This publication provides health ministers and the public sector in general with validated information on which key implementation decisions concerning e-health may be made. An import issue discussed here is the reinforcement of the implementation and deployment of e-health systems by European health service providers. e-Health systems and services are looked at from a user perspective; the citizen, the patient, the healthcare professional, the hospital manager and the pubic health authority. This volume consists of the following sections: national and regional health information networks; e-health systems and services for health professionals; empowering patients and citizens in management for public health; and industrial and standardization issues.
During the last 20 years, ICTs (Information and Communication Technologies), have been introduced into manufacturing, commerce and business systems, but they are not yet fully integrated into the services industry and especially in the services of public interest such as the health, social care and public administrations.
The proper use of ICTs for data collection, processing and transfer, is the corner stone of productivity gain and re-engineering of all sectors that are information intensive. Health is an information intensive sector. The potential benefit of a fully integrated ICTs based re-organisation is significant, since it will enable not only more efficiency in information processing but also impact on access and quality of care.
The European Union has, over the past 15 years, allocated more than 450 Million Euro through its various Research Framework Programmes, for supporting research in areas of medical informatics, health telematics and eHealth. Now, at the beginning of the twenty-first century, this research is bearing fruit and the European market is seeing a growth in eHealth products and services.
The eEurope initiative has facilitated two high level eHealth conferences and exhibitions. The eHealth Ministerial Conference in 2003, organised by the European Commission under the Greek Presidency, and the eHealth conference 2004 organised by the Irish presidency in collaboration with the European Commission marked milestones of achievement in eHealth in Europe. The two conferences provided an opportunity to demonstrate a wide range of eHealth solutions in daily use in Europe and to show clear examples of benefits in access and quality of care as well as clear costs benefits. While eHealth is still a growing research and development field, there are many mature results that can be used immediately as key instruments by healthcare authorities, professionals, patients and citizens.
The European Union has now demonstrated a clear commitment to beneficial deployment of eHealth systems and services at all levels. The Ministerial Declaration adopted on the occasion of the eHealth 2003 conference has in turn led to the elaboration and adoption by the European Commission of a Communication on eHealth: Making healthcare better for European citizens: An action plan for a European e-Health Area COM (2004) 356 final, which includes an Action Plan aimed at accelerating the beneficial uptake of eHealth solutions.
It is my pleasure to recommend to you the exciting examples and best practices of eHealth solutions contained in this book, and to recommend that we all continue to share our European experiences in order to support healthcare systems that respond to all the demands and challenges facing the health sector in the twenty-first century.
F. Colasanti, Director General, European Commission, Directorate-General Information Society
“Infrastructure breeds impatience. It is important to note that the provision of infrastructure services is an enabling mechanism. The infrastructure itself will deliver some benefits, but the main outcomes will be achieved by the provision of additional applications and services. As with any infrastructure, information technology infrastructure does not provide direct business performance. Rather it enables other systems that do yield business benefits. IT infrastructure is strikingly similar to other public infrastructures such as roads, hospitals, sewers, schools, etc. They are all long‐term and require large investments. They enable business activity by users that would otherwise not be economically feasible.”
From “Implementing Information For Health: Even More Challenging Than Expected?”, a white paper prepared by Professor Dennis Protti for Dr. Peter Drury, Head, Information Policy Unit Department of Health and Dr. Gwyn Thomas, Acting Executive Director, NHS Information Authority June 11, 2002.
Sjunet is the Swedish Health Care Network comprising an infrastructure for communication between hospitals, primary care centres and home care. It is also hosting a wide range of services from national authorities and health care service providers and vendors of health care systems. Sjunet allows secure transmission of health care data and applications on an IP‐network separate from the Internet. The network is used for telemedical videoconferences, teleradiology, remote access to applications, database access, secure e‐mail, EDI‐messages and IP telephony. It is also useful for e‐learning in medical education and further training for health personnel. Carelink is responsible for Sjunet in close co‐operation with the county councils and other actors within Sjunet. Hence, Sjunet is as much a co‐operative network as it is a technical communication platform for Swedish health care.
The Danish Ministry of Health founded MedCom back in 1994. MedCom is acting as an umbrella project organisation, gathering health providers, health care professionals and industry in coordinated, nationwide projects, all aiming to reach large‐scale dissemination in few years. Almost all Danish health care organisations and IT‐vendors are participating in the projects and today more than 2.500 health institutions are communicating around 2.3 million messages monthly – 60% of the total clinical “cross‐sector” communication in Danish Health. In the next years the standards are going to be reused inside hospitals and a nationwide secure health care Internet implemented large scale.
The healthcare environment is currently changing and the health sector is being transformed to meet new challenges and to benefit from new opportunities. Priorities for the 21st century ought to be set based on emerging dominant trends in healthcare, including the shift towards shared or integrated care, in which an individual's healthcare is the responsibility of a team of professionals across all levels of the healthcare system hierarchy. In addition to the requirement for efficient and secure access to the Integrated Electronic Health Record (I‐EHR) of a citizen, this necessitates the development and deployment of Regional Health Information Networks (RHINs), synchronous and asynchronous collaboration services, and novel eHealth and mHealth services, facilitated by intelligent sensors, monitoring devices, hand‐held or wearable technologies, the Internet and wireless broadband communications. These further require the adoption of an open Reference Architecture and the creation of a scalable Health Information Infrastructure (HII).
This paper discusses the challenges encountered in developing and deploying HYGEIAnet
, the Regional Health Information Network of Crete, as well as relevant benefits for citizens and health professionals. Furthermore, HYGEIAnet systems and services are presented, with emphasis on the development of the HII and the implementation of the I‐EHR service for providing secure, role‐based access to validated content by authorized and authenticated users.
Liv Karen Johannessen, Trine S. Bergmo, Ellen Appelbom
79 - 93
Northern Norwegian Health Net (the Net) is a closed network for social and health care institutions in North Norway. In its present form it was established in 2000, but the early start was in the late 1980s. This proceeding will give a brief history of the network, description of the technology used and the services offered. It also gives a summary of experiences with the Net and research conducted on the services. Most health care institutions in the region are connected in the Net, and the usage is increasing.
Information‐ and communication technology is one of the most important cornerstones in more and more data and knowledge intensive health care sector. However these factors don't create financial gains and productivity benefits spontaneously. They need organisational and social innovations and new business models. The growth of productivity is connected to the process and organisational innovations and not to the number of computers and the growth of using ICT.
One of the problems prohibiting health care profession to move to real e‐work environment is the lack of the reliable measures and on these measures based performance measurement and strategic management. Health care can be improved by utilizing ICT and tools like performance measuring are key weapons in the arsenal of new e‐work environment and measuring based new strategic management. Neither public sector nor not‐for‐profit hospitals look for financial rewards as their ultimate proof of success. Instead, they seek to achieve ambitious missions aimed at improving the health standards and wellbeing of the citizens.
ICT‐ based new way of managing in the public sector is just beginning to gain a critical level of digitalization and will most likely come to its own in the coming years. Therefore, it is essential to research on how the health care sector can be moved towards new regional models and clinical workflow using intelligent standard based strategic management and performance measurement.
If the breakthrough of the eight‐hour working day and shortening of working time are evaluated afterwards, it can be stated that they have made the society more anthropocentric and humane. During one century the annual working time has shortened from 3000 hours to 1700 hours in the European Union countries. These foundations of a more humane society – eight‐hour working day and shortening of regular working time – are however disappearing in the post‐industrialized information society. There are various grounds for the eight‐hour working day. These grounds relate to quality of life, occupational safety and health and productivity of work. It is worth asking if the nature of work has changed in a way that the truths of an industrialized society do not hold true or has the development of working time in health care sector become uncontrolled in some new way?
The UUMA approach is based on a stepwise implementation of integrated regional healthcare services to create a virtually borderless healthcare organisation ‐ a patient centred virtual workspace. In the virtual workspace multi‐professional teams and patients collaborate and share information regardless of time and place. Presently the regional ehealth network is comprised of four different integrated services between primary, secondary and tertiary care within the county of Uusimaa. The strategic healthcare modules consist of an (1) ereferral and econsultation network, (2) a knowledge‐based disease management platform, (3) PACS system and (4) a universal model for integrated regional services between professionals and patients by a link directory service. The ereferral between primary and secondary care not only speeds up the transfer, but also offers an option for communication in the form of econsultation between general practitioners and hospital specialists. By sharing information and knowledge remote econsultations create a new working environment for integrated delivery of eServices between the health care providers. Last year over 60.000 eReferrals were transferred between health care providers. When associated with viewing of patient data through the link directory, interactive econsultations enable supervised care leading to the reduction of outpatient visits and more timely appointments. The link directory service extends the dimensions of networking between organizations by combining legacy systems within regional primary and secondary care. The link directory is an interface to diverse patient information systems, like HUSpacs, containing links pointing to the actual patient data located in remote information systems. The original data including images can be viewed with a web browser, but data can be accessed only with the patient's informed consent. The chronic disease management system is disease specific: information is utilised in parallel to viewing other relevant medical data through the link directory. We aim to create a new working environment for professionals by incorporation of innovative information and communication technology, new organisation of work and re‐engineering of workflows. The citizen has an active role in deciding on the use of his medical information, participating in decisions on his care, carrying out guided self‐care and taking steps of pro‐active prevention.
ICT opens new possibilities to health care and practice of medicine, but carries some inherent risks as well. Based on a study conducted by the CPME representing European doctors current telemedical practices and difficulties encountered by doctors are reported and next important steps are proposed.
An European e‐Health Highway should be built and obligatory standards for it and for all software used in the health care should be urgently fixed. The medical profession should take care of practical guidelines for doctors, and authorities should agree on international collaboration to supervise the practice of medicine over the net. Telemedicine should be a normal part of the national healthcare systems, and telemedical services should be reimbursed as any other medical services.
P. Cinquin, J. Troccaz, G. Champleboux, S. Lavallee
117 - 129
Research on “Computer Assisted Medical Interventions” (CAMI) was initiated in Grenoble in 1984, as an attempt to take up the challenge of “Minimally Invasive Interventions”, thanks to the introduction of Information and Communication Techniques in the Operating Room. In a first section, we will describe our initial vision. The corresponding achievements will then be presented. A final section will show that the challenge now is to “invert this movement”: instead of moving the computer in the Operating Room, we should embed the surgeon (or at least his or her expertise) into the Information Technology based tools he or she uses.
Jonathan D.S. Kay, Dave Nurse, Christos Bountis, Kevin Paddon
130 - 138
The Oxford Clinical Intranet provides clinicians in primary and secondary care across Oxfordshire with:
• Access to information about their patients held on multiple remote disparate computer systems, including admissions and episodes, Laboratory Medicine reports, Radiology reports and hospital discharge letters. The patient records are managed using CSW Case Notes.
• Access to support and advisory information, developed both within the organization and collected from other sites and projects, a wide range of internal handbooks, directories and guidelines and links to external resources, including evidence‐based resources, the Cochrane Collaboration and the NHS National electronic Library of Health.
• Automated retrieval and presentation of the support information that is contextually appropriate to the task being carried out by the clinician and the information held about the patient. For example laboratory reports are linked to handbooks and other reference sources using eLABook, a web‐interfaced database subsystem.
Internet technology has been used throughout, thus providing a thin‐client architecture with cross‐platform ability. Appropriate data standards have been used across the communicating systems and the intranet is compliant with the UK eGovernment Interoperability Framework. The intranet was developed at low cost and is now in routine use. This approach appears to be transferable across systems and organisations.
Historically, public health has been at the forefront of data processing applications but it is lagging behind other areas of health care in the application of advanced interconnected and mobile information technologies. Ready to use technologies are lacking not only for the management of emerging infections or bio‐terrorism but also for the coordination of prevention and chronic care initiatives. Advanced information and knowledge management for community health should expedite the transfer of research evidence to practice and provide essential logistical support for action. We need to find ways to integrate new scientific knowledge into our environment in order to expedite the translation of research to practice.
The latest advances in information technologies have allowed for the development of applications that have had tremendous repercussions in the healthcare field. Along with access, means must be provided to ensure that information is trustworthy and relevant. This article examines some of the problems arising from unprecedented access to vast quantities of health information made possible by the Internet. The role of search engines is explored and some of their associated problems are mentioned. We then presents the most mature of these initiatives to protect the Internet citizen, the HONcode, developed by the Health On the Net Foundation. Finally, we conclude on the concrete result of the Health On the Net Foundation initiatives since 1997.
In the UK NHS Direct has developed a multi‐channel e‐health service for patients and the public. NHS Direct is enabling patient and citizen opportunities for fast access to information by using 24 hour telephone call centres, the web, digital interactive tv and public touch screen kiosks. This multi‐channel strategy is based on the principle of providing people with maximum choice in the route by which they access information, with the assurance of consistent high quality information whichever channel they choose.
Area wide electronic booking provides patients with the choice of date, time and place as well as the certainty of appointment when referred into secondary care by their GP. The system provides substantial benefits to both primary and secondary care as well as to the patient. This model is to be imminently implemented throughout the NHS in England, drawing from the experiences gained in South East London.
The paper outlines a case of an implemented modern IT solution in the health care, that is, the Slovene health insurance card system. The system is in full operation nation‐wide and covers all the aspects of health care and health insurance operations. The system allows reliable identification of patients and service providers and, with its design open to enhancements, is a major breakthrough in the process of transition to e‐health. The paper addresses both the national and international perspective of such IT solutions, with the main issues and goals being the quality of services to the citizen, the health care system economics and management, and the free movement of people and services in the internal market. Special consideration is devoted to the compatibility and interoperability of national systems with the emerging European health insurance card. Furthermore, the paper outlines the main financial dimensions of the development to date and the changes achieved through the intensive development in terms of quality and accessibility of health care services.
The basic idea of Sustains III is to emulate the Internet banking for Health Care. Instead of an “Internet Bank Account” the user has a “Health Care Account”. The user logs in using a One Time Password which is sent to the user's mobile phone as an SMS, three seconds after the PIN code is entered. Thus personal information can be transferred both ways in a secure way, with acceptable privacy.
The user can then explore the medical record in detail. Also get full and complete list of prescriptions, lab‐result etc. It's also an easy way of exchange written information between the doctor and the patient.
So far Sustains has showed that patients are very satisfied and is also beneficial for the physicians.
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