National eHealth Research Articles

Setting the scene for the future: implications of key legal regulations for the development of e-health interoperability in the EU.

E-health has experienced a dynamic development across the European Union in the recent years and enjoys support from the European Commission that seeks to achieve interoperability of national healthcare systems in order to facilitate free movement. Differences that can be observed between the member states in legal regulations, cultural approaches and technological solutions may hinder this process. This study compares the legal standing of e-health in Denmark, Poland, Spain and the UK, along with key legal acts and their implications. The academic literature review along with an analysis of materials found through the desk study research (reports, legal acts, press articles, governmental web pages and so on) was performed in order to identify aspects relevant to e-health interoperability. The approach to legal regulation of e-health substantially differs by country. So do the procedures that they have developed regarding the requirement for patient's consent for the processing of their data, their rights to access to the medical data, to change the data, data confidentiality and types of electronic health records. The principles governing the assignment of responsibility for data protection are also different. These legal and technological differences must be reconciled if interoperability of European national e-health systems is to be achieved. Copyright © 2016 John Wiley & Sons, Ltd.

Comparison of national e-health implementation in the United States and South Korea

With the development of the health care industry, there has been growing recognition that e-health implementation is needed to improve the efficiency, quality, and safety of care. In addition, a review of previous studies suggests that much can be learned by investigating the difference in national e-health implementation in the United States and in South Korea. To this end, the main objective of this article is to compare the national e-health implementation in the case of the United States and South Korea. The results show that in the United States a decentralized e-health implementation is being followed by individual-level e-health. South Korea is pursuing ubiquitous health u-health after a hospital information system and electronic health were implemented. The United States still lags behind many other countries in the implementation of e-health, possibly due to its low uncertainty avoidance culture. South Korea has been among the frontrunner groups in e-health implementation as a consequence of its highly developed telecommunication infrastructures and high uncertainty avoidance culture. On the basis of these results, we recommend that establishing health care policies be done on a national scale that takes into account the countries' cultures.

The Influence of National Factors on Transferring and Adopting Telemedicine Technology

Telemedicine has drawn increasing attention as a beneficial healthcare delivery medium, especially in developing countries that struggle with physician and health professional shortages, through providing health services in remote areas. This paper presents the findings of a survey conducted to investigate the national factors influencing the adoption of telemedicine technology in Iran, as a less developed country. Designing a self-administered questionnaire the data were collected from the Chief Information Officers (CIOs) of Iranian healthcare system. The findings indicate that political factors such as Information and Communication Technology (ICT) policies, national data security policies, national e-health policies, national ICT infrastructures and rational decision-making, along with organizational factors such as organizational readiness and implementation effectiveness, are positively associated with telemedicine capability in Iran. However, no evidence was found to support the direct impact of cultural factors on transferring telemedicine technology in the country.

국가 보건의료정보화의 정보전략계획(ISP) 수립 방안

국가 보건의료정보화의 정보전략계획(ISP) 수립 방안

The national e-medication approaches in Germany, Switzerland and Austria: A structured comparison

BackgroundRecent studies show that many patients are harmed due to missing or erroneous information on prescribed and taken medication. Many countries are thus introducing eHealth solutions to improve the availability of this medication information on a national scale (often called “e-medication”). The objective of this study is to analyse and compare the national e-medication solutions just being introduced in Germany, Switzerland and Austria. MethodsInformation on the situation in the three countries was collected within an expert group and complemented by an analysis of recent literature and legislation in each country. ResultsAll three countries formulate comparable goals for the national eHealth solutions, focusing on improving medication safety. All three countries do not have a national e-prescription system. In all three countries, the implementation process was slower than expected and e-medication is not yet fully available. Differences of the three countries exist regarding chosen architectures, used standards, offered functionalities, and degree of voluntariness of participation. ConclusionNationwide e-medication systems and cross-border harmonization are acknowledged as important goals towards medication safety, but they develop slowly mainly due to privacy and security requirements, the need for law amendments and last but not least political interests.

Ten Demands of Improved Usability in eHealth and Some Progress - Co-Creation by Health and Social Care Professionals.

Current healthcare organizations often do not accomplish the intended effects of their eHealth systems due to inadequate usability. Commissioned by the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish health and social care has been analysed from the perspective of their professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, nine workshops were held where health informatics researchers guided staff from different care organizations, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents ten demands that Swedish health and social care professionals find imperative to prioritize. The study emphasizes that development of eHealth systems must be integrated into the care practice improvement process and iteratively evaluated regarding usability.

E-Health: A promising solution for optimizing management of chronic diseases. Example of the national e-Health project E-care based on an e-platform in the context of chronic heart failure

Summary Background Monitoring patients with heart failure by using telemedicine systems is a potential means for optimizing the management of these patients and to facilitate the job of health care professionals. We report the experience of the deployment of such a monitoring platform, through the E-care project. Methods The national e-heath project E-care has developed an “intelligent” communicative platform enabling the monitoring of patients with NYHA stages III and IV heart failure using non-invasive sensors. This project has been deployed since October 2013 in the Strasbourg University Hospital (in Strasbourg, France). Results To date, more than 180 patients have been included. The patient profile included was: elderly patient, with several chronic diseases (>90%), chronic heart failure in more than 60% of cases, total loss of autonomy in 25%. The E-care system operated perfectly and the experimental phase enabled us to validate the technological choices. A qualitative survey helped to positively assess the system's ergonomics. A preliminary analysis of the relevance of alerts with our inference engine design resulted in no malfunction. Conclusion Preliminary results following the deployment of E-care system in hospitals appear to show that this platform will assist health care professionals, especially patient nurse or doctor, by providing an automated processing of these sensors’ transmitted data in order to early detect and report signs of cardiac impairment.

Implementation of information and communication technologies for health in Bangladesh.

ProblemBangladesh has yet to develop a fully integrated health information system infrastructure that is critical to guiding policy development and planning.ApproachInitial pilot telemedicine and eHealth programmes were not coordinated at national level. However, in 2011, a national eHealth policy was implemented.Local settingBangladesh has made substantial improvements to its health system. However, the country still faces public health challenges with limited and inequitable access to health services and lack of adequate resources to meet the demands of the population.Relevant changesIn 2008, eHealth services were introduced, including computerization of health facilities at sub-district levels, internet connections, internet servers and an mHealth service for communicating with health-care providers. Health facilities at sub-district levels were provided with internet connections and servers. In 482 upazila health complexes and district hospitals, an mHealth service was set-up where an on-duty doctor is available for patients at all hours to provide consultations by mobile phone. A government operated telemedicine service was initiated and by 2014, 43 fully equipped centres were in service. These centres provide medical consultations by qualified physicians to patients visiting rural and remote community clinics and union health centres.Lessons learntDespite early pilot interventions and successful implementation, progress in adopting eHealth strategies in Bangladesh has been slow. There is a lack of common standards on information technology for health, which causes difficulties in data management and sharing among different databases. Limited internet bandwidth and the high cost of infrastructure and software development are barriers to adoption of these technologies.

A Tap on the Shoulder: The Disciplinary Techniques and Logics of Anti-Pokie Apps

A Tap on the Shoulder: The Disciplinary Techniques and Logics of Anti-Pokie Apps

Developing a national e-health strategy for DR Congo: a preliminary analysis of business needs, existing information systems and solutions

Background and purpose: In order to reclaim its leadership and to better align existing and future ICT implementations in the health domain with the strategic options defined by the National Plan for Health Development, the Ministry of Health (MoH) of the DRC initiated early 2014 the development of a national e-health enterprise architecture. During the preliminary phase of the architecture development cycle, an initial analysis of human resources, business processes, hardware, software, communication and networking infrastructure related to health information management, had to be established. Methods: A first part of the study consisted of a detailed analysis of regulatory documents and strategic plans related to the Congolese health system and health informatics development. In a second part, field visits and semi-structured interviews were organized with a representative sample of relevant health structures throughout the country Results: The study demonstrates the large number of business needs that must be addressed by e-health initiatives. It also documents the donor driven unequal distribution of hardware equipment over health administration components and health facilities. Internet connectivity remains problematic and few health oriented business applications found their way to the Congolese health system. Paper based instruments remain predominant in DRC’s health administration. The study also identified a series of problems introduced by the uncoordinated development of health ICT in DRC such as the lack of standardization, data security risks, poor data quality, inadequate ICT infrastructures, an unregulated e-health sector and insufficient human capacity. Conclusions: The results confirm the precarious situation of the Congolese health information system but they also expose a number of bright spots that provide hope for the future: a political will to reclaim MoH leadership in the health information management domain, the readiness to develop e-health education and training programs and the opportunity to capitalize the experiences from early successes with DHIS2 and a number of hospital information management systems.

The Ethiopian National eHealth Strategy and its Alignment with the Health Informatics Curriculum

Background : Many countries have developed eHealth strategies based on the WHO and ITU eHealth strategy toolkit. However, the success of the strategy, which appears to influence the diffusion of eHealth systems, is mainly dependent on the availability of skilled health informaticians at all levels. The purpose of this paper is therefore to review the Ethiopian eHealth strategy draft with respect to expertise requirements and to compare it with the graduate profile of the only bachelor in health informatics program in Ethiopia. Methods : A comparative analysis of the eHealth strategy with the curriculum of the bachelor in health informatics program was done. In the analysis, we identify the main focus areas of the eHealth strategy and compare its coverage in the academic and practical competency areas of the curriculum. Results : The eHealth strategy identifies five main areas of priorities for health information system implementations. They are: Health information systems, Telemedicine, mHealth, eLearning (for health workforce training) and community information systems. The curriculum contains 62 ECTS courses directly related to those areas. Additionally, the curriculum contains 89 ECTS for strategic and communication level skills, 108 ECTS for technical level skills, and 50 ECTS for monitoring and evaluation level skills. Conclusions : The eHealth strategy expertise and the curriculum are well aligned, especially regarding the technical level skills. The department and the ministry must work together so that the students get practical experiences of all the courses during their study.

EHealth Strategy Development: A Case Study in Tanzania

Many developing countries have used different frameworks, some ad hoc and some more formal, to develop their national eHealth strategies. There is increasing interest in eHealth strategy in developing countries, as well as a move to a more integrated and less fragmented set of eHealth solutions that contribute to health objectives and outcomes. Developing a national eHealth Strategy from the national health sector priorities should lead to implementation of sustainable eHealth solutions. Some existing frameworks for developing national eHealth strategies can be difficult to implement effectively. This paper presents how an alternative country eHealth Strategy framework was applied in Tanzania to develop the Tanzania eHealth Strategy 2013–2018. This alternative framework begins with reviewing Tanzania’s Health Sector Strategic Plan III (2009–2015) priorities and goals, from which the eHealth strategy’s priorities and goals are developed. The process is informed by the current state of eHealth and the proposed future state of eHealth. It defines the vision, mission, and guiding principles, well-defined strategic objectives and actions, a high-level roadmap, and an appropriate monitoring and evaluation (M&E) framework. The application of this alternative eHealth strategy development framework is based on theories of business process re-engineering, strategy development, and complex systems analysis.

Stakeholder behavior in national eHealth implementation programs

As the capabilities of eHealth technologies have considerably improved over recent years, many countries have developed national programs to implement such technologies with the aim of increasing treatment efficiency and effectiveness beyond the scope of just a few individual healthcare providers. However, these programs are often longsome, costly and have previously been met with fierce resistance from key stakeholders. Two questions arise: firstly, why do national eHealth programs stall long before end-users are reaping the benefits? Secondly, what motivates stakeholders, particularly healthcare providers, involved in the rollout process to resist to the implementation of a potentially beneficial technology? Our study builds on a wealth of observatory qualitative data as well as semi-structured interviews to theorize that complex stakeholder structures across organizational levels offer an answer to these questions. Based on the case of the German Electronic Health Card (‘eGK’), we propose that asymmetries amongst stakeholders׳ objectives can posit a cause for implementation issues, risks and failure. The theoretical and practical implications of these findings are discussed.

Interoperability after deployment: persistent challenges and regional strategies in Denmark.

The European Union has identified Denmark as one of the countries who have the potential to provide leadership and inspiration for other countries in eHealth implementation and adoption. However, Denmark has historically struggled to facilitate data exchange between their public hospitals' electronic health records (EHRs). Furthermore, state-led projects failed to adequately address the challenges of interoperability after deployment. Changes in the organizational setup and division of responsibilities concerning the future of eHealth implementations in hospitals took place, which granted the Danish regions the full responsibility for all hospital systems, specifically the consolidation of EHRs to one system per region. The regions reduced the number of different EHRs to six systems by 2014. Additionally, the first version of the National Health Record was launched to provide health care practitioners with an overview of a patient's data stored in all EHRs across the regions and within the various health sectors. The governance of national eHealth implementation plays a crucial role in the development and diffusion of interoperable technologies. Changes in the organizational setup and redistribution of responsibilities between the Danish regions and the state play a pivotal role in producing viable and coherent solutions in a timely manner. Interoperability initiatives are best managed on a regional level or by the authorities responsible for the provision of local health care services. Cross-regional communication is essential during the initial phases of planning in order to set a common goal for countrywide harmonization, coherence and collaboration.

Scaling up a Mobile Telemedicine Solution in Botswana: Keys to Sustainability.

Effective health care delivery is significantly compromised in an environment where resources, both human and technical, are limited. Botswana’s health care system is one of the many in the African continent with few specialized medical doctors, thereby posing a barrier to patients’ access to health care services. In addition, the traditional landline and non-robust Information Technology (IT) network infrastructure characterized by slow bandwidth still dominates the health care system in Botswana. Upgrading of the landline IT infrastructure to meet today’s health care demands is a tedious, long, and expensive process. Despite these challenges, there still lies hope in health care delivery utilizing wireless telecommunication services. Botswana has recently experienced tremendous growth in the mobile telecommunication industry coupled with an increase in the number of individually owned mobile devices. This growth inspired the Botswana-UPenn Partnership (BUP) to collaborate with local partners to explore using mobile devices as tools to improve access to specialized health care delivery. Pilot studies were conducted across four medical specialties, including radiology, oral medicine, dermatology, and cervical cancer screening. Findings from the studies became vital evidence in support of the first scale-up project of a mobile telemedicine solution in Botswana, also known as “Kgonafalo.” Some technical and social challenges were encountered during the initial studies, such as malfunctioning of mobile devices, accidental damage of devices, and cultural misalignment between IT and healthcare providers. These challenges brought about lessons learnt, including a strong need for unwavering senior management support, establishment of solid local public-private partnerships, and efficient project sustainability plans. Sustainability milestones included the development and signing of a Memorandum of Understanding (MOU) between the Botswana government and a private telecommunications partner, the publication and awarding of the government tender to a local IT company, and the development and signing of a Memorandum of Agreement between the Ministry of Health Clinical Services department and the local tender winner. The initial system scale-up is scheduled to occur in 2014 and to ensure the project’s sustainability, the system is aligned with the national eHealth strategy and local ownership of the project remains at the forefront (1).

Verbal with visual aides and live demonstration

Introduction: The population in western Sydney is diverse with a high prevalence of chronic diseases and incidence of low health literacy. The workload on primary care providers is one of the highest in NSW. One major challenge in the better integration of healthcare services is improving the communication of healthcare data and pathways across primary care providers, specialists and hospitals. WentWest has developed an array of programs and systems to integrate the care of patients with chronic disease across the spectrum of healthcare providers. Two are LinkedEHR and HealthPathways. Technology Brief: Two critical aspects of integrated care are Clinical Decision Support (CDS) and shared care plans (SCP). These are potentially simpler for inpatients in hospitals with access to homogenous clinical records and more difficult in primary health care with multiple and independent providers and clinical systems. WentWest has developed a system which integrates CDS (HealthPathways) and SCP (LinkedEHR) and supports the healthcare professional’s workflow electronically. The CDS is a localised version of the NZ Canterbury District Health Board’s – HealthPathways. It is an online clinical decision support tool, populated with resources and assessment management and referral pathways agreed on by local clinicians from primary secondary and tertiary health care. HealthPathways sits on the Health Professionals desktop and is accessed via the internet. HealthPathways also provides resources for distribution to patients for action between consultations. LinkedEHR is a dynamic care plan which can be updated by GPs, nurses, allied health professionals, care integrators, specialists and hospital clinicians involved in the patient’s care. It has for each diagnosis/problem a set of goals, targets and activities with direct access to the relevant locally agreed HealthPathways. Referrals are sent securely between registered practitioners as in a Team Care Arrangement and require a response, electronically. LinkedEHR provides a simple, easy to access, web based, dynamic and secure shared care plan. The combined implementation of LinkedEHR and HealthPathways aims to provide an accessible and dynamic shared care plan informed by best practice routines. Access to the National eHealth Record (PCEHR Being cloud based it can be rolled out to other jurisdictions. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116612– http://www.ijic.org/ Implementation: Both tools were developed with the goals of improving the management of chronic disease across the healthcare delivery spectrum. LinkedEHR’s Clinical Advisory Group proposed embedding relevant HealthPathways resources in the LinkedEHR Shared Care Plan to support the effective application of problems and goals in LinkedEHR. Conclusion: This presentation will discuss the benefits of LinkedEHR and HealthPathways in integrating care in western Sydney and report on the progress to date. Lessons learnt include: • Privacy and security is possible on the Internet; • A majority of Chronic diseases fall into a group of 25 major “concept groups”; • There are common goals and targets for these chronic diseases; • Healthcare professionals appreciate improvements in workflow; • Changing people’s work practices is difficult.

The AIS consensus statement on the definition of injury and illness

Introduction: The Australian Institute of Sport (AIS) has recently invested in an online management system synonymous to the national e-Health program. This management system has been adopted by 19 National Sporting Organisations (NSO) and 4 State Institutes of Sport (SIS). The adoption of this monitoring system has grown exponentially with current estimations indicating 10,000 injuries will be recorded over the next 5 years. Currently there are many definitions of an injury and illness utilised in epidemiological studies of sporting-related injuries and illnesses.

Governance structures impact on eHealth

BackgroundNational eHealth implementation efforts need to move beyond the scope of making technology the primary focus and instead consider the broader spectrum of influences that can either hinder or facilitate eHealth adoption such as governance structures and policies. In this study, Denmark serves as an ideal candidate for further examination due to the country׳s rich history of intertwining events that have played an important role in the dynamic relationship between governance and eHealth success and failures. MethodsA case study approach was used to gather a combination of primary and secondary data sources. All data collection was carried out through desk-research. Data collection relied on performing an extensive search of literature for relevant studies using combinations of keywords that reflected eHealth and governance-related topics. Inclusion and exclusion criteria׳s were applied to identify relevant papers. ResultsThis study reveals that despite Denmark׳s high deployment of eHealth technologies, the Danish healthcare system faces significant interoperability challenges which stem from the country׳s decentralized and centralized approach to eHealth implementation. ConclusionStructural reforms, policies and the processes driving the rapid dissemination of eHealth have a combined influence on the overall progress of eHealth adoption. Successful national eHealth implementation requires that countries act sensitive to the dynamics of governance, and specifically strive for the right balance between centralization and decentralization to nurture synergy and transparency between all stakeholders involved in the dissemination of eHealth systems.

Disturbing or facilitating?--on the Usability of Swedish eHealth Systems 2013.

As many evaluations show, healthcare organizations do not accomplish the intended effects of their eHealth systems due to inadequate usability. On behalf of the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish healthcare have been analysed from the perspective of healthcare and social service professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, seven workshops were held where researchers within health informatics collaborated with staff from different care providers, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents a foundation for further development of eHealth systems, condensed into 10 issues that the Swedish health and social care professionals find imperative to improve. The study emphasizes that the development of eHealth systems is always a matter of organizational and process development and must be integrated into the care practice improvement process. Further, based on the findings, some identified challenges are discussed.

Unresolved Ethical Challenges for the Australian Personally Controlled Electronic Health Record (PCEHR) System: Key Informant Interview Findings

Background: A national Personally Controlled Electronic Health Record (PCEHR) system was made available across Australia in July 2012. While the technical, policy, and commercial aspects of the new Australian PCEHR system were examined thoroughly by the National E-Health Transition Authority in developing the new e-health record system, little attention was given to examining the related ethical implications of PCEHR advances. This article reports on ethical concerns about the new Australian electronic health record system identified by expert stakeholders. Methods: A qualitative study using semistructured interviews with a purposive sample of key informants from Melbourne, Canberra, Brisbane, and Sydney with expert knowledge about electronic health records was conducted. The 12 participants represented a range of health and other professionals, research, policy, and consumer/patient groups. Results: Major themes identified were the importance of privacy safeguards at implementation and in future PCEHR uses, the appropriate uses of PCEHR data in research, unique ethical challenges around children and adolescents with PCEHRs, conflicting stakeholder interests around record access and use, and cultural diversity and engagement. Conclusions: The technical, policy, and commercial aspects of the new Australian PCEHR system have been examined thoroughly to date. A greater focus is needed on the ethical implications of PCEHR advances. A continuing failure to address ethical issues in the national implementation and utilization of the PCEHR could limit its uptake and success in Australia, and is also not without risks to the future participants of such a system.