whither health information systems - وبلاگ شخصی عیسی ذوقی خبوشان ( کارشناس ارشد مدیریت بازرگانی بین الملل )

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نویسنده وبلاگ عیسی ذوقی خبوشان
آرشیو وبلاگ

وبلاگ شخصی عیسی ذوقی خبوشان ( کارشناس ارشد مدیریت بازرگانی بین الملل ) (وبلاگ دسترسی به مقالات مدیریتی)

محصولات رزومه کاری عیسی ذوقی خبوشان وبلاگ های مدیریتی شماره های تماس جهت همکاری اگر در دانلود به مشکل برخوردید وبلاگ اینجانب در مرجع الکترونیکی علوم مدیریت ایران رزومه کاری عیسی ذوقی خبوشان

Whither Health Information Systems نویسنده: عیسی ذوقی خبوشان - یکشنبه ٤ بهمن ۱۳۸۸

Appeared in the Spring 1998 edition of Hospital Quarterly

Whither Health Information Systems?

By Duncan G. Sinclair and Lewis Hooper

Information about the interactions between those who provide products and services and their customers is the sine qua non of every successful business. Such information is essential both to operate the business efficiently and to govern it and plan effectively for its future.

Most Canadians would not believe that in 1998, in this technologically and educationally advanced country, we do not yet have in place a well-developed health information system to support the effective operation of our most highly treasured and single most expensive social program. But it is a simple fact that, in one day, a busy customer can visit one or more physicians, a community health centre, a chiropractor, a hospital emergency room, a rehabilitation centre, an immunization clinic in a public health unit, and attend several pharmacies to fill prescriptions. No single provider of service would know anything about the visits elsewhere unless told by the patient. It is also a simple fact that while we have good, comparable data on patients treated in hospital beds, we have very sketchy data on the far greater number who visit hospitals as ambulatory patients and very little or none at all on those who receive services elsewhere in the community. Hospital records are not available to the home care organizations or physicians or nursing homes or community health centers that look after the same patients when they leave hospital or vice versa.

In his preface to the report of the National Task Force on Health Information, Martin Wilk, the chairman and one-time Chief Statistician for Canada, said, “I was aware from the outset that Canadian health information was not in good shape. My current assessment is that it is in a deplorable state.”1

Simple data on credit card transactions yield to those with access far more comprehensive and timely information than is available for the so-called health services “system” on which we citizens of Canada spend over $70 billion each year. Are we getting our money’s worth? To answer this question we have only our intuition and opinion polls. We have few truly useful measures of what’s going on and fewer yet of its worth!

So what’s to be done?

We suggest seven initial steps:

1. Acknowledge the fact that the provinces and territories are responsible for health services.

If, in the end, we can share health and care data2 Canada-wide, it will be the result of sensible inter-provincial agreements on common data standards and linkages among ten provincial and two territorial health information systems. The federal government could facilitate development of the standards and linkages, bearing in mind the Canada Health Act’s portability principle,3 but each province must drive its own process.

2. Forget about technology (for now).

The present state of play in information technology is so far ahead of the health system’s capacity to use it effectively that discussing now the relative merits of this or that hardware or software is like selecting a car for a yet-to-be-conceived child. When we have our health information system’s design in mind, a clear idea of the problems we want to solve, and some fundamentals in place it will be time enough to think about the enabling technology to make it work.

3. Demand and accept leadership!

In 1995 the President of the Czech Republic, an intellectual turned politician, observed wryly, “They are certainly right in saying that the Western world is suffering from a crisis of authority.”4 Canadians consider health services to be public services. The primary authority for the development of effective (and effectively linked) information systems for health and healthcare rests squarely on the shoulders of the provincial/territorial Ministers of Health. Although the impetus and policy direction must come from the ‘Boards of Directors’ of our vaunted health services system(s), governments should not try to develop information systems themselves. Outside experts must be engaged to do the work. Those in the health ‘business’ have to be intimately involved. But governments alone can appoint a leader in each province and delegate to him or her the responsibility to make health information systems ‘happen’ according to an approved plan and timetable. The systems themselves in each province will have to be built from the bottom up with the full support and enthusiastic participation of the full spectrum of ‘players’ in the field. But building will not proceed, nor will it be successful, without leadership, the discipline of top-down policy direction, and the authority to decide finally on matters in dispute.

4. Start simply, build on the basics, and don’t try to create the ideal system all at once.

There are no mature health information systems we can copy holus bolus from any other country or jurisdiction. But we can learn from those who have developed information systems in finance, business, and industry. A key lesson is that system building is like playing chess; wrong moves cost dearly later. Witness the “millennium problem!” The basics include things like determining the nomenclature and standards to describe interactions between the providers of health services and what some call patients, others clients, and yet others customers. They include such fundamentals as incentives and/or penalties to ensure the data capture the genuine nature of each interaction. Fee-for-service billing systems were not designed to do this; they ill serve the purpose!

5. Get representatives of the providers of health services together.

A major initial challenge will be to forge consensus (which is essential) if not agreement among the many ‘players’ on how to proceed. The most sophisticated, the hospitals, will urge quick adoption of the basics established for patients in beds years ago; many are fast developing regional inter-hospital systems now to meet their urgent needs for the information necessary to increase operating efficiency. Others will want first to meet “special” needs, pediatric or cancer or heart care, etc. – different “silos”. Still others, particularly those at the all-important primary-care end of the spectrum, have yet even to create organizations capable of participating authoritatively in discussions about nomenclature, standards, and how to stage development of a comprehensive, “silo-less,” health information system. Inclusion also of a few articulate and well-informed representative “customers” in the group would be salutary.

6. Confront the issue of confidentiality of health records.

There is little doubt that electronic-credit-card banking and income-tax data systems (or the customer-service records of automobile companies) pose much greater challenges to a determined snoop than do ‘confidential’ patient records in hospitals, nursing homes, physicians’ offices, or wherever. To be optimally useful, these records have to be shared among all those who provide a patient with health services, a key principle that conflicts directly with another - the patient’s right to privacy. This conflict will not be easily (or quickly) resolved. Important as it is, confidentiality is but part of the problem. The real issue is to ensure the legitimacy of the information’s use. If that were to be dealt with by anti-discrimination legislation, it would remove at least part of a substantial roadblock to the design of a health information system that truly serves the best interests both of customers and of the governors and operators of our health services system(s).

7. Get started now!

Money is scarce but not as scarce as the time left to get ready for the increasing numbers of elderly people who will put increasing (and entirely legitimate) demands on the healthcare side of provincial health systems in the early decades of the twenty-first century. Our lack of a functional health information system is a deficit as real as any fiscal one. Without information we can’t even calculate how much money its lack costs us in foregone operating efficiencies in our expensive but financially pressed “health system.” Since we have put off its staged development for so long, our lack of a health information system is like having an accumulated debt – we will need to sacrifice some of the other things we would like to do right now to pay it off and put it behind us.

Today is a better time to begin than tomorrow!

Duncan G. Sinclair is Chairman of the Ontario Health Services Restructuring Commission.

Lewis Hooper is a Consultant with the Ontario Health Services Restructuring Commission.

1 Health Information for Canada. Report of the National Task Force on Health Information, 1991.

2 Sickness care, Sjukvard, as it is straight forwardly referred to in Sweden.

3 Portability, accessibility, universability, comprehensiveness, public administration.

4 Havel, Vàclav. 1995. Canberra Australia, March 29. In The Art of the Impossible, Politics as Morality in Practice, Speeches and Writings, 1990-1995. Alfred A. Knopf, Toronto, 1997, p. 198.

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