Developments Shortage of labour in healthcare Participatory approaches increasingly popular World-wide trend towards national Electronic Health Records (EHRs) Relational Responsibility We need differentiation in the qualities of relating during medical encounters Relational Responsibility: process by which doctor and patient are responsive to each other’s ideas, norms and values Doctor and patient need to create an optimal role division, depending on the specific context of their interactions Central research question To what extent do EHR policy and EHR design in Canada, Denmark and The Netherlands support relational responsibility within medical encounters? Empirical approach Qualitative, explorative and comparative study, involving the analysis of policy and implementation documents on EHRs in Canada, Denmark and The Netherlands. Empirical findings EHR policy Policy makers in each of the three countries all to a greater or lesser extent link the EHR to patient participation and self-care Canada has the most extensive vision on enabling self-care by EHR services EHR design: functionalities Registration and retrieval of health information by professionals have highest priority in all three countries For the long-term each of the three countries has plans for developing self-help tools for patients, but in Canada and The Netherlands this is not part of the initial design Denmark already started to link their EHR to telemedicine projects Only in Denmark patients have access to health information through a patient portal EHR design: data In each of the three countries all data that are exchanged are provided by the community of health care professionals Patients do not have the possibility to add or link health related information to their EHR In Denmark the broadest range of paper forms has been replaced by electronic forms Conclusions The orientation towards informatics is still mainly provider-oriented EHR policy is more consumer-oriented than the initial design of EHRs For the upcoming years EHRs will support one traditional role division: the one in which the health care professional is in the lead and is the better-informed party Changing perspectives on informatics? Bettine Pluut en Arre Zuurmond Utrecht University Utrecht School of Governance Bijlhouwerstraat 6, 3511 ZC Utrecht The Netherlands E-mail: b.pluut@uu.nl Individual healthcare provider HIS/ZIS Prosumer of healthcare PHR Network of healthcare providers EHR Healthcare communities Converging records Focus on individual Focus on collective Provider-oriented informatics Consumer-oriented informatics Health records and their target group Development stages of EHR and PHR Focus on individual Provider-oriented Consumer-oriented Plotting EHR Policy Focus on collective Focus on individual Provider-oriented Consumer-oriented Plotting EHR Design Focus on collective Stage EHRs PHRs 1.Computerizing Computerized records Personal written annotations, personal knowledge 2. Automating Automated records Manual entry into pc- applications. Stand-alone medical devices with computerized records 3. Connecting Digital organizational infrastructure Putting output of medical devices into PHR 4. Networking Distributed EHR Automatic connections between devices and PHR, synchronizing EHR with PHR by hand 5. Converging - Virtual, multidimensional records on shared infrastructure - Automatic, multidirectional synchronization of PHR and EHR D D C

Developments

Shortage of labour in healthcare

Participatory approaches increasingly popular

World-wide trend towards national Electronic Health Records (EHRs)

Relational Responsibility

We need differentiation in the qualities of relating during medical encounters

Relational Responsibility: process by which doctor and patient are responsive to each other’s ideas, norms and values

Doctor and patient need to create an optimal role division, depending on the specific context of their interactions

Central research question To what extent do EHR policy and EHR design in Canada, Denmark and The Netherlands support relational responsibility within medical encounters?

Empirical approach

Qualitative, explorative and comparative study, involving the analysis of policy and implementation documents on EHRs in Canada, Denmark and The Netherlands.

Empirical findings

EHR policy

Policy makers in each of the three countries all to a greater or lesser extent link the EHR to patient participation and self-care

Canada has the most extensive vision on enabling self-care by EHR services

EHR design: functionalities

Registration and retrieval of health information by professionals have highest priority in all three countries

For the long-term each of the three countries has plans for developing self-help tools for patients, but in Canada and The Netherlands this is not part of the initial design

Denmark already started to link their EHR to telemedicine projects

Only in Denmark patients have access to health information through a patient portal

EHR design: data

In each of the three countries all data that are exchanged are provided by the community of health care professionals

Patients do not have the possibility to add or link health related information to their EHR

In Denmark the broadest range of paper forms has been replaced by electronic forms

Conclusions

The orientation towards informatics is still mainly provider-oriented

EHR policy is more consumer-oriented than the initial design of EHRs

For the upcoming years EHRs will support one traditional role division: the one in which the health care professional is in the lead and is the better-informed party