(fresh from the archives: 2013)
The time of Miracles has not yet passed. In 2016, swedish medical journals are coming online, accessible for patients, doctors or caretakers through the e-Health portal 1177.se. By coincidence (or maybe not?) the region first to offer this service – Norrbotten – has among the lowest population density in the country. When performing a risky experiment, to limit the risk by exposing a small subset of individuals, before targeting the entire population. Good thinking, Norrbotten! Worst case, a substantial part of medical staff may end up in Forensic Psychiatry – one way or the other … at least if we are to believe Jeanette:
Source: eHealth Innovation Centre, Luleå University of Technology & Norrbotten County Council
Medica 2015 has now come to an end. Among the activites was the Medica Connected Healthcare Forum, where (among other things) a mobile app competition took place. Out of 10 apps, 1 were for improved monitoring of severe medical conditions, 2 for communication in different forms for people with disabilities, and 7 were for patient-doctor communication and general health improvement purposes, such as SmokeWatchers and Oviva Coach.
Apps for purposes midway between entertainment, sports and healthcare have exploded in the last few decades – As useful and fun as they may be, how many of those do we actually need today, when 1 out of 3 people in this world lack even the most basic form of healthcare? Apart from being unworthy of a world with both global satellite systems, global communications systems and global transportation system, a global thinking in health systems is an economic issue. WHO estimates that better use of preventive measures [in healthcare] could reduce the global burden of disease by as much as 70%.
One of the apps in the competition stands out, from a global health perspective: The Doctome, developed by MedTrix. It is a mobile app which facilitates communication between patient and healthcare personel, at any time, any day, from any part of the world. For now, this app is limited to areas with electronic health record systems, that is – the industrially developed part of the world.
In developing countries, even in areas where copper-line phone contact is not available, mobile phones are the main connection with the outside world. Imagine then, if a global use of mobile phone connection could be implemented, to provide increased contact with basic healthcare. Instead of providing leasure care for the part of the world which allready has excellent health systems, there is a possibility of providing a reasonable level of medical care for many more. Technicians – Let’s get together to get ALL the world online!
Tuesday, November 3, 2015, 20 representatives for a number of companies with interests in medical technology gathered in Jonsered, Sweden for to exchange what we knew about managing software projects in this environment, a meeting facilitated by Mediteq Forum
The site for the venue was the beautifully located Jonsereds Herrgård, now operated by Gothenburg University. The day was not the best, with the fantastic view from the front porch somewhat diminished by heavy rain clouds, and the water in the taps being unsuitable for drinking due to an incident at the nearby waterworks. Luckily, the participants were all informed of this fact upon arrival, and adequate replacements in the form of tea and coffee were provided.
Some of the questions we wanted to discuss were:
In what way is software a part of the companies products?
How is the process managed and what problems are faced?
What tools are used?
What can we learn from each other?
The majority of the participants were software developers or project managers from companies providing medtech solutions, where software is only part of the deliverables. A few came from pure software companies, who also provide solutions for medtech. The structure of the meeting was a short update on latest information from representatives for Mediteq, after which a discussion between the participants followed, with some opportunity for mingling. The discussion focused on points of IT security, testing procedures, tools, risk and requirements analysis and the fulfillment of governmental requirements and international standards.
One point of major interest was the latest information on the standards IEC 62304:2015
and TR 80002-1:2009, and the latest on the not yet published IEC 82304. Some discussion take place along the system definition and classification of medical software, where the 2015 addition to 62304 is helpful in its definition. Most participants agreed that it is very hard to classify any software, used in a medical environment as A, C being the most common. The reason for this is that probability is not included in the risk classification, only the severity. In other words, if an application can cause severe injury to a patient, it will always be classified as C, no matter how unlikely the incident is, and even if the system requires failure on several levels in order to cause that injury.Sometimes it may be possible to separate systems into parts, after which the least critical parts could be classified as A. But in practice, the extra effort in separating the system is questionable, if the majority of the software is in any case undergoing scrutiny as class C. (A useful explanation by the classification system is given by Mitch).
One of the more useful outcomes was a survey among the participants resulting in a list of the most popular tools for process management (published below). The general opinion was that this meeting was very useful, both as an opportunity to exchange tips-and-tricks and to network. For many of the participants, this was a rare opportunity to exchange information with colleagues in the same field, and an opportunity which, sadly, does not come around often enough through other channels.
Most popular tools among the participants
For Requirement Management we used:
For Implementation we used:
– TFS/Visual Studio
– Enterprise architecture
For Verification we used:
– PC-Lint (statical code analysis)
– CppUnit (unit test)
– NUnit (automatic systemtest)
– TFS/Test Manager
For Release we used:
For Change Management we used:
Late Tuesday night, November 19, a 22 year old was arrested in Boliden, northern Sweden, by heavily armed security forces from Swedish Security Police (SÄPO) and placed under arrest, accused of plotting terrorist activity. Hours later his name and picture had been released to the press. On Sunday, he was released, cleared of all charges.
The arrest took place after a dramatic two day man hunt, despite the fact that the man lived at the address where he was arrested, with his name on the door, as well as being listed there in the Swedish migration services (Migrationsverket), and posting his whereabouts, name and personal information publicly online. The sources of the information, leading up to the arrest has not been revealed. On questions on why such prompt action was taken, press communications responsible Sirpa Franzén responded SÄPO has to act early on any suspicion of terrorism or other criminality with potentially significant consequences. Some criticism will likely befall SÄPO in the aftermath of this event. Let’s just hope they are equally critical to their own sources of information.
The reasoning makes sense from a security perspective, but still does not explain why full information was released to media. In an official press release, November 22, SÄPO informs that the threat level against Sweden after the Paris attacks remains high, and concludes:
“Given the unstable situation, it is likely that Europe will have to adapt to this type of incident.”
One may expect that this, in concrete terms, means more resources to intelligence and surveillance, and a less restrictive approach to guarding personal integrity. In other words, expect Big Brother to watch you more closely. The defence to this kind of reasoning is usually: “If you have nothing to hide, you have nothing to fear”. Of course we are all grateful that the Police released an innocent man without further delay. However, one may wonder if he would not prefer for the events to take place out of reach of the spotlight. Not everyone enjoys running a public gauntlet – even among those who have nothing to hide.
The medical field is by tradition and necessity a highly conservative business, and as such has been one of the last to adopt highly integrated computerized solutions. Probably with good reason given the critical systems involved. Robust systems of high quality does not come about by themselves, but are a product of adequate resources, efficiently put to use.
Both Sweden and the UK are countries where a discussion around these issues has started to yield concrete results. A new law on biobanking and an action plan for the implementation of an e-health system in the former, a strategy for Life Science in the latter. In 2014, three Swedish institutes, LIF, Swedish Medtech and Sweden BIO, concluded that quality in individual systems was usually sufficient, but that coordination between systems and organizations was missing. An action plan was devised. In UK, the situation is somewhat improved by the presence of a national healthcare system, the NHS, making it possible to launch nation wide research and healthcare collaborations such as the UK Biobank.
Clear is that the new technological environment will bring a new possibilities in healthcare, but also changes in how we work. How does this new environment patient, the researcher, the medical personnel and the provider of technical services? The technician will suddenly be an important part in a traditionally non-technological field. What will that require in terms of people skills, risk assessment and ethical thinking?
As a Swedish citizen, working for several years in the UK on the fence between medicine, biology and technology, I take a particular interest in some of the differences between their respective national systems, against the backdrop of European and Global policies, trying to bring to light some of the opportunities and challenges facing us. At the same time, I will try to share my knowledge in this field.
We hardly had time to start debating the effects of the extraordinary actions in response to the increased number of refugees from Syria and the IS, when IS gives us further reason to bring the question of migration and refuge to the table. Regardless of the terrible tragedy to the innocent involved, this is the time to extend a thanks to the Islamic State, if they are in fact (as they claim), responsible for this appalling act.
Migrants from Africa and the Middle East have been arriving to the European Union in ever increasing numbers for the past several years, often at great personal risk to themselves. The situation is now affecting not only the governmental agencies specially equipped to handle these matters, but the society as a whole. The question of how to deal with the situation has caused increasing discussion between representatives of the EU member countries. Together with other causes of disagreement (the financial situation comes to mind) the tone of the debate has sometimes reached an alarming tone. Nothing is so devastating for any relationship as financial trouble and disagreements on the division of labor, and on occasion sometimes there has been a feeling that the EU is soon ready for marriage counseling. Under the pressure of every day activities – of how to provide for refugees, attempting to share finances equally and regulating detailed laws in a fair fashion – in this daily toil we sometimes forget to raise our heads, and see what it is we are working for.
What we have forgotten to ask ourselves is the reason why we came to be the target for all those people on the move, hoping for a better life. Can it be so, that if so many people strife so hard to enter this Union, even risking their own life in the process, that there is something in this it worth striving for? The terrorist attacks on Paris by IS makes us ask the same question. Why were we targeted?
The answer to both can only be one.
So thank You, IS, for making us raise our heads, and see what You offer on the other side. Thank You for making us remember why we constructed this Union of Europe in the first place. Thank You for making us remember why we made the choice of going down the road of collaboration instead of competition, consensus instead of confrontation, words instead of arms, peace instead of war. Thank You for reminding us that our way of life is worth our support, and that it is in need of our constant protection, so much more in the face of the alternatives.
Let us hope that the promise we gave to each others when entering this union was no less than the commitment of a marriage. In bad times, as in good times, till death do us part – even with marriage counseling if necessary.
Open door policy
Thursday, 12th November, the Swedish Border Police initiated ID checks at a few places along the south and west borders. The last time there were border checks for non-Nordic citizens at internal Nordic borders was in 1958.
The action is intended as a temporary measure, and is not very surprising, given that Germany, Austria, Slovakia and Finland has done the same thing for some time. However, both the intended and the actual effect of this action merits some consideration.
Swedish Police states on their website that asylum seekers will be treated as usual, and that the right to seek asylum will not be compromised, but that persons not seeking asylum, or persons who can not prove their eligibility to enter the country satisfactorily, may be refused entry. The result may paradoxically be that the number of applications for asylum will increase as a consequence. Anyone who is entering the country, for whatever reason, without the legal right to do so, and is caught, may feel obliged to seek asylum. Already, Aftonbladet reports cases where people have entered Sweden with the intention to continue to Denmark, Norway or Finland to seek asylum there, but when being detained at the Swedish border felt forced to seek asylum.
The Swedish Police further states that controls will be random, and that every person crossing the border will not be checked. A total control is not possible, says Patrik Engström, in charge of the Police Border Division. One could image. More than 15.000 people commutes daily across the Öresund bridge between Sweden and Denmark on a daily basis.
The trains alone between Malmö and Copenhagen leaves every twenty minutes for most of the day, which gives a total 3 transports per hour or about 70 per day. If calculating half the commuters to use the trains (the rest by car or ferry), this gives us an average of approximately 100 people per train. Anyone who has ever used those trains will soon spot the underestimate, especially during the most popular commuting hours.
If we assume a successful passport check (that is a check which leads to now further interrogation or detention) takes 10 seconds, it would then take 16 minutes to check all the passports on the train. Given a police salary of 25.000 SEK per month, the cost of this check would be about $300/day for one very efficient police Officer to carry out. A reasonable cost, for better order, one may think.
In reality however, we may expect a somewhat different picture. We will leave it up to the Reader with an economic interest to add the cost of Swedish tax, pensions and mandatory compensations to the cost.
With regards to the speed of the check, we leave it to the Reader skilled in particle flow simulations, to calculate the average speed for a average weight, average fit and average socially competent police officer to maneuver through a swamped train cart at rush hour.
Finally we leave it up to the Reader with a social interest, to calculate the cost of delays to the over 15.000 commuters every day, including the domino effect of their customers and employers.
However small or large, there is a cost to consider. One may assume there is also the expectation of a gain at some point. Unfortunately, the comments from responsible, as well as the single day used to take the decision, seem to indicate that not much planning has taken place. Instead, the comments from the authorities breaths of an experimental approach. The checks are to last for 10 days initially, with potential prolonging, depending on the effects.
The decision to start the border checks has a background in the situation at Migrationsverket, says Mikael Hvinlund, communications manager, to the newspaper Dagens Nyheter (Daily News). The hope is that controls will result in a more structured refugee reception.
Police are not allowed to perform checks based on ethnic origin, gender, race or appearance. One may wonder how effective a check can be if the police is not allowed to check anyone who looks like an immigrant. Of course, what is stated in the police manual, what is communicated officially and what takes place in practice, are very different things. When the CEO at Migrationsverket was interviewed in Swedish radio on Thursday, the work “dignity” was repeated several times. One may wonder if not an informational booth at the border, giving aid and information when asked, would present a more dignified reception into this country.
When we decided to undertake the production of this internet magazine, there was half a plan of having it launch on 9th November, as a tribute to the tragic history of 11th September. By choosing the opposite of the more famous Nineleven, we thought we could announce this as a new global date to honor Common Sense – indeed the very opposite of what Nineleven has come to stand for. A day where we will only make logically and emotionally sound decisions, where our choice of words will be balanced and thought through, our arguments sound and our actions based on facts, skeptically scrutinized to the best of our ability.
But a quick review of human history through On This Day soon reveals the cruel facts:
9th November is just as filled with historic atrocities as any 11th September, including a declaration of war by president Saddam Hussein in 1980, a hurricane in 1965 (although it can hardly be blamed for its bad behavior), a nuclear test in 1962, and of course the Kristallnacht in 1938. The list is only slightly brightened by events such as quite a few successful space explorations in the 60:s, a romantic encounter in 1966 (which may not be an entirely positive event, depending on the view, since the lady in question is named Yoko Ono) and airplane flight lasting more than 5 minutes in 1904. Perhaps the only really worthwhile memorable event in recent history on this day is the fall of the Berlin Wall in 1989.
So – no this day seem to be occupied, sorry. Instead, we propose to elect 10th November the global day of Uncommon Sense. And in the spirit of this day, bringing logic extrapolated from lessons to the inescapable conclusion, we will not even bother to check what unsound actions may taint the history of this day, and the Reader is adviced to check out the backlog at their own risk. Is it even going to be possible to find a day without an overshadowing backlog of bloodshed, plundering or even the one occasional rampage? Any Reader is encouraged to post comments inspiring hope for the human race in the commentary field. It seems it will be needed.