Posts Tagged ‘NHS’

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

Early Day Motion 2031: Good

Monday, July 11th, 2011

http://www.parliament.uk/edm/2010-11/2031 on Private Eye, whistlblowing in the NHS, and the need for actual protection as opposed to the appearance and assertion of it.

BBC badly briefed, by whom?

Wednesday, May 18th, 2011

BBC on NHS IT and shared records http://www.bbc.co.uk/news/health-13430380

Wildly wrong in the first sentence.

I’m interested in who briefed them that “currently GPs use paper records”. This GP doesn’t, and hasn’t this century. Other bits of the NHS have carefully avoided learning from us, and are setting up systems similar to those we had in 1980, and I suspect the vendors and champions of those wish to compel us to abandon ours and move to theirs.

The record of central NHS IT projects is appallingly bad, but the failed model of development and control has been applied over and over again, and currently the centralisers are trying to take over the only success stories.

Bad.

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.

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.

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.

New Maps of Healthcare

Thursday, November 25th, 2010

As with various other things Muir Grey has driven, http://www.rightcare.nhs.uk/atlas/ an atlas of healthcare variations, is a good idea.

Kingsley Amis long ago wrote as a critic a book about Science Fiction, called “New Maps of Hell”. I don’t think that was as useful or will remain useful for so long, although it had its amusing or interesting parts.

Whether the NHS can keep it together to keep this running, and in the same place, is another matter and a recurrent one.

Much better locations for it would be http://rightcare.nhs.uk/atlas/ and http://nhs.uk/rightcare/atlas/ but these things tend to be decided by people whose map of the Web is defective, and who regard that as one of their many strengths in management.

Altogether now: “we told you so”

Thursday, November 19th, 2009

ISTCs might not be a totally stupid idea, but the implementation does not seem to me to have the same uncertainty. This North London scheme was not predicted to do well and is now suddenly suspended.

The challenge is to find something to express surprise over.