Principia Medicinae Digitalis Sotoniencis
Essays on the Evolution of the UHS Clinical Data Estate 1980 -2024
Essay 1:0 Introduction to the Project
Series Author and Editor David Rew QVRM TD MA MChir (Cambridge) FRCS (London) Consultant General Surgeon, University Hospital Southampton 1999-2023 7th October 2024
The Publication Plan This document introduces a collection of more than 30 essays which recount the history and outputs of the University Hospital Southampton (UHS) clinical digital programme over five decades. each will be available on completion as downloadable PDF documents on my website, https://www.wessexsurgical.co.uk for review, comment and as a basis for further contributions. Each will be amended, updated and supplemented as necessary and as any new material becomes available. All colleagues with knowledge and participation in the UHS digital programme are invited and welcome to contribute, by communication with me through dr1@soton.ac.uk.
Once the project is as complete as is achievable with the available contributions, final copies of each of the essays will be submitted to the University of Southampton ePrint server for formal publication.
Copyright The copyright of these essays is invested in Mr David Anthony Rew as the originator of the project, editor and principal author. The content of each essay is made available on a Creative Commons Version 2 CC BY basis, under which Licensees may only copy, distribute, display, perform and make derivative works and remixes on the basis of Full Attribution, including formal Citation where appropriate in books and academic publications.Contents
The Challenges of the Transformation from Paper to Digital Healthcare
Darwinian Processes and Digital Evolution
Healthcare and the Digital Revolution
Southampton and the Revolution in Digital Healthcare Systems
The Southampton Health System enters the Computer Age
My personal involvement with the UHS Digital Programme
The Intent of the Project
The Target Audience for the Writing Project
Creating this Essay Collection: The Key Participants and Contributors to the Projects
Looking to the Future of Clinical Computing
The Structure of this Collection of Essays
Section 1 Essays: The history of and principles of clinical computing in Southampton
Section 2 Essays: The UHS Lifelines story
Section 3 Essays: The Southampton Breast Cancer Data System story
Section 4 Essays: The Enhanced Somerset Cancer Register story
Section 5 Essays: Student Contributions, Digital Education, and Human Factor Analysis
Glossary of Terms
Acknowledgements
for major contributions to the development of the systems
for additional technical contributions
for clinical contributionsThe Challenges of the Transformation from Paper to Digital Healthcare
In January 2000, the US multinational company Electronic Data Systems aired a memorable one minute long mockumentary video during the televising of the American Football Superbowl final between the St Louis Rams and the Tennessee Titans.
The creative advertising team of Fallon in Minneapolis “filmed” a team of construction engineers harnessed to and building a large Boeing airliner at altitude and at speed, with a contingent of passengers on board. The narrator tells us that:
“Some people like to climb mountains. I like to build planes. In the air. .. I grew up wanting to be on the wing. Wanting to be up this high. .. Sometimes the temperature at this altitude will reach 60 below. It’s brisk. It’s refreshing. .. You never know what you’re going to come across up here. Canadian geese. Mallards. Owls. .. These people back here. That’s why I come to work. That’s why I build airplanes in the sky...We’re not just building a plane here. We’re building a dream!... I love this job... We don’t get a lot of thanks up here. But when I look over there and see that little kid, the look in his eyes, that’s all the thanks I need…” The video concludes with the voiceover:
“In a sense this is what we do. We build your digital business even while you’re up and running... and the strapline: “EDS. Managing the complexities of the digital economy. The senior contributors to this book and to the digital transformation programme at the University Hospital of Southampton were born in late 1950s and early 1960s, when you went to a school with a pencil, a pencil sharpener and an eraser in your satchel; when you were taught off a blackboard with chalk; and you went home to a blurred black and white TV with an unstable signal and the BBC or ITV as your only viewing choices.
Personal computers, hand held video devices, flat screen TVs, and information on demand were unknown except in the imaginations of Gerry and Sylvia Anderson and their puppeteers on the Thunderbirds, Joe 90, Fireball XL5 and Stingray film studio sets.
The digital transformation of the world has been a revolution of previously unknown scale and speed in human history. Technological and social change which once took centuries and millennia has been compressed into months and years, and we have lived right through a tsunami of change which has swept all before it.
The electronic computing era began in the 1940s with the codebreakers of Bletchley Park, and with Alan Turing’s theoretical work which defined the universal computing machine. The earliest commercial machines were huge mainframes for government, academic and business purposes. Citizen engagement in the digital revolution began in earnest and gained pace in the 1970s and 1980s, with the earliest personal computers, processing and memory chips, alphanumeric software codes and digital hobby enthusiasts.
The public Internet, the World Wide Web and mobile telephony took shape in the early 1990s, and hand held digital devices evolved in the early 2000s, to the point where most global citizens of all socio-economic classes, cultures and nationalities have access to a "smart phone".
Huge reams of information and imagery are now available in real time at almost any point on the planet, including through constellations of micro-satellites in low earth orbit. In the early 2020s we are now debating the applications of advanced machine learning and "Artificial Intelligence" in daily life and in a wide range of healthcare applications. # Darwinian Processes and Digital Evolution
The Coming of the Computer Age exemplified technological Darwinism in its purest form. The fittest ideas, microchips and code flourished and generated vast wealth for their creators. Nobody wrote a master plan or a road map for the digital revolution, but many brilliant minds and brave entrepreneurs had the visions and developed the transformative products which fuelled an accelerating cycles of progress. In this technological survival of the fittest, this year’s state of the art system became next year’s dinosaur. Million and Billion dollar businesses rose and fell in the sunshine of Silicon Valley, and governments, Corporations and Citizens struggled to keep pace with the rate of change.
The revolution prompted the human imagination and organisational energies to deliver chips at the nano-scale and to join up the entire world with fibre-optic cables, wireless and satellite links.
The early commercialisation of computers at scale was primarily driven by the needs of large scale businesses and mainframe applications such as payroll, accounting and inventory management. These applications generally had a logical structure and linear processes which leant themselves to computer programming. The mainframe computerisation of healthcare systems took off in the 1980s, but largely in those areas where the needs of health service providers mimicked those of trading companies in core business processes.
The programming of the patient medical record was largely out of scope, because its complexity in describing the cradle-to-grave health needs and consumption of individual patients and whole populations was out of commercial scope. In the UK, individual health professionals experimented on the margins with their BBC Micros, Amstrads, IBM and Apple Personal Computers and databases for particular cohorts of patients and diseases. However, the transition of the medical record from a paper to a digital architecture was still on the far horizon. Ambitions for healthcare computing in the 1980s were handicapped: