e-Health Expert - Primum non nocere

Choosing the best manual to help someone else on the difficult journey of setting up an Healthcare Information System / Hospital Information / HIS is, by itself, no simple endeavor. But, if we had to pick a single book on the subject, it would certainly be the World Health Organization's time proven manual:

Setting up Healthcare Services Information Systems: A Guide for Requirement Analysis, Application Specification, and Procurement, ISBN 9275122660, edited in 1999 by PAHO (Pan American Health Organization) - a branch of the World Health Organization (WHO).

This manual was assembled from the contributions of dozens of knowledgeable and experienced collaborators and according to its editors:

"This book discusses the implementation of information systems and the application of information technology in terms of the requirements in health care services, and provides a comprehensive review of information systems and information technology solutions."

"contains practical guidelines and suggestions to be used by healthcare and systems professionals when embarking in the initial stages of planning and developing healthcare services information systems and information technology (IS&T) applications."

From the manual:

• "A successful implementation is one that promotes and supports the institution's ability to execute its plans and meet its goals."
• "Organizations are discovering that successful information systems implementation in the health services institution requires a firm understanding of the organization's overall strategic plan."
• "A health services information system has the purpose of improving the overall performance of the institution."
• "The system being implemented must be recognized as a strategic tool and corporate asset that represents an investment in the organization's viability. "
• "A technology that is appropriate to an advanced, sophisticated user such as a large teaching institution in an urban area may not be appropriate for an emerging health services organization in a rural setting."
• "The social and economic context must always be considered along with issues related to availability of resources and personnel, health information infrastructure, sustainability and continuity of the decisions, and appropriate flow of financial resources."

We couldn't agree more.

UMIT, an Austrian University specialized in Health & Life Sciences, has a page where they keep an account of reported incidents in health care where Health IT (Health Informatics ) was the cause or a significant factor: UMIT - Bad Health Informatics Can Kill

The Government HealthIt site has an interesting article - The mountain cure -, about the work of Dr. Brent James at the Intermountain's LDS Hospital.
Dr. James has been applying W. Edwards Deming doctrine on improving outcome quality as a means to improve health system's security and reducing costs of operation.

You may find the full article at the Government HealthIt site

Complexity is a prominent characteristic of any healthcare organization.

The Wharton School [of Business - Univ. Pennsylvania, USA] just published a joint work with the George Group about Complexity in Products and Services and how it affects an organization.

In the Wharton tradition that report is clear and concise. Most of the problems pointed also show up in our hospitals and healthcare organizations and for that reason the report deserves a few minutes of you attention.

Taken from the report:
"...three important rules of complexity:
One, eliminate complexity that customers will not pay for;
Two, exploit the complexity customers will pay for;
And three, minimize the costs of complexity you offer."

"Complexity is not easy to recognize, and typically doesn’t raise red flags in financial statements. Very few organizations successfully capture the costs of complexity in their standard accounting systems
...It’s a bit like pollution, It builds up over time, it’s hard to see, but it definitely affects the overall health of the business. It’s a systemic issue created by multiple people so no one person is really accountable."

You may download the full report in .pdf format from:
http://knowledge.wharton.upenn.edu/index.cfm?fa=weblink&linkID=175

You may find the report page at:
http://knowledge.wharton.upenn.edu/index.cfm?fa=SpecialSection&specialId=45

The "Healthcare Informatics" magazine, January 2006 issue cover story is about Six Sigma Practices for the Healthcare Industry.

Six Sigma is a process-improvement methodology that is highly data-driven, and highly focused on achieving very specific, data-documented efficiency improvements, cost savings, and customer satisfaction enhancements.

It seems that executives at hospitals and health plans who have led Six Sigma initiatives are proud of the process changes and cost savings it has brought. They seem to love Six Sigma's focus on the bottom line and quantifiable results.

It is believed that the Six Sigma work can bring important benefits in healthcare for at least three substantial reasons:

• The funding for improvement projects at healthcare organizations is limited, so when one is undertaken, senior executives are demanding increasingly solid ROI--a strong orientation of Six Sigma.
• The complexity of healthcare processes requires objective data as the foundation of any improvement-driven activity.
• The rigorousness of Six Sigma work is particularly appropriate for the rather unorganized delivery of care and management of business operations in healthcare.

The full article is available at: Six Sigma Practices

Related article: Lean, Sigma, Kaizen - will they work for healthcare?

The Artemis project is an European Commission funded project that aims to define a Semantic Web Service-based P2P Infrastructure for the Interoperability of Medical Information Systems.

Among its main purposes are:

• the ability to provide the interoperability of medical information systems through semantically enriched Web services (using a to phase process through, first a Message Ontology Mapping Process and then a Message Instance Mapping);
• to find and retrieve clinical information about a particular patient from different healthcare organizations where concrete sources are unknown.

The project started in 2004 and is a joint effort of Turkey, UK, Greece and Germany teams.

More information at the The Artemis Project home page.

The US Government published (2005.12.23) a list of the 20 messaging and vocabulary standards that from now on will be used at the US Government funded health care information systems.

“The portfolio of 20 adopted standards will be used in all federal agencies implementing new, and to the extent possible, in modifying existing health information technology systems, as well as related business processes”

These seem to be big news as this list has the potential to be the basis for further Health IT Interoperability initiatives.

The main adoptees are: HL7 2.x, DICOM, SNOMED CT, LOINC and HIPAA (Trans. and Code Sets).

The list may be freely downloaded from the US Gov. Printing Office.

(The e-HealthExpert.org members will have to log into the e-HealthExpert.org site to be able to download a copy by following the "attachment"/"fr23de05-78.pdf" link presented bellow these lines.)

The International Journal for Quality in Health Care published this month (Dec 2005) the preliminary results of a study about the the World Health Organization (WHO) sponsored "Performance Assessment Tool for quality improvement in Hospitals" Project (PATH).

The article is titled "A performance assessment framework for hospitals: the WHO regional office for Europe PATH project"

The following was taken from that article's abstract:

Objective . The World Health Organization (WHO) Regional Office for Europe launched in 2003 a project aiming to develop and disseminate a flexible and comprehensive tool for the assessment of hospital performance and referred to as the performance assessment tool for quality improvement in hospitals (PATH). This project aims at supporting hospitals in assessing their performance, questioning their own results, and translating them into actions for improvement, by providing hospitals with tools for performance assessment and by enabling collegial support and networking among participating hospitals.

Newsweek has a very interesting article by no less than Google's own CEO, Eric Schmidt.

In that article, named "Google: Ten Golden Rules", it is explained how Google has been inspired by Peter Drucker to manage their "knowledge workers".

It seems that they have been following Drucker's doctrine, according to which knowledge workers believe they are paid to be effective, not to work 9 to 5, and that smart businesses must "strip away everything that gets in their knowledge workers' way."

Google believes that in doing that kind of management those that succeed will attract the best performers, securing "the single biggest factor for competitive advantage in the next 25 years"

You may print the full article from: "Google: Ten Golden Rules - printer"

Jakob Nielsen is well known author that has been writing about computer usability for years. His "Top Ten Web Design Mistakes" article series is by now well known and appreciated globally.

In April 2005 he wrote a small article on Medical Software Usability, named "Medical Usability: How to Kill Patients Through Bad Design". The following was taken from that article:

"A field study identified twenty-two ways that automated hospital systems can result in the wrong medication being dispensed to patients. Most of these flaws are classic usability problems that have been understood for decades."

That article's full text is available at: http://www.useit.com/alertbox/20050411.html and the full list of Nielsen's "Alertbox" articles on usability are available at: http://www.useit.com/alertbox/