By José Miguel Selman (*)
A huge amount of data is produced in the healthcare field. In fact, it has always been a surprise that it has taken so long to informatize the clinical area.
The complexity of the patient care process, especially when they are hospitalized, generates great difficulties that have not yet been fully resolved.
The general spread of the use of digital equipment in every medical area has made it essential to face up to this process – delayed for many years if we compare it to the development of banking or other complex activities such as air travel.
One of the main obstacles has been the model of patient care which historically has occurred among units with a strong tendency to isolate themselves from each other and to create local standards. Thus a patient’s health information has been “guarded” by these units, which, for reasons of confidentiality and even commercial motives, are not interested in sharing data. Neither has the hospital equipment industry helped by trying to maintain proprietary formats to monopolize a certain area or set of providers.
However, the creation of standards such as DICOM, HL7 and diagnostic and procedural nomenclatures has opened the possibility of communicating data at such magnitude that the pressure to informatize the clinical area is now overwhelming.
Patients have informatized their entire lives, from family photographs to their friendships and managing their personal finances. In this context, the traditional healthcare system appears to be an inefficient anachronism.
The possibilities opened up by the informatization of the “clinical layer” are enormous but we are just scratching the surface. Latin America has some particular characteristics that make the transition from traditional paper records to digital ones especially difficult. In the majority of our countries there is a mixed healthcare system, with a greater or lesser state presence and a wide variety of other institutions of different natures and interests.
Many healthcare systems are facing a chronic budget deficit, which makes it difficult to make an initial investment, and thus prevents access to information that could allow for the optimization of the budget.
One of the biggest difficulties facing an IT team is how to evaluate the technology that is best suited to an institution. We don’t have the luxury of a second chance and very often we don’t have the necessary knowledge to evaluate them properly.
A large part of collective healthcare knowledge in an institution is local, so there is a strong tendency to resist change, this being the result of years of collective creative efforts. When change to an informatics system is led by the clinical establishment, generally the process is more fluid.
However this is not usually the case: the benefits, be they real or imaginary, are usually perceived in the administrative area which frequently imposes change without allowing adequate participation in the process prior to the decision. In this context, our Latin roots lead us to resist standards that we see as foreign.
So, in this context, the solutions to be implemented should be:
a) Closely adapted to the user’s needs
b) Maintain standards that allow for the future interoperability of the system
Both aspects, which require intense and lengthy work, need to be developed simultaneously in collaboration with every department. In turn, the structure for maintenance, development and training should be incorporated from the beginning with adequate financing.
Now, during this software tool adaptation process many clear flaws in the workflow become evident and here it is necessary to change the format. It is thus vital to bear in mind the language difficulties that appear in every phase of the project.
Normally the least successful area of any software is documentation, and if it is also in a language that only half the staff understand, we are faced with a serious problem. The complexity of the task necessarily requires full understanding of the systems by the IT staff. This is where the idea of local development from scratch arises, and it is very praiseworthy, but immediately the difficulties and subsequent extra costs can rapidly lead to the project going over budget. Cutting costs in the presentation hardware of the user is tempting, especially in countries that impose import duties on electronic products and hardware.
Finally, one must take into account the training of human resources in the use of computers because the same people who appreciate and applaud what has been achieved at their bank and airline tremble at the prospect of implementing an electronic health record.
Generally, clinical software does not have a very user-friendly interface; what would be perfectly fine for an IT professional can seem completely unsuitable for the average clinical employee at a hospital.
The challenge is enormous and the task ahead is great. We need to start as soon as possible, committing the necessary human and material resources as clinical information is fundamental to avoiding errors – which cause so much damage – and improving patient care, which is our greatest concern.
(*) Dr. José Miguel Selman will give a “Level 6 Training Session” at the Annual HIMSS Conference and Training Session Latin America; he is a neurosurgeon and is currently the CMIO at the Clínica Las Condes (Santiago de Chile), the first care center in Latin America to achieve HIMSS Level 6 certification.
