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September 30, 2006

RFID: mark of the beast?

Picture of Turkish angora kittenMad sorties across the sitting room on legs spinning like Tom's chasing Jerry in a Hanna-Barbera cartoon. Constantly supervising his hosts while giving them lots of affection: a Turkish Angora kitten has arrived at home. The breeder had him RFID tagged, which will identify him and may renunite him with us if he gets lost. It also helps the vet to maintain her records.

The thought of humans tagged in this way fills us with horror. Some allude darkly to the "mark of the beast" referred to in the Bible's book of Revelations. Others aren't concerned about eschatology and worry about tags on high street goods: could they be used to track us or our credit card use? Or could criminals target homes by scanning trash for the tags on the packaging of expensive new appliances, like TVs or mediacentres?

A previous post reported the ease with which encrypted data held on RFID tags on prototype passports had been accessed—so there is cause for concern. I recently chaired a seminar at Intellect, the UK IT industry's trade body. Delegates agreed that RFID tags should store only an ID number—which anyway is the original concept. Related patient-based data should be stored on more secure IT systems. This may give the anxious some comfort.

Mind you, some members of the Baja Beach Club in Barcelona are happy to be tagged with a subcutaneous Verichip for ease of entry and card and cash free payment. Cool for cats, maybe?

September 25, 2006

Computers Better than the Docs?

Doctor examining an X-ray film.Regular readers will know, or have guessed, that I think the future of healthcare lies with computer diagnosis and intervention and the human touch. Machines will be able to calculate and infer more reliably, efficiently and accurately than us, but it will be a long time before they exceed us in empathy and in detecting non-verbal or numerical signs to our fellows's state of health.

In a study by Swiss researchers, neural networks exceeded humans in predicting epoetin responsiveness in treating anaemia in patients on dialysis. The study concludes: "In predicting the erythropoietin dose required for an individual patient and the monthly dose adjustments ANNs are superior to nephrologists' opinion. Thus, ANN may be a useful and promising tool that could be implemented in clinical wards to help nephrologists in prescribing erythropoietin."

Computers can also help in the detection of breast cancer. The Journal of Radiology reports that computers may also be more efficient and accurate in detecting breast cancer. One expert assisted by a computer could do the job just as well as two, speeding up screening for women who have waited for longer than three years. Read the BBC's report.

September 18, 2006

First Set of Acrylic Nails on Bionic Arm

Former Marine Claudia Mitchell may be the first person in the world to have a set of acrylic nails fitted to a bionic arm. Claudia lost her arm in a motorbike accident and has been fitted with a state-of-the-art prosthesis.

The bionic device costs about £32 000 and takes a five-hour operation to install. The nerves needed to operate the arm then regrow in about five months. Claudia can control the prosthesis by thought using nerve impulses from the muscles in her chest--and she clearly has priorities about the way it looks!

The UK's media covered this story last week; for example, here is the BBC's coverage where you can watch a clip of the limb in action.

September 16, 2006

Remote Testing for Influenza?

Picture of clinician using microscope.Scientists from the University of Colorado at Boulder and the Centers for Disease Control and Prevention (CDC) have developed a microchip-based test that may allow more labs to diagnose influenza infections and learn more about the pathogenic viruses.

The FluChip successfully distinguished among 72 influenza strains - including the H5N1 avian influenza strain - in less than 12 hours. Bichip can be used at lower levels of biosafety, which may increase the number of labs that can determine critical details of a virus's origin.

FluChip is constructed by a robotic arm dropping thousands of spots of DNA and RNA onto a microscope slide in a known sequence. The spots are exposed to sample material and scientises can then compare gene sequences to identify the virus.

It seems to me that this technology could be the basis for remote diagnosis, maybe using the silicon biotechnology I talked about in this FHIT post.

September 09, 2006

Lean is for Teams

Reading Robert Bruce in a UK Financial Times special report you could think management accountants were about to save the NHS single handedly.

His article cobbles the management accountant's role to a report published by the NHS Confederation on the application of Lean Thinking to the NHS.

Pioneered by Toyota, Lean reduces waste by challenging organisations to eliminate steps that don't add customer value and speeding up those that do.

The NHS Confederation report discusses the reorganisation of Pathology services at Bolton Hospital, which reduced test resulting from a minimum of 24 hours to between 2 and 3 hours and the need for space and staff. I have been impressed by the hospital's achievements, as I mentioned in another post.

I have experience of improving processes as a veteran of a hospital process redesign. Even if impressively named point Kaizen, optimising part of a process--such as Path--carries the risk of deoptimising the whole; for example, by creating a larger queue at the next bottleneck, say admission for treatment. Service improvement needs to be seen as a whole.

Similarly, improvements by Lean are certain to be the result of whole group of workers, particularly those who actually do the work: clinicians, porters, consultants and lab staff. After all, a key principle of Japanese management is "go and look". First-hand experience of processess if often invaluable in improving them. Nonetheless, I would weclome management accountants who engage in the operation of departments and who display skills in process mapping and measurement.

September 08, 2006

Norwich Deploys Free WiFi

Picture of a baby feedingI apologise for not posting recently--a result of holiday and sharpening my skills by attending courses.

The city of Norwich in the UK has deployed the UK's largest free Wi-Fi network, which spans 4 kilometres.

Coverage by BBC TV showed a community midwife visiting a mother and newborn. The midwife was able to sit in her car, update and read records and check the latest advice, which she found a boon.

This is certainly a taste of future healthcare: wireless applications will, paradoxically, allow care to centralise and devolve. Specialists may be centralised in monitoring and diagnostic centres, while generalists may be devolved and mobile.