I want to go to and the medical insurance I have. I don't know about HIPAA but in Europe the GDPR gives you the right to ask any entity to provide you the medical history in an interoperable format. This doesn't necessary means FHIR, but rather xml or json.
What do you think about this? What are the other problems and how do you tackle it?
Adoption patterns of FHIR vary from country to country and discipline to discipline. They're influenced by a bunch of factors:
are there regulations or government initiatives requiring the use of FHIR? requiring the use of a different standard? requiring interoperability at all?
are there business drivers that encourage interoperability (e.g. "My patients want to have their data on their phone" or "I can't keep up with the customization demands, I need people to be able to write plug-ins for my system"
are there already interoperability solutions in place and, if so, do they work?
These don't typically break down into public/private but in some countries they might.
Certainly there can be pushback against interoperability because of concern it may make it easier for patients to move elsewhere. That's one of the reasons for regulations such as GDPR or the data blocking rules in the U.S. Such regulations help, but if the desire isn't there to make sharing easy, then the tendency will be to meet the barest letter of the laws and to avoid as much as possible supporting their spirit.
One of FHIR's advantages is that it reduces the technical cost of interoperability. It's also spawned lots of examples of successful interoperability which proponents can point to. Both factors help to lessen the excuse for inaction of "it's too hard/expensive". However, for those who want excuses, there are always others to be found...
I'm currently designing a new enterprise system. The system's purpose is to track, display, and notify employees of customer's interactions (i.e. events) with the company. Using an event source pattern to keep a ledger of all the customer interactions/events being collected seems like a very good fit, since all of our additional domain objects are derived from the stream of events. However, I came across an article saying that a whole-system based off of event sourcing is an anti-pattern. Why would this be?
https://www.infoq.com/news/2016/04/event-sourcing-anti-pattern
The article is indeed summarises the Greg's talk "A Decade of DDD, CQRS, Event Sourcing" at DDD Europe 2016.
I personally dislike the title of this summary since this is definitely not the point of Greg's talk. Basically, as usual, it depends.
When Greg talks about the system, he means the whole thing. This thing, in DDD terms, has a context map, with multiple bounded contexts in place. Usually, on this context map you can identify subdomains, where one or more can be in addition identified as core domain(s).
When you have your core domain - there will be a good fit for advanced techniques, would this be more traditional DDD tactical patterns like aggregates, or "fancier" stuff like Event-Sourcing. The implementation indeed need to be based on the context needs.
From what you describe, you have a good fit for Event-Sourcing. But you might think about other parts of your system, for example, customer/contact management and employee management. These details should come from somewhere. May be these are CRUD candidates? So if your core domain in this case is to track interactions between employees and customers, some sort of CRM, you can decide to build that part using Event-Sourcing and other parts of your system using less advanced techniques.
Remember putting all parts on the context maps anyway, including external systems, then you will see that the system word means in the article and the talk.
The article cites a talk by Greg Young. The relevant section is viewable here.
Young explains that CRUD hides "all kinds of crazy use cases", and gives correcting typos as an example.
He also points out that analysis can be more expensive in an event-sourced system.
In general, having immutable events as the source of truth for a given part of a system, separated from read models, carries costs and should not be adopted blindly.
Young suggests that "something more like event-driven" would be a top-level architecture rather than CQRS/event sourcing.
I know this questions seems extremely open ended. I will try to narrow scope.
I have been struggling for some time as to include or exclude real time user performance stats in an application gui.
Does anyone have any info on the harm vs gain in including these stats in an app?
i.e. number of emails answered, number of customer calls taken, average time per customer etc.
The users are begging for more info on their stats, as it is how they are rated. However there is concern that given access to see their performance real time or near real time it will negatively affect their work.
I can kind of equate it to being measured on how many lines of code I churned out in one day. Would this help me to be more productive or just teach me write code as fast as possible and most likely make a lot of mistakes.
In my application I can think of these scenario's
i.e. BAD: "I see I have spent 10 minutes on this issue already, I need to finish this up asap"
vs
i.e. GOOD: "I was able to help that customer quickly, My productivity is good today"
I think there may indeed be a phenomenon one could call “The Facebook Effect,” where by merely presenting a metric (e.g., number of “friends,” minutes per call), you imply that it’s important. However, I don’t think that’s an issue here because it’s clear that users already regard these metrics as very important, otherwise they wouldn’t be begging you for them.
I believe there is a wealth of psychology research showing that adding faster feedback on a metric will very likely improve user performance on that metric. Furthermore, it is emotionally stressful for people to be evaluated on a metric that they cannot track well themselves, which appears to be the case now.
I say show the metrics real time. Management obviously wants high performance on them otherwise they wouldn’t be rating the users on it. User want it, and it’ll reduce their job stress. Sounds like a win-win to me.
Of course, the customers probably lose out, so there’s a bit of an ethical dilemma. However, if these metrics are problem, then the problem lies in corporate policy, not in the user interface. By showing the metrics to the user, you will highlight whatever shortcomings this policy has to the managers. Maybe management will get a clue.
If it’s part of your role, you could propose measurements of customer satisfaction (e.g., after-call automated survey, random follow-up surveys by a human) so that managers can at least track the impacts of their policy. Assuming they care (how are they evaluated?).
KISS principle, is this information pertinent to what the users will be doing?
If no, then no do not add it. One thing that I like on web apps is the time it takes for a page to load after updating / submitting something (basically posting back data).
That way I / a user can tell if there is an issue with data going to the database or a caching issue.
The problem with displaying say for instance calls to customers is your average times may not be as accurate as you'd hope. You may have a customer who likes to chat, or is having technical issues that are irrelevant to your business but yet get reflected in your apps.
This data shouldn't be trusted because of these types of things. Another thing is, if you start displaying call times you end up having employee competitions to see who can get off the phone first..that's when you start hurting yourself more..bad customer service.
A few big names used to rate employees based on things like call volume, average time on the call, etc. Remember when Dell tried to outsource all their technical calls to India? Customers here in the US were frustrated and calls were either too long (not understanding) or too short (Customers did not want to deal with it). Well the big shooters thought hey call times are pretty inline with what we had forecasted and our costs are going down. But it hit rock bottom as time went on...
Your application is useful as a tool to convey this information, and you should definitely include it if users are clamoring for more visibility and transparency into the data it collects. A user's response to the information, however, will largely depend on what the organizational culture already does with it.
For example, does management aggressively encourage users to keep calls short and deal with as many customers as possible, and fire those who don't meet quotas? If so, that's going to provoke an equally strong reaction from users to keep their calls short when they discover they've been a bit on the longer side. ("Uh-oh, I'm getting to the 2-minute mark. I'd better hang up and fake a disconnection to avoid getting my average call length too high.")
Conversely, if management simply encourages everyone to do a good job and provide excellent customer service, this information can be synthesized by users in the overall context of this work. ("I've spent a lot of time on this customer -- I should see if I can wrap things up shortly, or escalate him if I can't fix this problem.")
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I am a reasonably experienced C# developer (about 5 year experience) that has recently been put in charge of my first development team as technical lead (varying between 3-5 other developers). Over the last 4 months in this role, one dilemma that keeps arising is trying to find the right degree of sharing awareness of the communication that goes on between the project manager, account manager, clients, designers, CEO and myself (especially via emails).
On the one hand, I know the more awareness each developer has of the overall direction of the project, the better they can understand the scope that their particular functionality has in the big picture.
However on the other hand, a lot of my time seems to be lost in the sea of emails between all the different stakeholders and managers, so I like to think that isolating the developers to just "what they need to do their current bit of work" will keep them free from interruptions.
I have considered just BCCing all the developers so they can filter these emails and essentially "opt in" to all the emails, but I'm concerned that some of the developers will just see this as extra noise to deal with. It may open the door to "too many cooks" if all the developers want to contribute to too many discussions. Yet on the other hand, other opinions can help me reach better decisions (i.e. House MD style).
Phew... so much to consider. Anyone have some wise guidance in this area?
Answering late, but still believe there is something to add to the superb advice given so far. To answer your question we need to go a level higher, hence the long response.
You’ve been made a tech lead responsible for team and although many aspects of your everyday job might seem to resemble your dev days the way you need to go about them has changed. In software development environment there is usually not that much of a tangible change when you appointed a tech lead (you’re probably still seating at the same desk, wearing the same outfit) as opposed to becoming a foreman on construction site or a factory. The flattering change though is that you now get invited into all these meeting and start getting all these e-mails and phone calls from people outside the dev team.
The lack of tangible change might trick your mind into thinking that you just need to keep treating your job mostly the same. This is not the case and you need to be conscious about your actions and re-actions in the new capacity. It might seem you’re now a bit “more respected” externally and you might be inclined to share some of that “respect” coming your way internally, play a bit of democracy and generally be fair.
Well, this is not that much about fairness or respect, the new job is to:
Direct the dev team (mostly by personal example and creating imagery depicting the goal).
Be an abstraction layer between the team and other organisational units.
Pretty much like in programming you often create an abstraction layer to encapsulate and hide complexity, the same happens in organisations. You’re the layer, the interface that has to encapsulate the dev team. And any good encapsulation from an outsider point of view:
Hides inner complexity that is not relevant to the task at hand (such as concrete implementation of an algorithm) from the outside observer.
Makes things that could affect the outside user explicit (exceptions that can be thrown, any limitations and constraints etc).
Always gives meaningful feedback.
Acts consistently.
These principles are equally applicable to the team’s outward communication. It’s not an easy task to follow these principles; actually it involves a lot of concrete work, such as deciding what details are internal and what facts need to be communicated and when, how the feedback needs to be best structured and be presented in a consistent manner and who should be notified externally of what, and who needs to followed up and when. This is a lot of work, even if some of it seems to be just trivial admin.
Now to internal, inward communication. One way is to broadcast. But it clogs the internal network and everyone has to spend their time on deciding whether the communication bears any relevance to them. It is like having a very generic algorithm that regardless of input always does the exact same amount of work. It’s sure possible, but why would you want to do that? A more efficient way is obviously to adjust processing depending on the input and here it has to be someone’s job to make a decision how the team should go about something, to dispatch, or convert the input:
Decide what sequence of actions needs to be taken,
or just acknowledge and store for future reference,
or follow up,
or put an issue off for a later review and then make sure it is reviewed and fed back into the decision-making loop.
This is not a small job either and someone has to do it. Obviously now it’s your job to manage the outward and inward communication, and you have to spend some of your brain’s processing power to do it well, so no one else has to and devs can concentrate on their tasks.
There are some other good reasons for not CC-ing or BCC-ing everyone regardless of your job title:
TO means “take action”, CC — “take note for future reference”, BCC — “eavesdrop or mass mail”. You should be careful when you use one or another e-mailing a group of people:
E-mailing a single person is a straight forward “TO”, when E-mailing a group of people only “TO” these who you need to take action (including a simple acknowledgement). This is default meaning, in any other case explicitly tell them what is expected (i.e. FYI, no action needed etc).
CC only these who you want to take note of the information for the future reference. If you expect a number of e-mails to go back and forth before an agreement is reached or issue is resolved don’t “CC”, it’s best to send a summary confirmation later to other parties that need to be notified. Besides saving everyone’s time and avoiding misinterpretation due to someone taking note of a non-final communication that will help make exchange more personal, flow more naturally, and reduce formalism and red-tape. Often CC-d e-mails treated formally and this isn’t always a good thing (but sometimes exactly what you want).
Using BCC is almost never ok. The knowledge of someone eavesdropping on your conversations if come to light will easily ruin your trustworthiness. It is simply a question of “when”. And should your team worry then that you might be BCC-ing their conversations to someone else? Mass mailing through BCC in most cases is also wrong, it creates an impression that e-mail is specifically addressed to the recipient.
Forwarding, CC-ing and BCC-ing require little effort, but multiply noise and dilutes signal. It is worth to give some thought to what exactly you need a person to do and what they should know to act on your communication before composing it.
Some conversations are best taken completely "off line" (phone or better still face-to-face), because it gives you more room for maneveour. Broadcasting or formalising in writting is just like putting yourself into a corner. You can always confirm in writing latter.
Moving to the second part of a tech lead responsibility (directing the team through personal example and imagery depicting the goal). To accomplish that you don’t need to pass on to the team every single piece of information that happen to end in your inbox. You have to create a story and any good story is an abstraction of real events that consists of only relevant and interesting detail for a particular audience. Creating this brief story on the basis of your everyday experience and judging what is relevant and interesting and then presenting it regularly to the team is also quite a job.
But don't forget that by directing the team and serving as abstraction layer you help developers and outside world to interact more efficiently, accomplish more and tackle greater complexity, the job has a point.
The engineering team needs to understand the business reasons of why they are asked to do things on a macro-level. The engineering team will gain understanding and motivation from this. But too much chatter is a no-no, as you note, part of your job is to filter, and part of that means not exposing them to tons of noise. Your developers likely have opinions and insights as to how to do particular things or why to pick particular technologies, and they should be fielded for their expertise in those areas.
Definitely don't create a culture of BCCing.
One option is to have separate mailing lists that interested parties can subscribe to, but of course, not all chatter will be on those lists.
And of course, a regular company meeting is a must. Let the engineering guys know why the business depends on delivery of a stable, complete product (or whatever the upcoming milestones require). 20 minutes, no slides, no bullshit is what works for me. Your team & situation may vary.
It sounds like you're technical so I would give you this advice: Follow Joel Spolsky's advice on what Program Managers do. Basically, try to isolate your developers as much as possible so they can be as productive as possible.
He just mentioned this briefly in this recent article, How to be a program manager, but he has gone into more depth on this topic before. Look through his past writings for more info:
Once the spec was finished and the development team got down to work, I had two responsibilities: resolving any questions that came up about the design, and talking to all the other teams so that the developers didn’t have to.
If you aren't technical then you need to select someone from your team to help with the design work and they will have to interface with the customer a little to figure out what the requirements are and what the best design is.
EDIT:
On Joel's home page there are two sections titled Tech Lead and Program Manager. Look at the articles there for some more info on program managers, especially Human Task Switches Considered Harmful.
I'd be using a Wiki, you don't want to add to the email storm, and your developers can also contribute and change things. It's also really useful for sharing documents, and if done well it will become self-supporting.
BTW Cut/Paste from email to wiki seems like an odd thing to have to do, does anyone know a lightwieght .Net wiki that I can email content too?
One way might be to not forward all those emails and once a week compile all the relevant information, design changes, and so forth into a weekly meeting. I definitely wouldn't send out a barrage of emails to the developers. Of course, if something critical is discussed, then that should be put to their attention. However, try for a weekly recap and discussion of relevant details.
I'm seeing this question one year after it's been posted, however I can add my experience with some specific data for my case. For 2-3 developers on the project, I mostly do one-on-ones. Lot of times I do this over the IM or phone since most of my team spends a lot of time in home office. Meeting from time to time is inevitable, mostly when project is starting (1-2 developer meetings tend to be enough to kick off reasonably complicated project), but as a rule, all communication with the rest of the company goes through me and developers get a digest. Only exception is when I connect developer directly with the user (not management!) to work out details of the project.
I tend to avoid regular meetings (weekly or daily) and schedule meetings only when at least two of these happen, in this order:
Important info comes in (depending on urgency this can wait up to a week)
Developers are in the office, preferably for other reasons (developer-to-developer meetings)
Client is available (not much choice there, but I try to do meetings and connect developers with single hands-on expert on the client's side later)
I need design advice (since I'm a technical lead, I'm responsible for most of the high-level architectural decisions)
For teams of 4-8 people (8 people usually means two teams) I found out that short 30-minute meeting roughly once a week is more then enough to keep everyone up to date. This, of course, is in addition to one-on-ones which I do daily for junior developer and about twice a week for senior developers.
For one-on-ones, I prefer that developers contact me when they're looking for more to do or when they're have questions on task they just started doing. This is also a great way for me to keep eye on how things are going without developers needing to think about keeping me up to date. I tend to avoid e-mail when IM is enough, otherwise switch to phone (when there's something to explain or discuss) and to e-mail when:
Customer reported bug via e-mail
There are a lot of important small details and developer will probably go through that e-mail a lot of times during implementation
There are also developer-to-developer meetings when they need to coordinate on something (for example, when Java and Javascript developer need to work out interface details).
This way of working means that I have to respond to IM as fast as possible, and that I usually deal with a lot of interruptions so that developers have to deal only with interruptions for me or other developers. Which is OK, since important part of my job is to make developers effective.
If I need peace for coding (and can afford it) I found that delegating client communication to non-technical project managers and even beta testers (who are much better with distractions than programmers).
Ask them what they'd prefer. I assume they would rather not be cc'd on every email and would opt for a short verbal update on a regular basis.