Issues which Limit Informaticians


What problems or issues limit health informaticians' abilities to evaluate health information infrastructures; why?  

An information infrastructure is defined as a combination of communication networks, databases, and procedures etc. that are combined to meet the initiatives of the organization (Zwass, 2017). For healthcare this is a complex network of disparate systems, policies, and procedures put in place to accomplish a common goal to improve quality of care. The disparity in technology being used in healthcare is what I perceive as one of the major challenges faced in healthcare today by informaticians. The goal is to eventually achieve interoperability. Other common issues seem to be the impact technology has on workflow, and our lack of understanding the correlation between technology and the patient’s ability to use the technology (Jackson et al., 2011).

Interoperability

Technology in healthcare today has emerged as a plethora of heterogenous information systems that lack interconnectivity. Iroju et al. (2013) identified the complexity of healthcare domains, misinterpretation of standardization requirements, and the use of legacy systems to be some of the key challenges in becoming fully interoperable. These key challenges have an upstream effect on continuum of care, implementation, and the overall bottom line. With regards to implementation the challenge would be in vendor selection and the philosophy of a best of bread model or single-source. Although, both models may work well in certain circumstances. When trying to leverage legacy software to avoid additional costs. The challenge you will be faced with is integration not only within the four walls but external as well (Cambridge Healthtech Institute, 2013). Moreover, this disconnect can lead to negative effects on patient care and unnecessary services being provided that would impact the organization and patient costs. 

Workflow

Understanding how workflow is impacted by certain technologies may also pose as a barrier in evaluating health information infrastructures. In many organizations’ workflow can be siloed and not known across the multiple divisions. Moreover, the informatician may not be privy to these workflows. The impact this has is with regards to modifications or changes to technology causing an upstream effect that may impact the workflow of certain departments. Being that technology can be used by multiple departments for different purposes. It is important to have a sort of statement of work that assists the informatician when evaluating a health information infrastructure. I have seen this personally as a challenge in a working environment I have been in. In my case a system that was being used by one department for a specific reason was modified and caused the entire department to create entirely new processes to complete their duties. These sort of impacts cost money and take time to mitigate. Jackson et al. (2011), identifies this as a common issue and barrier to determining the impact of health IT. The example provided is in regard to the expanded use of secure messaging between the physician and the patient. With a lean towards better communication between physicians and patients. Adding an additional task without comprehending the current workflow of a physician may cause many upstream problems and dissatisfaction.

Patient Use

The lesser evaluated topic is the correlation between the technology and the patient’s ability to use the technology. A common challenge in patient intervention is the patient’s ability to use healthcare technology. Whether it be a wearable device or simply accessing the patient medical record (PMH). A patient depending on technology literacy, socioeconomic factors, or even age will impact the whether or not the technology is being used as intended (Jackson et al., 2011). In many cases this can be a negative or positive effect but does require additional evaluation by the informatician in order to understand the patient’s direct needs.

The three primary limitations as stated are interoperability, impact on workflow, and understanding the patient ability to use the technology. Interoperability consists of a heterogenous method of developing health information technology which has caused issues with interconnectivity amongst health systems. Workflow issues stem from technology changes causing upstream effect on departments with siloed workflows. The lack of understanding the patient’s capabilities to use technology essentially leads to challenges in patient care. Although there are solutions that can mitigate risk of these challenges. I believe they still pose the biggest risk for informaticians in evaluating a health information infrastructure. 

References:

Cambridge Healthtech Institute (2013).  Battle Between Best-of-Breed and Single-Source Philosophy Continues.  Digital healthcare and Productivity.  Retrieved June 20, 2014 from http://www.bio-itworld.com/DigitalHealthCare_Article.aspx?id=37974.

Iroju, O., Soriyan, A., Gambo, I., & Olaleke, J. (2013). Interoperability in healthcare: benefits, challenges and resolutions. International Journal of Innovation and Applied Studies, 3(1), 262-270.

Jackson, G., Krein, S., Alverson, D., Darkins, A., Gunnar, W., Harada, N., . . . Bosworth, H. (2011). Defining core issues in utilizing information technology to improve access: Evaluation and research agenda. Journal of General Internal Medicine, 26(0), 623-627. doi:10.1007/s11606-011-1789-3.

Zwass, V. (2017). Information system. In Encyclopedia Britannica. Retrieved from: https://www.britannica.com/topic/information-system/Information-system-infrastructure-and-architecture

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