List of Figures
Fig. 6.1 The inukbooks that draw together a number of career-long contributions that have illuminated the ‘what is’ and ‘why is’ questions about life and information, discussed in this chapter. Photograph by David Ingram (2023), CC BY-NC.
Fig. 7.1 The changing NHS from 1946 to 1996–after a lecture of John Swales, Head of the NHS Research and Development directorate, 1996. Image created by David Ingram (2010), CC BY-NC.
Fig. 7.2 Maps of ethnic genetic diversity, internationally, and diversity of socio-economic stratification in one London Borough–after Bernadette Modell, 1999. Image created by David Ingram (2010), CC BY-NC.
Fig. 7.3 The coevolution of information technology hardware and computation during the Information Age. Image created by David Ingram (2010), CC BY-NC.
Fig. 7.4 Anticipating Grid Computing, the Cloud, and information as a utility–from After the Internet, Royal Society lecture, Joel Birnbaum, 1999. Image created by David Ingram (2003), CC BY-NC.
Fig. 7.5 The co-evolving focus of health care services and their supporting information systems during the Information Age. Image created by David Ingram (2010), CC BY-NC.
Fig. 7.6 The interaction over time of factors causative of disease–after a lecture of Melvin Greaves, 2001. Image created by David Ingram (2003), CC BY-NC.
Fig. 7.7 Some early comparative metrics of the scale of factual content in the curricula of different first-degree subjects. Image created by David Ingram (2010), CC BY-NC.
Fig. 7.8 Integration of research and practice through informatics–after a lecture of Richard Begent, 2001. Image created by David Ingram (2010), CC BY-NC.
Fig. 7.9 An image of scrambled and non-coherent clinical data. Image created by David Ingram (2010), CC BY-NC.
Fig. 7.10 The inverted triangles depicting the transition from Industrial Age to Information Age medicine. The original image was used by Richard Smith in his 1997 BMJ Editorial discussed in this chapter. The version here was created by David Ingram (2010), CC BY-NC.
Fig. 8.1 A slide from a Medical Research Council conference presentation on health informatics. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.2 The scope of health care information systems–domains served, regulatory perspectives and expectations of the quality of data encompassed. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.3 A military analogy for the challenges faced in harmonizing and integrating disparate infrastructures. Image created by David Ingram (2002), CC BY-NC.
Fig. 8.4 Advocacy for information as a utility–adapted from Royal Society lecture, Joel Birnbaum, 1999. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.5 Factors impacting on progress with health care information systems. The sawtooth progression of implementation of information policy–the gradient of improvement, overall, a matter of perspective and debate. Image created by David Ingram (2003), CC BY-NC.
Fig. 8.6 Octo Barnett–clinical and computer science pioneer of medical informatics at the Massachusetts General Hospital and Harvard University. CC BY-NC.
Fig. 8.7 Jo Milan–architect, designer and implementer of the innovative hospital information and care records ecosystem of the Royal Marsden Hospital, London. CC BY-NC.
Fig. 8.8 Progress in going paperless: a figure illustrating the outstanding achievements of Jo Milan and his team at the Royal Marsden Hospital. Adapted from the 2003–04 Diagnostic Audit of NHS Acute Hospital Trust IT, The UK Audit Commission. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.9 Cost-benefit expressed as information acquired in relation to investment made, further illustrating the outstanding performance of the systems developed at the Royal Marsden Hospital. Adapted from the 2003–04 Diagnostic Audit of NHS Trust IT, The UK Audit Commission. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.10 Cost benefit expressed as clinical value perceived in relation to investment made. Illustrating how clinicians at the coal face of care rated the systems developed at the Royal Marsden. Adapted from the 2003–04 Diagnostic Audit of NHS Trust IT, The UK Audit Commission. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.11 Stanley Huff–career-long Chief Medical Informatics Officer at Intermountain Healthcare in Utah and architect of its innovative information systems based on clinical element models. CC BY-NC.
Fig. 8.12 Sam Heard–East London GP and co-founder of openEHR at Bart’s, UCL and Ocean Informatics. Now medical director for Aboriginal community health care services in Alice Springs, Australia. CC BY-NC.
Fig. 8.13 Bill Aylward–ophthalmic surgeon, formerly Medical Director at Moorfields Eye Hospital in London, and founder of OpenEyes. Now an ocean sailor navigating the world with his wife in their catamaran, Double Vision, and pictured here on Antigua (2023).
Fig. 8.14 Bernadette Modell–epidemiologist at UCL and Director of the WHO Collaborating Centre for the Community Control of Hereditary Diseases. CC BY-NC.
Fig. 8.15 The interdisciplinary science of medicine, connected around Ranganathan’s circle of knowledge. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.16 The connected information landscape of human biology and medicine. Image created by David Ingram, Anne Warner and Dave Delpy (2000), CC BY-NC.
Fig. 8.17 Diverse perspectives in play when seeking to bridge academic, clinical service and industry domains of health care information. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.18 The current scene of health care computing, spanning fifty years. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.19 The NHS clinical effectiveness drive from twenty-five years ago. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.20 The contrasting perspectives of the AIM Third and Fifth Framework Programme objectives for health care–from patient as data source for systems to systems serving the needs of citizens. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.21 Flemming Rosleff’s definition of managed care. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.22 The comprehensiveness of the electronic care record ecosystem, as expressed in the requirements for the GEHR architecture and mission. Image created by David Ingram (1992), CC BY-NC.
Fig. 8.23 Front sheet of the GEHR Project Brochure, 1994. Image created by the GEHR project team (1994), CC BY-NC.
Fig. 8.24 The earliest formulation of the GEHR Object Model in 1994. In subsequent years, it was separated into the Synex reference and clinical data object model and aligned with the Ocean reference and clinical data archetype model, to provide the foundational openEHR architecture, in 2002. Image created by the GEHR project team (1994), CC BY-NC.
Fig. 8.25 Early ideas for a technology and vendor neutral care record exchange between systems. Image created by the GEHR project team (1994), CC BY-NC.
Fig. 8.26 The entanglement of non-coherent information systems. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.27 Interoperability achieved through the common ground of a coherent semantic framework. Image created by David Ingram (2010), CC BY-NC.
Fig. 8.28 The scope of the first open-source openEHR platform, Opereffa. Image created by Seref Arikan and David Ingram (2010), CC BY-NC.
Fig. 9.1 Looking down from the red trust apex of the threefold implementation pyramid. Image created by David Ingram (2022), CC BY-NC.
Fig. 9.2 A fractal three-dimensional printed model of the Sierpiński tetrahedron–tetrahedron enfolded within tetrahedron, illustrating the fractal nature of implementations. Based on a design by Josef Prusa (2021), CC BY-NC, https://www.printables.com/en/model/67531-sierpinski-tetrahedron
Fig. 9.3 A first step towards framing a scope and architecture of requirements for a Care Information Utility, with you in charge–CIU with uic! Image created by David Ingram (2012), CC BY-NC.
Fig. 9.4 An imagined organic ecosystem of the Care Information Utility, inspired by Escher’s Circle Limit III woodcut and the journal Nature’s characterization of Suzanne Simard’s vision of forest ecology as a ‘Wood Wide Web’. Image created by David Ingram (2022), CC BY-NC.
Fig. 9.5 Creating coherent common ground on which to base the openCare Care Information Utility. Image created by David Ingram (2022), CC BY-NC.
Fig. 9.6 The integration of information sources drawn on in formulating the APoGI (Accessible Publication of Genetic Information) utility developed at CHIME in UCL for patients affected by thalassaemia. Image created by Bernadette Modell, Matthew Darlison and David Ingram (2000), CC BY-NC.
Fig. 9.7 An early slide highlighting the changing nature and scope of clinical skills and roles. Image created by David Ingram (2010), CC BY-NC.
Fig. 9.8 An early slide highlighting the changing nature and scope of care information systems. Image created by David Ingram (2010), CC BY-NC.
Many of the figures in the book have been made accessible via a QR code. This originally served the dual purposes of magnifying figures containing smaller text and providing access to figures that were originally omitted from the printed publication, to reduce the page count. With the book now cast as a two-volume work, the latter was no longer necessary and thus these images are now included in the printed version as well.