International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study.

BACKGROUND: Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare. OBJECTIVES: This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined "availability of patient data" as the ability to access data in and to add data to the patient record in the respective country. METHODS: The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators. RESULTS: Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden. CONCLUSION: Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.

Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.

The more widespread implementation of electronic health records has led to new ways of providing access to healthcare information, allowing patients to view their medical notes, test results, medicines and so on. In this article, we explore how patients perceive the possibility to access their electronic health record online and whether this influences patient involvement. The study includes interviews with nine patients and a survey answered by 56 patients. Our results show that patients perceive healthcare information to be more accessible and that electronic health record accessibility improves recall, understanding and patient involvement. However, to achieve the goal of involving patients as active decision-makers in their own treatment, electronic health records need to be fully available and test results, referrals and information on drug interactions need to be offered. As patient access to electronic health records spreads, it is important to gain a deeper understanding of how documentation practices can be changed to serve healthcare professionals and patients.

Same, same but different: Perceptions of patients' online access to electronic health records among healthcare professionals.

In this study, we explore how healthcare professionals in primary care and outpatient clinics perceive the outcomes of giving patients online access to their electronic health records. The study was carried out as a case study and included a workshop, six interviews and a survey that was answered by 146 healthcare professionals. The results indicate that professionals working in primary care perceive that an increase in information-sharing with patients can increase adherence, clarify important information to the patient and allow the patient to quality-control documented information. Professionals at outpatient clinics seem less convinced about the benefits of patient accessible electronic health records and have concerns about how patients manage the information that they are given access to. However, the patient accessible electronic health record has not led to a change in documentation procedures among the majority of the professionals. While the findings can be connected to the context of outpatient clinics and primary care units, other contextual factors might influence the results and more in-depth studies are therefore needed to clarify the concerns.

Guidance Through Use: Value as a Pathfinder in e-Health Services Implementation.

The lack of awareness and confidence in eHealth solutions among certain stakeholders creates a barrier for the implementation of e-Health services. The aim of this paper is to explore issues that promote the development and implementation of patient-centered care services for the elderly. An exploratory case study approach is applied to a e-Health monitoring service that was developed and piloted in 38 homes for the elderly in Sweden and the Netherlands. The unit of analysis, concept of 'value-in-use', was used in order to determine how pilot participants felt about a service of this kind benefiting them the most. The findings were then translated into actionable considerations for implementing organizations. The results indicate a need for active participation, technical support infrastructure, mobility demands, and an extension of the concept of trust in e-Health services. The knowledge presented in the study is important for decisions makers, public organization strategists, and policy writers.

Challenges of stimulating a market for social innovation - provision of a national health account.

Innovation in healthcare can be associated with social innovation and the mission to contribute to a shared value that benefits not only individuals or organizations but the society as a whole. In this paper, we present the prerequisites of stimulating a market for social innovations by studying the introduction of a national health account. The results show that there is a need to clarify if a national health account should be viewed as a public good or not, to clarify the financial responsibilities of different actors, to establish clear guidelines and to develop regulations concerning price, quality and certification of actors. The ambition to stimulate the market through a national health account is a promising start. However, the challenges have to be confronted in order for public and private actors to collaborate and build a market for social innovations such as a national health account.

Steps to consider for effective decision making when selecting and prioritizing eHealth services.

Making the best choice for an organization when selecting IT applications or eHealth services is not always easy as there are a lot of parameters to take into account. The aim of this paper is to explore some steps to support effective decision making when selecting and prioritizing eHealth services prior to implementation and/or procurement. The steps presented in this paper were identified by interviewing nine key stakeholders at Stockholm County Council. They are supposed to work as a guide for decision making and aim to identify objectives and expected effects, technical, organizational, and economic requirements, and opportunities important to consider before decisions are taken. The steps and their respective issues and variables are concretized in a number of templates to be filled in by decision makers when selecting and prioritizing eHealth services.

Nordic eHealth indicators: organisation of research, first results and plan for the future.

eHealth indicator and benchmarking activities are rapidly increasing nationally and internationally. The work is rarely based on a transparent methodology for indicator definition. This article describes first results of testing an indicator methodology for defining eHealth indicators, which was reported at the Medical Informatics Europe conference in 2012. The core elements of the methodology are illustrated, demonstrating validation of each of them in the context of Nordic eHealth Indicator work. Validation proved the importance of conducting each of the steps of the methodology, with several scientific as well as practical outcomes. The article is based on a report to be published by the Nordic Council of Ministers [4].

Barriers and opportunities to the widespread adoption of telemedicine: a bi-country evaluation.

Recognizing that current practices for healthcare delivery are no longer sustainable, OECD governments are focusing more and more on how to leverage ICT to facilitate superior healthcare delivery. One such possibility is the use of Telemedicine. A major goal of telemedicine today is to develop next-generation telemedicine tools and technologies. However, key "classic" barriers continue to challenge widespread telemedicine adoption by health care organizations. These barriers include technology, financial, legal/standards, business strategy, and human resources issues. This comparative study explores the current status of barriers and opportunities to the widespread adoption of telemedicine in two different countries: Sweden, and USA.

Towards capturing innovation effects of a CDSS (NjuRen).

The e-service NjuRen is a clinical decision support system used by physicians to calculate patients' renal function and provide support for selection of appropriate drug and dosage for patients with renal failure. Project NjuRen is a collaboration between Stockholm County Council and Jönköping International Business School and aims at evaluating the socio-economic impact of implementing IT-systems in healthcare. The project consist of several steps, first the development and adaptation of a model to measure innovation effects. In the second step the development of a survey to capture factual impacts and effects. Finally, in the third step to translate the effects into socio-economic terms. The result will help decision makers to identify the achieved benefits and outcomes that the implementation of the system has brought with it.

What type of innovation effects can you expect when offering e-services in the AAL domain.

The objective of the AAL-FOOD project (funded by the AAL Joint Programme and VINNOVA) is to develop e-services that assist elderly in their procurement, preparation and the social construct of eating food to maintain a diverse nutritional intake, and hence stay healthy longer. The project consists of members from Denmark, Italy, Netherlands, Romania and Sweden. The AAL-FOOD project has so far completed collecting user requirements from potential users in Italy, Romania and the Netherlands and identified opportunities for design solutions made available through an IT-platform under development. Service classifications have been identified as well as identification of 13 potential e-services which in turn have been ranked in accordance of technical feasibility and implementation. Here we present preliminary results from on-going evaluation work conducted in the AAL-FOOD project. The evaluation aims at identifying effects of innovations through the offering of e-services directed at elderly within their homes.

Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to work.

In Sweden, the activities initiated to promote return to work (RTW) are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The aim was to gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients. Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects. First, the analysis identified that the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constructive in that it facilitated recognition and mobilisation of strengths and abilities. Fourth, the differences in rules and regulations between the social insurance and the unemployment insurance standards were often perceived to induce problems, for example, on how to assess the work capacity of clients. The assessments of work capacity represent important and complex tasks that professionals must perform without having access to either scientific knowledge or consensus agreement on which to base their decisions.

Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory.

BACKGROUND: Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. METHODS: The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. RESULTS: More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P < 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = < 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P < 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians' agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P < 0.001). CONCLUSIONS: Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group.

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Methods to evaluate health information systems in healthcare settings: a literature review.

Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers, as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system' productivity and effectiveness.

Locating ICT's benefits in elderly care.

The impact of information and communication technology (ICT) is indirect and depends on redesign of practices and structures also outside health care. Improvements will only be realized if all parties involved can coordinate their efforts to take advantage of new technology. A 'package' of changed work practices and structures extending across organizational boundaries needs to be designed and implemented. This is very different from the common conception of introducing new ICT tools. Calls for 'evaluation of benefits' before new ICT systems are introduced need to recognize this complexity. This article investigates how analysis and economic evaluations can be used to improve decision-making when new applications are proposed. This is done by drawing parallels with experiences from other industries. We conclude that the entire 'change package' should be analysed for its consequences on the well-being of care recipients, and the requirements it presents for capital investments and changed labour inputs, in particular changed competence needs. Some concepts and structures are suggested for such evaluations.

A theory for classification of health care organizations in the new economy.

Most of the available studies into information technology (IT) have been limited to investigating specific issues, such as how IT can support decision makers distributing the information throughout health care organization, or how technology impacts organizational performance. In this study, for use in the planning of information system development projects, a theoretical model for the classification of health care organizations is proposed. We try to reflect the development in the contemporary digital economy by theoretically classifying health care organizations into three types, namely traditional, developing, and flexible. We describe traditional health care organizations as organizations with a centralized system for management and control. In developing health care organizations, IT is spread over the horizontal dimension and is used for coordinating the different parties throughout the organization. Finally, flexible health care organizations are those which work actively with the design of new health care organizational structure while they are designing the information system.

Management demands on information and communication technology in process-oriented health-care organizations: the importance of understanding managers' expectations during early phases of systems design.

There are numerous challenges to overcome before information and communication technology (ICT) can achieve its full potential in process-oriented health-care organizations. One of these challenges is designing systems that meet users' needs, while reflecting a continuously changing organizational environment. Another challenge is to develop ICT that supports both the internal and the external stakeholders' demands. In this study a qualitative research strategy was used to explore the demands on ICT expressed by managers from functional and process units at a community hospitaL The results reveal a multitude of partially competing goals that can make the ICT development process confusing, poor in quality, inefficient and unnecessarily costly. Therefore, from the perspective of ICT development, the main task appears to be to coordinate the different visions and in particular clarify them, as well as to establish the impact that these visions would have on the forthcoming ICT application.