ABSTRACT
Healthcare system of New Zealand is one of the most highly developed in the Pacific region (World Health Organization, 2001). The citizens, residents and guests of the country receive professional medical assistance through the network of publicly and privately owned medical institutions. In 2014, the total financial turnover in the healthcare services market amounted for $17.3 billion, making it one of the fastest growing industries in the country. The country spends 9.1% of its domestic gross domestic product on the healthcare needs of its population (Asia Pacific Observatory on Health Systems and Policies, 2014).
Another quickly growing industry in New Zealand is informational technology. Synergy between the two is considered an important element of progress and development in the both industries (Mostashari, Triphathi & Kendall, 2009). Developed IT infrastructures are highly effective in streamlining strategic and daily operations of the healthcare units (Engelberg Center for Healthcare Reform, 2010)
The importance of informational technology in healthcare segment has been analyzed by many commentators. Some of them suggest informational technology is particularly important for enhancing and developing healthcare infrastructures. For instance, using laser- based technologies surgeries can be done with the utmost precision and accuracy (Naylor & Kudlow, 2013). Others consider that the primary mission of informational technology is facilitation of spreading the knowledge, so that everyone can become informed about particular healthcare activities (American Medical Association, 2015). Finally, a certain group of commentators suggests that informational technology is especially effective in streamlining and improving daily management, as well as strategic performance of the entire healthcare industry in general, and a particular healthcare unit (hospital) in particular (Mostashari, Triphapi & Kendall, 2009). Thus, the purpose of this research is to explore the validity of these assumptions for the healthcare sector of New Zealand.
The practice indicates that the best method testing an academic assumption is to examine their existing practice in its regard. This research revolves around external and internal analyses of the informational technology infrastructures of Auckland City Hospital, examining the increasing role of its IT department, and concluding why line with the technology is becoming an indispensable requirement for professional excellence.
CONTENTS
SECTION 1 – Overview Roles And Functions Of The It Sector 5
SECTION 2 – Sustainability, Opportunities And Developments 7
SECTION 3 – Interview Results Interpretation 9
SECTION 4 – Ethics and Opportunities 11
References 13
SECTION 1 – OVERVIEW ROLES AND FUNCTIONS OF THE IT SECTOR
Nowadays, Auckland City Hospital has its own professional information technology team, which is responsible for designing, discussing and implementing the newest technological solutions into the hospital infrastructure. The main theoretical rationale of establishing it was to explore the potential of improving quality, safety and effectiveness of hospitals and healthcare, and thus to increase its competitive advantage. Practically, the main mission of the hospital's IT department is to provide the most effective, fast and reliable method of collecting, storing, retrieving and transferring information electronically.
Understanding the elements of this program implementation is highly important, because it will help to determine the directions of future growth and development of the institution. In addition, implementing different informational technology solutions is important because:
a) It removes many bureaucratic burdens, helping the clinician staff to concentrate their efforts on meaningful activities only (Naylor & Kudlow, 2013).
b) It significantly increases speediness of communication between members of the staff, which is sometimes vital in the healthcare industry (American Medical Association, 2015). The commentators argue that in some cases human lives are dependent on the effectiveness of communication between the clinicians (Engelberg Center for Healthcare Reform, 2010). Moreover, contemporary healthcare industry, though a highly developed one, is still in a nascent state, if measured by the age of our civilization. The key component of its progress is incessant, profound and far-reaching research, which is impossible without active cooperation between the professionals from different parts of the globe (Mostashari, Tripathi & Kendall, 2009). Contemporary information technology solutions provide the best options for cooperation between the specialists even if they are separated by continents.
c) It substantially raises the scope of community awareness about the hospital, its activities, mission and operations. In some cases, public support is extremely important for harmonious functioning of a medical institution (Naylor & Kudlow, 2013). Sometimes, information about their particular medical institution may be urgently required by a member of the community, by an aspiring student or by the government authorities. In this case, web-based solutions are the best, and the shortest way to obtain this data (Naylor & Kudlow, 2013).
This case study of the several sections, each one covering a particular aspect of the continually growing informational technology Department of Auckland city Hospital:
Section 2 provides a detailed description of the various sustainability challenges and opportunities faced by the organization. It also identifies the most important directions of the future informational technology developments, and discusses how the new changes may positively affect sustainability challenges and opportunities of the organization.
Section 3 represents the findings of primary research. Mainly, it relies on the interview with one of the senior engineers of the hospital IT department Mr. Mathew Mfoy. The chief technical director was not accessible for comment, and the secretary of the hospital informed the research team that the chief engineer is familiarized with the technological processes, and therefore will be capable of assisting with our inquiries. This section of the report specifically analyzes roles and functions in the IT spectrum of the hospital, analyzes current relevant ethical principles and dilemmas, as well as it speaks about potential future challenges and opportunities.
Finally, Section 4 highlights similarities and differences between the anticipations of the hospital, and the realities of the future IT development. In addition, this section of the research explains how the organization should I just its IT priorities, ethical principles and approaches to corporate social responsibility.
SECTION 2 – SUSTAINABILITY, OPPORTUNITIES AND DEVELOPMENTS
Many studies demonstrated that keeping financially and organizationally sustainable is one of the most serious challenges ever encountered by the healthcare organizations (American Medical Association, 2015). In contrast to typical businesses, healthcare institutions are constantly on the verge of bankruptcy. Their profit margins are one of the lowest nationwide, while increasing them is not possible because of intense competition from the public sector, is below by the comparatively low incomes of the population. Thus, the first sustainability issue faced by the Auckland City Hospital is how to keep afloat financially, while providing high-quality healthcare services to the community.
Secondly, Auckland City Hospital employs more than 3,000 professionals, both clinicians and non-clinicians. Another, not less important dimension of sustainability is providing full-scale compensation and benefits package to the employees of the organization. Because of the nature of their job, healthcare professionals have special status, thus, the hospital cannot pay to them lower compensations, than the national average.
Considering these two increasingly important sustainability issues, management of the hospital can resolve them by extensive use of technology. In other words, informational technology creates opportunities, which, if realized, can resolve problematic sustainability issues of the healthcare organization in question. Firstly, informational technology provides multiple opportunities for increasing the profit margins of the hospital by significantly reducing its overhead expenses (American Medical Association, 2015). To illustrate, nowadays 27% of the entire hospitals staff is responsible for performing different compliance actions - filing patients’ forms, completing audited accounts forms, writing reports about clinical case studies etc. The practice, however, demonstrates that much of this work can be entirely automated (Engelberg Center for Healthcare Reform, 2010), thus, the biggest portion of this professionals can be laid off. Despite the fact that this situation is hardly consistent with the ethical principles advocated by the hospital, it should be done. Otherwise, the very existence of a hospital becomes seriously questioned.
The second feasible opportunity of utilizing informational technology services is active cooperation with the overseas partners. Traditionally, the research centers located on the islands have been developing in some form of isolation (Mostashari, Tripathi & Kendall, 2009) - the digital technologies are helpful in breaking these curtains. Yet, despite the fact that the technology is already available, the people are not much accustomed to using webinars, searching information in the Internet and interacting with their overseas colleagues. Instead, traditional medical conferences, and 'brick and mortar' seminars remain the main forms of cooperation and interaction in this professional community (American Medical Association, 2015). Instructing and teaching the senior clinical staff how to use web solutions for the needs of their profession, not for their individual ones only, will be productive for Auckland City Hospital research and development.
For the needs of Section 3 of this report, an interviewee was asked to sign the following informed consent form:
“I volunteer to take part in this research project. Being in sound mind, I fully understand that the project aims at gathering and analyzing information about IT operations of Auckland City Hospital. I have been informed that my privacy will be protected, and the research team will use a fictional name in all publications. The research team guarantees that the information from this interview will never be communicated to any third parties”
Mathew Mfoy _____________________ Date ___________________
SECTION 3 – INTERVIEW RESULTS INTERPRETATION
Among other issues, the chief engineer informed that information technology department of the Auckland city Hospital several essential intertwined roles and functions:
1. The development team created internal system of medical cases management. This system enables the hospital administrators to keep records of all inpatient and outpatient clients of the medical facility, stores their medical histories, as well as enables to quickly retrieve access and analyze this data. Once the patient is admitted to the hospital, he is requested to sign a consent letter, which authorizes the hospital administration to process his personal data. The system also identifies similar cases in the past, and immediately provides the clinicians as potential diagnoses, though it is imperative to analyze each case on the individual basis. In contrast to the old, paper-based system of files storage, this digital alternative helped to store indefinite amount of data and access it without extensive, time-consuming search.
2. The hospital operates internal system of communication between the clinicians, which allows transferring data, and seeking professional opinion of a colleague in a real-time mode. However, the practice demonstrates that in the majority of cases the hospital staff utilizes either popular mobile and desktop messengers (Skype, Viber), or make a phone call (American Medical Association, 2015). This section of the IT operations requires further development and enhancements.
At the same time, the existence of this system poses several essential ethical questions.
Firstly, the hospital aggregates enormous amount of personal, sensitive data about its patients. In accordance with the legislation of New Zealand, this data is strictly confidential. However, recently the number of cyber-attacks against healthcare institutions skyrocketed (Reynolds, 2010). Thus, on the one hand the medical facility has substantially simplified its data storing and transferring practices. On the other hand, this system poses a serious threat on the personal privacy of the hospital patients. Consequently, the key ethical principle, which underpins all further development of the IT infrastructure, is the priority of personal data protection. In other words, if there is a conflict between practical necessity and cyber security, the latter should always prevail.
Secondly, the development of information technology department of the hospital jeopardizes many jobs, especially in the administrative department. The principle of duty of care is therefore relevant in this context Addressing this important ethical concern, the hospital provides free vocational training courses, which enables the staff in the 'potentially dismissed' category to acquire new skills and to retain their employment.
SECTION 4 – ETHICS AND OPPORTUNITIES
In general, the future priorities of the hospital’s informational technology infrastructure development are entirely consistent with the current international trends. In particular, both the Auckland City Hospital and the international community prioritize the importance of city data protection over effectiveness and operational efficiency (Asia Pacific Observatory and Health Systems and Policies, 2014; American Medical Association, 2015). Additionally, the IT department of the hospital, as well as its general administration respects the principle of the research data openness. All key scientific achievements and research studies of the hospital are regularly published on its webpage, as well as on the variety of other informational resources.
In the meantime, several recommendations appear to be necessary for the hospital to retain its operational excellence:
Firstly, it is highly recommended to seek the main stakeholders’ opinion in order to integrate future upgrades and improvements. Nowadays, the IT department of the hospital focuses on the analysis of the best industry practices to develop the respondent solutions. However, the research states that each clinical institution has its unique individual peculiarities (Engelberg Center for Healthcare Reform, 2010). Therefore, a reasonable approach is to start collecting and interpreting feedbacks from the clinicians and the support staff.
Secondly, the hospital should continue remaining a socially responsible institution. In practice, it should preserve affordable pricing, as well as the administration should attempt securing job positions of the administrative department, which is endangered by the advent of the digital files storage and management systems. Considering its social obligation for the employees, the hospital should increase its investments in vocational re-training and skills development of its administrative staff.
REFERENCES
American Medical Association. (2015). Health Information Technology. Retrieved from: http://www.ama-cmeonline.com/health_it/ama_health_it_transcript.pdf (last accessed March 14, 2015)
Asia Pacific Observatory on Health Systems and Policies. (2014). New Zealand – Health systems review. Health Systems in Transition, 4, 2. Retrieved from: http://www.wpro.who.int/asia_pacific_observatory/hits/series/Nez_Health_Systems_Review.pdf (last accessed March 14, 2016)
Engelberg Center for Healthcare Reform. (2010). Using information technology to support better health care: one infrastructure with many uses. Retrieved from: http://www.brookings.edu/~/media/events/2010/5/14-health-information/final-issue-brief-51310.pdf (last accessed March 14, 2016)
Mostashari. F, Tripathi, M., & Kendall, M. (2009). A tale of two large community electronic health record extension projects. Health Affairs, 28(2): 345-356.
Naylor, K.T., Kudlow, P. (2013). Improving healthcare with information technology. Retrieved from: http://www.uwomj.com/wp-content/uploads/2011/08/Naylor.pdf (last accessed March 14, 2016)
Reynolds, G. (2010). Ethics in information technology. Boston, MA: Course Technology, Cengage Learning.
World Health Organization. (2001). Healthcare systems in Transition – New Zealand. Retrieved from http://apps.who.int/iris/bitstream/10665/108467/1/E74467.pdf (last accessed March 14, 2016)
