The Future of EMLondon

I have been authoring this post for about two weeks now… I have been delaying finishing it in the hopes that I receive news that our beloved Tarek is being released. I realize now that it is becoming increasingly unlikely that that will happen anytime soon. And so here we go…

Tarek and I have talked many times about the future of EMLondon. In fact, the last conversation we had, which took place a mere 3 hours before he was arrested, was about this very subject. I didn’t often disagree with Tarek, but when it came to this I did.

When I took the website over in 2006, it was simply to provide a secure place to view and store our schedules. Around the same time, web technologies had begun to evolve beyond simply serving pages, and I saw an opportunity to incorporate these into our academic and clinical environments, in the hopes of streamlining existing processes but ultimately with the goal of improving patient care through the free exchange and sharing of information. While this has happened in many other industries, medicine continues to lag behind significantly, as is often the case (why this is still escapes me, although I do have my theories). My attempts to bring the group into the 21st century has failed on every front: electronic staff directory, discussion forums, online sharing of academic & teaching materials, electronic academic calendar… I could go on but you get the point. I also want to be clear that this has nothing to do with money. One of the many things I have learned from Tarek is that while money is necessary, it should never be important, as it causes one to lose focus of the actual goal.

And so in light of this and given Tarek’s ongoing absence, I have made the decision to cease development of everything related to EMLondon. I have outlined a plan below of how to replace the various functions that are still in use.

[li]Kitab is a completely separate application and will continue to function independently. My plan going forward will be to continue development of Kitab, as I know that is what Tarek would want me to do. This will not be an easy task, as I had not been closely following his development of it in the past 12 months or so, and so I will have to go back and look at every line of code before I even start thinking about adding to it.[/li]
[li]The shift evaluations can either[/li][/ul]
[li]Be done directly in One 45. I explored this briefly before I created the online form, and could facilitate trying to set this up.[/li]
[li]Go back to paper[/li]
[li]The housestaff & peds schedules (which are still Excel or PDF based) can be managed in one of two ways:[/li]
[li]Via a shared local drive on the LHSC network. People could then access them simply by logging into their LHSC desktop[/li]
[li]Via Google Docs which is how the chief residents manage their own schedule currently - the more elegant solution in my opinion, but I suspect it will be seen “too much trouble” by many.[/li]
[li]The academic calendar is simply a Google calendar which can continue independently if people so desire. I suspect I am the only one who uses it (other than Doran) and so if I am correct about that, I will simply close the account.[/li]
[li]There are several “static information” pages that get hit reasonably frequently (the OHIP code page, the ODB-LU code page and the FAQ). Those pages could easily be served on the LHSC intranet. Surprisingly, clinical informatics does not manage the intranet, and so I’m not sure who to talk to about that, but I’m sure no one would object.[/li]
[li]In terms of maintaining a divisional presence on the web, I would suggest getting in touch with someone at Western to determine who manages the departmental/divisional pages for virtually every other div/dept. They all look very similar, and after inspecting the code, it is clear that many have been designed by the same person. I’m sure there is a fee for this, however I suspect it’s reasonable or no one would have a page up at all.[/li]
[li]I will also offer the option of having someone else taking over the reigns, however it is not a simple task and would require knowledge of web programming (HTML5,CSS3,Javascript,PHP) as well as web security protocols and UNIX command line syntax. The group could choose to hire someone external to take over, but I suspect if you did, they would not want to manage the CMS Tarek & I have built (largely based on the “trust no one” philosphy) and would want to develop from scratch.[/li]
When Tarek returns, he may choose to resurrect the existing site (a trivial task) or, more likely, develop something from scratch himself. He has wanted to do that from day one (for the same reason an external developer would want to) but I have told him repeatedly if he did, I would have to bail, as I did not any interest in learning yet another language. He has always been completely understanding of that, and has supported everything I have done or tried to do with the website. In addition, he has always said that if I wasn’t on board with whatever changes he was considering, then he wouldn’t do it. I wanted to share that with everyone so that people have an understanding why I am neck deep in the free Tarek campaign - he is a true friend whom I trust implicitly - which I know most of you know is not an easy thing to find.

I welcome your comments / opinion / input on the matter, but I want to be clear that this is a not question I am posing, it is a statement of fact. I will reconsider Tarek’s plan of starting from scratch upon his return, whenever that is.

Thanks for taking the time to read all of that.

EDIT: 2013-09-21 1955
I have received a number of emails and realize now that the above post may sound a bit whiny. That was not my intention, nor am I trying to solicit kudos. I tried to present the information as fact rather than opinion.

With respect to the emails, I would appreciate it if people post their thoughts here so that everyone can read them.

EDIT: 2013-09-22 2230
I have now also realized that I failed to mention that I am in fact paid for at least some of the work we do. I have no idea what pot the $$ comes out of - I submit an invoice to Gary for hours worked and he cuts me a cheque. Tarek has never wanted any $$, and actively declined taking anything. But like I said - it’s not about the $$.


Well, Andrew, I will tackle the first reply. I am not sure exactly what input/comments you want, as you have stated that this is not a question you are posing. So, I will just give you some general thoughts on the website:

  • firstly, what an amazing resource to have designed specifically for our department and by department members. I believe that this feature by itself has allowed our group to benefit greatly from many, many aspects of the website. I have often thought how much work you must have put into this, and I haven’t taken the time to thank you for it - I realize you weren’t looking for appreciation with this post, but it’s true - we all owe you a big debt of gratitude.
  • secondly, I would label the website a resounding success. I am not sure what is prompting you to not feel it is the case. As I write this, there something like 18 users and 126 guests online. I use the website all the time for schedules, updates, online rounds, kitab, and EM resources. Just because I don’t personally think the forum is a great way to transmit threads (I use the forum, but I prefer email threads in terms of inclusiveness of all opinions), or I don’t use the academic calendar that often (I do use it occasionally), doesn’t make the website something we should trash. The international access and outreach of our online rounds, the ability to highlight divisional accomplishments, and the feel of a professionally designed site as opposed to a generic monolith just like everyone else’s make it a huge resource for us. The addition of the online housestaff evals seems to have had excellent uptake and is a further added plus.

So, not going to coerce you into doing something you don’t want to do, but thanks sincerely for making this into something very valuable. It will be a real loss if it is gone. You have done very good work my friend.

I read with great dismay regarding your decision which I know must be a difficult one. I do not fathom to think about the unrecognized time and effort you (and tarek) have put into maintaining this website and all the improvements that have been made to make my professional life easier to access. I really hope (and apologize) that you do not feel under-appreciated by your colleagues for your work. I do agree with Amit that this site is a very important website to maintain or continue in some form. The majority of visiting students and residents have commented to me on the website and how great it is for information about the programs, talks, and some of the research we have undertaken etc. The website has been pointed out by other blogs and will only serve as a growing calling card for our program across Canada.
I am not sure if Andrew’s concerns have been mentioned recently or attempts if any had been made to address them by the group, but I hope our web presence will not be cut short, not to mention the ability to find useful ‘on-the-job’ resources and student evals etc.
great job Andrew

So my thoughts?

Without question the website is a highlight of our program. I believe this medium has single handedly been a boost in all aspects of what we do as a Department, a business group and most certainly as a Division. To lose it would be devastating for our online presence - a huge factor in our successes over the last 1-2 years.

I will also add my obvious statement of appreciation for all of your work (and have extended the same to Tarek). Our home grown content and computer skills that each of you have proffered is nothing short of amazing for our program.

The question remains - how do we continue this success? I do not favour a step backwards into common website design and would be very supportive of funding someone to continue our own unique design and content. I believe all players have a stake in this crossroads we face. It is an invaluable resource to EMA and potential applicants, a similar solution to the the needs of the Department, and of course a key player in the success of our Division. I hope all three groups see the value and we can support its ongoing success.

Although specifically requested to be avoided - I will ignore that request and extend a HUGE Thank You for all the work you have done.


Without belabouring the point I echo the sentiments of the previous posts. Great job, sad to hear this decision.

I feel that this resource is valuable enough to our program as well as to our prospective colleagues that every effort should be made to keep it intact. I would propose at least one possible solution for the interim until Tarek is home safely and a more long term plan can be established…

If all the static information remains unchanged, I would be willing to take responsibility for the “critical” dynamic updates necessary to keep our beloved EMLondon up and running. Andrew, If you could show me how to upload the schedules, academic calendars, and basic upkeep, I believe we could at the very least MAINTAIN the excellent presence we (and by ‘we’ I suppose I mean ‘you and Tarek’) have worked so hard for.

I am not sure if this is a viable plan in your eyes but certainly if you are willing to act as a mentor, I would be willing to help.


A big thanks to you Andrew and Tarek for all your high tech contributions to our division…most of which I could never even begin to understand.

That aside, I completely understand why you wish to step aside, at least for now.

I think we should hire someone to continue to make our presence in the internet important and unique.

In terms of wants, I strongly desire that we will continue to have an online schedule system like Kitab. I find having my schedule on google calendar invaluable. I think it would be great to have the academic schedule also on google calendar. I did not know that was an option. I also find having resident/med student evals on line better than paper, as they seem less likely to be lost. Simple things like having limited use drug codes and billing codes are also useful.

In other words…I like what we’ve got and I think your suggestions for further improvement sound good - if we can find a “replacement”.


The work you and Tarek have so unselfishly and diligently undertaken with respect to EM IT is nothing short of astounding. You have produced a product that is contemporary, polished, practical and constantly in use. I have never logged in without having multiple other users present and active.

However, in spite of my complete ignorance of anything beyond the on/off button and most of the keyboard on a computer, I realize that the task you two are embroiled in is nothing short of monumental, your and Tarek’s modesty notwithstanding. But when you say it’s never about the money, I have to disagree. If financial planning and support is not commensurate with the magnitude of the job, then eventually erosion of goodwill and resources leads to a wall. The fact that we have two busy and dedicated PHYSICIANS doing all our IT work means that spare time is eaten into, family time is eroded, sleep is lost and 24/7/365 support cannot be sustained. Thus, with Tarek in prison and you having kids at home and neither of you getting the remuneration you deserve, it’s a recipe for disaster, which the loss of EMLONDON would indeed be.

You mention that you are not sure why medicine is so far behind in IT. The private sector spends money on IT with consultants on the payroll because they realize the immense advantage afforded by intensive and constant IT access. It makes them profits. Not so with publicly funded health care. However, for us as a group, the EMLONDON site is an invaluable time saver and a channel of communication amongst ourselves and the world around us. It is therefore worth something. It has a cost and we must decide if it’s worth it.

My thought is that we should get funds (from the hospital/university/EM group) to support an IT consultant who can take the majority of the work on and leave you and Tarek as managers. Even if we all chipped in a $1000 annually, that would generate close to $60K a year for such support. Is that enough? You would have to determine that. The group would have to debate and decide what it’s worth. I believe it’s worth throwing some money at this and make it sustainable with a system in place that makes it easy to pass this on to future generations of EM docs at LHSC.

Respectfully submitted,

PS Does our leader have access to this forum? Since, I believe this matter speaks to the stature and repute of this department as a whole, Gary should likely be looking at your letter and reading the comments. Plus he may have some purse strings to loosen.