卫生和社会保健中的边界和电子健康实施。
Boundaries and e-health implementation in health and social care.
机构信息
General Practice and Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
出版信息
BMC Med Inform Decis Mak. 2012 Sep 7;12:100. doi: 10.1186/1472-6947-12-100.
BACKGROUND
The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost.
METHODS
To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA) in Scotland, using three retrospective, qualitative case studies in three different health board locations.
RESULTS
Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs' understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals.
CONCLUSIONS
To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make integration possible, long-standing boundaries constitute substantial risks to IT implementations across the health and social care interface which those initiating major changes would do well to consider before committing to the investment.
背景
当今全球卫生和社会保健系统面临的主要问题是，人口老龄化且对卫生和社会保健需求复杂，这给系统带来了日益严峻的挑战。为满足复杂需求人群提供高质量、有效协调护理的长期挑战一直是卫生保健和社会保健之间的历史分离。及时准确地获取关于患者及其治疗的信息有可能以较低的成本提供更好的护理。
方法
通过对苏格兰实施电子版单一共享评估（SSA）的实证研究，探讨结构性、专业性和地域性边界如何影响卫生和社会保健领域的电子健康实施，该研究使用了苏格兰三个不同卫生委员会地点的三个回顾性、定性案例研究。
结果
有效共享电子数据的进展缓慢且不平衡。一个原因是存在既定的结构性边界，这些边界导致竞争优先级、不兼容的 IT 系统和基础设施以及合作不佳。另一个原因是既定的专业边界的存在，这影响了员工对数据共享的理解和接受程度以及他们的信息需求。地理边界也存在，但不那么突出，对于卫生和社会保健专业人员的同地办公等问题存在不同的观点。
结论
为了向那些有复杂卫生和社会保健需求的人提供全面的护理，我们必须开发综合的护理方法。成功的整合需要采取良好的项目管理和治理措施，确保系统互操作性、领导力、良好的培训和支持，同时努力改善跨越专业边界的工作关系，并传达明确的项目愿景。本研究表明，虽然技术发展使集成成为可能，但长期存在的边界对卫生和社会保健界面的 IT 实施构成了重大风险，那些启动重大变革的人在投入之前最好考虑这些风险。
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