Sub director of assistance evaluation, Health Service of Balearic Islands, Palma de Mallorca, Spain

Availability of more data  in a faster way means:
1. To Be more informed
2. To take well-substantiated decision
3. To improve service management and results in healthcare

Not necessarily !

Objectives
1.  To substantiate it in a reasoned way (7)
2. To make reflections on how this is being carried out
3. To warn about the problems that may arise
4. To spur a necessary honest and rigorous debate

Premises
•    Informatics is not enough to achieve the necessary improvement
•     It is a means; to computerize is not an end objective
•    Risk of introducing formal, isolated, non-integrated changes and thus wasting resources.

1. Place of an strategic plan
1.    What is shown is not precisely a plan (amalgamation, tactical or operational postulates)
2.    There is a plan but it outshines (the only results ) Tactical objective
3.    Turned de facto into an aim (protocols, programs, paths, GPC)
4.    Servitude of professionals, technological determinism
5.    Does the function really make the organ?
6.    Key center of SSII : needs, objectives and models
7.    Informatic change = transition, non-transformation (Matvejevic)

OTA, 1996 ,  Still, the information technology is often found in “automation islands” disconnected from the health set.

Validity?

1.    Strategic, complex and deliberate reflection (participatory?)
2.    What should be computerized, why, how, when, order of priority, starting point, cost of opportunity
3.    Impetuous, unexpected decisions
4.    Rush into having installed programs

Besides, interest increased by the burocratic tendency to “maximize the budget” and also related to the human weakness of let oneself swept away by the many providers present in the market. A true risk is the implementation and development of IT applications through uncoordinated actions.

Ricard Meneu

2. Information systems
Strategic plan of computerization (anacoluthon,  planning rule)

Plan
1.  Semantic laxity
2.  Combined actions (surgery rooms, electronic prescription, prior appointment, RIS)
 3 .Lack of an articulating axle

 4. The whole thing is mistaken by some part

Datawarehouse:

OLAP : it perpetuates previous structure, bass (homogenization of allowances : CCEE, surgery rooms,  day care hospital)

Switching boards, static operation, semaphores

Digital radiology efficiency
1.    Queue management, test volume
2.     Integration of RIS and PACS at hospital
3.    Type of  storage
4.    Patient circuits
5.    Formation of techniques

Worsened by:
1.    Design of new assistance processes (theoretical and apart from existing SSII, arbitrated by informatics experts)
2.    Lack of knowledge in data reliability,  database refinement
3.    Dissatisfaction
4.    Underutilization of new programs

3. Managing teams
1.    Last non-informed decision (digital radiology); by confidence
2.    Getting around the skepticism of professionals due to previous failure; someone’s  else innovation hinders
3.    Compulsory mimetism
4.    Premature programs (informatic patches)
5.    Reluctance to admit criticism
6.    Support only at the beginning (not in keeping and consolidation of projects)
7.    Aprioristic triumphalism (Lauda finem!)
8.    Pre-election political pressure

[….] we must be aware that in the digital field, the lack of coordination between assistance levels and the shortage of applications that include health resources with a comprehensive perspective is reproduced.  The interest of managers and professionals to be at the vanguard position of “modernization”, taking advantage of the good reputation of e-Health technologies, also contributes to this.

Ricard Meneu

4.  The informatic experts
1.    Those who are avoided
2.    Those who receive neither enough information nor support
3.    Contact and knowledge of health assistance realities.

6. The informatic enterprises and their projects

Premature programs = commercial pressure + rush
Functions falsely attributed to programs are exclusively from the cognitive sphere.
It is wrongly believed that informatic tools make what one even does not know that should be done before use them.

Set of technical conditions

[…..] global applications are scarce whereas partial development proliferates with opportunistic slides to related sectors[…..] , which makes that once a new application is available, then previously ignored fields are searched to which the use of this application is transferred.  This rational search of new markets is often accompanied by promises of benefits that do not resist minimal analysis of consistency and that show the big gap between the development of tools that is intended to be introduced and the knowledge about the specific needs of the sector.

7.  The cost of opportunity

What role does the decision-making process play?

Restriction of resources makes one to estimate needs and to set priorities.