Replies to This Discussion

Permalink Reply by Dr.Naresh Yallapragada on October 19, 2012 at 10:20pm

I disagree, Irrespective of the changes in Technology, Clinicians should make the minimum change in their approach to deliver Healthcare. If the Clinician is expected to move to a different way of working because the technology is better, it will again require a learning curve to be good at it.

As the standard phrase goes... IT  should fit into Healthcare and not the other way round.

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Permalink Reply by Chris Paton on October 20, 2012 at 1:07am

I think that sometimes the technology is an enabler of change rather than just an automation of a physical process or a way to improve efficiency. For example, the introduction of ultrasound technology offered physicians a way to significantly change the way they approach diagnosis and treatment of certain diseases.

However, for a lot of technology, I agree with you - the ideal is that the technology follows the clinical practice and not the other way round. We've just been having a discussion on twitter about this topic: https://twitter.com/mrcthompson/status/259012634475646976

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Permalink Reply by Mohab Maysara Abdelwahab Ahmed on October 20, 2012 at 1:39am

What if the clinical practice differ from physician to physician, and no clinical guideline followed in the clinical practice and no standard (as ICD10 ) is used. in this case technology will not only require to automate and enhance performance of clinical practice, it will be also required to fill the gap between physician actually does and the standards and guidelines.

We cannot automate something that is non-standardized non-unified, we have to fix it first. 

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Permalink Reply by Chris Paton on October 20, 2012 at 1:47am

This is a significant issue in many implementations. Often, there is no established evidence base to even create a guideline so a compromise has to be reached. If a large new system is being installed, it is sometimes more cost-effective to use standardised workflow templates that may or may not adhere to evidence based guidelines or be appropriate for the locality. It often comes down to a case of cost versus perfection.

The ideal world is that clinicians first establish up-to-date evidence based practices that are as efficient as possible using paper (or existing) systems and then migrate to the same practice using EHRs. The reality when time and budget constraints come into play may be different!

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Permalink Reply by Dr.Naresh Yallapragada on October 20, 2012 at 2:09am

Yes.. Until and unless we implement Evidence Based Medicine and adopt a standardized form of delivering care..any Healthcare IT application trying to adopt templates, work flows, care plans etc..will be difficult to achieve success..

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Permalink Reply by Chris Paton on October 20, 2012 at 2:14am

I think we have to do both at the same time. Iteration is the key - as we develop better evidence we should be able to upgrade the IT systems to include this. There are so many gaps in the evidence that we would be waiting forever to implement IT if we don't make a few compromises.

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Permalink Reply by Dr Lavanian D on October 20, 2012 at 3:32am

"changes in [Information] technology require clinicians to make substantial changes to the way they deliver patient care". This, regrettably, is what is happening today when it should not be so. 

Any changes in patient-care should happen only through peer review in the hands of clinicians and as per needs of patient care and safety - again as seen fit by clinicians.  IT is but a tool - and a tool is there help the physician, Making a physician make substantial change to his processes to suit the tool is nothing but a failure on the part of the tool maker. I have, many a time, seen a programmer throw in a ready made component into an app that 'roughly works' rather than precisely write code to adhere  to the required specs, exactly. Why? - because it is less effort, they say. It is never to be forgotten that a programmer works very hard so that the user does not have to!  It is this sloth, inadequate domain knowledge and perhaps commercial pressures that lead to "clinicians requiring to make substantial changes to the way they deliver patient care" to use the said tool. Truly a case of the tail wagging the dog.

So let me say it again - The most excellent technology is that which is extremely easy (for the physician ) to use safely and with the minimum disruption to his work flow or time.

Dr Lavanian Dorairaj

www.hcitconsultant.com

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Permalink Reply by Chris Paton on October 20, 2012 at 3:50am

Thanks for your thoughts Dr Dorairaj. There is always a balance between perfection and cost (or even laziness!) but we should certainly be striving for minimal disruption to workflow.

Do you think that educating programmers about 'evidence based medicine' would help them prioritise clinically designed pathways over solutions that are easier to program or implement?

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Permalink Reply by Ify Agholor on November 16, 2012 at 9:14am

I believe developing and IT tool for the user there should be collaboration with both parties from the onsets to determine requirements and what is expected and usability studies to determine it functionality but that is in the ideal world. The reality is that IT personnel are faced with a lot of constraints deadline, time, budget, lack of clear definition of what is expected, lack of corporation from clinicians, common excuses no time between seeing patients and discussing with programmers on the needs so the clinicians should not complain when the get programs that do not integrate with their workflow, it very crucial for the programmer to understand the manual workflow to be able to to translate this to computational codes, bearing in mind that there are some aspects that may not have direct translational. The programmer cannot achieve this without the willing corporation of the clinician.

Also lack of standards or clinical guidelines can be very frustrating for the programmers who spend hours to codify this elements until there is uniformity standards EHR integration and adoption would continue to be at slow pace and few facilities would be eligible for the meaningful act initiatives / incentives     

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Permalink Reply by Dr Jerry on October 20, 2012 at 9:37am

Ofcourse clinicians need to change the way they deliver patient care because technolgy will now enforce guidelines, give patients access to clinicians outside office hours, and across regional boundaries and demand more responsibilty

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Permalink Reply by Ify Agholor on November 16, 2012 at 9:19am

Technology is here to stay and the proliferation of the internet has made more widespread other industries has embraced the technology in almost all aspect of operation so why not healthcare Clinicians should embrace the way of things to provide a better improve quality care for their patients and increased patients safety as stated in the report "To err is human"

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Permalink Reply by Jarrold White on October 20, 2012 at 2:20pm

I would have to agree with Dr Lavanian D this is about the tail wagging the dog because the stakeholders want it that way. "Where ever there is a big pile of money, someone will figure out a way to get it" that's what I said about the "401K" retirement plans which started in the 1980's and thousands of people got robbed of their retirement. Now its about their information. I attended a meeting at a local college when I wanted to upgrade my computer education and the meeting was about this new thing called Health Infomatics. The sharing of information looked "cool" but I had a question the coordinator refused to answer; "What safe guards do you have for keeping the insurance companies from getting the health information and thus telling the doctors what they will ultimately do in their health care practices and who they will serve?" Are they (health care professionals) going to serve the insurance companies or any other big stake holders, or are they going to serve the clients who are at the mercy of the health care professionals? A system designed by big stake holders will not be the same as one that searches out the real not imaginary needs of the client's comfort, safety, and care. I want to hear what the clients have to say so the system can be designed right. This "Have to change right now" mentality is not what computer science is all about. How will this system serve the helpless with out their input? Is it the client comfort, care, and safety or the stake holder's comfort, care, and safety? One is the right way and one is the wrong way and there is no in-between because if there is there will be no information integrity for the helpless. I asked one of my instructors a question about being a good programmer because anyone can get "A's" on tests so he said,"If you want to be a good programmer you will have to be good at error trapping then you will be a good programmer". Eliminating or altering established program design is definitely an error. The clients should know who, when, why, where, how and what on a statement so they know their information is being used correctly. This none sense of needing to put a system online before it is ready is nothing more than a trap. Let me give you an example: Over twenty years ago the Department of Motor Vehicles hired programmers to install a system at a cost to tax payers of $27 million and on purpose they switched to the new system abruptly and this error in established program design cost the tax payers $60 million. The programmers knew there would be a lot of errors and a lot of overtime and money and the DMV and tax payers would be at their mercy. I wouldn't consider a system that wasn't working side by side with the system already in service for at least 3 years so it is known if the integrity of the system serves who it is suppose to. Information is money to some people so remember what Jesus Christ said,"You will know every tree by the fruit that it bares.

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