The document discusses interoperability in health care systems and the need to design systems that are sustainable given increasing demands and limited resources. It argues that health care must be reinvented and that technical systems have social consequences and vice versa, so sociotechnical systems must be designed with an understanding of how people and technologies interact. The document also notes that progress on health information systems in Canada has been slow.

1. Donald W. M. Juzwishin PhD
Adjunct Associate Professor
University of Victoria
Health Information Science
May 4, 2009
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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
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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
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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.
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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’
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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
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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.
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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
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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
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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
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11. Understanding
Behavior &
Access
Practice
Discourse Trust
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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
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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
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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
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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
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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
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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
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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
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