What is the “it”, in Health IT?


Do we really know what we want, are we a seeking a solution to a problem we don’t understand?

In the last two weeks I have had numerous scenarios where some technology could have helped improve patient safety, reduce medication error and improve the quality and effectiveness of what I do every day.

Three examples come to mind from the last week:

The first is a simple allergy record of an elderly gentleman and nursing home resident of mine. He had an allergy to an antibiotic recorded in my notes, and in the nursing home notes ,but neither was available to another clinician in another entity who prescribed the drug and consequently aggravated his know allergy.

The second is a feisty elderly woman discharged from hospital whose medications were directly transferred to her pharmacist. The discharge changes never made it as far as my practice, nor did my changes make an impact on her medications list at the chemist. The end result was no one knowing exactly what she should be on, most of all her care team.

The third isn’t so much a direct care error, but a test I administered to a group of doctors about a rare disorder. Humans being well “human” look for patterns and familiarity, we see what is common. Three widgets of data in the test patient’s history ,when combined, give a clue to an unusual disease Plummer Vinson Syndrome.

While the medical students groaned and said it was a typical University case, the fact remained no one considered the diagnosis when it was one of the displayed options. Decision support and the meta-analysis of those Widgets of information could have expanded their differential diagnosis to include the rare or unusual conditions.

The debate around “eHealth” in Australia has been derailed by lack of understanding of what “it” is that we are talking about. In addition we have been focussing too much on technology, and its failings such as privacy, usability and most importantly relevance.

As a clinician I can see the value of sharing certain “widgets” of data with others, that I collect from my work with patients and their health maintenance.

Consumers believe that the eHealth record will see their whole medical story every consultation available on line transparently to be shared at their discretion; in fact most people I talk too expect that to be the case now.

Government sees the value of data that can tell them the state of health of the nation, trends in population health needs, priorities and opportunities for sharing with profit and non profit making entities. Big Data is Big Business.

Are we creating technological solutions that don’t fit with our biological needs?

None of us, it seems to me, can agree on what eHealth is and what it should be but we’re spending stacks of money on collecting data, investing in diverse siloed systems, and expecting users (be they clinicians, consumers or researchers) to work in ways that are not natural to the flow of human connection.

There is an urgent need to understand what the “it” is in eHealth, and to focus on what is important for the biological entity that enters data and derives benefit from the complex hardware that we are designing.

We need to be driven less by the WOW factor of the latest handheld device or program and more by the benefits that a nationally consistent eHealth strategy would bring.

There is a new conversation to be had, driven by consumers and clinicians, that defines what we’re aiming for when considering future investments in digital dreaming. More So that conversation needs to be grounded in reality by defining achievable, meaningful ,iterative changes that will produce visible positive health outcomes.

The key issue is defining a common goal that technologists can build the architecture to deliver.


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