eHealth is not a panacea

There seems to be a prevailing sense that by using information and communications technology more effectively in health care, that many of the problems we face will somehow (magically) disappear. An opinion piece available on Computerworld’s website (“It’s the year for e-health records” by John Halamka) makes it seem like eHealth will be the cure to all that ails the health system. Dr. Halamka is a physician and CIO of a health care organization, so I’m sure has an idea about what he’s talking about.

In his piece, he was making the case that eHealth needs to be adopted faster and by more people in health care (namely physicians) and pointed out some possible strategies to use. His suggestion that the Bush government provide financial incentives to get physicians to adopt technology is pretty standard thinking in the health informatics field: line up financial reward with the target behaviour. Here in Ontario, the government basically threw $300-$500 million at family physicians to reorganize their practices and adopt electronic health record systems. I also agree with Dr. Halamka’s suggestion that health care needs to start implementing more automation like other industries. But, there are some major challenges that need to be overcome.

While everyone likes to compare health care with other service industries, I think people try and oversimplify health care too much. Health care is not like financial services, the hotel or airline industry. The demands and pressures found in health care are different. Sure, some aspects are comparable and even similar, but I am amazed that it’s always health care looking at other industries rather than the other way around. True, much of health care could potentially be improved by better use of technology, but we are far from there. Standardisation is not something that comes easily in this field.

The second , and perhaps more important, criticism I have is that there is no mention of human factors or usability issues. Sure, we can all provide rebates, subsidies, or incentives for health care professionals to buy and then use technology, but we haven’t determined what these technologies should look like, how they should function, or understand how they should be designed. We are making a huge assumption that building the system and then plopping it into the health care domain will ensure cost-savings, quality improvements, and a host of other benefits. How do we know for sure that these benefits will be realized?

I strongly hold my view that use of technology and eHealth is not the answer – but it can be part of the solution. Technology is merely a tool that we use (a medium, or a channel) to transmit the human intention and action. We need to address the social, political, and structural issues of health care to really make a difference.