Primary Care, Communication, Collaboration, and Inclusion

Healthcare is always underpinned by information. ‎

It is the information that supports decision-making processes. If information is timely, ‎appropriate and accurate then the quality of our health is directly impacted. ‎Consider how difficult it is for us to make decisions about diet, exercise, ‎and care for ourselves if we don’t know what we should eat and what we should ‎do.‎

Think, for a minute, how difficult it is to provide care for someone if you ‎don’t know what they are allergic to, what health problems they have, what ‎medicines they are taking or even what their home-circumstances are.‎

Our knowledge about healthcare and disease prevention today is imperfect, in ‎some areas it is significantly flawed. Much of the food that we believe is ‎‎“healthy” is exactly the opposite. Some of the food that is deemed ‎‎“unhealthy” is not. Messages are often driven by marketing agendas than by ‎evidence-based best-practice that has been tested and proven under controlled ‎conditions.‎

Today’s “western” medicine is partly, and increasingly, based on evidence. ‎This means that, under controlled conditions, practices have been tested to ‎determine whether they do indeed have a significant positive impact on ‎healthcare outcomes. ‎

There is some debate about how much of the medicine practiced by our doctors ‎and nurses is, in fact, evidence-based. However there is little doubt that an ‎increasing amount of practice has been reliably proven and that the quality ‎and accuracy of our knowledge is increasing. ‎

Now imagine a more perfect healthcare scenario. ‎

Imagine… that we all know exactly what we should and what we shouldn’t eat, ‎in what quantities and when. ‎

Imagine… that we all know exactly the exercise that suits us best and that ‎will deliver us optimum fitness. ‎

Imagine… that we, and our healthcare providers, have full and complete ‎understanding of the ways in which socio-economic circumstances influence our ‎risk-factors

Imagine… that we, and our doctors, know which drugs will work best for us as ‎individuals in treating a particular condition (some estimates are that, ‎today, up to 50% of drug therapies are ineffective)‎

Imagine… that our healthcare provider knows about personal circumstances that ‎might affect the treatment they prescribe.‎

Imagine… that all information generated about you within the health system ‎can be made available, or not, at your discretion.‎
Imagine… that when your doctor is talking to you he is reminded to perform ‎tests and checkups that are appropriate to your personal circumstances.‎

Imagine… that when you, your doctor, and others involved in your healthcare ‎are deciding the most appropriate treatment for you that you are doing this ‎with a common understanding of your history, your circumstances, and the best ‎possible options for treating your condition.‎

And imagine… that you have access to the best-quality care, anywhere in the ‎world, when and where you need it, at any time of day or night.‎

All of these things are possible and it is through effective, planned ‎implementation of information and communications technology that they will ‎come to pass.‎

Sharing Information Across the Continuum of Care

Healthcare is often described as a continuum, it doesn’t start or end ‎with any individual. When we are young our care is a collaborative effort ‎between parents, doctors, nurses, teachers, and others involved in our ‎oversight. As we get older we take an active part ourselves and we may ‎encounter laboratories, imaging centres, hospitals, psychologists, therapists ‎and social workers. In our old age, our children, extended families, care ‎homes, and even hospices may become part of the continuum.‎

Technology is not the limiting factor in sharing information for the ‎betterment of healthcare. Any hurdle of challenge can be addressed with ‎technology and any imaginable solution can be delivered.‎

The limiting factor enabling communication, collaboration and inclusion in ‎healthcare today is our ability to effectively work together across the vast ‎continuum of care.‎

You see effective healthcare is not the responsibility of a few doctors and ‎nurses, it is not your GP’s sole responsibility, your hospital’s ‎responsibility or even your own responsibility. ‎

Effective healthcare is the outcome of a wide range of businesses, government ‎agencies, academics, clinicians, patients, and other professionals working ‎together for the benefit of every one of us and our community.‎

The challenge that we have faced in the past is that the most significant ‎healthcare events in our lives are those that involve a trip to a hospital. ‎

This is no coincidence. Many of the treatments offered by hospitals are ‎complex and expensive. Some are beyond the financial reach of a small ‎business and some resources are only financially viable if they can be shared ‎in a central location. As a result, in the twentieth century, healthcare ‎funding tended to gravitate to hospitals where efficiencies of scale could be ‎achieved and where costs could be controlled and resources rationed.‎

As a result of this concentration of resources, hospitals and hospital groups ‎have often developed information and communication technology resources that ‎are sophisticated and effective for sharing information with the hospital ‎organization.‎

Over time however, in healthcare, there has been a shift in emphasis away ‎from hospitals, to the “other end” of the healthcare spectrum. Life ‎expectancies have extended dramatically over the past century. As a result, ‎and with the realization that quality of life and healthcare outcomes are ‎improved if patients are not hospitalized, there has been a refocusing of ‎effort toward the provision of care outside hospitals. This has focused on ‎the home, in the community, and in smaller healthcare centres. ‎

This shift has involved, necessarily, a commensurate shift in funding and ‎this continues. As well there have been significant and many successful ‎efforts in the development of information and communications technology to ‎support healthcare outside hospital settings.

The challenge for the primary ‎care authorities is to bring order and coherence to the plethora of ‎information and communication technology solutions in use across the ‎continuum of care. For without order there is a danger of significant waste, ‎duplication of effort and a decline in quality of outcomes.

The most ‎sophisticated hospital IT systems in the world will not contribute to the ‎well-being of patients if they do not add value to the work of healthcare ‎providers outside the hospital.‎

The strength of a primary care authority is in its diversity. The authorities that manage primary care understand better than most the challenges surrounding effective communication and the need for “actors” in the healthcare continuum to collaborate and to be inclusive in their activities. I anticipate that as healthcare informatics evolves, and the needs highlight the deficiencies in the monolothic-solutions model in hospitals, it will be primary care authorities that take a lead role in the healthcare transformation that will follow.


One comment

  1. Caroline · · Reply

    Great blog. A couple of thoughts…

    The ultimate goal of primary health care is better health for all.

    WHO identified five key elements to achieving that goal:

    – reducing exclusion and social disparities in health (universal coverage reforms);
    – organizing health services around people’s needs and expectations (service delivery reforms);
    – integrating health into all sectors (public policy reforms);
    – pursuing collaborative models of policy dialogue (leadership reforms); and
    – increasing stakeholder participation

    All five elements require robust health information systems to support and monitor activities designed to deliver the goal and in my opinion primary care information is pivotal – not just to improve diagnosis and patient management, but to improve evidence-based decision making and emerging innovations such as home monitoring.

    Whether or not primary care organizations have the capacity to take the lead role is questionable – they certainly should have but traditionally investment in management, healthcare informatics etc is low – certainly in comparison with the acute sector. It will require government policy and political will to change this.

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