The VERDIKT Conference 2013 OPPORTUNITIES AND CHALLENGES OF INTRODUCING PATIENT-ORIENTED ICT SOLUTIONS: the REACH project

• Research Project Overview • Initial Observations

• Next Steps

Presentation Outline

REACH: project identity • REACH: Responsive Architectures for Innovation in

Collaborative Healthcare Services

• Motivation: novel web-based and mobile technologies offer opportunities for shifting healthcare towards more patient-centric services. Experience has shown that despite the significant resources devoted this shift towards patients is far from straightforward.

• Object of Study: the project studies design and implementation trajectories for a number of such initiatives.

• Purpose: Generate cross-disciplinary knowledge about how to achieve responsive architectures (i.e. technical, organizational and economic structures). Responsive architectures are those that can accommodate new needs, and stimulate innovative provision of patient-centered health services.

• Participants: UiO Department of Informatics, BI School of Management, Oslo University Hospital, Sunnaas Rehabilitation Hospital

• Timeline: January 2012 – December 2015

• Focus on sociotechnical complexity: i.e. the way that technical, organisational and social issues are intertwined

• Qualitative Research: multiple longitutidinal case studies

• Cross-disciplinary approach: Information Systems, Organisational Studies, Science and Technology Studies

Research Approach

Analysis of on-going deployments of patient-centred technologies. Investigate how technological, economic, and organizational structures impact the process of introducing patient-oriented ICTs.

• Ongoing shift in care services from being provider-centred to being patient-centred. The shift is triggered by concerns about aging, increase of patients with chronic conditions, rising costs and citizens’ pressure for higher quality services.

• Patient-centred approach:

– Patients are involved in self-health management activities

– Patients have facilitated access to relevant and trusted information and to their own health information and medical records

– Patient-doctor communication practices are facilitated

– Patients experience continuity of care

• Information and Communication Technologies are considered key for this shift.

From provider- to patient- centred care

patient

Stimulus for this Research and Aim Novel web-based and mobile technologies offer opportunities for

reconfiguring healthcare towards more patient-centric services.

However research in IS has shown that: It requires more than technical and organisational innovation to shift to

patient-centred care - it is a complex reconfiguration process New artifacts and organisational arrangements are introduced into an

already filled space – an evolving infrastructure Technology contributes to the emergence of new unforeseen social

phenomena

We aim to put together existing research findings, theories and

conceptual frameworks with new empirical facts and new insights.

New insight to be made available to researchers and practitioners in the form of principles or guidelines (theoretical – methodological contribution).

Relevant previous Research

• Information infrastructures literature: – attention to existing investments, existing structures, existing resources – heterogeneity (disparate components) and complexity

• Innovation literature

– path dependency, inertia – confrontations and frictions

• Critical IS literature

– shaping processes – users role matters

The projects we follow

– Commonality • Ongoing projects involving patient-oriented ICTs

– Variety • Different stages, project owners, ambitions, user groups

– Longitudinal engagement with the cases • Observations (meetings, design workshops, etc.) • Interviews • Documents’ analysis

– We follow the projects as observers and not as participants. Our aim is to develop design principles or guidelines and we are not involved in the development of specific project components

Three projects that leverage the web Vision Status Owner

“National Platform”

National infrastructure for patient empowerment: access to trustful information (1st stage), secure communication and tele-health services (2nd stage). Mashup paradigm: a blend of patient and provider controlled components.

Ongoing. Launched in 2011. Functionality under development and deployed (e.g.: content available to all and login services to view deductibles, prescriptions, change GP, etc.).

Government

“My Record”

A door to the hospital to allow collaboration: tailored services to patients based on relationship with specific clinics. Secure internet communication. Hospital controlled.

Ongoing. Initiated in 2005. Functionality under development and deployed (e.g.: arrange appointments, report health data, access documents)

Hospital clinics

“My Health Passport”

An easy to use solution for network storage and web-sharing tailored to healthcare. A tool to improve patient – doctor communication. Patient controlled.

Ongoing. Initiated in 2012. Pilot to start before end of 2013.

Private initiative

Three hospital transforming projects Vision Status Owner

General Hospital

Consolidate systems, ensure a holistic view of patient information.

Ongoing. Initiated in 2009. Changes in internal infrastructure continuously deployed, significant changes planned for 2014. Healthcare personnel as users.

Hospital

Rehabilitation Hospital

Improve the interface between the clinical side of care and patients by introducing novel patient-provider multimedia communication channels (i.e. including text, video, etc.).

Ongoing. Initiated in 2008. New organisational structure in place to deal with the new patient relation (telemedicine outpatient clinic)

Hospital

Remedial Care Hospital

Introduce ICT tools to support a new healthcare institutional role that stands between general hospitals and municipal care. Ensure continuity of care and smooth patient handover.

Ongoing. Initiated in 2012. Multiple technological options need to be evaluated (e.g. separate, integrated, shared records)

Hospital

Example 1: the challenge of defining a charging mechanism for e-consultation

• What types of medical consultation can be made available? • How much to charge? Shall it be charged exactly as a physical presence

consultation? • What will be the definition of start and end for consultations performed via

asynchronous communication (sequence of messages)? • How can it be ensured that patients will be aware of charges beforehand? • How the charged amounts will be collected (e-invoices, e-payments, regular

payments, etc.)?

Example 2: the challenge of adaptation to hospital context • Appointment booking

– Simple functionality to avoid phone queuing – Triggered by a ’real problem’ – Patients can request a change of appointment – Minimum information required, does not require log in

• Adoption process by various outpatient clinics exposed various

challenges: – Diversity: somatic vs psychiatric patients

• Phone calls have a specific purpose – Occasion for educating and disciplining patients

• Synchronous information exchange • Not fully structured communication

– Even this simple function has to be adapted to the needs of different processes.

Example 3: the challenge of dealing with the legal framework

• Norwegian regulatory framework for managing ”health information” and personal data.

• The design process of MHP exposed various challenges:

– What is the most appropriate law interpretation? – How can the patient be ”in control” of his own health information? – How can the patient share health information with health personnel?

Various challenges - not only technical

Project Opportunities Challenges

“National Platform” Simplify patient-health system interaction Novel economic models required

“My Record” Extend patient-hospital collaboration Adaptation of tools to hospital processes

“My Health Passport” Enrich patient-doctor communication Legal constraints to shape the solution

General Hospital Develop a holistic, seamless patient view Semantics taken into account when connecting and reconciling different data

Rehabilitation Hospital

Improve the interface between the clinical side of care and recurring patients

Organisational unit to be established for hosting new types of service offered

Remedial Care Hospital

Improve continuity of care and smooth patient handover

Define architecture to distribute, manage and interconnect data

Next steps

Analysing

Relevant literature review

Empirical case data collection and analysis

Conceptualising

Conceptual development

Concept operationalisation

Reporting- Disseminating

Reporting and dissemination

Key outputs Journals Workshops Conferences

Oct 13 Jan 14 Jun 14 Jan 15 Jun 15 Dec 15

THANK YOU