Wednesday, February 03, 2010

iPad therefore I am?

Before there was an NHS IT programme (later called NPfIT) I met a company called Zmedix in the USA. They had a big idea to digitise the patient diagnostic process. Their thinking was that a doctor needs to know about 2 million potential end points when diagnosing a patient and that in the typical 15 minutes spent with a patient, they'd never get through even a fraction of those possibilities - hence why, they theorised, doctors often sent people away for tests and more tests so as to provide more data and narrow the range. So they developed a product that asked patients lots of questions, starting very generally and then gradually narrowing based on the responses, trying to eliminate a lot of the noise and give the doctor a fighting chance of finding what was really wrong.

When we looked at this idea in the OeE, we wondered if we could use it to short circuit the digitisation of patient records - i.e. when a patient was sitting in the waiting room, give them a tablet PC with the Zmedix code on it (wrapped in a nice presentation layer) and have the patient complete the questions. We figured it would take 20 minutes. We thought that if we figured out a reasonably generic XML file format, we'd then be able to store this patient information and later (possibly much later) upload it into whatever the NHS decided would be their national patient record system (what eventually became the spine). Rather than try and digitise paper records, or upload existing (likely out of date or incorrect) records, we thought this might be a way to get some really good data much faster than we might otherwise get it.

I wrote this up on this blog once before in a post - The Single Heath Record Conundrum - in early 2003 - piggy backing off something that Phil Windley had written.

We pitched this idea to those involved in NHS IT but they were frying bigger fish and it probably didn't fit with what they were thinking about. Zmedix look to have disappeared since - their domain name is gone and there seems little trace of their work on the web.

But, what if we could restart that idea ... and use an iPad as the input device. Less threatening perhaps than a tablet with a pen - a lean back way of doing health records rather than the PC-centric lean forward?

We'd still need the Zmedix engine, or one like it but we could wrap it in a much simpler layer - perhaps with pictures and videos that would encourage patients to complete it fully ... although not necessarily in one session of course, they could do it in stages, a bit before each visit.

It seems to me that the iPad - far more than previous iterations of the tablet PC - will likely encourage far more thinking about how to deploy consumer facing applications for front line government services. Why? Because:

  • Battery life looks enough to last an entire office day before a recharge
  • The operating system is simple and uncluttered (it doesn't come with the baggage of a fully fledged PC or Mac operating system)
  • The ability to enter data (tick boxes, rate on a sliding scale) with your finger rather than a pen pr stylus will make data entry simpler
  • People are now (getting) used to the idea of an iPhone (or similar) and data entry meaning that the fear factor is less
  • Upgrades can be deployed quickly and easily straight to the device (even if it's operating on a closed wireless network); or the app could operate entirely in the cloud

I'd love to see this idea come back to life.


3 comments:

  1. David Zakim9:03 pm

    Alan - This is David Zakim. I am the founder of ZMedix;  we met when you visited SF. The program to which you refer is still alive although ZMedix is not. We have a demonstration project at Robert Bosch krankenhaus, Stuttgart, De. The program with the eponym CLEOS for Clinical Expert Operating System is owned by a charity, which I also founded for the purpose of protecting the integriry of the program. I can be contacted at dzakim@pacbell.net.

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  2. David Zakim9:03 pm

    Alan - This is David Zakim. I am the founder of ZMedix;  we met when you visited SF. The program to which you refer is still alive although ZMedix is not. We have a demonstration project at Robert Bosch krankenhaus, Stuttgart, De. The program with the eponym CLEOS for Clinical Expert Operating System is owned by a charity, which I also founded for the purpose of protecting the integriry of the program. I can be contacted at dzakim@pacbell.net.

    ReplyDelete
  3. David Zakim9:04 pm

    Alan - This is David Zakim. I am the founder of ZMedix;  we met when you visited SF. The program to which you refer is still alive although ZMedix is not. We have a demonstration project at Robert Bosch krankenhaus, Stuttgart, De. The program with the eponym CLEOS for Clinical Expert Operating System is owned by a charity, which I also founded for the purpose of protecting the integriry of the program. I can be contacted at dzakim@pacbell.net.

    ReplyDelete