Book Reviews
Health Informatics: A Socio-Technical Perspective
Sue Whetton
ISBN: 0-195550-78-1 2005 262 pages Oxford University Press
Chris Kelman
Sue Whetton's text is a comprehensive review of the state-of-the-art of Health Informatics. The book is fairly lengthy, partly because she defines the discipline in a much broader manner than I am accustomed to. In her definition, Whetton has included everything related to data or information management that has anything to do with health care. Initially, I resisted this rather catholic approach. However, as I read on, I realised the relevance of her sub-title: A Socio-Technical Perspective. The whole point of the work is to emphasise the relevance of a socio-cultural perspective and to explore the dynamics between health informatics and the socio-cultural environment of health. Health informatics is very much Information Technology in the service of health care. It is not an end in itself; to be useful, it must engage with the users, so it is appropriate that Whetton includes all aspects of information management from accounting and staff management, clinical records, decision support systems, telemedicine and research, to surveys and consumer opinion polls.
Whatever the scope of the definition, Health Informatics is here to stay. Modern Information and Communications Technology (ICT) has a habit of generating massive amounts of data. In health care, these data describe both what we know about medicine and what we do with this knowledge. In both these areas, the quantity of data is already so vast that we cannot cope with it without the aid of (increasingly powerful) computers. The potential benefits for the management of these electronic resources are exciting, and achieving such dividends as a national electronic patient record, systematic safety monitoring of medicines and seamless communication across systems is the goal of the ‘health informatician'. However, none of the various e-Health initiatives underway in Australia or overseas provide a model of success: it is clear that health informatics is a vital discipline that is rapidly evolving in the primeval soup of increasingly complex medical care and increasingly capable ICT.
The author starts by reminding us of the widespread optimism common in the last century that ICT would ‘break down barriers, bring economic growth and prosperity and generally enrich the lives of individuals and communities around the world'. While ICT has certainly brought great benefits in many areas, most would agree that in health care, the promises have far outstripped the results. The book provides a basis for explaining this rather disappointing situation and gives some insight into the causes of the many conflicts that have slowed the introduction of informatics in health.
The discussion covers the early tensions between technocentric enthusiasm and the limitations and complexities of health care politics, resource constraints, organisational inertia and the poor management that often sabotaged worthy developments in new areas. Brief sections on systems theory and social science are included, and provide a framework for understanding these problems. Sections on computer hardware and operating systems I found less useful, and the student may want to refer to other sources for a more comprehensive grounding in this area.
While the book states that it is intended for health professionals and various consumer groups, it has the feel of a text intended for tertiary students. The rather pedagogical structure may be off-putting to the casual reader, but does provide a structure for home study. As the author suggests, the reader may want to ‘paddle in the shallower waters, occasionally venturing out into deeper waters to explore areas of specific interest'. An extensive bibliography and internet site list included at the end of each chapter provide ready sources of further information, at least while they remain current in this fast moving discipline.
The final chapter contains a detailed analysis of a hypothetical health informatics project in action. In this case a rural/remote setting is chosen, one that theoretically would most benefit from an integrated health informatics system. The scenario presented plays out a depressingly realistic story of thwarted hopes, a scenario that is familiar to all who have worked in this field, one that clearly underlines the unavoidable challenges and complexities of real-world practice. The introduction of a regional health ICT system requires coordination and professional management on a large scale. For any large project the problems arising from state, local and personal politics have been demonstrated recently with several national or provincial scale projects cancelled late in their gestation. In health informatics there are in addition, the challenges of bringing together experts from multiple disciplines and providing for the disparate and often conflicting needs of the health care industry and consumers. There are surprisingly many pitfalls just in selecting appropriate hardware to support IT projects, partly due to the rapidly changing market where a one year delay in implementation can mean that hardware is obsolete by the time it is installed. Finally, the author stresses the importance of providing appropriate hands-on training at all levels and of ensuring cooperation and support from providers who are already time-limited. The results portrayed in this not-unlikely rural scenario are sobering and will provide a reality check for those new to the field.
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