Medical Data, Information Economy and Federative Networks: The Concepts Underlying The Comprehensive Electronic Clinical Record Framework.
Goal: This book has the aim to present some fundamental pillars that must be taken into account for the design and the construction of a medical record system. The work does not claim to be exhaustive, as the spirit of the book is to propose to reason out on some issues that have to be considered as the main features to take in consideration in the design and deployment of medical record systems, trying to bring positive issues to the general discussion.
The first challenge has been to face the issues proposed in a co-productive way, in which the point of views of different actors (technicians, doctors, policy makers) are harmonized in shared visions, where the requirements that must be posed and considered become opportunities and challenges to overcame, also offering different shared solutions based on technology, organizational changes, medical actions and workflow in a unitary way; in which actors must be empowered to be participants and to negotiate their contributions in the process of construction of shared visions of socio-technical systems of care, without the division into experts and clients.
Considering positive all the efforts done so far, in this book we assert that medical record issue is a complex living object - not only a collection of information, but rather a complex systems for managing the clinical knowledge - and its design, construction and deployment must be faced considering different aspect of the problem in a co-productive fashion
It is composed by four parts.
Starting from a brief review of the state of the art of the medical record systems’ exploitation in which are emerged lights and shadows, including the expectation of Central Governments that have promoted and started national programs, in section two are presented the requirements posed by the actors of the health context: the doctors, the patients, the researchers analyzing how is produced clinical information, and the mechanisms that transform information into clinical knowledge. In the patient-doctor-researcher relationships must be considered the human perspective of the information collection because the patient-centered gathering of medical information must be done for human aims, for which the term “patient-centered”, often used, must be considered not only by a technical perspective but first of all by considering the human point of views.
In Section Three the complex living object medical record is placed in an information ecosystem.
Health job is a collaborative work, different agencies, institutions and organizations are engaged at different level and the patient is involved in the process of care.
Clinical information produced in this ecosystem fosters collaboration among users and can be intentional or accidental, because it is based on the meaning of the information created: social collaboration among health actors is based on voluntary traditional clinical information sharing, but there are a great amount of medical information produced for some scopes that can be reused, revealing hidden connection among data that promotes accidental collaboration, unthinkable in the past.
These information live and are nurtured in the information spaces, in which clinical information value chain is composed through voluntary acts of “publication, brokerage and delivery” of clinical information, necessary for making available medical records and for creating a virtual community of actors, making effective and real the collaboration among the individuals interested in the healthcare context, therein included the patient.
At last but in strict relationships with the previous ones, the technological point of view is presented in the Section Four.
These opportunities and challenges, unthinkable some years ago, are made possible by the new development of technology, that allows pervasive computing, shared information and distributed knowledge, collaborative tools, sophisticated and complex algorithms for information analysis across agencies, institutions and nations, making effective the creation of virtual communities of actors engaged in the treatment of clinical information for the individuals comprising the patient, subject of care.