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No. 83 - ICTs and health

DigiWorld Economic Journal - C&S - 29/09/2011 No. 83 - ICTs and health

3rd quarter 2011

The papers presented in this issue shadow the diversity of approaches related to ICT implementation within the health system. They point out also the specificity of the sector. The particular position of health within our economies, the weight of public financing, the role of public authorities in the decision process to launch a new product and change health delivery systems, the vital issue of improved outcomes for users of health services, and the specific relationship between them and healthcare professionals: all of these issues help to explain why the health sector is often “late” in terms of ICT penetration. Development of the ICT health market and applications are very much related to the value perceived by each of the numerous stakeholders.

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ICTs and health

Edited by Robert Picard, Elettra RONCHI & Graham VICKERY


By the Editors


Open Innovation: Transforming Health Systems through Open
and Evidence Based Health ICT Innovation

Empowering Patients through ICT
Organisational Impact on Healthcare Systems in England and Scotland 

Maria LLUCH 

Management of Care
through Computerised Protocol-Based Care Plans


Contribution of Standards and Profiles to Interoperability in eHealth


Need for ICTs Assessment in the Health Sector:
A Multidimensional Framework



Hervé BARGE, Chief Information Officer, Franche-Comté ARS, Besançon
Conducted by Robert PICARD

Fredrik LINDÉN, Project Coordinator, Smart Open Services for European Patients, epSOS
Conducted by Elettra RONCHI


Firms and Markets

The ICT Landscape in BRICS Countries: Brazil
Jean-Paul SIMON

World Telecom Services Market

World Video Games Market

Book Review

IDATE, DigiWorld Yearbook 2011: The Digital World's Challenges
By Isabelle POTTIER

Summary: Jean GABSZEWICZ & Nathalie SONNAC, L'industrie des médias à l'ère numérique

Author biographies


DigiWorld Summit 2011 (Montpellier) - Will the device be king?
eHealth 3rd Associate Seminar (Montpellier)

Dossier: ICTs and health

Open Innovation:
Transforming Health Systems through Open
and Evidence-Based Health ICT Innovation
Key words: open innovation, open source, ICT, healthcare.

For many years the full potential of creating and leveraging integrated health ICT systems such as electronic health records to improve healthcare delivery, reducing its cost and promoting prevention has been elusive. Traditional health ICT business, innovation, development and adoption models have failed to address chronic road blocks to realizing its full potential and have led to many high profile failures. The chronic symptoms include persistent barriers to integration and interoperability, high cost, duplication of effort, and poor, to no support for collaborative, "evidence based" medicine. This paper provides a review of case studies and analysis on how open innovation, or open source processes, can break the grid lock and bring the fundamental paradigm shift needed to exploit the full potential of health ICTs. The paper will discuss how the open innovation model, as applied to health ICT, provides a framework for harnessing the naturally occurring "bottom up" forces and emergent behaviour found in complex adaptive systems such as healthcare. It does this by describing a model and context for collaborative, open, peer reviewed, evidence-based innovation and technology transfer processes. Evidence from case studies are presented on how open ICT innovation in healthcare provides essential feed backloops for supporting, researching, developing and disseminating while driving continuous quality improvement at a global scale.

Empowering Patients through ICT
Organisational Impact on Healthcare Systems
in England and Scotland
Key words: healthcare, organisational impact, ICTs, health information technology, remote patient monitoring and treatment (RMT), telehealthcare, Personal Health Systems (PHS), ageing population, chronic disease, patient empowerment.

This paper reports on the efforts carried out by England and Scotland to promote the widespread use of telehealthcare within Personal Health Systems (PHS) for patients with chronic conditions. In each setting, it explains the political drive, the trends in empowering patients, the needs for healthcare systems to treat chronic patients at home, the search for evidence supporting the case for telehealthcare, the reorganisation of services around these technologies and the need to coordinate and/or integrate different tiers of care in order to address the needs of patients suffering from chronic conditions. It details the achievements to-date and building on recent policy developments, it provides an overview on the likelihood of these services becoming a routine form of care. Following the two different approaches on telehealthcare in England and Scotland, it puts into perspective the need for adequate systemic governance and institutional reforms required to address the challenges associated to ICT implementations at organisational level and how the industry may be able to deliver solutions supporting them.

Management of Care through Computerised
Protocol-Based Care Plans

Key words: Health Informatics, Population Health, Aboriginal Health.

Health care for Aboriginal people in the Kimberley region of Western Australia is based on a pro-active, community-level and protocol based approach supported by a web-based clinical information system called MMEx. In MMEx, protocols are encoded as structured care plans that prompt health professionals to perform specified activities according to a specified schedule. Use of the care plans means that care for patients, who exhibit a high incidence of chronic disease in this population is more effective and efficient. Performance of the health services can be measured easily with meaningful measures of benefit to the patients they serve. This paper describes the basis for this system and how it was implemented in this remote region of Australia.

Contribution of Standards and Profiles to the Interoperability in eHealth
Key words: eHealth standards, interoperability, deployment, health information.

This paper provides an overview on the standards that are used in eHealth in order to share and exchange medical data. The development of innovative solutions in eHealth and eAgeing and their adoption is dependent on the sharing of medical data in the health ecosystem. Therefore IT products used to support this ecosystem need to interoperate in a secured and safe manner. The corpus of standards at the international level is quite important but their deployments have proven more complex than expected. The obstacles of the diffusion of the standards are discussed and several possible solutions or recommendations are explored. For instance, the recognition of a set of standards-based integration profiles along with the supportive test tools at the European level gives direction to the suppliers and encourages them to adopt these profiles technical standards in their products. The usage of a European set of profiles by eHealth projects, be it national or regional in scope, will promote the interoperability harmonization among European countries and accelerate the delivery of quality and efficiency in the care processes.

Need for ICTs Assessment in the Health Sector:
A Multidimensional Framework
Key words: ICT, telemedicine, telehealth, evaluation, decision making aid, indicators.

What are the various impacts of a massive deployment of ICT solutions in the health sector on the objectives of various initiators, investors, and project developers? To get the answer to this question, a robust and multidimensional model needed to be developed to evaluate planned technology projects. This model also had to be of use in making decisions on expanding these technologies. Some authors have presented models based on the HTA (Health Technology Assessment) method which they anticipate completing. This article presents a universal multi-criteria and multidimensional ICT evaluation model: GEMSA, Grille d'Evaluation Multidisciplinaire Santé Autonomie [Multidimensional Evaluation Grid for Health and Autonomy]. The medico-social sector which relies on evaluation procedures to identify needs and determine the means of compensation favourably welcomes this method to refine the available methods. The proposed evaluation framework is based on five specific categories: strategy, technology, quality and usage, organization and economics. Actual tests have been performed to validate the operational value of the grid and to implement indicator measurement.

The Editors

Robert PICARD is "Référent Santé" of the Conseil Général de l’Industrie, de l’Energie et des Technologies, a French Council for Industrial Policies which he chairs as the Minister in charge of the Industry. He has a Ph.D. in Management Sciences, is also graduate from Ecole Polytechnique and Telecom Paris. He began his career within France Telecom, as a manager in charge of networks and IS. He joined the French national regulatory body for telecom regulation within the Ministère des Postes et Télécommunications. He became Director at GSI, today a sister company of ADP, for 6 years, as marketing and communication manager. In 1995, he joined Stratorg, a French consulting group, where he was in charge of the IT sector. From 1999 to 2004, he was Chairman of Athanor, an independent consulting body, where he worked with large firms from different high tech sectors. Since the end of 2004, he has contributed within the CGIET to several missions at higher level in the field of ICT. His work deals in particular with the identification and promotion of development factors of new usages of ICT, and their contribution to the development of the economy, with a focus on e-Health & e-Inclusion.

Elettra RONCHI is Senior Policy Analyst in the Information, Computer, Communications Policy Division of the Organisation for Economic Co-operation and Development (OECD) in Paris where she co-ordinates work on Information and Communication Technologies (ICTs) and health innovation. From 2006 to 2009 she led a project geared towards understanding the drivers and barriers to the adoption of electronic health records in the health sector across OECD countries. Elettra Ronchi has more than 15 years experience as policy analyst in technology, innovation and health systems, evaluating the instruments available to governments to improve public benefits from investments in science and technology. She started her policy career in 1993 as consultant for the United Nations Development Programme and was in charge of managing a programme on biotechnologies and health innovation at the OECD from 1995 to 2004. Elettra Ronchi earned her Ph.D. in neuroendocrinology from Rockefeller University/Cornell Medical School in New York, her other training qualifications are in health system management and public administration.

Graham VICKERY was formerly programme director and head of the Information Economy Group, OECD, in charge of areas including the information economy, information technology, ICT and environment, digital content, e-business and ICT-related employment programmes, and the OECD Information Technology Outlook. Expertise includes: public policy, information economy, environment, growth and employment, public sector information, intangibles and intellectual capital, new technologies, industry performance, and industry globalisation. He is author of numerous publications and articles on information technology, digital content industries, public sector information, business services, environment industry, globalisation, advanced manufacturing technology, information technology development and diffusion, technology and investment, high tech industries and work organisation.
Ph.D. (Chemistry), University of Adelaide, Australia, 1972.
B.A. (Economics), University of Melbourne, Australia, 1983.

The interviewees

Hervé BARGE is Chief Information Officer (CIO), Franche-Comté ARS, Besançon, France. In 2000 medical engineering specialist Hervé Barge joined the Franche-Comté ARH where he was responsible for information system projects and telemedicine. As an expert in the problems of sharing information in the health sector, he set up technical and operational structures for bringing together the region's health system stakeholders. In 2006, Le Monde Informatique awarded the Prix special du Jury, an annual IT award, to the Franche-Comté ARH highlighting the quality of its project steering and the technological innovation used when working on the DMP in Franche-Comté. Hervé Barge was also behind the creation of the Institut Edouard Belin in Besançon. In 2010, he joined the senior management of the Franche-Comté ARS.

Fredrik LINDÉN has a Master of Science in International Business Administration from the University of Lund, this included studies at ESCP, Ecole Supérieure de Commerce de Paris. After the studies he did a traineeship at IBM and during nearly seven years with IBM he worked both with managing Business Partners, Sales, Projects and Business Development in Sweden and the Nordic countries. The last couple of years he has been working for the Swedish Competence Centre for eHealth managing the work involved in creating the common technical infrastructure for eHealth in Sweden. Since 2008 he has been the Project Coordinator of the Large Scale eHealth Pilot.

The authors

Karima BOURQUARD is Senior Consultant in IN-SYSTEM and director of Interoperability in IHE-Europe, where she leads the contribution of IHE-Europe (Integrating the Healtcare Enterprise) to the European projects such as HITCH (Healthcare Interoperability Testing Harmonisation), epSOS (European Patients- Smart Open Services). Over the last decade, she worked as director Interoperability and director of studies in GMSIH (Groupement de Modernisation des Systèmes d’Information Hospitalier) and she developed a strong expertise on ehealth standards as well as on Healthcare Information System. She was the first User Cochair of the association IHE-Europe created in 2008. She was also User Cochair of IHE-France, member of IHE International and member of standards committees (CEN/TC251, ISO/215, HL7 Inc.). She was in charge of studies on Electronic Health Record (EHR) and eHealth architecture (patient identification, Professional directories and security). Before joining the GMSIH in 2000, she worked as Senior Consultant and architect in Cap Gemini and contributed to the development of the new solution for the Hospital Information System in 1993-1997 in France.
She obtained a Ph.D. at the University of Sciences and Technology of Languedoc- Roussillon in Montpellier.

Joseph DAL MOLIN is President, of e-cology corporation, and Chairman of WorldVistA. Joseph is an internationally recognized expert in health ICT, open source strategy and establishing collaborative, community ecosystems. He has pioneered the development and application of open innovation and open source models in healthcare since 1998. Joseph's community building accomplishments include: co-founding the WorldVistA and Open Source Health Care Alliance non-profits and communities, and authoring the strategic plan for European Commission funded SPIRIT open source, health ICT collaborative. He successfully led the open source software development and certification for WorldVistA EHR and developed the business plans for McMaster University's Dept. of Family Medicine's OSCAR primary care EHR. He has authored several key reports including Industry Canada's investigation of the implications of open source to the Canadian public and private sectors. Joseph was most recently engaged as chief health ICT advisor for Jordan's open source based, national eHealth initiative. Joseph is a co-recipient of the 2007 Wired Magazine "Rave Award" for Medicine, and winner of the Linuxmednews Freedom Award for his contributions to advancing open source in the health sector.

Associate Professor David GLANCE is director of the University of Western Australia Centre for Software Practice, a UWA research and development centre. Originally a physiologist working in the area of vascular control mechanisms in pregnancy, Professor Glance subsequently worked in the software industry for over 20 years before spending the last 9 years at UWA. The UWA CSP has developed the software MMEx which has been used to provide electronic patient management and secure messaging throughout Australia. Professor Glance's research interests cover health informatics, social network science, mobile and eHealth and computer security.

Myriam LE GOFF-PRONOST is associate professor of Economics at Telecom Bretagne, graduate engineering school in the field of information technologies. In July 2003, she obtained her Ph.D. in Health Economics from the Université de Bretagne Occidentale (France) on the subject of Telemedicine assessment. She is mainly interested in health Economics, health technology assessment, evaluation framework and business models. She participates in numerous research contracts on Health Economics applied to Telemedicine and E-Health.

Maria LLUCH has worked at the IS Unit (IPTS, Joint Research Centre, European Commission) since April 2010 carrying out research on ICT for Health in general and Personal Health Systems and Mobile Health in particular. She holds an MPharm from the Universidad de Barcelona, an MBA from IESE Business School and an MSc International Health Policy - Health Economics from the London School of Economics and Political Science (LSE) where she is completing her Ph.D. Prior to joining IPTS, she combined both management and research, focusing on cost effectiveness studies and regulatory frameworks in health systems with a specific focus on the pharmaceutical sector and ICT for Health (the latter being her PhD topic). She has been a member of the Spanish National Jury of the EU Health Prize for Journalists organised by DG SANCO since its inception in 2008.

Carole MANERO is Project Manager, Director of Research at IDATE. An IDATE Senior Consultant since October 2000, Carole is in charge of monitoring the globe’s mobile markets, operator (networks, MVNO) and mobile services development. She is also an expert in spectrum management issues. Before joining IDATE, Carole worked for the COGEMA’s North American corporate strategy department where she was involved in several acquisitions in the nuclear sector. Carole is a graduate of the École de Hautes Études Commerciales du Nord business school (class of 1991), with a major in Marketing, and holds a Masters in Human Resources and Corporate Management from the École Supérieure de Commerce in Paris (1992).

Sue METCALF is a primary health care consultant with 25 years experience working in the Kimberley of Western Australia.  A registered nurse with MPH&TM, Sue’s experience spans both clinical primary health care provision and regional population health development and support.  Her key interest, the use of computer systems for improved organisation of patient care, grew from assisting the induction of computers in the late 1980’s within the Kimberley Aboriginal community controlled health sector.  Fascinated by the reorienting and empowering effect that appropriate software can bring to Aboriginal primary health care, Sue has provided ongoing user support, help with system upgrades as well as software development, across Healthplanner, ProjectFerret and MMEx systems. Sue now works as a consultant from Kalgoorlie-Boulder.

Laurent MICHAUD is Senior Consultant, Head of Digital Entertainment Practice at IDATE. Laurent acts as project manager for market reports on video games, music, peer-to-peer, digital rights management and content protection, mobile electronics and the digital home. He provides OSEO Innovation (a national business development and support organisation) with expert technical-economic analysis of strategic issues relating to video games, TV, internet and video. Laurent has also created the International Video Game Forum, which has been taking place in Montpellier every year since November 2002. Prior to coming to IDATE, he worked as project manager for the Centre d’Études et de Projets, Montpellier University’s Economic Sciences research laboratory.
Mr. Michaud holds a post-graduate degree in Economic and Financial Regional Project Engineering from the Université de Montpellier. 

Carmel NELSON is a GP, and although originally from Melbourne, most of her working life has been spent in remote northern Australia - in Queensland, the Top End of the NT, and now WA. Carmel first moved to the Kimberley at the end of 1998 to join the newly established Derby Aboriginal Health Service, where she remained for the next six and a half years, leaving in 2005 to take up her current role as the Medical Director of the Kimberley Aboriginal Medical Services Council, based in Broome. Dr Carmel Nelson has overseen the entire Kimberley region's move to electronic health records with numerous innovations in public health and primary health care for the benefit of the Kimberley people.

Isabelle POTTIER is attorney-at-law and head of the research and publications department of the law firm Alain Bensoussan. She has particular expertise in drafting studies on the assessment and legal protection of new technologies as well as on electronic evidence and archival.

Jean-Paul SIMON has been Senior scientist at the Institute for Prospective Technological Studies (IPTS), European Commission, Directorate-General JRC, (Sevilla, Spain) since January 2010. He works on the economic assessment of the IT sector, the IT sector in BRICs countries and the media and content industries. Prior to that he held different positions in the industry and worked as a consultant specialised in media/ telecom law and regulation. He holds a Ph D in Philosophy (1975) and is a graduate from the Ecole des Hautes Etudes Commerciales (HEC) (econometrics) 1971. He has written several books and articles on communications and public policy. He is a frequent speaker on telecommunications and media in Europe and the USA.




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