Guest Editorial

Effecting Change for Better Health Outcomes
 

There is a sense of momentum in health informatics, both nationally and globally. Health information technology (IT) is now ubiquitous. Computing and connectivity in clinical settings is now only notable if absent. There is no longer any question of whether or not to computerise in the health care sector. The hot issues are developing out of debate about which ways to improve the existing electronic systems for day-to-day health care transactions. New Zealand is embarking on a national information systems upgrade in the health sector; yet recent history overseas would indicate that significant national health IT initiatives do not necessarily proceed smoothly. What are the pathways to success? What elements of leadership, planning, technology and culture must come together to enable the implementation of IT systems that make a measurable difference to health care quality and efficiency?

The October edition of Health Care and Informatics Review Online offers a selection of the best papers from the HINZ 6th Annual Forum and Exhibition - Health Informatics: Effecting Change for Better Health Outcomes, held in Rotorua 29-31 October 2007. We are expecting that there will be a couple of late additions to this issue, but at "press time" (such as it is for an online journal) we have six papers that are broadly related to two perspectives on the conference theme: (a) primary care; and (b) technology-enabled futures.

New Zealand has an outstanding history of technology uptake in general practice, putting us at the global forefront of maturity in IT for primary care. We are now looking beyond electronic recordkeeping to tools for directly measuring and improving targeted clinical outcome areas. In this spirit, Susan Wells, Janine Bycroft, Ai-Wei Lee, Tim Kenealy, Tania Riddell, Paul Roseman, Kate Moodabe and Rod Jackson present "Patterns of Adoption and Use of a Web-based Decision Support System in Primary Care (PREDICT CVD 7)" which describes the uptake of the PREDICT decision support tool for cardiovascular disease risk assessment and management. As an interesting counterpoint to the first paper, Judith Engelbrecht, Inga Hunter and Richard Whiddett in "Further Evidence of How Technology Availability Doesn’t Guarantee Usage" present findings on how resource and clinical issues - including time, cost, training, credibility and skills - affect decision support use. Rekha Gaikwad, Thusitha Mabotuwana, John Kennelly and Timothy Kenealy, along with myself, then report ongoing work to improve the reporting capability from General Practice systems in "Developing a Quality Audit Report for General Practice Prescribing for Hypertension: Methodology".

It is the essence of modernism to look to technology for solutions, and this expectation is alive and well in health informatics. While it is important to be critical - to insist on objective measures of progress and to acknowledge the unintended downsides of technology as well as its benefits - it is also important to keep an eye out for the technology based pathways that can in fact deliver real innovation to health care. RFID is one technology that appears to be a particularly promising spark for innovation, and David Parry, Judith Symonds and Jim Briggs explore its potential for home telecare in the aptly titled article "RFID Solutions to Support Home Telecare Information Flows." Next, Malcolm Miller’s "Evidence-based Health Care Connectivity: Putting the Promise Back into Technology" reports on recent experience in Australia in applying a methodology that is centred on connecting users, as compared to a focus on "infrastructure" per se, to achieve (and measure) improved health outcomes. Finally, Doug Neilson presents us a report from the future, 12 months after the successful implementation of a comprehensive national connected health solution for diverse stakeholders, in "Electronic Health and Case Records, 2012".