e-HealthExpert.org - Primum non nocere

The "Healthcare Informatics" magazine, January 2006 issue cover story is about Six Sigma Practices for the Healthcare Industry.

Six Sigma is a process-improvement methodology that is highly data-driven, and highly focused on achieving very specific, data-documented efficiency improvements, cost savings, and customer satisfaction enhancements.

It seems that executives at hospitals and health plans who have led Six Sigma initiatives are proud of the process changes and cost savings it has brought. They seem to love Six Sigma's focus on the bottom line and quantifiable results.

It is believed that the Six Sigma work can bring important benefits in healthcare for at least three substantial reasons:

• The funding for improvement projects at healthcare organizations is limited, so when one is undertaken, senior executives are demanding increasingly solid ROI--a strong orientation of Six Sigma.
• The complexity of healthcare processes requires objective data as the foundation of any improvement-driven activity.
• The rigorousness of Six Sigma work is particularly appropriate for the rather unorganized delivery of care and management of business operations in healthcare.

The full article is available at: Six Sigma Practices

Related article: Lean, Sigma, Kaizen - will they work for healthcare?

The Artemis project is an European Commission funded project that aims to define a Semantic Web Service-based P2P Infrastructure for the Interoperability of Medical Information Systems.

Among its main purposes are:

• the ability to provide the interoperability of medical information systems through semantically enriched Web services (using a to phase process through, first a Message Ontology Mapping Process and then a Message Instance Mapping);
• to find and retrieve clinical information about a particular patient from different healthcare organizations where concrete sources are unknown.

The project started in 2004 and is a joint effort of Turkey, UK, Greece and Germany teams.

More information at the The Artemis Project home page.

The Journal of Medical Internet Research is assembling a special theme issue on "Online Cancer Services".
Most articles are also of interest for those having (or preparing to have) their Hospital/Clinics interfaced with the Internet.
Articles for the upcoming issue will be published as they become available. You may find them at: http://www.jmir.org/2005/3/

The 26 April 2005 edition of the European eGovernment News Roundup, reports that according to a recent study by Frost & Sullivan the European e-healthcare industry is moving towards consolidation and the market is set to double in size within five years.

Anticipated sustained investment in this field could mean that the market could be worth USD 6.34bn (EUR 4.8bn) in 2010.

Up until now the growth rate has primarily been achieved due to the active implementation of Hospital Clinical Information Systems (HIS) in the major markets across Europe.

The full article is available at: http://europa.eu.int/idabc/en/document/4180/194

Also available from that page is a link to the full .pdf text of the European e-Health Action Plan adopted by the European Commission on 30 April 2004 - which aims to improve access to healthcare and boost the quality and effectiveness of health services offered across Europe.

Innosight which, as you may know, is the latest endeavor of Prof. Clayton Christensen, the author of the Disruptive Innovations Theory, has an interesting analysis of what went wrong in the Merck Vioxx case. The full article is freely available in .pdf format from: The Winner’s Curse

One of the most insightful articles about the reasons why Clinical IT projects succeed or fail must be Angelina Kouroubali's article: "Structuration Theory and Conception-Reality Gaps: Addressing Cause and Effect of Implementation Outcomes in Health Care Information Systems". In a clever way she connected Heeks work with the Giddens structuration concepts to create a single framework:

"...To facilitate the introduction of IS [Information Systems] in health care, research should investigate the way IS affects human actions and organizational structures and the reasons it affects them...
[Giddens] Structuration theory introduces the notion of the interdependency between human actions and organizational structures. Heeks theory of conception-reality gaps helps illuminate the causes of an implementation outcome...
The paper describes the two theories and how they may help healthcare information systems research. It illustrates its points using examples from the field."

The article was part of the Proceedings of the 35th Conference in Information Sciences (2002) and is available in .pdf format from: Structuration Theory and Conception-Reality Gaps: Addressing Cause and Effect of Implementation Outcomes in Health Care Information Systems

The Journal of American Medical Association (JAMA) just published an article by Koppel et al. about the impact of a widely used computerized physician order entry (CPOE) system in facilitating medication errors at a hospital:

This study identified 22 situations in which CPOE increased the probability of prescribing errors.

See the full article at: Role of CPOES in Facilitating Medication Errors.

Harvard Business School professor Clayton Christensen has gained a reputation for his work on "Disruptive Innovations":

• Christensen's research explains why established companies - even those competently managed by smart people - have such trouble countering or embracing disruptive innovations that are on the horizon.
• His theory says that organizations customarily develop mind-sets and processes that revolve around doing what they already know.
• Once that pattern becomes established, managers have great difficulty justifying to others or even themselves the need to turn their processes upside down to respond to a barely emergent market change.
• By the time the threat is apparent, however, it's usually too late; upstart companies have seized a substantial lead.

See the full article at: Disruption is good

Prof. Scot Silverstein's, an experienced medical informaticist, has a web page named: Sociotechnologic Issues in Clinical Computing: Common Examples of Healthcare IT Difficulties. In that page he presents a clear insight on the sociotechnologic issues in clinical computing, giving real life examples of dangerous, common, costly, preventable healthcare information technology failures.