June 02, 2013

Process and Outcome

It's years ago, but I still remember the reception I received when during my first large-scale NHS IT implementation I suggested that doctors might like to record outcome information. I can still recall the smell of my singed fingertips. Until recently, the NHS has been obsessed with recording process data fitting an organization with its roots still in the mid-twentieth century.

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May 01, 2010

HC2010 Conference: sitting uneasily?

Doubling the quality of thinking on the podium of the opening plenary session of HC 2010, veteran Professor Heinz Wolff arrived late and stole the show.

After listening to the platitudes and threadbare academic definitions of the three previous speakers, octagenarian Professor Wolff hobbled across the stage on crutches, followed at a respectful distance by a cushion for his rear carried by the session chair, and applied his razor sharp mind.

The UK's aging population would ensure healthcare became unaffordable, so it would be split into acute and community care, he suggested. Acute care, treating and operating on disease, would be the job of the NHS. Community care, watching out for your neighbours and helping to care for them, the job of the local community. To fund your own community care, you would acquire credits throughout your life by good deeds and community service. Agree or not, at least it was insightful and stimulating.

Which is more than can be said of Dr. Ben Goldacre's after dinner speech that evening. Delivered at the rate of the 36 barrel Metal Storm gun, his speech was too clever, too factual and too long. After 15 minutes I watched Blackberry ® smartphones (yes, I did look up the plural) being unsheathed and eyelids drooping.

But any who did drop off were galvanised to wakefulness by the first chord of Helter Skelter's set, so potent it immediately drove guests at the tables nearest the stage to the exit with the rest of us soon following. 'Was the enterainment no good?' asked one of the cloakroom staff as I left for my hotel 40 minutes later. 'About 200 people left all at once.' The band was very tight, I assured him, but their music inappropriate and too loud.

Though it has been relocated, recovered with go faster stripes and refitted with stereo headphones, the comfortable old chair that was the HC conference stands unsteadily.

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.

September 29, 2007

Lands of Opportunity

Picture of the old fort at DubaiIt's two months since I last posted. Holiday, work pressure and, well, lack of inspiration are my excuses.

I attended the Information Technology in Healthcare congress in Abu Dhabi in early September 2007 and gave a workshop on Successfully Implementing Hospital Information Systems.

Now, I used to tour the Gulf regularly several years ago but the changes that have taken place are amazing. Dubai now has a commercial infrastructure set to rival Hong Kong. One of the delegates described the aspiration of Dubai Healthcare City to become a regional centre of excellence.

But even after a 7 hour flight to an entirely different culture some things don't change. Conference delegates described the challenges of implementing healthcare IT: clinician indifference, underperforming suppliers and the retention of skilled staff. Sound familiar?

But the Gulf countries do have advantages most countries in the Europe do not: fewer legacy IT systems and legacy notions of how healthcare should be conducted—which gives them a fantastic opportunity.

June 25, 2007

Evolution and Revolution

Picture of cogsWhile in a secondhand bookshop at the weekend I picked up John Gall 's book Systemantics. In it he describes the seductive nature of systems, which promise to do a hard job faster and more easily, but once set up take on their own life, growing and encroaching and eventually even opposing their own function.

Technological and demographic forces mean heathcare systems like the NHS cannot avoid major disruption. But, in another small book, Bodil Jonsson says: "All disruptive changes have at least one effect: they upset people."

Perhaps with that in mind both the Secretary of State for Health, Patricia Hewitt, and the Leader of the Opposition, David Cameron, speaking at last week's NHS Confederation Conference in London tried to soften the blow. Mr. Cameron promised "evolution not revolution". Though the phrase has a nice rhetorical ring, it means more change. Bodil Jonsson also says: "The most effective way of changing the future is to create a new system of thought." Perhaps that's what healthcare needs.

June 13, 2007

Past and Future

dinosaur.jpgWatching BBC's The Apprentice yesterday was like witnessing a flock of newborn mammals being ambushed by a pack of corporate dinosaurs. Fortunately, "alpha female" Katie dented the onslaught by telling Sir Alan Sugar what he could do with his job. Enough of Jurassic age recruitment techniques.

Health IT conferences in the UK are in a period of evolution. Attendances have fallen, probably not helped by the troubled and uncertain progress of NPfIT. I attended the Smart Heatlhcare 2007 exhibition yesterday. It was a large conference with exhibitors ranging from furniture and office equipment to IT and telecomms suppliers; though I am not sure the mix of suppliers and attendees was entirely felicitous.

I also attended talks by BT's Patrick O'Connell and Connecting for Health's Richard Granger. Mr. O'Connell told us the differences between projects, programmes and large programmes and Mr. Granger seemed in fine fettle as he summarised the achievements of the National Programme for IT. He even had a sideswipe at his old sparring partners the GPs, by suggesting a difference in their enthusiasm for the Choose and Book system, which supports patient choice, and the Quality Management and Analysis System, which supports their income.

March 25, 2007

Observations on HC 2007

On the first morning of the Healthcare IT 2007 conference Lord Hunt, the Minister of State for NHS Reform and the man responsible for NPfIT, spoke. The withdrawal of NHS Connecting for Health's speakers from the conference led many to expect an important announcement--but they were disappointed.

Lord Hunt stressed the importance of healthcare IT in improving patient safety and the quality of care several times. He also stressed the importance of decentralisation and local ownership of the implementation of NPfIT, called the NHS Local Ownership Programme (NLOP), though he did not say what form this would take.

Nor did he say much on NHS CFH's procurement of Additional Systems Capacity and Capability, which will be a catalogue of specialist clinical systems available to the NHS, though representatives of NPfIT's Local Service Providers were listening carefully. You can read another view of his speech on E-Health-Insider.

I chaired a light-hearted debate on the motion : “To increase patient confidentiality, this house believes that patients should retain their own health records”. The motion was carried with a small majority. Though the debate wasn't serious the attitudes of some attendees to the motion were. After the event I was approached by a number of animated people with distinct views on the matter.

Simon Dodds (subject of a previous FHIT entry) spoke cogently about his successful IT enabled transformation of the management of leg ulcers. Simon has a background in computer science and is also a vascular surgeon—a rare combination. Nonetheless, he thought the process of improvement he had applied could be applied by others. He also agreed with me that people are not afraid of change, but of the process of change—which is often poorly effected.

Then We Will Fight in the Shade

Ancient Greek ruins touched by the rising sun.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.

October 22, 2006

Electronic Health Record: different nations, different approaches

view.jpgIn a panel session at last week's International Healthcare Innovation Congress in London speakers from Denmark and Canada spoke about how their nations are tackling the Electronic Health Record (EHR).

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October 11, 2006

Healthcare Innovation Congress

meeting.jpgI am chairing the first day of the International Healthcare Innovation Congress which takes place in London on 17-19 October 2006. Its topic will be health informatics and it has presenters from UK, Canada, France and Denmark. The rest of the congress examines other areas of innovation.

The healthcare innovation market is growing rapidly, with more funding and investment being added. The congress offers a forum for primary and secondary healthcare providers to share and develop strategies to address the changing nature of healthcare delivery.

The UK government is consulting on the proposed white paper Health Outside Hospitals and plans are already in place for NHS services to be contracted out to the independent and private sectors. This fundamentaly affects all healthcare stakeholders and creates fresh opportunities.

You can see a program of the event.

March 24, 2006

Clinicians Thrash Informaticians

On 21 March 2006 the BCS London and South East Health Informatics Group sponsored a lively and light-hearted debate at the HC 2006 conference:

“This house believes that real innovation using ICT in healthcare delivery is driven by clinicians rather than informaticians.”

Simon Dodds and Mark Outhwaite proposed the motion and Ian Herbert and I opposed with Keith Clough in the chair.

I argued that healthcare in the UK was facing illness because of a shortage of cash and qualified staff and an aging population that is likely to lead to an increase in chronic disease. Never has healthcare needed ICT innovation more—but who will provide it?

I tacitly accepted that clinicians and informaticians must work as a MDT, but I was speaking against the motion. I had three main arguments:

  • Clinicians are experts in patient care, informaticians in ICT;

  • Informaticians have a broader view of healthcare than clinicians; and

  • Innovation is not about ideas, it’s about the implementation of ideas.

Cyber means “art of steering” in ancient Greek. Informaticians would be the cyberanauts building the pathways and finding the passages that led to a coherent, patient-centred healthcare system.

All to no avail, I'm afraid! After contributions from the audience—one of whom said he thought clinicians should be leading ICT innovation, and asked why then they didn't get on with it—the motion was carried by 18 votes to 9.

Rod from Informaticopia also wrote an official blog entry on the debate. In addition, Simon Dodds, a Consultant Vascular Surgeon and Innovator, is allowing me to use some comments that he emailed me in an entry to follow.

Reposted by FHIT on 29 March 2006 adding the hyperlink to Simon Dodds' entry.

March 23, 2006

Healthcare IT 2006

I apologise for not posting recently. I spent the first part of this week at Healthcare IT 2006, the annual conference and exhibition in Harrogate UK, listening, presenting and visiting suppliers.

This year the event lacked energy. Major suppliers were missing, as were exhibition visitors—I have never known the halls so deserted. Perhaps the purpose and format of the event must be revised, because it risks falling into terminal decline—which would be a great shame.

In the next few postings I will write about a debate in which I took part and a few interesting things I noticed on suppliers’ stands.

Rod from Informaticopia was at the event and here is his entry in the official blog about a tutorial I gave on RFID in healthcare.