Boundaries and e-health implementation in health and social care

Abstract

BackgroundThe major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost.MethodsTo explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA) in Scotland, using three retrospective, qualitative case studies in three different health board locations.ResultsProgress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs’ understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals.ConclusionsTo provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make integration possible, long-standing boundaries constitute substantial risks to IT implementations across the health and social care interface which those initiating major changes would do well to consider before committing to the investment.

Understanding value in health data ecosystems: A review of current evidence and ways forward

“…Data can be shared among people who use the service and the agencies and the professionals who deliver the service (King et al 2012). …”

“…As emphasised by an interviewee for this review: 'This is becoming a cross --sectoral --up and sustainability. For example, in a healthcare paradigm that puts the patient at the centre, health and social care systems would need to complement each other's competencies and avoid inefficiencies in collaboration, including potentially through more integrated models (King et al 2012). One interviewee stressed that 'health and social care data need to be treated in the same way, in terms both of the constraints put on them and the sharing' (INT12).…”

“…One interviewee stressed that 'health and social care data need to be treated in the same way, in terms both of the constraints put on them and the sharing' (INT12). In the context of data--driven sectors, this would imply a need to overcome structural, cultural and historical boundaries to collaborative working and data sharing, and incompatible IT systems and infrastructure (King et al 2012). …”

eHealth Advances in Support of People with Complex Care Needs: Case Examples from Canada, Scotland and the US

“…eHealth technologies can help to enable personcentred care and support by allowing information to be shared between providers and users of services across care systems (King et al 2012;Winkelman and Choo 2003). The information to be collected could include person-centred data collected through mobile apps and telemonitoring devices; however, most integration efforts in the three cases focus mainly on interoperability between healthcare EMR systems.…”

O impacto da exclusão digital na utilização potencial de um mercado eletrónico de serviços de cuidados de saúde e serviços sociais

“…No entanto, os governos estão a mudar sua abordagem à responsabilidade social e começam a abrir o setor dos serviços de cuidados de saúde e assistência social à iniciativa privada. Em toda a Europa se encontram casos documentados de iniciativas privadas em substituição do setor público na saúde e na assistência social (Blomgren & Sundén, 2008;King et al, 2012;Mandiberg & Warner, 2012;Plomp, 2008;Stolt, Blomqvist & Winblad, 2011).…”