Wednesday, July 18, 2007

Government's Role in eHealth

I’ve always struggled with the role of government in health care, and more recently in eHealth. I’m a supporter of publicly funded healthcare. What better insurance pool than the entire population of a nation? And who better to set the rules around regulation of an industry that affects the health and well-being of every citizen?

Governments and government-sponsored agencies are good at several things: infrastructure for one, and rules, regulation and enforcement for another. Think about our road systems. Governments usually build and maintain the roads. They set the rules for driving on the roads, and they enforce those rules with police forces. By and large they do a pretty good job.

But they don’t run trucking companies, or car dealerships, or the myriad of businesses that spring up along transportation arteries to take advantage of a traveling public. Those things are better left to market forces and private initiative, which by and large do a pretty good job.

So what should government and government-sponsored agencies do in eHealth? In my own opinion it’s just like the road system:

Planning and Strategy – to drive consensus on how the all stakeholders in the eHealth game will approach their own applications and how they will interact with one another.
Infrastructure – like secure high-bandwidth networks, systems to identify and authenticate citizens be they patients or health care providers, secure communications systems to support public health and other services.
Standards – to define minimum requirements for security, safety, usability and interoperability for everything running on the infrastructure.
Rules of behavior – defining acceptable uses for the information and services flowing through the network and acceptable behaviors with respect to privacy and safety.
Enforcement – to ensure that standards are adopted and rules obeyed.

As a general rule, governments should stick to systemic initiatives and avoid getting involved with application systems and other activities that impacts healthcare workflows or the complex interactions between stakeholders. They are not close enough to the action to understand end-user needs or impacts.

In those instances where governments are funding the development and deployment of eHealth applications, they should behave as any prudent investor would. Government should avoid direct involvement and intervention, but is within its rights to demand action and behavior that will deliver promised results.

So what would the ideal situation look like?

The government would lead on the development of an eHealth strategy based on consensus amongst eHealth stakeholders, would establish a common eHealth infrastructure that would otherwise be outside the purview, competence or capacity of any other stakeholder, set and enforce standards and the rules of engagement for eHealth participants.

Health care organizations and providers (including regional collectives such as health regions or districts) would worry about their own priorities for eHealth applications and undertake development and deployment of eHealth systems in response to the needs of their communities.

Government could participate in local application initiatives as a prudent investor, focusing on results and value for money, but letting the community determine its own needs and approach to development and deployment.

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