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Information Systems Frontiers
Erschienen in: Information Systems Frontiers 1/2012

01.03.2012

Ski hill injuries and ghost charts: Socio-technical issues in achieving e-Health interoperability across jurisdictions

verfasst von: Ellen Balka, Sandra Whitehouse, Shannon T. Coates, Dug Andrusiek

Erschienen in: Information Systems Frontiers | Ausgabe 1/2012

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Abstract

This paper looks at the challenges associated with consolidating and leveraging patient information recorded at various points in a distributed, multi-jurisdictional health care system. We draw on insights from two ethnographic case studies to illuminate varied issues related to interoperability of information management systems. Our first case study is an investigation of duplicate medical charts which exist in several ambulatory care clinics located on the same campus at an acute care hospital. The second case study is an ongoing exploratory project intended to develop an understanding of information collection, storage and handover procedures in the pre-hospital care chain, a health care domain that includes varied actors and organizations with different information needs. Whereas findings from our case studies show that achievement of interoperability will be difficult, our analysis suggests ways to begin to overcome these challenges.
Vorheriger Artikel Autonomous mapping of HL7 RIM and relational database schema
Nächster Artikel Authorization in cross-border eHealth systems

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Fußnoten
1
Health indicators measure something that cannot directly be measured. They are “variables linked to the variable (studied), which itself cannot be directly observed” (Chevalier et al 1992, p.47). In an era of increased accountability, indicators—which result from performing mathematical operations on data (Moed et al. 2004)—are increasingly used to evaluate a range of issues, such as whether or not health interventions are resulting in desired outcomes.
 
2
Canada Health Infoway, “a not-for-profit organization that collaborates with the provinces and territories, health care providers and technology solution providers to accelerate the use of electronic health records (EHRs) in Canada” (Canada Health Infoway 2010, n.p.), significantly reduced the scope of its vision for electronic health records in recent years, moving from an early vision of a complete and seamless record of care to something more akin to an encounter record in recent years, as it became apparent that the initial vision could not be achieved in the short-term.
 
3
See Suchman’s Plans and Situated Actions (1987) for an in depth elaboration of this perspective, and Star and Ruhleder (1996).
 
4
Additionally, we have built relationships which will allow us to explore issues and challenges associated with handovers in care across a patient’s entire trajectory from point of injury through to point of definitive care, which will allow us to pursue another series of cases for comparisons (handovers across providers).
 
5
We have omitted identification of the units here in order to protect the identity of the facility and staff who made our study possible.
 
6
The PI conducted observation in all settings. A post-doctoral fellow with training in both qualitative methods and as a health professional conducted observation in both clinics, where junior members of the research team (a senior undergraduate and a doctoral student) also conducted some observations as part of their training, under the supervision of the PI and in collaboration with the post-doctoral fellow.
 
7
Information about patient sub-populations was verified with clinic medical and administrative staff. We used the clinics’ daily rosters as a starting point in our random selection in order to minimize the workload for staff responsible for pulling charts, and to reduce costs associated with pulling charts.
 
8
Our review of all paper based forms yielded inconsistencies across forms in how key fields such as names and dates were captured from form to form. Inconsistencies were identified, and changes have been made in an effort to standardize the format in which this information is captured across in house forms. Ironically, since the form which must be completed by all ski patrollers attending an injury is an industry form (and not an in-house form), no changes have yet been made to that form, which will require the cooperation of an industry association.
 
9
Interestingly, the reverse is true as well - in discussions concerned with the social benefits of electronic patient record systems, technical structures and features of those structures (like interoperability) are more often than not implicitly addressed as part of the landscape, and are assumed to work. Work concerned with social aspects of technical infrastructures (e.g., Star and Ruhleder (1996) and Bowker and Star (1999) as well as much of the work undertaken by scholars concerned with computer supported cooperative work points to a more complicated relationship between underlying computer infrastructures, their users, and the tasks such infrastructures seek to support.
 
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Metadaten
Titel
Ski hill injuries and ghost charts: Socio-technical issues in achieving e-Health interoperability across jurisdictions
verfasst von
Ellen Balka
Sandra Whitehouse
Shannon T. Coates
Dug Andrusiek
Publikationsdatum
01.03.2012
Verlag
Springer US
Erschienen in
Information Systems Frontiers / Ausgabe 1/2012
Print ISSN: 1387-3326
Elektronische ISSN: 1572-9419
DOI
https://doi.org/10.1007/s10796-011-9302-4

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