Institutional Liability in the E-Health Era

This paper examines the jurisprudence on institutional liability for medical er- ror. We argue that the existing jurisprudence relies on assumptions that have been made obsolete by technological advances. In particular, we concentrate on the use of information and communication technologies (ICTs) in the health care domain. As we demonstrate, the use of these tools does not merely increase efficiency and support new health care functions; among other effects, ICT can have a profound influence on how health care practitioners make observations, exercise judgment and perform tasks. These tools influence human capabilities (at both the individual and systems level) in ways that are not recognized in the jurisprudence or scholarly literature on health law. In this paper, we do not set out a positive program for changes to the law of institutional liability. Our goal is merely to point out that the status quo is inade- quate from an intellectual, practical and moral standpoint. The first section of this paper discusses the traditional approaches to institutional liability in health care — namely, direct duties and vicarious liability. After summarizing the jurisprudence, we shift our attention to the use of ICT in the health care domain. We outline key themes, and identify some of the major efforts underway in Canada to provide new technologies. In the next section, we argue that the jurisprudence concerning insti- tutional liability is based on dated assumptions; in particular, we show that ICT can have subtle yet profound effects on health care practitioners. Arguing that the sys- tem-level errors that arise in these contexts cannot be treated adequately by the current legal framework, we briefly explore the potential of the law of fiduciary duties as a tool to rectify the situation. Our ultimate conclusion is that none of the current legal tools are adequate for dealing with the issue

Information Systems and Health Care - V: A MultiModal Approach to Health Care Decision Support Systems

Decision Support Systems (DSS) in health care must be designed in consideration of the empirical context and problem space where they are being applied. However differences such as workflow, clinical expertise and organizational norms make it hard to define the context where a DSS will be used. What is needed is a DSS that is able to enhance health care delivery in different contexts. In this paper we present a multi-modal DSS that supports decision making in different contexts. The paper describes the theoretical basis for the DSS, explores a problem space in palliative care and describes a prototype implementation of the DSS to address the issues from the problem space

APPLICATION OF ACTIVITY THEORY TO ELICITATION OF USER REQUIREMENTS FOR A COMPUTERIZED CLINICAL PRACTICE GUIDELINE: THE ACTCPG CONCEPTUAL FRAMEWORK

Clinical practice guidelines are knowledge uptake instrument that support decision making by the physicians. They are often implemented as computer-interpreted guidelines that are embedded in a hospital information system. We argue that computer-interpreted guidelines should be considered as regular information system, thus their development should follow all the steps of system analysis and design, starting with exploration and definition of user requirements. In this paper we propose the ActCPG conceptual framework to establish basic user requirements for implementing computer-interpreted guidelines. This framework relies on the Activity Theory to structure and decompose information coming from a clinical practice guideline and associated narrative so UML use cases can be developed. We illustrate operation of the ActCPG framework with an example of a practice guideline for a management of clinically obese children enrolled in some obesity program

Brokers as Catalysts for the E-Health Market

In this study we use the experiences from the service industry and explore pre-requisites of the e-health market which will need to achieve to stimulate both sides of the market (vendors, healthcare organizations, government, institutions, corporations and services organizations) to interact with each other and develop demand driven services and social innovations. The results presented in this paper may be of interest for decision makers, industries (e.g. software or technology designers), small and medium enterprises (SME) and entrepreneurs with an interest in becoming a part of the e-health market, and for consumers (e.g. healthcare personnel and patients) that are willing to influence the market through their choices. The outcomes of the study shown that the role of virtual brokers is essential to the further development of a sustainable e-health market globally because its role as catalyst for interaction between the two-sides of the markets, its effects on the reduction of competitive constrains, its effects on the accessibility to broader network of actors and its effects on the support of public-private exchanges of knowledge and experience

Is There a Consensus when Physicians Evaluate the Relevance of Retrieved Systematic Reviews?

Background: A significant challenge associated with practicing evidence-based medicine is to provide physicians with relevant clinical information when it is needed. At the same time it appears that the notion of relevance is subjective and its perception is affected by a number of contextual factors. Objectives: To assess to what extent physicians agree on the relevance of evidence in the form of systematic reviews for a common set of patient cases, and to identify possible contextual factors that influence their perception of relevance. Methods: A web-based survey was used where pediatric emergency physicians from multiple academic centers across Canada were asked to evaluate the relevance of systematic reviews retrieved automatically for 14 written case vignettes (paper patients). The vignettes were derived from prospective data describing pediatric patients with asthma exacerbations presenting at the emergency department. To limit the cognitive burden on respondents, the number of reviews associated with each vignette was limited to three. Results: Twenty-two academic emergency physicians with varying years of clinical practice completed the survey. There was no consensus in their evaluation of relevance of the retrieved reviews and physicians’ assessments ranged from very relevant to irrelevant evidence, with the majority of evaluations being somewhere in the middle. This indicates that the study participants did not share a notion of relevance uniformly. Further analysis of commentaries provided by the physicians allowed identifying three possible contextual factors: expected specificity of evidence (acute vs chronic condition), the terminology used in the systematic reviews, and the micro environment of clinical setting. Conclusion: There is no consensus among physicians with regards to what constitutes relevant clinical evidence for a given patient case. Subsequently, this finding suggests that evidence retrieval systems should allow for deep customization with regards to physician’s preferences and contextual factors, including differences in the micro environment of each clinical setting

Context Sensitive Health Informatics: Concepts, Methods and Tools

__Abstract__ Context is a key consideration when designing and evaluating health information technology (HIT) and cannot be overstated. Unintended consequences are common post HIT implementation and even well designed technology may not achieve desired outcomes because of contextual issues. While context should be considered in the design and evaluation of health information systems (HISs) there is a shortcoming of empirical research on contextual aspects of HIT. This conference integrates the sociotechnical and Human-Centered-Design (HCD) approaches and showcases current research on context sensitive health informatics. The papers and presentations outlines theories and models for studying contextual issues and insights on how we can better design HIT to accommodate different healthcare contexts

Using Social Network Analysis to Explore Issues of Latency, Connectivity, Interoperability & Sustainability in Community Disaster Response

ABSTRACT Community-based disaster response is gaining attention in the United States because of major problems with domestic disaster recovery over the last decade. A social network analysis approach is used to illustrate how community-academic partnerships offer one way to leverage information about existing, mediated relationships with the community through trusted actors. These partnerships offer a platform that can be used to provide entré into communities that are often closed to outsiders, while also allowing greater access to community embedded physical assets and human resources, thus facilitated more culturally appropriate crisis response. Using existing, publically available information about funded community-academic partnerships in Wisconsin, USA, we show how social network analysis of these meta-organizations may provide critical information about both community vulnerabilities in disaster and assist in rapidly identifying these community resources in the aftermath of a crisis event that may provide utility for boundary spanning crisis information systems