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Archive for the ‘Product Innovation’ Category

Picture this: You are diagnosed with a heart problem and hospitalized to have it treated. You meet the doctor, who will be responsible for your treatment and you ask him what is going to happen to you.

He is clearly only remotely interested in you, but directly addressed, he mentions that you will be operated. Otherwise he only mumbles about the fact that you’re very ill, and that you will probably never recover completely. You will get an injection and if you don’t corporate, they might consider using force to ensure that you do. Don’t worry too much, though, he says, and leaves you, clearly signalling that he’s too busy to talk to you, and that after all, you’re just the patient.

Such treatment of patients would be scandalous in somatic care, but in psychiatric care all over the world, it happens routinely.

Fortunately, things are changing. Former Danish prime minister Poul Nyrup Rasmussen hosts a yearly ”Pscychatric Summit Meeting”, where users of psyhicatry and their peers get together to discuss problems, actions and trends. There are top politicians attending the meeting, but the ”stars” are the users – or patients as we often call them.

His summit meetings have already helped improving things a lot, pushing psychiatry to depart from the old paradigms of force and medicine based treatments, moving towards a user centered approach. We’re not there yet: Recently a case of systematic, life dangering, overmedication of patients in Copenhagen was revealed. But the situation is clearly improving.

There’s no doubt that if we are to change psychiatric care, we need to focus on values, but we will also need new ways of treating patients, and one of the more promising trends is to employ information technology in psychiatric care.

We’re not talking brain scanners or electromagnetic brain therapy machines, though. We’re not even talking neurofeedback therapy. No, what we’re talking about is communication technology. Thats why we call it tele-psychiatry, implying the increased use of tele-communications.

During the Psychiatry Summit Meeting last Saturday October 6th, I participated in a workshop organised by the danish ADHD Foreningen on tele-psychiatry.

Our hyphothesis is that tele-psychiatry could possibly improve treatments by:

  • Eliminating barriers – it’s easier to get in touch with your doctor.
  • Empowering the patient – psychiatrists should get off that soap box, stop talking down to the patient, and face him or her as a peer.
  • Improved coordination of treatments between different sectors, hospitals etc.
  • Less transport time wasted by patients.
  • Reducing anxiety and fear for some patients by allowing them to stay in touch with their caretakers without leaving home.

On the other hand, we worry that tele-psychiatry could also make things worse by:

  • Patients becoming more lonely
  • Tele-psychiatry is just a way for politicians to save money
  • Some users will feel alienated
  • It will be forced on users, further reducing their feeling of control over their own lives.

Text on the t-shirt reads: Mental illness does not make people dangerous

The workshop was only about 1 ½ hour, but the conclusions were never the less very, very interesting:

  • Voluntarity is important: The user should always decides for herself or himself whether information technology is something he or she would want to use in hers or his communication with caretakers. This applies both to apps or programs used by the user to record his or hers emotions, sleep or other aspects of mental health, as well as to tele conferencing tools (e.g. Skype).
  • Tele-psychiatry should not replace any existing parts of treatment programmes: It should supplement treatment programmes.
  • What about information safety? If you’re meeting face to face with a doctor, you can be pretty certain noone is listening, but when you are meeting your doctor over the Internet, you don’t know who might be listening in on you. The possibility of information leaks should be taken seriously.
  • Ethics: If you’re a psychiatrist communicating with a patient over Skype, you might gain insight in things going on in the patients home. How do you deal with that?
  • How will the virtual communication space affect what is being communicated? We need to know this to make sure treatment plans still apply (e.g. systematic interviews conducted by psychiatrists could be affected by this).
  • It will be easier to capture daily problems: Many users in psychiatry find it difficult to remember or to convey their experiences to the doctor during the regular meetings. With communication more easily accessible, this could improve and the doctor would be better able to make the right descisions about treatments.
  • Social networks should be included, not excluded from the technology. Peers are often the best ”doctors”.
  • Politicians should not treat tele-psyhicatry as the new magic technology which will allow them to save money and improve care at the same time.

Even though I’ve been working with information technology for almost 20 years now, I was initially very sceptical about tele-psychiatry, thinking that we need to be careful not to waste what we have. The workshop made me realise that tele-psychiatry can improve psychiatric care. I intend to follow the technology developments closely, primarily from the user side, but – if opportunities turn up – possibly also professionally.

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As a teenager, I spent hours reading datasheets for CPU components like the bit slice processors AM2901. I also designed hypothetical CPUs in block diagrams. A 16 bit CPU was my objective, and it should have had a clock of 20 MHz. The instruction set was to be small and beautiful. My first computer was based on a National Semiconductor SC/MP processor, which had a very nice and simple instruction set, and I’ve always liked things which are the simple, beautiful and logical.

I never did build my own CPU, but at university, I spent hours playing with the old RC4000 mainframe we had in the electronics club. It was (is!) a 24 bit machine from the late 60’s, a very nice and advanced design. Its concurrent programming system was among the first in the world (appearing at about the same time as Unix was developed in the US), and my father, who used to work at Regnecentralen, gave me one of the original books about the system, which I read with great interest. It was a message passing based system, and I think the design had a few drawbacks, but the beauty of it was fascinating.

Yesterday I saw my old friend again. She is now residing in the rooms with computer historic enthusiasts. I visited the club with 14 year old son Frederik.

Photo of the RC4000 computer from 1971 in the basement of Dansk Datahistorisk Forening

The RC4000 computer was designed in the 1960's and was built from the late 60's to mid 70's when it was replaced by RC8000. It was a 24 bit architecture with up to 384 Kb core memory.

The RC4000 still works, but the enthusiasts are more focused now on its predecessor: A GIER computer, which has recently been brought back to life. The first GIER was delivered on July 31st 1961, so the design is turning 50 years old this year. About 50 of these machines were built and the club owns two: One early model and a late model. It is the late model which they are bringing back to life.

Photo of the now running late model GIER computer

GIER, a 50 years old computer design, now being brought back to life.

There are very few test programs for GIER, and this makes the repair process a bit more complicated. Poul-Henning Kamp, the author of the Varnish Cache, who is one of the active enthusiasts in the club, mentioned that it was probably because the designers found test program development to be too boring. These guys were innovators! Poul-Henning has unit tests for Varnish with great code coverage, but admits that writing tests is not the fun part of that project.

I used to program for a living and I can agree with this. Unit testing isn’t fun!

The smell of the old computers, their physical size, the noise they make, and their sheer lack of computing power (by todays standards) suggest that these machines are of a different era. Technology has evolved a lot, but people are still people. And the people matter – the technology is just a means to an end.

I still love working hands-on with technology, but my view on IT has grown a lot wider since I was young.

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I came across this on a web site today:

I think among the reasons [insert product name] works so well is that it was developed not by endless betas and adding too many features requested by wankers who do nothing but play on their computers, but instead by people who understand the importance of simplicity and usability.

[Insert product name] has exactly what I need in a simple enough form that I can figure it out.

The product in question is Apple’s Aperture, but that’s not important. But Ken Rockwell (who wrote this) “even dream in Photoshop”. It’s a big statement.

This is about shifting focus to from technology to product value. Looking at myself in the mirror, I hope I won’t see a “wanker” who makes computer systems just for the fun of playing with technology. But I know the feeling. After all, it was the passion for technology that started my computer career almost 30 years ago. In that respect, I hope I’ve grown up a bit! ;-)

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Software is based on technology and software engineers love it. The most popular subject of discussions between programmers is which platform to choose for the next project, what tools to use, and what development methodololgy to use.

New technologies and methods are heavily accompanied by marketing campaigns that promise many good things if we base our new product, project management, testing etc on this great new invention. They don’t even have to be commercial products: There are people in our industry who advocate common paradigms and free tools very firmly without any kind of focus on their limits.

During my career, I have found that technology fascination alone usually leads us nowhere in terms of business value and making a different to users.

In this series of blog posts, I’m going to point out why we have to pay specific attention to this pit-fall, and why we must repeatedly to evaluate the technology we’re using against its influence on the result of the project: The product.

I’m going to suggest a product focused software development paradigm.

Focusing on the end product (and knowing how to focus) in software development projects, will lead to better products.

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