political, policy and social barriers to system interoperability

Donald W. M. Juzwishin PhD Adjunct Associate Professor

University of Victoria Health Information Science

May 4, 2009

www.ideastoaction.ca

  Interoperability is a property referring to the ability of diverse systems and organizations to work together (inter-operate). The term is often used in a technical systems engineering sense, or alternatively in a broad sense, taking into account social, political, and organizational factors that impact system to system performance.

  Wikipedia, Interoperability


  If health care is to flourish in the coming setting of diminished resources and increased demand, then it will do so because we have explicitly designed and implemented new systems of care that are fundamentally sustainable. Given the likely enormity of that task, it may require nothing less than the reinvention of health care

  Enrico Coiera, British Medical Journal   Volume 328, 15 May 2004, p. 1197   BMJ.com


  Technical systems have social consequences;   Social systems have technical consequences;   We don’t design technology, we design

sociotechnical systems; and   To design sociotechnical systems, we must

understand how people and technologies interact.


  Old think   Doctors, nurses and

administrators are in charge of the health care system

  Health care delivery is a one to one relationship between a provider and a patient

  Institutions & programs fit in ‘tight compartments’

  Rethink   Citizens and patients

are partners in the health care systems

  Citizens and patients rely on teams to deliver care

  Citizens and patients move effortlessly between types and levels of health care


  Old think   Institutions own the

citizens & patients health information

  Health care providers are accountable to their peers or employers

  Performance measures are process oriented

  Rethink   Citizens and patients

own their health information

  Health care providers are accountable to the citizens

  Performance measures are outcome oriented


  Despite recent investments through Canada Health Infoway, Canadian governments have been slow to make progress in the information systems needed to support the delivery of high – quality care. We are not on track to meet Infoway’s goal of 50% of Canadians having a secure electronic health record linked to other aspects of health care delivery by 2010 – a goal that the Health Council has said was too modest from the start. Public support for these investments is strong, however, and governments must find ways to fund and accelerate this essential part of health care renewal.   Rekindling reform: Health care renewal in Canada, 2003

– 2008, June 2008, p. 35.


  Provincial jurisdictional responsibility   Canada Health Act provides guidance   13 interpretations   Developments within provinces

  Ontario   Alberta

  Canada Health Infoway   Making strategic investments

  Political will within provinces for accountability and performance reporting


  Paternalistic purveyors of knowledge   Ownership of the knowledge   Boundary maintenance of roles – professional

and contractual   Health literacy   Institutional historical time frames   Trustworthiness of institutions   Lack of transparency


  Definition of a high performing health care system

  Financial incentives and disincentives   Defined and agreed on performance indicators

for health system performance   Transparency and public reporting on health

system performance   Paying lip service to patient centered care   Allocating funding based on historical global

budgeting



Understanding

Access

Trust Discourse

Behavior & Practice


Public

Providers

Policy makers

Researchers

Informed Improved Results

Web 2.0

Health 2.0

Medicine 2.0

Patient outcomes

System performance

Population health

Practice Behavior

Knowledge

Data Decisions

Policy


  Social phenomena representing a cultural revolution that captures the Internet and Society

  Continually changing and designed to maximize creativity, communications, secure information sharing, collaboration and functionality of the web

  Social networking sites, video sharing, wikis, blogs and folksonomies

  Health 2.0 is participatory health care characterized by the ability to rapidly share, classify and summarize individual health information with goals of improving health care systems, experiences and outcomes via integration of patients and stakeholders

  Ian Furst, www.waittimes.blogspot.com


  Applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups”

  G. Eysenbach, www.medicine20congress.com


  Facilitate informed choice   Facilitate provider commitment to excellence

and best practice   Nurture trust   Facilitate researcher autonomy   Encourage citizen responsibility   Build egalitarian state direction with a

commitment to solidarity   Encourage critical assessment of outcomes


  Define a high performing health care system

  Agree on performance indicators and report on them

  Remove barriers among providers

  Provide incentives   Provide researchers with

access to anonymous and linked health data

  Give the personal health record to patients and citizens


  Captures emergent character of society for openness, collaboration and peering

  Provides citizens, consumers and patients with unfettered access 24X7

  Provides for social networking   Anyone can build or contribute to it   Citizens take responsibility for their health

information


political, policy and social barriers to system interoperability

Technology