3^rd Annual Workshop on Interoperability and Smart Interactions in Healthcare (ISIH)

In May 2011 the Health Council of Canada released its second report on the state of healthcare renewal in Canada. Although the report identified that significant progress had been made in several areas since the previous report in 2008, the 2011 report still described the need for more work to ensure that our healthcare system will evolve and be sustainable for the years to come. One particular challenge is the need to integrate services over an expanding continuum of providers, services and illnesses. Healthcare delivery is becoming increasingly complex as it shifts from care provided by a single provider or setting and towards a collaborative care supplied by multiple providers across multiple settings. For example, patients with chronic illness frequently move between inpatient and outpatient settings and require collaboration by physicians, nurses, therapists, pharmacists and other healthcare professionals who act as an integrated network across hospital and community settings. Another highlighted challenge was the need for performance measurement of healthcare delivery by establishing meaningful targets and measurable goals to enable healthcare delivery is driven by good management practices.

In light of the above challenges to healthcare delivery, it can be argued that the fundamental challenge our healthcare system faces is one of connectivity. Successful healthcare interoperability will be dependent upon our ability to connect people, processes, data, policies and procedures, as well as the need to connect outcomes to system objectives through performance management. In our previous two workshops on Interoperability and Smart Interactions in Healthcare (ISIH) we emphasized that the fundamental challenges facing interoperability are not technical but are rather process, people or evaluation issues. It is important that we do not define interoperability as the ends but rather as a means for achieving core health system objectives such as efficient, effective and timely delivery of patient centered healthcare. Subsequently we should not evaluate interoperability efforts solely by our ability to connect disparate computer systems but rather by our abilities to achieve health system objectives. However to effectively evaluate healthcare delivery we need to develop and implement business analytic solutions to enable timely evaluation of healthcare delivery.

As we move towards digital solutions such as electronic health records to enhance healthcare delivery, our goal should not be to simply automate existing healthcare processes such as group decision making or communication. Rather our goal should be to leverage smart interactions and technologies to enable processes that go beyond how healthcare delivery is currently provided. Healthcare is a complex, dynamic and exception laden domain. Smart interactions and mobile technologies provide us the tools to support the dynamic nature of healthcare delivery that enable us to support meaningful interoperability. For example, the management of diabetes requires medical registries to track patients over time and to communicate guidelines for ongoing clinical management. Meaningful interoperability can also enable performance management solutions to ensure we provide timely, efficient and patient-centered care delivery. However, the development of technologies to support meaningful interoperability faces significant challenges such as obtaining consistent, timely and quality data in a secure manner in order to facilitate performance-managed driven healthcare delivery. We also caution that an uncoordinated approach to the design and implementation of smart interactions and other information technology will only create barriers to accessibility and integration. It will also burden healthcare providers with administration and information overload that falls short of delivering real benefits.

To facilitate meaningful interoperability we needed to first understand the underlying complexity of healthcare interoperability by developing models and frameworks that enable us to effectively leverage Web 2.0 tools and other Smart technologies to support healthcare delivery. This workshop was presented and coordinated by a select group of health informatics and software engineering researchers, and practitioners from across Canada and built upon our previous two workshops with the theme of going beyond basic healthcare interoperability. Our workshop emphasized the need to develop healthcare interoperability solutions using an interdisciplinary perspective. ISIH workshops have been well attended by a mix of health care administrators, practitioners and representatives from standards body's initiatives, as well as academic researchers and industry partners. The workshop focused on developing an agenda for meaningful interoperability.

The following questions were posed: How can business analytics and care flow process modeling be effectively combined to improve health care delivery (i.e. achieve smart interactions)? What are the current interoperability barriers that need to be overcome in order to achieve meaningful interoperability using smart interactions?

The focus was on presenting case studies and anecdotes to illustrate the issues and potential solutions as a starting point for brainstorming as well as research initiatives that can generalize a systematic approach to these issues. The core of the workshop focused on a panel discussion and brainstorming around the question about whether electronic health records initiatives and Health 2.0 are in conflict or consensus. Are they diametrically opposed approaches to the problem with inherently different philosophies and approaches? Or do they represent complementary approaches tackling different aspects of the same problem in which both would be required for a solution? The workshop opened with short presentations from the panel members who provided background and outlined their basic position. They also recounted actual experiences or academic results related to the questions.

The second half was devoted to an interactive discussion in which the presenters debated different aspects of the problem in response to questions from the audience. The closing portion was reserved for general brainstorming guided by the moderators into a discussion of potential next steps and an action plan for collaboration and further exchanges of ideas beyond the end of the workshop. The panel presentations discussed the promises, challenges and risks of federated electronic health record system infrastructures and how we could devise Health 2.0 technologies to provide smarter interactions between health care providers and health care consumers (the patients).

The workshop concluded with a summation of interoperability issues in health care and a chance to form collaborative partnerships between the workshop participants. The overall objective was to foster brainstorming sessions and continue the collaboration spawned at ISIH 2009 and ISIH 2010 in the areas of academic and industry efforts to adopt standards, technology and processes related to electronic health records.