Equally important is to have robust governance arrangements in each healthcare organization to ensure that doctors maximize their utilization of IT.
We have read the article of Dr Douglas Fridsma with interest and the recommendations made are highly welcome (1).
All data are not created equally (2). Currently, available health information management systems (HIMS) allow doctors to mainly complete documentation. These systems with time have inevitably become huge reservoirs of data. Unless the right information is analysed and delivered to the right person at the right time these legacy systems remain not fully fit for purpose. Offering clinicians at their disposal: appropriate decision making support in health care settings, proactive differential diagnosis prompts, forecast of emerging diseases, detection of outbreaks, detection of disease prevalence patterns are only a few examples to mention that require more machine intelligence (3,4). Therefore, the scope of these systems at present despite their perceived intelligence is still at its infancy.
Training clinicians to be competent in application based solutions i.e. using the HIMS is always part of the mandatory requirement of any institution using HIMS. This involves training that requires knowledge of data entry. Clinical informatics training as suggested in this editorial may be ideal for all clinicians, however it might not be practical. Clinicians with special interest in IT and who have practical knowledge of informatics, or have experience managing “big data” may be entrusted as being key human resource who can contribute to the advancement of informatics within the institution. Physicians with experience in programming languages C++, Python, or Visual Basic may be aptly placed in developing and managing large clinically relevant databases in their specialities. The idea in informatics is not in knowing how to work on the computer but in making the computer work for you.
Some of the Asian countries have incorporated Informatics practices as a subject along with science subjects as part of their national curricula at High School e.g. Central Board of Secondary Education in India (5), thus keeping them well prepared for the 21st century informatics. It would be encouraging to see future doctors coming out of this system with this skill as part of their repertoire in managing health informatics data (6).There is currently no one stop solution to healthcare informatics as almost all systems manage their databases each running different scripts.
The bottom line is there is ample opportunity for doctors to better utilise the toolkit of informatics to what is in the best interest not only of patient welfare in terms of quality, patient safety and patient experience but also to more cost-effective utilization of healthcare resources (7, 8).when doctors combine their own knowledge with decision support, they can make a better analysis of patient data. A survey of doctors in an NHS Trust has shown that 44% showed no skills in data base software (9).
It would also be helpful if the appraisal process also captures IT capabilities and learning needs of doctors and could be included as part of the quality improvement section within the Medical Appraisal Guide (MAG) toolkit of appraisal (10).Furthermore it could also be included as part of the multi-source feedback (MSF) procedures.
As for the governance framework of the healthcare organisation there is always opportunity to further improve and enhance clinical engagement. There is usually a lead clinician in IT who leads a multi-disciplinary clinical engagement group. Although the group members represent all clinical services but in reality, are the genuine IT clinical needs of each clinical service effectively sought and are they objectively known? It is so crucial that the IT utilisation needs, issues and challenges facing doctors in each clinical speciality are proactively captured, understood and promptly addressed. It is also advised that regular audits of reports produced by the system are continually carried out. This will ensure that correct information was entered in the system.
In the USA, Health Information Technology for Economic and Clinical Health Act (HITECH), was passed in 2009. The legislation mandates that health care providers demonstrate “meaningful use” of health care IT, or face penalties in the form of reduced Medicare payments, beginning in 2014. One of the provisions of the meaningful use guidelines is that hospitals and doctors adopt the use of clinical decision support systems (CDSS).
Intelligent healthcare system is the way forward in technology and Intelligent people trained in clinical informatics allow to design these systems in a way that allow better patient and community healthcare management without compromising patient safety.
1. BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3043 (Published 12 July 2018.
2. AHIMA Work Group. "Defining the Basics of Health Informatics for HIM Professionals"Journal of AHIMA 85, no.9 (September 2014): 60-66.
4. Wilson G, Badarudeen S, Godwin A. Real-time validation and presenting cumulative antibiogram using a novel in-house software ABSOFT. Am J Infect Control. 2010 Jun 4. PMID: 20627367 Issue 38/9, 2010
Competing interests: No competing interests