Graduate student seminar at the University of Victoria, Canada

1. Information Technology in
Healthcare: Achievements to
Date and Challenges Ahead
DR. DONALD W. M. JUZWISHIN
HINF 580
UNIVERSITY OF VICTORIA
OCTOBER 15, 2009
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2. Professor Protti‟s Assignment
 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.
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3. Accomplishments against what measure?
 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
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4. Accomplishments 1970 -2010
 Social
 Information symmetry  Organization
 Technological  Capacity building
 Informational  Ubiquity
 Differentiation  Best practice
 Data, info, knowledge, truth  Clinical effectiveness
 Empowerment  Technological
 Private vs. public  Molecules to genome
 Political  Rapidity
 Democratization of data  Relevance - customization
 Monitoring & reporting  Comprehensiveness
 Transparency  Causality
 Accountability  Machine/machine interface
 Public & private surveillance  Economic
 Rights & responsibilities  Opportunity cost
 Commoditization of information
 Scenario building
 Cost effectiveness
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5. Muir Gray‟s vexatious problems
 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
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6. Hurdles 2010 - 2020
 Political  Policy
 Canadian federalism  Leadership
 Leadership  Management
 Governance  Incremental tampering
 Structural & process  Population health and
interoperability SDOH approach
 Public confidence  Privacy and confidentiality
 Legislation & regulations  Incentives/disincentives
 Access, quality and
sustainability
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7. Hurdles 2010 - 2020
 Economic  Technological
 One solution vs. many  Parochial thinking
 Public confidence  National harmonization
 Societal perspective in  Standards
cost effectiveness studies  Definitions
 Comparative effectiveness  Global convergence
analysis  Interoperability
 Macro resource allocation  Protecting the public
decisions vs. technical interest
allocation decisions
 HIT evaluation &
assessment
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8. Hurdles 2010 - 2020
 Social  Organization
 Professional boundaries  Ontario vs. Alberta
 Paternalism  Disincentives to
 Who owns it? interoperability
 Hierarchical  People centered health
 Privacy/confidentiality
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9. Solutions
 Political  Policy
 National consensus on  Population health and
standards and definitions SDOH
commensurate with global  All government approach
developments  Health system structure
 Being explicit with private and process
and public split in funding interoperability
and delivery  One patient – one record
 Benefits coverage
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10. Solutions
 Economic  Social
 Improved quality saves  Web 2.0
lives  Medicine 2.0
 Improved quality saves  Health 2.0
money  Apomediation
 Disinvestment  Social networking
 Clinical and cost
ineffectiveness
 Team work
 Ubiquity of cost and price  Self care
data  Remote sensing
 Link interventions to
outcomes
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11. Web 2.0
 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
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12. Web 2.0 & 3.0 Potentialities
 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.
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13. Using Web 2.0 to improve understanding, access,
trust, discourse, practice and behavior in the
health care system
Dimensions
for Citizens Providers Researchers Policy
Improvement makers
Understanding
What mechanisms exist or are emerging?
Access
How can the mechanisms be improved?
Trust
What are the issues and problems?
Discourse
What are the opportunities?
Behavior/practice
What research is necessary?
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14. Concluding Remarks
 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!
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15. Questions
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