Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Health informatics, changes and beyond!
- Dr. Naseem A. Qureshi, MD, IMAPA, LMIPS (17 May 2004)
-
Do doctors fear new technology?
- David Topps (23 May 2004)
-
Patient Care Barriers
- Maura Murphy, Prescot St, Liverpool, L7 8XP (26 November 2004)
|
|
|||
|
Dr. Naseem A. Qureshi, MD, IMAPA, LMIPS, Medical Director [A], Director, CME&R Postcode 2292, Buraidah Mental Health Hospital, Saudi Arabia
Send response to journal:
|
Sir: Prof. Nancy M Lorenzi suggests transtheoretical model, still in use in the treatment of patients with drug addictions, as an example of how effectively to bring technological changes in health care delivery system. She further expands on this model's five stages/phases, which are pre- contemplation, contemplation, preparation, action and maintenance. Clinical wisdom suggests that a proportion of addictive patients shuttles between these phases and never reach the phase of action or maintenance. However, even if some of them reach the manitenance phase, the reported relapse rate is very high during this phase meaning thereby that some but not all the patients with addictions return to square one. Similar possibilities may crop up when electronic changes in health care are introduced rapidly without addressing the interests and opinions of multiple partners in delivering health care to the consumers. I personally suggest that ehealth care changes should be introduced slowly in phases where medical and paramedical staff must prepare themselves well to take up such challenging new tasks based on health informatics and likewise patients should be familiarized with health related information technology and its useful applications in the medical fields. I would also warn the concerned health planners and managers that the maintenance phase of electronic health delivery systems would be the most difficult to sustain. Reference: Nancy M Lorenzi. Beyond the gadgets. BMJ 2004; 328: 1146-1147 Competing interests: None declared |
|||
|
|
|||
|
David Topps, Assistant Professor University of Calgary, Canada
Send response to journal:
|
Richard Smith, in his editorial in this issue, points out that medicine has been the last of the major industries to adopt information technology. Professor Lorenzi, in this article, shows us how to think about the stages of change in adopting new technology. But this leaves me with the unsettled feeling that they are both still subscribing to the view that doctors' fear of new technology is the major barrier to its implementation in the medical arena.
A decade ago, the technology was clearly not up to the task of efficiently handling the complexities of the medical record but in the last few years, I increasingly hear vendors of medical software proclaiming that software and hardware are no longer the barrier. Indeed, I embraced this view and used it as a carrot to entice my colleagues into taking on this challenge. Now that we have gone through the process, and looking back on the enormous amount of time and effort that we spent on just the issues of change management, it is clear that the information flow in the average doctor's office is far more complex than most information system architects realise.
From this statement, you might surmise that we are not happy with our clinic information system. Far from it, we are very pleased with how our staff, students, teachers, vendor and IT support staff have all worked wonderfully together - it has been a very smooth transition with 100 users going live across 3 sites simultaneously in our academic family medicine clinics. But as we start to explore the capabilities of the system and where we would like to go, it has become clear that our information processes and flow patterns have a complexity that is staggering. No wonder it was so chaotic before. Our new information system has made a huge difference but we obviously have a long way to go.
I have also been involved with the transition of our hospital information systems in Calgary to something that is more appropriate to this millennium. Indeed, with our previous system that was designed in the late 70's, there was a sense expressed by one wag that maybe it came from not one but two millennia ago. Its ugly cranky character-based interface, shoe-horned into Windows, was a nightmare in interface design. And yet, to my dismay, on asking about the apparent lack of progress in this area, I was reliably informed that this was one of the few truly reliable and flexible hospital systems out there. More recent candidates were not able to cope with the complexity of the information flow. Interface was not everything. Happily, we are now well on the way to introducing a flexible and speedy system, with an interface that will be comfortable to our now Windows-savvy staff. But again, this illustrates that the systems have not been able to cope with the complex information flows of the average hospital unit. And yet our Unit Clerks, the poor underappreciated anchors of information flow in every ward, have steadily pulled most of this stuff together for us.
It is now my belief that this complexity of information flow has been the true barrier to widespread adoption of information systems in the medical world. The IT world is only just starting to get a real handle on all the concurrent and parallel information flows that cross the average doctor's desk every hour. We multitask more than any other industry - it's time our computers did too. Competing interests: None declared |
|||
|
|
|||
|
Maura Murphy, GP Tutor The Education Centre, Royal liverpool University Hospitals,, Prescot St, Liverpool, L7 8XP
Send response to journal:
|
Many doctors are probably not so scared of the new technology as the effect that it could have on the care of their patients.Certainly as a sessional GP using 3 different computer systems, a major part of the consultation is taken up with putting data into a computer hopefully correctly. This time probably detracts from the relationship with the patient. Losing eye contact at a crucial point can upset the continuity and depth of history taking which is all important. At the end of the consultation everyone can read what is on the computer, but this could be a double edged sword.What to put on the screen is another problem potentially as confidentiality issues in the future will become even more complex. We cannot put the geni back in the bottle but doctors need a healthy fear of new technology and a carefully timed progression with it so that patients interests are not put at risk.We would not be advised to act as lemmings do. Competing interests: None declared |
|||