The use of IT in healthcare goes back many years. During the 1960s and 1970s, we saw a focus on using computers as a substitute for human labour. In the 1970s and 1980s, the emphasis shifted to more efficient processing, while in the 1980s and 1990s we saw information technology allowing us to engage in activities that would have been impossible with paper systems. At the start of the new century, we have come to focus on how to improve the quality of health care.
Ideally, our focus should be on building a health support system that includes not just technologies but, more importantly, values, practices, relationships, laws, standards, systems, and applications that support all facets of individual health, health care, and public health. A system that encompasses tools such as medical records, clinical practice guidelines, educational resources for the public and health professionals, geographic information systems, health statistics, and many forms of communication among users.
Today however, we have ‘islands of data’ about patients, unconnected from each other while there is still a dependence on clinicians to remember vast amounts of information. Healthcare professionals spend a significant proportion of their time on paperwork, yet that paperwork remains poor and prone to error. Clinical science continues to expand rapidly and there is a huge growth in knowledge, but not in the ability of systems to deliver high-quality care.
The health sector is lagging far behind others (banking and entertainment, for example) in adapting and using information technology for its own purposes. Use of information technology in the health sector has been evolving, but randomly and without a plan. Much more would be possible if all the capacities could grow in a coordinated way, guided by a comprehensive vision.
The concept of Electronic Health Records has emerged quite some time back, but only recently has it been put in motion by major government initiatives worldwide. The vision is to have a single record (as planned in England) or at least interoperability between multiple systems (as planned in the US). Real improvements in clinical outcomes and cost savings have been achieved; however, the Electronic Health Record remains our "Holy Grail". The focus needs to change from the healthcare record to using the record to support decisions and care delivery.
If the banking industry is able to successfully realize their/our Electronic Wealth Records, there is no reason why it shouldn’t be possible to "similarly" build and deploy the robust next-generation Electronic Medical/Health Records we all dream of.
Certainly, it is not as simple as replacing the ‘W’ with an ‘M’ or an ‘H’, but the main ingredients for success remain largely the same across different industries. There are many useful things to learn from the banking industry including focusing on information (not technology) and services to be provided with it, and ensuring perfect interoperability and extensibility of information services and their components by fully adopting agreed-upon industry standards and languages of communication.
We are in the Information era and past the IT era. We should think and talk about "services" and "programs" (focus on people, information and tasks) not "systems" and "projects" (focus on technology). Services should be information-driven not IT-driven. We must however not forget the issue of new technologies, both on the medical side, for example with the potential of proteomics and ‘designer drugs’, and on the information technology side.
We have known for some time that adverse events in healthcare result in a huge mortality; we now have evidence, for example, to show that IT systems are effective at reducing their occurrence. The Internet is also changing patients’ relationship to their health. One way the Internet may be particularly significant is as a possible technological solution for the Electronic Health Record. Internet Personal Health Records controlled by the patient may be the way forward, sidestepping some intractable issues around consent and confidentiality.
When it comes to security, privacy and confidentiality, it’s not a matter of ensuring 100% absolute security and confidentiality (this is impossible and can be handicapping, even in the banking sector), but of maintaining good balance between actual (realistic) needs, risks, costs, potential losses (including impact on reputation), etc. Banks were successful because they have focused on information and tasks to be achieved with it, employing technology to serve information and realize tasks.
Although it can be difficult to justify technology that provides an infrastructure and is transformative within a cost/benefit model, it is true that such technology can deliver huge cost savings in the end.
In conclusion, Electronic Health Records will continue to be a journey rather than a destination. We have a timely opportunity and an urgent need to build a 21st-century health support system—a comprehensive, knowledge-based system capable of providing information to all who need it to make sound decisions about health. Consumers, healthcare providers, public health professionals, employers, policymakers, and others recognize that ready access to relevant, reliable information would greatly improve everyone’s ability to address personal and community health concerns.
What remains to be seen is how fast we will go on this journey, and whether or not we will enjoy the ride. In any case, it will certainly be worthwhile.
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