PERSPECTIVES IN E-HEALTH
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PERSPECTIVES IN E-HEALTH. Roberto J. Rodrigues Regional Advisor for Health Services Information Technology Division of Health Systems and Services Development Pan American Health Organization / World Health Organization Washington, D.C.

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Perspectives in e health

PERSPECTIVES IN E-HEALTH

Roberto J. Rodrigues

Regional Advisor for Health Services Information Technology

Division of Health Systems and Services Development

Pan American Health Organization / World Health Organization

Washington, D.C.

Workshop on Global Telehealth/Telemedicine and the Internet

2001 Symposium on Applications and the Internet (SAINT 2001)

San Diego, January 8-12, 2001


Perspectives in e health

DEVELOPMENT ISSUES IN E-HEALTH

  • DEFINITION, DRIVING FORCES, AND BARRIERS

  • HEALTH SECTOR ASPECTS

  • INFRASTRUCTURE AND MARKET

  • IMPLEMENTATION

  • LATIN AMERICA & CARIBBEAN METRICS


Perspectives in e health

DEVELOPMENT ISSUES IN E-HEALTH

  • DEFINITION, DRIVING FORCES, AND BARRIERS

  • HEALTH SECTOR ASPECTS

  • INFRASTRUCTURE AND MARKET

  • IMPLEMENTATION

  • LATIN AMERICA & CARIBBEAN METRICS


Perspectives in e health

INTERACTIVE HEALTH COMMUNICATIONS

APPLICATION OF INFORMATION AND TELECOMMUNICATIONS

TECHNOLOGIES TO HEALTH AND HEALTHCARE

  • TELEMEDICINE

  • PATIENT CARE APPLICATIONS

  • TELEHEALTH

  • TELEMEDICINE, DISTANT EDUCATION AND TRAINING,

  • HEALTH PROMOTION, PUBLIC HEALTH, SERVICES MANAGEMENT,

  • TECHNICAL INFORMATION RETRIEVAL

  • CYBERMEDICINE

  • INTERSECTION OF INFORMATICS WITH BIOENGINEERING,

  • IMPLANTABLE DEVICES, PROCESS AUTOMATION, BIOSENSORS,

  • DEVELOPMENTAL ROBOTICS, NANOTECHNOLOGY

  • E-HEALTH

    INTERNET-BASED HEALTH APPLICATIONS, INCLUDING PURELY

    ADMINISTRATIVE (B2B, E-COMMERCE, ETC)


Perspectives in e health

EVOLUTIONARY TECHNOLOGIES

  • POINT OF CARE TECHNOLOGIES

  • PROCESS AUTOMATION

  • ELECTRONIC MEDICAL RECORD (CPMR)

  • DATA WAREHOUSING

  • DATA ACCESS AND SECURITY TECHNOLOGIES

  • APPLICATION INTEGRATION

  • DECISION-SUPPORT TECHNOLOGIES


Perspectives in e health

REVOLUTIONARY TECHNOLOGIES

  • ELECTRONIC COMMERCE

  • “PUSH TECHNOLOGIES”

  • RESOURCE ADQUISITION TECHNOLOGIES (Auction Technologies)

  • ON DEMAND REMOTELY-BASED APPLICATIONS (ASP)

  • MOBILE AND WIRELESS TECHNOLOGIES

  • INTELLIGENT AGENTS

  • INTERACTIVE TECHNOLOGIES (Voice, Writing Recognition)

  • ALWAYS-ON CONNECTIVITY WITH COMMUNITIES

  • KNOWLEDGE MANAGEMENT (Retrospective >>> Simultaneous)


Perspectives in e health

DRIVING FORCES (1)

  • QUEST FOR QUALITY AND COST MANAGEMENT

  • RISING DEMAND FOR ADVANCED MEDICAL TECHNOLOGY

  • SHORT PRODUCT LIFE CYCLES / OBSOLESCENCE

  • DISSATISFACTION WITH HEALTH SYSTEM (CHOICE, ACCESS, QUALITY)

  • DISREGARD FOR “CUSTOMER SERVICE”

  • CONVENIENCE MORE IMPORTANT THAN PRICE


Perspectives in e health

DRIVING FORCES (2)

  • CAPTURING LONG-TERM SERVICE RELANTIONSHIPS

  • INEFFICIENCY OF ADMINISTRATIVE PROCESSES (ELIGIBILITY,CLAIMS,

    REIMBURSEMENT, PROCUREMENT AND SUPPLY MANAGEMENT)

  • INCREASED DEMAND FOR DATA AND INFORMATION (DISTRIBUTED

    MULTIDISCIPLINARY PRACTICE, IMPROVED DOCUMENTATION)

  • LOGISTICS OF HEALTHCARE (DYNAMIC SCHEDULING, DATA COMMUNICATION)

  • ACCESS TO BIOMEDICAL KNOWLEDGE (REFERENCE, PROTOCOLS OF CARE,

    REGISTRIES, KNOWLEDGE BASES, EVIDEDENCE-BASED PRACTICE,

    CONSUMER PARTICIPATION)


Perspectives in e health

DRIVING FORCES (3)

  • 26% U.S. HEALTHCARE SPENDING ARE ON ADMINISTRATIVE TASKS (HCFA)

  • PHYSICIANS/PAYERS BOTTLENECK 13% COST (12.7 BILLION IN 1999)

  • E-HEALTH B2B GROWTH (6 BILLION IN 1999 ….. 348 BILLION IN 2004)

  • ONLINE PROCUREMENT WILL REACH 27.3 BILLION BY 2004

  • CONNECTIVITY OF THE PUBLIC TO THE INTERNET

  • MOBILE TECHNOLOGIES AND PORTABLE DATA MEDIA (SMART CARDS)


Perspectives in e health

HEALTH SECTOR BARRIERS (1)

HEALTH SECTOR REQUIREMENTS SPECIFICATION

  • LOW DEFINITION LEVEL OF CONTENTS (DELIVERABLES) OF

  • HEALTH INTERVENTIONS

  • INDETERMINATION OF OBJECTIVES AND FUNCTIONALITIES

  • CONFLICTS IN DEFINING MINIMUM DATA SETS FOR OPERATIONAL

  • MANAGEMENT AND CLINICAL DECSISION-MAKING

  • HEALTHCARE ORGANIZATIONS AND PROVIDERS TEND TO

    SEE THEIR OWN DATA AS THE ONLY GOOD AND VALID DATA

  • DISTRUST OF HEALTH PROFESSIONALS IN OFF-SITE DATA

    STORAGE AND ACCESS CONTROL


Perspectives in e health

HEALTH SECTOR BARRIERS (2)

ORGANIZATIONAL AND POLICY-RELATED

  • INFRASTRUCTURE, INVESTMENT SUSTAINABILITY AND

    DEPLOYMENT CAPABILITY

  • HEALTHCARE ORGANIZATIONS FEEL PROPRIETARY ABOUT

    THEIR INFORMATION -- HEALTH PLANS DO NOT LIKE TO LET

    PROVIDERS INTO THEIR INFORMATION CYCLE AND VICE VERSA

  • COMPLEXITY AND VARIETYOF OBJECTIVES, FUNCTIONS, AND

    TECHNICAL CONTENTS OF APPLICATIONS

  • NATIONAL POLICIES AND STRATEGIES FOR THE STANDARDIZATION

    AND COST-EFFECTIVE USE OF TECHNOLOGY AND INFORMATION

  • CONSISTENCY AND CONTINUITY OF POLITICAL SUPPORT


Perspectives in e health

TECHNOLOGY BARRIERS (1)

INFORMATION TECHNOLOGY INFRASTRUCTURE

  • TECHNICAL RESOURCES AND WEB DEMOGRAPHICS

  • DATA AND COMMUNICATION STANDARDS

  • INCREMENTAL DEVELOPMENT X BIG BANG

  • TECHNOLOGICAL INNOVATION X ACTUAL USE GAP

  • OPEN x PROPRIETARY ARCHITECTURE

  • COST-BENEFIT


Perspectives in e health

TECHNOLOGY BARRIERS (2)

INFORMATION TECHNOLOGY DEPLOYMENT (1)

  • SECURITY, PRIVACY AND CONFIDENTIALITY

  • ALIGNMENT TO INSTITUTIONAL GOALS, IMPROVEMENT OF

    HEALTH AND EXPECTATIONS OF PROVIDERS, CLIENTS,

    PAYERS AND REGULATORS

  • INTEGRATION IN THE WORK ENVIRONMENT

  • PROJECT MANAGEMENT

  • ACCESS TO RELIABLE APPLICATIONS PRODUCTS AND

    SERVICES (INTEGRATION, CUSTOMER SUPPORT, SECURITY,

    AND TRAINING)


Perspectives in e health

TECHNOLOGY BARRIERS (3)

INFORMATION TECHNOLOGY DEPLOYMENT (2)

  • LACK OF INVOLVEMENT OF LINE MANAGERS

  • DISCONTINUITY OF INSTITUTIONAL STRATEGIES / POLICIES

  • LOW QUALITY OF PRIMARY DATA

  • OVERRIDING OF DEPARTMENTAL BORDERS AND AUTHORITIES

  • EDUCATION AND TRAINING OF HEALTH PROFESSIONALS

  • VENDOR DEPENDENCY


Perspectives in e health

DEVELOPMENT ISSUES IN E-HEALTH

  • DEFINITION, DRIVING FORCES, AND BARRIERS

  • HEALTH SECTOR ASPECTS

  • INFRASTRUCTURE AND MARKET

  • IMPLEMENTATION

  • LATIN AMERICA & CARIBBEAN METRICS


Perspectives in e health

HEALTH INFORMATION DOMAINS

HEALTH STATUS

EPIDEMIOLOGY

HEALTH PROMOTION

POPULATION

INDIVIDUALS

EXAMINED

PREVENTIVE

CARE

INDIVIDUALS

WITH HEALTH

PROBLEM

MONITOR

CONTROL

INDIVIDUALS

RECEIVING

CARE

CONTINUOUS

RECORDING

OF CARE


Perspectives in e health

MONTHLY PREVALENCE OF ILLNESS (ADULTS 16 YEARS AND OVER)

ADULT POPULATION AT RISK

1,000

ADULTS REPORTING

ILLNESSES OR INJURIES

PER MONTH

750

ADULTS CONSULTING

PHYSICIAN PER MONTH

ADULTS ADMITTED

TO HOSPITAL PER MONTH

250

ADULTS REFERRED TO

ANOTHER PHYSICIAN

PER MONTH

9

5

ADULTS REFERRED TO

SPECIALIZED MEDICAL CENTER

PER MONTH

1

WHITE KL, WILLIAMS TF, GREENBERG BG. NEJM 265:885-892, 1961


Perspectives in e health

PERSPECTIVES OF PATIENT-BASED INFORMATION

POPULATION

- REFERENCE

- HEALTH STATUS

- SERVICE UTILIZATION

AND PRODUCTION

- RESEARCH


Perspectives in e health

PERSPECTIVES OF PATIENT-BASED INFORMATION

GROUPS

- BY CLINICAL ATTRIBUTES

CLINICAL FINDINGS REFERENCE

GROUP COMPARISONS

IDENTIFY ASSOCIATED ATTRIBUTES

- BY INTERVENTION CHARACTERISTICS

MANAGEMENT AND REPORTING

PROCESS CONTROL

POPULATION

- REFERENCE

- HEALTH STATUS

- SERVICE UTILIZATION

AND PRODUCTION

- RESEARCH


Perspectives in e health

PERSPECTIVES OF PATIENT-BASED INFORMATION

GROUPS

- BY CLINICAL ATTRIBUTES

CLINICAL FINDINGS REFERENCE

GROUP COMPARISONS

IDENTIFY ASSOCIATED ATTRIBUTES

- BY INTERVENTION CHARACTERISTICS

MANAGEMENT AND REPORTING

PROCESS CONTROL

INDIVIDUAL

- SEQUENCIAL

- CHRONOLOGICAL

- PROBLEM-ORIENTED

- PERMANENCY

- HISTORICAL RECOVERY

- COMMUNICATION

- RECENT EVENT RECOVERY

DETAIL

DIFFERENT “VISIONS” OF DATA

DIFFERENT OUTPUTS

INTENSIVE DATA MANIPULATION

POPULATION

- REFERENCE

- HEALTH STATUS

- SERVICE UTILIZATION

AND PRODUCTION

- RESEARCH


Perspectives in e health

INFORMATION IN THE HEALTHCARE OF INDIVIDUALS

PROG

CLINICAL

PRACTICE

COLLECTIVE

HEALTH

DIAG

THERAPY

PREVEN

BIOMEDICAL

KNOWLEDGE


Perspectives in e health

INFORMATION IN THE HEALTHCARE OF INDIVIDUALS

PROG

CLINICAL

PRACTICE

COLLECTIVE

HEALTH

DIAG

THERAPY

PREVEN

BIOMEDICAL

KNOWLEDGE


Perspectives in e health

TYPOLOGY OF REQUIRED INFORMATION AND ORGANIZATIONAL LEVEL


Perspectives in e health

DEVELOPMENT ISSUES IN E-HEALTH

  • DEFINITION, DRIVING FORCES, AND BARRIERS

  • HEALTH SECTOR ASPECTS

  • INFRASTRUCTURE AND MARKET

  • IMPLEMENTATION

  • LATIN AMERICA & CARIBBEAN METRICS


Perspectives in e health

DISTRIBUTION OF GROSS DOMESTIC PRODUCT BY SECTOR, 1995

Percentage of GDP

Sector

Source: World Bank, World Development Report 1997


Perspectives in e health

HEALTH CONTRIBUTION TO THE SERVICES SECTOR

HEALTH SERVICES AS PERCENTAGE OF THE SERVICE SECTOR

%

Source: World Bank, World Development Report 1997


Perspectives in e health

WORLD MARKET FOR INFORMATION AND

COMMUNICATIONS TECHNOLOGIES (1998)

JAPAN (11%)

OTHER (23%)

USA (36%)

EUROPE (30%)

Value: 1,363 billion US dollars


Perspectives in e health

Projection of Revenue Growth (US$ bn)

1000

Actual

Projected

900

)

800

Other: Data, Internet,

bn

Leased lines, telex, etc

700

600

Mobile

500

Int'l

Int'l

Service revenue (US$

400

300

Domestic Telephone / Fax

200

100

0

90

91

92

93

94

95

96

97

98

99

00

01

02

Source: ITU “World Telecommunication Development Report 1999: Mobile cellular”


Perspectives in e health

GLOBAL WIRELESS INTERNET ACCESS GROWTH

BY 2005 THERE WILL BE MORE THAN 1 BILLION WIRELESS PHONE SUBSCRIBERS

OF THOSE, 87 PERCENT WILL BE USING INTERNET DATA SERVICES


Perspectives in e health

Global Distribution of IP Hosts

Developed:94 % of hosts16 % population

Developing:6 % of hosts84 % population

Australia,

Japan &

New Zealand

6.4%

3.7 %

Canada &

Developing

US

Other

Asia-Pacific

65.3%

5.9%

LAC

Europe

1.9%

Africa

22.4%

0.3 %

Source: ITU 1999 “Challenges to the Network: Internet for Development”


Perspectives in e health

E-HEALTH BUSINESS IMPERATIVE

  • GLOBAL MARKET PLACE AND INTERACTIVE COMMUNICATIONS

  • LEASING, MEMBERSHIP, SERVICE AGREEMENT, STRATEGIC

    ALLIANCES REPLACE OWNERSHIP OF PHYSICAL ASSETS AND

    LONG-TERM ORGANIZATIONAL STRUCTURES

  • NETWORKS OF PRODUCERS, SUPPLIERS, AND CUSTOMERS

  • LIFE-TIME VALUE OF CUSTOMER REPLACES “ONE TIME SELL”

  • ECONOMIES OF SPEED REPLACE ECONOMIES OF SCALE

  • CUSTOMIZATION OF PRODUCTS AND SERVICES

  • MAXIMIZE CONVENIENCE AND “JUST-IN-TIME” PROCESSES

  • PRIVACY AND SECURE TRANSACTION PROCESSING

  • SEAMLESS APPLICATIONS


Perspectives in e health

TRADITIONAL MODEL

Producers

- Government

- Health Professionals

- Healthcare-providing

Organizations

Intermediaries

- Distributors

- Marketing Channels

- Value-Added Resellers

Suppliers

- Insurance (Pub/Priv)

- Medical Supply Indust

- Pharmaceutical Indust

- Knowledge Distribution

CLIENT


Perspectives in e health

FIRST ORDER NETWORKING

Producers

- Government

- Health Professionals

- Healthcare-providing

Organizations

Customer Networks

- Manufacturers

- Distributors

- Marketing Channels

- Value-Added Resellers

Supplier Networks

- Managed Care Orgs

- Insurance (Pub/Priv)

- Medical Supply Indust

- Pharmaceutical Indust

- Knowledge Distribution

CLIENT


Perspectives in e health

SECOND ORDER NETWORKING

Producer Networks

- Government

- Health Professionals

- Healthcare-providing

Organizations

Customer Networks

- Manufacturers

- Distributors

- Marketing Channels

- Value-Added Resellers

Supplier Networks

-Managed Care Orgs

- Insurance (Pub/Priv)

- Medical Supply Indust

- Pharmaceutical Indust

- Knowledge Distribution

CLIENT


Perspectives in e health

THIRD ORDER NETWORKING

Technology Cooperation

Networks

- Sharing Expertise

- Knowledge Dissemination

Standards Coalition

Networks

- Technical Standards

Develop / Promotion

Producer Networks

- Government

- Health Professionals

- Healthcare-providing

Organizations

Customer Networks

- Manufacturers

- Distributors

- Marketing Channels

- Value-Added Resellers

Supplier Networks

-Managed Care Orgs

- Insurance (Pub/Priv)

- Medical Supply Indust

- Pharmaceutical Indust

- Knowledge Distribution

CLIENT


Perspectives in e health

FOURTH ORDER NETWORKING

Technology Cooperation

Networks

- Sharing Expertise

- Knowledge Dissemination

Standards Coalition

Networks

- Technical Standards

Develop / Promotion

Producer Networks

- Government

- Health Professionals

- Healthcare-providing

Organizations

Customer Networks

- Manufacturers

- Distributors

- Marketing Channels

- Value-Added Resellers

Supplier Networks

- Insurance (Pub/Priv)

- Managed Care Orgs

- Medical Supply Indust

- Pharmaceutical Indust

- Knowledge Distribution

CLIENT

Customer Networks

- Self-help Groups

- Special Interest


Perspectives in e health

ENTERPRISE APPLICATION INTEGRATION

1a. Internal Data Sources

Creating an integrated apps

environment involves collecting

and normalizing data from multiple

sources and database structures

2. EAI Technologies

Numerous technologies

smooth technical differences

among applications and

allow connection of

existing systems to the

integrated framework

4. “Business” Rules

More effective when

applied to a comprehensive

set of information

  • Databases

  • Legacy Systems / Data

  • EIS, ERP, CRM

  • Messaging MW

  • CORBA

  • COM

  • JAVA

  • XML

5. Integrated Apps

Handle organizational

processes more efficiently

and with better control

1b. External Data Sources

By using Web channels, information

from outside the organization can

merge with internal data

  • Partners

  • Suppliers

  • Customers

6. Decisions

Application integration

helps to achieve better

informed decisions

3. Consolidated Data

More realistic perspective

of organizational activities

EIS - Enterprise Information System

ERP - Executive Reporting Program

CRM - Customer Relationship Management

EAI - Enterprise Application Integration

COM - Component Object Model


Perspectives in e health

ENTERPRISE APPLICATION INTEGRATION

  • PROS

  • Improve organizational efficiency

  • Expand “business” vision to include outside partners / suppliers

  • Embrace real-time or near real-time data from all operational aspects

  • Offers higher-level management of business rules

  • CONS

  • Clear definition of workflow and control rules

  • Involvement of external organizations (partners / suppliers)

  • Complex and expensive to implement

  • Difficult to find IT professionals with expertise

  • Rapidly evolving market


Perspectives in e health

DATA WAREHOUSING


Perspectives in e health

THE CONNECTED EMPOWERED CONSUMER

  • WELLNESS AND MEDICAL INFORMATION

  • SHOPPING FOR PROVIDERS AND SERVICES

  • RISK ASSESSMENT TESTING

  • BUYING PRESCRIPTION AND OVER-THE-COUNTER DRUGS

  • BUYING HEALTH PRODUCTS

  • COMMUNICATION WITH SPECIAL INTEREST GROUPS

  • E-MAIL PROVIDERS AND PAYERS


Perspectives in e health

FULL

SERVICES

DIRECT CONSUMER BYPASS

STOCK TRADING

HEALTH SELF-CARE

E-COMMERCE

FUND TRANSFER

PHYSICIAN ADVERTISING

PHARMACEUTICALS / DEVICES

E-AUCTION

PERSONALIZATION

CONSUMER CAPABILITY / VALUE

CUSTOMIZED NEWS

HEALTH RISK APPRAISAL

HMO PERSONALIZED REPORTS

COMMUNITY

INFO

ACCESS

CHAT GROUPS

ONLINE INVESTMENT CLUBS

HEALTH SPECIAL INTEREST GROUPS

HEALTH PROMOTION

NEWS

KNOWLEDGE REPOSITORIES

INTERACTIVITY


Perspectives in e health

DEVELOPMENT ISSUES IN E-HEALTH

  • DEFINITION, DRIVING FORCES, AND BARRIERS

  • HEALTH SECTOR ASPECTS

  • INFRASTRUCTURE AND MARKET

  • IMPLEMENTATION

  • LATIN AMERICA & CARIBBEAN METRICS


Perspectives in e health

E-HEALTH COMPONENTS

POLICY / REGULATORY / LEGAL

SUPPLIER / PRACTITIONER / ORGANIZATIONS

PATIENT/ EMPLOYER / PAYER / RESEARCHER

ELECTRONIC CLEARINGHOUSES / BROKERS

TRANSACTION & SERVICE PROVIDERS

INTERFACE EQUIPMENT / EDI / SECURITY

TELECOMMUNICATION INFRASTRUCTURE

HEALTH INFORMATION INFRASTRUCTURE

(BUSINESS RULES, ROUTINES, STANDARDS)

NATIONAL / INTERNATIONAL MARKETS


Perspectives in e health

INFLUENCE ON HEALTH-RELATED LIFESTYLE CHOICES

SOURCES USED BY THE PUBLIC FOR PERSONAL HEALTH DECISIONS

%

U.S. Survey by Gómez Advisors, Inc. , 2000


Perspectives in e health

SOURCES OF INFORMATION ABOUT NEW HEALTH WEB SITES

HOW THE PUBLIC LEARNS ABOUT HEALTH INFORMATION IN THE WEB

%

U.S. Survey by Gómez Advisors, Inc. , 2000


Perspectives in e health

U.S. PHYSICIANS USE OF COMPUTERS

PERCENT

Source: Pricewaterhouse Coopers Modern Physicician 2000


Perspectives in e health

SHARED STANDARDS GOALS

  • Single industry-wide information model adaptable to each

    implementation environment

    - generic health information framework (modules, functions)

    - standard terminology and classifications (data definition)

    - standard health record structure (contents)

    - standard management/patient-oriented transactions- minimum data sets

    - user defined tables and queries

    - common data exchange protocols

  • Hardware/Software Platform “Independence”

    - health data networks (Internet/Intranets)


Perspectives in e health

HEALTH DATA STANDARDS

  • ACCREDITATION BY INTERNATIONAL SDOs

  • DESCRIPTION OF STANDARD

  • READINESS OF STANDARD

  • INDICATOR OF MARKET ACCEPTANCE

  • LEVEL OF SPECIFICITY

  • RELANTIONSHIPS WITH OTHER STANDARDS

  • COSTS


Perspectives in e health

LEADING HEALTH DATA STANDARDS ORGANIZATIONS

  • International Organization for Standardization (ISO)

  • Comité Europeen de Normalisation (CEN)

  • UN Electronic Data Interchange (EDIFACT)

  • Data Interchange Standards Association (DISA)

  • Health Level Seven (HL-7) version 3

  • Digital Imaging and Communication in Medicine (DICOM)

  • American Society for Testing and Materials (ASTM)

  • American National Standards Institute (ANSI)

  • Institute of Electrical and Electronic Engineers (IEEE)

  • Agency for Healthcare Policy and Research (USDHHS)

  • Health Care Financing Organization (USDHHS)

  • Computer-based Patient Record Institute (CPRI)

  • Joint Commission on Accreditation of Healthcare Organizations

  • World Health Organization

  • American Medical Association

  • College of American Pathologists

  • Food and Drug Administration (FDA)

  • National Library of Medicine (NLM / NIH)

  • National Council for Prescription Drug Programs (NCPDP)


Perspectives in e health

HEALTH RECORD DATA STANDARDS

  • IDENTIFIER (PATIENT, PROVIDER, SITE-OF-CARE, PRODUCT)

  • MESSAGE FORMAT (COMMUNICATIONS)

  • CONTENT AND STRUCTURE OF HEALTH RECORDS

  • CLINICAL DATA REPRESENTATION (CODES)

  • CONFIDENTIALITY, DATA SECURITY, AND AUTHENTICATION

  • COMMON MINIMUM AND EXTENDED DATA SETS

  • QUALITY


Perspectives in e health

DATA INTEGRITY, SECURITY, AND PRIVACY

  • RELIABILITY

    Data is accurate and remains accurate

  • SECURITY

    Owner/users can control data transmission and storage

  • PRIVACY

    Subject of data can control its use and dissemination


Perspectives in e health

DATA INTEGRITY, SECURITY, AND PRIVACY

  • PHYSICAL PROTECTION

    Protection against intentional of accidental damage

  • INTEGRITY

    Prevention of unauthorized modification of information

  • ACCESS

    Prevention of unauthorized entry into information resources

  • CONFIDENTIALITY

    Protection against unauthorized disclosure of information


Perspectives in e health

DATA INTEGRITY, SECURITY, AND PRIVACY

  • Reliability and privacy require security, but implementation

    of data security may impair privacy

  • Patients may be unable to consent

  • Clinically anonymous information is useless

  • Differently than in national security and defense environment

    where it is better to lose information than to loose it, in the

    health sector it is preferable to expose information than to

    loose it

  • In healthcare responsibility is distributed among different

    stakeholders

  • Security is a multidimensional problem that must be solved

    for each specific situation, not as a generic technical add-on


Perspectives in e health

SECURITY AND PRIVACY ISSUES

  • Highly sensitive personal and identified data

  • Interdisciplinary activities and multiprofessional access

  • Remote access to medical records

  • Access by clerical staff (payers, controllers, insurers)

  • Unobtrusive in the healthcare environment

  • Balance of need for access and integrity / privacy issues

  • Individual rights versus collective needs of public health

  • Great concern regarding the physical protection of records

    and intrusion, unauthorized use, data corruption, intentional or

    unintentional damage, theft, and fraud


Perspectives in e health

IMPLEMENTING A SECURITY AND PRIVACY PROGRAM

  • HIGH SECURITY RISK OF HEALTHCARE ORGANIZATIONS

  • DISTRIBUTED RECORDS AND AUTHORITY

  • TIMELY ACCESS IS ESSENTIAL

  • DATA IN USE MUST BE DECRYPTED

  • DATA IN TRANSIT MUST ME ENCRYPTED

  • MOST SECURITY VIOLATIONS ARE UNINTENTIONAL

  • OPERATOR’S ERROR IS FREQUENT REASON

  • MOST DAMAGING VIOLATIONS ARE INTERNAL

  • EXTERNAL ATTACKS ARE ON THE INCREASE


Perspectives in e health

MAINTENANCE STAFF X SW PORTFOLIO SIZE

28 countries / 30 sectors / 16,000 sources

Source: META Group, 2000


Perspectives in e health

SYSTEMS MAINTENANCE CONSULTING COST

Source: META Group, 2000


Perspectives in e health

SYSTEMS MAINTENANCE CONSULTING COST

Source: META Group, 2000


Perspectives in e health

SOFTWARE MAINTENANCE IN KLOC X PROFESSIONAL

100 KLOC

73 KLOC

28 countries / 30 sectors / 16,000 sources

Source: META Group, 2000


Perspectives in e health

EXTERNAL CONSULTANTS EXPENDITURE (1999)

in US$ millions

28 countries / 30 sectors / 16,000 sources

Source: META Group, 2000


Perspectives in e health

IT “MARKET BASKET” COST (1999)

28 countries / 30 sectors / 16,000 sources

* U.S. = 1.00

Source: META Group, 2000


Perspectives in e health

DEVELOPMENT ISSUES IN E-HEALTH

  • DEFINITION, DRIVING FORCES, AND BARRIERS

  • HEALTH SECTOR ASPECTS

  • INFRASTRUCTURE AND MARKET

  • IMPLEMENTATION

  • LATIN AMERICA & CARIBBEAN METRICS


Perspectives in e health

IT DEVELOPMENT AND IMPLEMENTATION

MANAGEMENT AND

ORGANIZATIONAL ISSUES

INFORMATION SYSTEMS

IN HEALTH CARE

IMPLEMENTATION

ENVIRONMENT

TECHNOLOGY BASE


Perspectives in e health

HEALTH SECTOR IN LATIN AMERICA & THE CARIBBEAN

  • 80% URBANIZATION / LARGE URBAN AREAS

  • INADEQUATE INFRASTRUCTURE AND DISTRIBUTION

  • WESTERN EUROPEAN BIOMEDICAL / SOCIAL SECURITY MODELS

  • VARIETY OF REIMBURSEMENT MODELS

  • HEALTH SECTOR REFORM


Perspectives in e health

E-MARKET IN LATIN AMERICA


Perspectives in e health

NEW TECHNOLOGY NETWORKS AND FOR DEVELOPING COUNTRIES

  • >95 per cent of global IP capacity passes through the U.S.

  • 96 out of top 100 websites are in the U.S.

  • Developing countries wanting to hook up to the U.S. backbone must pay both half-circuits of the leased line

  • Smaller ISPs must pay bigger ones for transit

  • Accelerating returns to scale

    • High volume routes have lowest unit costs

    • Large hubs get larger

    • Resources go to the strongest


Perspectives in e health

IMPLEMENTATION IN LATIN AMERICA & CARIBBEAN

  • E-HEALTH DEVELOPMENT INTEGRATES TECHNOLOGY,

    GEOGRAPHY, CULTURE, LANGUAGE, AND….HEALTHCARE SYSTEMS

  • NO SINGLE “COOKBOOK” OR “TRANSLATED”SOLUTION

  • MOST USERS PREFER A CAREFULLY CRAFTED PARTNERSHIP

    TO A PURE VENDOR-CLIENT RELATIONSHIP

  • LEASING / OUTSOURCING

  • LEADERSHIP

  • GROWING MARKET WITH GREAT POTENTIAL BUT IDENTIFICATION

    OF OPPORTUNITIES AND MARKET DEVELOPMENT MAY BE A

    LONG AND DIFFICULT PROCESS


Perspectives in e health

Pan American Health Organization

Organización Panamericana de la Salud

Organização Panamericana da Saúde

www.paho.org

http://165.158.1.110/english/hsp/hsphsi.htm


Perspectives in e health

PAHO/WHO

HEALTH SERVICES IT DEVELOPMENT INDICATORS INITIATIVE

Regional Advisor for Health Services Information Technology

Division of Health Systems and Services Development

Pan American Health Organization / World Health Organization

Washington, D.C.


Perspectives in e health

INFORMATION TECHNOLOGY METRICS

  • STANDARDIZED INFORMATION (CONSISTENCY, COMPARABILITY)

  • SYSTEM / APPLICATION ENVIRONMENT RANKING

  • MONITOR CHANGES

  • FOLLOW TRENDS

  • QUANTITATIVE AND QUALITATIVE INDICATORS

    “NOT EVERYTHING THAT CAN BE COUNTED COUNTS, AND NOT

    EVERYTHING THAT COUNTS CAN BE COUNTED”

    ALBERT EINSTEIN


Perspectives in e health

HEALTH INFORMATION TECHNOLOGY DEVELOPMENT INDICATORS

LIMITATIONS OF INFORMATION TECHNOLOGY METRICS

  • LACK OF STANDARDIZED DEFINITIONS FOR IT COMPONENTS

  • DATA ON IT RARELY COLLECTED ON A SYSTEMATIC BASIS

  • ABSENCE OF COST DATA

  • INFORMATRION ON HOW IT IS BEING ACTUALLY USED

  • EVALUATION OF POSITIVE AND NEGATIVE IMPACTS

  • RAPIDLY CHANGING TECHNOLOGY


Perspectives in e health

HEALTH INFORMATION TECHNOLOGY DEVELOPMENT INDICATORS

  • INFRASTRUCTURE

    general population aptitudes; physical IT and telecom

    infrastructure; market openness; information distribution capability

  • EXTENT OF IT INSERTION IN SOCIETY

    penetration computers; labor force and revenues in

    the computer and telecommunications sectors

  • UTILIZATION OF IT BY THE HEALTH SECTOR

    penetration of information systems in the private and

    public sectors; implementation of regulatory aspects

  • IMPACT

    state-of-the-art, appropriateness; technical effectiveness;

    effect on policy, structures organization, equity and privacy


Perspectives in e health

PERCENTAGE OF ADULT ILLITERACY (1998)

PERCENT

AVERAGE

Source: PAHO Basic Indicators


Perspectives in e health

AVERAGE YEARS OF EDUCATION FOR AGE 25+ (1999)

YEARS

Source: World Bank Health Report


Perspectives in e health

MAIN (FIXED) TELEPHONE LINES X 100 INHABITANTS (1999)

NUMBER

Source: International Telecommunication Union and PAHO Basic Indicators


Perspectives in e health

WAITING TIME FOR NEW WIRED CONNECTION IN YEARS (1998)

YEARS

Source: International Telecommunication Union


Perspectives in e health

COST OF WIRED CONNECTION

ANNUAL RESIDENTIAL SUBSCRIPTION AS

PERCENTAGE OF GNP x CAPITA (1997)

PERCENT

Source: International Telecommunication Union and PAHO Basic Indicators


Perspectives in e health

WIRELESS TELEPHONE SUBSCRIBERS x 100 INHABITANTS (1999)

NUMBER

Source: International Telecommunication Union and PAHO Basic Indicators


Perspectives in e health

LATIN AMERICAN AND CARIBBEAN TELECOMMUNICATIONS MARKET

Millions

69

54

50

25.3

12.7

7

Source: International Telecommunication Union, Jan 2000


Perspectives in e health

PERSONAL COMPUTERS x 100 INHABITANTS (1998)

NUMBER

Source: International Telecommunication Union and PAHO Basic Indicators


Perspectives in e health

PERCENTAGE OF POPULATION CONNECTED TO THE INTERNET (1999)

PERCENT (LOG)

Source: International Telecommunication Union and PAHO Basic Indicators


Perspectives in e health

INTERNET HOSTS x 1,000 INHABITANTS (JAN 2000)

NUMBER (LOG)

Source: International Telecommunication Union and PAHO Basic Indicators


Perspectives in e health

INTERNET SERVICE PROVIDERS (JAN 2000)

NUMBER (LOG)

Source: International Telecommunication Union


Perspectives in e health

INFORMATION TECHNOLOGY GROWTH, 1985-1995 & 1995-2000

PERCENT

Source: International Data Corporation, 1996


Perspectives in e health

INTERNET USE - PHYSICIANS IN BRAZIL

42,744 PHYSICIANS

58

%

42

1999 SURVEY


Perspectives in e health

INTERNET USE - PHYSICIANS IN BRAZIL

24,603 PHYSICIANS

SITE FROM WHERE INTERNET IS ACCESSED

85

%

10

1999 SURVEY


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