The Voice of Management:
Holistic, human-factor approach complements health technology

The Voice of Clinicians:
Use technology more creatively to give governments in developing world a better chance to save lives

The Voice of the IT Professionals:
IT interaction and co-ordination puts professionals in charge

The Voice of Policy Makers:
Delivering the best healthcare beyond economic growth rates

The Voice of Industry:
Lowering costs and securing quality of healthcare delivery are the two biggest challenges

Conference and Exhibition Updates:
Summer Early Bird Deadline ends 30 June

The Voice of Management
Holistic, human-factor approach complements health technology

“Our unit of transaction is the human being in a social and cultural context. Excessive ‘automation’ of this concept can be very, very dangerous, and that is the challenge that the prevalence of healthcare IT poses.”

Dr. Mike Stein, chief medical officer, Map of Medicine and Informa plc, will be addressing this theme at World of Health IT conference in October, and, while he acknowledges the myriad advantages that IT has brought to the provision of healthcare, he is adamant that the best approach must be ‘holistic’.

“As the human being is a holistic organism so must the growing wealth of published and electronic medical record [EMR] – derived information be used within the context of the whole patient’s journey across the various care settings and specialty silos.

“A standard yet localizable structure is essential – a dynamic GPS system, if you like, for healthcare professionals, means that the introduction of new treatments can be monitored far more effectively than was previously possible. This also means that the patient and doctors have a greater ability to make an informed choice when it comes to treatment – they may be following a particular course, but can choose to go ‘off-piste’ if a better option becomes available. If the system is used as it should be, a platform for presenting knowledge, means that life-saving innovations can also be more quickly and safely implemented, making 17-year delays in the introduction of treatments, such as was the case with Barry Marshall and Robin Warren’s Nobel Prize-winning research that ulcers are caused by Helicobacter pylori bacteria (which initially met with great scepticism when first published in 1983), a thing of the past.”

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The Voice of Clinicians
Use technology more creatively to give governments in developing world a better chance to save lives

Dr. Sally Stansfield is executive secretary of Switzerland-based Health Metrics Network (HMN), a global partnership that works to improve health and lives by strengthening and aligning health information systems around the world. It is founded on the premise that better health information leads to better public health decision-making that will improve health for millions worldwide.

For Stansfield, technology’s impact on healthcare delivery, while having made remarkable progress, is still to be properly felt where it’s clearly needed the most. For her, the goal is clear: “It’s obvious that the world has not yet achieved the task of harnessing technology for the health benefit of developing countries,” she declares.

“We have a huge opportunity to use technology more constructively and creatively, to really get off the starting blocks.”

Stansfield says the great gaps in technology that exist throughout the developing world limit the level of understanding health leaders and governments have into the actual health of their people.

“Without the tools to know what is killing or making their people ill, governments do not have the ability to plan and implement the most essential health services to care for their citizens,” Stansfield explains. “This is where HMN is starting from. We work to arm governments with the correct means to enable them to collect, analyse and use information on their people to ensure better community-wide health.”

Communication is key: “Sure, we have the emergence of cell-phone technology, for example, for the transmission of critical information, such as outbreaks of disease or the logistics of medical equipment transfer, but the basic connectivity of health IT, which is taken for granted in the West, is simply not yet being achieved in rural communities in the developing world.”

“It’s such a terrible waste that it all seems so separate, when there is such a chance for education to link the people in these communities who have very good technology experience, who are adept at creating the right software, to better manage clinical care. The solution seems simple, of course – we need better basic standards in place to exchange information better. Once we have cleared that hurdle, the benefits of connectivity will begin to fall into place. Better information will mean better decisions and better outcomes for health. But it’s a big first step.”

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The Voice of the IT Professionals
IT interaction and co-ordination puts professionals in charge

“In a medical centre,” says Santiago Marimon, director of the Shared Electronic Healthcare Record program (SEHR) in Catalonia Health Department, “there are many professionals such as nurses, doctors and resources such as x-rays, gym, rehabilitation unit. All of these play a defined role in the organisation of any department where they are included. The co-ordination between different departments in the same hospital or between different hospitals is therefore vital, which is why the problem becomes more a question of the EHR system than the technology.”

“To be able to contrast information quickly enough, to gain understanding of the situation at hand at the right time, that’s key,” Marimon continues.

“There are three kinds of interactions to co-ordinate: human-resources, resources-resources, and human-human. This co-ordination has temporal constraints that must be considered.”

“SEHR systems provide healthcare professionals with access to most of the mentioned documents as part of an electronic medical patient record, to record data, or to allow the creation of new documents. Consequently, applied medical informatics research could ensure/improve efficient, medically advanced and yet affordable future healthcare systems.”

Another key goal, as Marimon explains, “is to make the step forward and provide real co-ordination and co-operation between humans and medical services using guidelines (GLs). In order to achieve this goal, we need an architecture that defines several kinds of agents and their roles.”

“From a healthcare perspective, it is difficult to gain consensus on how this can be achieved. But that is what we are here for – and impatience will serve no one’s interests, not the doctors, technicians or patients.”

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The Voice of Policy Makers
Delivering the best healthcare beyond economic growth rates

Martin van Rijn, director-general of healthcare at the Dutch ministry of health, welfare and sport, is clear about health technology in the Netherlands: "IT is a big issue. As a result of national reforms, most Dutch primary care groups have begun using electronic patient records.”

Again, centralisation seems to be the perceived key in moving from the planning to the implementation of healthcare ICT projects: “We now want [the records] to become interoperable with pharmacies, hospitals and clinics," Van Rijn explained.

In his WHIT07 lecture, Van Rijn intends to focus on the necessity of innovation and IT in healthcare. Not only technical innovation, but also process innovation and the importance of improvements in labour-productivity.

“The relationship between IT and the common challenge in almost every Western country is the key issue facing every health-care professional. How to accommodate rising demand for healthcare and growth rates in health expenditures that go far beyond economic growth rates, while maintaining or even improving quality?”

“Primary care systems across the globe are in the midst of significant changes in the areas of IT implementation and investment - the Commonwealth Fund 2006 International Health Policy Survey, which was announced on 2 November last year, featured the United Kingdom, Germany, the Netherlands, Australia, New Zealand, the United States and Canada, in an effort to identify the nations that lead and trail in primary care.

“The success of a country’s IT implementation was one of the key factors determining the gap between nations with overall high performances and those that did not score well. In fact, the survey identified The Netherlands, United Kingdom, Australia and New Zealand as leaders in primary care – and these all have well-established, burgeoning IT implementation.”

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The Voice of Industry
Lowering costs and securing quality of healthcare delivery are the two biggest challenges

For Germany-based Dr. Balazs Szathmary, EMEA Healthcare and Life Sciences director of strategy and operations and Health Information Network Europe (HINE) member, the emphasis is on speeding up the implementation of healthcare IT projects, which he feels has been “relatively slow in the EU”.

Having said that, Szathmary understands the problems thwarting health IT investment: “Healthcare IT projects are frequently under-budgeted,” he says. “Justifying IT investments is trickier in the hyper-linked western world because it is not easy to show where the money is going. It is simply not as ‘visible’ as with projects into healthcare infrastructure (hospitals, equipment, people) in the Middle East or African continent, the affects of which are usually immediately noticeable.”

“Because the approach in European countries like Germany or Netherlands is frequently decentralised,” he adds, “centralisation would appear to be the cure – France is more central, as is the UK, but an IT reorganization of a complete national HC system is very challenging, which is why a good median regional approach seems to be the best one, as has been adopted in the Nordic countries, Spain and Italy. By sharing collective knowledge, expertise and resources, we can help to develop community capacity and support effective community strategies.”

“Lowering costs and securing the quality of healthcare delivery are the two largest challenges of our health system. IT concepts of sharing standardized medical information towards the holistic support of disease processes can lead to the improvement of quality with simultaneous cost reduction. That is what we must aim for.”

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