Informatics - the social impact

There have been considerable developments in the use of computing technologies and information handling since the early 1960s, which have made significant contributions to care and treatment and to the maintenance of wellness in the community. However, care and treatment are now delivered in an environment of shared care and plurality of providers and the subjects of that care demand more involvement in their health maintenance, so the landscape is increasingly complex.

Health informatics
Health informatics (HI) is an umbrella term that encompasses the design, development and use of technologies, and the provision and use of information. The solutions developed are targeted to support effective care delivery, operational management, strategic planning and clinical decision making across the domain.
    
Integrated systems that bring together data about the history of an individual patient are already available in 99.9 per cent of general medical practices and operate in many acute hospitals and other care facilities. Historically these systems have been well-deployed in some areas and not so in some others; predominantly providing “best of breed” support to selected areas of care or treatment.
    
This has resulted in patchwork provision, with patients’ information not being available in all necessary situations and clinical decisions being made in the absence of the full context or patient history. The expectation is that a much richer picture of the patient’s history will be available when determining whether an intervention is required; whether for emergency, acute or chronic conditions.
    
Whilst there is much debate over how to get there, there is little argument over aspiring to have access to sufficient past information and general evidence about an individual and their condition in order to make effective decisions about potential treatment. Across all the home countries the overall objective is to create “joined up working” across all the agencies involved in care and health maintenance, albeit using different overall technology strategies. However, there are many challenges to address in achieving this.

Improving functions
There is a considerable challenge in firstly determining what health business functions can be improved by informatics solutions. What is actually required to support efficient and efficacious working in each clinical and management area, how these areas will securely share information whenever necessary and how the services provided are continually available to the service which is all year around and 24/7.
    
Added to the equation must be a realistic estimate of the changes necessary to bring that about. This includes giving existing staff enhanced competence to make best use of the proposed solutions.
    
Appraisal of the risks of implementing new solutions at certain times and in particular circumstances, and within budgetary constraints, addressing local priorities and governmental targets, alongside maintenance of the overall service must also be considered.
    
All these elements are factored into plans and proposals which must be achieved without interruption to service to the public. We learn much from our past experiences and from looking at IT and informatics introduction to other sectors.

Patients’ involvement
The philosophy behind all the home counties’ HI developments are to establish a platform from which an extended brief of integrated health and social care can ensue; in conjunction with greater involvement from patients themselves in their own lifestyle management. Patients will be placed centre-stage when such a collaborative platform is in place.
    
The technology should become pervasive rather than invasive with linked hospital, non-hospital and general practice based systems which robustly collect data that is sensitively shareable and securely maintained, and can be utilised by any clinical or management professional with authorisation to use them.
    
Data will be available on a “just-in-time” basis for patient management, efficient running of operational facilities and the planning of strategic services in the appropriate locations for projected populations in both geographic areas and with specific clinical conditions.

Access
The basis for opening up such comprehensive information resources to different entities and purposes may well in future be at the behest of the subject of the record rather than organisations per se. This shifts the responsibility for deciding access to the individual but organisations will retain accountability for the quality of their inputs and the probity of use of such content in decision making and planning.
    
High quality data will be captured at or near its source, providing a full clinical history of each individual, regardless of where care is delivered; that information also being used to manage healthcare provision as an efficient business, regardless of what types of organisations are actually involved.

Helping find target areas
In an environment where expectations of quality of care and resulting outcomes are getting ever higher, hard decisions must be made about where to target scarce resources – to certain individual conditions, to support in the community, specialist monitoring of  chronic conditions or heroic interventions, to name but a few. Informatics can provide previous performance profiles and good practice information on which to base such decisions.
    
Solutions being developed and deployed today must make best use of the residual life of existing systems out there, capitalise on experiences to date and make best efforts to be able to incorporate innovations as they arise in the future. It is not an inconsequential challenge to address all these perspectives whilst supporting a never-ending service to an increasingly mobile population that can see for themselves on the Internet what potentially might be available to address their situations, if only unlimited resources were available.

International cooperation
The world is getting smaller – we are already required to operate within national and European legislation, peer group protocols and standards, to have access to facilities and expertise across national boundaries and to travel further and faster for both business and pleasure. More health interventions can be delivered remotely (sometimes referred to as telehealth or e-health); robotic surgery delivered under the supervision of specialist experts, third party clinical advice based on precision images and signals beamed around the world, individual patient monitoring through devices embedded in the body.
    
Natural and man-made disasters and incidents require multi-national clinical responses to be made rapidly and in synergy. Whether expert triage for a tsunami victim or a battlefield casualty, or a device to prevent a patient with Parkinson’s disease becoming house-bound, informatics can help to bring together skills, evidence and actions on the ground.
    
Returning to the patient-centric goal – records of interventions, observations, factual results, plans and opinions can come from many sources and be useful in many other locations and to many professionals at different levels.

Simple information
A common “language” must ensure that each decision maker has access to the specific information they need to carry out their role effectively, without the additional “noise” of unnecessary material around it, and safe in the knowledge that what they are presented with is of the best possible quality and “fit for purpose”.
    
Different clinical professionals (and the managers who ensure the business in which they work is efficient) require differing views of the available data. This may require data selection or deduction and/or aggregation, presentation through different media and in different formats. This is a daunting set of challenges to health informatics; given that over one hundred types of professionals may be involved with an individual during any episode of care, in or out of hospital; at home or away.

Adapting health professionals
Society is demanding more involvement in its own care; from solely understanding the implications of a clinician’s words, searching out and presenting their specialists with in-depth material found through Internet searches, to taking action themselves and self-medicating or making lifestyle choices.
    
Different patients (and their families and carers) will be active to different levels, depending on circumstances and situations; but the health professional must be able to work within whatever environment they find themselves. Informatics solutions must be able to harness all the presented material to support the achievement of the most beneficial outcomes in the circumstances. The paradigm is shifting and informatics is facilitating much better decision support for both professionals and the public.

Patient notes
Over and above physical care for the individual, health services providers must be accountable for what they do, and be able to demonstrate probity, good governance and best efforts in all they do. Thus the systems used at patient level must also provide aggregations of data to meet stringent demands for audit of accountability and responsibility.
    
Patient notes must be complete, consistent, comparable, contextualised and contemporary. The knowledge base of general published evidence about health issues similarly needs to be readily accessible; in a form which gets appropriate information to the right person, at the right time and in an appropriate form for use. Organisations must be able to demonstrate that they are developing or at least maintaining their services relative to expectations and targets; local and national; public and general.
    
Many of the issues discussed in this article are already being addressed by the NHS and other providers in the UK and abroad; but are not yet ubiquitous to all locations. Some of the developments are prototypes from which we will develop different ways to do things in future. Some current developments will over time be rolled out across the NHS and beyond. Some challenges have yet to come over the horizon. As in all things, there will be a mix of ways forward towards truly patient-centric care and better health maintenance; one size will not fit all!

Dr Jean Roberts is involved in the British Computer Society Health Informatics Forum and is, by day, a Senior Lecturer in Health Informatics at the University of Central Lancashire.

For more information
More information about contemporary HI can be found at: www.bcshif.org