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September 29, 2011

Robots in Healthcare

'Bots are back. It's a while since I wrote about them--for example, see here for a collection of musings--and in the interim they seem to be moving into the mainstream.

BBC Radio 4 has a series: Robots that Care. The first episode poses an interesting question: if robots are to live with us, are they pets, slaves or companions? It includes interviews with Rodney Brookes a robot luminary.

With aging populations in many countries, particularly in Japan, robots are seen as a means of filling the care gap. Panasonic is set to introduce three new robots at the 38th Home Care and Rehabilitation Exhibition: a communication robot, a hair washing robot and a robotic bed.

September 28, 2011

Gamers Solve Medical Problem

Never say your kids are wasting their time with online gaming again. On the Foldit site gamers resolved the structure of a protein that had foxed scientists for 15 years in only three weeks.

M-PMV retroviral protease causes AIDS in rhesus monkeys. After the failure of attempts to find the crystal structure of it by other techniques, Foldit challenged players to produce accurate models of the protein. They did, and the structure was confirmed by x-ray crystallography. A paper has been published in Nature Structural and Molecular Biology with the gamers as co-authors.

These types of enzyme help the AIDS virus to develop and proliferate and intensive research is seeking to find a way of blocking them. But this was hampered by ignorance of the molecule's structure.

Foldit encourages gamers to collaborate and compete in suggesting the structure of protein molecules. Tools, and some assistance from a computer program called Rosetta, encourage participants to shufffle graphics into protein models.

Who said online games are all fun and no work?

September 22, 2011

Online Antics

Clinicians are still struggling with relating information technology to their jobs. No, I am not referring to the dilatory uptake of electronic patient records, but to social media.

The Daily Telegraph reported the social networking antics of doctors who made references to 'birthing sheds' (maternity units) and "cabbage patches" (intensive care, from CABG). The former was regarded as worse by a consultant because it entailed having to work with 'madwives'. On being questioned online about their opinions, the doctors resorted to some unconvincing post hoc rationalisation.

Now doctors are not the first to have posted unwisely on social networks. Politicians and policemen have also been caught out. Still, you wonder how many employees of other organisations could get away with being so disparaging of their customers and colleagues.

This coincides with the removal of the combinations to locks posted on patient records on the national Patient Demographic System (PDS).

Do we see the mistakes of an industry taking its first awkward steps into the information age?

September 20, 2011

Punk Rock People Management

I have just received an advance copy of an unusual book on managing people by the business author and speaker called Peter Cook. He is the author of ‘Best Practice Creativity’ and ‘Sex, Leadership and Rock’n’Roll’, acclaimed by Professor Charles Handy and Tom Peters. Peter mixes up business academia with music in a heady cocktail that reaches the parts that other business gurus do not dare to touch.

Peter has just released his latest 'album'. The curiously titled Punk Rock People Management takes a critical look at Human Relations and offers some short and straightforward advice on hiring, inspiring and firing staff.

In the spirit of punk, Peter has made each chapter just two pages long – ideal for busy people and those who now browse books online. On hearing of the idea that you could read a chapter in less time than it would take to pogo to a Ramones or Linkin Park song – international author and speaker Tom Peters tweeted just four characters to Peter – “DO IT”. That’s economy!

Peter offers keynote seminars and more traditional business consultancy without guitars, based on his ideas – you can find out more at The Academy of Rock. He also invites you to connect with him on LinkedIn.

A full colour printed book and a Kindle version are available.

Informed Patient: how do you know?

A couple of years ago I suffered many sleepless nights owing to some excruciating pain in my stomach area. After about three months of misdiagnosis, I was referred for an ultrasound scan that showed damage to my gall bladder. The consultant packed me off with some OTC remdies and told me that the offending organ would have to be removed if the symptoms persisted. Another sleepless night gave me time do some Internet research and as a consequence I asked my GP for some antibiotics as a last resort. Within a week of taking them the pain was gone.

Nowadays, people have a marvellous knowledge base of information on the Web and they should use to it to challenge experts, including medical practitioners. The Sense About Science organisation seems to agree and has launched an ask for evidence campaign.

I strongly believe that the best person to look after your health is you. Moreover, by being an informed customer you will also play a part in changing healthcare delivery to meet the needs of the 21st Century. So, as Sense About Science recommends, always be ready to ask the experts: 'How do you know?'

Ask for evidence button

September 13, 2011

EPR Models: checklists or constraints?

I was reminded of the good old six level Electronic Patient Record (EPR) model that originally appeared in Information for Health back in 1999 through a posting on the E-Health Insider group on LinkedIn. For those of you who haven't seen it or have maybe forgotten it, here it is...

  1. Level 6 Advanced multi-media and telematics Level 5 plus: telemedicine, other multi-media applications (e.g. picture archiving and communications systems)
  2. Level 5 Speciality specific support Level 4 plus: special clinical modules, document imaging
  3. Level 4 Clinical knowledge and decision support Level 3 plus: interactive care pathway support, electronic access to knowledge bases, embedded guidelines, rules, electronic alerts, expert system support
  4. Level 3 Clinical activity support Level 2 plus: electronic clinical ordering, results reporting, prescribing, passive multi professional care pathways
  5. Level 2 Integrated clinical diagnosis and treatment support Level 1 plus: integrated master patient index, departmental systems
  6. Level 1 Clinical administrative data Patient administration and independent departmental systems

Unfortunately, it never really influenced NHS thinking outside of the IT department. Most Chief Executives hadn't heard of it and---dare I say--neither had some IT directors. To some extent this ignorance paved the way for the NHS National Programme for IT. Now the HIMMS EMR adoption model gains in popularity.

But I am not sure that these models are any good at all, other than as a communication tool. At a time when healthcare should be looking sideways to its partners and forwards to its customers, these models encourage introspection. Good IT Directors will implement a strategic plan appropriate to their organisation's starting point and to look outwards. At best these models are useful ticklists, at worst misleading anachronisms.

September 05, 2011

Is That it Then?

The NHS National Programme for IT (NPfIT) seems to have come to an anomalous end. No-one seems to be clear about what is happening to it. The most likely scenario is that the contracts for the local service providers will be allowed to run their term, because it will be too costly for the NHS to exit. This will leave large sums of money tied up--money that could be invested by NHS organisations to procure information systems to help them to realise the £20bn of economies expected of them. But that isn't the worst outcome.

Worse is that a new generation of ICT manager and Directors have spent the last 9 years in meetings watching Gantt charts slide to the right as NPfIT deliverables were continually rescheduled. Existing ICT systems became obsolete; strategic and procurement skills grew weaker, because the world's biggest IT programme would take care of everything.

The NHS will now have to learn all of the old skills again from those left who still remember.