Future Health IT

Stop Saving the NHS: new book

2013-05-10T10:47:37Z

Well I have done it. My book Stop Saving the NHS and Start Reinventing it has been published in Kindle and paperback. It's aimed at NHS leaders and managers, but will probably interest anyone who is interested in the shape of 21st century healthcare.

]]> It has already garnered some nice reviews, including from the influential Chief Executive of University College London Hospital, Sir Robert Naylor: An aging population, increased chronic illness and unprecedented demands for greater efficiency mean the NHS is facing its greatest challenge. To tackle it, Colin proposes a new model for healthcare based on the increased integration of information technology. This is an engaging and challenging book that all NHS and healthcare leaders and planners should read.

It includes the stuff which interests me like healthcare, man and machine, science fiction, and the need to tether new health business models to the implementation of large-scale IT systems. This last point is the key to the whole book, which includes chapters on:

Genomics and Medicine as an information science
Social media
Expert systems and artificial intelligence
Remote care
Remote monitoring
Robotics
Uneasy past of the NHS and IT

It begins with a chapter called The Machine Stops that uses EM Forster's short story as an analogy to the UK NHS. Older, fatter, sicker patients and increased expectations mean the NHS is facing its greatest challenge. And this is no call of 'wolf'. This time it is true.

Any who doubt should look at recent reports; for example: reports on the state of NHS emergency care. A wave of elderly and chronically ill patients is building in the community and the British care system is not geared up to stem it.

All over the world the machine is stopping and we must do something now

Buy Stop Saving the NHS and Start Reinventing it on Amazon now.

Alan Turing Enigma

2012-06-22T17:34:22Z

In the photographs, dressed in jacket and dark tie, he looks like the prefect at my grammar school who cowered against the corridor walls when other pupils approached him. The mathematician and visionary Alan Turing is the subject of a compact exhibition at the Science Museum in London.

During the Second World War Turing famously helped to crack the German Enigma code using one of the earliest electronic computers, the 'bombe'. The cracking of the cipher, which the Germans believed impossible, probably shortened the war by years, saving countless lives.

Dozens of wheels rotated in each bombe making a noise like 'a thousand knitting needles'. And a legion of bombes supported decryption on an industrial scale. So effective was it that on one occasion a message was decoded in less than 15 minutes.

When the war ended, Turing worked on the government Advanced Computing Engine (ACE) project. Before such machines were invented, large scale arithmetical calculations were carried out by teams of specially trained women.

Computers were then quickly applied to complex problems in chemistry and life sciences. At Manchester University, Turing researched the relationship between mathematics and cell growth, beginning a new field he named Morphogenesis. At Oxford, in 1957, Dorothy Hodgkin used Pilot ACE and X-ray crystallography (a technique also fundamental to the discovery of the structure of DNA) to help her to crack the structure of vitamin B12 and was awarded a Nobel Prize.

Turing was condemned for homosexuality in an era when it was illegal. Under constant surveillance as a security risk, he apparently took a bite from a cyanide-laced apple. His death was officially declared suicide, though the exact circumstances remain a mystery.

As a leader in computation--particularly in programming--he deserved better. However, in recent decades he has been recognised as one of the greatest thinkers of the 20th Century.

Information Governance Industry

2012-06-17T09:13:42Z

Has the NHS gone compliance crazy? In a few years information governance has expanded from a toolkit into an industry. NHS trusts are spending more and more on ensuring compliance—a trend accelerated by the large fines being handed out.

]]> I worry the NHS is developing a compliance culture in the way of Children’s Services or to some extent the Police. This is a particularly concerning when staff are challenged to improve the efficiency of services, because structured compliance soaks up the time needed for innovation. It is easier to tick a box than seek solutions outside the box.

Information governance is following a similar path to data quality. I still come across NHS staff whose job is to correct the data entry mistakes of frontline staff. It is also impossible to eliminate risk. One of the commonest things I find when managing programmes, or digging out those in a hole, is the gulf between risk identification and risk management. Risks are often identified and then forgotten.

Of course, you have to question NHS culture when photographs of patients are posted on Facebook, confidential data on hard drives are not erased before disposal, and the correct identification of a patient needs policing.

If I know that someone else will correct my mistakes, there is less incentive for me to get it right first time. Therein lies the problem and the solution. The emphasis should not be on creating an IG industry but on empowering, and training frontline staff. Then the solution lies not in compliance but in good mangement.

Twenty First Century Healthcare with IT

2012-06-10T12:10:36Z

There was a good turnout of clinicians at the planning session with an NHS client the other evening. Main strategic work streams were quickly agreed, and we got onto enablers. I expected the usual suspects: more consultants, more nurses and more money. I was wrong. Almost all of the groups chose IT as a major enabler of change for the better.

]]> The NHS must save £20bn in the next 4 years or so. It has well worn approaches to economising—top slice budgets, freeze recruitment, cut some services. Mergers and takeovers and consolidations are also looming. That lot may keep us on target for a couple of years…and then what?

Now the traditional fixer for the NHS is money. Yet, despite unprecedented increases in funding in recent years, the National Audit Office says efficiency has fallen steadily. Most of the increased funding has gone on increased salaries and increased staff, but that hasn’t led to comparable increases in procedures and appointments. That means even if more funds were available, the NHS would still not meet increased demand.

I hope this will lead it to the conclusion that options around status quo are exhausted. In its present form, the NHS has gone as far as it can. The only way to create an affordable, efficient service that meets customer expectations—in other words a 21st century service—is complete redesign based on the effective use of IT.

I hope the participants at that planning session realise that. After all, adding 21st century digital parts to a 20th century mechanism will not do it. What is needed is a complete rethink. Part of me thinks the time is right for just that, and part of me thinks the powerful interests in and around the NHS will make it impossible.

Smart Phone

2012-05-30T15:26:14Z

Wakes me in the morning, and I choose not to snooze. Check my emails at breakfast (quicker than firing up the laptop). Weather fine today, but cooling in the week--which is OK because the London Underground has a good service on all lines.

Check the news and tweets sitting on the Central line. Find the client’s office with GPS. Call my Mother on the way.

In Starbucks before next meeting and quick notes typed in. Read chapter of Hunger Games using the Kindle application (not great literature but engaging). Tackle a couple of chess puzzles. Get them right: brain clear this morning—always a sign. Check my notes on Evernote. Take a photo of an article in the free Metro so I can look at it later.

Life is a succession of choices, and this helps you to make them. Smart these phones.

Wirelessness

2012-05-22T06:56:59Z

I make my offering at the altar, pay the priest and nod at the high priestess as I leave the temple of Apple on Regents Street. I still have ten minutes to make it.

]]> Taking the straightest route along Oxford Street I notice them now the sun is (at last) shining. Bowing to the omnipresent god of wireless on their handsets. Heads down changing their music, checking the route, calling a companion. Walking in a half world of real and representation. Glancing anxiously ahead to avoid collisions with the shoppers and tourists.

Turning down South Molton Street, I dodge a woman wearing Bose lids jabbing at her phone sending a text. I am going to be a few minutes late.

In the Matrix Morpheus welcomes Neo after he swallows the red pill with: ‘Welcome to the desert of the real’. But I see my friend outside Starbucks from 300 yards. Haven’t seen her for four years, but she stands out, tall and well-dressed.

We buy our cappuccinos and sit down to chat. She is now working in merchant banking. Her phone rings…

We live in a wireless world that is fully integrated into our lives. It's a technology whose time has come.

Medicine as an Information Science

2012-01-07T10:53:29Z

I remember vividly reading about DNA and its mechanisms in James Watson's Double Helix. The unzipping of the two reversed strands interlocked by the strict pairing of nucleotides--adenine to thymine and guanine to cytosine. The complex and choreographed interactions with other molecules leading to the construction of proteins. The systematic beauty at the nucleus of life. It was all engaging enough for me to decide to study Biochemistry at university.

When I finished my degree I worked in international marketing and travelled the world. I was always proud (and grateful!) that English is the most widely spoken language with about 80 percent of the world being able to speak it. But it is not the real lingua franca any more. The most popular language comprises 0s and 1s--the binary language of computers. GB Shaw said America and England were 'separated by the same language,' but the binary language unites the world.

What's more, the two binary languages of DNA nucleotide pairing and computer coding are set dominate the coming decades in a combination of genomics and computer science. David Baltimore said that Biology is today an information science. Indeed, Bioinformatics combines life and computer science so that they are as interlocked as the strands of DNA.

We will see if genomics lives up to its promise, of course. As another scientist, Neils Bohr, said: 'Prediction is difficult, especially about the future.' Even the exquisite DNA translation process sometimes gets it wrong and proteins end up with the wrong amino acids, impairing their function. Indeed the majority of DNA itself is regarded as 'junk', because it seems to have no function. All of this all sounds a bit like computer code and its creation, another systematic human process.

I have been fascinated by interface between man and machine for more than 30 years. Now it seems more alluring than ever.

Sign of the Times

2011-12-28T16:21:45Z

Last week BBC's Click programme showed (6m 38s) a one year old iPad user confused by a print magazine where she couldn't 'flick' the pages: a sign of the times.

]]> Print media have been in decline for some time, long enough to worry the staff at my local Waterstones bookshop who don't know what to make of it all. They are physical book devotees. Even when I tell them how easily it is to annotate and manage the annotations on the Kindle application and how I can even do that on my iPhone, they are unimpressed.

Looking around the carriage on the London Underground as I type this, people are prodding and flicking at their mobile phones. A couple of middle aged travellers flick copies of the Times or Guardian on their tablet PCs. Others stare bored at the reflections in the windows. A sign of the times.

About two thirds of all mobile phones now purchased in the UK are smartphones. And I guess, like me, people rapidly become addicted to them and they become a vade mecum--an essential companion.

We are all riding the wireless wave that is transforming the way we live our lives and making the online world as real and immediate as the real world. Judging by my travelling companions, the online world is sometimes to be preferred: a sign of the times.

Drug Administration and IT Reconciled

2011-11-02T07:19:08Z

A few years ago there was a kerfuffle in healthcare IT. A study at the Childrens Hospital of Pittsburgh concluded that mortality rates had increased with the implementation of Computerised Physician Order Entry System (CPOE). Despite being rebutted almost immediately after publication, the study gained wide credibility. It was still being quoted without qualification by a prominent academic at a UK healthcare IT conference a couple of years ago.

]]> The findings fly in the face of common sense, of course. Thankfully, a recent study at University Hospitals Birmingham showed that the implementation of a similar system reduced mortality rates among emergency patients by 17 percent, suggesting 16 000 deaths a year could be prevented if a similar system was implemented across England.

The Birmingham study has a crucial difference, because it concentrates on the whole system. Before implementation 1 in 5 drug administrations were missed. Simple functionality addressed this systemic problem in a potent combination of IT and human process change. An important lesson for us all.

Some clinicians disparage such approaches and complain about 'tick box medicine'. But I find tick boxes rather useful for automating routine tasks--which I am not very good at. This frees my mind to address less routine matters and to be more creative. I am not the only one to think so: read Atul Gawande's Checklist Manifesto. However, I am not suggesting they make human intervention redundant.

Changed practice with the support of IT is the way of 21C healthcare, and if that means clinicians ticking boxes to relieve them of routine, free their creativity and reduce errors, so be it.

What's After the NHS IT Programme?

2011-10-16T16:39:14Z

]]> My second patient record procurement gained the attention of those setting up what would become the NHS National Programme for IT. I remember suggesting there were essentially three options for a national health IT system: replace everything with one system, seek to integrate exisiting or disparate systems, or something in between. I said the integration option was the one most likely to be successful.

Of course, I speak with the advantage of 20:20 hindsight, but maybe we are about to find out if I was right. In a recent interview Katie Davis, managing director of NHS informatics, says the new watchword will be connect all rather than replace all.

The NHS IT Programme squeezed out many of the smaller, and more innovative, suppliers from the health IT market, something Katie Davis accepts. Thankfully, some determined suppliers have managed to hold on and are now ready to re-enter the market applying their long experience of the NHS. Also, though my cartoon pokes fun at them, IT departments have been itching to deliver local solutions that add real value for 9 long years.

The energy of NHS IT staff and suppliers and the need for more efficient services may be enough to carry us through this very difficult phase in the evolution of healthcare IT. Let's hope so.

Do Doctors Dream of Electronic Records?

2011-10-11T08:55:52Z

A former Apple CEO says healthcare missed the PC and Internet revolutions. He loads the blame squarely on the shoulders of reluctant doctors.

]]> When I first came to healthcare fresh from completing my MBA, my head was full of ideas of quality management. In leading my first electronic patient record programme in a London teaching hospital, I found doctors warmish at the prospect of having transactional information, like diagnostic test results and visit information, but distinctly cool at the prospect of recording outcome information.

Evidence-based healthcare should encourage the analysis of the relationship between process and outcome, but much clinical practice still seems to have no evidence base. Could this be the reason for slow uptake of electronic records?

In an insightful article in Information Week one chief medical officer supports this view, pointing out that most doctors still prefer medicine as an art rather than a science. That being the case, electronic records would represent a cultural mismatch.

In the UK all GPs now use computers to automate their practice and information from them them is used to manage the Quality and Outcomes Framework (QoF). For me QoF has some way to go before it manages quality rather than process. Nonetheless, GPs regard themselves as being at the forefront of medical computing.

GP systems have automated GP practice and eliminated some routine tasks, but this is hardly a revolution in care delivery. My former GP was one of the last to computerise his practice and the main benefit for me was that I was handed a typewritten prescription--though I did have to go back among the sick in the waiting room to an erratic printer to collect it. It is difficult to identify the direct patient benefits of GP automation. Given it began in the 1990s, this is very disappointing.

It is unfair for doctors to shoulder all of the blame for the slow uptake of IT, but they must shoulder some of it.

Robots in Healthcare

2011-09-29T18:49:00Z

'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.

Gamers Solve Medical Problem

2011-09-28T09:00:08Z

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?

Online Antics

2011-09-22T14:17:59Z

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?

Punk Rock People Management

2011-09-20T17:25:48Z

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.