Clinical Informatics in Developing Countries
Background
Implementation of healthcare informatics in developing countries has had to face many issues. Many of these are due to being in a "resource poor, high demand healthcare environment" [1]. It is important that these nations are able to implement healthcare technology because systematic reviews in developed countries have demonstrated that "information and communication technology can improve the quality and safety of health care while reduce its cost" [2]. Globalization of health informatics infrastructure will allow for development of healthcare in developing nations and using models in developed nations will prevent many of the same mistakes from being repeated.
Barriers to Implementation
Workforce Needs
Both in developed and developing countries, there is a need for a workforce that is skilled in healthcare, information, and communication technology [2]. Both categories of nations require implementation of programs and other initiatives to educate workers in this sector of healthcare. One such program in the United States is the American Medical Informatics Association’s (AMIA’s) 10×10 initiative [3]. On the international front, there is the Informatics Training for Global Health Program (ITGH) [4] which provides funding for U.S. based and international academic program partnerships to grow informatics training in Africa, India, and Latin America [2]. AMIA also has a Global Partnership Program [2].
Migrating data from a paper chart to a digital form would also require a significant workforce. There are also other constraining factors such as a lack of communication and information sharing infrastructure in developing nations. Politics may also come in to place at this time because some "state owned telecommunications systems inhibit the rate of infrastructure distribution, reduce variation, innovation, and technology adoption" [5].
Access to research
Many developing nations still do not have adequate access to up to date information regarding informatics due to limited access to the Internet books and/or journals [5]. Not having access to research prevents the implementation of evidence based practices. The United Nations (UN) have stated that "access to information and communication services is new a component of the...principles and human rights and development" [5]. Hopefully, this will help decrease the barrier to access to research.
"Ethos of the Open Source software movement that enabled the development of...the Open Access approach to publishing has enabled an exemplar of how to move academic publishing forward to open up routes to publication for authors in resource constrained settings"[6]
Financial Constraints
Health information systems have significant implementation and maintenance costs. Many developing nations face socioeconomic issues that make it even more challenging to implement an electronic health record system [5].
Post-Implementation Issues
User Dependency on the System
- Users become heavily reliant on the system to provide them information and abandon their own criteria and committing errors
- Institution may get rid of double check mechanisms and may not be prepared in an event where there are technological issues [7]
Alert Fatigue
- "Workers become desensitized to safety alerts, and as a result ignore or fail to respond appropriately to such warnings, changes in Communication Patterns"[7]
- Often due to the number of alerts and also because many find them to be inconsequential
- Lack of standards that impact quality of care may be an issue when developing the knowledge base that supports the alerts [7]
Changes in Communication
- Implementation of electronic systems removes the need for face to face communication
- Less redundant checks leads to lost opportunities to catch errors
- Need to implement methods to have strong close communication among healthcare providers
References
1. Paton, C., M. Househ, and M. Malik. "The challenges of publishing on health informatics in developing countries." Applied clinical informatics 4.03 (2013): 428-433.
2. Hersh, William, et al. "Building a health informatics workforce in developing countries." Health Affairs 29.2 (2010): 274-277.
3. https://amia.org/education-events/amia-10x10-virtual-courses
4. http://www.fic.nih.gov/programs/training_grants/itgh/
5. Oak, Mugdha. "A review on barriers to implementing health informatics in developing countries." Journal of Health Informatics in developing countries 1.1 (2007).
6. Paton, C., M. Househ, and M. Malik. "The challenges of publishing on health informatics in developing countries." Applied clinical informatics 4.03 (2013): 428-433.
7. Otero, C., et al. "Health informatics in developing countries: a review of unintended consequences of IT implementations, as they affect patient safety and recommendations on how to address them." Yearbook of medical informatics 25.01 (2016): 70-72.
Submitted by (Suhani Goyal)
