Workflow Bribery

A while ago the Economist magazine published an article [1] in which the author stated that "Since April, General Practicioners (GPs) [in England] have received 96p [about EUR 1.5, or USD 2] every time they use Choose and Book, a controversial electronic system for referring outpatients. Fed up with the doctors' resistence to newfangled information technology the National Health Service (NHS) has resorted to bribery."

To me this rang a bell. I remember someone from a Danish healthcare standardization (probably MEDCOM) who expressed similar sentiments (although not using wording with such negative connotations) based on experiences with the exchange of electronic messages within Denmark. Within Danish healthcare the amount of electronic messages (percentage wise, of overall communications) is very high. In order to motivate providers to participate in the project they were forced to pay a coiuple of Euro those that generated the electronic messages. Those that recieve the data have to pay a couple of Euro to ensure that the entire process is neutral in terms of costs.

When one thinks of it this makes perfect sense from a workflow perspective. For a GP to go the extra mile he'd have to be properly motivated. Assisting a patient in booking an appointment in a hospital may benefit the patient, but it carries an associated cost for the GP in terms of time. It takes a certain amount of time to enter and send information in an electronic fashion. The receivers of electronic communication benefit the most from that information: it saves them from having to re-enter the data or they may achieve cost savings elsewhere. To offset this unequality in terms of cost/benefit, one may indeed have to resort to "bribery".

-Rene

[1] The Economist, "The NHS and IT", June 17th 2006

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Index of columns:

HL7 Version 3 Tooling (Nov 16, 2022)
Bye bye IHE XDS and CDA. (Sep 01, 2021)
Combining the best of IHE XDS with HL7 FHIR (Jun 27, 2019)
FHIR DevDays and the year in review (Dec 27, 2018)
Creation and Curation of FHIR Profiles - process and governance (Dec 14, 2017)
Impact of the GDPR on the use of interoperability standards (Jun 27, 2017)
Next XDS Release (Oct 27, 2016)
Five years of FHIR (Aug 11, 2016)
Update from the trenches on CDA R2.1/R3 and HL7v2. (Oct 15, 2015)
Most often implemented IHE Profiles (Jun 08, 2015)
Mapping HL7v2 messages to FHIR. (Apr 13, 2015)
Recent and Future developments of the DICOM standard (Mar 06, 2014)
Documenting the history of HL7 (Sep 03, 2013)
Interoperability Standards - the no-sales pitch (Jul 09, 2013)
CDA Implementation Guides - (not) invented here (Apr 17, 2013)
Usage of IHE Profiles (Feb 25, 2013)
10 year anniversary - Dutch Ringholm HL7 v2 training courses. (Feb 19, 2013)
HL7 Connectathons (Sep 09, 2012)
Frequency of use of HL7 message types (Jul 24, 2012)
Reflections on the HL7 membership model - the affiliate life cycle (Dec 28, 2011)
RFH (Resources for Health): HL7 version 3 taken to the next step (Aug 18, 2011)
Timezone Hotel (Mar 29, 2011)
The changing role of HL7 country organizations (Jul 16, 2010)
How to lower the hurdle for HL7 v3 implementers (Jan 21, 2010)
The HL7 roadmap for CDA R3 and the CCD (Jan 17, 2009)
HL7 based Tree inventory system (Jan 30, 2007)
Workflow Bribery (Sep 15, 2006)

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Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.