Innovations in digital healthcare

John W Lewis's picture
Chat Date: 
Thu, Jul 14, 2016

Opportunities for digital innovation in the field of healthcare are at least as substantial as in any other field and realising them is at least as challenging. During this #innochat, we are delighted to welcome, as our guest, Shahid Shah (@ShahidNShah) who is extremely knowledgeable, experienced and articulate in the field of digital healthcare.

The history of healthcare information systems is not a rosy one, to put it generously. There are numerous examples of system developments which have fallen short of their objectives or have failed completely.

As CEO of Netspective Communications, Shahid Shah brings to this field a wealth of understanding, including knowledge and experience gained as a technology strategy advisor to US Veterans AffairsNational Institutes of Health, and the White House’s Office of Management & Budget. However, perhaps his most valuable asset is his intelligence, clear thinking, and straightforward common sense.

Further information on his contribution to this field is also available at ShahidShah.com.

There are a variety of aspects of the primary challenge that many people perceive in healthcare IT systems: this is often expressed as the challenge of data interoperability. (However, as described in the additional notes below, this perception of the challenge might actually be a cause of some of the difficulties!)

Questions

Let’s discuss the opportunities for innovation in digital healthcare during #innochat on Twitter on July 14th for an hour starting at noon Eastern time, based on these questions:

  1. Who uses digital systems in healthcare and what do they use them for?
  2. What are the major obstacles to the successful adoption of digital systems in healthcare?
  3. How will trends towards payment based on outcomes (rather than services) ease or exacerbate these obstacles?
  4. What advantages are available through the increased use of general purpose and open source software?
  5. What can healthcare learn from other industries about the adoption of digital systems?


Further notes

(A personal perspective)

In digital healthcare, as in other fields, there are multiple challenges including data collection, storage, privacy, and compatibility. However, it is abundantly clear to anyone with even a rudimentary knowledge of IT system architectures that there are fundamental misunderstandings in the healthcare field about the relative importance of the three main capabilities of information systems: storage, processing, and communication.

How many times have we heard healthcare people proclaim that most of their problems would be solved if they could somehow get all of the information into one place and all in the same format? While this, storage centric, approach might make some sense for very small systems, it rapidly breaks down as systems increase in scale. The unworkability of this perspective is illustrated by the abject failure of the UK’s £12Billion NHS patient records system, of a similar Aus$500Million system in the Australian state of Victoria, the lack of interoperability in the USA between systems funded to the tune of US$35Billion, and, no doubt a variety of other systems around the world.

It is based on a misunderstanding of the realities of large IT systems. Their strength and value are derived from their ability to do exactly the opposite of the objectives proclaimed above, i.e. to enable interoperation between systems distributed across multiple locations and storing information in a variety of formats. These are primarily communication systems, not storage systems.

By way of comparison with other industries, consider the successful roll-out of aviation’s AMHS internationally, while healthcare systems failed within single countries or states. There’s a clue in the name: MH stands for Message Handling; it’s a communication system. In even larger examples, would we describe the Internet or the international telephone systems as information storage systems? Probably not!

On a personal note, for 20 years or more, I have delivered training to professional software engineers on the fundamentals, technologies and applications of the most important innovation in software over the last 30 years (namely object-oriented design and development, including service-oriented architectures). The emphasis has continually been on the importance of focussing on behavioural issues and relaxing about data and its formats. So it appears somewhat backward-looking to see the current focus on data, including “big data”. It seems that those who would try to reverse this trend will continually to be thwarted by the reality that, as the famous quote from the late Roger Needham goes: “all problems in computer science are solved by introducing yet another level of indirection”.

Attempts to over-simplify and over-generalise will, inevitably, result in more complexity, not less, and will introduce unnecessary and unmanageable coupling and dependencies between otherwise unrelated components of these systems.

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