political, policy and social barriers to system interoperability
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Donald W. M. Juzwishin PhD Adjunct Associate Professor
University of Victoria Health Information Science
May 4, 2009
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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
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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
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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.
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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
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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
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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.
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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
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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
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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
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Understanding
Access
Trust Discourse
Behavior & Practice
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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
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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
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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
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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
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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
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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
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