Information and Communication Technologies (ICTs) in Health Systems

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Today, there is no lack of agreement on the quality benefits that might derive from widespread adoption of information and communication technologies (ICT) in the health sector. Health ICTs are increasingly seen as part of an inevitable process of modernisation of the health care system and “e-health as the cost of doing business in the 21st century health care”. The technology has progressed significantly and many estimate that ICT implementation can result in care that is higher in quality, safer, and more responsive to patients’ needs, and at the same time, more efficient (appropriate, available, and less wasteful). Advocates, in particular, point to the potential of ICTs to enable health system transformation.

Recognising this potential many OECD governments have issued nation-wide strategies, set targets, allocated significant resources and established coordination bodies to promote widespread use of ICTs. Despite this support, implementation of ICTs is proving a difficult and risky undertaking. Getting doctors and hospitals to adopt ICTs requires overcoming a host of financial, technical, and logistical obstacles.

This OECD project is concerned with identifying main blockages and policies, incentives, or institutional arrangements under which ICTs can deliver the desired efficiency and quality improvements. Work is based on a review of the literature and an analysis of lessons learned from case studies in six OECD countries.

Key questions

Four key questions define the policy issues under study:

• How can OECD countries reap efficiency and quality gains in the health sector through ICTs?
• Are there framework policies, incentives, institutional arrangements under which an ICT initiative can be effective? 
• How do policy makers/ project managers evaluate adoption and impact of ICT programmes?
• Are there good practices to draw upon?

The answers aim to be of immediate policy relevance.

Case studies

All case studies represent examples of implementation of ICT as enabler of substantive changes in the health sector and in the relationships among health care providers and the roles they perform. They highlight how ICT projects can support ‘transformation’ in four high-impact areas. These address the implementation of ICTs to enable and sustain:

• Primary care renewal (e.g. chronic disease management)
• Improved access to care in rural and remote areas (e.g. to support multipurpose service delivery, tele-health)
• Patient safety
• Quality improvement activities (e.g. care coordination and performance reporting)

Preliminary analysis of findings from case studies show that there are a number of actions that governments can take to help pave the way for effective implementation of ICTs.

In all case studies, a range of incentives acted as key motivators and were critical in guiding implementation and effective use. Using multiple reinforcing incentives enhanced the likelihood of changing provider behaviour.

While the case studies are not perfect, they also illustrate the types of benefits that can result from a ‘value-based approach’. A value-based approach is grounded in 3 simple principles:
- the goal is value for patients,
- care delivery is organised around medical conditions and care cycles, and
- results are measured.

For example, in British Columbia (Canada), implementation began with the innovations necessary to realign the health care delivery system for more effective chronic care management, a new framework for evidence-base medicine, and then with experimentation with a chronic disease management toolkit integrated with electronic medical record.

Financial and other incentives rewarded clinicians who led the shifts to collaborative care and evidence-based care. By tracking patient care processes using best practice guidelines and flow sheets, the toolkit allowed physicians to conduct systematic patient monitoring, improve their practice, report on improvement and particularly for the management of chronic diseases such as diabetes and heart failure. Countries currently working to restructure their own systems through ICTs may find it useful to examine and build upon these accomplishments while also learning from their possible failures.

For many of the ICT efforts included in the case studies, once the initial funds run out, the most significant challenge is the development of a sustainable business model. This appears to have been widely recognised and a number of business models are emerging.

Timeline

• April 2007: A first expert meeting, sponsored by the German Ministry of Health, was held on 13 April 2007 in Paris. The primary aim of the meeting was to discuss and refine the research agenda for the project.
• March 2008: A second expert workshop discussed "Monitoring and benchmarking adoption of Health ICTs", resulting in recommendations for the development of an international model survey. 
• May 2009: To discuss the latest findings, national ICT experts from over 16 OECD countries and representatives from the European Commission, the World Health Organisation and the private sector met in Paris on 25-26 May, 2009.

Although the evidence base is still incomplete, delegates agreed that there is much more to the adoption of health information technology than cost-efficiency. ICT applications are proving highly desirable, if not necessary, to sustain primary care renewal and to promote better performance and patient safety. Decreasing the financial barriers, shifting or sharing the financial risk, and obtaining reliable metrics to evaluate the benefits of ICTs can be expected to greatly accelerate effective adoption of ICTs.

Contact

For more information on the project, contact Elettra.Ronchi@oecd.org.

Visit the OECD website to learn more about OECD work on ICT and on health.