See, hear, feel... Drama still has a role to play

Mr Bates vs The Post Office

4 Episodes

The first part of a four-part drama.

Mysterious financial losses lead the

Post Office to sack and prosecute village

sub-postmasters who have no way

 to prove their innocence.


INDIVIDUAL
  |

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

personal ethics? listen - listening Well, this hasn't happened to anyone else! Losing control of one's horizons ...	socio-technical methods software testing verification - validation life-cycle management data/information standards human-factors - (need a chance to breathe?) ... !?
	politics law justice Establishment Institutions Public services group think lack of whistleblowers?

Sometimes* political and legal action -::- needs a social nudge.

*All the time?

My sources:
Quality press and BBC Radio 4 The Great Post Office Trial

IRMS Conference 2022 - RESILIENCE RECOVERY RENEWAL

  

Information & Records Management Society (IRMS)
RESILIENCE RECOVERY RENEWAL

15th-17th May 2022, Glasgow - Doubletree by Hilton

The annual IRMS Conference is *the* go-to event in the information management calendar, bringing together 400 practitioners, compliance managers, senior executives and others from a range of organisations across all industry sectors in the UK and beyond.

Our theme for 2022 is Resilience, Recovery, Renewal, recognising the phases of individuals' and organisations' response to the effects of the global pandemic, and the critical role of information and records management in enabling and supporting business continuity.

More details ... 

 

n.b. See you on the 17th? PJ

Dear Apple,

... and Google, Microsoft, Amazon et al.

By any stretch of the four* care

 (knowledge) domains, the following does 

not  

provide a holistic view 

of a person's health...

 

"Give your patients a more holistic view of their health.

Empower your patients to access and securely store their health records right on their iPhone using just their credentials from your existing patient portal.

Learn more about health records on iPhone"

 

*Four - embedded within the fifth - the spiritual.

30 Years of Progress: Nursing informatics and Nursing theory

Going through some papers I found some notes written in the 90s:

Allan Curtis a clinical services manager described the experience of setting up a 24 hour information service to a hospital paediatric hospital service.

Creating a system using Sensible Solution (a database package), Curtis noted how:

"The intricacies of programming were more difficult than I imagined."

Problems occurred when the school of nursing changed its adopted model of nursing, some information was then either redundant or incompatible.

"Although it would be nice to redesign the program to take account of such changes, it would take too much time - and money."

  <>

I do not have the article and a search failed to locate the full reference. I am assuming the link above is the 1980s-90s database package in question. When able to visit a university library I will update accordingly. It would be interesting to see if the model of nursing and the change was noted and any reasons. I'm sure they were? The point for me are the divides in skills, academic - service settings, finance and the status of 'models of nursing' (care). There is also the extent of change in programming and information systems. What is now referred to as 'the development stack' is far more powerful and yet more complex and complicated.

Curtis, A. (1990) Nursing Times, February 28, 86, 9, pp.69-70.

Special Issue: Critical Realism and ICT4D

The Electronic Journal of Information Systems in Developing Countries (EJISDC)

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Philosophy Subjectivity	Planning #ICT4D research or writing it up: then check the recent open-access special issue on #CriticalRealism and ICT4D Research in EJISDC. Analysis, reflections and case study applications of critical realism in ICT4D https://t.co/TiG4ju4dlC pic.twitter.com/AEitFggA8d — Richard Heeks (@CDIManchester) February 22, 2019
SOCIO - technical?

My source: https://twitter.com/CDIManchester/status/1098962321471348736

Articulating the Socio-Technical and much more c/o @Atul_Gawande

individual

|

INTERPERSONAL : SCIENCES

HUMANISTIC ----------------------------------------------- MECHANISTIC

SOCIOLOGY : POLITICAL

|

group

John ---- Atul

"The story of modern medicine is the story of our human struggle with complexity. Technology will, without question, continually increase our ability to make diagnoses, to peer more deeply inside the body and the brain, to offer more treatments. It will help us document it all—but not necessarily to make sense of it all. Technology inevitably produces more noise and new uncertainties. Perhaps a computer could have alerted me to the possibility of a genetic disorder in John Cameron, based on his history of skin lesions and the finding of high calcium. But our systems are forever generating alerts about possible connections—to the point of signal fatigue. Just ordering medications and lab tests triggers dozens of alerts each day, most of them irrelevant, and all in need of human reviewing and sorting. There are more surprises, not fewer. The volume of knowledge and capability increases faster than any individual can manage—and faster than our technologies can make manageable for us. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them."

Cameron ---- Gawande "I had more time for his questions now, and I let him ask them. When we were done and I was about to get off the phone, I paused. I asked him if he’d noticed, during our office visit, how much time I’d spent on the computer. “Yes, absolutely,” he said. He added, “I’ve been in your situation. I knew you were just trying to find the information you needed. I was actually trying not to talk too much, because I knew you were in a hurry, but I needed you to look the information up. I wanted you to be able to do that. I didn’t want to push you too far.” It was painful to hear. Forced to choose between having the right technical answer and a more human interaction, Cameron picked having the right technical answer."

Atul Gawande, Why Doctors Hate Their Computers. Annals of Medicine, November 12, 2018 Issue

A Toolbox from: BCS 2nd Sociotechnical Annual Symposium

On the 26th October 2018 I attended the Sociotechnical symposium in London as planned.

There was a sense of deja-vu in terms of speakers and some content but it was worthwhile.

Peter Bednar presented his SOCIO-TECHNICAL TOOLBOX v.13.2 and I like the inclusion on the hyphen as there still is a divide to bridge, or at the very least for people on IT and complex projects to acknowledge. Peter explained how he 'landed' within academia. He also brought some copies of the toolkit and I was able to pick up one.

As a toolkit and on this particular topic the text is helpfully concise at 130 pages. As readers here will know 'information' is a concept of great interest here. The cover (lid?) appeals instantly, referring to "Information Systems Analysis and Design" that eventually arrives at "Job-Crafting". Below this is the "Infological Equation":

I = i(D, S, t)

Of course, it is what's inside that counts. There is an introduction to information systems, the above equation and ten pages devoted to systems thinking. There then follows the main section comprised of templates with descriptions, elements explained were necessary, advice, and examples of paperwork (in many cases e-forms also no doubt). From p.109 the appendix provides a series of questionnaires. Peter's own approach is included 'Critical Systems Analysis'.

What stands out looking at the various tools listed is how h2cm operates at a more generic and yet  still very useful level.

You can use h2cm to reflect and consider projects socio-technically across (potentially) all contexts. You can also however deal with so many other crucial dichotomies:

bio-social
psycho-political
physico-political
socio-political
medico-legal
human-machine (humanistic-mechanistic)
one-to-many (individual-group)
demand-supply
...

There is no link but the toolkit 2nd edition 2018 is published by Craneswater Press Ltd

inquiries AT craneswaterpress.co.uk

I'll revisit the event and there is a related call for papers which I will post soon.

A Health Self-Portrait...

individual - self - patient - client - carer - person - resident - guest ...
 (you get the picture...?)

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

How easy is  it to create  a portrait of a  patient's health? How easy is  it for a patient to create a  health self-portrait?	Self-portrait pic.twitter.com/nA5gv1Qk2H — The Human Experience (@thehumanxp) February 2, 2018

Source:
https://twitter.com/thehumanxp/status/959501549901934593
https://twitter.com/thehumanxp/status/959501549901934593

EHR Individual - Group: Aggregator

People probably look at Hodges' model and see something that is simplistic. There is a great power, however, in the scenarios that the structure of Hodges' model can readily encompass. Not just in the hospital, but across all care contexts.

"Where is the great value promised by the transition to EHR [Electronic Health Record]? Where is the huge surplus from all those lives saved? Without an actor who can find it, and deploy it to shift the doctors into surplus, nothing will happen. 

If the ecosystem* includes just the five traditional players, EHR will remain an academic dream. The answer, then, requires introducing a new player - an aggregator. Because the odds of mistakes are so low, the benefits of EHR are invisible to the individual patient. They become material only when we aggregate outcomes over a large enough number of patients. We need to find an actor whose surplus is affected by patients not as individuals but as a group, and who is able to both capture and distribute this benefit; insurers, health-care systems, and governments all fit the bill. And the larger the group, the larger the surplus." p.130.

*The ecosystem illustrated by Adner is simplified and includes:
Payer/ Insurer, IT Provider, Hospital Administration, Hospital Department, Doctor, Nurse, Patient
(I have added Nurse)

Adner, R. (2012). The Wide Lens: A New Strategy for Innovation. London: Portfolio/Penguin.

Paper: Wang and Nickerson (2017). A literature review on individual creativity support systems

Hodges' model can lay claim to being a creativity support system [CSS]. While I do not have evidence, the model presents a diversity of stimuli in its structure and the care - knowledge - domains. It follows then that from the outset it is a motivational primer on both affective and achievement counts. Immediately, there is the motivation provided by the blank space, viewed as one or four conceptual spaces to find an initial starting concept. Affective as users gravitate towards their chosen reflective and creative journey, and achievement priming as having a goal that is prompted by professional, interpersonal and educational goals. If there is a case of 'creativity block' then perhaps a group approach can be adopted? Hodges' model then becomes a collaborative creativity support system. With Hodges' model and no doubt the proposed CSSs the collaborative agents add their own affective and achievement priming, whether student-student; patient-student (supervised); or mentor-student.

With the important caveat that the studies identified do not include healthcare but many papers are general. The authors provoke many questions: "Creativity support systems, like other information systems, are most effective when they instantiate underlying theories..." (p.140). I have already posed this question - which is (as ever) compound. As per the review's general domain papers, is there an underlying theory for all of Hodges' model; or is there a need for a theory per care domain?

"The literature on individual creativity support systems has drawn from theories about design, human computer interaction, information systems, and creativity.. " (p.140). 

If 'design' can be complex, what of 'care design'? That is what we are about. This in turn impacts upon the other sources of theory above.

There is much to draw upon in Wang and Nickerson (2017) but finally on page 145:

"the authors did a survey to verify the notion that creative self-efficacy, individual knowledge and IT support affect individual creativity through mediating variables: individual absorptive capacity, exploration and exploitation." 

Creativity must contribute to literacy, Wang and Nickerson allude to a relationship, referring to self-efficacy above. This is what we are seeking in health literacy and self-care. An ability to explore and exploit available resources being a sign of autonomy and efficacy.

Table 3
A framework for designing individual creativity support systems.

Aspects	Components	Features to Support the Component
Motivation	Motivational priming	Affective priming Achievement priming
Creative Process	Process completeness Process control	Modules to support each step in a complete creative process Allowing iteration and selection of steps
Divergent thinking	Stimuli Long term memory Working memory Creativity techniques	Providing different levels of stimuli, Providing stimuli dynamically External long term memory, such as knowledge base and case library; Facilitating search Supporting association, Visualization, Random combination Facilitating the use of creativity techniques; Computational creativity techniques
Convergent thinking	Comprehension Decision	Labeling, classification, simulation Criteria based comparison, Decision support

Table 4
The steps in a complete creative process.

Process Stage	The Divergent Step	The Convergent Step
Problem finding	Formulating problem presentations in various ways	Selecting the best ways to present the problem
Information finding	Collecting potentially relevant information	Selecting the most relevant information
Idea finding	Generating many ideas	Selecting the best ideas
Solution finding	Improving the selected ideas	Selecting the improved ideas and integrating them into a solution

Reference:
Wang, K., & Nickerson, J. (2017). A literature review on individual creativity support systems. Computers In Human Behavior, 74, 139-151. (tables p.145).
http://dx.doi.org/10.1016/j.chb.2017.04.035

Fences too far? Prevention, Health Education and Promotion

On my community visits I see many horses out in the fields. There are 'horses' in information systems too:

What are "horses"?

“As an intentional nod to Clever Hans, a 'horse' is just a system that is not actually addressing the problem it appears to be solving.” (Sturm, 2014).

In healthcare we keep talking about the need for more emphasis on prevention, health education and promotion. So much of what we do is not futile, despite the growing^* debate on euthanasia, but as a 'system' that incorporates and enacts prevention, health education and health promoting principles (and literacies) we continue to fail. In short, the healthcare system is a horse as defined by Sturm.

I'm certain - even without evidence (intuition influenced by the quality^# media?) that public health AND public mental health have been going backwards. Or if you like, the politicians keep talking the talk but this is limited to the political domain (or paddock)? So many promises in the form of committees, consultations, green, white papers that could be betting slips. In fact the government seems to favour those betting slips or the associated behaviours that produce tax revenue as opposed to the 25 year cross-party plan that would really herald change. This level of change will take longer and would be realised in younger people. Perhaps there are signs of change as many young adults eschew drugs and alcohol (UK)..?

There are two ways in which Hodges' model is a horse; or not:

1. Firstly, there is (still) no information system based on Hodges' model that might appear to be solving a problem.
2. Secondly, Hodges' model has not really had the opportunity to address the health and social care problem. As such it cannot be judged in such equestrian terms.

In the meantime the horses remain in their respective paddocks. Some are racing about, others jumping, a group do dressage, while increasing others are out to pasture - they graze and neigh-say (everything is fine DO carry on)!

^*Whatever one's respective views this debate will grow - a consequence of demographics driven through the heart of the political divide.
^#A sticky wicket then?

B. L. Sturm, “A simple method to determine if a music information retrieval system is a 'horse',” IEEE Trans. Multimedia 16(6):1636–1644, 2014. Winner of the 2017 IEEE Transactions on Multimedia Prize Paper Award.

My source: B. L. Sturm email to: http://digitalhumanities.org/humanist

HORSE2017

On “Horses” in Applied Machine Learning

Research workshop, QMUL, London

Wednesday 20 September 2017, approx. 9h30-17h 

Location: Arts One Lecture Theatre, QMUL, London E1 4NS

http://c4dm.eecs.qmul.ac.uk/horse2017/

Plug & Play and IT Arms Races ... wither Patients, Persons...

On the internet, in journals and the conference circuit judging from various calls for papers and other announcements, you cannot move for innovation, creativity, biotech and change that is inevitably transformative. This is good don't get me wrong but in the push for plug and play ecosystems or calls for an IT arms race something(s) are repeatedly lost.

In the former its about consumers with a single diagrammatic mention of 'patient'. I looked for the person as in person-centered. I looked for the client. In the latter the arms race will be a mechanistic affair: a circuit that runs from finance to technology. I realise the agenda and audience for the articles is specific: IT is Healthcare IT News and a Consultancy Co. As previously noted here on W2tQ it's not just that I may be talking out of turn: I'm out of Continent too.

Reading these articles just convinces even more of the need for a conceptual grounding. We really should read:

 'plug and play' as mechanistic AND humanistic.

As for the IT arms race. Let's race by all means, that is what innovation and (rapid) progress is all about. But lets exercise our legs too and ensure that the data is not only stored holistically and distributed, but that this is the nature of its inclusive purpose and source.

Here and across the water they just don't get IT.

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

Prompted by:

PwC Health Research Institute December 2015

HIMSS Time for a health IT arms race

"For portals, speak patients' language" c/o Healthcare IT News

Mike Miliard's 

For portals, speak patients' language 

in Healthcare IT News is a reminder of accessibility and engagement at the level of a communities languages.

This is one of the reasons why I am committed to using Drupal, to try to make use of its Internationalization capabilities amongst others. 

Thanks to Mike's post I'm now familiar with a 'full court press' as a hospital - enterprise wide no less - seeks to achieve defined patient engagement levels by accessing their electronic health record.

This begs the question of what constitutes the patients' language? I don't just mean the purely linguistic forms of Chinese, Korean, Russian and Greek mentioned in the article. The effort is driven by the statutory demands of meaningful use, but what of the patient's general literacy, IT and health literacies? How do patients make sense of their own health (or another in the role of a carer) not just in a given language, but culturally from a medical sociological and public health perspective? What is the community's vocabulary when it comes to health?

How can we assure that meaningfulness? How can we affirm that use and critically translate use into patient benefits and self-efficacy?

You could also entitle Mike's article as

4 portals speak patients' language

individual

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

Health Literacy, Accessibility	Measures (health literacy, patient engagement, health and well-being, clinical outcomes)
Cultural Diversity, Languages, Carer	Internationalization 'Meaningful Use', Standards, Legislation, Policy

When we focus on languages we must remember that listening is a great gift. Whether as health and IT professionals, educators, patients and carers, listening to the care domains can help us integrate diverse social, clinical, policy and technical objectives.

What do these portals say to you?

https://twitter.com/MikeMiliardHITN
https://www.healthcareitnews.com/author/mike-miliard

Personal Health Records: Part I - revisiting Kim and Johnson 2002

When I was at HC2004 or 2005 I was given a copy of the Medical Informatics Yearbook 2003 from the British Computer Society - Nursing Specialist Group stand. Within this volume of key papers for the year April 2001 - March 2002 I found the following:

Kim MI, Johnson KB. Personal Health Records: Evaluation of Functionality and Utility. Journal of the American Medical Informatics Association. 2002. Mar-Apr; 9(2):171-180. Selected for inclusion in the IMIA 2003 Yearbook of Medical Informatics. 

The paper identified candidate Personal Health Records [PHRs], then developed criteria examining the entry and display of data elements necessary for the PHRs to serve as adequate representations of information. Then in the final third phase a selected group of PHRs were assessed for their functionality and utility (p.370). Of the 12 PHRs assessed I thought it would be interesting to check  their current status (this was a quick visit to the published domains).

Several Personal Health Records 2002 - 2012

Web Site	Record	URL	Findings
Dr. I-Net	My Medical Record	www.drinet.com/	A good start! Still operational domain redirects from original www.aboutmyhealth.com Continues to offer a PHR.
HealthCompass:	Lifelong Health Record	www.healthcompassnet.com	While there are several site using 'Health Compass' the original version was not obvious.
MedicalEdge	Medical Register	www.medicaledge.com/	Domain currently offers support to physicians, so a PHR may be part of a package?
MedicalRecord.com	Your Medical Record	www.medicalrecord.com	This now appears to be a directory to electronic medical records.
MedicData	MedicData	www.medicdata.com/	This does not appear to offer a PHR and the homepage is 'under construction'. It looks like the domain may have a new owner.
Medscape AboutMyHealth	Personal Health Record	www.aboutmyhealth.com/	Now leads to GE Healthcare.
myhealthnotes.com	Personal Health Manager	www.myhealthnotes.com/	Server not found.
PersonalMD	My Medical Records	www.personalmd.com	Retired - leads to: www.eheandme.com/personalmd_announcement.html
TheDailyApple	Health Records	www.thedailyapple.com/	Social networking is vital to well-being but no PHR here.
VistaLink	Health Profile	vistalink.com	Domain for sale.
WebMD	WebMD	www.webmd.com/	Very much alive and kicking commercially, but my health record / PHR not in immediately in evidence.
Wellmed.com	Health Record	www.wellmed.com	This site leads to http://www.webmdhealthservices.com/

Kim and Johnson provide several lessons as a high quality contribution to the medical informatics literature. From the above we see that while we talk about timeliness in terms of the written record, time takes on a series of new meanings when it comes to electronic records, media, commercial companies and clearly the internet.

As I read the paper and reflected on the past decade other things fell into focus. At the end of the day a PHR should be what it says - personal. Reading Kim and Johnson this did not stop them looking at the PHRs from the perspective of doctors and informatics practitioners. There is nothing wrong with this. Although developers and political masters quite rightly seek to engage with the user, espouse usability and user testing - a system is aimed at a community.

If title [personal] follows function [record] and form [electronic] follows function then what do we have?

Don't worry if you're lost, me too (I'm musing again); let's add the fog....

It's crucial to know what's going on over the fence (similarly sometimes it helps to climb a tree). In this case the person in the form of patient is not the only consumer of the information in the record.

This is the point: systems are about a user AND a stakeholder community. Stakeholder is a much maligned word, found on the lips of those seeking to reach and engage remote ('difficult' to reach) community groups. It has a definite role here though.

Every health discipline has its record, that is a professional must. So in effect you have a series of 'X' -HRs. On paper they were - and remain in many cases - a mess. What we should have then is a hybrid health record that depending on the user morphs itself accordingly. But what is the point in pointing to users and stakeholders? Well, conceptually how far is personal from medical (nursing...) and how far again to personality? Add to the mix the question of where patient, well-being and health fit in to the management of long term medical conditions as per the critieria of Kim and Johnson, accurate entry of medicines, medical conditions, lab tests, monitoring ... and you see what is frequently a record breaking task.

This is (or was*) the challenge: to transform something that is generically personal (with the potential contradiction this implies) to something that is personalised as in 'I'.

*Part II to follow.

Top 5 worst EMR myths: c/o Healthcare IT News

I came across this post by Molly Merrill, Associate Editor and thought I could add some comments.

I'm usually wary of posts of the list of ... and top 5, top 10 variety. You see much of social media is cordial - not the concentrate form - but the dilute as observed in many of the comments. Anyway ....

You can read the original full text for each of the five on Healthcare IT News, here are some additional thoughts:

1. EMRs are bad for “bedside manner".

They can be BAD it all depends on usability, engagement, attitude, requirement, the overall environment and the extent to which the EMR is considered in all its socio-technical glory. Whatever the research does show item #2 admits the qualitative differences that exist in the marketplace - some EMRs are easier-to-use. If we expand the engagement beyond the professionals then the bedside equation demands the patient is factored in.

With the right care philosophy and conceptual framework (#h2cm?) e-health records of all varieties (EHR, PHR, EMR, Summary ....) can also support a positive, person centered bedside manner - transforming it to one that chomps at the bit ;-) to become a community based manner.

2. You can't teach old doctors new tricks.

Continuing professional development (or its equivalent) dictates that older doctors and other senior members of the multidisciplinary health and social care team can (should and must!) learn new tricks right up to retirement. Lifelong learning applies to all.

3. Only hospitals use EMRs.

I've little experience here working in the community (and in mental health), but judging from the applications and the infrastructure that an older EMR may demand, I suspect that they are indeed hospital (organisational) centered. That clearly is changing as mobile, mhealth applications mature to meet the rigorous demands of this market.

4. Having my data stored in an EMR is a security risk.

The security of electronic records cannot be assured. Data on devices that is not encrypted - is an open door, especially when those devices are portable. (If the use of encryption leads to complacency then I am uneasy.) Disciplinary measures may follow, but they are not a remedy. The human link in the chain aside - electronic records can be security assured to international standards. Far better than paper records and the photographs (anybody?) of paper hospital files sitting at the side of a corridor and other horror stories.


(Former link: The New York Times, 21 August 2011, New Data Spill Shows Risk of Online Health Records)


5. EMRs are expensive.

There are beholders, stakeholders, budget holders and tax payers. Despite the need for research findings I like the reflection of reality in item 5 that presages new players using new architectures and approaches. I've always felt that standards are essential and yet how do they relate to the scope for innovations? What is the relationship and how does that impact the market and in turn costs?

I've come across an item in .Net magazine that relates to EMRs - indeed all health informatics - I'll post on this while in London and attending Drupalcon.

Image source:
http://www.computerweekly.com/blogs/cwdn/2010/08/carry-on-doctor-your-electronic-patient-records-are-secure.html

Innovation and the 'middle' in NHS computing

Let's start with a quote:

Information systems are no longer associated mainly with data processing; they are increasingly seen as a management tool and an aid to action. This means that the costs of failure are much greater, and these costs are incurred when expensive systems are not used or are inadequately used. Surveys have shown that in as many as half of systems there are large gaps between users' expectations and the system's performance.

When do you think the above was written?

Here's the reference:

Mumford Enid (1991) Need for relevance in management information systems: what the NHS can learn from industry. BMJ. June 29; 302(6792): 1587–1590

1991: quite sobering really.

Previous - part-time - work reviewing data standards proposals focuses the mind in terms of the role of standards in interoperability, service impact and other essential assessment qualities. As the NHS has sought to implement standards as with the National Programme for IT you are also aware of the clamour for creativity and innovation. Innovation is there in the title of agencies.

I have long pondered about the extent to which - like Nature and vacuums - standards abhor innovation and creativity. How much is the 'standard' about doing things by the 'book' ... page 57 : para.3 ...

My eye caught the viewpoint piece in this week's Computing -

If you approach the world positively, a downturn is a good time for innovation. The shortage of people and money can create the pressure that leads to creativity. There are three areas where action will help organisations succeed in exploiting IT to enable business innovation:
Kick out Prince2

What more is there to say about innovation and Prince2? The focus of the Prince2 project management methodology – on organisation and control, and defining what to deliver before you have begun – is death to innovation. It is a bad solution trying to solve the wrong problem. It takes the IT profession in the wrong direction if we want to contribute to business innovation. It has to go. The agile development movement provides much stronger foundations for succeeding with projects that result in business innovation.

Ashurst, Colin, Viewpoint: How to use IT to enable innovation, Computing, 5 November, 2009.

Of course there IS a world of difference between information standards and project management standards, but there is no escape from the need for (effective) management of transition and change WITH business continuity. Within that management - engagement approach (as per agile) -

+++++++ socio-technical +++++++

- perspectives, as highlighted by Mumford (and others) all those years ago must have a place.

Additional link:

BCS Sociotechnical Specialist Group

HC2009 April 2009, W-Tech 2009, IHE-Europe Vienna Workshop 2009

The following items may be of interest to Health Informatics Professionals. Please contact the organisers direct for more information or to book. Feel free to pass on to colleagues.

HC2009 - Shaping the Future 28-30 April 2009

Closing date for submissions is 1^st December. Don’t miss your opportunity…. submit now and see the HC:Showcase.



W-Tech: Co-hosted and organised by BCS Women’s Forum.

A FREE motivational showcase supporting women interested in IT – Tues 3rd Feb, London.

Meet with some of the smartest IT professionals, the biggest recruiters in IT, attend career development workshops, revamp and submit your CV, prepare yourself for that next interview or promotion.




IHE-Europe Vienna Workshop
22-23 April 2009

Sharing clinical documents and integrating workflow

The event will provide an in depth review and discussion of IHE solutions in parallel sessions for users and suppliers. Also an opportunity to visit the 2009 Connectathon.

The Integrating the Healthcare Enterprise organisation (IHE) in Europe has asked IHE-Austria to organise this two day workshop. It will provide an in depth review and discussion of IHE solutions in parallel sessions for users and suppliers. The main focus will be on the nature and means of applying the IHE document and image sharing facilities to improve the real world of clinical practice.

There will also be the opportunity to visit the IHE-Europe connectathon, which will be held in Vienna at the same time. During the week around 80 different suppliers will show that their software can interoperate with that of three other suppliers to perform clinical tasks correctly as described in the relevant IHE specifications. Connectathon visitors gain a real understanding of the way IHE enables suppliers to work together to obtain interoperability of systems in a very enjoyable atmosphere. Experts from all healthcare specialties will be present including medical imaging.

For detailed information and registration visit the IHE-Austria homepage.

My source: BCS

Google launches online personal health records project

Here is an item from Computer World by Heather Havenstein:

Google launches online personal health records project

Pilot to test exchange of patient data between its health offering and the Cleveland Clinic ....

My source: Records Management List.

new Essential IT Skills Programme - EITS

It's a refreshing change to learn of something IT on a mental health nursing list, but that is the case with a new IT skills initiative:

NHS Connecting for Health (NHS CFH) has announced that it will be introducing the Essential IT Skills (EITS) Programme on 3 March 2008, to replace its European Computer Driving Licence (ECDL) Service which is due to close on 21 March 2008.

Source: http://www.connectingforhealth.nhs.uk/newsroom/news-stories/eits

The PSYCHIATRIC NURSING list is 10 years old and currently deliberating upon its future, wider membership and the state of IT skills.

Ack: Thanks to Clive Simpson for his post.

Thanks BGS & CPNA-T: NCRS* Project secondment ends; back to clinical practice

I would like to publicly thank the British Geriatrics Society# and CPNA Trustees who have covered my travel costs to the SPT conference 2007. I could not have attended otherwise.

You may notice a lack of advertising on the website and blog. I've tried to focus on the message - but funds do matter. If an 'appropriate' organisation(s) would like to fill the vacant space here that could feature advertising to help sponsor future conference attendances please get in touch!

Come August 1st - I'm back in clinical harness (Community Mental Health Nurse Older Adults) after an almost three year secondment, which has been a great experience. The highlights? Well, that would include...

• Working with new colleagues - Barbara, Jeremy, Tracey and Heather - good luck all! - and change consultants, learning the ropes and being let loose on the service.
• Working on data quality, comms materials...
• Explaining to clinicians what's coming down their way (locally and nationally), why it's needed and the challenges we still face.
• Being able to comment on proposals for future system content, including aspects of the interface(s) which are often taken for granted, but are of course critical in so many ways: safety, usability...
• Meeting other clinicians from other areas and organisations, notably Social Services and debating what's happening in their locality (have any dots been joined for you?).
• Going on a 2nd secondment and gaining insight into information standards development and management - a real challenge and well worth the effort - I'm still tingly from that.
• Acting as mentor for Chris our (former!) Trainee Public Health Analyst. All the best for September and Med. school Chris! Thrilled to pieces when I heard !
• Although not directly related to my secondment the week long Ideas Factory in Bath last October definitely still has me tingling from the new Roman baths complex and at 0230 on the Friday trying to finish a research proposal. This was quite scary in some ways, I had nothing to lose, but for the academics you could see the stakes were very high. Another set of processes revealed, an opportunity to use and share Hodges' model.
• One of the biggest things was being part of a National programme and seeing the amazing work that is going on amid enormous challenges and hurdles. The future of health and social care really is going to be different, it has to be: we have to make sure it is also better. Clinicians on the ground must never be an after thought. And there's the question of public engagement too.

As to my future - in-between the home visits, allocation meetings and case reviews each month I'll definitely be keeping in touch with things informational. I'm really grateful to my clinical and ICT managers for being able to pursue all the above and ongoing informatics threads...

Back in Nov 2004 I really needed a change and I felt the team needed a change too. I grabbed the opportunity, in denial about the piece of elastic that would eventually haul me back. Well it has and it isn't the prospect of the clinical work that brasses me off, it's walking into a building I first entered in 1989. Its days are numbered as a base and it's true I have been 'leaving' for at least a decade, but in that time I've been drafted onto other projects, constantly learning and I hope helping others to learn too.

Clinical work: no problem! You can't beat the buzz of knocking on a person's door in order to check what's happening and help them to help themselves whenever that's a goer. When you can't do that there's still a vital role to play. It's a sobering responsibility and when you see how and what people are struggling/coping with - well....

So, if you are reading this AND a student - undecided regards a career - do check out nursing (and other career pathways) and social care: you really can make a difference.

After all the above for me it's time for a proper change. I've started another book chapter on socio-technical structures and Hodges' model - now with a philosophy of technology bias. I'd really like to focus on learning and teaching with space reserved for clinical practice - cognitive/humanistic therapy.

I've mentioned Drupal, Ruby on W2tQ; but I've have no time to pursue and test ideas. I'm sure I could use these tools, if time, time...

Better still exercise the need to pass on this keystone, this baton to students - it is their race, their care that counts now.

I'm sure h2cm isn't just an over-valued idea.

There are vast and rich seams to mine here (without damaging the environment) and they run under ALL the subject disciplines.

Before that - IF it happens at all ;-) let's see what's happening for clinicians, as I pick up the phone and knock on doors once again.

Having knocked on two already, I have a feeling I'm going to need my infra-red glasses - more to follow....

Whatever you are about - keep smiling as you join your own dots...

*NCRS: NHS Care Record Service
# Conference brief on its way...