The integration of information technology into a medical setting can often be problematic; while information technology can offer marked improvement in safety and efficiency of patient care, measures must be taken to avoid removing the human element of medical care in pursuit of efficiency. To this end, both senior hospital staff and information technology experts must be involved in the decision-making process. A joint effort between the technology and functional care staff of the hospital can improve the outcome of the implementation for all.
Senior staff at Curbishley Royal Hospital, a small private hospital specializing in outpatient surgeries, have identified two areas of interest in information technology implementation that they believe can improve their operations, increase efficiency and improve patient care. The first, a telephone-based triage system, holds the promise of improving the efficiency and quality of care for patients who are directed to go to the Emergency Room or who are transferred to a doctor’s office for care.
The second area of information technology improvement under consideration is the ‘Tele-home Health Care’ system. Using this system, patients can access remote follow-up care in order to reduce the number of unnecessary follow-up visits for patients recovering from previous surgeries. Follow-up care would be provided either via a nurse using a remote consultation system or via specially designed electronic menus offering guidance on such areas as nutritional advice, information about support resources and other medical support services.
Examination of these areas of expansion for Curbishley Royal Hospital yields insight into the probable outcome of these proposed plans. In order to make a decision regarding resource allocation, senior hospital staff and information technology experts pool their knowledge regarding these systems. Method of Enquiry An enquiry method or system is a means of determining information and making decisions about a project. It provides a framework for determination of a pathway through a project as well as a way in which to form consensus about the project.
The three enquiry methods are inductive-consensual, analytic-deductive, and multiple reality. Each of these enquiry methods has a different means of determining information and forming group agreement, and each method’s strengths and weaknesses can be examined in order to determine an appropriate method for an individual problem. The inductive-consensual method is the simplest of the three enquiry systems. Inductive-consensual enquiry works from a “bottom-up” perspective rather than a “top-down” perspective.
Individual lower level aspects of the problem at hand are examined, with facts about the problem and problem-solving ideas being generated for each aspect examined. After this step, the low-level solutions are generalised to the larger system, with several phases of refinement taking place if necessary until an appropriate solution in place. Because part of this method is the consensual agreement of all parties involved, group participation by all interested parties is encouraged and is required to ensure the best possible outcome.
The analytic-deductive enquiry system views the world as a system that can be tweaked, if the appropriate methods are known. The analytic-deductive system is also a “bottom-up” approach, with low-level aspects of the problem at hand being solved before attempting to generalise the results across the upper-level aspects of the problem. However, unlike the inductive-consensual approach, emphasis is placed on the fact gathering and scientific or quasi-scientific analysis of the problem and deduction of a solution from this analysis rather than on inductive or consensual reasoning.
Using the analytic-deductive system, there is seen to be only a single logical solution to the problem, and group consensus is not considered to be an important decision-making tool. The multiple-reality enquiry system is the most complicated of the three. In this system, there is not a single best solution, but the potential for multiple good solutions. These solutions are examined using theoretical frameworks as well as facts about the problem at hand, and solved in a top-down method, with the overall framework being propagated to the low-level aspects of the problem.
Multiple reality approaches may involve system prototyping and other methods of examining the implementation of multiple methods. Multiple points of view, solutions and methods are considered, with the final decision being placed in the hands of a single appointed decision maker. This decision maker must analyse all the proposed solutions and choose the best possible option. The multiple-reality enquiry system places no emphasis on group consensus or decision making, and a high emphasis on fact-gathering and multiple viewpoints. It is suitable for large, complex problems with no obvious solution.
For this discussion, we will use the analytic-deductive enquiry system. The nature of the problem under consideration is too complex for the inductive-consensual approach, and consensus decision-making is not required in this instance. The multiple reality system, while ideal for much larger projects, is exceptionally complicated and its methods are outside the scope of an exploratory document. The analytic-deductive system focuses on fact-gathering, analysis of methods and agreements among major parties, and is ideal for the exploration of implementation of information technology at Curbishley Royal Hospital.
However, some elements of inductive-consensual enquiry will also be used, as staff resistance to the new systems must be considered. Information Technology at Curbishley Royal Hospital Curbishley Royal Hospital is a small, private 120-bed hospital specializing in minor surgeries for well-to-do patients. The hospital offers short notice procedures to their patients who might otherwise have to wait to be seen in a public facility. The hospital faces pressures from two sides. On the one hand, financial considerations require that cost reductions must be found as often as possible.
On the other hand, Curbishley’s private patient base means that it must offer consistent and high-quality patient service. In order to provide the best service to their patients and to reduce costs, an examination of increased information technology use has been undertaken. Administrators at Curbishley Royal Hospital have identified two ways in which an expansion of information technology could provide enhanced service to their patients. The first area identified by administrators is initial patient contact. Currently, patients who call the clinic speak to the reception desk, and receive guidance from there.
If a patient has not been seen at the hospital before, the reception administrator makes an appointment in a hand-kept appointment diary. Existing patients may speak to a nurse who will manually assist them. Common paths patients are routed along are: being given direction to go to the emergency room, having an appointment made, or speaking to their doctor or another specialist. If an emergency room visit is required, the hospital’s staff will connect the patient to the emergency room so that the patient can get instructions as required.
Patients are currently routed manually along these paths by reception staff. Hospital administrators would like to explore an automated telephone reception system that will perform these tasks more efficiently. This would both reduce costs by decreasing the number of reception staff required to answer phones and increase patient care efficiency by allowing them to choose from a set option menu that would reduce confusion. The second area identified by administrators is follow-up care.
Administrators view information technology as a means of providing automated, at-home follow-up care, in order to reduce the number of follow-up visits required by a patient recovering from surgery as well as to increase the patient’s chances of successful recovery. Remote consultation via the hospital’s web site would be used to provide home consultation with a specialist nurse or physical therapy expert. A database of information could be used to provide information on ancillary topics such as wound care, diet and exercise guidelines, physical therapy instructions and social services contacts using on-demand queries from the patients.
This would both reduce costs by reducing the number of staff dedicated to follow-up care visits and increase the patient’s chances of successful recovery by offering comprehensive information from a home setting. In order to examine the effectiveness of these two implementations of information technology at Curbishley Royal Hospital at meeting their goals of cost cont, we will consider a number of factors, including technical feasibility, staff and patient training and potential resistance to the new methods, patient benefit from the programmes and cost savings.
External influences on Curbishley Royal Hospital which have precipitated the further use of information technology, such as requirements for cost containment and rising medical care costs, will also be examined, as the regulatory and commercial environment driving the change is an important part of the background for risk analysis of implementation. Each point of entry for information technology will be examined separately, as each implementation would offer distinctive benefits and create a distinctive risk profile.