Patient record – for the patient, the consultant, the hospital?

Does the patient want to manage the data?

Any time a patient enters a hospital – be that outpatient or inpatient – a detailed patient record is created and updated throughout the stay.  And in these days of GDPR (General Data Protection Regulation – to be effective 25 May 2018) there is now a great deal of focus on who owns the data.  Pretty clear, fundamentally, that a patient record records data pertinent to a patient and should, therefore, logically be owned by the patient.  But the patient does not have a way to record the data – and generally it falls on the hospital to do so – notwithstanding that some of the data may be recorded and stored separately by the consultant attending to the patient.

And GDPR brings many welcome improvements and protections for the patient with respect to the data, the patient’s access to the data and other people’s use of the data.

Microsoft and Google – false starts

In his book ‘The Digital Doctor’ Robert Wachter devotes one chapter to ‘Personal Health Records and Patient Portals’.  He recounts the efforts of two of the Technology giants in looking to break into healthcare: Google Health and Microsoft’s HealthVault.  And both seem to have given up the ghost.  Probably because when people went to use the platforms the value did not match the effort to accumulate and maintain the data.

And what I had not realised: most of the Health Information Exchanges formed during the Obama Healthcare drive have also failed: not as much effort and interest in aggregating and integrating the various health records as we had all expected.  Or perhaps it just proved too hard to do.

So Wachter believes that for now most of the patient health record will be focused with the Electronic Health Record (‘EHR’) providers (e.g. Epic, Cerner, Meditech, etc.).  nad the better EHR providers will, with their customers, provide good portals for the patients to access their data.

And this is not to say that the facebooks, googles, microsofts and amazons will not return once more to provide consumers with another, smarter solution.  But for now looks like the action will be controlled by the EHR vendors.

In some respects I think this is a reflection of the lack of standards and relatively late deployment of EHR (which is the equivalent of ERP in industry). We are now left with lots of data which is not easily integrated or aggregated – certainly not at consumer level. It will probably take a major shift: where consumers have electronic data available to providers and will only deal with providers who are able to process (and update) the patient data. There are some signs that this may be driven by the health insurers – as they look to dictate more and more to the providers. For now through looks like there are major opportunities in the next few years for the Epics, Cerners, Meditech etc – to build out very strong positions, probably to be taken out by the Apples, Googles, Facebooks and/or Amazons when they see fit.



The Digital Doctor by Robert Wachter

The Digital Doctor -Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age

In The Digital Doctor Robert Wachter reviews the successes and disappointments of recent investments in information technology in healthcare in the US.  More recently this  included a €30bn incentive program between 2010 and 2014.  His focus is very much on IT in hospitals and the implementation of Electronic Health Records (‘EHR’).  He compares what people are trying to achieve and what they are actually achieving.

The book provides  excellent background reading

for any clinician or administrator currently involved in planning for an EHR implementation or in building a clinical/ business case for the same.  From the start Wachter distinguishes between the technical and the adaptive challenges,  He argues convincingly that the adaptive changes offer by far the greater challenges and the greater rewards.

Pro Technology Investment

The Digital Doctor should not in anyway be seen as being anti investment in technology in healthcare.  In fact Wachter is clear on the requirements for the investments in EHR and the tangible benefits.  However he shares with the reader some of the mistakes or misapprehensions of previous EHR implementation sponsors.  He would prefer that previous errors are not repeated.  And in the later part of the book the author draws a clear picture of hospitals operating in a highly technology dependent environment.  In this hee also makes the point that all of the constituent elements are already available.

Practical examples and commentary

The book is full of practical and relevant commentary and analysis.  He references patients concerns at doctors focusing on computers rather than patients.  He has a number of suggestions on this.  He references rapid advances in IT in Radiology – but the growing isolation of Radiology from other parts of the hospital.  Again he has a number of suggestions.  On the EHR itself part of the issue relates to trying to serve too many masters. The EHR is important to the clinicians, the insurers, the patients and, sometimes, the lawyers.  As a result having struggled to consolidate/ aggregate the data it may be ‘watered down’.  Lots of discussion also included on ePrescribing and alerts.  His comparison of management of alerts in aircrafts and hospitals provides food for thought.

Relevant to all involved in EHR

We know that to get EHR right we need clinical leadership and sponsorship.  As a CIO and CFO I found the clinical perspective in the book thoughtful and informative.  Would recommend to clinicians, IT and admin/ finance personnel involved in upcoming EHR projects.




Internet use

Interesting to read the internet use statistics (2017) mon the Central Statistics Office site.

Some of the spread is use not that surprising e.g. by location or by age group.  So, as would expect, greater use of the internet by younger groups, more use of the internet for leisure purposes e.g. social media by younger groups.  But interesting to see how the internet has penetrate all age groups as a source of information on goods and services.

The statistics seem to suggest that there are still 11% of households not making regular use of the internet.  And would be inclined to think this is putting that group of households at a serious disadvantage: in terms of accessing best prices, researching options and generally not having a valuable channel of communications open to them.

cloud storage 2015 to 2017

cloud storage

I am curious at the relatively low level of use of cloud storage by internet users.  Curious as to reasons for this – cost, privacy concerns, lack of knowledge of options available?  Would have expected that more people would be using cloud storage for photographs, video, music – whatever about storing documents.

individual e-skills

The most interesting information related to the comparison information on e- skills – looking to see what type of activity was being undertaken by different users.  In this we can clearly see that while older people have taken to using the internet (accessing information, booking travel, online banking) the use of various software applictions and tools is much more of a young person’s game e.g editing photos, videos.  That said the number of young people programming seems very low – with programming code undertaken by 13% of students.  I think if we aspire to playing a leading role in this global economy we should be seeing that 80% of students have some level of programming experience.  But this would require a new subject and resources in the secondary school curriculum and will not happen overnight.

Ancient Greece – part III

From Olympia continue the trip through Ancient Greece by driving on to Pylos on South West of the Peloponnese.  Planned to stay one night – ended up staying three.

Karlis city hotel – Pylos
Navarene Bay from castle at Pylos


Pylos looks our over the Bay of Navarene – famous from the capture of the Spartans by the Athenians during the Athenian/ Spartan wars.  But more recently famous as the scene of the naval battle between the Sultan (Turkey) and the British, Russian and French fllet in 1828 – leading shortly afterwards to the Independence of Greece.

Stayed in a centrally located hotel – Karalis City Hotel – with a view out over the harbour and the bay.

The Castle at Pylos (only 300m from the centre) is well worth a visit – and includes an excellent museum with great history of the naval battle of 1828.  Also

from the castle mseum

includes great range of artifacts recovered from various local sites.

Found Pylos a great place to stay – good local beaches, good restaurants, nice village and plenty to do.  And we experienced the only rain of our trip – all of five minutes.



From Pylos we drove to Nafplio – about a three and a half hour journey (50% motorway).  I had been to Nafplio in 1981 – and was looking forward to the return trip.  We actually based ourselves at a beach hotel about 15km outside Nafplio (at Tolo Beach).

Hotel itself was disappointing – but on the beach so no need to use the pool when the sea is directly outside your hotel.  Spent  a couple of evenings in Nafplio – lovely pedestrianised areas, great selection of restaurants and shops, street artists – with the magnificant castle in the background.

Nafplio was a perfect base for revisitng two of the highlights of my 1981 visit: the theatre at Epidaurus and Agamemnon’s palace at Mycenae.

Theatre at Epidaurus


The theatre at Epidaurus is famous for the outstanding acoustics – and we all certified this by having one person speak from the centre of the theatre and another listen from the top row.  Just to sit there for an hour in the late evening sunshine, looking out over the groves of trees.


Also took the opporuntiy to run on the track at Epidaurus.

Running in Epidaurus

Fun to meet with someone else also revisiting Epidaurus for the first time in 36 years.



There is something magical about Mycenae – about a 30 minute drive out from Nafplio (on the way you pass Tiryns – the former palace of Menelaus).

Lion’s Gate at Mycenae

We enter Mycenae via the Lion’s Gate and walk up through the site.

From Mycenae

The views from the top demonstrate the commanding position and location – looking out over the plain and down to the sea in the distance.

And the museum at Mycenae is well worth an hour or two before leaving for a swin back at Nafplio

All of these sites just remind me of the importance of Greece in the history of civilisation and Europe.  It is so important that we preserve these sites and encourage younger people to experience and enjoy them.

Combining sun, sea and archaeological sites in Classical Greece – part 2


Sunday afternoon went well, deferred visit to archaeological sites to see Dublin win their ‘three in a row’- courtesy of internet.  Followed up with a pool swim at the Amalia Hotel and an excellent dinner in Delphi.  Would be afraid to ask the Oracle whether Mayo will win next year.

On way into Delphi site

Monday morning went to the archaeological site.  Blew my mind – the combination of votives, theatre and stadium.

The theatre itself is stunning – to think that they held their festivals here – with combinations of religious sacrifices, theatre and games.

Temple at Delphi

The other striking part is the climb above the votives and the temple to reach the stadium.  Unfortunately, unlike at Olympia and Epidaurus you cannot enter the stadium (or at least the day I was there).

Shauna at Stadium in Delphi

And finally the museum itself is well worth the visit – with all sorts of items which have been recovered from 2,000 to2,500 years ago.

Unfortunately we did not have time to visit the gymnasium – on the lower slope (but something for the next visit).  Delphi was everything I had hoped for – and more.  We stayed on another evening becuase, unfortunately, needed to spend a few hours working remotely (the blessings of modern technology!).  But another excellent meal and welcoming Greeks made for a most enjoyable evening.


Next morning headed off on longest drive of the trip (c. 300km)- heading for the Peloponnese – initial target: Olympia and from there on to Pylos.  The drive as far as the Peloponnese (crossed the bridge at Patra) was spectacular.  Shortly after Patra pulled in for first sea swim of the day – at some beach bar already closed for the off season.  and from there headed to Olympia.  Scenery very boring until fot within about 10km of Olympia – and then all changed.  Olympia is a beautiful village/ town and we had a lovely lunch in the main square.  Then I headed to the archaeological site for a couple of hours in the late afternoon – this time on my own.

I started with the museum.  Olympia was dedicated to Zeus.  And you get a good understanding of the site and its history at the excellent museum.

Zeus at Olympia

There is also a botanical garden in which you get an introduction to the various plants which are native to the Peloponnese.

But then the site.  There is so much to see.  The temple of Hera is very striking.

Stadium at Olympia

But obviously the big attraction is the stadium: the Olympic Stadium.  Unlike Delphi the spectator area is simply grass banks – and apparently this accommodated 45,000 people at the games back in 700BC.  And you get to enter the stadium and to walk/ run the approx. 190m track.


After Olympia we had another 120km to cover.  Stopped off for a swim on the way – as you do.  And got in to the beautiful village of Pylos by 9pm. in time for an excellent meal at the restaurant next to our hotel (Karalis City Hotel).

Older people

Respect and celebrate older people. Today is International Day of the Older Person.

Check out details on the UN page.

In Ireland we recognise that people are living to an older age – and we should celebrate this.  But we also often seem to see this as a problem – as a financial burden – that an increasing proportion of the population will be old and will require more support from a decreasing proportion of younger people.  I just think we have not thought this out.  It is good that people live longer.  Necessarily people will require support for longer – pensions will have to payout for longer, healthcare will need to be available to older people for longer.  But this is progress.  and the objective must be to promote indepdent living for people for as long as is possible.

I think the recent development whereby state pension eligibility is being pushed back to 68 and eventually 70 is an example of a part thought out solution.  This will save the government money in the first instance.  But many of these people find themselves in employment contracts which see their employment ending at 65.  And many of these people are well capable of continuing to work past the age of 65.  But the economics have not actually been worked out.  It may be that people will not want to continue in full employment, that they may want to take on a less physically demanding role, that they may be willing to work at a different level in their current organisation.  But after a career with an organisation they have no entitlement to such arrangements – yet the government sees fits to defer their state pension.

The answers are not necessarily straightforward.  For the companies extended contracts may change their people cost ratio – with relatively expensive human resources being retained in an organisation and potentially ongoing commitments to continue to support pension contributions.

But it is International Day of the Older Person today – and when I read two Sunday newspapers I saw no discussion/ celebration of people living longer.  Let’s make this an Older PErson friendly world – since most of us have an objective of living healthily to an old age.



Population growth in Ireland

Interesting to read the latest release from CSO re net population growth in Ireland.

Population is now at 4.792m (as of April 2017) – having grown by ~50k in both 2017 and 2016.  And this growth is a combination of natural growth (births less deaths) and net immigration.

30 year growth

I qualified as a Chartered Accountant in 1987 – population was 3.546m.  30 years on the population has grown by 35% (approx. 1.25% per annum compounded).  If we continue at this rate for another 30 years we should reach a population of c. 6.5m.

Of course there are so many interesting analyses – movement by location, movement by nationality, movement by work status/ profession.

But would certainly be of the opinion that the country is more sustainable at increased levels of population – and that the 35% growth over the last 30 years has been very positive,


Combining sun, sea and sites in Classical Greece – part 1

Back in Greece after 36 years

Just back from a nine day trip to Greece.  Lucky enough to have had the chance to have studied both Latin and Greek for my leaving cert in 1980.  And my only visit to Greece todate was via interrail in 1981 (having travelled by train from Venice, through Yugoslavia, to Athens).  On that visit saw the Parthenon and the museum in Athens and Epidaurus, Mycenae and Tiryns on the Peloponnese.

This time flew to Athens and drove – itinerary taking in Marathon, Thermopylae, Delphi, Olympia, Pylos, Nafplio, Epidaurus, Mycenae and Tiryns.

September is a beautiful time to visit Greece (temperature in the 30s during the day and the 20s at evening time).   Initial hotel bookings were with the assistance of and additional nights booked locally.  Logistics could not have been more straightforward.  Road network was excellent – ranging from motorway to highway to quiet country roads.  And traffic and parking were no challenge post summer peak times. The people were very friendly and informative in all respects –  looking for restaurants, beaches, archaeological sites, whatever.

Burial mound (tumulus) of Greeks who died at the Battle of Marathon


Visited Marathon Saturday afternoon.  After a swim in the sea headed to the site of the Battle of Marathon and the tumulus in which the bones of the dead Greeks were buried.  As you read the history and learn about the battle you begin to understand the heroism shown at the time – in terms of the complete mismatch of the two sides.  You also gain an insight into the tactics used by the Greeks (weak centre and strong wings).  Of course this battle gave its name to the use of the word marathon to describe our best known long race: based on the runner running back to Athens to inform the Athenians of the victory at Marathon.  We also visited the museum which is about 5km from the battle site.  Lots of interesting items there, including a number of graves which have been discovered and opened up.

From Marathon we headed north to Kamena Vourla on the coast – within easy striking distance of Thermopylae.  Nice little seaside resort – stayed in a seaside front property – Mitsis Galini Wellness spa & Resort.

Leonidas who died a hero’s death at Thermopylae


On Sunday after a swim headed to Thermopylae.  As you approach you get the sense of the location and the logic of the battle which took place.  There is a narrow passage between the sea and the mountains and a small number of Spartans looked to block the Persian advance through this gap.  Really excellent museum and 3-D presentation explaining the background to the battle, what happened over the three days and the subsequent impact for Athens and Sparta.

Honouring the Spartans at Thermopylae

When about to be overrun Leonidas and the remaining Spartans climbed on a mound to fight to the end. They died under a hail of Persian arrows, having bravely fought off the Persians for three days.

And from Thermopylae we headed across the hills (and through a number of mountain villages) to Delphi.  This was the day of the All Ireland football final (I think we were the only tow people in Delphi following the match.  But we succeeded in seeing the gamle courtesy of Go GAA – using the broadband at our hotel.

Looking down from the village of Delphi

Delphi is a beautiful setting at about 500m above sea level – with wonderful views down into different valleys from the top.  Lovely village in which to stay with a number of very good food options.  Again was struck by the friendliness of everyone we met.

Being mortal – Atul Gawande

Just finished reading ‘Being Mortal’.  I guess in your 50s ‘being mortal’ seems to have some more immediate relevance than in your 20s!  Atul Gawande’s book is an excellent, thought provoking read.

Only learn through experience

Much of the book focuses on the options available as people get older or as their health deteriorates.  And for all of us it is difficult to anticipate how we may feel about these developments until we experience them on a personal level – most often firstly in context of relatives and friends and then, more directly, in person.

Gawande is a medic and a prolific writer.  And this is not the first of his books I have read.  He is keenly aware, as a doctor, of the approach taken by medics: analyse the symtoms and look to implement a fix.  But he shares his concerns about where this approach leads in the case of very ill or very old people.  He is not promoting euthanasia.  And he writes from a very personal perspective – patients he has looked after and his own father’s illness, treatments and death.

Quality of mortal life = independence?

Being Mortal asks questions about later life – how we all seek to maintain quality of life and how this requires the ability to think and act independently.  Right now as I write this I am contemplating whether I will watch a football match, watch the Open golf championship, go for a walk, go to the cinema, what I will cook for dinner, etc.  and all of these options are available to me (and I take this for granted).  But if illness means that I am dependent on others then I lose much of this independence and quality of life.  And in this context re reviews options around assisted living and nursing homes.  His comparison of living at home (supported by family), assisted living and nursing home living provides lots of food for thought.  And at this stage in my life I would have little appetite for the third option.  But statistically this seems where we are all headed.  So Being Mortal is suggesting we have not yet got this right.
The examples Gawande includes around complex, expensive, intrusive, limited benefit treatments provided to patients in the throes of advanced illnesses are challenging – for medics, family relatives of ill persons and the persons themselves – not to mind the insurers and health providers.  We are well familiar with the analyses of grater life expectancy, older populations, more instances of chronic illnesses, more options for treatment of same.  But they need to be understood in context of quality of life and independence.

I learned a lot about palliative care and its role through reading the detail of some of the examples in the book.  And its a much more broader science and engagement than I had appreciated.  I am not sure how well it is really understood.

All in all an excellent book – and good material for anyone.

GAA backdoor alive and well

Watched two ‘backdoor’ games this afternoon.  Tipperary hurlers were very relived to run out tow point winners over Clare.  Both are fine hurling teams – although netiher playing particularly well today.  But we got a great contest with Clare coming back from several points behind, only to have Tipp score a couple of points to close out the game in the last three or four minutes.  After that watched a thriller football match between Mayo and Cork.  Cork have been poor until today.  They same back strongly in the second half of today’s game against Mao – forcing the match into extra time (after scoring two goals to close the deficit). Extra time was very close – and probably Mayo’s experience saw them through by one point.

So, because of the backdoor, these teams had an extended season and improved by having additional competitive games.  And I believe Tipp will be strong competition for anyone in a semifinal while Mayo have again availed of the backdoor route to prepare them for what should be an excellemnt quarterfinal against the winners of Rocommon and Kerry.