Showing posts with label informatics complexity. Show all posts
Showing posts with label informatics complexity. Show all posts

Thursday, February 21, 2008

Tools to battle the complexity of biomedical software and medical information systems

Those who regularly read this blog know that one of my pet peeves is the increasing complexity of biomedical software. My belief is that complex systems are chaotic and unpredictable, and the best way to deal with software complexity is to eliminate it.

Here is a list of the basic intellectual tools that I believe can help reduce complexity.

1 Classifications. A class inherits properties in a direct lineage from a parent class. An object can only occupy a single class. Classifications are easy to understand and compute. This is the definition of classification that is used by biologists (as in the classification of all living organisms) and applies well to computer science. Classifications are related to (but different from) ontologies. Ontologies, unlike classifications, can become hightly complex. Classifications always reduce the complexity of a knowledge domain.

2 Flat data files that can be extended but not re-written. A telephone book is a close example. If people never changed their names, never died, and never changed their telephone numbers, a telephone directory would be an ideal example. Data that can be sensibly organized in this kind of flat file is very simple to work with.

3 The EMR (electronic medical record). The EMR is the digital equivalent of the patient chart. In this model, all new clinical reports pertaining to a patient are inserted into the EMR object for the patient. This is a simple data model that can work well so long as one and only one record is created for each patient.

4 Small, self-contained specialized information systems. These applications are designed for a specific and narrow function (e.g. cytopathology information system). Complexity does not intervene until the specialized information system needs to interact with other systems in the hospital.

5 Fundamental algorithms. Almost all important algorithms are simple and can be explained in a few steps. From these simple algorithms, complex systems can arise.

6 Simple protocols. Very simple protocols can support incredibly complex systems. TCP/IP (the internet protocol)is a simple strategy for transferring packets of information over a network of computers.

7 Elegant object oriented programming languages, such as Ruby. Though Ruby is a simple and elegant language, it can be used to create hopelessly complex software. Programmers need extensive training in design principles that minimize complexity.

8 Specifications. Specifications are formal ways of explaining what you've done so that computers and humans can understand and replicate your work. It is important to have a standard syntax for describing data and for organizing information into meaningful statements that can be interpreted by software agents ( RDF is a fine example). I distinguish specifications from standards. Informatics standards impose an idiosyncratic, specialized format on data and tend to increase the complexity of information across different data domains.

9 Unique data identifiers. Computers are good at creating and tracking unique identifiers.

10. Encryption algorithms. It is easy to make something a secret.

11 De-identified public datasets. Publicly released de-identified data simplifies research by permitting multiple projects on the same set of data. With remarkably few exceptions (zero, in my opinion), de-identified public medical datasets have not hurt patients.

Most programmers would include UML (Unified Modeling Language) in this list. I left it out because UML seems very complex to me and it permits programmers to manage complexity (rather than reduce or eliminate complexity). I confess that I do not know much about UML, but this is my current perception.

The topic of medical software complexity is a topic that I discuss at great length in my recently published book, Biomedical Informatics.

- Jules Berman

key words: medical informatics, informatics complexity, classification, ontologies, ontology, hospital information systems, laboratory information systems
My book, Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information was published in 2013 by Morgan Kaufmann.



I urge you to explore my book. Google books has prepared a generous preview of the book contents.

Sunday, January 13, 2008

Complex Hospital Information Systems (HISs)

This is one of a series of blogs on hospital information technology, emphasizing limitations and pitfalls.

The following is a short excerpt from Biomedical Informatics.

Beginning of excerpt:

Much can be learned from documented technology disasters. A 2003 article in the British Medical Journal described a project to install a computerized integrated hospital information system in Limpopo (Northern) Province of South Africa (1). This poor province with 42 hospitals had invested heavily to acquire the system. This fascinating article describes what went wrong and provides a list of factors that led to the failure of the system. this included a failure to take into account the social and cultural milieu in which the system would be used. There was an underestimation of the complexity the undertaking and insufficient appreciation of the length of training required by the hospital staff.

Failed system implementations occur in the U.S. The Veterans Administration spent hundreds of millions of dollars on a financial tracking system. The software implementation failed during trials at the Bay Pines VA in Tampa Bay Florida. Plans for extending the system to other VA hospitals became the subject of Congressional hearings (2).

End of excerpt

When an IT disaster occurs at a major medical center, there is a tendency to hush up the news. I have been told, in confidence, of other expensive systems that failed to implement or that implemented in a way that most users considered unsatisfactory. My perception is that HIS disasters are actually common, but I have no way of proving it.

There are many blogs in which health IT problems are openly discussed. Two of these are are:

http://labsoftnews.typepad.com/

http://www.histalk2.com/

References:

1. Littlejohns P, Wyatt JC, Garvican L. Evaluating computerised health information systems: hard lessons still to be learnt British Medical Journal 326:860-863, April 19, 2003.
2. Untangling the VA computer crash: How Bay Pines hospital went from guinea pig to paralyzed victim because of pressure to implement a new system. St. Petersburg Times Tampa Bay. March 28, 2004. Comment. The Veterans Administration spent nearly $500 million on a failed computer system.


-Jules Berman
My book, Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information was published in 2013 by Morgan Kaufmann.



I urge you to explore my book. Google books has prepared a generous preview of the book contents. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

tags: big data, metadata, data preparation, data analytics, data repurposing, datamining, data mining

Saturday, January 12, 2008

Computerized physician order entry (CPOE)

This is one of a series of blogs on hospital information technology, emphasizing its limitations and pitfalls.

The following is a short excerpt from Biomedical Informatics.

One of the most challenging features of many HISs is computerized physician order entry (CPOE). The intent of CPOE is to eliminate the wasteful hand-written (often illegible) doctor's orders that may need to be transcribed by nurses, pharmacists, and laboratory personnel before finally entered into the HIS. Having the physicians directly enter their orders into the HIS has been a long-awaited dream for many hospital administrators. In a fascinating report, patient mortality was shown to increase after implementation of CPOE.

[Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 116:1506-1512, 2005. text of article]

In this study, having CPOE was a strong, independent predictor of patient death. Somehow, a computerized service intended to enhance patient care had put patients at increased risk.

Without commenting on this particular study, it may be useful to review some factors that transform CPOE, and other well-intended medical informatics efforts, into destructive technologies.

Reasons why hospital informatics projects, such as CPOE, may fail.

-Tasks that were traditionally accomplished through intepersonal communication may be replaced by solitary entry sessions with HIS computer terminals. Opportunities to share helpful explanations and patient status updates may be lost.

-Computer entry tasks may be tedious, time-consuming, and repetitive. Harried staff, under these circumstances, may do an incomplete or sloppy job.

-Computer orders, once entered, may have no mechanism for correcting entry errors, leading to miscommunications.

-The asynchronous nature of multi-user entries into the HIS may cause havoc in a system that depends on coordinated workflow. For instance a prescription may not be filled by pharmacy until an order entered by a clerk-typist is released by a physician. If there is no system to ensure that each entry occurs in a timely and coordinated manner, workflow is halted.

Beyond informatics issues lie all-important social issues. High-tech medical solutions seldom achieve a desired effect for low-tech medical staff. Introducing complex informatics services, such as CPOE, requires staff training. There needs to be effective communication between the clinical staff and the hospital IT staff and between the hospital IT staff and the HIS vendor staff. Everyone involved must cooperate until the implemented system is working smoothly.

-Jules Berman

In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.



I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

tags: common disease, orphan disease, orphan drugs, rare disease, subsets of disease, disease genetics, genetics of complex disease, genetics of common diseases, cryptic disease