AN estimated 5000 deaths, two million GP and outpatient visits and 310,000 hospital admissions could be prevented every year if an effective IT system were rolled out - saving up to $7.6 billion in health costs annually, according to an analysis for release today.

I'm always a little cynical about this kind of number of crunching. I'm all for saving lives, but remain unconvinced that we can actually build the better IT systems they call for - the health industry doesn't have a great track record here after all.

However, listening to a news report on the radio today about a community protesting about the reduction of services at their rural hospital here in NSW today, I couldn't help thinking that we don't just need better technology, but better ways of managing complex systems like the public health system. We need global systems that allow local solutions, not one big homogeneous business process engine for health care.

This is because not everything in health (and other community service areas too) can be boiled down to a transaction, like medication or lab tests. Even if we can achieve it, improving health transactions with IT will only take us so far in improving patient outcomes (and ultimately saving tax payers money).

Kurt Nielsen, the hospital’s director, says that while the doctors are not particularly adept at information technology, they have gradually embraced it. And it helps that the staff was involved in developing the innovations.

“My staff at the hospital is very, very satisfied,” he said. “We build these systems in an incremental way, and seek their input throughout.”

Talking of Social Business Design, I've written before about the need for new approaches to IT in healthcare. It sounds like the Danish have the right attitude more than anything else.

In 2010, the Gov 2.0 community needs to think harder about how this movement will bridge economic disparity. Open data, open source, social media, transparency and collaboration are great, but look around the room at the people it serves and ask yourself, ‘how is this bridging the digital divide?’

I’m not saying Gov 2.0 isn’t accomplishing this on some scale. I’m saying there needs to be more of a conscious effort to do so. There needs to be consideration as to how this is catering to more than just the iPhone-wielding, Twitter-tweeting community, or we risk further alienating those who need government most.

An important point. Its something I've talked about back at the Public Spheres on Government 2.0 in Canberra and Sydney. However, its also important to remember that Government 2.0 doesn't need to save the world - it just need to contribute to help saving lots of little bits of the world in ways that really count. Its one reason why Patient Opinion continues to be one of my favourite case studies for meaningful Government 2.0.

The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld.

Himmelstein, an associate professor at Harvard Medical School, said that in its current state, hospital computing might modestly improve the quality of health care processes, but it does not reduce overall administrative costs. "First, you spend $25 million dollars on the system itself and hire anywhere from a couple-dozen to a thousand people to run the system," he said. "And for doctors, generally, it increases time they spend [inputting data]."

Himmelstein said that only a handful of hospitals and clinics realized even modest savings and increased efficiency -- and those hospitals custom-built their systems after computer system architects conducted months of research.

This is a quote from an interview by Computerworld with one of the authors of a research paper published in the American Journal of Medicine on the impact of IT on the delivery of health care in the United States.

Their conclusion, based on the data: not much.

However, I think there are some hints here about the root cause of the problem:

• Don't expect benefits from systems built as a means to an end;
• Build systems to fit the people, not the other way around; and
• Real ROI data takes time and effort to gather.

This is also all very interesting when you consider my recent posts about measuring the value of Enterprise 2.0 versus the clear and obvious bottom line benefits of three-letter acronym systems... because it sounds like these health information systems were sold on the same sort of 'hard' ROI numbers.

Hat tip to Nicholas Carr.

OPEN source software offers one cure for clinical system implementation woes, as authorities struggle to find solutions that meet all medical requirements, a leading health informatics researcher says.

...

Rather than the all-in, big-bang approach of a full CIS (clinical information system) implementation, an open, standards-based approach would allow a more incremental, lower risk approach, with organic expansion based on lessons learnt.

I think the mixing of terminology around open source software and open standards is a little confusing in the piece. However, what is clear is that complex environments, like we find in health care, need new approaches to information technology to avoid the mistakes of the past. This includes open source software, open standards, etc but also new approaches to procurement, support, solution design and project management. Just focusing on open source software itself is missing the bigger picture of the challenge. And what about the hardware too?