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Operational Readiness for Transformation in Healthcare:

Operational Readiness for Transformation in Healthcare:

Making Cross-Border eHealth Possible – An Example from the Baltic Sea Region

Our first contributor is Janne Rasmussen, who describes the success of an eHealth project that clearly demonstrates how cross-border healthcare services can be delivered.

One of the great challenges facing the delivery of healthcare in Europe today is the lack of medical specialists, particularly in rural regions. At the same time an increasingly aging population and a general rise in chronic diseases combined with a smaller percentage of people of working age are inevitably causing pressure on the whole healthcare sector. Part of the solution can be found in cross-border eHealth as it allows for medical resources to be distributed and can help avoid the brain drain from other hospitals or countries.

Ten partners; five countries

Baltic eHealth (2004-2007) – a project partly financed by the European Union – brought together ten partners in five countries from the Baltic Sea Region: Denmark, Norway, Sweden, Estonia and Lithuania.

“The overall aim of the project was to facilitate cross-border eHealth,” says Janne Rasmussen. “The project addressed the different challenges (infrastructure, legal issues, reimbursement, culture and language) to cross-border eHealth and provided guidelines on how to overcome and manage these.”

In the case of infrastructure the project built the technical ‘expressway’ – the Baltic Health Network (BHN) – which connects the national healthcare data networks in Denmark, Norway and Sweden with two regional networks at hospitals in Vilnius, Lithuania and Tallinn, Estonia.

Remote reporting in practice

At Svendborg Hospital in Denmark, BHN was used to send X-rays of knees to East-Tallinn Central Hospital and Vilnius University Hospital for reporting. “The purpose of the pilot was to test the technical infrastructure, establish a clinical working relationship and build trust as well as to implement the legal guidelines in a real-case scenario,” explains Rasmussen. “The linguistic issue was overcome by using a Structured Reporting Tool (SRT) with multilingual translation functionality that was developed for the purpose.”

The pilot proved that a lot could be gained from cross-border cooperation. Not only did the BHN prove to be a safe and reliable infrastructure for the transfer of images and data but also the SRT proved to be a functional tool to manage the linguistic barriers. Clinical satisfaction was obtained as the cooperating hospitals demonstrated their high competence level and mutual trust was established.

“The Danish Hospital was so satisfied with the pilot that regular commercial contracts on continued production of X-ray reporting were made with the two cooperating hospitals when the project ended,” adds Rasmussen. “The next challenge is to make the solution integrated with the hospital systems, such as RIS and PACS, for a seamless workflow.”

Future perspectives

The trans-national Baltic Health Network has removed one important technical barrier to cross-border eHealth and provided a secure IT infrastructure. The pilot in the Baltic eHealth project is just one demonstration of how cross-border healthcare services can be delivered. Until now, the solution has enabled point-to-point remote reporting in the Baltic Sea Region, but the possibilities and advantages are much larger and exceed the region.

A virtual marketplace, for the buying and selling of imaging related eHealth services over a trusted and secure framework not limited by any national borders, distance or language, is the future as it opens many opportunities for fast, flexible and equal healthcare delivery.

“The idea of a common portal for the selling and purchasing of imaging related eHealth services is currently being market validated in the EU-funded R-Bay project,” summarises Rasmussen. “In conclusion, eHealth is becoming a natural part of today and tomorrow’s delivery of healthcare services.”

Further information: www.baltic-ehealth.org and www.r-bay.org.

Since March 2006 Janne Rasmussen has worked as a consultant at MedCom International. Janne holds a Masters Degree in English & International Relations and has a background in export sales and public relations in the US. At MedCom International she functions as project manager of large EU-funded projects that bring together many European healthcare stakeholders in a joint co-operation. She is among others responsible for the eTEN projects Better Breathing and R-Bay.

Healthcare Knowledge Management:  Fad or an Imperative for Healthcare?

Our second contributor is Ashish Dwivedi, a member of the Knowledge Management for Healthcare research group, who describes the need for an all-round approach to Knowledge Management.

During the last two decades there has been a revolution in both healthcare and IT, leading to progress in increasing life expectancy and disease control. Simultaneously, advances in IT have enabled healthcare stakeholders to access almost all existing health information available. However, they are facing an information overload and in some cases, paradoxical information. 

Pavia¹ notes that modern-day healthcare stakeholders, apart from dealing with the impact of all these advances (i.e. advances in hardware technologies, biomedical knowledge and genetic engineering) also have to deal with over 10,000 known diseases, 3000 drugs, 1100 lab tests, 300 radiology procedures, 1000 new drugs and biotechnology medicines in development and 2000 individual risk factors. “The inability of healthcare professionals to deal effectively with existing health information available has started to have an impact in lives lost and affected adversely, and in financial terms,” says Ashish Dwivedi. 

Memory and experience are inadequate

It is clearly no longer possible for healthcare stakeholders to possess all the pertinent knowledge in their domain of specialty. This notion is confirmed by Masys² who notes that “against a background of an explosively growing body of knowledge in the health sciences, current models of clinical decision-making by autonomous practitioners, relying upon their memory and personal experience, will be inadequate for effective twenty-first-century healthcare delivery”. 

Furthermore, the healthcare sector is ignoring the potential impact of two emerging revolutions (biomedical knowledge and genetic engineering) which have the potential to make irrevocable changes in the nature of healthcare processes. “It is clear that synergistic interaction between these two revolutions will further accentuate the information explosion in healthcare,” adds Dwivedi. “Consequently, healthcare policy makers have to reinvestigate the entire processes behind healthcare right from diagnosis, treatment to prognosis.”

Renewed interest in Knowledge Management

It is in this context that interest has increased in incorporating the Knowledge Management (KM) paradigm in healthcare. There are two main schools of thought which hold contrasting views on the nature of knowledge (Stefanelli³, 2004). The first – the cognitivist perspective – contends that knowledge is universal for all and that any two systems (biological or machine) should hold the same representation of the world. “This implies that knowledge is explicit, capable of being encoded, stored and disseminated,” says Dwivedi. “The cognitivist perspective has influenced the development of artificial intelligence.”

The second school of thought – the constructionist perspective – states that “knowledge resides within our bodies and is closely tied to our previous experiences”, and consequently knowledge is tacit, highly personal, not easily expressed, and therefore cannot be easily shared.

When a surgeon operates on a patient, he applies both tacit and explicit knowledge. Explicit knowledge is gleaned from books and procedures, and is combined with his individual tacit knowledge derived from an accumulation of individual experiences.

How to manage tacit clinical knowledge?

“However, the healthcare sector has focused on KM strategies that support codification, often at the cost of forging adoption of personalisation strategies,” claims Dwivedi. He illustrates this by pointing to the UK’s NHS, which he says has put an emphasis on KM strategies supporting codification to standardise treatment of routine cases. 

“However, currently there are very few research projects examining how tacit clinical knowledge can be managed in healthcare,” says Dwivedi. “This is detrimental to the future of KM in healthcare. There is a need for healthcare policy makers to examine in detail how the new emerging revolutions of biomedical knowledge and genetic engineering revolutions will impact upon the entire processes behind healthcare right from diagnosis, treatment to prognosis. They need to come up with alternative delivery and healthcare mechanisms that will allow healthcare providers to deal with this change. In this context, the role of KM strategies that enable both tacit and explicit knowledge in healthcare are welcome.”

Ashish Dwivedi is Deputy Graduate Research Director and a Lecturer in Information Sciences at Hull University Business School, UK. He is also a member of the Knowledge Management for Healthcare research group and a member of the Biomedical Computing Research Group (BIOCORE), Coventry University. His primary research interests are in knowledge management (in which he obtained his PhD), organisational behaviour, healthcare management and information and communication technologies. 

¹ Pavia, L. (2001). "The era of knowledge in health care." Health Care Strategic Management 19(2): 12-13.
² Masys, D. (2003). “Effects of current and future information technologies on the healthcare workforce” Health Aff (Millwood) 21(5):33-41
³ Stefanelli, M. (2004). “Knowledge and process management in health care organizations”. Methods Inf Med, 43(5): 525-535.

Choosing the Best Financing Opportunity for eHealth

“A key eHealth financing challenge is how much finance should be provided, and in what way, to ensure that costs are financed fully and benefits are realised promptly, and on a sufficient scale to create the required net benefit over time. Currently, there seems to be too much emphasis on financing ICT development and implementation, and not enough on financing eHealth life cycles. A challenge is to change this financing relationship towards a proper balance.”

So says Tom Jones, a specialist in improving the economic and financial performance of eHealth. He will be expanding on this theme during a special HIMSS EMEA eSeminar on Tuesday, 11 March 2008.

At no cost, take the time to sit down and listen to Jones’ online Seminar which addresses today’s toughest question: How to finance the full life-cycle of eHealth cost-effectively? Learn about the European finance models and more from the comfort of your desk.

Register Here

“What’s the Big Deal about E-prescribing?”

E-prescribing is the use of electronic tools to prescribe drug prescriptions. E-prescribing tools can include both software programs, as well as hardware like personal computers, handheld and wireless devices, and touch screens. E-prescribing is one of the integral steps to achieving broad deployment of the Electronic Health Record (EHR).

Currently, prescribers make their drug-prescribing decisions using whatever information is available to them, then they give a handwritten prescription on paper to the patient or fax it to the dispenser or pharmacy. Once the prescription reaches the pharmacy, tasks become somewhat more automated. Through electronic claims, eligibility, and benefits submission, the dispensing pharmacist may learn about contraindications, the need for prior authorisation, or lower cost alternatives. The dispenser then contacts the prescriber by phone for approval of changes, refills, or renewals.

As a result, the current process leads to an estimated 8.8 million adverse drug events in ambulatory care each year, of which over 3 million are preventable. E-prescribing can help address these types of problems through the use of standardised electronic data and processes. By moving away from paper-based systems and using electronic records to deliver patient and prescription data, e-prescriptions can prevent errors and save healthcare organisations many costs. According to some estimates, almost 30 percent of the 4 billion prescriptions written annually require such dispenser callbacks. This equals about 1.2 billion prescription-related telephone calls every year.

Hundreds of thousands of solo physicians and small group practices are now looking at the dawn of emerging electronic prescribing technology that will improve safety, quality and efficiency.

If you are interested in a new book on E-prescribing: “Electronic Prescribing for the Medical Practice: Everything You Wanted to Know but Were Afraid to Ask” by Patricia Hale, you can download the first chapter and valuable assessment tool for free.

Questions anyone?
Challenge us to help you with your (healthcare ICT related) questions. Send your input to emea@himss.org (subject line: question time) and we will research and publish your questions and our answers in forthcoming issues of the eMessenger.

The HIMSS Mission

The Healthcare Information and Management Systems Society (HIMSS) is the premier professional member organisation exclusively focused on providing leadership for the optimal use of healthcare information technology.

The HIMSS mission is to lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation and community affiliations. HIMSS EMEA brings this mission to Europe, Middle East and Africa.

HIMSS EMEA

HIMSS in Europe, the Middle East and Africa (EMEA) is dedicated to bringing together all the major players in the Health ICT community to transcend borders and languages and engender a truly regional dialogue. As members of HIMSS EMEA, individual professionals (managers, administrators, clinicians, technology experts and users), vendor companies and IT providers meet, interact and learn from one another.

With the opening of its EMEA office in Brussels, HIMSS is now positioned to provide activities, programmes and education specifically designed for the EMEA Health ICT community. Guided by a Governing Council of members from within the EMEA region, HIMSS EMEA focuses on the needs of individual and corporate members to ensure dedicated services and membership value.

To learn more about HIMSS EMEA take a look at our website: www.himss.org/emea