Ok, this is a paper that should provoke a huge discussion. This paper with two of its authors from Harvard says that the picture in hospitals with computers is quite different than the one we always thought we would see.

Obviously one should read the paper before discussing it, and I  did so. First of all, I have to say that the paper seems to give little thought into why software does not seem to decrease costs. There are three potential reasons mentioned in the conclusion part of the paper, but the final one is quite interesting. Quoting from the paper: “Finally, we believe that the computer’s potential to im-
prove efficiency is unrealized because the commercial marketplace does not favor optimal products. Coding and other eimbursement-driven documentation might take precedence over efficiency and the encouragement of clinical arsimony”

Yes! The marketplace does not let us push out better technologies easily. You’d think that once you have a better solution for a problem, the world would give you a warm hug and thank you for your work. The reality of the marketplace is cruel: there is huge politics and conspiracy around healthcare informatics, and working towards better solutions is not enough on its own. It is such a pitty that there is a huge amount of people trying to make things better, and the lack of desired outputs is not only related to capacity of the solutions we are building.

I’d like to see some honest discussion about this paper, and please let me know if you come accross any riplle effects regarding this paper.

Ok, slightly off topic, but if you are interested in my reading list for the last couple of months, here is a brief summary.

Atul Gawande, “Better “. Professor Ingram gave this book to me. If you want to see how doctors see certain things, and how hard it is to perform some tasks which they are expected to perform without any errors, read this book. Gawande discusses some interesting topics, including ethics, with quite unusual examples. Would you become a lawyer after years of being a medical doctor, and sue your own colleagues for malpractice cases? Could you use your medical knowledge to end someone’s life, for an execution? A great read.

Stephen King, “Cell”.  King is not the King I’ve admired for so long anymore. He has his style, he never loses it, you get the same feeling everytime you read his work, but Cell made me feel that I am reading a recycled version of his creativity in the past. You’ll find many common points with this book and his previous works. I do not want to believe that he is done with his universe, after finishing the Dark Tower, but I am failing to enjoy his recent works.

Vernor Vinge, “A fire upon the deep”.  My first encounter with Vinge, and  I think this is a good book. Vinge reminded me of Asimov in many ways, and he manages to build a different type of society which is real enough to keep you in the story. A couple of interesting ideas about the universe, including the slow zone, allows him to explore the outcomes of a partitioned universe. I have found some important parts of the book to refer to Gibson’s Neuromancer trilogy, but it is hard to avoid him when you’re writing about AI.

Neal Stephenson, “Snowcrash”.  This is the book that come closest to Gibson’s world in Neuromancer, among the others listed in this post. It almost gives that feeling I get when I read Gibson, but the main story did not create a powerful impact on me. Still, a good work of cyberpunk. I’d like to get my hands on this kind of books more, but I’d like to see a little bit darker material.

David Mitchell, “Cloud Atlas”.  A serious demonstration of talent. Can’t say the genre, because Mitchell shows that he can write four or five genres in the same book! Tom gave this one to me as a present, and it is one of the most interesting works of fiction I’ve read in the last couple of years. It made me realize that I need to go back to non-science fiction more often.

I am now reading  The Graveyard Book from Neil Gaiman, but I have to say that I want him to focus more on adults’ stories. His genious in Sandman and American Gods shows that he can be very impressive when he constructs complex stories, but all his other works I’ve read after American Gods are a little bit too simple (maybe flat is a better word here). Anansi boys was good, but I want something in the lines of American Gods. I’ll always follow him, but he seems to be a little bit too much into writing books for young people recently.

It used to happen to me in the past. After playing for about 4 or 5 hours, and slightly. After almost 10 years of not playing fps games, I bought myself a copy of Half Life 2, and it hit me like a truck!

I can’t believe the strength of the nausea I experience after only 10 minutes of play. I wonder if it is specific to Half Life 2, or to my XPS’s monitor etc. The problem is trying to figure this out is expensive both in money and health terms. I guess I am really getting older.  I have to lie down now, before I decorate the keyboard in a very unpleasant way!

The competition amont different information models in healthcare will never end. Yes, I know that there are many out there who think that a particular piece of work is so much better than the rest, and it is the feature of healthcare informatics. Sorry, I don’t agree. There are many other reasons, which I’d like to outline in another post, but in general, I can’t see this competition going away in the future.

What is interesting is, use of terminologies is common in many information model standards, whether it be HL7, EN 13606 or openEHR. There are many open source tools for many aspects of healthcare informatics, but when it comes to terminology management, the choices are surprisingly few! Other than NCI’s LexGrid initiative and Apelon, I can’t see any serious terminology server work in the open source domain. These two have their own pros and cons, but in general, this sub domain is surprisingly deserted. Please know that I’m not considering projects which were updated 3 years ago for the last time as candidates for my work in Opereffa.

There is huge work around the concepts which will eventually get linked to terminologies, but there is not much effort in the terminology server area. Yes there are many browsers out there, but whatever you do in the modelling phase, you’ll have to have access to a proper terminology server during use of that model (be it a Snomed CT subset or an HL7 message with Snomed CT codes in it). So why I can’t see an interest in this? Is it because people are so focused at well known problems, that they do not bother to think about what lies beyond them? Did open source healthcare attack the problem of informatin model based solutions first, omitting terminology based solutions? Terminology based approaches are old, and they are well established, so I can’t explain the lack of open source decent projects in this field. If you know one, drop me a line, and I’ll buy you a beer/wine/{insert your favorite drink here}.

Does not sound possible right? I’m afraid the news are not that good though; not only it is possible, but we are just about to do this. Yes it is not about healthcare informatics or development or anything like that, but some things just get to me. Check out this independent article for details.

I’ve personally witnessed death of a great piece of sea. Gemlik bay, where I spent all summers of my childhood turned from a virgin piece of heaven into a pit of industrial waste and the fish I used to catch is just a memory of the past, just like my childhood. Somehow, this worries me too much, I’d love to go back to that little house near the bay and go to fishing again, but the fish is simply not there anymore.

Imagine this for all of the world. Scary.