Health Perspectives

Elsevier, double-dipping, and the NHS

2012-02-11T11:00:00.000Z

Mike Taylor recently questioned the practice of paywalling and profiteering from selling the results of publicly funded research back to taxpayers in a Guardian comment http://www.guardian.co.uk/science/2012/jan/16/academic-publishers-enemies-science

Central to the surge of criticism of Elsevier is that they take a free good and charge for it. What has figured less prominently is that Elsevier sometimes charges twice or even three times for the same free good.

The practice is known as double dipping. Publishers at least recognise the phrase and are a pains to deny that they do it. Unfortunately the paywall business model makes it almost certain that they do.

Let's take the NHS. Elsevier et al double dip the NHS by selling subscriptions to the same journals at all levels. Where they can they sell subscriptions to electronic versions of journals to the NHS as a whole. They also sell electronic and paper subscriptions to departments, individual libraries across the NHS. They also sell subscriptions to universities, to which many NHS staff are associated. As a result it is quite feasible for an academic clinician to have had a subscription to a journal paid three or four times over.

What makes Elsevier a stand out though is triple-dipping. In addition to multiple charging the NHS for subscriptions they require the NHS to pay $3-$4,000 dollars per article to enable the NIHR to implement its policy of open access to the findings of NIHR funded research - research that has usually been conducted on volunteer NHS patients, in taxpayer funded facilities, with grants and other funding from NHS budgets.

Elsevier argue that the NHS is paying for different things - and they deny that paying for subscriptions and paying to archive is double-dipping. Yet Elsevier's costs only occur once and ultimately all the different payment streams are off-setting that one parcel of costs. So double, triple or even higher orders of dipping is the almost inevitable consequence of their approach.

Elsevier are very sensitive about double dipping. Theyclaim they lower subscription prices to reflect any articles in closed accessjournals that the NHS has paid to make open access. This is an admission that the costs of subscriptions and the costs of open access are linked.

Elsevier's double dipping avoidancelist is here - http://bit.ly/ycCyQP - and itis notable that it doesn't include any papers published in the Lancet. This seems extremely unlikely, and indeed PubMed Central contains many Lancet papers. Sosomething doesn't add up.

How much does double dipping cost the NHS? The figure ishard to quantify because Elsevier's pricing model lacks transparency and haslittle interest in monitoring a practice that the NHS seems happy to permit.But at a guess Elsevier probably benefits several millions pounds a yearoverall from double- dipping the NHS. In an NHS desperately short of cash enoughto worry about.

IfElsevier are genuinely concerned to avoid double dipping what could they do?Firstly, drop their charges to NIHR. And if they are really concerned, theyshould hasten the move away from a business model that makes double dippinginevitable - perhaps by supporting the Federal Research Public Access Act.

Integrated Reading Environment

2012-01-28T21:00:00.001Z

As far as I know there is no such thing as an Integrated Reading Environment (IRE). But there should be. Lets see what it would do:

Webpage, app or widget, you would drop a well formed bibliographic reference, DOI or URL into the IRE, which would fetch the full text and load it for reading.

You'd be able to see comments from other readers

You'd be able to call up the papers in the reference section in a popup window

You'd be able to add comments and lengthier responses, which would be relayed directly to the authors

You'd be able to check data, obtain datasets, re-analyse

You'd be able to read protocols, grant applications and other related documents

You'd be able to find similar papers

I'd happily pay £10-£15 per week for a service like this.

The Research Works Act

2012-01-15T06:37:00.000Z

My experience of negotiating with publishers is that they find it difficult to quantify or even identify the value they believe they add to the outputs of publicly funded research. I don't want to be too specific about the publisher. I don't think it matters who they were, although it wasn't Elsevier.

About ten years ago we were negotiating the terms and conditions for the renewal of a large contract involving publicly funded research outputs. We were trying to reach fair price essentially, somewhere on a continuum between £0 and £several million per annum. Difficult. At one point we wrote to the publisher asking two questions:

How were they going to take account of the financial contribution from the public sector into the production of the research, which we estimated conservatively at £20M? and
Could they identify and quantify the value that they added as a publisher?

I remember the whole episode quite clearly because of the nature of their reply. The value they added was set out in terms of a few rather obvious and generic services ('marketing', 'innovation') and not costed in any way despite our request. Not helpful. But the more telling part for me was that they seemed genuinely baffled with the concept that the public sector had largely paid for the production of the resource. It seemed as if no one had ever suggested this to them before.

I worry when I read about the Research Works Act because it is regressive, because if passed it may create a threat to open access to Pubmed, and because once again it shows Elsevier to be on the wrong side of the argument. I wonder as well if any publisher has answers to the questions that went unanswered ten years ago?

Parliament Hill Fields

2011-12-19T12:56:00.001Z

Panorama of Parliament Hill Fields on Hampstead Heath supplied by Panoramic Earth

2011-12-06T05:10:00.001Z

No inherent objections to the use of health records for medical research. There are ways to anonymise, protect AND link records, as the SAIL project has shown. But a few observations come to mind at this point:

Research on large sets of anonymised NHS records has been taking place in the UK at least since the 1960s (Lester Gill PDF)
The critical question in relation to medical records is who owns them. This development answers the question in a round about way - the government has primary ownership, not clinicians or patients.
What research will be done? Research using large datasets has been talked about for many years, and has been conducted, especially in the US. Datasets are much easier to assemble than prospective sets of consented patients. But the nature of the dataset methodology makes it unclear that it produces genuinely new knowledge.
Pharmaceutical companies have worked with the NHS on anonymised datasets under the heading of practice audit. The general aim of these studies has been to increase prescribing rates of existing drugs.
The key area of development is personalised medicine. But this requires the collection of genomic information - a complex process requiring explicit patient consent being explored in the Stratified Medicine Programme
The political aspects of the decision being made here has some similarities to the previous Government's National Programme for IT.

Types of cloud - app internet versus drive-in-the-sky internet

2011-06-11T07:35:00.001+01:00

In February 1996 Wired magazine published an interview with Steve Jobs in which he predicted an Internet of digital agents rather than websites (http://www.wired.com/wired/archive/4.02/jobs.html). The ideas in that interview pre-dated Tim Berners-Lee and colleagues better known semantic web paper by 5 years. (http://www.scientificamerican.com/article.cfm?id=the-semantic-web)

An internet of digital agents didn't look likely at the time. But 15 years on it is beginning to take shape as one vision of the computing cloud. Apple's iCloud shifts the centre of personal computing from the device (PC, Mac, smartphone, tablet, whatever) to the cloud. As Steve Jobs said "We're demoting the PC to being just another device".

There is another vision of the cloud, as a hard drive in the sky (dropbox for example) which lets you store files remotely. It's a great model. But it might not be around for too long. The iCloud model does away with file-syncing altogether. If anything it is data-syncing. And it is transparent - you don't have to do anything to have a photo on one device appear on another.

The first implementation of the cloud was file-oriented. The second implementation, which will benefit Apple at Microsoft's expense, is data oriented. And a cloud of data may be the beginning of a new app-oriented, intelligent-agent Web.

And what the Wired article shows most is the benefit of having a good clear vision and sticking to it. Apple has done that, but Microsoft hasn't. The huge cash mountain at Microsoft has disguised an underlying lack of vision for a long time; even (maybe especially) the purchase of Skype is a sign of playing catch-up

'Good' organizational reasons for 'bad' clinical records

2011-05-20T08:04:00.000+01:00

As the inverted commas imply, good and bad are the words analysed in this foundational text for health informatics by Howard Garfinkel. Unfortunately it isn't available online. At the risk of censure from fair dealing zealots here is a central part of the paper:

When any case folder [medical record] was read as an actuarial record its contents fell so far short of accuracy as to leave us puzzled as to why "poor records" as poor as these should nevertheless be so assiduously kept. On the other hand, when folder documents were regarded as unformulated terms of a potential therapeutic contract, ie as documents assembled in the folder in open anticipation of some occasion when the terms of a therapeutic contract might have to be formulated from them, the assiduousness with which folders were kept, even though their contents were extremely uneven in quantity and quality, began to "make sense".

Digression

2011-04-25T10:19:00.000+01:00

Leopold Bloom: "What is weight really when you say the weight? Thirtytwo feet per second per second. Law of falling bodies: per second per second. They all fall to the ground. The earth. It's the force of gravity of the earth is the weight."

Frank Wilczek: "Matter is not what it appears to be. It's most obvious property - variously called resistance to motion, inertia, or mass - can be understood more deeply in completely different terms. The mass of ordinary matter is the embodied energy of more basic building blocks, themselves lacking mass"

Bloom, and his creator, would have liked that, especially the phrase "themselves lacking mass"

Is ownership important?

2011-04-07T08:11:00.001+01:00

There was a debate on LinkedIn recently about personal health records, and about what 'patient control' meant. A fairly prevalent view was that the question of who 'owned' the record was irrelevant.Yet it seems to me that ownership is easily the most important aspect of a health record.

I realise I'm in a minority on this issue. I was therefore interested to read yesterday from Sir Ian Kennedy (http://bit.ly/eWVAIr):

I begin with the culture of professionals.The professional owns knowledge. From this, as I suggested in the Reith Lectures, flows power.And, power here is used in a neutral, descriptive sense. Speaking in general terms, and conscious that, being general, we all know of exceptions, the patient is someone in the professional’s power whom the professional seeks to care for.The professional grants the patient the benefit of his/her knowledge, but does so on terms.The fundamental term is that the professional remains in charge of the exchange. Yes, the patient may be granted the autonomy to make a choice, but it is an autonomy granted by the professional, rather than owned by the patient.
The striking feature of this analysis is that the relationship between patient and professional is not perceived as one of service.The professional is simply not at the patient’s service.Thus, analogies with relationships more obviously characterised by the notion of service are out of place. (And this is equally true of the two other ancient professions, the law and the church.) Introducing the rhetoric of the market, in the form of there being a commercial relationship between the patient and the professional, does not change this dynamic.The fact that the patient is paying the bill has to be managed by the professional. Manners may change a little, but little else. Power is not relocated. Indeed, the very word “service” is too close to “servile” to many a professional’s ear.To repeat, the professional in healthcare is not like, does not see her/himself as a on a par with, a restauranteur, an electrician, a hotelier, or a shopkeeper.To all of these “the customer is always right”.To the professional in healthcare, the word customer sticks in the throat, given its symbolic quality of being the
more important player in the exchange, and is not right.The patient is there to be guided, advised, led, but not in charge.And, none of this analysis is intended to deny for a moment that the vast majority of professionals are immensely caring and supportive people, committed to doing their best for their patients. What I am seeking to understand is some kind of cultural characteristics which constitute the DNA of professionals.

This consideration does not suit existing suppliers, who are struggling to get clinicians interested in electronic records. But in the longer term a more patient-owned approach to information will be part of new forms of professionalism.

VistA going Open Source

2011-04-02T08:40:00.000+01:00

Quite an important moment, though it should have happened years ago. From the RFC/RFP:

Specifically, VA believes that a structured, deliberate, and predictable migration from our custom and proprietary EHR software to an openly architected, modular, and standards-based platform will achieve five crucial objectives:

It will unleash EHR innovation inside and outside VA.
It will release VA’s captive dependency on any particular component or service and give our clinicians access to the best available tools and solutions.
It will reduce the costs and risks of reliable implementation (and integration) of new functional modules that improve VistA’s capabilities.
It will measurably improve health outcomes for our nation’s Veterans.
It will enable other providers in the public and private health care system to benefit from, contribute to, and interoperate with this national asset.

Semantics and semantic interoperability of health records

2011-03-24T21:21:00.000Z

I share Robert Dolin and Liora Alschuler's view that evaluation and measurement in health informatics is vital, and that frameworks for evaluation should be informed by examining the underlying concepts to be measured, in this case semantic interoperability. (JAMIA 2011;18:99-103 )

Their analysis raise a few questions however.

Firstly, the most basic type of semantic interoperability is that which enables one computer to correctly interpret a character string sent from another computer. "John Smith" for example, interpreted as the name
of a relative rather than the patient himself, or 02-19-1959 as a date of birth rather than a date of death. This is a modest but valuable type of semantic interoperability. It has been available for many decades in computer science, for example through semantic modelling in relational database management systems. As Dolin and Alschuler note, health  informatics has yet to provide a truly reliable method for the semantic interoperability of structured data. They cite the example of the  differential diagnosis of pneumonia. In fact, as William Hogan has shown,  HL7 can struggle to reliably model even basic information such as marital status (http://bit.ly/fSRN70 ) and gender (http://bit.ly/iitzPL ).  Ambiguity and complexity are hard-wired into the construction of HL7;  these are not desirable features for a system intended to exchange meaningful information transparently.

Secondly, the meaning of a piece of data might not be self-contained  but may depend on other data items. For example, a data point ("prescribed penicillin") could be interpreted as vital, or unnecessary, or harmful, depending on other data about the patient. Measures of semantic interoperability need to take into account the potential interdependency  of data items in a record. Dolin and Alschuler discuss context sensitivity, but as far as I am aware there appears to be no recognition  in any current HIT standards that the meaning of a piece of information  may depend on the meaning of other pieces of information.

Thirdly, it is not clear how much of the meaning in a record is  locked in unstructured data. This matters because even if all the  structured data in a record could be exchanged accurately, a portion of  the meaning of a record cannot be exchanged, at least not in machine  oriented form. It could be argued that it is becoming possible to parse  and auto code free text. But this is technically problematic. Doing so also highlights the largest challenge of all, which is that codification  is always a translation, and translation risks losing, changing or adding  to the semantics in the original text of a medical record.

In conclusion, Dolin and Alschuler's paper is very welcome, but it  does not sufficiently challenge the assumptions about meaning made by messaging and coding standards for EMRs. These need to be examined, and a  more sophisticated model of meaning within the EMR developed, before a  framework for evaluation semantic interoperability between EMRs can be established.

Copyright and innovation

2011-03-15T19:39:00.001Z

A couple of things struck me when reading the submission to the the Hargreaves review from the Copyright Licensing Agency, prepared for them by Price Waterhouse Cooper http://bit.ly/fJeWst

For a report which its commissioners could only want support for its position, the message is surprisingly lukewarm. Take Figure 9 for example, which compares global competitiveness with strength of IP protection. Both measures are problematic, but presumably PWC were charged with finding the most supportive evidence, so this must be it.

The authors optimistically say that "there is a positive correlation between perception of the IP framework and overall competitiveness". Actually, there isn't. Had PWC undertaken an elementary statistical test (Spearmans Rank), they would have found the degree of correlation to be 0.395, which is statistically non-significant for 18 data pairs. A more accurate summary would be a statement that there is no correlation between strength of IP protection and a country's competitiveness.

A second oddity is the transaction chain for higher education licensing with CMOs. Not only does it focus on only part of the transaction chain, leaving out the part in which higher education subsidises the chain, it assumes that academics are busy copying sections of books by commercial authors, rather than copying papers in academic journals. And not surprisingly at all, the analysis ignores the impact of Open Access material on transaction costs.

Your text is out there somewhere (but probably not in an IR)

2011-01-22T17:30:00.001Z

Needing a copy of this, and not wanting to pay $40 for something I've already paid for as a tax payer, I found this Institutional Repository record which needless to say didn't link to the full text. Eventually I found a copy on the University of Plymouth extranet.

University Institutional Repositories continue to under perform, often seeming like glorified publication lists.

Wordle

2011-01-03T18:54:00.000Z

REALIZING THE FULL POTENTIAL OF HEALTH INFORMATION TECHNOLOGY TO IMPROVE HEALTHCARE FOR AMERICANS: THE PATH FORWARD

2010-12-21T19:01:00.059Z

Published in December 2010 by a Whitehouse scientific advisory group which includes Craig Mundie and Eric Schmidt, available at http://www.whitehouse.gov/blog/2010/12/08/pcast-releases-health-it-report . Main recommendation

It is crucial that the Federal Government facilitate the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records while strictly ensuring patient privacy. More specifically, PCAST recommends that the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services develop guidelines to spur adoption of such a language and to facilitate a transition from traditional electronic health records to the use of healthcare data tagged with privacy and security specifications.

Summary of report:

Great potential for health IT but held back because 80% of US docs have no EMR system.
Even where EMRs do exist they are rudimentary and lack interoperability.
Areas where IT has had a transformational effect have employed simple standards and developed new products to knit together fragmented systems into a unified infrastructure. [Examples? Google, which knits the web into a unified search engine. Not iTunes though, which is anything but disparate]
Health IT is a long way off this goal. Current EMRs are highly proprietary; inward looking; generate legitimate privacy concerns; and are oriented towards administration.
Meaningful use rules have been helpful but establishing a framework for information exchange is vital to accelerate progress.
Standardized records and SOA aren't the solution
Health IT should use the disruptive effects of the Internet to move forward, and not wait for EMRs to evolve.
A universal exchange language and the associated infrastructure are priorities. Both need to be funded centrally.
Tagged data elements, accompanied by meta-data, are key
The indexing and retrieval of metadata-tagged data, across large numbers of geographically diverse locations, is an established, highly developed, technology—the basis of web search engines, for example.
The approach that we describe requires that there be a common infrastructure for locating and assembling individual elements of a patient’s records, via secure “data element access services” (DEAS). Importantly, this approach does not require any national database of healthcare records; the records themselves can remain in their original locations. Distinct DEAS could be operated by care delivery networks, by states or voluntary grouping of states, with possibly a national DEAS for use by Medicare providers. All DEAS will be interoperable and intercommunicating, so that a single authorized query can locate a patient’s records, across multiple DEAS.

Some other points in the review:

More than 3 million Kaiser patients are registered to access their health record online. Over 100,000 access the system on a given day, reducing office visits by 26%
Google and Microsoft, the two largest vendors of web-based PHRs, recently agreed on mechanisms to enable the free exchange of information between their respective PHR systems, and others may follow.
US physicians who adopt electronic records by 2014 can qualify for Medicare bonus payments of up to $44,000

The case for terminologies in healthcare

2010-12-20T19:30:00.264Z

One of the foundational axioms in health informatics is the need for codes, more formally clinical terminologies, to represent conditions, diseases and symptoms. For example, this paper, or this statement from IHTSDO:

The IHTSDO seeks to improve the health of humankind by fostering the development and use of suitable clinical terminologies, notably SNOMED CT, in order to support safe accurate and effective exchange of clinical and related health information. The focus is on enabling the implementation of semantically accurate health records that are interoperable.

I want to show that coding creates the illusion of semantic interoperability, and that far from improving, it degrades the quality of semantic exchange.

What do codes look like? Heart Failure for example, can be coded as D006333. It can also be coded as 150 or G58 (Read Code v2, widely used in primary care in the NHS). It can be coded 10019280 in the Medra Ontology.

You might ask "Why so many codes for the same thing?", and a plausible answer might be "it doesn't really matter, because the codes all point to the same concept, and this way everyone can use the coding system they are familiar with, and share information when they need to".

And this would be true if heart failure was a single entity. But heart failure is a syndrome. It embodies a collection of concepts - several causes, a range of underlying pathology and a variety of symptoms. It is not a single thing, and the coding schemes reflect this.

Even a relatively simple scheme such as ICD 10 includes a range of possible codes to cover different types and causes of Heart Failure, including I11.0 for heart failure caused by hypertension, 150.0 for congestive heart failure, and 150.1 for left ventricular failure. Do both 150.0 and 150.1 map onto D006333? Or do they map to sub-codes of D06333? Read Codes contain separate codes for acute and chronic congestive heart failure. How do these map to 150.0? Several coding schemes have separate codes for the grades of hypertension as defined by the New York Heart Association scale for grading the severity of Heart Failure. Read Codes 662f - 662i cover these, but they are not represented in all coding schemes (Medra lacks codes for NYHA grades for example). It is recognised that some of the distinctions encapsulated in codes - for example between systolic and diastolic heart failure - are "somewhat arbitrary" (see this ref)

In principle it would be possible to map between each of the codes for heart failure in the major coding schemes. But even if it were done the mapping across schemes would not be 1:1, resulting in a loss of information and the inclusion of code generated uncertainty. As a result, machine based translation would only be reliable if the terms in each coding scheme were kept high level. But that would mean that the high level code for Heart Failure in one scheme would be translated to the high level code for Heart Failure in another scheme. It would be simpler to use the term 'Heart Failure' in this case.

There are two more significant issues with codes. First issue - was the original diagnosis correct? Setting a diagnosis in a code removes the ambiguity and uncertainty that often surrounds diagnoses, which then travels unencumbered across systems.

Second issue - has the diagnosis been coded correctly? Research shows a good deal of variation within and between clinics in the way diagnoses are made and coding is applied. In part this is because of operator error. But also it arises from the often multiple ways of coding a diagnosis. Choice of codes is always a local decision, based on rules which do not travel with the code.

Clinicians are aware of the problems of medical coding, and these problems cover most diagnoses. A receiving doctor will want to review the diagnosis medication and treatment of a newly presented patients. In which case a narrative account will convey enough information for semantic interoperability. Coding adds nothing, and may cause semantic degradation by reducing the amount of information available in the originator document.

Even if all coding were done in a single terminology variation and error would be present. All the studies show variation in the coding for the same condition. Coding therefore introduces new uncertainty on top of the uncertainty already in the underlying narrative record.

There are other justifications for coding. Use in decision support or clinical audit for example. The introduction or error and the loss of information associated with coding mean that coding does not have the value it is assumed to have. In the early days of computing it was useful to code diagnoses because bandwidth and hard disk space were at a premium. But that is no longer the case. The remaining justification is that coding is useful for re-imbursing and other administrative systems. Coding in these circumstances may be valuable, but this is not in itself justification for the continuing development of detailed coding systems. to carry clinical meaning.

What is value in healthcare?

2010-12-10T09:03:00.000Z

Professor Michael Porter has written passionately about the need to reconsider what constitutes value in healthcare for many years. His latest article in the New England Journal of Medicine summarises his views http://bit.ly/gl4XIm and highlights the health informatics issues associated with not focusing on value.

What is surprising is that his perspective should still be seen as radical and challenging in an open market such as the US. In other areas of life the idea that "value should always be defined around the customer" would hardly deserve mention, yet in healthcare it is radical and challenging.

The idea works well in the UK. But there is one thing to add. That in the UK system some of the value of health expenditure is manifest at the population level, and there is still (just) some value in the notion of social solidarity which the NHS represents - some of the value I gain from NHS expenditure is knowing that people I don't know may gain access to healthcare.

Cloud watching

2010-12-08T22:18:00.001Z

There is still a chance for Microsoft to get ahead in the cloud. But with each passing day that they don't it gets less likely that they will. Just this week, more innovation, all driven by cloud computing - Chrome Webstore, Salesforce database, Google Cloud Print, new Amazon Web Services. This level of innovation is exceptional and it makes it very hard for Microsoft to get ahead.

Sobering realities about Health Information Technology

2010-11-28T13:20:00.001Z

Just noting this important paper in JAMIA (J Am Med Inform Assoc 2010;17:617e623. doi:10.1136/jamia.2010.005637) . The paper identifies critical issues for Health Information Technology (HIT) in all healthcare systems

HIT has been slow to embrace the concepts and practices of safety critical computing. There doesn't need to be FDA level of scrutiny, but there has to be recognition that HIT is analogous in some ways to a new drug or device. I would add that the current approach to certifying the fitness for use of HIT in the NHS appears to be User Acceptance Testing, which is wholly inadequate. The current consultation document Information Revolution says nothing about safety critical computing. The final version could of course, but it would require a more centrally directive approach than seems to be envisaged at the moment, a consequence of NPfITs failure.
The logic that since 'to err is human', computerisation will reduce error is too simplistic. Errors are generally produced by the interactions between multiple systems/people. So it's wrong to assume that computerising manual processes necessarily reduces error. Computerisation may introduce error.
Measurements of usage are not in themselves an adequate measure of the success of an implementation. I think a lot of people would settle for usage as a measure of success. The point made here is that in a complex system any single measure doesn't tell the whole story.
The messy desk fallacy - it is tempting to think of clinical processes as somewhat chaotic and therefore ripe for rationalisation. Some truth in this of course, but only some - healthcare is complex and non-linear. I would add that some of key techniques of computerisation, such as Business Process Modelling, look pretty inadequate in relation to complex systems.
HIT is too focused on delivering benefits of an administrative nature, and not enough on delivering direct benefits to clinicians and patients. With a few exceptions, this appears to be true. Think for example about the huge efforts that go into standardisation and terminologies, which are largely irrelevant to clinicians and patients, compared to functionality and user experience. The basis for this error is the belief that a central aim of healthcare is the efficient production of good records. That it is not was demonstrated by Garfinkel in the 1950s. But major areas of HIT activity, for example HL7, appear to have overlooked this.
The field of dreams fallacy - if we provide new IT systems they will attract users
'Sit-stay'. The fallacy that computers are in a smarter than humans. A very deep seated error, almost one of the founding stones of HIT - medicine is a cognitive/information processing profession (make a diagnosis then apply the right treatment), so lets see if computers can do better. The NHS PRODIGY programme was an example of this erroneous way of thinking.
HIT is often designed as if a single clinician were dealing with a case, or at most a team of clinicians sharing a common perspective on a case. Again, this may be too simplistic.
"Paper forms are not simple data repositories that, once computerized, could be eliminated. Rather such ‘scraps’ of paper are sophisticated cognitive artifacts that support memory, forecasting and planning, communication, coordination, and education"
"Teams of well-intentioned clinicians and software engineers may believe that understanding of clinical processes coupled with clever programming can solve the challenges facing healthcare. But such teams typically will not have the requisite breadth and depth of theories, tools, and ideas to develop robust and usable systems."

Individually and collectively, these criticisms of the current approach to developing HIT have some force. The NPfIT can be seen as suffering from most of them. But there is nothing to suggest that the incoming government's market led strategy has recognised these issues yet.

Does the NHS have an IT infrastructure?

2010-05-18T14:16:00.003+01:00

The NHS spent something like £1bn plus per year on IT even before the advent of NPfIT. But for all that expenditure it is questionable whether or not it has an IT infrastructure in the sense described by Susan Leigh Star and Karen Ruhleder (reference here , criteria set out below). Why is this important? Because until there is an infrastructure the NHS won't be in a position to benefit from IT, and expenditure will be fragmented and of uncertain purpose.

Infrastructure includes the following, and I've scored the NHS on each

Embedded (3/10 - computers and computing seem to be an anathema to many NHS staff)
Transparent ie does not need to be reinvented for each new task (2/10 much of the NHS computing estate consists of point solutions which need to be significantly modified as each new need arises - including BI systems)
Reach or scope beyond local practice (2/10 . This is an area where NPfIT has signally failed to make a case or implement change)
Learned as part of membership (1/10 . There are some steps are being taken to embed IT in professional life but little impact yet)
Links with conventions of practice (2/10 - a few honourable exceptions in primary care. Maybe PACS is on the way to becoming infrastructure)
Embodiment of standards (2/10 the keyword here being embodiment. And no, the use of TCP/IP doesn't count)
Built on an installed base (4/10 - once upon a time there was an installed base, for example regional computing centres. Nowadays there are a few elements of an installed base, such as N3 and NHSmail, NHS Choices, NHS Evidence)
Becomes visible upon breakdown (Comments about the breakdown of IT systems having no impact on patient care suggest 1/10 for this criteria, but in some situations a failure of an IT system would be significant, so 6/10)

A reasonable conclusion is that, with a few exceptions, despite huge expenditure the NHS lacks a an IT infrastructure.

docs.com ux

2010-04-22T07:01:00.000+01:00

bad user experience after logging in to docs.com

NHS 2.0

2010-04-20T12:25:00.001+01:00

Derek Meyer has produced a timely critique of the NHS Summary Care Record and Healthspace - The report argues that SCR and Healthspace in their present format are doomed, but also that alternatives such as Google Health and HealthVault are unlikely to succeed either. The success of Web 2.0 points the way towards an NHS 2.0 approach, as outlined below. I think its worth discussing:

Flowdock looks interesting

2010-04-07T08:19:00.002+01:00

Potentially useful...

A spin-off of Finnish software development company Nodeta, Flowdock aspires to help developers and others sift out actionable bits of knowledge from ongoing conversations and make them retrievable. Their team messenger services allows separation and tagging of conversational elements.

'In Flowdock, the epiphany comes when you tag a chat message for the first time,' Nodeta and Flowdock's CTO Otta Hilska wrote us. 'You realize how you just took a piece of conversation and turned it into a nugget of knowledge. Somebody talked about a bug, and you turned it into a bug report. Or pasted a snippet of code, and you categorized and organized it. The real validation for the concept comes when you are looking for some other snippet of code, a link to a partner, an eBook or something else and come to think 'I wonder if it's tagged in Flowdock'. Sure enough it will be.''

Designed for groups, Flowdock attempts to address a new kind of information overload, the one that intensified when social media tools began to be adopted by exponentially more people. The theory is that by tagging bits of the conversation, they are made discreet and retrievable based on folksonomy.

Exploring public data

2010-03-27T18:32:00.000Z

Google recently released its public data explorer which combines the Google visualization tools with public datasets include population data and health data. For healthcare, the initial launch includes Sexually Transmitted Diseases in the U.S. and Cancer cases in the U.S. The charts allow selection by state and time options. For these two charts, CDC data sources are used.

Something like this approach is needed in the UK, where there is a very rich, but dispersed, layer of population health data.

Health Internet and the guiding principles for standards

2009-11-21T06:20:00.005Z

John Halamka writes of his experience of the HIT Standards Committee and sets out some guiding principles for creating health IT standards. They all seem important, but the one which caught my eye was:

Leverage the web for transport whenever possible to decrease complexity & the implementers’ learning curve (“health internet”)

Notable, it seems to me, in the context of the possibilities created by Chrome OS

Google in 2009

2009-11-21T05:02:00.004Z

Useful review of Google in 2009 from Matt Cutts. Social search is particularly interesting, though has been down recently.

The review misses the announcement of the Chrome Operating System, which has the potential to transform user experience in the next 3-5 years. Video below.

More library catalogue woes

2009-10-26T07:33:00.001Z

By chance, more use of a library catalogue this week. This time a friend just starting a PhD wanted to know how to access journals either on paper or electronically. Finding paper holdings was relatively easy, though as a PhD student she hadn't been able to work it out on her own.

But the electronic journals were a shambles. Part of the problem was that SFX didn't seem to do more than take us to journal home pages even when we'd asked for a specific issue; integration with free journals and archives was poor (we wanted an old BMJ article, which I know is freely available by several routes), and part of the problem is that, as the library website acknowledged, ejournal access doesn't work very well unless your computer is directly connected to the university network.

And then my friend said she's been told to avoid Google. So we tried Google and found several reports and articles, and a book, full text freely available (well the book was only part available but it was available enough for essay writing purposes). I was disappointed that a library system in a top 10 UK university was falling this far behind the reasonable expectations of modern users and am wondering what librarians have been doing to improve the tools of their trade for the last 10 years.

Using a library catalogue

2009-10-24T12:50:00.000+01:00

I used a library catalogue last week in a big academic library, and it was the first time in several years that I've done this. It was clearly the latest version of the system. And maybe that was the problem. It looked Google-esque, but when I searched for a person it took me to an authority list, which was just annoying because I wasn't sure which Smith was mine. I'd rather have gone, Amazon style, to some books, and then homed in on my Smith. In the end I needed to get help from a nice librarian, so I felt a bit of an idiot, being a trained librarian.

Designing URI Sets for the UK Public Sector

2009-10-22T23:05:00.000+01:00

The state of public sector URLs is probably no worse than that of private sector URLs, but anyway they're pretty awful - just a few examples. So the release of Cabinet Office guidance on URI sets is welcome.

The most radical proposal is to use data.gov.uk , for example transport.data.gov.uk , or health.data.gov.uk . I hope it happens. But I wonder how this will happen - it will take a huge change in Whitehall at least.

Enabling interoperability in healthcare

2009-10-21T09:26:00.000+01:00

Interoperability in healthcare is vital (HL7, SNOMED - http://www.e-health-insider.com/comment_and_analysis/501/personal_view:_tim_benson, ) but it won't be achieved until the non-technical barriers to achieving it are recognised.

Two non-technical barriers are critical:

- commercially it may not make sense for systems suppliers to make it easy for data to move in and out of their systems

- professionally, it is unclear that the needs and interests of different professional groups point towards shared data.

The answer I believe lies in patients owning and holding their health record, with each system and professional holdig their own record and able (if permitted by the record owner) to read and write to the master record. The challenge is to create a value proposition for patient held records. It may be something as simple as electronic prescriptions. I like the approach www.keas.com are taking.

Medpedia and Wikipedia

2009-10-08T06:50:00.000+01:00

I like Medpedia very much, and the Medpedia page on Atrial Fibrillation is better in some respects than the corresponding Wikipedia page. But it's less up to date, eg no reference to http://circ.ahajournals.org/cgi/content/full/115/24/3050 which challenges some of the content of the article. I don't have the time, inclination or expertise to edit the Medpedia page by the way.

Limitations to evidence based medicine

2009-10-06T15:57:00.000+01:00

A limitation of the EBM approach is that as questions get more specific the evidence becomes less available. EBM can be quite good at answering broad brush answers questions, but these are rarely what clinicians actually need. Here is a recent example, taken from a recent NICE guideline on rheumatoid arthritis (pdf)

The available data does not answer the clinical question of whether a patient who is not responding to DMARD therapy should go onto other conventional DMARDs or onto a biological drug. There are no head to head trials of these comparators.

This question, about switching to another low cost DMARD or to a high cost biologic, important as it is, doesn't seem to have an answer. The problem in part is that the underlying research agenda regarding the effectiveness of therapeutics is motivated (of course) by commercial concerns, as we showed 15 years ago in an analysis of NSAIDS for osteoarthritis.

Mendeley growing rapidly; alternative model for repositories

2009-09-27T18:57:00.000+01:00

I've argued that Mendeley and ResearchGATE can add some pep to the repository pattern. Here's some more of the same from Open Access News.

Mendeley growing rapidly; alternative model for repositories: "John MacColl, Mendeley scrobbles your papers, HangingTogether, September 24, 2009.

Mendeley is a social web application for academic authors that has been receiving quite a lot of attention recently. Victor Keegan wrote about it in The Guardian last week, likening it to the streaming music service Last.fm:

How does it work? At the basic level, students can “drag and drop” research papers into the site at mendeley.com which automatically extracts data, keywords, cited references, etc, thereby creating a searchable database and saving countless hours of work. That in itself is great, but now the Last.fm bit kicks in, enabling users to collaborate with researchers around the world, whose existence they might not know about until Mendeley’s algorithms find, say, that they are the most-read person in Japan in their niche specialism. You can recommend other people’s papers and see how many people are reading yours, which you can’t do in Nature and Science. ... There are lots of research archives. For the physical (but not biological) sciences there is ArXiv, with more than half a million e-papers free online – but nothing on the potential scale of Mendeley. Around 60,000 people have already signed up and a staggering 4m scientific papers have been uploaded, doubling every 10 weeks. At this rate it will soon overtake the biggest academic databases, which have around 20m papers.

The site has grown fast, aided by significant investment capital from investors associated with Last.fm, Skype and Warner Music Group. ...

If it realises the potential many people are now predicting, the library community is bound to ask why a web application based on an entertainment model should have proved so much more attractive than the painstakingly built repositories we have been holding under the noses of our academic authors over the last several years?

I think there may be a few reasons for this. First, its appeal is intuitive. Put your papers in our service and we will give you lots of webscale data back on how popular they are. The system can show you instantly how your research profile compares with the average researcher in your field. Second, it is instant. The map of research adjusts daily as new papers are added. Want to find out who is the most popular author in your field today? Mendeley can tell you. ... And third, the demands it makes are low compared to the benefits it provides. A range of simple tools allow you to ship your papers into it. ... [Y]ou can scrobble. Scrobbling is the word Last.fm uses to describe the use of a tool that works invisibly in the background to add your music choices to your Last.fm account. ... In Mendeley, the same notion is applied via the 'Watched Folder' facility. With it, you can designate folders on your hard disk that Mendeley will monitor, and from which it will suck new papers as they appear.

By adopting these approaches, Mendeley has grabbed the attention of users because it understands what they like. They like simplicity. ... What do they not like? Tedious rules about copyright (the Mendeley FAQ, perhaps ironically, quotes the E-prints Self-Archiving FAQ to reassure authors about the extent of Open Access tolerance among publishers). They don’t like rigorous requirements for metadata (Mendeley automatically extracts metadata, and asks users to help it make corrections where it gets things wrong). In other words, the requirements libraries often put up front are almost dismissed as non-issues. ...

Comment. To me, the better analogy may be Napster. I don't necessarily mean that pejoratively: both Napster and Mendeley watch a folder on the user's computer and automatically share files in that folder. That takes the effort out of sharing, which means more documents get shared. It also means that metadata will often be incomplete or inaccurate. In addition, since there's less emphasis on copyright compliance, I'd suspect that some authors may share documents in ways that violate their publisher's contract -- more so than traditional repositories. In short, the Mendeley model seems to have some major advantages over traditional repositories, but also some significant shortcomings vis-à-vis traditional repository goals. I think there's a place for both in a healthy scholarly communications ecosystem, with both competition and collaboration.

See also our past posts on Mendeley.

Google doesn’t use the keywords meta tag in web search

2009-09-26T17:34:00.000+01:00

From Matt Cutts:

Google doesn’t use the keywords meta tag in web search: "

We went ahead and did this post on the official Google webmaster blog to make it super official, but I wanted to echo the point here as well: Google does not use the keywords meta tag in our web search.

To this day, you still see courts mistakenly believe that meta tags occupy a pivotal role in search rankings. We wanted to debunk that misconception, at least as it regards to Google. Google uses over two hundred signals in our web search rankings, but the keywords meta tag is not currently one of them, and I don’t believe it will be.

In addition to the official blog post, we made a video as well:

I hope this clarifies that the keywords meta tag is not something that you need to worry about, or at least not in Google.

US Government Opens-Up to OpenID and Information Cards

2009-09-16T14:15:00.000+01:00

US Government Opens-Up to OpenID and Information Cards: "

Today at the Gov 2.0 Summit in Washington, DC: the Federal Government is announcing they will be implementing OpenID and Info Cards as part of its open government initiative. The looming adoption of these two standards paves the way for citizens to use existing accounts and online identities (such as their Yahoo or Google accounts) to participate in various government web sites. This also means that citizens can customize their experience on government websites without needing to reveal any personally identifiable information – including passwords.

The collaborative effort, which will initially include participation from a variety of digital identity providers, will be phased in as part of a pilot program implemented by the following three agencies:

Center for Information Technology (CIT)

National Institutes of Health (NIH)

U.S. Department of Health and Human Services (HHS)

And the identity providers participating in the pilot include several major players in the tech industry:

Yahoo!

PayPal

Google

Equifax

VeriSign

Acxiom

Citi

Privo

Wave Systems

In order to ensure a fair opportunity for digital identity providers, companies participating in the pilot are being certified under a collaborative framework set up between the Federal Government and both the OpenID Foundation and the Information Card Foundation. An Open Trust Frameworks for Open Government white paper provides more insight and detail about this effort.

There have been a slew of positive reactions to this new facet of the open government initiative. You can check out the various reactions by government directors, identity providers, and digital identity advocates at the Information Cards blog.

Chris Messina, an active and vocal advocate of open technologies perhaps sums it best:

This effort sets in motion a shift in how individuals can interact with the public sector and makes progress on the Obama administration’s promise for a more open, transparent, and participatory government.

And indeed this new effort is indicative of the fact that changes are underway in the government’s adoption of Web 2.0 technologies, as well as its migration towards providing online services that are more than just digital brochures. The implications for developers are profound as well, as the use of open standards signals another step towards enabling a truly programmable government web. It provides hope and potential for citizens to not only participate as stakeholders, but also to contribute to and assist with government efforts that benefit the public at large.

The Information Cards blog has posted the formal press release for the initiative. As we have covered in previous posts, including our recent post on the latest upgrade to The New York Times Congress API, this is an important and popular topic that is increasingly gathering attention. Marshall Kirkpatrick has posted some additional analysis on the news over at ReadWriteWeb.

New Knol developments from Matt Cutts

2009-09-16T13:32:00.000+01:00

From Matt Cutts:

New Knol developments: "

Google launched Knol about a year ago. The big worry back then was that Google might favor Knol in our search rankings. I stopped around various places on the net to debunk that idea back then, but I think it’s safe to call this idea fully debunked now. As I said six months ago:

Google Knol does not receive any sort of boost or advantage in Google’s rankings. When Knol launched, some people asked questions about this. I dutifully trundled around the web and said that Knol would not receive any special benefits in our scoring/ranking for search. With the benefit of six months’ worth of hindsight, I hope everyone can agree that Knol doesn’t get some special boost or advantage in Google’s rankings.

I think we can call that idea completely debunked now.

In the mean time, the Knol team hasn’t been standing still. In a recent announcement on the Google Blog, the Public Library of Science is starting up a new website on Knol to publish research results about influenza. PLoS Currents: Influenza will be moderated by an expert group of researchers. With H1N1, it’s important to communicate preliminary results, and this new site provides a way to do that.

I wanted to talk about something else cool that I recently saw on Knol. One of Knol’s strengths is making it easier to add knowledge to the web. For example, the web has fewer documents written in languages such as Arabic. One Google Knol project resulted in a ton of informative pages being added to the web in Arabic. They made a video about it:

Getting more useful content onto the web is a good thing, so I’m glad that Knol can help with that.

Twitter API Adds Location Data - Tweets Get Realtime Geo

2009-08-25T23:33:00.000+01:00

Twitter API Adds Location Data - Tweets Get Realtime Geo: "

Twitter co-founder Biz Stone has just announced a new geolocation API that will be available to developers fairly soon (Twitter API profile). The new API, which will likely be rolled out in Twitter clients before being available on the Twitter site, will allow users and developers to add latitude and longitude to tweets, thereby adding a valuable new layer of meta information to tweets.

According to Biz’s post, the new API has various implications for improving how Twitter is used, including the ability for users to connect with other users based on geographic commonality:

For example, with accurate, tweet-level location data you could switch from reading the tweets of accounts you follow to reading tweets from anyone in your neighborhood or city—whether you follow them or not. It’s easy to imagine how this might be interesting at an event like a concert or even something more dramatic like an earthquake. There will likely be many use cases we haven’t even thought of yet which is part of what makes this so exciting.

The API will first be released as a developer preview, and it likely that we will see existing apps and mashups built with the Twitter API quickly integrate this new feature. We can only guess that we also will see the rapid emergence of a new breed of geolocation enabled apps and mashups that use this new API in unexpected ways.

Documentation on the new API is not yet available. Developers and Twitter users should note that this in an opt-in feature, especially important with respect to privacy. As Biz describes it:

Folks will need to activate this new feature by choice because it will be off by default and the exact location data won’t be stored for an extended period of time. However, if people do opt-in to sharing location on a tweet-by-tweet basis, compelling context will be added to each burst of information.

The news is certainly leading to quite a buzz on various blogs (TechCrunch, Mashable, and Google Maps Mania) as well as on Twitter itself. O’Reilly’s Brady Forrest points out that there are more technical details in the Twitter developer group, including source example shown below

We’re excited to hear about this, and we’re curious to see how this new API will fit into the overall geolocaiton ecosystem, which includes Yahoo!’s Fire Eagle (our Fire Eagle API Profile) and Google Latitude.

Related ProgrammableWeb Resources

Twitter API Profile, 249 mashups

Two projects for civic-minded student programmers

2009-08-13T08:12:00.000+01:00

Two projects for civic-minded student programmers: "

One of the key findings of the elmcity project, so far, is that there’s a lot of calendar information online, but very little in machine-readable form. Transforming this implicit data about public events into explicit data is an important challenge. I’ve been invited to define the problem, for students who may want to tackle it as a school project. Here are the two major aspects I’ve identified.

A general scraper for calendar-like web pages

There are zillions of calendar-like web pages, like this one for Harlow’s Pub in Peterborough, NH. These ideally ought to be maintained using calendar programs that publish machine-readable iCalendar feeds which are also transformed and styled to create human-readable web pages. But that doesn’t (yet) commonly happen.

These web pages are, however, often amenable to scraping. And for a while, elmcity curators were making very effective use of FuseCal (1, 2, 3) to transform these kinds of pages into iCalendar feeds.

When that service shut down, I retained a list of the pages that elmcity curators were successfully transforming into iCalendar feeds using FuseCal. These are test cases for an HTML-to-iCalendar service. Anyone who’s handy with scraping libraries like Beautiful Soup can solve these individually. The challenge here is to create, by abstraction and generalization, an engine that can handle a significant swath of these cases.

A hybrid system for finding implicit recurring events and making them explicit

Lots of implicit calendar data online doesn’t even pretend to be calendar-like, and cannot be harvested using a scraper. Finding one-off events in this category is out of scope for my project. But finding recurring events seems promising. The singular effort required to publish one of these will pay ongoing dividends.

It’s helpful that the language people use to describe these events — “every Tuesday”, “third Saturday of every month” — is distinctive. To being exploring this domain, I wrote a specialized search robot that looks for these patterns, in conjunction with names of places. Its output is available for all the cities and towns participating in the elmcity project. For example, this page is the output for Keene, NH. It includes more than 2000 links to web pages — or, quite often, PDF files — some fraction of which represent recurring events.

In Finding and connecting social capital I showed a couple of cases where the pages found this way did, in fact, represent recurring events that could be added to an iCalendar feed.

To a computer scientist this looks like a problem that you might solve using a natural language parser. And I think it is partly that, but only partly. Let’s look at another example:

At first glance, this looks hopeful:

First Monday of each month: Dads Group, 105 Castle Street, Keene NH

But the real world is almost always messier than that. For starters, that image comes from the Monadnock Men’s Resource Center’s Fall 2004 newsletter. So before I add this to a calendar, I’ll want to confirm the information. The newsletter is hosted at the MMRC site. Investigation yields these observations:

The most recent issue of the newsletter was Winter ‘06

The last-modified date of the MMRC home page is September 2008

As of that date, the Dads Group still seems to have been active, under a slightly different name: Parent Outreach Project, DadTime Program, 355-3082

There’s no email address, only a phone number.

So I called the number, left a message, and will soon know the current status.

What kind of software-based system can help us scale this gnarly process? There is an algorithmic solution, surely, but it will need to operate in a hybrid environment. The initial search-driven discovery of candidate events can be done by an automated parser tuned for this domain. But the verification of candidates will need to be done by human volunteers, assisted by software that helps them:

Divide long lists of candidates into smaller batches

Work in parallel on those batches

Evaluate the age and provenance of candidates

Verify or disqualify candidates based on discoverable evidence, if possible

Otherwise, find appropriate email addresses (preferably) or phone numbers, and manage the back-and-forth communication required to verify or disqualify a candidate

Refer event sponsors to a calendar publishing how-to, and invite them to create data feeds that can reliably syndicate

Students endowed with the geek gene are likely to gravitate toward the first problem because it’s cleaner. But I hope I can also attract interest in the second problem. We really need people who can hack that kind of real-world messiness.

Dismantling IT and urban flu myths

2009-08-13T08:00:00.000+01:00

Testing the new Google Reader share this feature with this blog post by Hanna from the Informaticist

Dismantling IT and urban flu myths: "

According to Pulse (Tories unveil plans to ‘dismantle’ NHS IT infrastructure) a new Conservative government would dismantle the national programme for IT in favour of a lovely local version instead which a bit similar to arguments surrounding local versus centralised medicine albeit this has some degree of logic viz quality; somehow IT projects do get stereotyped as unfathomly unwieldly whatever original size/budget. The BMA welcomed the move but wanted the control of patient records to stay with patients not private companies. It seems it will fall into private hands in any case, with Labour they love a good PPI. Perhaps people should walk around with it round their neck on a secure dongle? It is interesting where this will go now that many people are publishing details freely on the internet and not making the connection…

Meanwhile something I don’t think we have mentioned yet on this blog is avian flu or its many other names. The Lancet sped up a systematic review of the use of Tamiflu et al or neuraminidase inhibitors and found that they are not beneficial when given out to the healthy general populace…hmm evidence based policy is rather thin on the ground now anyone can ring up for their antivirals; one GP says public health is now a patronising public nuisance.

And a last thing I came across today is a blind search engine test. Blindsearch, from a Microsoft employee with no much time on his hands, searches across Google, Yahoo and Bing and gets you to vote for the one you prefer when you’ve seen the results, the search engine is revealed once you’ve voted. It seemed to slide off my page but that might be a local problem, otherwise intriguing.

NHS Evidence

2009-05-01T14:39:00.000+01:00

NHS Evidence is a very promising start - it's already good enough to be used in favour of Medline and Google for quick searches on clinical effectiveness in the UK. It could do with a really good database of recent systematic reviews because DARE is not up to date.

One odd result so far - a search for BNP (a peptide not the dark side of UKIP) in heart failure worked well, but when the 'diagnosis' filter was applied the results became less relevant to the use of BNP as a diagnostic tool. It's difficult to get get metadata right on search engines (Berry Brothers does a very good job, but that is because of the nature of their business). Maybe not even worth it. Just let users put in the words they want and let the technology de-fangle the query.

The end of clinical coding

2009-04-29T08:29:00.001+01:00

One of the reasons put forward by its advocates is that clinical coding is a vital component of a standardised health record, which is itself a vital pre-requisite to sharing clinical records. So the investment goes on, in initiatives, committees, sub-committees, standards, taxonomies, meta-taxonomies, ontologies, to support the wide range of coding systems used in health.

The effort would be worthwhile if coding was essential to the accurate structuring and transmission of the information in a medical record or medical information more generally. One recent incident has shown how fragile that claim is. And there is nothing to suggest that using SNOMED-CT will improve matters, since SNOMED-CT is itself far too large, complex (and oddly incomplete) to accurately and consistently convey the meaning of free-text or even semi-structured text in a compressed format. (Hint for Google - SNOMED-CT is to health information as the semantic web is to understanding language)

"The use of codes ensures the information derived from them is standardised and comparable." is an often repeated claim. The fact that it does neither continues to be overlooked, and there is still an open question about the value of coding in support of decision making, patient safety. Where coding clearly has a role (HRGs, Read codes) is in support of physician and provider payments. Even this role is of questionable value , and there is always a risk of medical coding being affected by the level of payment associated with a class.

An electronic mess

2009-04-10T22:31:00.000+01:00

I'm trying to access the European Journal of Heart Failure, whose website says it is available on Science Direct. But it's not on Science Direct. The catalogue of the University I'm working at says it is available on Science Direct. But it's not. TDNet says it is available on Science Direct...even the journal website says it is available on Science Direct. But it's not.

Rooting around, there was an announcement on Science Direct last August that EJHF was transferring to OUP in 2009. More rooting around finds an old message:

The European Society of Cardiology (ESC) has transferred the publishing contract for the European Heart Journal from Elsevier to Oxford University Press(OUP). OUP started publishing the title as of volume 26, 2005. All publishing and electronic rights have also been transferred. The archival content is available via the new publisher’s website.

In the majority of transfer cases, Elsevier manages to secure the non-exclusive archival rights, allowing content to be available on ScienceDirect as well as the new website. Unfortunately, in this case, this was not possible and the content had to be removed from ScienceDirect. Whilst such removals are not common, they do happen occasionally and Elsevier is legally obliged to comply.

Maybe ECS/OUP take all their content away from Science Direct. Whatever, it's a bit of a mess.

Semantic Web - the unreasonable effectiveness of data

2009-03-30T07:14:00.001+01:00

Not much response yet to The Unreasonable Effectiveness of Data , except for this oddity . It makes the case against RDF style angle bracket web intelligence pretty effectively and adds to the 'meaning is use ' approach to semantics.

Information Architecture - moving on

2009-03-29T10:10:00.000+01:00

Jesse James Garrett

Here are some of the most common terms from past IA Summit programs: taxonomy, thesaurus, controlled vocabulary, metadata, faceted classification, navigation, content management -- and then there was that one year with all the talks about tagging. Like my grandparents, we cling to these things because they are what saved us. They are the tools by which we proved that yes, IA is real, and it is valuable. But that war is over. We won. And now it's time to move on, because those comfortable, familiar things represent only part of what information architecture can be.
So it's time to leave the nest. Thank you, Lou and Peter. Thank you, library science. For getting us off to a great start. For giving us the tools and knowledge to win a place for IA in the world. There will still be a place for library science in IA, but it's only a part of our larger destiny.

DirectGov search

2009-03-28T19:31:00.000Z

Why does Jayne Nickalls thinks it significant that DirectGov has teamed up with Internet Explorer 8 ? Given MS's desperation to revive it's fortunes on browsers I'm sure it didn't cost DirectGov a penny. But will it have any real benefit for the public? You have to wonder.

Anyway, the real problem with Direct is its search engine. Accelerating people to it isn't going to be much fun:

FAST talk

2009-03-27T07:02:00.002Z

The best way to follow FAST's fate is through commentator Stephen Arnold, who really does know a thing or two about enterprise search. Here is his latest:

More problematic is the Fast Search & Transfer technology. Perhaps it was once “best of breed”, but now the Fast ESP (enterprise search platform) has become more complex with the addition of new home grown functions, components obtained via licenses or open source, and the integration of sophisticated third party functions from other vendors.

Is anyone talking about FAST in the NHS?

Metrics for enterprise social computing

2009-03-27T06:58:00.000Z

Consumer social computing - obsessive twittering, midnight blogging, endless xbox live sessions, Wikipedia editing - hardly needs to prove itself. The volume of activity tells its own story.

But what about social computing in the Enterprise? Enterprise Social Computing metrics are in their infancy. Take one recent example. A large pharmaceutical company switches from a range of ad hoc user-introduced social computing tools to a strategic platform. Gartner reports that 7000 internal websites are sitting on the new platform. And says that this has 'fostered information sharing and collaboration'.

Really? Maybe these are 7000 little used silos. What the Gartner report doesn't say is that a site at Pfizer is considered active if it is used once a month. That's not very often for a tool that supports the lifecycle of a team. How many sites would there be if the metric was once a day? We don't know - the question for Gartner and other independent analysts is - what are the reliable metrics about enterprise social computing to base investment and management decisions on?

More strange results from Clinical Decisions

2009-03-26T15:18:00.007Z

I mentioned a while ago that the Scottish Clinical Decisions search engine was giving some odd results. It's based on FAST, which claims to improve with use, so I went back today and tried some similar searches. The result of a search for 'effectiveness of heart failure specialist nurses' was, if anything, more off the mark than before:

I wonder what's going on? Meanwhile, I'll be sticking with TRIP or Google, or even Medline.

Taxonomy to go?

2009-03-18T07:09:00.000Z

From the BBC

Council leaders have compiled a banned list of the 200 worst uses of jargon, with "predictors of beaconicity" and "taxonomy" among the worst horrors.

At library school

2009-03-18T05:41:00.000Z

The author Michele Roberts trained at UCL in the early 1970s

For example, all public libraries in Britain used the Dewey decimal system, which categorised human knowledge as a pyramidal structure. Subjects were arranged one to 10, and under them came sub-divisions, and then sub-divisions of sub-divisions. The system locked subjects into fixed places. Under category seven, Sociology, you could find Women, alongside Lunatics and Gypsies. Men were nowhere to be seen: as designers of the universe, and of classification systems, they did not need to be visible.

Serendipity - collaborative curation / research data curation

2009-03-13T08:34:00.000Z

RSS readers are modern serendipity machines. This morning reports from Jon Udell and Alf Eaton, one about establishing patterns for the collaborative curation of calendar data, the other about bootstrapping transparency in science data .

Broken users or broken system?

2009-03-08T10:14:00.000Z

Some time ago a librarian blogger chastised users in this case a PhD student) for not using Medline properly and not wanting to be inducted into the complexities of the Medline interface. Here is some more evidence if it were needed that librarians need to adapt their systems to user needs. It will still be possible to return high quality data sets to Google style interrogations of Medline - it just takes a bit more effort, which begins by not wishing users would become au fait with the complexities of MeSH headings and Boolean queries.

In the library

2009-03-06T22:46:00.000Z

I had occasion to visit the University of Worcester library today. Very nice and pleasant. Wireless network if you had the password. Good coffee just around the corner.

The thing that struck me after being in the library for a little while was that almost no-one was consulting a book or journal. People were either pecking away at a laptop, or chatting quietly in small groups.

EtherPad - for really real-time collaboration

2009-03-05T19:33:00.002Z

Etherpad - surrealists would have loved it

Sharepoint - MySite - yawn or groan?

2009-03-04T19:01:00.000Z

On a Sharepoint portal where apparently I have a MySite I get the following:

The Cochrane conundrum

2009-03-04T12:26:00.001Z

A recent paper at the Cochrane Colloquium highlighted the need for free access to best evidence. However, despite providing significant funding for their production, the public still has to pay Wiley Interscience for full access to Cochrane Reviews.

Sharepoint and Documentum - a cautionary tale

2009-03-01T16:52:00.000Z

Interesting story here in which neither Documentum nor Sharepoint comes up smelling of roses.

Desperate times - in libraries or at Microsoft?

2009-02-27T07:41:00.002Z

here's a recent blog post from a Microsoft emerging business specialist:

Drastic times call for creative measures. Many public libraries sit on a rich vein of data – the borrowing history of their customers – that can be mined & monetized for delivering highly targeted ads. For example, people typically check out books like “What to Expect When You’re Expecting”, “Fodor’s Disneyland for Kids” or “The Official Guide for GMAT Review” for quite specific reasons. Also, hobbies such as canoeing, cooking or calligraphy can be easily discerned from borrowing patterns. That being said, there are many issues that will need to be addressed, such as ensuring advertisers do not get their hands on personally identifiable information (PII), and that regulations like COPPA are complied with.

Yahoo Pipes

2009-02-25T00:17:00.002Z

Declining standards of clinical guidelines

2009-02-24T23:41:00.002Z

Some evidence in this week's JAMA:

Recommendations issued in current ACC/AHA clinical practice guidelines are largely developed from lower levels of evidence or expert opinion. The proportion of recommendations for which there is no conclusive evidence is also growing. These findings highlight the need to improve the process of writing guidelines and to expand the evidence base from which clinical practice guidelines are derived.

Why it's better to do things with simple open tools

2009-02-24T20:40:00.000Z

Researching COPD services, I found an interesting looking report from the NHS Institute. It included a link to a video - but the URL is long-gone. If the video had been put straight onto YouTube it would still be there. Use simple open tools like del.icio.us, Flickr, YouTube for content management.

Microsoft - as confusing as ever

2009-02-21T17:34:00.000Z

In November 2008 Kim Cameron announced that LiveIDs could be used as OpenIDs. I have both but haven't checked out the LiveID-OpenID linkage till today.

I logged in to my LiveID account [turns out it wasn't a LiveID account but a Windows Live account, but didn't see anything about OpenID. Looked in 'more services' and FAQs - nothing. Hmmm, typical big organisation that doesn't really do the Web very well....so I searched LiveID OpenID using Live.com (just joking, I searched using Google and found a few results, of which https://login.live-int.com/beta/ManageOpenID.srf looked promising)

Although I was logged in to Windows Live the site didn't spot this and asked me to log in again (yawn, groan, typical Microsoft). So I tried to login and....I got an error message:

"The e-mail address or password is incorrect. Please retype the e-mail address and password, or sign up if you haven't already done so." (I typed it in ok)

Maybe my LiveID account is different from Windows Live ID? (Microsoft genius branding) So I tried to create a Windows Live ID account and used the same email and password as my LiveID account...

As a comic aside, when registering I used my mother's birthplace as my secret question I was told her place of birth was too short, and needed to be at least 5 characters long. I will ask my Mum to be reborn in a place with a longer name when I get time...

So having put in a longer placename.... the next screen shows a VERY scary messsage:

*** This is a Windows Live ID test cluster. Entry of any Personally Identifiable Information (PII) in this cluster is prohibited under Windows Live ID security requirements. DO NOT enter production (actual) Windows Live ID credentials - member name passwords, question and secret answer, etc., or any other personally identifiable information such as email address. Information in this cluster is not protected under the standards for Windows Live ID PII. ***

What does that mean? I don't know but I will continue to register anyway.....

Success - or so it seems. Now I have a Windows LiveID and a Windows Live Account. Both with the same email address and password but seemingly not the same. Confused, I click on 'More about Windows Live ID'...the pop-up window says "You are not authorized to view this page. The Web server you are attempting to reach has a list of IP addresses that are not allowed to access the Web site, and the IP address of your browsing computer is on this list."

Anyway, it looks as if Windows LiveID is not the same thing as a Windows Live Account. The following wikipedia article confirms this. I wonder:

- do I have 2 accounts with Windows Live?
- why was there no link from Windows Live account to Windows Live ID?
- why was I able to create a Windows Live ID account with exactly the same credentials as my Windows Live Account?
- why can't my Mum be born in a place that is 4 letters long?
- why now does my Windows Live ID login take me to my Windows Live Account page? And why is it possible to have different secret questions for my Live Account and my LiveID account if they are the same thing?

Strangely enough, although I now have a LiveID OpenID URL it isn't visible in my Live account, and some of the settings I updated earlier (date of birth, gender) seem to be lost. I also have a Live unique ID that is not an OpenID. I also have a URL (http://cid-b74592fd20a7de07.profile.live.com/) that isn't the same as my LiveID OpenID.

The final indignity of course is that when I try to use my new Microsoft OpenID it doesn't work:

The specified ID provider has not yet been implemented in Scrapplet.
A message has been sent to the developers to add it pronto!
Current supported providers include: Facebook, Google, Yahoo, AOL, MyOpenId, LiveJournal, Verisign, and WordPress

http://openid.live-int.com/bentoth

Other

http://openid.live-int.com/bentoth

At this point I give up, and overall this just confirms my impression that Microsoft isn't yet a Web native outfit.

Obtaining articles in 2009

2009-02-19T11:28:00.003Z

Once upon a time it would have been quite a challenge to get hold of a paper like the following

Gates MA et al. Talc Use, Variants of the GSTM1, GSTT1, and NAT2 Genes, and Risk of Epithelial Ovarian Cancer. Cancer Epidemiology Biomarkers & Prevention 17, 2436, September 1, 2008

Not many medical libraries will carry the journal ($1000 dollar subscription). A user could request an Inter Library Loan, or try to fathom out if they have access to the journal via an omnibus subscription service by way of a library they use (a challenge in itself sometimes).

The AACR says that articles are freely available after a year, and that the journal is part of HINARI. It also says that pay per view is $15 dollars for 24 hours, but elsewhere says that the cost is $35

The AACR journals have a web page and also a portal. The web page doesn't have a search engine but the portal does. A field delimited search for Gates, M 2008 produces a nil result.

AACR has a rather jaundiced view on open access:

Although AACR does not agree with the decision of some funding agencies to require deposit on government websites of articles that are already made available free to anyone online at the Publisher’s expense and that are maintained online in stable archives, we recognize that funding agencies have forbidden their grantees to publish in journals that do not allow such mandated deposits.

but grudgingly accepts the NIH access policy. Its statement on UK funders is wrong since it omits the NIHR, which provides over £1bn research funding annually and supports open access. AACR is a supported of the Washington DC principles, which is trying to reverse the NIH access policy.

None of this byzantine architecture will be of the slightest interest to the average researcher, who just wants to read the article. They might just be interested in doing this search however, which is easy, likely to be part of their work flow and will take them directly to an abstract (content at last!) and the email address of the lead author who will supply a reprint/preprint, probably by return and without cost.

Instead of propping up the unfathomable and inefficient superstructure of journal publishers, could librarians make a real start on helping users (Ranganathan Law 4) obtain texts using modern methods?

The IBM Amazon Cloud

2009-02-12T08:18:00.009Z

This is important I think. For some months IBM has been gearing up an initiative on enterprise strength cloud computing standards. Today, an announcement that IBM is teaming up with Amazon Web Services to make some IBM services available via Amazon. Seasoned cloud watchers may shrug and say so what? But, provided AWS is enterprise strength this marks a turning point for the cloud computing paradigm.

Facebook and OpenID

2009-02-08T14:08:00.003Z

I see that Facebook is cosying up to OpenID

Adam Bosworth - fixing US health care

2009-02-06T23:31:00.001Z

slides here

Variation in browser security

2009-02-04T07:04:00.005Z

Technical, but interesting:

Browsers in this review run the gamut in cipher support. Firefox (v.3.12) has the strongest first cipher showing (TLS, ECC, AES, 256-bit key) followed by Opera (v.9.63). Firefox also has strong defaults, and 34 total ciphers to choose from. (Click each browser name to view its entire cipher order.)

Opera is impressive because it offers 256-bit symmetric ciphers for the first five suggestions (TLS, RSA, AES being the first). However, Opera doesn't offer ECC support at all, which means that Chrome (v1.0) and Internet Explorer (v.8 beta 2), which do offer ECC, could easily be considered tied for second in cipher support if more than first cipher offered were considered.

Both Chrome and Internet Explorer offer TLS, RSA, AES with a 128-bit key first and with a 256-bit key second. In both cases, ECC isn't offered until fifth. Still, Safari runs away with last place with weak first offerings (TLS, RSA, RC4, 128-bit key is offered first and second), frequent MD5 offerings, and no support for ECC, AES, or 256-bit keys.

Google world library

2009-01-26T23:41:00.000Z

New York Review of Books is carrying a good overview of the recent Google Books deal.

The changing Microsoft eco-system

2009-01-24T06:21:00.000Z

For may NHS IT staff Microsoft is not part of the eco-system, it is the eco-system. So if Microsoft is changing, and I think it is, then the world of NHS computing is going to change. Here are some of the facts.

The credit crunch is reshaping Microsoft. MS is not going away tomorrow - it probably has a bigger income than the UK at the moment. But it's been affected by the credit crunch and is laying off staff in various divisions.

Microsoft can't make the Internet work for it. MS is still a pre-internet company, still can't shake off its desktop and mis-size enterprise mentality. As a recent post said, MS is a way of thinking not just a company. And despite the elevation of Ray Ozzie there's no sign of MS being able to unshackle itself from its great legacy. I think that will change, but as long as it can make money from basically lame products such as Sharepoint it doesn't have space within the company to innovate.

Microsoft can't make search work. Its 'pay you to search' campaign doesn't seem to have had any impact, and it is struggling to find any useful roles for Powerset and FAST. Unfortunately for MS, every time I use Live search is an advert for Google.

The last few years masked Microsoft's decline from itself. Let's hope MS emerges from the global recession as a leaner, fitter organisation, more able to support the next wave of computing innovation. For the NHS, it will mean a more web based and hopefully more open eco-system.

A couple from Chicago

2009-01-22T18:33:00.000Z

There is a lovely 1996 interview and photo of Barack and Michelle Obama in the latest New Yorker. The interview includes the following: "There is a strong possibility that Barack will pursue a political career, although it’s unclear."

The importance of prototyping

2009-01-22T15:29:00.000Z

Paul Buchheit: The first version of Gmail was literally written in a day

Lotus Notes fights back

2009-01-22T14:54:00.000Z

... with a LinkedIn mashup

Personalising search Google style

2009-01-19T20:13:00.000Z

Google is introducing a new search feature, that lets users tune search results to the sites users prefer/trust. Not sure this will take off, but technically it's very impressive

eeggi - non semantic web semantic search

2009-01-19T17:43:00.000Z

A terrible name, and impossible to tell if it is more than just a VC honeypot, but here is another semantic search engine:

Our scientific, engineering, and technical staff is composed of leading experts in mathematics, linguistics, information technologies and business management with advanced degrees from the world's top institutions. Their role is to continue developing eeggi's new search engine technology, and its new mathematical-linguistic algorithms; while helping you customize the searches of your clients, yours, and your industry's.

Tabbloid

2009-01-16T14:24:00.000Z

Tabbloid turns RSS into a newspaper of sorts. Must have some uses.

Clinical Checklists

2009-01-15T06:29:00.000Z

seem to work. And you have to wonder how something so simple can be effective. Maybe because it is simple. There is an interesting saga about the struggle to introduce checklists in one setting in the US.

Google and the semantic web

2009-01-08T10:50:00.000Z

Some thoughts from Stephen Arnold here

Contested semantics

2009-01-08T09:33:00.001Z

To my knowledge proponents of the semantic web say little about the contested nature of meaning. But reading a review of drug companies and doctors highlights this neglected aspect of semantics among information professionals, for whom classification in all its forms is simply a good thing ; and the main issue is how to get people to apply or use or just put venture capital into semantics.

Alongside the review in the dead tree edition of NYRB is an advert from John Hopkins University Press, headed Resisting Categorization. A timely reminder that semantics are as much contested as agreed, and that rather than communities creating ontologies a la semantic web, ontologies create communities:

In recent years, drug companies have perfected a new and highly effective method to expand their markets. Instead of promoting drugs to treat diseases, they have begun to promote diseases to fit their drugs...to promote new or exaggerated conditions, companies give them serious sounding names along with abbreviations. Thus, heartburn is now "Gastro-eosophageal reflux disease" or GERD.

The world of classification might say Heartburn SEE GERD, or draw up some fancy RDF statement. But in doing so creates too simple a model of the real world, especially a real world that is rapidly making its knowledge fully digital.

Even outside drug company politics, medical classification is contested. For example, coding of the treatment of COPD is bound up with contested visions of the organisation of the NHS. The following quote reflects layers of complex disagreement and negotiation:

The Government appears to be committed to the pursuit of a market economy approach and the evolution of Payment by Results (PbR) has necessitated the production of many more codes to provide greater definition of our activity. We have been successful in bids for several new codes but there is still some way to go before we iron out some of the residual bids and any frustrations associated with the lack of definition of some of our more specialised activity.

Evidence of the instability and contested nature of semantics is ready to hand, but of necessity overlooked by classificationists for whom the possibility of stable agreed ontologies is part of their ontology.

GData Health API

2009-01-05T14:34:00.000Z

here

The growing Web

2008-12-31T18:00:00.002Z

Take all this with a pinch of salt, but the BBC are reporting that British women spend 47% of their leisure time online and social networking accounted for 10% of recent UK web traffic.

academia.edu - academic social networking

2008-12-30T21:42:00.001Z

www.academia.edu might just work

Practical Internet Groupware - del.icou.us as a database

2008-12-30T20:58:00.000Z

Jon Udell's Practical Internet Groupware is still one of the most important books about the Web. His recent entries on shared calendaring are very much in that vein, and his most recent posting uses del.icio.us as a database to drive a shared calendaring website. Neat!

Why not the best?

2008-12-28T07:32:00.000Z

is a new health provider comparison website, supported by the Commonwealth fund. Interesting to see if this one has any impact, and what providers make of it.

Do librarians get Open Access?

2008-12-26T20:38:00.004Z

This post was prompted by a comment from Graham Walton, the outgoing editor of HILJ, to a post by Tom Roper. The original post and comment are here. Tom believes, as I do, that librarians should be promoting open access, and that consequently the closed access publication model of HILJ is to be regretted. Graham's argument against open access is in 3 parts, which are, in summary: 1. You know the position so why are you raising the issue? 2. The arrangement enables HLG to deliver valuable services to users. 3. Wiley's support has given HILJ an impact factor.

Let's look at the arguments in turn.

HILJ does indeed have a journal impact factor, placing it 31st out of the 56 journals in the library and information science category. This is a very modest performance after 25 years. But the point is - could this have been achieved without publisher support? The evidence suggests that it might. There are higher ranking journals in the category, which are open access, such as Information Research. And evidence from other fields suggests that open access journals can have very good impact factors. The suggestion that publisher support was needed to achieve an impact factor is therefore not borne out by the facts.

The arrangement with HILJ does produce an income for HLG. But does the income benefit HLG members, who pay a stiff fee to CILIP or a £25 per annum fee direct to HLG? Looking at the HLG accounts and list of recent activities it appears that the largest expense borne by HLG is its conference, which takes place every 2 years. The second largest expense is that of the committee itself, not surprising given the large number of committee members. Beyond the conference, and using the HLG website as a guide, its is hard to detect many educational and professional development activities arranged by HLG. The ones listed here are mostly organised by other bodies or are expensive CILIP training days. Where are the activities and events that Graham mentions? The guide to working in health information is out of date. Perhaps there are events organised by HLG, but they don't appear as a significant cost on the HLG balance sheet. In fact it appears that most of the income from HILJ is not spent on anything. But there is a query against the 2008 accounts so maybe it is wrong.

The third argument can be paraphrased 'that's just the way it is'. This argument might carry more weight if the income from HILJ was used to obvious benefit and if the publisher was making the journal a leader in its field. Neither of these appears to be true, so maybe it's time for a drains-up look at the relationship between HLG and HILJ, especially in a year when HLG agreed a 9% increase in the price of the journal (that's about x3 the rate of inflation, more likely around x8 inflation by the mid 2009). Maurice Line once wrote, in a journal that is not freely available (Librarianship as it is practised: a failure of intellect, imagination and initiative, Maurice B. Line, Journal: Interlending & Document Supply, 2005 Volume: 33 Issue: 2 Page: 109 - 113)

Unless we can see our future in a far broader context, we may not have a future. Our territory is being lost while we think we are defending it, because we are defending the form and not the substance, and the substance is changing.

The quote might have been designed specifically for HILJ.

George Bush creates his own perfect exit

2008-12-25T08:58:00.001Z

here

merry christmas everyone

Back end plumbing for the real time web

2008-12-23T11:05:00.001Z

Geting beyond RSS - here

YouTube the search engine

2008-12-23T10:36:00.000Z

Techcrunch: Video search on YouTube accounts for a quarter of all Google search queries in the U.S., according to the latest search engine numbers from comScore. Its monthly qSearch report, which was released on Thursday night, breaks out the number of searches conducted on YouTube. If it were a standalone site, YouTube would be the second largest search engine after Google

CTO of the year

2008-12-22T11:36:00.001Z

Congratulations to Werner Vogel, Amazon CTO, Blogger, and Information Week's CTO of the year Richly deserved, and a nod towards cloud computing.

Do librarians get Google?

2008-12-21T13:46:00.002Z

Some do certainly, but lots don't. Here for example is the view of a library academic on the evidence-based [!] librarianship discussion list:

The only thing that I would add to this analogy [of Google with an unqualified library assistant] is that some one has described the World Wide Web as a library where someone has ripped off all the covers and title pages and piled the books randomly in the middle of the floor. I therefore think that Eve is being slightly too kind to Google - unless her personal experience of Library Assistants is that they indeed do that!

Compare this to a recent quote from someone who does know something about the Internet:

Google is slowly becoming a force in medical information. I know that librarians will point to the wonders of commercial medical information services. Heck, 20 years ago I was involved in Pharmaceutical News Index, and Google blows that system out of the water by accident. Are the commercial medical information companies aware of the Google. Sure, but I don’t most of these outfits think Google is savvy enough to master the mysteries of MeSH.

Some librarians are moving beyond narrow prejudice. This slideset by Patricia Anderson for example. What remain difficult is to see the world through the eyes of users. What makes this difficult for librarians? - ignorance often, but also a reliance on a commercial model that is disappearing.

Publish (in wikipedia) or perish

2008-12-20T06:49:00.001Z

"Publish or perish" has been the mantra for university researchers for many decades. The need to appear in print has enabled the growth of the academic publishing industry, which essentially takes possession of the product of thousands of hours academic labour and sells it back to the producer. (For a good account of medical journals see here)

Requiring researchers to contribute something to Wikipedia is not without some questions, but is undoubtedly a step in the right direction, along with other open access initiatives.

Hugo's cartoon

2008-12-19T22:00:00.001Z

by whale499 | Create your own Cartoon at www.toondoo.com

Semantic search - food for thought

2008-12-17T07:11:00.001Z

from Stephen Arnold

In my opinion, the Google - Guha approach is the one to watch. The semantic Web is gaining traction, but it is in its infancy. If Google jump starts the process by saying, “We will do it for you”, then Google will “own” the semantic Web. Then what? The professional semantic Web folks will grouse, but the GOOG will ignore the howls of protest. Why do you think the GOOG hired Dr. Guha from IBM Almaden? Why did the GOOG create an environment for Dr. Guha to write five patent applications, file them on the same day, and have the USPTO publish five documents on the same day in February 2007? No accident tell you I.

Cloud resiliance

2008-12-17T06:56:00.002Z

IBM is launching a Cloud Resiliance certification programme. This sort of thing is needed urgently in addition to SAS70.

SAP, Deloitte, IBM and Framework contracts

2008-12-17T06:39:00.000Z

The Public Accounts Committee has some fun and games with Sir Humphrey and partners . One of the things the PAC rightly calls into question is buying IT services off Framework contracts without developing a specification or going to competitive tender.

The system implemented was SAP, by IBM, with Deloitte advising:

The Department has, to date, paid Deloitte around £4.6 million for assistance on this project. In April 2004, the Department appointed Deloitte to provide consultancy support to the Department’s Support Services Review and subsequently extended this contract to assist it in developing the outline business case and the handover of the shared services design stage to IBM. The value of that contract was some £2 million. Following the appointment of IBM as the Department’s main delivery partner, Deloitte has provided

quality assurance and other support on the project at a cost to date of around £2.6 million

Scottish eLibrary search produces some very strange results

2008-12-13T22:04:00.003Z

I'm seeing a lot about FAST at the Scottish NHS eLibrary. And I'm doing some work on heart failure at the moment. So I gave it a go....and got some very odd results.

1 Search term heart failure found over 1000 guidelines on heart failure (that's about 950 too many hits). The top result shows that whichever search engine is in use hasn't solved the old 'not' chestnut.

2 More bizarre still were the results for 'nursing interventions in heart failure':

These are pretty strange results by any measure. Is it me? FAST? Search engines only get a few goes to deliver some value before being discarded.

RDF in healthcare

2008-12-12T17:25:00.001Z

As far back as the early days of Artificial Intelligence, healthcare has always been a topic of interest for leading edge ideas in computer science, principally because medical decision making looks like a computable function. But the “return on investment” of such interest has been negligible, and there is no reason to suppose that the application of RDF to healthcare – even in areas such as bioinformatics or genomics - will be different. In fact the main result of computing’s interest in healthcare to date is a mess of unimplemented standards and a lack of basic applications – the New England Journal of Medicine reports that as of 2007 only 4% of US physicians had fully implemented electronic health records. The reality in healthcare is that even basic informatics building blocks such as a unique patient identifier are not sufficiently in place.

Wherever you look in healthcare there are too many elaborate standards (see Eric Browne's recent presentation on the semantic ambiguity of HL7) and too few effective ones. The NHS for example is awash with standard vocabularies – SNOMED, Read Codes, Clinical Terms, ICD 9 and 10, MeSH, OPCS, HRGs, NHS Data Dictionary, BNF Drug Categories, DMD. Yet none of them are used widely or applied consistently, nor are they interoperable – and none of them produce patient benefit. To imagine that this situation might be improved by adding RDF is a complete non-starter, even in areas such as drug discovery. In contrast, modest applications such as Google Flu trends, which links public health surveillance to search trends, might just be useful. There is one area where the idea of linked data ought to be surfacing - PCT data analysis - but there's no sign of any RDF activity in public health informatics.

Clinical Questions and Answers beyond PICO

2008-12-10T20:05:00.003Z

A nice new interface for TRIP Answers Elsewhere the precise framing afforded by the PICO method gives the hope of improved answerability. But this is a mirage - as precise questions are addressed they throw up new uncertainties in direct proportion to the precision of the question, and the ability to give useful answers recedes.

Sharepoint - not simple, not easy

2008-12-04T22:14:00.001Z

Beyond Search:

"Microsoft’s SharePoint has become the dominant content management, collaboration, and search platform with 100 million licenses in organizations. SharePoint, however, is not well understood as technically complex and a work in progress. Anyone who asserts that SharePoint is simple or easy is misrepresenting the system. Here’s a diagram from a Microsoft Certified Gold vendor in New Zealand. Simple this is not."

It's true, Sharepoint is popping up everywhere. The ones I've seen recently all had the same half finished look to them - sparse calendars, badly organised folders containing a few random files, nugatory discussions. In other words just like the shared drives/calendars all over networks, but with a web front end and an annoying login.

Mary Jo Foley: A plea to the Windows team

2008-12-04T18:16:00.000Z

Don’t make Windows 7 too Mac-like

The case for librarians promoting open access

2008-12-03T12:26:00.001Z

The strongest argument for librarians to be active in supporting OA (be journals, books, data, primary research or secondary research) is that library users now and increasingly in the future will be in places (real and virtual) other than the library AND STILL REQUIRE ACCESS to resources. Lorcan Dempsey has written about the need for libraries to be in the flow. Open Access is a simply a part of the 'in the flow library service'.