Cresswell Kathrin M, Sheikh Aziz
Centre for Population Health Sciences, University of Edinburgh.
Future Hosp J. 2015 Feb;2(1):50-56. doi: 10.7861/futurehosp.2-1-50.
Healthcare is at an important crossroads in that current models of care are increasingly seen by politicians and policymakers as unsustainable. Furthermore, there is a need to move away from the reactive, doctor-centred model of care to one that is more patient-centred and that consistently delivers accessible, high-quality and safe care to all. Greater use of health information technology (HIT) is seen by many key decision makers as crucial to this transformation process and, hence, substantial investments are made in this area. However, healthcare, particularly in UK hospitals, remains a laggard in HIT adoption. To uncover the underlying reasons, we discuss current implementation and adoption challenges and explore potential ways to address these. We outline strategic, organisational, technical and social factors that can 'make or break' technological implementations. Most importantly, we suggest that efforts should be characterised by an underlying awareness of the complexity of the hospital environment and the need to develop tools that support provision of integrated multidisciplinary care. We conclude with a discussion of promising future developments, including increased patient involvement; access and contribution to shared records; the penetration of smart devices; greater health information exchange and interoperability; and innovative real-time secondary uses of data. We argue that there is considerable merit in evaluating the introduction of these interventions to help ensure that they are optimised for effectiveness, support efficient working and minimise the possibility of inadvertently introducing new risks into already complex health systems. Our over-riding message is that HIT should be seen as, where appropriate, a potential enabler and an important source of data to support healthcare redesign and that critical, ongoing evaluation is key to maximising benefits. However, it should not be seen as a silver bullet.
医疗保健正处于一个重要的十字路口，因为当前的医疗模式越来越被政治家和政策制定者视为不可持续的。此外，有必要从被动的、以医生为中心的医疗模式转向更以患者为中心的模式，这种模式要始终为所有人提供可及、高质量和安全的医疗服务。许多关键决策者认为，更多地使用健康信息技术（HIT）对这一转型过程至关重要，因此在这一领域进行了大量投资。然而，医疗保健领域，尤其是英国的医院，在采用HIT方面仍然滞后。为了找出潜在原因，我们讨论了当前实施和采用过程中面临的挑战，并探索应对这些挑战的潜在方法。我们概述了可能“决定”技术实施成败的战略、组织、技术和社会因素。最重要的是，我们建议，相关努力应基于对医院环境复杂性的基本认识，以及开发支持提供综合多学科医疗服务工具的必要性。我们最后讨论了未来有前景的发展，包括患者更多地参与；访问和贡献共享记录；智能设备的普及；更多的健康信息交换和互操作性；以及数据创新的实时二次利用。我们认为，评估这些干预措施的引入具有相当大的价值，以帮助确保它们能优化效果、支持高效工作，并将在本就复杂的卫生系统中无意引入新风险的可能性降至最低。我们最主要的观点是，在适当情况下，HIT应被视为支持医疗保健重新设计的潜在推动因素和重要数据来源，持续进行关键评估是实现最大效益的关键。然而，它不应被视为万灵药。
