Excelsior!
This issue of the Journal reviews the progress in health to
which medical computing in Europe has contributed over the last 35
years: three further articles demonstrate achievements in medical
informatics, both in concept and in practice, across Europe, and in
doing so show how far medical computing has come in the same time
span.
In our opening article, and drawing on his presentation to MIE
2002, John Bryden offers a view on the areas where medical informatics
has had a positive impact on national health. Computer-based call and
recall systems in immunisation, pioneered by Galloway in West Sussex,
achieved increases in immunisation rates of up to 30%. Similar
improvements occured in screening, and the second report of the
National Screening Committee has recently emphasised the potential
offered for informed choice, and the ensuing reduction of risk.
Hospital information systems such as those pioneered at The London
Hospital have brought many benefits, not least in better-informed use
of beds, and in order communication and reporting systems: and work in
the Wirrall has already shown how benefits are obtainable in many more
fields.
Computing systems have made up-to-date clinical information
available for both doctors (for example, the Scottish GPASS Drug
Dictionary) and for the general public (England’s NHS Direct is an
outstanding example). And finally, when thoughtfully designed, and
properly used, medical computing produces statistics that allow the
reasoned use of scarce resources. None of this has been without trauma
and, often, gargantuan effort: but the achievements are there, and the
potential ahead for increasing benefits for healthcare is substantial.
What of the IT effort that underlies these advances? Across Europe,
there is a wide span of endeavour, and achievement at a variety of
levels. In their article, Dr Michael Shifrin, Head of the Medical
Informatics Laboratory of the NN Burdenko Neurosurgical Institute in
Moscow, and colleagues describe the Institute’s EPR project, its
growth from small beginnings and five users in 2000, to its current
level with 350 users, and plans for further expansion. Professor Bernd
Blobel of the University of Magdeburg sets out the technical and
theoretical backgound to the German Health Telematics Platform, and
the move to a virtual EHR system as its core application. In February
2002, the Journal carried an article by Claus Pedersen on
electronic communications and Internet opportunities in the Danish
health services. In this issue, Søren Lippert, and Arne Kverneland of
the Danish Board of Health describe further progress on the Danish
health informatics strategy that has built on that increasingly
successful programme of electronic healthcare communication, and the
development of a generic basic EHR structure.
A number of interesting themes emerge from this wide range of
articles. The first is one upon which the Journal has already
commented in previous international issues. Despite often large
differences in the range and method of providing healthcare services,
delivering information services to support them shows very wide areas
of commonality, both in achieving success, and in the problems that
have to be faced. A small example: in his recent article1
Dr Al-Zahrani from the King Abdulaziz Military Academy in Saudi Arabia
cited the problem of staff resistance to change as an obstacle to
progress. And in this issue, Dr Shifrin identifies organisational
issues as more often a barrier to progress than technical difficulties
— a view shared by Professor Mihalas2 in describing work in
Romania.
A second point of interest to emerge is the result of progress in
information technology over the years. Our articles from Russia,
Germany, and Denmark all emphasise the importance of scalability and
interoperability for success; concepts that are achievable with
today’s technology, but which would — though highly desirable — have
been impossible for the early pioneers of big hospital information
systems. For them, getting the system to work in their organisation
with the limited range of applications that technology could achieve
was enough, sometimes more than enough. Such an approach would today
be positively short sighted, if not positively reprehensible.
Overall, therefore, this issue of the Journal records
progress. Across the world, there is general agreement that medical
informatics is there to improve the standard of patient care, by the
timeliness of data achieved through infocommunications technology. Our
articles show specific ways in which this can be achieved. We all
know, however, that there is still very much more that can be done.
Together with St Paul, we must hope that “the sufferings of the
present time are not worthy to be compared with all the glory that
shall be revealed to us”.
Michael Fairey
References
1. Al-Zahrani S. Use of information and communications
technology in Saudi Arabian hospitals. Br J Healthcare Comput Info
Manage 2002; 19(10): 17–18.
view abstract
2. Mihalas G. Current trends in medical informatics in
Romania. Br J Healthcare Comput Info Manage 2002; 19(10): 26–8.
view abstract
