Concerning medical software complexity - big

 

In this article, I will briefly describe the principles that were laid in the development of software 'Blood Center Manager' and 'Blood Center Manager Assistant' in this area (further BCM(A)). As usuaul, Rundall Munroe from xkcd.com, whom draw I placed at the top, explains its complexity with great sence of humor.

At the current moment, I'm thinking that approach implemented in these programs still acceptable, but going to be outdated soon. Changes are needed in the computer support of Blood Service, which must be carried out in conjunction with the rest of the health care and other public services. I'm writing briefly about it in the article 'Quo vadis Healthcare IT?'. Otherwise, making a costly circle, we will inevitably come back to the currently in use solutions, just maybe transferred to the 'WEB-cloud'. In any case, I have not met publicly available detailed descriptions of this size, and hope that mentioned above documents will be helpful for dear readers, as well as this brief introduction.

In the institution should be just a few key people, who have rights and sufficient knowledge to make decisions in complex emergency situations. For example, while active automatic plasmapheresis on 20 PCS-machines the process suddenly lost electricity. The procedure for manual completion of the donation procedure does not represent a particular problem and can easily be carried by personnel. A key figure in such situation likely to have just for staff additional monitoring and maintain a calm state of donors. In case of software, a key figure like the Director of the Center needed,  for proving problematic results of product testing, which automatically transferred to the National Donor Deferral Register (NDDR).

The software must provide transparent for the staff process of procedure resume, without involvement of IT-specialists after the restoration of electricity. All software interfaces with the user (GUI) should be as simple as possible and correspond to the level of official duties of the staff, providing a specific stage of the production process. Access to the functions of the program should also be adjusted and meet the employment status of staff.

Transparent to personnel the database network operations should allow easy to maintain at least 200 donors daily without require the presence of IT-staff (System administrator, engineers, programmers, etc.)

I often found blood centers provided 30 or more computers while serving only 50-60 donors per day. IT-staff, in some cases were up to 10 people. In my opinion it is wasteful in case of such low performance. BCMA-software serviced average 200 people, using only 6-7 computers without the involvement of IT-specialists, my presence or remote access to the database server or client stations in the local network area of establishment.

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The software should be Active

Unfortunately, the Passive programs which USA FDA calls the 'file cabinet' are not uncommon even in the current time. In fact, the ultimate function of these programs is the production of documents and reports, which if desired, can be replaced by conventional spreadsheet (eg, Excell).

By Active I mean a system that provides maximum automatic support of staff, without requiring additional action. Employees must know their business and not waste time and attention on those extra data requests or studying the specifics of the computers, SQL requests definitions, etc. The computer should automatically intervene only when needed and the possible range of responses employee must comply with its duties. In some cases, there is very difficult to achieve a harmonious balance of ease communication with the program and the distribution of functional responsibility in conjunction man-machine. You may be interesting to compare the approaches used in BCM(A) versions. At first glance, they are not very noticeable, but on closer examination you notice fundamental differences and understand the reason, why I added the word of Assistant in the title. Briefly the idea of ​​an active program is shown in the following video:

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Often developers are laying into the software support functions that are not inherent in the process of maintenance of donors and the collected product. For example, book-keeping support in modern Ukrainian program Crystal Finance Millenium. In my opinion, this approach robs the program of flexibility, especially in the case of attempting to use software in other countries. It is enough to provide a simple interface, to communicate with other programs and related services. For example, in our country widely in use a sort of standard software 1C, which incorporates a means for providing such information exchange. In addition, the difference in dynamics and the specific of data processing can lead to team-work conflicts if apply Donor/Product Service and Book-keeping procedures simultaneously.

In this regard, in my view a necessary function of the program is to provide active assistance to the staff in the selection of consumables, applicable directly to the process of donation in each particular case. After all, with the proper organization of the case, for some donors even specific type of needles should be used, and computer should actively assist staff performing monotonous routine work, which can lead to errors. Another important aspect - ban of expired soft goods use. I applied this approach in the DOS-version of program, but it was used just about one month, after which the management of the Centre refused to use this function, referring to the fact that it takes up a lot of staff time. Select from the automatically prepared list of materials, possible to use for a particular donor, takes only 5-7 seconds and eventually just reduce the overall time. At least because so much needed control of the production process becomes tougher. At the same time, planning the procurement of necessary supplies and maintaining daily operational warehouse becomes easier for the accounting department, because data on the materials used are available immediately, based on the operational requirements of production and not on the secondary statistical plan of management of the Blood Center. Unfortunately, in reason, said lack of demand, I refused to support this idea in the development of software Windows-version.

The system should not be expensive

The program must provide equivalent functionality and quality as in networking with the distribution of functions on different computer stantions and when installed on a one computer, that is configured to support all possible functions. For example, for obstetric or very small blood transfusion offices at the hospitals the only one computer enough. It is important that the donor registration (including efficient check against NDDR), donation, product testing and other procedures produced by the same rules, and standard information about this was available in the future. Thus, the cost of the system should be available for any medical institution corresponding to the desired performance. Price largely must be determined by cost of periodic maintenance services of system.