Integrating Healthcare with Information and Communications Technology

Wendy Currie, David Finnegan

• Publisher: CRC Press
• Year: 2018
• Topic: Business
• eBook ISBN:
  9781315357294
• Subtopic: Information Technology
• Index: Business

This book sets out to answer the key question of how healthcare providers can move from a fragmented to an integrated provision, including how ICT be used to develop a market approach - variety and choice of service providers for patients - against a background of institutionalised and ingrained practices. A team of academic and practitioner experts with many years' healthcare and research experience considers the broad issues of transforming healthcare using ICTs, electronic health records (EHRs), and approaches taken internationally to the healthcare integration challenge. The book will be essential reading for those involved in ICTs at a strategic or managerial level, and for contractors and developers implementing solutions on their behalf. The book will also be of interest for all those concerned with integrating healthcare and ICT at every level throughout the world.

PART ONE

Transforming Healthcare Services using ICT

CHAPTER 1

Integrating healthcare

Wendy Currie

ABOUT THIS BOOK

The challenge to provide a nationwide integrated healthcare service continues unabated in the 21st century as politicians and managers drive through policies to modernise the UK National Health Service (NHS). Government policy to ‘modernise’ the NHS for the past four decades has produced a series of white papers and reports (e.g. Patients First, 1969, The Griffiths Report, 1983, Working for Patients, 1989, The New NHS, 1997, The NHS Plan, 2000, Delivering 21st Century IT Support for the NHS, 2002, High Quality Care for All, 2008). While the overriding theme of these contributions has been the introduction of private-sector-style practices and procedures into the UK NHS, the consequences have often led to confusion and chaos as continuous change initiatives have produced unintended outcomes such as process and service fragmentation rather than integration (Currie and Guah 2007). The key research question addressed in this edited volume is: How can ICT be used to develop market-driven healthcare (more variety and choice of service providers for patients) against the current background of relative stability and persistence in healthcare practices (institutionalised practices) while simultaneously moving from a fragmented (disparate healthcare services) to an integrated (seamless services) healthcare industry?

To answer this question, contributions were sought from a team of academic and practitioner experts, with many years’ experience of researching and/or working in healthcare. This book is divided into three parts. Part One considers the broad issue of transforming healthcare using ICTs. It focuses upon market, organisational, managerial and technical aspects of ICT-enabled transformation of healthcare. Part Two considers the topic of electronic health records (EHRs), which is a broader agenda than electronic medical or patient records. International governments are currently introducing policies to develop and implement EHRs to move healthcare away from a supplier-driven to a consumer-driven approach. The chapters focus on theoretical and practical issues. Part Three considers the global healthcare integration challenge featuring research studies from different countries. Empirical work includes studies from Scandinavia, the US, UK and the Netherlands to provide a basis for comparison of different clinical and non-clinical healthcare systems. While cross-national comparisons need to recognise socio-political, cultural and economic diversity, they provide some valuable lessons on different policies and practices of ICTs in healthcare, some of which may be transferable across geographical and organisational boundaries.

INTEGRATING HEALTHCARE: A 21ST-CENTURY CHALLENGE

The academic and practitioner communities recognise the challenge of integrating healthcare to improve service delivery to patients, yet few studies exist which identify the broad range of themes and issues necessary to achieve this goal. Our lengthy review of the literature points to multiple silos where clinicians are unlikely to read studies on ICT and healthcare published in management and IT journals, and academics and practitioners interested in business, management and IT issues are also unlikely to refer to clinical and health informatics journals. Such a narrow scholarly and practitioner focus inevitably leads to poor understanding of the broader clinical and non-clinical challenges of introducing large-scale ICT change in healthcare organisations. Figure 1.1 identifies four broad disciplines or fields of investigation that publish studies on ICT in healthcare. From a clinical perspective, studies commonly focus on issues such as ICT for clinical decision making and support and related issues of patient safety and medical error. Studies from the more general business and management literature tend to emphasise issues of organisational transformation and change. Whereas some of these studies focus on the macro level of analysis, including the political impetus for driving through changes in healthcare, other studies consider how managers and healthcare professionals may impose or become the recipients of change in healthcare organisations. Many of these contributions include case study scenarios on the adoption, implementation and evaluation of ICT change.

Alongside clinical and managerial studies, we identify two further technology-focused areas that overlap. Each area draws academics and practitioners from a variety of disciplines and backgrounds. Within the field of information systems and technology, a range of studies look at the ‘engineering’ problems of introducing large-scale ICT into healthcare organisations. Many of these studies stem from the field of computer science and engineering and often consider the technical imperative to be the most important and challenging issue. Studies in this field highlight the technical changes which take place, such as how hospitals have moved from the early radiology systems of the 1960s, through to the patient administrative systems in the 1970s, to the personal computers of the 1980s, the Internet of the 1990s, and more recently, the issue of software as a service and the networked society of the 21st century (Carter 2008). Recently, the information systems and technology domain has considered the technical challenges of data security and protection, particularly as electronic data storage of patient records carries additional risks over paper records (Johns 2008). Coupled with the work in this area, the field of health informatics fully embraces the link between healthcare and information technology. Health or medical informatics is defined as the intersection of information science, computer science and healthcare. The subject considers the ‘resources, devices, and methods required to optimise the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems’.

FIGURE 1.1 Integrating healthcare

Since the literature on ICT and healthcare is spread across several disciplines, with academics and practitioners tending to restrict their participation to their own professional groups and subject areas, it is not surprising that our review of the literature reveals a tendency among writers to revisit issues and debates that are well rehearsed in some areas but not in others. For example, within the management and organisation literature, the notion that IT is not simply about the technical imperative, but also about policies, people, processes and practices, is a perennial issue. However, in the field of medical/health informatics, which has commonly produced studies that identify the engineering and technical challenges of introducing ICT into healthcare, authors welcome studies on the socio-technical approach to evaluation (de Lusignan and Aarts 2008). Spanning different disciplines is a fruitful exercise since it reveals a rich source of material on different, yet related, themes and issues on the deployment and use of ICT in healthcare organisations. We would therefore encourage an interdisciplinary focus, particularly to avoid reinventing the wheel.

The next three sections present an overview of some of the literature from various disciplinary areas organised around specific themes and issues. This is not an exhaustive list of the literature, but an attempt to isolate studies which embrace ICT as a driver for change or more broadly discuss issues around innovation and transformation. One of our observations from reading the range of papers is that the more general business and management literature tends to ‘black box’ technology, whereby technology is peripheral to the wider managerial and organisational issues. While this perspective offers an interesting and insightful contribution to managing change within healthcare settings, it often underplays the role of technology, and, more importantly, specific technical applications which may be integral to the change process. Equally, the health informatics and IT literature often underplays the importance of ‘people’ issues, often aggregating this critical element under the term ‘human factors’. In this regard, human behaviour is often seen as ‘rational’ and amenable to performance measurement if not management. From our analysis of the literature, we delineate three broad interdisciplinary themes which we consider integral to the relationship between ICT and healthcare. They are: institutional and organisational change and ICT; ICT architecture, applications, process and systems integration; and performance measurement, risk assessment and benefits realisation.

INSTITUTIONAL/ORGANISATIONAL CHANGE AND ICT

The fields of business management and health informatics are replete with studies on institutional/organisational change and ICT. The former offers a broad range of studies which focus on policy and economic issues relating to value creation in public services and redefining the healthcare industry. These contributions consider how publicly funded healthcare organisations may adopt methods and practices used in the private sector to create a ‘New Public Management’ (Moore 1995) which better serves the public interest. More specifically, the global healthcare industry is perceived to be in a parlous state as budgets soar without a commensurate increase in service levels to patients and citizens (Porter and Teisberg 2006). While these studies do not identify ICT as a leading contender to improve healthcare services, other writers more specifically consider the role of innovation and technology in healthcare (Casebeer, Harrison and Mark 2006). An earlier study identified how the UK NHS introduced a Resource Management Initiative (RMI) to deploy information systems to connect medical activity to resource usage and to costs (Bloomfield 1991:701). This study showed how IT was used to improve ‘greater communication, planning and control, and even to bring about changes in organisational cultures’.

Since the late 1980s, ICT has been increasingly linked with the performance management of healthcare organisations, together with studies on how management methods and practices developed in the private sector have been introduced into public services. These initiatives include total quality management techniques (Currie 1995), business process re-engineering (McNulty and Ferlie 2002, 2004; Willcocks and Currie 1997) knowledge management (Currie and Suhomlinova 2006) and, more recently, new variants on quality management and lean manufacturing (Boaden, Harvey, Moxham, et al. 2008).

While these practices may produce variable benefits across healthcare services, many writers caution that simply applying management tools and techniques from the private sector into healthcare is not a guarantee for success (Willcocks and Currie 1997), particularly as each sector is governed by different management philosophies, policies, practices and procedures. In conjunction with studies on policy and market drivers for ICT, others focus on technology-enabled improvement in service delivery in healthcare. This is partly fuelled by government policy to introduce ICT as a change agent in transforming the healthcare industry (see Department of Health reports 2000, 2002) and also ICT adoption and diffusion practices in specific clinical or non-clinical organisational settings, e.g. cardiology, renal dialysis, patient administration. An integral part of studying ICT in healthcare is the recognition that health professionals are governed by different management practices, embedded into organisational structures and cultures. The notion that new management practices can easily translate across private sector settings into healthcare is somewhat misguided. As writers have identified, it is important to understand the contextual nature of medical information and how it is used by professionals in their day-to-day activities (Berg 1999). Thus implementing an information system in banking or manufacturing will be very different from doing so in a hospital.

Empirical research into the design and implementation of ICTs in the UK NHS has found that poor user engagement is a significant barrier to adoption (Currie and Guah 2007). Despite the label of a national health service, ICTs have developed across a very fragmented system over the past 50 years, not helped by the constant structural and organisational changes in the service. So, whereas some healthcare organisations (e.g. the large hospitals) have invested more money into developing ICTs, albeit in specific clinical and non-clinical settings, other less well-resourced providers have not been able to embrace the full benefits from technical change (Brennan 2005). This is a significant factor in understanding the potential and actual adoption of ICTs, particularly as the level of IT maturity (i.e. the understanding, ability to use, propensity to use and perceived effectiveness of ICT) varies considerably across the landscape of healthcare providers. For example, a teaching hospital may be a world leader in renal dialysis and therefore invest considerable resources in developing ICT to retain its status. The same organisation, however, may be less inclined to invest in other forms of technology (devices or software), particularly where clinicians show little interest. Introducing technology is therefore closely related to the contextual situation, so quick-fix solutions are unlikely to produce satisfactory results (Doolin 2004; Currie 1995). The institutional/organisational change and ICT literature provides a useful multi-level analysis on the importance of understanding policy, organisational and managerial issues in the adoption and diffusion of ICTs. One observation is that the ICT or technical aspects are often underplayed as contributions highlight structural, cultural and ethical factors, thus ignoring the varying effects of different technology artefacts across organisations, departments and units.

TABLE 1.1 Institutional and organisational change and ICT

Policy and market drivers for ICT	Healthcare policy, ICT and transformation in healthcare, health economics and global challenges, the history and development of ICTs in healthcare, medical/professional bodies and their comments on government ICT policy, market-driven approaches to healthcare.	Bloomfield 1991, Brennan 2005, Burgoyne, Brown, Hindle, et al. 1997, British Computer Society 2006, British Medical Association 2007, Brown 2001, Currie and Guah 2007, de Lusignan and Aarts 2008, Ham 2004, Harrison 2004, Institute of Medicine 2002, Klein 2001, Mohan 2002, Payne and Rhia 2006, Pollock 2005, Scott, Ruef, Mendel, et al. 2000, Summers 2007.
ICT service delivery in healthcare	Primary care (GPs and practice team) are ‘high maturity’ in terms of provision of ICT hardware and software. Secondary care (hospital doctors, nurses, administrators) are ‘low maturity’ users of ICT. Supplier knowledge/capability of NHS/healthcare industry...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• About the editors
• Contributors
• PART ONE Transforming Healthcare Services using ICT
• PART TWO Electronic Health Records
• PART THREE Global ICT Adoption and Implementation in Healthcare
• Index