Inaugural Scottish Threshold Concepts Conference: TCs in Action [i]

Never having been to Dundee but being keen on Threshold Concepts for reasons to follow, I headed North stopping off at Glasgow the day before.

Some thought had clearly gone into the 'conference pack' which included a local comic , marmalade and a caramel biscuit (appreciatively consumed while writing this!).

[Earlier in the week, on twitter someone had pointed to the paper and pens laid on all the chairs in Manchester it appeared - questioning the sustainability. The organisers duly took note and a message for all.]

The first keynote was:

Threshold Concepts on the Edge by
Emeritus Professor Ray Land, Durham University and subtitled: 'Learning, risk and difficulty'.

As an initial co-author of the work on Threshold Concepts, Prof. Land is engaging and facilitating further research. The references flowed and were absorbed by a ready audience taking photos and notes. Next time, if there is one, I may rely on notes more. The presentations should be made available. The etymology of our language(s), liminality, complexity the experience of learning negotiated through variously safe and unsafe spaces were explored. As a concept itself threshold might indicate edge(s) and boundaries, referring also to knowl-edge. The presentation brought home the need for balance in education. Balance that in a way cannot be attained if learning is to occur? What should students be exposed to - in drama, literature as preparation for a [health] career, a life?

Through Timmermans (2010, Changing Our Minds) Prof. Land highlighted how even knowing something presents limits. I read this as the context internal or external calling into question this knowing. Complexity and chaos were inevitably added to this mix.

I thought of lacuna here. There are gaps in knowledge, but a nearby concept might just afford a stepping stone. This ability to 'step' begs a question. In what can become the domestic chaos of  unsupported care for people with dementia, I frequently have to empathise with the carers, relatives and close friends. These individuals will encounter 'gaps' appearing in their world. How they perceive, experience, interact and recall it. I temper this account depending on the situation. The changes to perception it is thought can be quite marked and disturbing, contributing to agitation. This is an edge fragmenting.

'Edges' are evident in Hodges' model:

Most obviously where the model's axes demarcate the care (knowledge) domains and additionally:

Sciences: Skin, touch, (surgical-knife) edge, cognitive map (home, locality), location - built environment, scientific thresholds as in blood tests, visual - auditory ... cues*
Intra- Interpersonally: identity, personal belief systems and schema, personal ethics, biases and prejudices (which may go 'unchallenged'), empathy - rapport, transference, *triggers perceived, incisive argument.
Sociology: Personal space, (Second...) language skills, breaking bad news, intimacy, nuclear - extended families.
Political: Negotiation, cross-party, consensus, debt, criminal activity, public disorder

I've some reflections on the image below to follow.

The citations of Waldrop (1992, p.12) and Zygmunt Bauman (2000) dissolving, turbulence and 'liquid modernity', prompts me to think of students [ and others ;-) ] getting stuck in minima and recall the work of Serres on Lucretius and non-linear dynamics. Prof. Land noted much more - supplantive and lost learning. We learn that the safety of education is unsurprisingly related to education (and its systems) becoming stronger. As it does there is a price, since learning involves weakness (Gert Biesta, 2013). The active debate on trigger-warnings, safe spaces and deplatforming gives me further reason to champion #h2cm. The model provides a blank, agnostic space, that can address all forms of truth, reality and if the situation requires disturbed experiences of reality.

I can clearly envision how student mental health nurses could find certain lectures challenging. Prof. Land weaves the point (Barnett, 2004) that we cannot reduce uncertainty for new students through a 'predictable' form of curriculum. For the MH students to learn they must be challenged personally. If not it is education that is failing them. Linking his themes it seems we can equate weakness with uncertainty but education must learn to appropriate and be comfortable with this. Contrasting uncertainty v. ambiguity I can see how Hodges' model can assist in understanding these relations and relationships from the lived - situated - experience - of a person, to the interpretation by several people, or the same person through time (frames of Hodges' model).

This was a marvellous start to the conference, about which more to follow.


See also:
http://nu2018.se/wp-content/uploads/2018/10/Keynote-abstract-Vasteras-October-2018.pdf

Pihl, O. V. (2015). Hidden realities inside PBL design processes: Is consensus design an impossible clash of interest between the individual and the collective, and is architecture its first victim? . Journal of Problem Based Learning in Higher Education, 3(1), 20-45. https://doi.org/10.5278/ojs.jpblhe.v3i1.1201

- and on W2tQ:

Inaugural Scottish Threshold Concepts Conference: TCs in Action [ii]

Inaugural Scottish Threshold Concepts Conference: TCs in Action [iii]

Threshold Concepts: Reflection on chaos, complexity and AI

Edge(s) Computing ... IEEE EDGE 2023

IEEE EDGE 2023 - CALL FOR PAPERS

c/o AI-SGES list

 

“It’s the edges of the maps that fascinate ...”
― David Mitchell, The Bone Clocks
[Goodreads.com]

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

'domains'	"Edge computing, as the convergence of computing and communications executed close to data collection and places of storage and application, provides a paradigm that offers several research and application opportunities across a wide range of domains." ... [IEEE EDGE 2023] ...
'domains'	'domains'

 

"Passport please!"

Press release

'Innovator passports’ set to accelerate cutting-edge NHS care

The move is a key part of the government’s Plan for Change and its 10 Year Health Plan, which will transfer power to patients and transform how healthcare is delivered, creating an NHS fit for the future.

For too long, cutting-edge businesses avoided working with the NHS and went elsewhere, weighed down by slow timelines and reams of processes. Now, organisations will be able to join up with the NHS quicker than ever before through the removal of needless bureaucracy. Not only is this better for patients but also for our NHS and economic growth.

A ‘one-stop shop’ thorough check from the NHS will now allow businesses to get to work as quickly as possible and deliver on what matters most to patients across the country. It means NHS patients will get more effective treatments and support quicker, and the NHS will make the most of its finite assessment resource, all while businesses are given a boost through the government’s industrial strategy.

Treatments including special wound dressings - already reducing surgical site infections by 38% at Barking, Havering and Redbridge University Hospitals - could be adopted more widely, benefiting patients across the country.

At Barts Health NHS Trust in London, use of antimicrobial protective coverings for cardiac devices has cut infections and saved over £103,000 per year. At University Hospitals Dorset, adopting rapid influenza testing reduced bed days and antibiotic use, freeing up vital resources.

The new passport will eliminate multiple compliance assessments, reducing duplication across the health service. It will be delivered through MedTech Compass, a digital platform developed by DHSC to make effective technologies more visible and widely available.

MedTech Compass will make these innovations and the evidence underpinning them clear to buyers within the NHS.

The initiative builds on the government’s drive to slash waiting lists and ensure people have access to health and care when and where they need it under the Plan for Change.

Wes Streeting, Secretary of State for Health and Social Care, said: 

For too long, Britain’s leading scientific minds have been held back by needless admin that means suppliers are repeatedly asked for the same data in different formats by different trusts - this is bad for the NHS, patients and bad for business. 

These innovator passports will save time and reduce duplication, meaning our life sciences sector - a central part of our 10 Year Health Plan - can work hand in hand with the health service and make Britain a powerhouse for medical technology.

Frustrated patients will no longer have to face a postcode lottery for lifesaving products to be introduced in their area, and companies will be able to get their technology used across the NHS more easily, creating a health service fit for future under the Plan for Change.

Dr Vin Diwakar, Clinical Transformation Director at NHS England, said:

We’re seeing the impact improvements to technology are having on our everyday lives on everything from smartwatches to fitness trackers - and we want to make sure NHS patients can benefit from the latest medical technology and innovations as well.

The new innovator passports will speed up the roll-out of new health technology in the NHS which has been proven to be effective, so that patients can benefit from new treatments much sooner.

It also forms an important element of the industrial strategy through the upcoming Life Sciences Sector Plan, which will turbocharge Britain’s life sciences sector and cement the UK’s position as a global innovation leader.

MedTech Compass helps speed up decision-making in trusts, allowing technology to scale faster - making it easier for trusts across the country to find, assess and adopt proven technologies that improve and speed up patient care.

The passports mean that once a healthcare tool has been assessed by one NHS organisation, further NHS organisations will not be able to insist on repeated assessments, reducing the need for local NHS systems to spend their limited resources on bureaucratic processes that have already been completed elsewhere.

The digital system will act as a dynamic best buyer’s guide, making it easier for trusts to compare products side-by-side in one place.

Read the full press release:

https://www.gov.uk/government/news/innovator-passports-set-to-accelerate-cutting-edge-nhs-care

In my source (below) Laura Hughes also notes:

'However, the Financial Times has reported on calls by frontline workers for basic NHS infrastructure to be brought up to a minimum standard before politicians extol the virtues of cutting-edge tech.

Matthew Taylor, head of The NHS Confederation, which represents health managers, said not all NHS organisations were at the same stage of digital maturity, which would "affect their ability to either innovate or implement preapproved innovation in this passport model."'

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

innovation personal passport awareness of existing state / processes	innovation 'innovation passport' duplication
innovation public safety waiting lists / times accountability - standards - assurance	innovation bureaucracy - multiple Trusts procurement of infrastructure and innovation - cutting-edge technology

Laura Hughes NHS use of medical innovations streamlined. FTWeekend, 2 July, 2025, p.3.
https://www.ft.com/content/1d025579-990a-4d58-9e0b-6d0d29d27dab

Previously:

Infracare - Hodges' Health Career - Care Domains - Model

edges : Socio-Technical

Life, Literacy, Oppositions, Complexity and Information

Literacy in Traditional Societies

"Durkheim's work on primitive classification is being applied to societies within the orbit of major civilizations. The polarities and oppositions of la pensée sauvage turn up in ancient Greece, and tools developed in the study of the narratives of American societies are applied to the Oedipus story, the Book of Genesis and even contemporary literature, with little sense of the basic incongruity involved.

Polarities of some sort are of course present in all societies; their significance, however, varies widely. Aristotle describes one Pythagorean theory in the following terms:

 

Others of this same school say that there are ten principles, which they arrange in ten columns, namely:

limit unlimited
odd even
one plurality
right left
male female
at rest moving
straight crooked
light darkness
good bad
square oblong

. . . How these principles maybe brought into line with the causes we have mentioned is not clearly explained to them [quoted Guthrie 1962: 1, 245]."

Goody, J. (1968) Literacy in Traditional Societies, Cambridge: CUP. pp.10-11.


Taking each of these in-turn as may relate to Hodges' model (I may update/edit these):

limit  unlimited

As a template the model invites both a limit (boundaries) and some-thing unlimited.

odd  even

There is a symmetry - evenness to the model, but the invitation noted above is also a prospect for odd-ness. This may extend to the frustration experienced when a phenomena, account (patient's narrative . . .) defies explanation and classification.

one  plurality

This polarity is key in Hodges' model. 'One' refers to the person, patient, carer, any - individual who the model is applied to. In respect of plurality this can include the dyad of patient - nurse, couple, family, team, community, national or global population (and Biosphere).

 

right  left
 

The horizontal axis is not the last word in Hodges' model, as intra-domain we also find right and left. Of course, the vertical axis (indeed, the whole model if required?) can also be repeated in a domain.

 

male  female

 

You quickly recognise the potential for disagreement* which is fundamental in dichotomous situations, a point further reinforced below.

at rest  moving

 

The model is 'at rest' as a snap-shot, but as a frame it can represent the change over time and so has its own dynamic potential.

 

straight  crooked

 

The axes as continua are 'straight' but this distinction (as noted above) has distinct psycho-socio-political connotations. In the model, line-of-sight is acknowledged, while 'crooked' might suggest what is uncertain, and unseen?

 

light  darkness & good  bad

 

Again, these two oppositions seem 'loaded': especially socially - politically.

Tread carefully. If you have light, that's good, but if lost: bad.

 

square  oblong

 

Viewed as containers, or sets the model's domains can be represented as several shapes, as long as the axes are retained as part of the structure. The adopted rectilinear form is an affordance of the (underlying) HTML, and the traditional (paper-based) tabular format. From the domains being of equal area, the point where the axes intersect could be shifted, such that a single domain is enlarged (prioritised?), at the expense of another.

*Incredible harmony too!

Then prior to an anticipated move, and sorting through books and papers:

Complexity:
Life on the edge of chaos

“The discovery that universal computation is poised between order and chaos in dynamical systems was important in itself, with its analogies to phase transitions in the physical world. It would be interesting enough if adaptive complex systems inescapably were located at the edge of chaos, the place of maximum capacity for information computation. The world could then be seen to be exploiting the creative dynamics of complex systems, but with no choice in the matter. But what if such systems actually got themselves to the edge of chaos, moved in parameter space to the place of maximum information processing?” p.54.

Lewin, R. (1993) Complexity: Life on the edge of chaos. London: Phoenix.

The conclusion? 

Perhaps, the ubiquity of polarity, opposition and dichotomy is that they anticipate and presage an increase in information processing (for good or ill: there we go again!). 

This is also a ( the ) function of Hodges' model.

Previously:

Opposition  . . . See also - Polarity , Dichotomy , Literacy . . .

Healthcare Evolution through AI and Digital twins - HEAD 2026

Dear colleagues,

We do hope this Call for Papers may be of your interest.
We do apologize if this CfP reaches you more than once.

Yours sincerely
HEAD Organizers

=========================================================

Healthcare Evolution through AI and Digital twins - HEAD 2026

18 - 21 May, 2026 - Sydney, Australia

https://www.head.icar.cnr.it/

- in conjunction with the 26th IEEE International Symposium on Cluster, Cloud and Internet Computing (CCGrid 2026) and in-cooperation with ACM SIGHPC

Submit your paper by using the link:

https://easychair.org/conferences/submission_new?a=35863199

=======================================================

MISSION:
------------

All over the world, the number of investments in Information and Communication Technology (ICT) for healthcare and wellbeing (eHealth) is rapidly increasing. GLOBE NEWSWIRE has predicted that the Global eHealth market is expected to reach $123.78 billion by 2030. This means that digital health is of considerable interest worldwide, as it has the potential to improve both the quality of services and users’ access to health information, while also saving time and reducing the workload and associated costs for health service providers in the long term.

In this context, an increasing interest is growing around eHealth and ICT technologies, such as Artificial Intelligence (AI), Digital Twins, Cloud computing, Edge and Fog computing, and Internet of Things (IoT),

which are at the basis of revolutionising healthcare by bringing innovative network applications and services. In fact, modern healthcare applications are becoming increasingly dependent on heterogeneous infrastructures, including IoT and edge medical devices, as well as High-Performance Computing (HPC) backends, to support the execution of AI-driven models and patient-specific Digital Twins.

The HEAD workshop would explore the open challenges and current issues surrounding the application of these technologies, while bridging the gap between healthcare innovation and the hardware and software systems that support scalable and reliable computing. HEAD aims to encourage interdisciplinary discussion about how technologies such as HPC, distributed systems and performance optimisation can facilitate the deployment of reliable and scalable Digital Twins for healthcare. The workshop will highlight the role of computing infrastructures as key enablers of future digital medicine by linking algorithmic advances with architectural and systems-level innovations.


TOPICS:
----------

■ AI Algorithms and Learning Frameworks for Healthcare
■ Modeling and Simulation Methodologies for Healthcare
■ Programming Techniques and Architectures for Healthcare
■ Data Management, Analytics, and Knowledge Extraction
■ ICT Infrastructure and Tools for Healthcare Digital Twins
■ Cloud Computing, Edge and Fog Computing for Healthcare
■ Internet of Things (IoT), Big Data, and Wearable Devices for Healthcare
■ Ethical, Legal, and Societal Implications of ICT for Healthcare
■ Accelerator-based architectures (GPUs, NPUs, FPGAs and DPUs) for Healthcare
■ Parallel and Distributed Training and Multi-GPU/Multi-Node Execution for Healthcare Applications
■ Energy-Efficient, Sustainable, and Optimization-Oriented Computing for AI in Healthcare


IMPORTANT DATES:
--------------------------

• Submission deadline: February 01, 2026
• Notification of paper acceptance: February 28, 2026
• Submission of camera-ready papers: March 15, 2026
• Registration: March 15, 2026


PAPER SUBMISSION:
---------------------------

Manuscripts should describe original work and should be formatted according to the IEEE conference proceedings format. 

Papers will be submitted through the CCGrid 2026 submission system.

Submit your paper here:

https://easychair.org/conferences/submission_new?a=35863199

All submissions will undergo a rigorous peer-review process. Each paper will be reviewed by at least three members of the Technical Program Committee. Reviews will be double-blind.

Accepted papers will be published in the CCGrid 2026 workshop proceedings and will be submitted for inclusion in IEEE Xplore.


BEST PAPER AWARD:
---------------------------

A Best Paper Award certificate will be conferred on the author(s) of a paper presented at the workshop, selected by the Chairs based on scientific significance, originality, and technical quality, as evaluated by the Program Committee.

Please visit https://www.head.icar.cnr.it/  for more information and if you have any questions kindly get back to us by sending an email

Kind regards,
HEAD 2026 Organizers

My source: Dr. Giovanna Sannino

'Our broken sticks' c/o Roger Lewin "Complexity: life at the edge of chaos"

Chapter 4 Explosions and Extinctions

  'Is Stu being led astray? I asked. "There's something called the broken stick model in statistics," said Dave. In this trick, a random number generator "breaks'' a stick a hundred inches long at twenty-five points, and produces twenty-six short sticks. Measure them, count the number that are one inch long, the number two inches long, and so on, and draw a histogram. You get a skewed distribution, toward the short end, just like many natural phenomena, including the distribution of sizes of U.S. cities, for instance. "One thing you have to remember about extinctions is that some species are more likely than others to die out, just because they exist as small, isolated populations,'' explained Dave. "This sort of statistical quirk can skew your results, easily." So, you would be suspicious of anything that looks like a power law? "I would, because it's common, just in the nature of statistics. It may tell you that a system is poised at a critical point, whatever that means, but it may not. In any case, when Stu says that the curve he gets from my data is close to a power law, he knows that there are many other mathematical models that could fit equally well."
  Clearly, there were many reasons to be cautious about drawing the conclusion that global ecosystems are poised at the edge of chaos, using just the extinction data.' p.80.

 

Hodges' model: Axes (structure) and Domains (content)

If we take the axes of Hodges' model, and break them at twenty-five points, I wonder what we end-up (or start) with?

 

Lewin, Roger. (1993) Complexity: life at the edge of chaos. London : Phoenix [Dent, 1993] ISBN: 1857990285.

Previously: 'complexity' : 'system'

Innovation & Change: Pick an edge, any edge...

individual

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group-population

PURPOSE ...  "change always starts with the activists  and it always starts at the edge". p.23 subjective	PROCESS "Very often our change management approaches aren't very sophisticated. We'll pretend this change is an objective process when it can't be."  Endless transformation using the same processes is another well trodden path. p.23   objective
PRACTICE	POLICY  "... there is no clearly understood model for how services can adapt to changing population needs." p.23

Gbadamosi, N. (2015) Turn the tables on top-down change, Health Service Journal, 16 January, 125, 6430: pp. 22-23.

Interviews, playwriting, and clinical encounters: pause for breath - Roger Lewin

It can be surprising how you know something. Something that should be obvious to you. It's your 'Bread and Butter' as the saying goes. And yet for a variety of reasons, you persist in not seeing it, or you frame it in a way that ultimately reveals a bias, influence, and may even mask several aspects of truth. It might be the influence of work over four decades plus. Sitting down, or frequently finally getting out for a walk after several weeks of nudging, in a one-to-one therapeutic context. Or, ever since secondary school, that distant performed encounter with the Crucible. And, more recently as 'Ken', a Post Office subpostmaster and his wife (a brief 10-12 mins), and over the years a desire to write dialogue.

Reviews of Roger Lewin's Complexity, vary in their conclusions about the book's quality. No surprise there, but reading the book it was a revelation to see the method: a series of interviews and the resulting dialogues. 

'In this revision of his book originally published in 1992, Roger Lewin explains what the science of complexity is all about through interviews with some of its most important practitioners (and critics) organized around some of the central ideas. As such this is both a fine introduction to the subject and an interesting read. Lewin includes 16 pages of photos of the scientists he interviewed captioned with a significant quote from each. He has added an afterword on the application of complexity science to business, and an appendix about John Holland, whom he dubs, "Mr. Emergence."

"Everything works toward an ecology" is an old dictum of mine. I have the sense that I came up with that myself, but I probably read it somewhere years ago. At any rate, what is being said here is that complex systems work toward a state of equilibrium near a transition phase, near "the edge of chaos." This equilibrium can be an ecology (Darwin's "tangled web"); indeed it can be the entire planet, as in the concept of Gaia in which "the Earth's biological and physical systems are tightly coupled in a giant homeostatic system" (quoting Stuart Kauffman on page 109).'

Source: https://www.goodreads.com/en/book/show/384547.Complexity

There's nothing profound in this post, and yet this melange of interviews, playwriting, and clinical encounters gives me pause for breath.

Previously: 'Our broken sticks' c/o Roger Lewin "Complexity: life at the edge of chaos"

Book: "Poems from the Edge of Extinction"

 individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

	"One language is falling silent every two weeks. Half of the 7,000 languages spoken in the world today will be lost by the end of this century".
Poems from the Edge of Extinction

Chris McCabe

My source:
Crawford, M. (2019) Poetry, Books, FT Weekend Life&Arts, 21-22 Sepember, p.11.

Hodges' model: Watch, Listen and (really) Join the Edges

individual
|
INTERPERSONAL : SCIENCES
humanistic ---------------------------------------  mechanistic
SOCIOLOGY : POLITICAL
|
group

The EDGE NHS

Edge

Comment on Paul Roemer's "EHR market is ripe for the taking by Google, Microsoft, Oracle"

I read with great interest Paul Roemer's post last month -

EHR market is ripe for the taking by Google, Microsoft, Oracle

I've a lot of respect for the people working at that other sharp end of health. There are times when they are where I would like to be: not the bleeding edge, but the business edge:

Paul is a healthcare strategist and the managing partner of Healthcare IT Strategy, which helps health care providers solve business problems using EHR, workflow improvement, and change management.

Mr Roemer is out there among the corporations, the deals, the media frenzy and the stock market's take on health care AND health IT. He is addressing specific audiences and over here in the UK we can hear the debate raging. My problem is that working for the NHS all my career I have been and am cocooned. Even though I try to venture out and get involved, this is the very powerful criticism of long-term public sector employees. While far from totally sheltered from economical and political climate change, we are protected from the worst of the business elements. Despite this, seeing the title of Paul's post and his two rules:

Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.
Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.

- two additional rules sprang instantly to mind. ...

Rule 3: Beware low hanging fruit

I posted in April 2009 Data sharing, privacy, health, citizenry.... "Database State" expressing concern that the sanctity of personal data is being eroded bit-by-bit in the mind of the general public by the media and the sheer ubiquity of information and technology. Peaches, plums, pears are delicious when ripe, but as such they need to be handled very carefully. So too does the Personalised health record amid a variety of threats - the worst of which are often internal. In health care the patient data that Paul identifies in his Rule 1 is central, and a key issue is the demarcation of individual and anonymised aggregated data. Hence, Paul quite rightly points to a regulated market. Personal data can be far more valuable in terms of direct marketing and so the temptations for misuse are profound.

In the UK an NHS consultation has addressed the additional uses of patient data. This concerned the research capability programme and provision of a health research support service; with events to present proposals and debate the various issues that include information governance....

Information governance is not fixed, nor should it ever be.

In Paul's rule 1 content is king and content=data - in this case:

• patient data;
• effectiveness data;
• disease data.

This list of data would surely qualify as being 'broad spectrum' in nature. If its circulation is not very tightly controlled it can damage the (care) environment. If not managed effectively across multifold 'borders' - national, regional/state, corporate, systems, organisations, users, testing, interfaces, legislative, public bodies - this data can mutate markedly despite the insistence upon standards. You see although Google, Microsoft and Oracle may take that ripe fruit, as they pick it they come across -

Rule 4: Whenever and wherever picked,
fruit can be tainted

This might include the odd bug, or one or two tainted fruit items perhaps? It could be problems in the form of parts of the EHR that are difficult to incorporate, with questions of shared access and ownership? If the fruit is indeed pristine, no blemish, no chemicals, no truly-devoted-insect-kisses: what are the overheads with this particular harvest?

If Google, Microsoft and Oracle believe they can do an Indiana Jones and just shoot to solve the problem because, as Paul suggests, they have the 'numerics' in the cable/telco model, then they need to take care (even if only improvising).

Microsoft, CSC and many other corporations already know of the complexity that reigns (pours in fact!) from their experience in health IT. Paul highlights Google as a new kid in town. Maybe acquisition does obviate the need to learn quickly (let others learn the lessons). But whatever the point of entry: health care (IT) remains a cussed business. And the future mix demands (begs!) the integrated addition of social care, but how and to what level?

It is not enough to counter "let's attack this complexity with simplicity." Health and social care are metronomic. They alternate between complex - simple descriptions (one of which is re-organisation). Plus, that metronome may as well be in a closed box:

Its owner is one Mr Schrodinger.
Care to gamble?

Paul's post is also fascinating since predictions about subscription numbers do count and speak volumes (sorry - but they really do). They will not only reach shareholder's ears, but when the model takes off - the general public's too. This could help erode the cherished sanctity of my personal data. So am I saying that some of the giants of corporative intelligence turn and run screaming, arms raised like surprised Martians in alien territory? No.

Maybe, as I have found -

the real low hanging fruit is the m+del.

Is it as ripe and appropriate in this market as it seems?

Or is it past its sell by date?

Time as ever will tell.

Additional link: NHS data breaches: the 'cogeography' of who and where?

Image source:LowHangFruit.com

=============== Paul's Post Follows ==============

December 17th, 2009
by Paul Roemer
The national EHR market is ripe for the taking by a big three like Microsoft, Google and Oracle. Heck, I'll even go so far as to suggest that when the dust settles in about five or seven years, the National Health Information Network will be a regulated combination of a handful of those firms.
As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario: Let's say I am in charge of Google's somewhat non-existent healthcare line of business. One of my goals would be to have more users of my PHR than any other firm.
Why does this model make sense? Two ways, both of which come from the cable/telco business model.
Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.
Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.
So, back to the example of me running Google's healthcare offering. (If you don't like Google as an example, insert your favorite firm.) If I'm Google, am I troubled by the fact that other firms are building their own solutions? No, because the difficult part of the business model is adding users, adding subscribers. Why not let a bunch of firms do the business development work for me, do the dirty work to get the users, and then just devour those firms? Once I own them, I convert them to my platform. Do I then get some 'ownership' or right to use the data? That would certainly be the business goal.
One million users valued at $5,000 adds $5 billion in valuation. Ten million adds $50 billion. Ten billion is about 2.5 percent of the U.S. market. Do I stop at the border? Of course not.
By the way, while all this is going on, Google, Microsoft, or some other company will also be creating standards and building or buying up EHR firms.

#RCN26 RCN Congress - Nurse Education

If you think hard-enough all the debates at RCN Congress connect to 'education', but two are laser-focussed:

Protecting nurse education

Resolution submitted by the Education Forum
That this meeting of RCN Congress asks RCN Council to lobby UK governments to protect nurse education from university sector economic pressures.

Quality of clinical placements

Matter for discussion submitted by the Students Committee
That this meeting of RCN Congress discusses ways in which the quality of clinical placements can be ensured and consistent across all 4 countries.

For more senior colleagues, you may momentarily think back - all rose-tinted - to the pre-undergraduate Schools of Nursing, but you also realise change was needed and inevitable. A new millennium was fast approaching.

Now, however it seems within the university ecosystem, nursing is a threatened subject and discipline. Nurse education is exposed and itself vulnerable. In the 21st century fitness-stakes - finance wins:

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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group

mental fitness	physical fitness
SOCIAL VALUE  & VALUES	FINANCIAL FITNESS

 

At RCN Congress, the status of nursing as a profession in the USA, was raised. Looking online, I found the following at the U.S. Department of Education: Myth vs. Fact: The Definition of Professional Degrees.

In January 2025 I posted about the situation at Cardiff University. At Congress the matter of the quality of clinical placements, became a resolution. The protection of nurse education provoked an impassioned and emotional debate. Student nurses seeing what is happening to nurse faculty. Nurse faculty seeing the years of experience 'walk' be-pushed out through the door. It seems there is no collective noun for a group, or collection of redundancies. Mass comes to mind, especially in this instance. A 'rash' seems appropriate. But, the condition is more serious and bears further investigation:

As a Google search demonstrates - https://share.google/SViFPWuJovKWhErEE

IT doesn't stop there ...

How many of us (nurses, and other 'professionals') are seeing job offers(?) such as:

Remote
Contract

$35/hr - $80/hr (this is lower than others ...)

About the job

Nursing Informatics Specialist (AI Training)

About The Role

Your clinical knowledge is more valuable than you think — beyond the bedside. We're looking for experienced nursing professionals to help train and evaluate AI systems built for healthcare. As a Nursing Informatics Specialist at Alignerr, you'll apply your frontline expertise to ensure AI understands real-world clinical workflows, EHR systems, and nursing documentation the way actual nurses do.

This is a unique opportunity to work at the intersection of nursing practice and cutting-edge AI — on your own schedule, from anywhere.

• Organization: ---------
• Type: Hourly Contract
• Location: Remote
• Commitment: 10–40 hours/week
  
  

What You'll Do

• Evaluate AI-generated clinical content for accuracy, safety, and alignment with real nursing workflows
• Review and annotate EHR documentation scenarios, flagging errors or gaps in clinical reasoning
• Translate nursing practice knowledge into structured feedback that improves AI model outputs
• Assess how well AI systems reflect clinical informatics best practices across areas like documentation, data integrity, and care coordination
• Provide expert insight on health IT tools, including EHR platforms such as Epic or Cerner
• Work independently and asynchronously on task-based assignments
  
  

Who You Are

• Registered Nurse (RN) or equivalent clinical background with hands-on experience in a healthcare setting
• Familiar with EHR systems and clinical documentation workflows
• Able to analyze clinical scenarios and communicate clear, structured feedback
• Detail-oriented with strong written communication skills
• Self-motivated and comfortable working independently in a remote environment
• No prior AI experience required — your clinical expertise is what matters
  
  

Nice to Have

• Experience in clinical informatics, health IT, or nursing informatics roles
• Familiarity with data annotation, quality review, or evaluation processes
• Background in quality improvement, patient safety, or clinical education
• Exposure to health data standards (e.g., HL7, FHIR, SNOMED)
  
  

Why Join Us

• Work on cutting-edge AI projects with leading research labs and AI teams
• Fully remote and flexible — set your own hours and work at your own pace
• Freelance perks: autonomy, variety, and global collaboration
• Apply your nursing expertise in a completely new and impactful way
• Contribute to AI that could meaningfully improve how healthcare technology serves patients and clinicians
• Potential for ongoing work and contract extension

You might think (no pun intended!): 

'Well this all about informatics. Don't worry - it will all work out fine!'

But, please notice, the clinical and nursing requirement:

"Registered Nurse (RN) or equivalent clinical background with hands-on experience in a healthcare setting."

Not exactly, Hodges' model is it? Even if specific to this role, what does it say:

• about :: the title of 'Registered Nurse'
• about :: Nurses and Nursing as a Profession
• and :: to search engines and agentic AI?

So be aware, and concerned (worried even!) for nursing and nurse education ... 
for the humanity of healthcare:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

de-humanisation	BIG TECH
"Where has everyone gone?" Social values Social justice What about research, debate, evidence..?	Nursing Faculty Universities as Institutions that reflect Society Why is there an echo in here? It's been hollowed out.

P.S. I am not a technophobe. Previously: 'AI' : 'SOCIO-technical'