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Opportunities and challenges in the deployment ofglobal e-health
Roberto J. Rodrigues
Science Technology and International Affairs Program,Edmund Walsh School of Foreign Service, Georgetown University,Washington D.C.Vice President, Medical Informatics Foundation, Miami, FLSenior Consultant, INTECH ± The Institute forTechnical Cooperation in Health, Inc. Potomac, MD, USAE-mail: rrodrigues@ehealthstrategies.comWeb: http://www.healthstrategies.com
Abstract:
In developed countries, e-health has rapidly evolved from the deliveryof online medical content toward the adaptation of generic e-commercesolutions to the processing of health-related administrative transactions andlogistical support of clinical tasks. E-health is perceived as being particularlyuseful in the operational support of the new decentralised and collaborativehealthcare models being implemented in many countries. Heretoforedesigned for large organisations and industrialised countries, e-healthsolutions are being increasingly proposed as an answer to the many healthsystem management problems and healthcare demands faced by healthorganisations in developing societies. There are hard lessons to be learnedfrom e-commerce, e-government, and e-health achievements and failures indeveloped countries and a careful examination of those experiences,
vis-a Á-vis
the characteristics of the health sector, organisational preparedness, andtechnological infrastructure of developing countries is a helpful exercise inthe selection of appropriate e-health design and deployment strategies.
Keywords:
developing countries; health sector; information andcommunication technologies; technology deployment; technologyinfrastructure; technology markets.
Reference
to this paper should be made as follows: Rodrigues, R.J. (2003)`Opportunities and challenges in the deployment of global e-health',
Int. J.Healthcare Technology and Management
, Vol. 5, Nos. 3/4/5, pp.335±358.
Biographical notes:
Since 1974, Dr. Rodrigues works in the area of healthservices information and communication technologies in public, private,and intergovernmental institutions in Latin American and the Caribbean,and as a Consultant for international and private organisations, multilateralagencies, and technical cooperation agencies. From 1991 to 2002, full-timestaff at the Pan American Health Organization/World Health Organization,Washington DC. Adjunt Faculty at the Johns Hopkins University School of Nursing, Baltimore and at the Science, Technology and International AffairsProgram (STIA), School of Foreign Service, Georgetown University,Washington, D.C. Seventy-seven publications in health informatics andinformation technology, health systems management, clinical medicine,pharmacology, and military medicine.
Int. J. Healthcare Technology and Management, Vol. 5, Nos. 3/4/5, 2003
335
Copyright
#
2003 Inderscience Enterprises Ltd.
 
1 Introduction
Advances in information and communication technologies (ICT) and thedissemination of networked data processing have led to widespread access toinformation resources and globalisation of communications, businesses, and services.In the health sector, this trend is expressed by the growing consolidation of `e-health' ± an area distinguished by the combined utilisation of electronic communication andinformation technology to transmit, store, and retrieve digital data for clinical,educational, and administrative purposes, both at the local site and at distance [1±3].The essence of e-health is reliable transaction delivery in a fast-changing environmentinvolving people, processes, and a service or business infrastructure focused on the illor healthy citizen. E-health solutions have emulated e-commerce and e-governmentstrategies and experiences in using internet-based networked technologies to rethink,redesign, and rework how businesses and public services operate and, typically,have been aimed at the improvement of productivity, effectiveness, and efficiency,both internally and in the external relationships with clients, customers, suppliers,and partners.Among leading digital technologies, internet-based ICT solutions have broughtthe greatest impact and they are rapidly changing the way health organisations,providers, care plans, payers, regulators, and consumers, access information, acquirehealth products and services, deliver care, and communicate with each other [4,5].Emerging e-health applications are oriented to professional networking, integrationof the clinical care process management, and the provision of web-based healthinformation and patient care, including remote monitoring and healthcare. Thisexpanded view of e-health has been promoted as the final stage in bringing online theentire healthcare industry.
2 Social, economic, and organisation challenges faced by the health sector
In developed and developing societies, the health sector faces two demands: firstly, toprovide expanded and equitable access to quality services and, secondly, to reduce orat least control the rising cost of healthcare. Changing demographics, particularlyage structures and lifestyles; urbanisation and industrialisation; and growing demandfor better access to patient-oriented quality care have been the main drivers in thereorientation of health systems in every country. Shifting epidemiological profiles areputting an increasing burden on healthcare services and on the society ± in high- andmiddle-income countries, about 40% of the population has one or more chronicconditions and in many societies, chronic conditions account for up to two-thirds of healthcare expenditures. In each care setting, a limited set of health conditionsaccount for most of the cost due to the mounting demand for high-cost diagnosticand therapeutic resources.In developing countries, a considerable number of preventable diseases andpremature deaths, both in absolute and relative terms, do still prevail and there isgreater inequity of access to basic health services resulting in regions, communities,and social groups being left without access to the most basic level of care. In mostcountries the health sector is underfinanced ± this has led to quantitative and
R.J. Rodrigues
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qualitative deficiencies in service delivery and to growing gaps in facility andequipment upkeep. Inefficient allocation of scarce resources and lack of coordinationbetween health subsectors, institutions, and other social agents and stakeholders withduplication of efforts, overlapping responsibilities, and resource wastage arecommon and troublesome problems.
3 Trends in the organisation and delivery of healthcare
Most countries are at some stage of reform, aimed at introducing substantivechanges into the health sector and in the relationships among stakeholders and theroles they perform, with a view to increasing equity in benefits, efficiency inmanagement, and effectiveness in satisfying the health needs and expectations of thepopulation [6]. Those new models of care require innovative functions and freshresponsibilities for users and providers and the increased involvement of localgovernments and non-traditional professional categories. Competition, merger of provider organisations, aggressive contracting by payers, and rising involvement of employer and public purchasers have characterised the changing processes occurringin health services management.Health reform processes have many facets and there is no single model beingadopted by all countries. Each country is moving at a different pace in theimplementation of its own particular health system model but the economic andglobalisation changes of the last years have brought a new urgency to the reformprocesses. There are, however, common trend-setters and responses that characterisemost health sector reform processes:
*
the universalisation of a high cost±benefit basic package of health services
*
a set of standardised public health interventions
*
cost containment and recovery
*
administrative decentralisation and operation of healthcare services
*
recognition of the role of the private subsector and the intersectorality of healthinterventions
*
health models oriented towards primary care and centred on people
*
focus on quality and accountability
*
moving away from the reactive delivery of care to a more proactive managementapproach of the health status of individuals and population groups [6,7].
4 E-health and the new models of healthcare organisation and delivery
In this environment, the business imperative for e-health is concrete, is driven by theoperational requirements of health reforms, and is aligned to many of thedeterminants found to be relevant in e-commerce [8±10]:
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