Category Archives: Usefulness

Agreement on terminology might be possible

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In this post I cited the EHR benchmarking report, claiming that difficulties in agreeing on common terminology is a major stumbling block in the deployment of eHealth solutions. It was quite a pessimistic post…

Today, I had a meeting with the CIO of SLSO – an organization employing a substantial chunk of the 25000 people using Stockholms TakeCare EHR system daily. She enthusiastically told me what happened when the primary and psychiatric care recently migrated to the same database that was being used by the hospitals. The health care staff on the floor quickly realized that there would be large gains in synchronizing the way they documented their information. Consequently, terminology harmonization soon started happening. It was largely a “bottom up” approach which seems to have increased compliance with the new vocabulary substantially.

So. Time to be a bit more optimistic!

What stops the use of eHealth?

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As I said: our systems are not put their best use. Why?

The eHealth benchmarking study gives some clues. According medical directors in Europe the top 3 percieved barriers are: system incompatibility, getting people to agree on terminology and security. Financial concerns are right at the bottom.

This is fascinating for several reasons.

One reason is that incompatibility and security is relatively easy to solve. At least if you don’t place your demands unreasonably high. Mapping data between systems is not always fun, but my experience is that it’s doable. And getting a decent level of security is possible in all systems I know of. But it does take quite a bit of commitment from the customer.

Another reason is that discussions with customers so often focus on price and relatively unimportant bits of functionality. None of which, obviously, are big barriers.

Maybe the basic problem actually is what I hinted at: making eHealth systems useful requires groundwork in the customer’s organization. And we suppliers aren’t ready to help them with that. We are not staffed and we don’t have business models to handle it.

Suggestion: a little less focus on selling software, a little more on selling services. That may improve outcomes quite a lot.

Are our systems useful for patients?

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eHealth is all the rage. A lot of us who build and implement it really, honestly, believe it does more good that harm.

I do too. But the truth may be that the usefulness of eHealth is hard to prove. At least when it comes to improving health. One new study (a review of reviews) finds it hard to show any usefulness at all. And in this study from EU, medical directors are pessimistic about treatment impact:

So, we should stop spending money on this, right? Is it better to channel IT-spending into employing more doctors and nurses?

I don’t really know. What I do know is

  • I could write many pages about the benefits of the systems I’m involved in building (access to data, decision support, process improvements etc, etc)
  • Everyone I talk to and read really believe that eHealth can bring improvements
  • None of the above benefits are actually reflected by academic studies

They say that 50,000,000 Elvis fans can’t be wrong. Or can they?