Patient Centered Care and the Healthcare Ecosystem

One of my favourite keynote speeches at the annual eHealth conference was delivered several years ago in Quebec City by Andre Picard, the Globe and Mail reporter. He spoke in layman’s terms about the need for electronic health records and made, what I felt, were some excellent points about the need for electronic health records.

This past fall Mr. Picard spoke  at a “Breakfast with the Chiefs” event.  His talk, “What Do Patients Want” addressed what he felt were the under represented views of Canadian patients.

During his talk, Mr. Picard noted that “we do have these wonderful pockets of care along the way, but our connections between them fail all too often“.  He stated that “there’s no reason that we can’t deliver a continuum of care, because we have all the elements in place, but we’re just not connecting them“.

I think that Mr. Picard is making the same mistake in logic that people trying to deliver eHealth solutions make … he is assuming that we have a healthcare “system”.   As I have argued in past blog posts, we don’t have a single “healthcare system” but, rather, a healthcare “ecosystem”.    Each of the individual elements in this ecosystem operate independently, each with their own agenda and budget.   We must recognize this reality and stop trying to deploy eHealth applications as though all the various organizations are part of a single enterprise.  Instead, provincial and national organizations such as eHealth Ontario and Canada Health Infoway need to focus on putting in place the elements necessary to encourage and facilitate the exchange of information such as interoperability standards.  Only when we approach the continuum of care as an ecosystem instead of an enterprise will we realize our goal of true patient centered care.


One response to “Patient Centered Care and the Healthcare Ecosystem

  1. Great post Mike. I think you make an important distinction. It reminds me of the old arguments about integrating Enterprise applications.

    Do you write hard-coded tight integrations between applications or loosely coupled SOA type connections? I think the issue in healthcare is that most of the powers that be believe that the best option is for tight integration. The point most of them miss…is that given the current organization of healthcare services delivery, that tight integration is not even an option. As long as services are de-centralized and delivered at a local level, you will never get enough decision makers to agree to a tight-coupling style of integration. Call it SOA or something else for all I care, but in the end a loosely-coupled integration is the only option that has a chance of succeeding.


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