Christian Bourret

Data concerns and challenges in health: networks, information systems and electronic records

Since the beginning of the 1980s most industrialized countries have had to cope with the problem of managing the costs of their Health care systems and particularly the costs of hospitalization. The development of information technologies accelerated by the Internet have led to responses that depend greatly on the better management of information. Health care is entering the Information Society: the rise of networks is a key aspect of our Knowledge and Information Society. With information and services developments that allow for greater involvement of the patient, Health data and more particularly medical data represent a very important economic and social concern. This paper analyzes the rise of networks within the Health field from the French experience in Healthcare Networks and compares it with that of the United States, Canada, the United Kingdom and Spain. Then we outline the special properties of Health data: its personal, sensitive and confidential nature as well as how it needs to conform to particular legislation. Finally we study the use of these data, the essential role of Information and Communication Systems with its key element, the patients Electronic Health Record, in promoting new practices based on information sharing and the quality of data. This marks the beginning of huge changes.

DATA FOR DECISION MAKING IN NETWORKED HEALTH

In developed countries, nowadays we live in a networked society: a society of information, knowledge and services (Castells, 1996), with strong specificities in the Health field (Bourret, 2003, Silber, 2003). The World Health Organization (WHO) has outlined the importance of information for improving health for all. However, financial resources remain limited. Health costs represent 11% of GNP in France, Germany, Switzerland and Canada, 14% in the USA, and 7.5% in Spain and the United Kingdom. Governments, local powers, health or insurance organizations therefore face difficult choices in terms of opportunities and priorities, and for that they need specific and valuable data. Firstly, this paper provide a comprehensive overview of our networked society and the appointment of ICT (Information and Communication Technologies) and Health (in other words e-Health) in a perspective of needs and uses at the micro, meso, and macro levels. We point out the main challenges of development of Nationwide Health Information Network both in the US, UK and France. Then we analyze the main issues about data for Decision Making in Networked Health: coordination and evaluation. In the last sections, we use an Information System perspective to investigate the three interoperability layers (micro, meso and macro). We analyze the requirements and challenges to design an interoperability global architecture which supports different kinds of interactions; then we focus on the harmonization efforts provided at several levels. Finally, we identify common methodological and engineering issues.

New Socio-technical Devices to Improve Coordination in Healthcare in France

In the specific context of the Healthcare coordination between medical, socio medical and social organizations of the ambulatory field in France, we propose to examine some tracks with the perspective offered by new ways of sharing information. First we explain our researchers’ position and the methodology used. Then after reviewing different models of coordination entities, we intend to clarify the role played by such organizations acting as interface between hospitals and ambulatory services. We will then address the issue of Information and Communication Technologies (ICT) that contribute to support and improve the healthcare coordination. Through the evolution observed with the convergence between organizational models of coordination and technological devices, we will try to highlight the way of producing and sharing information on healthcare platforms for care coordination. As an illustration of the value created by the new socio-technical devices, we will have a glimpse at the current innovative trend in healthcare coordination in France.

AIDS Crisis as a Shock to Overpass the Frontiers within the French Healthcare System: the Case of Healthcare Networks

The AIDS epidemic implied a new approach in the French Healthcare System and has impulsed cooperation in Frontier areas between primary care and hospital. To vary views on the question, in an Information and Communication interdisciplinary prospect, our analysis is based on the articulation of issues in meaning, relationship, knowledge and action according to the view of F. Bernard (2006) supplemented by that of identity and power. From a methodological point of view, we use an analytical framework showing through past and present stories of actors, their positions and roles, their stakes and values, such as the quality of their relationships in a specific context (Situational and Interactionist Semiotics, A. Mucchielli, 2010). We will study the situation of two categories of stakeholders: patients and general practitioners in primary care, particularly through the emergence of a new organizational interface: the Healthcare Networks. Then, we will analyze the limitations of this solution. KeywordsHealthcare; Networks; Frontiers; AIDS; Situations; Meaning