5th Annual Workshop on Interoperability and Smart Interactions in Healthcare (ISIH)

In May 2013 the Health Council of Canada released its third 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 reports in 2008 and 2011, this year's report still described the need for work to ensure our healthcare system evolves and will 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 and setting to collaborative care provided 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 that 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 to be 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 and assurance. Successful healthcare interoperability will be dependent upon our ability to connect and assure people, processes, data, policies and procedures, as well as the need to connect outcomes to system objectives through performance management. Mobile healthcare has the potential to dramatically extend the reach and impact of interoperability and smart interactions on healthcare outcomes.

In our previous four workshops on Interoperability and Smart Interactions in Healthcare (ISIH) we emphasized that the fundamental challenges facing interoperability are not technical but rather process, people and evaluation issues. It is important that we do not define interoperability as the ends but rather as a means for assuring core health system objectives such as efficient, effective, and safe 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 to go beyond how healthcare delivery is currently provided.

Healthcare is a complex, dynamic and exception laden ecosystem. Smart interactions and interoperable technologies provide us the tools to support the dynamic nature of healthcare delivery to enable us to assure quality of care. For example, the management of diabetes requires medical registries to track patients over time and to communicate guidelines for ongoing clinical management. In that context, human factors research, cloud computing, consumer health services, and the ongoing evaluation and adoption of standards, technology and processes are all relevant.

Meaningful interoperability can also enable performance management solutions to ensure we provide timely, efficient patient centered care delivery. However, the development of technologies to support meaningful interoperability faces significant challenges such as obtaining consistent, timely, quality data in a secure manner 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 by burdening healthcare providers with administrative and information overload that falls short of delivering real benefits. To facilitate meaningful interoperability we need to first understand the underlying complexity of healthcare interoperability by developing models and frameworks that enable us to effectively leverage Mobile Health, consumer health apps, and other Smart technologies to support healthcare delivery.

This year's workshop was presented and coordinated by a select group of health informatics and software engineering researchers, and practitioners from across Canada and will build upon our previous four workshops with the theme of going beyond individual applications towards a "systems of systems" perspective that considers technology as well as human factors and organizational structures. Our workshop will emphasize the need to develop healthcare approaches to assure safety, interoperability and quality of care at the level of the integrated socio-technical health care ecosystem.

The previous four ISIH workshops were well attended by a mix of health care administrators, practitioners, representatives from standards body's initiatives, as well as academic researchers and industry partners. This year workshop focused on developing an agenda for researching meaningful ways to assure safety and interoperability in socio-technical health ecosystems and included case studies and anecdotes to illustrate the issues and potential solutions as a starting point for brainstorming and research initiatives that will lead to a systematic approach to the issues.

The following questions will be posed:

The workshop opened with short presentations from the panel members who provided background and outlined their basic position but 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 and issues in response to questions from the audience. The closing part 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 an information technology focused healthcare ecosystem and how we can leverage human factors research, cloud computing, health consumer informatics, safety engineering and the ongoing evaluation and adoption of standards, technology and processes to assure smarter interactions between health care providers and health care consumers (the patients). The workshop concluded with a summation of interoperability and assurance issues in health care and a chance to form collaborative partnerships with the workshop participants. In particular, we hope that one of the outcomes of this workshop will be to create a call for papers for a special journal issue on interoperability, assurance and smart interactions in socio-technical healthcare ecosystems.