Four rules for the reinvention of health care

British Medical Journal: "Futurists might like to speculate on what the health services of 2020 look like. The world may be such that as a clinician you work in flexible virtual teams and some of your colleagues are computers. You would of course instinctively mistrust clinicians who always know the answer without consulting the information grid, and patients often choose to be the team leader. Keyboards are banned as harmful and can be found in museums, next to punch cards and spittoons. The health record is a direct multimedia history of conversations, and a software agent is its curator. For the still cognitively limited clinician, your earring whispers your patient's name when you meet. "

The four rules referred to are:

Rule 1: Technical systems have social consequences.
Rule 2: Social systems have technical consequences.
Rule 3: We don't design technology, we design sociotechnical systems.
Rule 4: To design sociotechnical systems, we must understand how people and technologies interact.

From a systems development perspective, this is not news. It may be news in medical circles and thus may be well worth mention.

There is an extensive literature and best practice documentation to help out with the design and development of stuff like this.

In order to build useful solutions, system developers variously draw on things like patterning (which came from ethnography and anthropolgy in the first place), use cases and the whole UML methodology as well as usability studies (in the vein of Jacob Nielsen's ground breaking work).

These practices are not nearly universal. As usual, art leads public practice. Commercial software is all too often driven by the mantra 'Ship now, fix later'.  ⊕

Huge penalty in drug fraud - Pfizer settles felony case in Neurontin off-label promotion

La Leva di Archimede (ENG): : "A division of Pfizer Inc., the world's largest drugmaker, has agreed to plead guilty to two felonies and pay $430 million in penalties to settle charges that it fraudulently promoted the drug Neurontin for a string of unapproved uses.

In an agreement announced by government prosecutors Thursday, Pfizer unit Warner-Lambert admitted that it aggressively marketed the epilepsy drug by illicit means for unrelated conditions including bipolar disorder, pain, migraine headaches, and drug and alcohol withdrawal.

A company whistle-blower, whose 1996 civil suit spurred government investigations of Neurontin's marketing campaign, will receive about $26.6 million through the settlement under legal provisions that reward citizens for helping to recover government money obtained by fraud.

The settlement includes $152 million to pay back amounts spent on Neurontin by the federal Medicare program and 50 state Medicaid programs for the poor. In addition, Pfizer will pay a $240 million criminal fine, the second-largest such fine ever imposed in a health care fraud prosecution, the Department of Justice said."

The story goes on with more details. Suffice this to illustrate the economics at stake in the pharma business.  ⊕

St. Joseph's Hospital, Miami, gives Healing Touch therapy a try

ABC Action News: "When you are in the hospital, you want to know you are in good hands. Now, a new program at St. Joseph's Hospital is making that wish a reality, literally, with the new 'Healing Touch' therapy."

"..."It actually works on balancing the energy of the body to provide an optimum environment for the body to heal," explained Kimberly Garcia, a nurse at St. Joe's for 21 years."

"...Kimberly was working as a nurse and doing healing touch on the side, but demand is so high now they are going to try a pilot program at St. Joe's. They'll allow her to do only the healing touch for three months and then evaluate the impact on those patients."  ⊕

Dutch Patients Start Using Online Nursing

Associated Press: "Ooms hopes CamCare will enable him to remain at home with his wife of nearly 55 years, Tilly, instead of going to an old-age home. A stroke has left him half paralyzed, with serious blood circulation and lung problems.

The technology isn't new, but its application is.

The connection is established easily using a television set-top box and an ISDN phone line, which has about twice the speed of a regular analog dial-up connection.

A picture is transmitted from a Web cam mounted on top of the patient's TV to a computer at the nursing center. A video image of the nurse appears on the patient's TV, with the nurse's name on the screen.

During a reporter's visit, the picture was good enough to make out facial expressions and read the label on a box of medicine, although it was not as clear as video sent over high-speed broadband Internet."

This is interesting. 10 years ago I ran a project to put a new patient administration system into 5 hospitals in Norway. As part of that project we set up video conference links using off-the-shelf PC applications with ISDN connections. This was not used for therapeutic purposes, but there were a lot of focus on 'Telemedicin' in Scandinavia at that time. (Still is, I imagine.)

The issue was how to provide specialist care to outlying and remote communities. I can remember two projects in particular. One dealt with X-ray pictures and remote diagnosis by radiologists. The other was for dermatologists. As I recall, the picture resolution was acceptable in both cases.

I can't remember what type of connection they used. It could have been ISDN, but most probably a dedicated network or backbone between the hospitals in the health region. (ISDN is much more prevalent in Europe than in North America.) No matter what the technology, the issue will always be how to make it available to remote areas as there is no commercial incentive to provide it.

The vehicle for ensuring basic communication services are available in remote areas anywhere, not just in Norway, is known as the Universal Service Obligation (USO). A private provider willahve to honor the USO, but will get a refund from the government to cover the loss. I worked with Norwegian Telecom when they were in the privatization process and bid on a project to sort out how the USO should be handled by a private telecom provider and how to calculate the refunds. We didn't get the project which was a big, hot political potato of the first degree. Still, it was fun putting together the proposal and talking to various people around the world in our firm who had worked on this in other jurisdictions. That's one of the benefits of working for a global consulting firm.  ⊕

New Strain of Bird Flu Found in Canada

Associated Press: "A new strain of bird flu has been found in the Fraser Valley, different from anything seen in the area before, officials said"  ⊕

Mexican A.F. Pilots Film 'UFOs' |

CBS News: " Mexican Air Force pilots filmed 11 unidentified flying objects in the skies over southern Campeche state, a Defense Department spokesman confirmed Tuesday. "  ⊕

Self-Defeating Beliefs

Inspiranote: "Any worry about possibilities that may happen is usually quite irrational. There are also many people who are not assertive enough and are constantly in turmoil because they do not dare to be themselves."  ⊕

Purifying - A Quality of Pure Consciousness

"I, schooled in misery, know many purifying rites, and I know where speech is proper and where silence."
Aeschylus (525-456 B.C.)

"Always aim at complete harmony of thought and word and deed. Always aim at purifying your thoughts and everything will be well."
Mahatma Gandhi (1869 - 1948)

When snow is falling on my city, everything becomes quiet, calm and white outside. There's a special feeling when it is like that. The dog likes it, too, even though she was born in Mexico and grew up on our sailboat. She must have "gypsy" genes like the rest of the family.

The weather image, it has snowed twice in Calgary this weekend, is harmonizing with my progression along the Qualities of Pure Consciousness. Today's quality is purifying. I think of snow that way. It drapes the world in a clean, white blanket. Everything looks pure, fresh and untouched. Then life continues writing its story starting with me as I leave my footprints behind me in the snow.

The snow is not a perfect metaphor, of course, because it covers things up to make everything look great. And with snow, we can get too much of a good thing, too.

A pure consciousness is purifying because it dispels untruths and confusions and brings awareness and clarity about how things are as they are and in no other fashion. There is no more room left for any confusion after that. It also brings a purity of purpose; we are as we are and need have no more doubts about what we should do in our lives. I think it would be wonderful to fully embrace that. I have so many doubts about so many things.  ⊕