The Socio Technical System

Published Date: 02 Nov 2017

Introduction

This training material has been developed to share the management’s knowledge of current developments in Information Systems with the staff of Hopetoun Health. The training has been divided in two sessions of 1 hour each.

In session 1, the discussion will be focused on the current developments in electronic health information systems. An attempt will be made to introduce Health Information System and how it can be utilized at various levels of management. i.e. Strategic, Tactical and Operational levels. We shall also discuss the trends and issues in the context of national and state priorities particularly in the areas of National Electronic Health Records, Individual Healthcare Identifier (IHI) and some interesting developments in technology like the National Broadband Network, Increasing Integration etc.

In Session2, we will be discussing how an information system can be a socio-technical system and what are the various social issues and technical issues. We will then discuss as to why socio-technical approach is appropriate in the development of Health Information System.

Session 1

Health Information Systems

A health information system is a collection of a number of integrated applications which provide various functionalities which are required by a health organization to process data and provides information required by the workers at every stage of management to make better and informed decisions about business and patient care. (Conrick, 2006)

Since Health Industry’s core business is providing patients with quality care, a Health Information System’s primary purpose is to enable quality patient care which it does by storing and dealing with patient data. It should also be able to connect to other facilities which can share data using common standards. In addition, it supports all clinical and non-clinical function of an organization from billing and finance, staff rostering and human resources management to pathology, medical imaging and pharmacy, ordering and viewing results and decision support. (Conrick, 2006)

According to Whetton, information systems can be differentiated according to their purposes which are:

Transaction processing Systems (TPS): Includes payroll, inventory, admission and discharge and office automation systems including word processing, spreadsheet, email and other communication tools.

Management Information Systems (MIS): They provide managers with necessary information to do their work.

Decision Support Systems (DSS): Assists decision makers in the management by providing information, models and data manipulation tools.

Expert Systems (ES): They use rules and models which organize facts and knowledge and aid in decision making.

All these systems can be a part of a Health Information System are used by certain level of organizational management.

At the Strategic level, the executives use the Executive Information Systems to build long term strategies and set goals for the organization and the managers are responsible to archieve those goals. The Tactical Level uses the Management Information Systems, Decision Support Systems and Expert systems which enables them to develop business processes, audit and process data and improve on current process and workflows and divert resources as needed to achieve these goals and the Operational level uses Transaction processing systems and other work specific application to plan and work on a day to day basis.- for example using patient admission and discharge applications, preparing correspondences, locating and indexing medical records etc. (Whetton,2005).

The diagram below shows which applications are used by which levels of management:

EIS

Strategic

Groupware and communication tools

Managerial

MIS, DSS, ES

Operational

TPS, OA

Clinical

Research

Admin

Education

Fig: Levels and Types of Information systems (Whetton, 2005)

Issues and Trends

A number of major national and statewide projects have recently been introduced in Australia which will make it possible for the government to provide more effective e-health services.

Personally Controlled Electronic Health Records: Australians are now able to have a personally controlled electronic health record – which is an electronic health record which can now be viewed and controlled by patients. Patients are now able to control what is recorded in their medical records and who is able to access it.

The benefit of PCEHR is that it allows medical service providers to access patient’s records thorough an online portal and will have all the historical medical records and treatment information in one place.

<http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/pcehr#.UWFYTZNTCCl>

Individual Healthcare Identifier: It is a unique 16 digit number allocated to anyone with Medicare, DVA card or any person seeking healthcare in Australia by the Healthcare Identifier Service which is part of Medicare Australia on behalf of National E-Health Transition Authority ( NEHTA). <http://www.nehta.gov.au/connecting-australia/healthcare-identifiers>

A Healthcare Identifier (HI) can be used to improve security and manage an individual’s personal health information. It enables the HI service to uniquely identify each individual and their healthcare providers and makes PCEHR possible.

<http://www.humanservices.gov.au/customer/services/medicare/healthcare-identifiers-service>

The National Broadband Network :The National Broadband Network will enable telehealth to function at its true potential and will open avenues for many new applications and technologies which will benefit from cheaper, more reliable and faster fiber optic network provided by the NBN. The broadband network delivered by the NBN will make it possible to have electronic consolations and people living in rural and remote areas will have more access to specialists – most of who are based in metropolitan hospitals.

<http://www.health.gov.au/internet/ministers/publishing.nsf/Content/D139D6B3BB2D1338CA2577D60021EB88/$File/nr167.pdf>

It would now be possible for the people to have high quality video conferencing, transmit images and view telemetric readouts directly with appropriate devices and as it has already been trialed in a nursing home in NSW where 50 chronically ill, high risk patients are being monitored remotely using a remote patient monitoring system over the NBN.

<http://www.nbnco.com.au/nbn-for-home/health-case-studies/case-study-healthcare-intel-hunter.html>

Increasing Integration

As we moved from paper based medical record to electronic health records, one can clearly see the increasing level of integration.

EHR today is not only an electronic version of the paper based medical record, but is is a comprehensive record of individual’s health information which are stored in a variety of formats, they can originate from various providers and they may be stored in different databases and maintained by different organizations but now they are accessible to multiple health professionals and also the consumer (Whetton, 2005).

As we move towards the future, we can see the NBN providing a backbone which can support this increasing integration of patient health information stored in various formats which is made possible by IHI number which enables each individual to be identified correctly and PCEHR which can provide a very high level of integration of data stored in many silos and databases across different facilities.

Health Data Integration (HDI) integration tools have now been developed by CSIRO which allows data from previously incompatible data sources and databases to be organized in a secure virtual database which makes it possible to get a complete picture of patient care- which will enable health service providers to provide better health services and will aid in research and building of better plans and policies.<http://www.csiro.au/en/Outcomes/Health-and-Wellbeing/Technologies/HDI.aspx>

It will now be possible for a patient in Hopetoun village to have electronic consultation with a GP based in Melbourne and at the same time the GP can access the patient’s health record and discuss with another specialist based in Perth who can look at the complex reports and medical images and give his expert opinions and the GP can write a prescription online.

Session 2

The Socio Technical System

The concept of socio-technical systems was devised by a group of researchers working at Tavistock Institute of Human Relations in the 1950s and they were interested in how to minimize the de-humanizing effects of the scientific management practices which were implemented at the workplaces during that time. These early researches were interested in improving the worker’s quality of lives and increasing their job satisfactions. (Whetton and Gergiou, 2010)

Back then Social and Technical systems were considered independent but embedded in the workplace environment and both were considered to be equally important but even to this day, the technology side has been getting more attention than the social system and mostly only discussed in the context of minimizing change resistance.

Oxford Dictionary defines System as "A set of things working together as part of a mechanism or an interconnecting network; a complex whole:" For a socio-technical system to exist it must have a technological component and a sociological component in their relevant context. In the context of health informatics, socio-technical system may comprise of the following: <http://www.computingcases.org/general_tools/sia/socio_tech_system.html>

Computer Hardware, Software and Infrastructure

Physical Surroundings

People

Procedures

Laws and Regulations

Business Processes

Culture

Data and Data structures

Which form a single system and act as a interacting part and hence the technical and social elements should be designed or updated as a single system so they work in a symbiotic relationship and provide better results

<http://www.uclan.ac.uk/schools/school_of_health/divisions/files/ST_Manifesto_26_08_10.pdf>

We tend to forget that technology is just a tool which is used by people to work and while designing health informatics systems, we have to mindful that healthcare systems are by nature a very complex and deceptively large system where we have interaction between the public, private and public / community hospitals and other healthcare providers where services are provided by mix of non-medical and medical workers in vast number of specialties and each with their own areas of expertise. There are issues of politics, power, workplace cultures, compliance, legal boundaries and many levels of hierarchy and responsibilities which must be taken into account while developing a health information system. (Whetton, 2005).

While Developing a Health Information System, we will encounter a number of social and technical issues:

Social Issues:

Heathcare is a skill intensive industry and it requires people from many areas of expertise and skill sets to work together in the same environment and people develop cultures, subcultures, work practices and procedures which they tend to follow and resist any technology or system which interferes with their workflows and cultures. <http://rhwtas.com.au/ehealth/data_info/docs/topic_3.pdf>

When developing a Health Information System, it is important to consult with the users and stakeholders about their workflows and routines. A new system will most likely require people to significantly change the way they work and if that is the case, it is important that such changes be made by consulting with the users so that they do not resist to the new system instead they consider it an improvement in their current workflow and routines.

<http://rhwtas.com.au/ehealth/data_info/docs/topic_3.pdf>

Technical Issues:

The Technical component of Health Information systems is very complex because of the nature of the business itself and how things were done in the past is also an issue in today’s health information world where we are after very high level of integration.

In places where we have existing applications, it is very likely that most of them were designed only with the business process of that particular department and they would often have their own databases, data structures and their own information systems. Since they were not designed to integrate well with other systems, we now have a number of incompatible legacy systems in each department. For example, pathology, labs, medical imaging usually have their own business specific information systems which need to be integrated into an enterprise wide information systems where the orders, results, images should be made available in one location.<http://rhwtas.com.au/ehealth/data_info/docs/topic_4.pdf>

Decisions should also be made about how to deal with these legacy systems, some departments may still be reliant on old hardware and softwares which are now not possible to maintain because the hardware has changed dramatically and old softwares can be near impossible to maintain or improve upon because they may run on codes which cannot be maintained because of lack of documentation and programming know how about those legacy languages.

Because most legacy softwares weren’t built to conform to any current common data or technical standards, it would be very difficult to integrate with other systems. <http://rhwtas.com.au/ehealth/data_info/docs/topic_4.pdf>

But since most of the legacy systems are already in place and have been doing what they were designed to do, they also have a big benefit that people working around them are used to working with them and familiar with their workings and workflows and business processes are already established and they may be resistant to any change to this system. We also need to decide if it is worthwhile to move away from legacy systems to newer systems in terms of financial, operational, business continuity and change management perspectives. <http://rhwtas.com.au/ehealth/data_info/docs/topic_4.pdf>

Any new or modification to existing health information system should also ensure security and the principles of computer security - Confidentiality, Integrity and Accessibility is always ensured by the new system or changes. (Techrepublic, 2008)

Where Confidentiality means that information is not open to anyone who should not see it, Integrity means that it should not be possible for anyone to perform unauthorized data alteration and Availability means that data should be accessible to the legitimate user when required.

Appropriateness of Socio-technical system in Health Information System Development:

IT projects traditionally have a poor success rate are and it is widely accepted that upto 80% of all IT projects fail and they fail not because of technology, it’s because of people and failing to acknowledge the needs and expectations of the people who are supposed to work with the system.<http://www.bizjournals.com/portland/stories/2008/10/20/smallb4.html?page=all>

Most IS and IT projects focus largely on technology and fail to acknowledge the people part of the equation. A socio-technical system on the other hand, acknowledges importance of both technology and people who work or depend on the technologies and instead of focusing on technologies, it also focuses on complex organizational and cultural aspect of the environment. Which is highly relevant in healthcare industry where people from different backgrounds and disciplines work together in a complex and interrelated environment. The socio technical approach takes in account the work practices, communication, user attitudes, perception and user satisfaction and usability so that these systems have a better change of acceptance by the intended users (Whetton and Georgiou, 2010).