Comments

The IEEE Computer Magazine, in a number of 1997, sorry, I don't have the exact reference at this moment tells a bit technical but very interesting history of the first connections and trials between the first ... four of five remotely distributed mainframes along USA testing the communication protocols that support the whole Internet as we know it today.

I think you could find a bunch of "cool friends" between those pioneers.

Posted by Esteban at June 10, 2008 9:26 AM

"For those of us who are Avowed Capitalist Pigs, it's amusing to see that all the initial funding, decades' worth, for Web-related activities came from the Feds—so much for only-the-private-sector-matters!"

Amusing indeed. In health care, wouldn't it be great to have the same sort of innovation? That is, innovation in the right areas-systems, processes, etc.--all of which will require substantially more investment and standardization in IT. We argue about why IT adoption in physician practices is slow or non-existent. Much of it is because existing solutions, relatively speaking, are crap...and expensive. Create a great tool, and people will use it, and it will spread virally. We don't have this in healthcare, and I believe its partly because of an inadequate structure or substrate for this sort of innovation to occur. Too much fragmentation is the result.

As we reflect on the amusing origins of the internet, I wonder if at least for our current crisis, similar federal intervention and funding for a health IT infrastructure is necessary.

(The VA has one of the best IT systems around...at least for now).

Posted by Manoj Pawar at June 10, 2008 10:28 AM

I’m not a capitalist pig – I guess I’m a pragmatic pig. I’m not at all surprised that ‘government’ provided the intial funding. I am with you Manoj and we are seeing major government investment in IT in healthcare here in the UK. Time will tell what the outcomes will be but I am optimistic that if clinicians embrace the opportunities without falling out with each other and being too precious then we have the real possibility in the UK for universal linkage of IT in health care. It seems crazy to me that our two recently acquired lovely puppies have an implanted chip that is linked to a national database which means if our precious dogs go missing, they can be traced back to me. (and by the way provides access to computerised vet records) And yet, as a patient in a national health system if I collapse 20 miles away from my village there is a chance that no one in the healthcare system will even know who the hell I am, never mind my medical history. Incredible to think in our techno 2008 how far healthcare has to travel in IT. That is one of the reasons healthcare is the biggest business challenge worldwide of current times. And by the way, in my humble opinion, the answer is NOT to privatise an existing UNIVERSAL healthcare system thus fragmenting the system even more and penalising the most vulnerable in society. I get more than a bit tired of ‘experts’ outside the NHS telling me how bad the universal system is and how it could all be sorted if it we had a private system. That is simply an unproven argument because no-one, to the best of my knowledge, has proved how a private healthcare system would provide universal healthcare of a standard we currently have in the UK as a RIGHT for ALL citizens.

I will as usual await the bullets and arrows from the folks who tell me I am out of date in my view of universal healthcare. I am happy to discuss such criticism but please provide more than anecdotal evidence of a better UNIVERSAL system within the same financial envelope as that provided by the UK National Health Service.

Posted by Trevor Gay at June 10, 2008 5:00 PM

Most of the healthcare IT systems are as bad or worse than Manoj so delicately puts it. There is an article in Time magazine about the Cleveland Clinic and their electronic health record. The main problem they had was physician buy in. Seems that even if the clinicians, nurses, physicians, et al are in on the design, they might not want to use it. And if it does work and the folks at Cleveland Clinic like and use it, if you try to transplant it somewhere it may not gain acceptance since it wasn't invent there and that's not the way we do it here.

And while I do work in healthcare, it isn't at the Cleveland Clinic.

Posted by MikeC at June 11, 2008 7:39 AM

MikeC..As you know because you work in health care and obviously follow such things - the Cleveland Clinic is at the center of a 'powershift' (Alvin Toffler circa 1990 wrote an interesting book titled Powershift). This powershift is from doctors to patients.... The health care system is going global and thus breaking the shackles of the C20th Nation-State model and the old fashioned thinking about how it is funded, provided, and the depth of coverage each patient receives. Ahead lies the challenge of discerning how much power the patient will have in pursuing her health care plan whether she belongs to a full or a partial taxpayer funded system... The resistance of doctors to this move is predictable but not sustainable....

Posted by Richard Lipscombe at June 11, 2008 5:03 PM

Mike C - I agree. In my experience in healthcare the only issue is clinician 'buy in' as I suggested in my earlier comment and that you put rather better than I did.

It is a reality that we have to get the doctors, nurses and other front line clinicians to 'own and implement' the change; otherwise, I'm sad to say, it is doomed to fail in spite of the fact we all know it makes sense.

The 'real world' of healthcare delivery in my experience is that we just cannot click our fingers as managers and expect obedient and automatic 'buy in.' As you so rightly say we cannot even guarantee the buy in when the clinicians have been involved in the development of the IT systems.

Posted by Trevor Gay at June 11, 2008 5:32 PM

To be absolutely accurate, if not hair-splittingly pedantic, ARPA gave birth to the internet, not the Web.

It was Tim Berners-Lee, CERN, and the creation of hyperlinking that transformed a global network of machines which could communicate with each other - and did so using email, newsgroups, and bulletin boards - into what we now know as the Web.

That said, without the internet there would be no Web...

Posted by Kenny Hemphill at June 18, 2008 6:08 AM