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Stop Saving the NHS and Start Reinventing it Kindle Edition
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There were good ideas in the book: using the genome to develop personal treatments, using RFID chips to make sure patients are properly identified, the use of expert systems in diagnosis and a "Facebook"-like patient record.
However there are also a few "pie in the sky" ideas, such as robots who look after the elderly, and on social media: "...the greater use of social media opens the possibility of customers managing their own illness. My view is the best person to manage your health is you. Fellow suffers (sic)--or ever the worried well--can lend each other support and can share experiences of what has, and what has not, worked for them." On the one hand, such patient networks are supportive, but from reading "Bad Pharma", patient groups can also be manipulated to promote quack-remedies.
Another dubious idea is to administer Cognitive Behaviour Therapy via computer programmes. Jervis does give evidence that they can work, by asking questions such as "What do you mean by?" "Tell me more about...", so therapists could potentially be replaced by "inexpensive" computer systems. However the efficacy of such systems is more contested than the book suggests (see doi: 10.1186/1471-244X-13-113). Common sense also just tells you that speaking to a human rather than a machine is better for someone with complex pyschological problems in need of CBT.
Jervis sometimes uses ideas that do not really support his conclusions, for example by using "Moore's Law" (that references the continual improvements in microprocessors) to suggest that "standardisation" of "processes" will result in ever increasing benefits. A better comparison would be to Adam Smith's "division of labour" increasing productivity. Moore's Law is not achieved through standardisation, but rather ever rising capital investment costs in R&D into new chips.
What Jervis really means with "standardisation" of "processes" is more private sector involvement, who can pick up these standardised procedures. He says this isn't "cherry picking", but making better use of public money. However the gains through the division of labour could work without private sector involvement, which in part negates efficiency savings by its need to make also make a profit out of NHS patients.
What could have been developed is the need to integrate NHS and social care. The book also demands "vision" without really explaining what that "vision" is. Perhaps there are lessons in the government's gov.uk programme, that parachutes technologically-aware civil servants into departments and instead of "vision" uses the open source model of rapid application development and prototypes to see what works early on.
The author's ideas on individual pro-active healthcare as well as integrating healthcare systems with software technologies, is refreshing. He mixes his experience with anecdotes and references to science fiction, keeping the tone light and enjoyable throughout.
This book is well written and filled with some truly unique and interesting insights. Anyone interested in what a 21st century health service could and should be like will enjoy reading this book!
But it's not just about technology. As Colin states "Often the real tension in major health IT projects is not related to technology, patient outcomes or evidence, but to who gains and who loses among the affected power groups."
Perhaps, if enough people read this book, there will be a ground swell of opinion that stimulates radical change before it's too late.
We're in that position in the NHS now- and this book begins to suggest ways that will go beyond saving it into radical transformations (I dislike the term transformational changes- it seems a tautology to me like "your next station stop..") that will be necessary if we are going to keep a viable NHS- accessed on basis of clinical need- by all who have contributed to it- in the UK.
This book shows some of the ways our thinking will need to go in to achieve this. There are radical thinkers within the NHS, and in the next few years some of our ideas will need to be backed or the system could be sacked.
The author does not dodge the chequered past of the NHS and IT and his book effectively covers a range of technologies that could better drive change in the future, including genomics, wirelessness, social media and telehealth. However at the end of the text his vision of a new NHS is perhaps not summarised as concretely as it might have been, the arguments leading to it are clear - as in the success of the US Department of Veterans Affairs - a publically funded healthcare system that has improved quality and reduced costs with a combination of organisational and process changes underpinned by shared, integrated IT systems.
The writing style makes it suitable for senior managers not familiar with IT and its potential
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