A Qualitative Study of Health Information Technology in the Canadian Public Health System
Zinszer, K., Tamblyn, R., Bates, D. W., & Buckeridge, D. L. (2013). A Qualitative Study of Health Information Technology in the Canadian Public Health System. BMC Public Health, 13(509), 1-7.
Over the past decade, Canada has seen the adoption and advancement of Health Information Technology in the public health system. The support of the development, effective use, and broad adoption of health information technology has however faced significant challenges that continue to persist. With improvements in the infrastructure of health information technology in public health practice, practitioners and policy makers are confident that the process will become efficient and effective.It is with the intention to explore these possibilities of improvements to the infrastructure of health information technology that Zinszer, Tamblyn, Bates, & Buckeridge (2013) conducted this qualitative study. The study focuses on the Canadian public health system and exploresthe policy aspects of the health information technology by engaging provicincial and national organizations’charged with the establishment of strategic direction and policy for health information technology.
With the engagement of representatives from at least 24 key stakeholders, the study aimed at identifying the policy aspects of health information technology that were currently succeeding in Canada and the challenges that were being faced. From the findings of the qualitative study the team would then be best placed to make suggestions regarding the future directions in the improvement of not only the adoption of health information technology but also its effective use in the public health system.According to Zinszer, Tamblyn, Bates, & Buckeridge (2013), the qualitative study succeeded in its quest as it effectively identified the benefits of health information technology in the Canadian public health system and further identified the barriers to effective and efficient adoption of health information technology in the public health area.
This paper seeks to provide a critical analysis of the qualitative study of health information technology in the Canadian public health system as carried out and presented by Zinszer, Tamblyn, Bates, & Buckeridge (2013). This paper will conduct the critical analysis by carrying out an extensive and intensive literature review of peer reviewed articles with the aim of highlighting the limitations of this qualitative study, the theoretical divergences and the main points of consensus between the study and articles reviewed.
Canada launched a $1.6 billion initiative in 2001 towards the implementation of a nation-wide system Figurethat allows and promotes the interoperability of electronic health records. This initiative is a brainchild of Canada Health Infoway; a corporation funded by the Canadian government, and which was envisioned to enhance collaboration between provinces and territories towards the development of a national framework with core aspects. Despite this massive investment, Canada still lags behind in the adoption of the electronic health records compared to other countries in the west such as the Netherlands, New Zealand, the United Kingdom and Australia as depicted in Figure 1 below.
In light of these findings, the paper recommended the following to aid in the effective and efficient adoption and use of health information technology in the Canadian public health system: automation of core processes and the identification of innovative applications in the advancement of outcomes in public health. For this to happen and yield the desired results, it would be necessary to develop expertise and institute a process through which stakeholders in the public health arena can contribute to policy designed to govern health information technology. To spearhead and take up these roles, the authors recommended that the Public Health Agency of Canada would be the best-suited body as it has the capacity and know how to propel effectivelythe required advancements(Zinszer, Tamblyn, Bates, & Buckeridge, 2013).
The outright limitation of this study is that while collecting views and opinions from the key stakeholders made up of representatives from provincial and national organizations that concern themselves with giving direction, developing policy and other such matters regarding health information technology, the material collected was treated with equal weight. There was no considerations made with respect to the differences and variables that have occasioned a difference in opinions and feedback from the key stakeholders that participated in the study. Since the outcomes and settings would be widely varied if such considerations were made, the study opted not to employ any formal weighing mechanisms on factors that could the evidence leaning towards generalizations. To this effect, statistical methods, multiple measures, and sampling were not subjected to a formal weighing system; participants in the study were simply drawn from 24 key stakeholder organizations based on their expertise, interest, and active participation in the matter.
Concerning the recommendations proposed by this study towards the improvement of the effective and efficient adoption of the health information technology in the Canadian public health system, there appeared to be theoretical divergences from some of the other studies and literature reviewed for the purpose of this critical analysis.For instance, while this study made recommendations for improvements by charging the Public Health Agency of Canada with the responsibility of coordinating and influencing the process of adoption for this e-health plan, in their recommendations, Rozenblum, et al. (2011) took a different approach. They recommended that instead of the top-bottom approach advanced by this study, a bottom-up and a clinical-needs-first approach would yield better results in fostering a solid and meaningful adoption process. This approach is far more realistic as it would use financial incentives based on patient outcomes and a national policy for investment to achieve a not only compelling but also a functional system of electronic health records.
This study does not make a concerted effort to acknowledge that one of the reasons the e-health plan is taking so long to be adopted is because it does not meet the needs of the public health system and thus most providers are simply dissatisfied with it performance and prefered thereby not to use it (Buntin, Burke, Hoaglin, & Blumenthal, 2011).
Main Points of Consensus between the study and articles
The articles and the study had many things in common in terms of their assessment and analysis of the successes that health information technology has achieved so far in the Canadian public health system. According to Rozenblum, et al. (2011), from feedback by key stakeholders the e-health plan has made important achievements in the areas of patient registries, national standards, digital imaging and funding. Just like in this study, Buntin, Burke, Hoaglin, & Blumenthal (2011) in their investigations measured the successes of Canada’s adoption of health information technology based on the criteria of how the system impacted outcomes, which can be measuredin terms of provider satisfaction, efficiency, and quality.There is sufficient evidence from the world over and from benchmark institutions to demostrate that quality and efficiency of healthcare can be improved by health information technology(Chaudhry, et al., 2006).
Regarding the barriers hindering the effective and efficient adoption of the rolled outhealthinformation technology identified by this study, Rozenblum, et al. (2011) also found similar challenges. Among them: the use of a rigid approach, the failure to establish a business case for the use of electronic health records, inadequate involvement of clinicians, the absence of an e-health policy and an emphasis on interoperability on the national level as opposed to the regional level slowed down the plan’s adoption(Hu, Chau, Sheng, & Tam, 1999). By looking at the United States where similar challenges are being faced in the adoption of health information technology, it becomes even more apparent that a business case for this initiative needs to be developed since more hospitals and even more doctors find this initiative significantly costly to install and maintain. In addition to these, as users there is a general feeling among doctors and hospitals that e-health plans do not have a compelling financial return on investment. Privacy and security concerns among both physicians’ and consumers’ alike is also a major hurdle to the speedy adoption of health information technology (Blumenthal, 2009). Innovation is key in the efforts to stimulate the adoption of this initiative since there are numerous opportunities and benefits to be found when players bring their expertise and strengths while leveraging partnerships to transform the delivery of healthcare(Leventhal, 2016).
Towards improving the infrastructure for health information technology, the issue of aligning the development of policy on health information technology and the major strategic directions of health care reform(Rozenblum, et al., 2011), emerged as one of the main points of consensus between the study and the articles.By posing the question of how technology can influence the experience of patients and ways in which an organization can leverage the use of technology to provide a patient with a positive return on their investment, an important link is drawn between health information technology and patient experience. This link holds the answers to the sustainable adoption of health information technology, highlights areas where innovations would be best applicable and how its application can yield maximized benefits for all stakeholders(Werder, 2015).
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