but much more remains to be done. ehealth technologies enable the delivery of higher quality and more efficient services to European citizens,
by supporting personalised therapies and by implementing innovative telemedicine services. The smart use of technologies
Ultimately, ICT should enable users to better manage their health and lifestyle, with improved quality of services and reduced healthcare costs.
telemedicine services should be deployed widely. To reach these objectives, the ehealth Network, which is composed of Member States'representatives,
the ehealth Action Plan 2012 2020 will support Member States in bringing forward Interoperable ehealth services within and between national healthcare systems.
On a practical level, ehealth services, just as other electronic public services, rely on digital infrastructure: effective and fast broadband connections are key to the spread of telemedicine services.
In 2011,95%EU citizens had basic broadband access, meaning that the Digital Agenda for Europe's target of 100%broadband coverage for all Europeans by 2013 is well on track.
The project is currently testing how to make the patient summaries securely accessible to the European emergency services (112 emergency number) and the potentialities of the European Health insurance card
2011-2014 11 The widespread usage of telemedicine services based on interaction between doctors and patients or among health professionals through electronic media is an opportunity for citizens and a driver of great economic impact.
However, despite a general level of maturity in telemedicine applications and Personal Health Systems (PHS) devices which enable the provision of personalised health services regardless the patient's location the market is developed not yet on a large scale.
The Renewing Health project seeks to deliver telemedicine and PHS services to the large segment of the population suffering from Chronic obstructive pulmonary diseases (COPD), diabetes and cardiovascular diseases.
and evaluation of innovative and patientcentred PHS and telemedicine services using a common rigorous assessment method (MAST).
and telemedicine services are sustainable and improve the quality of life. Moreover, they enable patients'involvement and empowerment while optimising the use of resources in healthcare provision. epsos epsos has the aim of at improving medical treatment of citizens while abroad by providing healthcare professionals with the necessary electronic patient data.
the project provides the foundation for evidence of the effects of telemedicine services and PHS.
2010-2012 12 The attitude of the end user is key to allow the diffusion of telehealth services.
and coordinate the management, organisation and delivery of health and care services related to diagnosis, treatment, care, rehabilitation and health promotion.
To this end, the project assessed deployment of four innovative Integrated Care Services (ICS) for chronic patients (respiratory,
Greece and Norway where it developed insights into local structural and operational barriers to overcome for further development of Integrated Care Services.
Development of Integrated Care Services for chronic patients with enhanced effectiveness and reduced costs; Consolidation of an open source modular Health Information Sharing Platform supporting organizational interoperability among actors and clinical decision support systems An innovative business case Strategies for scalability of the ICT
services at regional level http://www. nexeshealth. eu Funded by the ICT Policy Support Programme (ICT PSP)- Competitiveness & Innovation Programme (CIP) Duration:
The pilot project Dreaming developed a solution that integrates different services (such as tele-care, tele-medicine and elderly-friendly videoconference),
The services were tested in six pilot sites across Europe over the last 24 months of the project.
The final results showed that the services were accepted well by the trial participants, whose majority experienced an increased sense of security. 15 DREAMING DREAMING integrated familiar devices-such as blood pressure cuffs, mobile phones and TV-in a single platform.
2008-2012 In the same field, the recently ended Living Lab on Wellbeing Services and Technology project,
Runtime support, a software environment providing services for the execution of AAL applications. Development support,
and SMES with the research base to develop products and services for innovation in healthcare.
and services can automatically adapt their user interface to the specific impairments and preferences of elderly users.
GUIDE puts a dedicated focus on the emerging Web & TV platforms and services (Connected TVS, Set-Top Boxes, etc..
Online delivery of basic services to citizens (e g. personal documents and certificates, income taxes and job search tools) and businesses (e g. company registration, social contributions, corporate tax, VAT) help
there has been a steady increase in the interactive use of these services, such as the downloading of official forms
and specific needs, such as services for online registration of new companies or getting the unemployment rights, are met not yet fully.
The objective is to empower users to actively contribute to the production of egovernment services or even policy-making.
so that citizens and businesses can benefit from on-line services in other EU Member States as easily as they do at home,
the personalisation of services to better respond to users'needs and the promotion of more open, proactive and transparent administrations.
The Plan is requesting Member States to formally agree on a common list of key cross-border public services and implement seamless crossborder e-Government services in the EU single market.
STORK has developed a European Electronic Identity (eid) Interoperability Platform allowing citizens to use their national electronic identities to access public egovernment services in other Member States, in full respect of data protection
The project STORK 2. 0 now aims to expand the identification services to legal entities, representatives and mandates,
It thus builds a basis for a future widespread use of eid solutions across borders contributing to Europe's leadership in eid market. eprocurement is one of the high impact services with the potential to represent an important portion of Europe
services and works by the EU public sector is estimated to be almost 20%of EU GDP (2010 figures).
Also called‘Virtual Company Dossier',this STORK 2. 0 Cross-border eid services in real life settings (pilots in elearning and Academic qualifications, ebanking, Public services for Businesses and ehealth
building blocks and services and promoting implementation across Europe. The European services sector accounts for 75%of the EU's GDP and employment,
and the 4. 4 million firms in this sector generate 95%of all new jobs. Benefiting from the results of PEPPOL and the STORK Large scale Pilot
SPOCS seeks to build the next generation of Points of Single Contact (PSCS) intermediaries between services providers and national public administrations as foreseen in the Internal Market Services Directive.
and the interoperability between national egovernment services is poor. In this context, SPOCS has been aiming to take down barriers to cross-border business
the proposed Connecting Europe Facility (CEF) sets as one of its main goals the interconnection of national digital services infrastructures to unlock the potential of European public services.
The proposal foresees to support investment in the provision of cross-border digital services in key areas including eprocurement,
It was very important to collaborate closely with the STORK project on the recognition of electronic identity for anyone accessing the services network. 1 http://ec. europa. eu/budget/reform/documents/com2011 0665 en. pdf ECRN The project's main objectives were:
and social networking) to pilot a range of citizencentred services (e g. searchable inventories on national migration policies and related legislation).
Immigrationpolicy 2. 0 The projects proposes a single entry point to a range of services,
Data repositories Search Services Knowledge Harvesting and Content Extraction Services A Governmental Management and Modelling Service (GMMS) Migration Policy synchronization and homogenization services Open Debate
Suport Services (ODSS) http://www. immigrationpolicy2. eu Funded by the ICT Policy Support Programme (ICT PSP)- Competitiveness & Innovation Programme (CIP) Duration:
monolithic architecture models make it difficult to reuse services for the development of new applications. What if these services were connected
and the access to information opened up? The European commission is currently testing the potential of a Cloud of public services for the development
the project plans to demonstrate the ability to build more intelligent services by using and combining data integrated seamlessly through the Cloud.
It will assess the business benefits for both public and private organizations of developing new collaborative services in areas such as transport and mobility, localization and geographic information,
and deploy services, as part of a Cloud of e-Government services that supports the granting of environmental licensing procedures to citizens and businesses.
At the same time it supports public participation, consultation and transparency in policy making. http://www. eenviper. eu/32 In many regions of Europe,
or impossibility of finding information and services provided by local public authorities on the internet.
and businesses information and better adapt public e-services to the needs of people and businesses.
thus seeking to make services more accessible, user-friendly, efficient and less expensive for the taxpayer. 33 Living in a secure and trustworthy society The concern for security is as old as humankind.
ICT services and devices have become an integral part of our way of life, and even of our culture.
and provide citizens with the trust in ICT services and devices, a twofold approach is needed:
or attack on, our services and devices. To meet this requirement, the European commission will propose the EU's Strategy for Cyber security.
and trust services for electronic transaction in the internal market to boost the user convenience, trust and confidence in the digital world. 2 The investment in research and development of secure, trustworthy and privacy-protecting ICT.
participation in virtual communities or the use of personalised services, maintaining lifelong privacy control. To date, credentials such as digitally signed pieces of personal information or other information used to authenticate
2010-2014 38 Secure and trustworthy service infrastructures Today, tens of millions of users rely on the internet to do business and access a wide variety of applications and services.
Examples include banking transactions, voice over ip, e-government services, e-commerce and business-to-business interactions. Trustworthy applications and services,
and their underlying software-based service platforms, are a prerequisite for the use and uptake of innovative business models and services that benefit the further development and growth of the European economy.
The Future Internet will provide an environment in which a diverse range of services are offered by a diverse range of suppliers.
Users are likely to unknowingly invoke underlying services in a dynamic and ad hoc manner. Moving from today's static services,
we will see service consumers that mix and match service components depending on attributes such as availability, quality, price and security.
Thus, the applications that end users see may be composed of multiple services from many different providers. The consequence is that the end user may have little guarantee that a particular service
or service supplier will actually offer the security claimed. The ANIKETOS project will help to establish
The project is aligning existing and developing new technology, methods, tools and security services. Tabula rasa (Trusted Biometrics under Spoofing Attacks) The project will:
and trusted composite services. ANIKETOS The project is addressed to all service users, developers and suppliers.
the establishment of a commonly agreed methodology to quantify the energy and carbon footprint of ICT goods, services and companies;
and ITS (intelligent transport systems) applications and services can bring to safer, cleaner and more energy-efficient mobility of people and goods. Green ITS can have a significant positive impact on road transport,
which has developed new information tools and services to help turn citizens into active energy-saving players.
ESESH is providing ICT-based services directly to tenants, allowing them to quickly and easily obtain information on their energy consumption through a web-based platform. http://esesh. eu/project/Funded by the ICT Policy Support Programme (ICT PSP)- Competitiveness & Innovation Programme (CIP) Duration:
A Green IT Service Centre is an infrastructure for executing business services and a repository for the storage, management,
It enhances existing deployment strategies by moving computation and services around a federation of data centres sites.
and services for energy efficiency) The project will tackle three main causes of avoidable energy use by road vehicles:
In manufacturing and services, this leads to various types of reorganization of value chains for efficiency reasons,
Impact on transport demand (persons) Use of E-services: shopping, banking, education, entertainment, government services On-line, last minute, booking (flights, hotels, holidays,
theatre) Reduces travel needs for routine transactions, but may cause increase of travel demand to central places with high-level services (e g. to enjoy shopping experience).
May add extra mode. Causes new travel demand due to lower consumer prices. Use of E-networking in social relations:
Layer 2. Services on the infrastructure Public transport services, services for maintenance and transport management Public transport companies Operators of links and nodes ICT system manufacturers Public authorities
Providing/preventing access of public transport services to persons Matching different services. Layer 1. Physical infrastructure (links and nodes) Rail
In advanced modes, opening times of facilities (shops, services, etc. and the length of stays are used as an input,
Micro-enterprises and SMES benefitting from a voucher can exchange the latter against ICT services, including services from private companies,
universities, research centres and other accredited ICT knowledge and service providers. The voucher provides the company with easy access to specialist services,
such as creating a business website and using it profitably, learning to use e-commerce tools to buy or sell,
support and advice received from senior officials from the Health Services Executive, the Department of health and Children, the Department of Finance and the Health Information and Quality Authority during the preparation and review of the report.
Health Service Transformation cannot be achieved without ICT The HSE Transformation Programme calls out six transformation priorities that refer to easily accessible integrated health services,
we will also begin to position Ireland as a world class supplier of healthcare services and healthcare ICT systems for the global market.
and our cancer services are reaching world class standards with increasing survival rates. The substantial progress achieved has recently been indicated in the Euro Health Consumer Index 2009,
where Ireland has made a significant improvement to 13th place out of 33 European health services reviewed.
In the UK and Europe, there is considerable effort to manage the growth of private healthcare services.
Opportunities for shared services have not been exploited, with excessive levels of staffing across multiple procurement offices, labs and other facilities.
and strategy for healthcare, including elements such as public health education and improvement, engaging all stakeholders in the planning and delivery of healthcare services,
and services that they have confidence in and staff are proud to provide. The expectation that citizens have of healthcare services continues to rise,
and steps need to be taken to understand and respond to these demands. Advances in medical science, especially in the areas of diagnostics, therapeutic medicines and surgical procedures, are suggesting a future where many medical conditions will be predicted,
the adoption of mobile and digital services in other areas of life will cause many to question why they have to travel to obtain medical care,
-Right Patient, Right Medication, Right Dose, Right Route, Right Time‘Effective'is about providing services based on scientific knowledge, also known as evidence-based medicine.
and best practices for the better management of certain conditions. 4. 8 Telemedicine Telemedicine consists of a series of technologies that enable care services to be provided remotely.
The Secretaria Municipal de Saúde de Belo Horizonte (SMSA-BH), reorganised its citywide health services and defined nine health districts that each serve a certain geographic, population
) in hospitals Ambulatory Care Level Enable the delivery of healthcare services in the patient's home through home health monitoring Availability of entire healthcare record at any ambulatory care facility the patient attends,
By driving the more effective delivery of high calibre services from the overall investment in our health service,
or consumers of medical services, depending on their capabilities and capacities. Clearly one of the factors that will influence Ireland's reputation in those markets is our competitive position in all aspects of modern medicine,
helping us become a world-class supplier of healthcare services to the rapidly growing international market.
we will also begin to position Ireland as a world class supplier of healthcare services and healthcare ICT systems for the global market.
but rather in the supply of finalassembly services, which form only a small portion of the iphone's final price.
To ensure the adoption of new healthcare services, the new innovative technologies need to be complemented with new methods that can help patients to establish trust in healthcare service providers in terms of privacy, reliability,
This paper sketches various lines of research for the development of trusted healthcare services namely, patient compliance, reliability of information in healthcare,
and user-friendly access control. 1 Introduction The high bandwidth connectivity provided by the Internet enables new services to support citizens in their daily lives.
An important category of these services is healthcare services. The first examples of these services already exist today,
and soon new services will emerge offering increased sophistication and improved but cheaper healthcare. An exponential growth of these services is expected, due to two tenden-cies.
First, demand for care and cure will increase over the next decades caused by the ageing population (within 40 years,
one in every four people will be over 60). Secondly, the number of healthcare workers is expected to diminish relative to the total population (without changes to the healthcare system,
New ICT supported healthcare services can overcome this problem by allowing people not to rely only on traditional care.
However, to ensure the adoption of new healthcare services, the new innovative technologies need to be complemented with new methods that can address related ethical and societal issues.
Current home healthcare services are rudimentary in nature. Often they rely on call centers or nurses visiting the patient
Trust is a requirement for the widespread adop-tion of healthcare services by clients (patients
In this paper, we present the research lines for trust management in home healthcare services. Home healthcare services aim to support people who are chronically ill
or who are rehabilitating. These services gather patient's sensitive information that is then interpreted by medical professionals to manage their diseases.
The adoption of such services, however, hardly relies on the patients'trust in a healthcare service provider in terms of privacy of the data chain
and physicians'trust in the reliability of information and data contributed by patients. In particular a number of questions should be addressed:
How can patients use home healthcare services while ensuring their privacy and controlling the use of information in a simple intuitive way?
Section 3 discusses the problem of trust towards healthcare services. Section 4 discusses trust management for home healthcare services.
Finally, Section 5 concludes the paper providing directions for future work. 2 ICT innovation in Healthcare The advance of ICT technologies is leading to the design of novel electronic healthcare services that improve people's health
and well-being but also extend beyond the individual towards sustainability of our society. Consequently, many countries created policies to foster innovation and spread the successful adoption of these technologies in their healthcare sector.
and provide faster and cheaper healthcare services. On the other hand, they are exposed to different security and safety threats as the patient is far from healthcare providers,
and search electronic health data, thereby endangering people's privacy. 3 Trusted Healthcare Services Electronic healthcare services offer important economic and social benefits for our society.
Patients rely on these services for their safety and care and for improving their quality of life. For physicians, electronic health and wellness services offer support for providing more effective and continuous Care for insurers and governments,
these services bring a reduction of costs, and for commercial service providers, this is a new business opportunity.
However, electronic healthcare services cannot be exploited until the trust question has been addressed in a fundamentally correct way.
Indeed trust is a prerequisite for the acceptance of these services by end users. Trust establishment is crucial for physicians
and service providers as they will use healthcare services to implement and extent (medical) treatments.
In particular, healthcare providers need to trust the patient data they obtain remotely from the measurement devices deployed in patient's home.
trust is also of special relevance because healthcare services deal with very personal and private information.
Home healthcare services monitor patients and gather data that is interpreted by medical professionals. Health and well-ness services support people in need in many ways on the basis of personal and health related information.
People in health communities share health and well-being information which then becomes potentially available to the whole community and beyond.
stating that their electronic health records cannot be shared electronically. 2 To facilitate the acceptance of electronic healthcare services,
The THECS project addresses the very important trust questions (transparency, privacy and security) for healthcare services.
The project addresses trust as one of the key issues for new electronic healthcare services.
This notion is new for electronic healthcare services (and for Internet services in general), and it is fundamental for their success. The objective of THECS is to create new techniques for measuring
and to benefit from these new services. The concrete goal of the THECS project is to create and define:
Ethical, legal, sociological and psychological requirements for trust in healthcare services. The spectrum of healthcare services is very wide,
ranging from formal medical services to pure commercial services that support every day activities. Often these services share information.
It is this integration of services from different domains and information sharing that is of particular interest.
A technical protocol to reliably assess the quality of medical data (e g.,, blood pressure) measured by patients at home, e g.,
, identification of the patient, compliance with measurement protocol, certification of the measurement device. A cryptographic technology that enables health service providers to process encrypted medical information
In the remainder of this paper, we will focus on trust management for home healthcare services. 4 Trust Management for Home Healthcare Services Home healthcare services have been proposed to decrease the cost of healthcare while making it more comfortable for the patient.
These services aim to support people who are chronically ill (e g. post-stroke, diabetes, Chronic obstructive pulmonary disease (COPD)) or who are rehabilitating.
The adoption of such services, however, hardly relies on the trust that both patients and medical professionals have provided in the healthcare services.
In particular, a number of questions should be addressed: How can compliance with a treatment be measured reliably?
How can patients use home healthcare services while ensuring their privacy and controlling the use of information in a simple intuitive way?
In the remainder of the section, we discuss various research lines to address these challenges. 4. 1 Patient Compliance In home healthcare services,
we need comprehensive solutions for measuring patient compliance for home healthcare services. The development of such solutions requires investigating
where patients rate the services of doctors and healthcare providers via a web portal or a health oriented network 20,
Additional problems appeared with the growing use of web portals rating healthcare services. Patients often subscribe to expert websites and search information regarding their illness on the Internet.
on addressing the problem of trust in home healthcare services. Moreover, to reassure patient safety,
and tools that visualize indicators for data reliability in a way that is understandable by end-users. 4. 3 User friendly advanced access control Healthcare services deal with very personal and sensitive information.
A fundamental need is to design novel electronic healthcare services that improve people's health
the adoption of electronic healthcare services relies also on ethical and societal aspects such as the trust that end-users (e g.,
, patients and physicians) has towards such services. In this paper we discussed the challenges for developing trusted home healthcare services.
The THECS project addresses the issue of trust in healthcare services. In particular, the project aims to define the technology necessary to deploy trusted healthcare services.
We presented various lines of research which will be investigated also within the project to address such challenges, namely patient compliance, reliability of information in healthcare,
and user-friendly access control. Acknowledgements. This work has been done in the context of the THECS project
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.
2004) found that innovation helped Estonian SMES to improve their performance in terms of market share and diversified range of goods and services.
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.
33 1. 2. Reducing operating costs of clinical services...37 1. 3. Reports on cost-savings tend to be anecdotal in nature...
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.
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,
In rural Western australia, remoteness has increased the need to develop more integrated and comprehensive primary health services,
when many of the economic benefits are going to be felt by payors and purchasers of health services?
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
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.
or takes into account, the payment systems in place for health care services more generally. Accelerate and steer interoperability efforts:
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
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 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.
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)
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
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,
Although e-increased use of preventive services leads to higher, not lower, medical spending overall,
) 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.
and purchasers of health care services that have the most to gain financially. While costs for these systems can vary from country to country,
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
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,
The empirical evidence that FFS payment schemes tend to result in the over-provision of services and the under-provision of coordinated,
and services where patients interact with providers in a variety of settings (e g. GP practice, specialist office,
For frequently used services such as clinical laboratory tests, Walker et al. 2005) predicted that connectivity and effective HIE between providers
A Systematic Review, Journal of Health Services Research Policy, Vol. 6, pp. 44-55. Government Accountability Office (GAO)( 2005), Health care:
or services related to the use of ICTS (e g. use of emails or telemedicine). Withholding payments from providers:
It was introduced in the United kingdom as part of the new General Medical Services (GMS) contract in 2004.
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.
B c. Ministry of Health Services. Given the bottom-up approach for costing/reimbursement taken in British columbia,
whereas the more mature initiatives are faced with challenges about how to expand their services in a financially sustainable way.
which they provide services. Their tax-exempt status can help to reduce funding challenges and costs, may also provide special tax credits/incentives.
or maintain services like the one offered in Western australia by the Great Southern health Managed Network (GSHMN).
Beaulieu, N d. and D. R. Horrigan (2005), Putting Smart money to Work for Quality Improvement, Health Services Research, Vol. 40, pp. 1318-1334.
The role of the POSP is to enable physicians who provide insured services in Alberta to use electronic medical records to improve patient care
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.
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,
G. W. School of Public health and Health Services, 2009. There is, therefore, a need for coherent and consistent policies around the storage, exchange,
and carry out the necessary associative studies to improve services for citizens. To overcome some of the obstacles to the secondary use of data,
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
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 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).
Increased capacity for ICT services. Support for organisations whose state of ICT-readiness is low.
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.
in the form of a financial incentive, the take-up of broadband services in general practices in the region.
and impacts of electronic messaging have been noted by GPS, allied professionals, staff in hospitals and the Western australia Country Health Services.
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,
Integrated services provide single point access to a range of services significantly broader than those delivered by general practice.
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,
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
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
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.
For patients Enhanced health outcomes and quality of life through early and accurate delivery of appropriate medical services.
and associated legal services. Budgeting for such support was generous typically about one-third of total expenses.
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 guiding vision of the plan to deliver equal access to health services regardless of patient location
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.
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,
Made e-prescription services available virtually throughout the country. Deployed a national e-prescription mailbox allowing patients to store all their prescription drug information.
However, ICT policies and e-prescription will continue largely intact with the formation of a new company, Apoteket Services
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