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 shuffled 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?

Posted by Colin Jervis, Kinetic Consulting at 05:26 PM | Permalink | Comments (0) | TrackBacks (0)

If 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.

Posted by Colin Jervis, Kinetic Consulting at 10:35 AM | Permalink | Comments (0) | TrackBacks (0)

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?

Posted by Colin Jervis, Kinetic Consulting at 07:27 AM | Permalink

Lecturers told students on my wife's Physiotherapy course that journals using peer review--like the British Medical Journal--were the gold standard.

But in New Scientist 23 February 2008 Donald Braben argues that we are seriously deluded if we think peer review can lead to innovation. Peer review might work for the mainstream, he writes, but it excludes radical research. Now this chimes with an exchange between Checkland and Jackson I read when researching a Masters dissertation.

Checkland's Soft Systems Methodology is a way of finding solutions to problems that cannot easily be defined and might only be sensed as a vague feeling that all is not well. Predictably Checkland suggests defining the problem and then "identifying feasible and desirable changes". Part of this identification is for the interested parties to generate options and it was here, as I recall, that Michael A. Jackson argued group dynamics meant the methodology was normative, rather than radical. Groups tend to fall into heirarchical working, he suggested, often with one particular individual or group of individuals dominating this meant that radical solutions would often be rejected by those supporting the status quo.

The same limitation may apply to multi-disciplinary review. In a previous posting I wrote about a presentation by Prof Berg in which he argued computers should support standardised pathways of care which would be continually enhanced by review. On the face of it this sounds reasonable. Indeed the idea is not new. I was proposing it at least 15 years before Berg and I doubt I was the first.

But Berg argued that the review would generate innovation. I doubted it and what I have read and heard about the dynamics of multi-disciplinary working supports my scepticism.

Nor is that the end of the story. Peer review may be part of the future of medical practice, but only part. Wikipedia also quotes Drummond Rennie of the Journal of the American Medical Association:

"There seems to be no study too fragmented, no hypothesis too trivial, no literature too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print."

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I've been reading Garrick Alder's Mind Bombs which is a collection of short articles designed to galvanise your thinking.

He reports Professor Richard Smith, editor of the British Medical Journal until 2004, said only about 5 percent of the entire planet's scientific papers came up to scratch. In most journals, Professor Smith said, it was less than 1 percent.

I have a comparable view of most of the Health Informatics publications I have read. They fall into two categories: the bean counting variety best kept by the bedside as a soporific and the other weak and subjective.

Health Informatics faces the same challenges as fields like sociology and psychology which also depend highly on the interpretation of human behaviour. At this stage in its evolution, the success or failure of healthcare IT is largely determined by how well users apply it. Therefore, IT must become fully integrated into healthcare, not seen as something separate. This goal is not best served by the creation of another specialty, Health Informatics, in a field already overflowing with them. That just gives practitioners an excuse to continue to pass the buck: "It's not my specialty, mate".

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It's been a while since Peter wrote for FHIT, but he's back. You can also read some of his previous entries. Let's rock!

‘I was looking for a job, then I found one. Heaven knows I’m miserable now’. How often have you heard these words for real in the workplace? Poor morale and motivation account for massive waste in effort, costs and profits in even the most successful organisations. So what can Morrissey, Minztberg, Meatloaf, Maslow, Motorhead, Madonna et al teach us about how to create a work climate and culture that rocks? In the book ‘Sex, Leadership and Rock’n’Roll’ I explore classic ideas about motivation through a rich mix of great academic thinking ‘tamed’ with the pithy wisdom of rock and pop culture. Let’s start with a look at the Blues.

Can’t buy me love?
Most Blues songs begin: ‘Woke up this morning’ and then move on to motivational problems such as ‘The landlord wants to repossess my home’ or ‘My woman left me’.

In the modern workplace, you cannot have a Blues that goes ‘Woke up this morning, the server was down’ or ‘Woke up this morning, I got a good HR manager who self actualises me!’

Quite surprisingly, this cheesy contrast makes a great deal of practical sense. Frederick Herzberg pointed out the difference between those factors that merely remove dissatisfaction at work, e.g. pay, administration, supervision (called dissatisfiers) and those factors that encourage job satisfaction e.g. responsibility, advancement etc. (called satisfiers). Just think about those ‘fly like an eagle’ motivational posters in some hospital corridors. Yes, they are cheap, but they do not create workplace satisfaction.

Many reward systems only focus on removing dissatisfaction - it’s no surprise that they fail to motivate – just try doubling someone’s salary and notice how long they work twice as many hours! As Prince said ‘Money don’t buy you happiness, but it sho’ ‘nuff pays for the research.’ i.e. inadequate pay dissatisfies, but no amount of pay will produce long term job satisfaction. This is especially true for Generation Y and beyond, who crave much greater things from work today. Companies such as First Direct, B&Q and Prêt à Manger have learned this point well and surpass others with people who bring their heads, hearts and souls to work. The NHS is well positioned to offer people some Herzberg satisfiers e.g. career development, intrinsic job satisfaction etc.

Key point:review Hertzberg’s model in the book and ask yourself ‘How does our motivational strategy line up with his findings?

River deep, mountain high
Coming back to our Blues examples, repossession of the home and losing one’s lover are located towards the lower levels of Abraham Maslow’s hierarchy of needs i.e. shelter and belonging. Maslow crucially pointed out that there was a hierarchy of needs from physiological through to ego and self actualisation. So we really cannot have a Blues that starts ‘Woke up this morning, I got a good manager, who sets meaningful performance goals and leverages my talent in ways that provide long term career development tailored to my talents’ unless the basics are also in sufficient supply. As an aside, the lyric does not scan well either!

Key point:HR needs therefore to be not only strategic and visionary but also tactical and detail conscious in the way it motivates staff.

I want it all and I want it now
In a culture of mass individualisation, employees expect to be treated as individuals, yet many HR systems tend to treat them as a collective in the interests of fairness, equity and conflict avoidance.

Key point:personalisation is the key to individual motivation. This requires motivational systems that are responsive both in speed and flexibility. Ask your HR people to tell you how the HR system achieves these ambitions.

We gotta get out of this place
Blues can take place in New York City, but not in Newark. Hard times in Minneapolis or Canterbury is probably just clinical depression. Chicago, St. Louis, and Kansas City are still the best places to have the Blues, not York, Bath or Slough. You can’t have no Blues in a shopping mall. The lighting is all wrong.

The physical and psychological environment are important components of motivation. Although working conditions are a Herzberg dissatisfier, poor working conditions really make for poor performance and, more importantly, these things are not so expensive to put right. Companies that recognise the contribution of the built environment on performance include Pfizer. However, as I pointed out earlier, décor is cheap but insufficient if people feel unable to do a good job. Furthermore, a pleasant work environment is no substitute for the least expensive and most effective motivator – behaviour that encourages others to give their all, which leads us to our last point…

I’d do anything for love, but I won’t do that
I did a gig with Lorraine Crosby, who sang on Meatloaf’s classic song, but failed to discover what ‘that’ is in the context of the song, so we’ll concentrate on the ‘love’ part… Praise is the least expensive but highest value motivator. It merely takes time and must come from the heart.

Key point: the built environment helps people to feel good about work, but how people behave is crucial to long term motivation. Find ways to spot people doing things well and let them know about it.

You can buy Peter Cook, MD, Human Dynamics's book: Sex, Leadership and Rock’n’Roll – Leadership Lessons from the Academy of Rock.

He is also speaking at a conference for the NHS Innovation Institute HR Network Scotland Conference on February 14 2008.

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This weekend I went on a nostalgia trip back to the North East of England and sat for an hour in the Rendevous Cafe sipping coffee and contemplating the incoming North Sea. The feel of the Cafe is encapsulated in a poem by local poet Julia Darling, who died in 2005 after a fight against cancer and a photograph of her drinking coffee on her final visit hangs on the wall. Throughout her illness she promoted poetry for its healing properties, particularly in this collection of poems which I have.

"Poetry should be a part of every modern hospital, not just as something to keep patients amused. It's a powerful force, which can help us through the darkest times."

The rising tide of technology will wash away much that is commonplace in tackling illness, but the role of the human spirit will stand.

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"Please check the coffee cup coasters on your desk just to make sure," quipped a colleague today. But it's no laughing matter. Who would have thought two mislaid CDs could brew such a storm?

And it's just beginning. In future, cyber criminals will target high-value information. Personal emails, grocery purchases and—dare I say—patient record information such as the results of genetic and HIV tests, will have value on the black market and could lead to anything from spam mail to blackmail.

Technical steps such as encryption and identity management take us only so far. I remember hearing an anonymous cyber thief on the radio saying he wouldn’t bother trying to hack computer security. It was easier to simply bribe unscrupulous employees to get information.

But most people working with sensitive data take their responsibilities very seriously, though, as HM Revenue and Custom's loss of CDs packed with confidential information shows, it only takes one mistake (and we are human) to rattle plans for large databases of shared records to the roots.

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Hindsight being a perfect science, I can see why Richard Granger, Director General of NHS IT, seemed more relaxed than I have seen him before at the presentation the other day. Times Online reports he is moving on by the end of this year.

Mr. Granger's most quoted comment likens the NPfIT's suppliers to huskies pulling a sled. The weaker dogs would be shot and fed to the rest to sustain them and as an example. Certainly, some well-known huskies are gone, Accenture and IDX being two. Lead dogs have also fallen to the back of the tugline. But will the remaining huskies survive the departure of the sled driver? And will they be challenged by new teams pulling different sleds? We'll see.

Posted by Colin Jervis, Kinetic Consulting at 12:19 PM | Permalink | Comments (0) | TrackBacks (0)

In its editorial the Health Service Journal of the 19 April 2007 says Mr. Richard Granger, the Director General of NHS IT is "expected to leave soon". Now how many times have I heard that in the last 2-3 years? Nonetheless, the recent mostly critical report on NHS National Programme for IT by the House of Commons Public Accounts Committee (PDF 4.5Mb) cannot have strengthened his position.

The HSJ also refers to a report by Professor Sir Ara Darzi, the national advisor on surgery and one of the medical profession's rare technological innovators. In Saws and Scalpels to Lasers and Robots Professor Darzi suggests 80 percent of local surgery could be carried out in health centres and large GP practices.

It seems if anything is going to drive NHS modernisation it will be public expectation combined with the march of technology--with or without a centrally led IT programme.

Posted by Colin Jervis, Kinetic Consulting at 04:32 PM | Permalink | Comments (0) | TrackBacks (0)

The Healthcare IT conferences in Harrogate may be an ember of their glory days, but one determined to continue glowing. Maybe in sensing that, I enjoyed HC 2007 more than its recent predecessors.

Given the UK release of the movie 300 about the battle of Thermopylae, it is topical for me to refer to a tale of ancient Greece.

The crowd jeers an old man looking for a seat at the Olympic Games until he reaches the Spartan section, when every Spartan younger than him, and some older, stand and offer him their seat. The crowd applauds and the old man turns to it and says: "Ah, all Greeks know what is right, but only the Spartans do it."

I attended a couple of notable presentations and I’ll write something about them next. After 20 years in healthcare IT maybe I have become jaded, but many of the presentations reminded me of that tale: many know what to do, few do it.

Posted by Colin Jervis, Kinetic Consulting at 12:50 PM | Permalink | Comments (0) | TrackBacks (0)

Listen, do you hear it? Has a balloon been pierced by a pin? Or is NHS Connecting for Health deflating? If so, how quickly and by how much?

Government agencies aren't the only ones to have felt a jab. The Guardian's Polly Toynbee in a jerkily argued article says underperforming GPs should be brought into the fold of the NHS (more interesting are the emotional arguments in the comments section that follows it). Also, in a recent TV program management trouble shooter Gerry Robinson turned his attention to Rotheram General Hospital where consultant medical staff apparently arrived late, left early and were never in theatres on Friday. Undoubtedly tensions between managers and clinicians are still with us.

Let's hope it's the sound of metamorphosis then. For with or without a national IT programme it is beyond debate that a 21st Century NHS must emerge as a system where humans and technology seamlessly interact. The real question is how that is to be created. Many of us who have worked in the NHS could have saved Gerry Robinson the walkabout by pointing out the problems. Maybe he could then have turned his talent to addressing them. That would have been interesting.

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“Dark days before Christmas,” my Mother says. It may be those short days just after the winter solstice that are dulling my mood while I look back on my time in healthcare IT. How much has changed and how much have we learned? Not nearly enough.

Darkness hangs over the NHS National Programme for IT (NPfIT) as we end the year. Accenture has left and the future of software supplier Isoft is unclear. Progress on the core cross-organisational National Care Records Service—for me the Programme’s essence—is also well behind schedule.

But shafts of light pierce the dark. NPfIT’s PACS deployments have progressed well. Though an easy win, they are nonetheless an important one because they highlight the benefits of sharing electronic patient-based information. Also, Cinderella sections of the NHS like Community and Mental Health are benefiting from the deployment of new systems.

My mood has also been lightened by the number of young clinicians, especially doctors, excited by the possibilities of information technology. I have recently met several—some working with Professor Sir Ara Darzi’s unit in London, which looks at the integration of technology into medicine.

At this time of year the days lengthen slowly with the darkest hours just before dawn.

Posted by Colin Jervis, Kinetic Consulting at 01:25 PM | Permalink | Comments (1) | TrackBacks (0)

In the last month or so I have attended a couple of conferences as a speaker and a chair. What caught my attention were the number of opportunities for using technology in healthcare--particularly in remote monitoring and diagnosis--and how this contrasts with the situation of UK healthcare ICT.

At the BCS eBrochan conference in Glasgow (brochan means porridge, apparently) Prof. Frances Mair, Professor of Primary Care Research, at the University of Glasgow, talked about the real application of telecare and telemedicine, stressing the importance of having clear aims and of adequate preparation and reorganisation. Too often such projects are tacked on to existing practice, which often means staff have to do their day job and manage the pilots.

I chaired the recent Mobilising the Clinician conference where talks ranged from making better use of the PDA to remote monitoring and diagnosis using wireless and GPRS. On the second day, Professor Istepanian of the Mobile Information and Network Technologies Research Centre (MINT) described an array of applications some using GSM or the faster GPRS for monitoring vital signs; for example, transmitting ECGs, blood oxygen saturation and blood sugar levels. Ultasound scans have even been taken remotely in Cyprus.

Dr Omar Aziz works in Professor Sir Ara Darzi's unit at Imperial College in London. He described the possible use of body sensor networks (BSN) in mobile health (m-Health). BSN could be applied widely in healthcare; for example, in monitoring vulnerable patients and post-operative recovery.

Lest we lost touch with reality at these rarified heights, Jon Holmes, Informing Healthcare Project Manager at Gwent Healthcare Trust in Wales, told us about the challenges of implementing wireless computing on wards, which allowed nurses to record Admissions, Discharges and Transfers in real time.

In the UK, 21st Century ICT must be implemented in a 20th Century healthcare system. Benedict Stanberry of Avienda suggested healthcare IT is on the brink of the chasm referred to in Geoffrey Moore's book Crossing the Chasm. The chasm is a void on a notional curve that spans the phases of technology adoption. Moore's chasm opens up between the phases of early adoption (comprising the enthusiasts) and early majority (the pragmatists), because expectations are distinctly different.

The illustrious Royal Society also suggests UK healthcare's adoption of ICT is dilatory. Its report Digital Healthcare covers familar ground for readers of FHIT. As well as looking at the view from the top, it suggests more can be made of existing systems and that even applications like mobile phone SMS messaging still offer unexploited footholds.

Hmmm. When it comes to integrating ICT into healthcare, scaling the peak will be an achievement and the views will be fantastic--but there's a lot of abseiling and climbing still to do.

Posted by Colin Jervis, Kinetic Consulting at 10:25 AM | Permalink | Comments (0) | TrackBacks (0)

Physician, heal thyself with the support of remote monitoring, suggested Dr. Paul Johnson, Director of the telemonitoring service Xenetec last week at the International Healthcare Innovation Congress in London.

He pointed to a pandemic in lifestyle-related diseases exacerbated by growing levels of obesity in Western countries (in the UK 23 percent of us are now classed as obese—the highest level in Europe). As a consequence, incidence of chronic diseases—like asthma, coronary heart disease and chronic obstructive pulmonary disease—is increasing. In the UK, chronic disease apparently accounts for 65 percent of the visits to Accident and Emergency departments.

With such a pandemic, it's fortunate advances in IT and communications make 24-hour health monitoring a reality. Vital signs like respiration and heart rate are useful indicators. A healthy heart rate has a high degree of variance, showing as a spikier trace than an unhealthy one. In addition, nocturnal breathing disorder is often a co-morbidity in asthma, COPD, hypertension and heart disease. Close monitoring of such signs could assist sufferers to manage their conditions and carers to pre-empt crises.

Dr. Johnson said that multi-centre trials in Europe show such monitoring is practicable. Patients in the trials had worn a cluster of electrodes on their chests stuck on with adhesive tape that reminded me of the spaghetti at the back of my aging HiFi system—yet compliance was high. This is a good sign. If patients can tolerate being wired up like that then compliance with newer, wearable equipment should be at least as high (see future posts).

Supported by monitoring centres, self-management of chronic illness is real option. As an example of its possibilities, Dr. Johnston referred to work by Dr Dean Ornish et al on the effect of diet, exercise and stress management on heart disease. Dr. Ornish's work assessed the power of a rigourous risk management regime to arrest—or reverse—the progression of atherosclerosis.

If it's practicable (inevitable maybe), where does remote monitoring figure in NHS plans, or indeed in the NHS National Programme for IT (NPfIT)? Do the operational vision for the NHS and the technology planned to support it need revision?

Posted by Colin Jervis, Kinetic Consulting at 10:49 AM | Permalink | Comments (0) | TrackBacks (2)

I used this soapbox piece as a the basis for a short introduction to the session I chaired at last week's International Healthcare Innovation Congress in London. I will also be posting on a couple of talks that caught my interest--though all of the speakers were good.

Though information is its basic currency, healthcare has been remarkably slow to embrace Information and Communications Technology (ICT). It has mostly been applied piecemeal to automate existing practice rather than transform it. As a consequence, ICT implementation has rarely dramatically improved care or the patient's experience of it.

Continue reading "Healthcare Must Ride the Wireless Wave" »

Posted by Colin Jervis, Kinetic Consulting at 10:26 AM | Permalink | Comments (0) | TrackBacks (0)

Mad 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?

Posted by Colin Jervis, Kinetic Consulting at 10:13 AM | Permalink | Comments (0) | TrackBacks (0)

Finding the right data device for clinicians resembles the search for the Holy Grail, as I have commented before.

I continue to like pen and paper-which provides me with the freedom to use a mélange of words, diagrams and runes. Perhaps that's why I was so taken by Datapulse's Smart Pen, when I came across it at a recent IT Directors event.

Continue reading "Smartpen: rewriting the record" »

Posted by Colin Jervis, Kinetic Consulting at 02:11 PM | Permalink | Comments (12) | TrackBacks (2)

For weeks the UK’s media have been cleaning and oiling their guns preparing to lay a broadside on the NHS IT Project.

Last Friday, on the morning of the release of the National Audit Office’s report on the NHS National Programme for IT (NPfIT), even my favourite BBC Breakfast news presented by the elfin Sîan Williams and the grounded Bill Turnbull could not resist a ranging shot: the NAO report would “criticise” the NHS IT project.

Continue reading "Changing the System: NAO’s report on the NHS IT project" »

Posted by Colin Jervis, Kinetic Consulting at 11:33 AM | Permalink | Comments (2) | TrackBacks (0)

Lord Warner announced last week that NHS Connecting for Health’s National Programme for IT (NPfIT) was likely to cost closer to £20bn than the much-quoted £6.2bn. This has brought out the emotive in journalists and the hoped for response from some members of the Public.

Continue reading "NHS: back to quill pens and ledgers?" »

Posted by Colin Jervis, Kinetic Consulting at 02:53 PM | Permalink | Comments (0) | TrackBacks (0)

Last week, I attended a presentation by David Craig (a pseudonym) who wrote Plundering the Public Sector, which criticises the cost, justification and management of NHS Connecting for Health's National Programme for IT (NPfIT). Book and presentation contain nuggets of wisdom tarnished by uneveness and inaccuracy.

Continue reading "Blundering the NPfIT?" »

Posted by Colin Jervis, Kinetic Consulting at 09:00 AM | Permalink | Comments (2) | TrackBacks (0)

In a recent interview for an article, Honda Motor Europe’s William de Braekeleer told me: “The long term objective of our engineers is to create a robot able to help people in their daily lives. So that is why ASIMO has been designed to walk and move just like us.”

Others have in mind resemblances beyond movement. Android Science in May 2006’s Scientific American describes an honest-to-goddess android called Repliee Q1Expo that looks like a thirty-something woman. To create it, Hiroshi Ishiguro used silicon rubber and polyurethane to cover the metal armature and Japanese newscaster Ayako Fujii as his model.

Continue reading "Scientific Metamorphoses: robots resemble humans" »

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In 1995 I visited the exhibition in London's Tate Gallery of the (infamous) Turner Prize shortlist. Stepping into the darkness of Mona Hatoum's installation Corps Etranger I watched a video journey through her intestine and other bodily passages. Today she could avoid the discomfort of the endoscope in the interests of Art by using the multi-vitamin-pill sized Smartpill®.

When swallowed, SmartPill records its trip through the digestive tract using its battery of on board equipment and sensors, like a thermometer, pressure gauge and acidity meter.

Unlike the miniaturised submarine carrying Raquel Welch et al in the 1966 movie Fantastic Voyage, SmartPill is propelled by peristalsis. When excreted 24-48 hours later, a doctor downloads its data in less than 10 minutes and analyses them, a process which could transform the diagnosis of conditions like dyspepsia, constipation and irritable bowel syndrome.

For more see Roger Dobson's article in the UK's Daily Mail of 25 April 2006 or visit SmartPill Corp's website.

Posted by Colin Jervis, Kinetic Consulting at 01:14 PM | Permalink | Comments (0) | TrackBacks (0)

I am a big fan of Idries Shah’s tales of the Sufi wisdom of Mulla Nasrudin. Here is one of my favourites:

One night a neighbour found Nasrudin down on his knees looking for something under the street light: "What have you lost, Mulla?"

"My key," said Nasrudin.

After a few minutes of searching, the other man said: "Where did you drop it?"

"By my house."

"Then why, for heaven's sake, are you looking here?"

"There is more light here."

A veteran of a Hospital Process Redesign, I remain an advocate of transforming healthcare with IT. So, I enjoyed consultant vascular surgeon Simon Dodds’ book Three Wins, which recounts his experience at the Good Hope Hospital, Sutton Coldfield, UK of developing the Leg Ulcer Telemedicine (LUTM) Service.

Continue reading "Winning Ways: transforming healthcare using IT" »

Posted by Colin Jervis, Kinetic Consulting at 07:15 PM | Permalink | Comments (1) | TrackBacks (0)

Simon Dodds is a Consultant Vascular Surgeon. He refers to the debate reported in this FHIT entry. I am posting this extract from an email he sent me with his permission.

With my clinical head on I rant about the informaticians that never actually come and see what frontline healthcare delivery entails, never experience for themselves what the problems are, or help tease out the information requirements from the rest of the process (i.e. write the information requirement specification), then offer simple, workable, quick, cheap options based on existing technology, then help choose the most viable options, then quickly design and build prototypes that are usable, then test options and find those that actually work better than what we were doing before, then implement the best seamlessly so we never really even notice it's there (until it goes away and we suddenly realise we can't do without it).

Continue reading "Views of a Hybrid: clinician and informatician" »

Posted by Colin Jervis, Kinetic Consulting at 07:00 PM | Permalink | Comments (1) | TrackBacks (2)

I am perplexed. Will we ever find the right input device for clinicians? The ones we have are too big, too small, too slow, too unreliable, too nickable or may carry bugs.

Continue reading "Healthcare Input: mission impossible?" »

Posted by Colin Jervis, Kinetic Consulting at 08:58 PM | Permalink | Comments (2) | TrackBacks (2)

In January, delegates at a conference at the the Regenstrief Institute Inc. discussed Relationship Centred care and how important it is to success. The conference considered the interactions of the healthcare team, the patient and the patient’s relatives and friends. But a more virtual relationship is increasing in importance.

Continue reading "Evolving Medical Relationships" »

Posted by Colin Jervis, Kinetic Consulting at 08:00 PM | Permalink | Comments (1) | TrackBacks (0)

I have just come back from visiting my Mother, who lives in the north of England. On the outbound train I found myself sitting next to a recently-qualified GP, and we talked about primary care. I explained to Helen (let’s call her that) I thought using IT for remote monitoring would be the key to healthcare in Britain’s aging population. She thought that closer communities and families were needed.

Continue reading "Close Communities or Remote Monitoring?" »

Posted by Colin Jervis, Kinetic Consulting at 03:19 PM | Permalink | Comments (3) | TrackBacks (0)

Peter writes for FHIT as a guest author

I was working with a group that provide call centre services for the NHS Choose and Book system a few weeks back. Casually I enquired: “Do patients exercise choice when asking for health services?”

The person I asked appeared to swell a little and then launched into a bit of a rant:

Continue reading "Patient Choice: nightingale or nightmare?" »

Posted by Colin Jervis, Kinetic Consulting at 01:53 PM | Permalink | Comments (2) | TrackBacks (0)

At a conference last week in London, UK “Successful Implementation of NPfIT 2006” engaging clinicians in the National Programme for IT was brought up time and again by speakers: let's engage them, let's involve them, let's get them on board—phrases that to me are meaningless shibboleths. I do not want to involve them at all.

Continue reading "Forget Clinical Involvement" »

Posted by Colin Jervis, Kinetic Consulting at 08:00 PM | Permalink | Comments (3) | TrackBacks (0)

Those of you who have been visiting regularly will know this topic is a hobby horse of mine. Often, healthcare finds an operational problem, and instead of addressing it by changing human activity (which is difficult) it decides to buy a computer (which is easy) hoping that it will sort everything out. Invariably the IT makes matters worse or creates a new set of problems.

For an example of IT in action, please read this account on HHN Most Wired of a man who took his son with meningitis to a US hospital: “A Patient's View of Health IT”.

Now, of course, there is no excuse for poor customer service. Healthcare in UK is different from that in the US, and, in the main, I have had few problems with it. Most of my irritation is caused by long waiting times and administrative processes that often seem to be for the benefit of staff rather than the patient.

However, I guess what I should be concerned about is outcome. After all, poor processes and old-fashioned buildings are much less important than a first-class outcome. The National Patient Safety Agency in the UK in “Right Patient, Right Care” (PDF) identified a 10 percent mismatch between required and delivered treatment for the UK's annual 8m inpatients.

Is that mismatch symptomatic of broken processes? And, if it is, will the deployment of the National Programme for IT's (NPfIT) information systems make them better or worse? I remember reading this on a poster in an office:

“We all make mistakes that's very true indeed,
But to really mess things up a computer's