The recommendations from the 2009 SiHIS working conference in Hiroshima—Issues on trustworthiness of health information and patient safety

Abstract

Held on 21st to 23rd November 2009 in Hiroshima, the SiHIS working conference aimed at finding solutions to approach to an idealistic society where (1) the individual can trust information with full understanding and responsibility, (2) the individual can allow the use of information backed by sound legitimated environment, (3) information can play its role for better healthcare and the improvement of medicine. The purpose of this paper is to propose recommendations from this working conference.

Introduction

In many countries, the healthcare sector is entering a time of unprecedented change due to aging populations and increasing demands for better healthcare [1]. Soaring medical expenditures have become a threat for keeping a sustainable society, challenging us to master those difficulties [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. To mitigate these problems, it will be necessary to increase quality and efficiency of healthcare by fully utilizing information and communication technology (ICT) [3], [10], [11]. There are many eHealth implementation projects in various countries. Gordon Blackwell has estimated the near future vision of ICT use in healthcare sectors by extrapolating the developing histories of ICT [7]. According to his paper, it seems that we soon will have a seamless, fully integrated care system, in which adequate data is instantly available in the right place to ensure optimal care is provided. Indeed, there are many papers concerning interoperability of eHealth, e.g., [12], [13], and HL7, which is already widely used, and may become the leading standard for interoperability of health information systems in the near future. However, as Kathrin Cresswell et al. pointed out, the history of large-scale information technology projects is littered with examples of failure [10], and this is also true for healthcare [14], [15], [16], [17], [18]. In any large project, acceptance of the project by the entirety of stakeholders is of crucial importance, but in the case of a large-scale information system, there are a large number and wide variety of stakeholders, so it is very difficult to have a common understanding about objectives, values, and merits [10], [14]. Misunderstanding or lack of trust among the stakeholders might be a key element of difficulties occurring [19]. Eike-Henner Kluge also pointed out in his key note address the danger of believing that computer technology can solve everything [20]. It will be necessary to seek a way to improve mutual understanding and trust between all stakeholders about the content and use of information. In order to find plausible solutions to approach an idealistic society where individuals can trust information fully with complete understanding and responsibility, we organized a workshop on Security in Health Information System (SiHIS) on the 21st to the 23rd of November (SiHIS2009) in Hiroshima. SiHIS2009 was the most recent of a long standing series of SiHIS working conferences held every three years, starting in 1976 with a first conference titled “The Achievement of Data Protection in Health Information Systems”. On that very year, the International Association of Medical Informatics (IMIA) provided funds to establish its Working Group 4, and in 1979, the first working conference “Data Protection in Health Information System – Consideration and Guidelines” was held. Established as working conference, it is expected that SiHIS should pose guidelines for the use of health information. Though data protection was originally the primary target of SiHIS, the scope has become much more diversified, and at SiHIS2009 it was “The trustworthiness in health information, - issues in security and system management for patient safety“. This paper reports the outcome of SiHIS2009.