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Dr. Andy Bond - National E-Health Transition Authority
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National E-Health Transition Authority www.nehta.gov.au
Evaluating the Policy Drivers for eHealth Interoperability
Dr Andy Bond Manager Standards & Informatics NEHTA
National E-Health Transition Authority www.nehta.gov.au
The National E-Health Transition Authority (NEHTA) was established by the Australian, State, and Territory governments in 2005 to develop better ways of electronically collecting and securely exchanging health information.
Our Board of Directors consists of the CEOs of all nine Commonwealth, State, and Territory Health Departments, and two Independent Directors one of who is Chair of the Board.
About NEHTA
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National E-Health Transition Authority www.nehta.gov.au
• What is interoperability?
• Relative improvements in cost, quality, and safety of care delivery
• Dealing with complexity and change
• Empowering users to engage and contribute
• Realigning the bottlenecks of healthcare capacity, information, and workflow
• Creating a national, patient-centred, long-term policy effort to enable success
Outline
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National E-Health Transition Authority www.nehta.gov.au
What is Interoperability?
Interoperability is the continuous ability of systems to share information and/or functionality with another system based upon common standards
• a capability
• a process
• an environment
Integration is the combination of separate systems into a new system functioning as a whole
• a point-in-time solution
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National E-Health Transition Authority www.nehta.gov.au
Why Interoperability?
• Health is complex not just complicated
• Moments of integration are costly to scale without an interoperability underpinning
• A process leading to known alignments
• Support flexibility between current requirements, future changes, and local variation
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National E-Health Transition Authority www.nehta.gov.au
Components of Interoperability
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Policy, Regulation, Legislation Complex
Business Process, Behaviour Complex, Complicated
Semantics, Information Complicated
Technical, Software Complicated, Simple
National E-Health Transition Authority www.nehta.gov.au
Improving Care Delivery
• Policy and business process alignment: Complex
• Improvements relative to existing care delivery models
• Augment existing care processes?
• Modify existing care processes? • Introduce new care processes?
• Trade off safety/quality, cost, and time
• Cost of conducting the tradeoff • $1.43 of every $100 in America
goes toward hospital administration1
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1http://content.healthaffairs.org/content/33/9/1586.full
National E-Health Transition Authority www.nehta.gov.au
Complexity and Change
• Change is an emergent issue for all aspects of interoperability: Complex
• Change is self creating
• A static system is a fragile system
• Design should build in facility for evolution up front including co-existence of current and future solutions
• Learning system will change with emergent system behaviour
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http://www.genome.gov/sequencingcosts/
National E-Health Transition Authority www.nehta.gov.au
Engagement and Contribution
• Enabling the knowns and the unknowns: Chaos
• Collaboration
• Consensus
• Transparency
• Learning from alternatives and failures
• Leading by example
• Fostering motivation
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National E-Health Transition Authority www.nehta.gov.au
Impediments and Enablers
• Numerous and interdependent: Complex
• Conducive business model • Technology can grease the
wheels but is often seen as the focus of interoperability
• Sharing health information is subject to
• policy enablers, • supporting business models, • shared contexts of use, and • common information
understanding
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National E-Health Transition Authority www.nehta.gov.au
Environment for Success
• A robust solution requires multiple, independent success supports
• A “good enough” solution flourishes in a conducive environment
• Intervention for change
• ABIDE1 - Attractors, barriers, identity, dissent, environment
• Changing the barriers that imply behaviour
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1 Cynefin Framework, Dave Snowden
National E-Health Transition Authority www.nehta.gov.au
Drivers for Interoperability
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Improving Care Delivery
Complexity and Change
Engagement and Contribution
Impediments and Enablers
Environment for Success
Policy Align systemic health funding, business models, and policy
Build in approaches to evolution up front
Recognise and reward leaders
Enable a sound, self-‐supporting business model
Checks and balances to optimise success
Behaviour Agreed and documented clinical models
Learn from emergent behaviour
Behaviour contributes the context of use
Changing business models is harder than changing technologies
Attract behaviour change
Information Aligned and known models of meaning
Meaning must span islands of understanding
You can’t create knowledge outside its context of creation
Agree on what not to agree upon as well as the common
Aim for an ontology of understanding
Technical Right information, delivered at the right time
Abstract from single technology solution with independent interface capability
Enable consensus agreement through standards
Interoperability can’t be validated through interface conformance
Support legacy, current, and future options
National E-Health Transition Authority www.nehta.gov.au13
Questions?
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