Covid-19 Unmasks Electronic Patient Record

 

Fonte: UEM - Brasil           

More than twenty years ago, we published a work showing the difficulties of developing a computerized electronic medical record system that could be used in the health care process, considering the lack of data standardization and the fact that an information system in health is a social system, which requires information available at the point and time of care. At that time, the practice was to develop systems of patient records that would serve the financial interests of hospitals, which are still used today.

We have recently developed work on the difficulties of having sustainable health information technology and the coronavirus is showing that what we have are unsustainable technologies.1 Using the philosophy of Michel Foucault, Professor Colin Koopman, and colleagues from the University of Oregon, USA, carried out an in-depth study on the use of electronic medical records, published a few months ago, concluding that what we have today are data directing health and disease. The electronic medical record's reliance on insurance company requirements often turns patients into billing payment units.2

In turn, a few months ago, 15 academic centers from different universities in the United States called for urgent actions to develop and implement health information systems, networks, and platforms that have the possibility of sharing data between different institutions, with the ability to answer important critical questions of this Pandemic and other health conditions.3

Unfortunately, in the western world, software vendors and some consultants are the ones who define the needs of users in terms of defining information systems. Consequently, information technology is oriented by the market and not by the needs of the user, that is, people have to adjust to the technology and not the technology to be adjusted to the interests of the user, for the benefit of well-being and quality of life. Furthermore, often when information technology is introduced in developing countries, it has usually been developed as applications and systems that are “first world solutions” to “first world problems.” Now, if they don't even solve the problems of the first world, they are useless for developing countries.

Therefore, traditional health information systems were developed with a strong emphasis on software engineering, neglecting user participation. In other words, technical decisions of software engineers were more relevant in the design process than the participation of non-engineers or users, always very limited.

The so-called Participatory Design, originally called Cooperative Design, which originated in Scandinavian countries is still a relatively new approach to product design. This approach emphasizes stakeholders, designers, researchers, and end-user in the design process. In the case of health information technology, the main users are doctors, nursing professionals, social workers, paramedical professionals, among others. They do not always participate in the development of these technologies and suffer from the imposition of their implementation. Unfortunately, top-down information systems development methodologies are still prevalent.

In summary, participatory design is an approach that brings users into the design process, empowering them in such a way that the main concern is to build systems that are more suited to their needs. In this process of prescribing attitudes of user inclusion and their thinking participation, both the technical and non-technical sides become sensitive to the political and ethical challenges they will face as designers of new technology. Therefore, participatory design takes the approach of developing technological systems that can be improved by including users in the design process.

In addition, one cannot fail to observe that medical sociology shows the problems that one can have with the dissemination of patient information online, compromising clinical work, the doctor-patient relationship, and the authority of medicine. Finally, there are numerous questions that one must have during the design of an electronic medical record system. Fortunately, the literature is showing good participatory design experiences of health information technology development in several countries.

In the case of Brazil, which has always had a history full of irregularities in the acquisition of health information technologies, favorable to corporate actors and health managers, instead of meeting basic needs, it is regrettable to know that corruption continues as usual in the acquisition of these technologies, as shown by the Federal Audit Court (TCU). It is ridiculous, according to recent information from the TCU, that the top management of the Ministry of Health did not participate in health information technology decisions, prevailing the initiatives of bureaucrats in the IT sector.

Finally, the dominant actions of the private sector in the decision-making process emphasize the top-down model or tool approach in the country's health sector, the result of which is the loss of resources, tolerance of inefficiency, corruption, and bad management. I didn't even need Covid-19 to know this.

1.Rodrigues Filho, J. The Challenges of Implementing eHealth Technology for Sustainability in Brazil. Journal of Sustainability and Management. Vol. 9(1), 2019.

2. Koopman, et al. (2021) When data drive health: an archaeology of medical records technology. BioSocienties.

3. Madhavan, S. et al. (2021). Use of electronic health records to support a public health response in the United States: a perspective from 15 academic medical centers. Journal of the American Medical Informatics Association, 28(2): 393-401.