8. Care Information as a Utility

Abstract

This chapter is in three parts. The first explores what we have learned during the anarchy of transition of health care in the Information Age and why new ideas are needed. It emphasizes the organic nature of a care information utility, distinguishing it from a technical infrastructure. Organic, that is, in the sense of ‘relating to, or derived from living organisms’ and being adaptable, evolving and humanly-centred, to serve the needs of individual citizens for supportive health care services. In this regard, it draws an analogy with the forest ecosystem of the natural organic world, which was termed a ‘Wood Wide Web’ in a 1997 issue of Nature. It makes a parallel analogy with monetary ecosystems, discussing the relevance for health care information policy of the lessons drawn by Mervyn King, when writing about the world monetary system crisis of 2007–08. The second part of the chapter celebrates pioneers I have known and worked with, who have made notable contributions in framing and implementing new ideas for information systems, achieving iterative and incremental advances towards meeting longstanding policy goals. The third part draws together future-facing perspectives of the changing patterns of knowledge and discipline, professional practice, education, research and global village community, which will form the landscape on which the care information utility evolves. It discusses the values and principles that should guide the development of the utility, the importance of a viable means for its standardization and the difficulties faced in achieving this. The chapter concludes with a parenthetical reflection on what matters at the heart of the interconnected and currently fragmented domains of care information services, and the dilemmas they pose. This has been characterized in other contexts of public services as the need for a unifying change of perspective, from a focus on ‘What is the matter with you?’ to one of ‘What matters to you?’