Ragaban Nouran, Day Karen, Orr Martin
School of Population Health, University of Auckland, New Zealand.
Stud Health Technol Inform. 2012;178:186-91.
Policies that support strategic development and implementation are related to health ICT implementation successes. This research aimed to explore the question, 'Why have we not seen more successful ICT implementation in healthcare, and what does policy have to do with success?'
Healthcare systems are faced with rising costs, increased prevalence of chronic diseases and diminishing resources. E-health initiatives have gained acceptance in addressing these crucial health sector issues. National governments and healthcare organisations are finding it necessary to have health Information and Communications Technology (ICT) systems in place. However, poorly developed health information policies, lack of a clear business plan and ineffective leadership contribute to failure of ICT implementation in healthcare.
This study uses a Grounded Theory approach, in which a series of data gathering activities will be completed. The first author attended the Health Information Management & Systems Society (HIMSS) Policy Summit in the USA in 2011. Five Summit participants were approached individually and informally discussed the 'meaningful use' policy and how it influences ICT implementation in healthcare. Field notes were made and analysed for themes relating to the research question.
There were three overlapping concepts that all of the participants indicated as primary considerations for policymakers. The alignment aspect stresses the need to align e-health initiatives with overall health policy, ensuring that e-health is incorporated with other healthcare investments. The shared responsibility theme involves the need for e-health initiatives to be recognised as a priority along all levels of government, i.e. local, state, federal, and national. This stresses the importance of health ICT development and implementation in a joint government direction. The last theme is collaboration with stakeholders, including clear division of tasks and clarity about technical and non-technical expectations. Engaging and working with stakeholders in a collaborative and consensus-driven way can help realise common goals.
The concepts of alignment, shared responsibility and collaboration regarding e-health policy are not new; the fact that they are still being raised in discussion and addressed in recent literature indicates that they are still an issue today. An examination of policy tools to help aid in more cohesive practice can possibly help inform and influence future e-health initiatives.
E-health policy development and implementation varies due to differing health system infrastructure, funding and interests. Artefacts such as the summary of the 'meaningful use' policy could be used to leverage the effects of alignment, shared responsibility and collaboration. The next step from this research will be to examine the New Zealand National Health IT Plan's summary diagram (an artefact itself) and what role it plays in aspects of e-health policy development.
支持战略发展与实施的政策与卫生信息通信技术(ICT)实施的成功相关。本研究旨在探讨“为何我们在医疗保健领域未见到更多成功的ICT实施案例,以及政策与成功有何关联?”这一问题。
医疗保健系统面临成本上升、慢性病患病率增加以及资源减少的问题。电子健康倡议在解决这些关键的卫生部门问题方面已获得认可。各国政府和医疗保健组织发现有必要建立卫生信息和通信技术(ICT)系统。然而,不完善的卫生信息政策、缺乏明确的商业计划以及无效的领导导致医疗保健领域ICT实施的失败。
本研究采用扎根理论方法,将完成一系列数据收集活动。第一作者参加了2011年在美国举行的卫生信息管理与系统协会(HIMSS)政策峰会。与五位峰会参与者分别进行了交流,并就“有意义的使用”政策及其如何影响医疗保健领域的ICT实施进行了非正式讨论。做了实地记录并分析了与研究问题相关的主题。
所有参与者都指出有三个相互重叠的概念是政策制定者的主要考虑因素。一致性方面强调电子健康倡议需要与整体卫生政策保持一致,确保电子健康与其他医疗保健投资相结合。共同责任主题涉及电子健康倡议需要在各级政府(即地方、州、联邦和国家)被视为优先事项。这强调了在政府联合指导下卫生ICT发展与实施的重要性。最后一个主题是与利益相关者的合作,包括明确的任务分工以及技术和非技术期望的清晰性。以协作和共识驱动的方式与利益相关者参与并合作有助于实现共同目标。
关于电子健康政策的一致性、共同责任和合作的概念并不新鲜;它们仍在讨论中被提及并在近期文献中得到探讨这一事实表明它们如今仍然是个问题。研究有助于更具凝聚力实践的政策工具可能有助于为未来的电子健康倡议提供信息并产生影响。
由于卫生系统基础设施、资金和利益的不同,电子健康政策的制定和实施也各不相同。诸如“有意义的使用”政策摘要之类的人工制品可用于利用一致性、共同责任和合作的效果。本研究的下一步将是研究新西兰国家卫生信息技术计划的摘要图表(其本身也是一种人工制品)以及它在电子健康政策制定方面所起的作用。