Medical Software- Make Medicine Modern
(...please!!!)
.Frank O'Connor
AmphiaZiekenhuis Breda- Oosterhout, The Netherlands
What a stark contrast?
- Modern life style. Dynamic, speedy, progressive.
- The Universal Web, smart mobile phones, Pads, Ebooks.
- Extensive social electronic communication
- Rapid easy access for IT, Travel, Finance, Sport,Entertainment,Meteology, News.
- What about Medicine, Hospitals.
Contemporary "modern" Hospital Systems -1
- Medicine, Hospitals. Maybe 10 or more years behind.
- The public have limited knowledge of the functioning of hospitals.
- This may explain the widening gap.
- Data collection, storage, processing, display and coupling are inadequate
- Hospital Systems are collections of units with an administrative orientation
- Access is usually through an immobile workstations
Contemporary "modern" Hospital Systems -Workstation
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Contemporary "modern" Hospital Systems -2
- These static workstations each demand a fresh login and then.You wait...
- Logged in. Click and Choose. Till Click and Complete.
- Close and Run. Great for the less motivated
- Purposeless Clicking is too frequent.
- Clicking is demotivating for the thought processes
- There is "Free text" if Clicking is not adequate for data collection
- "Free text". Text now replaces paper.
Contemporary "modern" Hospital Software -3
- Paper documents can still be scanned in.
- Smart text processors(=producers) are available.
- Copy-paste-copy-paste cycles are popular too.
- Choice between clicking and "free text" is open.
- All patient contacts are auto-logged.
- Tendency to compulsory correspondence.
- Warning! Electronic Text Deluge Imminent!
Contemporary "modern" Hospital Systems -4
- Trash? Delete? Clean up? Who knows?
- Too much text? then Text Filters can help - Primitive.
- Incorrect entries. Error correction is extremely tedious.Lots of Clicking!
- Graphics and medical data processing are absent,limited or outdated.
- Search Engine? Shhhh! They might give us one!
- Crashes have been few.
Contemporary "modern" Hospital Systems -5
- Professional personnel carry a heavy burden during development and deployment.
- Design and corporate backup are poor
- Computer delays irritate patients
- Keyboard use irritates patients
- The public and patients expectations are high for Healthcare IT.
- Are such systems really "State of the Art"?
Closing the Gap - What is needed.
- Medical systems should be MORE sophisticated than what public have!
- Dedicated mobile graphic devices.
- Rapid information exchange.
- Accurate focused information.
- Capacity to telephone.
- Use should be self explanatory.
- Can be achieved by Politics? Work with "Industry"? Self help?
Quo Vadis?
- Medical personnel are essential for developing such systems.
- Their advice and effort is necessary for future improvements.
- Minority of medical personnel have this knowledge or experience.
- How does one begin using software? What program would you find most useful to create?
Self help- Write and understand IT 1.
AudioVisual sites asking for fees, cheap and good value
- Code School.
- Rails Casts.
- RailsTutorial Book and Video.
- Peepcode.
Self help - Write and understand IT -2
Writing your application -Development Stage
- Modern software is becoming easier to understand and use.
- Open Source(OS) software has few financial constraints.
- There is a wide range of software for any task.
- Large numbers of tutorials,forums, and documentation, audiovisual aids.
- Ruby, JavaScript, Perl, PHP are some of the scripting Languages.
- Rails, jQuery,CoffeeScript are programming frameworks
- Databases include Mysql, Postgres, and Sqlite.
Self help - Write and understand IT -3
Writing your application- Development Stage
- TextMate, Sublime are sophisticated text editors.
- Rspec,Jasmine give Test Driven Development for Ruby and JavaScript.
- Haml, Sass, HTML5 aid web presentation and design.
- Store and share programming on Github a software repositories.
- New Relic supplies stastics on web software performance.
- NetBeans,Eclipse,and Aptana are graphic IDE's.
- There are many Web servers available. Apache, Sinatra, Thin.
Self help - Write and understand IT -4
Writing a web application -Deployment, Staging, Production
- Deployment (making the application available on a remote server)
- Production, public can access information on a host
- Web Hosting is cheap , and flexible (Heroku, Webbynode, Amazon).
- The complete operating system on which the application runs can simultaneously be hosted.
- Databases can also be hosted separate from a web application
Self help - Write and understand IT -5
Writing a web application -Deployment, Staging, Production
- Cloud Computing of Amazon infrastructure use is billed on data storage and transfer.
- Storage can be rapidly acquired or released, ideal for low budget projects.
- Inexpensive technology is available for developing sophisticated software.
- It has as yet been sparsely applied in medical practice.
- Will medical professionals realize this short-coming?
Old fashioned, Watson? Certainly not!
Deductive reasoning. Sherlock Holmes
"When you have eliminated the impossible, whatever remains, however improbable, must be the truth". "Elementry my dear Watson!
Sherlock Holmes - Based on Doctor Joseph Bell, his surgical tutor
Contemporary "modern" Hospital Systems -Holmes-Moriarty
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Sophisticated PDMS
- Aim - PDMS approaching the ability of a good clinician.
- Using thought processes such as association, pattern matching
- Concepts from IT could be useful. Modelling. Object orientation. Data driven developement
- Medical codes would play a role - maybe need refinement
- Dombal - acute abdomonal pain in A/E +/- 1974
Conclusion
- Medical software is becoming increasingly outdated.
- Inexpensive technology is available for developing sophisticated software.
- It has as yet been sparsely applied in medical practice.
- Medical codes could play in important part in development
- Will medical professionals correct this short-coming?
Lessons from IT
| Write an (initially failing) automated test case defining a new function or improvement. | Produce the minimum amount of code to pass that test. | Refactor the new code to acceptable standards. |
Operatic Origins
- Opera 4 introduced Opera Show, a projection-mode style sheet technology
- Allows a single XHTML document to be turned into a PowerPoint-like slide show
- Adding screen and print style sheets allows for multi-medium views of a single document
- Highly efficient, but highly browser centric...
Expanding The Field
- When Opera 7.5 for OS X came out, the banner ads persisted in projection mode
- Tantek Çelik created a JavaScript-driven slide show technique that worked on multiple browsers
- Unfortunately, it required each slide to be ID'ed ahead of time, making additions and rearrangement difficult
- Navigation was only linear; no way to jump to an arbitrary slide
- There was also no facility to "switch off" the slide show styles short of killing all CSS
- Motive and opportunity combined to point the way...
Where We Are Now
- S5 builds on Tantek's scripts and ideas, with input and ideas from several other people
- Each slide is enclosed in a classed element; IDs are dynamically assigned via JavaScript
- Navigation menu is automatically built at run time
- The S5 format is compatible with Opera Show Format 1.0, making it easy to move slides between the two formats as needed
- S5 can also run slide shows based on XOXO
How It Works
- Controls are...
- Next slide: Space bar, return, right arrow, down arrow, page down, click anywhere in slide that isn't in the control area (lower right corner), click "arrow" in lower right corner, accesskey "X"
- Previous slide: Up arrow, left arrow, page up, click "arrow" in lower right corner, accesskey "Z"
- Toggle the slide styles: Click on the toggle button (to the left of the arrows), press "t", accesskey "T"
- To invoke the navigation menu: mouse into the lower right corner of the slide (below the navigation arrows)
The Advantages
- With one file, you get a slide show, a printable outline, and a screen presentation
- Files are incredibly lightweight and compress easily
- Thanks to being semantic XHTML, slideshow files are also highly accessible
- New slide themes can be created simply by writing new style sheets
- Unlike Opera Show, which has all of the above advantages, S5 works in multiple browsers
S5 Default File Structure
S5 Themes
(just a sampling)
Features New to 1.1
- Incremental display of slide content
- Font scaling based on window size
- Support for PNG alpha channels in all supporting browsers, including IE/Win
- Ability to jump to any slide, or skip a number of slides, via keyboard commands
Incremental Animation
- A demonstration of just one of the many ways to accomplish simple animation-like effects (using a diagram from "XFN and...")
Current Limitations
- Only one author can be listed in the metadata
- Opera falls back to use OperaShow; thus no extras (like the navigation menu or progress indication) are available
- Images are not scaled along with the text when the window size changes
Open To The Public
- S5 1.1 is released under an explicit Public Domain license
- Contributors to S5 must be willing to accept those terms
- In other words: if you submit a contribution, you are agreeing to abide by and place your contributions into the Public Domain along with S5
- On the other hand, anyone can freely use S5 for their own presentations or modify S5 to suit their needs
In Summary
- With minimal scripting, we have recreated and improved upon a (currently) browser-specific technology, making it cross-browser in the process
- New themes are just a matter of writing a new style sheet
- The S5 format is OSF 1.0 and XOXO compatible
- S5 is a very flexible and lightweight slide show system available for anyone to use