www. oecd. org/publishingwith the financial assistance of the European union -HSTCQE=U Y UZ: isbn 978-92-64-08460-581 2010 07 1 P
OECD Health Policy studies improving Health sector Efficiency THE ROLE Of information and COMMUNICATION TECHNOLOGIES
Despite the promise they hold out, implementing information and communication technologies (ICTS) in clinical care has proven to be a very difficult undertaking.
More than a decade of efforts provide a picture of significant public investments, resulting in both
notable successes and some highly publicised costly delays and failures. This has been accompanied by a failure to achieve widespread understanding among the general public
and the medical profession of the benefits of electronic record keeping and information exchange With consistent cross-country information on these issues largely absent, the OECD has
Sweden and the United states to identify the opportunities offered by ICTS and to analyse under what conditions these technologies are most likely to result in efficiency and quality
COMMUNICATION TECHNOLOGIES The full text of this book is available on line via these links
COMMUNICATION TECHNOLOGIES ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT The OECD is a unique forum where the governments of 30 democracies work together to
such as corporate governance, the information economy and the challenges of an ageing population. The Organisation provides a setting where governments can compare policy
Le rã'le des technologies de l†information et des communications Corrigenda to OECD publications may be found on line at:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 FOREWORD This report presents an analysis of OECD countries†efforts to
implement information and communication technologies (ICTS) in health care systems. It provides advice on the range of policy options, conditions
These ranged from foundational communication infrastructures to sophisticated electronic health record (EHR) systems Within the OECD Secretariat, this report was developed by
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Organero and Josep Pomar Reynã s (Spain;
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Table of contents Abbreviations...9 Executive summary...
1. 2. Reducing operating costs of clinical services...37 1. 3. Reports on cost-savings tend to be anecdotal in nature...
a prime opportunity for savings...40 1. 6. Achieving â€oetransformation†through ICTS...41 References...46
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Chapter 3. Aligning Incentives with Health System Priorities
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Annex A. Country case studies...127
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
Box 4. 4. MAEHC turned consent to demand...109 Box 5. 1. Implementation efforts provide a picture of significant
public investment...113 8 †TABLE OF CONTENTS IMPROVING HEALTH SECTOR EFFICIENCY: THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010
Box 5. 2. Criteria for the selection of indicators...119 Box 5. 3. Adoption of basic and fully functional EHRS...
Table 3. 2. Attitudes about payoffs according to main stakeholders...90 Table 3. 3. Attitudes about HIE in the United states according
to main stakeholders...93 Table 4. 1. Measures to address lack of interoperability by country...
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Abbreviations AHRQ Agency for Healthcare Research and Quality
ICT Information and communication technologies IM/IT Information management and Information technology 10 †ABBREVIATIONS IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 MAEHC Massachusetts e-Health Collaborative
ROI Return on investment USD US dollars VCUR Vendor conformance usability requirements EXECUTIVE SUMMARY †11
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 EXECUTIVE SUMMARY Today the range of possible applications of information and
communication technologies (ICT) in the health sector is enormous. The technology has progressed significantly and many estimate that
significant public investments, notable successes and some highly publicised costly delays and failures. This is accompanied by a failure to
and the United states) to identify the opportunities offered by ICTS and to analyse under what conditions these technologies are most likely to result in
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Findings illustrate the potential benefits that can result from
•Reducing operating costs of clinical services •Reducing administrative costs •Enabling entirely new modes of care
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 associated with preventable hospitalisations, provides, therefore, an
opportunity for significant â€oequick winsâ€. This was the case in Canada, where through the combined implementation of new approaches to care delivery
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, and by reducing multiple handling of documents.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 turnaround time was reduced by 41%following the implementation of
represent a prime opportunity for savings. Among the case studies reviewed here, experts in Massachusetts (United states) reported huge administrative
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 adoption and use by physicians, in 2007 the Australian Government
also ran a targeted communication campaign to promote Medicare electronic claiming to the Australian public Enabling entirely new modes of care
health services, and electronic messaging and telemedicine can facilitate this. In The netherlands, electronic access to patient
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 identification of quality improvement opportunities.
In the United states, the Massachusetts e-Health Collaborative (MAEHC improved the electronic capture of laboratory, pharmacy and other
or support them in making investments in ICT systems, limited resources can deter from pursuing these
stakeholders, investments which are cost-effective from the point of view of the system as a whole are not automatically going to be
introduced to facilitate interconnection and communication between specific ICT systems. Because of fragmentation in the market and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 unambiguous public health priorities with clear benefits and that would not
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Case studies indicate that subsidies are suited best to a situation where
there is a clearly identifiable capital or fixed assets investment. In the Balearic islands (Spain), local government subsidies were used, for
a sustainable business model. In other words, once the initial investment has been made, what steps need to be taken to ensure that the ongoing costs of
maintaining the system will be met? For example, who will compensate general practitioners for the costs of maintaining electronic health records
purchasers of health services? These long-term sustainability and financing issues appear to be the most challenging and, in most cases, unknown
sustainability but central to shared reaping of benefits from the investments made. The financial incentive packages in these countries are designed to
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Achieving commonly defined and consistently implemented standards
vendors†products and services, and includes a number of â€oeusability†requirements such as service levels, technical support responsiveness
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Enabling robust and reliable privacy and security frameworks
health care demands a strict adherence to confidentiality. A view held by many physicians in nearly all the case studies was that sharing identifiable
associative studies to improve services for citizens In addition, in most of the case study countries, compliance is complicated
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 separate regimes for public sector and private sector organisations and specific
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 that in many cases health institutions may use both ICT and more traditional
The challenges described above place health ICT investments in a space that is quite different from other capital investments in the health sector, for
example a hospital building or medical equipment. But health ICT projects are still often evaluated using traditional appraisal techniques, limiting evaluation
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 One shared characteristic of the programmes reviewed here is that they
stakeholders to achieve their goals. Successful adoption and use generally depended on the simultaneous implementation of new service delivery
place for health care services more generally •Accelerate and steer interoperability efforts: agreement on and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 data from the patient†s primary care record can facilitate greater
and the collaboration of the relevant stakeholders to establish standards and develop innovative solutions •Strengthen monitoring and evaluation:
comparable indicators to benchmark ICT adoption and ensuring that systems for monitoring ICTS are sufficient to assist in meeting
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 INTRODUCTION Policy makers in OECD countries are faced with ever-increasing
demands to make health systems more responsive to the patients they serve as well as improving the quality of care,
containing costs, reconciling rising demands for health care and public financing constraints in the context of rapid demographic and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 From 1990 through 2009, an increasing share of the gross domestic
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 These studies provide examples of the kinds of difficulties in continuity of
to which it can be put, means that information and communication technologies (ICTS) that ensure the timely and accurate collection and
despite more than a decade of promotion and significant public investment There are large variations particularly in the adoption and use of
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 often largely paper-based. Some of the variations are due to the costs
in deploying ICT solutions that ranged from foundational communication infrastructure to sophisticated EHR systems, plus a broad overview of the
considers how investments in health ICTS can generate â€oevalue†for health systems. Drawing from case studies, Chapter 1 illustrates the types of
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 technical, legal and organisational. Chapters 3 and 4 report on how
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 References Bates, D. 2002), â€oethe Quality Case for Information technology in
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Chapter 1. Generating Value from Health ICTS
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Introduction Understanding how ICTS can generate â€oevalue†in health systems can
business case for further investment and identify outcome drivers The term â€oevalue†in this report implies a broader view of how ICTS can
investment analyses (ROI In the health sector there is often no measure of performance analogous to profits for private sector firms.
While a non-healthcare business selecting its investments in ICTS might consider only financial return on investment
health care is a sector that places an unusual emphasis on nonfinancial goals. In health care, a standardised production process is difficult to
change the mix of services it provides, the resulting financial costs and benefits to the hospital will depend on how the care is delivered
however, a substantial opportunity: to improve health care quality and reduce health care costs through ICTS †by
the delivery of services with little or no value. While the case studies are not perfect, they do illustrate the types of benefits that can result from
•Reducing operating costs of clinical services •Reducing administrative costs •Enabling entirely new modes of care
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 1. 1. Health information technology can drive improvements in
and facilitate communication between providers have been cited as providing substantial benefits in health outcomes (Bates et al.
) Communication between patients and providers is also vitally important for safety, especially at the hospital/primary care interface
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 These conditions require regular monitoring of patients to track trends in
Canada, a relatively modest investment in IT has led to a major rapid change in diabetes care, yielding significant payoffs
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Box 1. 2. Improving compliance with clinical guidelines in British columbia
reduced utilisation of health care services On efficiency, or value for money, the most frequently cited positive
effect is attributed to reduced utilisation of health care services. More effective information sharing, such as rapid electronic delivery of hospital discharge
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 informing physicians about â€oecomparative effectiveness†of alternative medical
This could offer a basis for ensuring that existing costly services are used only in cases in
to those of other, cheaper services. These benefits on utilisation of health services increase as more of the available decision support features are used
and as the time horizon is lengthened (Government Accountability Office 2003 Case studies show that the use of Picture Archiving and
Box 1. 3. Benefits of investments in picture archiving and communication systems PACS is a computer system that replaces conventional x-ray film,
measuring the benefits of investments in PACS. A PACS Opinion Survey was devised to record end users†opinions about the impact of PACS on such areas as provider efficiency
patient care, report turnaround time and communication. The survey was conducted in three provinces (Ontario, Nova scotia and British columbia),
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 regarding patient care, 80%reporting that PACS has reduced the time they had to wait to
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 of documents etc
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 type of decision support tool adopted,
communication, and the availability of higher quality and more complete data Similarly, pharmacists in Sweden reported that processing prescriptions had
satisfaction, while also allowing staff to provide new services that could help diversify the pharmacy's revenue base
ICT investments and benefit realisation (Devaraj and Kohli, 2000. Recent studies, for example, suggest that the financial benefits are realised not until
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 The upshot is that while most of the case studies in this report had
investment strategies are most likely to achieve savings Box 1. 4. Report on the costs and benefits of health information technologies
preventive services leads to higher, not lower, medical spending overall, RAND concluded that the additional costs are not large
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 As is the case with any modelling project and prospective estimates, both this study and
investments in ICTS, increasing numbers of health care organisations are reaping â€oenon-financialâ€, intangible gains from these technologies.
confidentiality, speed of communication was the most commonly perceived intangible benefit (e g. the prompt receipt of discharge summaries from
countries a prime opportunity for savings Administrative processes such as billing represent in most countries a
prime opportunity for savings. Duplicative requirements and idiosyncratic systems can drive up the cost of care,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 paper transaction, after the introduction of NEHEN, were processed
also ran a targeted communication campaign to promote Medicare electronic claiming to the Australian public. Although data was limited, in
Western australia, physicians reported faster communication, fewer telephone calls, and savings in mail handling, stamps, and paper
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 pursuing health care reform agendas. In general, there are three broad goals
adoption of ICTS by the many diverse stakeholders. Health ICT adoption was coupled also tightly with a reassessment of the clinical care model as
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 of physicians, and particularly of specialists, between rural and urban
In all six case study countries, telemedicine services are being used to great effect in areas with large rural or remote populations.
2004, and physicians recognised an opportunity to extend stroke care services to the more scattered parts of the region.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Furthermore, the Balearic telestroke programme has turned out to be much more than
identification of quality improvement opportunities. It can also enhance CHAPTER 1. GENERATING VALUE FROM HEALTH ICTS †45
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 documented adherence to quality assurance criteria and the efficiency of
EHRS, offers an opportunity to engage providers effectively and increase alignment between incentives programmes (Box 1. 6
It also offers an opportunity to engage providers effectively and increase alignment between incentives programmes,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 References Balamurugan, A. et al. 2009), â€oea Pilot Study of Diabetes Education via
Telemedicine in a Rural Underserved Community †Opportunities and Challengesâ€, Diabetes Educator, Vol. 35, pp. 147-154
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Coye, M.,J. Ateret Haselkorn and S. Demello (2009), â€oeremote Patient
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Kukafka, R. et al. 2007), â€oeredesigning Electronic Health Record Systems
Pricewaterhouse Coopers (2007), The Economics of IT and Hospital Performance Renders, C. M.,G. D. Valk et al.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Solutions at Ten European Sitesâ€, DGINFSO, European commission
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Chapter 2. What Prevents Countries from Improving Efficiency
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Introduction The process of ICT implementation is a notoriously complex and
investments in ICT systems, limited resources can deter from pursuing these systems. In particular since the costs associated with adopting
new technologies are shared not equitably among stakeholders investments which are cost-effective from the point of view of the
system as a whole are not automatically going to be undertaken •Lack of commonly defined and consistently implemented standards
introduced to facilitate interconnection and communication between specific ICT systems. Because of fragmentation in the market and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 2. 1. Are there any financial gains to be made †and if so, by whom
One significant barrier to investment in ICTS is recognised the widely fact that any resulting cost savings may not always accrue to the
and considerable investment is required both initially and on an ongoing basis. For many small to mid-size
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 in many cases there is little or no financial incentive for them to do so, given
and purchasers of health care services that have the most to gain financially. While costs for these systems can vary from country to
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Box 2. 1. Functional characteristics of an electronic health record
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Table 2. 2. EMR/EHR costs in the United states and Canada
investment, and the potential collateral benefits, which, in most circumstances, are unlikely to carry any substantial weight
own incentives depending on how providers produce health services, how efficiently and equitably services are provided, the quality of care, and how
intensively patients make use of health services CHAPTER 2. WHAT PREVENTS COUNTRIES FROM IMPROVING EFFICIENCY THROUGH ICTS?
†57 IMPROVING HEALTH SECTOR EFFICIENCY: THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010
In 2003 Wang et al. performed a cost-benefit study to analyse the financial effects of electronic medical record systems in ambulatory
and managing these health and business opportunities On the other hand studies have shown that FFS schemes create incentives for GPS to provide shorter consultations and more services than
would otherwise be provided in an incentive-neutral environment. This means that they do not provide the appropriate incentive environment for
physicians to engage in complex cases, co-ordination of care or in services outside of the traditional office visit, such as phone consultations or using
electronic media to communicate with patients. The empirical evidence that FFS payment schemes tend to result in the over-provision of services and
the under-provision of coordinated, complex care is now fairly persuasive Gosden et al. 2001 FFS also creates a culture where the use of new technologies requires
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 informed/shared decision-making are key components of the problem of
provided in a hospital outpatient environment is salaried mostly In a salary-based system, a physician is paid a fixed amount of money
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 It is, therefore, in the interest of payers to help health care providers
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Box 2. 2. Physicians†willingness to pay for electronic medical records in
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 implementation of standards and appropriate organisational changes are
patchwork of care and services where patients interact with providers in a variety of settings (e g.
Even with such an investment, differences in the underlying architecture of EHR systems, and the way that the systems are configured and
competition alone will produce the necessary standardisation of EHRS †as further discussed below 62 †CHAPTER 2. WHAT PREVENTS COUNTRIES FROM IMPROVING EFFICIENCY THROUGH ICTS
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Box 2. 3. Dealing with legacy systems:
requiring additional effort and/or investment in research, development, testing, and evaluation In The netherlands, a great deal of up-front effort and co-ordination went identifying of the
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 One key factor is that standard setting has the potential to regulate the
into account views from all stakeholders, may be very important as the choice of the standard could virtually eliminate, not merely disadvantage
development with multi-stakeholder input and broad industry recognition availability for use by all interested stakeholders (users, vendors;
and the high level of access to its specifications for ready promulgation in a variety of hardware
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 for compatible information systems and ensure broader interoperability
enterprises. Given these problems along with the changes in the marketplace and the proliferation of proprietary ICT tools, the transition to interoperability
provide healthy competition to the existing closed source commercial market, encouraging innovation whilst promoting compatibility and interoperation.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Mechanisms must, therefore, be found to enforce standards
and this limits the opportunities for reducing the error rate or cutting costs. Although Level 4 may be the ideal state,
frequently used services such as clinical laboratory tests, Walker et al. 2005) predicted that connectivity and effective HIE between providers
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Table 2. 4. Healthcare information exchange and interoperability taxonomy
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
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 well-publicised serious lapses in existing systems and stories about security
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Restoring public trust that has been undermined significantly is much
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 References Agency for Healthcare Research and Quality (AHRQ)( 2006), Costs and
Services Research Policy, Vol. 6, pp. 44-55 Government Accountability Office (GAO)( 2005), â€oehealth Care:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Hammond, E. 2008), â€oea Perspective on Interoperabilityâ€, Paper presented
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Walker, J. et al. 2005), â€oethe Value of Health care Information Exchange
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Chapter 3. Aligning Incentives with Health System Priorities
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Introduction There are three ways governments can intervene to promote the
cost-benefit structure of the economic activities of the target. The greatest advantage of economic instruments is that they allow
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 3. 1. A range of financial incentive programmes have emerged to
physicians†returns on investment. Indirect incentives on the other hand work by setting or changing the overall framework, for instance by
services related to the use of ICTS (e g. use of emails or telemedicine •Withholding payments from providers:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Table 3. 1 illustrates the use of these incentive mechanisms across the
interventions are needed to defray upfront investment costs and initial productivity losses Subsidies are very flexible,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Despite the apparent simplicity of subsidies, they do pose some
clearly identifiable capital investment. Second, sometimes it can be difficult to judge the appropriate level of a subsidy.
investment in ICT and health information exchange. In Canada, the B c. Government adopted a mix of strategies in association with direct cash
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 3. 3. Payment differentials Payment differentials are bonuses or add-on payments that reward
in the United kingdom as part of the new General Medical Services (GMS contract in 2004. It is a voluntary annual reward and incentive programme for
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 One year after its introduction, QOF had made already a difference to
•The additional services domain: consisting of eight indicators across four service areas including cervical screening, child health surveillance, maternity services
and contraceptive services In 2004-05, GP practices were scored against 146 performance indicators, with clinical
quality accounting for more than 50%of the total. Each point earned had a financial bonus
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 The Australian Practice Incentive Programme
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Figure 3. 1. Western Australian practices using IM/IT
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 •Coordination during implementation to ensure that all the key
B c. Ministry of Health Services Given the bottom-up approach for costing/reimbursement taken in British columbia, PITO€ s reimbursement levels are remarkably
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Compensation for attending learning sessions
Physicians and medical office assistants (MOAS) are compensated for their investment in making changes in their practices.
two-way telephone or e-mail communication with the patient or the patient†s medical representative to follow-up case
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 clinical quality and other measures.
Services (DHHS) to make competitive grants to states and qualified state-designated entities to support establishment of sub-national
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 HIE infrastructure. According to the e-Health Initiative (ehi) Sixth Annual
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 In addition, a Medical Group Management Association (MGMA) study
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 3. 4. Long-term sustainability and financing
significant challenge is developing a sustainable business model. Long-term sustainability and financing appear to be the most challenging and, in most
used and health information exchange benefits the various stakeholders they will be placed better to see how fiscal and financial responsibilities
feasibility and achieving successful adoption with the economics of the approach often playing a secondary role.
economics and the value to society which will determine whether a system can survive or not
services in a financially sustainable way. Financial sustainability is a critical issue for all initiatives, even those that are relatively more mature and
return on investment (whether financial or otherwise), to gain ongoing financial, institutional and political support for their efforts.
It would seem that the return on investment from implementation of ICTS should be relatively straightforward to assess, yet, the evidence today
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 been involved in the intervention at all.
only many years after the investment was made or until a level of functionality is reached that allows the systems to truly serve the needs of clinicians and system planners.
health care ICT investment. The same study, however, concludes that the financial breakeven point will strictly depend on the levels of investment.
Above a certain level of ICT investment †or tipping point †the cost impacts levels off
and is associated with cost reductions. The levelling off occurs despite the added costs of more ICT capital;
ICT capital at some point pays for itself by displacing costs elsewhere in the hospital
countries and contexts, identified a 2: 1 return on e-health investment when benefits were
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 The changes needed to redress this situation require a more active role
four general categories of business models appear to emerge •Not-for-profit: the not-for-profit initiatives are driven by their charter
to help the patients and the community in which they provide services. Their tax-exempt status can help to reduce funding
challenges and costs, may also provide special tax credits/incentives The Great Southern Managed Health Network in Western australia
is a good example •Public utility: these initiatives are created and maintained with the assistance of central government/local state funds.
These initiatives can be set up as either for-profit or not-for-profit organisations; however, the key to this category is the collaboration
•For-profit (often resulting from the conversion of a not-for-profit initiative at a mature stage:
for-profit initiatives are created with private funding. These organisations look to reap financial benefits from their transactions (envisioned as a future development in the
stakeholder will determine their sustainability in the long term. This requires therefore, an assessment of the viewpoints and respective roles of the main
stakeholders but also clarifying whether there is a social case, that is, whether the activities or interventions enabled by ICTS provide a â€oebenefit to the
Table 3. 2 lists the viewpoints of main stakeholders on payoffs from ICTS in four of the case studies which are representative of the
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 subsidies or incentives they expected neutral or unfavourable returns from
business models and how they are attempting to achieve long term sustainability Table 3. 2. Attitudes about payoffs according to main stakeholders
Payoffs according to each stakeholder Funding source Business model Case study Users Individual patients Society Payer E-Messaging
Western Australia Neutral /Favourable physicians allied health professionals nurses Favourable Favourable Favourable Shared Not-for-profit
Chronic disease management toolkit/EMRS Canada Neutral /Unfavourable physicians Favourable Favourable Favourable Government Collaborative Telestroke
adopt a public utility business model: the telestroke programme is entirely developed and maintained with the assistance of national/local government
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 health care in Spain clearly makes government a critical stakeholder in
electronic health information and a benefactor to its potential positive impacts. The Baleares Government is,
basis of a potentially sustainable business model The not-for-profit model It is the nature of ICT projects that
if there are too few active participants scattered over a very dispersed area, it would no doubt be uneconomic to offer
or maintain services like the one offered in Western australia by the Great Southern health Managed Network (GSHMN.
volumes of participation and partnering with other community stakeholders such as community groups, public health agencies, and others) to improve
The not-for-profit status of the GSMHN is an essential facilitator of the process
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 The collaborative model A Health Information Exchange (HIE) is a multi-stakeholder
organisation that enables or oversees the business and legal issues involved in the exchange and use of health information, in a secure manner, for the
All stakeholder groups share the challenges and benefits of an HIE network model (see Table 3. 3 below
sustainable business model to keep the HIE in operation once the initial money has been spent To date, initial funding has generally come from national and state
In this case the business model is as good as patients†willingness to allow their data to be shared in ways that clinicians
business model also depends on incentives that adequately reward physicians for their participation in quality improvement activities which require data
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 stakeholders, including physicians, health care institutions and community
leaders, and 3) participation in other relevant activities, such as clinical data exchange (e g. Medsinfo) or Computerised Physician Order Entry (CPOE â€
Table 3. 3. Attitudes about HIE in the United states according to main stakeholders Stakeholder Major value Attitudes about HIE Major constraints
Patients High-quality affordable health care Favourable Privacy confidentiality and security concerns Federal government Control costs Improve quality
and investment expectations No immediate ROI and high upfront costs Pharmacies Enhance efficiency and accuracy of drug
Very favourable Other stakeholder co-operation Source: Adapted from Deloitte Center for Health Solutions (2006
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 References American Medical Association (2009), H r. 1, the â€oeamerican Recovery and
for Quality Improvementâ€, Health Services Research, Vol. 40 pp. 1318-1334 Deloitte Center for Health Solutions (2006), States†Roles in Health
stakeholders www. providersedge. com/ehdocs/ehr articles/States role in health inf o exchanges. pdf E-Health Initiative (ehi)( 2009), Migrating Toward Meaningful Use:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Mcinnes, D. K.,D c. Saltman and M. R. Kidd (2006), â€oegeneral Practitionersâ€
Pricewaterhouse Coopers (2007), The Economics of IT and Hospital Performance Stroetmann, K. A t. Jones, A. Dobrev and V. N. Stroetmann (2006
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Chapter 4. Enabling a Secure Exchange of Information
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Introduction While health care organisations have access to an ever-increasing
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Figure 4. 1. Use of EHRS and of electronic discharge and referrals by Primary Care
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 4. 1. Governments†role in the adoption of standards
Health Infoway, an independent, not-for-profit corporation, was formed in 2001 by the Government of Canada to accelerate the development and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Box 4. 1. Compliance with standards:
300 stakeholders across Canada, the Blueprint is a framework that defines standards (e g. the requirements and enabling solutions for privacy and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 4. 2. Certification of products
independent, not-for-profit organisation that certifies health IT products. HHS entered into a contract with the commission in October 2005 to develop
Each vendor sets up a test environment that replicates the live environment of its EHR system,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 testing to execute all the procedural steps in the published test scripts,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 •The timeframe and cost involved in certification and re-certification
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Programme (POSP)( Box 4. 3). This list is updated from time to time
is to enable physicians who provide insured services in Alberta to use electronic medical records to improve patient care
electronic health environment. Through a combination of funding, information technology services and change management services, POSP has helped nearly half of Alberta†s
practicing physicians to incorporate information technology into their practices Some of the initiatives that POSP supports include
•Working with stakeholders to update the Vendor Conformance and Usability Requirements (VCUR) for physician's offices.
regularly to ensure they continue to reflect the needs of all stakeholders •Collaborating with Alberta Health Services and Alberta Health and Wellness to
ensure integration and interoperability with provincial systems (e g. the Pharmaceutical Information Network (PIN), lab test results and diagnostic
•Providing a broad range of change management services to support those physicians who are automated already,
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Both POSP and the VCUR programme are recognised as being critical
G. W. School of Public health and Health Services, 2009 There is, therefore, a need for coherent and consistent policies around
difficult because stakeholders may have differing views of what can be shared and with whom. The implementation of security requirements is
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 country consistently noted that privacy
associative studies to improve services for citizens To overcome some of the obstacles to the secondary use of data, in
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Four options can be considered in making the decision about whether and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Box 4. 4. MAEHC turned consent to demand
Following extensive discussion within the MAEHC€ s own privacy and security committee, with the communities,
recruitment became a preeminent concern for the HIE enterprise, if it was to be viable.
so that patients would want and demand to participate To engage patients, the MAEHC enlisted the assistance of outside professionals with
from the focus groups guided MAEHC€ s further communication strategy and consent process in the three communities
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 References Beckerman, J. Z. et al.
G. W. School of Public health and Health Services (2009), â€oepatient Privacy in the Era of Health Information technology:
G. W. School of Public health and Health Services, Washington, D c Goldman, J. 1998), â€oeprotecting Privacy to Improve Health Careâ€, Health
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Chapter 5. Using Benchmarking to Support Continuous
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Introduction As discussed earlier in this report, evidence of the impact of health ICTS
The result is that after more than a decade of large investments in health ICTS, OECD governments are still unable to provide reliable evaluations of
the financial and social returns on their investments This chapter reports main findings of an analysis of the challenges
ICTS and realise the benefits intended from investment in these technologies? On the surface, the answer appears simple.
provide a picture of significant public investment (Box 5. 1), some notable successes and highly publicised costly failures.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Box 5. 1. Implementation efforts provide a picture
of significant public investment Health ICT investments costs are difficult to determine. Costs are provided usually
as rough estimates only and it is often difficult to separate health ICT costs within
investment per capita varying from USD 5 to 13 In a strategic planning document, Canada Health Infoway in 2006 reported a rough
assessment of total investment costs per capita to establish a fully functional EHR system that ranged from an estimated CAD 133 in Canada as of 2009 to CAD 570 per
investment in the United kingdom. Although similar to the per capita being spent by Kaiser permanente, it stands out from other countries.
therefore, inevitably underestimate the true public investment. Other countries may well be investing comparable amounts per capita
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Table 5. 1. Current budget for ICT initiatives in three OECD countries
Current investment per capita (USD) 10 6. 83 13.80 5. 47 Table 5. 2. Total budget allocated by national government in two OECD countries
Total investment per capita (USD 54.34 340.27 Note: The budget allocation amounts shown for Canada in both Tables 5. 1 and 5. 2 do not
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 The main information needs today †as listed by policy makers in response
There is likely to be some demand for all three types of indicator, but priorities will differ over time
These questions address the state of â€oereadiness†of the environment 116 †CHAPTER 5. USING BENCHMARKING TO SUPPORT CONTINUOUS IMPROVEMENT
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 â€oeuse†refers to the applications of the technologies in clinical activities
services provided to patients (impacts CHAPTER 5. USING BENCHMARKING TO SUPPORT CONTINUOUS IMPROVEMENT †117
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 With the exception of Finland, where ICT adoption has been monitored
although there appears to be some demand for indicators to track population access to ICTS, patients†opinions and attitudes, including for health-related
Services Industries surveys undertaken by the Australian Bureau of Statistics and a 2008 mail survey of office-based physicians by the National Center for Health
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 The scope of the surveys and the methodologies used therefore vary
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 5. 3. Common information needs are reflected in a core set of widely
can create a significant barrier to the entire enterprise of regional/national integration. Until the least advanced participants, be they hospitals or
and opportunities to promote efficiencies and reduce redundancies in the establishment of a national/local e-health
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 •Installation, training and support
•Increased capacity for ICT services •Support for organisations whose state of ICT-readiness is low
•Opportunities to leverage shared capacity To steer and stimulate adoption and use of ICTS
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Figure 5. 2. Rates of adoption of electronic health records by physicians
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 some importance, much importance) are inevitably qualitative in nature and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Developing and implementing a â€oemodel survey†(OECD,
common set of guidelines to measure ICT usage in enterprises and in households and is adopted today widely by national statistics offices
different questions, wording or explanations may be necessary in different environments To be useful in all contexts,
modules to ensure flexibility and adaptability to a rapidly changing environment. While the use of core modules allows measurement on an internationally comparable basis, additional
changing environment. While the use of core modules allows the measurement on an internationally comparable basis, additional modules and new indicators
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 References Agency for Healthcare Research and Quality (AHRQ)( 2007), Health
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Hwang, J. et al. 2007), â€oedisruptive Innovation In Health care delivery
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 samhandling i helsetjenesten, Dokument nr. 3: 7 (2007-2008
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Annex A. Country case studies The Great Southern Managed Health Network (GSMHN
providing these services GSMHN has established also one of the few examples in OECD countries of a not-for-profit self-sustaining â€oee-health network†where health providers pay an
annual fee to join the information exchange Determinants of success The significant role of Divisions of General Practice and of the University of
not-for-profit partnership agreement Targeted financial incentives The Practice Incentive Payments (PIP) Information management and Information
take-up of broadband services in general practices in the region. Payments depended on adoption of either satellite or terrestrial (including ADSL, cable and wireless technology.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 High rates of basic computerisation
established in 2007 as a not-for-profit association between the Great Southern General Practice Network (GSGPN) and the University of Western
Australia Country Health Services. The most commonly cited effects can be categorised according to five groups:
communication was the most commonly perceived benefit (e g. the prompt receipt of discharge summaries from hospitals †previously often arriving
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 unavailable, at least routinely), faster communication, higher quality of data
and more complete information. GSMHN allowed health providers to improve how, and what, they communicate with each other
health services in WA presents, therefore, many challenges. These include •Hiring and keeping doctors:
•Achieving economies of scale and viability of services in a dispersed or isolated population: recent evidence suggests that a critical
comprehensive and sustainable range of health care services •Improving access to specialist services, mental health services and
aged care: access to specialist services remains a problem for many residents of isolated settlements which often have to relocate to
utilise these services. Inability to readily access specialist services when required can result in health needs not being met adequately
lack of continuity of care and worse health outcomes. The poorer health status and higher mortality rates in the Kimberley region
compared with the state†s average is attributed largely to poor access to secondary and tertiary health services and the greater health needs
of the local aboriginal population 130 †ANNEX A. COUNTRY CASE STUDIES IMPROVING HEALTH SECTOR EFFICIENCY:
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 The challenging circumstances of rural Australia have resulted in
•Integrated services provide single point access to a range of services significantly broader than those delivered by general practice.
services across primary and specialist care •Comprehensive primary health care services are typified best by the
Aboriginal Community Controlled Health Services (ACCHSS ACCHSS have adopted a primary health care approach to healthcare delivery over the past 30 years,
which includes preventive and health promotion activity, as well as education and capacity building •Outreach models are characterised by the periodic supply of a range of
health services from one location which has these services to other locations which do not.
services to satellite communities or some other visiting mechanism such as where a GP resident in one community may visit a second
Services can also be supplied on a virtual basis (virtual outreach) or on a fly-in, fly-out basis
services within these networks •Integration of services by achieving greater collaboration between medical, nursing and allied health staff across regions,
to ensure that patients receive seamless health care irrespective of how they enter the system and to ensure small communities receive good access to
services including through telehealth The Divisions of General Practices (DGP) have received substantial funding to support adoption of health IT
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Incentives Programme (PIP) which is one of the most comprehensive and
The GSMHN is a not for profit collaboration between GSGPN and the UWA. The University was not new to this type of partnerships as it had
dedication of its staff, the not for profit nature of the partnership and the extensive expertise in software development
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Physician Connect and the chronic disease management toolkit
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 Incremental change Experience with â€oehome-grown systems†and a supportive environment contributed to
acceptance and successful implementation of EMRS. Prior to the launching of Physician Connect over 50%of family physicians in Prince George were already using a â€oehome-grown†patient
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 toolkit experience enabled providers to produce more integrated and efficient
services for people with complications is approximately CAD 776 million each year. By 2016, direct health care costs to treat patients with diabetes in
created a value proposition for all key stakeholders. These include •For patients †Enhanced health outcomes and quality of life through early
and accurate delivery of appropriate medical services •For family physician practices †ICT enables a comprehensive chronic disease management
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Policy context and sustainability The overall approach to chronic disease in British columbia includes
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 The Massachusetts e-Health Collaborative in the United states
The health ICT effort was based on extensive stakeholder consultations and took account of the varying needs and objectives of the three communities.
contracting and associated legal services. Budgeting for such support was generous †typically about one-third of total expenses
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Addressing privacy and security concerns
major health care stakeholders for the purpose of establishing an EHR system through community-based implementation that would enhance
ensure smooth transition to the digital environment •Developed community-level HIES custom built and organised
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Business case In Massachusetts, a baseline survey done in the spring of 2005 found
Human Services (US DHHS) is providing leadership for the development and nationwide implementation of an interoperable health information
This provides a unique opportunity to invest in maturing HIE initiatives and making them sustainable
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 The MAEHC€ s original BCBSMA funding is exhausted nearly as the
services. It can provide the services at two levels. Either through incentive payments to physicians for EHR implementation or through state grants as
supporting a state designated HIE or other entity. To this effect, MAEHC has successfully launched a for-profit subsidiary to provide consulting services
related to EHR deployment, HIE, and quality data warehousing. As with the MAEHC, the service will include start to finish implementation including
and project execution services Governance The MAEHC is a public/private collaborative of providers, payers
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Telestroke in the Baleares (Spain
system-wide EHR, radiology information system (RIS)/ picture archiving and communication system (PACS), pharmacy information system, and others.
deliver equal access to health services regardless of patient location and providing continuity and co-ordination of care have created the foundation for telehealth as a necessity in the
Garnering stakeholder buy in Although the technology to build and operate a telehealth programme for stroke patients
stakeholders from the various hospitals and health authorities had to be convinced of the potential benefits of the programme.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 via telestroke system and are receiving emergency stroke expertise from the
services also seems to reduce inappropriate variations in practice Business case Stroke is the leading cause of death for women and the third leading
heavy toll on the local economy Fortunately, of the stroke cases, approximately 86%are ischemic strokes and readily amenable to clot busting drugs like tpa.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 statement of the overall aims and goals of stroke management agreed upon
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 with the region†s only specialised stroke unit, serves today as the â€oehub†with
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 E-prescription in Sweden Key achievement
-profit organisation offered medication to all Swedish citizens through its network of about 900 outlets nationwide, including both full-scale pharmacies and local village shops in more
Early adopters within an innovation-friendly environment Swedish pharmacists had been experimenting with e-prescription since 1981, based on
communication. The network infrastructure allows secure communication and distribution of patient data, pictures, medical applications and services for which the Internet is not
acceptable. Subsequently, in 2001 when the first large scale e-prescription implementation effort began in Stockholm county, the vital communication link between physicians and
pharmacies was already in place. As a result, technical implementation of e-prescription was focused largely on designing, developing,
and deploying the e-prescription applications on either end of the Sjunet, at the providers and pharmacies.
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Close co-operation between all stakeholders
Apoteket†s implementation strategy emphasized the partnering with local health regions County Councils), physicians, and other local stakeholders.
To achieve this, Apoteket formed implementation teams in each county across the country. These teams led by dedicated local project managers at the health care providers
start to finish local implementation approach created the necessary stakeholder relationships bonds, and buy in that are essential to any technology project.
In effect, creating and cultivating a consumer demand Background and benefits The first Swedish efforts in e-prescription date back to 1981 with a
•Made e-prescription services available virtually throughout the country •Deployed a national e-prescription mailbox allowing patients to store
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 process. The traditional paper prescriptions required over a dozen daily
stakeholders, beneficial for the entrepreneurial development of the new technology Furthermore, in support of better aligning laws and regulations to
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 To this effect the e-prescription programme has accomplished the major
Services which will continue to maintain and operate the national e-prescription programme and related infrastructure
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Implementation of a Patient Summary Record System in Twente
•What investments are necessary and what costs will be incurred by physicians •What are expected the benefits
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 also introduced a national unique patient identifier:
â€oegapsâ€, technical and information needs requiring additional effort and/or investment in research, development, testing, and evaluation
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 It appears that the availability of patient information, at least from the
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 implemented a regional service that allowed electronic communication
relevant health care and IT sector stakeholders and also serves as an 152 †ANNEX A. COUNTRY CASE STUDIES
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 independent expert organisation providing guidance on infrastructure and
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES Â OECD 2010 Annex B. Project background and methodology
THE ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGIES  OECD 2010 •Person (s) responsible for the development, implementation and
THE ROLE Of information and COMMUNICATION TECHNOLOGIES Despite the promise they hold out, implementing information and communication
technologies (ICTS) in clinical care has proven to be a very difficult undertaking. More than a decade of efforts provide a picture of significant public investments,
resulting in both notable successes and some highly publicised costly delays and failures. This has been
Sweden and the United states to identify the opportunities offered by ICTS and to analyse under what conditions these technologies are most likely to result in efficiency and quality
COMMUNICATION TECHNOLOGIES The full text of this book is available on line via these links
Reducing operating costs of clinical services Reports on cost-savings tend to be anecdotal in nature
Administrative processes such as billing represent in most countries a prime opportunity for savings Achieving â€oetransformation†through ICTS
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