Engineering Health Information Systems

The word “eHealth” has gained a bad rep in the light of recent scandals around spending billions of dollars on projects with questionable outcomes. Significant funds have been invested in “eHealth” – not only in Ontario, but across the country. Still, as Mike points on his blog, a recent article in the Canadian Medical Association Journal, states that “confusion and disarray appear to be the only form of national standards in operation within health information record-keeping circles“.
What went wrong? – and how can we avoid such scandals in the future? The answers to this question is complex. Karim Keshavjee has offered detailed analysis of the reasons behind the scandals in a recent issue of Canadian Health Care Technology. Among other factors, he criticizes that there is a “deeply held belief in Canada that eHealth products are mature and can be purchased ‘commercial off-the-shelf ’ (COTS); i.e., ready to use from the package.” However, as he continues to argue, “each healthcare organization is unique and every healthcare jurisdiction is different. Functions that work well in one setting may not work in another.”

What I take away from this is an argument for the necessity of “Engineering” of a solution rather than the mere “installation” of a product. So what is the essence of Engineering? Nagib Callaos has written an enlightening paper about this topic. He defines several conditions that are necessary in Engineering:

1. Usefulness – an Engineering activity must produce a useful thing, to generate human benefit. (As Karim pointed out in his article, usefulness and evaluation has not been afforded much attention in the eHealth Ontario project in the past.)
2. Know-How Knowledge – Engineering requires scientific knowledge and training. Vendors and consultants should be selected based on their know-how, not based on political or other factors.
3. Practice and Praxis – practical experience and tacit knowledge of how to “do things” are key to success. (As Karim pointed out, eHealth Ontario failed in involve end-users and domain experts in a sufficient manner.)

My suggestion to on how to move forward and reestablish the image of “eHealth” would be to define the “e” in this term as “Engineering”, and use Nagib’s definition as a guiding principle from now on:

Engineering is the development of new Knowledge (scientia), new ‘made things’ (techné) and/or new ways of working and doing (praxis) with the purpose of creating new useful products (artifacts) or services.