Healthcare systems and services across the developed world have had mixed success with the introduction and application of information and communications technology. The landscape is littered with the corpses of costly, high-profile failures.
PPARS, the ill-fated project for modernising health service payroll and personnel systems, is probably the most high-profile failure of any information technology project in Ireland.
In Britain, the most expensive health technology project in history, the NHS supercomputer — which could yet cost €35 billion — has been dogged by delays, cost over-runs and the obvious problem of getting the thing to work properly.
To be fair, ambitious ICT projects fail as often as not in the private sector, often for the very same reasons, though the problems there generally attract much less attention, as the impact is felt on shareholders’ rather than taxpayers’ money.
It’s tempting to think that the pitfalls of these projects are the best reason for avoiding them in the first place. The strategic priority should be to know what we want from the technology and then let the experts do the job of delivering it.
Like most public services, the health sector feels the need to have in-house expertise for all or many activities. I think a lot of this has to do with the general culture of risk-aversion that characterises our public sector — the notion that if all the knowledge you need is under one roof, the end result will be infinitely better or at the very least, more predictable.
However, the world does not work like that, and the argument that public services should concentrate on what they can or should be good at, while leaving the rest to those that have the necessary expertise and experience, cannot be gainsaid.
Even for technophobes like your humble scribe, the act of googling the world wide web for information has become part and parcel of daily life, so much so that few could survive long without the world’s favourite internet search engine.
Google’s tentacles are spreading beyond the original ‘search, retrieve and serve’ mission for internet information; they are now embracing the issue of customisation to consumer preference.
Perhaps the most exciting development from a health service point of view is a prototype called GoogleHealth, which is intended to be not just a window to a world of general health information but an electronic personal health record, which people can access anytime, anywhere.
So how does it work; why might it succeed where others have failed; and should our health services be thinking about using it as a viable and cost-effective alternative to a home-grown electronic health record?
GoogleHealth is based on four principles: a) the individual owns their own health information; b) this information is accessible to anyone the individual wants to have it; c) the information is easy and straightforward to manage; and d) the information is accessible on interoperable systems i.e. systems that can talk to and be heard by the ‘mother ship’.
The application allows the individual to create a complete personal profile of their general health, conditions, medications, allergies, procedures, test results, immunisations and family medical history.
The profile can be updated as things change and can either be accessed online, or pulled through any practice or pharmacy computer which is set for interoperability.
There is no limit on the amount of patient information that can be stored or on the number of care settings that can be linked. It is the individual who determines which healthcare professional can access what information.
In other words, an entire hospital episode can be recorded before the patient is discharged and the GP can have instant access to all of the records, including memory-hungry images like x-rays, CT or MRI, while the patient is sitting in their surgery.
The reverse also holds: a patient’s primary care history would be available in its entirety to a hospital, saving countless hours and millions in scarce resources. There would be no need for legislation mandating use of personal public health numbers by the health services. The optimist in me says this new application will have a massive impact within a short time of being available.
Given that Google is capable of retrieving masses of data in milliseconds, and is trusted by millions all over the world every day to do precisely that, it’s hard to imagine that the health application would not be robust and easily adaptable to changing needs. Until now, it has been assumed this would have to be built from the ground up at enormous cost to the State.
With technology moving so fast, and apparently now capable of getting disparate electronic systems to communicate with each other, we are now closer than ever before to being able to build comprehensive electronic health records quickly and cheaply. We can only hope that our health services won’t take the longest and most expensive route there.