Education And The Spread Of Health Information Technology

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Yes I admit it - I do have a passion for continuing education, particularly when it comes to health informatics. Education is a central part of the culture within HISA and is reflected in the delivery of our conference and seminar programs and our work with other associations. The last 6 months have seen a further growth in these activities, as we build our new online education programs aimed at enhancing the health informatics skills of both the general healthcare community and health informatics specialists. There are number of reasons why we are extending our educational services, but a core driver is the growing realisation that education has become one of the critical factors limiting the deployment and effective use of health information technology in Australia. Let me explain the rationale for this.

In Australia there are some compelling forces driving the increased use of health information technology. The growing complexity of health care, an ageing and more demanding population, along with limited financial resources have all led to a common belief in the need for change in our healthcare system, and the importance of information technology in enabling that change. Alongside this we have significant investments from information technology providers developing innovative solutions to these specific healthcare challenges. However, even with all this interest and activity, we are finding it enormously difficult to implement the required system and process changes.

This difficulty seems to be independent of the model for delivery of these improvements. From the centralised change model of the British NHS, to the highly decentralized approach in the US, there is a universal concern that the changes we are driving are taking much longer and are much harder to deliver than was ever anticipated. To better understand this challenge we need to look in more detail at the forces that drive technology diffusion within a healthcare organisation.

Healthcare does have its own distinctive ecosystem of clinicians, managers and supporting staff, with often highly personalised motivations for the work they do. However, within this unique environment, the factors that accelerate or restrict change appear to have strong similarities to industries outside of healthcare. This was one of the conclusions of the Rand Corporation in their extensive review of the subject published in late 20051. Here they looked at the way health information technology, and in particular the electronic health record (EHR) had penetrated healthcare in the US. They found health technology diffusion could be interpreted with the same generals parameters used to understand technology diffusion in a broad range of other industries.

So what are some of these parameters? The drivers of change within any organisation can be described by a combined set of external and internal influences as summarised in Figure 1. The internal organisational influences have been traditionally grouped into three categories (Rogers2) and they include the organisation’s perceptions of the innovation, their “culture” of change (innovators to laggards) and their leadership/management.

A primary conclusion from the Rand review for the healthcare community was the importance of perceptions. That is, how people within the affected community perceive the benefit of the change, its compatibility with their own experiences, the complexity and risks associated with the changes.

There is a third set of influences that are often not well articulated when the subject of technology diffusion in healthcare is discussed. These are the factors related to the capability of an organisation to respond to change, the availability of staff with the skills and physical resources to envision, lead and manage change. It is this capability which strongly influences the clinician’s perception and acceptance of change. This issue of capability is at the heart of Berwick’s3 7 rules for technology diffusion in healthcare.

While, for Information technology projects, the physical resources of hardware and systems can usually be externally purchased, the challenge lies in developing the skill levels of personnel within the organisation. How do you create an environment where clinicians and health care managers understand and believe in the benefits of the information technology changes and the ability of the organisation to deliver them? This is the key question when trying to convince busy and committed healthcare professionals to divert their personal time and resources into systems changes where the benefits are often not immediately observable.

Developing this level of competency within an organisation requires not just the importation of a few health informatics experts or leaders (although this can be an important catalyst); it is about progressively building the information systems skill levels throughout the operation. This is a commitment that should be made at the earliest possible stage, and certainly before the critical systems design phase of any major implementation. This commitment needs to be maintained to ensure that investment in change finds strong roots within the organisation and is used to build future improvements.

To engage a highly educated and committed workforce, with little if any spare time, requires the delivery of compelling educational content, relevant to their skill level and needs, delivered on a flexible, as required basis. It also needs to be highly customizable, to account for the broad spectrum of information systems skills and learning interests. Finally it needs to reflect the stage of development of the healthcare organisation as a whole and be able to deliver on specific and immediate needs within the operation.

Now, while I don’t want to drag the conversation back into the 90’s with overused management clichés promoting the need to create a “learning culture”, the recognition and reward of skills improvement is going to be critical to success.

One of the challenges we have in health information technology is that education is often delivered during or after a change or system implementation has occurred. However education is a necessary precursor to effective change. To be able to engage the appropriate clinical and health managers and to ensure the support of the general healthcare community we need to significantly strengthen their health information systems awareness and skills. Their commitment and direct involvement is essential to the effective design and acceptance of complex health technology systems.

While HISA, through its national and international network of Health Informatics educators, has its own approach to targeted, flexible education, there are many approaches to delivering these skill development programs. I strongly urge health management and clinical leaders as well as individuals to seek out these options and further build the health information technology skills within their organisations.

If you are interested, I would be happy to further discuss these skills development issues. You can call or email me at HISA anytime.

Posted in Australian eHealth

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