Thursday, 28 February 2013

Digital Health - Understanding the Challenges Facing Health IT Implementation

The goals set out in the CPEHN HealthIT plan, while lofty, are not beyond the ability of digital technology. Much of the plan is based on responding to patient data, either medical or demographic, in an appropriate manner.

Some key emerging technologies are already enabling a "responsive web" which will be able to identify individuals and provide them with the information most relevant to their situation.

Websites can already be built in such a way that they respond to user data (from a central database) and communications can be sent out responsively ensuring that the right message reaches the right audience.

As a non-healthcare "insider" there are several challenges which I have encountered time and time again when localizing materials and when attempting to construct systems which use data to provide more informed messaging. One example of these challenges can be found outlined in the CPEHN HealthIT plan, where they discuss the challenge with native Spanish speaking population’s use of the internet

Image care of CPEHN
One major challenge is that there is a heavily cultural element to localization which often only an "insider" can be aware of. Translating content, for example, is far less effective than having a semantic translation in which an expert in the local culture completely rewrites the message so that his audience will "receive" the same message as other readers, even though they will not be a literal translation. In this HIT has the distinct advantage of having many stakeholders within niche communities who have a vested interest in supporting this semantic translation.

Another challenge is the sheer quantity of groups that can be identified within a population as large as the United States (or even just the state of California). In President Obama's 2012 election campaign, he divided the country into 10,000 distinct groups, all of whom received different messages with the specific intent of ensuring maximum engagement with his audience. 10,000 distinct subgroups multiplied by just a couple of conditions is... well... a MASSIVE amount of content.

It has been my experience that in such an effort, it is necessary to develop the system to cater to the majority, and over time to expand it to treat the minorities. Trying to create a system from scratch able to cater to all the various minority groups identified within the healthcare system creates a project so lofty that it often struggles to take wing and leave the planning stage. However, by strategically implementing the key tools, using a staged release which constantly targets the largest groups not yet targeted, the project can be divided into achievable and manageable sub-projects each able to achieve some portion of the ideal result.

Technology can certainly be the key to the success of a project such as this. However, the unlimited scope of technology to implement change requires a very careful process of limiting goals to manageable, staged objectives and focusing on implementation and testing to ensure that the results desired match the outcomes achieved.

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