Some of this is from a talk I did recently in an APAC country. The discussion was very lively and interesting and I got grilled with many aspects of what was discussed. For those of you that attended THANK YOU! and I look forward to more discussion and your insights on these subjects.
In the sciences we need to be able to define something so that we can measure it, so defining what we mean when we say “Healthcare IT” is important.
The term “Healthcare IT” is actually 2 aspects of a single concept and the questions we need to ask are: “What is Healthcare?” and “What is IT?”.
So, what is Healthcare?
Is healthcare about the patient? The immediate answer for many is that “Yes, Healthcare is about the patient”, but I would suggest that “healthcare could be about the doctor – without them there would be no data collection or healthcare system – but what about nurses? Are nurses what healthcare are all about? What, then about hospitals, clinics, GP practices, Money(?!?). Where do Subjective and Objective care practices fit into all this? What/How exactly do we define healthcare? Encarta says that the term “healthcare” means:
the provision of medical and related services aimed at maintaining good health, especially through the prevention and treatment of disease
But this, as with all the definitions I have found, is too limited a definition in my view and for the purposes of this discussion not nearly accurate enough to base any form of measurement on. Overall finding a definition of health to measure is confusing. and, other thing, measuring the success of “aimed at maintaining good health” is so subject as to be irrelevant for a comparative purpose based on current definitions of what constitutes success. As I will present later – there are no failures in healthcare IT, only successes
And what about IT? Is IT about the programs/applications? Is it about the devices or the networks or the information exchange?
When it all comes down to the wire:
WHAT EXACTLY GLUES HEALTHCARE AND IT TOGETHER TO CREATE “HEALTHCARE IT”?
Well, my view is that people (not the integration technology) are the glue of “Healthcare IT” and to have a clear view of the definition of “HIT” we need to look at the constituent human entities that make up the Universe of Healthcare IT.
I think the [Scientific] definition of Healthcare IT should be along the lines of:
The measurement of interaction of human entities (including groups) as interfaced across the healthcare continuum and leveraging IT.
Healthcare IT is the result of the intersection of these 2 primary groups of people creating some systemic solution to a stated issue within the clinical space through an IT medium.
Part of the problem with the current definitions of Healthcare IT is that they pay too much attention to one or the other areas. In the USA especially (and in some private institutions around the world), when I speak to IT people there, I hear that IT takes the lead – hence I find that there is an “IT-bias” in healthcare IT in several USA/Private centric cases. In other countries where public health is at greater effect I am finding that there is a clinical-bias to healthcare IT.
(I am also noticing that I write “Healthcare IT” as “healthcare IT” more often than not – showing my own subconscious bias, perhaps?)
It may be that such [subconscious] biasing aspects of the human entities is effecting the success rate of Healthcare IT implementation. (THERE! caught myself!)
If you can accept that Healthcare IT is about people and not [so much] about technology and clinical process then new avenues for investigation and mitigation are opened. (and some interesting questions can be addressed).
One key area of investigation I am pursuing is how to define success for Healthcare IT implementations.
None of this is formalized research. Everything we are about to discuss is from informal questions and responses from clinicians and IT people across APAC.
Now I have a broad academic focus in the work I do. More precisely, I want to understand Healthcare and the application of IT in Healthcare from a scientific perspective and apply that to strategic projection of IT use in the Health sector.
I have found that, in many cases, one cannot any term to describe HIT implementation except “Success” no matter if the delivery did not produce the expected outcome (be it for infrastructure, policy, applications, …).
It is for this reason I would like to introduce the concept of “Degrees of Success”.
HIT projects are usually small and individual – reflecting the nature of clinicians (especially doctors) and their work practices (tribal). They usually do not take into account broader strategies that have long-term issue resolution in mind and they tend to be abject “Successes” – no matter what happens in their final deployment.
Each project that is delivered usually has a list of items in-scope that are to be present in the final deployment. They also have a budget to be spent against the deployment and a date of release. In some cases there may even be a list of attributes that constitute a successful deployment (“reduced number of incidences of Gnats”, for instance).
While there have been some efforts academically to define a framework for the measurement of HIT implementations I find that these papers too be removed from the reality of cross-environmental deployments I have investigated. Deployments in healthcare of IT tend to be subjective in nature and cater for minority (interest group) requirements in many cases. It is not that this is bad (imaging having an Oncology system developed by a specialist in Podiatry) it is just that they may not be appropriate to use in other areas.
But this is not the problem we face in HIT. I think that the problem is measuring the success and being able to find a way to compare such measurements.
It is for this reason I started to look at implementations using a concept derived from Diffusion of Innovation (Rogers E. 1997) which I currently term “Degrees of Success”.
To my way of thinking each deployment has individual [subjective] criteria that make it (in the minds of its participants) a success – and no-one can say otherwise… :) If this is the case then each deployment of a HIT solution has a set of attributes it needs to achieve which constitute success. These attributes are usually part of the initial scoping exercise and consolidation of any scope creep that may occur.
If we us Adoption/usage of a deployed HIT solution as an absolute measurable factor we can review in any deployment (I am not normalising for forced v.s. absorptive adoption/usage) and look at the uptake OF ATTRIBUTES then we can do an easy calculation of the degree of success at the point of environmentally attributed success.
What this means is that nothing ever fails – it succeeds with zero (0) degrees – it just “WURKZ”