Protocols and evidence-based healthcare

Abstract

IntroductionThe care of patients now almost inevitably seems to involve many different individuals, all needing to share patient information and discuss their management. As a consequence there is increasing interest in, and use of, information and communication technologies to support health services. Indeed, if information is the lifeblood of healthcare then communication systems are the heart that pumps it.1 Yet, while there is significant discussion of, and investment in, information technologies, communication systems receive much less attention. Whilst there is some significant advanced research in highly specific areas like telemedicine, the clinical adoption of even simpler services like voice-mail or electronic mail is still not commonplace in many health services. Much of this would change if it were more widely realised that the biggest information repository in healthcare sits in the heads of the people working within it, and the biggest information network is the complex web of conversations that link the actions of these individuals.There remain enormous gaps in our broad understanding of the role of communication services in health care delivery. Laboratory medicine is perhaps even more poorly studied than many other areas, such as the interface between primary care and hospital services. Yet clinical laboratories in many ways are message-processing enterprises, receiving messages containing information requests, and generating results that are sent as messages back to clinical services. While there is much current focus on improving laboratory turn around times and internal efficiencies, little is really known about the broader communication processes within the healthcare system, of which clinical laboratories are but one link in the chain. Yet without this broader view, there is an ever-present risk that local systems within laboratories are optimised and over-engineered, but that the global performance of health services remain relatively unchanged.Given this lack of specific information about laboratory communication services, this paper will step back and generally review the components of a communication system, including the basic concepts of a communication channel, service, device and interaction mode. The review will then try and summarise some of what is known about specific communication problems that arise across health services in the main, including the community and hospital service delivery. Review Article Communication Systems in Healthcare Enrico CoieraCentre for Health Informatics, University of New South Wales, NSW 2052, Australia For correspondence: Dr E Coiera e-mail: e.coiera@unsw.edu.au AbstractThe care of patients now almost inevitably seems to involve many different individuals, all needing to share patient information and discuss their management. As a consequence there is increasing interest in, and use of, information and communication technologies to support health services. Yet, while there is significant discussion of, and investment in, information technologies, ...