31 March 2016

Cycling to raise money for Nazareth kids

Nazareth EMMS Hospital needs your help!
Back in 2009 I joined a group of 18 cyclists travelling from Madaba in Jordan down to the Dead Sea and up the Jordan Valley, eventually crossing into Israel and up to Nazareth, in order to raise money for the Nazareth Hospital.

Operating Room facilities in Nazareth
In 1993, as a young medical student, I spent my overseas elective period in Nazareth, learning about medicine and the local culture. Nazareth is home to the largest Palestinian Christian community in Israel, although the majority of people in the area are Muslim. There are also a lot of Jewish people, so it's a somewhat eclectic place, and given the history of the last few decades, you can imagine that it's not without its issues.

When I was there in '93 the facilities were, while not exactly primitive, hardly up to modern standards. There has been a massive amount of work put in to upgrading things, much of it funded from international fundraising activities, and Nazareth Hospital is now one of the best-performing hospitals in Israel. It is also a shining beacon of coexistence in a very troubled region - a model, perhaps, of how people can put aside their differences and work together for the benefit of all.

But this success is not assured, and has required constant attention. This year, 2016, the Nazareth Trust is holding a sponsored cycle around the Galilee to raise money for the much-needed refurbishment of the Paediatric Ward. Unlike many hospitals elsewhere in Israel, there are no wealthy American donor organisations willing to fund expansion - just hard working people in Israel/Palestine, Europe, USA and Australia, who are trying to make a difference.

You can make a difference too - you can sponsor me, OR you can sign up and do the cycle too!

VISIT SHANE'S SPONSORSHIP PAGE: https://my.give.net/shanemckee


30 March 2016

Virtual Donegal Banjo

This is an experiment. Please feel free to ignore, or collapse in amazement if it works...

(Or let me know if it doesn't...)

You can also try the Spherecast link.

23 March 2016

An Apple Watch a Day Keeps the Doctor Away

This morning I gave a talk to the Northern Ireland Connected Health Ecosystem at Belfast Metropolitan College. The theme of the meeting was digital health & social care, and my talk had the above title; I was keen to get the audience thinking about the new opportunities offered by tech to radically change our models of healthcare delivery.
My central thesis: over time we have let our ideas of "health care" grow quite massively; certain things now fall under the auspices of "health" that in years gone by we would have anticipated that other agencies, individuals and structures would have been able to fill. Care workers have taken the place of normal family interaction. Patients are disempowered to control even the smallest aspect of their daily lives without having to consult their doctor, nurse, carer etc. We have, perhaps, created a top-down hierarchy that has removed the initiative from the patient/service-user, and made them feel like a slave in their own skin, rather than the master or mistress of their personal vessel. Quite how much that issue is playing in the dramatically rising costs of healthcare, who knows? But I think it's likely to be significant, and if we are going to make things sustainable, we need to look at this. Some patients are making a big splash, like Molly Watt - have a look at the slides to see if there's anything that you may agree or disagree with...

13 March 2016

Digitising Healthcare - how hard can it be? #EHR4NI

Robert M. Wachter, MD
Professor and Interim Chairman, Dept. of Medicine
Chief, Division of Hospital Medicine
University of...

Pretty hard. And the rewards can take some time to arrive. Don't take my word for it - let Dr Bob Wachter explain.
[Click here for video]
[Click here for slides]
The Productivity Paradox is definitely something we need to be very aware of before we embark on this journey - but the journey itself is definitely worth taking if we keep our eyes open and our brains on.

A single health record for Northern Ireland? #EHR4NI

The Health Minister has unveiled the eHealth Strategy for Northern Ireland, and a key part of improving services for patients, and ensuring we can deliver high quality health care in an environment of continual improvement and patient engagement is an electronic health care record (EHCR) which brings together data from a multitude of sources and makes it available to inform what we do as health care professionals in many different environments. The plan also calls for patients to be able to interact with their own information - to view their doctors' letters, communicate with health professionals, arrange appointments, see their medications and access health promotional materials.
Dark Hedges, Co Antrim. Photo: Bob McCallion (Farm Life)
Unsurprisingly, this is a complex and potentially costly undertaking, and we're talking about doing it at a rather large scale. Not that our population of 1.8 million is particularly large, but the potential numbers of sectors involved means that there is a great deal of work to be done if we're working towards a single record.

One fairly significant problem is that a product that integrates all aspects of a patient/client's data (I'm going to try to avoid using the word "care" for reasons I've partly already outlined) doesn't actually exist - yet. The big integrated health platforms that are widely used in the US and elsewhere are marvels of software engineering, and do allow us to potentially do some very valuable things, but they are at best only part of the solution, not the full package. And I think this is an important point - when we are lookng at our strategy and where we are going, we are not looking at the product, but at what we are going to do. An EHCR project is not a procurement exercise for an IT solution, it is a redesign of how we (patients, doctors, nurses, allied health professionals, government etc) develop and support ways of working that make the most of what we have available.

A significant part of the challenge is linking together data from sources such as paper hospital records, GP systems, community systems, pharmacy, government etc, and making it actually work for us. This is not a trivial proposal, and there is no doubt that it's not all doable at once. The "change management" (or "service improvement" or whatever we end up calling it) presents enormous difficulties, and if you're mapping this across a health economy of tens of thousands of front-line staff and something like 500 different system installations, the potential for problems is very high. In many (perhaps most) cases where an "all-at-once" change was tried (the "Big Bang" approach), the experience was not at all straightforward.

It's clear that a skilled team is required to lead the change, and that team may need to be large. Where do we find these people? If we take them out of their front-line jobs (which we will have to - we need skilled and innovative doctors, nurses,AHPs who know their subject areas and their patients), how do we back-fill their positions with similarly skilled people to keep the services running? In Northern Ireland, being across the water from the rest of the UK, this may not be achievable.

To cut this long story short, I don't think we can do a "Big Bang" in Northern Ireland at the present time, even if a product was available off the shelf. One proposal which has been put forward is a bimodal approach - implement a version of a large EHCR for central hospital functions (including a patient portal), while in parallel working on an integration of specialist systems onto an open-standards data platform, such as one based on OpenEHR specifications (for example).

This has a number of potential advantages. We can stage the implementation over a longer period, allowing the system to adjust. We can continually review progress and change direction if required. We can foster innovation by providing an open standards platform that is accessible to smaller vendors and to health-delivery organisations themselves. We can avoid "lock-in" to a single vendor. We can support a more open and dynamic IT landscape. We can develop a cadre of healthcare professionals who are highly engaged with improvement. We can get patients and clients properly involved at a real decision-making level.

Some disadvantages may also be perceived - the whole process may take longer to bring benefit than a Big Bang. Standardisation may suffer if there is too much "innovation". Silos of data may re-emerge if not constrained in a single system.

My view is that the disadvantages of a bimodal approach are perhaps overstated, and in any case are not avoided by a monolithic Big Bang. We're on a journey here, and we have to accept that there will be a great deal of diversity in health systems even in the best case scenario of a Big Bang. We'll know we are on the road to success when we are moving towards a world where the data is secure and consistent, as well as independent of the system that is used to generate or display it. And far more importantly, where health decisions, whether made by patient or healthcare practitioner, are based on the very best and most up-to-date data.

08 March 2016

Data - that great enabler

So I'm back to thinking about Electronic Health Records. This is a complex yet fascinating area. How do we go about pulling together all the disparate strands of information, scattered in multiple systems which don't talk to each other (and often relying mainly on paper!), and presenting the results of our searches in a format that is actually meaningful to the patient and the health care professional they're meeting? The video below is Dr Larry Weed discussing the problems of source-based records back in 1971. And in the 45 years since, we are still very often faced with precisely the same problems.

But here in 2016 we have lots of advantages. We have had the computer revolution. We have multiple high-end health data systems in daily use around the world (and vendors keen to sell them). We have the internet and a relatively better-informed population. So many new drugs and medical techniques and guidelines have been worked over that our medicine of 2016 is better than it was in 1971. Yet things are not as good as they could be, nor are they as good as they should be.

What are we to do about this? I think at least part of the solution has to be to declare what Northern Ireland (or whatever region you're reading this from) actually is all about. And we've to make it about DATA. How do we know what our population needs? We get data. How do we know how to deal with a certain set of problems? Get data. How do we train doctors? Look at the data - what works, what doesn't? How do our local companies know what the market needs? Data. How do we relentlessly improve quality? How do we improve prospects for our young people? How do we help our elderly? How do we make sure our stressed resources go as far as we can make them?

The answer is in the data. We need to make Northern Ireland a data-driven society. I never want to see a patient treated poorly because decisions were made on faulty or incomplete data - particularly when the data may have already been available within "the system" but just not accessible to the decision-maker. I don't want to waste the precious time of patients or doctors or nurses, because time is perhaps our most precious resource.

I also want Northern Ireland to play a full and active role on the international stage. We have had enormous success with the Northern Ireland Electronic Care Record, but I want our national and international visitors to come here and find even more. I want them to find a health system, an economy, a society which is actively studying ways to continually improve.

Life is hard, the future is uncertain. We're gonna have to science the shit out of this.