Some Thoughts on the Psychology of Integration of Informatics in Healthcare; and a Suggestion

1. Some Thoughts on the Psychology of Integration of Informatics in Healthcare; and a Suggestion Sanjoy Sanyal MSc student, Health Informatics, RCSEd and University of Bath, UK

2. Financial Constraints in Healthcare • Available resources are always several paces behind the demands on healthcare. • Whenever national budgets need to be revamped, healthcare sector is among the first to receive the axe. • When budgetary allocations are considered, healthcare sector is among the last in the dole list.

3. General Constraints in Healthcare • Healthcare facilities are often understaffed and under-equipped; providers are generally over-worked. • Wide inter-regional and international variation in scope and depth of healthcare infrastructure • Healthcare sector lags behind non-healthcare sectors in IT implementation

4. Psychological implications - 1 • Feeling of being left behind by the world • This has served to make many of us go on the defensive, even bordering on the diffidence.

5. Psychological implications - 2 • As a belated knee-jerk attempt to catch up with the Joneses… • We are engaged in a race to anyhow implement informatics in healthcare, often without proper background study.

6. Psychological implications - 3 • Smarting from this state of affairs… • We are unconsciously trying to mimic other disciplines in our attempts to integrate informatics in healthcare.

7. Mixed Psychological Interplay Grandiosity Diffidence Inferiority complex Hesitation Overambitious Copycat syndrome Mimicking Defensive attitude Not recognising faults

8. Re-orienting our psychological personae - 1 • We should not flog a tired / dead horse: When a system is in its death throes… • Should have the wisdom to recognize it • Should not throw good money after bad • Have the humility to admit our faults, learn from our mistakes, cut our losses, and plan again more rationally for the future… • With a balanced perspective

9. Re-orienting our psychological personae - 2 • We should avoid being a “me too” chick: Implementation of a system should not be just to say, “We also have a system in place.” • Is this what we want or need (?) • Is it benefiting our patients (?) • Is it supporting providers in their work (?).

10. Re-orienting our psychological personae - 3 • We should not swallow more than we can digest, like boa constrictor: • Informatics plans should not be overambitious and grandiosely expensive • Should be just right for the POC • Requires possessing the right perspective of the magnitude of the problem.

11. Re-orienting our psychological personae - 4 • We should not be a copy-cat: Trying to blindly mimic other healthcare / non-healthcare implementations. • Each place has its own unique set of requirements and resources; system implementation should match these two

12. Re-orienting our psychological personae - 5 • We should not get into a rat-race: • Non-healthcare domains are way ahead, or • Other healthcare facilities have expensively computerized their activities • These should not be deciding factors in our decision to do the same with our POC.

13. Communication and Patient Anamnesis • Diversity of information • Ambiguity / confusion of classifications and terminologies • Problems of data entry • Problems of interpretation of coded data • Importance of, and problems in, anamnesis capture

14. Anamnesis Capture • Computerised voice dictation system: • Logical progression from Dictaphone, but… • NLP is still in infancy • Mainly operational in X-ray reporting environments with a keyword macro-type language.

15. Anamnesis Capture – Potential Solution • Record and store spoken word directly into the EPR • Capability is available now; may overtake quest for converting spoken word to text • Lateral thinking is needed. • Patient communication (a la humanities / social sciences) can be included in DV format (reduction in cost of multimedia, increasing versatility)

16. Anamnesis Capture – Potential Solution • Instead of trying to ‘code’ patient narrative, capture anamnesis in audio/audiovisual files • Break into smaller manageable sections, with hyperlinked subheadings, and store • Click/point on relevant linked subheading to see / hear patient anamnesis recording

17. Anamnesis Capture – Potential Solution • 4GL multimedia compiler (for audiovisual anamnesis), which would be compatible with most of the common OS in PCs

18. Multimedia Compiler – Features • Audiovisual anamnesis, database systems, patient data banks, knowledge transfer / complex tables, PC technology for video/screen titling, synchronization • Multimedia translation PCs / "speaking" question catalogs in different languages (digit interpreter) • Representation of logistic operational sequence, process animation and visualization

19. Multimedia Compiler – Network and Control Systems • Information and control systems for hospitals • Multimedia information networks • Network communication in hospitals, multimedia patient information • Radio data base access on central server • Global data base accesses by Internet (‘intelligent’ / associative term search • Internet video-phones / full-duplex video conferencing

20. Conclusion – 1 • Healthcare informatics implementation: Complex entity without any comparisons with other domains • Socio-cultural • Psychological • Technical • Commercial • Political

21. Conclusion – 2 • Patient anamnesis audio/audiovisual capture • The theoretical perspective should form a test bed for practical validation through collaborative research.