Informatics vs. Clinical engagement: the general and the specific

If there are two aspects to life that both allow us to get on, but also trip us up it is the marvellous ability we have to generalise and also be specific. As ever context rules.

In mental health and cognitive therapy in particular people affected by anxiety or depression (sometimes both) have over time adopted negative attitudes and beliefs about themselves, others and the future. These assumptions are gross not only in their impact and ability to disable, but their generality. They may take root and grow from specific interpersonal experiences, it is surprising though this conversion from small instances and how much store is placed upon generalities.

Cognitive therapy in part involves getting to the specifics - the core beliefs. Then with some effort positive and adaptive change can happen.

All statements and declarations of intent in Health IcT must begin somewhere. Policy and government funding is a key driver, as is the existence of corporations ready to respond. In our daily lives there is a natural market by virtue of the beliefs, thoughts and behaviours that are framed by our selves, others, and the future.

In health IcT there are two distinct markets - the inevitable consequence of the application of a technology - brought together with a definitive purpose. InformationWeek Healthcare features the following post by Marianne Kolbasuk McGee:

EHR Adopters: Confident, Or Cocky?

This begins -

Healthcare providers are doing whatever it takes to deploy electronic health record systems and all the related technology they'll need to qualify for a share of the $27 billion in U.S. federal stimulus funds set aside to encourage investment in health IT. Their top priorities this year all relate in some way to the government's financial incentive program, including meeting regulatory requirements, managing digital patient data, improving care, reducing costs, and increasing efficiencies.

In health IcT good project management can and does assist. As per the post having a reference point that dictates access to finance through certified EHR systems is a vital check. Providers and the market must recognise the emergent properties and tendencies that prevail, not least the supply of informatics savvy nurses and other clinicians. I notice on HiMSS the question -

Do you think the federal healthcare IT training programs will turn out enough truly qualified people to combat the EMR/EHR staff shortage?

What is the difference between meaningful use in general and specific cases? What is the distance from the bold text in the quote above to the dashboard specifics - the minutia? That is the art and science of informatics. Who has the core beliefs?

I'm writing this in NW England so experience and the market differ markedly; but wherever the locale  health IT's meaningful use should not solely rely on $ £ € and business consultants to drive change. Especially when "improving care" is at stake.

The big 'E' - ENGAGEMENT is always the e-lephant in the SPeC.

Meaning arises from what is often emergent. Project management is about keeping things ordered and tidy.

If the allure of the general is not to prove distracting, then we need to be prepared to get messy too. Give the tools to the clinicians.

Socio-technical perspectives are essential, that is the fuzzy, messy (HUMANISTIC) and the tidy, disciplined [MECHANISTIC] ends of h2cm need to have a combined voice.