Complex Event Processing in Healthcare

It is interesting how new ideas and technologies rise to meet the needs of one industry and then diffuse into other industries. Classic examples are the trickledown from aerospace into the motor industry, and the application of diagnostic imaging technology into airport security.

I've recently spotted the early stages of a technology which has risen in the investment banking sector now starting to find its feet in healthcare. The technology is known as complex event processing (CEP).

As recorded on Wikipedia, a complex event is "what one infers from simple events" and gives the example of a lady in a white dress, a man in a tuxedo and lots of rice flying through the air being a wedding. In banking, CEP is used to take on board very simple events (e.g. sell prices) and infer from them something richer (e.g. market trends) from which a decision can be made (e.g. go short on a specific portfolio stocks). A search on Google of "complex event processing healthcare" returns a relatively modest 193,000 results. I can see this exploding and look forward to checking in with Google Trends in due course to see the references rolling in.

One area of health care where I think this will hold great value is in post-operative recovery monitoring of vital signs. The Association of Anaesthetists of Great Britain and Ireland recommends that during anaeasthesia and recovery a variety of monitors should supplement clinical observation. The challenge is that once outside of theatre the available clinical resources are limited and can only observe on a sampled basis. Also, the analysis of the monitor readings is trying to spot early onset of a complex range of problems such as hypoxemia, hypoventilation, hypotension, hypertension, hyperthermia, hypothermia and dysrhythmias.

In the event of deteriation, rapid response is a critical success factor in intervention. Different jurisdictions recommend different frequencies of monitoring (research for this article found a range from 5 mins to 30 mins for most vital signs) so you can't help but feel this is driven by the limiting factor of resources rather than clinical need. In fact, muscle relaxants (one possible intervention) are often chosen on the basis of an onset speed which is measured in minutes, not tens of minutes. CEP could be applied to spot problems on a real time basis, moving the limiting factor onto being the monitors' sample rates rather than the care pathway. I'd be very interested in talking to anyone who's working in applications in this area.

Like many other technologies in healthcare, no doubt we will see the rise of this technology met by the acronym being misinterpreted as clinical event processing. Look out for that!

Microblogging- a Sort of Electronic Graffiti?

There was a fantastic article in today's Financial Times by Chris Nuttall titled "Micro-bloggers of the world keep it short" which describes the phenomenon which is set to put all us macro-bloggers with the dinosaurs- Micro-blogging.

Unlike blogging, micro-blogging puts more emphasis on the aggregation of even more sporadic information through sites and apps such as Twitter, Tumblr, Jaiku, Mozes and Moodgeist. The article quotes Jack Dorsey, the founder of Twitter, on how the limiting of posts to 140 characters (the SMS single message limit) is like "...writing on a wall and if some chooses to read it they can do".

As a child of the 70s and 80s, it strikes me that this is analagous to graffiti. On the surface, it seems futile, but it shows that many people are driven to hang their short thoughts out there and people do enjoying reading them- and not only to find out how free 'Mandy' is with her affections or who "was here".

Tags: technology, Internet, blogging, blogger, micro-blogging, microblogging, macro-blogging, macroblogging, graffiti, Financial Times, FT, Twitter, Tumblr, Jaiku, Moodgeist, Mozes, FT

Going Ga Ga for Open Process Frameworks

Not since Jim felt the same techno-twinge of excitement 339 days ago in March 2006 has anyone posted anything on a blog about Open Process Frameworks (OPF)*. Anyway, yours truly was trying to reconcile our organisation's Testing Process with a third party's who we need to demonstrate compliance to. In needing a little Google-help I stumbled across the Open Process Framework Repository Organization.

The description on the tin isn't going to see this competing with Britney's shaven head for popularity in the search engines... "a public-domain object-oriented framework of free, open source, reusable method components". However, this is a gold mine for IT professionals. Anyway, if you haven't already sensed that this is serious competitive advantage stuff, then more fool you... I'm not telling anymore. You need to find out for yourself.

I've only bounced around one small corner of this vast repository, but I'm sure this will be helping to shape our IT organisation work for years to come.

*quick Technorati plug.

Tags: technology, information technology, IT, metamodel, analysis, method, ontology, Open Process Frameworks, OPF, OPFRO, Open Process Frameworks Repository Organization, policy, procedure, repository

Technology Entropy in 3D Visualisation

Not long ago visualisation was the preserve of cutting edge aerospace research. In the last decade, it was still the preserve of high end workstations from organisations like Silicon Graphics. Those folks are still leading the pack, but now fairly ubiquitous PCs and Macs can be used with the right software to create stunningly rendered environments. Still, I was amazed to see recently that 3D visualisation has moved into the realm of the FREE Adobe Acrobat Reader. The 3D images need to be created from a CAD package with the $995 Adobe Acrobat 3D product, but then anyone with Reader can view and manipulate the image. Sounds dull huh? Just try it...

Have a look at this jet engine data sheet. Zoom in on the engine in the top right corner of the sheet and then use the special toolbar to pan, zoom and rotate. Also, try the tabs on the left hand side to add or remove components and assemblies.

Absolutely amazing. Just remember this is a free viewing tool.

There is a warning message here for other specialist technology companies. You need to keep innovating to stay in business. You can't hold back the knowledge from progressing into the main stream- I call it 'technology entropy'. We're seeing the same in healthcare with Picture Archiving and Communication Systems (PACS) which are used to store and distribute complex and large MR and CT images. We are moving from this being the exclusive domain of heavy iron manufacturers into being wrapped up in terrabyte drives, browser applets and broadband connections.

Tags: technology, technology entropy, visualisation, visualization, Adobe, 3d, Adobe Acrobat 3D, Adobe Acrobat Reader, SGI, healthcare IT, PACS, render, IT

How Tech Savvy are You? Vista Wizard or Vista Wotnot?

When impressing upon people how tech savvy you are, don't sum up your cutting edge knowledge in terms of what you read about the launch of Vista this morning in "Metro" (the free London paper). We want to hear about how it compares with the Mac OS roadmap, whether the pricing model is too complicated and how it reflects the Windows Presentation Foundation- not that it "is apparently better than XP". $200 billion says it is better than XP!

Sometimes, you meet people like that and wonder why they are in IT.

Tags: technology, information technology, IT, Microsoft, Windows, Vista, career, jobs

Keep it Simple with Healthcare IT

In healthcare IT you hear alot about interoperability and integration of systems. Whilst this is extremely valid, I and my peers often lose our colleagues in technical jargon and presume that the sector is more mature than it really is. Some problems are more immediate than that.

If you watch how a retail assistant, waiter/waitress or bar tender interacts with their terminal, it is very quick and rapid fire. Tokens often allow near instantaneous log on. Then they punch some buttons and walk away. Do they put time aside at the end of their shift to reckon up? No. How long do you think it took to train new joiners? Not long- they probably picked it up on the job.

Now look at how clinicians access healthcare IT. Ouch.

Add that to the list.

Tags: technology, information technology, IT, health, healthcare, health care, healthcare IT, user experience, retail IT, hospitality IT, hospital, clinician

British Computer Society Recommend CfH Changes

A report by the British Computer Society is being widely reported at the moment. I wish to do little else than add my voice to those who say "here here". I believe it is a very rounded review and I would urge anyone in the NHS, DH or Healthcare IT to read the full version- and not just what they read in the press.

The only thing I would add is that a move away from monolithic systems to interoperable standards will require an evolution in the maturity of healthcare IT (See There be Dragons in Phase 4). The commercial environment required to enable this out-of-cashflow investment would probably be too large to run alongside NPfIT. As expensive as it is, the systems being implemented through LSPs are only an incremental improvement at a functional level rather than a fundamental rearchitecting. We need to focus on some core areas and keep them simple if this is to work.

Tags: technology, healthcare IT, health care IT, IT, information technology, NPfIT, CfH, NHS, BCS, British Computer Society, IT architecture, interoperable, monolithic

NHS Cautiously Proceeds with Patient Records

It's been announced that Lord Warner has decided that the NHS should press on with the National Care Record System- albeit in a watered down 'summary' format and with the ability to opt-out and keep your data local.

I welcome the news. Well, I welcome the progress bit within the news. We're out of the gate. Personally, I'm happy for the brakes to be taken off the technology but the media suggests that the public thinks differently. This announcement leaves the path open to eventually extend the summary records into being more detailed and provides the opportunity for people to see the benefits. I want all of my medical records on line NOW and I want to contribute to it. It's my information and I feel that future clinicians I have the misfortune to need the services of will be able to serve me better if they have more information. The further away I am from my friends and relatives at home when I need that help, the more I want the information available to clinicians with my life in their hands.

Security? It's doable. What's more, do you know what they're doing now? When were you last asked for your consent? Believe me, technology will be better- it can be explicit. The problem with health care is that moral dilemmas are always a short step away which can bring progress to a stiffling halt. Am I the only person who wants to live longer and healthier?

And in case anyone asks... GPs do not represent me. The media keeps giving the GPs' opinion as if it is surrogate for the public. Not so. Ask me.

Tags: technology, health care, healthcare, IT, healthcare IT, health care IT, information technology, EMR, Electronic Medical Record, EHR, Electronic Health Record, NCRS, National care Record System, NHS, National Health Service, CfH, Connecting for Health, NPfIT, National Programme for IT

Does IT Matter?

In May 2003, Harvard Business Review published a paper authored by Nicholas G. Carr titled “IT Doesn’t Matter”. A business partner of ours sent it too me and yes, it was thought provoking, and yes, it nearly made my blood curdle.

A Technorati search shows that the article has been widely reported on by AccMan and Navarik. The title isn’t a total red herring designed to hook you in before it makes some clever ironic play. The paper really does make the case that at a strategic level “IT Doesn’t Matter” because it is approaching commodity status. Quite simply- I disagree, especially in health care IT.

1. The article paints a static picture of any company’s IT investments. This is a war of continuous evolution rather than a battle between individual systems.

2. I would argue that the commoditisation of IT provides the opportunity for organisations to construct orchestrated solutions disruptive to markets and their competitors. Customers can apply technologies in ways that the creators of the building blocks had not imagined. This is a highly competitive capability which depends on organisation competence and agility.

3. The investment in IT is being painted in black and white. Because the customer was not intelligent, IT investment was focussed on features that solve problems without consideration of how the problems are solved. The “how” has become crucial because for features from many suppliers to work together requires an understanding of this architecture. I would agree there was overinvestment in features- but only now are we looking at the architecture.

4. You cannot compare, as Nicholas Carr does, IT to electric power or railways by analogy at almost any level. Information simply does not conform to the First Law of Thermodynamics. If the physics don’t stack up, nor will market comparisons. We’re talking about tools for knowledge workers, not core utility services.

5. Technology as a competitive factor in health care is only just beginning. We are along way off a sector with the characteristics this article is describing. Technology is still widely seen as a necessary evil in this sector which is amazing as few other sectors would benefit from computerisation more than healthcare. It is such a complex sector that control of information will make the controllers very competitive. The status quo suits only the incumbant. Managing vulnerabilities is important, but there is an opportunity for a health care IT company to be created out of the current climate who will lead us into the next phase of IT maturity.

*ClickRich’s New Rules of IT Management would therefore be:

Spend wisely, but large investment in health care IT is required to catch up.
Follow on core technologies, lead in how you apply them.
Focus on Opportunities if you are an emerging Health care provider.

Tags: technology, information technology, IT, healthcare IT, health care, Harvard Business Review, IT Doesn't Matter, IT strategy, IT architecture, Nick Carr, Nicholas Carr, HBR, IT management

There be Dragons in Phase 4

Software Development organisations need to be very aware of the maturity model of their industry. Based on the forming, storming, norming, performing model of change management I've devised the following phased model of IT maturity. The bigger they are, the more aware the organisation needs to be because in Phase 4 lurks the small start up who wasn't even on your radar, but who will bring you down.

Phase 1 (embryonic)
-Niche technology pockets addressing specific challenges
-Feature focus. No one minds how you solved the problem, as long as you solved it.

Phase 2 (childhood)
-Technology pockets grow so as to bump up against each other
-Boundaries are created
-Interfaces cause unexpected complications that result in under delivery

Phase 3 (adolescence)
-Responding to the escalating costs and complexity, clients reduce the downside risk and consolidate suppliers
-Fewer boundaries
-Gorilla takes all

Phase 4 (adulthood)
-With benefits realigned with expectation, clients turn to maximising the up side and exploiting new generation technologies
-How you've been solving the problem becomes VERY important, because it needs to be consistent with other methods, frameworks and ecosystems
-Creation of platforms for effective competition
-People who can master taking the same components and reuse them in interesting ways will create new business models that redefine the market

Now we can discuss where your company or sector is, and where you're heading.

Tags: technology, information technology, IT, software development, maturity, model, IT architecture, software architecture, developer

Abuse of Chatham House Rules

I was pleased to meet with Richard Granger, the Director General of NHS Connecting For Health, (aka NHS IT Chief) earlier this week. I have to say he was very impressive and it was a good opportunity to hear about the GREAT progress being made in many areas of the National Programme for IT. Clearly, all things the press is not interested in printing.

However, I can't say any more because the event was Chatham House rules. That is, people can take away what was said in the meeting, but it is not to be referenced in a way which makes it attributable to any individual present. This encourages openness and enables us all to learn from mistakes as well as successes.

Richard Granger suffers much at the hands the media. You could argue that's just part of the job- and that is fair enough. My point is that comments which he made last week in a Chatham House rules governed event are now splashed across the pages of the New Statesman and have been picked up by all the usual healthcare IT publishers. We have to lose this rapcious appetite for sensational headlines if we can have reasonable discussions we can all learn from.

Tags: technology, IT, CfH, Connecting for health, NPfIT, National Programme for IT, Chatham House rules, Chatham, health, health care, healthcare, Healthcare IT, NHS, Richard Granger, Granger