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I read this paper1 first published on 5 March 2018 in your journal with great interest.
The great pace of health information technology (health IT) advancement in recent decades held promise in improving patient safety and quality of care, but unfortunately there has since been inadvertent consequences and carry-over effects of technology-related safety concerns in its use and implementation.2 This paper has further fuelled the boon or bane debate of health IT.3
Ironically, the implementation of a national, multifaceted, quality improvement (QI) programme of ‘de-implementing’ electronic health record (EHR) notifications to primary care physicians (PCPs) has shown some benefit.1 This has, in some way, proven that being too reliant on technology in healthcare may yet rear its ugly head.
The paper has shown that high volume of EHR notifications can overwhelm PCPs;1 the proposed measure of breaking these down into “low-value” and “high-value”, and enforcing certain mandatory ones, may merely be an intermediate stopgap technique. Determining which is which, by its nature, is difficult to do and standardise.
Further, implementing a nationwide programme such as this poses certain challenges that the authors have not considered – will there be a difference between urban and rural healthcare facilities in its implementation, given resource limitations?4 Will technology have improved or changed by the time this programme is fully implemented nationwide?...
Further, implementing a nationwide programme such as this poses certain challenges that the authors have not considered – will there be a difference between urban and rural healthcare facilities in its implementation, given resource limitations?4 Will technology have improved or changed by the time this programme is fully implemented nationwide? If so, the costs of constantly chasing our technological tails will be great, especially if applied to larger countries, or ones with sprawling rural/regional areas like in Australia.
National programmes pose other barriers as well: would measurements be commensurate with other driving factors like local differences in practice and accessibility? The authors assumed that reduced notifications is a positive outcome, but if a regional facility has limited access to certain diagnostic tools or treatment capacity, the EHR notifications for these things will inevitably be less. Does that truly mean that the medicine practised in these areas are optimal and evidence-based, as espoused by the article?
But the paper has also shown that technological de-implementation of a health IT system is a double-edged sword. The results have indicated that there are PCPs and facilities enabling higher notifications post-intervention.1 Perhaps the real issue here isn’t using one form of technology to counter another’s pitfalls: we’re so focussed on technology alone where we’ve become so used to ordering diagnostic tests and monitoring because of its availability, at the expense of proper clinical practice and reasons, that we need to be constantly reminded of what we’ve ordered. Perhaps we should aim to integrate technology into a healthcare culture where principles of safety and quality are emphasised instead.5
1. Shah T, Patel-Teague S, Kroupa L, et al. Impact of a national QI programme on reducing electronic health record notifications to clinicians. BMJ quality & safety 2018 doi: 10.1136/bmjqs-2017-007447
2. Magrabi F, Aarts J, Nohr C, et al. A comparative review of patient safety initiatives for national health information technology. International journal of medical informatics 2013;82(5):e139-48. doi: 10.1016/j.ijmedinf.2012.11.014 [published Online First: 2012/12/26]
3. Jacobson J. Health information technology: bane or boon? The American journal of nursing 2014;114(12):18-9. doi: 10.1097/01.Naj.0000457401.30598.69 [published Online First: 2014/11/26]
4. Chipp CL, Johnson ME, Brems C, et al. Adaptations to Health Care Barriers as Reported by Rural and Urban Providers. Journal of health care for the poor and underserved 2008;19(2):532-49. doi: 10.1353/hpu.0.0002
5. Thimbleby H. Technology and the Future of Healthcare. Journal of Public Health Research 2013;2(3):e28. doi: 10.4081/jphr.2013.e28