Assessment of ICT standards in the health sector

Abstract

Interoperability of ICT applications is a serious challenge in the European health sector. This applies to national and regional health systems as well as to single hospitals, community care centres and general practitioners. From a buyer and user perspective, problems often arise due to the large number of – national and international – standards currently used or proposed to be used, different versions of the same standard as well as “proprietary standards”. From an ICT industry perspective, there is a lack of sufficiently specified and commonly used ICT standards meeting user needs and concrete use cases. Consequently, seamless electronic communication between applications within an organisation and between different service providers is not the rule but rather the exception. This study will

• provide a structured overview of the most important ICT standards in health as well as of approaches to standardisation and explore the main trends in their development and deployment, thereby paying particular attention to standards for electronic patient records;
• discuss economic implications of a lack of common standards in the health sector;
• propose policy implications, including mechanisms for a more intensive involve­ment of the ICT industry in the development of standards;
• prepare a roadmap for the development of common standards in the areas of electronic patient records and electronic messages between health professionals.

Background

The e-Business Survey 2006 and the sector report about e-business in hospitals provided evidence that a lack of common standards and interoperability in the health sector is more severe than in other sectors. This may result in various disadvantageous effects:

• Compromised service quality: A lack of commonly adopted standards is an important reason for a lack of information systems integration, for example within hospitals or between health service providers. This may prolong the access to patient data for physicians and nurses, compromising the quality of health care.
• Lost opportunities for cost containment: Due to a lack of commonly used standards, opportunities for streamlining health service processes and for delivering activity data for more effective accounting and controlling are lost. Possible cost optimisation and containment is not achieved.
• Lack of economic growth: Health service providers may hold off investments in ICT infrastructure, thus limiting growth of companies supplying ICT for the health sector.
• Loss in competitiveness: ICT manufacturers from other parts of the world, notably the US and East Asia, may set de facto standards that are subsequently adopted in Europe. In such cases, the ICT manufacturers from other parts of the world may experience higher growth than European manufacturers that merely deploy standards developed without input from European institutions.

In summary, the use of commonly agreed ICT standards in health would benefit health service quality, cost containment, economic growth and competitiveness of both European healthcare providers and the ICT for health industry.

Study focus

This study will follow up on the issues mentioned above. Analysis will focus on the following issues:

• State of the art. Description of the current situation in standards development and adoption in the area of ICT in the health sector. Issues to be discussed include:
• Standards, standardisation and actors: Which standards exist, how can they be categorised, which approaches to standardisation exist, and which organisations are involved in the development? A special issue is the number and development of standards for Electronic Patient Records.
• Assessment of standards development: Which standards are of principal importance for the various applications and systems? What is the state of the art in standards development; which standards are most advanced?
• Standards use: What standards are used in practice and by whom? What differences in use do exist between different countries and continents? How do health service providers cope with differing and changing standards and versions?
• Barriers: What barriers have to be overcome in the foreseeable future to widely adopt standards? What initiatives exist to overcome the barriers?
• Industry involvement. A focus will be on industry involvement, for example in initiatives such as “Integrating the Healthcare Enterprise (IHE)” and Continua Alliance as well as in relationships to the European Committee for Standardisation (CEN) and the International Standardisation Organisation (ISO). Barriers to more fruitful co-operations will be discussed.
• Economic implications. Opportunities and risks related to ICT standardisation in the field of health will be discussed. Main issues include opportunities arising from the use of common standards and disadvantages caused by a lack of common standards.
• Policy implications. How can policy makers contribute to the development and use of common ICT standards in health? How can an increased involvement of the ICT industry be achieved? An important issue in this regard may be the promotion of open versus proprietary standards. Policy implications will include a proposal for a collaboration mechanism under the umbrella of the International Standardisation Organisation (ISO), including different European and international Standard Development Organisations. There will also be a suggestion for a roadmap for the development of common standards in the areas of electronic patient records and electronic messages between health professionals.

Methods

For this special report, various methods will be applied:

• Desk research: The focus of this special study will be on desk research. Literature review and evaluation of data from existing studies, including, for example, the e-Business Survey 2006, realisations of previous e-Business W@tch studies about the health sector, and the overview report of the so-called CEN/ISSS eHealth Standardisation Focus Group (2005).
• Expert interviews: 4-5 expert interviews with representatives of e-standards users from the health sector or users’ associations, of the ICT industry (solution providers) and of standardisation organisations. Interviews will either be conducted by telephone or face-to-face, depending on distance and opportunities for meeting.
• Online Survey. Through various e-health projects and professional relationships, empirica has access to e-mail addresses of at least 100 experts who can be targeted for an online survey about economic impacts of ICT standardisation in the health sector. The experts are related to ministries, industry, hospitals, universities, and health associations. The survey could include experts not only in Europe but also in other parts of the world, notably the US, Canada, and Australia.