How the Romans built the space

shuttle: standards, innovation

and eHealth

Jane Grimson

Director of Health Information

Health Information and Quality Authority

eHealth Week, Dublin May 13-15 2013

What is eHealth?

• e-health is an emerging field in the intersection of medical

informatics, public health and business, referring to health services

and information delivered or enhanced through the Internet and

related technologies….

Eysenbach G. What is eHealth? Journal Medical Internet Research. 2001

What is eHealth?

• e-health is an emerging field in the intersection of medical

informatics, public health and business, referring to health services

and information delivered or enhanced through the Internet and

related technologies….

the term characterizes not only a technical development,

but also a state-of-mind, a way of thinking, an attitude, and

a commitment for networked, global thinking, to improve

health care locally, regionally, and worldwide by using

information and communication technology

[Eysenbach 2001]

Overview

• Standards

• Innovation, Standards and eHealth

• Conclusion

Standards

Standard: a definition (ISO)

“...A document established by consensus and approved by a recognised body,

• that provides for common or repeated use, rules, guidelines or characteristics for activities or their results

• is aimed at the achievement of the optimum degree of order in a given context...”

A standard story or how the Romans built the space shuttle

7

Benefits of standards

• Major role in ensuring safety e.g. Safe Surgery Saves Lives (WHO)

• Support health service improvements

• Deliver economic benefits

• Benefit stakeholders including patients

Example: Safe surgery saves lives (WHO)

• Standard checklist, repeatable

• Has resulted in significant reduction in surgical morbidity and mortality

Health service improvement

[

Economic benefits

“The existence and use of

standards makes it easer to

produce, sell and buy products and

services. Standards enable a

market. ”

[Peter Swann, The economics of standardization, 2000]

Stakeholders

• Health software suppliers: provide greater market certainty, basis for certification, simplify procurement, provide prospect of growth in export markets if standards are international

• Purchasers and implementers: simplify procurement including assessment of compliance, improved confidence that produce purchased will be interoperable, avoid vendor “lock-in”

• Policy makers and regulators: promotes solutions which have been proven to be successful elsewhere and provides insights into where there are problems

• Patients information is available when are where it is needed to provide optimum safe care, allows services to be delivered in the most appropriate setting

Standards in healthcare

Standards in healthcare cont.

“ the nice thing about standards is that there are so many to chose from….

Andrew Tannenbaum, Vrije Universiteit, Amsterdam

“and if I cannot find one I like, I’ll make up my own!”

Paul Amos, NHS

15

Types of standards

• Official (regulatory) Standards – developed by Standards Development Organisations (SDOs) and made obligatory by government organisations e.g. HIQA’s standards for Safer Better Healthcare

• Consensus standards developed by SDOs but compliance is not (yet?) enforced e.g. HL7

• Proprietary (industry) standards defined by single company or group of companies (e.g. Microsoft office doc formats)

• Open standards - everyone can help to define them – don’t have to be part of an SDO; the final specification is available to all and can be used on a royalty free basis e.g. OpenEHR

Challenges facing SDOs

• Standards development process too slow

• Over-reliance on “voluntary” involvement from individuals and organisations

• Steady long-term decline in resources provided by governments and large organisation

• Many organisations involved and not always co-ordinated

• Increasing competition from industry collaborations

• Separation of standards development from implementation creating risk that standards are overly academic

• Lack of infrastructure for managing compliance.

Innovation, Standards and eHealth

Standards and Innovation

Innovation

• new, original, or improved product or process

• that creates value

Standards

• part of the infrastructure of innovation-led growth

Do standards limit innovation?

• Timing is everything – too early: may shut out promising and ultimately superior technologies

– too late: cost of transition may be too high preventing diffusion (impact of shortening product cycles?)

– very new: challenges the innovator (“bleeding edge”)

– very old: lock innovator into legacy systems

• Informing vs constraining – Information provided in standards stimulates innovation

– Constraining effect of too many standards

• Standards can create a common platform on which to build innovative applications – e.g. World Wide Web Consortium, apps for smart phones

.....it depends

eHealth and innovation

• Ehealth as a disruptive innovation?

– creates a new market

– potentially radically alters the way healthcare is delivered

The healthcare system of the future

Personalised medicine

+

Disease prevention and health promotion

Conclusion

Leadership

Two vital ingredients

Key building blocks +

Thank you