- Choose and Book: A critical appraisal of its early development
- Information System Failures and the NHS
- Evaluating a Clinical Decision Support System: A basic field study approach
- The challenge of Knowledge Management at the point of care
- Pre-hospital thrombolysis and telemedicine in the NHS
This is a selection of articles on clinical informatics.
It covers topics like the use of Telemedicine in Pre-hospital Thrombolysis of Myocardial Infarction, the challenges faced by the initial implementation of the London Ambulance Service Computer Aided Dispatch system and a critical appraisal of the Choose and Book project in its initial stages.
There is also an example on the basics of software/hardware usability assessment in the real world setting, which may be help clinicians to make their own evaluation of pilot Health Informatics systems in the clinical setting, and hence be able to provide better feedback.
The reasons, in general, of why some Information Systems fail to deliver as expected are also explored here.
Of all the above, the author feels most strongly about the implementation of of pre-hospital thrombolysis using telemedicine.
Having been involved in such a unit for over 18 months, and supervising the pre-hospital thormbolysis and the subsequent patient management on the coronary care unit , the benefits to patients and the logistics of running such a unit is clear. There is a place for such a service in both the rural and hyper-urban environments..
It is also not inconceivable that this technology can be extended and used in the setting of thrombolysis of acute ischaemic stroke in the future, where the principles of the golden hour applies equally.
For this to happen, there will need to be available reliable miniaturised portable CT head scanners with telemedicine capabilities, highly trained mobile medic/paramedic units, robust scoring and treatment protocols.
Broadly speaking, Clinical Informatics can be sum-up as the application of Health Informatics in clinical practise, with the aim of improving patient care and the clinical practise itself.
The Stanford Centre for Clinical Informatics offers a more detailed definition::
"Clinical Informatics is the scientific discipline that seeks to enhance human health by implementing novel information technology, computer science and knowledge management methodologies to prevent disease, deliver more efficient and safer patient care, increase the effectiveness of translational research, and improve biomedical knowledge access"
Health Informatics, in turn has been succinctly defined by Enrico Coiera as:
"The rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how medical knowledge is created, shaped, shared and applied."
[E. Coiera. The Guide to Health Informatics (2nd Edition) 2003. Open Clinical website, 2010]
"If physiology literally means the logic of life, and pathology is the logic of disease, then health informatics is the logic of healthcare.."
[E. Coiera. The Guide to Health Informatics (3rd Edition) 2015. Author's website]
More definitions of Health Informatics are available at the Open Clinical site.
The question today is not whether Information Technology can play a part in delivering better patient care and help facilitate the practise of Evidence Based Medicine.
The challenge is how we are going to develop and apply this technology in the clinical setting, acquire buy-in from all stake holders and put in place effective long term maintenance and continuous development provisions.
There is an abundance of academic literature in Project Management, Software Engineering and Human Computer Interaction which clearly states and emphasise the importance of end-user involvement early in the process of software design.
The development of any information system does not end on completion of the design and implementation process. It is only just the beginning, due to the innate iterative nature of software design which can be best summarised as the continuous design, test and redesign cycle.
Hence, clinicians, as the primary users of these tools, have an important role to play in their design, development and implementation.
There is an impetus for clinicians to be actively involved because when the implementation of clinical systems fail, it is patient-care that suffers the most in a "double-blow".
Firstly, via the consumption of resources (financial and personnel) during its initial development and secondly, via the implementation and maintenance costs of the ineffective systems.
Often, partial project failures have far more devastating effects compared to complete project failures, as the drain on resources and subsequent ill-effects are sustained for longer periods of time in the former.
However, In order to be able to participate in a meaningful manner, clinicians need to:
- think about what are their information needs,
- think about how this need can be met,
- get to know the basic information systems available in clinical practice,
- have a basic idea of how these systems can be evaluated
- be aware of the risk-benefits and opportunity costs involved in the implementation of these systems.
It is hoped that these articles will help stimulate some thoughts on the above issues.
Page Updated: 17 May, 2017Tweet