Category Archives: i2tic

A Composite Index for the Benchmarking of eHealth Deployment in European Acute Hospitals Distilling reality into a manageable form for evidence-based policy

A Composite Index for the Benchmarking of eHealth Deployment in European Acure HospitalsIn a previous post entitled Benchmarking HIT Adoption in European Healthcare Organisations several challenges, including transparency, were mentioned. To tackle of those challenges, during the past few months I had the pleasure to collaborate with my colleague Cristiano Codagnone in the development of JRC Scientific and Technical Report entitled “A Composite Index for the Benchmarking of eHealth Deployment in European Acute Hospitals Distilling reality into a manageable form for evidence-based policy” published May 2011 .

Compared to other areas of the Information Society, where benchmarking has been conducted more systematically for longer (i.e. eGovernment), it is evident that benchmarking of eHealth deployment is lagging behind.

In this context, the results of the eHealth Benchmarking, Phase III survey, carried out by Deloitte and IPSO on behalf of Unit C4 of DG INFSO, with the rich information provided on about 1,000 European acute hospitals, could be a strategically important tool to close this gap. As we show in more detail later, this survey sheds light on key issues such as hospitals’ deployment of ICT infrastructure, applications, and much more.

The reasons why benchmarking of eHealth deployment is lagging behind are structurally related to the multi-dimensional complexities of this field, to the relatively greater difficulty/costs of getting the data (i.e. data cannot come from web-based measurement, as it can for eGovernment benchmarking), and especially to the challenges of making sense of the data.

This report uses multivariate statistical methods to analyse with a selective but deep vertical focus the results of the above-mentioned survey. The objectives of this exercise are two-fold:

a) to make sense of the results by constructing a composite index;
b) to extract key policy messages and new directions for future research.

The main objective is the elaboration of a composite index of eHealth deployment with a view to proposing a roadmap towards systematised and replicable benchmarking. In addition, we also explore the possible link between benchmarking and eHealth impact.
Therefore, our focus is much more selective but deeper than the broader descriptive analysis produced by Deloitte and Ipsos. In addition, we do not simply conduct multivariate statistical analysis but we put this into a conceptual and theoretical perspective and we follow it with a discussion of the results and with a set of policy and research recommendations.

This first introductory section is followed by four more. Section 2 provides the general conceptual and theoretical framework for benchmarking within an international policy perspective. Section 3 presents the data and the methodology used. In Section 4, we present and comment on the results of our multivariate statistical analysis. Finally, in Section 5 we discuss these results and extract recommendations for future research and policy making.

The Composite Index

The Hospital eHealth Deployment CI has been developed following a totally transparent multistage approach, which is graphically rendered in the figure below:

Composite index Figure

ehealth_figure7

Countries with more intensive (per capita) healthcare spending in ICT score higher in our hospitals eHealth Deployment CI and it seems now perfectly sound that Italy, France and Germany have lower than expected CI in view of the fact that their ICT expenditure is considerably less intensive than in countries such as for instance Denmark, Sweden, and Norway. The data used are too aggregate and we do not dare going further than simply pointing out a mere statistical association. Yet, at least the direction is comforting: if it was negative (high rank in CI associate with low level of spending intensity) than we might have had a problem.

figure_12

We replicated the operation done with ICT expenditure in healthcare with the following supply side indicators: “Hospital beds – Per 100,000 of population”; “Practising physicians – Per 100,000 of population”; “Number of Computer tomography scanners per 100,000″.

Again we stress that our aim was explorative and we looked for mere trends and statistical associations, with no claim to demonstrated significant statistical correlations and even less so infer causal relation. Yet, all of the trends illustrated in the following figures are comforting and not counterintuitive with respect to what one would expect as a result of wide introduction of eHealth on the above three supply side indicators: a) it would be counterintuitive and challenging to find the our CI is higher in countries with the highest number of hospital beds; b) it would be counter-intuitive and challenging to find the our CI is higher in countries with the lowest number of practicing physicians; c) it would be counter-intuitive and challenging to find the our CI is higher in countries with the highest number of computer tomography scanners. The trends in the figures do not support such instances. Naturally, we do not claim that having a higher CI enable to use fewer beds, to support more physicians, and to substitute scanners, for a much more in depth and granular analysis would be needed to substantiate this hypothesis. We simply observe that at least the direction of the trend is in line with what one may expect from relatively higher deployment of eHealth in hospitals.

Despite very relevant comparability problems, we can risk concluding that the results of the eHealth Benchmarking Phase III survey show that progress has been made in Europe with respect to the levels of eHealth deployment registered in previous, less systematic and extensive data gathering activities such as Business Watch and Hine. For instance, the penetration of Electronic Patient Records (EPRs) has increased from the 34% reported for 2006 by Business Watch to the current 81%. This 81% penetration of EPRs puts
Europe way ahead of Japan and US, where only between 10% and 15% of hospitals have introduced them. However, there are also several indications of areas in need of policy action, of which we emphasise the following four:

1) The CI shows large scope for improvement. The average EU27 CI stands at 0.347, whereas that of top scoring Sweden is just slightly above 0.5. This means that there is still room for general improvement.

2) Wide variation across countries. In particular, the lowest deployment measured by our CI is concentrated mostly among the new Member States and candidate countries. Of the bottom 13 countries, 12 are from this group – Greece is the exception. The only new Member State that scores above the EU27 average is Estonia, confirming its excellence in the domain of ICT. This calls for awareness raising policies and possibly financial support targeting this group of countries.

3) The summary indexes of the four dimensions identify areas to be prioritised. Whereas infrastructure deployment is quite high in most countries, electronic exchange of information lags behind fairly generally (across countries). It is important to close this gap, since these exchanges constitute one of the pillars of the vision and promises of ICT-supported integrated personal health services. These services are the key to producing better health outcomes while pursuing system sustainability and they must be developed around a seamless view of the user, for which exchange of information and timely clinical decisions are crucial. Yet, our analysis shows that electronic exchanges are still limited among the potential interacting players. Furthermore, cross-border exchanges are extremely limited, a gap that from the perspective of EU policy should be quickly addressed.

4) Predominant intramural orientation. From both simple descriptive statistics and from our multivariate statistical analysis, it emerges clearly that the deployment of eHealth in hospitals has been predominantly focussed on intramural needs and applications. For instance, levels of deployment for Personal Health Records and home-based Telemonitoring are very low. We need to stress that if the objectives and targets of the upcoming European Innovation Partnership on Active and Healthy Ageing are to be realised, much more progress will be needed in terms of both electronic exchange of information and user-oriented applications and services, such
as PHR and Telemonitoring.

The integration of Information and Communication Technology into nursing

I’m delighted to announce that the article entitled “The integration of Information and Communication Technology into nursing” has been accepted and is already in press at the International Journal of Medical Informatics. As soon as possible I will upload a pre-print version.

Abstract

Objectives
To identify and characterise different profiles of nurses’ utilization of Information and Communication Technology (ICT) and the Internet and to identify factors that can enhance or inhibit the use of these technologies within nursing.

Methods
An online survey of the 13,588 members of the Nurses Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model was undertaken.

Results/Findings
Although most of the nurses (76.70%) are utilizing the Internet within their daily work, multivariate statistics analysis revealed two profiles of the adoption of ICT. The first profile (4.58%) represents those nurses who value ICT and the Internet so that it forms an integral part of their practice. This group is thus referred to as ‘integrated nurses’. The second profile (95.42%) represents those nurses who place less emphasis on ICT and the Internet and are consequently labelled ‘non-integrated nurses’. From the statistical modelling, it was observed that undertaking research activities an emphasis on international information and a belief that health information available on the Internet was ‘very relevant’ play a positive and significant role in the probability of being an integrated nurse.

Conclusion
The emerging world of the ‘integrated nurse’ cannot be adequately understood without examining how nurses make use of ICT and the Internet within nursing practice and the way this is shaped by institutional, technical and professional opportunities and constraints.

Keywords
Nurses, Internet, World Wide Web, Delivery of healthcare, Patients, Information and Communication Technology

This article is part of the research papers related with the integration of ICT into medical practice and into Community Pharmacists practice.

Personal Health Record Seminar

On October 29th 2010 I had the opportunity to participate in the Personal Health Record Seminar organized by TICSALUT Foundation I would like to share my presentation and the video recorded.

Seminari sobre la carpeta Personal de Salut – Dr. Francisco Lupiañez from Fundació TicSalut on Vimeo.

The integration of Information and Communication Technology into medical practice

I’m delighted to announce that the article entitled “The integration of Information and Communication Technology into medical practice” has been accepted and is already in press at the  International Journal of Medical Informatics. As soon as possible I will upload a pre-print version.

PREPRINT

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

ABSTRACT

OBJECTIVES:

To identify doctors’ utilization of ICT; to develop and characterise a typology of doctors’ utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice.

METHODS:

An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken.

RESULTS:

Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as ‘integrated doctors’. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled ‘non-integrated doctors’. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an ‘integrated doctor’.

CONCLUSIONS:

The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands.

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

Health and the Network Society: Spanish/Catalan book launched

I’m delighted to present my book: Health and the Network Society published by Ariel now available at the book stores. I perfectly know that it would not become a best-seller but I hope it could contribute just a little to foster new debates and further research on ICT and Health.Health systems are embedded within technological, economic, social and cultural changes of our current social structure: the network society. This book is based on empirical research about the transition of the Catalan health system towards the network society. The results show how the interaction between the technological, economic, organizational, social and cultural dimensions are facilitating the emergence of new profiles of citizens, patients and healthcare professionals. The determinants that shape these new profiles allow us to identify the inhibitors and drivers of Industrial healthcare systems towards the Network healthcare systems.

Internet information and email: shaping professional / patients relationship

“Innovative health technologies: health systems in transition Workshop”

Supported by: Internet Interdisciplinary Institute (IN3)

Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and Technology Studies Unit, Department of Sociology, University of York)

Data: 27th November

Place: UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3, 08860 Castelldefels (Barcelona)

Francisco Lupiáñez-Villanueva and Michael Hardey – Health professionals, the Internet and Internet informed patients

The practice of medicine and health care has been increasingly influence by and made use of the Internet as a source of information, communication and social interaction. This paper examines how doctors, nurses and community pharmacists use the Internet and how this shapes their interaction with patients. It is based on data from surveys of doctors, nurses and pharmacists working within the Catalan National Health Care System (CNHS) that were carried out during 2006. The consequent data provides an extensive and detailed quantitative database that is amenable to multivariate statistical analysis. This analysis is described and from it the manner in which the different health professions engage with Information and Communication Technologies (ICTs) and the Internet is identified.  It is suggested that the Internet should now be understood as part of mundane work and that professionals have recognised that it can be an important source of information and support for patients. There appears to be a cumulative effect whereby the more engaged with ICTs practitioners become the more likely they recognise and respond to patients who want to discuss and use resources and information from the Internet.

People living with chronic disease and the Internet in Catalonia Working in Progress

UPDATE

Following Ismael Peña advises I have drawn new graphics that represents the relationship between people living with chronic disease and the Internet in Catalonia . It looks like the inverse care law could be also applied to these citizens.

I have started to explore and analyse the relationship between people who live with chronic disease and the Internet in Catalonia based on Internet, Health and Society. Analysis of the uses of Internet related to health in Catalonia and all the inputs gathered during my period as a visiting researcher at Science and Technology Studies Unit (SATSU) in the Department of Sociology at University of York.

I would like to share some of the preliminary figures, it is just a working in progress to a multivariate statistical analysis.

Of course any comments or suggestions will be very welcome.

Measuring digital development for policy-making: Models, stages, characteristics and causes

Yesterday I had the pleasure to attend the defence of Ismael Peña‘ thesis Measuring digital development for policy-making: models, stages, characteristics and causes, “which deals about the digital economy and whether governments should help in its development for it might have a positive impact on the real economy and on the society at large”.

Dissertation supervisor: Tim Kelly

Composition of the committee:

President: Tim Unwin (University of London)
Secretary: Joan Torrent Sellens (UOC)
Members: Robin Mansell (London School of Economics)
Bruno Lanvin (INSEAD)
Laura Sartori (Università di Bologna)

Substitutes:
Gustavo Cardoso (Instituto Superior de Ciências do Trabalho e da Empresa)
Rosa Borge Bravo (UOC)

CONGRATULATIONS Dr. Peña-López. I’m proud to work with you in the same research group I2TIC.

Knowledge, networks and economic activity: an analysis of the effects of the network on the knowledge-based economy

I would like to disseminate a paper entitled Knowledge, networks and economic activity: an analysis of the effects of the network on the knowledge-based economy written by Joan Torrent, director of ICTs Interdisciplinary Research Group (i2TIC), brand new research group I belong to.

This paper contextualises the disruptive change of the transition to a knowledge-based economy and discusses the social sciences postulations with regards to this phenomenon. Once the general context is explained, the article focuses on the microeconomic foundations, understanding knowledge as an input and as a commodity. Finally, after discussing the microeconomics of knowledge, the paper tackles network externalities and their  impact on economic functions and market structure.

Abstract

The progressive consolidation of a knowledge-based economy has caused network effects to become a focal point of analysis into the changes in behaviour evinced by economic agents. This article analyses the changes in production and demand for knowledge commodities arising from network externalities. The analysis reveals two distinct patterns of behaviour in knowledge-based economic activity. Observable knowledge commodities are governed by the effect of direct and indirect network externalities. Also, their demand curve and business strategy depend on new-user entry (marginal value) and the relative size of the network. However, tacit knowledge commodities are governed by learning network externalities and their demand curve and business strategies are dependent on the value generated by the addition of the goods themselves to the network (intrinsic value).

This paper could help towards a better understanding of  health care systems within the network society.

Health and the World Wide Internet

I’m glad to share my slides presented on World Internet Project 2009 – Macau entitled Health and the Internet: Autonomy of the User. The presentation is based on a paper written by Rita Espanha and myself for the book “World Wide Internet. Changing Societies, Economies and Cultures” edited by Gustavo Cardoso, Angus Cheong and Jeffrey Cole.

I’m delighted with the great atmosphere of the conference due to the different research perspectives that have been presented by researchers around the world. Twitter #wip200. Finally, thanks Rita for the opportunity to work together. This presentation and the book chapter are just the begining.