Every so often, someone asks: why can’t the health sector get its act together with ICT? Tell me why health is ‘different’?

Dilbert - advances in healthcare

Every so often a new and interesting answer to this question pops up…John Halamka just published an excellent list of 7 things that make healthcare (and by extension, health-related computing) hard in this post. Given his day job, this list can be taken as something very close to reality rather than being purely speculative. I mentioned a few of these things peripherally in an old blog post on the e-health standards crisis. Halamka’s comments just make me think that the The Innovator’s Prescription (Clayton M Christensen, Jerome H Grossman, Jason Hwang) really does provide an excellent analysis on how to think about economics and health care.

For a bit of history on the economic analysis of healthcare, including the amoral view on health of right-wing US commentator Rush Limbaugh, see here.

For a philosophical point of view, see these posts by Colin Farrelly (Professor and Queen’s National Scholar in the Dept of Political Studies at Queen’s University) – part 1, part 2.

Grahame Grieve recently put up his list of why healthcare is special, which touches on computing, sociology and economics.

In 2005 I wrote a paper for IMIA called ‘Why is the EHR so hard‘, in which I took a biomedical/social complexity viewpoint (more or less ignoring Halamka’s points above), and used EHR requirements as a way of looking at health complexity:

• information and efficient user interface reflecting multiple levels of hierarchical biological and social organisation;
• mobile patients;
• longevity of information (e.g. 100 years);
• multi-lingual;
• data shared and authored by multiple users simultaneously;
• integrated with knowledge bases such as terminology and clinical guidelines;
• wide geographical availability of a given record to multiple carers and applications;
• consent-based, potentially finegrained privacy rules on information use (with exceptions for emergency access);
• multiple sources of constant change to requirements including medical technology, clinical procedures and guidelines, genomic/proteomic medicine;
• reliable medico-legal support for all users.

Even just perusing the above resources which I happen to have to hand, health does indeed looking more daunting than other domains. Maybe we should quit and try something easier? I’m thinking of a) climbing Mt Everest, b) building a house on the moon and c) convincing the world that TV is evil.

~~~ post script ~~~

In my haste to put this up, I completely forgot the final item I meant to include in this list of indicators of health’s ‘wicked nature’ – and that is Alan Rector’s (Professor of Medical Informatics, School of Computer Science, University of Manchester) famous paper “Clinical Terminology: why is it so hard?“. This was one inspiration (and a proper scholarly one) for my little EHR paper above, but far more importantly laid out much of the ground for enquiry into representing health in ontologies and terminologies.