HIM 301 Introduction to Health Informatics WK5-D2

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Chapter 30 International Efforts, Issues, and Innovations

Hyeoun-Ae Park

To promote international development in health and nursing informatics it is necessary to provide tools for the development of national and regional ehealth initiatives and strategies.

Objectives

At the completion of this chapter the reader will be prepared to:

1.Outline key international health informatics initiatives

2.Describe key organizations leading international health informatics initiatives

3.Discuss the role of health practitioners such as nurses in international health informatics initiatives

Key Terms

Derived classifications, 482

eHealth initiatives, 474

Reference classifications, 482

Related classifications, 482

Abstract

This chapter highlights international health informatics initiatives, international organizations involved in these initiatives, and how health practitioners such as nurses are involved in the activities of these organizations. There are numerous international health informatics–related activities that have been initiated across the different regions of the world. In addition academic societies within these regions are pursuing health informatics theory and practice developments. These international health informatics initiatives, along with associated academic organizations, are introduced here with brief histories and the key activities of each region. There are also several international organizations involved in the development of health informatics, such as the World Health Organization, the International Medical Informatics Association, the International Organization for Standardization, the International Council of Nurses, the International Health Terminology Standards Development Organisation, and Health Level Seven. These organizations are introduced with a short description of health practitioners' contributions to their activities. Finally, global issues in health informatics initiatives are also described.

Introduction

In many parts of the world healthcare is one of the largest sectors of the economy. As a result, health spending plays a major role in economic policy throughout the world with growing pressure on the healthcare industry to streamline costs, gain efficiency, and become more innovative in improving and maintaining the health of the population. Today the health industry around the world is looking for better ways of providing healthcare and improved health for all. The application of health information technology (health IT), called information and communication technology or ICT in international settings, to healthcare is seen as key to realizing this aim. The World Health Organization (WHO) uses ehealth as an umbrella term to cover all aspects of the use of ICT in healthcare. While the terminology differs—from health IT to ICT to ehealth—the goal of using technology to effectively and efficiently improve the health of individuals, families, and communities remains the same. An important difference exists between the meaning of these terms and the term health informatics. Health informatics is a broader term that refers to the discipline as a whole. The terms ehealth, ICT, and health IT refer to the use of technology in meeting healthcare needs and reflect international differences in how the terminology evolved in different areas. In this chapter all three terms are used in an attempt to reflect the terminology of the different regions of the world.

However, whichever term is used—ehealth, health IT, or ICT—the use of technology to improve health faces many challenges, many of which are international. A concerted effort is necessary if these challenges are to be overcome. This chapter highlights international ehealth initiatives and describes the work of health practitioners such as nurses and others in meeting these challenges.

Key Initiatives in World Regions

The following section of the chapters explores key initiatives in health IT and informatics throughout the world by dividing the world into recognized regions. Within each region government supported ehealth initiatives are described. This is followed by a description of the health informatics activities within the region using the IMIA framework.

eHealth Initiatives in Europe

Given the increasing importance of the health and computer industries, the European Union (EU) introduced ehealth as one component of the Digital Agenda for Europe.1 The history of ehealth in Europe dates back to the beginnings of health informatics in the late 1950s and early 1960s. Since its formation under the Maastricht Treaty in the 1990s the EU has provided more than €500 million in research funding to develop ehealth tools and systems. These EU-supported projects have helped to establish Europe as a world leader in the use of national and regional health networks and electronic health records (EHRs), especially in primary care, and in the deployment of digital health cards.1

In 2004 the EU adopted the first ehealth action plan (for 2004 to 2010) to facilitate a more harmonious and complementary European approach to ehealth. The action plan covered everything from electronic prescriptions and digital health cards to new information systems that reduce wait times and errors. The plan identified necessary actions for a widespread European adoption of ehealth technologies and encouraged individual members to customize strategies to their own needs. Thus each member state has developed its own national or regional road map for ehealth. These strategies are directed at addressing the challenges of providing citizen-centered healthcare services to meet the rising expectations of Europeans while concomitantly dealing with the issues that are raised by increasing mobility, aging populations, and budgetary constraints.

National and regional strategies are now focused on deploying ehealth systems, ensuring interoperability, using EHRs, reimbursing ehealth services, and other related issues. To meet these goals the EU has set up a database of European ehealth priorities and strategies to enhance knowledge and facilitate cooperation between states and regions. It includes documents about national ehealth priorities, strategies, road maps, and research programs.

The progress of the first ehealth action plan was evaluated in 2011.2 Soon after, the European Commission launched the second eHealth Action Plan (eHAP) for 2012 to 2020. This plan combines—and improves when possible—previous actions implemented while looking toward the future of ehealth in Europe.

In addition, the EU supports ehealth research activities under its Research Framework Programme. Furthermore, the EU supports the deployment of innovative ehealth solutions into concrete services that are actually used by those who need them. The ehealth subgroup began in 2005 as an ehealth working group to provide expert ehealth-related advice. Members of the subgroup are key decision makers and leaders in the definition and implementation of national ehealth initiatives. They work in concert with the eHealth Stakeholder Group, whose members are expert representatives of European umbrella organizations active in the ehealth sector, such as telecommunications ministries, health authorities, healthcare professional associations, and industry, as well as patient and citizen groups. The ehealth subgroup is also expected to contribute to the development of ehealth-related legislation and policy. Additional information about these groups can be found at https://ec.europa.eu/digital-agenda/node/1103. Since 2003 member states' health ministers and state secretaries have met yearly to discuss and move ehealth initiatives forward. These annual conferences provide an opportunity to develop and improve European ehealth services.

Another key European initiative to promote ehealth within the region is the European Patients Smart Open Services (epSOS) initiative (www.epsos.eu). The goals related to this effort include building and evaluating a service infrastructure for cross-border interoperability between EHR systems in Europe. This initiative promotes a European health information network and has already influenced member states and provided opportunities in business.

To provide input on legal, ethical, and regulatory issues crucial to ehealth implementation across the EU, the member states proposed SEHGovIA (Supporting the European eHealth Governance Initiative and Action; http://ihe-europe.net/eu-projects/57/sehgovia-thematic-network). SEHGovIA addresses semantic interoperability, terminology, identification, and authentication standardization issues that are vital to successful information exchange of health data across the EU.

With the goal of cross-border interoperability in mind the Healthcare Interoperability Testing and Conformance Harmonisation (HITCH) project was established in the EU for testing and certification of ehealth systems (www.hitch-project.eu). The project encourages the development and approval of common guidelines for testing quality and the organization of a testing tool development infrastructure to fill critical gaps for tools and test plans. A European interoperability framework with an objective set of profiles based on interoperability standards is required before proceeding with testing, projected for piloting in 2014.

HITCH proposes that this common foundation be used by national or regional ehealth projects across Europe to organize their own testing and certification. The common testing tools and test plans found in the foundation would permit products to be tested at the European level and additionally tested only for regional and national extensions to the European interoperability framework. Ideally this would increase consistency, reduce costs, and significantly accelerate deployment across multiple national and regional ehealth projects, improving on the current inconsistent and fragmented approach.

The European Federation for Medical Informatics

The European Federation for Medical Informatics (EFMI) was created in 1976 with the assistance of the WHO Regional Office for Europe. Its main purpose was to enhance European health sciences by encouraging the implementation of information science in the field. Each European country is entitled to be represented in EFMI by a suitable health

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FIG 30-1 European Federation for Medical Informatics (EFMI) member countries: Austria, Belgium, Boznia-Herzegovina, Croatia, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Republic of Moldova, Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, Serbia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, and United Kingdom.

informatics society. As of this writing, 30 countries in Europe have joined EFMI. The footprint for these countries can be seen in Figure 30-1.

The objectives of EFMI are as follows:

•To advance the international cooperation and dissemination of information in medical informatics within Europe

•To promote high standards in the application of medical informatics

•To promote research and development in medical informatics

•To encourage high standards in education in medical informatics

•To function as a regional member of the International Medical Informatics Association (IMIA)

While the term medical informatics is used in stating these goals, it is meant to include the whole spectrum of health informatics and all disciplines concerned with health and informatics. EFMI is a regional member of the International Medical Informatics Association (IMIA) and has formal liaison relations with WHO as well as the Council of Europe. Activities of EFMI include academic conferences and publications, including organizing the Medical Informatics Europe (MIE) congresses. These take place in 2 of every 3 years in order not to clash with IMIA's triennial MedInfo conferences. The first such congress, MIE 78, was held in Cambridge, England. The proceedings of these congresses are usually published as a series: Lecture Notes in Medical Informatics and Studies in Health Technologies and Informatics. A selection of the best papers from the MIE conferences is published in special volumes of the International Journal of Medical Informatics and Methods of Information in Medicine. Open access to the latest MIE conference proceedings is provided on the EFMI website located at http://www.helmholtz-muenchen.de/ibmi/efmi/. Less well known but equally important are the Special Topic Conferences. A Special Topic Conference is organized by a member society in combination with its annual meeting. The topic of the conference is defined by the needs of the member society. Relevant EFMI working groups are engaged for content selection. The EFMI's working groups also organize their own working conferences or business meetings. Currently there are 16 working groups within the EFMI (Box 30-1).

eHealth Initiatives in the APEC Region

Health IT is one of three projects overseen by the Health Working Group (www.apechwg.org) of the Asia-Pacific Economic Cooperation (APEC) oversees. The APEC ehealth collaboration started as a health IT project when leaders accepted the ecommerce agenda at an APEC summit meeting in 1999. At the 2000 APEC summit meeting this group recognized the digital divide among member countries and began to support services for underprivileged populations within the region. In 2001 leaders of member countries addressed basic health issues within the region and recommended the use of health IT to extend healthcare services to a wider community. In 2003 APEC leaders called for health security and established a health surveillance network to monitor disease outbreaks and bioterrorism. At a meeting in 2005, health ministers underscored the importance of the use of health IT to better face threats to health in the region and welcomed ehealth initiatives. In 2006 to 2009, as part of the APEC e-Health Initiative, annual APEC e-Health Seminars occurred and in 2006 to 2008 an APEC e-Health Action Project was held.

Box 30-1 European Federation for Medical Informatics (EFMI) Working Groups

Education in Health Informatics (EDU)

Electronic Health Records (EHR)

Assessment of Health Information Systems (EVAL)

Health Informatics for Interregional Cooperation (HIIC)

Health Information Management (PG HIME)

Human and Organizational Factors of Medical Informatics (HOFMI)

Informatics for the Disabled and Rehabilitation (IDR)

Libre/Free and Open Source Software in Health Informatics (LIFOSS)

Minimum Basic Data Set, Case Mix, Resources Management and Outcomes of Care (MCRO)

Medical Image Processing (MIP)

Natural Language Understanding; Nursing Informatics in Europe (NLU)

Nursing Informatics (NURSIE)

Primary Care Informatics (PCI)

Personal Portal Devices (PPD)

Security, Safety and Ethics (SSE)

Traceability of Supply Chains (TRACE)

Participants of the e-Health Seminars indicated that it was difficult to do the following:

•Share information through only an annual conference

•Reflect outcomes in relevant industrial areas immediately

•Include public sector involvement in legislation and policy planning, standardization, and human resource development for ehealth services

Based on this feedback the APEC e-Health Community was introduced in 2009. The Community made it possible for APEC member countries to share information and exchange ehealth human and material resources through a connection between developed and underdeveloped economies. It is now possible for industries to reflect the outcomes of seminars immediately by inducing participation from hospitals, clinics, and global companies that deal in relevant health IT and health areas. The APEC e-Health Community also made it possible to promote government participation in the development of policy, legislation, and standards and encourage member country participation by arranging for each country to take turns hosting seminars.

The APEC e-Health Community holds an annual meeting called the APEC e-Health Community Forum. Key objectives of the APEC e-Health Community Forum include the following:

•Bridging the gap between APEC member countries through seminars, capacity building in information sharing, and acknowledging high-value cases related to ehealth

•Stimulating ehealth-focused industries within the region

The main activities of the e-Health Community Forum are technical presentations, exhibitions of ehealth products, and poster presentations. Experts from industry, academe, and research institutes actively participate in these activities. Activities of the e-Health Community Forum include the following:

•Sharing knowledge, skills, and models of the ehealth service system to help collaboration between the public and private health sectors in the APEC region

•Enabling APEC regional governments to maximize ICT applications for healthcare, respond more effectively to epidemic diseases, and vitalize ehealth fields

•Establishing guidelines for the level of ehealth in the region and collaborating with other forums to stimulate ehealth within the region

•Publishing The Current Status and Future Prospects of eHealth in APEC Regions

The APEC e-Health Community Forum supports its member countries with a detailed plan that depends on the current status of ehealth within a particular country. The Forum implements this plan on the following three levels:

•Initiative level. Health IT technology and sharing information on and awareness of the current status of ehealth

•Middle level. Development of technology through attainment of relevant advanced health IT information

•Advanced level. Introduction of current status of technology and newest ehealth technology3

Asia Pacific Association for Medical Informatics (APAMI)

To promote the theory and practice of health informatics within the APEC region, the Asia Pacific Association for Medical Informatics (APAMI) began in 1993 as a regional group within IMIA (www.apami.org). Currently it has 15 society members as seen in Fig. 30-2 and listed in Box 30-2.

APAMI activities include triennial conferences and working groups. The inaugural APAMI triennial conference was held in Singapore in 1994. Over the last several years these conferences have been held in seven different Asian countries, including China in 2012. The four working groups within APAMI include Standardization, Health Informatics for Developing Countries, Decision Support, and Nursing

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FIG 30-2 Asia Pacific Association for Medical Informatics (APAMI) member countries: Australia, China, Hong Kong Special Administrative Region, India, Japan, Korea, Malaysia, New Zealand, Pakistan, Philippines, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam. Observer Members: Bangladesh, Indonesia, and Kazakhstan.

Informatics. Each hosts a workshop during the APAMI triennial conference.

Box 30-2 Asia Pacific Association for Medical Informatics (APAMI) Member Countries

Australia

China

Hong Kong Special Administrative Region

India

Japan

Korea

Malaysia

New Zealand

Pakistan

Philippines

Singapore

Sri Lanka

Taiwan

Thailand

Vietnam

Observer Members

Bangladesh

Indonesia

Kazakhstan

APAMI actively promotes telemedicine, bioinformatics, and public health informatics. Because of the large size of its countries, the low specialist-to-population ratio, the affordable cost of technology and telecommunication, and the high penetration rate of health IT for equitable distribution of healthcare services, telemedicine is an important aspect of ehealth within the Asia-Pacific region. One example is the National Telemedicine Initiative of the Thai Ministry of Public Health started in 1998. Thai telemedicine supports remote, underserved populations in Thailand. This system links the Ministry of Public Health and 19 hospitals with about 60 district hospitals. Another example is oncology telemedicine in Japan, which connects 14 cancer centers throughout Japan. High-resolution images are transferred among centers as part teleconference services. Asia-Pacific countries with active telemedicine projects include China, Korea, Australia, India, Bhutan, Singapore, Indonesia, Hong Kong SAR, and New Zealand.

Many countries in the Asia-Pacific region including China, Hong Kong, Japan, Korea, Singapore, India, Malaysia, Thailand, and the Philippines are actively promoting bioinformatics. APAMI plays a key role in facilitating and advancing cooperation within the region. China, Hong Kong, Singapore, and Taiwan have been especially active in public health informatics since the outbreak of severe acute respiratory syndrome (SARS) in 2003. The SARS outbreak provided an opportunity for APAMI to demonstrate the importance of a public health informatics approach to the health of each country with the region. APAMI continues to address public health informatics research and development through contact tracing, epidemiologic reporting, and monitoring for acute disease outbreaks, as was seen with SARS.

eHealth Initiatives in the Pan American Health Organization (PAHO) Region

The Pan American Health Organization (PAHO) initiated the PAHO eHealth Program to improve public health in the Americas through the use of innovative health IT tools and methodologies.4 The PAHO eHealth Program is the strategic response to the Health Agenda for the Americas presented by the Ministers of Health of the Americas in 2007.5 This program introduced a conceptual model based on the following three components:

1.Access to information such as PAHO and WHO content and public health content

2.Access to educational material such as training, lectures, web conferences, and open educational resources

3.Interaction management in the Web 2.0 context, which includes the physician–patient relationship and all aspects of telemedicine and telehealth5

These follow a strategic pathway consisting of six steps:

•Identification of needs

•Development of innovative solutions

•Adoption of the solution(s)

•Training for implementation

•Implementation and use

•Recording of lessons learned

As of 2013 the PAHO eHealth Program consists of nine projects:

1.Personal health card

2.Digital clinical history

3.Electronic prescriptions

4.Appointment via the Internet

5.Health portals and the social web

6.Risk management and patient security

7.Telemedicine

8.Regional call center

9.Digitalization of clinical and administrative documentation5

PAHO is expected to move its ehealth program forward with PAHO and WHO Corporate Initiatives. PAHO Corporate Initiatives include the Regional Health Observatory, desktops, intranet and extranet, Web 2.0, web conferences, social media, Pan American Journal of Public Health, Virtual Campus, Virtual Health Library, and the PAHO Institutional Repository. WHO Corporate Initiatives such as the Global Health Observatory, Web 2.0, Global Health Library, Global Institutional Repository, and multilingualism will be used.

Expected results from the PAHO eHealth Program have been established as follows:

•“Support for the formulation and adoption of people-centered ehealth public policies at the national and regional level of the member states.

•Improved organizational and technology infrastructure promoting epidemiologic surveillance services and sustainable, interoperable development of ehealth-centered programs and initiatives

•Intersectoral cooperation, both within each country and among countries with electronic mechanisms for sharing best practices, regional resources, and lessons learned

•Established training in information and communication technologies in universities and among health professionals”6

Sample indicators to evaluate whether expected results are achieved include metrics on the use of tools by patients and on the use of web-based collaboration tools by citizens, public health workers, and public health institutions from dispersed or disadvantaged populations.

IMIA-LAC

The Regional Federation of Health Informatics for Latin America and the Caribbean, called IMIA-LAC (www.imia-lac.net), was founded in 1996 to promote theory development and the practice of health informatics within Latin America and the Caribbean (LAC). The IMIA-LAC board proposed the following goals to develop health informatics within the region and strengthen regional ties:

1.Strengthen the network of health informatics societies in Latin America and the Caribbean

2.Define the main health informatics topics to promote and the best groups to engage in such initiatives7

Member societies of IMIA-LAC include Argentina, Brazil, Chile, Cuba, Mexico, Uruguay, and Venezuela as shown in Fig. 30-3.

Activities include regional congresses, national conferences, and working groups. An inaugural regional congress of IMIA-LAC was held in Buenos Aires, Argentina, in 2008, organized by Asociación Argentina de Informática Médica (AAIM) with the help of several other organizations working in health informatics in Argentina. As part of the conference IMIA held its board meeting demonstrating its support for the IMIA-LAC regional congress. In addition, the IMIA Health and Medical Informatics Education workgroup held its business meeting there, coordinated by the group from the Hospital Italiano de Buenos Aires. Both the Spanish (SEIS) and the American (AMIA) health informatics societies have supported and participated in the regional congress and coordinated other activities with IMIA-LAC.

The two main working groups within IMIA-LAC are the Health and Medical Informatics Education workgroup and the Health Information Systems workgroup, coordinated by Argentinean, Brazilian, and Cuban experts, with participation from several countries in the region. The Health and Medical Informatics Education workgroup has devised a work plan, including an assessment of the situation in each country and a coordination of health informatics education. Three additional working groups have been established by experts working in these areas. These include:

•Bioinformatics workgroup

•Nursing Informatics workgroup

•Informatics and Quality in Healthcare workgroup

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FIG 30-3 IMIA-LAC member countries: Argentina, Brazil, Chile, Cuba, Mexico, Peru, Uruguay, and Venezuela.

eHealth Initiatives in Africa

Africa has been identified as one of the least economically developed areas in the world. The wealth of a nation depends on the health of its population making healthcare an area of high developmental priority in Africa. In many African countries continued health challenges reveal slow progress toward achieving WHO's Millennium Development Goals related to health.8 For example, a majority of the population in sub-Saharan Africa still has limited access to modern health facilities. It is hoped that implementing new ehealth and mhealth (mobile health) solutions will allow African countries to use ehealth to deliver higher quality healthcare services.

According to the WHO regional office in Africa, health IT can play a significant role in strengthening national health systems to accelerate progress toward the Millennium Development Goals and improving health outcomes in the region.9 Needed are strengthened health information systems, public health surveillance systems, mobile devices at the point of care, EHRs, and other applications that provide patient billing, patient scheduling, and the electronic transmission of prescriptions. Telehealth would also contribute to improving equity for underserved populations in rural areas.

Key challenges impeding the wide-scale implementation of ehealth solutions in Africa include:

•the “digital divide,” as demonstrated by the need for increased awareness of ehealth among health professionals and patients

•a cohesive policy environment, providing leadership and coordination with improved financial and human resources

•a technical infrastructure and services within the health sector with monitoring and evaluation systems

Health IT knowledge and expertise is needed to deploy and adopt ehealth technologies. One strategy recommended by ehealth solutions in the African region is to introduce health informatics into the curriculum of institutions thereby systematically developing widespread familiarity and comfort with ehealth.

Health Informatics in Africa (HELINA)

HELINA, IMIA's African regional arm, was created in 1993 with three main goals:

1.to create and implement education and research programs specific to the African perspective

2.to bridge the gap between the public sector and the private sector

$C:\Users\chanda\AppData\Local\Temp\978-0-323-10095-3_0107.jpg$

FIG 30-4 HELINA member countries: Cameroon, Ethiopia, Ivory Coast, Malawi, Mali, Nigeria, South Africa, and Togo.

3.to plan for the continued development of informatics and ehealth in Africa (www.helina-online.org)

Currently eight countries are members of HELINA: Cameroon, Ethiopia, Ivory Coast, Malawi, Mali, Nigeria, South Africa, and Togo, as shown in Fig. 30-4. Countries such as Algeria, Democratic Republic of the Congo, Egypt, Kenya, Madagascar, Tanzania, Uganda, Zambia, and Zimbabwe are corresponding members. HELINA organizes conferences within the African region. The first was held in Nigeria in 1993 and five more conferences have been organized since that inaugural meeting. These conferences revealed a broader view of local initiatives within Africa. However, the use of health IT in Africa remains very low due to the lack of health information systems suitable for the African requirements and the lack of qualified healthcare personnel to develop, implement, and maintain such systems

Recognizing the need for education, an educational opportunity called Health Informatics Building Blocks (HIBBs) was introduced in 2008 with the goal of offering practical educational tools for applied informaticists, public health workers, policy makers, and healthcare practitioners in low-resource settings.10 HIBBs modules are open educational resources designed to be portable, reusable, and adaptable to local needs. The program focuses on foundational health informatics concepts and related skills that are needed to develop and manage systems in these environments. HIBBs currently offers 19 modules covering 8 different topic areas as outlined in Table 30-1. The leadership for the development of the HIBBs modules is provided by the Global Health Informatics Partnership (GHIP), in partnership with AMIA. Individuals and organizations around the world continue to contribute ideas and expertise to the HIBBs project.

TABLE 30-1 Modules of Health Informatics Building Blocks (HIBBs)

TOPIC AREA

MODULES

Fundamental skills

Introduction to Computers

Introduction to Word 2010

Introduction to PowerPoint 2010

Information Retrieval: Access to Knowledge-Based Resources

Introduction to informatics

Introduction to Medical Informatics

Health Informatics Terminologies

Health information systems

Introduction to Electronic Medical Records

Routine Health Information Systems

EMR Implementation Considerations

Ethics and legal issues

Ethics and Integrity in Data Use and Management

Privacy, Confidentiality, and Security

Data quality

Data Quality: Out-of-Range Values

Data Quality: Missing Data

Data Quality: Data Cleaning

Data Quality: Introduction to Form Design

Research

Preparing Research Datasets

Introduction to Bioinformatics

Leadership and management

Managing Change in Healthcare IT Implementations

Training tools

Game-based Assessment Quiz Template

From the South African Institute for Distance Education (Saide) (nd) HIBBs Modules. Retrieved from http://www.oerafrica.org/hibbs/Modules/tabid/1884/Default.aspx.

International Organizations with Informatics Implications

From its beginnings international health-related organizations have played a major role in the development of health informatics. This section of the chapter provides an overview of key organizations that are providing that leadership along with a brief description of their programs and efforts.

eHealth and Health Informatics at WHO

WHO plays a key global role in the development of global health informatics (www.who.org). The vision of WHO knowledge management, one of its programs, is a world with better and more equitable health outcomes through the use of information and communication technologies to improve health services and systems. WHO uses ehealth as an umbrella term that covers all aspects of the use of information and communication technology in healthcare and has promoted its use for many years. In more recent years WHO has taken steps to make ehealth a priority in strengthening health systems worldwide.

The eHealth Resolution

The 58th World Health Assembly took a historical step toward supporting ehealth by adopting a resolution for a global movement that recognizes the role of ICT to strengthen health systems and improve the safety, quality, and efficiency of services.11 The resolution urges member states to do the following:

•Create a lasting plan for ehealth development

•Create health IT infrastructure

•Encourage private and non-profit collaboration

•Broaden the reach of ehealth services

•Encourage universal collaboration to determine ehealth standards supported by evidence-based practice

•Create centers and networks for sharing best practices, policies, technical innovations, service improvement, communications, capacity building, and surveillance

•Think about developing national public health information systems

•Enhance surveillance and response to public health emergencies through increased flow of information12

Major Activities and Projects in WHO

Global Observatory for eHealth.

In direct response to the World Health Assembly ehealth resolution, the Global Observatory for eHealth (www.who.int/kms/initiatives/ehealth/) was established in 2005 to monitor and analyze ehealth and to support national planning through the provision of strategic information in member countries. Two global surveys were conducted, the first in 2005 to establish a baseline and the second in 2009.13 Key findings of the first survey include the following:

•A digital divide exists in ehealth

•Member states are looking to WHO and its partners for assistance and guidance in the ehealth domain

•Many countries expect to implement ehealth policies in the near future and will need support

•Development of national ehealth governance mechanisms within countries is necessary

•Public-private partnerships for ehealth projects are on the increase and effective management practices should be promoted

•Citizen protection policies should be put into place to ensure patient data confidentiality; interoperability issues should be made a priority by member states

•Health information in electronic formats should be provided in relevant community languages

The second survey, conducted in late 2009, was designed to build on the knowledge base generated by the first survey and identify and analyze trends in ehealth, including the following:

•The uptake of ehealth foundation policies and strategies

•Deployment of mhealth initiatives

•Application of telehealth solutions and adoption of elearning for health professionals and students

•Collection, processing, storage, and transfer of patient information

•Legal and ethical frameworks for electronic patient information

•Legislation and initiatives concerning online child safety, Internet pharmacies, and health information on the Internet

•Governance and organization of ehealth within countries14

The second survey proved to be a rich source of data, which have been used to create a series of publications titled the Global Observatory for eHealth series.14 A list of the publications is included in Table 30-2. Additional information about these surveys as they relate to international privacy and security of personal health data is included in Chapter 19.

WHO Family of International Classifications.

WHO is responsible for developing, disseminating, and maintaining international classifications on health called the WHO Family of International Classifications (WHO-FIC) to promote a consensual, meaningful, and useful framework that governments, healthcare providers, and consumers can use as a common language in health information systems (www.who.int/classifications/). Internationally endorsed classifications facilitate the storage, retrieval, analysis, and interpretation of data as well as allow data within and between populations to be compared.

The classifications within the WHO-FIC fall into two main categories: reference classifications and derived and related classifications. Reference classifications are classifications of the basic parameters of health. Derived classifications are developed by modifying or rearranging reference classifications. Related classifications are associated with the reference classification at specific levels of structure only. Box 30-3 provides a list of the WHO classifications and their related type.

TABLE 30-2 Global Observatory for Ehealth Series

TITLE

VOLUME NUMBER AND DATE OF PUBLICATION

Atlas—eHealth country profiles

Volume 1 (2010)

Telemedicine—Opportunities and developments in Member States

Volume 2 (2011)

mHealth: New horizons for health through mobile technologies

Volume 3 (2011)

Safety and security on the Internet: Challenges and advances in Member States

Volume 4 (2011)

Legal frameworks for eHealth

Volume 5 (2012)

Management of patient information: Trends and challenges in Member States

Volume 6 (2012)

From WHO(ND) Global Observatory for eHealth: Publications. Retrieved from http://www.who.int/goe/publications/en/.

Collaborating with Terminology Standards Development Organizations.

In 2010 WHO collaborated with IHTSDO to develop and sustain classification and terminology systems to more efficiently and effectively use public resources with less duplication of efforts.15 Thus mappings and linkages between International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) are being developed for automated processing of data to improve coding and information exchange. Additional information on these classification systems is provided in Chapter 22.

International Medical Informatics Association (IMIA)

IMIA is the world body for health and biomedical informatics (www.imia-medinfo.org), originating in 1967 as Technical Committee 4 of the International Federation for Information Processing (IFIP; www.ifip.org). It evolved from a Special Interest Group of IFIP to its current status in 1979. IMIA is connected with WHO as a nongovernmental organization (NGO) and with the International Federation of Health Information Management Associations (IFHIMA). Membership in IMIA is limited to organizations, societies, and corporations. For example, each country can be represented by only one member society. As of May 2012 there were 57 member societies. The regional members, with the exception of the North America member countries shown in Figure 30-5 and the Middle East Association for Health Informatics (MEAHI) member countries included in Figure 30-6 were discussed earlier in the sections dealing with informatics regions of the world. In a country where no representative society exists, IMIA accommodates involvement through corresponding members, especially within developing countries. As of May 2012 there were 32 corresponding members.

Box 30-3 World Health Organization Family of International Classifications (WHO-FIC)

Reference Classifications

Main classifications based on basic parameters of health. These classifications have been prepared by the World Health Organization (WHO) and approved by WHO's governing bodies for international use.

•International Classification of Diseases (ICD)

•International Classification of Functioning, Disability and Health (ICF)

•International Classification of Health Interventions (ICHI)

Derived Classifications

Those based on reference classifications (i.e., ICD and ICF). Derived classifications may be prepared either by adopting the reference classification structure and categories and providing additional detail beyond that provided by the reference classifications or by rearranging or aggregating items from one or more reference classifications.

•International Classification of Diseases for Oncology, 3rd edition (ICD-O-3)

•ICD-10 for Mental and Behavioral Disorders Clinical Descriptions and Diagnostic Guidelines

•ICD-10 for Mental and Behavioral Disorders Diagnostic Criteria for Research

•Application of the International Classification of Diseases to Neurology (ICD-10-NA)

•Application of the International Classification of Diseases to Dentistry and Stomatology, 3rd edition (ICD-DA)

Related Classifications

Those that partially refer to reference classifications or are associated with reference classifications at specific levels of structure only.

•International Classification of Primary Care (ICPC-2)

•International Classification of External Causes of Injury (ICECI)

•Technical Aids for Persons with Disabilities: Classification and Terminology (ISO9999)

•Anatomical Therapeutic Chemicals Classification with Defined Daily Doses (ATC/DDD)

•International Classification for Nursing Practice (ICNP)

Adapted from World Health Organization (WHO). Derived and related classifications in the WHO-FIC. WHO. http://www.who.int/classifications/related/en/index.html. 2012.

IMIA is an important player in ensuring that information science and technology are integrated into all fields of healthcare. Its main goals are as follows:

•To promote informatics in healthcare and research in health, bio, and medical informatics

•To advance and nurture international cooperation

•To stimulate research, development, and routine application

•To move informatics from theory into practice in a full range of health delivery settings, from the clinician's office to acute and long-term care

•To further the dissemination and exchange of knowledge, information, and technology

•To promote education and responsible behavior

•To represent the medical and health informatics field with WHO and other international professional and governmental organizations

In its function as a bridge organization, IMIA's goals are as follows:

•To move theory into practice by linking academic and research informaticists with caregivers, consultants, vendors, and vendor-based researchers

•To lead the international medical and health informatics communities throughout the twenty-first century

•To promote the cross-fertilization of health informatics information and knowledge across professional and geographical boundaries

•To serve as the catalyst for ubiquitous worldwide health information infrastructures for patient care and health research.16

IMIA provides networking opportunities as well as an international platform for health IT providers, consultants, and publishers. IMIA organizes the World Congress on Medical and Health Informatics, commonly known as MedInfo. The event provides an opportunity to share and exchange ideas and research as well as hold formal meetings and facilitate informal networking of members. From 2015 onward MedInfo will be held every 2 years. IMIA also publishes the annual IMIA Yearbook of Medical Informatics and three additional official journals. Since its inception in 1992 the IMIA Yearbook of Medical Informatics has been one of the most valuable products that IMIA provides to its members and the health informatics community. IMIA's three official journals are Applied Clinical Informatics (www.aci-journal.org), International Journal of Medical Informatics (www.ijmijournal.com/home), and Methods of Information in Medicine (www.methods-online.com).

IMIA pursues its scientific activity in specific fields of the wider domain of health and biomedical informatics through Working Groups (WGs) and Special Interest Groups (SIGs). A WG or SIG consists of a group of experts with a specific interest. Currently there are 24 WGs and SIGs (Box 30-4). Activities of WGs and SIGs include organizing business meetings at IMIA triennial conferences or IMIA regional meetings, publishing papers related to WG activity written by members of WGs and SIGs, and collaborating with other organizations within IMIA or IMIA regional or member societies. The Nursing Informatics SIG (IMIA-NI) is one of the initial and most consistently active SIGs.

IMIA-NI

The Nursing Informatics component of IMIA, IMIA-NI (http://www.imia-medinfo.org/new2/node/151), was originally called Working Group 8 in 1983. The main goals of IMIA-NI are listed in Box 30-5.

IMIA-NI currently has 33 members from 33 member societies of IMIA. IMIA-NI pursues its scientific activity in specific fields of the wider domain of nursing informatics through WGs. Currently there are four IMIA-NI WGs: Consumer/Client Health Informatics, Education, Evidence-Based Practice, and Health Informatics Standards.

IMIA-NI organizes an International Congress on Nursing Informatics. The event occurs every 3 years and provides a scientific exchange of current research and thinking in nursing informatics, formal meetings on nursing informatics topics, and informal networking. The first meeting of IMIA-NI was held in 1982 in London, England, as an international open forum titled “The Impact of Computers on Nursing.” Starting in 2012 the conferences are being held every other year. A list

$C:\Users\chanda\AppData\Local\Temp\978-0-323-10095-3_0108.jpg$

FIG 30-5 International Medical Informatics Association (IMIA) North America member countries: United States and Canada.

of the IMIA-NI conferences with locations and themes is included in the Evolve resources for this chapter.

International Standards Efforts

Over the past 2 decades significant efforts have been made in terminology development and standards. This section summarizes international work in this area and students are referred to Chapter 22 for more details where noted.

International Organization for Standardization (ISO)

The International Organization for Standardization (ISO) is the world's largest developer and publisher of international standards (www.iso.org). It is managed by a Central Secretariat in Geneva, Switzerland, and includes national standards institutes of 164 countries. This organization is not affiliated with governments and provides a link between the public and private sectors. Though many member institutes belong to the governmental structure of their countries (or are mandated by their government), others have private sector

$C:\Users\chanda\AppData\Local\Temp\978-0-323-10095-3_0109.jpg$

FIG 30-6 Middle East Association for Health Informatics (MEAHI) member countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, South Sudan, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen.

origins (i.e., they were established through national partnerships of industry associations). Therefore the ISO is uniquely able to establish a consensus on standards-related solutions for business and the broader needs of society. Currently there are more than 200 technical committees (TCs) developing standards in different domains.

Box 30-4 International Medical Informatics Association (IMIA) Working Groups and Special Interest Groups

Biomedical Pattern Recognition

Consumer Health Informatics

Critical Care Informatics

Dental Informatics

Francophone Special Interest Group (SIG)

Health and Medical Informatics Education

Health Informatics for Development

Health Informatics for Patient Safety

Health Information Systems

Human Factors Engineering for Healthcare Informatics

Health Geographical Information Systems (GIS)

Informatics in Genomic Medicine (IGM)

Intelligent Data Analysis and Data Mining

Medical Concept Representation

Mental Health Informatics (inactive)

Open Source Health Informatics

Organizational and Social Issues

Primary Health Care Informatics

Security in Health Information Systems

SIG NI Nursing Informatics

Smart Homes and Ambient Assisted Living

Social Media

Standards in Health Care Informatics

Technology Assessment & Quality Development in Health Informatics

Telehealth

Wearable Sensors in Healthcare

Data from IMIA: Working Groups. http://www.imia-medinfo.org/new2/WG.

Box 30-5 Goals of IMIA-NI

• To foster collaboration among nurses and other professionals who are interested in nursing informatics

• To explore the scope of nursing informatics and its implication for information-handling activities associated with nursing care delivery, nursing administration, nursing research, nursing education, and various relationships with other healthcare information systems

• To support the development of nursing informatics in member countries

• To provide appropriate informatics meetings, conferences, and postconferences and to provide opportunities to share knowledge and research to facilitate the communication of developments in the field

• To encourage the publication and dissemination of research and development materials in the field of nursing informatics

• To develop recommendations, guidelines, and courses related to nursing informatics

Adapted from International Medical Informatics Association (IMIA). SIG NI Nursing Informatics. IMIA. http://www.imia-medinfo.org/new2/node/151. 2012. Accessed November 16, 2012.

ISO TC 215 is the ISO's TC on health informatics. The scope of ISO TC 215 is to achieve compatibility and interoperability between independent systems, achieve compatibility and consistency of data for comparative statistical purposes (classifications), and reduce duplication of effort and redundancies through standardization. Currently there are 32 active participating (P-member) countries and 24 observing (O-member) countries. As of May 2012 the number of published ISO standards under the direct responsibility of TC 215 (including updates) was 94. ISO TC 215's current work program comprises more than 140 items, comprehensively covering the contemporary health information standards spectrum. Table 30-3 presents ISO TC 215's working groups and their activities. Figure 30-7 illustrates the current structure of ISO TC 215 and its eight working groups.

Many health professionals are involved in ISO. For example, nurses have played an active and important role in different WGs of ISO TC 215 in the development and testing of ISO 18104: Integration of a Reference Terminology Model for Nursing. This defines nursing diagnoses and nursing actions.17 Nurses can participate in ISO activities by providing comments on an ISO deliverable by becoming a member of their own country's delegation, participating as an expert, providing feedback to appropriate organizations about ISO standards, and participating in related organizations.

International Council of Nurses

The International Council of Nurses (ICN) is a compilation of more than 130 national nurses associations (NNAs) representing the more than 13 million nurses globally (www.icn.ch). ICN began in 1899 with the goal of encouraging quality healthcare, solid health policies, advanced health knowledge, and a respected global nursing presence.

ICN has three key program areas, or Pillars, that are pivotal in implementing quality nursing care: Professional Practice, Regulation, and Socio-Economic Welfare. eHealth is one of three significant ICN projects under the Professional Practice pillar.

The ICN ehealth program encompasses a range of ICN activities, including the International Classification for Nursing Practice (ICNP), which provides a standard for comparing nursing practice locally, regionally, nationally, and internationally, and the Telenursing Network, which encourages and assists nurses in the development and use of telehealth. ICN also participated in other international terminology standards development activities, such as the ISO reference terminology standard and the International Nursing Minimum Data Set (i-NMDS), The i-NMDS builds on the Nursing Minimum Data Set work of Werley and Lang explained in Chapter 22.

International Classification for Nursing Practice (ICNP)

The ICNP is a vocabulary system developed by the ICN after the ICN Congress passed a resolution to begin work on developing ICNP terminology in 1989.

The ICNP provides a systematic way of describing nursing practice across the world, to improve communication within nursing and with other disciplines. Using the ICNP, reliable information about nursing practice can be generated in order to influence decision making, education, and policy; better meet the needs of individuals and groups; deliver more effective interventions; improve health outcomes; and better use resources. The actual implementation of ICNP terminology is underway around the world. For example, there are ICNP-based electronic nursing record systems in Portugal and Korea.18,19

ICNP C-Space.

The aim of the ICN eHealth Programme is to transform nursing through the visionary application of information and communication technologies. Collaboration is a key to success but is also a big challenge at ICN, since it is a global organization working to connect nurses around the world. C-Space is a web-based collaborative workspace supporting the ICNP, where a group can meet to engage in meaningful dialog, work together on information resources, and publish those resources, without physically coming together (http://icnp.clinicaltemplates.org).

Groups within C-Space currently focus on a variety of topics, including the implementation, research and development, and translation of the ICNP. C-Space also provides a way to easily distribute the ICNP and its derived and associated products in a timely fashion to a range of people across the world. This allows the ICNP to stay responsive and dynamic in representing nursing practice.

TABLE 30-3 Scope and Standard Works of ISO TC 215 on Health Informatics

WORKING GROUP (WG)

SCOPE

STANDARD WORK

WG 1 Data structure

To develop standards that establish the structure of health information in order to facilitate the sharing of information and data among enterprises, organizations, and information systems

Health summary record dataset, quality requirements and methodology for detailed clinical models, health indicators for conceptual framework, a clinical data warehouse, EHR communication standards series, healthcare provider identification, identification of subjects of care, and service architecture

WG 2 Data interchange

To accomplish messaging and communication in health informatics such that the electronic exchange of information between individual systems and organizations is facilitated

Telehealth and teleradiology, clinical genomics pedigree, clinical document registry, web access to DICOM, web access reference manifest, data type harmonization for information interchange, clinical document architecture, and IHE global standards adoption

WG 3 Semantic content

To develop standards for semantic representation of content in the healthcare domain, for the development and use of ontology and terminology systems, and for the representation and management of knowledge

Categorization and nomenclature of medical devices, semantic harmonization across information models and terminologies, clinical knowledge resources, metadata, mapping of terminologies to classification, common terminology services, maintenance of terminology systems, concepts to support continuity of care, and traditional oriental medicine

WG 4 Security

To define health informatics security and privacy protection standards to protect and enhance the confidentiality, availability, and integrity of health information; to prevent health information systems from adversely affecting patient safety; to protect privacy in relation to personal information; and to ensure the accountability of users of health information systems

Data protection for personal health information, VPN for health information infrastructure, EHR security and audit trails, privilege management and access control, clinical risk management of patient safety, public key infrastructure, pseudonymization, and functional and structural roles

WG 5 Pharmacy and medicines business

To establish standards in the domain of pharmacy and medication (e.g., research, development, regulation, supply, use, and monitoring) to improve the efficiency and interoperability of information systems affecting patient safety

International coding system for medicinal products, individual case safety reports, test names and units for reporting laboratory results, data elements and structure for the exchange of product information, pharmaceutical product identifiers, structures and controlled vocabularies for ingredients and units of measurement, and a prescriber support system

WG 6 Devices

To standardize the application of ICT to health device informatics and device interoperability in support of medicine, healthcare, and wellness

ISO/IEEE 11073 series supporting real-time plug-and-play interoperability, point-of-care medical device communication, personal health device communication, a medical waveform format, device terminology and information modeling, transport and application service profiles, and risk management associated with device ICT

WG 7 Business requirements for electronic health records

To standardize the identification of business requirements for all of the health informatics aspects applied to health records for persons

Business requirements for public health standards, personal health records definition, scope and context, knowledge management of health information standards, requirements for EHR architecture, an EHR system functional model, and architecture for developing countries

WG 8 SDO harmonization

To harmonize work with other standard development organizations, including the Joint Initiative Council

DICOM, Digital Imaging and Communications in Medicine; EHR, electronic health record; ICT, information and communication technology; IEEE, Institute of Electrical and Electronics Engineers; IHE, International Health Exchange; ISO, International Organization for Standardization; SDO, standard development organization; VPN, virtual private network.

The Telenursing Network

The Telenursing Network is one of 11 networks that ICN introduced as a mechanism to provide opportunities for nurses to communicate and pursue common professional interests (www.icn.ch/networks/telenursing-network/). ICN acknowledges that telenurses using health IT extend nursing's reach and improve access to care. Telenursing represents an advance in healthcare delivery and is ideal for addressing health system challenges (e.g., aging population and chronic illness community- and home-based care; geographic, social, and financial circumstances; increasing costs and reduced funding; nursing shortages). Telehealth is defined and described in Chapter 8.

The history of the Telenursing Network dates back to early 2000. ICN published a monograph on telenursing in 2000 titled Telehealth and Telenursing: Nursing and Technology Advance Together and in 2001 published International Professional Standards for Telenursing Programmes.20 Through publications like International Competencies for Telenursing in 2007, telenursing was recognized as an important contributor to the ICN's mission of advancing nursing and health worldwide.

FIG 30-7 The current structure of ISO TC 215 and its eight working groups. EHR, Electronic health record; ISO, International Organization for Standardization; JWG, Joint Working Group; SDO, standard development organization; TC, technical committee; TF, task force; WG, working group.

The Telenursing Network was launched in 2009 with the aim of seeking, educating, supporting, and collaborating with nurses and other telenursing supporters worldwide. The overarching goal of the Telenursing Network is to improve healthcare services for individuals and institutions worldwide. As an evolving and dynamic resource, the Telenursing Network does the following:

•Provides a global forum for addressing issues related to telenursing and telehealth

•Promotes awareness of telenursing so that the roles and expertise of telenurses are understood, respected, and optimized

•Promotes telenursing as an accepted means for nurses to extend their reach to patients

•Assists with the development and sharing of knowledge, tools, and guidelines, which nurses can use to embed telenursing skills and competencies in their practice

•Establishes links between ICN's Telenursing Network and international organizations that promote and support the use of telehealth and advanced technologies for telenurses

•Provides opportunities for the exchange of knowledge and experience to develop the science and practice of telenursing

•Organizes meetings and conferences21

Health Level Seven (HL7)

HL7 (www.hl7.org) is an international community composed of healthcare subject matter experts and information scientists. Its goal is to create and sustain standards for the exchange, management, and integration of data that facilitate patient care and management, delivery, and evaluation of healthcare services. As explained in Chapter 22, HL7 encourages the use of such standards within and among healthcare organizations to optimize healthcare delivery for all.

International Health Terminology Standards Development Organisation (IHTSDO)

IHTSDO (www.ihtsdo.org) is an international nonprofit organization based in Denmark. It owns and administers the rights to SNOMED CT and related terminology standards. The goal of IHTSDO is to establish and maintain optimum interoperability and harmonization between SNOMED CT and standards produced by other international standards development organizations (e.g., American Academy of Ophthalmology; GS1; HL7; ICN; Institute of Electrical and Electronics Engineers; Logical Observation Identifiers Names and Codes; Nomenclature, Properties and Units; openEHR; WHO; and World Organization of National Colleges, Academies). Additional details on SNOMED CT are included in Chapter 22.

Global Challenges to eHealth

There are multiple challenges facing the use of health IT, at both the local level and the national and international levels. This section explores some of the more important challenges.

Global Interoperability

A key problem in achieving global interoperability in health IT is the lack of semantic (the meaning of terms) interoperability. Key barriers include issues related to the terminology used in describing and documenting healthcare such as cost and accessibility, gaps in exhaustiveness, and lack of granularity.22 There are many international efforts to solve this problem, such as the development of an international standard clinical terminology, development of clinical data models such as HL7 Clinical Document Architecture (CDA) documents, openEHR Archetypes, and integration of standard data models with terminologies such as SNOMED CT.23 Harmonization activities among international standards development organizations, such as ISO TC 215, HL7, and European Committee for Standardization (CEN) TC 251, are occurring and are necessary.

Human Resources for eHealth

According to the first global survey on ehealth carried out in 2005 by WHO, and described above, all respondents expressed a need for education and training in ehealth.13 The lack of human resources with the necessary skills and competencies is a problem for the introduction and use of ehealth in many parts of the world. Different types of professionals with an appropriate mix of skills are needed for the best use of ICT in healthcare (e.g., health informatics professionals, health information management professionals, and others with specialized informatics skills). Current shortages of skilled workers in the healthcare profession demand a human resource strategy and long-term plan for the education and training of ehealth personnel to ensure the quality of collected health data and its security and confidentiality and to manage and maintain the systems and data in the future.24

Based on the 2005 WHO survey data, elearning programs and professional development for professional education were recommended in the health sciences. In addition, collaborations need to be developed that can establish databases of existing elearning courses and WHO should advocate for the inclusion of ehealth courses within university curricula.25

Information and Communications Technology Infrastructure

eHealth depends on health IT infrastructure and services. Obviously, if infrastructure or services are missing or deficient, ehealth becomes less effective. The digital divide is the result of a gap in information exchange between different demographics and remains a major problem in terms of Internet and especially broadband uptake.26 This divide continues to expand as healthcare systems and providers increasingly depend on information from the Internet to guide day-to-day care. This is most evident in comparing fixed broadband penetration in Europe and the Americas (10% to 15%) to that in Africa (less than 0.5%).27 There is also a significant gap in the percentage of Internet users; compared to countries such as Norway and Sweden (which have Internet use of 97.2% and 92.9%, respectively). Many others lag significantly behind these high numbers of Internet use. In Africa only 13.5% of the population is online and although the number of users in China jumped from 22.5 million to 513.1 million between 2000 and 2011, this represents a mere 38.4% of the total population of China.28

As with the solutions to problems caused by a lack of knowledgeable personnel, awareness of the disparity and its impact on healthcare is the first step in narrowing the information gap. Education programs will prove beneficial in the attempt to close the digital divide. On the other hand, developments in the mobile sector have been phenomenal. Nearly 1 in 2 people worldwide had a mobile phone by the end of 2007. In Europe penetration has reached nearly 100%, in Asia it has surpassed 33%, and in Africa it has surpassed 25%. This particular digital divide was reduced due to a high level of competition and a decrease in prices.27 However, having a tool does not necessarily indicate that functionality is available and the lack of data communication services prevents mobile phones from being an effective tool for health management. Improved infrastructure to store data and transfer data securely and in a cost-effective manner and full compatibility, interoperability, and possibly integration with other services would be the best solutions to this challenge.

Legal and Regulatory Framework for eHealth

Patient privacy is a core element of good healthcare practice and legislation and regulation are key tools in protecting privacy. According to the second global survey on ehealth by WHO, a reasonably high level of legal protection of the general privacy of health-related information exists. However, the number of countries adopting more specific ehealth-related privacy protection legislation is still low.29

Legal and regulatory ehealth challenges vary from ambiguous legal frameworks to poor data management (e.g., access to personal data and lack of data security rules). A lack of regulations in the transfer of data leads to any number of challenges at the international level, including the following:

•Misinformation

•Unethical use

•Concealed bias

•Covert self-dealing

•Fraudulent practices

•Evasion of legitimate regulation

Security is another area within ehealth that presents many challenges. eHealth applications using mobile terminals and Internet services require authentication methods that are both convenient and highly secure. The increasing use of technology such as biometric authentication for identification is generating new challenges in security, safety, and privacy protection for healthcare providers and consumers alike. Additional information concerning international privacy and security issues is included in Chapter 19.

Conclusion and Future Directions

To promote international development in health informatics, it is necessary to provide tools for the development of national and regional ehealth initiatives and strategies. The health IT and health services sectors as well as the various health professions must work together to develop national and international ehealth initiatives and strategies. Successful ehealth services require more than just technology. They require collaboration between countries and professional groups with a focus on improving the health of all.

Many international organizations are ready to assist their members in strengthening their ehealth capacity to increase the impact and effectiveness of their investment in this field. It is also important to promote cooperation among member countries and facilitate information exchange.

Many global efforts are underway to improve the uptake and adoption of health IT. Clearly health IT has become a pan-national phenomenon, as demonstrated by the international efforts and organizations described in this chapter. Global interoperability and standards efforts will continue. It is likely that mhealth efforts will expand, connectivity will increase, and all countries including those with lower levels of resources will begin to maximize the benefits offered by health IT and informatics.

References

Europe's Information Society: eHealth: ICT for better healthcare in Europe. 2012, Europe's Information Society, Accessed May 20, 2012 http://ec.europa.eu/ehealth.

Kotsiopoulos, I, Whitehouse, D: Assessing the progress of the eHealth Action Plan for the period 2004–2010. August 2011, European Commission, Accessed May 20, 2012 http://ec.europa.eu/information_society/activities/health/docs/policy/ehap_assess082011.pdf.

Korea e-Health Association (KeHA): Driving growth through health IT: a case study report—promotion for APEC e-Health Community Forum. September 24, 2010, Asia-Pacific Economic Cooperation, Accessed November 6, 2012 http://aimp.apec.org/Documents/2010/LSIF/LSIF3/10_lsif3_011.pdf.

D'Agostino, M, Novillo-Ortiz, D: PAHO/WHO: eHealth conceptual model and work programme for Latin America and the Caribbean. In Novillo-Ortiz, D, Jadad, AR (Eds.): The Global People-Centred eHealth Innovation Forum. 2011, Affinity, London, England, [serial online] http://group.bmj.com/group/affinity-and-society-publishing/Satellite_18_Global_People_Centred_eHealth.pdf.

Pan American Health Organization. Health agenda for the Americas. Paper presented at: 37th General Assembly of the Organization of American States; June 2007; Panama City, Panama.

Pan American Health Organization (PAHO): Expected results. 2010, PAHO, Accessed November 6, 2012 http://new.paho.org/ict4health/index.php?option=com_content&view=article&id=12&Itemid=9&lang=en.

International Medical Informatics Association (IMIA): IMIA LAC: Regional Federation of Health Informatics for Latin America and the Caribbean. 2010, IMIA, Accessed November 27, 2012 http://www.imia-medinfo.org/new2/node/159.

World Health Organization (WHO): Millennium Development Goals. 2000, http://www.who.int/topics/millennium_development_goals/en/, Accessed May 23, 2012.

World Health Organization Regional Office for Africa: Health Solutions in the African Region: Current Context and Perspectives. 2010, Retrieved from http://www.afro.who.int/en/downloads/doc_download/5728-afrrc60r3-ehealth-solutions-in-the-african-region-current-context-and-perspectives.html.

10.

OER Africa: HIBBs: Health Informatics Building Blocks OER Africa http://www.oerafrica.org/hibbs/, Accessed May 24, 2012.

11.

World Health Organization (WHO): eHealth resolutions and decisions. 2005, http://www.who.int/healthacademy/media/WHA58-28-en.pdf, Accessed June 2, 2012.

12.

Al-Shorbaji, N: eHealth and health informatics @WHO/HQ. 2010, Pan American Health Organization, Accessed November 16, 2012 http://new.paho.org/ict4health/index.php?option=com_content&view=article&id=32%3Aehealth-and-health-informatics-whohq-by-najeeb-al-shorbaji-director-of-the-department-of-knowledge-management-and-sharing-world-health-organization-who-&catid=17%3Aentrevistas&Itemid=16&lang=en.

13.

World Health Organization (WHO): Global Observatory for eHealth: Alphabetical list of the ehealth country profiles. 2005, WHO, Accessed June 20, 2012 http://www.who.int/goe/data/country_report/en/index.html.

14.

World Health Organization (WHO): Global Observatory for eHealth: Publications WHO http://www.who.int/goe/publications/en/, Accessed June 20, 2012.

15.

World Health Organization (WHO): A collaborative arrangement between the International Health Terminology Standards Development Organization and the World Health Organization. 2010, Accessed May 20, 2012 http://www.who.int/classifications/AnnouncementLetter.pdf.

16.

International Medical Informatics Association (IMIA): General http://www.imia-medinfo.org/new2/node/1, 2013, Accessed January 31, 2012.

17.

International Organization for Standardization (ISO): ISO 18105: Integration of a Reference Terminology Model for Nursing. 2003, ISO, Geneva, Switzerland.

18.

Cho, I, Park, HA: Evaluation of the expressiveness of an ICNP-based nursing data dictionary in a computerized nursing record system. J Am Med Inform Assoc. 13(4), 2006, 456–464.

19.

Lee, YS, Park, KO, Bong, MR, Park, HA: Development and evaluation of ICNP-based electronic nursing record system. Stud Health Technol Inform. 146, 2009, 498–502.

20.

Hunter, KM: International Professional Standards for Telenursing Programmes. 2001, International Council of Nurses, Geneva, Switzerland.

21.

International Council of Nurses (ICN): Goals and benefits. 2011, ICN, Accessed November 16, 2012 http://www.icn.ch/networks/goals-and-benefits/.

22.

Hammond, W: Semantic interoperability issue of standardizing medical vocabularies. In Mohammed, S, Fiaidhi, J (Eds.): Ubiquitous Health and Medical Informatics: The Ubiquity 2.0 Trend and Beyond. 2010, IGI Global, Hershey, PA, 19–42.

23.

Qamar, R: Semantic Mapping of Clinical Model Data to Biomedical Terminologies to Facilitate Interoperability. [doctoral thesis]. 2008, University of Manchester, Manchester, England, http://www.openehr.org/publications/archetypes/RQamar-PhD-Thesis-Mar2008.pdf, Accessed May 20, 2012.

24.

Gibson, CJ, Covvey, HD: Demystifying e-health human resources. 2010, Information Resources Management Association, Accessed May 20, 2012 http://www.irma-international.org/viewtitle/53656/, DOI:10.4018/978-1-60960-561-2.ch501.

25.

World Health Organization (WHO) Global Observatory for eHealth: eHealth Tools and Services: Needs of the Member States. 2006, WHO, Geneva, Switzerland, http://www.who.int/kms/initiatives/tools_and_services_final.pdf.

26.

Coverdell, M, Utley, R: The health care information gap: a global and national perspective. Online Journal of Nursing Informatics. 9(1), 2005, http://ojni.org/9_1/coverdell.htm, Accessed May 20, 2012.

27.

International Telecommunication Union (ITU): ICT Data and Statistics (IDS): Global ICT developments http://www.itu.int/ITU-D/ict/statistics/ict/index.html, 2008, Accessed May 20, 2012.

28.

Internet World Stats: Usage and populations statistics: 2011. 2011, Internet World Stats, Accessed May 28, 2012 http://www.internetworldstats.com/.

29.

World Health Organization (WHO): Legal frameworks for ehealth. 2012, WHO, Accessed May 20, 2012 http://whqlibdoc.who.int/publications/2012/9789241503143_eng.pdf.

Discussion Questions

1. What ehealth initiatives exist in different regions of the world? Compare and contrast their aims and activities.

2. Discuss two international organizations involved in ehealth initiatives. Describe their roles and provide a sample of their activities.

3. What kinds of international academic organizations are available in different regions of the world? Based on your specialty, choose which conferences are most appropriate for you to attend and explain why.

4. What kinds of roles can a health practitioner in your specialty play in the ehealth initiatives?

5. How can the different disciplines in health informatics use the current international efforts to work together with an interprofessional approach to improving the health of individuals, families, and communities?

Case Study

You have been awarded a scholarship to visit South Korea for the next 6 months as an international student in healthcare informatics. The following description was included in the materials you received with the announcement of your award.

Health IT (with more recent focus on ehealth) infrastructure in the Republic of Korea has come a long way within a short period since the establishment of the Korea e-Health Association (KeHA) in 2003 by the Korean Ministry of Commerce, Industry, and Energy. Since then, four related government departments in the Ministry of Health and Welfare; Ministry of Knowledge and Economy; Ministry of Education, Science, and Technology; and the Ministry of Public Administration and Security have started planning and promoting their own strategies for ehealth applications. The departments have defined standardization, law and policy planning, human resources development, research and development (R&D) for ehealth products, and international collaboration as the five core pillars for the development of successful ehealth. In 2008, through the reorganization of the Korean government, ehealth has become an even more important growth engine for the Korean economy. Consequently, relevant government ministries produced more concrete and robust action plans for the realization of ehealth on the ground. Korean ehealth reached an important turning point with the establishment of KeHA in 2003. KeHA became the focal point of a national effort to develop ehealth in the Republic of Korea, with a focus on policy research, regulation, standardization, ehealth R&D, and ehealth best practices. KeHA and the Ministry of Knowledge and Economy collaborated internationally through Asia-Pacific Economic Cooperation (APEC) because ehealth was no longer considered a merely local concept. Korea hosted the APEC eHealth Seminar from 2004 to 2009, with support and sponsorship from the APEC Health Working Group and the Republic of Korea. Through this international collaboration, Korea began sharing information, knowledge, experience, and solutions regarding ehealth with countries around the world.

Discussion Questions

1. What universities, medical centres, professional organizations, government agencies, and individuals would you include on your “must visit” list?

2. How did you identify the list from question 1 as being important to your study of health informatics?

3. How would you learn about the history, culture, values, and health-related challenges of Korea before your visit?

Pageburst Integrated Resources

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Chapter 30 International Efforts, Issues, and Innovations

Hyeoun

Ae Park

To promote international development in health and nursing informatics it is necessary to provide

tools for the development of national and regional ehealth initiatives and strategies.

Objectives

At the completion of this chapter the reader will be pr

epared to:

1.Outline key international health informatics initiatives

2.Describe key organizations leading international health informatics initiatives

3.Discuss the role of health practitioners such as nurses in international health informati

cs initiatives

Key Terms

Derived classifications, 482

eHealth initiatives, 474

Reference classifications, 482

Related classifications, 482

Abstract

This chapter highlights international health informatics initiatives, international organizations involved

these initiatives, and how health practitioners such as nurses are involved in the activities of these

organizations. There are numerous international health informatics

–

related activities that have been

initiated across the different regions of the wor

ld. In addition academic societies within these regions

are pursuing health informatics theory and practice developments. These international health

informatics initiatives, along with associated academic organizations, are introduced here with brief

histo

ries and the key activities of each region. There are also several international organizations involved

in the development of health informatics, such as the World Health Organization, the International

Medical Informatics Association, the International Or

ganization for Standardization, the International

Council of Nurses, the International Health Terminology Standards Development Organisation, and

Health Level Seven. These organizations are introduced with a short description of health practitioners'

contr

ibutions to their activities. Finally, global issues in health informatics initiatives are also described.

Introduction

In many parts of the world healthcare is one of the largest sectors of the economy. As a result, health

spending plays a major role in e

conomic policy throughout the world with growing pressure on the

healthcare industry to streamline costs, gain efficiency, and become more innovative in improving and

Chapter 30 International Efforts, Issues, and Innovations

Hyeoun-Ae Park

To promote international development in health and nursing informatics it is necessary to provide

tools for the development of national and regional ehealth initiatives and strategies.

Objectives

At the completion of this chapter the reader will be prepared to:

1.Outline key international health informatics initiatives

2.Describe key organizations leading international health informatics initiatives

3.Discuss the role of health practitioners such as nurses in international health informatics initiatives

Key Terms

Derived classifications, 482

eHealth initiatives, 474

Reference classifications, 482

Related classifications, 482

Abstract

This chapter highlights international health informatics initiatives, international organizations involved in

these initiatives, and how health practitioners such as nurses are involved in the activities of these

organizations. There are numerous international health informatics–related activities that have been

initiated across the different regions of the world. In addition academic societies within these regions

are pursuing health informatics theory and practice developments. These international health

informatics initiatives, along with associated academic organizations, are introduced here with brief

histories and the key activities of each region. There are also several international organizations involved

in the development of health informatics, such as the World Health Organization, the International

Medical Informatics Association, the International Organization for Standardization, the International

Council of Nurses, the International Health Terminology Standards Development Organisation, and

Health Level Seven. These organizations are introduced with a short description of health practitioners'

contributions to their activities. Finally, global issues in health informatics initiatives are also described.

Introduction

In many parts of the world healthcare is one of the largest sectors of the economy. As a result, health

spending plays a major role in economic policy throughout the world with growing pressure on the

healthcare industry to streamline costs, gain efficiency, and become more innovative in improving and