What a difference the right person makes. During my first year at university I endured some impenetrable lectures on thermodynamics. The text book the lecturer recommended was equally gnomic. A change of course and a year later enter Dr. Hinchcliffe. His lectures were paragons of clarity which made the whole subject seem easy—enjoyable even.

After a period in the UK where CDs, zip drives and laptops containing large numbers of confidential data have been mislaid at a mind boggling rate it is hardly surprising that information security is now at the top of the agenda of many health organisations and their suppliers. I have recently been engaged in work for clients on information security particularly related to the ISO/IEC 27001 and 2 standards.

At the word standard eyes glaze because we assume they are as impenetrable as my first year thermo lectures. But if you want impenetrable try reading some of the books that are supposed to make the subject more accessible for your average manager or board member. They make the standards look like models of clarity.

If you are seeking to review your information security using ISO 27000 as the basis take my advice and read the standards, and, if necessary, get the right person who understands how they are applied operationally to help in any risk assessment and implementation. Don’t waste your money on derivative books.

Posted by Colin Jervis, Kinetic Consulting at December 07, 2008 | Permalink | Comments (0) | TrackBacks (0)

What can you say about a man who had two lives?

After the D-Day landings in 1944, Bil was on reconnaissance in Normandy prodding the positions of the retreating German army. While on high ground the scout car he was in was struck by a shell from a battery manned by a small group of recalcitrant German officers. That was the end of the line for the rest of the crew, but Bil was blown clear suffering a shrapnel wound to his foot.

In his second life he went on to exploit his love of Nature as a Landscape Architect, becoming a driving force in the restoration of the historic gardens at Hestercombe and at many other sites.

At a celebration of his life in a Sussex country church his friends and family heard about these and other achievements on the golf course and as a talented writer. It says much for someone when the people who knew him will travel hundreds of miles to pay their respects.

Live, love and leave a legacy: I can hope to achieve as much. Make sure you tell your loved ones how much you care and appreciate them before it is too late. It's the best health information technology we have got.

No more my heart shall sob or grieve. My days and nights dissolve in God's own Light. Above the toil of life my soul Is a Bird of Fire winging the Infinite.

Sri Chinmoy

Posted by Colin Jervis, Kinetic Consulting at November 04, 2008 | Permalink | Comments (0) | TrackBacks (0)

Ben Goldacre’s Bad Science has had excellent reviews. Read some of them on Amazon. I also enjoyed it, but I found myself more interested by what it doesn’t say.

Sure, Dr. Goldacre does a good demolition job on homeopathy, nutritionists and media cover of MRSA by turning the laser of critical thinking and science on their claims. He also gives a good summary of the scientific approach to medicine, asserting the importance of the proper construction of medical trials with randomisation and the maintainenance of proper controls--though to those who, like me, studied science none of that is news.

Dr. Goldacre is also big supporter of evidence-based medicine, which he says has saved millions of lives. He doesn’t give any evidence for that, but we can believe it to be true. In the chapter entitled Is Mainstream Medicine Evil? we find this:

Doctors can be awful, and mistakes can be murderous, but the philosophy driving evidence-based medicine is not.

In the same chapter he tells us about 13 per cent of all treatments have good evidence, and a further 21 percent are likely to be beneficial. A bit low, so he tries again. Ah, but if we look at how much medical activity is evidence-based that rises to 50-80 percent. Depending on how you interpret this and the method by which these figures were derived, that means a large chunk of medical practice has no evidence underpinning it.

In response to Archie Cochrane's call for up-to-date, systematic reviews of all relevant randomized controlled trials of healthcare, the Cochrane Collaboration was founded in 1993--perhaps the real birth date of EBM. But what happened before that?

OK, you say, we are where we are. So let’s not bother with what happened before. We are now flowing into an enlightened era of more scientific medical practice. Or are we?

We really do need to understand why the scientific approach seems to have been marginalised in medicine, because Sue Dopson’s Knowledge to Action? Evidence-Based Healthcare in Context suggests the flow to an enlightened era is turbulent. Interdisciplinary tensions, over assertive practitioners and the subjective conversion of evidence into practice make for erratic progress, it seems.

No matter how strong the philosophy of EBM may be it's in the integration into practice where the real patient benefits of it lie. Rather than trashing questionable reasoning in other practices, maybe Dr. Goldacre should redirect his laser logic onto that challenge. After all, conventional medicine is where most of us seek health care and where a substantial chunk of our taxes is spent.

Posted by Colin Jervis, Kinetic Consulting at October 26, 2008 | Permalink | Comments (0) | TrackBacks (0)

Is a man in fluorescent gear riding a mountain bike a suitable metaphor for innovation, information and technology? The Health Service Journal Intelligence supplement* seems to think so.

The HSJ's coverage of such matters is usually low key. This probably reflects the interests of its readers, which is a shame. Mind they did publish one of my articles on healthcare IT which now seems 15 years ahead of its time (!)

The supplement considers Imperial College London's construction of a virtual model of a future NHS in Second Life. I visited the site a couple of years ago to look at a construct of Polyclinics, which was eerily empty at the time. This future world seems locked into current models of care with a general marginalisation of the role of ICT. We need to realise that demographic and epidemiological trends mean that is not sustainable.

The HSJ also considers emergency services, their adequacy and their future--hence the mountain biker. They say they are not as fully integrated into the system as they could be. And this touches a common theme througout the supplement: the benefits of sharing of information and of the integration of ICT into practice--whether by COIN or by joining insular GP systems. That is the future of healthcare.

*18 September 2008

Posted by Colin Jervis, Kinetic Consulting at October 01, 2008 | Permalink | Comments (0) | TrackBacks (0)

Is it an EMR, an EPR, an EHR or a CRS and who cares anyway?

Professors on international trips measure how many hospitals are using order communications (or is it resulting and reporting) or computerised referral against their template of academic definitions, which I can guarantee fit almost no IT system in the real world, let alone (crucially) the manner in which it is used.

For some of us, Software Advice has tried to clear the matter up in EHR vs EMR - What's the Difference?

But do definitions help? I enjoyed reading about Socrates when I was at school. This gadfly of ancient Athens liked to ask questions such as “What is good?” or “What is the pious, and what the impious?” Then, by adroit questioning, he would lead his targets to realise what they thought they “knew” led to a contradiction.

But simply because you cannot define something does not mean you cannot appreciate or understand it—or, in the case of healthcare IT, use it. I worry the upsurge of academic interest in healthcare IT leads to introspection, and, like a hot bath, the more we contemplate it the colder it gets. Definitions have their place, but let’s get on with implementing healthcare IT and also learn from experience.

Posted by Colin Jervis, Kinetic Consulting at September 30, 2008 | Permalink | Comments (0) | TrackBacks (0)