This post is a summary of a presentation given a while back at the Openness and Future of Health Care Information Systems seminar at Aalto University Business School. The seminar was part of a series of events on the openness theme, giving the opportunity to discuss both the openness and ownership of health care data. It also allowed us to explore the drastic changes that will happen in the health care sector in the near future.
Other speakers and panelists were Karri Vainio from Kuntaliitto, VIlle Oksanen from Aalto University and co-founder of EFFI, and Sami Laine from Aalto University. Vainio discussed the challenges and solutions on the current health care system and the planned next steps in reorganizing health care and IT on a national level. Oksanen introduced the current status the data protection reform and medical privacy. Laine elaborated further on different levels of openness of health care data.
My own presentation, titled "Moving towards modern health care - Case Espoo" (view on Slideshare) explored two key points
- how should managing and purchasing IT change so that we could respond to the future challenges
- what practical problems are we facing as we try to make the change happen in the municipal (or any complex) organization, using Espoo as an example.
What's going on?
There are huge changes and leaps right now in health care: everything from affordable DNA analysis to individualized treatments to quantified self movement. However, there are also trends in demographics that most likely will affect the health care system much earlier than the flashy new technologies.
The trends that most affect an average Finnish city and most of the industrialized world are the rise of the elderly population and the polarization between haves and have-nots. Responding to these challenges does not necessarily require new technology but a new mindset. We are exploring new ways to organize care for the elderly and to support living at home and and we need to actively switch our focus to preventive care to keep the gap from widening.
These new challenges get to a whole new level of difficulty when we take a look at the current systems and contracts in the public sector. Many Finnish municipalities - Espoo being no exception - are still heavily tied to single vendor in most important IT systems. This means that changes are expensive, getting access to data through interfaces is difficult and costly and integrating systems from other vendors is sometimes nearly impossible. This is not a technical but a contract issue and it must be resolved with renegotiating contracts and developing competence in buying, contracts and managing the process.
However, there are many projects underway, some already completed and while many of the solutions are not perfect, they are still steps in the right direction. ePrescription, Kanta and many others will help in getting different parts of health care organization to communicate with each other. The Espoo pilot of the National Service Bus project was recently succesfully completed, and if the National Service Bus, Apotti and other ambitious projects are done right, we are on the right track. There are still huge risks involved, however.
We cannot fully see what lays ahead. This means that we need to adapt the system to be flexible, trustworthy and easy to update. This goes for the actual processes as much as IT.
Open data has been a hot topic for quite some time. The capital region has started to dip toes in the water with such success that it has already been internationally noted. Openness in health care is a slightly more complex topic since the regulations about data privacy are extremely strict, and for a reason. However, there is data that is possible to open: data such as the reservation queues, facility usage, anonymised statistics and the like.
Openness in health care cannot be mentioned without own data, a related hot topic: while this would not be data that would be released, giving user the control of their data and sharing it would be an important step in both improving communication between organizations and giving people better view on their own health records.
For IT, this means the emerging of the modular model. This means proper interfaces, the ability to move data (on agreed permissions) and eventually for the patient to gain more control of their own data. Plugging in new services should be easy and the systems should not prevent developing new ways of working. (As an IT professional, saying this hurts a little bit, but sometimes the best way to prototype new ways of working is on paper.)
Agile is but one piece of a puzzle and a word that is often misused. The key should be in being able to define and sharpen what is needed during the development process, but not without a clear target. One example where too strictly set requirements may become a burden is the new hospital that is being built in Espoo: will the systems be outdated already at launch, if they are defined years before they will actually be used?
Changing the untangibles
When developing new software, agile methods help steering the end result to the right direction: however, we need similar agility in everyday processes throughout the city.
All of this boils down to the change in thinking - both at the organizational level and as an individual. The current mode of operation needs to change, and that is the biggest challenge of all.