Tuesday, March 20, 2007

HC2007 - Strategies and technologies

The day closed with two good presentations. Justin Keen, Professor of Health Politics, Institute of Health Sciences, University of Leeds, posed the question 'Is an IT strategy possible?' He began with the premises that IT programmes have myths surrounding them, that are often not examined in a systematic way until things go wrong; they persist because we have so little rational evidence, but are often based in gut feelings. Some of the myths he posed are that electronic services will save money, improve patient safety, will enable joined up government, and that they will transform healthcare – but he says we have no evidence base to support any of these. He asked why this keeps happening, especially in regards of IT in healthcare. Among possible explanations we could consider, which may or may not be correct, he suggests, might be that the sector is immature, or that the research community is useless and cannot produce the evidence, or that the government has some kind of dastardly plan. Alternatively, he asks, does the status quo still suit too many groups?

In looking at what might be done, he suggests, as part of a move towards an evidence-based debate:
1.need for a sophisticated response to wider NHS policies
2.need to account for ways in which services currently work, so what might be transformed (eg how exactly does patient participation work?) ask what are alternatives to current government policies.

In answer to his question, he says 'yes' – if we generate evidence to puncture myths, if we are seen to develop plausible alternative policies, and if we remember that the world was not perfect before NPfIT.

Jonathan Kay, Professor of Health Informatics, City University, London 'Using everyday technology to challenge clinical boundaries'. In a thought-provoking session, he asked some of the 'blindingly obvious' questions that the health services seem not able to address. He asked why do we not pick up on common everyday technologies, such as entertainment and commerce? The technology of ecommerce involves personal computing devices, web architecture, email architecture, enhanced telephone technologies, and barcodes (for autoidentification). These technologies work because they are mature commodities, often non-proprietary (but based in standards), and have easy entry, low training ans switching costs, and high rate of change of functionality – but often same technologies for multiple purposes. But in healthcare there is often slow adoption, resistance to adoption, and structural bias in ICT departments against new technologies. He suggests there are far too many gateways and firewalls in the NHS, and too much use of proprietary implementations. He demonstrated benefits from his work in Oxford on barcode systems to ensure correct blood administration to patients. He suggests that patients and staff are familiar with uses of mature technologies, and that their use in healthcare could provide the same benefits as are seen in other domains, including trapping and preventing errors, instead of simply recording them.

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