Musings by Seref Arikan

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.

Superbugs, and not-so-strong-but-still-a-problem bacteria are threatening patient safety. All those publications out there, and excellent books like Atul Gawande’s “Better” explain the reasons behind this problem, so if you’re curious, you can take a look.

What I came across today during my never ending surfing, is a really promising method of increasing the efficiency of killing bacteria and viruses. A new device  that uses plasma is able to diminish the chances of carrying harmful bacteria to one in a million.Take a look

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 appears that every once in a while, makers of really good software remember that there are projects out there who could have used their software, if only they had the resources. Instantiations has very kindly donated a licence for their WindowBuilder Pro product for Opereffa, and I am more than happy to have access to their excellent tool. For those who have not heard about them Instantiations is a company which produces great tools for software developers. Especially if you are using Eclipse, and you are developing desktop or GWT based web applications, their WindowBuilder Pro is pretty much the best tool that money can buy. WindowBuilder Pro does only let you create SWT and Swing forms, but it also lets you create SWT gui artefacts which are crucial in Eclipse plugins. Developing views and editors using WindowBuilder Pro is much easier compared to hand coding them, and guess what: we have lots of tooling to do around Opereffa’s Eclipse plugins.

Simply by filling in a form you can ask for a licence donation for your open source project, and if you are granted one like us, then you can enjoy really good tooling. Since WindowBuilder Pro does not generate any unusual artefacts, you can easily distribute your source code without any dependencies to propriatry resources or libraries. What more can you ask for?

What? My research never goes out of fashion! How can it go out of fashion when the problem is not solved, and my PhD is not even remotely appearing in the horizon?

Well, you may be right, but when I say fashion, I mean the hype your research topic can create. The amount of people wondering what is that thing that you’re talking about, and the most important of all, the grants! Yes, grants by venture capitals, research institutions, EU Framework Programme calls, you name it.  Why the grants are labelled as most important of all? Well, I’m terribly realistic sometimes, and there are some topics out there, which are so big and complex that you can’t produce concrete outcomes without spending millions of hours of work on it, and an effort of this magnitude can’t exist only by people’s personal commitments.

I’ve been following the EHR domain for about 7 years now, and I’ve been also following the popular research topics via many grants and calls for projects, especially in the context of EU FP 6&7. Something I’ve noticed is, EHR domain is being mentioned less and less in the research grants, and people writing project proposals are now trying to avoid focusing on EHR aspects as the core of their projects. Reason?, well, according to many, EHR is now a topic that has reached saturation in research domain. We know that the state of EHR is nowhere near where it was meant to be, there is a huge amount of work waiting to be done, and the domain will need a lot of support. However, the focus of research around health IT seems to be shifting to some topics like genomics based medicine, bioinformatics, gene therapy etc. etc.  Don’t believe me? Check out this call for example. Take a look at the contents.

So the focus in research is shifting, but previous research in EHR did not bring a lot of change into this domain. Or did it? If it did, why am I not aware of it? There are bits and pieces of outcomes here and there, which I can use. These outcomes are the results of research projects, funded by various organizations, but did we achieve the goals we declared we had in our minds when we applied for all those research grants? My answer to this question is No. It appears though, that EHR is something that everybody is tired of hearing. This is a problem, we do not have the systems we want, but already people are beginning to skip to next hot topics in research, and EHR community will have to link its efforts, and its existing intellectual investment to these new frontiers, otherwise we’ll be disconnected from resources of funding. Sorry for being so much focused on funding, but I see great danger ahead if EHR domain can not sustain its research, and unless we put EHR work into larger contexts, we’ll have serious problems.

I believe openEHR and 13606 can survive this transition, and they can be relevant and useful for new research topics, and this is mostly due to their two level modelling approach. With right reference models these initiatives can help other research communities by providing them a better, computable platform for their work. HL7 has its industry roots, and it will stay alive due to its nature and probably due to a lot of money which will be spend in USA, but I can’t see it surviving the next wave of data, with its current design. HL7 still seems to be looking for a way of achieving the features of openEHR and 13606, only with different names, so they have some way to go.

Therefore, I think we need to consider other forms of data in relevant, but different medical domains as requirements that must be handled with our existing research topics. The work around EHR should be considered for alignment to handling of genomic data etc. Otherwise, from a purely academic research point of view, EHR research may become obsolete before reaching its target level in especially clinical practice domain.