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March 28, 2006

Human Biology and Health

Nice entry here on the Nature Newsblog: 2020 Computing mostly about the integration of IT and human physiology.

Also see this entry on our US cousin with a link to articles on Nature.

March 27, 2006

Views of a Hybrid: clinician and informatician

Picture of surgeonSimon Dodds is a Consultant Vascular Surgeon. He refers to the debate reported in this FHIT entry. I am posting this extract from an email he sent me with his permission.

With my clinical head on I rant about the informaticians that never actually come and see what frontline healthcare delivery entails, never experience for themselves what the problems are, or help tease out the information requirements from the rest of the process (i.e. write the information requirement specification), then offer simple, workable, quick, cheap options based on existing technology, then help choose the most viable options, then quickly design and build prototypes that are usable, then test options and find those that actually work better than what we were doing before, then implement the best seamlessly so we never really even notice it's there (until it goes away and we suddenly realise we can't do without it).

All I get is: "You are not allowed to do anything with IT because you are not to be trusted." Or: "If you can't write the requirement spec. then we can't help you." Or: "You'll have to wait until the National Programme [NHS National Programme for IT] delivers the solution". Bit of a gulf there ...

With my computer scientist head on I rant about the clinicians whose thinking is so ossified that their resistance to change is a dangerous obstacle to improving patient care, that just don't seem to be aware that the world outside their little empire is changing really fast and this change is bringing lots of opportunities for improving things with well designed application of IT, that their combined arrogance and ignorance (of IT) has reached a dangerous degree that they would do anything rather than admit that they might not know something, that behave as if their prime directive is to do as much private practice as possible and don't appear to have the patients' needs and opinions in mind at all (though they'll never say that openly).

What I need are clinicians who start from a shared principle of delivering the highest quality care possible, who are prepared to question the way they think and work along with everything else involved in delivering healthcare, who are prepared to change the things that will lead to improvement and keep the things that are working well, who are prepared to help specify options and test ideas, who are prepared to offer constructive feedback, and who are prepared to learn enough about the principles of IT development and implementation to understand the pressures and constraints that I am under. Bit of a gulf there too ...

I have deliberately overstated the case but the scenario is not fictional ... what is clear is that both scenarios are the actually the same scenario ... they are the classic conflict that arises from separate paradigms of the same problem .... but the wood is lost for the trees .... the conflict is all man-made and arises from lack of an explicit shared understanding of the actual goals - the protagonists are in heated agreement.

This is not a win-lose game: at the moment both are losing. With my two heads I see no conflict because I understand both points of view and can therefore drive the innovation to meet both needs: the win-win option.

In the debate I could have argued either side with exactly the same argument and the way the voting would go would depend entirely on the mix of paradigm and prior experience of the audience and nothing to do with what we said because we weren't addressing the underlying issues—though there were a few glimmers of insight appearing.

Until clinicians and informaticians start to address their collective ignorance of the age old principles behind the successful management of change, the sterile debate will continue. Both camps will continue to be unhappy but won't really understand why, disappointment will be inevitable, money will be wasted, and resistance to change will increase further, the "burned out" will jump, the inexperienced will make all the same mistakes again, and round we go .... thus it has ever been ...

Have a look at my website www.simondodds.com. The book "Three Wins ..." is the story of the telemedicine project ... it has been described as a "potted change manual" and I'd be interested to hear your views as an experienced informatician and innovator.

March 24, 2006

Clinicians Thrash Informaticians

On 21 March 2006 the BCS London and South East Health Informatics Group sponsored a lively and light-hearted debate at the HC 2006 conference:

“This house believes that real innovation using ICT in healthcare delivery is driven by clinicians rather than informaticians.”

Simon Dodds and Mark Outhwaite proposed the motion and Ian Herbert and I opposed with Keith Clough in the chair.

I argued that healthcare in the UK was facing illness because of a shortage of cash and qualified staff and an aging population that is likely to lead to an increase in chronic disease. Never has healthcare needed ICT innovation more—but who will provide it?

I tacitly accepted that clinicians and informaticians must work as a MDT, but I was speaking against the motion. I had three main arguments:

  • Clinicians are experts in patient care, informaticians in ICT;

  • Informaticians have a broader view of healthcare than clinicians; and

  • Innovation is not about ideas, it’s about the implementation of ideas.

Cyber means “art of steering” in ancient Greek. Informaticians would be the cyberanauts building the pathways and finding the passages that led to a coherent, patient-centred healthcare system.

All to no avail, I'm afraid! After contributions from the audience—one of whom said he thought clinicians should be leading ICT innovation, and asked why then they didn't get on with it—the motion was carried by 18 votes to 9.

Rod from Informaticopia also wrote an official blog entry on the debate. In addition, Simon Dodds, a Consultant Vascular Surgeon and Innovator, is allowing me to use some comments that he emailed me in an entry to follow.

Reposted by FHIT on 29 March 2006 adding the hyperlink to Simon Dodds' entry.

March 23, 2006

Healthcare IT 2006

I apologise for not posting recently. I spent the first part of this week at Healthcare IT 2006, the annual conference and exhibition in Harrogate UK, listening, presenting and visiting suppliers.

This year the event lacked energy. Major suppliers were missing, as were exhibition visitors—I have never known the halls so deserted. Perhaps the purpose and format of the event must be revised, because it risks falling into terminal decline—which would be a great shame.

In the next few postings I will write about a debate in which I took part and a few interesting things I noticed on suppliers’ stands.

Rod from Informaticopia was at the event and here is his entry in the official blog about a tutorial I gave on RFID in healthcare.

March 18, 2006

Right patient, Wrong Site—Right Technology?

rfid-healthcare-reader.jpgAnother tragic wrong site error in the UK remarkably similar to the Graham Reeves case referred to in this FHIT entry on patient safety.

That entry also notes that Radio Frequency Identification (RFID) may help to prevent this kind of right patient, wrong site error. The UK's Birmingham Heartlands Hospital is piloting RFID and W-Fi tagging and linking them to a picture of the patient on the EPR. I do not know the details of this pilot, but I would be surprised if it is a panacea, because the possibility of human error is not eliminated.

I listened to a talk the other day about the implementation of RFID in a hospital in the Netherlands. It confimed what I already knew: RFID application is still as much an art as a science. Even when readers are suitably located, tag and antenna alignment is still a problem. In addition, even if RFID could be used to trigger alerts, say in the operating theatre, they would have to compete with ambient stimulae and the noise of anaesthetic equipment, staff coming and going, respirators etc.

I am convinced that radio technologies are important in the evolution and integration of healthcare IT; I am still to be convinced that RFID will be any more than one of many of them.

March 14, 2006

Healthcare Input: mission impossible?

Image of paper records stacked up.I am perplexed. Will we ever find the right input device for clinicians? The ones we have are too big, too small, too slow, too unreliable, too nickable or may carry bugs.

  • CoWS (computers on wheels) are too unwieldy;
  • Tablet PCs are too heavy;
  • PDAs are difficult to read, especially for the longsighted; and
  • Handwriting and speech recognition are not accurate enough.
PDAs seem the most popular, but even they can carry infection (an Alaskan doctor cultured Hepatitis B from a PDA) and are likely to be stolen. See this article on HIMSS Daily News for a good summary.

I am partial to a scrap of paper and a pencil when working out, especially at the initial stages. Perhaps I am unable to escape habits learned at school, or maybe I find screens restricting. I like a mixture of words, diagrams and my own heiroglyphs; though some people don’t have this problem and cope easily with what I see as restrictions.

What is the incentive for clinicians to give up paper and pen? What is the right device for them? Could it be Microsoft’s Origami? Or do our clinicians need to change their habits and embrace new ways of working?

March 09, 2006

Full Integration of IT into Healthcare

da-vinci-healthcare.jpgWe need the full integration of healthcare and IT. Today it’s an optional extra for clinicians, perhaps not surprising, because applications are often little more than jumped up number crunchers that are irksome to use.

However, clinicians do adopt technology—think about surgery, antisepsis, anaesthesia and angioplasty—which leads to changes in practice. But most show a profound lack of interest in information technology. Two trends may change this.

The first, is the general need for IT to help healthcare to become safer and more efficient, economical and patient-centred. This is certain to be a push.

The second, is the general integration of IT into technology and instrumentation—this will become a pull.

In a recent FHIT entry I discussed the da Vinci surgical robot, which is an example of how IT, surgery and instrumentation can integrate. Such integration, together with better sensors and wireless applications, will make IT virtually invisible. Keyboards, cables, terminals and other detritus will be banished from wards to become part of the building infrastructure.

Manufacturers are alert to this second trend. GE Healthcare’s recent merger with IDX is an example of a technological giant acquiring the skills and expertise needed to exploit it.

This pull and push will bring about full integration of IT and healthcare. It’s an exciting time!

March 07, 2006

Evolving Medical Relationships

In January, delegates at a conference at the the Regenstrief Institute Inc. discussed Relationship Centred care and how important it is to success. The conference considered the interactions of the healthcare team, the patient and the patient’s relatives and friends. But a more virtual relationship is increasing in importance.

Successful outcomes depend on the mechanics of care and on the social and emotional context of the clinician-patient relationship. For example, a medical test might reveal that a patient has a condition needing a change in diet. The clinician must develop a working relationship with the patient if the treatment is to succeed. Simply telling someone to control his dietary intake will probably fail, unless the relationship is right.

When I visit my GP she has a representation of me on her IT system. It tells her my age, allergies, current prescription, last blood pressure reading and so on. This representation of me will become increasingly sophisticated as the multi-disciplinary EPR builds. Eventually, it may even be a virtual representation of the real me—a medical avatar.

Such an avatar would allow sophisticated monitoring and diagnosis and become just as important to my health as my relationships with medical staff. Could it be that the avatar is eventually used by computerised decision support to decide the mechanics of care and that clinicians will provide my emotional and social needs?

March 05, 2006

Help on Debate Requested

I taking part in a debate at the Health Care 2006 (HC 2006) conference in Harrogate, UK on 21 March 2006. The motion is:

“This house believes that real innovation using ICT in healthcare delivery is driven by clinicians rather than informaticians.”

I am speaking against the motion. If anyone has any ideas, arguments, interesting or amusing anecdotes for me to use, I would be pleased to read them.

March 01, 2006

Two FHIT?

Shocking, but there are two Future Health IT Blogs! Dale Hunscher made his first entry shortly before me, but I started regular blogging a bit earlier. Fortunately, Dale deals with the duplication in magnanimous style in this entry.

I am relieved our chosen areas differ. Dale concentrates on biomedical research informatics technology and you should pay a visit to his site.