Looking out

In those of the Journal’s editions with an international flavour (and the aim is to have one at least once a year) we try to spread our net as widely as possible. Previous international editions have carried articles from Saudi Arabia and Germany, from Lithuania and South Korea, from Russia and Denmark. In this edition, our net is as widely cast with articles from New Zealand and Finland, from the European Union and from Siberia.

The impact of modern technology — widespread air travel, the Channel Tunnel, global television — often makes us forget that England is an island, of which an occasional side effect is insularity. To counteract this feeling, a stimulating, if sometimes startling, antidote is to look at how other nations handle healthcare and the associated informatics.

The basic component of healthcare — the contact between the practitioner and the patient — is the same the world over, whether the practitioner is a barefoot doctor or a leading-edge transplant surgeon. Both need support, whether it is the provision of basic medical supplies or a state-of-the-art operating theatre with all the infrastructure that such a facility requires. The difference lies only in the level of support that is required, a view about the level of health to be sought, the economic capacity to sustain it and the political will to do so. At first sight, these may seem to be potent variables, as indeed they are, producing across the world a wide range of approach to healthcare provision. Diverse though the solutions may be, however, they all perform the same task: logistic support for the contact between patient and practitioner. With its increasingly important role in healthcare, informatics is a vital part of that support. Its manifestations are varied, as this month’s Journal shows, and the problems encountered are the same; but, though the methods may differ, the aim remains constant.

Our four articles all address, in one way or another, the issue of interoperability and the problems that face its achievement. In his article David Lloyd-Williams examines the problem within the enlarged European Union. His analysis stresses the tension between, on the one hand, the desire for person-centred healthcare and the consequent need for interoperability, and on the other, the need for massive investment over a long period (much longer than the average political cycle) and the need for substantial shifts of opinion amongst the clinical community. He accepts the many difficulties that have to be faced in creating interoperability in so diverse a community as the European Union, but proposes a role for the European Commission, employing industrial skills to tackle technical problems, using financial and economic skills to address the vexed question of affordability and harnessing the energies of enthusiasts for ehealth to show just what can be achieved.

In their article, describing the current status of health informatics in Finland, Dr Persephone Doupi and Dr Pekka Ruotsalainen explain the gradualist approach which has been adopted there, whilst at the same time seeing healthcare informatics as a driving force in triggering and supporting the redesign of the healthcare system. Of particular interest is the proposed continuing role for legacy systems, and the concept of certifying the interoperability of systems, rather than the imposition of standard systems.

In the third article, Dr Konstatin Vinogradov and his colleagues from Krasnoyarsk Territory describe the work they have undertaken to produce the data necessary to plan and organise healthcare provision in a geographical area that is over 13% of that of the whole Russian Federation. Drawing upon diverse sources, it has been possible to develop a uniform database that can help to determine both needs and priorities.

From New Zealand, Dr Martin Orr sets out the approach adopted there, which can be summed up as edging towards national integration. Deliberately avoiding the ‘big-bang’ method, the process is incremental and evolutionary, building upon existing and fundamental building blocks such as a unique patient-identifier system and a secure healthcare network. Of interest also is the focus on the innovative automation of traditional clinical processes, rather than an attempt to change them fundamentally.

Within these varied experiences, there may be much to consider. Perhaps we should wonder why both the experience of smaller countries, and proposals for the European Union, avoid a ‘big-bang’ approach? Is it possible that the concept of retaining core legacy systems, appropriately certified, may have some merit? Could it be that the incremental approach begun in England during the 1990s had something to be said for it? Might there be something in the idea that clinicians should be actively engaged in systems that are going to impinge heavily on their working lives? And is it just possible that by looking across the Channel, from Europe to the Antipodes, England might have something to learn?

Michael Fairey