19 July 2017

Bike ride postponed

Due to unforeseen circumstances, our Petra-to-Nazareth bike ride has had to be postponed until next year - probably March 2018. On the downside, this means it's longer until we can hit the trails; on the upside, this gives us longer to raise more money for the Dialysis Unit in Nazareth, AND it means we get to see Jordan and Israel in the Spring, when both are at their most lovely. Oh, and it gives YOU more time to get yourself organised to come and join us!

We really hope you will consider donating to the cause or coming on the ride - the Nazareth Trust will be extending the Dialysis Unit and carrying out urgent repairs on the old Doctors' House, which is where many of the Serve Nazareth volunteers stay while at the hospital. The volunteers are an important part of the social fabric of the hospital, helping to run the Nazareth Village (which in turn contributes to the running of the hospital), and themselves carrying out maintenance work and other tasks on-site, which means the hospital can offer more services to the people of Nazareth. More updates on http://justgiving.com/shanenaz. Thanks for your ongoing support!

09 July 2017

Peace in Israel & Palestine?

Every now and then I think it's important to air some ideas that everyone is going to hate. It's OK - I know that this blog post will anger everyone. I have lots of friends on all sides of the Israel/Palestine issue, including in the actual region itself, and I love them all dearly. But they are all going to hate this blog. Why? Because it is heresy to both Israelis and Palestinians. It cannot possibly work. It's a recipe for disaster. No-one is talking about it right now. It goes against all UN resolutions, declarations from the Israelis and declarations from the Palestinians.

But you know what? Living most of my life in Northern Ireland has taught me a number of things. One is that we are not all going to agree on everything, and some ideas that seem normal to me are utterly horrific to others, and vice versa. Another is that to get along (which is important), it is unrealistic - even nonsensical - to insist that the other person accept MY viewpoint on all matters, or even those that are part of my core. And yet another is that occasionally we need to think outside the box, even just as a thought experiment. Explore new possibilities. Follow ideas through to their conclusions. Imagine a different world - maybe even a parallel universe. So I offer this, just as I offered my Celtic Union of Scotland and Ireland, in that spirit - by all means hate it, but at least give it some thought. Chew it around a bit. Think - would it really be that bad if this came to pass? And if it did come to pass, how would we make a decent effort at it, so that at the very least things move to a better place?

So where are we now? The concept of separate states for Jews and Arabs is arguably dead in the water. How could it possibly work? There will always be Jews in the West Bank, and there will always be Arabs (Christian, Muslim, Druze) in Israel, and to evict people would be unconscionable. The ongoing strife and violence, which must inevitably flare from time to time, is making life intolerable for many many people. Maybe we need some new suggestions.

The proposal is this: A united state of Israel Palestine, with full rights for all citizens, regardless of religion or ethnic background. Anyone can live anywhere, without fear or favour. The West Bank and Gaza Strip and Golan Heights would be fully formally integrated as territory of Israel Palestine, and come under the full control of the central government in Jerusalem, which will be the internationally recognised capital.

Israel would cease to be a "Jewish state", but instead would be constituted as the Homeland of the Jewish and Palestinian People. A single national identity and single passport would be used (not "binational" status). Zionism would be regarded as a "completed project", rather than a goal, and everyone encouraged to move on with the new goal of building peace and prosperity for all.

The territory of Israel Palestine would be internationally recognised as of central importance to Judaism, Islam and Christianity. People with confirmed connections with the territory would be allowed to settle there, and purchase land legally from its owners. Historic misappropriation of land will be addressed by return of the land, or compensation.

Palestinian refugees, displaced by the 1948 and 1967 wars would be allowed to return, or offered significant compensation from an international fund. Existing refugee settlements in Jordan, Lebanon and elsewhere will have considerable infrastructural and economic stimuli applied from the UN to establish them as viable and productive population centres in their own rights.

There would be full recognition of Israel Palestine by its neighbours and by the United Nations. A new flag incorporating the multiple strands of identity would be designed, incorporating Judaism, Christianity, Islam and secular themes. It would be recognised as a nation with peace and equal rights as its over-riding objectives. The equal status of Hebrew and Arabic as the official languages of the state will be affirmed.

Equality, whether you're Jewish, Muslim, Christian, Druze, Atheist, LGBTQ, straight, whatever - that has to be the foundation of any new reality. We've tried the "go our separate ways" thing. We've tried ethnic cleansing. We've tried illegal settlement. What we haven't tried is sharing, and forging a new united identity.

By all means hate on this suggestion. Put forward all the reasons why it can't work. Explain why it's offensive and pisses over the graves of generations of those who have gone before. Go for it. But at least think about it. It's a fantasy for sure, but sometimes we need to think about the fantasy, and let go of our cherished ideas of what WE want and what constitutes justice for US or revenge against THEM, in order to move forward. Think about it.

03 July 2017

Petra to Nazareth 2017

Bike of the desert...
OK, this time we're taking bikes. When I was a young medical student in 1993 I spent an unforgettable and formative two months learning the art of medicine in Nazareth, Israel. It left an indelible mark on me, as well as a deep love for the Middle East.

I've been back to Nazareth a number of times since then - once to share the celebrations of the Nazareth EMMS Hospital's 150th Anniversary in 2012, and on two bike rides, raising funds for vital projects to allow the hospital to provide the best care to the diverse community in the Galilee.

In 2017 I will be joining a group of friends from Nazareth, Scotland and elsewhere to cycle the arduous and dusty journey from the mysterious and beautiful city of Petra in the Jordanian desert, to the Dead Sea, and up the Jordan Valley to the Sea of Galilee and then on to Nazareth itself in the fertile north of Israel.

We're raising funds for the vital work of the Nazareth Hospital Dialysis Unit, and we need your support! If you can join us on the bike ride, please do: CLICK HERE. The more the merrier! Or if you would like to sponsor us on our journey (and please make sure you follow our photos - I'll be tweeting them from @shanemuk like crazy in October), your donation would be very much appreciated - CLICK HERE for the Justgiving site http://justgiving.com/shanenaz - please tell your friends.

[We use Justgiving.com because this actually saves the charity a LOT of money by not having to administer cash and cheques - it is really worth it, especially if you add Gift Aid. Also, I am subbing all my travel and expenses as well as my own donation, so all your donation goes to the Dialysis Unit Fund. There is also part of the fund designated to improve volunteer accommodation, which translates directly into the work of the hospital, so it has a significant multiplier effect. I've seen the direct results of how the hospital uses the funds, and I'm really impressed.]

I have some photos of the 2016 bike ride here: http://www.answersingenes.com/2016/12/photos-from-our-galilee-bike-ride.html - you would be really welcome for the 2017 ride of a lifetime!

01 July 2017

Interoperability the Encompass Way

Northern Ireland has had great success with the Electronic Care Record (NIECR), which is a mainly read-only portal that allows health professionals across the region to get access to vital information on their patients. Letters, appointments, X-rays, lab results and more are all available at the point of care via the NIECR, and it's fair to say this has been revolutionary. I use it in my clinic all the time, and it allows me to have a far more valuable session with my patients, and to bring them up to speed with their own care across the system.

However, we are still stuck with largely paper-based systems for most of the activities relating to the patient's record, and this means that we cannot fully take advantage of the opportunities that a truly digital system would give us. For example, we are still prescribing on paper. Most clinical notes are physical charts with paper filed within them, covered in clinicians' scrawled handwriting. Communication between professionals and from professionals to patients, is still hugely dependent on dictated letters. Indeed, even synchronising information across the myriad electronic systems - databases, registers, ward whiteboards, GP records etc. - is still often mediated by paper transactions, with all the risks and problems that are associated with that.

So, armed with the experience gained via the NIECR, we in Northern Ireland are embarking on a new project - Encompass - an ambitious effort to unite Acute and Community (and eventually Primary) Care into a single patient-centred structure that merges data and workflow, and allows information to seamlessly follow the patient through the system. In addition, we want to allow patients to access their own data and to play a key part in how their care experience unfolds.

All this is in pursuit of the Quadruple Aim - four transformational principles that underpin where healthcare in Northern Ireland (and elsewhere) needs to go if it is to survive the mounting challenges that threaten to undermine sustainability of the entire enterprise:

  • Better healthcare
  • Better population health
  • Lower per-capita cost
  • Better staff experience
I could go on at serious length about how proper health transformation is not possible without digital transformation, but maybe that is for another post. But there is another aspect. One of the main challenges of digital transformation is making sure information is available right across the healthcare system, and that data has to be accurate, complete, and tightly linked to the care scenario. With the multitude of health systems out there, one approach has been to get a "megasuite" of software from a single software vendor to try to do it all. Where there are gaps, the megasuite vendor can work on stop-gap solutions, the care system can develop workarounds, or third-party developers can try to plug their solution into the megasuite itself. Or the systems can remain in separate data silos, synchronised by hand or by some other interfacing engine. This model is superficially attractive, and can deliver major benefits in many areas, but experience over the years has shown that there will always be a considerable bloc of the health data world that remains outside the megasuite, reducing the overall benefits and return-on-investment.

And there's more. It may seem churlish - or even a bit paranoid - to point this out: if you have all (or most of) your data being looked after by a megasuite in the megasuite vendor's system, when you come to contract renewal, or even when you want to change things to adapt to new conditions, you find yourself "locked in" to that vendor's solution. To get out of this lock-in, even if the contract has expired, can be very complicated, very costly, and put your patients' data at risk. So you do all you can (including perhaps paying over the odds) to stick with the same vendor's system, rather than tender for something cheaper or better. This really restricts competition in this space, and hampers development and innovation.

What's to be done? Well, there is another strategy, and this involves looking at how we design the overall project. In the Encompass Programme we are explicitly stipulating that patient data be placed in a parallel vendor-neutral archive (VNA) employing open data formats. The data transactions with the VNA must be bidirectional (read and write) and complete, using standard recognised interchange protocols. The types of data we are storing will include coded clinical concepts and core data, eg using the OpenEHR format and linking with SNOMED-CT, patient documentation in a clinical document archive (CDA), patient images including scans & X-rays and pathology pictures, and other pieces of data appropriate to management of the patient through the system.

If we do purchase a megasuite to do most of the heavy lifting (and that is certainly one of the options), this Open Data Format layer will be vital to ensure that we have control over access to our data, and that we can, with other partners, rapidly develop innovative solutions to the clinical and administrative challenges that we will inevitably face during our health transformation journey. In particular, security and confidentiality are critical.

I have been calling this open interoperability layer "OCEANIC" ("Open Core Engine for Accelerating NI Care"), but the name isn't important. It's a key integral part of the Encompass Programme, not an alternative, and not a bolt-on. It's almost a philosophy - one based on agility, sharing, consent and openness.

Another term that has been used to describe such implementations is "Bimodal" - a central megasuite core to bring together critical elements of patient data and the workflow structures to support its use, and a robust and open interoperability layer to support agile innovation, advanced analytics and seamless integration across the entire health system. A truly open approach to integration is being increasingly recognised as a critical element in joined-up care (eg see http://interopen.org )

It turns out that NIECR has already done a lot of the background work for us, and it is entirely logical (maybe even inescapable) that the next step should be to build the interoperability layer at an early stage in the Encompass Programme. A particular advantage of this approach is that it allows us to seriously engage our local technology ecosystem (NI companies and researchers) in our digital journey, developing apps and analytics to allow us to meet the Quadruple Aim, and transform healthcare for the future. Our patients (who after all are us and our families too) must be firmly at the centre of this. We need to talk to them, get their views, explain what we are trying to do, involve them in the delivery and decision-making. When I explain this to them, I am invariably met with significant enthusiasm.

Our goal is nothing less than to make the Northern Ireland healthcare system the best and most connected on the planet. Everyone - patients and professionals - on the same page. Ambitious? Yes. Crazy? Yes. Impossible? Only if we don't make the effort.

Encompass. Delivering the best care. The most connected care. The most comprehensive care. Together.