eHealth Tools Services WHO

8/6/2019 eHealth Tools Services WHO

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Report of the WHO Global Observatory for eHealth

Needs of the Member States

TOOLS&SERVICESeHealth


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World Health Organization 2006

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Report of the WHO Global Observatory for eHealth

Needs of the Member States

TOOLS&SERVICESeHealth

WHO/EHL/06


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AcknowledgementsSincere thanks are due to the hundreds o eHealth experts in over 90 countries world-wide

have helped shape this report by sharing their knowledge through completing the rst gl

survey on eHealth.

Special thanks or their guidance and vision are due to:

Yunkap Kwankam

Ariel Pablos-Mendes

The undertaking o the survey required considerable

coordination at the regional and national levels.

WHO regional coordinators played a vital role in

this process as well as in contributing their regional

perspective to help develop the survey instrument.

Thanks are due to:

Yok-Ching Chong

Angela Dunbar

Francois Fortier

P.T. Jayawickramarajah

Emmanuel Nkakoumoussou

Ezekiel Nukuro

Soe Nyunt-U

Abel Packer

Oana Roman

Reijo Salmelar

Grard Schmets

Najeeb Al ShorbajiSangay Thinley

Richard Van West-Charles

Tejbir Walia

This report was prepared by the WHO Global

Observatory or eHealth by:

Misha Kay

Maryo Olesen-Gratama van Andel

Kaarina Klint (consultant)

Clive Tristram (consultant)

Sta at WHO headquarters provided support idesign o the survey instrument as well as tech

input in their areas o expertise. Thanks are due

Barbara Aronson

Christopher Black

Philippe Boucher

Pascale Broisin

Can Celik

Somnath Chatterji

Chrissie Chitsulo

Robert Constandse

Raphal Crettaz

Joan Dzenowagis

Steeve Ebener

Jean-Claude Healy

Chandika Indikadahena

Iciar Jauregui Larizgoitia

Nirmala Naidoo

Alena Petrakova

Thomson Prentice

Ftima Sanz de Len

Tevfk Bedirhan Ustun

Special thanks to:

Fabrice Girardot, Eric Maroni and Franck Vasserot o

Mondoragilis Network or the design and layout and t

Lashley or technical editing.


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Contents

Executive summary 2

Key fndings 3

Proposed action 3

First global survey on eHealth 4

Introduction 4

Global Observatory or eHealth 5

Survey process 6

Data analysis 8

Results 10

Responses 10

Data summary 11

eHealth tools 13

eHealth services 21

Recommendations 27

Key fndings 27

Conclusion 28

Proposed action 29

Annex 30

List o Member States by WHO regional distribution 30

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Executive summaryThe Global Observatory or eHealth (GOe) was established by the World Health Organiza

(WHO) in 2005. As its initial task it carried out the rst global survey on eHealth. The su

covered seven key themes in the eHealth domain and one o these is the subject o this re

The ull survey results will be published in the Annual Report o the Global Observator

eHealth in May 2006.

This report summarizes the needs or eHealth tools and services o the WHO Member St

and their expectations rom the WHO Secretariat as expressed in the survey. It is targete

policy makers, eHealth practitioners, researchers and academics.

1

WHO emergency response

team member collecting

surveillance data and

transmitting it to

headquarters ater thedevastating earthquake in

Pakistan in October 2005.


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Key findings

The survey ound that:

active involvement o WHO in the development o generic eHealth tools, and guidance

in creating and implementing eHealth services would be welcomed by Member States;

the need or guidance in a broad range o eHealth areas was expressed in particular by

countries that do not belong to the Organisation or Economic Co-operation and Devel-opment (OECD);

OECD countries did not express consistent views o their needs in eHealth areas; and

there is a need to raise awareness as to what eHealth tools and services already exist at

global and national levels.

Proposed action

It is thereore recommended that WHO, in collaboration with public and private sector partners,

should take action in the ollowing key areas:

Provision of generic tools

WHO should acilitate the development o those generic eHealth tools most sought ater byits Member States including:

tools or monitoring and evaluation o eHealth services;

drug registries;

institutional patient centred inormation systems that could be extended to include

electronic health record systems; and

directories o health care proessionals and institutions.

Access to existing tools

As a parallel and complementary action, electronic directories o existing eHealth tools and

services should be created with an emphasis on open source solutions.

Facilitating knowledge exchange

An international knowledge exchange network to share practical experiences on the

application and impact o eHealth initiatives should be built. This would be Internet based

and could be complemented by international eHealth conerences to acilitate networking.

Providing eHealth information

WHO should create a digital resource o eHealth inormation to support the needs o Member

States in key areas such as eHealth policy, strategy, security and legal issues.

Education

The use o eLearning programmes or proessional education should be promoted in the

health sciences as well as in ongoing proessional development. Collaborations should be

developed to generate databases o existing eLearning courses. WHO should advocate or the

inclusion o eHealth courses within university curricula.

1 For statistical reasons, responding countries were grouped by OECD/non-OECD membership.http://www.oecd.org

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First global survey on eHealt

Introduction

At its Fity-eighth Session in May 2005, the World Health Assembly (WHA) adopted resolu

WHA58.28 establishing an eHealth Strategy or the World Health Organization. The resoluurged Member States to plan or appropriate eHealth services in their countries. It

recognized that a WHO eHealth strategy would serve as a basis or WHOs activities in eHe

and requested the Director-General to submit to the 117th Session o the Executive Bo

(EB) an action plan, including budgetary implications, aimed at the use o eHealth tools

services or implementation by Member States.

eHealth, the use o inormation and communication technologies (ICT) or health, is on

the most rapidly growing areas in health today. However, limited systematic research

been carried out to inorm eHealth policy and practice. It is or this reason that WHO, thro

its newly created Global Observatory or eHealth (GOe), undertook a world-wide surve

eHealth. The ndings provide an important rst measure o eHealth capacity in Member Stas well as their current and most important needs. With this global picture, these data w

used or comparison with those o urther studies. They will also help WHO tailor its sup

and guidance to match the immediate needs o its Member States in the area o eHealth

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All WHO Member States were strongly encouraged to participate in the survey. At the time

o printing, 93 countries had responded, which represents a response rate o 48%. The GOe

secretariat was encouraged by the response rate, especially given it was the rst survey o its

kind, and the short time rame in which it was conducted. It is anticipated that the response

rate to uture surveys will increase signicantly over the next three years as the GOe raises its

international prole and urther develops its collaboration with Member States.

Global Observatory for eHealth

Established in early 2005, the GOe is a signicant new WHO initiative; it reects the Organizations

recognition o the emerging importance o the use o ICT or health systems and services.

The Observatorys mission is to improve health by providing Member States with strategic

inormation and guidance on eective practices, policies and standards in eHealth. Its

objectives are to:

provide timely and high-quality evidence and inormation to help national governments

and international bodies improve policy, practice and management o eHealth services;

raise awareness and commitment o governments and the private sector to invest in,and advance, eHealth;

collect, analyse and distil eHealth-related knowledge, which will signicantly contribute

to the improvement o health using ICT; and

disseminate research ndings through publication o the GOe Annual Report on key

eHealth research topics as a reerence or governments and policy-makers as well as

theme-based reports on special topics.

The GOe operates within the eHealth unit o the Department o Knowledge Management and

Sharing (KMS) at WHO in Geneva. As a networked, decentralized operation, membership o the

secretariat includes at least one coordinator rom all six WHO regions and three sta members

rom headquarters. Fiteen experts at headquarters have been invited to contribute to various

tasks o the GOe through working groups. Project planning and implementation occurs mainly

through regular teleconerences to ensure active involvement o all WHO regions.

Operations and collaborations began expanding in mid-2005 to include research centres,

national and regional eHealth observatories and other operationally signicant partners

across the globe. A Strategic Advisory Group o Experts (SAGE) was created and consists o

international eHealth experts in industry, research elds, academia and practice. This group

will provide ongoing high-level strategic guidance to the Observatory.

2 The Annual Report o the GOe will contain all country responses including those received ater the publicationo this report.

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Survey process

As this was the rst survey o the Global Observatory or eHealth, and indeed the rst W

global survey on eHealth, it ocused on issues relating to processes and outcomes in

eHealth action lines previously identied by the World Summit on the Inormation Soc

(WSIS) and supported by the WHO.

The survey instrument was developed in collaboration with eHealth proessionals rom

WHO regional ofces and headquarters, Geneva. It was piloted in Jordan and the Democ

Republic o the Congo, beore being circulated globally.

It aimed to:

describe and analyse eHealth proles in countries, regions and internationally;

identiy and evaluate measures taken in key action areas to support the developmen

eHealth in countries; and

establish the useulness o WHO providing generic eHealth tools and services or Me

ber States.

The survey covered the ollowing seven themes:

Theme Action

Enabling environment Create an enabling environment or the development o eHealththrough policy.

Inrastructure Develop inrastructure in a health context.

Content Provide access or health proessionals and the community to dighealth content.

Cultural and linguistic diversity Produce and disseminate multicultural digital health content.

Capacity Build ICT knowledge and skills in the health sector.

National centres or eHealth Expand the eHealth international network.eHealth systems and services Query and respond to Member States requirements or eHealth t

and services.

Table 1. Survey th

The survey was carried out in six stages, which are described in Table 2. Surveys w

completed at country level by teams o three to ve key inormants, although some coun

selected up to ten experts to contribute. Survey meetings were held so that the quest

could be discussed and answered by all inormants. Where there were dierences o opi

the survey acilitator would request that the group reach a consensus. Meetings lasted o

eight hours.

The survey instrument, guidelines and glossary o survey and eHealth terms were provide

the six ofcial United Nations (UN) languages.

3 http://www.itu.int/wsis/

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Stage Activity Comments

GOe headquartersdistributed surveysand brieed regionalcoordinators.

Regional coordinators provided with translated survey instruments,procedures and timelines.

Country coordinators

brieed.

WHO regional coordinators worked directly with country coordinators

and liaison ocers to advise them o the process; survey materialsprovided.

Country coordinatorsselected keyinormants and sentsurvey materials.

Country coordinators given guidelines to assist with the selection okey inormants.(In some countries it did not prove dicult to fnd appropriate experts.In others, particularly where eHealth is not yet advanced, it was morechallenging.)

Inormants conductedresearch prior to takingthe survey.

Inormants given two weeks to conduct the background researchrequired to complete the survey.

Survey meetings held. Key inormants met in countries; meetings lasted between our hoursand one day.

Sessions acilitated by administrator.Endorsement by WHO representative or designated ocer requiredbeore survey returned to WHO or quality control and to ensure thatspecifed survey guidelines were met.

Completed surveysreturned to WHO.

responses were received by the time o publication.

Table 2. GOe survey process

Scientist studying

malaria mosquito an

transmitting data to othe

laboratories in Tunisia

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Data analysis

The inormation contained in this report is based on the country responses to the ollow

questions on eHealth tools and services:

Please rate the ollowing list oeHealth tools on the basis o how useul they would b

WHO could oer generic prototypes or adaptation by your country.

Electronic Health Records (eHR)

Patient Inormation Systems (PIS)

Hospital inormation Systems (HIS)

General Practitioner Inormation Systems (GPIS)

National electronic registries

National drug registries

Directories o healthcare proessionals and institutions

Decision Support Systems (DSS)

Telehealth

Geographical Inormation Systems (GIS)

Other, please speciy

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Which o the ollowing eHealth services does your country require rom WHO and plea

grade their useulness.

Advice on national needs assessment or eHealth

Advice on eHealth policy and strategy

Advice on methods or monitoring and evaluation o eHealth services

Inormation on eective/best eHealth practices

Advice on eHealth norms and standards

Inormation on trends and developments in eHealthAdvice on eLearning programmes

Advice on human resources development or eHealth

Other, please speciy

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Data rom the completed surveys were processed on a question-by-question and countr

country basis. Additional secondary data were obtained rom sources such as WHO He

Systems Financing, World Bank, United Nations Conerence on Trade and Developm

(UNCTAD) and OECD to investigate correlations based on internationally recogn

parameters. In order to establish a basis or analysis, correlations were made between

responses and various country characteristics. These included GDP per capita, the UNCICT Diusion Index, and membership in OECD. It was decided to group countries accordin

OECD/non-OECD membership as this provided the clearest separation to the responses

allowed or meaningul statistical analysis.

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The analysis below ollows the structure and sequence o the questionnaire. For each survey

question there is a denition o the tool or service, a description o the most important ndings

and the mean, median and mode score.

The useulness indicator or each eHealth tool or service is taken as being the mode point. It is

represented by bars in each table (Figure 1).

Extremely useul

Very useul

Moderately useul

Slightly useul

Not useul

Figure 1. Useulness levels and indicators

4 Mean: average value; median: value in the middle range; mode: most requently occurring value.


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Results

Responses

At the time o publication 93 countries had responded, which represents a response rat

48% and covers 65% o WHO Member States population (see Annex or list o countries).

Figure 2. Responding count

A number o actors may have aected the response rate: some countries ound the deaor completion too tight to meet; the timing o the survey coincided with summer in

northern hemisphere making it difcult to plan national meetings; and in some coun

eHealth is still in the early stages o development. Since 84% o the responding countries w

non-OECD members, this introduces a certain level o bias in the sample.

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Data summary

The number o responses received and the calculated mode or each survey question is shown

below. Responding countries were grouped by membership in the OECD (Table 3). Table 4

shows the responses by WHO region.

Non-OECD OECD

eHealth tools Responses Mode Responses Mode


Patient Inormation Systems (PIS)

Hospital inormation Systems (HIS)

General Practitioner Inormation Systems(GPIS)



Directories o health care proessionals andinstitutions


Telehealth

Geographical Inormation Systems (GIS)

eHealth services

Advice on national needs assessment oreHealth


Advice on methods or monitoring andevaluation o eHealth services

Inormation on eective/best eHealth

practices


Inormation on trends and developments ineHealth

Advice on eLearning programmes

Advice on human resources development oreHealth

Table 3. Analysis o the country responses to the GOe survey, grouped by membership in the OECD

5 See Annex or list o WHO regions.

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AricanRegion

(33*)

Regiono the

Americas

(9*)

South-EastAsia Region

(9*)

EuropeanRegion

(1*)

EasternMediterra-

nean Region

(1*)

WestPacRegi

(11

eHealth tools Responses

Mode

Responses

Mode

Responses

Mode

Responses

Mode

Responses

Mode

Responses


Patient Inormation Systems(PIS)

Hospital inormation Systems(HIS)

General PractitionerInormation Systems (GPIS)



Directories o healthcareproessionals and institutions


Telehealth

Geographical InormationSystems (GIS)

eHealth services

Advice on national needsassessment or eHealth

Advice on eHealth policy andstrategy

Advice on methods ormonitoring and evaluation oeHealth services

Inormation on eective/besteHealth practices

Advice on eHealth norms andstandards

Inormation on trends anddevelopments in eHealth

Advice on eLearningprogrammes

Advice on human resourcesdevelopment or eHealth

Table 4. Summary o responses to the GOe survey, by WHO r* Total number o responding countries per WHO r


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eHealth tools

Figures 3 and 4 illustrate the responses o the non-OECD and OECD countries. The x-axis

represents eHealth tools options. The y-axis indicates the percentage response and the level

o useulness as identied by responding countries.

Over 70% o non-OECD countries rated all eHealth tools as either very usefulor extremely useful

(Figure 3).

eHealth tools non-OECD countries

%

0

10

20

30

40

50

Geograp

hica

l

In

formation

Systems

(GIS)

Te

lehea

lth

Dec

ision

Support

Systems

(DSS)

Directorieso

f

hea

lthcare

pro

fess

iona

lsan

d

institutions

Nationa

ldrug

reg

istr

ies

Nationa

le

lectron

ic

reg

istr

ies

G

enera

lPractitioner

In

formation

Systems

(GPIS)

Hosp

ita

lInformation

Systems

(HIS)

P

atient

Information

Systems

(PIS)

Electron

icHea

lth

Records

(eHR)

Score questions

Not useul Slightly useul Moderatly useul Very useul Extremely useul

Figure 3. eHealth tools non-OECD countries

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VSAT dishes in Islamabad

Pakistan, to provid

the vital satellite health

communications link

required between WHO

headquarters and the feld

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All eHealth tools with the exception o GPIS and GIS were rated by at least 50% o O

countries as either very useful or extremely useful. GPIS and GIS were rated by 46% and

respectively as very usefulor extremely useful(Figure 4).

eHealth tools OECD countries

%

0

10

20

30

40

50

Geograp

hica

l

In

formation

S y s t e m s

( G I S )

Te

lehea

lth

Dec

ision

Support

Systems

(DSS)

Directorieso

f

hea

lthcare

pro

fessiona

lsan

d

institutions

Nationa

ldrug

reg

istr

ies

Nationa

le

lectron

ic

reg

istr

ies

Genera

lPractitioner

In

formation

Systems

(GPIS)

Hosp

ita

lInformation

Systems

(HIS)

Patient

Information

Systems

(PIS)

Electron

icHea

lth

Records

(eHR)

Score questions


Figure 4. eHealth tools OECD count

WHO Operations CentreIslamabad, Pakistan.

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Results are presented in the ollowing ormat:

a denition or description o the eHealth tool;

an analysis o the response; and

a table o aggregated data indicating the mean, median and mode values.

Electronic Health Records

Also called Electronic Medical Records (eMR), Electronic Health Records (eHR) o a patientsclinical history are used to support clinical actions by health proessionals. They include

inormation such as test results, medication and general clinical history. They can be made

rapidly available through ICT to authorized personnel providing patient care.

Table 5 indicates that eHR would be very usefulor non-OECD countries and extremely usefulor

OECD countries. It should be noted, however, that there is a signicant disparity between the

numbers or OECD countries.

RESPONSES MEAN MEDIAN MODE

Non-OECD .

OECD . .

Table 5. Electronic Health Records

Patient Information Systems

Patient Inormation Systems (PIS) contain inormation about a hospitalized patient and are

used to support both the administrative and clinical activities in a hospital. They are usually

hospital-wide, but may be restricted to single or multiple departments. They do not usually

contain multimedia data distinguishing them rom an electronic health record system. They

contain numeric and textual data about the patient in addition to the basic administrative

data, which distinguishes them rom hospital inormation systems.

Non-OECD countries indicated that they would nd a generic tool or Patient Inormation

Systems very useful. OECD countries were less consistent in their answers but overall scored PIS

as extremely useful(Table 6).


Non-OECD .

OECD . .

Table 6. Patient Inormation Systems

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Hospital Information Systems

Computer-based inormation systems that support inormation processing within a hos

in areas such as administration, appointments, billing, planning, budgeting and personn

Table 7 shows that non-OECD countries would nd it very useful to have a generic Hos

Inormation System (HIS) provided by WHO. OECD countries were less consistent and gene

inclined to nd it slightly useful. This may be explained by the act that the majority o hospin these countries already have some orm o HIS installed.


Non-OECD .

OECD .

Table 7. Hospital Inormation Sy

General Practitioner Information Systems

ICT-based systems that support the work o a general practitioner (GP)/primary health practitioner are called General Practitioner Inormation Systems (GPIS). The variation in he

care models makes unctions required by countries quite dierent. Where the GP is pa

a primary health care team the system may also be known as a Primary Care Inorma

System. Their prime unctions are to manage and share data about patients. They oten

to other health care systems such as billing, GP reimbursement or laboratory results repor

systems.

There was strong indication that non-OECD countries would nd it very usefulto have ge

GPIS provided by WHO. OECD countries were less consistent and generally inclined to

slightly useful(Table 8). This may be because many o these countries already have program

or equipping their GPs with computerized inormation systems.


Non-OECD .

OECD .

Table 8. General Practitioner Inormation Sy


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Electronic databases o related records on specic medical subjects. They contain data on

births, mortality, cancer, diabetes or other subjects o medical or epidemiological interest.

Registries can be accessed by authorized users through the use o ICT.

Creation o generic national registries or diseases were reported as very usefulby all non-OECD

countries and moderately usefulby OECD countries (Table 9).


Non-OECD .

OECD .

Table 9. National electronic registries


Electronic databases containing national pharmaceutical inormation. The content varies

depending on the purpose o the registry. Examples include databases o risks o exposure todrugs during pregnancy and potential drug interactions.

Table 10 shows that creation o a generic national drug registry was considered very usefulby all

responding countries. Access to these data can have a signicant impact on burdened health

care budgets.


Non-OECD .

OECD

Table 10. National drug registries

Laboratory worker in

Indonesia using ICT t

record sample inormatio

and transmit results to

the central hospita

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Directories of healthcareprofessionals and institutions

Electronic databases o individuals and institutions providing health care. These are usu

searchable by location, specialization, proessional association or credentials. They are o

associated with registration and accreditation status.

Creation o generic directories o health care proessionals and institutions was considvery usefulby the majority o non-OECD countries, with most OECD countries reporting t

would be extremely useful(Table 11).


Non-OECD .

OECD .

Table 11. Directories o healthcare proessionals and instit

Decision Support Systems

Automated or semi-automated systems that support decision-making in a clinical environm

Both country groupings reported that the provision o generic decision support tools w

be very usefulor the majority o respondents (Table 12).


Non-OECD .

OECD .

Table 12. Decision Support Sy

Telehealth

The use o ICT to either support the provision o health care or as an alternative to d

proessional care. It encompasses telemedicine and the use o remote medical expertise.

Table 13 shows that generic telehealth developments were seen by non-OECD countrie

extremely useful. This may reect a desire to supplement health care resources in less develo

areas. The OECD countries ound it moderately to very useful, possibly reecting the act

they have already established telehealth acilities.


Non-OECD .

OECD . .

Table 13. Teleh


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Geographical Information Systems

Computer-based applications or capturing, integrating, analysing and displaying data

related to geographic coordinates.

Generic geographical inormation systems were regarded by non-OECD countries as extremely

useful, however the response rom OECD countries was less clear (Table 14).


Non-OECD .

OECD .

Table 14. Geographical Inormation Systems

WHO Strategic Health

Operation Centre using IC

to share health inormation

and coordinate WHO

emergency respons

ater the Tsunami in

December 2004

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Other requests

This question allowed countries to express any urther needs not already included in the su

The comments made were mainly rom non-OECD countries. Some o the requirem

have been covered in other sections o this report, but their inclusion here reiterates

importance to the countries requesting these generic systems.

Tools for professionals

eLearning tools especially those which provide interaction between the learner an

instructer. There was also a specic request or eLearning on the topic o public heal

a digital library (also called virtual library); and

databases to support the use o evidence-based medicine.

Tools to support health care provision

telehomecare/telehealth support;

remote diagnosis;

radiology inormation system; and

laboratory inormation system.

Health care and financial administration

nancial inormation system;

patient reerral system; and

access to unding or eHealth tools.

Policy and population health care tools

disease surveillance;

health inormation system (this may be similar to a disease surveillance and reporting

system);

public health advisory inormation system;

an integrated public health monitoring and advisory system;

vaccination status reporting;

national eHealth portal; and

a global health inormation system (wider than national).

Technical requirements

basic generic systems on open source sotware;

generic inrastructure tools;

interoperability tools;

standard methods in eHealth;

meta-data models; and

data mining tools.

Tools for citizens

personal health care inormation systems.

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eHealth services

Figures 5 and 6 illustrate the responses o the non-OECD and OECD countries. The x-axis

represents eHealth services options. The y-axis indicates the percentage response and the

level o useulness as identied by responding countries.

Over 65% o non-OECD countries rated eHealth services as either very usefulor extremely useful

(Figure 5).

eHealth services non-OECD countries

%

0

10

20

30

40

50

60

70

80

Adviceonhuman

resources

development

foreHealth

Adviceon

eLearning

programmes

Informationon

trendsand

developments

ineHealth

Adviceon

eHealthnorms

andstandards

Informationon

eective/best

eHealthpractices

Adviceonmethods

formonitoring

andevaluationof

eHealthservices

AdviceoneHealth

policyandstrategy

Adviceonnational

needsassessments

foreHealth

Score questions


Figure 5. eHealth services non-OECD countries

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All eHealth services were rated by over 60% o OECD countries as either moderately, ve

extremely useful(Figure 6).

eHealth services OECD countries

%

0

10

20

30

40

50

60

70

80

Adviceonhuman

resources

development

f o r e H e a l t h

Adviceon

eLearning

programmes

Informationon

trendsand

developments

ineHealth

Adviceon

eHealthnorms

andstandards

Informationon

eective/best

eHealthpractices

Adviceonmethods

formonitoring

andevaluationof

eHealthservices

AdviceoneHealth

policyandstrategy

Adviceonnational

needsassessments

foreHealth

Score questions


Figure 6. eHealth services OECD count

With regard to eHealth services, there is a degree o consistency between the OECD and OECD country groups: both would consider it very usefuli WHO would provide:

advice on methods or monitoring and evaluating eHealth services;

inormation on eective/best eHealth practices;

inormation on trends and developments in eHealth; and

advice on eLearning programmes.

Results are presented along the ollowing ormat:

denition or description o the eHealth service;

an analysis o the response; and

a table o aggregated data indicating the mean, median and mode values.

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Advice on national needs assessments for eHealth

Services to assess the needs and benets o eHealth. These would be provided at a national

level and on a country-by-country basis.

Table 15 shows that the non-OECD countries would nd advice o this kind very useful. The

OECD countries, however, ound it only moderately useful. The dierences are likely to be

explained by the more advanced development o eHealth in the OECD countries.


Non-OECD .

OECD .

Table 15. Advice on national needs assessments or eHealth


The eective development o eHealth and its integration into mainstream health care is best

achieved through the creation o an eHealth strategy with the support o appropriate policies.Advice can improve the quality o both i provided in a timely manner.

Table 16 illustrates that non-OECD countries would nd this very usefulwhile the OECD countries

ound it moderately useful; many o the latter already have policies and strategies in place and

this would explain their response.

This policy theme will be covered in greater detail in the Global Observatory or eHealth

Annual Report.


Non-OECD .

OECD .

Table 16. Advice on eHealth policy and strategy


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Advice on methods for monitoring andevaluation of eHealth services

It is the responsibility o governments to ensure that money allocated to health care is s

eectively. The creation o monitoring and evaluation tools are expensive and time consum

so any advice provided which shortens the development process or improves its efcacy w

be useul. In the case o eHealth it is important to ensure that it is delivering the expec

promised benets.

Most countries would nd WHO guidance on methods or monitoring and evaluatio

eHealth services very useful(Table 17).


Non-OECD .

OECD .

Table 17. Advice on methods or monitoring and evaluation o eHealth se

Information on effective/best eHealth practices

There is an increasing acceptance that evidence-based medicine can contribute signica

to the eectiveness o medical practice. This principle also applies to eHealth.

Table 18 shows that most countries would nd this inormation veryto extremely useful.


Non-OECD .

OECD . .

Table 18. Inormation on eective/best eHealth pra


eHealth is a combination o ICT and healthcare technologies and practices. Standards

critical to ensure lowest cost implementations and interoperability between systems.

Most countries would nd this service very useful(Table 19). There was some variation am

the OECD countries as to the useulness o such advice. For example, some countries alre

have organizations applying technical standards in this domain.


Non-OECD .

OECD .

Table 19. Advice on eHealth norms and stan


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Information on trends and developments in eHealth

Providing such inormation allows or the benchmarking o progress. Others can learn rom

these experiences and apply them to their own situation.

Most countries would nd this service very useful(Table 20).


Non-OECD .

OECD .

Table 20. Inormation on trends and developments in eHealth

Advice on eLearning programmes

eLearning uses ICT to develop and deliver courses in most disciplines, and can be an eective

tool in teaching health sciences. Advice on the availability o existing courses as well as training

on how to develop new courses can help countries benet rom this mode o learning.

The non-OECD countries would nd this service very useful, while OECD countries ound itmoderately useful(Table 21).


Non-OECD .

OECD .

Table 21. Advice on eLearning programmes

Advice on human resources development for eHealth

This includes the provision o advice on all aspects o human resource development romtraining in the use o eHealth techniques to the organizational structures required to best

ensure the sae and eective use o eHealth.

Both OECD and non-OECD countries would nd this service moderately to very useful

(Table 22).


Non-OECD .

OECD . .

Table 22. Advice on human resources development or eHealth


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Other requests

This question allowed countries to express any urther needs not already included in

survey. Some o the requirements have been covered in other sections o this report, but

inclusion here reiterates their importance to the countries requesting these services.

Legal, policy and standards

legislation or eHealth implementation and use;

eHealth security issues; and

guidelines on what organizational structures are needed to integrate eHealth into th

existing health care system and how to achieve this.

Self-help and benchmarking

inormation on eective practice and an analysis o those eHealth initiatives that aile

a network to exchange inormation on eHealth;

study tours to learn rom other country experiences; and

guidelines on ICT equipment required to benet rom eHealth.

Use of eHealth services by health care professionals

training o eHealth proessionals and providing advice on the development o eHealt

services; and

equipping eHealth training centres.

Direct action by WHO

advocating the inclusion o ICT in government-sponsored health-related curricula;

organizing international conerences on eHealth;

encouraging the development o transnational collaborative programmes using eHe

technologies; and

creating and providing access to a network o suitably qualied eHealth consultants.

Finance and funding

allocation o unds and other resources to support the introduction o eHealth and

eHealth support.

Technical

encourage the use o open source sotware in the development o eHealth systems.

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Recommendations

Key findings

Several issues emerged ater analysis o the country responses to the survey.

First, it is clear that most Member States would welcome the active involvement o WHO

in the development o generic eHealth tools and the provision o guidance in creating and

implementing eHealth strategies and services.

Second, there is an overall lack o awareness as to what eHealth tools and services already exist

world-wide.

Third, the data were somewhat conounded because OECD countries did not express

consistent views o their needs in eHealth areas. This can be explained by the more advanced

and varying degrees o eHealth implementation in these countries. Non-OECD countries did,

however, consistently express their need or guidance in a broad range o eHealth areas.

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Conclusion

Based on the results o this survey, the Global Observatory or eHealth now has valuable

with which to tailor uture initiatives.

Healthcare

There was signicant demand or the provision o generic tools to support the clinical

administrative unctions o health care services. This included systems o varying deg

o complexity in both primary and secondary care such as electronic health records, pa

administration, hospital inormation systems and general practitioner inormation system

Policy and strategy

Countries indicated a strong desire or:

guidance with policy and strategy development or eHealth;

advice on needs assessment and evaluation o eHealth services;

inormation on best practice and trends;

advice on eHealth norms and standards; and

consultancy services to assist in all aspects o eHealth.

Education

All respondents expressed a need or education and training in eHealth. There is a

signicant demand or the use o eLearning methods in health sciences.

Some additional requests included:

access to digital libraries and inormation about evidence-based research within the

eHealth domain; and

establishment o a network to share experiences internationally.

Information

Directories o health care proessionals and institutions can assist governments in real

quickly and eectively, the required administrative and legal basis or many aspects o eHe

delivery.

Pharmaceutical or drug registries are undamental i control o the efcacy and cos

medicines is to be exercised at regional or national levels. This is especially true in situat

where health care consumes an increasing proportion o national budgets. Generic ICT-b

tools are seen as a undamental way o creating these both cost-eectively and rapidly.

Providing generic tools to enable registration o groups o patients suering rom sim

conditions creates a valuable basis or maintaining the health o these groups and identi

priorities or health care expenditure.

The importance and value o these inormation systems was clearly recognized by counresponding to the survey. Not surprisingly, the highest demand came rom countries w

are still waiting to implement these solutions.

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Proposed action

The resolution passed at the Fity-eighth World Health Assembly raised expectations that

WHO will become actively involved in the provision o generic eHealth tools and services. The

survey responses received have clearly demonstrated that this move is welcomed by many

WHO Member States. In this vein the report by the WHO Secretariat on eHealth tools and

services prepared or the 117th Session o the Executive Board proposes specic initiatives thatthe Secretariat plans to develop to support eHealth in Member States.

The ollowing recommendations complement the projects proposed to EB 117, ocusing on the

needs o Member States as expressed in the GOe survey.

It is recommended that WHO in collaboration with appropriate partners should:

Facilitate the development of those generic eHealth tools most sought after by

its Member States. These would include generic forms of tools for the monitoring

and evaluation of eHealth services, drug registries, institutional patient centred

information systems and directories of health care professionals and institutions.

Raise awareness of existing eHealth tools and services through the creation of

electronic directories and that there should be a special focus on open source

eHealth solutions.

Develop an international knowledge exchange network to share practical

experiences on the application and impact of eHealth initiatives. This would be

Internet based and could be supplemented by international eHealth conferences

to facilitate networking.

Create an eHealth information resource to support the needs of Member States in

key areas such as eHealth policy, strategy, security and legal issues.

Promote the use of eLearning programmes for professional and ongoing educationin the health sciences. Collaborations should be developed to generate databases

of existing eLearning courses. Further, WHO should advocate for the inclusion of

eHealth courses within university curricula.

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Annex

List of Member States byWHO regional distribution

(indicating survey respondents and OECD members)WHO Arican RegionAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral Arican RepublicChadComorosCongoCte dIvoireDemocratic Republic

o the CongoEquatorial Guinea

EritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauKenyaLesothoLiberiaMadagascarMalawiMaliMauritaniaMauritiusMozambiqueNamibiaNigerNigeria

RwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSouth AricaSwazilandTogoUgandaUnited Republic o TanzaniaZambiaZimbabwe

WHO Region o the AmericasAntigua and BarbudaArgentinaBahamasBarbadosBelizeBoliviaBrazilCanada**

ChileColombiaCosta RicaCubaDominicaDominican RepublicEcuadorEl Salvador

GrenadaGuatemalaGuyanaHaitiHondurasJamaicaMexico**

NicaraguaPanamaParaguayPeruPuerto Rico*

Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSurinameTrinidad and TobagoUnited States o America**

Uruguay

Venezuela (Bolivarian Republic o)

WHO South-East Asia RegionBangladeshBhutanDemocratic Peoples

Republic o KoreaIndiaIndonesiaMaldivesMyanmarNepalSri LankaThailandTimor Leste

WHO European RegionAlbaniaAndorraArmeniaAustria**

AzerbaijanBelarusBelgium**

Bosnia and HerzegovinaBulgariaCroatiaCyprusCzech Republic**

Denmark**

EstoniaFinland**

France**

GeorgiaGermany**

Greece**

Hungary**

Iceland**

Ireland**

IsraelItaly**

KazakhstanKyrgyzstanLatviaLithuaniaLuxembourg**

MaltaMonacoNetherlands **

Norway**

Poland**

Portugal**

Republic o MoldovaRomaniaRussian FederationSan MarinoSerbia and MontenegroSlovakia **

SloveniaSpain**

Sweden**

Switzerland**

TajikistanThe ormer Yugoslav Republic o

MacedoniaTurkey**

TurkmenistanUkraineUnited Kingdom o

Great Britain and

Northern Ireland**

Uzbekistan

WHO Eastern MediterraRegion

AghanistanBahrainDjiboutiEgyptIran (Islamic Republic o)Iraq

JordanKuwaitLebanonLibyan Arab JamahiriyaMoroccoOmanPakistanQatarSaudi Arabia

SomaliaSudanSyrian Arab RepublicTunisiaUnited Arab EmiratesYemen

WHO Western Pacifc ReAustralia**

Brunei DarussalamCambodiaChina

China, Hong Kong SpecAdministrative RegionChina, Macao SpecialAdministrative Region

Cook IslandsFijiJapan**

KiribatiLao Peoples Democratic RepMalaysiaMarshall IslandsMicronesia (Federated StatesMongoliaNauruNew Zealand**

NiuePalauPapua New GuineaPhilippinesRepublic o Korea**

SamoaSingaporeSolomon IslandsTokelau*

TongaTuvaluVanuatuViet Nam

Bold indicates survey respondents. * WHO associate members. ** OECD member countries.

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