June 22, 2012

Alan Turing Enigma

Picture of the user console of ACEIn 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.

January 07, 2012

Medicine as an Information Science

DNAI 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.

December 28, 2011

Sign of the Times

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.

Continue reading "Sign of the Times" »

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.

Continue reading "Online Antics" »

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.

Continue reading "Punk Rock People Management" »

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.

Continue reading "Informed Patient: how do you know?" »

November 26, 2009

Belle Tolls

My interest was piqued by Clive James' encomium broadcast on BBC Radio 4 last Saturday. He compares her to Rommel and Martin Amis and acclaims her expertise in health informatics (he would know, right?)

Dr. Brooke Magnanti outed herself as the author of the infamous Belle de Jour blog just before the UK's tabloid press did it for her. Despite hyperbolic media speculation about her identity, it turns out she is a previously unremarkable UK healthcare research scientist with a qualification in health informatics.

I have never read the blog (honest!) though I knew about it and had seen the resulting books in Borders. OK, I was a bit envious that someone could make so much money out of blogging, but, I comforted myself, health IT does not have the same mass appeal as sex.

Back to Clive James: though I've read a couple of Martin Amis' novels, I did not enjoy them as much as his other writings and reviews; for example, take a look at War Against Cliche in which his feel for words and general erudition sparkle. No wonder he was named "Smarty Marty". So does Dr. M's writing really compare?

This article describing an autopsy was written under her real name. It describes man after the god has left the machine and even makes a couple of analogies with IT. The image of a cutting scalpel in a curved fist is one that sticks with me. She's good, not as good as Amis, but good.

But the events leading to the denoument form a subplot worthy of John le Carre. A fellow blogger guesses her identity and sets up an early warning Googlewhack on his website. Galumphing newshounds on the cyberscent trigger the alarm. The blogger tracks IP addresses back to Associated Newpapers: the game is up. Before being shoved, Dr. Magnanti steps out of the shadows. You can read all about this from
the blogger himself (under Me and Belle de Jour...).

The veil of Internet anonymity has been sliced open, what now? Well, placing your life (fact or fiction) into the public domain on the Internet can affect your health. No-one will regard you in the same way again.

November 04, 2008


forest.jpgWhat can you say about a man who had two lives?

After the D-Day landings in 1944, Bil was on reconnaissance in Normandy prodding the positions of the retreating German army. While on high ground the scout car he was in was struck by a shell from a battery manned by a small group of recalcitrant German officers. That was the end of the line for the rest of the crew, but Bil was blown clear suffering a shrapnel wound to his foot.

In his second life he went on to exploit his love of Nature as a Landscape Architect, becoming a driving force in the restoration of the historic gardens at Hestercombe and at many other sites.

At a celebration of his life in a Sussex country church his friends and family heard about these and other achievements on the golf course and as a talented writer. It says much for someone when the people who knew him will travel hundreds of miles to pay their respects.

Live, love and leave a legacy: I can hope to achieve as much. Make sure you tell your loved ones how much you care and appreciate them before it is too late. It's the best health information technology we have got.

No more my heart shall sob or grieve. My days and nights dissolve in God's own Light. Above the toil of life my soul Is a Bird of Fire winging the Infinite.

Sri Chinmoy

October 26, 2008

Strong Medicine?

Ben Goldacre’s Bad Science has had excellent reviews. Read some of them on Amazon. I also enjoyed it, but I found myself more interested by what it doesn’t say.

Sure, Dr. Goldacre does a good demolition job on homeopathy, nutritionists and media cover of MRSA by turning the laser of critical thinking and science on their claims. He also gives a good summary of the scientific approach to medicine, asserting the importance of the proper construction of medical trials with randomisation and the maintainenance of proper controls--though to those who, like me, studied science none of that is news.

Dr. Goldacre is also big supporter of evidence-based medicine, which he says has saved millions of lives. He doesn’t give any evidence for that, but we can believe it to be true. In the chapter entitled Is Mainstream Medicine Evil? we find this:

Doctors can be awful, and mistakes can be murderous, but the philosophy driving evidence-based medicine is not.
Let’s not worry about the odd cast of this sentence and assume he means: medicine is sometimes bad, EBM philosophy isn't.

In the same chapter he tells us about 13 per cent of all treatments have good evidence, and a further 21 percent are likely to be beneficial. A bit low, so he tries again. Ah, but if we look at how much medical activity is evidence-based that rises to 50-80 percent. Depending on how you interpret this and the method by which these figures were derived, that means a large chunk of medical practice has no evidence underpinning it.

In response to Archie Cochrane's call for up-to-date, systematic reviews of all relevant randomized controlled trials of healthcare, the Cochrane Collaboration was founded in 1993--perhaps the real birth date of EBM. But what happened before that?

OK, you say, we are where we are. So let’s not bother with what happened before. We are now flowing into an enlightened era of more scientific medical practice. Or are we?

We really do need to understand why the scientific approach seems to have been marginalised in medicine, because Sue Dopson’s Knowledge to Action? Evidence-Based Healthcare in Context suggests the flow to an enlightened era is turbulent. Interdisciplinary tensions, over assertive practitioners and the subjective conversion of evidence into practice make for erratic progress, it seems.

No matter how strong the philosophy of EBM may be it's in the integration into practice where the real patient benefits of it lie. Rather than trashing questionable reasoning in other practices, maybe Dr. Goldacre should redirect his laser logic onto that challenge. After all, conventional medicine is where most of us seek health care and where a substantial chunk of our taxes is spent.

June 28, 2008

Healthcare: plagiarism and expertise

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 wriggled 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?

February 07, 2008

Health Informatics and Science

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".

December 07, 2007

Got Them Healthcare Blooze: motivation the rock’n’roll way

Picture of leaping guitarist.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.

December 03, 2007

Where the Horlicks is Sweet

Picture of the sea.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.

October 11, 2007

A Question of Identity

fingerprint.jpgI have been working on identity management recently. It’s a Tír na nÓg for techies: tokens, certificates, assertions, authentication. But the real challenges may have more to do with human processes than technical ones.
Recent workshops suggest the biggest problems may be in user management and the granting and revocation of access rights.

The NHS has implemented high levels of security with its use of smartcards based on chips with high levels of PKI encryption and sound processes for user registration and authorisation. But this article shows how users can still thwart security, in this case by remaining logged in and allowing colleagues to use their access rights.

Gerald M. Weinberg says (I probably misquote): all problems are people problems. Perhaps one day someone will come up with an incompleteness theorem like Kurt Gödel’s: that confirms no matter how sophisticated IT becomes users will always break the system.

July 26, 2007

Robots: the marrying kind?

At a recent conference a woman studying Health Informatics in London told me she'd seen this blog: "Oh yes, its about robots, isn't it?" Which probably means I have to make my intention clearer. Nonetheless, I can't deny a passion for them since reading about them as a child in old copies of the Eagle Annual I bought at a church jumble sale. So, at the risk of missing my intention, here are a couple of articles I spotted.

Professor Rodney Brooks talked about domestic and military robots in his RSI lecture for the British Computer Society. Prof. Brooks reckons that we are at the beginning of an exponential growth in the use of robots, partly driven by an aging Western population and our likely need for replacement body parts.

I also remember as a child reading a satirical SF book which somehow remains in my mind called Bill the Galactic Hero. Bill becomes a hapless hero when he accidentally destroys a Chinger command ship in a space battle. The Chingers are vilified by the humans who post questions on the decks of their space vessels like: "Would you let your sister marry one?" But another robot article I spotted in London's Metro might cause you to ask: "Would I be married by one?"

"Yes" is the answer of robot designer Seok Gyeong-Jae. Tiro the robot recently officiated at his wedding in South Korea.

July 22, 2007

Back to the Future

Some progress in healthcare can be helped by IT and technology and some can’t.

In the mid 19th Century Ignaz Semmelweis showed handwashing reduced cases of puerperal fever among new mothers. But newly published figures for care homes in 2005 make me wonder how far we have progressed. Clostridium difficile was mentioned as a cause of death in 144 cases.

In a low tech approach to reducing the march of superbugs like MRSA and c. difficile in UK hospitals, the Chief Medical Officer Sir Liam Donaldson suggests patients should ask doctors if they have washed their hands. This is yet another example of the need to inform and empower patients.

Read Death toll from 'superbugs' is soaring for some background.

November 16, 2006

Blogging and Healthcare

Dale Hunscher (who runs the US cousin of this site) has written a book: Blogging for Health Professionals Using TypePad: a jump-start approach. The Internet fundamentally changed the relationship between patient and clinician and blogging is a way for healthcare to adapt. More than ever clinicians and healthcare organisations need to build trust with their customers, and the use of social software, like blogs, is a way to do it.

Dale tells healthcare practitioners how to set up a blog on Typepad that will build their reputation and attract customers. Each stage of the set up is clearly described and once your blog is up and running he tells you how to drive visitors to it.

Dale sells Blogging for Health Professionals Using Typepad as an eBook, which means it's less expensive and you can download and read it now .

July 13, 2006

Breathe Easy: testing breath for disease

A mobile phone carrying a breathalyser is about to be launched in the UK the Sunday Times on 9 July 2006 reported. The Samsung LP4100 tests drinkers's fitness to drive and may also lock out certain numbers to prevent embarrassing drunken calls to bosses, former partners or the local takeaway. The phone is multifunctional, even offering a remote control for karaoke machines.

I also spotted this article about a breath test for metabolites asssociate with breast cancer.

Lack of testing and diagnostic devices not needing specialist intervention have limited remote monitoring and the development of carebots, but that's changing fast with breath testing a promising area.

July 05, 2006

Future Health IT--Not

Picture of water.I have just written an article on convergence in healthcare. I interviewed a director of a major software company (I will post more when the article is published) who reminded me that most healthcare companies have concentrated on developing products for 1 billion of the world's population; 5 billion in the developing world have, by and large, been neglected.

I spotted an article in London's Metro newspaper about a device costing £1.50 (less than $3) that prevents deaths from water borne bacteria and viruses causing typhoid, cholera and diahorrea. Half of the world's poor suffer from water borne disease.

Lifestraw uses a slalom of filters to purify water and has been used in Asia, Africa and South America.

Off topic and low tech, I know--but effective.

June 17, 2006

FHIT for the News

This blog is mentioned today in an article about the business benefits of blogging on the UK's Daily Telegraph website.

I have also joined the blogging team at Healthcare Today a new website that should appeal to all healthcare professionals. On the home page you can download a free version of the publication, register or subscribe.

May 10, 2006

Future Health IT in the News

FHIT is reviewed by Healthcare Today. You can download free a PDF of the April 2006 edition here. The review is at the bottom of page 21.

May 05, 2006

Sounds Healthy: iPOD in healthcare

On the London Underground everyone seems plugged into one. Even above ground in healthcare MP3 players are becoming ubiquitous.

Continue reading "Sounds Healthy: iPOD in healthcare" »

May 01, 2006

SmartPill® Tracks Your Tract

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.

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 05, 2006

Help on Debate Requested

I taking part in a debate at the Health Care 2006 (HC 2006) conference in Harrogate, UK on 21 March 2006. The motion is:

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

I am speaking against the motion. If anyone has any ideas, arguments, interesting or amusing anecdotes for me to use, I would be pleased to read them.

March 01, 2006


Shocking, but there are two Future Health IT Blogs! Dale Hunscher made his first entry shortly before me, but I started regular blogging a bit earlier. Fortunately, Dale deals with the duplication in magnanimous style in this entry.

I am relieved our chosen areas differ. Dale concentrates on biomedical research informatics technology and you should pay a visit to his site.

February 16, 2006


keyboard.jpgWhy QWERTY? Why indeed.

This keyboard layout was designed in 1874 by Christopher Scholes. An alphabetical layout caused the machine's levers to jam, so he positioned the most frequently used letters as far apart as possible. To assist salesmen to demonstrate, Scholes craftily arranged all of the letters needed for the word "typewriter" to be in the top row.

I think this is an awful input device. I have been using it for many years and learned to touch type when I was completing a Masters dissertation. Time and again I watch users hunting and pecking their way across the keyboard. Imagine the time wasted in this painful process.

This article on Slashdot refers to a Swedish study that shows that the keyboard is a bacteria farm. It is inhabited by 33000 bacteria per square centimetre, compared to 130 on a toilet seat.

Covering a keyboard makes it easier to clean, important in these times of super bugs like MRSA. But what about ridding ourselves of it altogether? It's time for FHIT to look at other methods of data input.

February 15, 2006

FHIT Makeover

Regular visitors will notice that FHIT has had a makeover. We hope you like it. If you notice any problems or glitches please let us know. We hope you enjoy the site and will continue to contribute with your comments.

January 30, 2006

Reposting for Eyeforhealthcare Delegates

This is a re-post of three entries about the increased mortality reported in “Pediatrics” after the implementation of a Computerised Physician Order Entry System (CPOE) for the convenience of delegates at the “Successful Implementation of NPfIT 2006” in London. These entries relate to discussions during the sessions I chaired on 30 January 2006.

First entry on the Pediatrics article.

Second entry on the article.

Third entry and link to post-publication peer review.

Links to other relevant blogs and websites are in the postings.

December 19, 2005

Disaster planning: how simulation and aggregation help

At this time of worry about a possible flu pandemic and terrorist attacks its good to know that computers are helping medical staff to prepare.

This article Bits and Bytes: Video Games and Disaster Training describes how gaming software is being used to prepare staff to deal with major incidents.

In the December 2005 edition of "Wired" (p208) "Reinventing 911" describes how a community in Portland Oregon has improved its emergency services.

No matter how much we plan, disasters are addressed by intelligent improvisation. In order to be effective and overcome the human tendency to pause before acting, warnings must not be seen as single events but as a series of triggers for actions by informal networks.

The Emergency Digital Information Service (EDIS) aggregates weather forecasts, alerts and official warnings into a single database which can be transmitted to police, emergency centres and television newsrooms.

A common alerting protocol (CAP) tags events by location and urgency, allowing emergency services--police, firefighters and paramedics--to share information in a common format and to filter it according to its relevance.

December 16, 2005

Digital Paper: pulp fact

Good news for bibliophiles, technophobes and cynics: digital paper is a reality and the "paperless" hospital might never be.

This article in the Guardian describes the "Librié" a new product from Sony, Phillips and E-Ink.

Charged black and white microcapsules in oil line up in response to an electronic charge to form words on a screen. The Librié can hold the equivalent of 10,000 pages, about 40 novels, which can be reloaded. The boot of a Consultant's 4x4 may never have to be full of patients' notes again! (Only joking, guys!)

Digital paper is already used for in store displays that can be refreshed by wireless links.

However, Siemens has developed paper thin displays that could replace conventional labels. Walking down the isle of the supermarket could soon be like strolling around Piccadilly Circus as the labels of goods present us with changing, alluring images and displays.

And, don't we already have e-books on PDAs and displays that respond to digital signals? Oh, and where do those digital signals come from? Computers?

Though I love gadgets, it's difficult to see what more digital paper offers. It may be yet another solution looking for a problem. Suggestions for healthcare applications on white pulp or (better) in the "Comments" section below, please.