Building an inter-organizational communication network and challenges for preserving interoperability

Healthcare Governance, Institute of Health Policy and Management, Erasmus University Medical Center, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
International Journal of Medical Informatics (Impact Factor: 2). 07/2008; 77(12):818-27. DOI: 10.1016/j.ijmedinf.2008.05.001
Source: PubMed


The ideal scenario for information technology to bridge information gaps between primary and secondary healthcare and to improve the quality of healthcare in the medication process is to build an interoperable communication network. This type of undertaking requires diverse information systems to be integrated, and central to this are the preservation of data integrity and the integration of different pieces of patient data. OBJECTIVES AND METHODOLOGY: In this study, we focused on sources of challenges to the integration process and to the building of an interoperable communication network. Interviews, document analysis, and observations were conducted to evaluate the integration process in a project that involved medication data communication between primary healthcare providers (i.e., general practitioners and community pharmacists) and secondary healthcare providers (i.e., hospital pharmacists and specialist physicians).
The project encountered numerous integration problems, many of which persisted even after extensive technical intervention. An analysis of the problems revealed that they were mostly rooted either in problematic integration of work processes or in the way the system was used. Despite the project's ideal technical condition, the integration could be accomplished only by applying human interfaces.
The main challenge to building interoperable communication network does not lie in technical integration. The real problem occurs when the technical linkage is implemented without the work processes being aligned and integrated.

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    • "However, many healthcare professionals remain reluctant to embed these tools in their medical practices (e.g. Pirnejad et al., 2008; Protti et al., 2007). Much of their work must be carried out quickly, and is completed away from their offices, so the need to frequently interact with technology, especially fixed workstations, can be resisted. "
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    ABSTRACT: This study formulates and empirically tests a theoretical model involving factors in the use of mobile devices for knowledge sharing in hospitals. The research model is derived from two important studies, Kankanhalli et al.'s (2005a, 2005b) studies on electronic knowledge repositories, and is adapted to the healthcare context. We conduct an exploratory case study of three mobile devices in two units of a hospital. The preliminary results reveal that factors such as image, privacy, reciprocity, quality of output, resource availability and portability influence the use of these devices for knowledge sharing.
    Proceedings of the Nineteenth Americas Conference o n Information Systems, Chicago, Illinois; 08/2013
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    • "Importantly, though, our qualitative study revealed that they could be indirectly significant by delaying the implementation process, thereby increasing the length of the development period, which is the main cost driver. Even when implemented, such systems remain a work in progress and may not provide the improvement in care desired [39,40]. Because the task of system development is usually contracted out to computer programmers and software developers, this reduces the autonomy that project leaders have over the timeline, the computer-based programme, and, consequently, the costs. "
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    ABSTRACT: Disease management programmes are increasingly used to improve the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. To increase our understanding of the choices that primary healthcare practices face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight cardiovascular disease management programmes initiated and managed by healthcare practices in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of cardiovascular disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Developing and implementing cardiovascular disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they also become more expensive. Better preparedness and training can prevent unnecessary delays during the implementation period and are crucial to reducing costs.
    International journal of integrated care 08/2013; 13(July–September):e028. · 1.50 Impact Factor
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    • "Yet computer-based health systems in general are still a work in progress for the technological developers and for the end-users [30]. Implementing computer-based systems is a major undertaking for health care organizations, needing support, organizational, cultural, and technical changes [31]; even when implemented, the computer-based system may not provide the improvement in care desired, but may increase mistakes in medical record documentation, medication dosing, and may, in fact, be more difficult for clinicians to use [32]. Developing and using computer-based systems to travel the program to and between health care providers, project leaders, and patients is not a simple task but is a ‘mutual shaping’ of expectations and goals [33]. "
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    ABSTRACT: Disease management programs, especially those based on the Chronic Care Model (CCM), are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of five disease management programs in the primary care setting, based on interviews with project leadership teams. Eleven semi-structured interviews were conducted at the five selected sites with sixteen professionals interviewed; all project directors and managers were interviewed. The interviews focused on each project's chosen chronic illness (diabetes, eating disorders, COPD, multi-morbidity, CVRM) and project plan, barriers to development and implementation, the project leaders' action and reactions, as well as their roles and responsibilities, and disease management strategies. Analysis was inductive and interpretive, based on the content of the interviews. After analysis, the results of this research on disease management programs and the Chronic Care Model are viewed from a traveling technology framework. This analysis uncovered four themes that can be mapped to disease management and the Chronic Care Model: (1) changing the health care system, (2) patient-centered care, (3) technological systems and barriers, and (4) integrating projects into the larger system. Project leaders discussed the paths, both direct and indirect, for transforming the health care system to one that addresses chronic illness. Patient-centered care was highlighted as needed and a paradigm shift for many. Challenges with technological systems were pervasive. Project leaders managed the expenses of a traveling technology, including the social, financial, and administration involved. At the sites, project leaders served as travel guides, assisting and overseeing the programs as they traveled from the global plans to local actions. Project leaders, while hypothetically in control of the programs, in fact shared control of the traveling of the programs with patients, clinicians, and outside consultants. From this work, we can learn what roadblocks and expenses occur while a technology travels, from a project leader's point of view.
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