Monday, July 30, 2007

Trust and Understanding

Friday's post on Making Progress Towards EHRs generated some lively discussion about the health sector's state of readiness with respect to EHRs and other information and telecommunications technologies. I agree that we are at a tipping point with respect to the capability of ICTs to revolutionize the work of health professionals. However, the skeptic in me keeps niggling away about the human issues that still must be addressed before we see health care providers embracing the technology in the way those promoting eHealth envision; i.e. a world of happy healthcare providers willingly and enthusiastically sharing information with one another and with other stakeholders in a collegial and collaborative way.

Central to it all is trust and understanding. By and large, I don't think the major players in the health sector trust and understand each other. In particular there is a great divide between those who provide health care and those who pay for it. At the 100,000 foot level we all agree on the basic tenets of health care and eHealth, but when it comes to implementing eHealth on the ground, different agendas and points of view come into play. Many eHealth initiatives are sponsored by the payer community (Government or private sector) who want to see improved efficiencies and happier customers. These initiatives are often regarded with suspicion by health care providers who fear unwanted intrusion into their daily work and relationships with patients.

I don't think that there is any maliciousness at play here. Everyone wants to do a good job providing excellent care to patients while at the same time making a decent living. Unfortunately each of the different stakeholder groups sees the promised eHealth world differently.

Witness the gaps (well documented in many of the papers noted on this site) in meaningful end-user involvement in the development of requirements and the design of eHealth systems. Many eHealth system developers live in a Dilbert world where users are seen as just another component in a complex business process that is better understood by engineers than by knowledgeable health care practitioners. This is particularly acute when the paymasters for the eHealth initiative is a government or insurance company rather than the health care providers, or some group acting on their behalf. He who pays the piper calls the tune. This lack of involvement promotes distrust, and ensures that we will not understand one another.

The answer is information governance. While the technological capability may exist for eHealth, and while health care providers are becoming more technically savvy, without some mechanism for brokering consensus about eHealth systems requirements, the rules and standards governing eHealth and a respected approach to enforcing those rules and standards, I fear that our eHealth initiatives will continue to flounder or fail to realize their real potential.

There is some progress being made towards information governance, particularly with respect to the privacy issue. But privacy is only one of a range of issues that must be addressed before we cross the tipping point into eHealth Nirvana. This is what I believe will take the time. Implementing technology is a lot easier than changing attitudes or building trust. The technology will be in place long before the human part of the system matures to the point that we will realize the full benefit of eHealth.

1 comment:

Michael Martineau said...

In general, I agree with the sentiment of more end-user involvement. As an industry analyst organization, our eHealth team is continually surveying the landscape to see how healthcare organizations across the country are employing various eHealth solutions. We are seeing a greater emphasis on end-user involvement, with organizations such as Trillium Healthcare in Mississauga, ON and the Calgary Health Region (CHR) in Alberta taking an aggressive stance regarding end-user involvement.

Both Trillum and CHR begin with the premise the eHealth enables and supports healthcare processes. Hence, they start with an examination of these processes to determine what changes can/should be made to increase efficiency, patient safety, etc. Once these changes are identified, they look to see how eHealth can be used to support these changes. By leading with healthcare processes, they naturally start with an end-user view that necessitates clinical involvement.

Like other industries, adoption of technology in healthcare works best when the end-user can see "what is in it for me". Other industries have also experience major IT implementation failures when end-user needs are not adequately considered. Healthcare is not unique in this regard.

Michael Martineau
eHealth Practice Lead
Branham Group Inc.