The management and policy challenges of the globalisation effect of informatics and telemedicine

Managers and policy makers face new and as yet unrecognised challenges-part icularly loss of control-through the application of new information technol ogies in healthcare. Whilst informatics and telemedicine are important deve lopments, the potential for adverse organisational and societal effects sho uld be recognised and anticipated. Health organisations are frequently seen as circumscribed networks, and the se in turn form local alliances with related organisations. Information tec hnologies are frequently construed as relating to operational systems withi n organisations, not least electronic patient record systems and diagnostic systems. These can then be linked to new generation health business system s, to provide accurate management information at low additional cost. However, this pair of assumptions is now seriously flawed, due to the effec ts of the latest developments in health informatics and telemedicine. In pa rticular, telecommunications and Internet technologies render ineffectual p revious external barriers of distance and national boundaries, whilst withi n the organisation the combination of knowledge bases with information tech nologies creates tendencies towards internal autonomy. Organisational and n ational policy control of health care face direct and radical challenges th rough perverse effects of otherwise beneficial developments, and early acti on is needed. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.