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« Two Future Health ITs | Main | Wired 14.03: A Nation of Guinea Pigs »

February 27, 2006

Comments

Robert DiLaura

Hospital HIT organizations have a fundamentally different mission from a research informatics group. The former must first perform like the power company, providing consistent, standard and highly available IT services that support patient care. They can push the curve be offering features beyond commercial installations with highly customized configurations, but beyond that they run the risk of a single organizational group losing focus. Their progress should be slower and wih greater emphasis on detail and contingency planning (and incurring the additional associated costs). Research informatics groups often look (for better or worse) at each new clinical study as a one-off coding challenge. Each investigator is unique, and wants something different that should be accomodated as much as possible. Our challenge is to be more sensitive to the ROI for programming efforts (a stress often felt by the patient care HIT folks, but not by research informaticians), with better reuse of code and data models that already exist.
The inherent competitiveness between the institutional IT group and a research informatics group may be necessary and healthy if understood and managed at the organizational level for net benefit. Having the central IT group manage research data (for example in an EHR/EMR) may be impossible due to current system design constraints and given the way current research studies are designed seeking uniqueness. Likewise, having a research informatics group design systems that support healthcare indirectly but may be useful for future research needs is a grey area to read that likewise conflicts with the core competency and mission. Both groups add value and need to co-exist in some degree of harmony.
As efforts continue to build a National Health Information Network (the backbone that will enable exchange of healthcare information) and Personal Health Records (the ability for individuals to have granular control over their own protected health information (and thus shift the question of "who owns the data" into the hands of the individual that the information represents), the lines between institutional IT and research IT will blur even further. And this might be a good thing, but will call on the centralized resources to become more innovative and agile, while the reserarch-focused resources will need to operate more professionally and efficiently under the competitive pressure to use limited funding to meet dramatically increasing demands on all technical staff time.

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