"The eHealth Strategies study analyses policy development and planning, implementation measures as well as progress achieved with respect to national and regional eHealth solutions in EU and EEA Member States, with emphasis on barriers and enablers beyond technology. The focus is on infrastructure elements and selected solutions emphasised in the European eHealth Action Plan of 2004."

"More than 30 individual reports detailing policy actions and deployment of eHealth applications in Member States and other European countries are available."

"The Plan is based on achieving the eHealth Vision. This means that each patient will have a virtual health record, with information stored electronically and accessible regardless of location by linking to: existing systems run by health care organisations (eg, general practice, hospital-based systems), a regional clinical results repository and a shared care record."

There are two phases to the Plan:

"Phase 1: Consolidate, co-operate and lay the foundations (July 2010 to June 2012)

Phase 1 of the Plan is based on increasing health care organisations’ use of health IT solutions to a consistent level of capability, incorporating:

• easy access to health information
• transfer of health information between health care organisations
• capture of clinical event information into a regional clinical data repository
• improvement of primary health care practice management systems
• consolidation of the systems used in secondary and tertiary settings into regional or national platforms
• improvements in the quality of information used for population health
• replacement of systems managing patient, practitioner and organisation identity."

"Phase 2: Shared Care (July 2010 to December 2014)

Phase 2 will commence with a design and ‘proof of concept’ phase and will deliver a shared care capability covering:

• patient vitals - historical patient information (eg, patient demographics, problem list, medications, alerts, access to more detailed e-events such as laboratory and radiology results, and medication history)
• a care plan - patient-based information that captures the plan for the patient’s future course of care and that facilitates a multidisciplinary approach to support integrated care
• decision support - knowledge-based information, in context, to support the optimal delivery of care (including clinical risk assessment, the most effective treatment options and appropriate use of a clinical pathway)."

"The NEHTA Strategic Plan outlines how we will fulfil our mission to lead the progression of e-health in Australia.

"The release of the Government’s National E-Health Strategy in December 2008 outlined four major strategic streams of activity: foundations, e-health solutions, change and adoption, governance.

"We have considered our future work program based on the National Strategy and other important work completed this year including the National Health and Hospital Reform Commission recommendations.

"As a result the NEHTA Strategic Plan has been developed to clearly show our stakeholders across the health sector the directions we are taking to drive the take-up and adoption of e-health nationally.

"The Strategy outlines four strategic priorities that define our role in adoption and implementation. They are:

1. "Urgently develop the essential foundations required to enable e-health. This priority stresses the need to deliver essential e-health services such as Healthcare Identifiers, secure messaging and authentication, and a clinical terminology and information service. These will form the backbone of Australia’s e-health systems.
2. "Coordinate the progression of the priority e-health solutions and processes. Some e-health solutions and processes provide the greatest opportunity to improve health practice and deliver benefit. Priorities include referrals and discharge, pathology and diagnostic imaging and medications management.
3. "Accelerate the adoption of e-health. It is critical to increase the awareness and uptake of e-health initiatives by the various stakeholder groups, through collaboration and communication programs, incentives and implementation support.
4. "Lead the progression of e-health in Australia. This priority reflects that NEHTA has a significant role in leading the direction of the current and future state of e-health in Australia, including future initiatives and the impacts on privacy and policy."

The European Files is a political, economic and social magazine from Euro Confluences, Paris. This special edition includes concise contributions from national governments, industry and the European Commission covering current and future eHealth strategies throughout the EU.

"The material for this document was collected, reviewed and collated by the project Towards the Establishment of a European eHealth Research Area... eHealth ERA is a Coordination Action that

Swiss National e-Health strategy covering the period 2007-2015. The report, published on 27 June 2007, is in German only; a short summary only is currently available in French.

The initial goal is the implementation of a national electronic health insurance card.

"[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): "Electronically 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].

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 Development (OECD);
• "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; drug registries; 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 and 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.

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:

• "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."

The following information is all taken from the report.

1. National network strategy
2. NHI (National Health Index) promotion (unique patient identifier)
3. HPI (Health Provider Index) implementation
4. ePharmacy (electronic prescribing - electronic transactions between prescribers and pharmacies.)
5. eLabs (electronic transactions between clinicians and laboratories) (to include decision support capability)
6. Discharge summaries (electronic)
7. Chronic care and disease management (includes guidelines)
8. Electronic referrals (including guideline-based decision support)
9. National outpatient collection
10. National primary care collection
11. National system access (secure, web)
12. Anchoring framework (ability to link data across the continuum of care).

1. Investment management framework
2. Strategic information planning framework
3. Collaboration frameworks
4. Data sets
5. Applications
6. Networks
7. Standards
8. Privacy and security.

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.

• 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.

This short report (or "Highlight") constitutes an estimation of "the potential costs and benefits 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.

Key findings:

• "Properly implemented and widely adopted, Health Information Technology would save money and significantly improve healthcare quality.
• "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 $1 billion".]
• "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 related savings.
• "The government should act now to overcome obstacles and realize benefits."

"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].

" 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:

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 telecare.
• 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 integrated."

• "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 telecare."

"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."

Recommendations

1. "That a significant ring-fenced fund be created to finance eHealth projects
2. 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
3. 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
4. That every eHealth investment is contingent on proving the business case against the health benefits framework HIQA should develop
5. 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
6. That a formal project evaluation be completed at the end of every project to test whether the anticipated benefits have been delivered.
7. That HIQA and the HSE proactively seek opportunities for the deployment of technology to facilitate the Health Reform Programme
8. That current examples of best practice in eHealth are used as a basis for further development
9. 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
10. That a programme be established to identify the feasibility and value of becoming an eHealth excellence hub
11. That third-level institutions, and other publicly-funded research institutions, are encouraged to develop a focus on eHealth
12. That Irish health agencies proactively seek to benefit from the funding and expertise available from participating in the forthcoming FP7."

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".

" 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. "