HIT Doom and gloom is relative

In my entry “Interesting Times” I commented on an article relating to a review of information on Healthcare IT implementations and how they have not been as successful as many would/did imagine. It is not all doom and gloom in this area – there are many places where IT is making a difference in healthcare (both in expected and unexpected areas).

As with any literature review you should read as much as possible and make up your own mind. In my case I always go to the peer reviewed journals such as JAMIA or the Journal of Internal Medicine (JIM). The point below are taken from 2 articles that appeared in JIM earlier this year – the studies basically examined the relationship between improvement in clinical outcome and IT. They found the following: (quoted: Amarasingham et al, Arch Intern Med. 2009;169(2):108-114)

• a 10-point increase in the automation of notes and records was associated with a 15% decrease in the adjusted odds of fatal hospitalizations
• Higher scores in order entry were associated with 9% and 55% decreases in the adjusted odds of death for myocardial infarction and coronary artery bypass graft procedures, respectively.
• For all causes of hospitalization, higher scores in decision support were associated with a 16% decrease in the adjusted odds of complications

In an article that referenced Amarasingham et al the following, very telling point is made":

“…Another question is whether the negative consequences of implementing HIT in hospitals overwhelm or wash out the positive ones, as some have suggested. The article by Amarasingham et al provides additional evidence that they do not overall, although those who have emphasized the unintended consequences have made many valuable points about the importance of evaluating any new technology after implementation and making multiple changes to it—points that are all too often ignored…” (Bates D.W., Arch Intern Med. 2009; 169 (2): 105-107)

To me this last item says one thing, one very IMPORTANT THING:

When we look at anything it is best to understand where things work AND do not work and address these issues so that they do deliver. Fix it now before it becomes a bigger issue later.

No matter where you are in the healthcare area the one overriding factor is “How can we provide better care?”. Inevitably IT comes into the equation as a way to increase quality, efficiency and effectiveness and, inevitably, people start talking about EMR/EHR/PHR and systems in that vein (bad healthcare pun). But let’s look at something totally left-field, waste and energy management – which many might not consider IT to have an ability within and which many might not consider to be as important in affecting the quality of care as the EMR/EHR/PHR arguments and discussions we see bandied about.

In healthcare environmental wastage includes such things as organic and inorganic material. We chop bits off people and/or bits of things are used on those people – some things grow back

Everything in a healthcare environment generates organic waste; people bleed, cough, vomit, have bits removed, etc. In many cases these items are usually bagged to be disposed of later. Currently IT is not considered to enter into this area much but it is a prime point in the sequence at which to use such technologies RFID and barcode to track such bagged such waste.

Next, what about inorganic waste? – bits of things used on people. Many items, such as catheters and cannulas cannot contain either barcodes or rfid tags (for now). But it should be possible to use image recognition capabilities to track their disposal.

So what about environmental citizenship issues in healthcare IT? Now this may not seem like it, but it is something which is important when we think of such issues as the energy wasted by operating machines (such as computers).

This concept applies as much to the X-Ray machine in radiology as it does to the accounts payable clerk’s machine in the back office. If we can save energy usage we can save money and that money can be better spent in the service of care provision rather than being used up by the idle cycles of a computer. We, as in “IT”, are able to allow this redirection to take place using either software or hardware of a combination of both.

All this only demonstrates that there are core IT capabilities that healthcare can adopt directly but these adoptions might not be seen as directly influencing the delivery of care. The articles from many health informatics sources tends to look at complex cost-benefit that directly involves lives and limbs – which is important! – but they tend to forget the “silent majority” contribution of all those machines that go “ping”.

In much of these arguments we forget the simple truth – that IT does contribute to the saving of lives in a positive way right now…we may just not be looking in the right places or asking the right questions.