It is clear that both internationally and in South Africa, the medical profession is adopting a bigger focus on medical information systems. There is a theoretical and practical need for the collection, analysing and sharing of patient information between healthcare practitioners, institutions and researchers. The big question is however “is the medical profession ready for it?” In our experience, the private sector is quite advanced from a readiness point of view, but the public sector, although in dire need of such information systems, is definitely lagging behind.
The development and use of informatics applications in healthcare offers tremendous opportunities to improve the sector, its delivery and outcomes. However, there are also vulnerabilities and problems related to the use of IT in healthcare, like the issue of patient confidentiality, for example. This is a key issue to be addressed. The dilemma here revolves around the fact that there is a fine line between what needs to be kept confidential and what can be used for research purposes, etc. The uncertainty around this issue is certainly not oiling the cogs for medical informatics.
When one reviews the relevant Gartner Hype Cycles around medical information systems, it is evident that there are many robust systems that can provide the healthcare practitioner and the patient with many benefits. There are however so many of these systems, they are still very expensive, and in addition to this many existing facilities, especially in the public sector, have multiple legacy systems. Throw all of these problems into one pot, and you have a quagmire that is both potentially expensive and even if implemented well, won’t guarantee success.
To briefly explain Gartner Hype Cycles: Gartner, the world’s leading information technology research and advisory company, has used Hype Cycles to characterise the over-enthusiasm or “hype” and subsequent disappointment that typically happens with the introduction of new technologies. Hype Cycles also show how and when technologies move beyond the hype, offer practical benefits and become widely accepted.
In the field of medical informatics, the hype has certainly not yet transformed into tangible benefit. In fact, the brief history of medical informatics is littered with horror stories of systems that were not completed, that ran ridiculously over budget, or that were not used by the primary population for which they were designed. Yes, there have been major evaluation studies of systems and experts have been studying the effect of implementing IT in healthcare for years. Yet, the majority of the medical informatics community seems to be either unaware of this phenomenon or uninterested in it. Given the magnitude of change represented by even the simplest information system, this lack of interest is perplexing. Perhaps it is because what they should be studying is not so much the hardware, software or system design, but the organisational factors and attitudes of people in the work place.
Irrespective of the technical nature of the package, there is always a huge element of human reliance in the whole process. The appropriate Stakeholder Management (SM) and Change Management (CM) is often lacking in implementations, which has a negative effect on success. Many implementations are completed “successfully” but due to a lack of SM and CM the users still run parallel systems, resulting in not all the functionality being used. Training levels are also hardly ever up to scratch. Negative factors like these lead to “change fatigue”, which does not bode well for future implementations.
Another issue is that when a new product becomes available it can seem attractive as something that could really add value to an institution. But – and this is a very big but – if it does not form part of an overall plan, commonly known as a Master Systems Plan (MSP), any good product can “feel” disjointed and counter productive. In many cases, implementations have been fairly successful but the downfall has been the support provided, whether in-house or external, after the hand-holding period comes to an end.
In conclusion, I believe that CEOs and IT managers faced with implementing healthcare informatics need a trusted, independent advisor who is not aligned to any specific product, and who has intimate knowledge of which products can offer the right solutions. And, more importantly, which products can align hospital-specific needs to specific products. In the public sector especially, it is mostly the softer issues, combined with affordability and a lack of an independent advisor, which are distorting the picture and opportunities in medical informatics for CEOs and other stakeholders.