Bridging the Gap Between New Technology and Clinical Practice

eHealth – bridging the gap between new technology
and clinical practice

Séamus MacSuibhne
Consultant Psychiatrist, Health Services
Executive, St Luke’s Hospital, Kilkenny
Ireland

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eChallenges e-2013

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Healthcare and technology
- Health systems are increasingly large parts of our
economies, consuming increasingly large proportions of
state budgets. The sustainability of health spending is often
questioned, especially in the context of demographic
change.
- Technology is often promoted as an answer to these
resultant dilemmas, potentially improving the quality of care
and the efficiency with which services are delivered. Given
the vast sums spent on healthcare, it is also seen as an
opportunity for the “next big thing” in technology to become
highly profitable.

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Barriers
• However, there are significant barriers between the
introduction of new technologies and their adoption by
patients and healthcare professionals.
• Neil Versel,, MobiHealthNews, Feb 7th 2013 “Rewards for
Watching TV vs rewards for healthy behaviour” and follow
up piece Brian Dolan Feb 12th 2013, “MobiHealthNews
readers weight in on direct-to-consumer” – two articles
focused on pitfalls of mobile direct-to-consumer health apps
but which capture a lot of the deficiencies I would perceive
in the approach of technologists to health issues

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Quotes from Versel/Dolan article
• “What those projects all have in common is that they never
worked out some of the basic realities of healthcare.
Fitness and healthcare are distinct markers. The vast
majority of healthcare spending comes not from workout
freaks and the worried well, but from chronic diseases and
acute care.”
• “The vast majority of these products are created by people
who have had success in other areas of ‘digital’ – and
therefore they build what they know – consumer facing
apps/websites that just happen to be focused on health.
They think that healthcare is huge ($$$), broken, and
therefore easily fixed using the same principles applied to
music, banking or finding a movie.”
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Clinician’s Perspective
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Consultant Psychiatrist, St Luke’s Kilkenny
4 main work locations
Department of Psychiatry (inpatient unit)
Outpatients Department
General Hospital Wards
Community Mental Health Services (off site)
Regular clinical sessions away from hospital and regular
home visits/nursing home assessments.
• Service has an electronic (desktop based) patient
registration system but paper based patient records, with
different sets of notes for inpatients/outpatients and
different aspects of services.

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The technological landscape at my work
• Carbon copy forms are used to refer service users to other
disciplines within the mental health services. Bound
registers are kept of patients seen by the service with
separate volumes for on call, patients seen via general
hospital etc.
• Work email is currently available to me at a single desktop,
although there is the option of obtaining a specific work
mobile device if I wished to explore it (at least a theoretical
possibility!)
• There is a library on site with paper copies of journals. I
personally have access to journals via other institutional
links.
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Barriers to adoption of technology
-financial
-systematic
-institutional
-“practice”/professionalism
-labour-intensity
-concerns re data privacy
-concerns re equity of access

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• Context of global economic crisis and specific issues in
Ireland.
• Immediate financial cost of electronic patient record system
which has led to it being “kicked down the road” despite
benefits of reducing scope for errors and administrative
costs
• Differences between healthcare and other markets –
information asymmetry, lack of perfect information being
available.

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Systematic barriers
Any technology I might personally adopt would have to fit into
wider systems.
•Recently asked to beta test an app for taking patient histories
on a mobile device.While impressive in ways, to integrate into
existing notes I would have to make a hard copy
•Not only within a particular hospital, but within a particular
department of the hospital there are a range of systems, often
operating in systemic silos.
•Practice can be in multiple settings

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Institutional barriers
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In my experience, healthcare institutions tend to be
Highly risk averse
Particularly conscious of potential legal liability
While these attributes are in ways justifiable and laudatory,
they may delay the adoption of technology
• Inertia of the institutional – paper based notes (say) are
“working OK” and changing to an electronic system seems
too involved.

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Practitioner barriers
• Doctors and other healthcare professionals have their own
ways of practice and of self-management. Some may have
specific concerns or specific reluctance about technological
approaches.
• My own example was alluded to above – although I have
been told that it is possible that a dedicated mobile device
for accessing email away from the desk would be a
possibility.
• However, my role is as a clinician seeing patients rather
than checking email and am happy to have access on
certain days during the week.
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Time/workflow
• Technologies may require a certain amount of training.
Their use may also involve an investment of time. Unless
this total use of time results in a net saving of time, or has
some demonstrable and significant benefit over practice as
usual, the technology is likely to be abandoned.
• Example – the App mentioned above for taking notes –
overall it involved too much extra work to be clinically useful
• “physician workflow” – very often notes etc are written after
a group of patients are seen

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Data privacy/security
• From an institutional/legal perspective one of the major
obstacles to adopting technologies in healthcare settings is
concerns about access to personal data.
• Make it more likely to institutions to favour bespoke
systems that are less likely to “speak to each other.”

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Equity
• Health care workforces tend to be diverse in terms of age,
level of formal education and other factors. Levels of
computer literacy may vary.
• The above applies even more so to patients themselves.
There is an ethical obligation to ensure that care is
accessible to all. Even among the so called “digital
generation” there is considerable variation in confidence
and enthusiasm for technologies that are often assumed to
be ubiquitous and popular (Vaidhyanathan)

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Conclusion
• Already, there have been a plethora of ambitious digital
attempts to “revolutionise” healthcare.
• “Massive Health, Google Health, Revolution Health and
Keas never came to grips with the fact that healthcare is
unlike any other industry. In the case of Google and every
other “untethered” personal health record out there, it didn’t
fit physician workflow.” – Neil Versel

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Bridging the Gap Between New Technology and Clinical Practice

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