This appeared last week:
Toward Comprehensive Patient-Centric Care by Integrating Digital Health Technology With Direct Clinical Contact in Australia
- Penelope Schofield1,2,3,4, BSc (Hons), PhD ;
- Tim Shaw5, BSc (Hons), PhD ;
- Michaela Pascoe2,6, BSc Psych (Hons), PhD
ABSTRACT
Background: There is an escalating crisis in health care, locally and internationally. The current health care model is unable to meet the increasing health care demands.
Objective: The aim of this study was to reconceptualize the provision of health care to produce better outcomes at no greater cost, by placing individuals in the position of authority to direct their own care, in a personalized, integrated health care system.
Methods: In this study, we used the Australian health care system as a model. We reviewed the current landscape of digital health in Australia and discussed how electronic medical records (EMRs) can be further developed into a personalized, integrated health care system.
Results: Some components of an EMR and digital health system are already being used in Australia, but the systems are not linked. A personalized, integrated health care model that is responsive to consumer needs requires not just a passive repository of medical information; it would require a team approach, including the government, health care funders, industries, consumers and advocacy groups, health care professionals, community groups, and universities.
Conclusions: Implementation of a personalized, integrated health care system can result in reduced pressure on the current health care system, and it can result in the delivery of best-practice health care, regardless of location. Importantly, a personalized, integrated health care system could serve as an education platform, “upskilling” not only clinicians but also, more importantly, patients and carers by providing them with accurate information about their condition, treatment options, medications, and management strategies. By proposing personalized, integrated health care, we offer an intelligent model of health care that is ubiquitous, efficient, and continuously improving.
J Med Internet Res 2019;21(6):e12382
doi:10.2196/12382
The full paper (about 20 pages) is here:
You can also view an hour long webinar on the topic here:
What is most troubling to me about the paper and the webinar is that there is a great deal of truth provided about the complexities, difficulties and forces buffering health systems everywhere, but that then there is a suggestion EMRs and Digital Health can somehow become some sort in integrating panacea for what ails us.
To imagine that things like the #myHealthRecord be anything other than a barrier to real progress in the health system causes my head to hurt. A totally new and visionary system is maybe a part enabler of the desired future but not what we see now!
For the effective, safe, accurate, personalized, coherent health system Dr Schofield seeks the secondary, incomplete and possibly wrong #myHealthRecord is a totally wrong starting point.
What do others think?
David.
4 comments:
It always looks plausible from a distance. The image painted by some is as close to reality as NCIS is to forensics. It is good to dream but it is also fair on others to visit reality.
I think - you are right. I think you should ask the authors to prepare an article for your blogspot describing 'precisely' how they envisage realising their utopian vision.
Ian, Good idea.
The first sentence of the article is correct. "There is an escalating crisis in health care, locally and internationally" From there on it goes woefully wrong. The authors are looking in the wrong place - it's called the Steet-lamp Effect.
Part of the crisis (i.e. the real problems facing healthcare) is "Cognitive bias".
This tells you something about the problem:
Cognitive bias in clinical medicine
https://www.rcpe.ac.uk/sites/default/files/jrcpe_48_3_osullivan.pdf
Abstract
"Cognitive bias is increasingly recognised as an important source of medical error, and is both ubiquitous across clinical practice yet incompletely understood. This increasing awareness of bias has resulted in a surge in clinical and psychological research in the area and development of various ‘debiasing strategies’.
This paper describes the potential origins of bias based on ‘dual process thinking’, discusses and illustrates a number of the important biases that occur in clinical practice, and considers potential strategies that might be used to mitigate their effect."
The paper lists 10 biases. I have seen claims that there are about 100.
Maybe David could ask the authors just how access to health records (which do not get a mention, even once, in the paper) will/could reduce cognitive bias?
The most telling part of the paper is the first quote:
"The human brain is a complex organ with the wonderful power of enabling man to find reasons for continuing to believe whatever it is that he wants to believe.
Voltaire"
And while you're at it, maybe someone could ask Tim about these fantasies:
https://conversation.digitalhealth.gov.au/case-studies
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