meaning that the Digital Agenda for Europe's target of 100%broadband coverage for all Europeans by 2013 is well on track.
Managing health data Up to 50%of European adults search online for health information. The need for widespread online access to accurate
as well as to personal health data, is essential. The same is true on the research side,
where access to wide sets of health data for scientific purposes is vital for making progress in areas such as clinical trials and drugs safety.
Access to healthcare data helps researchers to produce more accurate, faster tests on medicines to be launched on the market.
The EU-ADR project exploited advanced ICT to develop new ways of using existing clinical and biomedical data sources to detect EU-ADR The Adverse Drug Response (ADR) system
It then applies text mining, epidemiological and other computational techniques to assess and detect‘signals'.'http://www. eu-adr-project. com Funded by the Seventh Framework Programme (FP7) Duration:
and communication technologies to provide healthcare specialists with a framework for the monitoring and analysis of epilepsy-relevant multi-parametric data.
and data capture system to provide the patients with daily valuable Euheart Euheart uses clinical data from various sources,
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 result is a service infrastructure enabling the exchange of patient data Patient Summaries and eprescriptions across borders. 23 different European countries participate in this Large scale Pilot. http://www. epsos. eu Funded by the ICT Policy Support Programme (ICT PSP) Competitiveness & Innovation Programme (CIP) Duration:
An elderly day navigator, e g. reminders of daily activities, a visual phonebook, digital communication facilities. http://www. aal-rosetta. eu Funded by the Ambient Assisted Living Joint Programme
Concrete goals include the registration of data with governments only once, the EU-wide use of national electronic identities (eid),
and data exchanges based on the development of common technical standards in the field of e-Identity, e-Signatures,
Syndication of data and edirectories; A Secure delivery and data tracking exchanges. http://www. eu-spocs. eu Funded by the ICT Policy Support Programme (ICT PSP)- Competitiveness & Innovation Programme (CIP) Duration:
2009-end 2012 28 eid, ejustice and ehealth. The funding from CEF would link up Member States'infrastructures by ensuring interoperability
Effective transmission of individual data between national authorities must therefore be a priority. The European Civil Registry Network project (ECRN) allowed EU Member States'local administrations to exchange civil status acts (birth
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
the project plans to demonstrate the ability to build more intelligent services by using and combining data integrated seamlessly through the Cloud.
and data collected by public authorities and agencies. It will allow them to model and deploy services,
IT networks and end users'terminals still remain vulnerable to a wide range of evolving threats (lack of privacy, loss of data, malfunctioning of the network due to a cyberattack.
and the Internet of things are bound to bring more pervasive data collection, longer persistence of collected data, higher and more heterogeneous traffic volume.
All these factors make network management an evolving environment that becomes more challenging every day. The DEMONS project seeks to build a novel cooperative network monitoring
and exporting data across operator domains and multiple jurisdictions. These issues have prevented previously other security solutions from being deployed widely
Trust, privacy and identity in the digital economy The information society has deeply and irreversibly transformed our society.
generate data, give advice and work bi-directionally), near-zero energy buildings and more energy-efficient transport systems.
and innovation projects to improve the energy efficiency of data centres and investigate how ICT could reduce energy and water consumption in sectors other than buildings and grids.
The real time data gathered is then centralised and used to generate an action plan for reducing energy use via the‘serious game'interface
to review their own consumption history allowing them to take appropriate action to reduce it. esesh will also provide social housing providers, regional and national governments with the data they need to optimise their energy-related policy and investment decisions
Reducing the energy consumption of Data centres In the era of information and data deluge, data centres play an increasingly critical role in every aspect of our socioeconomic activity.
While there is an insatiable need for more computation and storage power, the energy consumption in data centres poses an energy wall that must be addressed to be able to advance to more powerful data centres.
Moreover experience has shown that up to now only a holistic approach leads to the most efficient and sustainable solutions.
This starts from the decision on the data centres location all the way up to the technologies used in the various systems
2008-2011 45 The Games and FIT4GREEN projects are two ongoing initiatives on energy efficiency for data centres exploring two different approaches.
and dissemination of data in which the mechanical, lighting, electrical and computer systems are designed for maximum energy efficiency and minimum environmental impact.
Thanks to its holistic approach, GAMES is expected to increase energy efficiency in data centres by up to 25%.
%The FIT4GREEN project applies power optimization by spreading load across multiple data centres. It enhances existing deployment strategies by moving computation and services around a federation of data centres sites.
The project expects to provide at least 20%saving in the energy consumption of servers and network devices in comparison with a traditionally managed data centre and an additional 30%saving due to reduced cooling needs.
FIT4GREEN The project aims to save energy in data centres, and works with existing logistics. It has been designed to work for any data centre, Computing style, Monitoring and Automation frameworks
and also federated data centres. The project dynamically tunes the amount of computing resources to the workload,
unused servers are turned off and automatically restarted when load increases. http://www. fit4green. eu Funded by the Seventh Framework Programme (FP7) Duration:
2010-2012 GAMES The project will adopt an innovative approach, taking into account the interrelations between different layers (business/applications, infrastructure, facility) and their effect on energy consumption.
and transmits a set of data, including the exact location of the crash site. ecall is to be introduced in all new models of passenger cars and light-duty vehicles,
ICT hubs in Europe The European commission has published a study identifying the European ICT hotspots with an atlas showing where digital economies flourish.
and software) that allow for electronic communication, data collection and processing in distributed networks (e g. Newton, 1998.
speeds up data retrieval, processing and steering, and reorganizes value chains and their spatial pattern Maybe an outcome but not a goal;
but these are linked not with data on transport behavior; also, disaggregate data at the level of regions or cities is often not available.
This situation may be explained by a lack of awareness among statisticians of the urgency to provide such data.
Concerning households, the lack of statistics means a need for a smart mix of large-scale surveys,
No available data, but seems effective. No available data; seems effective in time but maybe longer journeys.
Congestion relief Video Surveillance and Response (fixed)( public, private. Variable Message Signs (VMS)( fixed)( public, private.
No available data, but seems effective. Overall travel time reduction by 1-2%in regular congested areas (EU). No available data.
Reduces variation in acceleration by 40-50%(EU). Reduces fuel use of 8%(UK). ) No available data,
but seems effective. Fatality reduction Accident Sensors (in-vehicle)( private. Extended Viewing Systems (radar, sensors, infrared)( invehicle)( private.
No No data available, but seems effective. No data available, but seems effective. Substantial decrease of speed, but compensation (US.
Reduce fatality and heavy injury up to 30-38%(dependent on road type)( NL. Several gains expected.
Current GIS databases and GPS technologies in general are in most cases not accurate enough to be used in this way,
More recent data are available for the EU 15 where there were 35,905 fatalities in 2003 (ERF, 2005.
or country that will decide to use this instrument to trigger SMES'digitization and contribute to their business development.
such as electronic transfer of medical data between professionals, e-prescriptions and lab tests electronically communicated to patients.
Anecdotal and real data demonstrate excessive costs for overtime, medical card payments and drugs compared with European averages.
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.
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,
ETP enables prescription data to be transmitted electronically between the prescribing health professional and the pharmacy, making prescribing
and the health of others (dependents) through education and monitoring as well as enable the exchange of data with others regarding their health.
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 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.
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.
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.
and the utilisation of this real-time electronic data to reduce claims unpaid. A solution was developed
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.
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.
Through the creation of a national healthcare data warehouse, both government and the HSE will be positioned better to measure,
The Conference Board, Total Economy Database 6 0%20%40%60%80%100%1995 2007 2011 Export Shares, by Industry Group Science
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
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
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,
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
and allow for harnessing big data to improve healthcare. Clinical decision systems assist healthcare providers with decision making task.
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.
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.
Existing proposals 18,22 mainly focus on the reliability of the data maintained in the form of electronic and personal health records.
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.
or grant access to other users or groups on their data (e g.,, wall posts, photos.
, 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.
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.:
Event-driven data integration for personal health monitoring. Journal of Emerging Technologies in Web Intelligence 1 (2)( 2009) 110 118 15.
Use of text mining to predict patient compliance. SAS Global Forum, Proquest (2008) 16. Banescu, S.,Zannone, N.:
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 flexible content and context-based access control model for multimedia medical image database systems. In:
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 you can include excerpts from OECD publications, databases and multimedia products in your own documents, presentations, blogs,
119 5. 4. Improving comparability of data on ICT in health: What options?..122 References...
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:
COPD Chronic obstructive pulmonary disease CPOE Computerised Physician Order Entry EDI Electronic data interchange EFT Electronic funds transfer ehi e-Health Initiative EHR
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES OECD 2010 MAEHC Massachusetts e-Health Collaborative MOA Medical office assistant NEHEN New england Healthcare Electronic Data
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,
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,
Electronic data collection and processing can provide data in an accessible form that facilitates reporting on different quality metrics,
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
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
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.
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.
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.
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
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,
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.
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
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,
Although data was limited, in Western australia, physicians reported faster communication, fewer telephone calls, and savings in mail handling, stamps,
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 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:
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.
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:
The lack of fees or other incentives for responding to patient e-mail, working with data from new sources,
Improved efficiency, better access to medical information and faster chronic patient data charting and health trend analysis all act as drivers of physician interest.
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.
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.
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
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.
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;
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.
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.
Data used to calculate clinical quality indicators are extracted from the individual GP clinical IT systems
databases Practice administration Electronic data availability & exchange Electronic diagnosis & treatment 2003-04 2004-05 2005-06%Practices Source:
training and support (e g. by providing help with data entry). The basket of incentives, described below,
and the ability to submit data on 2. These programmes provide health coverage for eligible individuals
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
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:
and organisational efforts to achieve even the simplest clinical data exchange (Box 4. 1)( Goroll et al.,
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,
and data portability can often be very difficult to judge, and physicians sometimes find that the product they purchased does not perform as hoped.
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,
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
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.
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.
%or more cost sharing money provided by provinces for local Infoway health ICT projects. 1. OECD Health Data 2009;
OECD Population Data, 2007; 11. Through March 2010, exchange rate CAD 1. 10; 12. NAO, through December 2015, exchange rate GBP 0. 61;
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
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.
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,
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.
and are relevant to efforts to improve the comparability of health ICT data internationally. These features are reviewed below.
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
. 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.
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.
training and support (e g. by providing help with data entry), reimbursement for complex care e-mail/telephone follow-up,
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.
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.
and data for neurologists at Son Dureta to virtually examine stroke patients. Results on outcomes show that efficacy
The network infrastructure allows secure communication and distribution of patient data pictures, medical applications and services for
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.
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.
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.
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