The Voice of Management:
How ICT can monitor the dispensing of drugs – and the saving of lives

The Voice of Clinicians:
Seamless info flow is key to success of ICT in improving patient safety

The Voice of the IT Professionals:
Why ICT must think locally as well as thinking big

The Voice of Policy Makers:
Globalisation can help ICT help healthcare professionals help themselves and patients

The Voice of Industry:
The ‘Big Bang’ in Salzburg – a holistic and integrated 'super-system'

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The Voice of Management
How ICT can monitor the dispensing of drugs – and the saving of lives

How will the increased reach of ICT affect the multimillion-dollar pharmaceutical industry? Per Manell, MSc, is a major player in Scandinavian pharmaceuticals, Director at The Swedish Association of the Pharmaceutical Industry, and owner and founder of Pharma Forte, a company offering IT solutions to the drug industry and a member of the International Federation of Pharmaceutical Manufacturers, is bullish about the role ICT is likely to play in his industry, with the care of patients paramount among his concerns.

ICT, he feels, will do nothing but good for his own industry, for healthcare professionals and above all for patients.

More specifically: “As far as I am concerned, in terms of improving patient safety, our main focus is on the use of medications by the elderly, to be used by the staff taking care of the elderly, and to provide a set of controls.

Says Dr Manell: “Different symptoms and complaints mean different medications and these offer different dispensing opportunities. However, mistakes regularly occur – often, the risk is that a patient accidentally takes, or is prescribed double the dosage of, say, a hyper-tension drug, which can bring collapse or even death.”

“This happens regularly – between 10-20% of emergency attendances are caused by medical errors involving the elderly.”

Where does ICT come into this? Dr Manell looks at it from a logistical standpoint: “There are several thousand different brands of drugs, such as sleeping pills,” he explains, “so access to information, for patient and pharmacist, is obviously essential.” Fast and easy communication of information on drugs dispensed is central to Dr Manell’s view of how ICT can enable this better understanding of needs by both parties. To this end: “The increased use of personal digital assistant (PDA) technologies is also providing easier access to complex drug information via wireless network access – a service that needs to be extended 24/7.”

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The Voice of Clinicians
Seamless info flow is key to success of ICT in improving patient safety

Dr. Ursula Hübner is a professor in Healthcare Informatics at the University of Applied Sciences in Osnabrück, Germany, where she has been working, in the Department of Business Management and Social Sciences, since 1997.

Her research focus seeks to optimise healthcare through open networks, in particular the internet, including eProcurement and eLearning. As a member of the management advisory board of several firms in the eHealth sector, a faculty associate of Johns Hopkins University School of Nursing, Baltimore, she is well-placed to assess the benefits that ICT is bringing to patient safety.

“It’s all about increased transparency and visibility,” she explains. “The ever-increasing access for clinicians to information databases means that the mistakes borne of the arduous processes of the ‘paper age’ are far less frequent. Phone calls to other clinicians, paper records – whenever a patient’s health care provider changed, there was much manual checking and verification that had to be undertaken. Now, a clinician, when taking on a new patient, has access to a much more reliable online source of information, provided by the patient’s previous health care providers.”

“The clinicians simply have access to a far larger body of information on which to rely, and the constant improvements in ICT are all about the seamless flow of information, with all responsible practitioners being in close contact at any time.”

And a practical example? “Take medical expiry dates. Databases have largely made errors in this area a thing of the past – quite simply, clinicians now have far more immediately accessible knowledge on the tools with which they are working. And that can only be for the good.”

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The Voice of the IT Professionals
Why ICT must think locally as well as thinking big

After 23 years as a current affairs broadcaster in New Zealand, Earl Mardle moved to Community Access Radio and was asked by Wellington City in 1996 to establish the 2020 Communications Trust, which has since grown to a national organisation with multiple affiliates through the country.

He is now an independent consultant living in Sydney, Australia, where he has worked for AUSAID, The World Bank Development Gateway, Jhai Foundation and Bearing Point. He has also been involved with UNESCO and Action Aid India.

Earl Mardle has a strong focus on the ethical issues raised by globalisation. Most of his work in the past decade has focused on providing access to information technologies to underserved or specifically excluded communities. Since 2000 he has taught eCommerce at a variety of educational institutions in Sydney, Australia and is the Information Manager and Project Support for the Stockholm Challenge Award.

As an information-society consultant who deals with the effect and use of information technology in organisations and the broader community, according to one of his clients quoted on his website, Mr Mardle is a “global thinker on the ethical issues raised by globalisation”.

As he explains: “The vast majority of human communication takes place both in our local language and within a fairly small geographical horizon within which our most important social, economic and political activity occurs.

“The technology is able to facilitate, accelerate and archive that communication for many purposes, most of them benign.”

But while Mr Mardle is a great enthusiast for using information technology to improve lives, he sounds a note of caution to avoid seeing ICT as a panacea and outlines key issues that the industry must address.

He continues: “Information technology will only do that effectively if it is available to people when and where they need it.”

He cites an example. “Walking 5km to a telecentre is not the answer. Also, IT or ICT won’t work if people have an interface that they are comfortable using. For example, if the interface doesn't support non-literate users it will fail. IT interfaces above all must be in a language that makes sense to users. Local interfaces for local people must be in a local language.”

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The Voice of Policy Makers
Globalisation can help ICT help healthcare professionals help themselves and patients

ICT’s reach is increasingly global, and that can only be a good thing, says Dr Jean-Claude Healy, who as well as being a Director in the ADG’s office of WHO’s External Relations and Governing Bodies, is Senior Advisor of UN GAID (Global Alliance for ICT and Development) in New York, USA, a body for the promotion and development of ICT across the world.

He is vocal on the issue and the benefits that ever-wider dissemination of ICT can bring. It is not, he insists, something that one should necessarily equate with affluent western societies.

“As e-health is increasingly affected by globalisation, it means that the information and technology is increasingly being disseminated without hindrance, which is all for the good,” he says.

He raises an important issue about globalisation and ICT.

“Previously, technology was very expensive, but the prices worldwide are now falling all the time. Now, there is international access to information through facilities, through infrastructure and, most importantly, through user acceptance! Users are enabled to be proactive in their search for quality healthcare.” This then enables both professionals and patients to enjoy the benefits of e-health, no matter where they might live or what their material circumstances might be.

This spread of ICT and the subsequent depression of ICT prices have implications for both rich and poor countries. As Dr Healy continues: “The European Commission in Brussels and the WHO are very much in favour of promoting e-health issues.”

There is therefore a democratic angle in play here, as Dr Healy suggests that ICT can improve e-health for all.

“ICT increasingly offers all health-care professionals the chance to learn from mistakes, to improve on the quality of care offered, and the methodology of assessments, as well as facilitating the ease with which patients can access second opinions.”

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The Voice of Industry
The ‘Big Bang’ in Salzburg – a holistic and integrated 'super-system'

“Picking up the pieces was daunting, but we have proved that we can; the number of databases and subsystems that we had to address in order to achieve a holistic single system was mind-boggling.” So says Markus Schwarz PhD, MBA, the Administrative Director of the Institute of Public Health at Paracelsus Medical University, Salzburg, Austria.

He is referring to his institute’s efforts to fully integrate a series of its ICT networks into one giant co-ordinated system, and he will expand more fully on the topic at this October’s World of Health IT conference.

As Schwarz explains: “We are at a stage where the technologies available to us are ‘coming of age’; hospitals were at first very reluctant to change systems already in place.”

At Paracelsus, this reluctance seemed old-fashioned when such giant strides are being made in ICT and their answer was an undertaking on an enormous scale.

“We decided on an ‘Implementation of a fully integrated Hospital Information System (HIS), Radiology Information Systems (RIS) and Picture Archiving Systems (PACS)’.

It was an approach that was dubbed the ‘Big Bang’ at the Paracelsus University.

Schwarz makes no excuses for either the size or the ambition of the task but is robust in his defence of it. He also is not shy in pointing out the difficulties encountered by his team to better encourage other institutions to try a similar ‘holistic’ approach.

As he points out, the ‘Big Bang’ approach raised many questions and initiated much constructive discussion, not least about the role of patients in the integrated technology.

He told us, “among the issues raised by Paracelsus’s 'Big Bang' was the question of access to data. This is obviously going to be something of great concern to patients. After all, in this giant system, who exactly has access to what data?”

There were inevitable logistical difficulties but now Schwarz is cautiously confident of the project’s long-term success. As he puts it: “It was impossible to identify with many systems, but now we’re fairly comfortable with it.”

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