Keywords: Information and Communications Technology, Clinical Applications, National Health ICT Strategy, Policy, Pace of change, Nurse education, Hardware, Software, Media, Visualization, Tools.

Citation:
Jones, P. (2001) Visualization and Technologies - hard and soft,
<>, Accessed

Introduction

The observations made here are generalizations, Brian and I would be pleased to hear from anyone who may wish to comment / or contribute to the points raised here.

This section describes some of the historical influences, and more recent factors driving the adoption of ICT in health care.

1. The arrival of computers in clinical areas.

During the 1980's and 90's health services invested in ICT with dedicated monies. In the UK such investment has been concentrated in the primary and acute health sectors. (The total annual NHS spend on ICT is still often quoted as less than the proportion spent on ICT in commerce and industry.) Early programmes such as the resource management initiative were driven by objectives and goals, with claims of clinical benefits. The success of subsequent policies in primary care, such as fundholding and locality commissioning were closely allied to ICT in order to monitor contracts and service delivery.

The preoccupation with administrative and contractual data, led to the clinical relevance of some systems being called into question. Despite this legacy - or as a consequence of it - technology in the form of PCs can be found in many clinical areas. Whether this resource is fully utilized is another matter. Just because a PC resides in a clinical area, does not mean, of course that it is used for clinical purposes. Neither does it mean it is 'current', given the pace of change in the ICT industry.

As if to preempt development and future requirements, some hospitals adopted workstation technology. These systems (usually in larger Trusts?) were able to adopt software that used a graphical user interface, now the standard for human-machine interaction on even the most basic of personal computers. The role of ICT in health care remains high upon the political agenda. The NHS Information Strategy is a keystone in the architecture of the modern NHS. Health is not alone in seeking an ICT facilitated future. Government, whatever its colour, must grapple with the arrival and explosive rise of e-culture and the 'information society'.

2. Changes in pre and post registration nurse education.

The transfer of nurse education to colleges and universities assists the cross fertilisation of ideas, and access to further resources. Nurses, while in competition with other groups, should have access to more computer expertise and power than previously possible at isolated schools of nursing. Project 2000 works effectively then the proximity of researchers and practitioners should also help. Access to various degree courses - including nursing informatics - bodes well for postgraduate study as worthy projects must be found for MSc. and Ph.D. courses.

3. The relentless pace of ICT.

As Moore's Law continues its predictive feat, PCs now possess the hardware and software capabilities for what used to be workstation level graphics handling. Many managers would appreciate life more if the rate of change were to ease. Change is so fast it can actually be counterproductive for some companies involved. The equivalent of the tennis player with the fastest serve, but a poor return of service.

In the meantime though it is marvellous to compare what £1,500 ($2000) worth of computer will buy on a bi-annual basis. As a result businesses will 'skip' a generation, the media highlighting what is 'just around the corner': electric paper (Daviss, 1999; Fildes, 2003)? On several occasions I have decided to defer my own purchase for these reasons, the problem with this approach is of course - that you would never buy!

4. New technologies.

The sheer pace of PC innovation - vis-á-vis - processor development is a mechanistic factor, just one of several. Other crucial factors - social and political - are not so predictable. If Bill Gates can get futurology wrong, as with the Internet and telecoms companies wonder if they paid too much for their UK licenses; then what chance the rest of us? The WWW, object-orientation, multimedia - and the emergence of DVD, video, speech processing, object oriented technology and artificial intelligence, to say nothing of WAP and i-mode phones, and wireless computing. These technologies and others constantly form the foundations of ICT solutions (always solutions note!) to information, organisation and communication problems for users, from which it seems there is no permanent relief. These technologies are regularly combined to form very powerful systems with graphics an integral part. Geographical Information Systems (GIS) had to await suitable graphical technologies and fast, cheap data storage before finding widespread application as in epidemiology, planning and various other applications.

Telemedicine is now a fact of life for members of remote, isolated communities, as found in parts of Australia.

Today we are all aware of how databases hold records and can hold clinical records, but for some users and information system suppliers their target is not the data, but the document, in particular workflow and documents. Workflow and document management provides an alternative or complementary solution to the records problem. Document management had to await the arrival of cost-effective imaging, storage and communications 'solutions'. According to Daviss (1999) electronic paper 'heralds the greatest advance since papyrus'.

Long established software technologies are also subject to challenge. It is felt in some quarters that the relational model - an approach that defines how databases are specified, coded and deployed - is reaching its limits. The Associative Model of Data (AMD) is a response to overcome these limitations. Interestingly, from a clinician's point of view these older software technologies were already 'tried and tested' in other industries - financial, stock, logistics - but not clinical. New approaches such as the AMD may not only enable the information society, but innovative, usable health care applications too? Ongoing developments offer more succour. XML is still evolving as a standard and tool, but one that seems well suited to health offering a means of combining 'structure', 'content' and 'delivery' and much more?

5. The ICT market needs a health care market that needs graphical representation.

Although affected by Government policy as much as technological trends, the mid to late 1990s have seen rationalisation of the UK (International?) health care IT sector. Health informatics companies have merged, or pulled out of the sector altogether. Can the market produce the application the nursing and wider health care community (social services) would actually feel lost without? The nursing equivalent of the stock broker's system, the accountants spreadsheet. Can graphics provide nurses with the applications they can at last fully utilize, or is this web site a prime example of an ocularcentric fad? Given the numbers of nurses in the workforce (despite acknowledged shortages) and their distribution across most departments, nurses will undoubtedly use computer applications created for other professional groups. The majority of nurses remain sceptical of what technology can do for them. Or they recognise what technology could do, but question the ability of the organisation to harness that potential.

Perhaps nursing can benefit from other disciplines seeing visualization through its growing pains. To a degree people make technology as Kennedy (1989) states:

'The viability of technological change is ultimately adjudicated by the markets.'

In this sense the nursing market remains untapped, and to bring the argument up-to-date the multidisciplinary team market remains untapped. With some exceptions the health sector has still to get to grips with computer supported collaborative working. Too many services still fail at the first fence, being without basic E-mail facilities. This should change as the information strategy is rolled out across the service.

Sadly, the early experience of many clinical staff to IT may have promoted negative attitudes? Despite these negative work experiences the rise of the internet has generated renewed interest, rekindled via library PCs and home PCs frequently more powerful than those found at work - as noted below.

6. Visual tools and components are also a key to secure systems.

'Seeing is believing,' a key to feeling secure and certain about the world at large. Visual tools combined with biometric technologies should enhance security concerns that (rightly) bedevil confidence in health information systems. Information handling has for centuries necessitated security and preservation of confidentiality. Gone are the days when front door keys are lost through disuse. Security is currently a key concern as viruses not only invade the biological gene, but also the electronic circuitry that adorns our desks.

Confidence placed in PIN numbers and other personalised codes is being somewhat undermined, but improved forms of encryption and authentication are beginning to appear. Biometrics offers support, but as with all things is only as good as its weakest link. This being the need to store the biometric information used to verify identity.

7. The laggard factor?

Will health and the public sector always lag behind industry and commerce in deployment/use of ICT? Industry and commerce within the EU are often criticized for their slow uptake of new technologies the web and E-commerce especially. What defines ''leading edge' , 'current'' technology, and ' lapsed''? Does leading edge comprise only of 'high risk' research projects still emerging from academe? Commerce and industry have (for reasons of sheer survival) to manage the 'life cycle' of their investments. There is undoubtedly an optimal window of opportunity. A period within which technology provides improvements in productivity and hence an adequate return on investment. How does this differ between sectors - and within health sectors - acute; primary care; and mental health?

There will always be award winners in healthcare information management. Of course 'leading edge' does not necessarily mean 'better' or improved ease of use. As suggested above there are strategic occasions when the best way to proceed is to defer. Let others iron out the growing pains of leading edge applications. But just how long should we wait? Evans (1983) reveals how artificial intelligence techniques were deployed in 1983 with several practical implementations for a nursing expert system.

Evans (1983) acknowledged almost twenty years ago the need for information systems designers to attend to: 'how the working environment shapes the use of the systems they design.' p.1 In the 21st century these old problems remain, plus new ones. If, for example, health and social services do not have equivalence in information standards, ownership and interchange capabilities, then this must surely be a handicap to effective joint working.

Many private sector employers complain that new workers are leaving college without the requisite skills. Heaven forbid in health that we should have to 'retro-train' staff to use applications that 'still' run on the first Pentium PCs and even 486 processors. Now that would be an eye-opener for new employers - welcome to real world? ICT professionals have to reinvent themselves. Especially programmers who check the weekly computing press for the numbers of job vacancies for a particular skill - NT, W2K, SQL, C++, C#, Java etc.. IT leaders have called on the IT industry to assist in creating a new professional training body, to help solve the NHS ICT skills shortage. Rogers (2001) Strategies need people to make them happen.

How readily can the public sector keep up and yet maximise the benefits from ICT? There must be a 'break even' point in terms of staff training/morale, availability of applications, available hardware, longevity of systems and return on investment. The question is what is it?

© Peter Jones 2000

References:

Daviss, B. (1999) Paper goes electric, New Scientist, 15 May,36-39.

Evans, S. (1983) Nursing Applications of an expert information system, MEDINFO-83, IFIP-IMIA, North-Holland, 182-185.

Fildes, J. (2003) Electric paper, New Scientist, 18 Jan, 34-35.

Kennedy, N. (1989) The Industrialisation of Intelligence, London, Unwin Hyman, 193.

Rogers, J. (2001) News: Training body call for NHS, Computer Weekly, 22 March, p.4.

top : home

E-mail: Brian

E-mail: Peter