This study has been prepared within the UNU-WIDER project on Entrepreneurship and Development (Promoting Entrepreneurial Capacity),
The paper was presented at the UNUWIDER and UNU-MERIT Research Workshop on Entrepreneurship, Technological Innovation,
Further, it ascertains the growth rates of innovative SMES vis-à-vis non-innovative SMES in terms of sales turnover, employment, and investment.
L25, L26 The World Institute for Development Economics Research (WIDER) was established by the United nations University (UNU) as its first research
and policy analysis on structural changes affecting the developing and transitional economies, provides a forum for the advocacy of policies leading to robust, equitable and environmentally sustainable growth,
and visiting scholars in Helsinki and through networks of collaborating scholars and institutions around the world. www. wider. unu. edu publications@wider. unu. edu UNU World Institute for Development Economics
along with investment growth and employment growth on gross value-added growth by means of multiple regression analysis. The paper brings out substantial evidence to argue that innovations
and UNU-MERIT workshop on‘Entrepreneurship, Technical Innovation, and Development, held 30 31 october 2008 in Maastricht, The netherlands and the anonymous referees, for their comments and suggestions.
Tables and figures appear at the end of the paper. 1 1 Introduction Small and medium enterprises (SMES) have been considered one of the‘driving forces'of modern economies due to their multifaceted contributions in terms of technological innovations
because innovation lends competitive edge to firms, industries and ultimately, economies. Therefore, technological innovation has the potential to spur growth of individual enterprises at the micro level and aggregate industries and economies at the macro level.
Given the above, this paper attempts to understand issues such as what factors drive SMES to innovate,
and the business environment in which they operate (Burrone and Jaiya 2005). Particularly innovation in the manufacturing sector is a very complex process
Similarly, there must be a market demand for the innovated products in the form of an explicit customer demand or implicit market opportunities.
Of course, the relative importance of these internal as well 2 as external factors might vary from firm to firm or from industry to industry or even from economy to economy and from time to time.
and the most frequent way of achieving this included contacts with customers. Chanaron (1998) identified demand placed on business by customers/clients,
close working relationships with a key customer and close analysis of competitor products are the major drivers of innovation in SMES covered in three different countries: UK, France, and Portugal.
of which suppliers or customers are the most frequent. According to Ussman et al. 2001), SMES in Portugal do not just depend on internal sources
but are influenced also strongly by the overall environment. Hoffman et al. 1998) based on a survey of studies pertaining to UK,
and relating to customers (enabling the firm to serve certain customers). These studies strongly indicate that neither internal competence of the firm nor customer requirements alone will drive a firm to undertake innovations.
Lehtimaki (1991) observed in the context of Finnish SMES that on the average, the contribution of innovated new products was more to total sales than to profits.
2004) found that innovation effects were felt in terms of both product-oriented results such as (i) improvement in quality of goods and services,
and (ii) increased range on goods and services, and process-oriented results like increased production capacity and improved production flexibility.
does that directly contribute to the growth of firm size in the form of growth of sales turnover, investment, and employment?
Danneels and Kleinschmidt (2001) claimed that innovative products present great opportunities for SMES in terms of growth
2004) found that innovation helped Estonian SMES to improve their performance in terms of market share and diversified range of goods and services.
and offer some opportunities for growth. Coad and Rao (2008) probed the relationship between innovation and sales growth for incumbent firms in high tech sectors.
which covered 648 micro enterprises on a sample basis and 1358 small scale enterprises on a census basis across all industries in the manufacturing sector (Bala Subrahmanya et al. 2001).
The study found that 258 (about 40 per cent) micro enterprises and 716 (about 53 per cent) small scale enterprises had undertaken technological innovations primarily due to external factors such as competition, technological change, customer requirements,
and internal factor of selfmotivation. They were involved in both product and process innovations though emphasis was relatively more on product innovations than on process innovations.
and new services, new methods of production, and new ways of organizing administration. More than half of the increase in market share, competitiveness, profitability,
and new services. The above discussion brings out that no empirical study has probed explicitly the relationship between innovation and firm growth in the Indian context.
On the other hand, external factors such as customer requirements, information given by suppliers of equipments/materials, market opportunities, availability and accessibility of institutional support, economic incentives, competition, etc. might also prompt some entrepreneurs
investment and employment resulting in the growth of firm size. It is with the above theoretical framework that we have set the objectives of the study. 3 Objectives, scope,
To ascertain the growth rates of sales turnover, investment, and employment of innovative SMES vis-à-vis non-innovative SMES 6 To probe the relationship between innovation
Among the districts of Karnataka, Bangalore urban and Bangalore rural districts had the highest proportions of small scale industry (SSI) enterprises engaged in R&d and innovations.
& parts (37) industries had the highest proportions of SSI enterprises engaged in R&d and innovations (Bala Subrahmanya et al. 2001).
and data on economic variables such as employment, investment, sales turnover, etc. The validity and reliability of the questionnaire was ensured and based on the knowledge and experience of the authors,
based on a pilot study covering about 10 enterprises each in the three sectors, we did an item analysis for the questions excluding those
in order to set the stage for subsequent analysis. On average 90 per cent of SMES in all the three sectors were started as new ventures
/ME/Phd) is a significant feature of entrepreneurship of these SMES: 70 per cent entrepreneurs of auto, 69 per cent of electronics,
and/or to exploit market opportunities that majority of these entrepreneurs have setup their firms.
Their size characteristics revealed that size structure of the SMES was skewed more towards micro and small enterprises than towards medium sized enterprises.
and external factors such as customer requirements, information given by suppliers of equipments and materials, competition, etc. are responsible for a majority of SMES to innovate.
and market demand (demand pull) are important if innovations have to emerge. Given this it is appropriate to understand the dimensions of SME innovations.
In this context, a comparative growth analysis in terms of sales, investment and employment for innovative and non-innovative SMES is appropriate. 5 Innovative and non-innovative SMES:
growth of sales, investment, and employment The growth performance of SMES has been analysed in terms of sales turnover, investment, and employment.
The growth performance has been analysed for all the SMES of each sector for innovative and non-innovative SMES separately and within the innovative group of SMES, for innovative SMES
We have gathered data on sales at current prices as well as on employment and the current value of investment (in plant and machinery) from the SMES of auto
But the values of investment in different years represent their current values for the respective years
Small, and Medium Enterprises we derived the output deflator for 2005/6. Using this output deflator,
Table 7 presents the figures for the growth of sales, investment, and employment for innovative and non-innovative SMES.
It is clear that innovative SMES have registered a higher rate of growth compared to non-innovative SMES in terms of sales, investment,
In the auto component sector, both innovative and non-innovative SMES registered a higher growth of investment followed by sales and then employment.
In the electronics and machine tool sectors, sales growth was higher than that of investment and investment growth was higher than that of employment for both innovative and noninnovative SMES.
In the electronics sector, non-innovative SMES registered negative growth in terms of investment and employment. Overall, the growth analyses for the three sectors clearly indicate that innovative SMES are better off relative to noninnovative SMES.
If innovative SMES are compared better off to non-innovative SMES how do engaged innovative SMES in new products/processes compare with innovative SMES engaged in improvement of existing products/processes?
and grow in size of investment and labour would depend more on how far they have been able to satisfy their customers'needs and requirements rather than on the nature of innovations in terms of new products/processes or improved products/processes.
If improvement of existing products/processes as demanded/required by their customers is done appropriately it may prove to be more useful to increase sales than development of new products/processes.
What might be more decisive is customer satisfaction to expand the market base of an enterprise
and grow. Given this, it would be difficult to say whether new products/processes or improved products/processes are more helpful to SME growth. 6 Innovation
along with rate of growth of capital as well as that of labour, has a significant influence on the rate of growth of sales turnover of innovative SMES.
whether the former has any influence on enterprise growth. To ascertain the influence, we have carried out a regression analysis with the following equation:
Similarly, Kg and Lg are CARG of capital and labour, respectively, during 2001/2 2005/6 and ISP is average percentage of innovated products in total sales of individual SMES during 2001/2 to 2005/6.
We have used deflated values 12 for both GVA and capital (at 2001/2 prices. The analysis covers both innovative and non-innovative SMES.
which had investment in plant and machinery up to Rs. 1 million and 1 for the rest (since the investment limit for an enterprise to be considered small was Rs. 1 million,
as per the law of the Government of India, then). Since we have clubbed all the three sectors together for the analysis,
Since we did not find any statistically significant interaction effects of industries/sectors with the explanatory variables of labour and capital,
equally important is the increase in capital as well as labour. Thus if an innovative SME could expand the scale of production in terms of capital
and labour and achieve an increase in innovation sales, it will be able to experience a significant improvement in the growth of GVA.
and (ii) market pressure due to external factors like customer requirements and demand, information provided by suppliers of equipments and materials, market 13 opportunities, and competition.
Thus both‘technology push 'and‘demand pull'have contributed to the emergence of innovations. The major objective of SME innovations was enhancement of competitiveness in the form of quality improvement, cost reduction,
and the recognitions are confined largely to winning of awards from large enterprise customers and financial institutions.
Innovative SMES registered higher growth relative to non-innovative SMES in terms of not only sales turnover but also employment and investment in all the three sectors.
along with investment growth and employment growth, had a positive influence on GVA growth, in all the three sectors.
'The International Journal for Entrepreneurship and Innovation, 2 (3): 141 52.2005:‘‘Technological Innovations in Small Enterprises:
A Comparative Perspective of Bangalore (India) and Northeast England (UK)'.)' Technovation, 25 (3): 269 80.
Intellectual Property (IP) Rights and Innovation in Small and Medium-Sized Enterprises. Geneva: World Intellectual Property Organization. 14 Chaminade, C,
‘Managing Innovation in European Small and Medium-Sized Enterprises'.'Nijmegen Lectures on Innovation Management. Antwerp:
‘The Changing State of British Enterprise: Growth, Innovation and Competitive Advantage in Small and Medium Sized Firms'.
An Assessment of Enterprises in Industrial South Wales'.'Paper presented at the 41st European Regional Association Meeting, 29 august 1 september, Zagreb, Croatia.
The Economics of Industrial Innovation, Third Edition. London: Pinter. Harrison, N. J, . and T. Watson (1998).‘
‘The Focus for Innovation in Small and Medium Service Enterprises'.'Conference Proceedings of the 7th Annual Meeting of the Western Decision Sciences Institute, 7 11 april, Reno, NV, USA.
‘Technology, Innovation and Enterprise the European Experience'.'Paper presented at the Workshop of the ICSB 41st World Conference, 17 19 june, Stockholm, Sweden.
and Medium Enterprises (2007). Annual Report 2006/07. New delhi: Government of India. National Knowledge Commission (NKC)( 2007.
‘The State of British Enterprise: Growth, Innovation and Competitive Advantage in Small and Medium-Sized Firms'.
'Small Business Economics, 9: 523 37. UNDP (2001. Human Development Report 2001. New york: Oxford university Press.
'The International Journal of Entrepreneurship and Innovation, 2 (2): 111 18. Vonortas, N s, . and L. Xue (1997).‘
)* Noninnovative SMES (3)* Innovative SMES (51)* Noninnovative SMES (17)* Sales 18.86 7. 89 20.16 10.64 26.93 17.01 Investment 25.66 12.91
)**IP&P (25)**Sales 15.91 32.24 14.48 23.09 22.44 17.71 Investment 28.60 19.98 16.07 9. 49 20.17 24.39 Employment 13.95 16.79
Influence of innovation sales on enterprise growth Dependent variable: GVA growth Variables Coefficients Kg 0. 30 (4. 39)* Lg 0. 49 (6. 79)* ISP 0. 50 (4. 02)* DS
Innovation and growth of SMES Internal Factor (Firm Level competence)- Self-motivation-Technical education & entrepreneurship-Work experience-Innovative ideas External Factors (Market Pressure
)- Customer demand-Market opportunities-Suppliers of equipments/materials-Institutional support-Economic Incentives-Competition Technological Innovation in Products and/or Processes Cost reduction, quality improvement
, suitable changes in product size/dimensions or product diversification to suit customer demand, raw material substitution, new products Share of innovated products in total sales Growth of Sales
, Employment and Investment Drivers Dimensions Achievements Outcomes
OECD Health Policy Studies Improving Health Sector Efficiency The Role of Infor mation and Communication Tech nologies OECD Health Policy Studies Improving Health
Sector Efficiency THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT The OECD is a unique forum where the governments of 30 democracies work together to address the economic, social
and environmental challenges of globalisation. The OECD is also at the forefront of efforts to understand
such as corporate governance, the information economy and the challenges of an ageing population. The Organisation provides a setting where governments can compare policy experiences
Le rôle des technologies de l'information et des communications Corrigenda to OECD publications may be found on line at:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 FOREWORD This report presents an analysis of OECD countries'efforts to implement information and communication technologies (ICTS) in health care systems.
These ranged from foundational communication infrastructures to sophisticated electronic health record (EHR) systems. Within the OECD Secretariat
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Organero and Josep Pomar Reynés (Spain;
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Table of contents Abbreviations...9 Executive summary...11 Introduction...
33 1. 2. Reducing operating costs of clinical services...37 1. 3. Reports on cost-savings tend to be anecdotal in nature...
40 1. 5. Administrative processes such as billing represent in most countries a prime opportunity for savings...
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Chapter 3. Aligning Incentives with Health System Priorities Introduction...
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Annex A. Country case studies...127 The Great Southern Managed Health Network (GSMHN) in Western australia...
35 Box 1. 3. Benefits of investments in picture archiving and communication systems...36 Box 1. 4. Report on the costs and benefits of health information technologies in the United states (US Congressional Budget Office...
105 Box 4. 4. MAEHC turned consent to demand...109 Box 5. 1. Implementation efforts provide a picture of significant public investment...
113 8 TABLE OF CONTENTS IMPROVING HEALTH SECTOR EFFICIENCY: THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 5. 2. Criteria for the selection of indicators...
119 Box 5. 3. Adoption of basic and fully functional EHRS...120 Box 5. 4. Improving comparability of data on ICT in health:
76 Table 3. 2. Attitudes about payoffs according to main stakeholders...90 Table 3. 3. Attitudes about HIE in the United states according to main stakeholders...
93 Table 4. 1. Measures to address lack of interoperability by country...99 Table 5. 1. Current budget for ICT initiatives in three OECD countries...
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Abbreviations AHRQ Agency for Healthcare Research and Quality ARRA American Recovery and Reinvestment Act ASP Application service
Network GSMHN Great Southern Managed Health Network HIE Health information exchanges HIMSS Healthcare Information and Management Systems Society ICT Information and communication technologies IM
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 MAEHC Massachusetts e-Health Collaborative MOA Medical office assistant NEHEN New england Healthcare Electronic Data
Office System Programme QMAS Quality Management and Analysis System QOF Quality Outcomes Framework programme ROI Return on investment USD US dollars VCUR
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 EXECUTIVE SUMMARY Today the range of possible applications of information and communication technologies (ICT) in the health sector is enormous.
More than a decade of efforts provide a picture of significant public investments, notable successes and some highly publicised costly delays and failures.
and the United states) to identify the opportunities offered by ICTS and to analyse under what conditions these technologies are most likely to result in efficiency and quality-of-care improvements.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Findings illustrate the potential benefits that can result from ICT implementation according to four broad, interrelated categories of objectives:
Reducing operating costs of clinical services. Reducing administrative costs. Enabling entirely new modes of care. Increasing quality of care and efficiency A widely recognised source of inefficiencies in health care systems is the fragmentation of the care delivery process and the poor transfer of information.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 associated with preventable hospitalisations, provides, therefore, an opportunity for significant quick wins.
This was the case in Canada, where through the combined implementation of new approaches to care delivery, guidelines and the use of a web-based chronic disease management toolkit,
Reducing operating costs of clinical services ICTS can contribute to the reduction of operating costs of clinical services through improvement in the way tasks are performed, by saving time with data processing,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 turnaround time was reduced by 41%following the implementation of PACS.
Reducing administrative costs Administrative processes associated with health care such as billing represent a prime opportunity for savings.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 adoption and use by physicians, in 2007 the Australian Government introduced a range of incentives.
In May and June 2009, Medicare Australia also ran a targeted communication campaign to promote Medicare electronic claiming to the Australian public.
In rural Western australia, remoteness has increased the need to develop more integrated and comprehensive primary health services,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 identification of quality improvement opportunities. In the United states, the Massachusetts e-Health Collaborative (MAEHC) improved the electronic capture of laboratory,
or support them in making investments in ICT systems, limited resources can deter from pursuing these systems.
In particular since the costs and benefits associated with adopting new technologies are shared not equitably among stakeholders, investments
as well as a multiplicity of schemes introduced to facilitate interconnection and communication between specific ICT systems.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 unambiguous public health priorities with clear benefits and that would not have been achievable without ICTS.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Case studies indicate that subsidies are suited best to a situation where there is a clearly identifiable capital or fixed assets investment.
However, for many ICT projects, the most significant challenge is precisely the development of a sustainable business model.
once the initial investment has been made, what steps need to be taken to ensure that the ongoing costs of maintaining the system will be met?
when many of the economic benefits are going to be felt by payors and purchasers of health services?
but central to shared reaping of benefits from the investments made. The financial incentive packages in these countries are designed to insulate physicians from potential productivity and upfront financial losses from adoption of ICTS.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Achieving commonly defined and consistently implemented standards While health care organisations have access to an ever-increasing number of information technology products,
A variant to this approach, implemented at present only in Canada in a few provinces, has been to establish a certification process that targets vendors'products and services
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Enabling robust and reliable privacy and security frameworks Health information can be extremely sensitive and professional ethics in health care demands a strict adherence
and carry out the necessary associative studies to improve services for citizens. In addition, in most of the case study countries, compliance is complicated by multiple layers of regulations from central to local.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 separate regimes for public sector and private sector organisations and specific legislation applicable to entities which hold health records.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 that in many cases health institutions may use both ICT and more traditional practices simultaneously.
The challenges described above place health ICT investments in a space that is quite different from other capital investments in the health sector, for example a hospital building or medical equipment.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 One shared characteristic of the programmes reviewed here is that they were embedded all in wider reform projects,
and required the support of all stakeholders to achieve their goals. Successful adoption and use generally depended on the simultaneous implementation of new service delivery models, organisational partnerships, changes in GP compensation, clear and dedicated leadership.
for want of a better phrase, a sustainable business model which either adapts, or takes into account, the payment systems in place for health care services more generally.
Accelerate and steer interoperability efforts: agreement on and implementation of standardised EHRS remains a challenge,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 data from the patient's primary care record can facilitate greater efficiency
and the collaboration of the relevant stakeholders to establish standards and develop innovative solutions. Strengthen monitoring and evaluation:
and internationally comparable indicators to benchmark ICT adoption and ensuring that systems for monitoring ICTS are sufficient to assist in meeting the improvement goals.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 INTRODUCTION Policy makers in OECD countries are faced with ever-increasing demands to make health systems more responsive to the patients they serve,
reconciling rising demands for health care and public financing constraints in the context of rapid demographic and epidemiological change continues to be a dilemma.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 From 1990 through 2009, an increasing share of the gross domestic product (GDP) of OECD countries has been devoted to the provision of health care.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 These studies provide examples of the kinds of difficulties in continuity of care that confront patients and their families and caregivers due to the lack of adequate and timely exchange of information.
means that information and communication technologies (ICTS) that ensure the timely and accurate collection and exchange of health data are likely to foster better care,
Adoption has remained remarkably uneven despite more than a decade of promotion and significant public investment. There are large variations particularly in the adoption
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 often largely paper-based. Some of the variations are due to the costs associated with adoption of these new technologies.
which all reported varying degrees of success in deploying ICT solutions that ranged from foundational communication infrastructure to sophisticated EHR systems, plus a broad overview of the current literature.
Chapter 1 considers how investments in health ICTS can generate value for health systems. Drawing from case studies, Chapter 1 illustrates the types of benefits that can result from implementation of ICTS.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 technical, legal and organisational. Chapters 3 and 4 report on how governments are intervening to overcome these barriers
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 References Bates, D. 2002), The Quality Case for Information technology in Healthcare, BMC Medical Informatics and Decision making, Vol. 2
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Chapter 1. Generating Value from Health ICTS Chapter 1 illustrates the types of benefits that can result from implementation of ICTS.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Introduction Understanding how ICTS can generate value in health systems can help to guide decision about ongoing and future ICT initiatives,
underpin the business case for further investment and identify outcome drivers. The term value in this report implies a broader view of how ICTS can produce results than the usual metrics commonly used in return on investment analyses (ROI.
In the health sector there is often no measure of performance analogous to profits for private sector firms.
While a non-healthcare business selecting its investments in ICTS might consider only financial return on investment,
health care is a sector that places an unusual emphasis on nonfinancial goals. In health care, a standardised production process is difficult to identify,
or change the mix of services it provides, the resulting financial costs and benefits to the hospital will depend on how the care is delivered
however, a substantial opportunity: to improve health care quality and reduce health care costs through ICTS by improving the efficiency with
and reducing the delivery of services with little or no value. While the case studies are not perfect,
Reducing operating costs of clinical services. Reducing administrative costs. Enabling entirely new modes of care. CHAPTER 1. GENERATING VALUE FROM HEALTH ICTS 33 IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 1. 1. Health information technology can drive improvements in quality
and facilitate communication between providers have been cited as providing substantial benefits in health outcomes (Bates et al.,
) Communication between patients and providers is also vitally important for safety, especially at the hospital/primary care interface.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 These conditions require regular monitoring of patients to track trends in clinical parameters
In Canada, a relatively modest investment in IT has led to a major rapid change in diabetes care, yielding significant payoffs.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 1. 2. Improving compliance with clinical guidelines in British columbia In 2002, chronic disease research identified a problem of low adherence
The most frequently cited effect of ICTS on efficiency is reduced related to utilisation of health care services On efficiency,
or value for money, the most frequently cited positive effect is attributed to reduced utilisation of health care services.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 informing physicians about comparative effectiveness of alternative medical treatments.
This could offer a basis for ensuring that existing costly services are used only in cases in
which they confer clinical benefits that are superior to those of other, cheaper services. These benefits on utilisation of health services increase as more of the available decision support features are used,
and as the time horizon is lengthened (Government Accountability Office, 2003). Case studies show that the use of Picture Archiving and Communication systems (PACS)
This leads to increased capacity, more effective healthcare and more satisfied consumers (Box 1. 3). Box 1. 3. Benefits of investments in picture archiving
British Columbia has employed both quantitative and qualitative approaches to measuring the benefits of investments in PACS.
patient care, report turnaround time and communication. The survey was conducted in three provinces (Ontario, Nova scotia and British columbia),
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 regarding patient care, 80%reporting that PACS has reduced the time they had to wait to review an exam (images),
1. 2. Reducing operating costs of clinical services ICTS can contribute to the reduction of operating costs of clinical services through improvement in the way tasks are performed, by saving time with data processing, reduction in multiple handling
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 type of decision support tool adopted,
They related this gain to easier access to patient data, faster communication, and the availability of higher quality and more complete data.
while also allowing staff to provide new services that could help diversify the pharmacy's revenue base. 1. 3. Reports on cost-savings tend to be anecdotal in nature In the countries covered by the case studies,
It is also necessary to recognise that there may be lags between ICT investments and benefit realisation (Devaraj and Kohli
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The upshot is that while most of the case studies in this report had included some sort of formal evaluation to justify initial budgets,
see Box 1. 4). There is a clear need for a more organised approach to systematic research in this area to assist OECD governments to determine which investment strategies are most likely to achieve savings.
Although e-increased use of preventive services leads to higher, not lower, medical spending overall,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 As is the case with any modelling project and prospective estimates,
Despite the difficulty of measuring the cost-benefits associated with investments in ICTS, increasing numbers of health care organisations are reaping nonfinancial, intangible gains from these technologies.
In Western australia, together with confidentiality, speed of communication was the most commonly perceived intangible benefit (e g. the prompt receipt of discharge summaries from hospitals previously often arriving after the patient had been seen by the GP following surgery.
and higher quality of care including more patient satisfaction. 1. 5. Administrative processes such as billing represent in most countries a prime opportunity for savings Administrative processes such as billing
represent in most countries a prime opportunity for savings. Duplicative requirements and idiosyncratic systems can drive up the cost of care,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 paper transaction, after the introduction of NEHEN, were processed electronically at 25 cents per transaction (Halamka, 2000.
In May and June 2009, Medicare Australia also ran a targeted communication campaign to promote Medicare electronic claiming to the Australian public.
Although data was limited, in Western australia, physicians reported faster communication, fewer telephone calls, and savings in mail handling, stamps,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 pursuing health care reform agendas. In general, there are three broad goals
the implementation of ICTS to achieve change in primary care was combined without exception with the realignment of incentives as well as a strong business case intended to motivate the adoption of ICTS by the many diverse stakeholders.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 of physicians, and particularly of specialists, between rural and urban settings (Jackson et al.,
) In all six case study countries, telemedicine services are being used to great effect in areas with large rural or remote populations.
and physicians recognised an opportunity to extend stroke care services to the more scattered parts of the region.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Furthermore, the Balearic telestroke programme has turned out to be much more than just a technology project;
and processing can provide richer data in an accessible form that facilitates benchmarking and identification of quality improvement opportunities.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 documented adherence to quality assurance criteria and the efficiency of surveillance, population and outcomes research (Kukafka et al.
offers an opportunity to engage providers effectively and increase alignment between incentives programmes (Box 1. 6). Health authorities
It also offers an opportunity to engage providers effectively and increase alignment between incentives programmes,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 References Balamurugan, A. et al. 2009), A Pilot Study of Diabetes Education via Telemedicine in a Rural Underserved Community Opportunities and Challenges, Diabetes Educator, Vol. 35, pp. 147-154.
Balas, E. A. et al. 2000), Improving Preventive Care by Prompting Physicians, Archives of Internal medicine, Vol. 160, pp. 301-308.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Coye, M.,J. Ateret Haselkorn and S. Demello (2009), Remote Patient Management:
And Evolving Business models For Chronic Disease Care, Health Affairs, Vol. 28, No. 1, pp. 126-135.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Kukafka, R. et al. 2007), Redesigning Electronic Health Record Systems to Support Public health, Journal of Biomedical Informatics, Vol. 40, pp. 398-409.
Pan, E. 2004), The Value of Healthcare Information Exchange and Interoperability, Center for Information technology Leadership (HIMSS), Washington, D c. Pricewaterhouse Coopers (2007), The Economics of IT and Hospital Performance.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Solutions at Ten European Sites, DGINFSO, European commission, Brussels. Walker, J. M. 2005), Electronic Medical records and Health care
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Chapter 2. What Prevents Countries from Improving Efficiency through ICTS?
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Introduction The process of ICT implementation is a notoriously complex and expensive undertaking.
or support them in making investments in ICT systems, limited resources can deter from pursuing these systems.
In particular since the costs associated with adopting new technologies are shared not equitably among stakeholders, investments
as well as a multiplicity of schemes introduced to facilitate interconnection and communication between specific ICT systems.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 2. 1. Are there any financial gains to be made and if so, by whom?
) One significant barrier to investment in ICTS is recognised the widely fact that any resulting cost savings may not always accrue to the implementer,
and considerable investment is required both initially and on an ongoing basis. For many small to mid-size primary care practices this means that they cannot afford to implement an EMR system as the costs are often prohibitive.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 in many cases there is little or no financial incentive for them to do so, given that it is the payers
and purchasers of health care services that have the most to gain financially. While costs for these systems can vary from country to country,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 2. 1. Functional characteristics of an electronic health record One the basis of advice from an expert panel, in 2008
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Table 2. 2. EMR/EHR costs in the United states and Canada United states MAEHC (USD) Canada PITO (USD
the decision by physicians to adopt EHRS will depend both on the foreseeable financial returns on their investment,
Each model of payment generates its own incentives depending on how providers produce health services, how efficiently and equitably services are provided, the quality of care,
and how intensively patients make use of health services. CHAPTER 2. WHAT PREVENTS COUNTRIES FROM IMPROVING EFFICIENCY THROUGH ICTS?
57 IMPROVING HEALTH SECTOR EFFICIENCY: THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 In 2003 Wang et al. performed a cost-benefit study to analyse the financial effects of electronic medical record systems in ambulatory primary care settings at Partners Health care Systems
in Boston (United states. The authors reported that while some savings to the health care organisation were obtained under both capitated (or per capita) and fee-for-service (FFS) reimbursement,
and managing these health and business opportunities. On the other hand studies have shown that FFS schemes create incentives for GPS to provide shorter consultations
and more services than would otherwise be provided in an incentive-neutral environment. This means that they do not provide the appropriate incentive environment for physicians to engage in complex cases, co-ordination of care or in services outside of the traditional office visit,
such as phone consultations or using electronic media to communicate with patients. The empirical evidence that FFS payment schemes tend to result in the over-provision of services and the under-provision of coordinated,
complex care is now fairly persuasive (Gosden et al.,2001). ) FFS also creates a culture where the use of new technologies requires new fees.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 informed/shared decision-making are key components of the problem of introducing ICTS in these countries.
while specialist care provided in a hospital outpatient environment is salaried mostly. In a salary-based system, a physician is paid a fixed amount of money per hour worked.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 It is, therefore, in the interest of payers to help health care providers finance the switch to ICTS because of the benefits that would accrue both to themselves and to the people on
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 2. 2. Physicians'willingness to pay for electronic medical records in Ontario, Canada In 1998, the Centre for Evaluation of Medicines,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 implementation of standards and appropriate organisational changes are necessary to facilitate this process.
and services where patients interact with providers in a variety of settings (e g. GP practice, specialist office,
Even with such an investment, differences in the underlying architecture of EHR systems, and the way that the systems are configured
prospects are slim that private market competition alone will produce the necessary standardisation of EHRS as further discussed below. 62 CHAPTER 2. WHAT PREVENTS COUNTRIES FROM IMPROVING EFFICIENCY THROUGH ICTS?
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 2. 3. Dealing with legacy systems:
technical and information needs requiring additional effort and/or investment in research, development, testing, and evaluation.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 One key factor is that standard setting has the potential to regulate the market
which takes into account views from all stakeholders, may be very important as the choice of the standard could virtually eliminate, not merely disadvantage,
open source could provide a possible reference point 1. The term open standard as used here refers to the nature of the standard's development with multi-stakeholder input and broad industry recognition;
availability for use by all interested stakeholders (users, vendors; and the high level of access to its specifications for ready promulgation in a variety of hardware and software.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 for compatible information systems and ensure broader interoperability.
there is no assurance that this information will be conveyed reliably across different vendor systems or enterprises. Given these problems along with the changes in the marketplace and the proliferation of proprietary ICT tools,
Open source health care applications would provide healthy competition to the existing closed source commercial market, encouraging innovation whilst promoting compatibility and interoperation.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Mechanisms must, therefore, be found to enforce standards
and this limits the opportunities for reducing the error rate or cutting costs. Although Level 4 may be the ideal state
For frequently used services such as clinical laboratory tests, Walker et al. 2005) predicted that connectivity and effective HIE between providers
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Table 2. 4. Healthcare information exchange and interoperability taxonomy Level Attributes 1 Non-electronic data
2005). 2. 6. Privacy and security are crucial How health care organisations handle their digital information environment affects the uptake of health ICTS.
Sharing sensitive patient data in a large and heterogeneous environment through the use of web-based applications raises a series of privacy and security issues.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 well-publicised serious lapses in existing systems and stories about security breaches.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Restoring public trust that has been undermined significantly is much more difficult than building it from the outset.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 References Agency for Healthcare Research and Quality (AHRQ)( 2006), Costs and Benefits of Health Information technology, AHRQ, Rockville, Maryland.
A Systematic Review, Journal of Health Services Research Policy, Vol. 6, pp. 44-55. Government Accountability Office (GAO)( 2005), Health care:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Hammond, E. 2008), A Perspective on Interoperability, Paper presented at the conference on Making the e-Health Connection:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Walker, J. et al. 2005), The Value of Health care Information Exchange and Interoperability, Health Affairs, Supplement Web Exclusives, pp.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Chapter 3. Aligning Incentives with Health System Priorities Chapter 3 reports on how governments can intervene to promote the adoption and use of ICTS
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Introduction There are three ways governments can intervene to promote the adoption and use of ICTS:
economic incentives need to affect the cost-benefit structure of the economic activities of the target.
The emerging business models which might ensure that those who benefit from the success of the system also bear a fair share of its ongoing cost are considered.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 3. 1. A range of financial incentive programmes have emerged to accelerate ICT adoption As we have seen already, physicians,
The former are designed to affect cost-benefit structures and directly influence physicians'returns on investment.
or services related to the use of ICTS (e g. use of emails or telemedicine). Withholding payments from providers:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Table 3. 1 illustrates the use of these incentive mechanisms across the six case study countries.
These types of financial interventions are needed to defray upfront investment costs and initial productivity losses.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Despite the apparent simplicity of subsidies, they do pose some problems.
First, subsidies are suited best to a situation where there is a clearly identifiable capital investment. Second, sometimes it can be difficult to judge the appropriate level of a subsidy.
Ideally, public and private incentive systems should be aligned to maximise benefits, fostering long-term use and continued investment in ICT and health information exchange.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 3. 3. Payment differentials Payment differentials are bonuses
It was introduced in the United kingdom as part of the new General Medical Services (GMS) contract in 2004.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 One year after its introduction, QOF had made already a difference to the quality of patient care provided in two out of the three conditions that had been monitored routinely both before and after the introduction
The additional services domain: consisting of eight indicators across four service areas including cervical screening, child health surveillance, maternity services,
and contraceptive services. In 2004-05, GP practices were scored against 146 performance indicators, with clinical quality accounting for more than 50%of the total.
Each point earned had a financial bonus associated with it, and GPS stood to achieve additional income amounting to 30%of their salary.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The Australian Practice Incentive Programme The Australian Practice Incentive Programme (PIP) is blended a payment approach for general practice
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Figure 3. 1. Western Australian practices using IM/IT 0 25 50 75 100 Patient information
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Coordination during implementation to ensure that all the key aspects come together at the right times.
B c. Ministry of Health Services. Given the bottom-up approach for costing/reimbursement taken in British columbia,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Compensation for attending learning sessions Adoption of the CDM Toolkit is one component of the CDM Bundle, a series of learning sessions
Physicians and medical office assistants (MOAS) are compensated for their investment in making changes in their practices.
This fee enables the practice to use two-way telephone or e-mail communication with the patient or the patient's medical representative to follow-up case.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 clinical quality and other measures. The proposed regulation formally defining the requirements of meaningful use is expected to be published for public comment by the end of 2009.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 HIE infrastructure. According to the e-Health Initiative (ehi) Sixth Annual Survey of Health Information Exchange, the ARRA provisions have influenced already a number of health ICT efforts in the United states to consider becoming regional health
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 In addition, a Medical Group Management Association (MGMA) study found that for practices that have implemented EHRS,
and sustainable business model to motivate adoption and continued use of EHRS by physicians. CHAPTER 3. ALIGNING INCENTIVES WITH HEALTH SYSTEM PRIORITIES 87 IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 3. 4. Long-term sustainability and financing For many ICT projects, once the initial funding runs out,
the most significant challenge is developing a sustainable business model. Long-term sustainability and financing appear to be the most challenging and, in most cases,
and health information exchange benefits the various stakeholders, they will be placed better to see how fiscal and financial responsibilities could be shared equitably.
and achieving successful adoption with the economics of the approach often playing a secondary role.
Ultimately, however it is the economics and the value to society which will determine whether a system can survive or not.
whereas the more mature initiatives are faced with challenges about how to expand their services in a financially sustainable way.
Health care organisations, public or private, need to project a positive return on investment (whether financial or otherwise),
It would seem that the return on investment from implementation of ICTS should be relatively straightforward to assess
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 been involved in the intervention at all. One health care entity's short-term ROI may also be another one's loss.
Box 3. 3. Delayed benefit realisation Studies suggest that the financial benefits from ICT implementation are realised often only many years after the investment was made
and improved service efficiency followed on average two years behind initial health care ICT investment. The same study
however, concludes that the financial breakeven point will strictly depend on the levels of investment. Above a certain level of ICT investment or tipping point the cost impacts levels off
and is associated with cost reductions. The levelling off occurs despite the added costs of more ICT capital;
that is, ICT capital at some point pays for itself by displacing costs elsewhere in the hospital.
The European union's e-Health Impact Project, covering ten case studies in different countries and contexts, identified a 2: 1 return on e-health investment
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The changes needed to redress this situation require a more active role and a financial commitment of private payers and government.
which four general categories of business models appear to emerge: Not-for-profit: the not-for-profit initiatives are driven by their charter to help the patients and the community in
which they provide services. Their tax-exempt status can help to reduce funding challenges and costs, may also provide special tax credits/incentives.
The Great Southern Managed Health Network in Western australia is a good example. Public utility: these initiatives are created
and maintained with the assistance of central government/local state funds. This is the case of most European initiatives.
These initiatives can be set up as either for-profit or not-for-profit organisations; however, the key to this category is the collaboration between and mutual benefits for participating payers and physicians.
For-profit (often resulting from the conversion of a not-for-profit initiative at a mature stage:
for-profit initiatives are created with private funding. These organisations look to reap financial benefits from their transactions (envisioned as a future development in the case study in the United states.
and revenues and extract value from ICT implementation for each stakeholder will determine their sustainability in the long term.
therefore, an assessment of the viewpoints and respective roles of the main stakeholders but also clarifying
Table 3. 2 lists the viewpoints of main stakeholders on payoffs from ICTS in four of the case studies which are representative of the aforementioned models.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 subsidies or incentives they expected neutral or unfavourable returns from ICT adoption and use.
The sections below will consider in some detail the different business models and how they are attempting to achieve long term sustainability.
Table 3. 2. Attitudes about payoffs according to main stakeholders Payoffs according to each stakeholder Funding source Business model Case study Users Individual patients Society Payer E
-Messaging (Western australia) Neutral/Favourable (physicians, allied health professionals, nurses) Favourable Favourable Favourable Shared Not-for-profit Chronic disease management toolkit/EMRS (Canada) Neutral
OECD based on case studies. The public utility model The strategy of the Health Ministry in the Baleares (Spain) has been to adopt a public utility business model:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 health care in Spain clearly makes government a critical stakeholder in electronic health information and a benefactor to its potential positive impacts.
form the basis of a potentially sustainable business model. The not-for-profit model It is the nature of ICT projects that
if there are too few active participants scattered over a very dispersed area, it would no doubt be uneconomic to offer
or maintain services like the one offered in Western australia by the Great Southern health Managed Network (GSHMN).
and partnering with other community stakeholders (such as community groups, public health agencies, and others) to improve quality
The not-for-profit status of the GSMHN is an essential facilitator of the process.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The collaborative model A Health Information Exchange (HIE) is a multi-stakeholder organisation that enables
All stakeholder groups share the challenges and benefits of an HIE network model (see Table 3. 3 below).
2) building a sustainable business model to keep the HIE in operation once the initial money has been spent.
In this case the business model is as good as patients'willingness to allow their data to be shared in ways that clinicians
The business model also depends on incentives that adequately reward physicians for their participation in quality improvement activities
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 stakeholders, including physicians, health care institutions and community leaders,
Table 3. 3. Attitudes about HIE in the United states according to main stakeholders Stakeholder Major value Attitudes about HIE Major constraints Patients High-quality, affordable health care Favourable Privacy, confidentiality,
organisational, competitive Payors/Health plans Accurate patient and treatment information Favourable but concerned about ROI and investment expectations No immediate ROI and high upfront costs Pharmacies
Enhance efficiency and accuracy of drug delivery Favourable Financial, organisational Medical data repositories Accurate patient medical data Very favourable Other stakeholder co-operation Source:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 References American Medical Association (2009), H r. 1, the American Recovery and Reinvestment Act of 2009 Explanation of Health
Beaulieu, N d. and D. R. Horrigan (2005), Putting Smart money to Work for Quality Improvement, Health Services Research, Vol. 40, pp. 1318-1334.
A collaborative approach across multiple stakeholders. www. providersedge. com/ehdocs/ehr articles/States role in health inf o exchanges. pdf E-Health Initiative (ehi)( 2009),
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Mcinnes, D. K.,D c. Saltman and M. R. Kidd (2006), General practitioners'Use of Computers for Prescribing and Electronic Health Records:
Pricewaterhouse Coopers (2007), The Economics of IT and Hospital Performance. Stroetmann, K. A t. Jones, A. Dobrev and V. N. Stroetmann (2006), E-Health Is Worth It:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Chapter 4. Enabling a Secure Exchange of Information While health care organisations have access to an ever-increasing number of information technology products,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Introduction While health care organisations have access to an ever-increasing number of information technology products,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Figure 4. 1. Use of EHRS and of electronic discharge and referrals by Primary Care Centres in Finland and Norwegian Health
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 4. 1. Governments'role in the adoption of standards Many governments have set up specific bodies
Canada Health Infoway, an independent, not-for-profit corporation, was formed in 2001 by the Government of Canada to accelerate the development and adoption of information technology. 3. European commission Recommendation of 2 july 2008 on cross-border interoperability
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 4. 1. Compliance with standards:
The result of months of extensive consultations and collaborations with over 300 stakeholders across Canada
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 4. 2. Certification of products EHR product suitability, quality, interoperability,
not-for-profit organisation that certifies health IT products. HHS entered into a contract with the commission in October 2005 to develop
Each vendor sets up a test environment that replicates the live environment of its EHR system
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 testing to execute all the procedural steps in the published test scripts,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The timeframe and cost involved in certification
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Programme (POSP)( Box 4. 3). This list is updated from time to time
The role of the POSP is to enable physicians who provide insured services in Alberta to use electronic medical records to improve patient care
and to support best practice care delivery within Alberta's electronic health environment. Through a combination of funding, information technology services and change management services, POSP has helped nearly half of Alberta's practicing physicians to incorporate information technology into their practices.
Some of the initiatives that POSP supports include: Developing solutions to move patient data from one physician office system to another.
Working with stakeholders to update the Vendor Conformance and Usability Requirements (VCUR) for physician's offices.
These requirements are reviewed regularly to ensure they continue to reflect the needs of all stakeholders.
Collaborating with Alberta Health Services and Alberta Health and Wellness to ensure integration and interoperability with provincial systems (e g. the Pharmaceutical Information Network (PIN), lab test results and diagnostic imaging text reports).
Providing a broad range of change management services to support those physicians who are automated already,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Both POSP and the VCUR programme are recognised as being critical components of the high adoption rates of EHRS by GPS in Alberta.
G. W. School of Public health and Health Services, 2009. There is, therefore, a need for coherent and consistent policies around the storage, exchange,
because stakeholders may have differing views of what can be shared and with whom. The implementation of security requirements is proving particularly challenging (and cumbersome) in the context of EHRS,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 country consistently noted that privacy and security concerns were an overriding factor in every aspect of the technology deployment from start to finish.
and carry out the necessary associative studies to improve services for citizens. To overcome some of the obstacles to the secondary use of data,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Four options can be considered in making the decision about
To address this concern the MAEHC adopted a turning consent to demand approach investing significant resources in an information campaign (Box 4. 4). The extensive privacy protection measures
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 4. 4. MAEHC turned consent to demand Following extensive discussion within the MAEHC's own privacy and security committee
As such, patient recruitment became a preeminent concern for the HIE enterprise, if it was to be viable.
To address this concern the MAEHC adopted a turning consent to demand strategy investing significant resources in an information campaign
The input received from the focus groups guided MAEHC's further communication strategy and consent process in the three communities.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 References Beckerman, J. Z. et al. 2008), Health Information Privacy, Patient Safety, and Health care Quality:
G. W. School of Public health and Health Services (2009), Patient Privacy in the Era of Health Information technology:
Overview of the Issues, G. W. School of Public health and Health Services, Washington, D c. Goldman, J. 1998), Protecting Privacy to Improve Health care, Health Affairs, Vol. 17
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Chapter 5. Using Benchmarking to Support Continuous Improvement This chapter reviews the principal information needs of policy makers
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Introduction As discussed earlier in this report, evidence of the impact of health ICTS remains limited.
The result is that after more than a decade of large investments in health ICTS, OECD governments are still unable to provide reliable evaluations of the financial and social returns on their investments.
This chapter reports main findings of an analysis of the challenges associated with the measurement and evaluation of ICT use in health care in nine OECD countries and at EU level (OECD, 2008.
and realise the benefits intended from investment in these technologies? On the surface, the answer appears simple.
Nonetheless, more than a decade of implementation efforts provide a picture of significant public investment (Box 5. 1),
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Box 5. 1. Implementation efforts provide a picture of significant public investment Health ICT investments costs are difficult
ranging between 0. 1%to 0. 3%of total expenditure on health in the three countries investment per capita varying from USD 5 to 13.
In a strategic planning document, Canada Health Infoway in 2006 reported a rough assessment of total investment costs per capita to establish a fully functional EHR system that ranged from an estimated CAD 133
and the United kingdom. Striking in both the Infoway and Anderson estimates as well as those from this present study shown below (see Table 5. 2) is the relatively large per capita health ICT investment in the United kingdom
therefore, inevitably underestimate the true public investment. Other countries may well be investing comparable amounts per capita
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Table 5. 1. Current budget for ICT initiatives in three OECD countries United states Canada Australia Agency/initiatives
) 76 8274 (8. 7%of GDP) Current budget for ICT initiatives (million USD at exchange rate) 2 0615 4556,7 1158,9 Current investment per capita (USD) 10
20 74812 Total investment per capita (USD) 54.34 340.27 Note: The budget allocation amounts shown for Canada in both Tables 5. 1 and 5. 2 do not include 25
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The main information needs today as listed by policy makers in response to an OECD questionnaire are reflected in the areas encircled in Figure 5. 1 below.
There is likely to be some demand for all three types of indicator, but priorities will differ over time.
These questions address the state of readiness of the environment. 116 CHAPTER 5. USING BENCHMARKING TO SUPPORT CONTINUOUS IMPROVEMENT IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Use refers to the applications of the technologies in clinical activities,
and to improve the quality of health care services provided to patients (impacts). CHAPTER 5. USING BENCHMARKING TO SUPPORT CONTINUOUS IMPROVEMENT 117 IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 With the exception of Finland, where ICT adoption has been monitored since 2005 on an annual basis and across various segments of the health sector,
although there appears to be some demand for indicators to track population access to ICTS,
the Services Industries surveys undertaken by the Australian Bureau of Statistics and a 2008 mail survey of office-based physicians by the National Center for Health Statistics (NCHS) in the United states (the purpose was to obtain a preliminary estimate of use of EMRS by GPS).
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The scope of the surveys and the methodologies used
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 5. 3. Common information needs are reflected in a core set of widely used indicators The OECD analysis clearly shows that the way countries are currently monitoring ICT
Variation in the level of readiness can create a significant barrier to the entire enterprise of regional/national integration.
and opportunities to promote efficiencies and reduce redundancies in the establishment of a national/local e-health strategy.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Installation, training and support. Increased capacity for ICT services.
Support for organisations whose state of ICT-readiness is low. Opportunities to leverage shared capacity.
To steer and stimulate adoption and use of ICTS A first challenge for many countries is the adoption gap, particularly in relation to the use of EMRS/EHRS.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Figure 5. 2. Rates of adoption of electronic health records by physicians in the United states, 2007 0 25 50
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 some importance, much importance) are inevitably qualitative in nature and limit the use of these indicators for purposes of international comparisons.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Developing and implementing a model survey (OECD,
and has proved successful in establishing a common set of guidelines to measure ICT usage in enterprises
since different questions, wording or explanations may be necessary in different environments. To be useful in all contexts,
self-contained modules to ensure flexibility and adaptability to a rapidly changing environment. While the use of core modules allows measurement on an internationally comparable basis,
self-contained modules to ensure flexibility and adaptability to a rapidly changing environment. While the use of core modules allows the measurement on an internationally comparable basis,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 References Agency for Healthcare Research and Quality (AHRQ)( 2007), Health Information technology for Improving Quality of Care in Primary Care
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Hwang, J. et al. 2007), Disruptive Innovation In Health care delivery:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 samhandling i helsetjenesten, Dokument nr. 3: 7 (2007-2008), Riksrevisjonen, Oslo.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Annex A. Country case studies The Great Southern Managed Health Network (GSMHN) in Western australia Key achievement The GSMHN is delivering web-based
In providing these services GSMHN has established also one of the few examples in OECD countries of a not-for-profit self-sustaining e-health network where health providers pay an annual fee to join the information exchange.
The University of Western australia's Centre for Software Practice (UWA Centre) provided dedicated technical support under a not-for-profit partnership agreement.
in the form of a financial incentive, the take-up of broadband services in general practices in the region.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 High rates of basic computerisation A 2001 study found that 86%of Australian general practices had at least one computer
Background and benefits The Great Southern Managed Health Network (GSMHN) was established in 2007 as a not-for-profit association between the Great Southern General Practice Network (GSGPN) and the University of Western australia (UWA) Centre for Software Practice.
and impacts of electronic messaging have been noted by GPS, allied professionals, staff in hospitals and the Western australia Country Health Services.
Together with confidentiality, speed of communication was the most commonly perceived benefit (e g. the prompt receipt of discharge summaries from hospitals previously often arriving after the patient had been seen by the GP following surgery.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 unavailable, at least routinely), faster communication, higher quality of data and more complete information.
Providing access to health services in WA presents, therefore, many challenges. These include: Hiring and keeping doctors:
Achieving economies of scale and viability of services in a dispersed or isolated population: recent evidence suggests that a critical minimum population base of about 5 000 inhabitants for rural regions
and of 2 000-3 000 people for remote communities is necessary to support quality assurance in services and a comprehensive and sustainable range of health care services.
Improving access to specialist services, mental health services and aged care: access to specialist services remains a problem for many residents of isolated settlements
which often have to relocate to utilise these services. Inability to readily access specialist services when required can result in health needs not being met adequately, lack of continuity of care and worse health outcomes.
The poorer health status and higher mortality rates in the Kimberley region compared with the state's average is attributed largely to poor access to secondary and tertiary health services
and the greater health needs of the local aboriginal population. 130 ANNEX A. COUNTRY CASE STUDIES IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The challenging circumstances of rural Australia have resulted in unprecedented innovation in health care service delivery over the past ten years,
which can be classified according to three broad categories. Integrated services provide single point access to a range of services significantly broader than those delivered by general practice.
They comprise a variety of models. For example, the shared care model of mental health care addresses access to and co-ordination of services across primary and specialist care.
Comprehensive primary health care services are typified best by the Aboriginal Community Controlled Health Services (ACCHSS. ACCHSS have adopted a primary health care approach to healthcare delivery over the past 30 years,
which includes preventive and health promotion activity, as well as education and capacity building. Outreach models are characterised by the periodic supply of a range of health services from one location
which has these services to other locations which do not. The arrangement may include either a hub and spoke arrangement,
where a centrally located service provides services to satellite communities or some other visiting mechanism, such as where a GP resident in one community may visit a second community for short periods.
Services can also be supplied on a virtual basis (virtual outreach) or on a fly-in
fly-out basis. Policy context and sustainability The 2007-10 strategic plan for Western australia's Country Health Service includes plans for:
which specifies regional health networks and roles for hospitals and health services within these networks.
Integration of services by achieving greater collaboration between medical, nursing and allied health staff across regions,
Effective care networks in each region by strengthening outreach services including through telehealth. The Divisions of General Practices (DGP) have received substantial funding to support adoption of health IT
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Incentives Programme (PIP) which is one of the most comprehensive and flexible primary care incentive programmes established to date in any OECD country.
Governance The GSMHN is a not for profit collaboration between GSGPN and the UWA. The University was not new to this type of partnerships as it had managed for over three decades population health data in Western australia on behalf of the Department of health.
It was acknowledged that the UWA Centre for Software Practice had been a critical, if not major factor in the successful implementation of the project, both for the enthusiastic dedication of its staff, the not for profit nature of the partnership and the extensive expertise in software
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Physician Connect and the chronic disease management toolkit in British columbia (Canada) Key achievement Today Physician Connect links private physicians to the health authority via a low-cost,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Incremental change Experience with homegrown systems and a supportive environment contributed to acceptance and successful implementation of EMRS.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 toolkit experience enabled providers to produce more integrated and efficient care,
With diabetes alone, one of the most common chronic diseases in the province and steadily increasing, the direct cost of providing health care services for people with complications is approximately CAD 776 million each year.
the Physician Connect effort has created a value proposition for all key stakeholders. These include: For patients Enhanced health outcomes and quality of life through early and accurate delivery of appropriate medical services.
For family physician practices ICT enables a comprehensive chronic disease management approach Automated tools to support changes in care delivery,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Policy context and sustainability The overall approach to chronic disease in British columbia includes two interrelated and complementary strategies, 1) the Framework
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The Massachusetts e-Health Collaborative in the United states Key achievement The Massachusetts e-Health Collaborative (MAEHC) successfully supported the implementation of electronic
A close community relationship The health ICT effort was based on extensive stakeholder consultations and took account of the varying needs and objectives of the three communities.
and associated legal services. Budgeting for such support was generous typically about one-third of total expenses.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Addressing privacy and security concerns A dedicated privacy
Background and benefits The Massachusetts e-Health Collaborative (MAEHC) was formed in 2004 as an initiative of the physician community to bring together the state‘s major health care stakeholders for the purpose of establishing an EHR system through community-based implementation
as well as practice support to ensure smooth transition to the digital environment. Developed community-level HIES custom built
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Business case In Massachusetts, a baseline survey done in the spring of 2005 found that
This provides a unique opportunity to invest in maturing HIE initiatives and making them sustainable.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 The MAEHC's original BCBSMA funding is exhausted nearly as the community pilots draw to a close.
As such the new national and state legislation supporting health ICTS has left the MAEHC ideally positioned to be eligible for funding by providing a range of health ICT implementation services.
It can provide the services at two levels. Either through incentive payments to physicians for EHR implementation or through state grants as supporting a state designated HIE or other entity.
To this effect, MAEHC has launched successfully a for-profit subsidiary to provide consulting services related to EHR deployment
and project execution services. Governance The MAEHC is a public/private collaborative of providers, payers, associations,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Telestroke in the Baleares (Spain) Key achievement The Balearic health authority (Ib-Salut) has implemented a telestroke programme
The guiding vision of the plan to deliver equal access to health services regardless of patient location
Garnering stakeholder buy in Although the technology to build and operate a telehealth programme for stroke patients was available,
stakeholders from the various hospitals and health authorities had to be convinced of the potential benefits of the programme.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 via telestroke system and are receiving emergency stroke expertise from the lone stroke unit hospital in the region, Son Dureta in Palma.
The use of telestroke services also seems to reduce inappropriate variations in practice. Business case Stroke is the leading cause of death for women and the third leading cause of death for men in the Balearic islands.
Combined with an average annual cost per patient upwards of EUR 30 000 and a population of just over 1 million in the Balearic region the cost of stroke could take a heavy toll on the local economy.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 statement of the overall aims and goals of stroke management agreed upon by THE WHO to be achieved by 2015.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 with the region's only specialised stroke unit, serves today as the hub with connections to the smaller hospitals in the other islands.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 E-prescription in Sweden Key achievement A national e-prescription system has been deployed connecting all of the pharmacies in the country to a majority
Early adopters within an innovation-friendly environment Swedish pharmacists had been experimenting with e-prescription since 1981,
and vendors who are connected to Sjunet and use it both for telemedicine and administrative communication.
The network infrastructure allows secure communication and distribution of patient data pictures, medical applications and services for
which the Internet is not acceptable. Subsequently, in 2001 when the first large scale e-prescription implementation effort began in Stockholm county,
the vital communication link between physicians and pharmacies was already in place. As a result, technical implementation of e-prescription was focused largely on designing, developing,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Close co-operation between all stakeholders Apoteket's implementation strategy emphasized the partnering with local health regions (County Councils), physicians,
and other local stakeholders. To achieve this, Apoteket formed implementation teams in each county across the country.
The start to finish local implementation approach created the necessary stakeholder relationships, bonds, and buy in that are essential to any technology project.
In effect, creating and cultivating a consumer demand. Background and benefits The first Swedish efforts in e-prescription date back to 1981 with a national working party, in collaboration with the county hospital in Jönköping.
Made e-prescription services available virtually throughout the country. Deployed a national e-prescription mailbox allowing patients to store all their prescription drug information.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 process. The traditional paper prescriptions required over a dozen daily clarifications between individual pharmacists and physicians due to illegibility, unclear short hand,
Low degree of detailed regulations, giving high responsibility to stakeholders, beneficial for the entrepreneurial development of the new technology.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 To this effect the e-prescription programme has accomplished the major goals.
However, ICT policies and e-prescription will continue largely intact with the formation of a new company, Apoteket Services
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Implementation of a Patient Summary Record System in Twente (The netherlands) Key achievement The pilot project established the foundations for the electronic transfer of patient
What investments are necessary and what costs will be incurred by physicians? What are expected the benefits? The results were used to decide between specific implementation approaches or strategies,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 also introduced a national unique patient identifier:
technical and information needs requiring additional effort and/or investment in research, development, testing, and evaluation.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 It appears that the availability of patient information,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 implemented a regional service that allowed electronic communication between GPS and other local healthcare providers.
and IT sector stakeholders and also serves as an 152 ANNEX A. COUNTRY CASE STUDIES IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 independent expert organisation providing guidance on infrastructure and standards related to the national EHR effort.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Annex B. Project background and methodology This report builds on activities carried out under two distinct but overlapping work streams.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Person (s) responsible for the development, implementation and evaluation of the programme/project which the case study addresses.
of Infor mation and Communication Tech nologies Despite the promise they hold out, implementing information and communication technologies (ICTS) in clinical care has proven to be a very difficult undertaking.
More than a decade of efforts provide a picture of significant public investments, resulting in both notable successes
and some highly publicised costly delays and failures. This has been accompanied by a failure to achieve widespread understanding among the general public and the medical profession of the benefits of electronic record keeping and information exchange.
Sweden and the United states to identify the opportunities offered by ICTS and to analyse under what conditions these technologies are most likely to result in efficiency
Overtext Web Module V3.0 Alpha
Copyright Semantic-Knowledge, 1994-2011