11. E-Health

Main policy objectives

ICTs are used to enhance health care systems in numerous ways. The main high-level policy objectives include the following:

• Efficiency gains and cost reduction.
• Improved access and health care delivery, supporting the goals of universal care coverage.
• Reduced medical errors and improved patient safety.
• Improved prevention and management of chronic diseases.
• Improved data sharing for infectious disease monitoring.

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Tools for measurement and analysis

Indicators are grouped into four broad domains in which measurement of availability and use are policy priorities for most countries:

• Provider-centric electronic records.Systems used by health care professionals to store and manage patient health information and data, including functions that support the care delivery process (e.g. electronic medical records, or EMRs, EHRs, or electronic patient records, or EPRs).
  
  
• Patient-centric electronic records.Systems typically used by patients and their families to access and manage their health information and organise their health care (e.g. personal health records (PHRs), patient portals and other patient-centric electronic records).
  
  
• Health information exchanges. The process of electronically transferring (or aggregating and enabling access to) patient health information and data across provider organisations (e.g. e-transfer of patient data between ambulatory care providers or e-transfer of data at the regional level).
  
  
• Tele-health. A broad set of technologies that support care between patients and providers, or among providers in different locations (e.g. video-mediated consultations between physicians and patients, remote home monitoring of patients, teleradiology).

Further guidance on implementation is available in the Draft OECD Guide to Measuring ICTs in the Health Sector (OECD, 2013a). Some of the experiences in implementing the model survey, including in LAC countries, are reviewed below (Box 11.1).

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Overview of the situation in the LAC region

In the last few decades, public spending in the social sectors in LAC has grown significantly. According to the United Nations Economic Commission for Latin America and the Caribbean (CEPAL, 2012), the region spent USD 461 per capita in 2005 on average around 1990, compared to USD 1 026 per capita by 2010. Public spending on health, education and social protection increased from 11.2% of GDP in 1990 to 18.6% of GDP in 2010. Growth of health spending and its long-term sustainability have, thus, become important issues on the political agenda of LAC countries, as growth in public spending puts pressure on budgets, provision of health care and household spending. This growth can be explained by several factors. Some are structural, such as the ageing of the population, urbanisation and the increasing availability of advanced medical technologies. Others are related to policy and the overall performance of health care systems. Health care administrators and policy makers across the LAC face major questions regarding the allocation of scarce health care resources. LAC governments have a wide range of policy tools available to control the escalation of costs. “Command-and-control” policies, such as accepting a decline in the quality of services, a decline in the number of interventions or diseases covered, or a change in the balance between what is funded through the national budget and what people pay out of pocket can hold expenditures down in the short term, but they often have unintended consequences in the long term. Many LAC countries already have high levels of out-of-pocket spending.

The general finding based on analysis of OECD/IDB questionnaires returned by LAC countries and the literature is that most of the LAC region is still at an early stage of health ICT adoption and use. One of the main obstacles to implementing e-health in the region is the lack of professionals with the skills and experience to develop and execute e-health projects (WHO, 2014d). Another important obstacle in the LAC region has been the deficiencies in the technology infrastructure due to instability of connections, limited spectrum, bandwidth and elevated costs of services (often with high upfront costs).

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Good practices

One shared characteristic of the programmes in Chapter 11 is that they all required the full support of all stakeholders to achieve their goals. Notable facilitators included dedicated community caregivers and physician leaders who envisioned the specific changes needed, and were able to overcome organisational and cultural barriers and unforeseen technical challenges at implementation. All initiatives had dedicated funding; many were launched as pilots through dedicated grants and against specific public health goals. Although there are limits to the generalisation of results, the case studies covered here illustrate the interdependence between various policy dimensions, which are difficult to disentangle, but must be addressed if countries are to achieve the intended efficiency gains from ICT implementation. The following points summarise the main findings:

• Align incentives with health system priorities.
  
  
• Ensure long-term political commitment through direct regulatory measures, also known as “command and control instruments”, economic instruments such as financial incentives and market stimuli to persuade users to change their behaviour, or persuasive measures, such as providing education and training, and the use of social or peer pressure and recognition.
  
  
• Support infrastructure development.
  
  
• Establish robust security and privacy protection.
  
  
• Strengthen monitoring and evaluation.
  
  
• Promote user-friendly solutions and capacity-building.
  
  
• Accelerate and guide interoperability efforts.

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BROWSE TOPICS OF THE TOOLKIT

Introduction •  Regulatory frameworks and digital strategies •  Spectrum policy •  Competition and infrastructure bottlenecks •  Extending broadband access and services •  Affordability, government charges and digital inclusion •  Convergence •  Regional integration •  Skills and Jobs •  Business uptake, entrepreneurship and digital content •  E-health •  Digital government •  Consumer protection and e-commerce •  Digital security management •  Privacy protection