Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Tuesday, May 21, 2013

Excellent Papers On Doing Large Scale E-Health and EHR Quality and Safety. Must Read Stuff.

The following papers were published a few days ago.
J Am Med Inform Assoc 2013;20:e9-e13 doi:10.1136/amiajnl-2013-001684
  • Perspectives

Ten key considerations for the successful implementation and adoption of large-scale health information technology

  1. Kathrin M Cresswell,
  2. David W Bates,
  3. Aziz Sheikh


The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale health information technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, health directorates, healthcare management, and senior clinicians.
The full article - freely accessible is found here:
This introduction should be enough to encourage careful reading of the whole article.


Large-scale, potentially transformative, implementations of health information technology are now being planned and undertaken in multiple countries.1 ,2 The hope is that the very substantial financial, human, and organizational investments being made in electronic health records, electronic prescribing, whole-system telehealthcare, and related technologies will streamline individual and organizational work processes and thereby improve the quality, safety, and efficiency of care. The reality is, however, that these technologies may prove frustrating for frontline clinicians and organizations as the systems may not fit their usual workflows, and the anticipated individual and organizational benefits take time to materialize.3 ,4 In this article, we reflect on our mapping of the literature (see box 1) and complement this with our experiences of studying a range of national evaluations of various large-scale health information technology systems in the UK and USA to provide key pointers that can help streamline implementation efforts.4 ,52–54 In so doing, we hope to inform policy and practice development to support the more successful integration of technology into complex healthcare environments. This is particularly timely given the US Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes a $19 billion stimulus package to promote the adoption of electronic health records and associated functionality.55

The paper provides Ten key considerations for the successful implementation of health information technology which make a great deal of sense  to me!

I will leave it to you to work out how close DoHA and NEHTA have got to these insights
This article is part of a JAMIA special edition. The contents page is found here:
A useful introduction to the whole issue is found here:
Also included and freely accessible is a policy document from AMIA on EHR useability and safety.

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

  1. Jiajie Zhang


In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.
The whole paper is found here:
Good to see these quality and safety issues associated with EHRs getting thorough discussion and review.
Enough reading for the whole week…


Bernard Robertson-Dunn said...

A few comments, none of which should come as a surprise to anyone who has been reading this blog.

First: Recommendation 1:
"Clarify what problem(s) the technology is designed to help tackle."

At least there is a recognistion that eHealth should be about solving a problem. However, the recommendations do not recognise that eHealth is a Wicked Problem.

You can't solve a wicked problem in a sequential manner as they have suggested. In fact "clarifying" a Wicked Problem is a difficulty all of its own.

If you don't treat eHealth as a Wicked Problem from the start, any technology solution will fail to meet the expectations of stakeholders.

Second: The discussion in the whole document (and it would appear, the whole special edition) is all about health information technology, not health information.

IMHO, eHealth should be about achieving better health outcomes by improving the quality and timeliness of information available to health professionals and patients when making health related decisions.

Technology only exists to manage health information.

Third: My first recommendation would be:
Understand what information you need, where it comes from and how it should be processed, stored and protected. Then you have a good idea what the technology needs to deliver.

This alone will not solve the problem of health information, but at least the technology will be appropraite for managing the information contained within.

Trevor3130 said...

BBC Radio 4 has just aired a 38min broadcast on antibiotic-resistant bacteria.
I was most surprised to learn that in England the NHS has handed off the collection of prescribing data (from community pharmacies) to IMS Health. The point was made, also, that prescribing data from hospitals is not pulled together.
So, does anyone know how far IMS has burrowed into our health care systems? I've got a bad feeling about the answer.