Health Information Technology in the International Context: Volume 12


Table of contents

(16 chapters)

Section 1 begins with an chapter focused on the state of health information exchange within and among nations. Vest writes of the relation of exchange efforts to national health care systems, the common challenges, and the implications of cross-border information sharing. Also written from a broader view is the chapter by Hotchkiss and colleagues that reviews the use of routine health information systems (RHIS) and makes suggestions for how to enhance their role in improving health system functioning. Their work outlines the “numerous knowledge gaps on the ability of RHIS to improve health systems functioning and performance” and puts forward a call to assess the effectiveness of RHIS projects in order to build the evidence-base in this realm.

Purpose – Health information exchange (HIE), the process of electronically moving patient-level information between different organizations, is viewed as a solution to the fragmentation of data in health care. This review provides a description of the current state of HIE in seven nations, as well was three international HIE efforts, with a particular focus on the relation of exchange efforts to national health care systems, common challenges, and the implications of cross-border information sharing.

Design/methodology/approach – National and international efforts highlighted in English language informatics journals, professional associations, and government reports are described.

Findings – Fully functioning HIE is not yet a common phenomenon worldwide. However, multiple nations see the potential benefits of HIE and that has led to national and international efforts of varying scope, scale, and purview. National efforts continue to work to overcome the challenges of interoperability, record linking, insufficient infrastructures, governance, and interorganizational relationships, but have created architectural strategies, oversight agencies, and incentives to foster exchange. The three international HIE efforts reviewed represent very different approaches to the same problem of ensuring the availability of health information across borders.

Originality/value – The potential of HIE to address many cost and quality issues will ensure HIE remains on many national agendas. In many instances, health care executives and leaders have opportunities to work within national programs to help shape local exchange governance and decide technology partners. Furthermore, HIE raises policy questions concerning the role of centralized planning, national identifiers, standards, and types of information exchanged, each of which are vital issues to individual health organizations and worthy of their attention.

Purpose – Health system performance depends on production and use of quality health data and information. Routine health information systems (RHIS) are defined as systems that provide information at regular intervals of a year or less to meet predictable information needs. These include paper-based or electronic health records and facility- and district-level management information systems. RHIS are receiving increasing attention as an essential component of efficient, country-owned, integrated national systems. To guide investment decisions on RHIS, evidence is needed on which types of RHIS interventions work and which do not.

Design/methodology/approach – This chapter is a systematic review of the literature on the evaluation of RHIS interventions in low- and middle-income countries, starting from the premise that investments in RHIS could be better understood and so produce greater benefits than they currently do.

Findings – We describe the conceptual literature on the determinants of RHIS performance and its role in improving health systems functioning, discuss the evidence base on the effectiveness of strategies to improve RHIS performance, provide an overview of RHIS evaluation challenges, and make suggestions to improve the evidence base.

Originality/value – The goal is to help ensure that (a) RHIS interventions are appropriately designed and implemented to improve health systems functioning and (b) resulting RHIS information is used more effectively.

Purpose – This chapter reports on experts’ perspectives on health information technology (HIT) and how it may be used to improve health care quality and to lower health care costs.

Design/methodology/approach – Two roundtables were convened that focused on how to best use HIT to improve the quality of health care while ensuring it is accessible and affordable. Participants drew upon lessons learned in the Netherlands, the United States, and other countries.

Findings – The first roundtable focused on the use of (1) electronic health records (EHRs) by health care providers, (2) cloud computing for EHRs and health portals for consumers, and (3) data registries and networks for public health surveillance. The second roundtable highlighted (1) the rapid growth of personalized medicine, (2) the corresponding growth and sophistication of bioinformatics and analytics, (3) the increasing presence of mobile HIT, and (4) the disruptive changes in the institutional structures of biomedical research and development.

Practical implications – Governmental sponsorship of small pilot projects to solve practicable health system problems would encourage HIT innovation among key stakeholders. However, large-scale HIT solutions – developed through small pilot projects – should be pursued through public–private partnerships. At the same time, governments should speed up legislative and regulatory procedures to encourage adoption of cost-effective HIT innovations.

Social implications – Mobile HIT and social media are capable of fostering disease prevention and encouraging personal responsibility for improving or stabilizing chronic diseases.

Originality/value – Both health services researchers and policy makers should find this chapter of value since it highlights trends in HIT and addresses how health care quality may be improved while costs are contained.

Purpose – The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context?

Design/methodology – We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal: to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services; (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy.

Findings – The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT.

Originality/value – There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.

Purpose – Health information technology (HIT) has been lauded as a foundation upon which the development of an integral solution to cost and quality problems facing many nations is predicated. Countries throughout the world have taken differing approaches in their efforts to advance that foundation through policy, financial, and cultural systems that come to support or hinder adoption. As we explore potential opportunities to learn from the experience of others, we pause to consider the environmental, regulatory, financial, and social dynamics that define the US context.

Design/methodology/approach – This chapter outlines the framework for a comparative approach through four dimensions – environmental, regulation, financial, and social – through which comparative HIT studies should be explored.

Findings – With such markedly different contexts in which their HIT is embedded, it is important to not simply look at other countries as a yardstick upon which we compare our failures and successes. Rather, we must look critically at these examples understanding that the dynamics at play in each context have created opportunities and obligations that have come to define each country's implementation.

Originality/value – The need for a common framework through which scholars can explore comparative HIT systems, while remaining grounded in the US context is an important aspect of effective knowledge translation in adoption.

Purpose – Health information technology (HIT) holds promise for improving the quality of health care and reducing health care system inefficiencies. Numerous studies have examined HIT availability, specifically electronic health records (EHRs), and utilization among physicians in individual countries. However, no one has examined EHR use among physicians who train in one country and move to practice in another country. In the United States, physicians who complete medical school outside the country but practice within the United States are commonly referred to as International Medical Graduates (IMGs). IMGs have a growing presence in the United States, yet little is known about the availability and use of HIT among these physicians. The purpose of this study is to explore the availability and use of HIT among IMGs practicing in United States.

Design/methodology/approach – The Health Tracking Physician Survey (2008) was used to examine the relationship between availability and use of HIT and IMG status controlling for several physician and practice characteristics. Our analysis included responses from 4,720 physicians, 20.7% of whom were IMGs.

Findings – Using logistic regression, controlling for physician gender, specialty, years in practice, practice type, ownership status and geographical location, we found IMGs were significantly less likely to have a comprehensive EHR in their practices (OR=0.84; p=0.005). In addition, findings indicate that IMGs are more likely to have and use several so-called first generation HIT capabilities, such as reminders for clinicians about preventive services (OR=1.31; p=0.001) and other needed patient follow-up (OR=1.26; p=0.007).

Originality/value – This study draws attention to the need for further research regarding barriers to HIT adoption and use among IMGs.

Purpose – Use of telemedicine is increasingly prevalent in order to provide better access to expert care, and we examine telemedicine use internationally.

Design/methodology – Using Donabedian's structure, process outcome framework, we conduct an analysis of published studies in the United States, Europe, and Asia to examine the uses, conditions treated, barriers, and future of telemedicine.

Findings – We identify several similarities and challenges to telemedicine use in each region. We find use of videoconferencing between providers or providers and patients for the treatment of acute and chronic conditions. Studies in the United States are more likely to identify applications for the use of chronic conditions, whereas studies in Europe or Asia are more likely to use them for acute access to expertise. Each region reported comparable challenges in reimbursement, liability, technology, and provider licensing.

Research limitations – We compare available research articles from three diverse regions, and many of the articles were merely descriptive in nature. Furthermore, the number of articles per region varied.

Practical implications – Barriers to telemedicine use include a lack of reimbursement, language commonality, technological availability, physician licensure or credentialing, trained support staff and patient privacy, and security assurances. Practitioners and policy makers should work to address these barriers.

Originality/value – Through this work, a summary of the research to date describes telemedicine use in the United States, Asia, and Europe. Identification of use and barriers may provide impetus for improving access to care by finding ways to increase telemedicine use through standardization.

Purpose – Harnessing the advantage of mobile information technology (IT) solutions at the point of care and contributing to patients' safety by involving them.

Design/methodology/approach – International collaboration between specialists in health communication processes and information management and systems.

Methods used – Case studies, design science.

Findings – User-friendly portable IT applications going beyond documentation of patient records and administration require an understanding of complex communication processes between patients and the different caregivers. Home care increasingly faces structural deficits to be mitigated by integration of IT solutions. Platforms chosen in combination with services should be well established. How to implement this must be scrutinized by comprehensive research as initiated here. Preliminary results indicate potentials for novel mobile applications.

Practical implications – Contribution to increasing patients' safety by developing mobile solutions to support health care. Those may also contribute to cost savings in health care.

Social implications – Health care experiences an increasing significance for Western industrialized countries because of demographic developments. Care generally shifts from inpatient to outpatient settings; the global shortage of qualified nurses becomes even more prevailing. More support, among others by IT and enhanced interprofessional communication, is demanded for an improved quality and efficiency of care processes.

Originality/value – Mutual approach benefits from the partner's understanding of complex interactions among clinicians, health services, and patients: the ability to design, monitor, and evaluate research strategies integrating care (information) needs is invaluable when applying creative technology solutions within health care domain.

Purpose – The purpose of this chapter is to illustrate the importance of using open source technologies and common standards for interoperability when implementing eHealth systems, and to illustrate this through case studies, where possible.

Design/methodology/approach – The sources used to inform this chapter draw from the implementation and evaluation of the eHealth Program in the context of the Millennium Villages Project (MVP).

Findings – As the eHealth Team was tasked to deploy an eHealth architecture, the Millennium Villages Global-Network (MVG-Net), across all 14 of the MVP sites in sub-Saharan Africa, the team not only recognized the need for standards and uniformity but also realized that context would be an important factor. Therefore, the team decided to utilize open source solutions.

Practical implications – The MVP implementation of MVG-Net provides a model for those looking to implement informatics solutions across disciplines and countries. Furthermore, there are valuable lessons learned that the eHealth community can benefit from.

Originality/value – By sharing lessons learned and developing an accessible, open source eHealth platform, we believe that we can more efficiently and rapidly achieve the health-related and collaborative Millennium Development Goals.

Publication date
Book series
Advances in Health Care Management
Series copyright holder
Emerald Publishing Limited
Book series ISSN