changing perspectives on informtics?
DESCRIPTION
This is a poster presentation of an article that is accepted for the International Conference on Health Informatics in Portugal.TRANSCRIPT
Developments• Shortage of labour in healthcare
• Participatory approaches increasingly popular
• World-wide trend towards national Electronic Health Records (EHRs)
Relational Responsibility• We need differentiation in the qualities of relating during medical
encounters
• Relational Responsibility: process by which doctor and patient are
responsive to each other’s ideas, norms and values
• Doctor and patient need to create an optimal role division, depending
on the specific context of their interactions
Central research questionTo what extent do EHR policy and EHR design in Canada, Denmark and
The Netherlands support relational responsibility within medical
encounters?
Empirical approachQualitative, explorative and comparative study, involving the analysis of
policy and implementation documents on EHRs in Canada, Denmark and
The Netherlands.
Empirical findings
EHR policy• Policy makers in each of the three countries all to a greater or lesser
extent link the EHR to patient participation and self-care • Canada has the most extensive vision on enabling self-care by EHR
services
EHR design: functionalities• Registration and retrieval of health information by professionals have
highest priority in all three countries• For the long-term each of the three countries has plans for developing
self-help tools for patients, but in Canada and The Netherlands this is
not part of the initial design
• Denmark already started to link their EHR to telemedicine projects
• Only in Denmark patients have access to health information through a
patient portal
EHR design: data• In each of the three countries all data that are exchanged are provided
by the community of health care professionals
• Patients do not have the possibility to add or link health related
information to their EHR• In Denmark the broadest range of paper forms has been replaced by
electronic forms
Conclusions• The orientation towards informatics is still mainly provider-oriented
• EHR policy is more consumer-oriented than the initial design of EHRs
• For the upcoming years EHRs will support one traditional role division:
the one in which the health care professional is in the lead and is the
better-informed party
Changing perspectives on informatics?Bettine Pluut en Arre Zuurmond
Utrecht UniversityUtrecht School of GovernanceBijlhouwerstraat 6, 3511 ZC UtrechtThe NetherlandsE-mail: [email protected]
Individual healthcare provider
HIS/ZIS
Prosumer of healthcare
PHR
Network of healthcare providers
EHR
Healthcare communities
Converging records
Focus on individual
Focus on collective
Provider-oriented informatics
Consumer-oriented
informatics
Health records and their target group
Stage EHRs PHRs
1.Computerizing Computerized records Personal written annotations, personal
knowledge
2. Automating Automated records Manual entry into pc- applications. Stand-alone
medical devices with computerized records
3. Connecting Digital organizational infrastructure
Putting output of medical devices into PHR
4. Networking Distributed EHR Automatic connections between devices and
PHR, synchronizing EHR with PHR by hand
5. Converging - Virtual, multidimensional records on shared infrastructure
- Automatic, multidirectional synchronization of PHR and EHR
Development stages of EHR and PHR
Focus on individual
Provider-oriented
Consumer-oriented
Plotting EHR Policy
Focus on collective
Focus on individual
Provider-oriented
Consumer-oriented Plotting EHR Design
Focus on collective
D
DC