Editorial
To Succeed, Computers Need to be 'Irresistible'
Computers have not as yet been embraced by the healthcare industry,
although they have become an essential part of the accommodation industry (e.g.
hotels), supply industry (e.g. stock control of supermarkets and pharmacies),
financial industry (e.g. accountants and banks) and travel industry (e.g.
airlines) - to mention but a few examples.
Why then, have computers been so slow to be used in healthcare?
- If a computer is to realise its potential, the data it requires must be
entered at its source. In healthcare, this means the nurse and doctor must
type, swipe, point or click. Such activities are foreign and distracting.
- The hardware required is not portable, is expensive, becomes outdated and
breaks down.
- Appropriate and available software is often lacking, primitive, expensive,
difficult to adapt, and requires considerable time and effort to learn to use.
- The alternative is a piece of paper, a pencil and a rubber. This is
portable, cheap, reliable, and familiar.
- The main concern of doctors and nurses is their individual patients. This
requires a one-to-one relationship during each meeting where even paper and
pencil is a distraction.
-
Why then, should we bother with computers?
Because the healthcare industry has changed:
- It was possible for one person to know all that was considered necessary to
practice all aspects of medicine. Specialisation then evolved to cope with an
expanding volume of knowledge. Now the rate of increase of world knowledge in
almost any aspect of healthcare is bewildering. Enter computers!
- Healthcare providers used to treat patients, and charge according to their
apparent ability to pay. This was a very private arrangement between two
people. Now the government is involved in the payment of most healthcare
events. This has introduced a third party who is demanding increasing value
for the decreasing taxation dollar. Financial monitoring has resulted.
- Quality of care used to be a personal matter between the doctor or nurse,
and the patient. The patient was very ignorant of medical matters. Now,
patients are much better informed, and consequently much more demanding. The
medical and nursing professions are acutely aware of the delivery and
maintenance of high quality healthcare. The government, being involved
financially and politically, demands high standards. This means that
indications, methods, techniques and protocols are ever changing, and often
manifest as rules and regulations. Now, "healthcare teams" of several allied
healthcare workers are involved in the management of one case. Each require
adequate documentation from the other.
- The legal profession rarely locked horns with the medical and nursing
professions. Doctors and cures were few, and diseases were many. Now there is
an oversupply of lawyers, doctors and nurses. There are many complex cures,
and a very aware community. Litigation is increasing, very expensive, and
results in defensive medicine, obsessive documentation, and a distracting
observance of protocols, rules and regulations.
Consequently, the nursing
and medical professions are increasingly involved in:
- keeping up with essential knowledge,
- repetitious documentation for others,
- anxiously looking over their shoulders for lawyers, government officials,
and economists.
All this in a setting of:
- increased competition from relatively more colleagues,
- increasingly demanding patient population who are aware of
- increasingly expensive treatment possibilities.
Those funding the
healthcare system have to cope with all this and:
- an aging population and
- decreasing healthcare funds.
Some in the healthcare industry say their
job satisfaction has declined!
How then, can computers help?
Computers have the potential to assist the doctor and nurse, in the
following ways:
- provide up to date and appropriate medical knowledge
- relieve the tedium of repetitious documentation
- monitor management protocols and costs and thus avoid treatment omissions,
excesses and conflicts. The provider could be guided along safe, economic and
recommended lines.
-
How then, do we get the healthcare providers to embrace computers?
Computers must be made "irresistible" to the doctor and nurse. They
will have to use the technology. They must be rewarded. Potential rewards
offered by computer systems include:
- Clear and rapid presentation of patient information in a form appropriate
for optimal management.
- Removal of needless documentation repetition. Nothing need be recorded
more than once. Automatic request form and prescription generation is simple.
Semi-automated summaries, referral letters and operation reports are a little
more difficult.
- Up to date knowledge within the computer can be presented in an appropriate
and timely manner. This can help save the user from drowning in the volume of
new clinical information.
- An up to date knowledge-base within the computer which monitors what is
done and not done, and can appropriately advise the user, as data is entered.
This will be the most rewarding, but will be the most difficult to achieve. It
will evolve.
- An increase in net income.
When systems are "irresistible," market
competition will cause their quality to improve further. Until they are, there
will be buyer resistance. An "irresistible system" has not yet been produced.
Perhaps the industry needs some help.
Don Walker, 6 Botanic Street, Hackney, South Australia, 5069.
Phone: 61+(0)8.3621768. Fax: 61+(0)8.3633025
E-Mail: dwalker@medicine.adelaide.edu.au
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Revised Thu Sep 14 21:09:08 1995