Health information systems must be “medicine by design”

In the tender specifications of health information systems, the medical component is often of little relevance. The focus is on technological, administrative and organizational aspects.

Try reading some of the tender specifications for hospital information systems (HIS) and measure, in terms of pages, the breakdown between technological, administrative, management and process, clinical aspects; you will see that these represent between 10 and 20% of the total. If we then examine the specifications of territorial information systems, the distribution is even more unbalanced; here the clinical component is often marginal.

Those responsible for the information systems of health care companies (both hospital and ASL) are mostly engineers, computer scientists or physicists who are obviously more comfortable with technology, management aspects and organizational processes than with medicine. The companies that produce software for health care are in turn composed almost entirely of technicians (engineers, physicists, computer scientists, bioengineers).

In the drafting of the specifications are obviously involved some doctors and nurses who have as references the paper or the software used previously or, in some cases, what they have seen in some presentation, so it is difficult, in this context, to generate a request for innovation.

The supply responds and adapts to demand, it does not evolve. The result is that if you try to compare a specification from twenty or ten years ago with one of these days, you will notice that there are few changes at the clinical-assistance level. Most of these concern technological aspects (architectures, interfaces, databases, integration), while in functional terms you will not find significant changes.

Some may argue that clinical practice and nursing practice have not changed much in the last twenty years, while technologies have seen a great evolution. The problem, however, is to understand how the great potential of technologies can improve clinical and nursing practice. The introduction of the mouse and touch screens afterwards have not brought benefits to doctors and nurses, even less the transition from client – server architectures to web based systems. At the interface level the improvements have been marginal.

Doctors and nurses continue to use software as containers of information that they type themselves, without any real added value. The software does not possess “intelligence” and does not provide support either at the decision-making level or at the operational level.

The transformation of data into digital has certainly increased its accessibility and usability, but it has not so far, with some exceptions, been accompanied by the development of a set of functions and services able to capitalize on the digitization of information.

To draw a parallel with the automotive world, the digitization in healthcare has allowed to have more graphic dashboards than the analog dashboards of the past, but not to realize the equivalent of security systems (ABS, ESP, smart mirrors, sensors) or semi or automatic driving.

So how is it possible to evolve the quality of demand, thus stimulating the market to develop intelligent “medicine by design” solutions? The answer in the next article.

1 – to be continued

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