Covid-19 Unmasks Electronic Patient Record
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.
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