• A response to the article above. This is not written by Dr. Fridsma
• “… are the genuine IT clinical needs of each clinical service effectively sought and are they objectively known? It is so crucial that the IT utilization needs, issues and challenges facing doctors in each clinical specialty are proactively captured, understood and promptly addressed.”

Framing the question correctly ensures correct data

• City planning, NOT architecture. Requires gov’t involvement, Socio-technical system- people are not using the system, they are a part of the system
• Continuous growth, education, and deployment = ultra large scale systems. Informatics is orchestration rather than demanding control
• Interoperability is both sending and receiving
• Frame solutions in terms that matter to people. Don’t think of medicine vertically, think of it horizontally.
• Standardize: meaning, structure (need a common format for granular data, as in chemistry, a periodic table), transport, security, services (services = four previous themes combined)
• A patient is not a collection of granular data, patients are a narrative.

“Extend existing standards in a modular way and develop methods to evaluate standards. Standards that are built from smaller building blocks provide greater flexibility and can be extended in ways that support both interoperability and new kinds of information. We see this in Warner et al., as the authors extend the consolidated clinical document architecture to support a new oncology-specific document format. Similarly, Del FIol et al., uses that same consolidated clinical document architecture map between the information used in poison control centers and information needed by emergency rooms. These reports highlight the value of modularity in standards that allows developers to use standards as building blocks to create new functionality.” This quote reflects the need for use case MDDT