Healthcare Needs Information Systems, Not Information Technology

By Gerrit Van Wyk.

A camel is a horse designed by a committee.

No industry produces as much data as the health care industry, and no industry converts it as poorly into information and knowledge. One may think of data as bits of information, which, by itself, is meaningless, and becomes information when stitched together, and knowledge when we ask questions about the information.

Like many other industries, the fantasy in health care is if you put computers on people’s desks, it miraculously improves things, which is a fallacy based on a profound misunderstanding of information needs. Information technology (IT) is media, hardware, and the software making it work, and an information system (IS) the use of IT to make data and information useful to the people using it. IS starts with what people need, and IT is a tool that may be used to make that happen. Introducing IT without considering people’s information needs is a Hail Mary pass in the hope computers will somehow organize itself into an IS. Health care uses IT and have no functioning IS, and that is a big problem.

In most provinces in Canada and many states in the US, using IT in health care is now mandatory. When a medical practice introduces an IT system, productivity drops by around 40%, and it takes around 6 months before it returns to about 80% of what it was before. In a system with long wait times that is a disaster. There is a learning curve, files must be scanned into the system, which is a tedious backbreaking job, and computers doesn’t simplify practice, it makes it more complex.

A second problem is the design of all health care software is based on a deep flaw; it tacks on patient information to legacy systems, often ones previously used for billing. In addition patient information is sprinkled around on many different servers, and getting that information is like swimming in molasses, as you navigate different servers that are slow, down, the Internet malfunctions, etc. I am aware of only one software program designed from the ground up by physicians, i.e., is an IS, it is free, and it is open source and in the public domain, so can be grown or adapted to local needs. Proprietary health care software vendors don’t like it, which introduces the lobbying and backhand deals problem. I don’t know of anyone in Canada using VistA, instead we prefer to limp along with what doesn’t work well because of deals between vendors and governments.

A third problem with IT is, it depends on uninterrupted power and Internet connections, and technology that doesn’t break down, and is robust enough to survive assaults by humans. If anything quits, everything comes to a halt, which for most industries is not a problem, but becomes a critical issue when your life depends on it. Power and Internet interruptions can and do happen, hard drives break down, and humans accidentally corrupt or erase data and information.

Finally, health care information must be behind a very good firewall to protect it from hackers and ransom attacks, and must be designed in such a way people’s private data and information is protected. Many health care IT systems in practice are porous sieves and unregulated, putting data at risk.

It should be possible for me to take my health information with me on a thumb drive, and transfer it across provincial borders and between hospitals and medical practices. In Canada that is not the case, and the ultimate proof current health care IS don’t work. More evidence is it is virtually impossible to get useful information quickly, cheaply, and easily about Canadian health care. Withdrawing information from a properly designed IS is a piece of cake, what we have instead is a mess. The ability to extract information timely is critical for planning and adapting health care systems, and right now we simply can’t. It is an important piece of the puzzle.

I accept the fact a new generation of physicians, nurses, and other health care workers, who grew up with electronic media, expect to work with it in health care, but then we must provide them with something that works. We can and must do better.