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.

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.

Virtual Worlds for Healthcare

The NHS Healthcare Innovation EXPO had an excellent demonstration of a Secondlife simulation- sort of the virtual world of healthcare helping to make the real world of healthcare better. Put together by Imperial College London, the Medical Media and Design Laboratory (MMDL) explores how to use digital media in healthcare. Although created to explore new models of care delivery in the widest sense it seems that the Secondlife simulation fulfils a fairly immediate training need.

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!

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

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