Governance

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Governance Health Information in a Digital Age

• Dr Anni Dugdale
• School Of Business Government
• University of Canberra

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The context shaping public sector health
information has changed

• ICT separation of information from the context
  of its collection
• Information has become a managed and transferable
  resource
• Globalisation political examination of role of
  the state
• pressure for economical use of taxes State as
  contractor
• Empowerment of citizens decline in
  state secrecy
• Growing demand for public access to government
  information

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History of health information as a managed
resource

• Modern liberal state was founded on information
  management
• Administrative information could have a double
  life
• Planning
• Policing
• Risk management
• 20thC proliferation of demand for
  information
• Welfare state systematic use of information for
  management of health social security systems
• Technology state industry in standard
  setting, registration inspection to ensure safe
  norms

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History Commonwealth Health Department

• Established 1921 gt WWI with from Rockefeller
  Foundation by organisation you can do anything
  CEW Bean
• Central dynamic information, communication
  co-ordination
• Trust in central command control 1916 crisis
  in drug supplies
• Spurred by 1919 Influenza epidemic competing
  state governments withheld information
• Availability of a trained corp of army medical
  officers accustomed to hierarchical military
  organisation
• New relationship between state medicine private
  practice

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History Commonwealth Health Department

• Vision a national chain of public health
  laboratories .. in provincial rural centres to
  provide diagnostic facilities to local doctors
  educate them in the latest techniques Cumpston
• General Practitioners were to be eyes, ears
  field collectors of a centrally directed public
  health policy
• Nationally coordinated consistent reporting of
  disease, laboratory diagnosis, research into
  causes supervision of official response
• Health Dept. must say what is to be done
  medical profession must do it

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Australian Dental Standards Laboratory

• Established 1939 to research dental materials
  metallurgy very quickly enlisted by medical
  Equipment Control Committee for the 3 defence
  forces
• Why high altitude pilots suffered dental pain?
• How could corrosion of dental materials be
  prevented in Bouganville
• Began in Dental Materials Research Laboratories,
  University of Melbourne Dental School
• initially funded by NHMRC at request of all
  states territories to
• Prepare communicate standards
• Carry out product testing, accreditation
  registration

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Reshaping Government Orientation to Information

• Private sector increase in quasi-public
  research institutes, private data online
  information services
• lobbied for policies making public sector
  information available/profitable
• Public sector realised value of its information
  resources
• For internal administration
• For other government functions
• In commercial transactions

• WWII/cold war government information as
  propaganda
• Computing advances Search link large databases
  hidden inter-relations
• Deregulation of internet tele-communication
  leading to questioning of state monopoly of
  public information dissemination

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Explosion in Health Information Management

• Eg 1. Australian Research Alliance for Children
  and Youth (ARACY) 2002 ?
• Aims to achieve a more coordinated response to
  problems affecting the health of children and
  young people in Australia
• Key national data network to make the most
  effective use of existing knowledge
• Use of unique identifiers to link individuals
  confidentially between data bases
• Eg. 2. CAPTOS (Child Adolescent Psychiatry
  Telemedicine outreach Service)
• Video conferencing connects young person in rural
  areas with specialists at Westmead Childrens
  Hospital connecting local carers to
  consultation, support training

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Explosion in Health Information Management

• Eg 3. Electronic health records smartcard
  system Health Connect
• Health Minister Tony Abbotts 1 year plan
• connectivity for access to information and
  financial transfers.
• patients can claim rebate online from doctor's
  surgery.
• private patients can access information about
  rebates gap get a consolidated bill.
• Patients can access their summary health
  record, this is provided to all health
  professionals at all points of treatment.
• Holy grail of Hospital administration Completely
  electronic patient records complete access to
  hospital systems for clinicians wherever they are

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Explosion in Health Information Management

• Eg. 4 Health informatics - Clinical decision
  support systems
• Assisting clinicians to increase frequency with
  which patients receive recommended treatments
• Health consumer decision support

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Health Connect
Dr Brian RichardsNational Director, e-Health
Implementation Department of Health and Ageing

• Store health data electronically at point of care
• Structured standardised clinical data (electronic
  clinical record)
• Digital images
• Exchange clinical data electronically
• Standardised structured messages (semantic
  interoperability)
• Automate data handling (accuracy and efficiency)
• Use broadband (high speed connections, always on)
• Build shared summary EHR over time
• By-product of clinical data entry and messaging
• Enables electronic care planning and decision
  support
• Ongoing stakeholder engagement (consumers,
  providers, industry) required

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HealthConnect

• A national change management strategy, based on
  partnerships, aimed at improving health care
  delivery in Australia
• Improves the quality and safety of health care
  decisions by improving access to relevant health
  information at the point of care

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Differences

• 21stC Health information management
• Knowledge systems disperse knowledge to enable
  local collaboration action benefiting each
  differently
• value is not dependant on your knowledges
  scarcity, but on its complementarity with others
  in your local situation
• Knowledge as naturally fragmented fluctuating
  selforganising non-algorithmic systems open to
  incompleteness, undecidability interactivity

• 20th C CSL ADSL
• Vision observant administrative state
  rationalises contains excesses of capitalism
• Top-down processor
• welfare-warfare state Gouldner
• Knowledge as a public good - distributed
  widely
• Knowledge as a positional good value scarcity

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Differences

• Information management aims to maximise return
  from investment in knowledge by reducing the
  level of uncertainty
• In economics information is whatever an agent
  needs to determine their strategy (usually market
  domination)
• Consumption quality of information does
  quality of knowledge determine quality of action
• Production investing in mediating instruments
  to allow my direct pursuit of goal, but also
  others pursuit of their goals model is the
  market
• Information costs are transaction costs
  (advertising markets existence, quality assurance
  of goods) ensure market can work by making it
  predictable law works to redistribute these
  costs internalisation of externalities
  includes Intellectual Property Law

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Some forces shaping health information management

• 2 mutually contradictory interests
• Exclusivity
  Access
• Governance dilemmas arise
• Who may/must have information for what purpose?
• Who has the right to exclusive authority over
  what happens to information they have produced?
• If information is widely disseminated it lowers
  rewards for investing in better dissemination
  tools

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Some forces shaping health information management

• For the state possession of information
  collection, storage, processing management
  central to highly personalised administrative
  decisions move away from one size fits all
  welfare
• What rights does the state have to enjoy
  commercial benefit from its data
• Democratic rights entitle citizens to
  transparency
• Fair government processes, puts a duty on
  governments to make information accessible
• As a citizen I have a social right to make
  informed decisions on matters pertaining to me
  can conflict with property rights

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Some forces shaping health information management

• Privacy considerations openness as pillars of a
  democratic society
• Australias recent privacy law trumped commerce
  with human rights limit of purpose
• With some limited exemptions for health
  recognising some equally important democratic
  purposes can be served by secondary data reuse
• Recent pressure for more intensive information
  gathering sharing to police perceived terrorist
  crisis

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Some forces shaping health information management

• Expansion reinforcement of intellectual
  property rights seems to be the order of the day
• Strengthens perception of information as property
• Move away from knowledge as basis for
  rent-seeking, or wage-seeking to profit-seeking
• Eg GPs selling their de-identified patient
  records to pharmaceutical companies