Why the NHS needs its own health-tech university

Posted on April 6, 2019 by wolandscat

The NHS has around one million employees and serves most people in England and Wales. We could easily imagine a slightly larger organisation serving the whole UK, although for historical reasons Scotland and Northern Ireland are separate. Another large public healthcare organisation is the US Veteran’s Administration, which manages around 160 veterans hospitals and countless clinics in the US. Brazil has an organisation called SUS – the universal healthcare system – which provides public sector care for 160m people not on private care. Smaller countries have similar, generally large, organisations, at least by the standards of each country. Large private organisations such as Kaiser Permanente and Partners Healthcare are in the same position, with the same needs.

There has been an endless search by such organisations over the 25 years I have been involved in e-health for the silver bullet to solve their IT challenge.

Continue reading →
Posted in Health Informatics, openehr, standards | Tagged , , , | 4 Comments

The long slow death of UML

Posted on March 7, 2019 by wolandscat

The Unified Modelling Language aka UML has been around for 22 years, as you can see from the OMG UML page. We use it extensively to publish the openEHR specifications, in a similar way to many other organisations. Developers often use it for whiteboard brain-storming. But hardly anyone uses it for its original purpose: formal modelling of software leading to code, ideally with round-tripping. And this is despite the availability of excellent UML tools. Architects these days tend to limit their use of UML to package diagrams and a few illustrative class diagrams, while developers tend to go straight to code or use tools that pretty-print extracted textual forms of software such as swagger and apiary.

In openEHR, we publish specifications, so graphical representation of formal models is important. UML is still the only widely used graphical format, so we use it. However, to get around all its problems, I had to develop an alternative for static models, called Basic Meta-Model (BMM), to enable correct formal model representation for our tooling. This was not done lightly – we had to do it because UML does not represent the developer view of models correctly, and that’s the one we want. Worse, its serial form, XMI, is unreliable and unusable by humans or tools other then the creating UML tool. We also developed a UML extractor for the UML tool we use, to fix some of the problems it has, so we know a thing or two about UML under the covers. I have no doubt other organisations have resorted to similar fixes.

A few years ago I asked 8 senior software engineers at a meeting who was using a UML tool in their development work. A total of zero hands went up. And yet humans love pictures, so we should be using some sort of graphical modelling language. What went wrong for UML?

Continue reading →
Posted in Computing, Health Informatics, openehr | Tagged , , | 3 Comments

Why NPfIT failed

Posted on October 28, 2018 by wolandscat
(from Campion-Awwad, Hayton, Smith and Vuaran, 2014)
Below is my list of reasons why I think NPfIT failed. NPfIT was the NHS National Programme for IT in health, starting in 2002, with Richard Grainger appointed as NHS IT director. A timeline is published here. NPfIT is generally conceded to have spent £10.7bn by the government in 2013, when it was definitively shutdown. Claims have been made that slightly more than this was delivered in value. Realistic analyses such as the one linked to from the image at the top of this post show that the realised benefits are miniscule. Right now, the benefits for ‘Choose and Book’ can probably also be written off, as it is no longer generally used. I would guess the only benefits that those in the industry would agree were actually realised are N3, the secure NHS network and possibly NHS mail. The Spine supplies some benefits, but is so badly designed and over-complicated that it will undoubtedly be completely replaced in the next 5 years. Continue reading →
Posted in Health Informatics, openehr, Politics, standards | 8 Comments

Services Landscape for e-Health

Posted on October 23, 2018 by wolandscat

Every so often I get bored of what I am doing and start trying to draw one of those ‘services roadmap’ kind of diagrams for e-Health. These pretty pictures appear in slide presentations, standards, whitepapers etc, but are not often used as a tool to help map out the road ahead, mainly because (I think) they mix too many conceptual levels together. We do however need some sort of vision of the future for defining services. I like my latest version enough that I thought it would be worth putting up publicly to get reactions and input. Please comment and/or add content to the wiki page.

Posted in Computing, Health Informatics, openehr, standards | Tagged , | 2 Comments

FHIR v openEHR – concreta

Posted on October 10, 2018 by wolandscat

Some readers may have read my previous post FHIR compared to openEHR. If not, I recommend you do, it is available in Spanish, Japanese and Chinese as well as English. Here I aim to clarify some of the concrete differences which are increasingly common sources of confusion, particularly with the FHIR hype wave preventing coherent thinking in many places. It seems that the human psychological pre-disposition for uncritical silver bullet thinking is as strong as ever, but I still hope (perhaps vainly) that in e-health we can soon get back to real science and engineering.

Continue reading →
Posted in FHIR, Health Informatics, openehr | Tagged , , , , | 2 Comments

Why the platform will replace today’s interoperability standards in healthcare

Posted on July 21, 2018 by wolandscat

For decades, most of us working in health informatics and e-health have lived on the assumption that ‘interoperability’ is one of the main things we are trying to achieve, and that it is the most important because the lack of it blocks progress on nearly every other priority. In the last decade, the gold version of interoperability has become ‘semantic interoperability’, a fabled Nirvana in which today’s sewers of recalcitrant proprietary data are magically transformed into a sea of pure Evian whose meaningful molecules will be ‘understood’ by drooling next generation apps that will instantly discover what is wrong with each of us, and tell us how to fix it.

Continue reading →

Posted in Computing, FHIR, Health Informatics, openehr | Tagged , , , , , | 9 Comments

openEHR Basic Meta-Model (BMM) and syntax major upgrade

Posted on July 16, 2018 by wolandscat

The openEHR Basic Meta-Model (BMM) that has been in use in some form for nearly 10 years now was recently upgraded to version 3.0.0 (from 2.x), with the persistence format (now called P_BMM) being backwards-compatibly upgraded to version 2.3. The purpose of the upgrade was to improve the separation of class and type, and to greatly strengthen the semantics of generic types and classes.

Continue reading →

Posted in Computing, FHIR, Health Informatics, openehr, standards | Tagged , , , , | Comments Off on openEHR Basic Meta-Model (BMM) and syntax major upgrade

Standards or toilet paper? A Linus Torvalds reality check

Posted on June 22, 2018 by wolandscat

Linus Torvalds, rightly praised for his literary flair and subtlety, serves up a classic today, on the topic of standards and when to just forget about them.

Continue reading →

Posted in Computing, Health Informatics, standards | Tagged , | Comments Off on Standards or toilet paper? A Linus Torvalds reality check

Major German research project chooses openEHR

Posted on June 20, 2018 by wolandscat

I just returned from Heidelberg, where another very successful ‘openEHR day’ was held, this time by the HiGHmed research consortium, with 100 attendees. HiGHmed is funded with 20m€ by the German Federal Ministry of Education and Research (BMBF) under the “Medical Informatics” funding scheme, and has as its goal (my bolding):

Continue reading →

Posted in FHIR, Health Informatics, openehr, standards | Tagged , , , , | Comments Off on Major German research project chooses openEHR

Will the tech giants ever succeed at e-Health?

Posted on April 8, 2018 by wolandscat

Amazon, Apple, and Google are all having another go at e-Health. But we have been here before: remember Microsoft HealthVault? It’s still around, and still hasn’t taken off. Google Health went live in 2008, but was retired at end of 2011, due to ‘lack of adoption’.

Fast forward to 2018, and we see Apple, Amazon, Google and Uber making new e-Health plays. Initially each corporation will probably work from its strengths – retail delivery for Amazon, booking for Uber, data for Google, and devices for Apple. In the US at least, some of them will build their own healthcare providers for the workforce, and use the environment as a place to work on next-generation health IT solutions. Some challenges, particularly in the devices area, will undoubtedly see progress – there is no doubt that the tech giants do some things really well.

But I remain sceptical about overall success.

Continue reading →

Posted in Computing, Health Informatics, standards | Tagged , , , , | 1 Comment