In an exclusive interview with Talkstandards, Professor David Ingram of openEHR, one of the most innovative players in the eHealth field, outlines some of his expectations for the future of ICT in the health care sector. This transcript has been prepared from notes taken during a telephone interview on February 22nd.

Part II: eHealth in an international perspective
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eHealth development and implementation are prioritized areas in Europe, both on EU and National level. In March, a ministerial meeting on eHealth will be held in Barcelona in connection to eHealth Week 2010 and World of Health IT Conference where hopefully, some important issues on how to bring eHealth implementation and interoperability forward. In order to reach the goals set up in the i2010 eHealth Action Plan, actions need to be taken quickly.
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Talkstandards.com had an Open Forum on eGovernment and ICT standardization yesterday. The discussion focused on eGov policies and how eGov strategies can contribute to the development and innovation of the public sector.
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Technical standards will invariably be articulated in an eGovernment strategy; but typically such standards won’t impede a government’s successful pursuit of an eGovernment strategy because useful standards are both widely available and known (and therefore generally not a challenge) and ever-evolving (and therefore not well suited to rigid lists or mandates).  However, without organizational interoperability, an eGovernment strategy may become mere words on a page and a lot of money spent. Organizational interoperability means the organizational structures, business processes and personnel enable enterprise-wide and cross-enterprise information sharing, cooperation and collaboration.

The government enterprise may need to reorganize to eliminate barriers to collaboration. Enterprises may need to reform the organizational structures, management hierarchy, mission statements, rules and leadership guidance to implement changes to information management, workflow and business processes. For example, historically, business processes were designed to meet needs internal to the enterprise.  Today, an enterprise must start with the service being consumed by the end user – the citizen, small business, industry or other government agency – and design business processes to provide the service most efficiently.  Similarly, the enterprise may need to redesign their information management to achieve the proper degrees of information sharing and privacy protection.

Individuals, whether staff or senior managers, need to adapt. As business processes and practices are altered or eliminated – managers may have to identify new means to measure productivity, transition the old revenue streams and methodologies to new processes and organizational structure, or identify new revenue streams.  Workers at any level of the administrative hierarchy may feel threatened by new interconnectedness.  Trust, norms, and networks central to social capital are fluid and could be threatened by reorganization.  Change in job content, loss of status or power, changes in interpersonal relationships, changes in the decision-making approach, and job insecurity are common reasons employees resist new technologies. A worker may perceive a threat to their “ownership” of information — their influence, or social stature — that may have accrued over many years of service. One method to avoid some of these problems is to include the workforce in the design of the eGovernment initiative from the outset. Their input could lead to innovations otherwise lost.  Workers may not have the skills to effectively undertake the imperatives of an eGovernment strategy and do their job within a new organizational structure with new processes and systems.  The government must make it a priority to develop proper training for, and achieve “buy-in” by, all who manage and work for the enterprise, these are the people who will or will not implement the eGovernment strategy.

In 2002 the US Senate approved the eGovernment Act. A special Committee was assigned to work out the most feasible and efficient solutions to improve citizen, intergovernmental and business access to information and services by supporting interoperability between federal, state and local government agencies. The objective is to make public information accessible by everyone – at all times. An official federal portal has been set up at USA.gov

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Photo: El C

Cloud computing is now becoming mainstream and there are discussions about the meaning of ‘Interoperable Clouds’. To me, this term is not easy to define as I explain below:
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Smart Grid  technology can enable substantial savings of energy, decrease cost and increase reliability.  ZigBee Alliance technology currently has a momentum and is being selected as the interoperability standard on several continents.  
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As a frequent world traveller, I am a user of a system called IRIS. IRIS is retina scanning system and once you have signed up to it and been validated by a scan of your retina, you can walk through an IRIS scanner and avoid the queue for immigration.

It’s a bit clunky but it works… So, I was intrigued when I saw a post from Toby Stevens titled “My eyes have expired” (read post here).
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Photo: Tom Harpel

Following the previous trend of Mobile Healthcare, Smart Grids is another area where previously discrete areas are converging. In this case, it is ICT, Telecoms and Energy. Once again, we have a familiar theme of recession driven stimulus funding driving this space. And again, the same question arises – how do we standardise a domain when it is rapidly evolving, spans multiple traditional domain and has a sense of urgency (in this case – global warming and other ecological considerations)?

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Almost ten years ago I was involved in the process to write one of the first eGovernment Interoperability Frameworks, the eGIF work in the UK.
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