Skip to main content

Advertisement

SpringerLink
Log in

Ski hill injuries and ghost charts: Socio-technical issues in achieving e-Health interoperability across jurisdictions

  • Published:
Information Systems Frontiers Aims and scope Submit manuscript

Abstract

This paper looks at the challenges associated with consolidating and leveraging patient information recorded at various points in a distributed, multi-jurisdictional health care system. We draw on insights from two ethnographic case studies to illuminate varied issues related to interoperability of information management systems. Our first case study is an investigation of duplicate medical charts which exist in several ambulatory care clinics located on the same campus at an acute care hospital. The second case study is an ongoing exploratory project intended to develop an understanding of information collection, storage and handover procedures in the pre-hospital care chain, a health care domain that includes varied actors and organizations with different information needs. Whereas findings from our case studies show that achievement of interoperability will be difficult, our analysis suggests ways to begin to overcome these challenges.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Notes

  1. Health indicators measure something that cannot directly be measured. They are “variables linked to the variable (studied), which itself cannot be directly observed” (Chevalier et al 1992, p.47). In an era of increased accountability, indicators—which result from performing mathematical operations on data (Moed et al. 2004)—are increasingly used to evaluate a range of issues, such as whether or not health interventions are resulting in desired outcomes.

  2. Canada Health Infoway, “a not-for-profit organization that collaborates with the provinces and territories, health care providers and technology solution providers to accelerate the use of electronic health records (EHRs) in Canada” (Canada Health Infoway 2010, n.p.), significantly reduced the scope of its vision for electronic health records in recent years, moving from an early vision of a complete and seamless record of care to something more akin to an encounter record in recent years, as it became apparent that the initial vision could not be achieved in the short-term.

  3. See Suchman’s Plans and Situated Actions (1987) for an in depth elaboration of this perspective, and Star and Ruhleder (1996).

  4. Additionally, we have built relationships which will allow us to explore issues and challenges associated with handovers in care across a patient’s entire trajectory from point of injury through to point of definitive care, which will allow us to pursue another series of cases for comparisons (handovers across providers).

  5. We have omitted identification of the units here in order to protect the identity of the facility and staff who made our study possible.

  6. The PI conducted observation in all settings. A post-doctoral fellow with training in both qualitative methods and as a health professional conducted observation in both clinics, where junior members of the research team (a senior undergraduate and a doctoral student) also conducted some observations as part of their training, under the supervision of the PI and in collaboration with the post-doctoral fellow.

  7. Information about patient sub-populations was verified with clinic medical and administrative staff. We used the clinics’ daily rosters as a starting point in our random selection in order to minimize the workload for staff responsible for pulling charts, and to reduce costs associated with pulling charts.

  8. Our review of all paper based forms yielded inconsistencies across forms in how key fields such as names and dates were captured from form to form. Inconsistencies were identified, and changes have been made in an effort to standardize the format in which this information is captured across in house forms. Ironically, since the form which must be completed by all ski patrollers attending an injury is an industry form (and not an in-house form), no changes have yet been made to that form, which will require the cooperation of an industry association.

  9. Interestingly, the reverse is true as well - in discussions concerned with the social benefits of electronic patient record systems, technical structures and features of those structures (like interoperability) are more often than not implicitly addressed as part of the landscape, and are assumed to work. Work concerned with social aspects of technical infrastructures (e.g., Star and Ruhleder (1996) and Bowker and Star (1999) as well as much of the work undertaken by scholars concerned with computer supported cooperative work points to a more complicated relationship between underlying computer infrastructures, their users, and the tasks such infrastructures seek to support.

References

  • Accreditation Canada. (2008a). Patient safety area 2: Communication. Accreditation Canada. http://www.accreditation-canada.ca/upload/files/pdf/ROPs%20EN%202007/PS%20ROP%20communication_info%20transfer_EN.pdf. Accessed 30 June 2010.

  • Accreditation Canada. (2008b). Patient safety area 2: Communication. Accreditation Canada. http://www.accreditation-canada.ca/upload/files/pdf/ROPs%20EN%202007/PS%20ROP%20communication_patient%20client%20education_EN.pdf Accessed 30 June 2010.

  • Alvarado, K., Lee, R., Christoffersen, E., Fram, N., Boblin, S., Poole, N., et al. (2006). Transfer of accountability: transforming shift handover to enhance patient safety. Healthcare Quarterly, 9, 75–79.

    Google Scholar 

  • Amatayakul, M. (2003). HIPAA reins in shadow charts, independent databases. The Journal of AHIMA, 74, 16A–16C.

    Google Scholar 

  • American Health Information Management Association. (2011). Frequently asked questions. American Health Information Management Association. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_017169.hcsp?dDocName=bok1_017169. Accessed 15 November 2010.

  • American Medical Informatics Association, Board of Directors. (1997). A Proposal to Improve Quality, Increase Efficiency, and Expand Access in the U.S. Health Care System. Journal of the American Medical Informatics Association, 4, 340–341.

    Google Scholar 

  • Australian Medical Association. (2006). Safe handover: Safe patients. Guidance on clinical handover for clinicians and managers Australian medical Association. www.ama.com.au/system/files/node/4064/Clinical_Handover.pdf. Accessed 30 June 2010.

  • Balka, E. (2008). Preliminary report: Clinical records and hospital charts: Implications for computerization. Burnaby: Simon Fraser University, Assessment of Technology in Context Design Lab.

    Google Scholar 

  • Balka, E., & Whitehouse, S. (2007). Whose work practice? Situating an electronic triage system within a complex system. Studies in Health Technology and Informatics, 130, 59–74.

    Google Scholar 

  • Balka, E., Wagner, I., & Jensen, C. (2005). Reconfiguring critical computing in an era of configurability. In. O.W. Bertelsen, N.O. Bouvin, P.G. Krough & Kyng, M. (Eds.). Critical Computing- Between Sense and Sensibility. Proceedings of the Forth Decennial Aarhus Conference, Aarhus, Denmark, August 20–24, 2005 (pp. 79–88) New York: ACM Press.

  • Berg, M. (2004). Health information management: Integrating information technology in Health Care work. Oxford: Routledge.

    Google Scholar 

  • Bowker, G. C., & Star, S. L. (1999). Sorting things out: Classification and its consequences. Cambridge, Mass.: MIT Press.

    Google Scholar 

  • Brailer, D. J. (2005). Interoperability: the key to the future health care system. Health Affairs, Suppl Web Exclusives, W5-19-W5-21.

  • Broder, C. (2004). Case study: Utah physician practice saves with EMR system. Washington, DC: Advisory Board Company. http://www.allscripts.com/marketing/articles/Utah_Physician_Practice_Saves.pdf. Accessed 29 May 2009.

  • Canadian Health Coalition. (1998). Ensuring medicare's future: A submission to the Department of Finance and the alternative federal budget process. Ottawa: Canadian Health Coalition.

    Google Scholar 

  • Canada Health Infoway. (2010). About Infoway. Canada Health Infoway. http://www.infoway-inforoute.ca/lang-en/about-infoway. Accessed 10 June 2010 .

  • Canada Health Infoway. (2006). EHRs blueprint (Version 2). https://www2.infoway-inforoute.ca/Documents/EHRS-Blueprint-v2-Exec-Overview.pdf. Accessed 8 February 2011.

  • Canadian Council on Health Services Accreditation. (2004). Accreditation survey report, Capital Health, Halifax, Nova Scotia. Ottawa: Canadian Council on Health Services Accreditation.

    Google Scholar 

  • Canadian Council on Health Services Accreditation. (2007). Accreditation survey report, Capital Health, Halifax, Nova Scotia. Ottawa: Canadian Council on Health Services Accreditation.

    Google Scholar 

  • Chacko, V., Varvarelis, N., & Kemp, D. G. (2006). eHand-offs: An IBM Lotus Domino application for ensuring patient safety and enhancing resident supervision in hand-off communications. AMIA …Annual Symposium Proceedings/AMIA Symposium.:874, 2006, 874.

  • Chevalier, S., Choinière, R., Bernier, L., Sauvageau, Y., Masson, I., & Cadieux, E. (1992). User guide to 40 community health indicators. Ottawa: Health and Welfare Canada, Community Health Division.

    Google Scholar 

  • Coleman, E. A. (2003). Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. Journal of the American Geriatrics Society, 51, 549–555.

    Article  Google Scholar 

  • Department of Veteran’s Affairs & Office of the Inspector General. (2007). Healthcare inspection: Infusion clinic closure and patient notification (Rep. No. 07-03298-048). Las Vegas: VA Southern Nevada Healthcare System.

  • Eysenbach, G. (2001). What is e-Health? Journal of Medical Internet Research. doi:10.2196/jmir.3.2.e20.

    Google Scholar 

  • Gibbons, P., Arzt, N., Burke-Beebe, S., Chute, C., Dickinson, G., Flewelling, T., et al. (2007). Coming to terms: Scoping interoperability for health care. Health Level Seven EHR Interoperability Work Group. http://www.hln.com/assets/pdf/Coming-to-Terms-February-2007.pdf. Accessed 27 October 2010.

  • Gottschalk, P. (2009). Maturity levels for interoperability in digital government. Government Information Quarterly, 26(1), 75–81.

    Article  Google Scholar 

  • Gutheil, T. G. (1994). Documentation: burden or blessing? Journal of the American Association for Medical Transcription, 13(2), 39.

    Google Scholar 

  • Haggerty, J., Reid, R., Freeman, G., Starfield, B., Adair, C., et al. (2003). Continuity of care: a multidisciplinary review. British medical journal, 327, 1219–1221.

    Article  Google Scholar 

  • Harrington, S. (2004). Record rollout for physicians. Health Management Technology, 25(8), 18–25.

    Google Scholar 

  • Health Canada. (2010). Canada’s Health Care System (Medicare). http://www.hc-sc.gc.ca/hcs-sss/medi-assur/index-eng.php. Accessed 1 November 2010.

  • Heckman, T. (2008). Tips to avoid trouble. Information letter. The Canadian Medical Protective Association, 23, 3.

  • Heckman, T. C. (1997). Transfer of care can create problems. Information letter: The Canadian medical protective association, 12, 4–5.

    Google Scholar 

  • Helmer, W. (2005). Communication vital when transferring care of a patient. Information letter: The Canadian medical protective association, 20, 1.

    Google Scholar 

  • Heubusch, K. (2006). Interoperability: what it means, why it matters. Journal of AHIMA, 77(1), 26–30.

    Google Scholar 

  • Institute of Electrical and Electronics Engineers. (1990). IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries. New York, NY.

  • Institute of Medicine, Committee on Data Standards for Patient Safety. (2003). Key capabilities of an electronic health record system: Letter report. Washington: National Academies Press.

    Google Scholar 

  • JCAHO. (2003). Sentinel event statistics. Joint Commission on Accreditation of Healthcare Organizations. http://www.jointcommission.org/SentinelEvents/Statistics Accessed 30 June 2010.

  • JCAHO. (2007). FAQ’s for the Joint Commissions 2007 national patient safety goals. Joint Commission on Accreditation of Healthcare Organizations. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/07_npsg_faqs.htm. Accessed 30 June 2010.

  • Jenkin, A., Belson-Mitchell, N., & Cooper, S. (2007). Patient handover: time for a change? Accident & Emergency Nursing, 15, 141–147.

    Article  Google Scholar 

  • Juzwishin, D. (2009). Political, policy and social barriers to health system interoperability: emerging opportunities of Web 2.0 and 3.0. Healthcare Management Forum, 22(4), 6–16.

    Article  Google Scholar 

  • Kaplan, B., & Shaw, N. T. (2002). People, organizational and social issues: Evaluation as an exemplar. Yearbook of Medical Informatics, 91–102.

  • Knaup, P., Pilz, J., & Thalheimer, M. (2006). Can temporary paper-based patient records sensibly complete an electronic patient record? Studies in Health Technology and Informatics, 124, 207–212.

    Google Scholar 

  • Kofax Image Products. (2011). Removing the 'Shadow' from Electronic Medical Records. http://www.isit.com/st/documents/document3240.htm. Viewed April 13, 2011.

  • Laughnan, E. (2005). Rodney Dykehouse of Froedtert and Medical College of Wisconsin warns against tech for its own sake. Fusion CIO. Madision, WI: WTN Media. http://wistechnology.com/fusioncio/article/1750/. Accessed 10 Nov 2010.

  • Lowes, R. (2004). Practice pointers: how to win the paper (chart) chase. Journal of Medical Economics, 81, 40–45.

    Google Scholar 

  • Marshall, C., & Rossman, G. B. (1999). Designing qualitative research (3rd ed.). Thousand Oaks: Sage.

    Google Scholar 

  • McArthur, W., Ramsay, C., & Walker M. (2001). Improving health care for Canadians. Part II of healthy incentives: Canadian health care reform in the international context. http://collection.nlc-bnc.ca/100/200/300/fraser/healthreform/improving.htm. Accessed 10 August 2001.

  • Moed, H. F., Glänzel, W., & Schmoch, U. (2004). Handbook of quantitative science and technology research: The use of publication and patent statistics in studies of S&T systems. New York: Springer.

    Google Scholar 

  • National Alliance for Health Information Technology. (2005). What is interoperability? www.nahit.org. Accessed 4 March 2007.

  • Nausbaum, M. (2010). Looking for interoperability in all the right places. Guest Editorial. Healthcare Information Management & Communication, 24 (1), 6.

    Google Scholar 

  • openEHR. (2007). Aims of the openEHR architecture. http://www.openehr.org/releases/1.0.1/html/architecture/overview/Output/aims.html. Accessed 25 February 2011.

  • Pothier, D., Monteiro, P., Mooktiar, M., & Shaw, A. (2005). Pilot study to show the loss of important data in nursing handover. British Journal of Nursing, 14, 1090–1093.

    Google Scholar 

  • Schuurman, N., & Balka, E. (2009). Alt.meta.data: Ontological context for data use and integration. Journal of computer supported cooperative work, 18, 83–108.

    Article  Google Scholar 

  • Sim, I., Gorman, P., Greenes, R. A., Haynes, R. B., Kaplan, B., Lehmann, H., et al. (2001). Clinical decision support systems for the practice of evidence-based medicine. Journal of the American Medical Informatics Association, 8, 527–534.

    Article  Google Scholar 

  • Shetty, V., Murphy, D. A., Zigler, C., Resell, J., & Yamashita, D. D. (2008). Accuracy of data collected by surgical residents. Journal of Oral and Maxillofacial Surgery, 66, 1335–1342.

    Article  Google Scholar 

  • Star, S. L., & Ruhleder, R. (1996). Steps toward an ecology of infrastructure: design and access for large information spaces. Information Systems Research, 7(1), 111–134.

    Article  Google Scholar 

  • Stegwee, R., & Rukanova, B. (2003). Identification of different types of standards for domain-specific interoperability. Standard Making: A Critical Research Frontier for Information Systems MISQ Special Issue Workshop, pp. 161–170

  • Stone, E. (2005). Shared care: issues you should consider. Information sheet: The Canadian medical protective association.

  • Stoop, A. P., & Berg, M. (2003). Integrating quantitative and qualitative methods in patient care information system evaluation: Guidance for the organizational decision maker. Methods of information in Medicine, 42(4), 458–62.

    Google Scholar 

  • Streitenberger, K., Breen-Reid, K., & Harris, C. (2006). Handoffs in care–can we make them safer? Pediatric clinics of North America, 53, 1185–1195.

    Article  Google Scholar 

  • Suchman, L. (1987). Plans and situated actions. Cambridge: MIT.

    Google Scholar 

  • Suchman, L. (1995). Making work visible. ACM Transactions on Information Systems, 38, 56–64.

    Google Scholar 

  • Tolar, M., & Balka, E. (2010). Beyond individual patient care: Enhanced use of EMR data and changing work practices in a primary care setting. Proceeding of the Information Technology and Healthcare Conference, Victoria, BC, February 24–27.

  • Wikipedia. (2010). Interoperability. Wikimedia Foundation. http://en.wikipedia.org/wiki/Interoperability. Accessed 6 July 2010.

  • Wong, M. C., Yee, K. C., & Turner, P. (2008). Clinical handover literature review University of Tasmania, Australia: eHealth services research group.

  • Yasnoff, W. A., O'Carroll, P. W., Koo, D., Linkins, R. W., & Kilbourne, E. M. (2000). Public health informatics: Improving and transforming public health in the information age. Journal of Public Health Management & Practice, 6, 67–75.

    Google Scholar 

  • Ye, K., McD Taylor, D., Knott, J. C., Dent, A., & MacBean, C. E. (2007). Handover in the emergency department: Deficiencies and adverse effects. Emergency Medicine Australasia, 19, 433–441.

    Article  Google Scholar 

  • Yin, R. K. (1984). Case study research: Designs and methods. Newbury Park: Sage.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Communication, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada

    Ellen Balka

  2. Department of Pediatrics, BC Children’s Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada

    Sandra Whitehouse

  3. School of Interactive Arts + Technology (SIAT), Simon Fraser University Surrey, 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada

    Shannon T. Coates

  4. School of Population and Public Health, Faculty of Medicine, University of British Columbia, 5804 Fairview Ave, James Mather Building, Vancouver, BC, V6T 1Z3, Canada

    Dug Andrusiek

Authors
  1. Ellen Balka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra Whitehouse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shannon T. Coates
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dug Andrusiek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ellen Balka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balka, E., Whitehouse, S., Coates, S.T. et al. Ski hill injuries and ghost charts: Socio-technical issues in achieving e-Health interoperability across jurisdictions. Inf Syst Front 14, 19–42 (2012). https://doi.org/10.1007/s10796-011-9302-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10796-011-9302-4

Keywords

Search

Navigation