critique 2_Understanding the role of technology in health information systems

Understanding the role of technology in health information systems (Lewis, Hodge, Gamage & Whittaker, 2011) is a working paper review of the health information systems (HIS) and information technology (ICT), current to 2011 and specific to the Pacific Island region. The main impetus of the paper is to provide a structured overview of the issues, challenges and vulnerabilities that face countries that are involved investing in a technological based health system. The authors define key areas of focus for further empirical studies and recommend a framework that might help initiate an effective system.

The paper gives an overview of what HIS is, the elements that comprise them and the benefits they provide in both a short term analysis and assessment and in the broader term of an integrated health information database. The primary goal of a HIS is improving the efficiency and quality of interactions between patients and the medical profession, (Herrick et al, 2010, pp.3-4) whilst ensuring the safety of the patient within the system. (Chadwick et al, 2012, p.1) Lewis et al (2011) define HIS in two ways, restricted and extended. The restricted being the system that ‘captures and reports’ aggregated statistics and the extended being any system that ‘captures, stores, manages or transmits’ statistics on individuals and organizations. For the purpose of this paper, Lewis et al (2011) focus on the extended or broad definition of HIS.

The report discusses the expense of establishing HIS in terms of time, money and stakeholder engagement and the commitment of governments and organizations since the 1960’s to instigate a successful and cost efficient HIS. (Herrick et al, 2010, pp.3) But question the veracity of the global programmes in place or those being trialled, due to the limited ‘rigorous’ or ‘slender’ empirical evidence of the substantial return on value, especially for developing countries. (Rippen et al , 2013, p.e1). Lewis et al (2011) highlight that due to the ‘complexity’ and ‘sensitivity’ that surrounds many ICT health information systems there is a need to address the following areas:

• Developing a common language for categorising
• Summarising benefits and opportunities
• Discussion of critical failures
• Providing a framework and methodologies to assess ICT in HIS

A major theme throughout the paper is that the countries of the Pacific Islands region face the same issues that developed countries do of economic, government, infrastructure, but with additional layers of specific issues to the individual nations, climate, different cultures, dispersed populations, education levels, staffing.
Although the report gave a broad and enthusiastic overview, there were areas that were not as comprehensive as they might have been. The paper didn’t really enumerate details of implementing HIS’, the ideas of which come across as ‘blue sky’ to some extent. Their strategy appears to be: conduct more research, use the outcomes to establish the HIS strategies, and once this is done success!

This contradicts their earlier comments regarding the diversity of the regions – population, economic, government and environmental. With all these “differences” a one-fix solution will not work. Nor due to the same constraints, would a tailor made solution be an option. Another areas that the report didn’t really address which are primary areas of importance and contention, were privacy; ethics; security; clients/patients opting out of providing their personal and medical history.

The report appears to be a starting point for future studies and initiatives so although it provides an outline of the main challenges of barriers to ICT’s within the Pacific Island regions it doesn’t make any definitive suggestions and the references they refer to many of the ideas were ‘intuitively’ assumed. (Lewis et al, 2011, p. 12)

The paper set about outlining the benefits and issue with HIS in developed and developing nations but with further levels of complications specific to these regions. It also highlights the undertakings of governments and organizations in their focus on HIS. Whilst presenting an overview of the status and benefits of HIS, the paper also provides suggestions and a framework to assist in solving the issues that affect HIS’.

References
Lewis, D., Hodge, N., Gamage, D & Whittaker, M. (2011) Understanding the role of technology in health information systems. Available from the University of Queensland Health Information Systems Knowledge Hub at http://www.uq.edu.au/hishub/wp17

Bardhan, IR. & Thouin, MF. (2013). Health information technology and its impact on the quality and cost of healthcare delivery. Decision Support Systems, Volume 55, Issue 2, May 2013

Chadwick, L., Fallon E.F., van der Putten, W.J. & Kirrane, F (2012) Functional safety of health information technology. Health Informatics Journal, 18(1) 36–49

Herrick, D.M., Gorman, L. & Goodman, J.C. (2010). Health Information Technology:Benefits and Problems Policy Report No. 327

Rippen, H.E, Pan, EC Russell, C, Byrne, CM & Swift, EK. (2013). Organizational framework for health information technology. International Journal of Medical Informatics, Volume 82, Issue 4, April