National E-Health Transition Authority www.nehta.gov.au

Evaluating the Policy Drivers for eHealth Interoperability

Dr Andy Bond Manager Standards & Informatics NEHTA

National E-Health Transition Authority www.nehta.gov.au

The National E-Health Transition Authority (NEHTA) was established by the Australian, State, and Territory governments in 2005 to develop better ways of electronically collecting and securely exchanging health information.

Our Board of Directors consists of the CEOs of all nine Commonwealth, State, and Territory Health Departments, and two Independent Directors one of who is Chair of the Board.

About NEHTA

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National E-Health Transition Authority www.nehta.gov.au

• What is interoperability?

• Relative improvements in cost, quality, and safety of care delivery

• Dealing with complexity and change

• Empowering users to engage and contribute

• Realigning the bottlenecks of healthcare capacity, information, and workflow

• Creating a national, patient-centred, long-term policy effort to enable success

Outline

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National E-Health Transition Authority www.nehta.gov.au

What is Interoperability?

Interoperability is the continuous ability of systems to share information and/or functionality with another system based upon common standards

• a capability

• a process

• an environment

Integration is the combination of separate systems into a new system functioning as a whole

• a point-in-time solution

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Why Interoperability?

• Health is complex not just complicated

• Moments of integration are costly to scale without an interoperability underpinning

• A process leading to known alignments

• Support flexibility between current requirements, future changes, and local variation

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Components of Interoperability

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Policy, Regulation, Legislation Complex

Business Process, Behaviour Complex, Complicated

Semantics, Information Complicated

Technical, Software Complicated, Simple

National E-Health Transition Authority www.nehta.gov.au

Improving Care Delivery

• Policy and business process alignment: Complex

• Improvements relative to existing care delivery models

• Augment existing care processes?

• Modify existing care processes? • Introduce new care processes?

• Trade off safety/quality, cost, and time

• Cost of conducting the tradeoff • $1.43 of every $100 in America

goes toward hospital administration1

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1http://content.healthaffairs.org/content/33/9/1586.full

National E-Health Transition Authority www.nehta.gov.au

Complexity and Change

• Change is an emergent issue for all aspects of interoperability: Complex

• Change is self creating

• A static system is a fragile system

• Design should build in facility for evolution up front including co-existence of current and future solutions

• Learning system will change with emergent system behaviour

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http://www.genome.gov/sequencingcosts/

National E-Health Transition Authority www.nehta.gov.au

Engagement and Contribution

• Enabling the knowns and the unknowns: Chaos

• Collaboration

• Consensus

• Transparency

• Learning from alternatives and failures

• Leading by example

• Fostering motivation

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National E-Health Transition Authority www.nehta.gov.au

Impediments and Enablers

• Numerous and interdependent: Complex

• Conducive business model • Technology can grease the

wheels but is often seen as the focus of interoperability

• Sharing health information is subject to

• policy enablers, • supporting business models, • shared contexts of use, and • common information

understanding

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National E-Health Transition Authority www.nehta.gov.au

Environment for Success

• A robust solution requires multiple, independent success supports

• A “good enough” solution flourishes in a conducive environment

• Intervention for change

• ABIDE1 - Attractors, barriers, identity, dissent, environment

• Changing the barriers that imply behaviour

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1 Cynefin Framework, Dave Snowden

National E-Health Transition Authority www.nehta.gov.au

Drivers for Interoperability

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Improving  Care    Delivery

Complexity  and    Change

Engagement  and  Contribution

Impediments  and    Enablers

Environment  for    Success

Policy Align  systemic  health  funding,  business  models,  and  policy

Build  in  approaches  to  evolution  up  front

Recognise  and  reward  leaders

Enable  a  sound,  self-­‐supporting  business  model

Checks  and  balances  to  optimise  success

Behaviour Agreed  and  documented  clinical  models

Learn  from  emergent  behaviour

Behaviour  contributes  the  context  of  use

Changing  business  models  is  harder  than  changing  technologies

Attract  behaviour  change

Information Aligned  and  known  models  of  meaning

Meaning  must  span  islands  of  understanding

You  can’t  create  knowledge  outside  its  context  of  creation

Agree  on  what  not  to  agree  upon  as  well  as  the  common

Aim  for  an  ontology  of  understanding

Technical Right  information,  delivered  at  the  right  time

Abstract  from  single  technology  solution  with  independent  interface  capability

Enable  consensus  agreement  through  standards

Interoperability  can’t  be  validated  through  interface  conformance

Support  legacy,  current,  and  future  options

National E-Health Transition Authority www.nehta.gov.au13

Questions?