Wednesday 30 November 2011

Wooly vests, Engines and Health care: One stroke or two?

The cover of Nursing Times this week declares helpfully and positively that nursing is not broken. Stressed on several fronts clearly, but not broken. The feature explores the contribution that skill mix makes to nursing practice, quality and outcomes.

With the past day of industrial action and the economic climate you hear repeated commentators extolling the need for and benefits of investment in services be that: health and social care, house and road building, high speed rail, green energy, ...

The economy is often described as an engine. The knowledge and skills of the workforce (and students) help fuel prosperity through creativity, innovation and ultimately productivity.

As the looming winter settles in - I start to think about vests. The wooliest I can find.* You wonder to what extent the in-vest-ment in skill mix on the wards and other clinical encounters are oriented  towards tasks, activity and how much that skill mix has the necessary redundancy in place to afford high-quality patient education and person-centered care? You see we need to revest patients and the public at large with the knowledge and self-efficacy to keep well and stay well.

Economies that rely on two cylinder engines are usually considered as a bit behind the times. Noise. Pollution. Waste. How many cylinders do our health care systems run on?

Well, it looks and sounds like one.

One poorly machined cylinder with CURE at one end and PREVENTION at the other. So, the irony. We need a two-cylinder engine not just in health and social care, but people's lives. What a dream machine that would be. Is there a conceptual prototype out there...? You hope that Local Authority changes can refactor the engine, because looking at re-admissions (Milne and Clarke, 1990; Dowler, 2011) a radical redesign is greatly needed.

The truth is that as things stand (and the masses sit) this isn't enough.

(Interesting to note that apparently some 'one-cylinder' designs actually depend on two operations that overlap.)

Milne, R., Clarke, A. (1990) Can readmission rates be used as an outcome indicator? BMJ, 301, 17 NOV. 1139-4.

Dowler, C., (2011) Penalties fail to cut readmission rate, HSJ, 24, 11, 11, 4-5.

*Only kidding.

Wednesday 23 November 2011

Job Position: one Research Assistant in Semantic Web and Healthcare areas

This presents a great opportunity:

The Unit for Health Care and Life Sciences (HCLS) at the Digital Enterprise Research Institute (DERI: http://www.deri.ie/) of the National University of Ireland, Galway invites applications for a Research Assistant (RA) position.
 
Research Assistant (RA) Position: Semantic Web in HealthCare and Life Sciences
DERI – National University of Ireland, Galway
 
DERI is a leading research institute in semantic technologies that offers a stimulating, dynamic and multi-cultural research environment, excellent ties to research-groups worldwide, close collaboration with industrial partners and up-to-date infrastructure and resources.
 
The DERI HCLS group (http://hcls.deri.ie/) has a focus on applied research in the use of semantics in solving some key healthcare problems and dealing with: 

  • Interoperability of Electronic Healthcare Records (EHRs).
  • Interoperability of distributed healthcare policies.
  • Infrastructure which will scale to the thousands, and, in some environments millions, of patients who will avail of telehealth in the future.
  • Secure infrastructure which accounts for the ownership of patient data, the privacy and dignity of the patient, and which allows the patient play a part in managing his/her chronic illness.
This will involve research into HCLS ontologies and standards (e.g., HL7, openEHR) within the area of healthcare messaging, patient modelling and distributed personal health records. Research in the DERI HCLS research group is carried out in close collaboration with other collaborating institutions and industrial partners. Candidates should have:
 
  • A graduate degree in Computer Science/ Software Engineering or related fields.
  • Knowledge of Semantic Web Technologies (RDF, SPARQL, OWL).
  • Knowledge of healthcare standards (e.g., HL7, openEHR) is a plus but not a mandatory requirement.
Successful candidates are expected to have the willingness to combine formal scientific work with hands-on evaluation with healthcare providers.
 
Please send your application (CV, two letters of reference) in PDF format to the email address below – by Friday, February 3rd, 2012
 
Ronan Fox/Ratnesh Sahay
Domain for Health Care and Life Sciences
DERI - National University of Ireland, Galway
IDA Business Park,
Lower Dangan,
Galway, Ireland
 
E-mails: ronan dot fox at deri dot org, ratnesh dot sahay at deri dot org
For more information about Galway, NUIG, and DERI, visit the following websites:

My source: Post by Ratnesh Sahay to several lists.

Saturday 19 November 2011

Musings - The Caring Tableau: there's a method in conceptual overloading

[Still trying to figure some things out. ... ]

... Our foundation and scaffold must serve two purposes then. On the one hand it must facilitate conceptual modelling, and on the other hand it must be able to reflect the real world, the real time experiences we encounter.

Our models are built using words, specifically concepts. A minimalistic-holistic approach for the foundation [of h2cm] helps achieve balance, neutrality, agnostic credentials and avoids the additional danger of conceptual overloading.

In computer programming languages conceptual overloading has a specific meaning and application. It refers to the facility of some programming languages – Java for example (Bergel, 2011) – to have methods that have the same name. Methods are re-usable pieces of code that process data in a specific way. In conceptual overloading methods that share a common name are differentiated by different number and types of data specified as parameters. From a minimalist point we can readily expand the model thereby introducing conceptual overloading. The care domains can be viewed as methods, each with their own parameters. In the case of health care the parameters whilst indicated are not fixed. They are instantiated when invoked through a specific context, event or process. This is the challenge facing new recruits as they learn, and the expert as they continue to re-learn, forget, re-learn.

[If we continue the overloading process here, we arrive at the inevitable(?) philosophical junction of truth. In the health career domains model we can look upon the model with its domains as being filled with pebbles. I have frequently described the model as a mental means to turn over the cognitive – conceptual - pebbles and check their relevance. It is as if we have to include all concepts. Then many pebbles are automatically excluded by the very act of the initialization referred to above. This reduction, the emergence of conceptual dimensions is critical, it also reduces conceptual overload. What we have in effect then is a truth table – a care tableau.]

Bergel, A. (2011). Reconciling method overloading and dynamically typed scripting languages. Computer Languages, Systems & Structures. 37, 3, 132-150.

Musings... axes in hand and mind