Health Informatics - how she bewitched me

18 years ago frustrated with the heavy workload in my ED - emergency department in Al Ain hospital, Abu Dhabi (350+ patients/ day) in the single govt hospital where all emergencies were brought and the lack of process or much career progression in emergency medicine I reached a dead end. With clumps of hair falling off in adrenaline driven stress related alopecia areata the writing on the wall was clear; pause or perish. Internet had just arrived in UAE and I was playing happily like a child with a new toy, exploring its new capabilities that it opened up. Once it became clear that this is a new frontier opening up, I dived in with joy. After a hectic night duty with my eye lids half closed, I headed to computer science classes and learnt VB - visual basic and Microsoft Access. Building my website in HTML typed on notepad I came the traditional way into software, not as a fastfood generation that has everything served up on applications. Frontpage, Dreamweaver came much later but when the capabilities of application limited my creativity, it tool a flip to enter the familiar HTML world.

After a few months got called to the court to explain to a judge why a patient I certified dead was alive. On digging a bit deeper, this perennial problem surfaced again and again. When police found an unidentified person or dead body they either wrote Mohamed or left the name field blank while registering on paper form in the ED. Hence rest of documentation followed as Mohamed. We wrote death report for the name entered in the A&E - accident and emergency registration. I had to give the explanation in writing to the court. CAPA - corrective action was done but I wanted to fix it with preventive action. I went to my HOD Dr Taha Ibrahim FRCS with a proposal to digitize the ED. Dr George Bell a canadian olympian was our medical director who had introduced computers into the hospital in 1997. Except for regular office typing work and printing out discharge summaries it was sparsely used. Dr Taha allowed me to proceed and allotted some funds. I got three PC - personal computers into the department, discovering they lacked networking I got network cards and inserted them myself. We had an intranet of 3 PC. With my VB/Access skills I designed and coded the UI for a simple A&E registration form and deployed it on the intranet. There was a huge waiting list in the ED, even after triaging much of the patients to allow only medical emergencies into the ED. On close study the bottleneck turned out to be in few places viz., registration, clinical documentation and the mandate from MOH - ministry of health that only the treating doctor should fill all lab orders. At a minimum each patient had to get CBC, RBS, Electrolytes, Urine, Chest Xray, ECG which of course increased many fold when other tests became necessary. My answer was to create a label with the mandatory data/ barcode and print it on self adhesive stickers. We printed a set of 10 to begin with and the regsirtation clerk would staple it to the ED one sheeter. Nurse would then just peel of the stickers and affix them on the requests and also sample tubes/ containers. Suddenly the waiting list disappeared in the ED and our patients TAT-turn around time came down dramatically. We were able to count the number of ED attendees with confidence now. On presenting the daily number of patients attended to in ED to management, they refused to believe us. I held my fort and said 'data never lies'. After multiple checks they confirmed the massive numbers we were handling with not a single miss, so far. Next month the A&E workforce was doubled.

This made me think, if I could achieve this by learning technology after night duty in half sleeping mode how much more could I do full time. Being a military school cadet, I was fortunate to be adopted by Prof Khalid Moidu, a legend in the medical informatics world with a PhD from Sweden and veteran from AFMC-armed forces medical college. On his advise I got myself the bible of Medical Informatics written by Prof Ted Shortliffe,  a doctor with a PhD in computer science from Stanford University. His PhD thesis MYCIN in 1950s literally launched the AI - arificial intelligence stream which now is a gushing torrent. Interestingly MYCIN was a proven technology to pick antibiotics in the ICU but healthcare killed it. Nevertheless all other domains gladly adopted AI in telecommunication, banking, finance, insurance, aviation, transportation, energy, media, etc. When I got a chance to meet Ted in 2006, I asked him as to why this happened. His answer is etched in my mind for posterity: 'Human will always be supreme'. MYCIN was compared to highly experienced intensivists decisions, it turned out to be far superior as it was always objective whereas the human was subjective. When it was pitched as replacement for the human, they human killed it. Unfortunately the same mistake continues to be done today with all HealthIT solutions. IBM Watson for all its strength still is frowned upon by humans. All technology should be slave to the Human and never positioned as an alternate. Millions of years of evolution and survival ensures we win, always. After much reading, pondering on a mid career domain shift, deep discussions with family and rearranging finances it was decided to complete a Masters in USA/UK. Next few years went by so fast until I joined GE Healthcare as Clinical Director for South Asia based out of the global star facility JFWTC - John F Welch Technology Centre, Bangalore.

Like Brecon (Brecon Beacons national park) the silent beauty that the welsh have kept a secret for millenia Health Informatics remains an enigma for those who glance at her. If one has the courage to tame this wild beast and ride her, she coyly unravels her secrets. It is left to ones imagination to use her ananth (infinite) capabilities as one pleases. Being an 'Acute Care Informatician' my quest is to have her floating in the skies of my acute care environment (ED-ICU-OT) wafting into every nook and corner like perfume. With her by my side, the acute care environment shall be a much safer, nicer and predictable experience, when patients literally entrust their lives in our hands.