Political, Policy and Social Barriers to System Interoperability


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4th International MCETECH Conference on eTechnologies, Carleton University, Ottawa

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Political, Policy and Social Barriers to System Interoperability

  1. 1. Donald W. M. Juzwishin PhD Adjunct Associate Professor University of Victoria Health Information Science May 4, 2009 www.ideastoaction.ca
  2. 2.   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 www.ideastoaction.ca
  3. 3.   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 www.ideastoaction.ca
  4. 4.   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. www.ideastoaction.ca
  5. 5.   Old think   Rethink   Doctors, nurses and   Citizens and patients administrators are in are partners in the charge of the health health care systems care system   Citizens and patients   Health care delivery is a rely on teams to deliver one to one relationship care between a provider and   Citizens and patients a patient move effortlessly   Institutions & programs between types and fit in ‘tight levels of health care compartments’ www.ideastoaction.ca
  6. 6.   Old think   Rethink   Institutions own the   Citizens and patients citizens & patients own their health health information information   Health care providers   Health care providers are accountable to are accountable to the their peers or citizens employers   Performance   Performance measures are measures are process outcome oriented oriented www.ideastoaction.ca
  7. 7.   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. www.ideastoaction.ca
  8. 8.   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 www.ideastoaction.ca
  9. 9.   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 www.ideastoaction.ca
  10. 10.   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 www.ideastoaction.ca
  11. 11. Understanding Behavior & Access Practice Discourse Trust www.ideastoaction.ca
  12. 12. Informed Improved Results Public Web 2.0 Practice Patient Knowledge outcomes Behavior Providers Health 2.0 System performance Decisions Policy Data makers Policy Population Medicine 2.0 health Researchers www.ideastoaction.ca
  13. 13.   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 www.ideastoaction.ca
  14. 14.   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 www.ideastoaction.ca
  15. 15.   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 www.ideastoaction.ca
  16. 16.   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 www.ideastoaction.ca
  17. 17.   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 www.ideastoaction.ca
  18. 18.   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 www.ideastoaction.ca