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eGovernment Forschung | eGovernment Research 2001 - 2017

There are recognizable ‘sources for health care services’ in Nova Scotia: the pharmacy, the family doctor office, 811 telephone health advice, the emergency department, and so on.

How well do these services “communicate” with each other?

How well are they connected so that people experience a seamless transition through them? How is the record of the patient journey through these services managed?

For each citizen, such records grow over time. In order to remain meaningful at the points of patient care, records need to be available to the health practitioner.

Traditionally, records were kept with the practitioner and used as needed. Citizens were marginalized in this information exchange and had limited access to their own health information.

The advent of the Internet and its repository of knowledge, access to computers, with innovative human-computer interfaces, were major changes in the mid-1990s. These changes had a major impact on health care. Innovations such as machines that could measure your blood pressure in hospital appeared trivial when compared with the results of your Internet search on “blood pressure.”

Early health care innovators in Nova Scotia, working in community and hospital settings, started to develop affordable, simple software that supported their practices and would offer computerized appointment booking and billing functions.

Hospital systems were more complex and less nimble in their ability to help practitioners. Data collection, data privacy, data validity had to be accounted for, within hospitals and within government, as they considered these developments from positions of responsibility for system-level changes.

In 2001, Canada Health Infoway was created to improve digital health solutions across Canada. It was set up as an independent, not-for-profit organization funded by the federal government.

Infoway offered an e-health blueprint for the provinces. There was much excitement and hope within the innovator community and governments. Everyone could “see” solutions to complex issues in health care.

Deputy ministers of health from each province sat at the planning tables of this venture. The dream of seamless electronic transfer of health information appeared within our grasp.

In 2004 EMR came to primary care. The preferred solutions in e-health were set forth in a joint effort by government, district health authorities, DoctorsNS and health practitioners. Hospitals were also being slowly transitioned toward digital systems that could connect to one another and with community services.

Meanwhile, end users of technology in Nova Scotia’s health services had made investments in e-health solutions for issues they faced in daily practice in family doctor offices as well as within hospitals.

They developed efficient systems to help manage health information and systems, developing electronic workflows that replace the painstaking work of managing information collected, such as daily collation of infection rates on each floor of the hospital, managing call schedules and managing operating room schedules.

Consider the workflow using paper charts in a doctor’s office.

The patients call by phone, large paper schedules are created and modified daily in real time, by two to three staff. Patient charts are pulled and made ready for the doctor daily. Lab and diagnostic information that arrive by mail are opened and put into file folders for the doctor to review. After the doctor’s review and sign-off they’re separated into piles for filing, piles for urgently calling in patients and piles for charts to be pulled, so the doctor could review the information with the patient chart on hand, then refiled.

Offices needed a large space to keep paper charts and multiple staff to complete these processes daily and the doctor had to keep up with this work on a daily basis.

These workflows took time, required human resources and affected patient care.

Innovators and early adopters of technology developed software that digitized these workflows. These solutions existed in small pockets. Those who believed in this vision of efficiency, and could afford the computers to do it, started to shift the system. By 2003, there were at least half a dozen systems in place and many others that simply did the scheduling and accounting functions needed in the office.

The organic development of e-health solutions from the ground up, thus met the top-down solutions developed by Canada Health Infoway and provincially co-ordinated solutions intended to organize and manage the anticipated proliferation of e-health solutions.

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Quelle/Source: The Chronicle Herald, 21.01.2017

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