GENEVA, Switzerland -- Why does healthcare need IT?
"In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison." Those words could reflect the workflow frustrations of practitioners in just about any hospital today, but the sentiment is not exactly new. They were written in 1863 by Florence Nightingale.
Tuesday, a century and a half later and an ocean away, Antoine Geissbuhler, medical informatics director and chairman of radiology at Geneva University Hospitals, cited Nightingale in illustrating that lack of information is a longstanding, universal problem in healthcare.
Indeed, several speakers at a physician informatics symposium ahead of the first-ever World of Health IT conference here talked of the many global commonalities in obstacles to health-IT implementation.
- "I would reckon that the most important barrier is the cultural one," said Luis Pareras, M.D., chief of the Healthcare Policy Chamber for the Spanish state of Catalonia (Barcelona).
- "The area where we need to invest more money, probably, is in the interface between the data and the physician. We need to design something intelligent that will make the work of physicians easier," said Pareras, a neurosurgeon at Hospital Valle de Hebron in Barcelona.
- "Amazing as it may seem, a pad and pen are a great way to collect information," he said, clearly explaining why it is so difficult to convince physicians to trade in their paper for computers. "Time is the most valuable thing that I have." As a physician, an electronic medical record should save him time.
- "Creating a culture of safety is very difficult," noted an American luminary, longtime patient-safety guru Lucian Leape, M.D., health policy analyst at Harvard School of Public Health. He explained that "fault lines" can form along leadership, physician engagement, patient focus, and accountability.
However, change should be required. "Safety is not optional," said Leape, a member of Institute of Medicine Committee on Quality of Health Care in America, which produced the landmark 1999 report, To Err Is Human, and the 2001 follow-up, Crossing the Quality Chasm.
No matter where it is attempted, change must be managed properly. Jacques Cinqualbre, head of surgery and electronic health records at Hôpital Strasbourg in France described a scenario reminiscent of the infamous 2003 computerized physician order entry project at Cedars-Sinai Medical Center in Los Angeles. "With CPOE, we went from failure to failure," Cinqualbre said.
He said that physicians and nurses at his hospital preferred writing to typing or mouse-clicking. It took plenty of trial and error before Cinqualbre brought in tablet PCs and high-tech digital pens with electrostatic paper to capture handwriting.
CPOE is never easy, Swiss medical informaticist Geissbuhler said. "Give physicians information to buy goodwill," Geissbuhler recommended. "You will need that goodwill when you try provider order entry." After that, he said, other components of an advanced health-IT system—care planning, clinical decision support, event notification, among others—ought to be less difficult.
And clinicians would have all the information Florence Nightingale ever wanted.