"Reduce, Reuse, Recycle" is a mantra that works for the environment, but how does it play out in the healthcare IT ecosystem?
Reduce: Stopping the routine collection of needless information has resulted in significant savings in cost, time and frustration. This requires active review of information flows and uses, but is a very low cost and low risk way to improve things. It also creates the goodwill and confidence that will sustain other change initiatives. Focusing on specific collaborations where information needs to be shared for a particular purpose is also a way to avoid the collection of precise data when something simpler is good enough.
Reuse: Finding ways to reuse existing information systems and infrastructure rather than assuming that it must be replaced makes sense. This applies to software and networks, but it also applies to paper forms and processes. Using architectural frameworks and standards-based interfaces to support incremental change, and a collaboration-based strategy that focuses on the human and systems issues that support specific collaborations allows for strategic improvements to be introduced with minimal change.
Change management is hard - leveraging the reuse of infrastructure, processes, skills and ideas is a good way to increase the benefit:change ratio - and so the return on expensive and risky change management effort.
Recycle: Healthcare data is full of "toxic" confidential information that prevents it being made available for purposes other that those for which it was collected. However we get value out of scrap metal and glass by dramatically denaturing it and throwing away much of the structure that was painstakingly designed in for the initial use. We should be getting value out of de-identified healthcare data. Some recycling is better than none - so even if much of the semantic value has to be lost to avoid perceived or actual risks to confidentiality - in the interests of health we should be recycling more. The next step will be to make our healthcare data more recyclable in the first place, just as has been done with physical packaging. How to promote recyclable healthcare information is a topic for another day.
By Charlie McCay