Recently HSCIC and NHS England published an Interoperability Handbook, intended to help provider CIOs and others steer the difficult waters of obtaining interoperable health IT solutions. The target audience is listed as:
CCG Clinical Leaders, Chief Clinical Information Officers, Chief Information Officers, Directors IMT
so the publication can be understood primarily as an aid to procurement and in-house planning and development of EHR and other clinical information solutions.
I won’t provide a proper analysis of the document here, other than to say that it is likely to be a useful resource for its audience, and a good starting point for ongoing conversations and education in the e-health solutions area within the NHS (even just establishing standard nomenclature in the NHS for talking about the relevant concepts is a worthwhile exercise). Interoperable solutions are a huge engineering enterprise, so hopefully it will be understood that documents like this one act as useful reference points, but in no way replace the needed human resources and competencies to plan and deliver actual solutions.
However, I do have some comments…
I am probably one of the longest time users of Adobe FrameMaker in the world. I started using it at version 2, sometime around 1990, and finished with it a few months ago. For most of this period it was the unbeatable desk top publishing solution for ‘serious’ documents and books (as opposed to magazine articles and the like). It was used by Sun Microsystems, IBM, and still I believe, HP for their technical publishing. The IMIA yearbook was historically published using it. Thousands of software and engineering companies around the world used it to publish manuals. It did a pretty good job of multi-channel publishing, at least to PDF and HTML, using WebWorks (now ePublisher), and was unbeatable for control over fonts, layout, cross references, and most other details of publishing.
Why did I stop using it?
openEHR training session last week at Hospital Sirio Libanes, one of the premiere teaching and research hospitals in Brazil. I delivered the background and theory part, Samuel Frade and Bostjan Lah (both from Marand) delivered the programming part.
We were there at the invitation of Beatriz de Fario Leao (no introduction needed there). Met a great team of business analysts and developers, some in the above photo. Looking forward to working more with them.
Brazil is starting to work a lot with openEHR, and may become one of the premier locations using it. Which would be great – a large country moving to a semantic, model-based technology for the EHR and interoperability.
My favourite topic these days is the phenomenon of fundamentalist thinking. You don’t need to go to Iraq to find it, it’s all around us….
Recently I chanced upon a post entitled ‘Coding is not the new literacy’ by Chris Granger, who as far as I can tell is one of the smart young generation of start-up developers creating interesting new ways of doing software. I suspect he is not yet 30, going by his ‘about’ page. Not a bad post for a young guy. It essentially says the following:
- coding is ultimately the act of externalising our mental models into computer-understandable form
- the main game is building and refining those mental models
In his view, ‘modelling is the new literacy’. He says:
Modeling is creating a representation of a system (or process) that can be explored or used.
I happen to agree with this, and I would go so far as to say that if you think that coding is the main activity of understanding or formalising a solution to a problem, you are profoundly wrong.
Normally this blog is reserved for my work. This evening I make an exception. I am outraged and disgusted at what I see has happened in Paris this afternoon. A massacre of 12 at and around the offices of Charlie Hebdo, a widely read satirical magazine in France, by Islamist terrorists, apparently in response to a cartoon published recently of the ISIS leader, and no doubt for other perceived slights.
It would be easy to direct our anger at Islam in general, and today I have some sympathy for those who do that. But they are wrong. Not because I think Islam is ‘really peaceful’, and the violent extremists who commit these crimes are ‘not true Muslims’, as various apologists are wont to say. Personally, I think Islam is a pretty useless religion, along with most other religion. The perversion of enforced celibacy and the systemic child abuse – and its systemic denial – of the Catholic church are hardly more defensible than the precepts of Islam commonly targetted by its critics. Some experts’ reading of the ISIS situation concludes that ISIS followers are in fact among the most faithful Muslims, as they (apparently) truly believe they are engaged in holy war in defence of the core values of Islam. However the endless debate about religion isn’t my point for today.
What is important is for all of us who cherish freedom of thought to understand and defend what we think defines a civil society. And one thing I believe defines it is that we do not recognise any ‘right’ to kill in the name of an idea. We particularly do not recognise any right to murder, maim, torture, rape or commit other violence against the person, or against the public in general, based on one’s private or shared beliefs.
We cannot tolerate individuals within our civilised societies who give themselves this right and act upon it. We can only see them as psychopaths and a danger to the rest of us. And today proves that we cannot simply assume that our system of laws and human rights will passively protect us. It won’t. It requires our involvement.
On the other hand, we do recognise the right to freedom of thought and of speech; but this is a right not accepted by the fundamentalists among us, those who arrogate for themselves the right to murder.
We must recognise one thing however. Although in this decade we reel from a seemingly endless barrage of events in which the terrorists are Islamic fundamentalists, history is replete with atrocities committed in the name of ideas, many of them not even religious, let alone Islamic.
The true enemy of any truly just civil society is and has always been absolutists and ideologues. The horrors of the holocaust, Stalin, the killing fields of Cambodia, Uganda and Rwanda are apt reminders that you don’t need religion to commit atrocities. There are those who argue that religion, or some religions, are particularly well-suited to creating and justifying ideological terror, since religion appears to confer divine blessing on the righteous actions of its followers. Although it’s difficult to argue with them (particularly the critique of the idea that ‘all religions are the same’ – they clearly are not), we need to recognise they are talking of religion as ideology, not religion as personal faith.
Let us spare a thought for those who died today at Charlie Hebdo. They were journalists and satirists, just like those you know from TV – Jon Stewart, Ian Hislop, Stephen Colbert, Bill Maher – and those who work for newspapers around the world. Yes they are sometimes tasteless, and even offensive to some. But I find they represent our true thoughts much of the time. They skewer the inflated egos of politicians and demagogues, conservative and radical alike, and help us to laugh (and maybe cry) at some of the outrageous injustices we put up with in our flawed world. But they can only exist within those societies that believe in freedom of thought and speech. Those societies are fundamentally incompatible with the intellectual and physical oppression the violent fundamentalists wish to install.
Today reminds us that we can’t take for granted our right to freedom of thought and speech, nor our rejection of ideological violence. The murdered journalists and cartoonists at Charlie Hebdo were, in their way, fighting for these freedoms, in the same way that Voltaire did in his time – publishing satire and polemic against injustice.
Windows 8 – a Lesson in Corporate Schizophrenia
Recently I moved up to a Dell XPS 15 (fast i7 machine) with Windows 8.1, from an old Dell with Windows 7. I am now, along with the rest of us, suffering in different ways from inexplicable corporate stupidity. This post on Tom’s tech Take II blog nudged me to post my own frustrations. I’ll be short and sweet.
A few months ago I posted on what makes a standard or set of standards in e-health investible. The headline requirements I can summarise as follows:
- platform-based: the standards must work together in a single coherent technical ecosystem, based on common information models, knowledge definitions, and interfaces;
- semantic scalability: there must be a sustainable way of dealing with both the massive domain diversity and change, and the massive local variability;
- implementability: is the standards ecosystem available in a developer-friendly form?
- utility: does the standards ecosystem actually bring real value?
- responsive governance: does the ecosystem, and its constituent standards have a maintenance pathway?
In the above, I use the word ‘standard’ to mean anything that is in wide use, as per this post.
In the above, #1, and #3-5 are about technical and management issues. They need to be well understood and carefully addressed. But they can be solved. Most importantly, they are of ‘constant size’, more or less, if we agree that the relentless churn in software platforms essentially produces the same thing every time, solved in slightly different ways.
It is #2 that really matters – the question of semantic scalability. This is the one characteristic that directly reflects the domain subject matter itself: biomedical knowledge, clinical information, workflow, practices and processes.