Many things to reply to!
1. Ahmad - no offence is taken. New paradigms will emerge, but I suspect
that current favourites will seem twee in a while - just steps along a
path.
Clinical information is complex. And varied. And there is lots of it.
And it may be uncertain. And maybe unreliable....but the highest standards
are demanded.
Just going for the flavour of the month as the answer to everything is a
red herring. There are few systems out there even scratching the surface.
Getting there will be a long haul because it *is* complicated.
New drugs pass through stages of enthusiasm, backlash and rational use.
What's different here?
2. Alan Capey says "From your approach I assume you have formal systems
training" Not strictly true - I lapsed from GP into AI/Clinical
Informatics research, but am interested in user centred design, formal
methods and evaluation.
It *is* hard for IT people and clinicians to communicate well, but they
must. We demand a rigorous (+/-) process with drugs - design, trials,
evaluation, evidence. Why not computer systems? The more safety-critical
the system, the greater the need for confidence in its performance, surely.
I regard information used for making decisions as very quality-sensitive.
That is why we need Clinical Informaticians (self-interest declared).
3. Gerard Freriks asks why I am fed up. Many little things, not one big
one. Someone who works with me "discovered" relational databases a couple
of months ago. They will, of course, be the answer to everything. Expert
systems were going to take over in the '80s...where are they now? (well,
some of the bits that work are in things like Microsoft's Wizards). Many
commented that many of the EU's Advanced Informatics in Medicine (AIM)
projects seemed to be ignorant of clinical life (they now demand a clinical
lead and demonstrators in real clinical establishments).
My view is that we must understand what needs to be done before we can go
and do it. New developments bring new opportunities - I'm at the more
formal end of the spectrum when looking at these things, that's all.
4. Mary Hawking says something very important. Get a lot of users on
board the development process early and keep them in! For example, Pen&Pad
in Manchester was user-centred - GPs came in and tried versions of the
system and said what was wrong, right, missing, not needed. At least had
something to react to - conventional design methods just ask up front -
nothing to say "horrible!" about.
5. The Internet is a messaging system. The browser/client sends a request
message to the server. A reply message comes back. The protocol defines
the form (syntax) but not the content (semantics in a way, I suppose). I
think we need both - use the Web as the means, content structuring to
prevent nonsense and errors, and to enable the fancy stuff. People are
pretty good at picking up mistakes, but computers need a lot of help.
Andrzej Glowinski
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|