The business case for doctors’ involvement in medical informatics.

Years ago I was heavily influence by this paper in JAMA.

Most broadly, medical informatics aims to get the right information in the right form to the right people at the right time. Informatics also aims to get information in computers recorded in a format that lends itself to computerised processing for decision support. This all helps doctors and nurses and other members of the large team health team do their job better.

Which is all well and good, but why should’t all this be left to the business analysts and software engineers and technical managers? That’s their job isn’t it? To make systems that meet peoples needs. They are trained to do it! Doctors, on the other hand, are expensive, opinionated, over-confident, in short supply and are generally a bit difficult to work with.

Surely the IT department would run a lot better if the doctors stay at the coal face and where they are useful and leave the technical stuff to the qualified professionals?

Maybe. But... in the long-run, I'm convinced it is a false economy not to have doctors in the hospital IT department. In my view the absence of doctors who understand both clinical and technical realities causes many opportunities to be missed.

Without a grasp of the difficulty (or ease) of achieving various technical outcomes often the wrong things are requested. Repeating patterns of information processing are not identified, so the opportunity to build reusable components is missed. Too often new systems are built again from scratch, or separate vendors are engaged because the similarity of functionality between two different jobs was not realised.

Obvious simple opportunities to tweak systems to better meet clinical needs are not recognised.

This isn’t a great outcome for the health care workers, and it doesn’t make for a fulfilling life for the technical team either, stuck out there in a branch of the organisation chart. Their role and the unique difficulties they face in an extraordinarily complex typical hospital information system constellation are poorly understood. Users make unreasonable, and unreasonably urgent, demands without any ability to comprehend the bigger picture of a rational system migration pathway. The IT department are thus given the unenviable task of choosing between the competing need of multiple doctors all demanding better information in a seeming cacophony of white-noise. Once a project is approved, time and resources are very limited and there is little time for laying the foundation for the next project.

I guess eventually everybody will get there. But this just doesn’t seem to be the way of doing it efficiently.

It just seems to me that with more cross-domain understanding it would be possible to migrate along an incremental development plan, gradually evolving flexible and reusable system components. The potential is enormous...