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June 30, 2006

VoIP: the future of healthcare communications?

Newton Meckley has written this good summary of Voice over IP telephony. Please note some of the article is only relevant to US readers.

Voice over Internet Protocol lets you make a telephone call using your computer and its high speed network. The voice signal from your telephone converts to voice over Internet protocol technology to a digitized signal that lets it be delivered across the Internet. Then when it gets to the person you're calling it changes back to regular telephone technology.

You can have a traditional phone conversation calling any standard phone number. When you call with Voip using your land line phone using the adapter for VoIP you get a dial tone just as usual and you dial just the way you always did. VoIP sometimes lets you call directly from your PC using an ordinary microphone or standard telephone.

There are two options for calling by VoIP. The first is to install an adaptor to your broadband Internet connection.
This way the call would actually go through your local phone carrier to a provider of VoIP. The call goes out over the Internet to the local phone carrier of the person you are calling to have the call completed.

Another way you can use VoIP is to plug a headset with microphone into your PC or laptop and then dial from your keyboard and route it through your cable modem. To get your VoIP telephone connection active you'll need the use of a cable modem or other high- speed connection such as local area network or DSL. You can directly connect a telephone directly to the phone adaptor or buy an inexpensive microphone and hook it up directly to the computer.

Costs for VoIP services vary by provider. Some charge nothing for their services if you're calling people who are also their subscribers. Your provider of voice over Internet Protocol might permit you to choose an area code that is not your local home area code. What this will do is give you free local calls to this area code, which saves on the long distance charges. It can affect the price of calls that people make to you, however, either negatively or positively.

If your VoIP offers this service you'd want to choose an area code that is most active for your outgoing as well as incoming calls. There are VoIP providers that charge long distance fees just as the local carriers do - for calls outside your local calling area. Others charge you a flat rate to call anywhere for a predetermined maximum number of minutes.

Who you can call with VoIP depends on which provider you use. You might be only able to call those who have the same provider or you might be able to make a call to anyone you choose anywhere in any country. You can make a VoIP call to a local landline, a cell phone, or a long distance domestic or international call. VoIP even allows conference calls.

Whoever you are calling does not need VoIP, an adapter or even a computer. They just need a phone like any other call.

VoIP's unusual features are because of its being digital. With VoIP and your high speed Internet connection you can save telephone service charges. The plus side of VoIP is financial, with the reduction in phone use fees.

The con side of VoIP is that some standard services are missing that you're used to with your phone carrier such as 911 service, directory assistance and access to listings in the white pages. Also, its connection to electrical power can be a negative if the power goes out.

Newton Meckley is the owner and operator of Mico Voip Ltd which is an excellent place to find VoIP links, resources and articles. For more information on this article, please visit: http://www.micovoip.com/.

Also see the posting on Vocera.

Mapping Health and Social Care

I thought this comment from Peter Jones was worth posting as an individual entry.

Great blog! I am working on a blog but have much catching up to do!

Noting your focus - the site introduced below, may be of interest to you and your readers?

Originally created in the UK by Brian E Hodges-

Hodges' Health Career - Care Domains - Model [h2cm]

- can help map health, social care PLUS other issues, problems and solutions. The
model takes a situated and multi-contextual view across four knowledge domains:

* Interpersonal;
* Sociological;
* Empirical;
* Political.

Our links pages cover each care (knowledge) domain e.g.

Sciences includes a range of informatics links.

Our political links may be of particular relevance:

political links

Will add you to my blogroll.

Best wishes
Peter Jones


[HTML in this entry added by FHIT together with some minor edits.]

Please note: FHIT cannot be held responsible for the content of external websites or blogs or for any offence it may cause. Nor are the views expressed in external webites to which we link necessarily representative of our own views.

June 25, 2006

Smartpen: rewriting the record

smartpen.jpgFinding the right data device for clinicians resembles the search for the Holy Grail, as I have commented before.

I continue to like pen and paper-which provides me with the freedom to use a mélange of words, diagrams and runes. Perhaps that's why I was so taken by Datapulse's Smart Pen, when I came across it at a recent IT Directors event.

Smartpen allows pen and paper to be integrated with IT. You write with ink in the normal way and a tiny camera records the pen's strokes which you download onto a PC. You then have a hard copy and a digital copy that can be integrated into an Electronic Patient Record accompanied by a full audit trail.

It could digitise readings of vital signs, such as heart rate and temperature, that are written on a chart at the foot of a patient's bed. Time and date could ensure regular readings are taken, perhaps alerting staff if they are not.

Find out more on the Datapulse site.

Read about Smartpen in Healthcare (PDF).

June 24, 2006

NHS IT Project: media responses to the NAO report

Please compare two articles on the E-Health-Insider website that respond to the UK's National Audit Office report on the NHS Connecting for Health's National Programme for IT—which was generally positive.

The first is by the Guardian Online's Mike Cross: Press gang.

The second by Jon Hoeksma editor of EHI: Healthy Optimism.

I will allow you to draw your own conclusions.

June 18, 2006

Changing the System: NAO’s report on the NHS IT project

For weeks the UK’s media have been cleaning and oiling their guns preparing to lay a broadside on the NHS IT Project.

Last Friday, on the morning of the release of the National Audit Office’s report on the NHS National Programme for IT (NPfIT), even my favourite BBC Breakfast news presented by the elfin Sîan Williams and the grounded Bill Turnbull could not resist a ranging shot: the NAO report would “criticise” the NHS IT project.

So, what did it say? Broadly, NPfIT is in good shape.

Yes, it is about two years behind plan.

Yes, it has not sufficiently engaged NHS staff but intended to do so when the risk of raising false expectations was lower. (This decision seems to have been sound.)

Yes, it has spent some money, but was under budget overall (£654m compared to £1.4bn) because it has not paid contractors who have failed to deliver—a principle I also employ in my IT contracts.

The NAO estimates that the overall cost will be £12.4bn, but admits that ignores likely savings. For example:

  • Spend on existing IT due for replacement;

  • Savings from centralised purchasing--independently estimated at £4.5bn; and

  • Human effect of medication errors £2.5bn.

Duplicate diagnostic tests, adverse events that affect 900K inpatients a year and clinical negligence claims that cost the NHS more than £400m a year are also likely to be reduced.

The NAO is also positive about the robust management structure and style—which has also been independently assessed.

On a smaller scale, I have faced similar challenges to those faced by the NPfIT. Any major change programme that drives the free flow of information across disciplinary and organisational boundaries will meet resistance. Perhaps Machiavelli explained it when he wrote:

There is nothing more difficult to plan, more doubtful of success, more dangerous to manage than the creation of a new system. The innovator has the enmity of all who profit by the preservation of the old system and only lukewarm defenders in those who would gain by the new system.

The NAO report adds much needed rationality to the public debate about the NHS IT Project. The critics' guns have fallen silent—for a while.

June 17, 2006

FHIT for the News

This blog is mentioned today in an article about the business benefits of blogging on the UK's Daily Telegraph website.

I have also joined the blogging team at Healthcare Today a new website that should appeal to all healthcare professionals. On the home page you can download a free version of the publication, register or subscribe.

June 14, 2006

Real Innovation in Healthcare Delivery is Driven by Clinicians?

I took part in a light-hearted debate at the UK's Healthcare IT 2006 conference in March, which I reported in a previous posting.

The British Journal of Healthcare Computing transcribed the debate PDF (96K).

June 11, 2006

Lean Keenness: transforming healthcare with Lean thinking

The National Motorcycle Museum near Birmingham, UK seemed an apt venue for a conference on a change philosophy pioneered by Toyota. Despite the early start to the Lean Healthcare Forum on the 6th of June, the buzz at coffee was palpable. This excitement continued throughout the event, though at times it verged on overzealousness.

Most impressive was Bolton NHS Trust's chief executive David Fillingham who described independently assessed reductions in mortality for the patient flows touched by Lean thinking.

I took part in a hospital process redesign based upon the principles of total quality management about ten years ago. This took its cue from systems like Six Sigma and was led by a multi-disciplinary team of NHS staff wielding simple modelling and statistical techniques.

Here, presenters seemed to hold simple techniques like brown paper modelling in low esteem, favouring Lean’s greater sophistication and action over analysis.

This has merit. Participants in change tend to over-model the current system, because they are more familiar with it, and to spend less time generating, modelling and implementing the future system. Nonetheless, changes must be based on sound evidence---which is where Six Sigma's statistical emphasis may have an edge over Lean.

In addition, Lean keenness sometimes went too far. In one session a trust leader treated any challenge like an affront. One of the delegates commented it was a case of “my way or the highway”. Lean practitioners need to take care. In the NHS such an approach will go down like a blue whale in a shoal of krill.

Patient outcomes must be paramount. I would endure poor organisation and dodgy structure if I were assured of the best outcome for my condition. None of the sessions I attended tackled this controversial area—which is a surprise as the relationship between Lean and Integrated Care Pathways is obvious.

In addition, few presenters made much of the potential role of information technology, only one delegate stating that IT was good for reducing cost. In fact, this view has little support. In my experience, costs are reduced and benefits magnified by hitching IT and process change together.

Given the NHS’s overspending and likely changes to its structure, the time has come for philosophies like Lean, especially if they are integrated with the systems NPfIT will deploy.


Read my article about transforming healthcare with IT and process change: Making NP Fit.

Link to the Lean Enterprise Academy.

June 04, 2006

NHS: back to quill pens and ledgers?

Picture of quill pen.Lord Warner announced last week that NHS Connecting for Health’s National Programme for IT (NPfIT) was likely to cost closer to £20bn than the much-quoted £6.2bn. This has brought out the emotive in journalists and the hoped for response from some members of the Public.

For an example, look at this article in the UK’s Daily Mail and the comments that follow it.

Even consultants are taxpayers: I also want to see my money spent wisely. But I wish someone would assess the NPfIT in a rational, knowledgeable and even-handed way that looks at options and benefits, rather than quoting a meaningless gross cost.

It would be easy to think it was an option to run a 21-century health service with an army of clerks with quill pens and ledgers and to overlook that approach also needs money for equipment and training. In fact, the NHS already spends more than £1bn a year on IT and for that we get:

  • GP IT systems that are unable to transfer records, even to a system from the same supplier two miles up the road;

  • Hospitals that are unable to tell concerned relatives on which ward their loved ones are, because there is no real-time bed management;

  • Systems unable to correlate clinical, financial and activity information to help better management and the public to decide if it is getting value for money; and

  • A healthcare system that gives inappropriate treatment to ten percent of its inpatients.

To help put that lot (and more) right means major change, and, yes, we are going to have to invest.

The UK is waiting for an imminent (and long-delayed) report from its National Audit Office (NAO) on NPfIT and for the appearance of NHS Connecting for Health’s senior management before a Parliamentary Public Accounts Committee on 26 June 2006. Let’s hope both give us a more balanced and rational assessment.