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While it may seem like a new discipline, medical informatics is much older than most people realize. Back in 1977, well before most people had personal computers, plans for the third global conference on medical informatics were under way.
You could argue that the discipline has since gotten stuck. The health care communitys sluggish pace in adopting IT has become a running joke, especially compared with other information-laden industries such as travel or banking.
To show how far other industries have moved, advocates of health IT are fond of describing a hypothetical bank in which the tellers, bankers and account managers first write down numbers for your deposits on a series of paper scraps covered with similar information from other accounts and then transfer information to several accounting books by hand.
This humorous scenario demonstrates a good way to lose information and sacrifice accuracy. Still, as more and more hospitals “go live” with comprehensive health care technology systems, we must consider what intangibles could be lost in the transfer.
When a hospital system transfers to electronic health records, computerized physician order entry and other forms of IT, the switch “obliterates a system that has been used for institution-based health care delivery for 200 years and replaces it with something that was designed by a software company,” said Russ Cucina, a professor of internal medicine at the University of California in San Francisco who helps the universitys affiliate hospital use clinical IT more effectively.
Joan Ash, a professor of medical informatics at Oregon Health & Science, researches “silent errors” that can result from patient-care information systems. The errors can be technical, such as entering and retrieving information, or social, such as the communication and coordination necessary to care for patients.
In fact, the adoption of IT systems can have profound effects on professionalization and communication with patients and families, aspects that clinicians think of as “intrinsic to health care,” Cucina said in an interview with eWEEK.com. These issues are understudied, he said. Worse, they may be far from the minds of the professionals who design and implement IT solutions for hospitals.
“There is no IT system that can take the place of people when patients start to crash,” Samantha Collier, vice president of medical affairs at Health Grades Inc., said in an interview with eWEEK.com. Collier recently published a high-profile report on medical errors.
Both Collier and Cucina said they see IT playing a key role in improving health care, but to do so, it must consider people just as much as software. To be most effective, Cucina said, clinical IT professionals should have some presence in the clinic.
He himself, for example, spends 40 percent of his time taking care of patients, a responsibility he says is crucial in thinking about how best to design decision-support systems that integrate physicians entries and access of information within the normal workflow of examining patients and consulting with other clinicians.
Caring for patients also constantly reminds him how useful the right IT tools can be. “A huge amount of the time we spend as clinicians is managing information and compensating for inadequate systems for managing information,” he said.
