Posts Tagged ‘IT’

Federate PACS with FLOSS

Wednesday, October 12th, 2011

PACS – picture archiving systems used to stroe and retrieve xrays and other medical images. Each xray department gets one as it give up film.
FLOSS – Free (Libre) and Open Source Software. The UK.gov abbreviation for stuff such as Linux, Apache, WordPress and of course this.

“Dicoogle is a Open Source project that aims (for now) to index DICOM repositories. Thus, you can search in every field that the image contains. Moreover, Dicoogle is a distributed repository. You can have several repositories in your intranet and they communicate with each other, creating a federate view of the repository.”

This appears to be a sensible approach to the problem asserted to exist and to be solved by sucking the whole country’s medical images into a single separate and of course new and additional storage system.

It is an easy and well-enough understaood problem that I expect the implementation to be adequate, and the design means it fails gracefully, of course.

And is philosophically satisfactory.

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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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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/

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SNOMED CT announced for NHS hospital service. Again

Thursday, August 18th, 2011

The 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

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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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Concentrate on Automation rather than on records

Thursday, April 21st, 2011

the focus on records is unhelpful, automation is what people should be thinking of.

Records follow naturally.

The Unix approach of many small programs each doing one thing and doing it well, but talking easily to each other, is a good one.

This is quite opposite the idea that in an ideal world all hospitals (and why just hospitals?) would adopt the same “platform”.

People get it wrong even by saying apparently sensible things such as “First decide what doctors do (not that easy) and then automate the bits that are helped that way”

The error there – which was in full flight at the beginning of NPfIT – is that a complete description is unfeasible. THe correct approach is to identify one thing done by some doctors, and provide automation for the tedious computable bits of that. Then move on to another tiny bit of the problems.

NPfIT has taken a decade out of progress. Microsoft Office adoption has taken another out.

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Sickileaks next?

Saturday, December 11th, 2010

Governments tend to be persuadable that putting all the information in one place in a big database is the solution. It isn’t, and among the reasons it isn’t are the problems that have been solved in a few distributed systems (such as the World Wide Web) and have not been solved in any big centralised database I’ve been pressed to use yet.

Centralise medical records and the records will no longer fit the local organisations and geographies that produced them, and there _will_ be some huge leak of records on the order of Wikileaks.

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