I talk to a lot of IT people and clinicians in my travels and it would probably come as no surprise to anyone in the field of Health IT that clinical people and IT people do not regularly see eye-to-eye. What surprises me is the (often) level of underground animosity within the 2 groups for the other side.

From a clinicians point of view they feel they are pulling IT to give them what they ask for, a bit like this:

…and they would be right. In many respects clinicians are always pulling IT to give them what they want. From a clinical point of view each doctor has individual requirements that IT needs to meet. These requirements cannot easily be met by monolithic applications in which one size (in this case UI and workflow rules) fits all – but essentially we end up with “one size fuds all”. Over time clinicians compromise because the computers cannot and everyone ends up with something that was not exactly what was asked for in the first place.

From the IT professionals’ point of the feeling can be represented as follows:

…and they would be right. In many respects IT is always pulling Clinicians to give them systems they ask for. From a technical point of view clinicians are way behind the times. There is a common understanding that healthcare is 10 years behind the times – and IT is very correct in this – but there is also a frustration that Clinicians keep on changing the goals and this is not how computers work (in the view of many technologists, but not the one writing this article).

It is clear that neither side is wrong and neither side is right either. (This is another reason we need “Degrees of Success” in looking at Diffusion of Innovation (of IT) in healthcare.) But what neither side realises is just how alike they each are.

So what is actually happening here? All this is IMO of course I have nothing to back this up…yet…let’s look at what is really occurring here.

If we place an independent observer at right angles to the clinical and technology spheres and ask them to observe/analyse IT/Clinical spheres objectively they may see the IT view of clinical aspects of HIT projects in this way:

There would be 2 distinct areas of attribute; the observable and the underlying – in many respects we could also call these the tangible and in-tangible aspects of clinical practice review. The observable aspects include such things as the people, their processes, the patient throughput, healthcare budgets – the “Evidence”.

What the observer does NOT see are the Underlying aspects; the Beliefs, the attitudes, governing philosophies, work practices and “Why clinicians do what they do and are as they are” (by the way, I am quoting from Professor Jeffery Braithwaite (UNSW) 2009). In essence the “Underlying” aspects are those which make the clinical culture “The Clinical Culture”. They make healthcare; Healthcare.

Then, when the same person looks at the clinical view of IT they would/could see the following:

Here too there are 2 distinct areas of attribute, as with the IT view of clinical aspects. the difference here is that it is IT looking at clinical.

An Observer would see the User Interface, the complexity, the lack of “What I asked for”. What they would not see would be the cost benefit analysis, the requirements gathering, deployment planning, support regime, rule analytics, business process analysis, the need for a single sign on the need to have a master patient index, the connections to allow data interfacing with other systems, and so on.

So really all each group sees of the other is the observable and the observable is the shallow end of the pool or, in the case of the above examples, the tip of the iceberg or the rear end of the donkey…

Is it sad that when it comes down to the wire that one of the things holding success in check is the lack of trust and communication between the 2 core areas of human integration? At least I think it is.

If these 2 spheres of people could just come to respect each others’ abilities it just may be that we could get much more HIT to WURK.

(I have been known for my unbridled optimism).

..oh, look kids, it’s an animal of porcine persuasion in aeronautical configuration!