Keywords: Nursing / Health Languages, Representation, XML, Data models.

Citing this page:

Jones, P. (2000) Hodges' Health Career - Care Domains - Model, HCML?

<>, Accessed

Introduction

There is what is now a rather dated illustration of a play swing that shows the problems in translating the needs of users to systems analysts and programmers with 'versions 1, 2 and 3.....' (or cockups) and the final result. Still far short of what was specified!

Nobody, would wish to make excuses for problems in IT - a cock-up is a cock-up - whether you are staff, tax-payer, patient or all of these. What is often forgotten is that ALL the stakeholders in public sector health and social care ICT projects, enter a land full of bridges. What bridges?

It is primarily about bridging communications gaps. This website has traversed several already. Health care theorists and academics have their theory-practice gap; IT managers and corporate management have their own (and not all gaps are equal). Politics makes the gaps wider. Life demands that people problem solve. So, on these bridges people try to march in step, in harmony, reading the same project management plan. The challenge becomes clear as at times they need to break step to preserve the very bridge they are not only walking upon, but constructing. Quite a trick really.

This is where maturity and emergence becomes vital, a quality that is recognized in enterprise management. Does the enterprise adopt this technology or wait? What are our competitors doing? How do we recognize that this technology, resource, or market has reached the required level of maturity?

In health and social care there are more than several pieces of 'the' jigsaw, each with its own characteristic contribution (+ve, neutral, -ve) to maturity, complexity and emergence:

1Definitions of the EPR and EHR can be couched in terms of time and with whom the records originate. Firstly, EPR relates to episodes of health care, while the EHR records health care throughout a person's life span. Secondly, the EPR is held by primary care, the EHR is the integrated health record adding secondary care and other agencies, notably social services and the latest initiative of Connecting For Health, which is implementing the National Programme for IT (NPfIT)

The HCM can capture aspects of a single episode of care, or multiple HCM 'panes' (glossary to follow?) can capture an individual's health care throughout their life. (The UK government offers information to the public based on life stages.

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3	The EPR & EHR will soon be 'jointly' held by patients and their carers (were appropriate), this creates a need for a quick method of outlining a record of care, with the option for detail. This also determines the need for a range of devices and software, for use in a variety of localities.

The rise of multimedia, hypermedia with its links and communications facilities is posing new challenges for database, storage and retrieval architectures and systems.

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So where is the evidence of maturity? This page will highlight two sources, the first picking up the latter point above. A new data model is the Associative Model of Data (AMD). The AMD utilizes semantic network techniques. Semantic nets were mentioned in the section on coding and classification, where they play a crucial role. Several websites present information on semantic nets, such as, Rochester. The AMD incorporates features that hold much promise for the future.

Under the AMD the designers decision on whether to model something as an entity or an association is theirs alone.

Associations are more true to life. 'Customer' is not an independent entity, it is a name we give to a role. p.79 The AMD, Williams (2001)

Patient is not an independent entity. As above, it is also a name given to a role.

The AMD is mentioned here as a significant development. Health and social care information systems need data models that can reflect the problem domain, the real world. So there is still a question to try to answer: What does the phrase language of nursing (or health) refer to? And what exactly is that second sign of maturity?

To answer this, let us refer to an XML user manual and define what XML is not:

• a programming language.
• It is not the next generation of HTML.
• It is not a database.
• It is not specific to any horizontal or vertical market.
• It is not the solution to all your problems, but it can be a very powerful tool in building such a solution.

What is XML then?

XML is a clearly defined way to structure, describe, and interchange data. (p.6 XMLSpy 3.5 Manual)

A previous figure showed a range of technologies, domains and standards that must all be suitably mature to facilitate benefits realization, even then of course there is still much work to do. XML - with the arguments just mentioned - is a key piece of the jigsaw as maturity beckons.

As the computing media is so keen to point out XML facilitates the separation of:

STRUCTURE CONTENT FORMATTING & STYLE DELIVERY MEDIA (device)

Considering the 'function overload' of wordprocessors this may seem trivial initially. Why separate, when the usual ICT mantra is 'integrate'? In the figure above there is a pictorial representation of what this section started with - the table showing the real & conceptual worlds (data models that lie behind the applications) through to the physical world (problem domains). The applications could be three different programs. The health and social care team need ready access to several applications, be that clinical, management or education and training for example. Security is crucial for the information systems and the disparate locations where care is delivered, and recorded, accessed etc. on the most appropriate device. XML facilitates this process.

Conclusion

Are these two developments - AMD and XML - sufficient to ensure production of ICT tools clinicians will want to use (with their clients and carers!) routinely? No: but they could (will?) help us towards that goal, improving the usability of tools already deployed. This is certainly an exciting time for health and informatics. Major challenges calling for leadership, creativity and innovation as never before.

© Peter Jones 2000

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References:

Williams, S. (2000) The Associative Model of Data, Lazysoft.