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December 18, 2009

Modelling Clinical Trials

London Euston station is a child waking up. Shutters raising. Bleary-eyed passengers staring at the information board. I am catching an early train, for which I’m early.

WH Smith bright and inviting. On the shelf the US edition of Wired. What's inside? Yes: The Body Synthetic. Something to enjoy on the journey.

In 1997 David Eddy applied a model he designed called Archimedes to predict the result of a clinical trial named Collaborative Atorvastatin Diabetes Study or CARDS.

Archimedes is like a Treasury Model of human physiology: knowledge from epidemiology, clinical trials and clinical interviews encoded into differential equations.

Using broad patient data, Eddy and his team constructed a comparable trial to CARDS in 2 months and issued the results. When the 7-year clinical trial reported, it turns out the findings of the model were remarkably close.

It is also remarkable to read the criticisms of the model: a self contained ant farm that has no bearing on reality, a black box. Interesting remarks, because the whole of medical practice is based on abstractions, assumptions about biological reality. Do we fully understand the complexity of human physiology? We do not.

Medicine is often quick to point to the mote in the eyes of others (black box, lack of evidence), while forgetting the beam in its own (black box, lack of evidence).

Nonetheless, it’s refreshing to read about people prepared to face criticism and innovate with IT. To open eyes. Like shutters raising in the morning.

December 07, 2009

NPfIT to be Scaled Down

The Chancellor, Alastair Darling, has announced that the NHS National Programme for IT (NPfIT) will be reduced in scope. Apparently, cuts will affect IT not essential to the frontline.

NPfIT has been incessantly critised since its inception, but you cannot run a £100bn healthcare system with little more than quill pens and ledgers, so I wonder if the cuts will arouse as much discontent as planned expendiure did...

December 06, 2009

Healthcare IT does not Reduce Costs

If you have researched academic papers you will have read much that is derivative and little that demonstrates new insight. This state of affairs is exacerbated by a general academic tendency to prolixity and bad grammar that rivals a breakfast news TV programme.

I can't comment on the quality of the writing in this case, but E-Health-Insider reports Harvard Medical School et al have concluded that healthcare IT systems do not cut costs. That may be news to the researchers, but it is not to me.

Many authorities have pointed out that the introduction of IT does not cut costs. See Paul Strassman or Leslie P. Willcocks' Beyond the IT Productivity Paradox. But the myth persists.

A few years ago I heard a woman present on the use of Lean in her hospital. Though it's a method specifically designed to remove activities that add no value and speed up those that do, it had not reduced costs, but then, she said, they had not implemented any IT systems, which, she asserted, were good at reducing costs. There is little evidence to support this assertion. Nor is that a surprise.

If we add an IT system to a mix of unchanged processes then we must expect costs to increase, especially if workarounds have to be implemented because the system doesn’t support "the way we do it here".

Peter Drucker said: “Whenever anything is being accomplished, it is being done, I have learned, by a monomaniac with a mission.” Benefits from IT systems do not magically appear as soon as the boxes are switched on. Implementing beneficial processes, and thereby saving money, with the support of IT requires the courage to challenge status quo, the analytical skill to identify shortcomings and the determination to implement real change. Is healthcare ready for such a mission?