PERSPECTIVES IN EHEALTH

1
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
2
DEVELOPMENT ISSUES IN E-HEALTH

• DEFINITION, DRIVING FORCES, AND BARRIERS

• HEALTH SECTOR ASPECTS

• INFRASTRUCTURE AND MARKET

• IMPLEMENTATION

• LATIN AMERICA CARIBBEAN METRICS

3
DEVELOPMENT ISSUES IN E-HEALTH

• DEFINITION, DRIVING FORCES, AND BARRIERS

• HEALTH SECTOR ASPECTS

• INFRASTRUCTURE AND MARKET

• IMPLEMENTATION

• LATIN AMERICA CARIBBEAN METRICS

4
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)

5
EVOLUTIONARY TECHNOLOGIES

• POINT OF CARE TECHNOLOGIES
• PROCESS AUTOMATION
• ELECTRONIC MEDICAL RECORD (CPMR)
• DATA WAREHOUSING
• DATA ACCESS AND SECURITY TECHNOLOGIES
• APPLICATION INTEGRATION
• DECISION-SUPPORT TECHNOLOGIES

6
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 gtgtgt
  Simultaneous)

7
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

8
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)

9
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)

10
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

11
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 VARIETY OF 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

12
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

13
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)

14
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

15
DEVELOPMENT ISSUES IN E-HEALTH

• DEFINITION, DRIVING FORCES, AND BARRIERS

• HEALTH SECTOR ASPECTS

• INFRASTRUCTURE AND MARKET

• IMPLEMENTATION

• LATIN AMERICA CARIBBEAN METRICS

16
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
17
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
265885-892, 1961
18
PERSPECTIVES OF PATIENT-BASED INFORMATION
POPULATION - REFERENCE - HEALTH STATUS -
SERVICE UTILIZATION AND PRODUCTION - RESEARCH
19
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
20
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
21
INFORMATION IN THE HEALTHCARE OF INDIVIDUALS
PROG
CLINICAL PRACTICE
COLLECTIVE HEALTH
DIAG
THERAPY
PREVEN
BIOMEDICAL KNOWLEDGE
22
INFORMATION IN THE HEALTHCARE OF INDIVIDUALS
PROG
CLINICAL PRACTICE
COLLECTIVE HEALTH
DIAG
PREVEN
THERAPY
BIOMEDICAL KNOWLEDGE
23
TYPOLOGY OF REQUIRED INFORMATION AND
ORGANIZATIONAL LEVEL
24
DEVELOPMENT ISSUES IN E-HEALTH

• DEFINITION, DRIVING FORCES, AND BARRIERS

• HEALTH SECTOR ASPECTS

• INFRASTRUCTURE AND MARKET

• IMPLEMENTATION

• LATIN AMERICA CARIBBEAN METRICS

25
DISTRIBUTION OF GROSS DOMESTIC PRODUCT BY SECTOR,
1995
Percentage of GDP
Sector
Source World Bank, World Development Report 1997
26
HEALTH CONTRIBUTION TO THE SERVICES SECTOR
HEALTH SERVICES AS PERCENTAGE OF THE SERVICE
SECTOR

Source World Bank, World Development Report 1997
27
WORLD MARKET FOR INFORMATION AND COMMUNICATIONS
TECHNOLOGIES (1998)
JAPAN (11)
OTHER (23)
USA (36)
EUROPE (30)
Value 1,363 billion US dollars
28
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
200
Domestic Telephone / Fax
100
0
90
91
92
93
94
95
96
97
98
99
00
01
02
Source ITU World Telecommunication Development
Report 1999 Mobile cellular
29
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
30
Global Distribution of IP Hosts
Developing6 of hosts84 population
Developed94 of hosts16 population
Australia,
Japan
New Zealand
6.4
3.7
Canada
Developing
Other
US
Asia-Pacific
5.9
65.3
LAC
Europe
1.9
Africa
22.4
0.3
Source ITU 1999 Challenges to the Network
Internet for Development
31
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

32
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
33
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
34
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
35
THIRD ORDER NETWORKING
Standards Coalition Networks -
Technical Standards Develop / Promotion
Technology Cooperation
Networks - Sharing Expertise - Knowledge
Dissemination
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
36
FOURTH ORDER NETWORKING
Standards Coalition Networks -
Technical Standards Develop / Promotion
Technology Cooperation
Networks - Sharing Expertise - Knowledge
Dissemination
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
37
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 processe
s 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
38
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

39
DATA WAREHOUSING
40
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

41
FULL SERVICES
DIRECT CONSUMER BYPASS STOCK TRADING HEALTH
SELF-CARE
E-COMMERCE
FUND TRANSFER PHYSICIAN ADVERTISING PHARMACEUTICAL
S / 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
42
DEVELOPMENT ISSUES IN E-HEALTH

• DEFINITION, DRIVING FORCES, AND BARRIERS

• HEALTH SECTOR ASPECTS

• INFRASTRUCTURE AND MARKET

• IMPLEMENTATION

• LATIN AMERICA CARIBBEAN METRICS

43
E-HEALTH COMPONENTS
POLICY / REGULATORY / LEGAL
SUPPLIER / PRACTITIONER / ORGANIZATIONS PATIENT/
EMPLOYER / PAYER / RESEARCHER
ELECTRONIC CLEARINGHOUSES / BROKERS TRANSACTION
SERVICE PROVIDERS
INTERFACE EQUIPMENT / EDI / SECURITY TELECOMMUNICA
TION INFRASTRUCTURE
HEALTH INFORMATION INFRASTRUCTURE (BUSINESS
RULES, ROUTINES, STANDARDS)
NATIONAL / INTERNATIONAL MARKETS
44
INFLUENCE ON HEALTH-RELATED LIFESTYLE CHOICES
SOURCES USED BY THE PUBLIC FOR PERSONAL HEALTH
DECISIONS

U.S. Survey by Gómez Advisors, Inc. , 2000
45
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
46
U.S. PHYSICIANS USE OF COMPUTERS
PERCENT
Source Pricewaterhouse Coopers Modern
Physicician 2000
47
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)

48
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

49
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)

50
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

51
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

52
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

53
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

54
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

55
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
• OPERATORS ERROR IS FREQUENT REASON
• MOST DAMAGING VIOLATIONS ARE INTERNAL
• EXTERNAL ATTACKS ARE ON THE INCREASE

56
MAINTENANCE STAFF X SW PORTFOLIO SIZE
28 countries / 30 sectors / 16,000 sources
Source META Group, 2000
57
SYSTEMS MAINTENANCE CONSULTING COST
Source META Group, 2000
58
SYSTEMS MAINTENANCE CONSULTING COST
Source META Group, 2000
59
SOFTWARE MAINTENANCE IN KLOC X PROFESSIONAL
100 KLOC
73 KLOC
28 countries / 30 sectors / 16,000 sources
Source META Group, 2000
60
EXTERNAL CONSULTANTS EXPENDITURE (1999)
in US millions 28 countries / 30 sectors /
16,000 sources
Source META Group, 2000
61
IT MARKET BASKET COST (1999)
28 countries / 30 sectors / 16,000 sources
U.S. 1.00
Source META Group, 2000
62
DEVELOPMENT ISSUES IN E-HEALTH

• DEFINITION, DRIVING FORCES, AND BARRIERS

• HEALTH SECTOR ASPECTS

• INFRASTRUCTURE AND MARKET

• IMPLEMENTATION

• LATIN AMERICA CARIBBEAN METRICS

63
IT DEVELOPMENT AND IMPLEMENTATION
MANAGEMENT AND ORGANIZATIONAL ISSUES
INFORMATION SYSTEMS IN HEALTH CARE
IMPLEMENTATION ENVIRONMENT
TECHNOLOGY BASE
64
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

65
E-MARKET IN LATIN AMERICA
66
NEW TECHNOLOGY NETWORKS AND FOR DEVELOPING
COUNTRIES

• gt95 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

67
IMPLEMENTATION IN LATIN AMERICA CARIBBEAN

• E-HEALTH DEVELOPMENT INTEGRATES TECHNOLOGY,
• GEOGRAPHY, CULTURE, LANGUAGE,
  AND.HEALTHCARE SYSTEMS
• NO SINGLE COOKBOOK OR TRANSLATEDSOLUTION
• 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

68
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
69
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 Washingto
n, D.C.
70
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

71
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

72
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

73
PERCENTAGE OF ADULT ILLITERACY (1998)
PERCENT
AVERAGE
Source PAHO Basic Indicators
74
AVERAGE YEARS OF EDUCATION FOR AGE 25 (1999)
YEARS
Source World Bank Health Report
75
MAIN (FIXED) TELEPHONE LINES X 100 INHABITANTS
(1999)
NUMBER
Source International Telecommunication Union and
PAHO Basic Indicators
76
WAITING TIME FOR NEW WIRED CONNECTION IN YEARS
(1998)
YEARS
Source International Telecommunication Union
77
COST OF WIRED CONNECTION
ANNUAL RESIDENTIAL SUBSCRIPTION AS PERCENTAGE OF
GNP x CAPITA (1997)
PERCENT
Source International Telecommunication Union and
PAHO Basic Indicators
78
WIRELESS TELEPHONE SUBSCRIBERS x 100 INHABITANTS
(1999)
NUMBER
Source International Telecommunication Union and
PAHO Basic Indicators
79
LATIN AMERICAN AND CARIBBEAN TELECOMMUNICATIONS
MARKET
Millions
69
54
50
25.3
12.7
7
Source International Telecommunication Union,
Jan 2000
80
PERSONAL COMPUTERS x 100 INHABITANTS (1998)
NUMBER
Source International Telecommunication Union and
PAHO Basic Indicators
81
PERCENTAGE OF POPULATION CONNECTED TO THE
INTERNET (1999)
PERCENT (LOG)
Source International Telecommunication Union and
PAHO Basic Indicators
82
INTERNET HOSTS x 1,000 INHABITANTS (JAN 2000)
NUMBER (LOG)
Source International Telecommunication Union and
PAHO Basic Indicators
83
INTERNET SERVICE PROVIDERS (JAN 2000)
NUMBER (LOG)
Source International Telecommunication Union
84
INFORMATION TECHNOLOGY GROWTH, 1985-1995
1995-2000
PERCENT
Source International Data Corporation, 1996
85
INTERNET USE - PHYSICIANS IN BRAZIL
42,744 PHYSICIANS
58

42
1999 SURVEY
86
INTERNET USE - PHYSICIANS IN BRAZIL
24,603 PHYSICIANS SITE FROM WHERE INTERNET IS
ACCESSED
85

10
1999 SURVEY