ICT standards in the health sector: current situation and ... - empirica

ICT standards in the health sectorBarriers to e-health standards adoption and promotionReasons for the currently problematic situation in e-health standards can be broken downby stakeholders: governments, SDOs, industry, and ICT users (section 2.2.2):Political barriers: On the one hand, there are many different national and alsoregional health systems with different standardisation approaches and standardsimplemented across Europe. On the other hand, there is also low governmentalsupport for developing prominent e-health standards and the level of incentives tocommunicate electronically – which may spur the use of standards – is low.SDO barriers: There is a large number of SDOs developing e-health standards.The main reason why they do not simply agree on common standards or harmonisetheir standards is that standards development is an expensive investment, andSDOs wish to realise positive returns.Company barriers: Just like SDOs, ICT firms seek to realise the returns from theirstandardisation efforts. Furthermore, manufacturers may not be willing to adoptcommonly used standards because these are very complex and thus expensive toimplement. Finally, a situation of many conflicting standards may be favourable forcompanies that sell middleware or services to make systems interoperable.ICT user barriers: On the part of health service providers such as generalpractitioners, community care centres, and hospitals, barriers to adopt widely usede-health standards are mainly related to costs: Search costs for systems with themost suitable standards, costs of converting existing data to new standards, andcosts of software upgrades which may be necessary before adopting standards.Activities to harmonise standardsCurrently there is now powerful process to harmonise existing standards. However,recently there has been a major advance in such activities. In August 2007, acollaborative e-health standards harmonisation group was formed between the EuropeanStandardisation Committee (CEN), the International Standardisation Organisation (ISO),and Health Level 7 (HL7). This initiative may potentially be very influential in the future.All in all, the stakeholders involved in e-health standardisation are increasingly becomingaware of a need to develop the market for standards, and they are more and more activein this respect. The Member States’ e-health large-scale pilot planned to start in 2008,being funded by the ICT Policy Support Programme (PSP), is expected to become afurther catalyst in this respect (section 2.2.3).Standardisation of electronic health recordsIntroducing electronic health record (EHR) systems and defining related standards is animportant topic on the agenda of many European countries and the EC. In July 2008 theEC issued a Recommendation on cross-border interoperability of electronic health recordsystems. EHR applications are available for an increasing number of institutions.However, solutions are often isolated without data exchange and interoperability, andthey have implemented early and limited EHR versions. Contributing to the delay of moresophisticated EHR implementations is a lack of EU-wide standards for the collection,coding, classification and exchange of clinical and administrative data (section 2.2.4).6