This was published a while ago but I only spotted it a few days ago.
National electronic health record systems as `wicked projects': The Australian experience
Article (PDF Available)Information Polity
DOI: 10.3233/IP-160389
Karin Garrety University of Wollongong
Ian Mcloughlin Monash University (Australia)
Andrew Dalley University of Wollongong
Ping Yu University of Wollongong
Abstract
Governments around the world are investing in large scale information and communication technology projects that are intended to modernize and streamline healthcare through the provision of nationally accessible electronic health records. In this way, they hope to 'tame' the complex 'wicked' problems facing healthcare, such as rising costs and fragmented delivery. However, these projects often encounter difficulties. Using a case study of Australia's 20-year journey towards a national electronic health record system, we show how these projects can ironically take on the characteristics of the 'wicked problems' they are intended to solve, and how a failure to recognize and cope with these 'wicked' characteristics can lead to waste, conflict and frustration among potential users. We suggest some alternative approaches to the management of large-scale ICT projects in healthcare and other public service sectors that deal with complex, sensitive data.
Conclusion:
The story of NEHRSs in Australia is far from over and new enthusiasms for the use of big and open data to drive innovation in the healthcare sector suggest that the digital health record is a thin end of a much larger digitalization wedge. It remains to be seen whether the proposed shift to an opt-out model and financial incentives for use by GPs will help to evolve the Australian MyHR system into a more useful tool that is valued by those delivering and receiving healthcare. Regardless of what happens in the future, we now have 15 years of experience of attempts to build a workable NEHRS. (More on the site)
Lots more found on the link:
There are about 10 pages supported by 91 references so a lot of work has gone into this!
Well worth a browse to appreciate there are perspectives out there other than that we get from the ADHA.
David.
David, I am hopefully responding to the paper "National electronic health record systems as `wicked projects': The Australian experience" in a positive but critical manner.
ReplyDeleteThis paper is well written and provides an excellent summary of what is already known (so what is new?). From this perspective it is essentially a conflation of the exiting knowledge. In the conclusions it offers imprecise suggestions as to what to do.
A scan of the extensive reference list highlights 'what is missing'. I could find very little citations on successful projects. Also the references to involvement of experts in our NEHRS can easily be countered by the "clinician" involvement that already exists (so why have we not been successful?).
The paper offers good insights into what areas require focussing on the achieve success however we need to 'tread water' for a little while to see what we can retrieve form the NEHRS wreckage and 'learn from the successes as well as the known failures' for NEHRS.
Oh, it is so hard to write and summarise this topic and try and be helpful.
On the contrary Terry I thought the paper made some particularly relevant powerful observations.
ReplyDeleteIntroduction
Line: 32-35; 41-43
Not solving the wicked problem
Line: 160-168
Failure to recognize and understand complexity
Line: 242-245
Weakenesses of the conventional approach
Line: 259-267; 270-274
Inability to learn from divergent viewpoints
Line: 298-303
Managing wickedly problematic projects
Line: 371-381
Conclusion:
Line 428-433
Thanks for those line pointers Ian they really do synthesize why there has been so little progress. The authors of the article deserve a medal.
ReplyDelete