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Health Information Technology adoption, programmes and plans

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We welcome for publication further information on these or any other programmes and plans designed to implement Health IT services in any country.

Health Information Technology adoption, programmes and plans: global perspectives

Summary information is provided by region (Europe, Americas, Middle East, Asia, Oceania, Africa). We plan to introduce gradually pages on individual countries and territories.

This is an ambitious undertaking: we hope to build up content with contributions from registered members of OpenClinical and site visitors. You can help us greatly by emailing information (new details, updates, corrections) to open@openclinical.org.

introduction
The replacement of healthcare systems reliant on paper-based medical records or generally localised clinical information systems by very large scale health information infrastructures centred on interoperable electronic patient record systems (and/or electronic heath cards) is now underway in many western countries. Some countries are well-advanced in the implementation of electronic patient records and national network infrastuctures - particularly the Scandinavian countries of Denmark, Finland, Norway and Sweden. But most aren't. However, governments in France, Canada, Australia, England, New Zealand and the USA, for example, have now committed to deliver national electronic networks and medical record systems to support healthcare delivery for their populations, typically by the end of the current decade.

These national programmes, all established within the last few years, are so extensive they constitute a healthcare technology revolution in each country where they have been announced. In Europe, the European Commission took a lead in publishing in 2004 an action plan for a European e-Health Area. The plan specifies a sequential set of actions to be taken by EU member states over the period 2004-2010. The investment committed in one case - NHS England on its wholly publicly funded Connecting for Health programme - is unprecedented. Some other countries, including France, are also funding their programmes exclusively with public money. Other governments, including the USA, Australia and Canada, are promoting collaborations between the private and public sectors. Finland's FinnWell programme is focusing on promoting healthcare technology development to create opportunities for Finnish business and research, while at the same time aiming to improve the Finnish healthcare system.

Interest in implementing e-Health technologies is not limited to the most highly developed countries of the world. In Asia, countries such as Hong Kong, Singapore, South Korea, Thailand and Taiwan are developing and implementing e-Health policies. e-Health projects focusing on telemedicine in particular are running in many of the countries of Central and South America and the Caribbean. Some countries in Africa are starting to develop e-Health policies and strategies and are receiving impetus and support from various global and regional organisations from the United Nations, the World Health Organisation, UNESCO to the recently inaugurated Digital Solidarity Fund (which aims to support implementation of ICT - including e-Health - in Africa) and NEPAD (the New Partnership for Africa’s Development).

News in 2006 on delays and problems affecting progress in England, the USA and France, for example, suggest that initially planned deadlines are unlikely to met but if successfully implemented, these programmes will completely transform healthcare delivery for hundreds of millions of people. Announcements of further programmes, not solely from the developed world, look set to follow. Where developing countries have not announced plans for implementing information technology for healthcare specifically, reference will be made to projected eGovernment portals or similar.

references: HIT

Middleton B. Evaluating the value of healthcare information technology: finding the diamond in the rough, and tumble. AMIA Annu Symp Proc. 2006;:1172-3.

[PubMed]   []

" The value of healthcare information technology has never been more important. Identified as a key component of healthcare transformation to reduce costs and improve quality, deriving maximal value from considerable healthcare information technology investment in both the local office or hospital setting, as well as the national or societal context, remains difficult(1;2). Despite continued pressure from both the public and private payer community, and increasing evidence on the value of information technology albeit from isolated settings, adoption of healthcare information technology proceeds at a snail's pace. Studies performed at the Center for Information Technology Leadership suggest that significant potential exists for healthcare savings exists at the national and local level with adoption of several forms of healthcare information technology. These studies, however, examined information technology from particular technology vantage points, for example, ambulatory CPOE, or information exchange and interoperability. In this presentation, and overview of three studies from the Center for Information Technology Leadership - the Value of CPOE in Ambulatory Care Settings(3), the Value of Healthcare Information Exchange and Interoperability(4), and the Value of Information Technology in Chronic Disease Management(5) - will be provided and correlations and contrasts will be presented from the three studies. Specifically, four new perspectives on this work will be presented: 1. Key contributors to the value of healthcare information technology that underly all three analyses will be identified and described. 2. Key detractors from the value of healthcare information technology that underlie all three analyses will be identified and described, including barriers to obtaining maximum value potential for all three technologies. 3. Implications for healthcare information technology strategy at both the local clinic and hospital, and national level will be discussed. 4. Implications for the pricing strategy of healthcare information technology vendors will be discussed. "

Shekelle PG, Morton SC, Keeler EB. Costs and benefits of health information technology. Evid Rep Technol Assess (Full Rep). 2006 Apr;(132):1-71.

[PubMed]   []

" OBJECTIVES: An evidence report was prepared to assess the evidence base regarding benefits and costs of health information technology (HIT) systems, that is, the value of discrete HIT functions and systems in various healthcare settings, particularly those providing pediatric care. DATA SOURCES: PubMed(R), the Cochrane Controlled Clinical Trials Register, and the Cochrane Database of Reviews of Effectiveness (DARE) were electronically searched for articles published since 1995. Several reports prepared by private industry were also reviewed. REVIEW METHODS: Of 855 studies screened, 256 were included in the final analyses. These included systematic reviews, meta-analyses, studies that tested a hypothesis, and predictive analyses. Each article was reviewed independently by two reviewers; disagreement was resolved by consensus. RESULTS: Of the 256 studies, 156 concerned decision support, 84 assessed the electronic medical record, and 30 were about computerized physician order entry (categories are not mutually exclusive). One hundred twenty four of the studies assessed the effect of the HIT system in the outpatient or ambulatory setting; 82 assessed its use in the hospital or inpatient setting. Ninety-seven studies used a randomized design. There were 11 other controlled clinical trials, 33 studies using a pre-post design, and 20 studies using a time series. Another 17 were case studies with a concurrent control. Of the 211 hypothesis-testing studies, 82 contained at least some cost data. We identified no study or collection of studies, outside of those from a handful of HIT leaders, that would allow a reader to make a determination about the generalizable knowledge of the study's reported benefit. Beside these studies from HIT leaders, no other research assessed HIT systems that had comprehensive functionality and included data on costs, relevant information on organizational context and process change, and data on implementation. A small body of literature supports a role for HIT in improving the quality of pediatric care. Insufficient data were available on the costs or cost-effectiveness of implementing such systems. The ability of Electronic Health Records (EHRs) to improve the quality of care in ambulatory care settings was demonstrated in a small series of studies conducted at four sites (three U.S. medical centers and one in the Netherlands). The studies demonstrated improvements in provider performance when clinical information management and decision support tools were made available within an EHR system, particularly when the EHRs had the capacity to store data with high fidelity, to make those data readily accessible, and to help translate them into context-specific information that can empower providers in their work. Despite the heterogeneity in the analytic methods used, all cost-benefit analyses predicted substantial savings from EHR (and health care information exchange and interoperability) implementation: The quantifiable benefits are projected to outweigh the investment costs. However, the predicted time needed to break even varied from three to as many as 13 years. CONCLUSIONS: HIT has the potential to enable a dramatic transformation in the delivery of health care, making it safer, more effective, and more efficient. Some organizations have already realized major gains through the implementation of multifunctional, interoperable HIT systems built around an EHR. However, widespread implementation of HIT has been limited by a lack of generalizable knowledge about what types of HIT and implementation methods will improve care and manage costs for specific health organizations. The reporting of HIT development and implementation requires fuller descriptions of both the intervention and the organizational/economic environment in which it is implemented. "

Chaudhry B, Wang J, Wu S st al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006 May 16;144(10):742-52. Epub 2006 Apr 11. Review.

[PubMed]   [Ann Intern Med]

" BACKGROUND: Experts consider health information technology key to improving efficiency and quality of health care. PURPOSE: To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. DATA SOURCES: The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. STUDY SELECTION: Descriptive and comparative studies and systematic reviews of health information technology. DATA EXTRACTION: Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. DATA SYNTHESIS: 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. LIMITATIONS: Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. CONCLUSIONS: Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear. "

references: e-Health programmes

McConnell H. International efforts in implementing national health information infrastructure and electronic health records. World Hosp Health Serv. 2004;40(1):33-7, 39-40, 50-2.

[PubMed]   []

" Many countries are developing national strategies using information and communication technologies (ICTs) to implement health information infrastructure and electronic health records (EHR), into their medical systems. Efficiency, quality of care and medical error along with new opportunities presented by the technologies themselves have driven this process internationally. Many countries have had spectacular failures costing billions of dollars alongside some amazing successes. There has been very little dialogue internationally about what works and what doesn't work despite the fact that many government and international agencies have placed this key priority on their agendas. The nature of the technologies used promotes cooperation and these innovations in healthcare lend themselves particularly to working together for collaboration and for communication in order to learn best practice from each other. In this paper, I look at some of the national initiatives for developing an information infrastructure for healthcare as well as some of the challenges presented by these very different approaches around the world. We also review briefly the many organizations looking at international standards relating to eHealth and to implementation of electronic health records. "

Anderson GF, Frogner BK, Johns RA, Reinhardt UE. Health care spending and use of information technology in OECD countries. Health Aff (Millwood). 2006 May-Jun;25(3):819-31.

[PubMed]   []

" In 2003, the United States had fewer practicing physicians, practicing nurses, and acute care bed days per capita than the median country in the Organization for Economic Cooperation and Development (OECD). Nevertheless, U.S. health spending per capita was almost two and a half times the per capita health spending of the median OECD country. One proposal for both lowering health spending and improving quality is the adoption of health information technology (HIT). The United States lags as much as a dozen years behind other industrialized countries in HIT adoption - countries where national governments have played major roles in establishing the rule, and health insurers have paid most of the costs. "

Jones TM. National Infrastructure for eHealth: Considerations for Decision Support. Studies in Health Technology and Informatics, Volume 100, IOS Press, 2004, pp28-34.

[IOS Press]   [IOS Press - full text]

" ... Governments across the world are in various stages of planning initiatives designed to leverage advances in healthcare information technology (IT) for the health of their citizens. The hazards of not having an Electronic Health Record (EHR) have become too apparent to ignore. The era of hospital-based systems is about to give way to the era of community based systems. The health of the citizen is beginning to assume as much importance as the treatment of the patient. Citizen-centric, community focused systems demand new ways of thinking. The architecture for the infrastructure is critical. A flawed architecture will cause the system to collapse under the weight of usage across a region or a nation. In addition to the technical infrastructure required to support millions of users, a myriad of access devices, and unprecedented amounts of data, the design must incor- porate an information model that supports transactional decision support throughout the life of the citizen. ... "

references: HIT evaluation

Lau F, Kuziemsky C, Price M, Gardner J. A review on systematic reviews of health information system studies. J Am Med Inform Assoc. 2010 Nov 1;17(6):637-45.

[PubMed]   []

" The purpose of this review is to consolidate existing evidence from published systematic reviews on health information system (HIS) evaluation studies to inform HIS practice and research. Fifty reviews published during 1994-2008 were selected for meta-level synthesis. These reviews covered five areas: medication management, preventive care, health conditions, data quality, and care process/outcome. After reconciliation for duplicates, 1276 HIS studies were arrived at as the non-overlapping corpus. On the basis of a subset of 287 controlled HIS studies, there is some evidence for improved quality of care, but in varying degrees across topic areas. For instance, 31/43 (72%) controlled HIS studies had positive results using preventive care reminders, mostly through guideline adherence such as immunization and health screening. Key factors that influence HIS success included having in-house systems, developers as users, integrated decision support and benchmark practices, and addressing such contextual issues as provider knowledge and perception, incentives, and legislation/policy. "

Chaudhry B, Wang J, Wu S et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006 May 16;144(10):742-52. Epub 2006 Apr 11. Review.

[PubMed]   [Ann Intern Med]

" BACKGROUND: Experts consider health information technology key to improving efficiency and quality of health care. PURPOSE: To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. DATA SOURCES: The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. STUDY SELECTION: Descriptive and comparative studies and systematic reviews of health information technology. DATA EXTRACTION: Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. DATA SYNTHESIS: 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. LIMITATIONS: Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. CONCLUSIONS: Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear. "

Links
 bullet  The World Wide Web Virtual Library: Public Health (School of Public Health and Community Medicine - UNSW)  bullet  The World Fact Book (from the CIA)  bullet  ICT for Health portal - part of the ICT for Business and Citizens Directorate at the European Commission  bullet  e-Health [OC]  bullet  National and international public reports on healthcare issues (e-Health, safety, quality, technologies ...) [OC]  bullet  Electronic medical records [OC]

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acknowledgements
 
page history
Entry on OpenClinical: 17 September 2005; revised 19 October 2006
Last main updates: 19 October 2006; 23 November 2006
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