Lewis, D., Hodge, N., Gamage, D & Whittaker, M. (2011) Understanding the role of technology in health information systems. Working Paper Series 17. University of Queensland.

This article was born out of a meeting of the Pacific Health Information Network (PHIN) and the subsequent Pacific Health Information System Development Forum.  Thus the ensuing literature review was informed by practitioners’ living experience of the challenges faced by different health organisations in the Pacific in adopting ICT. The authors are clear in the summary about the intended "fourfold" objectives of the paper and there is a well-posited need for these outcomes. The paper is sectioned in terms of these outcomes, however the recurring themes that come across in the reading are that: 1. not enough research has been done in the area; 2. a one-size fits all approach is not appropriate; and 3. a tool is needed for the myriad health organisations in the Pacific to use – to determine the “rational” application of ICT in order to avoid failure and waste.  The literature review is thorough and well tied-together and led unswervingly to the paper’s discussion conclusions.

It is difficult to find fault in an article so well supported by evidence, professional opinion, and reason. The single tenuous assumption in the article is where the authors admit that there is little empirical evidence that ICT projects in the Pacific experience failure at the same (or higher) rates as in developed nations. This flouts the conventional wisdom, say the authors: that ICT in health leads to helpful and positive outcomes. However, as the authors point out, in neither the developing nor developed worlds, is this conventional “wisdom” backed up empirically. Regardless of the interplay between the established broad conception of ICT as panacea (alluded to by many including Carr, 2003) and the lack of research data available into ICT project success in the Pacific region (Lewis et al, 2012), it is certainly difficult to mount an argument against using an assessment tool to identify the capacity of an organisation to respond to ICT in general – other than that many would fail at the first hurdle.

The culminating proposal is to develop a “maturity model” to assist organisations and governments in the Pacific region to identify their individual state of affairs and thus identify a sensible direction for investment in ICT. The authors point out that according to these types of models, “electronically immature” organisations will be “reactive...solving immediate crises...” with “unpredictable health care quality”, implying that perhaps funds could be better directed in these cases. Vanuatu is cited as an example of a system struggling to meet basic health care needs. Some may argue this is the perfect opportunity for technology to ease the burden. The authors suggest, considering that basic infrastructure (such as a reliable electricity supply) is so lacking, any application of ICT may be likely to fail at this stage. The funds required to support new technology or systems could be better spent in initial (basic infrastructure or even pre-ICT) stages. At the least it is prudent to identify the best entry point (e.g. mobile phones) for technology, based on a rational analysis and available data.  Again, the suggestion that the more we can discover about both an organisation’s receptiveness to ICT and the potential benefit delivered by a particular ICT project, the better, is unequivocal. It is the same point made by Carr (2003) and respondents in the “Does IT matter?” debate (Stewart, 2003): that businesses should not assume that IT is going to deliver benefits wholesale and that application of judgement is required.

Another point in the article and throughout the literature, is the human element in the success or failure of IT ventures – the necessity of sponsorship by management and the receptiveness of the end-user. In the Pacific region, say the authors, sourcing people with the expertise to assist the integration of the technology and the training of people has been shown to be difficult, as is convincing busy health professionals and staff that the time required to learn the new tech is time well spent, considering the challenges they already face in the day-to-day. This latter is a problem not unique to health organisations or to specific parts of the world. For example, in a UK study, Tearle (2003, para. 2) comments that in UK schools, the “gap between ‘actual use’ and ‘potential use’ [of ICT] is not being reduced” due to moving “goal posts”, and emphasises the importance of change as a staged process. She suggests that “the high expectation of the role ICT could play in schools places both opportunities and challenges for those involved in its implementation and application for teaching and learning.” A literature analysis by Bingimlas (2009 p. 243, para. 4) in Australia recommends that “effective professional development, sufficient time, and technical support need to be provided to teachers” after finding that “the major barriers [to effective integration of ICT] were lack of confidence, lack of competence, and lack of access to resources”, while as Pelgrum (2001, p. 177, para. 2) found in an international study, “even under very favorable [material] conditions still 40% of the educational practitioners indicated that a lack of hardware was a major obstacle” This suggests a complex interplay between multiple factors in the adoption of ICT. In health applications in particular, say Lewis et al, end users (doctors and other health service professionals) may simply choose not to use the new technology on the grounds that it compromises patients’ health or security. Essentially, more time and professional development is needed which requires more human resources – not always available in remote Pacific communities.

It is obvious that some judgement and framework is needed in the selection and application of ICT, but the undercurrent in the Lewis article is the “digital divide” – little enough study is done in the area in the developed world, the authors say, but closer to none in the developing world. The authors mention the difficulty in some areas of getting human resources (person power) to remote islands which could remain as a barrier to ICT progress for some time. It is useful to know what the barriers are, however, and that is the essential conclusion of this article. Add the lack of research data and IT expertise to the unique challenges in primary health care on islands and in remote communities to well-meant but un-researched and consequently misdirected sponsorship by aid organisations or governments, and the result is ICT that, at best, is ignored by the end-user and at worst, leads to “an automated mess” (USEPA, 2012, cited in Lewis et al, 2011). To implement ICT effectively requires closing the gap in the infrastructure first.

References:

Bingimlas , K. A. (2009) Barriers to the Successful Integration of ICT in Teaching and Learning Environments: A Review of the Literature. Eurasia Journal of Mathematics, Science & Technology Education, 5(3), 235-245. Retrieved via EBSCOhost Education Research Complete database in the CSU Library Carr, N. (2003). IT doesn't matter. Harvard Business Review, May 2003, 41-49. Retrieved via EBSCOhost Business Source Complete database in the CSU Library

Lewis, D., Hodge, N., Gamage, D & Whittaker, M. (2011) Understanding the role of technology in health information systems. Working Paper Series 17. University of Queensland. Retrieved from http://www.uq.edu.au/hishub/wp17/

Pelgrum, W. J. (2001) Obstacles to the integration of ICT in education: results from a worldwide educational assessment. Computers & Education 37, 163–178

Stewart, T. A. (ed) (2003) Does IT matter? An HBR debate. Harvard Business Review. Retrieved from http://www.johnseelybrown.com/Web_Letters.pdf

Tearle, P. (2003) ICT implementation: What makes the difference? British Journal of Educational Technology 34(5), 567-583. DOI: 10.1046/j.0007-1013.2003.00351.x