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Monday, February 27, 2006

Access-management: Athens -> Shibboleth

JISC announces the development of a new access-management system for the UK

JISC (the Joint Information Systems Committee of the Higher Education Funding Council for England) have today announced that they will be moving from the Athens authentication system to an access-management system based on Shibboleth technology.

This will affect the processes used by millions of users and a three year plan is being put in place to manage the transition. Most of the work will need to be undertaken by institutions rather than end users, but it could potentially provide them whith a much easier process to access full text journal articles & bibliographic databases, video and audio files, research data sets and a host of research materials. As a user with multiple logins and passwords for different portals and databases (often with sveral sets of rights to the same resource through insitutional and personal subscriptions) I have been advocating this sort of development for years. The cry of "single sign on" is I believe one of the factors which wil increase the uptake of resources by those resistant to the use of some digital technologies.

Shibboleth does not carry out authentication itself. Instead, Shibboleth defines a set of protocols for the secure passing of identity information between institutions and service providers. It relies on the institution to establish identity, and on the service provider to confirm access rights, given information about institutional affiliation. It is written in SAML (Security Assertion Markup Language), an international standard developed by the OASIS Security Services Technical Committee and the Internet2 middleware group.

The word "Shibboleth" comes from the Old Testament (Judges 12:1-6). The Ephraimites who lived to the west of the river Jordan invaded Gilead on the other side of the river and were defeated. Retreating, their way was blocked by the Gileadites who controlled the fords. They had different accents and the
Ephraimites pronounced the ‘sh’ sound as ‘si’. To separate friend from foe, those crossing the river were asked to pronounce the word ‘shibboleth’ (it means an ear of corn). According to the bible, the 42,000 who pronounced it ‘sibboleth’ were killed.

The "ease of use" clearly indicates that this is the direction of travel, however financial and privacy arguments are still unresolved. Even with the growth of open access publication models, many publishers of materials which require subscription or one off payment, have been looking at micro charging for each article or page which is viewed, and improved ways of counting access and usage. Shibboleth developments may have a role in achieving this, particularly if the same processes are to be used by Amazon, eBay and other online vendors, which would save having to enter personal details at various points in the online transaction process. However these potential user and financial benefits may lead to worries about the potential for identity theft, and the powers of the new "Federations" (InCommon in the UK), which will manage the process.

It will be interesting to see if other organisations, especially the NHS, follow this path when JISC funding for the Athens service ceases.

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Saturday, February 25, 2006

Health Wonk Review

Managed Care Matters: UPDATE - Health Wonk Review Archives

Health Wonk Review is a new biweekly (or so) compendium of the best of the health policy blogs in which this blog is participating. Joe Paduda was the first "host" & asked over two dozen health policy, infrastructure, insurance, technology and managed care blogs to send in posts. Peter's piece Health informatics 2.0? on Informaticopia was selected to be included - others (largely from the US & Canada) cover a range of topics ranging from insurance systems, healthcare management and technology- so take a look & if you have a blog in these areas get involved.

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Friday, February 24, 2006

US to create a NHSU - Louisiana Politics and News

This report from Louisiana about the report to the White House on lessons learned from The Federal Response to Hurricane Katrina advocates the establishment of an National Homeland Security University (NHSU) - lets hope it's more successful ¬ as expensive as the National Health Service University (NHSU) which was created in the UK.

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VoIP "badges" for clinical staff

Cornwall NHS staff get VoIP phone badges

EHealth Insider has a story about Vocera system "badges" for staff at Royal Cornwall Hospitals NHS Trust "worn around the neck on a lanyard, which can put any user in touch with another member of staff just by saying their name or department into a microphone."

This looks like a very useful innovation, and may help to address issues with mobile phone use, but the costs of wireless networks for hospitals with large sites may be prohibitive. I also worry about potential cross infection and health and safety risks. I would have liked to have one of these when I worked in A&E to enable me to answer the phone & consult a wide range of staff without having to go back to the office etc - but I used to advise all staff not to wear anything around their necks because of the potential risks when it is grabbed by a patient - I even got the doctors who insisted on wearing ties to use "clip-ons".

I also wonder whether the badges can be put through an autoclave if they get covered in blood/vomit etc?

Perhaps we will see one of these on every nurses' uniform in a few years?

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Telemonitoring for patients in Cumbria and Lancashire

Wireless Healthcare-News - NHS Pushes Telemedicine System - A Little

Wirless healthcare today reports on this initiative by an NHS SHA working with Broomwell HealthWatch to provide remote monitoring and transmitition of a range of physiological data including, blood pressure, pulse, breathing rate, heart rate, temperature, heart rhythm (1 lead ECG) and Oxygenation levels (SPO2).

It is unclear whether this is just available from GP surgeries and NHS drop in centres (which for me defeats some of the benefits of telemedicine by providing it in patients own homes) or from the mobile devices in use in the project.

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Wednesday, February 22, 2006

Public sector catches wikimania | Society | Public sector catches wikimania

An interesting article in today's Guardian by SA Mathieson reports on a few initial steps to use wikis by government and other public sector bodies. He suggests that a higher level of security and registration by users is needed when compared with Wikipedia, and that greater checking of what is typed, to restrict spam and vandalism. He also suggests that a greater technical knowledge will be needed amongst users and therefore blogs, moderated chats etc are more likely to dominate in the short term. The article does however suggest that "expert patients" may soon be adding to non-medical pages on NHS Direct Online.

Having been editing Wikipedia for a couple of years (see my user page) I would agree that some of the editing functions and conventions take a while to get your head around (certainly longer than blog software of even html) the potential for group collaboration which are offered by wikis are worth the effort.

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Monday, February 20, 2006

NHS Connecting for Health - Nursing & Midwifery Conference - Oversubscribed

NHS Connecting for Health - Nursing & Midwifery Conference - Oversubscribed

Today I received an email about this conference, thanking me for my booking, but saying that the event is over-subscribed and has a growing number of people on a waiting list for a place. The email went on to suggest that if more than one person from an organisation is attending I might wish to cancel!

This could mean one of several things;

* Nurses and Midwives are now so involved & loads want to hear more about NHS Connecting for Health.
* The speakers look really exciting.
* They should have put on more events for this audience.
* They should have booked a bigger venue.

Or possibly;

* I'm the only one who received this & they don't really want me to attend, as I might ask awkward questions.

I will be interested to see if anyone else has received this message & what the attendance is like on the day.

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Sunday, February 19, 2006

AHIMA Health Information and Privacy Week - Electronic & Computerized Medical Records

AHIMA Health Information and Privacy Week - Electronic & Computerized Medical Records

This US initiative by the American Health Information Management Association (AHIMA), is designed to raise awareness among healthcare professionals, their employers, and the public of the importance of protecting the privacy, confidentiality, and security of personal health information.

They provide a range of tools for activites, articles and presentations. It would be nteresting to see a UK organisation taking on the same role.

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Libraries, logistics and the long tail

Lorcan Dempsey's weblog: Libraries, logistics and the long tail

Interesting post on Lorcan Dempsey's weblog considering issues around document/information supply in the internet age. Much of the discussion is based on an article "The Long Tail" in Wired Magazine and suggests that the capabilities to provide users with information of interest is not being well severed by InterLibrary Loan systems and catalguing services.

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Health Informatics National Occupational Standards

Health Informatics National Occupational Standards - Mini website

This new web site, which has been produced by the NHS Health and Social Care Information Centre and Skills for Health, brings together the work which has been undertaken in relation to health informatics and the knowledge and skills framework underpinning Agenda for Change for several key staff groups:

* Knowledge Management Staff
* Information Management Staff
* Health Informatics Senior Managers and Directors of Services
* Clinical Informatics staff
* Health Records Staff

It provides access to some useful documents, functional and occupational maps etc but I didn't find the interface and search functions particularly intuitive

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Thursday, February 16, 2006

'Frequent flyers' costing NHS £2.3bn a year | Society | 'Frequent flyers' costing NHS £2.3bn a year

An interesting report on "Frequent Flyers", their cost to the NHS and the potential for enhancing primary care management of patients with these chronic conditions has been published by Dr Foster.

The report (PDF available examines statistics for patients with one or more of 19 chronic diseases who were admitted to hospital 3 or more times in a year.

As well as this report The Guardian carries a leader and provides an interactive map which enables you to check out your local PCT (why there should be a particularly high rate of Pelvic Inflammatory Disease but no nutritional problems in my local area I'm not sure?)

Data also shows unsurprisingly that people most likely to be admitted were

"Families and pensioners who live in high rise flats and suffer from very high levels of social and economic deprivation, long term sickness and/or unemployment. Very few have qualifications or own a car."

while those least likely to be admitted 3 times in a year lived in areas of high land value & "They are likely to be members of the National Trust and the Women's Institute". (how long before they use the health giving properties of belonging to these organisations in their next recruitment campaigns?)

Dr Foster is a private company being paid by the DoH to analyse NHS data & then sell it back to NHS organisations in a "value added" format. This causes me some concerns!

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Monday, February 13, 2006

Health informatics 2.0?

Readers of this blog will know that we have discussed Web 2.0 (or WWW2.0) tools at intervals - indeed, blogging seems to be one of the quintessential elements of Web 2.0.

This got me thinking - what are the implications for health informatics (or nursing informatics, or [bio-]medical informatics - take your pick of term or speciality)? Many Web 2.0 tools can be explored for their use by health informaticians; but what about customising them for health informatics uses? - or even building health informatics applications using Web 2.0 tools and principles?

Among the key elements of Web2.0 are collaboration, building communities, fostering interactions, sharing of resources, etc. - tools such as blogs, RSS feeds, swickis, folksonomy applications. What might be their implications for developing health informatics? Could they put some of the sacred cows out to grass? For example, what are the implications for the whole debate and set of work on terminologies if people can create their own keywords and categorisations? What are the implications for the silo approach to health records if people can build their own and share links and information? Do we have the opportunity to create 'Health informatics 2.0'?

In addition to exploring the use of existing Web 2.0 tools, I and interested colleagues will be exploring these and other issues. Our thoughts will be added at intervals here, through and through various conference presentations and discussion papers. We invite anyone interested to share in the debate and provide their own perspectives.

Peter Murray

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Friday, February 10, 2006

Open Source Software in Health Informatics

Hi I have just joined Informaticopia
I work for where our mission is to facilitate open competitive choice in the IT market place by encouraging the production and use of open, competitive software products and solutions.
We are having some success in influencing EC and UK government policies in favour of Open Source and Open Standards, in the UK particularly in education where pioneering schools are saving between £40 and £80k pa. and in Local Government where we are a partner in .
We would like to have a go at health in the UK where the IT budgets seem to be extraordinarily high and not achieving much but committed to existing suppliers like IDX and iSoft on Microsoft platforms.
I have joined your blog to put forward some ideas, get some responses, understand the issues so we can work on facilitating appropriate solutions probably involving the use of some open source software along side proprietary systems - what we call the mixed software economy.
Re medical records, which is at the core of IT health, there is an open source solution in USA currently managing 44m records - see OpenEMR wpennington @ 2004-03-03. This has been deployed in Dublin.
There is another system in Europe, which is under development see a European OS ERM system.
If you are not already a knowing user of Open Source you might like to read a web book by Dr Mohammad Al-Ubaydli, a doctor who has got involved in IT and is good at explaining technology.

Comments welcomed

Now listen to your HC2006 blog

Now you don't even have to read the HC2006 blog - you can listen to it via podcast. As one of several experiments we will be trying out, to explore and expand the use of new tools on the HC2006 blog (, we have added a Blog2podcast, or Feed2podcast, capability. You will find the buttons towards the bottom of the righthand colummn on the HC2006 blog.

We have also added Talkr (, creating an individual audio file for each post (doesn't work for comments - yet); see the 'Listen to this article' link at the end of each post.

Please test them out and let us know what you think; we will be refining the functionality over the next few days.

In coming days, we will also be adding a number of other ways of listening to and interacting with the blog; some of these will be 'homegrown' (and so as 'beta with nappies' versions may be a little quirky) and some will test out some of the existing tools.

Two more 'world firsts' for HC2006? - we don't think this has been done for a health informatics conference before. If we as health informaticians do not explore the possibilities of these technologies, the tech-savvy 'new blood' we need to recruit will see the profession as irrelevant dinosaurs.

Peter Murray

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Thursday, February 09, 2006

Study by podcast

An item picked up from the 'Clinical cases and images blog' ( - Harvard Medical School (HMS) have made the whole curriculum available by podcast for students, faculty and staff.

See the HMS WebWeekly ( for a full report, or the blog link above.

And here in the UK its an uphill struggle to get some educators to use any kind of technology to support education...

Peter Murray

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Fujitsu sues CSC, 'The Register' reports

A report in 'The Register' ( states that 'Fujitsu Services is taking CSC Computer Science to court in the UK over breach of contract.' It goes on to state that the legal claim was filed with the Royal Courts of Justice in London in January, and speculates that 'their spat might have something to do with the ... National Programme for IT, in which both firms are Local Service Providers ...'

See for the full item - thanks to Jean Roberts for alerting us to this. I am sure many will watch developments with interest - we welcome any comments.

Peter Murray

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Wednesday, February 08, 2006

NHS SDO Call for proposals on Access to Healthcare

Call for proposals on Access to Healthcare

The NHS Service Delivery and Organisation (SDO) R&D Programme has today issued a call for proposals for research (up to £400,000 each) in the following interesting areas:

Ref: PC144- 'The effect of patient choice on access to care'.

The use of information by patients and carers to make choices (2 projects)

a) Ref: PC171 - 'General study on information';

b) Ref: PC172 - 'Study on information to facilitate appropriate choices by children and young people'.

Ref: PC173 - 'The effect of different patient choice regimes in the United Kingdom'.

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Health Information & Libraries J, Vol 23, Issue 1

Blackwell Synergy: Health Information & Libraries J, Vol 23, Issue 1: Table of Contents

The March 2006 edition of this journal has just been published and the table of looks interesting:

Health Information and Libraries Journal embarks on having and Impact Factor

Original articles
Developing efficient search strategies to identify reports of adverse effects in medline and embase
Su Golder, Heather M. McIntosh, Steve Duffy, Julie Glanville

Publishing trends in Chinese medicine and related subjects documented in WorldCat
Shirley Leung, Kylie Chan, Lisa Song

Market orientation: a concept for health libraries
Barbara Sen

A journal club is an effective tool for assisting librarians in the practice of evidence-based librarianship: a case study
Nicola Pearce-Smith

Clinical effectiveness and allied health professionals: an information needs assessment
Valerie Haigh

Knowledge in the Palm of your hands: PDAs in the clinical setting
Claire Honeybourne, Sarah Sutton, Linda Ward

Brief communications
Information retrieval for online patient groups
Roy Rada

Evaluating the impact of a project promoting library and information services to primary care in Nottingham, UK
Liz Doney

Using research in practice
Australian supermodel?-A practical example of evidence-based library and information practice (EBLIP)
Andrew Booth

Learning and teaching
Learning and teaching
Nicky Whitsed

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Headshift : Our Health, Our Care, Our Say?

Headshift : Our Health, Our Care, Our Say?

Interesting discussion from Stuart Hall and Lee Bryant of Headshift about recent white paper from the Department of Health and some of it's implications, including using technology to enhance patient involvement both in their own care and the organisation of health services.

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Sunday, February 05, 2006

Skill needs for nurses in their role as health informatics professionals: A survey in the context of global health informatics education

ScienceDirect - International Journal of Medical Informatics : Skill needs for nurses in their role as health informatics professionals: A survey in the context of global health informatics education

Interesting article from Australian colleagues Sebastian Garde, David Harrison and Evelyn Hovenga which reports a survey of 82 nurses via a web-based questionnaire on the preferred knowledge/skills set for health informatics professionals. Among others, the questionnaire is based on the International Medical Informatics Association's (IMIA) set of recommendations on education and IMIA's scientific map. Benner's five levels of competencies were applied to measure the degree of competency required for each skill/knowledge.

The paper suggests various areas not covered in the IMIA recommendations as being important for nursing education internationally.

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Saturday, February 04, 2006

Factors Affecting Clinician Acceptance of Clinical Decision Support

BioMed Central | Abstract | 1472-6947-6-6 | A Survey of Factors Affecting Clinician Acceptance of Clinical Decision Support

This paper by Dean Sittig, Michael Krall, Richard Dykstra, Alen Russell and Home Chin, which has just been published in the BMC journal Medical Informatics and Decision Making reports a survey of 110 adult primary care physicians in one (US) Health Maintenance Organisation (HMO).

They concluded that: "Even though a majority of our clinical decision support suggestions are not explicitly followed, clinicians feel they are of benefit and would be even more beneficial if they had more time available to address them."

Time and work patterns are obviously significant but this sort of research shows some indication of the ways in which Clinical Decision Support Systems need to perform to achieve acceptance, and illustrate wider issues about the use of technology by clinical staff.

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Friday, February 03, 2006

WWW2.0 applications for elearning

I've been doing some reading and experimenting recently with a range of software applications which could fall under the banner of WWW2.0 applications and thinking about possible educational applications - I would welcome your thoughts.

WWW2.0 is seen as being about applications which allow users to share and contribute in collaborative manners regardless of geographical differences. Obvious examples are things like blogs, but these can be much more than just one person's musings and I'm involved in an ongoing project to use blogging and podcasting technologies to enable people who are unable to attend a conference to become involved in discussion about topics raised (see the HI Blogs portal)

Other collaborative tools with a range of potential include wiki's -which allow multiple authors to work together on documents. Probably the best known example is Wikipedia (my user page is at: ) but there are various others on diverse topics eg Clinfowiki.

A development from wiki's is the swicki which provides a locally configured search engine (focusing on specific topics) and related Buzz cloud of popular words which learns every time someone caries out a search on it (see Eurekstar Swicki )

Perhaps the most innovative approaches (sometimes called mashups see Guardian article It's all in the mix ) use information sources from various sources and "mash" them together for an application. Most frequently these are based on google map but there are others - for an example you might want to see a map I made on Wayfaring which uses a google maps API and have a go at making one for your own area or using tools such as Frappr ( for everyone in a group or community (such as academici ) to put flags on a shared map indicating where they come from.

A collection of WWW2.0 applkications with comparisons between them s available at:

I see this sort of technology being very useful for group projects etc but would be interested in your views.

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Thursday, February 02, 2006

Mobile phones in hospitals - more good than harm?

Communication in Critical Care Environments: Mobile Telephones Improve Patient Care -- Soto et al. 102 (2): 535 -- Anesthesia & Analgesia

This article in the current issue of Anesthesia & Analgesia suggests that the benefits in rapid communication brought about by the use of mobile phones are likely to outweigh any small risks of electromagnetic interference between mobile telephones and medical devices.

The paper is based on 4018 questionnaires completed at the 2003 meeting of the American Society of Anesthesiologists.

According to a commentary on this in the Guardian it is unlikely that the blanket ban on the use of mobile phones in NHS hospitals will be changed.

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Wednesday, February 01, 2006

Nursing student blogs

Nursing students at Johns Hopkins School of Nursing are blogging their experiences as student nurses, and these are helping to recruit future students. "Prospective students can view a slice of real life as a Johns Hopkins University School of Nursing student through student "blogs" now posted on the School's website. In the blogs - website-based journals kept online for others to view - eight Hopkins nursing students write about all aspects of their lives, both on and off campus."

Thanks to Margaret Maag and her 'Nursing, Healthcare Informatics and Technology 2006' blog for alerting us to this -

The story is on Johns Hopkins School of Nursing website at:

- and the students' blogs can be accessed directly via:

A great development - does anyone know of anything remotely similar in the UK? - silly question, really, given the level of technology use and awareness among most UK Schools of Nursing. But maybe there are some nursing students out there doing similar themselves?

Peter Murray

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HITsphere - blog of blogs for health and IT

Yet another new development in the world of blogging related to health, IT, informatics, etc. Shahid N. Shah ( has set up 'HITsphere', which he describes as 'a network of premium weblogs that write content about the healthcare, medical, and clinical informatics and information technology (IT) industry. Combined, these sites reach a large readership of influential healthcare technology professionals.'

HITsphere ( currently links to around 25 blogs dealing with various aspects of 'healthcare IT'.

Peter Murray

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