Communications - November 2010

So why remove the most useful slide in the whole presentation—the summary—and replace it with a content-free alternative showing perhaps a word or two. Is your audience so dense it cannot hear you say “Thank you” or ask for questions unless they’re on the screen? Do you think the audience will forget to say something? Or is the problem with you, the presenter? Would you yourself forget to ask for questions if the slide wasn’t on the screen in front of you?

Technical presentations should be held to a higher standard of information content and knowledge transfer than a sales pitch. My advice: Remove the “Thank You” and “Questions” slides, and leave up your “Conclusions” and “Summary” as long as possible.

michael Wolfe, hillsboro, or

laboratory at age three. He was born in 1934, and the University of Cambridge Computer Laboratory was founded (as the Mathematical Laboratory) in 1937. The source of the error is apparently Milner’s official obituary, which noted he “held the first established Chair in Computer Science at the University of Cambridge.” Translation to American: He held the first endowed professorship. In Britain, the word “Chair” refers to a professorship and should not be confused with “Head of Department.”

Lawrence c. Paulson,
Cambridge, england
for electronic health Records,
Don’t ignore Vista

Why did Stephen V. Cantrill’s article “Computers in Patient Care: The Promise and the Challenge” (Sept. 2010) say nothing about the Veterans Health Information Systems and Technology Architecture (VistA) used for decades throughout the U.S. Department of Veterans Affairs (VA) medical system for its patients’ electronic medical records? With 153 medical centers and 1,400 points of care, the VA in 2008 delivered care to 5. 5 million people, registering 60 million visits (http://www1. va.gov/opa/publications/factsheets/ fs_department_of_veterans_affairs.pdf).

In his book The Best Care Anywhere
( http://p3books.com/bestcareanywhere)
Phillip Longman documented VistA’s
role in delivering care with better out-
comes than national averages to a pop-
ulation less healthy than national aver-
ages at a cost that has risen more slowly
than national averages. Included was a
long list of references (more than 100
in the 2010 second edition), yet Cantrill
wrote “Although grand claims are of-
ten made about the potential improve-
ments in the quality of care, decreases
in cost, and so on, these are very diffi-
cult to demonstrate in a rigorous, sci-
entific fashion.”
Public-domain VistA also general-
izes well outside the VA. For example,
it has been deployed in the U.S. Indian
Health Service, with additional func-
tionality, including pediatrics. Speak-
ing at the 2010 O’Reilly Open Source
Convention ( http://www.oscon.com/
oscon2010/public/schedule/detail/15255),
David Whiles, CIO of Midland Memo-
rial Hospital, Midland, TX, described
his hospital’s deployment of VistA and
how it has since seen a reduction in
mortality rates of about two per month,
as well as a dramatic 88% decrease in
central-line infections entering at cath-
eter sites ( http://www.youtube.com/
watch?v=ExoF_Tq14WY). Mean-
while, the country of Jordan (http://ehs.
com.jo) is piloting an open source soft-
ware stack deployment of VistA to pro-
vide electronic health records within
its national public health care system.

author’s Response:

I appreciate Bhaskar’s comments about the VA’s VistA medical information system and applaud his efforts to generate a workable system in the public domain, but he misunderstood the intent of my article. It was not to be a comparison of good vs. bad or best vs. worst, but rather a discussion of many of the endemic issues that have plagued developers in the field since the 1960s. For example, MUMPS, the language on which VistA is based, was developed in the early 1970s for medical applications; VistA achieved general distribution in the VA in the late 1990s, almost 30 years later. Why so long? I tried to address some of these issues in the article. Also, VistA does not represent an integrated approach, but rather an interfaced approach with several proprietary subsystems.

stephen V. cantrill, m.D., denver
correction

Tom Geller’s news story “Beyond the Smart Grid” (June 2010) should have cited Froehlich, J. Larson, E., Campbell, T., Haggerty, C., Fogarty, J., and Patel, S. “HydroSense: Infrastructure-Mediated Single-Point Sensing of Whole-Home Water Activity in Proceedings of UbiComp 2009 (Orlando, FL, Sept. 30–Oct. 3, 2009) instead of Patel, S.N., Reynolds, M.S., and Abowd, G.D. “Detecting Human Movement By Differential Air Pressure Sensing in HVAC System Ductwork: An Exploration in Infrastructure-Mediated Sensing” in Proceedings of Pervasive 2008, the Sixth International Conference on Pervasive Computing (Sydney, Australia, May 19– 22, 2008). We apologize for this error.

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correction

The tribute “Robin Milner: The Elegant Pragmatist” by Leah Hoffmann (June 2010) requires a small correction. It said Milner “served as the first chair of the University of Cambridge Computer Laboratory.” For all his many gifts, however, Milner was not precocious enough to have run a university