D R . D O N A L D W . M . J U Z W I S H I N

H I N F 5 8 0

U N I V E R S I T Y O F V I C T O R I A

O C T O B E R 1 5 , 2 0 0 9

www.ideastoaction.ca

Information Technology in Healthcare: Achievements to Date and Challenges Ahead

Professor Protti‟s Assignment

www.ideastoaction.ca

What has Health Informatics accomplished over the last 40 years since information technology was first introduced into health care delivery in the late „60‟s;

What policy, organizational, economic, technological, political and social hurdles are going to be faced in the next 5-10 years; and

What are some political, policy, social, organization and economic solutions.

Accomplishments against what measure?

www.ideastoaction.ca

Improve democratization of society

Empower and engage informed citizens

Increase accountability and transparency of governments

Understand population health and social determinants of health (SDOH)

Improve the welfare and wellbeing of Canadians

Contribute to a high performing health care system

“Out” the truth

Accomplishments 1970 -2010

www.ideastoaction.ca

Social Information symmetry

Technological Informational

Differentiation Data, info, knowledge, truth

Empowerment Private vs. public

Political Democratization of data Monitoring & reporting Transparency Accountability Public & private surveillance Rights & responsibilities

Organization Capacity building Ubiquity Best practice Clinical effectiveness

Technological Molecules to genome Rapidity Relevance - customization Comprehensiveness Causality Machine/machine interface

Economic Opportunity cost Commoditization of information Scenario building Cost effectiveness

Muir Gray‟s vexatious problems

www.ideastoaction.ca

The problems are:

a persistence of errors;

poor quality care delivery;

poor experience of patients;

waste;

unknowing variations in policy and practice;

failure to introduce high value interventions;

uncritical adoption of low value interventions; and

failure to recognize uncertainty and ignorance

Hurdles 2010 - 2020

www.ideastoaction.ca

Political

Canadian federalism

Leadership

Governance

Structural & process interoperability

Public confidence

Legislation & regulations

Access, quality and sustainability

Policy

Leadership

Management

Incremental tampering

Population health and SDOH approach

Privacy and confidentiality

Incentives/disincentives

Hurdles 2010 - 2020

www.ideastoaction.ca

Economic

One solution vs. many

Public confidence

Societal perspective in cost effectiveness studies

Comparative effectiveness analysis

Macro resource allocation decisions vs. technical allocation decisions

HIT evaluation & assessment

Technological

Parochial thinking

National harmonization

Standards

Definitions

Global convergence

Interoperability

Protecting the public interest

Hurdles 2010 - 2020

www.ideastoaction.ca

Social

Professional boundaries

Paternalism

Who owns it?

Hierarchical

Privacy/confidentiality

Organization

Ontario vs. Alberta

Disincentives to interoperability

People centered health

Solutions

www.ideastoaction.ca

Political

National consensus on standards and definitions commensurate with global developments

Being explicit with private and public split in funding and delivery

Benefits coverage

Policy

Population health and SDOH

All government approach

Health system structure and process interoperability

One patient – one record

Solutions

www.ideastoaction.ca

Economic

Improved quality saves lives

Improved quality saves money

Disinvestment

Clinical and cost ineffectiveness

Ubiquity of cost and price data

Link interventions to outcomes

Social

Web 2.0

Medicine 2.0

Health 2.0

Apomediation

Social networking

Team work

Self care

Remote sensing

Web 2.0

www.ideastoaction.ca

informed choice

collaboration

openness

provider commitment to excellence of practice (peering)

researcher autonomy

fair and egalitarian state direction based on the principle of social solidarity

Web 2.0 & 3.0 Potentialities

www.ideastoaction.ca

Improving citizen knowledge, access and choice regarding effective health care interventions to benefit their personal health care status;

Improving provider autonomy and practices to best serve the interests and health outcomes of patients and the health of the population;

Improving researchers‟ capability and capacity to bridge between the creation of new knowledge and contributing to its application; and

Improving the state‟s direction of the health care system through better data, information and knowledge thereby improving health care policy making.

Using Web 2.0 to improve understanding, access, trust, discourse, practice and behavior in the

health care system

www.ideastoaction.ca

Dimensions

for

Improvement

Citizens Providers Researchers Policy

makers

Understanding What mechanisms exist or are emerging?How can the mechanisms be improved?

What are the issues and problems?What are the opportunities?What research is necessary?

Access

Trust

Discourse

Behavior/practice

Concluding Remarks

www.ideastoaction.ca

What a wonderful clash of values! Coiera‟s rules

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 (Coiera, pp. 1198-1199).

Citizens

Politicians, policy makers, researchers

Ubiquitous knowledge

Information technology IS our future!

Questions

www.ideastoaction.ca