A colleague who is preparing university grant applications to fund his planned research in Health IT has recently challenged me to identify what I see as the value that can be derived from the implementation of Health IT. He is concerned that until a case is made that can be understood by laymen (read smart people who just know very little about the specific area) his job in obtaining funds will be harder as will my more general task of trying to sell the proposition to Government and other potential funders of investment in the area.
It considering the answer to the challenge it seems to me the best place to start is to consider what it is we want from an ideal healthcare delivery system. I would suggest the following are at the top of the desiderata:
1. The system should be safe and should not cause any harm either through action or inaction.
2. The system should utilise evidence of treatment efficacy and quality to guide patient care.
3. The system should be as cost- effective and equitable as is reasonably possible.
4. The system should operate as a supportive and interesting environment and be as stress-free as possible workplace.
5. The system should provide a co-ordinated seamless experience in managing a particular episode or care or illness with all those involved having the information they need to do their part without continued reference to the subject of care.
6. The system should, as a result of care delivered and with minimal extra effort, generate the information required to support functions such as academic and clinical research, post marketing surveillance of drug side effects, treatment outcomes, systemic system errors, general health system management and delivery of public health and bio-terrorism services and warnings.
If it is agreed these attributes are about right where the question to be asked is there Health IT in its generic form can make a difference.
Health IT can provide clinical decision support to those making the ‘life and death’ decisions and improve both the consistency and quality of the decision making – reducing errors of all sorts - saving both lives and money.
Appropriate use of Health IT can improve the accuracy of a clinician’s recall of a patient’s important attributes (allergies, current and past illnesses, medicines being used etc), ongoing clinical record keeping and in the process assist in the sharing of information between carers while also making available vital information for use in areas mentioned in point six. This is part of the importance of the electronic health record (EHR).
Health IT can assist in the increasingly overwhelming task of managing clinical knowledge and providing this information to those who need it. Increasingly the stream of information being generated by research and clinical trials is exceeding the capacity of clinicians to absorb the available information and to navigate available knowledge without help.
Health IT, as it has been seen to do in so many other fields of endeavour, can also replace much of the repetitive and drudge activities of the operation and delivery of health services. Service departments (laboratories, pharmacies etc) can be automated to maximise efficiency and quality of service, routine accounting and supply chain management can be optimised, photographic film can be replace by digital imaging improving both ease of use and eliminating film costs etc.
Health IT when combined with appropriate communication technologies can provide the information needed for safe consistent and properly co-ordinated care no matter where the patient is – from the surgery to the hospital to the home.
The combination of EHR technology and its implementation and use by the majority or practitioners, will provide the data-bases required to address the needs of research, management and all the other interests mentioned in point six above.
Of course there are potential risks, barriers and problems that need to be addressed. These include management of the security and privacy of identified clinical information, obtaining the proper levels of investment in appropriate technologies, having adequate trained practitioners to ensure proper system use, the proper allocation of the benefits flowing from Health IT deployment and use between all the stakeholders and having pragmatic standardisation of key areas of the technology to ensure effective system interoperation.
Nevertheless the benefits are demonstrable in all the areas mentioned above, have been proven to be there for the taking at a reasonable level of expenditure. All the risks are manageable and it is essentially just time to get on with it!
David.
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