Health

Getting what you need in healthcare: An information systems perspective

By - Integrated Care Journal

Getting what you need in healthcare:  An information systems perspective

Information is one of the World Health Organization’s (WHO) six essential “building blocks” of a healthcare system. Concurring with this, we have invoked the idea of a health information seeker (Young & Klein, 2021), a concept that cuts through complexity to support policy and decisions around commissioning, adoption or use of IT.

A health information seeker might be someone feeling unwell, a carer or professional such as a doctor or nurse or health manager, even someone with an idle interest. It might be a data scientist needing to update health information. It might even be a hacker!

From their perspective, a healthcare information system must promote access to relevant information, while preventing information overload. The key questions about a health information system are:

  • Is it easy for its intended health information seekers to get what they need?
  • Are they protected from irrelevant, confusing or conflicting data?
  • Are inappropriate requests denied?

Most existing health information systems fail against such criteria on many counts.

Figure 1: Typical sources of interactive information (upper half) and interpersonal information (bottom half) in health.

 

Health information seekers are trying to make decisions. Should I see a doctor about this? What’s the best treatment for my patient? Do I need to cancel all elective surgery this afternoon? They have two routes (see Figure 1): through interactive activity with technology (not necessarily digital), and through interpersonal activity. Information seekers have a repertoire of heuristics for seeking information from other entities, based on experience, intuition, rationality and guesswork. Their heuristics vary in quality and they are not always best placed to judge this quality for themselves.


Modelling the health information seeker

What more can we say about our information seeker? We might borrow Checkland’s (Checkland & Poulter, 2006) activity modelling concept to construct a generic activity model of the information seeker’s activities (see Figure 1). Starting from a perceived need for information (the input to the system), the information seeker must first formulate what information is required. Then they can use this to identify and prioritise possible sources of the information. This will be followed, presumably, by actively seeking to obtain the information, following which the information will be assimilated and assessed, leading either to the need for information being met (the output) or a doubling back to earlier activities in the sequence as necessary.

 

Figure 2:  An activity model of a health information seeker’s activities to transform a perceived need for information into the need met.

The model in Figure 2 could be the basis for any health information seeking system, existing or hypothetical. Its power lies in its ability to help would-be designers identify alternative ways in which activities might be carried out. Table 1 provides two examples.

 

Activity

A physician requiring to make a diagnosis

An individual deciding whether to consult a doctor

Formulate the required information

  • Match of symptoms to possible conditions
  • Need to know if condition is potentially serious enough to require medical intervention

Identify and prioritise possible sources

Possible sources:

  • Diagnostic databases
  • Immediate colleagues
  • Specialists
  • General internet

Possible sources:

  • Electronic diagnostic aids
  • Google
  • Friends
  • Your neighbour, the vet

Actively seek to obtain information from sources according to prioritisation

  • Consult sources according to prioritisation and availability
  • Delegate consultation to an assistant or colleague
  • Consult sources according to prioritisation and availability
  • Consult a doctor anyway
  • Forget about it

Assimilate and assess received information

  • Pick best solution (meeting threshold criteria)
  • Double back to earlier stage
  • Decide diagnosis not required
  • Refer to colleague
  • Judge information against personal risk criteria
  • Follow advice of trusted individual
  • Double back to earlier stage

 

An example

Consider the UK’s bowel cancer screening programme (BCSP) for people aged 60-74 who receive a test kit by post every two years. Recipients are invited to return samples (also by post) which are tested. If positive, the individual must consult their GP urgently for further investigation. The sample requirement was recently altered from three samples over a few days, to a single sample and take-up increased from 59.3 per cent to 66.4 per cent, perhaps due to the greater convenience of the procedure.

Using figure 1, with the test kit recipient as the health information seeker (other candidates are possible, but they would lead to different models), we can argue that the change in the information-seeking activity (the third activity in the activity model sequence in Figure 2) constitutes an improvement for the information seeker over what has gone before. (There is also an improvement in the diagnostic effectiveness of the test, which we have not considered here.)

Note that this system is proactive: many may not have sought this information until they received their first test kit. But if they had, there would have been considerable scope for dysfunction:  there is an amazing range of bowel cancer advice available online, for instance, and the quality of each site may not be obvious to the searcher.


Conclusion

In the publication from which this article is derived (Young & Klein, 2021) we have discussed more expansively the implications for information systems designers of viewing an individual as a health information seeker. Here, we hope we have illustrated how this perspective, coupled with systemic thinking, can provide insights for meeting healthcare information needs in efficacious, effective and efficient ways.

 


#ACJ #ACJDigital #ACJInsight

 

References

P.B. Checkland & J. Poulter (2006)  Learning for Action:  A Short Definitive Account of Soft Systems Methodology and Its Use for Practitioners, Teachers and Students. Wiley, Chichester, UK.

T. Young & J. H. Klein (2021)  Information systems in health:  what do you need and how will you get it? In:  L. Goldschmidt & R. M. Relova (editors) (2021)  Patient-Centered Digital Healthcare Technology:  Novel Applications for Next Generation Healthcare Systems.  The Institute of Engineering & Technology, London, UK.


About the authors

Dr Jonathan H. Klein is an Associate Professor in Management Science at Southampton Business School (University of Southampton, UK). His research interests include the application of systems thinking to healthcare management and delivery, and the nature and use of evidence in decision-making. He has a particular interest in the use of systems approaches, such as Checkland’s Soft Systems Methodology, to messy problems exhibiting high degrees of complexity, uncertainty, and subjectivity.

Professor Terry Young is Director of Datchet Consulting and Emeritus Professor, Brunel University London. His research interests throughout careers in industry and in academia lies in healthcare information systems and care delivery systems.

Jonathan and Terry’s introductory chapter on information services in health is now out in Patient-Centered Digital Healthcare Technology:  Novel Applications for Next Generation Healthcare Systems.