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June 28, 2008

Healthcare: plagiarism and expertise

Sir Isaac Newton said he saw further than others by "standing on ye shoulders of giants" thereby acknowledging his sources and influences. Celebrity psychiatrist Dr. Raj Persaud seems to have attempted an easier ascent by using ye copy and paste on the published work of others without such clear acknowledgment.

The UK General Medical Council found Dr. Persaud had behaved dishonestly and had undermined public confidence in the profession. Some examples of his plagiarism are at the bottom of this article.

But giving Dr. Persaud a kicking is not on my mind. I am more interested in the reaction to the GMC's decision.

The UK media are notorious for building up celebrities only to bring them crashing down. However, in this case the journalists seem to have wriggled uneasily in their ergonomic chairs. A web search will reveal the majority of the coverage is ambivalent, many journalists and others trying to deflect the debate by saying what a good chap Dr. Persaud is and that blatant plagiarism does not mean he is not a good doctor. Fair enough, but let's stay on topic, guys.

In the main, journalists earn expert status vicariously. It takes about 10 years of intensive work to be considered an expert in a field, and few journalists--particularly in healthcare IT--have that experience. Hence, we get the phenomemon of journalists interviewing other journalists, who are meant to be experts but in reality have a superficial understanding of their subject. It is no longer necessary to invest 10 years to be considered an expert. A few hours of web searching and mugging up can give that impression without the hard graft.

Comments allegedly made by Richard Madeley and Judy Finnigan encapsulate my area of concern. It was on their TV programme--which considers itself qualified to comment on life, the universe and everything--that Dr.Persaud first came to media prominence. They have stated they wish to continue working with Dr. Persaud. So it seems professional honesty comes second to presentation skill. Is the Internet taking us to a form of celebrity medicine where the ignorant are led by the superficially informed?

June 20, 2008

Mancunian Ways

Mountain ViewIf you think Windows Vista is slow you should have tried using Fortran IV. I studied at Manchester University where we were able to take advantage of the computing facilities—quite novel in those days. This entailed creating a stack of punched cards which I dutifully placed in a tray in the morning.

After lunch I returned keen to see if my program for calculating square roots had worked only to find the dreaded words “run time error” on the print out, usually after the first milliseconds of the programme’s run. I found my mistake, corrected it and put the cards back in the tray and thus it continued until I got my brainchild to work.

It’s the birthday of Baby the world’s first electronic computer created by Manchester University in 1948, the BBC reports today. Baby could complete calculations in hours that would have taken days by hand.

The UK NHS, also born in 1948, celebrates its 60th anniversary. Health Secretary Nye Bevan was ceremoniously handed the keys to the Park Hospital (now Trafford General ) in Manchester to mark the foundation of the Service.

As if that wasn’t enough coincidence, this year’s NHS Confederation Conference took place in Manchester this week. I was surprised to see how many NHS agencies had individual stands: NHS Improvement, NHS Pathways, NHS Connecting for Health, NHS Institute for Innovation and Improvement, NHS National Technology Adoption Centre.

They all do worthy work, I'm sure. But I was heavily influenced by the work of Enid Mumford who was a professor at Manchester Business School and her promotion of socio-technical systems, so I find it odd the NHS should have so many trays in which to stack what should be a unified blend of people, processes and technology. One day we will produce that blend, but only after this tendency to reductionism is addressed.

Listening to Joe Simpson (Touching the Void) tell the story at the Conference of his ascent and unconventional and agonising decent of the Siula Grande in the Peruvian Andes puts life into perspective. If we only have a fraction of his courage and dogged determination the NHS will become the socio-technical system it must and gain again the envy of the world.

June 11, 2008

NPfIT: full circle?

The departure of Fujitsu from the NHS National Programme for IT (NPfIT) dealt the Programme another body blow. Where does NPfIT go from here, if anywhere?

Perhaps the Southern Programme for IT should be handed to one of the remaining huskies . But this summary from the UK's Guardian newspaper leads to the conclusion that would not be easy because of the alleged poor reception of the Cerner Millennium system.

Yesterday I attended a talk at the Smart Healthcare 2008 conference in London. Last year a similar talk was packed to capacity. This year the same venue was barely half full.

Although the speakers were meant to address healthcare transformation, I heard little evidence of it. The speaker from NHS Choices came closest showing the NHS Choices website had the potential to increase the power of patients by providing them with real performance data on healthcare providers. But the CIO of the London Programme for IT gave a history lesson on NPfIT and implied that NHS organisations would play an even greater role in the choice and implementation of IT.

Now I have tried a few times to read James Joyce's Finnegans Wake. I have never succeeded fully, but I know, set in world between dream and reality, it begins and ends with the word "riverrun" having come full circle: "riverrun, past Eve and Adam's, from swerve of shore to bend of bay, brings us by a commodius vicus of recirculation back to Howth Castle and Environs". So it seems with healthcare IT.

For decades NHS organisations implemented their own choice of IT systems before the intervention of NPfIT. Is the dream ending and flowing back to a parallel reality having run full circle?

June 01, 2008

IBM Helps to Share Health Care Information

Artefact Informatique, a Canadian division of IBM, will be part of a new initiative to share health information with patients and doctors around the globe. This has begun with the creation of the Centre of Excellence in Quebec City, which acts as a repository and registry for healthcare information. It is through the Centre that authorized personnel can search and retrieve important documents, thus improving the efficiency of many patients' medical care.

The Centre of Excellence contains lab reports, digital images, drug profiles and other critical medical documents. This repository was created with IBM WebSphere and DB2 software and was designed to be easily compatible with commonly used Electronic Health Record (EHR) systems. Health facilities that are now using EHR technology should be able to communicate with IBM's new software.

IBM has instituted this new technology as a part of the Integrating the Healthcare Enterprise (IHE) initiative, which aims to improve the way information technology is used within the health community. Primarily, it is making the world safer for patients by keeping better medical records for easier transfer.

Says Jose Mussi, the executive director of IHE Canada:

It has been shown many times that systems using IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively. Physicians, medical specialists, nurses, and other care providers have been waiting for the day when vital information can be shared seamlessly regardless of where they are or which system they are using. That day is now.

The new software took three years to develop and was created by researchers and software engineers from Haifa, Israel; Rochester, Minnesota; and San Jose, California. IBM is now promoting the system for more widespread use.

Heather Johnson is a regular commentator on the subject of CNA Certification. She welcomes your feedback and potential job inquiries at heatherjohnson2323 at gmail dot com.