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This month’s edition of Healthcare Review – OnlineTM is the sixth and final in a series focussing on integrated care. This edition considers the role of information management and information technology (IM/IT) in integrated care.
It has been argued that sharing information and co-ordinating services is critical to the successful integration of health care services. Information technology and information management promise to streamline and co-ordinate the activities of service providers along the continuum of care. However, historically the development of technological solutions has often created incompatible management and control systems. Integrated care is making revolutionary demands on information systems, particularly with respect to ‘connectivity’ between systems. Our contributors this month each take a different stance in reviewing those demands and some of the solutions to them.
Stuart Francis and Rod Hart, Heath Care Consulting, Ernst and Young, highlight the principles and elements necessary for fully integrating health delivery within an organisation, in order to highlight the role of information technology in the integration endeavour.
Developments in advanced care management enhance demands for sophisticated information. Information management solutions are required to support the core elements of such a continuum of care model.
Francis and Hart describe emerging technologies for integrated delivery systems and managed care organisations. These include technologies which support providers, for example computer based records and health information networks, and data communication technologies such as the Internet and electronic ID cards. They also review technologies which help to increase operational efficiencies, for example data warehousing, document imaging and triage systems, and technological solutions to management of demand for health services, for example multimedia technologies for patient education. In addition Francis and Hart point to the role of technology in enhancing effectiveness of care delivery.
Francis and Hart emphasise the need for health care organisations to continue to develop increasingly collaborative approaches to improving patient care while improving resource effectiveness. Information management provides a variety of solutions to the continuous challenge of improving care management in an integrated delivery system.
The paper concludes with an outline of some recent information system developments in the New Zealand health sector . These largely relate to the move from fragmented health sector information management to greater collaboration, which has been supported by the 1997 Health Information Initiatives Programme from the Ministry of Health.
Mike Rillstone, Information Management Planner at the Health Funding Authority and Senior Lecturer in Health Information at the University of Auckland Medical School, also focuses on the role of IM/IT in supporting integrated care. Rillstone expands on the concept of a role for technology in enhancing effectiveness of care delivery which was introduced by Francis and Hart. He highlights new IM/IT priorities which relate to support for clinical decision-making rather that the automation of administrative and operational areas which were previously emphasised.
In Rillstone’s view, the systems approach of integrated care represents a significant challenge for IM/IT, demanding that IM/IT provide a more sophisticated set of enabling capabilities to meet the goals of an integrated care system. Fundamental requirements include support for collection of a broad array of patient focussed data components (clinical, patient and financial), a sound basis for data analysis, and timely and cost-effective dissemination of appropriate information to allow "information empowered behaviour".
Rillstone emphasises the need for providers to agree on common basic principles for information management, for example with respect to systems architecture, coding systems, data sets, privacy and security standards etc., and reviews each of these requirements.
A contribution from Peter Schloeffel, Managing Director Trident Health, Australia, focuses on the clinical information management requirements of integrated care.
He highlights the requirement in integrated care for provision of comprehensive, reliable, relevant, accessible and timely patient information to all members of the health care team. These needs demand the use of a standardised electronic health record (EHR) and ‘connected’ computerised systems that enable sharing and exchange of patient information. The requirement for shareability and exchangeability of patient information in turn demand standardisation of EHR architecture, the framework or structure of the EHR itself versus the format of the data within it. The Good Electronic (previously European) Health record (GEHR) is currently the basis for the European Standards Committee (CEN) pre-standard for Electronic Healthcare Record Architecture.
Schloffel also addresses issues related to data security in EHR systems and to distribution of EHRs. He views the Internet, with appropriate security safeguards, as the obvious communications network to provide widespread accessibility to patient information.
Finally, Schloffel presents examples of integrated care information management and information technology implementations including the Paradigm IPA and the Australian Co-ordinated Care Trials.
In November we will review the Foresight Project in health. The Foresight Project is an initiative led by MoRST, which aims to encourage an ongoing process of strategic thinking across diverse sectors, groups and communities within New Zealand, with respect to research, science and technology needs. The process is intended to guide the development of a new set of priorities for the Government’s investment in research, science and technology.
