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Like every other year, 1999 promises more change in healthcare and more developments in healthcare computing. Whatever the nature of these changes, one thing is crystal clear. Making better use of IM&T is no longer a question of procuring and installing new systems simply to carry out existing jobs. There is a growing realisation that developments such as the electronic patient record and telemedicine are set to fundamentally change the way that healthcare is practised on a world-wide scale.
Have these developments arrived too early? Is the NHS yet ready for them? The answer is no in both cases. New developments can never come 'too early'. They arrive as and when they become economically and technically viable. If we are not prepared for them when they come, it is because our own pace of change is not quick enough to keep up with them. In one sense, the NHS will never be fully ready, since new developments take some time to mature and for their acceptance to become established. However, there is now a clear need to increase the pace of change in the NHS if we are not to fall further behindhand with exploiting new opportunities offered by technology.
Despite continuing media reservations, the signs are beginning to look hopeful. Indeed, 1997 may yet be seen as a defining milestone as far as the future of healthcare IT is concerned. Since then we have seen a new Government and new momentum behind tackling issues in the post-reform health service, such as collaboration between health and social services, which are clear areas of need. At the same time, in IM&T we have seen a new direction being established at IMG, significant continuing interest in EPR, fruition of some of the infrastructure projects and radical consolidation of major healthcare IT suppliers.
Resources put to pressing needs
These are all early symptoms of a new dawn in healthcare computing in this country as the process of using IT to deliver more effective healthcare matures. As with most technical developments, use of computers in healthcare started with what can only be described as chaos. Nobody knew what computers should do or how to develop and manage systems that would deliver good results. Much of the residual antagonism towards computing was born during this early phase of NHS computing.
Chaos was followed by a 'scientific' phase comprising years of obsessive concentration on process and technology. Although some of this legacy remains, structured systems design and rigid standardisation have finally been discredited as the ultimate means of forwarding use of IM&T in the NHS. Associated initiatives are being wound down and resources put to more pressing needs such as Year 2000 problems (in which success or failure are easily demonstrable and for which the deadline is immovable).
IT incentives for clinicians
Emphasis is now being switched to the benefits of IT, particularly for clinicians, and the way it can be used to make healthcare more effective and make better use of clinical resources. The major obstacle to achieving this is not technology but integrating operations - and that means everything from integrated working among clinical staff to integrated systems which support them.
Signs of increasing integration at the operational level grow every day. Profiles of care. care pathways, care protocols, etc., are all evidence of the need to consider the whole care process (including evidence of success) and not just individual parts within it. These developments have not been initiated through the availability of technology but through socio-political pressures to use technology to make healthcare more patient centred. They have, however, started to give a rationale for using IT to support clinical practice and provided incentives for clinicians to become involved directly in IM&T at the point of delivery of care.
Major challenge for 1999
What can be done to speed up this process? Rather in the same way that 'Wessex and West Midlands' became an involuntary response to any hint of computer-related trouble, so 'computer-phobic clinicians' has, for some years, been the excuse for not making further advances in the use of IT. As the years roll on, however, this excuse is becoming less tenable. First, clinicians entering the profession are far more computer literate than their predecessors. And even among those not brought up on the subject, availability of useful information in electronic form, eg through the Internet, is encouraging much more use of computers.
Second, it is widely recognised now that one of the reasons healthcare professionals do not use computers is that IT people try to speak to them in a technical language they do not understand. IT suppliers have also failed to make an impression in terms which clinicians can easily relate to and there has been little incentive for them to get more interested in IT than absolutely necessary. Although declining, this is still a significant obstacle and remains one of the major challenges for 1999 and beyond.
Research shows that the fine detail of designing systems is given an undue level of importance in healthcare IT compared with the other key issues such as supporting collaboration and improving the quality of patient care. This is largely because clinicians are expected to concentrate on patient care, while IT people concentrate on IT. In between is a yawning gap down which many a 'failed' NHS system project has fallen. The question is, "Who is going to fill that gap - or are the parties eventually going to get on the same wavelength?" The answer has got to be the latter.
See what is over the horizon
Incentives for making better use of IT will not come from IT practitioners alone. They will come from pressures of all sorts bearing down on the healthcare system as a whole. Among these are growing consumer expectations, increasing risks of litigation and better informed patients. Together with political pressures and technological advances, these will be the driving forces for changes in the future. The trick in keeping up with change is for everyone to see it coming and anticipate its effects. It is in this particular area that a great deal more can be done to advance the cause of IT in healthcare.
IT managers and clinicians in the NHS are typically too busy dealing with day to day details to look above the parapet and see what is looming over the healthcare horizon. Yet this is exactly what is needed to forge real IM&T strategies that will meet future needs. In the four years that we have been writing this column, we have tried consistently to promote such a 'view from the bridge' and encourage a strategic vision of healthcare IM&T developments in the NHS. It is now time to hand over to you, our readers. Good luck for 1999 - and best wishes for a brave new millennium.
First published in BJHC Dec 97
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