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RE: Driving Digital Innovation in the Public Health Sector

Recently I read Dr Paul Eleftheriou's article in the Quarterly entitled ‘Driving Digital Innovation in the Public Health Sector’ and while the article covered the change process, and his hospitals experience, it failed to explore any successes of the scheme and whether an agile approach had been considered.
I have been involved in the classic ‘waterfall’ approach to an IT project which is a top-down driven with little or no deviation from the project specifications. Having recently been involved with a technology company that was keen to apply the “Agile” methodology it was a refreshing, and engaging way to approach an information technology change process. Agile methodology is one which involves taking an idea, involving those using the system, focusing on constant testing and validating through numerous iterations1.
Healthcare organisations are often afraid to move to an agile approach as we embrace a hierarchical structure in which power sits at the top and tasks are assigned. In contrast agile embraces a horizontal structure with the aim to empower those doing the work. Research is beginning to evolve which is supportive of the agile methodology2-4. A 2014 systematic review of electronic health records (EHR) implementation came up with numerous key findings including the importance of creating a fit between the EHR system and the existing work practices2. This review recommended that an EHR implementation is not just a technical project and that existing work practices will need to change due to the new system. But by customizing and adapting the system to meet specific user needs, users will become open to using it.
Another review of EHR implementation by Robert H. Miller and Ida Sim conclude that achieving quality improvement through EHR use is neither low-cost nor easy4. It would have been interesting to hear of any positive impacts of this change process. Adoption of electronic records in our own organisation has led to spiralling costs associated with storage of digital information.
Perhaps the last words should go to Alan W Brown  ‘If the organization remains in a vertical, hierarchical mode, with an approach of “here’s the system—implement it”, none of the advantages of computerization will accrue. In fact, costs will increase’5. ‘Waterfall’ and ‘Agile’ approaches are not an either/or choice, both development methodologies have their benefits and drawbacks, but it is about time we started looking at agile in healthcare!
Dr John Robson
RACMA Candidate
1.  Prahalad, C.K. & Ramaswamy, V. 2004, "Co-creation experiences: The next practice in value creation", Journal of interactive marketing, vol. 18, no. 3, pp. 5-14.
2.  Implementing electronic health records in hospitals: a systematic literature review Albert Boonstra Arie Versluis and Janita F J Vos BMC Health Services Research 201414:370 DOI: 10.1186/1472-6963-14-370
3.  Julia Adler-Milstein, Carol E. Green and David W. Bates ‘A Survey Analysis Suggests That Electronic Health Records Will Yield Revenue  Gains For Some Practices And Losses For Many Health Affairs 32, no.3 (2013):562-570 doi: 10.1377/hlthaff.2012.0306
4.  Robert H. Miller and Ida Sim  Physicians' Use Of Electronic Medical Records: Barriers And Solutions Health Affairs 23, no.2 (2004):116-126 doi: 10.1377/hlthaff.23.2.116
5.  Alan W. Brown Enterprise Software Delivery: Bringing Agility and Efficiency to the Global Software Supply Chain Published by Addison-Wesley 2012

Last Updated on Thursday, 29 June 2017 11:16