SIDEBAR: Modern Medicine
by B HeadAt Children's Hospital, IT means more than information technology. It also stands for insightful thinking.
Dr Ralph Hanson was a physician working in Emergency at the Children's Hospital in Camperdown, in Sydney's inner-west, when he first realised there must be technologies available which would improve patient care and provide better support for clinicians.
Working with the clinicians and the IT department, he started to help shape some of those systems, and gradually transitioned away from full-time patient care and into information systems. For the past three years he has been director of information services for the Children's Hospital, now relocated from Camperdown to Westmead, on Sydney's western fringe.
Given his background, Hanson is acutely aware that the hospital's information systems serve multiple needs - improve patient care, support the hospital's administration and aid executive decision making.
One of the key innovations that he and his team have delivered is the electronic health record, which chronicles a patient's history, and can be automatically updated with the results of clinical tests or procedures ordered by doctors using an online entry system. This will in time be complemented with a document imaging system to provide the full patient record at the point of care.
Outside these more generic information systems, Hanson says there are other "madly exciting" technologies in the medical arena. These include digital medical imaging, telemedicine, interventional technologies and computer-based tools that can support research into gene therapy, all of which support the hospital's fundamental charter to provide exceptional health services to children.
However exciting the technology, Hanson remains anchored by limited funds. "It is easy to be innovative when you are in a well-funded environment, but being underfunded also drives innovation," he says, explaining that some aspects of the electronic health record initiative came out of a need to do more with less.
The budget constraints mean that innovation at the hospital is more incremental than big bang, but Hanson does involve the hospital in technology pilots where he can. For example, Children's Hospital is participating in one of two NSW pilots for the Child Health Information Network, which is a precursor to the creation of a statewide electronic health record. Ultimately this project will allow doctors across NSW to view the same online patient health record as a treating specialist at the Children's Hospital.
Hanson does not see it as his role to impose technology applications on the doctors, however. "The high-end technology in the clinical space is driven by the clinicians - and largely by the clinician who has trained overseas," he says. So the main innovation driver as far as clinical technologies are concerned comes from the clinicians. Hanson then innovates around the concept with the introduction of complementary technologies, such as wireless networking or handheld terminals, to extend the reach of the clinical technology. For example, he is currently piloting wireless networks in Emergency to take the PC to the bedside.
Whatever the doctors may have seen overseas, though, Hanson is reluctant to be an alpha site for a new technology. "It's difficult enough being a beta site," he says. "And there is a cost to being an alpha site. [The technology] may look cheap at the time of buying in, but if you look at the pain you go through then it's not worth it" - particularly given the time some new technologies take to start delivering real value to an enterprise. Hanson adds that installing the technology in isolation does not necessarily result in benefits. Payback from new technology also requires a comprehensive change management approach that involves the chief users of the technology.
"You have to learn to focus on the core users and not on the technophiles who might raise expectations beyond what you can achieve," Hanson says. "At the same time you cannot be slowed by the technophobes. Sometimes you have to forget the tail and let them carry on their own way because they can derail a good strategy."
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