sph colloquim march 9

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

S C H O O L O F P U B L I C H E A L T H C O L L O Q U I U M S E R I E S

D O N J U Z W I S H I N P H D

M A R C H 9 , 2 0 1 0

A L B E R T A H E A L T H S E R V I C E S

Web 2.0 and 3.0:Social networking applications for health care policy makers

Objectives

Identify what is confounding our ability to provide 100% of Canadians with their personal heath record?

Ask whether web 2.0, 3.0, health 2.0, med 2.0 are part of the solution to the lack of ubiquity and interoperability?

Identify social, political and policy barriers to ubiquity and interoperability of personal health records

Identify a framework and recommendations to remedy contemporary challenges

Healthcare Management ForumWinter 2009, pp. 6 - 10

The Interoperability Challenge

8 Persistent Challenges 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

Failure to recognize uncertainty and ignorance

Sir Muir Gray in Castells

Old think Rethink

Health care providers

Boundary maintenance

Siloed services

Health care providers dispense

Top down

Extract truth

Citizens, patients

Seamless transitions

Integrated & coordinated

Providers & patients apomediate

Open & transparent

Interact to create truth

Contrast

Characteristics of Web 2.0 and Med 2.0

Web 2.0

Nobody owns it

Everybody uses it

Anyone can improve it

Health 2.0 and Med 2.0

Social networking

Participation

Apomediation

Collaboration

Openness

Citizen choice

Provider commitment to excellence

Researchers autonomy

Health Policy 2.0

Systems thinking – all government approach

Develop a patient – centered system

Give citizens their personal health record

Assure confidentiality, security and ubiquity

Become open, explicit and transparent in the governance, functioning and monitoring of the health care system

Political Barriers

14 health care systems that are disjointed and fragmented

Contest between access and choice

Agree on what constitutes effective health care delivery but squeamish on accountability

Trying to manage what is not understood

We appear to agree on values but not on what is valued

Social Barriers

The practice of health care – balkanized

Asymmetry of relationships

Contractual labor rigidities

Inflexible workforce

Policy Barriers

Solutions of the past become the shackles of the present

Conflict of values among citizens, providers, policy makers, politicians and researchers

Political will to steer political reform by not losing the support of citizens

Standardizing and defining terminology

Disincentives to reform or perverse incentives to maintain the status quo

Who owns the health record?

Policy Recommendations

Respect provincial responsibility for health care but not at the expense of effective national functionality

Define and standardize terminology of a high performing health care system

Converge toward standardized best practices in functional interoperability and informatics

Meet individual needs but maintain a population health focus

Monitor and report on individual and health system performance

Give citizens their secure and confidential health record Provide the Web 2.0 and 3.0 to patients and providers to

help themselves

Framework Advancing Health System Interoperability

Closing remarks

Health system interoperability is not merely a question of technical semantic interoperability Define the interoperability standards for a national health

information system

Political, social and policy solutions must be introduced confluent with technical solutions Replacing one set of problems with another set

New ones or the ones we know?

Political will, bureaucratic resolve and managerial courage are needed to turn system interoperability to reality

References

Castells Manuel, The rise of the network society. Cambridge, MA: Blackwell Publishers Inc.; 1996.

Juzwishin Don, Political, policy and social barriers to health system interoperability: Emerging opportunities of Web 2.0 and 3.0. Healthcare Management Forum, Winter 2009, 6-10.

Juzwishin Don, Enabling Technologies and Challenges for the Future of Ubiquitous Health: The Interoperability Framework in Ubiquitous Health and Medical Informatics, IGI Global, March 2010. ISBN: 978-1-61520-777-0