I started out titling this post “the getting of wisdom”, but slowly came around to acknowledge that there has been some real wisdom generated in health informatics over the years – it just seems to mysteriously dissipate like dry ice on a sunny day, simply adding to the world’s increasing entropy. People ignore it. People squander it. Essentially, I think, most people can’t actually distinguish wisdom from noise.
Most of you would be familiar with the proposition of the distillation process, converting data to information to knowledge to understanding to wisdom, and the concomitant funnelling effect of this processing – i.e. we need oceans of data to produce a single drop of wisdom. Since we have so little health data in readily processable form, it is not surprising that we have a dearth of wisdom in e-health. And having a dearth of wisdom holds us back from collecting health data in a readily processable form. A veritable catch 22!
Moreover, the critical shortage of good health informatics professionals; the almost total lack of engineering skills in the e-health domain; the vacuum in leadership and governance, particularly within bureaucracies that hold the purse and policy strings; and the diverse, uncoordinated voices of many participants, such as patients and GPs, all acutely amplify the need to recognise and base decisions on those few drops of wisdom that have been distilled over the years.
Some places I go for e-health wisdom include:-
- Enrico Coiera’s Guide to Health Informatics;
- Alan Rector’s AIM: a personal view of where I have been and where we might be going ;
- Why Technology Projects Fail – Classic Mistakes;
Of course, a counterpart to wisdom, and a far more prevalent artefact, is stupidity. Some examples that spring to mind in e-health include:-
- the Healthconnect SA Care Planning Project;
- the DoHA decision to reimburse GPs $millions for supporting an almost non-existent secure messaging capability
a NEHTA project to map SNOMED CT to ICD-10AM;
an HL7 project to re-invent (badly) a suite of Detailed Clinical Models
And whilst we continue to divert precious resources into daft (if often well-intended) projects by so squandering hard-earned wisdom, we will forever remain in an environment where:-
“Health care is an information- dependent profession that is operationally handicapped by a remarkably dysfunctional information transmission nonsystem.”
– George Halvorson, Permanente Journal : KP Healthconnect supplement, 2004