Archive for the ‘Medicine’ Category

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Neo-liberalism: sounds plausible but didn’t work.

Sunday, January 8th, 2012

the BBC’s Newsnight economics editor, Paul Mason:
“A deregulated banking system brought the entire economy of the world to the brink of collapse. It was the product of giant hubris and the untrammelled power of the financial elite. Basically neoliberalism is over: as an ideology, as an economic model. Get over it and move on. The task of working out what comes after it is urgent . Those who want to impose social justice and sustainability on globalised capitalism have a once-in-a-century chance”. Mason P. Meltdown. The End of the Age of Greed. Verso. 2009

Via Bevan’s Run

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Charity Status should be Revoked

Wednesday, October 19th, 2011

Given the ASA Adjudication on its homeopathy advert why should this bunch – Homeopathy: Medicine for the 21st century at http://www.hmc21.org/ – be a charity?

Posted in Medicine, Stupidity | No Comments »

NHS IT spine etc: The Internet works …

Thursday, September 29th, 2011

Which given the studious lack[0] of central planning and control of its development is interesting[1].

Its fundamental principle[2] may[3] be worth adopting. NPfIT started from 0/2 on that basis, and if anything got worse.

So the internet works by providing wires on which sit a load of computers (referred to as “hosts” or “peers”[4] ). Each can talk to each using a simple set of rules. Some vaguely central directories of machines are kept, and anyone may make a list of machines they trust and identifiers for them. This is a task which governments could do well, if they could do it well.

If the computer in the casualty department wants to know something about a patient, then it can send a question to the computer in the patient’s general practice. It could ask around to the Darzi Centre, the Nuffield[5], and the Orthopaedic clinic in Val Thorens[5] as well.

And then the patient should get an account showing what access has been made to their medical record[6], which tends to keep everyone honest, or at least visible.

(Adding a registry and security to this is not as hard as it may seem. Not trivial, and not something to do with secret programs, but the problems are known[8])

[0] After Al Gore steered funding for it through Congress the nerds just got on with making it work.

[1] Correlation does not prove causation

[2] Rough consensus and _running code_

[3] I mean is, but this is supposed to look more tactful

[4] An indication of the attitude which works, and prevails, and is opposite to that favoured in NPfIT thinking, where _our_ machines are regarded as clients of _their_ servers

[5] examples of places excluded by the currentfailed and abandoned approach to NHS sharing of records[6].

[6] whatever a medical record is, something which Accenture, Fujitsu, and CSC turned out to be no more sure about than the DoH, I think. I’m not sure about it either, but I’m quite keen on saying so because I think it is interesting to consider.

[7] refer to note 7 if you want to demonstrate having paid attention

[8] Some people may say understood and solved, but at least the latter group tend to be selling secret source programs that they claim solve them. The former group may be optimistic, but are likely to say that closed source solutions are unreliable, and are correct in that.

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Posted in Free (Libre) and Open Source Software (FLOSS), IT, Medicine, NHS, thoughts | No Comments »

Prescribing: The FP10 system is unfit for use

Saturday, September 10th, 2011

It was fit for use when it was introduced, has been for some time, and is adequate for many episodes of care but it is now past its sell by date.

It can be patched to make it usable, probably, but it may actually be better to separate its various functions.

Computers permit this without a perceptible increase in errors or effort or cost.

A handwritten addendum greatly increases cost, greatly increases the potential for error, is rarely designed well, accentuating those last faults, scales extremely poorly, and is very expensive.

Handwritten addenda are more common and likely to become more so.

Some of them could be substituted for by carrying a printer and producing sticky labels, as done in 1984 for such tasks as intravenous feeding regimes in some places with an Epson carry-able computer.

The problem, and the solution are likely to be unappreciated by those focused upon hospitals, which regrettably includes those in charge of district nursing and nursing home regulation. They lack the background. They may be educable.

Event-based financial system used, holding state needed.

The problem is that the FP10 form is overloaded[1]. It is an accounting token, a workflow token for pharmacy, a set of instructions to a patient, and it is not, and never has been, a complete list of what the patient should currently be taking, and how.
It is also used as an indication of what GPs prescribe, a task for which it is of course the least good record.[2]

A solution is to automagically produce a state document – IE each time a change of medicines occurs,

This is something which should come via doctor-driven development of IT systems, and introduction of it without IT support – automation – should be opposed vicigorously

[1] it has more than one function.

[2]If you substitute for “prescribe” something about what pharmacists admit to having dispensed for patients then it is marginally more accurate, but it does reflect as well as could be done the prescribing intentions of GPs which oddly is what the people looking at these analyses claim to be or should be trying to understand and sometimes influence.)

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Posted in IT, Medicine | No Comments »

If you call your organisation “The secret lobby group”

Monday, September 5th, 2011

… then nobody should really expect you to be forthcoming on your membership and sources of income. Nor on what you are doing.

If on the other hand (OTOH) you call your organisation “The Right To Know” then some degree less reticence might reasonably be expected of you.

“Neither Dorries nor Field, nor the Right to Know campaign – which was set up to lobby for support for the amendment – will reveal the details of who is involved with Right to Know and who has funded it. It has paid for a poll of MPs carried out by the private pollsters ComRes as part of a lobbying operation.

MPs who are opposing the amendment have called on Dorries to reveal the full sources of the backing for the campaign.”
http://www.guardian.co.uk/world/2011/sep/02/anti-abortion-critics-nadine-dorries

Ms Dorries describes her blog – the closest one can expect to get to seeing exactly what a politician wishes to say directly to peoople in general – as 75% fiction.

The Independent yesterday noted that on BBC1′s World at One programme Ms Dorries stated that she did not have abortion figures with her (unusual, I’d think, for someone called there to speak about them) but proceeded to make some upgive an estimate.

                            Now              15 years ago
Dorries                     200 000           40 000[1]
Independent,                189 100          167 916
after looking it up

The Grauniad also reports that the misleadingly named organisation includes or is associated with our colleague Dr Saunders of the CMF. A commitment to accuracy in statements is sometimes excused by references to religion, but not in doctors, I think.

[1] “may have been around 40 000″

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GMC: Cartoon characters. Not very good.

Friday, July 1st, 2011

http://www.gmc-uk.org/guidance/9748.asp The reason the number feeding back that it is irritating and uninformative, aimed at a less sophisticated population than doctors, and poorly executed in plot, production and presentation is low is that it is a fundamental pain to register to give that feedback. So poor marks for website usability as well. And an expensive luxury for someone to indulge themselves in using Other People’s Money including mine. The GMC became taxation without representation some time ago, and would be a suitable target if we had a Tea Party in this country.

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Posted in art, Medicine, Stupidity | No Comments »

8 Million health records lost by North Central London health board

Wednesday, June 15th, 2011

http://www.theregister.co.uk/2011/06/15/eight_million_health_records/

Apart from all the other things wrong, collecting that many records together was not a good approach, although it appears to be the one preferred by every NHS admindroid.

Posted in IT, Medicine, Stupidity | No Comments »

Clever: Twitter Journal Club

Sunday, June 5th, 2011

Blog pointing to and explaining it.

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Posted in Medicine | No Comments »

Security of digital camera cards: removing pictures of patients

Thursday, May 12th, 2011

Formatting the card will not remove pictures in most cases, and is never reliable for removing all of them. Deleting the images from the camera or the card doesn’t conceal them either.

Recovery is very easy, anyone finding a card will have no difficulty at all getting software to read the card byte by byte, and reassemble image files.

Someone who stole a card with the intention of embarrassing a doctor or looking for gain from images – not a large threat, actually – could be relied up on to be certain to recover any images.

I tried recoverjpeg on a 4GByte card which has been used and “erased” – IE files unlinked from the directory entry pointing to them – many many times, and new files recorded – and it retrieved 496 files. A sample of them were complete, I suspect that all of them, and certainly all recent ones, are undamaged.

Memory cards arrange that files are written to new areas of card rather than to previously used ones, so as to even out wear on the memory locations, to increase the life of the card. This opposes secure deletion.

To securely remove pictures from a 4 GByte card, the only approach which certainly succeeds is to actually write a value to each memory location on the card. This will hide previous information to a degree which would require at least research lab or national security facilities to recover.

It isn’t difficult, technically, and essentially involves writing a stream of say 4GBytes of zeroes or arbitrary patterns to the device, rather than to files on the device. In Linux dd will do it.

Copying files across would be more tedious, but if the card is filled with data and then reformatted it will reasonably secured.

Not losing the thing is a key point, however cameras, particularly shared ones in open buildings, are prone to being stolen, as are loose cards. Securing the cards used for patient photographs in the building, and substituting a different card when the camera goes outside is worth considering.

An alternative would be to not use a card, and operate the camera “tethered” to a computer.

recoverjpeg is licenced under the GNU GPL, you can use it freely.

Item 17 of the advice given at the RD&EH Trust Dermatology department website is wrong. I’ve told the author and it has remained wrong.

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Posted in Free (Libre) and Open Source Software (FLOSS), IT, Medicine, NHS, Photography | No Comments »

The antimerits of the SSEHR (Single Shared Electronic Health Record)

Tuesday, April 26th, 2011

Ewan Davis, who knows of these things, doesn’t say in his good posting that one of the problems or reasons for deprecating the development of a single record is that it is too hard for us.

It would be A Very Big Program, and we are not good at that, and Have Many Complicated Bits and we are not good at that either.

Whereas the (Unix) approach of many small programs doing small things and doing them well, with simple rules to connect them like the Internet has prospered on seems to be within our capacity.

Naturally this is less attractive to potential buyers of One Big System or potential winners of the fight to sell One Big System, or to Knowers of the One True Way who want to regulate doctors and other healthcare workers by using the computer to program people, than it is to the minority of doctors and others who have a problem they can see a solution to, and know how to program it or know someone who does.

Bring on the bazaar.

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Posted in IT, Medicine, NHS | No Comments »

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