What is a ‘wicked problem’. Explain why the development of a national medical records system should be considered as a ‘wicked problem’.
What will be an ideal response?
A wicked problem is a problem that is so complex and which involves so many
related entities that there is no definitive problem specification. Different
stakeholders see the problem in different ways and no one has a full understanding
of the problem as a whole.
Some of the reasons why the development of a national medical records
system is a wicked problem are:
1. Different medical specialities and institutions maintain patient records in
their own way according to how they use these records. There is no general
agreement on what information must be maintained in a national system and
the way in which that information is presented.
2. Medicine is changing rapidly to take into account new technologies (e.g.
genetic profiling). Hence, the system specification that sets out information
to be maintained is regularly changing.
3. Maintaining information electronically in a single database opens up new
ways of searching and accessing that information. This leads to privacy
issues and it is difficult for all stakeholders to reach agreement on these.
Furthermore, privacy is a sociotechnical rather than a technical issue and so
that what is meant by ‘privacy’ changes according to social perceptions.
4. Stakeholders in the system such as insurers and funding agencies, healthcare
management and clinical staff have different and often conflicting
requirements. The priority given to these requirements is likely to be
different in different places, depending on the influence of the different
stakeholder groups.
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