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Trying to do a Jigsaw without the picture on the box: The problem of joining up across internal and external boundaries in medicine, health and care

Lookup NU author(s): Professor Rob WilsonORCiD, James Cornford, Professor Mike Martin, Dr Susan Baines, Dr Roger Vaughan, Bob Sugden


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Currently in the UK a range of government departments and government projects are embarked upon a series of initiatives attempting the 'joining up' of services from the provision of a one stop shop for local government services a nationally provide National Index or register of Children. At the Department of Health in England policy and stategy is directed at the integration of services. This is directly mirrored in the nationally co-ordinated Connecting for Health programme whose aim is to provide an ICT infrastructure to make it possible to deliver the reforms and new services needed to improve patient care (including centrally procured systems for established health organisations including hospitals and GP practices, cross-cutting applications for e-booking, e-prescribing, assessment of older people, PACs systems etc and a nationally available 'summary record' on the 'NHS spine') An example of one of the arenas in which 'integration' is being attempted is the Single Assessment Process to support the care for older people. The current best practice is for information on clients from two or more agencies to be brought together in one place literally 'joined together' or integrated in a single information system or hub. This has been led either by Local Authorities or the local NHS (also provided by the Connecting for Health programme). This is carried out with the overall aim of 'integrating' care, often through the governance context of a multi-agency service partnership, to improve service delivery and is undertaken by a combination of a process mapping exercise and the creation/adaption of a single assessment process forms and a corresponding information sharing protocol. Thinking about joining-up and integration in this way often leads to the pooling of resources (e.g. using government act flexibilities) and the procurement and design of an information system to support the service delivery. The results of such technical integration are usually based on an ERP model used in the domain of commerce where single enterprises integrate information from internal sources for the sake of efficiency and a single view of the customer. In an inter-organisational domain such as health our work has shown evidence from a series of case studies which identify a problem of informational determinism through the over-integration of information where de-contextualised information can be viewed by groups of practitioners. Put simply integration of an enterprise and the pooling of information may lead to a 'view from nowhere'. Therefore integration may not be the panacea to the problem of sharing information and knowledge in the health or public sector domains where inter-organisational and cross-sector information sharing is required. This leads to questions such what else do health or medical organisation's need to share besides information and what sort of alternative policy and technical approaches may be available? The authors conclude by suggesting that thinking about information and identity in terms of relationships and the 'publishing' of information as more fruitful way of exploring this problem.

Publication metadata

Author(s): Wilson RG, Cornford JR, Martin MJ, Baines S, Vaughan R, Sugden B

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Infrastructures for Health Care:Connecting practices across institutional and professional boundaries

Year of Conference: 2006

Publisher: Center for Information and Communication Technologies

Sponsor(s): NordICT, MedIT