Re: Evaluating information technology in health care: barriers and challenges
Editor - Heathfield et. al.1 quite correctly stated that the current political context in which healthcare applications are evaluated emphasises economic gains rather than the quality of life. This is reflected in the general practice systems by their poorly developed clinical side as opposed to the administrative side. In these systems much more emphlysis have been given to GP Links, ISO claims and printing repeat prescriptions than the capture of clinical data and their manipulation to produce clinically useful information. This was the finding of the GP Computer Systems Satisfaction Survey which found that the systems were rated less highly for clinical than administrative use2. Doctors can not take part in a debate in order to improve the clinical side of the systems if they themselves do not understand the systems. They should have an understanding of the systems at a conceptual level similar to the understanding of drugs through the knowledge of pharmacology and an ECG machine through the knowledge of the Einthoven's triangle. This level of understanding of the data stored in the systems and how the various views are derived from the base data using a query language embedded in the application software gives the doctor a measure of usefulness and limitations of the data available through the system. The users need to be provided with a full description of any view that they use, including the definition of data and details of how they were derived. This should be preferably in the form of a printed user manual. Although it would be difficult at least initially to produce this kind of manuals, once they are available for different systems, they can be used to compare and contrast the systems based on common functionality, thus a useful method of evaluation of clinical systems.
Data in clinical systems can be inaccurate for many reasons. Unless doctors can detect them they would not be able to ask the supplier to mend it. The user interfaces should be constructed such that user can see the whole record in the sense that what is there is all there is3. According to them this makes it possible to reflect upon what is not there which means that the record should have no concealed levels.
Bernard Fernando General Practitioner
Thames Avenue Surgery, Rainhan, Kent. ME8 9BW
e-mail: b21fern@aol.com
1. Heathfield H, Pitty D, Hanka R. Evaluating information technology in health care: barriers and challenges. BMJ. 1998; 316: 1959-61.
2. Information Management Centre. Evaluation of GP Computer Systems 1997: Summary Report for GP's. 1998. NHS Executive. IMG Ref. E5407. Web: http://www.ctf.imc.exec.nhs.uk/
3. Nygren E, Henriksson P. Comput. Reading the medical record. I. Methods. Progr. Biomed. 1992.; 39: 13-25
Rapid Response:
Re: Evaluating information technology in health care: barriers and challenges
Editor - Heathfield et. al.1 quite correctly stated that the current political context in which healthcare applications are evaluated emphasises economic gains rather than the quality of life. This is reflected in the general practice systems by their poorly developed clinical side as opposed to the administrative side. In these systems much more emphlysis have been given to GP Links, ISO claims and printing repeat prescriptions than the capture of clinical data and their manipulation to produce clinically useful information. This was the finding of the GP Computer Systems Satisfaction Survey which found that the systems were rated less highly for clinical than administrative use2. Doctors can not take part in a debate in order to improve the clinical side of the systems if they themselves do not understand the systems. They should have an understanding of the systems at a conceptual level similar to the understanding of drugs through the knowledge of pharmacology and an ECG machine through the knowledge of the Einthoven's triangle. This level of understanding of the data stored in the systems and how the various views are derived from the base data using a query language embedded in the application software gives the doctor a measure of usefulness and limitations of the data available through the system. The users need to be provided with a full description of any view that they use, including the definition of data and details of how they were derived. This should be preferably in the form of a printed user manual. Although it would be difficult at least initially to produce this kind of manuals, once they are available for different systems, they can be used to compare and contrast the systems based on common functionality, thus a useful method of evaluation of clinical systems.
Data in clinical systems can be inaccurate for many reasons. Unless doctors can detect them they would not be able to ask the supplier to mend it. The user interfaces should be constructed such that user can see the whole record in the sense that what is there is all there is3. According to them this makes it possible to reflect upon what is not there which means that the record should have no concealed levels.
Bernard Fernando General Practitioner
Thames Avenue Surgery, Rainhan, Kent. ME8 9BW
e-mail: b21fern@aol.com
1. Heathfield H, Pitty D, Hanka R. Evaluating information technology in health care: barriers and challenges. BMJ. 1998; 316: 1959-61.
2. Information Management Centre. Evaluation of GP Computer Systems 1997: Summary Report for GP's. 1998. NHS Executive. IMG Ref. E5407. Web: http://www.ctf.imc.exec.nhs.uk/
3. Nygren E, Henriksson P. Comput. Reading the medical record. I. Methods. Progr. Biomed. 1992.; 39: 13-25
No conflicts of interest.
Competing interests: No competing interests