An analysis of the reasons why health IT impelmentation has been slow and cumbersome

1. Information Revolution in
Health: The Paradox
Starvation in the midst of plenty!
NSW ACHSM Dinner and IBM Executive HealthCare Dinner
Professor Steven C. Boyages
CE Clinical Education and Training Institute
November 2010

2. Definition
• Paradox
-n
• 1. a seemingly absurd or self-contradictory statement that is or may
be true: religious truths are often expressed in paradox
• 2. a self-contradictory proposition, such as I always tell lies
• 3. a person or thing exhibiting apparently contradictory
characteristics
• 4. an opinion that conflicts with common belief
[C16: from Late Latin paradoxum, from Greek paradoxos opposed to
existing notions, from para- 1 + doxa opinion]

3. Challenges to the health system
Rising Demand Constrained Capacity
– Growing & ageing – Patient Safety
population
– Chronic illness rising – Workforce shortages and
– High levels smoking, attitudes
obesity, stress – Manage demand within
– High consumer finite resources
expectations – Cost vs investment
– High key Worker
Expectations – NSW spends about 28% of
budget on health care
Needs – 1.3 million dollars per hour
technology
demography
3

4. “Process changes, like a new computer system
or the use of a checklist, may help a bit,” he
said, “but if they are not embedded in a
system in which the providers are engaged in
safety efforts, educated about how to identify
safety hazards and fix them, and have a culture
of strong communication and teamwork,
progress may be painfully slow.”

5. Investing In Health IT perceived as a
solution to some of these challenges
Benefits Risks
 Improved automation  Financial investment not
realised
 Improved productivity
 Poor connectivity
 Reduced duplication
 Lack of common standards
 Improved safety
 Increased risk to patients
 Improved patient and staff
experience  Increased staff frustration and
lower morale
 Improved reach of information
and service  Staff expectations not realised
 Poor execution and
implementation due to
inadequate training
5

6. Our Emotive Responses

7. Why is it so?
Have we overestimated the benefits?
Have we underestimated the complexity of the task?
Have we procured the wrong products or systems?
Have we had poor direction?
Have we started at the wrong place?

8. • Hype
• Failure to understand
the complexity of
workflow
• Poor Connectedness
and Interoperability
• Systems are not yet
agile and flexible
• Need for integrated e-
government strategy

9. Gartner
Gartner Hype Cycle

11. Technology Paradox of Personal Life and Work
Complex Work systems
Spot the Difference

12. Close to 450 million users sought access to the
Internet through mobile devices this year, IDC
said. That number could grow as Internet-
capable mobile phones, smartphones and
other wireless devices become affordable.
The number of mobile Internet users will grow
as the number of worldwide Internet users
increases. A total of 1.6 billion people accessed
the Internet this year, and the number could
reach over 2.2 billion users in 2013. More than
1.6 billion devices, including mobile devices,
PCs and gaming consoles, were used to access
the Internet this year, and that number could
top 2.7 billion by 2013.

13. Disconnect in School
Slide Courtesy of Cisco, Australia
13

15. Workflow
Competency Procurement and
Governance
and Training Implementation
Functionality Connectivity Standards IT system
Improved Improved reach
Improved Improved Reduced Improved
patient and of information
automation productivity duplication safety
staff experience and service

16. Figure 12
Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5)
Terms and Conditions

17. The Fly Wheel of Health
• Competency • Collaboration
• Culture • Capital
• Care Models
Workforce Capacity
Needs Demand
• Equity • Demography
• Social • Chronic Care
Determinants
Technology is the Accelerator

18. Success Failure