Dr Dr Geraint Lewis of the Nuffield Trust on VistA, which is a good thing.
Archive for the ‘NHS’ Category
Getting NHS IT going.
Wednesday, September 21st, 2011The chairman, Martin Watts,
Tuesday, September 20th, 2011“insisted the costs incurred had not affected patient care. ”
He may be depending on the use of the present tense, that until the bill is paid, no effect has occurred from it.
Alternatively, he might be asserting that if someone gave the Royal Cornwall Hospitals NHS Trust another £2 000 000 nothing could be found to do with it which would improve patient care.
Or perhaps it is just one of those things that NHS managers and directors say when things have gone badly wrong.
Is it compatible with the behaviour Trusts publicly demand from their doctors and other people who actually carry out healthcare? I think there is a gap, and should not be, in such expectations.
Case report in The Independent
John Watkinson, former chief executive of Royal Cornwall Hospitals NHS Trust was illegally dismissed.
The EMIS Outage
Saturday, September 10th, 2011An official letter from EMIS (which I have not seen) describes multiple consecutive component failures in a storage device in association with a previously unknown firmware failure. The combination led to shutdown of the storage device and for some reason failover to a secondary data centre was not possible for most practices. EMIS are reviewing complementary infrastructure for both local and data centre environments.
I continue to prefer keeping the data on the server in the building.
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″
GP Record Server Failure
Monday, August 22nd, 2011“GPs hit by care records server failure
Nearly 800 GP practices in England were unable to work after losing access to their patient care records systems, following a series of server failures.”
Health Service Journal
(See earlier entry here: http://defoam.net/wordpress/2011/08/18/general-practice-central-computer-sytems-broken-today-emis-down-across-england/
NHS Direct: How to get an interpreter. Um…
Thursday, August 18th, 2011http://www.nhsdirect.nhs.uk/en/About/CallingNHSDirect/InterpreterService
The page is in English, and I see no list of languages to click here to display it in the language of choice, which would seem useful.
General Practice central computer sytems broken today, EMIS down across England
Thursday, August 18th, 2011I’m told EMIS’ centrally hosted systems, in multiple redundant data centres, are broken today. Both EMIS PCS and EMIS Web have failed for swathes of the country. A report is that it is working in part of the Midlands. See DNUK thread, if you have access.
Me, I prefer a local server in my building. It fails more gracefully from the countrywide point of view, and has severalother advantages.
If I were to have a central system, then apaprt from it being actually reliable, I’d want two fibres connecting to it, leaving my building from 2 different corners, and staying separate all the way to two data centres.
The pressure on GPs has not been about reliability, although that is an excuse offered, but about power, responsibility and perhaps other people’s commercial interest.
SNOMED CT announced for NHS hospital service. Again
Thursday, August 18th, 2011The system being presented is SNOMED CT.
That is SNOMED plus the Clinical Terms Thesaurus (CTT)
CTT was the later name for the Read Code version 3, or actually Read 3.1, since we[1] regarded 3.0 as no good, largely as it didn’t contain the codes and rubrics from the earlier sets – Read 4 byte and Read 5 byte (most of you are using the latter, EMIS users will remember the former, and the pain of change).
The Mayo Clinic was contracted to handle the combination of the multiaxial SNOMED set with the Read 3.1/CTT. The NHS and Treasury[4] convened a working group to advise them whether a way of determining if this work was done well could be produced. We[2] gave a clear answer. The answer was “no”, but I expect it was done adequately well.
Read/CTT is good at general practice stuff, less good at hospital stuff. SNOMED is good at pathology, and I assume much of the hospital stuff apart from that. Read/CTT already embodied – actually enveloped – the ICD and the UK extensions to ICD 9 and I presume 10[3]
The two sets have an area of overlap, where codes should be mapped onto each other, and areas that don’t overlap where the result will be that you can code a wider range of concepts with the single system.
I think it is more complex, centralised, prescriptive and unevolutionary[5] than is ideal, but that the persistent efforts to hold copyright on these collections of terms and the manner of their handling compels that. And therefore coding systems, as with natural language, should not be restrictively licenced and should be presented as Open Source or Commons.
So it has been planned all this century, or at least intended.
[1] the specialty working group for quality assurance in Clinical Terms/Read/Thesaurus. We didn’t write them, we did criticise and accept.
[2] Just after the Hammersmith train crash, and just about under the line it happened on. I was asked to attend. One member got a curious smile when I remarked the whole lot should be Open Source, because he was unable to announce that his unit at the University of Manchester were about to do just that, until the following week.
[3] it was a while ago, and I’ve not been involved (I’m not sure if any doctors have been) for quite some time.
[4] It was an effort to explain to the Treasury chap why this mattered. I think it was accomplished – two cultures and all that.
[5] as in the evolving nature of language, with loan words and so on
Med 3 after hospital admission
Tuesday, August 16th, 2011
Security of digital camera cards: removing pictures of patients
Thursday, May 12th, 2011Formatting 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.