Healthcare can be seen as a complex adaptive system, as can the information that underpins, permeates and radiates from it.
According to the TED talk below, complexity implies that the system cannot be understood from one perspective alone, or using a single language.
The list is not intended to be exhaustive - in two significant ways - the set of categories / perspectives is not complete, and nor is the only way of categorising the space. Indeed the selection/discovery of categories/perspectives is part of the process of engaging with subject matter, and is an area where good choices can help to make that engagement more fruitful.
- The actual people involved (who does what when and why)
- The job descriptions / roles of the people involved (patient, doctor, parent, friend, guardian, nurse, programmer, venture capitalist, politician, voter, neighbour, manager, ...)
- The products (software, hardware, intellectual property, etc)
- The projects and programs involved
- The money involved (who pays how much for what, the result of a particular payment, etc)
- The activities (treatments, tasks, events, actions, encounters, processes)
- The subjects of care (genes, tumours, organs, patients, families, groups, populations, citizens, etc)
- The organisations involved (providers, suppliers, payers, interest groups etc)
- Purposes and Outcomes (what is the point - comfort, autonomy, health, care, QALY, social cohesion, individual care, public health, ...)
- Metrics (what can be measured? what can be compared? what questions can be answered?)
- Information Standards and Specifications, and the organisations that maintain them.
In a complex adaptive systems we should be cautious of single perspectives overshadowing all others, and becoming a dominant ideology.
- "Evidence-based medicine" is a way of seeing healthcare that has a lot of value, but it is not the only way of seeing. We do not insist on evidence-based marriage, or evidence-based cooking. In both cases there is relevant research but for most of us that is not the best language to use. The research indirectly informs us, but we do not see it as the basis of how we love or feed each other.
- Patient-centric. The patient's is a valuable perspective to consider. However if I need an operation on my knee, I want to know that the place I am going to will do a good job on my knee. I want them to really care about doing great operations, and that the staff want to be working there. As a potential patient, I care less about it being patient focused, and more about it doing a great job.
Evidence-based medicine is great. Patient-centered care is great. What I am suggesting is that healthcare is bigger and more diffuse than either of them alone.
As we engage with healthcare information we see in a particular way from a particular perspective and can strive to achieve particular outcomes. This involves working with others who have different perspectives and ways of seeing. Healthcare Informatics is about helping to build and sustain those bridges, as well as making it easier to deliver outcomes from a particular perspective and way of seeing.
By Charlie McCay