Public Reports: e-Health - details
Department of Health. Health informatics review report
"This report builds on the Next Stage Review by describing how informatics is supporting the delivery of better, safer care of patients, improving the NHS through better research, planning and management, and empowering patients to make more informed choices about health and care."
"The Health Informatics Review was commissioned by the NHS Chief Executive and
Department of Health Permanent Secretary to:
assess the supply of, and demand for, information across the NHS and social care,
so that the data collected can be used to provide valuable and relevant information;
make sure that, five years after the commissioning of the National Programme for
IT, the framework for the NHS Care Records Service (NHS CRS) and the Secondary
Uses Service (SUS) is in line with recent, current and potential future policy;
make sure that the governance of informatics within the NHS and the Department
of Health (DH) is clear and appropriate, and supported by the right management
"The Informatics Review comprised three linked projects:
Project 1 - A review of information flows to meet the needs of DH and the NHS.
Project 2 - A review of elements of NPfIT (notably NHS CRS and SUS) to ensure
that it meets needs of the NHS as it is formed today, can support the coming
changes and can maximise its benefits into the future.
Project 3 - A review of information and IT governance within the DH and
recommendations on how to align and integrate policy and information management."
"The recommendations include plans to:
extend and integrate NHS Choices and HealthSpace
provide Clinical Dashboards
provide a staff portal (mystaffspace)
extend the availability of metrics"
More specifically, the report details 5 key features (called the "clinical 5" (p.26)) for secondary care IT systems:
- "a Patient Administration System (PAS)
with integration with other systems and
- Order Communications and Diagnostics
Reporting (including all pathology and
radiology tests and tests ordered in
- letters with coding (discharge
summaries, clinic and Accident and
- scheduling (for beds, tests, theatres etc.);
- e-Prescribing (including ‘To Take Out’
Karl A. Stroetmann, Tom Jones, Alexander Dobrev, Veli N. Stroetmann.
eHealth is Worth it?
The economic benefits of implemented
eHealth solutions at ten European sites. (eHealth IMPACT project study supported by the European Commission Information Society and Media Directorate-General.)
26 September 2006
"[T]he study is one of the first attempts to assess the real impact of eHealth applications. ... [It]
study shows that across a wide range of eHealth applications clear evidence can be found of the benefits of
information and communication technologies in routine healthcare settings. These benefits range from improvements in quality, [safety, costs]
and better access [for] all citizens to care". [...]
The report evaluates ten individual e-Health sites using methods developed by the EU eHealth Impact project:
- AOK Rheinland, Germany – GesundheitsCard Europa (GCE), cross border access to healthcare (in the Netherlands and Belgium)
for german patients insured by AOK Rheinland on presentation of
their German health insurance card.
- Apoteket (Sweden’s national pharmacy) Sweden – ePrescribing
- City of Bucharest Ambulance Service, Romania – DISPEC teletriage and dispatch system
- Institut Curie (oncology), Paris, France – Elios (internal EHR system) and Promethee
(tool "supporting simultaneous enquiries in different databases enabling fast data collection for research purposes").
- IZIP, Czech Republic – web based national electronic health record
"supported by the largest health insurer in the Czech Republic, serving two thirds of the Czech population".
- Kind en Gezin, Flanders, Belgium – Flemish (children's) vaccination database (FVD) and Vaccinet
- Medcom, Denmark - Danish health data network (DHCDN)
- MedicalOrder®Center Ahlen – supply chain optimisation (Germany)
- NHS Direct, UK – NHS Direct Online (NHSDO) healthcare information advice service
- Sjunet, Sweden – radiology consultations between Sweden and Spain.
Some main conclusions (summary):
enhanced healthcare [when properly implemented] promises to reduce costs, improve quality and efficiency and treat more
patients with the same resources ...
The eHealth Impact project
conclusively demonstrated that there is over a 2:1 ratio between economic benefits and costs" [EC].
eHealth Tools & Services - Needs of the Member States.
Report of the WHO Global Observatory for eHealth.
This report constitutes the first global survey on eHealth.
Key survey findings:
- "active involvement of WHO in the development of generic eHealth tools, and guidance
in creating and implementing eHealth services would be welcomed by Member States;
- "the need for guidance in a broad range of eHealth areas was expressed in particular by
countries that do not belong to the Organisation for Economic Co-operation and
- "OECD countries did not express consistent views of their needs in eHealth areas; and
- "there is a need to raise awareness as to what eHealth tools and services already exist at
global and national levels."
Proposed actions (summarised from the report):
- Provide generic eHealth tools most sought after by
Member States (tools for monitoring and evaluation of eHealth services;
institutional patient centred information systems that could be extended to include
electronic health record systems;
directories of health care professionals and institutions).
- Support access to existing eHealth tools
services with an emphasis on open source solutions.
- Provide an international knowledge exchange network to share practical experiences on the
application and impact of eHealth initiatives should be built.
- Provide a digital resource of eHealth information to support the needs of Member
States in key areas such as eHealth policy, strategy, security and legal issues.
- Promote eLearning programmes for professional education in the
health sciences and in ongoing professional development.
Reforming Health Care for the 21st Century. National Economic Council, February 2006
The report, which follows up from the President's State of the Union address on 31 January 2006,
covers goals for the whole of healthcare.
Proposals specific to the implementation of Health Information Technology are quoted here:
"In 2004, the President launched an initiative to make electronic health records available to most Americans within the next ten years.
Realizing the promise of health IT will help transform our health care system by lowering costs, reducing medical errors,
and improving quality of care in a more efficient and hassle-free environment. Greater reliance on electronic health records
means that information needed to treat patients effectively will be a few computer clicks away, no matter where the patient
is receiving care. The Department of Veterans Affairs, as well as some private health care systems, has already begun to
demonstrate the power of health IT to reduce costs and errors and improve quality of care."
"Action: Through the President’s leadership over the past two years, the Administration has taken numerous steps towards fulfilling his health IT vision, including:
"In conjunction with these efforts, the Administration has established the American Health Information Community (AHIC)"
... to [help co-ordinate (editor's interpretation)] "a common framework for implementing a nationwide electronic health records system."
- "Establishing the position of the National Coordinator for Health Information Technology within the U.S. Department of Health and Human Services (HHS);
- "Providing support for several health IT projects to assess and develop solutions to key implementation issues such as:
- "harmonizing standards to allow different health systems to speak the same language and seamlessly share health information when needed;
- "developing certification criteria to ensure health IT investments meet proper standards;
- "addressing privacy and security issues; and
- "developing models for a national Internet-based system that allows electronic health information to follow patients no matter where they receive care."
Nationale Strategie „eHealth”, December 2006
Health Information Strategy Steering Committee. 2005.
Health Information Strategy for New Zealand. Wellington: Ministry of Health.
The following information is all taken from the report.
The purpose of HIS-NZ is to develop a single and co-ordinated strategy for information systems, including current and emerging information, communications and technology (ICT) within the health and disability sector. The process aims to develop consensus on vision, goals and activities for information systems in the sector over the next five years.
"New Zealand made early strides in recognising the value of information systems in improving health outcomes through the implementation of a national infrastructure."
Chapters 3 to 6 of HIS-NZ identify principle interventions that provide a linkage to major health and disability sector strategies and priorities that reflect areas where action is needed. For each of the priorities, ‘action zones’ provide a focus for implementation planning in the sector over the next 3 to 5 years.
Twelve priority areas / action zones covering the years 2005-2009:
Chapter 7 onwards of HIS-NZ discusses the specific guides for building the capability that we need to create workable solutions.
These ‘building guides’ outline the key structural components required to deliver integrated information systems to the sector. The eight building guides are:
- National network strategy
- NHI (National Health Index) promotion (unique patient identifier)
- HPI (Health Provider Index) implementation
- ePharmacy (electronic prescribing - electronic transactions between prescribers and pharmacies.)
- eLabs (electronic transactions between clinicians and laboratories) (to include decision support capability)
- Discharge summaries (electronic)
- Chronic care and disease management (includes guidelines)
- Electronic referrals (including guideline-based decision support)
- National outpatient collection
- National primary care collection
- National system access (secure, web)
- Anchoring framework (ability to link data across the continuum of care).
- Investment management framework
- Strategic information planning framework
- Collaboration frameworks
- Data sets
- Privacy and security.
In 3 to 5 years’ time, New Zealand should be able to see a number of advances.
Community providers will be connected to a secure health information network. This will support more seamless care, enabling them to participate in information sharing and in accessing relevant data as it becomes available to the different initiatives.
All parts of the sector will be able to access relevant key event summaries online.
Primary care and secondary care providers will interact electronically around key events, discharges and chronic care/disease management.
There will be greater collaboration and sharing of information between hospitals, general practitioners, diagnostic service providers, pharmacies and other practitioners.
Interactions between secondary care and primary care providers will be more uniform. Routine exchanges of information such as discharge summaries, referrals and admissions for services should be the norm.
At a national level, key information gaps in our existing collections will have been closed, particularly in regard to understanding:
– community, primary care and outpatient services; access to these data sets will be nationally enabled, supporting safe and high-quality care to consumers
– the implications of our health strategies from a policy, funding and research perspective; we need to be able to monitor progress and evaluate the outcomes of changes to our service configuration.
Figure 4, P12 of the report shows the architecture of the planned distributed electronic health record.
Figure 14, P64 shows the Benchmark targets for HIS-NZ for different care settings (3 to 5 year horizon).
The complete implementation roadmap (2005-2009) is shown on the last page of the report - Appendix 2: P94.
Report by the Secretariat, World Health Organisation
Following the May 2005 World Health Assembly resolution, WHO initiated a first world-wide survey on eHealth as part of the work of the WHO Global Observatory for eHealth (GOe),
established in early 2005 to provide Member States with strategic information and guidance on effective practices, policies and standards in eHealth. The GOe secretariat is based at WHO headquarters in Geneva (Switzerland) and the networked operation is planned to grow rapidly to include research centres and collaborating partners across the globe.
The 2005 eHealth survey focuses on issues relating to processes and outcomes in key eHealth action lines previously identified by the World Summit on the Information Society (WSIS) and WHO.
The 3 prime objectives are to:
- Describe and analyse the eHealth profiles in countries, regions and internationally
- Identify and evaluate measures taken in key action areas to support the development of eHealth in countries
- Establish the requirements of Member States for eHealth tools and services.
 RAND Corporation.
Health Information Technology: Can HIT Lower Costs and Improve Quality?
This short report (or "Highlight") constitutes an estimation of "the potential costs and
of widespread adoption of Health Information
Technology" (EHRs, DSS, CPOE ...) in routine care.
Research (from RAND and other sources)
used in the compilation of the report is referenced at the end of the document.
- "Properly implemented and widely adopted,
Health Information Technology would
save money and significantly improve
- "Annual savings from efficiency alone could
be $77 billion or more.
- "Health and safety benefits could double
the savings while reducing illness and
prolonging life. [The report estimates that if "all hospitals had a HIT system including Computerized
Physician Order Entry, around 200,000 adverse drug events
could be eliminated each year, at an annual savings of about
- "Implementation would cost around
$8 billion per year, assuming adoption
by 90 percent of hospitals and doctors’
offices over 15 years.
- "Obstacles include market disincentives:
Generally, those who pay for Health
Information Technology do not receive the
- "The government should act now to overcome
obstacles and realize benefits."
Brailer DJ. Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US Department of Health and Human Services. 2004.
"On July 21, 2004, the US Department of Health and Human Services released a report on the progress of the strategic plan to guide nationwide adoption of health information technology in both the public and private sectors. The report outlines the framework for 12 strategies that will achieve four goals: 1) introduction of information tools into clinical practice; 2) electronically connecting clinicians to other clinicians; 3) using information tools to personalize care delivery; and 4) advancing surveillance and reporting for population health improvement" [IHI].
President’s Information Technology
Advisory Committee (PITAC). Revolutionizing
Health Care Through Information Technology|
The essence of our recommendations is a framework for a 21st century
health care information infrastructure that revolutionizes medical
records systems. The four core elements of this framework are:
Electronic health records for all Americans that provide every
patient and his or her caregivers the necessary information
required for optimal care while reducing costs and administrative
Computer-assisted clinical decision support to increase the ability of
health care providers to take advantage of state-of-the-art medical
knowledge as they make treatment decisions (enabling the practice of
Computerized provider order entry—such as for tests, medicine, and procedures—
both for outpatient care and within the hospital environment.
Secure, private, interoperable, electronic health information exchange,
including both highly specific standards for capturing new data and
tools for capturing non-standards-compliant electronic information
from legacy systems.
Because these proposals involve significant technical challenges, our 12
individual recommendations address the technical issues in some detail. ..."
(PITAC: "The President’s Information Technology Advisory Committee
is appointed by the President to provide independent
expert advice on maintaining America’s preeminence in advanced information
e-Health - making healthcare better for European citizens: An action plan for a
European e-Health Area.
Commission Of The European Communities,
Brussels, 30 April 2004
The European Commission (EC) has supported research & development
into e-Health since the the 2nd Framework Programme, 1989-1990.
The report comprises the EC eHealth
Action plan for Europe
2004-2010 and was issued at the EPSCO Health
Council, June 2 2004.
The action plan includes a sequential set of actions to be taken by EU member states
and the Commission over the period 2004-2010. in three target areas:
- Common challenges including setting national roadmaps for e-Health, deploying e-Health systems
and health information networks (broadband, wireless, grids);
setting targets for interoperability and the use of electronic health records;
clarification of legal framework.
- Pilot actions accelerating implementation of e.g. teleconsultation, e-presciption,
e-referral, telemonitoring and
- Evaluation, confirmation of benefits and dissemination of best practices.
The strategy aims to facilitate access to healthcare in different countries
with the EU by citizens and to improve patient
safety. "The main
objectives of the action plan are to improve access and
boost quality and effectiveness of eHealth services offered in
Europe, and enhance the European eHealth industry by
making eHealth systems and services more interoperable and
Main target dates for EU member states listed in the e-Health action plan:
- "To develop a roadmap for e-Health by the end of 2005
- Setting up a European Union public health portal by the end of 2005
- Identifying a common approach to patient identifying data by the end of 2006
- Identifying interoperability standards for health data by the end of 2006"
- 2008: "supporting the deployment of health information networks based on fixed and wireless broadband and mobile infrastructures and Grid technologies."
- "By end 2008, the majority of all European health organisations and health regions
(communities, counties, districts) should be able to provide online services such as
teleconsultation (second medical opinion), e-prescription, e-referral, telemonitoring and
E-Health In Central And East European Countries with focus on Czech Republic, Hungary, Poland and Slovenia.
"The aim of this report is to give an overview about countries’ basic indicators, governments’ action plans for
eHealth, and provides a collection of different telemedicine projects and studies that have been conducted in Central
and Eastern Europe. [The terms eHealth and telemedicine
terms are used interchangeably in the report.] The focus is on the following 4 countries: Czech Republic, Hungary, Poland and Slovenia.
[Cyprus, Romania and Slovakia are also teated in some detail.]
Telemedicine work in these four countries is presented in separate chapters.
The overview is divided into short introduction on EU 15 eHealth market situation, general information about
Central and Eastern Europe (CEE) and more detailed description of above mentioned four countries. The latter
consists of presentation of official policy of each country, and eHealth and telemedicine projects/ pilots in the
various medical fields where telemedicine is already of increasing importance."
"The main report (53 pages) includes European Information Technologies market overview, Central and East
European (CEE) countries basic indicators and separate chapters on eHealth situation and more detailed collection of
pilots in 4 countries: Czech Republic, Hungary, Poland and Slovenia. The supporting materials such as complete
surveys reports, detailed articles mentioned in the report, contributions from the other authors and other material are
contained in the Annexes (130 pages)."
"Findings: There are many pilots, especially in Central European Countries, that are mostly local in nature and often
without any government or Health Authority commitment. All of the countries studied have eHealth action plans that
often stems in different ministries than Ministry of Health. In some cases, such as the Czech Republic, Poland, and
Slovenia, the competency and sometimes co-funding lies within Ministry of Health. Majority of the development
and set up of pilots have been financed from private sources, but without follow up. The pilots are predominantly
telemedicine services such as teleconsultation. Slovenia has made significant progress in deployment of electronic
health record and health cards and has the only “viable” eHealth service that the author found in his research. Several
countries are following that example of insurance based health data system. Also, the region of Krakow
(Malopolskie) has made significant progress in planning and deploying eHealth systems and services. The findings
of author lead to one major conclusion: creation of favourable environment for all the players (ministries, users,
industries and social insurance players) to have common understanding and objectives through open dialog and
optimising of resources. The national and regional plans should draw from the experiences and best practices that
were developed elsewhere and that were supported by the EU research and development programmes in eHealth."
An eHealthy State? – An assessment of the adoption of eHealth in Ireland
- "That a significant ring-fenced fund be created to finance eHealth projects
- That HIQA is equipped and resourced as required to play the leadership role in the planning and
implementation of a large scale eHealth investment programme
- That HIQA develop a framework to measure and evaluate the totality of benefits that should be
delivered and need to be delivered to justify the investment required in eHealth systems
- That every eHealth investment is contingent on proving the business case against the health benefits
framework HIQA should develop
- Increased attention with regard to project management, user acceptance testing and user training
for large ICT programmes to ensure that they do deliver their estimated benefits
- That a formal project evaluation be completed at the end of every project to test whether the
anticipated benefits have been delivered.
- That HIQA and the HSE proactively seek opportunities for the deployment of technology to facilitate
the Health Reform Programme
- That current examples of best practice in eHealth are used as a basis for further development
- That eHealth applications be designed and developed on a ‘shared alliance’ basis that facilitates
patient care. There is little benefit in developing, as an example, GP systems that do not integrate
with hospital or community systems. If patient interaction is placed at the centre of system design,
then the resulting systems will deliver maximum patient benefit
- That a programme be established to identify the feasibility and value of becoming an eHealth
- That third-level institutions, and other publicly-funded research institutions, are encouraged to
develop a focus on eHealth
- That Irish health agencies proactively seek to benefit from the funding and expertise available
from participating in the forthcoming FP7."
Télémédecine/Telemedizin CH. Swiss Academy
of Medical Sciences & Swiss Academy of Engineering Sciences
Report on the introduction of telemedicine services into the Swiss healthcare system co-ordinated in part by the
Swiss Academy of Engineering Sciences (SATW), "one of four academies recognised
by the Swiss government as institutions promoting research".
Ce rapport vise à fournir une approche cohérente pour la définition d’une stratégie nationale de développement
et de mise en oeuvre des technologies de l’information et de la communication (TIC) dans
le domaine de la télémédecine et à mobiliser des ressources et du know-how pour poursuivre un programme
d’applications permettant d’apporter des solutions nouvelles et novatrices à certaines questions
soulevées par le système de santé suisse. La question du maintien des personnes âgées à domicile
est également abordée. ...
Parmi les différents types d’applications de la télémédecine, il faut établir des priorités en tenant compte
des intérêts des parties prenantes et des aspects spécifiques à la Suisse. Les deux applications suivantes
paraissent les plus significatives et les plus prometteuses :
Télématique de la santé (transfert et gestion d’informations médicales via le réseau
public de communications, y.c. l’enregistrement crypté des données numérisées
et leur identification avec une carte patient).
Télémonitoring en temps réel ou différé de paramètres physiques et physiologiques pour
des personnes malades ou à risques, par exemple les personnes âgées à domicile. [P21]
Dieser Bericht soll dazu beitragen, eine kohärente Strategie für die Einführung der Informations- und
Kommunikationstechnologien (IKT) in den Bereich der Telemedizin auf nationaler Ebene zu definieren
und das benötigte Know-how und entsprechende Ressourcen zu mobilisieren. Es sollen Anwendungsmöglichkeiten
ausfindig gemacht werden, die neuartige und innovative Lösungsansätze zu aktuellen
Problemen des schweizerischen Gesundheitswesen aufzeigen können. Ferner wird die Frage des Verbleibens
älterer Menschen in der eigenen Wohnung erörtert. ...
Die Arbeitsgruppe empfiehlt die Einrichtung eines nationalen Forschungs- und Entwicklungsprogramms
über die Anwendungsmöglichkeiten der Informations- und Telekommunikationstechnologien
(ITK) in der Telemedizin. Mit hoher Priorität zu bearbeiten sind folgende Gebiete:
Medizinische Telematik: Übermittlung und Verwaltung von medizinischen Informationen
über das öffentliche Telekommunikationsnetz, inklusive verschlüsselter Speicherung
der digitalisierten Daten und Identifikation mittels einer Patientenkarte.
Telemonitoring: Überwachung, in Echtzeit oder verzögert, von physikalischen und
physiologischen Parametern für Personen, die krank oder einem erhöhten Risiko ausgesetzt
sind, zum Beispiel ältere Menschen zu Hause.
Um die Machbarkeit und die praktische Bedeutung dieser Ergebnisse zu untermauern, empfiehlt die
Arbeitsgruppe, eine Reihe von Pilotprojekten durchzuführen, von denen jedes ein spezifisches Ziel verfolgt.
National Committee on Vital and Health Statistics, Information for Health: a Strategy for Building the National Health Information Infrastructure, Washington, D.C., 2001.
This report from the National Committee on Vital and Health Statistics (NCVHS), a public advisory committee statutorily authorized to advise the Secretary of Health and Human Services on national health information policy, outlines a vision and a process for building such a health support system — the National Health Information Infrastructure (NHII).
"The NHII includes not just technologies but, more importantly, values, practices, relationships, laws, standards, systems, and applications that support all facets of individual health, health care, and public health. It encompasses tools such as clinical practice guidelines, educational resources for the public and health professionals, geographic information systems, health statistics at all levels of government, and many forms of communication among users.
"The report identifies the human, institutional, and technological factors — existing and as yet undeveloped — that must be involved in building the NHII. The Committee recommends a strategy that gives the U. S. Department of Health and Human Services a key leadership role at the center of a broadly collaborative process for the public and private sectors. In addition to offering a detailed implementation plan, the recommendations in the report are unique in that they are comprehensive; they stress the need for information flows across sectors and with the public; and they attach equal importance to the personal health, healthcare provider, and population health dimensions.
"The heart of the vision for the NHII is sharing information and knowledge appropriately so it is available to people when they need it to make the best possible health decisions. To meet the Nation's health needs, the NHII must serve all individuals and communities equitably. The interconnections made possible by the NHII would allow information capacities that now exist or are developing in the health field to be put to fuller use. Ready access to relevant, reliable information and secure modes of communication would enable consumers, patients, healthcare and public health professionals, public agencies, and others to address personal and community health concerns far more effectively.
The NHII would serve important national interests. The Committee believes that implementation of the NHII will have a dramatic impact on the effectiveness, efficiency, and overall quality of health and health care in the United States. Serious problems such as public health emergencies, medical errors, and health disparities could be addressed in a more timely and comprehensive fashion.
UN Global E-government
Readiness Report 2005.
From E-government to E-inclusion.
In reaffirming the vision of a peaceful, prosperous and just world, leaders at the United
Nations World Summit in 2005 outlined a vision of ‘…building a people-centred and
inclusive information society, putting the potential of information and communication
technologies at the service of development and addressing new challenges of the
Exploring the interlinkages between e-government and development, the UN Global EGovernment
Readiness Report 2005: From E-government to E-Inclusion, presents an
assessment of the countries according to their state of e-government readiness and the
extent of e-participation worldwide. The UN Global E-government Survey 2005, like its
predecessors, ranks the 191 Member States of the UN according to a quantitative
composite index of e-readiness based on website assessment, telecommunication
infrastructure and human resource endowment.
The basic message in this Report is that there are huge disparities in the access and use of
information technologies, and that these disparities are not likely to be removed in the
near future unless a concerted action is taken at the national, regional and the
enable delivery of much needed education and health information to remote areas of
the world with the promise of leapfrogging traditional development cycles... [P.18]
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