e-Health Policy Study

Telehealth policy baseline study


Principal Investigator: Richard Scott This study is investigating e-health policy awareness through the identification of specific inter-jurisdictional e-health policy issues, reviewing available e-health policy documents within British Columbia health authorities, and exploring the e-health policy making process. Based upon the results several policy options, recommendations, and broad lessons were extracted concerning e-health policy-making, potential inter-jurisdictional issues, and their implications.

Background

The fundamental ‘borderless’ characteristics of telehealth and e-health have huge implications and raise many questions for organizations and authorities wishing to integrate e-health into their existing policies and protocols. As e-health (here defined as “The use of information and communications technology in healthcare, specifically telehealth and health informatics”) becomes pervasive, it is essential that it be integrated into our existing healthcare system through smart policy and practice.

Motivation

While research around practical integration of e-health policy is increasing; understanding the breadth and depth of the related policy issues is poor, and empirical research on policy integration is sparse. Greater comprehension and awareness of these issues would better equip the healthcare system to address them, and allow the full networked potential of e-health to function.

Objectives

The overall goal of this study was to inform, in an evidence-based manner, the e-health policy debate in the province, and identify and define the spectrum of e-health policy issues. It was anticipated that the findings would lead to appropriate recommendations for the creation of a unified e-health policy in British Columbia and increase e-health utilization and uptake by facilitating functional inter-jurisdictional activity.

Methodology

Data collection was based on an exploratory case study research methodology: A literature review of existing published and grey literature; Distribution of an e-health policy survey to key decision makers at the participating health authorities, plus collection of telehealth policies in place; And key informant interviews of lead decisions makers. From each of the four participating authorities, three key informants were recruited based on their requisite knowledge, experience and involvement in e-health awareness, policy/guideline development or implementation.

Results of Literature Review

From this review it was determined that existing literature on e-health policy issues in general—and inter-jurisdictional e-health policy issues in particular—is sparse. The area is large and complex; yet remains dominated by a focus on privacy, security, and remuneration.

Results from E-Health Policy Survey

Findings from the e-health policy survey centered around two key areas: A. Awareness, Development, and Dissemination It was determined that all four participating BC Health Authorities typically have at least one telehealth application running in each of the following areas of application: clinical, administrative, research, or educational. Fifteen different clinical application areas were noted, some in early stages of development. All respondents agreed that e-health has a positive impact on the quality of healthcare rendered in their jurisdiction, in particular improving access, equity, efficiency, effectiveness and patient safety. Moderate awareness exists of personnel or committees involved in e-health policy development, and current policy documents reportedly have moderate to high impact on e-health decision-making and implementation. Policy documents are invariably disseminated electronically within the health authorities. Recipients of the distributed policy information are typically senior management and telehealth / e-health coordinator(s) within their respective authorities Following recent efforts by some health authorities and the Ministry of Health, two of the four authorities are actively sharing policy documents with health professionals in their jurisdiction. Conversely, one health authority clearly indicated they lacked any mechanism for tracking the distribution of e-health policy documents. Moreover, they reported that many of their documents related to e-health privacy and security are in draft and under non-disclosure agreements with the Ministry of Health, which precludes them being shared externally. B. Inter-Jurisdictional Issues All participants agreed that existing institutional and inter-jurisdictional policy issues preclude the immediate and effective integration of e-health policy into the healthcare system. Respondents identified several key priority issues: identity management and access, consent, auditing, data stewardship, provincial e-health policies, First Nations policies, strategic support, privacy policies (and role based access), documentation standards, data quality, and Interoperability. Other acknowledged issues included: continual review for existing policies, nomenclature standards, e-chart corrections, among other operational and professional issues. Inter-jurisdictional issues that could be detrimental for telehealth integration were cited as: access issues (patient’s electronic health record), documentation of the encounter, and connectivity.

Results from Key Informant Interviews

Three informants from each of the four participating health authorities were interviewed in the summer of 2007 for a total of twelve (12) respondents. Interpretive content analysis was performed to identify key findings. These were: Summarize this section to identify the lack of clear policy and the need for facilitation of future policy. Highlight key points of Privacy and security issues, reimbursement, human resources, liability and access.

Current Limitations/Barriers

Almost all participating health authorities provided instance(s) of where inter-jurisdictional e-health activity had been hampered or prevented due to the lack of clear policy. There is an absence of e-health related policy instruments to facilitate inter-jurisdictional activity at both regional and provincial levels. Key concerns included privacy, security, confidentiality, data stewardship, reimbursement, disparate processes among jurisdictions, human resources information access and sharing, liability and staff training. Policies for e-health privacy, security and information sharing exist; however many other issues remain unaddressed. Most health authorities either lack understanding or have no formal e-health policy-making process in place, and often develop policy in an ad hoc manner to meet emergent needs. Participants only had fair knowledge of personnel or groups associated with the health or e-health policymaking process. Barriers to policy development included: lack of identified need, lack of standardized process, improper allocation of resources, remuneration, ineffective communication, conflicting ideologies, ambiguity of roles, political barriers, and connectivity issues.

Potential for Future Development

All health authorities unanimously emphasized the need for e-health policy development recognizing that technology as new as e-health comes with novel challenges and needs policy support to create the effective e-health enabled health system envisioned. Facilitators to policy development included: Need for champions, citizen engagement, effective communication, resources, common governance, and proper organizational structure. Policy issues that require urgent resolution were cited as: Privacy and security, reimbursement, human resources, liability, and access. Policy recommendations included propositions for public participation, meaningful collaboration, incentives based on clinical outcomes, improved inter-professional and patient-provider relationships, and common infrastructure.

Conclusion

British Columbia is heavily invested in a variety of e-health (Telehealth and health informatics) activities, orchestrated at both the Provincial and Health Authority levels. The variety of initiatives raises the question of whether a clearer needs assessment process might provide greater focus and more impact to the Provincial e-health strategy. The available infrastructure is solid, but for Telehealth is focused on video-conferencing solutions almost to the exclusion of other alternatives. There is clear e-health policy at the provincial and health authority levels, but it is neither comprehensive nor aligned, and inter-jurisdictional e-health policy does not exist despite inter-jurisdictional (inter-HA) activity taking place. Given that e-health is inherently inter-jurisdictional in its application and impact, it is essential to develop policy in an inter-jurisdictional manner. Not to do so will slow development of some e-health initiatives, inhibit initiation of others, and perhaps even prevent others.