Development of Heath Information Systems in Crete - Case Study Example

Development of Heath Information Systems in Crete Summary of the case study Integration of health care services among the health care providers in Crete has experienced various challenges. Greeksoft and Crete Tech are two main Information Communication and Technology (ICT) providers who are conflicting about the development and implementation of the Regional Health Information Network (RHIN) in Crete. However, development and implementation of integrated healthcare information has been augmented by the introduction of Healthnet a brain child of Crete Tech. If the conflicts of intellectual propriety rights are resolved among Greeksoft and Crete Tech, the integration of health care system would proceeds at an increased pace. In 1983, Greece introduced National Hospital System (NHS) whose objective was to improve healthcare service through ICT. Unfortunately, the system has received support from few individuals as well as from small number of both private and public health care providers. They few adopters of the NHS have installed some laboratory, administration and financial information system in their work stations. Private sector is the leading adopter of the new systems and networking in their various departments. The development of regional health information network in Crete has been commendable as compared to other regions in Greece. Crete has moved faster to enhance primary healthcare and embrace ICT in the integration of health care information in Greece. Therefore, it has been earmarked as a role model for other regions in the field of health care information integration as well as adoption of ICT. Consequently, Crete has received support from various quarters to implement the regional health information network. The development in Crete has been attributed to Crete Tech. Crete Tech is an ICT company established in 1984. The Crete Tech had a full fledged research and development department that is fully equipped with personnel and equipments. It vision is to integrate all healthcare service in Crete. Crete Tech has developed a strategy to roll out its services to the health providers. In 1997, it developed an objective of creating an integrated electronic health record whose purpose was to store and retrieve patients’ records in the seventeen primary health care centers in Crete. The system included the needs and interest of the general health practitioners who wanted to network in order to promote primary health care. Throughout the strategy, Crete Tech amassed enviable support from the general practitioners and moral support from government officials. However, it had no support from the Regional Health Authority (RHA). RHA had strong ties with the Greeksoft (Crete Tech rival) and were not willing to support the competitor of their affiliate. In fact, RHA wage war against the Crete Tech on intellectual property rights issue. Fortunate for Crete Tech, it had motivational support from the regional secretary and secured funding from European research and development projects. The support enabled the Crete Tech to move on with it vision. Crete Tech created Healthnet from scratch. Healthnet was based on architectural technical of health committee Healthnet comprised of Common Object Request Architecture Platform, Extensible Mark up Language, Digital Imaging and Communication in Medicare, 3 Interface and Health level 7 Interface. It borrowed experience in identical projects. The application complied with internationally accepted technical and medical standards and protocol. Implementation of the primary health information system and integrated electronic health record faced many challenges. The implementation was voluntary, lacked adequate funding and training personnel, overwork or lack of patient in primary health care centers and intellectual propriety rights dispute. However, Crete Tech received European eHealth Award that boosted the reputation of the company. In addition, the company services complied with set health information standards and protocols, Healthnet was found to be practical and adaptive. According to the information provided in the article, Crete Tech seems to be well suited to handle the development and implementation of the RHIN in Crete. Organizational Change and Development Organizational change refers to the general activities, their extent and rate occurring throughout the period that an organization, institution or department aim to improve the overall performance of the organization. According to Kotter (1996) change activities are driven by change agents in response to the needs of the organization. These activities are project oriented and directed to deal with current overall problem or goal in the organization. Organizational development on the other hand refers to evolution of the organization during the overall organizational change activities. Organizational development is as a result of organizational change activities. There are different reasons why health organizations are involved in organizational development. Organizational development is important in order to improve its competitive positioning through improved networking, cost cutting, quality services, marketing, planning and research (Marquis and Huston 2008; McConnell 2003). Health organizations understand that they will cease to exist if they fail to embrace and tackle positive changes aimed at improving their quality of service. To keep pace with speeding rate of innovation, health organizations must become flexible to adjust to the fast changing environment (Galbraith 2001). Change and development enable health organizations to change their corporate culture, relax their hard positions, increase output, improves receptiveness to customers, enhance employee contribution and participation, improve employee morale as well as build up managerial skills and strategies for their employees. Crete Tech plans to scale up their ICT innovation to improve healthcare information management to real-time in the public and private primary health care providers Crete region. This is evident through the creation of research and development department meant to promote Crete Tech innovations. It is through development of the above department that led to formulation of Healthnet that has promoted development and implementation of regional health information network (RHIN). The RHIN pilot project had been extensive, demanding and unpredictable with many incompatibilities discovered between varying healthcare professionals in the public healthcare sector of Crete. Therefore, research becomes mandatory to solve the challenges of incompatibilities discovered during the implementation of the integrated information system. Intellectual Proprietor Rights Dispute According to Vave and Huber (2006) legal rights resulting from intellectual work in any field are called intellectual proprietor rights. The intellectual proprietor rights protect owners who create tangible or non tangible items by granting them time-bound rights to restrict their use. Intellectual proprietor rights are granted through patents, trademarks, copyrights, geographical indications, trade secrets and industrial designs. Crete Tech inventions fall into the category of industrial property rights. Crete Tech should have patented their Healthnet and other information management systems. This grants Crete Tech exclusive rights to use, distribute and sell their inventions to their clients. On the other hand, it protects them from future intellectual proprietor rights conflicts with there competitors. It cannot be established with certainty whose invention was electronic patient records. If Crete tech had patented it, then Regional Health Authorities personnel would not have stalled the progress. Intellectual property rights have substantial effect on international trade. For example, large brand companies such as pharmaceutical companies have patented their products. Therefore, they are able to restrict countries from producing and supplying generic antiretroviral drugs to treat people with HIV/AIDS. Power Dynamics During organizational change, power may be used to achieve desired change in health organizations. Chief executive officers, top managers, change agents, consultants and other interested parties may use power to supervise and manipulate the processes and procedures for change via authority and influences they posses. The actions taken by persons other than the management to confront and manipulate transformational procedures and process are perceived as opponents of change. This is because those activities fall outside the tenets of a change plan. During change processes, different actors may try to manipulate and influence each other. Nonetheless, manipulations may not necessarily lead to resistance. On the contrary, influence and manipulations may result in conformity. During change, element of power dynamics can be visible for all the groups that participate. Manipulation efforts may be exhibited openly and consciously by the agents. Power can be considered as dynamical social process that impacts either positively or negatively into views, feelings, and conduct of concern groups. Power may be imperceptible and lack sensibility if people skills, insight, knowledge and tastes are influenced in a manner that instinctively acknowledges the importance of change. Power is accepted universally when people’s differences, concern and likes are handled with care and respect. According to Marquis and Huston (2008), there are five perspectives on power dynamics that impact on organizational change. The first perspective is the deliberate use of visible and deliberate influence. The leaders and other change agents conspicuously use their influence and legal power to direct and guide change. The second perspective places knowledge on the forefront as a source of power. Individual power is recognized as important to create change that is needed in the organization. The second perspective, suggests that managers, advisers and supervisors invoke their powers by referring to evidence and sound opinion in their leadership roles. The third perspective suggests that power is shared among participants and it is that shared powers that direct processes and procedures of organizational change. The top management should be willing to share powers with other key participants in the organization. The third perspective can be very appropriate because most participants in the group are likely to own and accept the change process. The fourth perspective also lies on the management and organization presumptions. However, it applies less visible and insensible ways of power use. The issues that are key at this approach are perceptions, ideals, and norms that the management stresses at all levels in the organization. Change can be attained by complying with core values and culture of the organization. The fifth perspective embraces open negotiations. The participants and agents of change are able to influence and manipulate each other’s positions and views through democratic talks. When parties with conflicting interests discus their issues openly, they may arrive at an agreement towards a given direction. Negotiation is used to create an accord concerning the goals and direction of change. The case study on the creation of integrated health information in Crete, Greece demonstrated the elements of power dynamics. Greeksoft has power relationship with a number of Regional health Authorities personnel who have protected from Crete Tech. the existing relationships has made it extremely difficult for the Crete Tech to offer their ICT services in the development of the regional health information systems. Regional Health Authorities do not want the Crete Tech company to succeed. They have created various road blocks for Crete Tech ranging from proprietary rights dispute to failure to offer financial support to the company. The acts of Regional Health Authorities impacted negatively to the development and implementation integrated heath information systems in Crete. On the other hand, Crete Tech received external motivational and financial support for European research and development funds. European recognition through European eHealth Award boosted the struggling company and placed in a limelight of success. Therefore, power can be used to speed up or slow organizational change and development. However, if positive power is greater, development and change speed up but if negative power is greater, then change would be painful and may not even been realized. Boundary formation Boundary formation is key to organizational change and development. Boundaries help to manage mutuality among organizations through cushioning and bridging. Boundaries are demarcation as to the extent of roles and authorities of various organizations with shared interest in a particular activity. It must preserve boundaries that connect and disconnect them from their environments. Boundaries may also promote the image and identity of health organization. It promotes transparency and trust among various health organizations and cut dependency on other exchange partners in the environment in which it exist. The procedures and processes that have been used to develop boundaries have been analyzed from a wide range of different perspective. Boundaries have been analyzed using economics of cost operations and governance efficiency. The above perspective has suggested that boundaries should be set at the position that minimizes expenditures used to set up the boundaries. In addition, health organization boundaries should be set at the level that derives maximum value to the organization from the available resources. During the process of setting up the organizational boundaries, it is important to consider the beliefs shared by the members of the organization. Boundaries should either be rigidly defined or flexible boundary. It is worth noting that at the initial process of boundary formation, majority of the individuals may be involved. But as the process reach maturity, two groups of people emerge. The first group is the owners (insiders) and the second group is called the helpers (outsiders). Insiders are those who either have high ranking level of assets specificity or those whose resource enhance the capacity of resource management. They are opportunistic economic players whose deals are expensive to identify, supervise or implement and are likely to result to partial contracts. Insiders execute their economic roles more proficiently within the tenets of hierarchical firms rather than via market procedures that cross boundaries. When dealings are internalized and placed in a hierarchy, the key players need not to predict all the possible moves because they would be dealt with in the organizational governance structure. However, opportunism is hindered by the affairs of the authority and bureaucratic policies of the hierarchy. Opportunists may be penalized in monetary terms, prevented from advancing or fired. Asset specificity may be linked to the level of activities, type of physical assets or knowledge and human skills that have been devoted. Asset specificity in repeated transactions creates and nurture small number bargaining that increase potential for hold-up by opportunists actors. Advantages and Disadvantages of Coalition Coalition is defined as an association of groups or individuals who decide to cooperate to pursue a specific agenda but each with own specific agenda. Most coalitions are created as a matter of convenience. Through coalition, an organization can improve its credibility, economics of scale, saves time and labour (Yoder-Wise 2003). Coalition can also provide partners with distinctiveness in its sector, and if the coalition attains substantial market penetration, it puts the partners in very strong positions. By pooling resources together, coalition members multiply networking opportunities. Naturally, coalitions offer great networking opportunities. Effective networking helps coalition members to identify organizations that can fill a specific need or answer a question. It can also facilitate introduction or help to secure funds. Coalitions possess innate capacities to reenergize partners with new ideas and knowledge. Finally, it promotes sharing of new ideas and energy to existing programs. However, coalitions are prone to disintegration and discord. This is because coalitions are made up of different parties with differing beliefs and interests. Therefore, they may not always agree on the correct path for organizational policy and may result in resistance to change. Coalition may cause compromise on issues than need to be changed for the betterment of the organization. When disagreements ensue among parties of a coalition, coalition leaders may agree to remain silent on a problem. Influential partners may act maliciously against the weaker partner. Furthermore, more decision making organs can cause lots of controversies and may result into an overall inefficiency and ineffectiveness in organizational management. Coalition and partnership in provision of electronic patients’ record would be important. Coalition provides a practical approach of building, raising and maintaining composite health organizations. Coalition and partnerships should have well expresses and communicated vision, mission and bylaws to protect the credible of both the coalition and its members. Coalition is important because it can act as catalyst of change and has better representation of public needs and concerns. Coalition partners should be ambassadors for their program so as to broaden the reach of their messages and increase the project’s exposure to the relevant stakeholders. Through coalition, partners can serve as an effective network for dissemination of information and provision of their services to customers. The opportunities to improve are more frequent and varied; the rewards are larger and can be more inspirational if coalitions among partners are sustained. Consequently, it aims at fully maximizing the needs and wants of greater majority in the community as well as in the health organization. Therefore, coalition can be a powerful tool that can be used to speed up change and development in the community and health organizations. This is because it demonstrates wide spread support and active involvement of majority of its partners. Participants with diverse backgrounds can provide varied skills as well as access to important target population. As a result, every coalition partner can contribute their particular expertise and resource to advance the agendas of the coalition. The greater scope of skills and population would direct the organizations developments, implementation and improvement of quality products, services and policy. To be effective, coalitions made should have acceptable proportion of representation to promote a consensus based decisions. Crete Tech and Regional Health Authorities should have forged coalitions to be able to negotiate and agree on how they could accommodate the interest of the other party in order to unlock the stalemate in the intellectual propriety rights as well as lessen the bond that exist between the regional authorities and their competitor Greeksoft. Liaison with Government Liaison can be defined as a link or connection of a given organization with government agencies or ministries. Liaison is very important as it aims at gaining both the motivational and financial support from strong departments of the health organizations. It enlightens health organizations on the kind and amount of funding available for a given project or activity. Furthermore, government officials announce new financial support programs as they emerge to organization that they liaison with. Regional and central government agencies undertake to influence local, regional and even international organizations. Liaison with government departments requires setting up current and active relationship with specific officials of the government in relevant government ministries and departments. The process of creating strong liaison demands that the individual of various health organizations should make regular telephone calls or visits to the government departments to keep in touch with development in the relevant department. It is important to ensure that staffs of both health organization and government departments acquaint themselves regularly. Liaison should be developed appropriately so as to gain wider access to important and influential government officials who are willing and able to provide the assistance that is needed by the organization. When official from health organization become willing and actively acquainted over a long period with government departments it make it easier for them to converse when an opportunity for support present itself. There are practical challenges that arise in liaison with government departments. Increased employee turnover in both government and health organization may make it very difficult to maintain sustainable liaisons. This is because high employee turnover in both organizations breaks key links. Therefore, liaisons demands continued development of new and maintaining old relationships which at times may be tiring and time consuming Tushman and OReilly (1997). Health organizations should manage their staff well to prevent high turnover rates in their organizations and protect the organization from loss of key contacts. Liaison enables organizations to institute and sustain valuable communication channels with governments at a political as well as at departmental level. Liaison with government departments requires health organizations to formulate fundamental messages by identifying suitable objectives within government bureaucracy (Smith and Flarey 1999; Swayne and Duncan 2006). They should harm themselves with appropriate backing certification and secure meetings with appropriate decision-makers in government agencies. Finally, it is crucial to management useful relationship with government officials at all points so as to achieve current achievement and development of health organization. In the case study on Crete integrated information system, a key figure in coalition efforts was the director at one participating primary healthcare centers. He utilized his position to establish networks and collaborations among medical institutions, local authorities, Crete Tech and regional health representatives. The primary objective of the established network and collaboration was to promote primary healthcare education and research among the regional community and healthcare professionals. The results of coalition were enormous including publications of a number of epidemiological studies that led to creation of best practices in health care management and reporting. Had Crete Tech formed liaison with the health care government officials and departments, it would have been easier for them to drum up both the motivational and financial support (Shortell, M. 2006; Hepworth, et all 2009). Consequently, it would have been placed in a better position to solve the standstill that existed between them and Crete’s Regional Health Authority. Macro- change level Macro change is a change that occurs to a region, a country or global as a whole rather than to individuals. It is evident in a whole picture and has a definite improvement of lives of vast majority of persons. They are normally created and guided by interventions that are beyond individual level. For change to occur, interventions must be made at policy level. The proponents of macro change target systems that affect large entities and communities. Macro level change results from the following strategies. Resources should be developed and supplemented, support systems should be utilized and enhanced, social action and advocacy should be applied, there need to be social planning and organization, improve institutional environment as well as coordinating services and interorganization coalition. If Crete Tech could have collaborates and work together with the Regional Health Authorities, they will be in a position to bring large scale positive changes to the Crete region through promotion of primary health care information management systems. ICT can speed up storage and retrieval of patient information for speed provision of health care. Recommendations 1. Crete Tech should move forward and form liaisons with regional and national government agencies in order to improve their relationship with government officials to be able to drum up motivational and financial support. 2. Crete Tech should continue providing leadership in the Information and Communication sector in Crete through creation and innovation of applications that have the capacity and compatibility. This will give them competitive edge against their rival Greeksoft and buy in support of the regional Health Authorities and other Greek government agencies. 3. Crete Tech should patent their inventions and innovation to protect the company from unscrupulous employees who may leak out the information to competitors as in the case of the Regional Health Authority and the Crete Tech Intellectual Proprietor Rights Dispute. 4. Crete Tech Top management should continue exerting pressure to its employees for provision of best quality service to its clients. 5. Crete Tech should clearly demarcate the extent of their mission and vision as well as their interests in the provision of ICT to primary health care providers in the region of Crete. 6. Crete Tech should form coalitions with Regional Heath Authorities so as to drum up their motivational and financial support. 7. Crete Tech should create and nurture stronger ties with relevant Greek and European government agencies. 8. Crete tech should try as much as possible to participate in the ICT in the healthcare sector at policy levels 9. Greek’s government should monitor the actions of all Regional Health Authorities to ensure that they are not inhibiting the developments and implementation of regional health care information systems. References Galbraith, R. (2001) Designing Organizations: An Executive Guide to Strategy, Structure, and Process. San Francisco: Jossey-Bass Publishing. Huber, D. (2006) Leadership and Nursing Care Management.3rd Edition. 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USA: Jones & Bartlett Publishers Swayne, L. and Duncan, W. (2006) Strategic management of health care organizations .5thEdition. Oxford: Wiley-Blackwell. Tushman, L. and OReilly, C. (1997) Winning Through Innovation. Boston: Harvard Business School Press. Yoder-Wise, P. (2003) Leading and managing in nursing. 3rd Edition USA: Elsevier Health Sciences. Read More