Beyond Medical Informatics

Many HIT4Dev proponents fixate on a comparative set of HIT applications between more advanced countries and developing countries. They emphasize finding free and open source alternatives as a way to bridge the gap.

It’s too simplistic to think of the gap as a list of software applications. That’s like the proverbial blind men and the elephant. Software is just a small part of the problem.

The gap is less about the WHAT and more about the WHY. It is less about having applications but more about being ready for them. Some of the things to look into include:

• what they have (technology, applications)
• what they do (processes, operations, activities)
• what they are (culture, values, advocacies)

Understanding the endpoint—the destination—increases awareness of the problem. But bridging the gap involves studying the gap itself—the journey.

The script should NOT be “They have an EMR. Let’s get ours too.” Instead, it should be “They have an EMR. Do we need one? Are we ready for it?”

Asking what others have is a good start. But more important questions should come in:

• how different is their situation?
• what problems did they encounter and solve along the way?
• what opportunities were presented to them?
• what caused the failures?
• what contributed to the successes?
• what were their strengths and weaknesses in each stage of the journey?
• how did they manage change?
• where are we right now?
• where do we start?

This exercise should lead to answers that generate both long-term goals and short-term targets. It should identify the next steps. You’d find out that the “major major” task is more about creating a mindset that’s ready for change and less about implementing software. It is more about engaging stakeholders in discussions about their problems rather than pushing open source solutions. It is more about understanding where you are in the journey and less about focusing what others have in the destination.

The HIT4Dev gap is an important problem to address. Getting to the right solutions starts by asking the right questions.

 

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Comments? Objections? Violent reactions?

I’d like to hear your thoughts on this matter. Post them below. Thanks!

Recent email discussions got me thinking about the challenges of implementing Healthcare IT for developing countries (HIT4Dev). The basic assumptions of HIT4Dev include the following:

• The US (and other western countries) are more advanced in HIT concepts and implementations.
• Because of this, they are models for HIT implementations.
• Compared to these models, the developing countries lag behind.
• There is a palpable gap.
• HIT for developing countries (HIT4Dev) try to bridge this gap.

Here are 5 tips to help meet the challenges of bridging the gap and implementing HIT for developing countries:

1) Know what can work for developing countries.

With so much HIT updates today, it’s challenging to identify the ones applicable for Philippine settings. Not every technological advancement is relevant. Many implementations and applications brought about by US regulations may not hold true for the Philippines.

A good example would be the US HIPAA regulations. The concepts behind HIPAA are legitimate, yes, but direct compliance does not provide immediate or relevant impact to local implementations as of yet. It would be a foolish waste of resources to work on that given other areas for improvement.

 

2) Know why it worked.

Don’t stop knowing the “What”. The biggest lessons from successful HIT implementations in other countries are in the “Why”. Understanding and insight are the best tools in bridging the gap.

Being a copycat is a sure recipe for failure. Know what factors and concepts made it work. Know the conditions wherein it will NOT work. Get a clear handle of the ‘because’ of HIT implementations and activities, e.g. “Let’s do this BECAUSE…”, “Let’s not do that BECAUSE…”

 

3) Identify relevant target results.

After a thorough study, ask yourself these questions:

• What tangible results can I get out of the implementation?
• What specific deliverables provide the most relevant impact?
• What measures of success matters to the local users and stakeholders?

Get the successful US model and break it down into workable and relevant targets. As the saying goes, “You eat a whole elephant one bite at a time.” Just make sure the bite is something you can chew and use.

 

4) Understand ALL the components of the gap.

Understand that the gap is not specific to Healthcare IT because clinical applications do not exist in a vacuum. There are technological advancements, organizational dynamics, societal changes and governance structures that contribute towards the gap. These other things matter.

Focusing on clinical applications without understanding the non-clinical environment in which it thrives is a big mistake. Many HIT4Dev teams make that mistake.

 

5) Go beyond funding as the solution.

“If we only had funding, this problem would be solved.” How many times have we heard that?

People who think that way when trying to bridge the gap are simpletons.

The simplest problems are those where funding is the solution. They are easy to solve. But many problems are not that simple. Pouring money into a problem does not solve itself.

Take money out of the picture when solving problems. And you’ll find the real solutions worth funding.

 

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Comments and violent reactions? Do you have other tips for HIT4Dev teams? Post them below! Thanks!