Tgk1946's Blog

John Halamka writes about his New Year pledges, in his journal Life as a Healthcare CIO. They include, at Number One:
Use all my skills to support EHR change management – it’s very clear to me that many clinicians do not want an EHR. Meaningful use is an incentive, but many clinicians remain unconvinced that EHRs will save time, improve safety, and enhance their practices lives. They want to be implemented last in any rollout.
Halamka and his employer have been at the leading edge of e-health for decades, so this admission of failure is stark and has profound implications for the development of e-health in Australia.

One of the root causes of Halamka’s dilemma is, certainly, the matter of professional knowledge. All crafts (in the most general sense) harbour and nurture specialist knowledge, and in that possession is great power. On one hand we want our specialist clinicians to flourish in environments where they can share essential data and innovations with each other, but we recognise that silos work against the public interest and contribute to perverse outcomes including corruption. So, e-health must include tools that increase the capacity of clinical specialists to do their best. It’s possible that if e-health attracted the goodwill of the most entrepreneurial of our clinicians, then some of the influence of third-party lobbyists will be neutralised. That would be a boon for good governance across the board.

Predictions for 2010 and beyond.

• Safety and quality in niche areas will be improved with the use of check-lists. (See review of Atul Gawande’s “The Checklist Manifesto” at New York Times, free registration required to view).
• More evidence will gather that clinicians, especially nurses and doctors, abhor form-filling of any type, paper or electronic. Listen to podcast of interview with Rob Schuurman of Nedap Healthcare, telling how they have thousands of home-care nurses using smart-phones to keep track of their work, without entering data by keyboard.
• Some silly clinicians will try to get around multiple logins by using OpenID, or similar, only to find that pathway is blocked by systems administrators.
• Clinicians will be using 2-factor authentication over the web to manage their finances, and new mobile technologies for their purchases, while they continue to accumulate logins and passwords to gain access to their multiple platforms of clinical software.
• Despite the best intentions (and PR spin) of the Victorian Government, commuters with smart-phones are likely to use Twitter to make or break the new Myki transport ticketing system in Victoria.
• Similarly, front-line actors (clinicians) will probably find ways, through social media, to inform the public about the good things that are happening in health care. Here’s a trivial example from an observer, posted at Posterous.
• In the absence of a central clearing house for e-health, we will have more gee-whiz promotions thrust at us by eager proponents. A couple of campaigns ago, Steve Bracks, then Premier of Victoria, told voters how tablet computers would do wonderful things in acute care settings. It’s not likely that many busy clinicians have fallen in love with tablets, but it would be interesting if the results of that pilot program was published. It will never be, of course, and the next generation of tablets will find equally enthusiastic followers.
• Main-stream media, dependent on advertising, will promote electronic gadgets if they look good and new.
• Powerful media conglomerates will continue to publish wayward opinion as if it is fact and shirk the responsibility to critique their chosen experts. An article in The Australian newspaper, Swine flu was less severe than the seasonal sniffle, included an extravagant statement from Ed Kilbourne, emeritus professor at New York Medical College and influenza expert.
  “Hand-washing does nothing to curtail the spread of influenza but it may be a good substitute for hand-wringing.”
  There ought to be a standing court or panel of local experts to analyse and publish assessments of opinions like that, which could undermine efforts to improve general hygiene. As things are, it’s more likely that counter movements will be mobilised through social media.
• More instances of loss of highly sensitive personal health data, on USB sticks and portable storage devices, by eager researchers will provoke vain threats from managers; it will eventually dawn that health data will be best managed in “the Cloud”, accessed via tightly controlled authentication protocols, with severe penalties for transgressions.

Lastly, a hope that IBM didn’t totally abandon Oz e-health about five years ago, that the company is marshalling its strengths and innovations around the Pacific. No States to do battle with in NZ. If NSW can be different, by not mandating reports of Campylobacter (PDF OzFoodNet Quarterly Report: Methods), then it will be a long time before the States agree to common standards and structures for e-health.