A lesson in healthcare from the game Balderdash(TM)

I was fascinated to learn something new by playing the game Balderdash. In case you've not played the game before, you are basically given a word from a card and need to guess what it means from amongst a selection of options provided by other players and the real answer from the card. I was challenged with Question 4 from the card below:

Frankly, I had no idea.  I was shocked, given my line of work, to hear the answer:

Who would have thought it?

CircleBath. Yes, it's a hospital.

Looking at these photos which I took last week, you'd be forgiven for thinking that I've been hanging around rather swankier bars than normal. However, these are actually from the new CircleBath hospital. ClickRich has been working on this project for the best part of 4 years so it's really exciting to see the vision becoming reality and being so highly acclaimed.
What? You still don't believe it's a hospital? Well, take a look at the much better quality photos on our architect, Foster + Partners', website where you can see real healthcare-shaped things. In that gallery of photos you can glance at one of our state-of-the-art digital operating theatres, but in terms of technology, that was still a fairly simple win really. I look forward to bringing you more news about the tech in due course, including some healthcare firsts.

Indicating the Way to Quality Care

The NHS Information Centre has published a set of 200 indicators of quality care. This is the result of a piece of work started by Darzi's report 'High Quality Care for All' and you can tell the clinician involvement has been continued into the deliverable with the phrase "assured by clinicians for use by clinicians". The report, downloadable in specific sections, is structured around pathways so that the indicators are clinically relevent. I've not done a count of indicators to see whether the report really has 200 indicators, but I actually find it refreshingly transparent that many sections of the document as described in one way or another as 'to be done'. It has to be said that the mechanics of governance and maintenance have been put in place around the report too so it will continue to evolve. The indicators address Effectiveness, Patient Experience and Safety, and therefore reflects current progressive thinking about what value means in health care (see "War on Waste" by Ali Parsa).

More Money Than Can Be Spent? In a Credit Crunch?

I had a fascinating meeting with a senior officer of the Department of Health today to look at access to innovation funding through the National Institute for Health Research (NIHR) and some of the projects under their mentorship. What was particularly surprising is that we are seemingly conditioned to expect that funds are scarce, but actually fewer innovation grants are allocated than are available. A later check in the NIHR Annual Report confirmed that the organisation has an annual sum to spend and that for almost all categories, the 2008/09 spend is less than the forecast for 2009/10- implying that this year was underspent. This is not a criticism because the organisation rightly sets the quality bar high, but it is still a surprise that we're not generating enough good ideas to qualify for funding. Long live the Government's enthusiasm for innovating our way out of the credit crunch... thinking caps on people!

Leonardo the Inspiration for Robotic Surgery

In the fourth of my posts from the NHS Healthcare Innovation EXPO, I'll share a video I took of a magnificent piece of technology- the Da Vinci surgical robot. Designed so that surgeons could operate remotely on soldiers in the battlefield, the robot is increasingly being used for challenging laproscopic procedures. In this video you can see, briefly, how two surgeons are able to control extremely dextrous instruments in a confined space. At the last count I heard of, there were only a small handful of these robots in use in the UK. Unfortunately, it is hard to imagine what might drive an increase in adoption as it is difficult, if not impossible, for a healthcare provider to be reimbursed more for improved outcomes or for carrying out more complex procedures for which there is no tariff.

Review of a Spartan Healthcare Computing 2007

I have great respect for the organisers of the event, the British Computing Society (at least, I think they're involved somewhere along the line) and the exhibitors who made a brave stand, but that was the problem with Healthcare Computing 2007- it felt like the last stand. Having two posts in a row about the stiffling of innovation in the health care sector and I'm starting to sound like a broken record, but the event really depressed me.

Most annual shows for any industry sector worth billions of Euros are showcases of the latest and greatest technologies with all the buzz that goes with it. It simply wasn't all that. Harrogate was not ringing to the beat of deal making and new product launches. It was like stepping back at least 5 years. Perhaps more. I was going to have a harrumph at Cerner for emphasising the divide between the have (...an NPfIT contract) and the have nots (...an NPfIT contract) because their stand dwarfed most others... but at least they supported the event. BT, iSoft and the other big contract holders didn't even show up. Having been a supplier in another sector not too long ago I really appreciate the costs associated with exhibiting at such an event and therefore the valiant efforts of those who showed.

I spotted suppliers at the event who had chosen not to exhibit. They, and some of the exhibitors who could be frank with me, lamented the fact that of the thousands of people who pass through the depleted halls, only a handful of people are buying. The rest are not as they've no decision making power.

Still, with 90 minutes of my time there to go, I finally found a couple of tech nuggets. They were well hidden, reflecting the lack of recognition of anything new, but that makes the opportunity all the greater for us.

Tags: technology, health care, innovation, UK, healthcare IT, health care IT, Cerner, exhibition, Harrogate, Harrogate Computing 2007

Has State Managed Health Care Stifled Technology Innovation?

This will almost certainly prove to be a controversial post. I don't intend to offend, but I do wish to stimulate debate.

The hypothesis of the debate is that since the creation of the National Health Service in 1947, the UK health care sector has not been conducive to developing new technologies.

Although this has been in my mind for a while a piece of evidence came to me in a presentation on medical imaging at the IET London Local Network last night by Teresa Robinson, a Consultant Clinical Scientist in Bristol. Thanks for that Teresa, although I must stress that these are my views. Teresa showed that the early Computed Tomography (CT) research and development was done in the UK by EMI. The presentation also noted various British luminaries in the advancement of medical imaging.

EMI made a huge commercial success from innovations in such areas as radar, millimeter waves, microwave and CRT. This spans a period from WW2 through to recent decades. For some reason, EMI could not repeat that success with CT (which is also in the radiating electrophysics domain) and EMI abandoned its efforts in that arena. Now, just a few decades on, the CT industry is dominated by Siemens of Germany, GE of the US, Phillips of the Netherlands and Toshiba of Japan. These are all countries with what you might call progressive health care systems.

What went wrong? Perhaps EMI did not find a domestic marketplace full of clients ready to try new techniques?

I feel that customers drive innovation. It is their hunger to do things better, faster or cheaper that compels industry to satiate that hunger. Free health care at the point of delivery is a great vision, but have we lost the leading edge? Are the two mutually exclusive?

Tags: technology, Health care, innovation, NHS, National Health Service, UK, medical imaging, CT, Computed Tomography, GE, Siemens, Phillips

Can Gerry Robinson Fix the NHS?

Essential viewing starting tonight in the UK for all healthcare industry professionals is "Can Gerry Robinson Fix the NHS?" on BBC2 at 9pm. This British Business Guru spent 6 months in Rotherham General Hospital and the sneaky preview at The Telegraph suggests that he found it a very frustrating (but rewarding) experience. He cites the considerable challenges in the public sector and the difficulty in motivating consultant doctors to work more hours/more productively in coming to the conclusion that all is not lost. What is needed to manage these "brilliant, extraordinary people" are really excellent managers.

I agree. I think there are other ways to motivate the consultants too but I'll be interested to see if the programme covers these.

I'll be interested in seeing what the local press reaction to the programme is. So far the Yorkshire Post has been quite non-committal.

Tags: Gerry Robinson, health, health care, NHS, Rotherham General Hospital

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

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

Boost for Healthcare IT from Microsoft

Thank goodness Microsoft has finally published its Connected Health Frameworks. A whole toolbox for the healthcare IT sector.

This is a welcome announcement for a sector looking for an IT shot in the arm. I was privileged to see this a few months ago and am glad it’s now in the public domain so we can talk about it. It will be extremely interesting to see how healthcare IT organisations respond to the release. Which will crawl into their shells and which will embrace?

We need to see some maturity in this market. Consumers will expect it.

Tags: technology, healthcare, health care, healthcare IT, Microsoft, Connected Health Frameworks, IT architecture, information technology

PACS is dead. Long live PACS

It is my prediction that the days of the acronym "PACS" are numbered. Picture Archiving and Communications Systems are the hospital systems that store all those digital diagnostic images- X-ray, mammogram, MR, CT etc.

They need phenomenal storage capacity (Terabytes) and distributing those images (usually of the DICOM format) from the imagers to radiologists is therefore non-trivial.

When did you last hear an application based IT system have to define itself as a communication system? That's inherent in the fact that it is information technology. It feels illogical to make a big deal out of that, reflects challenges largely in the past and aspires to monolithic systems. I try and use the terms "DICOM Storage", "DICOM Viewer" and "Radiology Writer" to describe the constituent parts and apply as appropriate. Processes are being reengineered such that these elements are being reused in ways the inventing technologists hadn't imagined and the PACS term will itself be reengineered.

There's a lot of inertia in the acronym by virtue of the intellectual capital (deals, research papers, products, implementations) invested in it, so I don't expect a change any time soon... but watch this space

Tags: technology, medicine, medical, health, health care, healthcare, healthcare IT, Health care IT, PACS, Picture Archiving and Communications System, acronym, CT, MR, radiology, etymology, hospital, x-ray, xray, diagnostics

Lessons in Blogging- Rights and Responsibility

A recent series of posts by an employee of a US healthcare provider has landed him in hot water for his criticism of the technology decisions made by his bosses. His postings have been amplified by other blogs. I don't wish to comment on the specifics of this case.

Technology is complicated. There are rarely right decisions. Most decisions are a trade off with associated risk mitigation. When raising concerns in a corporate environment, you will rarely be criticised if you act professionally. The key is to avoid looking like a whinger or someone with an agenda. I'm not saying that senior management is infallible, but if you are not seen to carry your right to complain in parity with your responsibilities, you could find yourself on extended leave.

Tags: corporate ethics, Epic, health care, Healthcare IT, Justen Deal, Kaiser Permanente, technology management

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