Sunday, January 17, 2016

FHIR-fast healthcare inter-operability resource

FHIR came from Australia out of the frustration of complex HL7 ver 3.0 and RIM-reference information models. Fast Healthcare Interoperability Resource would allow a dunce like me to plugnplay. All complexity hidden from me, why do I want to know how many people built my car...all i want is my chevy. UI is also moving in this direction, so much so mommies play nursery rhymes on tablet/smart phone and jr soon knows where to dribble or soosoo to stop the annoying nursery rhymes. God it is bad enough being born to working parents, they expect jr to do all they dreamt but failed. IIT to start with....So when a baby can use tech, it should put people to shame saying hum pichle zamaney ke hain. Drs r famous for being technophobes but for anaesthetists whose danda runs on knobs and gases. FHIR is a God send but Graham the inventor probably is afraid of the big HL7 mothership and says it is still beta. We have HL7 India leaders in IAMI, guess they have had a chance to peek under the sheets. Pls share what u see or don't see, need to know both.

Hearing from folks on the field that the basic 'Z segment' tail continues to wag the HL7 dog in FHIR too. It is just a easier way to talk to systems using API calls and SOAP-XML but the basic HL7 design has to be revisited. RIM was an approach to get design out of the equation in creating a reference information model. Problem is it turned out to be a bigger monster that layety found difficult to grasp.

Only good thing that has happened is CDA-clinical document architecture. It is Case Record clinically high fidelity with XML running under-hood for system to system communication. CCD-continuity of care documents builds with CDA to create an EMR that can be strung together as a EHR.  

Friday, January 01, 2016

Happy New Year 2016

Hindu culture segments life into 4 phases; Baliya,  Brahmachari, Grihasta and Sanyasi. Upto 12, 25, 50 years of age you progress to renounce physical world and live a life of detachment beyond 50 years of age. Notice the doubling and the fact that 50% of life should be for community/society. All great men have done this viz., Jesus, Buddha, Mahavir, Guru Nanak, Ramanujam, Shankara...Simple life with great thinking marks the few from ordinary mortals.

My dad has always lead by example, I am one of his chelas. Sharing your joy with others, that too those less fortunate who are neglected, alone, hungry and deserted multiplies it manifold. My decade with GE taught me the power of education, there can't be a nobler charity than teaching. He distributes food and clothes but I insisted on reading/writing material. While shopping in Vashi Hypercity was approached by college students volunteering to raise money for a cancer child patient. Gladly helped them. Crossword and Landmark setup shop offering learning pack for Rs 100 (colouring book, pencil, eraser) once paid for by a patron to distribute amongst Kamatipura children. Kamatipura is famous for prostitution, the book pack is for their children who came into this world as a byproduct of someone's pleasure. Life is difficult for these poor souls who earn a pittance for working 18+ hours 7 days a week with constant fear of sexual disease, violence and exploitation. I donated willingly to help these children who grow up hearing and seeing their mothers being abused daily. Went on a shopping spree for my young brood, picked up colouring books, crayons and a cap with India flag. Dad distributed rava laddu and samosa, I gave out books and crayons. My gift will last a long time and of the 30 many will become IAS, IPS officers, DRs, teachers who will remember the uncle who gave them these gifts. I want to bring digital education, oops before that English, Maths skills so they confidently walk tomorrow's stage.

With my dream growing we left, content 30 children will snugly tuck into bed with hope, knowing there are still a few left in this world who are happy in giving rather than taking.

Sunday, September 28, 2014

Tamil Nadu - Healthcare role model

My heart swells in pride to shout at the top of my voice that TN-Tamil Nadu (where I was born) has been declared a ROLE MODEL for Healthcare by WHO circa 2014.
http://www.deccanchronicle.com/140808/nation-current-affairs/article/tamil-nadu-healthcare-role-model-world-who ]

The reasons behind this success are uniquely Indian, which I dissect here. What happens in TN can/should happen in the ROW-rest of the world too. The load is heavy but with each of your shoulders we will lift healthcare, locally then globally!​


Centrally purchasing drugs with a robust IT system in place gives purchasing power to drive down costs. Enforcing quality generic drug usage within the system weeds out corruption and unholy nexus between prescriber and manufacturer/supplier. Local empowerment and ownership makes the PoC-point of Care autonomous. Local manpower have sense of ownership, which anyway is high in rural settings. Urban living unfortunately forces strangers to live side by side. Participatory leadership with everyone clearly seeing the cathedral that is getting built means there is pride in the work done. Banavaram [ 
http://www.thehindu.com/todays-paper/tp-opinion/a-model-that-delivers/article4477096.ece ] and Nandivaram [ http://www.thehindu.com/news/cities/chennai/health-centre-near-chennai-achieves-over-100-rise-in-births/article5437244.ece ] are examples of such work.

Tamil values system put in place in ancient times, effectively reinforced (by the likes of Tiruvalluvar) at frequent intervals has given the Tamil a unique rigmarole of living a disciplined life. Modern distractions do swing aam aadmi away to frivolous pursuits such as fast food, malls and never ending wants to keep the market based economy humming but the values are there, if one wants to uncover. I believe in the uniquely Indian-Hindu concept of life in 4 stages - balya, brahmachari, grihastha and sanyasa. If man lives a 100 years 12, 25, 50, 100 are the milestones for which one has to prepare in every stage. Notice how the periods double but the thing that caught my eye was that you should renounce worldly living by 50 and spend half of your life for Society. True wisdom emanates from one who has no want...Buddha, Mahavira, Jesus, Gandhi are all examples of this. This was practiced by all in ancient times, even by the Great Emperor Chandargupta Maurya, Emperor Ashoka's grandfather. He renounced his throne to come and live in Sravanabelagola (in Karnataka today) where a hill is named Chandragiri after him. How much discipline it must have taken for one to give up an Emperor's throne to live the life of a mendicant?



Tuesday, August 19, 2014

miracles still happen

I was witness to a miracle that unfolded in front of my eyes this morning. A tiny fighter (4 months old weighing just 4.5 kg) came in for VSD (hole in heart) repair. The way a dedicated team of clinicians went about performing an open heart procedure on this handful of a baby brought tears to my eyes. In earlier times he wouldn't have lasted beyond school, dying of heart failure/respiratory infections but now he will probably outlive me! Wah...yeah hui na baath?

Medical work is noble, spiritual, unique in that the skills mean difference between life and death...literally. To accomplish such feats a team of clinicians, technicians and healthcare miracle workers has to synchronize and work together with clockwork precision. Like a relay race the baton passes from one to another seamlessly, communication is subtle and in gestures mostly. A hand reaches out to have the correct instrument placed at the right angle with the right things included, which then goes on to become an extension of the surgeon's fingers to deftly weave his magic on the tiny heart.

When the sheets came off in the end for him to be transferred out of the OT, the tiny fighter caught my attention by his sheer smallness. As the team lifted him onto the transport incubator there were many tubes and lines, which I gladly extended a hand to lift.

 BTW-by the way this too happened in a corporate hospital.

Saturday, August 16, 2014

head injury wonder


a RTA patient was admitted to one of the teaching hospitals GCS - 4/15 with SAH, LOC. In the corporate world this patient might end up with a huge bill (running into several lakhs), teaching hospital environment is different. Here the the team endeavours to practise medicine in an ethical way per hippocratic oath. Indiginisation runs in our veins as we grew up tinkering with ambassador car/lambretta scooters where repair is default, replace a luxury. Even the manufacturer is astonished to learn how much juice we can extract from a fruit :)

Patient went through HPE, FAST, airway secured, line access opened and neurosurgeon requested to assist. SAH was successfully evacuated. An intensivist team took over from here and gradually brought the patient back to GCS 15/15 to go home walking. Psychiatrist consultation was sought early to keep mental equilibrium as swings in mood during acute trauma are expected. Today he has been returned to the community by this wonderful team of medics, who work out of passion to serve. A refreshing change from a world, where even breast milk is sold and uterus hired like a bank vault!

Medicine is service...full stop.

Tuesday, November 09, 2010

God - east and west

the difference between eastern and western science is that in the west it is analytical as opposed to empirical in the east. We in the east accept things as they are and see realty as a spectrum. We dont look for cause/result always and can have all shades of gray from shoonya (zero) to ananth (infinity). God in my mind is a concept and you must see 'anbe sivam' a classic by Kamal Hasan to undderstand how everyone can be God. I am also drifting strongly towards Buddhist thought which preaches that the now and current is more important than past or future. I also am an admirer of Japanese culture of 'Perfection' in as subtle a thing as tea making or flower arangement (ikibana).

Stephen Hawking is a western scientist and he and his coworkers are splitting the atom to such an extent that now we are talking of a state in which matter can exist as matter or a wave. The further we go down that path, we are finding it is like going up further into space in search of other galaxies; both leading us to realms beyond human comprehension.

I believe our (eastern) approach to science and medicine is a workable way than trying to understand everything. What human intelligence cant comprehend is attributed to religion leading to the theory of religion begins where science ends.