Information communications technology and health information systems

A critical review of:

Lewis, D., Hodge, N., Gamage, D., & Whittaker, M. (2011, June). Understanding the role of technology in health information systems [Working paper].

Information and communications technology (ICT) has created many innovations to help people in a variety of areas such as business, government and education. Although there has been a lot of research into ICT, how this technology can be used effectively in healthcare has been overlooked—even in first-world countries such as Australia. This critique examines a study of the role ICT can play in the health information systems (HIS) of developing countries—specifically the Pacific Island countries and territories—and the challenges associated with implementing them.

The authors of this paper describe its purpose as being ‘four-fold’. Their aim is:

• To create a common language for defining the components of HIS.
• To highlight the opportunities and benefits available through the use of ICT in healthcare.
• To analyse the success and failure of existing ICT-enabled HIS.
• To use models to assess the plausibility of adopting HIS in developing countries

According to the authors, there are very few ‘rigorously evaluated health ICT interventions’ available to base their analysis on. This situation is confirmed by investigations conducted by researchers such as Wootton (2009), who states that ‘most of the material…has been in the form of comments, letters, discussions, product reports, news items or case reports’ (p. 229). Even enabled by Australia’s National Broadband Network (NBN), healthcare using ICT is still in the early stages of development (NICTA, 2010).

Despite this, the authors have created a common language for defining the components of extensive HIS—modelled on those used in first-world countries. This common ground is very useful in deciding how to design effective HIS for Pacific Island communities. However the authors do note that a proper maturity model would be required to avoid unsustainable development and inappropriate use of ICT—especially since the infrastructure of the Pacific Islands is quite weak.

The article does well in highlighting the opportunities and benefits available when ICT is used in HIS. The lack of data for existing ICT use in healthcare has not stopped the authors from putting together a list of investment ideas that would work for anyone constructing HIS. These ideas are well thought-out and have a good grounding in what the ICT systems would depend on if they were implemented. I believe the list could be improved if more data was available but the authors have done a good job with what they have.

The authors give many reasons for ICT failure when it is used to support HIS. The Pacific Islands classified as developing countries, and as the authors point out, they are home to populations which are separated by large distances and generally located in remote areas. This adds the burden of a socioeconomic digital divide to the geographical one already in place. Although the divide is mentioned as a large component of ICT project failure in HIS, the authors don’t focus on socioeconomic information in much detail. The education of clinicians, doctors and people in management positions is looked at—which is reasonable since they would be the ones implementing the systems.

The authors could have followed the lead of Panir (2011) and Sanderson (2007) who take a closer look at people on the ‘have not’ level of the Pacific Islands’ socioeconomic divide. An understanding of the constraints imposed on the resource-poor would have been a valuable asset to their research on why ICT-enabled HIS projects fail.

The last part of the article deals with frameworks, evaluation tools and methodologies for ‘reducing the amount of trial and error and wasted resources in eHealth interventions.’ The authors don’t spend much time on this, promising a second paper to examine these models.

The authors have written a fairly comprehensive paper which fulfils the goals they set for themselves at the start. I would have liked to have seen more detail in certain areas but for the most part they have done what they set out to do. The article gives an insight into how having access to ICT is not the same as implementing it successfully, especially in the area of health. As information professionals in any country we need to ensure we have the right information, infrastructure and data to base our decisions on before going forward with ICT projects of any sort.

---

Map the of Pacific Islands

Back to top

Additional references

NICTA. (2010, June). Telemedicine in the context of the National Broadband Network. Retrieved from Australian Government, Department of Broadband, Communications and the Digital Economy website.

Panir, J. H. (2011). Role of ICTs in the health sector in developing countries: a critical review of literature. Journal of Health Informatics in Developing Countries, 5(1), 197-208.

Sanderson, P. (2007, August). Designing and evaluating healthcare ICT evaluation: a cognitive engineering view. Paper presented at the Third International Conference on Information Technology in Healthcare - Sociotechnical Systems, Sydney, Australia.

Wootton, R. (2009). The future use of telehealth in the developing world. In R. Wootton, N. Patil, R. Scott & K. Ho (Eds.), Telehealth in the Developing World (pp. 299-308). London: Royal Society of Medicine Press.