title: An EHR-based paradigm shift in the operation of mental health and addiction services.
abstract: This paper responds to a commonly expressed belief, or perhaps hope, that full implementation of the electronic health record (EHR) will promote a "paradigm shift" in the delivery of health services, enhancing both service system efficiency and effectiveness in ways that would not have otherwise been possible. A model is proposed that defines stages in the development of the EHR in terms of two sets of functional components: 1) information management tools used to support the delivery of care; and 2) decision support tools that use information drawn from the EHR to promote functional integration among the components of complex service systems. "Paradigm shift" is defined operationally within this framework in terms of evolution of the EHR through these stages. The concept of "clinical interoperability" (anchored in a semantically interoperable EHR) is elaborated upon and presented as the sine qua non for a distinctive form of paradigm change that centres on support for care delivery within any given location in the system, and on EHR-based support for client movement through the system. The Vancouver Island Health Authority/Infoway Bridges, now deployed across the full array of hospital and community-based mental health and addiction services, is an example of an EHR that leverages the semantically interoperable components of an EHR to support a paradigm shift in clinical interoperability for the mental health and addictions service system.
authors.affiliation: Vancouver Island Health Authority, Victoria, BC, Canada.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Moselle
mesh_terms: D020000:Decision Support Systems, Clinical; D004059:Diffusion of Innovation; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D008605:Mental Health Services; D017146:Models, Organizational; D016320:Substance Abuse Treatment Centers; D018511:Systems Integration