HWB Background Info.


HWB Background Information:
On September 23, 1993 the Internal Revenue Service granted the HWB Foundation 501 (c) (3) tax-exempt, not-for-profit status. This completed a long and complex process of Foundation approval and certification by State and Federal agencies. The purpose of this notice is to publicly announce that the HWB (Hippocrates, Winslow & Babbage) Foundation for the Improvement of Medical Practice is now a viable legal corporate entity which fully intends to meet the terms of its charter. The broad purpose of the HWB Foundation is to support rigorous evaluation of measures designed to advance the quality of medical care. The ultimate beneficiaries of the Foundation's work will be all recipients of medical care : patients, whoever and wherever they may be.

The title of the Foundation acknowledges three major contributors to the fields of medicine, public health and computer science. The following quotations and descriptive excerpts of a distinguished triumvarate help to further elaborate the general purpose and spirit of this Foundation.

"Primum non nocere." - (first, do no harm)

- Abstract of the Hippocratic Oath.

"Public Health is the science and art of preventing disease and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services, for the early diagnosis and preventive treatment of disease, and the development of social machinery which will ensure to every individual a standard of living adequate for the maintenance of health."

- Winslow's definition of Public Health; Encylopedia Britannica, V18 p 740,

1851 Charles Babbage, a Cambridge University mathematician, is credited with the development of the forerunner of the modern computer. In 1820 he invented a "Difference Engine" for arithmetic calculations. Later in 1840, assisted by Lady Ada Lovelace, the daughter of the English poet Lord Byron, he developed a blueprint for the "Analytical Engine" - a conceptual breakthrough which could store a series of computational steps.

According to Lady Lovelace: "The Analytical Engine has no pretension whatever to originate anything. It can do whatever we know how to order it to perform. It can follow analysis; but it has no way of anticipating any analytical relations or truths. Its province is to assist us in making available what we are already acquainted with."

Statement of Purpose:

In the vast marketplace of expensive diagnostic and treatment methods (13% of the Gross National Product) there is not sufficient data with which to decide what works and what does not work. According to Dr. Richard S. Dick, from the National Academy of Sciences Institute of Medicine: "We lack the evidence to make more informed decisions in health care today across the spectrum from the bedside up to the formulation of national health care policy. Most of the evidence needed to make more informed decisions remains embedded in fragmented, irretrievable, and often illegible paper-based patient records ".

The root source of this evidence, the conventional patient medical record, costing an estimated $1,100 each, compiled in the handwriting of healthcare professionals (who are now estimated to spend between 40-45% of their time in such non-clinical bookkeeping activities), is failing to keep pace with burgeoning documentation demands. The deficiency of the medical record has been identified by Senator John Glenn of the Select Committee on Aging (in address of issues relating to Medicare) as "the singlemost important factor in improving the quality and cutting the cost of medical care".

In addition to the task of gaining orderly, uniform and well specified clinical input, improvements are required in raising the general level of awareness of the output of health information systems."There are now over 1000 medical journals published each week. A rapid calculation shows that if a doctor were to read 4 articles in a medical journal every night of the year, by the year's end he or she would be fifty years behind. The days of reading journals cover to cover to stay up-to-date are over." - Hogg, Physicians & Computers, 9 18 1991.

The mission of the HWB foundation is to collect uniform and well specified clinical data in the form of text and graphics from reliable, university-affiliated sources and make that data, in quantities of statistical significance, available in the public domain. There, scrubbed of personal identifiers in a webserved database format, collected data may be evaluated and re-evaluated by any party - particularly university affiliated research groups. The Foundation endeavors to establish a new pattern of research whereby instead of the basic data being available only in small samples within the purview of a select few determined to make a specific case - an open database deriving input from multiple sources is created to permit a larger sample size with equal access from all points of view. Thus, enhanced validation of the reporting is possible.

A specific example of implementation would be as follows :A University Medical Center Department of Surgery or an individual surgeon desires to improve and facilitate data collection for routine and research reporting. The individual or institution applies to the Foundation for the provision of hardware, software and service required for the task. In return the Foundation requires the return of depersonalized but highly specific data directly collected from the care-providing team. To ensure consistency, minimum inter-observer error and completeness, computer assisted observation will be required. The data derived is then web published without interpretation so that it may serve as source material for the advancement of medical education and the improvement of medical practice.

We ask that you join with us in this difficult, yet essential, mission.

William D. Burman, MD
Foundation President