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e-Health, an exploratory study using a systematic

literature review
Aida Isabel Tavares
FEUC, Feb. 2015
PhD programme in Gesto Cincia Aplicada Deciso

Aims

A1: exploratory research


research area of ehealth

in

the

emergent

A2: accomplish the evaluation requirements of


eGovernment;
use
a
manager
references
software;
learn
how
to
do
systematic
literature review
A3: provide answers to the research questions

Aida Isabel Tavares, FEUC/2015

Introduction 1/6
eHealth importance for society
delivery of high quality and affordable healthcare
improve the quality of treatment and broaden access to medical care
it can help to reduce pressures on public healthcare budgets
it allows health care professionals to place patients rather than budgets at
the centre of their health systems
European Commission has placed eHealth activities at the centre of the
Information Society and its eEurope Action Plan:
EU have funded more than 500 million Euros of R&D in the eHealth area
(2003, for 15y)
Aida Isabel Tavares, FEUC/2015

Introduction 2/6
European Commission's eHealth Action Plan 2012 2020 :
provides a roadmap to empower patients and healthcare workers, link up
devices and technologies, and invest in research towards the personalised
medicine of the future.
This means providing smarter, safer and patient-centred health services.
Given the fast growing uptake of smartphones and tablets, the action plan
also includes a specific focus on mobile health (mHealth).

Aida Isabel Tavares, FEUC/2015

Introduction 3/6
Global Observatory for eHealth (WHO)

http://www.who.int/goe/en/

Mission
improve health by providing Member States with strategic information and
guidance on effective practices and standards in eHealth
Objectives
-provide relevant and high-quality evidence and information to support
national governments and international bodies in improving policy, practice,
and management of eHealth;
-increase awareness and commitment of governments and of the private
sector to invest, promote, and advance eHealth;
-generate knowledge that contribute to the improvement of health through
the use of ICT;
-disseminate research findings through publications on key eHealth
research topics as a reference for governments and policy-makers.
Aida Isabel Tavares, FEUC/2015

Introduction 4/6
Global survey (WHO) 2005 / 2009 / 2013
summarizes the needs for eHealth tools and services of WHO member
states
eHealth tools & services:
Electronic Health Records
(eHR)

National drug registries

Patient Information Systems Directories of healthcare


(PIS)
professionals and
institutions
Hospital Information
Systems (HIS)

Decision Support Systems


(DSS)

General Practitioner
Information
Systems
Aida Isabel Tavares,
FEUC/2015 (GPIS)

Telehealth

Introduction 5/6

Portugal profile - p.186


Atlas eHealth country profiles: based on the findings of the second global
survey on eHealth, WHO (2011)
http://apps.who.int/iris/bitstream/10665/44502/1/9789241564168_eng.pdf

Aida Isabel Tavares, FEUC/2015

Introduction 6/6

Several other EU initiatives


eHealth News Portal:
http://www.ehealthnews.eu/
European eHealth Governance Initiative
http://www.ehgi.eu/default.aspx
eID EU Governance for eHealth Services; - Semantic and Technical Interoperability; - Data Protection; - Patient Summary
and Other Priorities

Report

Redesign health in Europe for 2020, European Union 2012


Aida Isabel Tavares, FEUC/2015

Concepts 1/2
e-Health (WHO glossary) - the use of ICT for health and more
It is the transfer of health resources and health care by electronic means.
It covers 3 main areas:
i) The delivery of health information, for health professionals and health
consumers, through the Internet and telecommunications.
ii) Using the power of IT and ecommerce to improve public health services,
e.g. through the education and training of health workers.
iii) The use of ecommerce and ebusiness practices in health systems
management.

Aida Isabel Tavares, FEUC/2015

Concepts 1/2
e-Health (WHO glossary, cont)
ehealth it provides a new method for using health resources such as
information, money, and medicines and in time should help to improve
efficient use of these resources.
The Internet also provides a new medium for information dissemination,
and for interaction and collaboration among institutions, health
professionals, health providers and public.

Aida Isabel Tavares, FEUC/2015

Concepts 2/2
Electronic health records EHR
( electronic medical records EMR)
a record in digital format that is capable of being shared across different
healthcare settings, by being embedded in network connected enterprisewide information systems.
(data includes demographics, medical history, medication and allergies,
immunization status, laboratory test results, radiology images, vital signs,
personal stats like age and weight, and billing information)
EMR it is the legal patient record created in hospitals and ambulatory
environments that is the data source for the EHR

Aida Isabel Tavares, FEUC/2015

Research questions

Q1: What are the drivers and the difficulties


for
implementing
and
adopting
ehealth
initiatives, mainly concerned with electronic
health records, in the healthcare systems
during the period 2010-2015?
Q2: What is the evaluation of the ehealth
initiatives during that period?

Aida Isabel Tavares, FEUC/2015

Research method

Systematic literature approach


(Dyba et al., 2007) and (Kitchenham, 2004)

1. Define search terms;


2. Select sources (digital libraries) on which to perform search;
3. Application of search terms on sources; and
4. Selection of primary studies by application of inclusion and exclusion
criteria on search results.

Aida Isabel Tavares, FEUC/2015

Search strategy 1/2

B-on / Biblioteca da FEUC


2010-2015

ehealt
h
ehealth

605
1

ehealt
h
ehealth

Academic journals
Integral text

Aida Isabel Tavares, FEUC/2015

677

refine the
search

Search strategy 1/2


Procedure for identifying primary studies
2010-2015

ehealt
h
ehealth

ehealt
h
ehealth

537

171

ehealth
e-health
electronic h
records

67

Academic journals
Integral text
Disciplines: Business and Management, Public Health

ehealth
e-health
electronic h
records

44

Aida Isabel Tavares, FEUC/2015

Further criteria:
-availability for
download
- exclusion nonscientific work
- exclusion out of
health field

15

21
Exclusion :
ehealth not in
title

Search strategy 1/2


Procedure for identifying primary studies
2010-2015

ehealt
h
ehealth

ehealth
e-health
electronic h
records

67

Further criteria:
- no duplicaton
-availability for
download
- exclusion nonscientific work
- exclusion out of
health field
--excusion: ehealth
not in title

Academic journals
Integral text
Disciplines: Business and Management, Public Health

Aida Isabel Tavares, FEUC/2015

15

Overview of included studies 1/3

Research methods
theoretical; qualitative multi-method multicase;
study design; qualitative research; quantitative
research; experimental methods; case study;
argumentative
Aida Isabel Tavares, FEUC/2015

Overview of included studies 2/3

Countries
(origin data)
5 developing countries
Australia
Canada
Denmark
Germany
Kuwait
Netherlands
Scotland
South Africa
USA

Aida Isabel Tavares, FEUC/2015

Journals (15)
BMC Public Health (1)
Health Management Technology (1)
Health Policy and Technology (3)
Information Systems Fronteirs (3)
International J Environmental
Research and Public Health (1)
International J Healthcare
Management (2)
Journal of Advertising Research
(1)
Milbank Quarterly (1)
Nurse Leader (1)
Quality in Primary Care (1)

Overview of included studies 3/3

Stage focus of
selected articles
Implementation and
adoption (5)

Aida Isabel Tavares, FEUC/2015

Assessment and
evaluation (10)

References - Mendley
Implementation
(Balka, Whitehouse, Coates, & Andrusiek, 2011) 1)
(He, Yang, Compton, & Taylor, 2012) 1)
(Hussey, Adams, & Shaffer, 2015) 2)
(Nuq & Aubert, 2013) 2)
(Weber-Jahnke, P, & Topaloglou, 2012) 1)

Two focus:
1) Interoperability of
information systems
2) Use of ehealth by health
care professionals

Aida Isabel Tavares, FEUC/2015

References - Mendley
Evaluation and assessment
(Conway et al., 2014)
(Delano, 2011)
(Greenhalgh, Russell, Ashcroft, & Parsons, 2011)
(Hendrikx, van de Wetering, P, & Batenburg, 2013)
(Hove, Paek, & Isaacson, 2011)
(Kierkegaard, 2015)
(Klocker, Bernnat, & Veit, 2015)
(Reinwand, De Vries, K, Wienert, & Lippke, 2013)
(Van Zyl, Kotze, & Laubscher, 2014)
(Zibrik et al., 2015)

Four Focus:
1) Patients and users
2) Policymakers
3) Stakeholders
4) Several

Aida Isabel Tavares, FEUC/2015

Criticism and limitations


1) Time constraints
2) B-on search engines are imperfect:
- titles without provided word (ehealth)
- articles not covering the EMR
- duplication of entries

3) Future improvements:
Different strategy for articles selection

Aida Isabel Tavares, FEUC/2015

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