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

Artefact Informatique, a Canadian division of IBM, will be part of a new initiative to share health information with patients and doctors around the globe. This has begun with the creation of the Centre of Excellence in Quebec City, which acts as a repository and registry for healthcare information. It is through the Centre that authorized personnel can search and retrieve important documents, thus improving the efficiency of many patients' medical care.

The Centre of Excellence contains lab reports, digital images, drug profiles and other critical medical documents. This repository was created with IBM WebSphere and DB2 software and was designed to be easily compatible with commonly used Electronic Health Record (EHR) systems. Health facilities that are now using EHR technology should be able to communicate with IBM's new software.

IBM has instituted this new technology as a part of the Integrating the Healthcare Enterprise (IHE) initiative, which aims to improve the way information technology is used within the health community. Primarily, it is making the world safer for patients by keeping better medical records for easier transfer.

Says Jose Mussi, the executive director of IHE Canada:

It has been shown many times that systems using IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively. Physicians, medical specialists, nurses, and other care providers have been waiting for the day when vital information can be shared seamlessly regardless of where they are or which system they are using. That day is now.

The new software took three years to develop and was created by researchers and software engineers from Haifa, Israel; Rochester, Minnesota; and San Jose, California. IBM is now promoting the system for more widespread use.

Heather Johnson is a regular commentator on the subject of CNA Certification. She welcomes your feedback and potential job inquiries at heatherjohnson2323 at gmail dot com.

Posted by Colin Jervis, Kinetic Consulting at 02:49 PM | Permalink | Comments (0) | TrackBacks (0)

A few weeks ago the BBC's Click programme showed us the possibilities of technology in health. PACS and voice recognition at the Countess of Chester Hospital; Radio Tagging of equipment at Bristol Royal Hospital for Children, in fact examples of what you read about on this site, and that made me sad.

No, not because the examples broadcast were poor. Not at all. But because it reminded me (yet again) of the difference ICT can make to healthcare but the slowness of its adoption. The Royal Berkshire Hospital in Reading, where I once worked, implemented PACS and voice recognition 6 years ago. Nor was it the first hospital to do so, with others like the Hammersmith near London already having led the way.

Seen all at once the examples in the Click broadcast give the impression of a high tech NHS; in truth, it is far from it. However, to challenge the funereal pace at which healthcare exploits ICT, perhaps we need some pilot sites where all of these technologies are embedded into business as usual that would serve as an example to the rest of the NHS.

Those hoping for the National Programme for IT (NPfIT) to help quicken ICT adoption would have been further disappointed by the UK National Audit Office's report this week. The report suggests that the NPfIT is running 4 years behind schedule and will not be implemented (whatever that means) until 2015 (if then). Many will once again be asking whether systems specified 3-4 years ago and targeted for implementation in 6 years may be obsolescent, not to say obsolete.

Posted by Colin Jervis, Kinetic Consulting at 09:36 AM | Permalink | Comments (0) | TrackBacks (0)

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".

Posted by Colin Jervis, Kinetic Consulting at 02:09 PM | Permalink | Comments (1) | TrackBacks (0)

This morning the BBC followed up previous reports on the summary care record pilot in Bolton. The piece was generally supportive, but the customary GP expressed concerns about the security of information on a national system compared to that held locally.

Such concerns are not fully addressed by technical security, as I have previously argued, secure human systems are also essential. When I was young the escapologist Harry Houdini was a hero of mine. When asked why he found it so easy to escape from the most secure of safes, he answered it was because they were designed to prevent people from getting in not getting out. Recent events show even though getting in to secure IT systems may be difficult, taking large amounts of data out is not.

People need to decide if the benefits of an online record outweigh the risks and in the Bolton pilot they can opt out if they think they do not. But eventually we should all be given sufficient information to make that decision ourselves.

Some may want their GP to be their advocate in such matters, and some may not. When I registered with my GP I was not given an option to opt out of having my information stored locally on his IT system, which at least 7 other people in the practice can access.

Also read this article in the Manchester Evening News about the theft from the Royal Bolton Hospital of patient-based information on a local computer.

I wish you a happy and successful New Year.

Posted by Colin Jervis, Kinetic Consulting at 01:47 PM | Permalink | Comments (0) | TrackBacks (0)

The BBC reports this morning that a number of NHS trusts have admitted losing patient-based information that seems to have been carried on CDs and memory sticks.

It's a sad indicator of the sophistication of UK healthcare IT that it still needs to transfer confidential data by what the US calls "sneaker net" and has only recently been able to transfer computer records electronically between GP practices.

Higher levels of technical security on the planned National Care Records Service should make NHS data more secure, but, as I have said before, technical security takes us only so far and must be underpinned by secure human processes. Recent events suggest we have some way to go.

Not a long way to go to Christmas day, though, so I wish you a joyful and peaceful time.

Posted by Colin Jervis, Kinetic Consulting at 08:46 AM | Permalink | Comments (0) | TrackBacks (0)

I have asserted the rapid adoption of wireless technologies will be a potent force for change in healthcare. In South Africa only 1 in 100 have broadband and remote areas may not even have telecommunications.

An episode of the BBC's ClickOnline this morning described how an AIDS clinic in the rural community of Peebles Valley is exploiting wireless to improve care. Clinic and a hospice are several kilometres apart and find it hard to communicate because of the hilly terrain. They have solved this problem by using a network of antennae inserted into tin cans, which focus the full power of the wireless transmissions giving the WiFi network added range.

Nurses and doctors now access the patient database and communicate using Voice over IP (VOIP).

Read the full article on the BBC site.

Posted by Colin Jervis, Kinetic Consulting at 10:07 AM | Permalink | Comments (0) | TrackBacks (0)

SignHealth helps GPs to communicate with deaf patients who use British Sign Language (BSL). Also a team of interpreters work at partner company SignVideo and can be booked by a GP's receptionist. The basic SignHealth programme gives immediate access to BSL translations using short video clips.

Here is a guide to BSL. No doubt someone will tell me the picture is American Sign Language :(

Posted by Colin Jervis, Kinetic Consulting at 04:51 PM | Permalink | Comments (0) | TrackBacks (0)

In a previous entry I drew an analogy between developments in weaving and the introduction of IT into healthcare. In Jacquard's Web I read:

“The real problem was that the drawloom was not a machine at all. Instead, it was only a device for facilitating the manual weaving of patterns or images in the fabric...”

Facilitating the manual weaving... The status of Healthcare IT is somewhere between an abacus and a calculator. This is why I find it interesting when academics and others claim there is little evidence of its value.

Some of you may remember a controversial study on the introduction of a CPOE system that suggested it had led to a sharp increase in mortality. You can follow the resulting exchange by following the links here. When the dust settled the most satisfactory explanation for the study's results was the system had been used and implemented poorly.

John Glaser's article IT is Not an Intervention summarises the situation nicely. At this stage in its evolution, healthcare IT does not carry out direct, independent patient care. Its success depends on a complex of factors, not least of which is the competence of the people implementing it.

Posted by Colin Jervis, Kinetic Consulting at 05:00 PM | Permalink | Comments (0) | TrackBacks (0)

Though γνωθι σεαυτόν (Know Thyself) was written on the gates of the Delphic Oracle, I don't think using Phillips Brilliance CT machine was what the ancient priests had in mind.

I spotted some of the machine's images on Monday in an article in the London's Metro. The Brilliance machine produces 3D images, yet reduces a patient's exposure to radiation.

Phillips Medical Systems predicts the machine will change the way Radiologists work—it can even see into your heart and capture an image of it in two beats.

Posted by Colin Jervis, Kinetic Consulting at 01:48 PM | Permalink | Comments (0) | TrackBacks (0)

"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.

Posted by Colin Jervis, Kinetic Consulting at 08:11 AM | Permalink | Comments (0) | TrackBacks (0)

I 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.

Posted by Colin Jervis, Kinetic Consulting at 06:30 PM | Permalink | Comments (0) | TrackBacks (0)

Google has set up a panel of experts to enhance its ability to respond to those of us seeking health information: Google Establishes Panel Of Health Care Experts . The ready availability of healthcare information has shifted the clinician patient relationship irrevocably. Now some doctors even encourage patients to become better informed and to challenge diagnoses.

One such is Jerome Groopman who in How Doctors Think tells of Rachel who adopted baby Shira in Vietnam. US doctors held Shira was suffering from SCID, an acronym for severe combined immonodefficiency disorder. Rachel researched SCID and was unconvinced. She thought Shira had a nutritional deficiency and insisted tests were redone. Rachel was shown to be right.

Posted by Colin Jervis, Kinetic Consulting at 06:38 PM | Permalink | Comments (0) | TrackBacks (0)

Though I had Salvador Dalí posters plastered to my bedroom walls at University, my passion for his work cooled. However a visit to the Dalí & Film exhibition at London's Tate Modern has warmed it again.

I was particularly engaged by Destino a short film sketched out by Dalí and Disney in 1946 and only completed in 2003 after both of them had died. It's a blend of Dalí and Disney clichés: ants that morph into Sisyphean cyclists carrying rocks on their heads and two chiseled lovers separated by walls are reconnected by flocks of birds.

With his friend Luis Buñuel, Dalí also created the visceral and influential surrealist film Un Chien Andalou. The film's weird(est) actor resembles Buster Keaton, perhaps not surprisingly because Dalí and Buñuel loved the silent comedies.

Keaton also made Electric House about the havoc wreaked when modern technology is installed in an old house...(!)

Posted by Colin Jervis, Kinetic Consulting at 08:51 AM | Permalink | Comments (0) | TrackBacks (0)

TV psychiatrist Professor Raj Persaud reports* the National Institute for Health and Clinical Excellence (NICE) has recommended making computer-based treatments for anxiety and depression more widely available. He argues this may be seen as another effort to reduce cost rather than meet patient needs. After all, patients want to be seen as individuals and prefer a person to a chip.

I’m not so sure.

In 1995 while researching for a MBA I came across some relevant research into the use of expert systems (considered part of artificial intelligence). Many patients who had consulted an expert system called ELIZA that did little more than ask reflective questions—for example: “Tell me more about…” or “What do you mean by..?”—responded positively. One woman left in tears saying she had never before met someone who understood her so well. Try some therapy from ELIZA.

In 2004 Whitfield and Williams asked: If the Evidence is so Good, Why Doesn’t Anyone Use Them? Surprisingly only about 5 percent of cognitive-based therapists were using computer-based self help as an alternative to face-to-face contact.

Today, if it comes to a choice between a highly personalised computer program, available day and night with no waiting list or 40 minutes with a busy human practitioner, I know which I prefer, Professor Persaud.

*Health Service Journal, 24 May 2007

Posted by Colin Jervis, Kinetic Consulting at 02:07 PM | Permalink | Comments (2) | TrackBacks (0)

Surgical robots are putting themselves about.

A fantastic experimental robot is reviewed in 24 April 2007 New Scientist. The Heartlander is inserted using a minimally invasive technique. It then attaches itself by evacuated suckers to the heart and inches its way across it concertina like injecting medication and attaching devices. You can read the article and see the device in action here.

Meanwhile, aquanauts on the NASA NEEMO mission are experimenting with telesurgery using robotic arms.

Posted by Colin Jervis, Kinetic Consulting at 09:54 AM | Permalink | Comments (0) | TrackBacks (0)

New Scientist (5 May 2007) describes transgastric surgery—a technique pioneered in India that passes surgical tools and a camera through the patient’s mouth to operate on their abdomen. The article ends with:

“Historically surgery is notorious for following fashions and ignoring evidence--to the detriment of patients....”

In an article on the 21 May 2007 A Helping Hand for Keyhole Surgery New Scientist describes a three-fingered hand researchers at Tokyo Institute of Technology have developed that is assembled inside the patient. Professor Sir Ara Darzi (that man again) endorses the novelty of the idea, because until now surgical toolmakers have concentrated on making keyhole surgery instruments smarter and more articulated.

Regular readers will know of my passion for the full integration of IT with patient care. At the moment IT comes later or is considered nice to have. We should build our care processes with IT on the inside rather than making it smarter on the outside. Then maybe we will have the evidence to underpin improvements to surgery and care.

Posted by Colin Jervis, Kinetic Consulting at 12:55 PM | Permalink | Comments (0) | TrackBacks (0)

I have been reading FierceHealth IT's website that has been making awards to hospitals for innovation. I was taken by Licking Memorial Hospital that since 1999 has been publishing quality information—good and bad—for 12 clinical specialties, including cardiology, chronic heart failure, maternity care, respiratory care and diabetes care. By addressing its failures openly it has turned this process into competitive advantage.

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)

Given healthcare's dilatory acceptance of IT it may be customers who force the pace. I received an email about a newly launched website: www.whoissick.com. It uses Web 2.0 technology to generate user content displayed through a simple Google Maps interface.

The website started in 2006 after the founders' poor experience with health services in the US with a mission to "provide current and local sickness information to the public - without the hassle of dealing with hospitals or doctors". The founders believe in the power of user generated content about local sickness.

Note: FHIT is not accountable for the content of other websites.

Posted by Colin Jervis, Kinetic Consulting at 03:31 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)

I have been occupied with work outside healthcare and it may be true what they say: distance enhances review. What I notice is how quiet the sector seems. Even the ever-alert E-Health-Insider is reduced to writing about the lifting of bans on mobile phone use. Nor am I the only one to comment on this. I have also come across a number of healthcare consultants taking similar time out. All mention frustration and lack of progress in the sector.

Has the leviathan that is NPfIT cast a giant restraining shadow over healthcare IT? A colleague recently described the situation as 'planning blight'. But it reminds me of a passage from Lord Macaulay's poem "Horatius at the Bridge" that my class read with Mr. Walker when I was about 11: "But those behind cried ‘Forward!’, and those before cried ‘Back!’".

I am preparing to go forward back to Harrogate for the HC 2007 Conference where I am chairing a debate. Last year in the plenary sessions speakers from NHS Connecting for Health hinted at reorganisations. This year speakers from NHS CFH's top team have withdrawn from the conference, generating considerable speculation. Nonetheless, Lord Hunt the minister in charge of NHS CFH's NPfIT will be speaking. Many will listen carefully to what he says.

Posted by Colin Jervis, Kinetic Consulting at 03:48 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.

Posted by Colin Jervis, Kinetic Consulting at 02:55 PM | Permalink | Comments (0) | TrackBacks (0)

“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)

Technology, shifting demographics and better informed customers will bring about the biggest changes in the NHS's history. But the reorganisation needed to meet the changes may not please everyone.

For example, the UK's Daily Mail described the tension between Nurse Practitioners and GPs at a walk-in centre in Canary Wharf, London.

To take part in Whole System Long-term Care Demonstrators, the UK's Department of Health is asking the NHS and Local Authorities to work together, supported by technology. But how will they do that?

Many of the pilot studies of long-term care have been telecare, or assisting people to remain remain independent at home. Very worthy. But telecare will not benefit the majority of people with long-term conditions who care for themselves. To support them and reduce demand for expensive hospital admissions we need real time monitoring on an unprecedented scale. New organisations and jobs are inevitable.

Technology is also making medical knowledge a commodity and medical pracitioners must adapt. A study published by the British Medical Journal suggests GPs unsure of a diagnosis search the internet with Google. That study used a general search engine: what levels of diagnostic accuracy will be achieved by specialist neural nets and the application of Bayesian learning?

Posted by Colin Jervis, Kinetic Consulting at 02:40 PM | Permalink | Comments (0) | TrackBacks (0)

That will teach me to ask rhetorical questions at the end of posts.

In a previous post on management of chronic conditions I asked where remote monitoring appeared in the vision for the NHS and in its NPfIT. The DoH has announced its intention to fund up to three Whole System Long Term Care Demonstrators covering a population of one million. The pilots will run for up to two years.

It will be interesting to see how the pilots are organised and their technical solutions. The DoH wants the NHS and Local Authorities to partner. The workings of such partnerships--which could include contributions from the primary and acute care in the NHS as well as the private, voluntary, charitable and private sectors--will be key to their succeess. And where will organisations like NHS Direct fit in, I wonder? All in all, we should gain insight into the structure of future healthcare and the technical, human and organisational dynamics needed to support it.

Partnerships will be able to draw upon offerings from 15 suppliers from a pre-competed Telecare National Framework Agreement.

Posted by Colin Jervis, Kinetic Consulting at 11:26 AM | Permalink | Comments (0) | TrackBacks (0)

Continuing the theme of chronic disease management, I notice Dale Hunscher on the US cousin of this site has posted on the use of the Internet in managing chronic disease. The post also refers to Cognitive Based Therapy websites that allow supported self-management of some psychiatric disorders. Take a look.

Posted by Colin Jervis, Kinetic Consulting at 09:36 AM | Permalink | Comments (0) | TrackBacks (0)

My previous post discussed the reality of remote health monitoring. I noted the high compliance of study participants monitored using large arrays of stick-on sensors. Such discomfort may now be unnecessary.

Toumaz Technologies has developed new, small, low power, wireless sensors that can be attached to the body with sticking plasters. These devices enable non-intrusive, continuous monitoring and analysis of ECG, temperature and at least one other vital sign, such as respiration or activity level. Vital signs are transmitted to a PDA or mobile phone and monitored with software that includes an arrhythmia detection algorithm for real-time monitoring of ECG.

You may also be interested in an article I wrote for an IT innovation magazine about real-time remote health monitoring (well, everyone likes to back a winner sometime) though I was thinking of a wristband.

Visit the Toumaz site for more on their device.

Posted by Colin Jervis, Kinetic Consulting at 04:57 PM | 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)

In 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).

Continue reading "Electronic Health Record: different nations, different approaches" »

Posted by Colin Jervis, Kinetic Consulting at 11:10 AM | Permalink<