or country that will decide to use this instrument to trigger SMES'digitization and contribute to their business development.
such as creating a business website and using it profitably, learning to use e-commerce tools to buy or sell,
14 4. 9 RFID and Bar-coding...15 4. 10 Business intelligence...15 5. Examples of Best Practice...
16 5. 1 Trinity Health...16 5. 2 York Hospitals...17 5. 3 Sundhed. dk...
), Prorec Ireland and The irish Computer Society, an ICT Industry group was established in mid-2009 to report on the role that Healthcare ICT can play in delivering a world class health system to the citizens of Ireland.
We would also like to thank the Health Informatics Society of Ireland, Prorec Ireland and The irish Computer Society for their role in the initiative
and Enterprise Ireland, BT and Microsoft for the provision of physical and electronic facilities to support the activities of the group.
such as electronic transfer of medical data between professionals, e-prescriptions and lab tests electronically communicated to patients.
clinical and executive leadership committed to a 10 to 15 year transformation programme. 2 ehealth is Worth it, the economic benefits of implemented ehealth solutions at ten European sites, Karl
the long term outlook is indeed bleak. Looking at some of the problems in more detail
Anecdotal and real data demonstrate excessive costs for overtime, medical card payments and drugs compared with European averages.
Citizens are made aware of these improvements every day through the news media and the internet, and will come to expect effective and safe medical care as a matter of course.
it can help to reduce medical errors through patient data delivery to the point of care. Collectively
by moving patient data instantly to where it is needed, and using electronic systems to order & view lab, radiology and other tests at high speed,
by capturing patient consent to share (or not share) medical data, and also by moving the doctor-patient relationship towards a model of‘shared care'through the use of disease management systems.
inform and collaborate via the internet also promotes patient engagement, independent living and better self management,
Quality of care (effectiveness and efficiency of care service provision) A number of key technologies were identified as proven catalysts to significant healthcare improvement,
and similar technologies can provide. 4. 1 Electronic Health Records (EHR) Electronic Health Records aggregate patient-centric health data from the patient record systems of multiple
Many EHRS include detailed clinical data such as individual lab results and prescription refill information. EHRS are used commonly to transfer a patient's healthcare information between organisations,
and effort spent capturing patient data when crossing organisational boundaries. Additionally ensuring the interoperability of these systems,
is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so.
Directly entering orders into a computer, at the point of care, has the benefit of reducing errors by minimising the ambiguity of handwritten orders,
ETP enables prescription data to be transmitted electronically between the prescribing health professional and the pharmacy, making prescribing
It allows patients to book appointments on site at the surgery, over the phone or over the internet in the way that is most convenient for them.
which a patient ought to be referred. 4. 7 Personal Health Record The Personal Health Record (PHR) is based an Internet patient owned and patient controlled set of tools that allow people to access
and the health of others (dependents) through education and monitoring as well as enable the exchange of data with others regarding their health.
ICT's Role in Healthcare Transformation Report of the Health ICT Industry Group Page 15 4. 9 RFID and Bar-coding Radio frequency identification (RFID) is a technology that allows traceable chips
called RFID tags, carrying a set of predetermined information to be embedded in objects. RFID readers can pick up radio signals
which provide particular information related to the carrier such as identification number, name, and medication requirements. These technologies can be used in a number of ways in a medical setting.
For example, Patients can be provided with identification wristbands carrying an RFID tag or a barcode that will be used throughout the patient's stay in hospital.
Bar-coding/RFID can also be used for inventory management and equipment tracking which allows for improved utilisation of expensive diagnostic equipment by providing real-time location information.
Some hospitals are already using it to track levels of medications and other supplies. 4. 10 Business intelligence (BI) for Real time Detection of Hospital Infection Patterns Through the collection, storage, analysis and interpretation of data,
Business intelligence systems can generate valuable actionable knowledge for tactical and strategic decision support, trend recognition, forecast,
Business intelligence and in particular Data mining are useful tools in the detection of outbreaks when used for the real time detection of infection trends within hospitals.
These tools are being used to analyse vast amount of data in real time and to help distinguish patterns that could indicate abnormal situations that would require further attention or action from healthcare professionals.
Through the implementation and utilization of Health Informatics technologies which have an EHR at their core,
while streamlining crucial processes within the hospital including electronic management of medication administration, provision of access to evidence-based clinical data for clinicians and identification of opportunities for clinical, operational, financial and regulatory
York Hospitals NHS Foundation Trust have converged a voice and data network with almost 4000 phones and over 2000 PCS.
using wireless phones which integrate with the hospital's patient record. There are two main routes for emergency admissions into the Hospital.
and send a message to the wireless phone on the on-call doctor (s) while the ward will also be notified of the pending admission, through it appearing on their own wardlist and electronic whiteboard.
From either a wireless phone or a computer screen on the ward, the medical staff will be able to see some basic details of the patient including the reason for admission,
and a further message is sent to the wireless phone, informing the doctor that the patient is present.
The doctor, using the phone, can acknowledge and accept the admission, which lets others know they have accepted the responsibility of attending the patient.
A list of my patients is always accessible on the wireless phone. The staff on the ward can see that the patient has been accepted using the electronic whiteboard
The public health portal, Sundhed. dk now integrates health-related data from disparate healthcare systems throughout Denmark.
view data from the National Patient Register and communicate with other healthcare providers. For patients
the portal offers access to health-related data, e-consultations and the ability to communicate with healthcare providers.
when time is available instead of being tied to the phone. Patients can renew their prescriptions online,
and the utilisation of this real-time electronic data to reduce claims unpaid. A solution was developed
Enterprise-wide collaboration software. Overview: 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
Doctors use the software's instant messaging capability to consult with each other for quick questions or opinions in a secure real-time environment.
healthcare professional can schedule a Web conference, which enables multiple doctors to collaborate in real time and to share documents
to improve the accuracy of their diagnoses and reduce diagnosis time from 15 days to just 3 days.
Most healthcare information is siloed currently in paper records, bespoke hospital information systems and clinical research databases.
and the Individual'The purpose of this section is to position Information technology in the context of the benefits across the entire continuum of individual and patient care.
and gives examples of the benefits that are already being realised through the strategic implementation of information technology.
Industry Group Page 23 Specific examples of benefits realised through information technology, as outlined in the Gartner study of 6 EU member states on behalf of the Swedish Ministry of Health
and result in potential savings of up to €118 million. 6. 1. 2 Hospital Acquired Infection (HAI) Reducing Hospital Acquired Infections (HAI) through Business intelligence and Data-mining
000 cases of inpatient HAIS could be avoided every year collectively in all six studied member states through the use of Business intelligence and Data mining for real time detection of in-hospital infections.
Reducing inpatient Mistaken Identity Medication Errors through RFID and Barcoding for Medication Administration Over 200 inpatient mistaken identity errors could be avoided in the UK and another 200 in The netherlands every year through the use
of RFID and Barcoding for medication administration in hospitals. Further assumed benefits of the technology could also impact patient Safety
ICT's Role in Healthcare Transformation Report of the Health ICT Industry Group Page 25 Increasing availability by Reducing Hospitalisation Bed-days through Computer-based Patient
. 7 Diagnostics Reducing Duplicate Surplus Laboratory and Chemistry Tests through Electronic Medical record/Computer-based Patient Record Over 800,
Through the creation of a national healthcare data warehouse, both government and the HSE will be positioned better to measure,
Gartner, July 2009, Swedish Ministry of Health and Social affairs ehealth is Worth it, the economic benefits of implemented ehealth solutions at ten European sites, Karl A. Stroetmann, Tom jones
European commission Health IT, Explaining International IT Application Leadership, Daniel Castro, Sept 2009, The Information technology & Innovation Foundation (ITIF) ehealth Strategy 2008 to 2011, The Scottish government/NHS Scotland
Gartner Enabling Healthcare Reform Using Information technology, Recommendations for the Obama Administration and 111th Congress, Dec 2008, Healthcare Information and Management Systems Society (HIMMS) Financing ehealth, Sources of financing and policy recommendations to Member
, Narges Kasiri, Dainis Zegners, Stefan Lilischkis, empirica, Germany, Dec 2008, European commission Evidence on the Costs and Benefits of Health Information technology, May 2008, Congress of The United states
-BT Cerner Cisco systems dabl Disease Management Systems DMF Systems ecom Ireland Garivo Technologies GE Healthcare IBM IMS MAXIMS Intel Microsoft
-Bearingpoint eircom Helix Health Hewlett packard Financial services IBEC IMEC Technologies Irish Software Assocation isoft Lincor Solutions MANITEX Silicon & Software systems (S3) Sláinte
The Conference Board, Total Economy Database 6 0%20%40%60%80%100%1995 2007 2011 Export Shares, by Industry Group Science
China is not competing with other countries in the supply of iphones, but rather in the supply of finalassembly services,
which form only a small portion of the iphone's final price. Accounting for a country's supply-chain position,
2008), and quality upgrades have featured prominently in this regard (Codogno, 2009. Export quality cannot be observed directly,
4wto/UNCTAD relative unit-value data is available at: http://www. intracen. org/country/italy/0 10 20 30 40 0. 2. 4. 6. 8 1 1. 2 Quality
Micro data on Italian firms confirms that this indeed has been a large part of the Italian story where the manufacturing sector has undergone a significant process of ongoing restructuring over the past 20 years, with a significant impact on overall export performance (Leichter
IMF Staff calculations using BACI database, developed by Gaulier & Zingano (2010) 19 Appendix. Shift-Share Analysis and Competitiveness (from ECB, 2012) The method envisages a decomposition of export growth based on a weighted variance analysis (ANOVA) of bilateral export data, disaggregated by product.
The methodology is based on Cheptea and others (2005), and seeks to identify the export growth of each exporting country
The computation of the method consists of four main steps: Step 1: Compute midpoint growth rates For a country i exporting a value x to a country c of product k at time t,
A separate regression is carried out for each year in the data. Hence, if a is the intercept, f is the regression coefficient for exporter fixed effects, ß the one for importer fixed effects
Computation of the indices from the estimated coefficients From the estimated coefficients, growth is decomposed for each exporter (i e.,
Data The analysis draws from the BACI product-level database developed from COMTRADE data by Gaulier & Zingano (2010),
For the regressions, 6-digit product data are aggregated down to the 2-digit level. Caveats Given the structure of the HS classification, some of the HS 2-digit categories include a very large set of products.
or the level of breakdown of the product data. 21 References Aghion, P, . and P. Howitt, 2009, The Economics of Growth,(MIT Press).
Evidence from a New Database of Competitiveness Indicators, mimeo. Ginsborg, P.,2003, Italy and Its Discontents:
integrity of the data chain and techniques that help service providers to assess the reliability of information
and data contributed by patients. 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.
while new propositions are based on the Internet. One of the important impediments for the use of the Internet is the lack of trust.
Trust is a requirement for the widespread adop-tion of healthcare services by clients (patients
Missing are techniques that help end-users to establish trust in a healthcare service in terms of privacy, reliability, integrity of the data chain,
and data contributed by patients. There is a need for an integrated and easy to understand approach to trust in terms of security, privacy, and transparency
however, hardly relies on the patients'trust in a healthcare service provider in terms of privacy of the data chain
and data contributed by patients. In particular a number of questions should be addressed: How can compliance with a treatment be measured reliably?
Can a physician trust data measured by a patient at home? How can patients use home healthcare services
via medical apps for mobile devices to next generation gene sequencing. The creation of national/regional EHR infrastructures such as RHIO's in the US, the NHS Spine project in the United kingdom and NICTIZ in The netherlands, is complemented with efforts on creating commercial Web-based personal health
record (PHR) systems such as Microsoft Healthvault. These applications process, store and exchange patient's medical information
and allow for harnessing big data to improve healthcare. Clinical decision systems assist healthcare providers with decision making task.
They allow clinicians to take into account all important clinical observations and up to date clinical knowledge when diagnosing and treating patients.
Healthcare providers and patients can access the most up to date medical resources anytime anywhere on their mobile devices.
RPM systems combine consumer electronics and the Internet to connect patients and their care providers,
In this way, patient's physiological and other contextual data can be collected and transmitted to remote care providers for review or intervention.
weighing scale or glucose meter) a medical hub device that collects the data from measurement devices
a hospital EHR or PHR systems are considered also as part of this eco system (the measurement data is sent from the medical hub to a PHR system,
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.
In particular, healthcare providers need to trust the patient data they obtain remotely from the measurement devices deployed in patient's home.
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.
it is necessary to develop the technology that help end-users to establish trust in healthcare service providers in terms of privacy, reliability, integrity of the data.
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
A technical protocol to reliably assess the quality of medical data (e g.,, blood pressure) measured by patients at home, e g.,
A cryptographic technology for privacy preserving data mining of patient health data to support clinical research and knowledge creation for clinical decision support systems.
Can a physician trust data measured by a patient at home? Home healthcare patients measure physiological parameters at home,
and a physician uses this data to make treatment and diagnosis decisions. It is very important that the measurements are accurate
In addition, some preliminary work on patient compliance prediction has been done by applying statistical methods and text mining techniques 15.
data authenticity and integrity, it is important to capture the correctness of the authentication process too.
Reputation systems have been studied in the literature for different domains, such as auction websites and peer-to-peer sharing networks 19.
where patients rate the services of doctors and healthcare providers via a web portal or a health oriented network 20,
Existing proposals 18,22 mainly focus on the reliability of the data maintained in the form of electronic and personal health records.
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.
Although this practice may have advantages, the major drawback concerns the trustworthiness of information. For instance, in Revolution Health3 and other similar online community reputation systems
a method for measuring the trustworthiness of information originating from the Internet should be integrated. An interesting research challenge is
thus the design of solutions for measuring information trustworthiness for home healthcare addressing also the trust issues related to data coming from the Internet.
We believe that a reputation-based solution can ensure the reliability of home healthcare data needed by physicians.
To this end, it is necessary to investigate the issue of data trustworthiness from both healthcare providers
information on data reliability should be easily accessible and understandable. Therefore, methods for assessing data reliability should be coupled with methods
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.
The protection of sensitive information is enforced usually using access control. Several access control models have been proposed in the literature (see 25 for a survey).
Furthermore, medical data can also be formed as arbitrary text, such as a patient report made by healthcare practitioners, leading to the need for policies based on content.
One example is Google dashboard privacy tool, which through a web interface displays to users what information about them is stored
and who can access it. Similarly social networks such as Facebook let users restrict or grant access to other users or groups on their data (e g.,
, wall posts, photos. Although these proposals provide a simple and straightforward solution, they neither allow users to understand the effect of the specified policies nor ensure secure access control.
Therefore, a need for more flexible yet friendly privacy management exists. Efforts such as privacy dashboard4, Privacyos project5, Primelife project6) and privacy room 34 provide tools (e g.,
, browser add-ons, mobile applications) for regulating the exposure of user data to the network. Pearson et al. 35 propose a client privacy management scheme based on data obfuscation (not necessarily using encryption) and user personas.
Although these proposals increase usability and flexibility they do not provide users with the overview of the effect of the specified policy.
not only allow users to define access rules to their data but also support them in visualizing the effect of the defined access control policy
and the data objects in which such information is stored. The aim of this semantic alignment is to support the automatic generation of enforceable policies from the high-level policies specified by users.
enforceable policies can be dynamically customizable with respect to user preferences. 5 Conclusions The growth of the Internet
Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures.
and persistence with hypertension therapy using retrospective data. Hypertension 47 (6)( 2006) 1039 1048 6. Leslie, S.,Gwadry-Sridhar, F.,Thiebaud, P.,Patel, B.:
Calculating medication compliance, adherence and persistence in administrative pharmacy claims databases. Pharmaceutical Programming 1 (1)( 2008) 13 19 7. Andrade, S.,Kahler, K.,Frech, F.,Chan, K.:
Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiology and drug safety 15 (8)( 2006) 565 574 8. Mabotuwana, T.,Warren, J.:
A Semantic web Technology Based Approach to Identify Hypertensive Patients for Follow-up/Recall. In: Proceedings of the 21st IEEE International Symposium on Computer-Based Medical Systems, IEEE (2008) 318 323 9. Reiter, H.,Maglaveras, N.:
Heartcycle: Compliance and effectiveness in HF and CAD closed-loop management. In: Proceedings of Annual International Conference of the IEEE Engineering in Medicine and Biology Society.
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J. Mob. Multimed. 1 (4)( 2005) 307 326 11. Alemdar, H.,Ersoy, C.:Wireless sensor networks for healthcare:
Event-driven data integration for personal health monitoring. Journal of Emerging Technologies in Web Intelligence 1 (2)( 2009) 110 118 15.
Petrou, C.:Use of text mining to predict patient compliance. SAS Global Forum, Proquest (2008) 16.
Banescu, S.,Zannone, N.:Measuring privacy compliance with process specifications. In: Proceedings of the 7th International Workshop on Security Measurements and Metrics, IEEE (2011) 17.
did you process the data for the intended purpose? In: Proceedings of the 8th VLDB Workshop on Secure Data Management.
LNCS 6933, Springer (2011) 145 168 18. van Deursen, T.,Koster, P.,Petkovic, M.:Hedaquin:
A Reputation-based Health Data Quality Indicator. In: Proceedings of the 3rd International Workshop on Security and Trust Management.
A medical data reliability assessment model. J. Theor. Appl. Electron. Commer. Res. 4 (2)( 2009) 64 78 23.
The challenge of assuring data trustworthiness. In: Proceedings of the 14th International Conference on Database Systems for Advanced Applications.
LNCS 5463, Springer (2009) 22 33 24. Moturu, S. T.,Liu, H.,Johnson, W. G.:
A role-based delegation framework for healthcare information systems. In: Proceedings of the 7th ACM Symposium on Access control Models and Technologies, ACM (2002) 125 134 27.
Access control in healthcare information systems. Phd thesis, Norwegian University of Science and Technology (2008) 29. Hart, M.,Johnson, R.,Stent, A.:
Access control in the Web 2. 0. In: Proceedings of the 1st Workshop on Online Social networks.
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Proceedings of the Conference on Information technology Education, ACM (2011) 251 256 33. Tzelepi, S. K.,Koukopoulos, D. K.,Pangalos, G.:
A flexible content and context-based access control model for multimedia medical image database systems. In:
A Privacy Manager for Cloud computing. In: Proceedings of the 1st International Conference on Cloud computing. LNCS 5931, Springer (2009) 90 106
Copyright UNU-WIDER 2010 1 Indian Institute of Science, email: bala@mgmt. iisc. ernet. in, 2 Anna University, Tiruchirapalli, 3 Indian Institute of Science.
This study has been prepared within the UNU-WIDER project on Entrepreneurship and Development (Promoting Entrepreneurial Capacity),
internal factors are likely to be more important core determinants of whether innovation plays a key role in success
Moreover, these studies focused on a particular year for data collection and are therefore, cross-sectional in nature.
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,
In the absence of an official database, we relied on the databases of SME associations like‘Karnataka Small Scale Industries Association',‘Bangalore and Peenya Industries Association',among others.
Accordingly, with the validated questionnaire, we approached about 150 to 200 SMES in each of the sectors and gathered primary data from 72 auto component SMES
The quantitative data were gathered for a period of five years from 2001/2 to 2005/6. Data collection was done during January December 2007.
While the first objective was analysed descriptively making use of frequency tables for innovative SMES, the second objective was analysed in terms of percentage growth of economic variables for both innovative and non-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
it is necessary to make the five years'data on sales comparable by converting the values of current prices into values at constant prices.
Using the latest series of data on SSI production, which are given at current prices as well as at 2001/2 prices from 2001/0 onwards by the Ministry of Micro,
and growth of SMES The core objective of this paper is to ascertain the relationship between innovation and firm growth in the identified SME sectors.
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32 1. 1. Health information technology can drive improvements in quality and efficiency in health care...33 1. 2. Reducing operating costs of clinical services...
112 5. 2. Countries have adopted a range of different approaches to monitor ICT adoption...116 5. 3. Common information needs are reflected in a core set of widely used indicators...
119 5. 4. Improving comparability of data on ICT in health: What options?..122 References...
124 TABLE OF CONTENTS 7 IMPROVING HEALTH SECTOR EFFICIENCY: THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Annex A. Country case studies...
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...
39 Box 1. 5. Improving access to emergency stroke care in the Balearic islands through telemedicine...
62 Box 2. 4. Open source health ICTS...64 Box 2. 5. The progressive introduction of interoperability provides a continuum of added value...
120 Box 5. 4. Improving comparability of data on ICT in health: working towards an OECD model survey?..
114 Table 5. 3. Overview of main data collections reported by countries...118 ABBREVIATIONS 9 IMPROVING HEALTH SECTOR EFFICIENCY:
provider AUD Australian dollar CAD Canadian dollar CCHIT Certification Commission for Healthcare Information technology CDM Chronic disease management CITL Center for Information technology Leadership CHF Congestive heart failure
COPD Chronic obstructive pulmonary disease CPOE Computerised Physician Order Entry EDI Electronic data interchange EFT Electronic funds transfer ehi e-Health Initiative EHR
/IT Information management and Information technology 10 ABBREVIATIONS IMPROVING HEALTH SECTOR EFFICIENCY: THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 MAEHC Massachusetts e-Health Collaborative MOA Medical office assistant NEHEN New england Healthcare Electronic Data
Interchange Network NEHTA National e-Health Transition Authority NGO Non-governmental organisation ONC Office of the National Coordinator PACS Picture Archiving and Communication systems PHCTF Primary Health care
Transition Fund PIN Pharmaceutical Information Network PIP Australian Practice Incentive Programme PITO Physician Information technology Office POC Proof of concept POSP Physician
Office System Programme QMAS Quality Management and Analysis System QOF Quality Outcomes Framework programme ROI Return on investment USD US dollars VCUR
and exchange of health data are likely to foster better care co-ordination, and the more efficient use of resources.
online access to clinical guidelines or drug databases, monitoring the effects of disease and therapies on the patient over time,
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,
while the annual cost of diabetes care dropped over the same period from an average of CAD 4 400 (Canadian dollars) to CAD 3 966 per patient.
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,
There was less ambivalence about Picture Archiving and Communication systems (PACS), which are considered an indispensable part of the drive towards a fully functional EHR and for the delivery of high-standard remote care through telemedicine.
Data from 22 sites in British columbia show that report 14 EXECUTIVE SUMMARY IMPROVING HEALTH SECTOR EFFICIENCY:
as a result of introducing electronic claim processing through the New england Healthcare Electronic Data Interchange Network (NEHEN), a consortium of providers and payers established in 1997.
electronic data interchange (EDI) and electronic funds transfer (EFT), have been implemented widely in other states. Barriers ranging from lack of nationwide standards,
In Australia, for example, electronic claiming over the internet has been available since 2002 when Medicare Online was introduced.
all six countries are aiming to use ICTS also to enhance their health information systems. Electronic data collection and processing can provide data in an accessible form that facilitates reporting on different quality metrics,
benchmarking and 16 EXECUTIVE SUMMARY IMPROVING HEALTH SECTOR EFFICIENCY: THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 identification of quality improvement opportunities.
pharmacy and other subset of data necessary for quality reporting and expanded the measurement of outcomes at GP practice level.
health care providers struggle with inconsistent medical terminology, clinical records and data storage, as well as a multiplicity of schemes introduced to facilitate interconnection and communication between specific ICT systems.
(or promoting) electronic data collection and reporting on quality improvement activities. There is a growing body of practical experience across OECD countries that could be analysed further in a more systematic way
and consistently implemented standards While health care organisations have access to an ever-increasing number of information technology products,
whether between systems or between versions of the same software. It must also be gathered consistently
if it is to permit effective secondary analysis of health data. Electronic capture of data through EHRS can facilitate clinical research,
as well as improve evidence-based care delivery. The development of standards to enable interoperability continues to be a political and logistical challenge and a barrier to seamless exchange of information.
A view held by many physicians in nearly all the case studies was that sharing identifiable patient data among different providers in a network raises the question of who should be allowed access to the file
Patient consent was identified also often as the main road block to creating a coordinated information system for patient care.
Some of the case study countries require that patients be informed at the time of data collection of all the purposes for which their data may be used.
In Canada, well-intentioned privacy laws have created barriers to data access. In British columbia an unintended consequence of this commitment to privacy protection is that privacy is cited often as the reason that government cannot access critical health data
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.
for example, to implement a locally developed web-based electronic messaging and patient management system in Western australia
These methodological difficulties are exacerbated further by data limitations, definitional problems and the lack of appropriate sets of indicators on adoption and use of ICTS
there is little or no available data which would allow measurement. Despite a plethora of anecdotal information, the hard evidence available today on the impact of health ICTS is
Failure to collect the data necessary to evaluate the impact of ICTS is one of the core challenges to achieving widespread adoption of high-performing ICT initiatives.
high-speed wireless communications network for over 97%of the region's rural private physician's offices through a CAD 1. 2 million (USD 1. 14 million) grant from the federal Primary Health care
In Australia, the Great Southern Managed Health Network developed a secure web-based electronic messaging system that is being now rolled out in the most remote areas of the region with start-up funding of AUD 1. 8
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 data from the patient's primary care record can facilitate greater efficiency
. 7 5. 7 048 12 16%of GDP 1. Data refer to 2006.2. Data refer to 2005.
Source: OECD Health Data 2009, June 2009.26 INTRODUCTION IMPROVING HEALTH SECTOR EFFICIENCY: 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.
On average, total health care spending represented just under 9%of GDP by 2007 up from just over 5%in 1970 and around 7%in 1990 (Figure 0. 1). By 2010,
Recent evidence indicates that the barriers to sharing patients'clinical data have remained unacceptably high despite the many calls for reforms.
and exchange of health data are likely to foster better care, and the more efficient use of resources.
and most physicians are still using their computers mainly for billing or other administrative tasks.
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
Family Caregivers'Odysseys Through the Health care System, United Hospital Fund, New york. OECD (2009), OECD Health Data 2009 Statistics and Indicators for 30 countries, online
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 1. 1. Health information technology can drive improvements in quality
In 2001, the Institute of Medicine (Institute of Medicine, 2001) reported that improving patient safety requires an information system that can prevent errors from occurring in the first place,
including greater availability of medical information such as online access to clinical guidelines or drug databases and clinical decision support tools.
and use of online medicines databases (e-MIMS). Access to online treatment guidelines. Easily accessible information for reconciling the medications prescribed to a patient.
compared with baseline data, the proportion of people with diabetes who had Hba1c, blood pressure and lipid tests complying with guidelines from the Canadian Diabetes Association,
guidelines and the use of the CDM toolkit, over the same period, the cost of diabetes care in the province dropped from an average of CAD 4 400 (Canadian dollars) to CAD 3 966 per patient.
Implementation involved the development of an interim, web-based information system for three chronic conditions: diabetes, congestive heart failure and major depressive disorder.
Case studies show that the use of Picture Archiving and Communication systems (PACS) which allows the digital capture, viewing,
and communication systems PACS is a computer system that replaces conventional x-ray film, and greatly improves access to patient information by making it possible for referring clinicians to review their patient's images on PCS from their own offices.
PACS also benefits radiologists who also have improved access to patient data and no longer have to forward information to other health care facilities.
was conducted on data extracted for 22 sites in British columbia. The analysis showed that report turnaround time decreased following the implementation of PACS by 41%(mean turnaround time decreased from 60.8 hours pre-PACS to 35.9 hours post-PACS.
60 All sites Rural sites Sites without on-site radiologist%decrease Source: Northern Health Authority (British columbia.
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
They related this gain to easier access to patient data, faster communication, and the availability of higher quality and more complete data.
Similarly, pharmacists in Sweden reported that processing prescriptions had become quicker and easier through the use of e-prescriptions
and benefits of health information technologies in the United states (US Congressional Budget Office) The CBO report, published in 2008,
provides an overview of the current challenges in estimating the value of health information technologies (ITS).
The report analysed the cost saving estimates from two major studies performed by the RAND Corporation and the Center for Information technology Leadership (CITL.*
GPS in Western australia and Canada were pleased that they did need not to return to their practices to consult patient data or clinical notes.
as a result of introducing electronic claims processing through the New england Healthcare Electronic Data Interchange Network (NEHEN), a consortium of providers and payers established in 1997.
electronic data interchange (EDI) and electronic funds transfer (EFT), had been implemented widely in other states. Barriers ranging from lack of nationwide standards,
In Australia, electronic claiming over the internet has been available since 2002 when Medicare Online was introduced.
Although data was limited, in Western australia, physicians reported faster communication, fewer telephone calls, and savings in mail handling, stamps,
making it difficult for them to evaluate acute stroke patients on site when needed. In addition
emergency room physicians typically do not have the requisite experience to make decisions about thrombolytic therapy without the backup of a vascular neurologist.
To do so, they exploited the new regional patient electronic health records to make critical patient data available not only at the point of care,
and Communication system is used to allow the rapid sharing of essential radiological imagery to make the confirmatory diagnosis of the stroke and its category by neurologists at Son Dureta.
and data transmission to enable Son Dureta neurologists to be virtually present at the bedside of a stroke patient anywhere in the region. 44 CHAPTER 1. GENERATING VALUE FROM HEALTH ICTS IMPROVING HEALTH SECTOR EFFICIENCY:
Case studies show that automated data collection and processing can provide richer data in an accessible form that facilitates benchmarking and identification of quality improvement opportunities.
It can also enhance CHAPTER 1. GENERATING VALUE FROM HEALTH ICTS 45 IMPROVING HEALTH SECTOR EFFICIENCY:
pharmacy and other data sources necessary to expand measurement of outcomes. The MAEHC's effort to extract health care quality data from the community level database,
which is an agreed upon subset of data stored in physicians'EHRS, offers an opportunity to engage providers effectively
and increase alignment between incentives programmes (Box 1. 6). Health authorities and payers can now have a more timely view of how the health system is performing,
Only good quality data can enable valid conclusions to be drawn, which in turn enable changes to be made for the better.
and collection and analysis of quality of care data have followed traditionally divergent paths. Although more and more patient data are held on computer systems
traditionally, quality data is collected and analysed retrospectively on the basis of insurance claims. Structured electronic data sources can,
however, provide useful, and in principle, more accurate and granular complementary information. Improving quality of care measurement has been a key goal of the Massachusetts e-Health Collaborative (MAEHC) since its inception.
Consequently, in implementing EHRS and health information exchanges (HIE) the Collaborative has been attempting to bring these divergent paths back together.
Most of the data today is sent directly to a central quality data warehouse from HIES via EHRS deployed in physician's practices, together with data from their billing system.
The shorter-term end product has been the production and distribution of EHR clinical performance feedback reports to participating providers,
These efforts to extract health care quality data directly from HIES has opened a live window on the performance of the local health system
as service delivery data can now be captured in real-time. 46 CHAPTER 1. GENERATING VALUE FROM HEALTH ICTS IMPROVING HEALTH SECTOR EFFICIENCY:
1999), A Randomized Trial of a Computer-Based Intervention to Reduce Utilization of Redundant Laboratory Tests, American Journal of Medicine, Vol. 106, pp. 144-150.
2001), Reducing the Frequency of Errors in Medicine Using Information technology, Journal of the American Medical Informatics Association, Vol. 8, pp. 299-308.
Improving Safety with Information technology, The New england Journal of Medicine, Vol. 348, pp. 2526-2534. Chaudhry, B. et al.
Impact of Health Information technology on Quality, Efficiency and Costs of Medical care, Annals of Internal medicine, Vol. 144, pp.
Congressional Budget Office (CBO)( 2008), Evidence on the Costs and Benefits of Health Information technology, Congressional Budget Office, Washington, D c. CHAPTER 1. GENERATING VALUE FROM HEALTH ICTS
Devaraj, S. and R. Kohli (2000), Information technology Payoff in the Healthcare Industry: A Longitudinal Study, Journal of Management Information systems, Vol. 16, No. 4, pp. 41-67.
Garg A x. et al. 2005), Effects of Computerized Clinical Decision Support systems on Practitioner Performance and Patient Outcomes:
Government Accountability Office (GAO)( 2003), Information technology: Benefits Realized for Selected Health care Functions, GAO-04-224, GAO, Washington, D c. Halamka, J. D. 2000), New england Healthcare EDI Network, The New england Approach
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.
Shekelle, P. and C. L. Goldzweig (2009), Costs and Benefits of Health Information technology: An Updated Systematic Review, The Health Foundation, London.
Assessing The Evidence, Health Affairs, Supplement Web Exclusives, pp. W5-97-107. 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 Solutions at Ten European Sites, DGINFSO, European commission, Brussels. Walker, J. M. 2005), Electronic Medical records and Health care
2005), The Value of Health care Information Exchange and Interoperability, Health Affairs, Supplement Web Exclusives, pp.
health care providers struggle with inconsistent medical terminology, clinical records and data storage, as well as a multiplicity of schemes introduced to facilitate interconnection and communication between specific ICT systems.
which health information technology functionalities are most likely to achieve certain health benefits and the assessment of costs is even more uncertain.
and who benefits from health information technology implementation in any health care organisation except those, such as Kaiser and the Veterans Administration,
Benefits may appear at one site and in one budget, while a large share of the cost commitments appear at another site and in another budget.
In addition, there are no incentives, and may even be disincentives for care providers to be the first to adopt ICTS (Taylor et al.,
traditional in-office installation of software/hardware, and patient management systems provided over the web via an application service provider (ASP).
In the United states, the MAEHC has performed traditional in-office implementations of EHRS in each of the physician's practices located in the three pilot communities.
MAEHC reports hardware and software costs of approximately USD 30 700, plus another USD 12 100 for support per physician.
In Canada, the Physician Information technology Office (PITO) programme established by the B c. Government in 2006 to coordinate,
facilitate and support information technology planning and implementation for physicians has adopted a different approach based on the ASP model.
and certified a panel of five vendors from which primary care physicians must purchase their EMR
PITO negotiated prices with these vendors on the basis of one time hardware and software start-up costs of approximately USD 15 500 plus an annual fee of almost USD 4 000 the first year, rising to almost USD 6 000 thereafter.
It should be noted that definitions of EMR and EHR vary significantly across countries. Rather than attempting to provide a single overarching definition,
the EMRS funded by PITO include all of the core elements of a fully functional EHR,
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 panel reached consensus on functions that should be present to qualify the system into two functional categories, a basic system and a fully functional system.
recording patients'clinical and demographic data, viewing and managing results of laboratory tests and imaging,
while a fully functional system has all sixteen functions present (Table 2. 1). Table 2. 1. Functions qualifying EHRS as basic or fully functional systems Health information and data:
) Hardware 22 800 6 364 Software & implementaion 17 200 9 091 Annual support/License 5 600 3 709 (1st year
which add up as well as costs for eventual major upgrades or system replacement. Physicians in all six of our case studies repeatedly referred to cost,
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,
The lack of fees or other incentives for responding to patient e-mail, working with data from new sources,
Only 20%of physicians reported that they were willing to purchase an EMR system Those who were willing to purchase said that they would be willing to pay between CAD 255 and 415 per month.
Improved efficiency, better access to medical information and faster chronic patient data charting and health trend analysis all act as drivers of physician interest.
sum Percentage of physicians Low=CAD 255 Med=CAD 415 High=CAD 575 Low=CAD 415 Med=CAD 575 High=CAD
690 Low=CAD 7 200 Med=CAD 11 200 High=CAD 15 200 Source: Keshavjee et al.
Information systems in separate health care business entities must be able to exchange clinical information on patients,
Different computer systems are said to be interoperable when they can exchange data with and use data from other systems.
Simply converting data from a paper format to a digital format is not enough to ensure interoperability.
Interoperability depends primarily on all the computer systems that need to exchange information being able to communicate.
The rules that specify how to send information back and forth need to be defined. This obviously involves technology issues
such as legal and business rules that need to be coordinated between organisations in order for them to feel comfortable exchanging confidential patient data (Chaudhry, 2005).
and this now makes it difficult to achieve adequate electronic data exchange among different patient management and/or other clinical data systems.
and quality of data that can be conveyed. While users have complained long about the situation, few appear to be willing to pay more for what many feel should somehow be a standard capability of the product.
which the various components of the planned exchange of patient information between existing health care information systems were tested for their compatibility.
These EMR software platforms were largely incompatible with each other and were not interoperable. They had to be modified to a greater
or lesser extent to enable smooth data transfer into the planned national database facilities. The POC was intended to demonstrate that the national facilities could operate properly and securely with the modified EMR systems.
This collaboration has resulted in some level of success. The open standards1 of DICOM for digital images
Another area where industry collaboration is gaining traction is the development of open source health care software with several initial successes. Open source software is developed with an open code that is made available
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;
and the high level of access to its specifications for ready promulgation in a variety of hardware and software.
The term open standard is coupled sometimes with open source with the idea that a standard is not truly open
if it does not have a complete free/open source reference implementation available. 64 CHAPTER 2
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 for compatible information systems and ensure broader interoperability.
Making open source software such as EHRS available as an option for physicians offers significantly lower upfront costs.
This, however, does not mean free software for everyone, nor it necessarily implies higher guarantees of reliability and quality than commercial products.
The success of any open source software depends on the community of developers who participates in its development (California Health care Foundation, 2006.
Recently, a growing chorus of policy makers have been advocating government support for more open source development of EHRS (see Box 2. 4). Even
) Box 2. 4. Open source health ICTS Examples of open source software that have been developed and are being deployed widely, include EMR software such as OSCAR, Freemed, Vista and other software such as Medline, Epi-X and others.
To this effect, a 2002 NHS Information Authority paper on Open source Software and the NHS concluded:
Open source health care applications would provide healthy competition to the existing closed source commercial market, encouraging innovation whilst promoting compatibility and interoperation.
This ultimately will lead to systems that are lower cost, better quality and more responsive to changing clinical and organisational requirements (Smith, 2002).
More recently in the United states, the success of the open source Vista EHR software developed by the US Veterans Administration,
Several law makers there have proposed legislation calling for grant programmes to support open source EHR development as well as encouraging federal agencies to evaluate implementations of open source technologies for their own use.
In another sign of increasing support for open source software, the Certification Commission for Healthcare Information technology (CCHIT) has created recently three separate pathways to electronic health records certification.
but the other two pathways were created with open source developers in mind, making their software potentially eligible under incentive programmes with funding guidelines calling for such certification.
CHAPTER 2. WHAT PREVENTS COUNTRIES FROM IMPROVING EFFICIENCY THROUGH ICTS? 65 IMPROVING HEALTH SECTOR EFFICIENCY:
and interoperability a conceptual framework describing how health care entities can share information has been developed by the Center for Information technology Leadership (CITL).
This provides a functional taxonomy based on three factors in data exchange: the amount of human involvement, the sophistication of the ICT,
the data can be used by humans, but for the most part cannot be used by machines to provide automated decision support, active guidance,
and this limits the opportunities for reducing the error rate or cutting costs. Although Level 4 may be the ideal state
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 Table 2. 4. Healthcare information exchange and interoperability taxonomy Level Attributes 1 Non-electronic data
and abstract data from paper sources. Examples: postal mail, phone 2 Machine transportable data transmission of nonstandard information via basic ICT;
information within the document cannot be manipulated electronically. Clinicians can access the information, but no computerised data processing or logic can be applied.
Examples: PC-based exchange of scanned documents or manual faxing, pictures, portable document format (PDF) 3 Machine-organisable data transmission of structured messages containing non-standardised data;
requires multiple interfaces that can translate incoming data from the each of the sending organisation's vocabulary to the receiving organisation's vocabulary;
usually results in imperfect translations because the vocabularies used have incompatible levels of detail. Data content is indexed down to single fields,
however human translation is required to convert actual data in each field from the vocabulary of the sending organisation to that of the receiving organisation.
Examples: secure e-mail of free text, or PC-based exchange of files in incompatible/proprietary file formats, HL-7 messages 4 Machine-interpretable data transmission of structured messages containing standardised
and coded data; the ideal situation in which all systems exchange information using the same formats and vocabularies.
All systems exchange data using the same messaging, format, and content standards, removing the need for multiple customised interfaces.
All content can be extracted and converted electronically in each field and no longer requires human intervention.
Examples: automated exchange of coded results from an external lab into a provider's EMR, automated exchange of a patient's problem list.
Center for Information technology Leadership; Walker et al. 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.
For treatment purposes, an individual's health information will need to be accessed by a variety of health providers:
As a recent Microsoft survey revealed, a large majority of the US public wants electronic access to their personal health information both for themselves
and for their health care providers because they believe such access is likely to increase the quality of the care they receive (Microsoft Corporation,
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.
California Health care Foundation (2006), Open source Software: A Primer for Health care Leaders, ihealth Reports. Center for Democracy & Technology (2008), Comprehensive Privacy and Security:
Critical for Health Information technology, Center for Democracy & Technology, Washington D c. Chaudhry, B. 2005), Health Information technology (HIT) Adoption Standards and Interoperability, RAND Health Working Paper.
Continued Leadership Needed to Define and Implement Information technology Standards, GAO-05-1054t, GAO, Washington, D c. 70 CHAPTER 2. WHAT PREVENTS COUNTRIES FROM IMPROVING EFFICIENCY THROUGH ICTS?
Institute of Medicine (1997), The Computer-Based Patient Record: An Essential Technology for Health care, National Academy Press, Washington, D c. Institute of Medicine (2001), Crossing the Quality Chasm:
Microsoft Corporation/Kelton Research (2009), Health Engagement Survey 2009, Microsoft corp.,, Redmond, WA. available at: www. microsoft. com/presspass/presskits/industries/healthandlifesciences/docs/MSHEALTHENGAGEMENTSURVEY2009. ppt.
OECD (2007), Improved Health System Performance through Better Care Coordination, OECD Health Working papers No. 30, Directorate for Employment, Labour and Social affairs, OECD Publishing, www
Smith, C. 2002), Open source Software and the NHS: White paper. National Health Service Information Authority, available at:
2005), Promoting Health Information technology: Is there a Case for More-Aggressive Government Action? Health Affairs, Vol. 24, No. 5, pp. 1234-1345.
2005), The Value of Health care Information Exchange and Interoperability, Health Affairs, Supplement Web Exclusives, pp.
Payment for electronically-delivered care (e g. consultations by email: which offers direct payment for new categories of care
or services related to the use of ICTS (e g. use of emails or telemedicine). Withholding payments from providers:
Data used to calculate clinical quality indicators are extracted from the individual GP clinical IT systems
Since 1999, the PIP includes a number of incentives to encourage practices to keep upto-date with the latest developments in Information management and Information technology (IM/IT.
It also encourages incremental compliance by software suppliers with the National e-Health Transition Authority (NEHTA) standards and specifications,
with 89%of GP practices using computers for clinical purposes. Most practices had computer software
and hardware to perform administrative and clinical functions, and most (78.3%)had speed a high Internet connection. Over half these practices (55.6%)had received a PIP payment for information technology/information management,
and nearly a third (31.5%)had received payments through another incentives programme intended to stimulate broadband uptake (Broadband for Health).
An earlier study by Nielsen in October 1997 had found that only 31.0%of practices had computers, most
of which were being used for administrative purposes only. This evidence depicts a rapid uptake of computers to access crucial patient information at point of care
and to support clinical decision in general practice over about half a decade from implementation of PIP.
These incentive programmes, which were administered generally with the support of Divisions of General Practices, have also been largely responsible for the significant levels of adoption of computers and patient management systems by GPS in rural Western australia.
By 2003 more than 80%of WA practices were using computers for clinical care and not just for practice administration (Figure 3. 1). This number has been growing since.
CHAPTER 3. ALIGNING INCENTIVES WITH HEALTH SYSTEM PRIORITIES 81 IMPROVING HEALTH SECTOR EFFICIENCY: 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
databases Practice administration Electronic data availability & exchange Electronic diagnosis & treatment 2003-04 2004-05 2005-06%Practices Source:
The Physician Information technology Office in British columbia, Canada In British columbia (Canada) the Physician Information technology Office (PITO) was established in 2006 as a voluntary programme to assist physicians with the adoption and use of EMRS.
A total of CAD 108 million was committed for 2006-12, to be disbursed gradually over the duration of the programme.
The hardware reimbursement levels were established based on real costs incurred by a representative group of practices, large and small in British columbia (source:
training and support (e g. by providing help with data entry). The basket of incentives, described below,
The toolkit is based a web software developed by the B c. Health Ministry with a Health Canada's Primary Health care Transition Fund grant.
MOA time is compensated at CAD 20/hour as an expense to the GP. Direct payments to spur use of the CDM Toolkit To spur the use of the CDM Toolkit,
since the inception of the programme in 2003, received a onetime payment of CAD 7 500.
The complex care e-mail/telephone follow-up management fee To encourage the use of e-visits, from 1 january 2008,
a complex care e-mail/telephone follow up management fee at a rate of CAD 15 (payable up to a maximum of four times per year/per patient) was made also available.
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 American Recovery and Reinvestment Act of 2009 A carrot and stick approach was adopted in 2009 by the United states to push for provider adoption of interoperable health information technology through the Health Information technology for Economic and Clinical Health
and the ability to submit data on 2. These programmes provide health coverage for eligible individuals
whose patient panels consist of at least a minimum threshold of low-income individuals and families who cannot afford health care costs.
ranging from USD 27 214 to 36 212 over five years (Figure 3. 2). It should be noted that the US incentives in this figure are compared to costs associated with in-office installation of EHR software/hardware
USD 1. 10 CAD. 86 CHAPTER 3. ALIGNING INCENTIVES WITH HEALTH SYSTEM PRIORITIES IMPROVING HEALTH SECTOR EFFICIENCY:
and robust data have been obtained. This conundrum is addressed later in the report. 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
systemic fiscal cost-benefit after ten years is actually negative at CAD 1. 5 billion,
By year 20, the systemic (national) savings is estimated at almost CAD 20 billion. This is further supported by a 2007 study by Pricewaterhouse Coopers of nearly 2 000 hospitals in the United states,
and the use of the clinical databases. Physicians'costs are more than offset by the Australian Government e-Health incentives for GP practices.
In this case the business model is as good as patients'willingness to allow their data to be shared in ways that clinicians
which require data collection and reporting. Payers and purchasers willingness to differentially reward improved quality of care is,
such as clinical data exchange (e g. Medsinfo) or Computerised Physician Order Entry (CPOE e g. main hospital implementing
Enhance efficiency and accuracy of drug delivery Favourable Financial, organisational Medical data repositories Accurate patient medical data Very favourable Other stakeholder co-operation Source:
Information technology (HIT) Provisions, American Medical Association, Chicago. Beaulieu, N d. and D. R. Horrigan (2005), Putting Smart money to Work for Quality Improvement, Health Services Research, Vol. 40, pp. 1318-1334.
2009), Community-wide Implementation of Health Information technology: The Massachusetts e-Health Collaborative Experience, Journal of the American Medical Informatics Association, Vol. 16, pp. 132-139.
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:
The Economic Benefits of Implemented e-Health Solutions at Ten European Sites, DGINFSO, European commission, Brussels. Tripathi, M. 2007), Massachusetts e-Health Collabortive, AHRQ
Annual Meeting, Powerpoint presentation at AHRQ Annual Meeting, Bethesda, Maryland. CHAPTER 4. ENABLING A SECURE EXCHANGE OF INFORMATION 97 IMPROVING HEALTH SECTOR EFFICIENCY:
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,
and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care.
and organisational efforts to achieve even the simplest clinical data exchange (Box 4. 1)( Goroll et al.,
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
lessons learned from the MAEHC From its inception MAEHC has had in place a Data Exchange Standards Workgroup.
The goal of the Workgroup was to establish interoperability standards that systems must meet that will allow for adequate data exchange to achieve the goals of clinical data sharing and access,
as well as meeting software and hardware compatibility requirements. However, though the MAEHC had done an extensive job researching the vendors and making final selections based on strict criteria,
Achieving interoperability of health information technology solutions requires detailed negotiations between the vendors involved. This must also be coupled with a highly developed community
and data portability can often be very difficult to judge, and physicians sometimes find that the product they purchased does not perform as hoped.
Box 4. 2. Health care IT product certification in the United states The Certification Commission for Healthcare Information technology (CCHIT) is an independent
and formally signing an accuracy attestation. The second step involves jury-observed demonstrations of the vendor EHR products, according to the test scenarios and scripts,
running at vendor facility with jurors and proctors observing via simultaneous Web conference/audio conference.
Certification Commission for Healthcare Information technology 2009, www. CCHIT. org, accessed 12,july 2009. Although numerous products have already been certified in these countries,
Certification addresses the full range of products open source, selfdeveloped, modular, and other vendor. Home-developed systems and open source developers, often don't understand why they need to go through the expense of detailed certification processes
and possibly developing unneeded functionalities for the sole purpose of meeting certification criteria. 5. http://healthit. hhs. gov/portal/server. pt/gateway/PTARGS 0 11113 881027 0 0 18/CA SUMMARY 071409
. pdf, accessed January 2010 104 CHAPTER 4. ENABLING A SECURE EXCHANGE OF INFORMATION IMPROVING HEALTH SECTOR EFFICIENCY:
all certification can ensure is a baseline of core functionalities and specifications that could be used to achieve interoperability.
http://healthit. hhs. gov/portal/server. pt? open=512&objid=1269&&pageid=1650 1&mode=2&in hi userid=11113&cached=true, accessed January 2010.
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.
Developing solutions to move patient data from one physician office system to another. Reducing the risk of data loss in physician offices caused by human, hardware or software failure.
Working with stakeholders to update the Vendor Conformance and Usability Requirements (VCUR) for physician's offices.
and access to patient health data, and on patient consent. Interpretation of privacy and security requirements are determined still often locally within countries
sharing data becomes more difficult because stakeholders may have differing views of what can be shared and with whom.
In Canada, well-intentioned privacy laws have created barriers to data access. In British columbia an unintended consequence of this commitment to privacy protection is that privacy is cited often as the reason that government cannot access critical health data
and carry out the necessary associative studies to improve services for citizens. To overcome some of the obstacles to the secondary use of data,
in May 2006 the B c. Government passed Bill 29 which introduced changes to the Freedom of Information
to implement a locally developed web-based electronic messaging and patient management system in Western australia
With the opt-in approach to consent, patients declare what data they are willing to share.
but would give the patient the option at the point of care to prohibit a clinician from looking up data.
the burden of proof was on the institutions that wanted to share patient data, rather than on the patients themselves,
since no data could be shared without written permission from the patient. From the MAEHC perspective, the consent form would educate individuals about how health information is exchanged,
while determining the extent of data sharing that most patients would be willing to accept. The risk that large numbers of patients would refuse to opt in had been an issue in other countries (e g. the United kingdom
whereby a signed patient consent form is required for patient‘s clinical data to be copied or uploaded to the HIE community database.
As such, patient recruitment became a preeminent concern for the HIE enterprise, if it was to be viable.
The MAEHC has focused on the core messages that appealed to all of the focus groups: convenience and data security.
Issues and Challenges in the Context of Treatment for Mental health and Substance Use, BNA's Health care Policy Report, Vol. 16, No. 2. Blumenthal, D. 2009), Stimulating the Adoption of Health Information technology
G. W. School of Public health and Health Services (2009), Patient Privacy in the Era of Health Information technology:
2009), Community-wide Implementation of Health Information technology: The Massachusetts e-Health Collaborative Experience, Journal of the American Medical Informatics Association, Vol. 16, pp. 132-139.
2007), Adoption of Information technology in Primary Care Physician Offices in Alberta and Demark, Part 2:
and comparability of data on health ICTS at OECD level. 112 CHAPTER 5. USING BENCHMARKING TO SUPPORT CONTINUOUS IMPROVEMENT IMPROVING HEALTH SECTOR EFFICIENCY:
there is little or no available data that could allow any quantitative estimation. It is equally difficult to obtain reliable figures on the success rate of health ICT projects or programmes.
The evidence collected shows that the currently available national and international data on health ICTS is often not comparable for a whole range of statistical reasons,
integrating the different systems that clinicians use at the point of care to document clinical patient data.
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
in Canada as of 2009 to CAD 570 per enrolee in Kaiser permanente (United states) in 2005.
%or more cost sharing money provided by provinces for local Infoway health ICT projects. 1. OECD Health Data 2009;
7. 2009, exchange rate CAD 1. 10; 8. Source: Department of health and Ageing, Australia; 9. 2009-10, exchange rate AUD 1. 19;
OECD Population Data, 2007; 11. Through March 2010, exchange rate CAD 1. 10; 12. NAO, through December 2015, exchange rate GBP 0. 61;
13.2007. CHAPTER 5. USING BENCHMARKING TO SUPPORT CONTINUOUS IMPROVEMENT 115 IMPROVING HEALTH SECTOR EFFICIENCY: 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.
Access is related to the availability of equipment and internet connections. Availability, relates to the question of how many different types of ICT application are available and
Secondary use of data for monitoring public health. 5. 2. Countries have adopted a range of different approaches to monitor ICT adoption Analysis of surveys from nine OECD countries (Australia
and United states) and at EU level shows that the major types of data collections are: Stand-alone surveys of health care providers (businesses or personnel), Surveys of the population, Use of administrative data. 7. An example of how this model can be applied to health ICT is Finland,
where the number of GPS using EMRS has not been an appropriate measure for tracking progress in this country for some time now.
most OECD countries have not yet set out to collect national data on health ICT adoption on any systematic basis. In addition,
Three out of the nine countries (Norway, Spain and Sweden) included in the OECD study also use routine administrative data to monitor ICT adoption.
The downside is compiled that data from such sources are constrained by the fact that in most cases administrative data collection has been designed for other purposes than monitoring ICT use and impact.
The main drawback is that the data is generally not comparable with other data sets that might be available for the same country or across countries for statistical reasons
Table 5. 3 below presents a simplified comparative analysis of the different data sources in terms of:
i e. how well the data reflects the information priorities of policy makers; b) feasibility, i e. how easily data can be gathered (cost and time);
c) prevalence, i e. whether the type of data collection is used frequently or not; d) extent of comparability.
Table 5. 3. Overview of main data collections reported by countries Data collections Relevance Feasibility Prevalence Comparability National statistics surveys of ICT use Low Low Low High
Use of administrative data Medium High low Low Surveys of the population Medium Low Low Low Stand-alone surveys of health care providers (businesses or personnel) High Medium High low Source:
OECD. The OECD study also reviewed how countries define ICTS in their surveys. With the exception of the term electronic health record and electronic medical record, there was very little
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
inevitably makes it difficult to compare data, within and across countries, or to link survey data to other data sources.
Nonetheless, it is possible to identify a core set of indicators widely used in these surveys.
These indicators were assessed against a set of criteria listed in Box 5. 2 and assigned to three broad priority groups of policy objectives.
Nonetheless, all surveys analysed in this report included indicators to gather relevant data to address the adoption and use gap.
recording patients'clinical and demographic data, viewing and managing results of laboratory tests and imaging,
and data transfer across settings. The efficient application of e-health solutions is predicated on the seamless sharing of patient information across the health care system.
Inter-provider data sharing is a challenge that is only just beginning to be tackled in many OECD countries,
Nevertheless, they can aid in detecting common obstacles to the diffusion of new information technologies and may be used with other types of quantitative indicators to explain differences in the intensity of use of new technologies across countries.
This, given the widespread use of financial incentives, appears as an incongruous omission. 5. 4. Improving comparability of data on ICT in health:
and the necessary data cannot be gathered from existing national statistics or data collections. There is clearly much work to be done to gather relevant information for:
a) improving the quality of existing data and indicators; b) improving the linkages between policy and indicators;
However, in addition to producing better data, it is important to improve the comparability of data and consequently the methodologies used to collect
and analyse this data. Data should be more easily accessible to the relevant users not only policy makers,
but also health care providers, and analysts and researchers, who serve as important intermediaries in processing the information for evaluation and policy analysis. The creation,
initial testing and subsequent use of an indicator entail high fixed costs (initial tests, survey design and implementation),
2005, see Box 5. 4 below) provides one possible way to establish a common set of international guidelines to improve the availability and comparability of data on health ICTS.
Box 5. 4. Improving comparability of data on ICT in health: working towards an OECD model survey?
2005) provides one possible way to improve the availability and comparability of data for a core set of indicators on health ICTS.
While the use of core modules allows measurement on an internationally comparable basis, additional modules and new indicators within existing modules can be added to respond to evolving
and are relevant to efforts to improve the comparability of health ICT data internationally. These features are reviewed below.
While the use of core modules allows the measurement on an internationally comparable basis, additional modules and new indicators within existing modules can be added to respond to evolving
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
Anderson, G. F.,B. K. Frogner, R. A. Johns and U. E. Reinhardt (2006), Health care Spending and Use of Information technology in OECD Countries, Health
Department of health and human services (2009), Public-Private Initiatives, HHS, Washington, D c.,http://healthit. hhs. gov/portal/server. pt?
George, D. and N. Austin-Bishop (2003), Error rates for Computerized Order Entry by Physicians versus Nonphysicians, American Journal of Health-System Pharmacy, Vol. 60, No. 21
2003), The Value of Computerized Provider Order Entry in Ambulatory Settings, Center for Information technology Leadership, Boston, MA.
OECD (2009), OECD Health Data 2009 Statistics and Indicators for 30 countries, online and on CD-ROM, OECD Publishing, Paris. See www. oecd. org/health/healthdata.
pragmatic progress and promising potential, Powerpoint presentation to OECD Expert Meeting on ICT in the Health Sector, Paris. Riksrevisjonen (Office of the Auditor General of Norway)( 2008), Riksrevisjonens
Wennberg, J. E.,E s. Fisher and J. S. Skinner (2002), Geography and the Debate over Medicare Reform, Health Affairs, Supplement Web Exclusives, pp.
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
The University of Western australia's Centre for Software Practice (UWA Centre) provided dedicated technical support under a not-for-profit partnership agreement.
and Information technology (IM/IT) scheme facilitated effective computerisation and widespread information transfer and storage. The broadband for health subsidy supported
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
and found that most practices had the computer software and hardware to perform administrative and clinical functions,
and most (78.3%)had speed a high internet connection. Furthermore, GSGPN survey results from 2006 indicated over 80%of Western australia practices using computers for both clinical and administrative functions.
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.
The goals of the project were to achieve: Secure messaging and increased collaboration between health professionals.
Reduction in time spent on preparing, forwarding and receiving hospital discharge reports. Reduction in the risk of clinical errors through improved legibility and reduced double-entry of patient information.
Improved patient data capture. Improved medication reconciliation. A wide variety of benefits and impacts of electronic messaging have been noted by GPS, allied professionals, staff in hospitals and the Western australia Country Health Services.
which related this effect to easier access to patient data (they were able to access information about their patients that was previously ANNEX A. COUNTRY CASE STUDIES 129 IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 unavailable, at least routinely), faster communication, higher quality of data and more complete information.
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
A tangible by-product of Physician Connect has also been the capability to access web-based clinical decision support tools such as the chronic disease management (CDM) Toolkit.
1. Physician compensation. 2. Information technology. 3. Privacy legislation. 4. Guidelines development. 5. Implementation of new service delivery models.
Targeted support and incentives encouraged and sustained change To encourage the adoption and use of information technologies,
training and support (e g. by providing help with data entry), reimbursement for complex care e-mail/telephone follow-up,
Adoption of the chronic disease management (CDM) toolkit The CDM self evaluation toolkit is based a web software developed by the B c. Health Ministry.
it provides an excellent entry to the world of information technology and getting a first glimpse of
which included the deployment and use of information technologies. These efforts, including those aimed at addressing care gaps and the rapidly increasing chronic disease trends
Physician Connect began in 2004 with a CAD 1. 2 million Primary Health care Transition Fund (PHTCF) grant.
and the NHA's information systems to enable quick and secure retrieval of laboratory results, and spur adoption of EMRS.
A tangible by-product of the adoption of Physician Connect has been the capability to access web-based clinical decision support tools such as the CDM toolkit.
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.
direct health care costs to treat patients with diabetes in British columbia are forecasted to rise 78%,reaching an estimated cost of CAD 1. 38 billion.
and integration of data within and across health authorities while maintaining their autonomy is an ongoing concern
A view held by many physicians was that sharing identifiable patient data among different providers raised the questions of who should be allowed access to the file.
and clinical data exchange capabilities in three Massachusetts communities. The three communities have unmatched today capabilities to aggregate
which patients are asked specifically to agree to as needed electronic exchange of their clinical data between clinical sites (however,
no permission is sought to have stored data in the practice's EHR); and the benefits of HIE participation were touted to encourage patient participation rather than making security a major concern.
Provided complete no-cost EHR systems to physician practices coupled with practice management software to link all clinical and administrative practice functions in one seamless health ICT solution.
and organised around each community's priorities, addressing the major issues surrounding patient privacy and data sharing agreements.
Built a novel health care quality data infrastructure to collect, organise, and analyse, health care system performance.
though it had increased coverage of the uninsured, was costing more than expected creating long-term funding sustainability concerns.
national health ICT efforts led by the Office of the National Coordinator for Health Information technology within the US Department of health and human services (US DHHS) is providing leadership for the development
and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care.
Determinants of success Government leadership and strong political commitment to widespread implementation Critical to the effective delivery of this form of acute stroke care has been Ib-Salut's overarching health information technology modernisation effort
radiology information system (RIS)/ picture archiving and communication system (PACS), pharmacy information system, and others. The guiding vision of the plan to deliver equal access to health services regardless of patient location
and data for neurologists at Son Dureta to virtually examine stroke patients. Results on outcomes show that efficacy
a move away from mainframe computing to desktop PCS. Combined with continued research and live implementations throughout the 1980s and 1990s,
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,
In addition, patients have ready Web access to their entire medication lists as prescribed and can be printed easily in preparation for physician consultations.
New legislation allowing national databases, independent of reimbursement form, but with high degree of patient consent and transparency.
Critical to these action areas, e-prescription has been highlighted as a key strategic puzzle piece in the context of future handling of national medicinal data.
For example, physicians are allowed not to view the entire prescribed medication list-resulting in low physician use of the national database.
and security measures to allow access to certain national databases, e g. National Pharmacy Register. Progress in hospital deployment has been limited due to competing interests of physicians and hospital administrators.
or mask discrete data items in their medical record by withholding authorisation or by requesting the masking or concealing of specific information at the local level.
With the UZI card the healthcare practitioner can add an electronic signature to a prescription, a letter of referral or a contract.
which the various components of the planned national health care information system were tested. ICT suppliers were invited to take part in the POC
These applications are being tested in pilot sites since 2007. The WDH provides the out-of-hours GP and allied health professionals with a summary of the patient's history
between the National Association of General practitioners and the government on an incentives package to promote the purchase of computers and the use of electronic medical records.
and a moderate increase in the fee for service for each private patient if the GP used a computer.
1) use an information system tested and approved by professional associations; 2) implement a patient management system within two years from the purchase of a computer;
and, 3) participate in data collection and reporting. In addition, until 2008, physicians could also receive an additional 25 cent quarterly/patient if participating in electronic claims processing.
The incentives programme was terminated in 2006. Physicians can, however, still qualify for extra allowances for caring for elderly patients and those living in low-income districts,
traditional in-office installation of software/hardware and installation through an external application service provider (ASP.
The national information system is based on a central locator service, the Landelijk Schakelpunt or National Switch Point (LSP),
Under this system, clinical data will be maintained locally, i e. in the databases of the health care provider or regional databases and will be accessed through the central search engine
which can locate and extract the data from local databases. The LSP cannot store patient histories
and doctors'systems will not be able to store records retrieved by LSP. To retrieve data,
LSP keeps an index of specific patient information kept by each healthcare practitioner. It also maintains a log of who accesses what information, and when.
specifically on surveys or data collections that are considered useful from a policy perspective and the most common indicators used today.
Given the dearth of data, the workshop concluded that implementation of case studies would be the most promising approach.
A group of OECD experts in health information technology was established to help guide the work, the development of a framework for the selection and analysis of case studies and interpretation of results.
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