Les rseaux de sant: une exprimentation franaise centre sur le partage de linformation

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IASSIST 2005
Information Issues in Health Networked
Organizations cooperative work and new
relationships Christian BOURRET


Edinburgh May 26 th 2005
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Contents

• Background
• The rise of Networked Health
• Information and Data Issues and Needs
• 3 Levels in Decision Making
• Main Challenges of Information Sharing
• Specific aspects of Health Data
• New tools and competences
• Conclusion

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Background

• A networked society both society of information
  (Castells and Aoyama), knowledge and services
  with strong specificities in Health field
• We talk about e-Health
• Challenges of quality improvement and costs
  mastering 11 GNP in France and Germany, 15 in
  USA. Towards 20 ?

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Background (2)

• Compartmentalization cf Glouberman Mintzberg
  and the four different worlds in hospitals
• cure (physicians),
• care (nurses),
• administration (managers)
• and collectivity (board)
• 15 of global costs (MEDEC 2005)

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Background (3)

• Health systems reforms are torn between four
  conflicting goals
• health systems financial viability
• equal access to care
• quality of care
• patients and professionnals liberty (Palier)
• There exists 3 types of health systems national
  (Beveridge taxes), social insurance (Bismarck
  social contributions), mixed competition (USA).

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Background (4)

• Regulation to position between two extremes
• Health does not have a price
• It is a commodity like the others (market free
  competition)
• 3 possibilities of regulation negotiation
  (physicians and health insurance in Germany),
  market (competition between private insurance in
  USA), State (control and care limitations in
  United Kingdom) France gets into a mess

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Networked Organizations

• Two types of networks
• Networks for transferring data (Internet, French
  RSS )
• Networks between organisations for co-ordination
  of management and traceability of patients
  pathways.
• Three types of healthcare organizations
  providers (hospitals, primary care teams, Spanish
  ambulatorios ) and purchasers (American HMO,
  British PCT, Catalan CatSalut ), mixed.
• The choice of primary care United Kingdom,
  Canada (Quebec, Ontario), Spain, Sweden
• In France the weight of hospital ? need for
  interface organisations

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The rise of HealthCare Networks

• Towards new organisations in healths proximity.
• A French experiment centred on information
  sharing health networks
• Two different approaches
• General Practitioners
• Health or Insurance Organizations cf American
  HMO and Managed Care
• The oppositions health care (cf WHO) / cure or
  private insurance / solidarity
• Try to converging gt French law of March 4th,
  2002

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The Health Network Components
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HealthCare networks (in the law of March 4th
2002 on Patients Rightsand Quality of the
Health System)

• Chapter V, item 84 
• Health networks aim at favouring access to care,
  co-ordination continuity or interdisciplinarity
  of sanitary taking care, especially these
  specific to some population pathologies or
  sanitary activities. They insure a taking care
  adapted to the person s needs, as well as on the
  field of health education prevention diagnosis as
  they can take part in public health actions as
  treatment. They set up assessment (evaluation)
  actions to guarantee the quality of their
  services and benefits.

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In other countries

• United Kingdom London ex tuberculosis or
  children (Great Ormond Street Hospital)
• Switzerland cure coordinated networks ex
  Geneva, Lausanne US HMO (Health Maintenance
  Organizations) model

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Holographic Organizations

• Networked organizations project, quality
  management
• Complexity management dialogic principles
  (E. Morin) complementary of opposition visions
  local / global, private / public, individual /
  collective, quantitative/qualitative
• Holographic organizations cf Shortell the
  ability to embed the whole into each part

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Data Needs (1)

• Medical errors 50 000 to 100 000 deaths every
  year in United States 30 of medical errors
  came from problems of management of information
  and especially from patients identifiers.
• Needs for reliable data both to manage health
  systems (efficiency), improve healthcare quality
  and inform citizens (disease, prevention cf SHOW
  / NHS Scotland) consumers for choosing
  healthcare providers (competition).

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Data Needs (2)

• Health systems should invest in automated
  health-data systems, including electronic medical
  records and systems to automate medication orders
  in hospitals. Better systems for recording and
  tracking data on patients, health and health care
  are needed to make major improvements in the
  quality of care .
• Towards High-Performing Health Systems
• OECD Report to health Ministers May 2004

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Data Needs (3)

• Data for Decision Making in Health is necessary
• at 3 levels
• micro between patients and physicians
• meso within health or insurance organizations
  (managed care)
• macro in regional powers and State governments
• With in background the issue of the new
  respective role of these actors, especially
  between States, local powers and Health or
  Insurance Organisations

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Challenges

•  The present inability to share information
  across systems and between care organisations
  represents one of the major impediments to
  progress toward shared care and cost
  containment  (Grimson and al, 2000).
• Mastering processes Coordination challenges
  Information Sharing challenges

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Information Sharing Challenges

• - interoperability between various legacy
  information systems (hospitals, doctors, British
  Primary Care Trusts, Health Maintenance
  Organizations in USA or Health Insurance in
  France, compagnies ), heterogeneous and
  distributed
• identifiers issues
• security confidentiality stakes
• Within Information Systems and their basic
  components shared Electronic Health Records

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Added Value of Information

• Depends on its uses and users and not only on its
  purchase price
• Linked with stakes and risks
• Cf information value chain // with M. Porter
• And consequences positives (using information)
  or negatives (not using)
• Reducing uncertainty, improving decision making
  and innovative capabilities

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What means right information ?

• A central question is about the  right 
  information for decision making with for example
  the problem of opposite perceptions between
  doctors and managers
• Doctors, nurses, managers do not have the same
  perception of a successful operation cf
  Glouberman-Mintzberg and consequenly dont ask
  the same data.
• Cf Marciniak the role of information systems
  (IS) is both producing reliable data and organize
  convergence of actors views or perceptions
  (representations) building shared meaning

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Health Data are different from other data

• In France, law of January 1978 about Informatics
  and Freedom. Role of the CNIL
• European Act of October 24th 1995 about
  sensitive and personal nature data, referring so
  to all data allowing a persons identification.
• Its transcription in national legislations (delay
  for France) only in 2004.
• Information Access Commission of Quebec
• USA HIPAA (Health Insurance Portability and
  Accountability Act) decree in 1996 effect in
  2003.

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Internet and Health Data

• Quality of information very unequal
• In June 2001, Direction of European Union Health
  and consumers protection points out
• transparency and honesty
• explicit sources
• respect of private life
• maintenance and updating
• authors responsibility
• accessibility of data

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Internet and Health Data (2)

• Project DISCERN of the British NHS and Swiss
  project HON (Health On the Net).
• Rules of the following good practices
• each medical opinion will be only given by
  specialised and qualified staff
• information spread on the site aims at
  encouraging and not replacing the existing
  relationship between the physician and the
  patient
• sources must be quoted
• help by financing must be identified
  (advertising)

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Internet and Health Data (3)
For stimulating users judgement, States may
also create their own sites cf NHS Scotland (SHOW
programme Scottish Health On The Web) or the
Canadian Health Network, a health Canadian
priority. The British NHS is thinking in this
way. Programmes linked to other actions
education of the citizens to health (prevention)
and responsibilisation Health Education Board
of Scotland (HEBS).
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Electronic Health Record

• Various experiments
• United Kingdom ERDIP (Electronic Record
  Development and Implementation Programme) /
  Information for Health. Huge investments.
  Operational in 2008 ?
• In USA HMOs ex Kaiser Permanente EHR project and
  Federal project an EHR for all American people
  in 2010.
• In France Dossier Médical Partagé (DMP) the
  main tool of August 2004 reform but without
  money !

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Information Systems

• Regional level ?
• Information System of CatSalut in Spanish
  Catalonia
• Evisand in Andalucia
• Hygeianet in Crete
• Primary Care Hospital in Laval Region in Quebec
• In France Fieschi report points out regional
  information systems

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New competences and professions

• Linked with information management and
  communication improvement
• Case managers in Canadian hospitals
• Health webmasters
• Health Data storage and administration
• Health Networks Coordinators
• Call centers staff nurses / British NHS Direct
  or Catalan Sanitat Respon

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Learning Organisations

• Information is no more a rare resourse but the
  main stakes are now assimilation and
  transformation into knowledge and into
  competences and even in health organisations in
  competitive advantage (Porter)

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Organized Delivery Systems

• For S. Shortell and al., the key challenge is
• building an effective community health care
  management system an integrated or, for
  us, better, an organized delivery system.
• Remaking Health Care in America, 1996.

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Conclusion
The use of Health Data is at the core of
Services, Information, Knowledge and Networked
Society Health is not only a cost but an
investment and with great future it is THE main
field of New Economy