The importance of health informatics for healthcare's future

10 December 2018

People often think of IT as a specialist subject – the domain of computer scientists and IT geeks with a whole new, impenetrable language.  But it doesn't have to be impenetrable and it is vitally important to all of us and healthcare's future.  In Dave Snowden’s words (more later):
"If we don’t change language, we don’t change the way that people think."

This is where Health Informatics comes into play. Health informatics is described as 'the intersection of healthcare, IT and computer science'. It brings together health experts who want to learn about technology and technology experts who want to know about health. It is very much part of what we are trying to achieve at i3: bringing together clinicians, patients, computer scientists, engineers, data scientists etc to learn and redesign healthcare together. 

One of the best ways to learn about what's happening in health informatics is the Health Informatics New Zealand (HiNZ) annual conference, held this year in Rotorua on 1-3 November 2017. We had 14 session presentations and three posters presentations from Waitemata DHB and the i3, and we co-sponsored key-note speaker 'e-Patient Dave', Dave deBronkart. Here are some of our presentations:

e-Patient Dave featured on Radio New Zealand in an interview with Katherine Ryan. The interview is worth listening to with Dave calling for New Zealanders to 'get online, get access to your medical records, and take charge of your health decisions'.

One of the best presentations from HiNZ was from David (Dave) Snowden, founder and chief scientific officer of Cognitive Edge, "well known for his pragmatic cynicism and iconoclastic style". His company is developing tools and methods to help organisations develop and build resilience, using insights from complex adaptive systems theory, anthropology and neuroscience. Dave used the analogy of organising a nine year old's birthday to describe different types of systems (ordered; complex adaptive; chaotic) and why deciding 'which type of system are we?' really matters.  You can read his description in more detail here or view it here (at timestamp 33:35) - it is really funny.

Dave also touched on why understanding systems and how to change them is important: "Until you change the system, nobody will change. It’s not good enough to just focus on individual change, we've got to focus on systematic change"; and, (advice that will resonate with clinicians), "extrinsic targets extinguish intrinsic motivation".

Cognitive Edge has developed a narrative-based research technology to capture patient experiences on a large scale. The approach substitutes for traditional questionnaires and Likert-type scale analysis.  People self-index their own stories which allows for continuous free capture of narratives with instant feedback. The 10,000 Voices Initiative in Northern Ireland is using the narrative-based research techology to capture patient experiences on a large scale and support 'real time' improvement. The initiative has led to improvements in pain management, providing food and fluid 24/7 in Emergency Departments (EDs), caring for children in EDs, and a general focus on dignity and respect.

"By empowering patients to keep continuous narrative records of their cycle through the hospital, we can have an empirical measure of the impact of the hospital on their perception of health, not one of those nonsensical smiley-face things at the end, and not something involving professionals interviewing them where they know the answer they are meant to give. We can see those patterns. Then we have a network we can ask questions of in real time. And we can also detect in real time small early indications of attitudes to health care."

- Dave Snowden

The potential to integrate this approach with our developing patient reported outcome measures (PROMs) programme, the organisation’s values programme, and our e-patient experience reporting system (PERSy), is very exciting.