...and so to home...

Friday: to lunch with Mary Logan and Leah Lough (AAMI). It was great to be able to spend time with them, to understand more about their agenda and the relationships between AAMI, FDA, AAMI Foundation, HTSI, HFES, the people and groups I have met over the past few weeks, and other key individuals and organisations. Not that I think I comprehend it completely even now, but the picture is getting clearer. AAMI has been orchestrating research and development around the safety of infusions devices as well as other themes such has home healthcare. Hopefully, our work on CHI+MED contributes to the overall "picture" even if we have a UK / European focus (compared with AAMI's natural US focus).

Then to the airport -- rather early, just because that's the way the day turned out. Fortunately, there were power sockets in the departures area, so I could get on with reading and writing. I ought to create a personal hit-list of airports that hide any power sockets so that you can only work on a digital device until the battery runs flat. And avoid them. Come on, airports: get into the 21st century!

On an earlier flight, I had found myself sitting next to another professor of Computer Science. On this one, I was next to a safety critical systems consultant. It was great to compare notes and to learn from each other...until it was time to sleep.

I have managed to stay awake all day, and to do many of the mundane tasks that needed doing after such a long trip. I even managed to stay awake through an episode of Horizon! Now the challenge is going to be to maintain the momentum as the pressures of the ordinary reassert themselves. I am very glad to be home with family, and looking forward to meeting up with my research team again, but I had a great time (I thoroughly recommend such a trip!), and I hope that the many dialogues will lead to fruitful future collaborations. Thank you to everyone who made this trip so interesting and enjoyable, and to the Royal Society and EPSRC for funding it.

Last day in Baltimore

This is probably the penultimate post on this blog, as I'm preparing to fly home tomorrow. I am very much looking forward to seeing family and friends again. I feel that I have made a lot of new friends on this trip, and various people have told me I must come again... and that Chris must come too next time. That would be great! Conversely, I hope that I can welcome some of the people I have met to London in the future.

 I spent this afternoon at the Johns Hopkins Hospital, learning more about their infusion pump safety project and much of their other human factors work, such as that on the management of alarms and even the layout of space and technology in the new intensive care units. I didn't see a single patient, but I did see a lot of infusion devices! And (yet again) I have a lot of notes scribbled down that I need to transcribe and make sense of.

We went for a quick drink in the Owl Bar at the Belvedere (which used to be a hotel, but is now condos), and for a meal at the Brewer's Art. I have never before been served a mushroom that looked so much like a steak; in fact, it wasn't even a whole mushroom – just a slice of one. It was delicious, but sooooo big!

The US-Canada asymmetry

Back in Baltimore for the last couple of days of my world tour of a few labs in North America. Looking forward to going home, to be honest, though it has been an amazing trip.

Yet another airport experience, but not as expected. Whereas flying Baltimore to Toronto felt like a domestic flight, the return trip involved entering all those tedious details such as destination address in the US, flight number, etc. etc. as part of check-in. And the queue at US Immigration (which happened in Toronto prior to boarding) had to be seen to be believed: it took at least an hour to get through it. What a good thing I'm a neurotic traveller who always allows at least two hours for check-in.

The plane was slightly larger than a domestic tumble-dryer, but not a lot. I somewhat resent the fact that I had to pay $25 to have my luggage stowed in the hold, whereas people with slightly smaller bags (who trundled them about 100m further than I did) had to pay $0 to have them stowed in exactly the same place. With 20:20 hindsight, I could probably have done this whole trip on a smaller suitcase and avoided all checked baggage fees, but when I left home I wanted to keep my options open. Climbing gear? Bring a minimum, just in case... Skirt and tights? Ditto... Hats, scarves, gloves? You can never have too many... The wisdom of hindsight is a wonderful thing.

On the flight I read a report on patient safety, which argued strongly that infection control is a much bigger issue than device design -- certainly in terms of cost-effectiveness of interventions. That is almost certainly true if one considers just hospital-based care in 2013. But home care in the future? We're all living longer; it will be essential to manage much more of our health outside the hospital setting; we're going to rely increasingly on medical devices for both monitoring and management... and they will need to be safe (as well as clean!). So hopefully our research has some long-term relevance.

Finally (for this evening): I love the defensive caution of the label on the condiments package that comes with the coffee machine in my hotel room. It apparently contains no nuts:

Smart pumps and technology that doesn't fit

Today, Nat Sims and Patrick Burdon gave a talk at University of Toronto on new technologies to improve patient safety. Nat is widely credited with introducing the concept (and the implementation) of "smart" infusion pumps that use drug libraries to reduce the chances of certain kinds of medication administration errors. Much of Nat's talk simply supported conclusions that I had reached by other means already, but I was particularly interested in his account of the history of the development of infusion pumps, which seems to account for some of the divergences in practices between the UK and North America. More details when I've checked my facts! Patrick focused on new neuroimaging techniques for managing anaesthesia (making sure the patient is properly sedated, but not so sedated that they won't recover full consciousness in a timely way). I won't pretend that I followed all the details, but it was a great reminder of how quickly medical science is advancing.

Then for a coffee with Kate Sellen. We have so many interests in common it is amazing that we hadn't met before: distributed cognition, situation awareness, human error, interactive medical devices and, in particular, the challenge of designing healthcare technologies that are not just 'usable' but that really fit their context of use. But I guess it illustrates one challenge of interdisciplinary working: that there are so many places one might publish, and events one might go to, that it's quite easy to move in the same 'space' without ever colliding. So to speak.

On the walk back, following my current strategy of taking a different route every time, I encountered the OCAD Design building. I have never seen a structure quite like it: a dalmatian-spotted box apparently standing over the top of a normal-looking building, on gangly stilts. The structural engineers must have had fun translating the artistic concept into a workable building!

Just around the corner, there was a very classical, colonial-looking building that is a complete contrast in style and culture... and almost certainly function too.

As you can see, Toronto is a little snowy, but not dramatically or debilitatingly so today.

Toronto: a day in the hospital

A day with the Human Factors teams at the University Health Network in Toronto. I gave my final talk of this trip, which seemed to resonate well with the work going on here. I also  had fascinating and thought-provoking meetings with many members of the team. They have an enviable set-up here, with excellent links into the hospital, good links into the university, and great connections with industry – both national and international. So they have opportunities to do good research that has a direct and immediate impact on practice. Much of their funding is industrial, and they are generally more concerned with practical impact than theoretical development, which would not go down so well in the UK funding system, but seems to work very well here. I am envious of the apparent ease with which they can engage with, and inform and be informed by, hospital functions such as procurement and incident reporting. It is an interesting illustration of the way that funding sources, physical location, organisational structures and history (a group emerging from biomedical engineering rather than HCI) influences the culture and practices of the group.

We all had dinner at Bannock (Canadian Comfort Food, apparently – sounds like a pretty good description to me). And it snowed (though it's actually rather slushy; will need to wear walking shoes tomorrow because my smarter shoes are now wet through...)

Freezing St Patrick's Day

It is cold (by my standards) in Toronto. I have been indoors most of the day (yes, working: it has to be done!), but took a stroll to the lakeside this afternoon. It feels as if the whole area is being rebuilt: big cranes, roads blocked, diversions everywhere: not actually particularly pleasurable for a wander. I thought of going up the CN Tower, but realised I'd have to get a bank overdraft to do so (it costs HOW much?!?). Ah well: there were some entertaining sights... and my brunch at the local Beer Bistro was definitely worth getting out for!

Today is St Patrick's Day. About half the people on the streets were wearing something green, and so were many of the dogs. I suspect the proportion (of green, not of dogs) was even higher in the pubs. I passed someone who was unashamedly wearing a big badge that proclaimed that he was "Irish for a day". St Patrick's Day seems to be much bigger here and in the US than anywhere in England; if it weren't at the weekend, I wonder whether it would be a national holiday!

There is a "beach" on the lakeside. I have some photos of family beach holidays when I was little that are good reminders of how unseasonal a British summer can be, but nothing to match the view of people sitting on deck-chairs under a sun-umbrella swathed in down jackets and fur hoods. Just along the way, people were ice-skating (and the ice didn't need to be artificially frozen: nature was providing that service). That seemed like a much more seasonally appropriate way to spend the time. I love the idea of a "turn up and skate" (no charge: just step onto the ice) rink. I can't imagine that happening as Somerset House (or any of the other places where rinks pop up around Christmas in London).

Another exhausting day of travelling

I'm now in Toronto. In a very well appointed apartment in downtown. Most things have gone well (flight on time, etc.), but had difficulty getting a bus ticket from the airport: found the ticket machine, but it would only take coins or cards. But not either of my cards -- no idea why, unless it's simply that they are foreign (like you don't expect to get foreigners passing through an airport). And I had no coins because I'd just arrived in Canada. Go to the bus; ask what to do. Can't pay on the bus -- have to go to the currency exchange (really? currency exchange?) upstairs to buy a cutesy little token for the bus. Who would have guessed it?

It's almost cold enough here that I'm glad I brought a down jacket. The air steward's comment on the plane was "minus one, minus three: is that cold?" in the tone of voice that made it very clear that he didn't think it was. It's cold enough for me!