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Abaixo voce encontra textos que informam e discutem os impactos, os planos e as estratégias de eHealth ao redor do mundo. Veja a listagem dos textos abaixo:

  • "A UE e a Sociedade da Informação"
  • "Telecare Healthcare Technology of the Future"
  • "Conclusions of the Forum EUROMED Health 2005"
  • "França testa Central Digital para Centralizar Dados de Saúde"
  • "Survey shows increase in health information exchanges"
  • "EMIS Web to be rolled out to 1.000 practices"
  • "O PEP e o quebra-cabeça da privacidade"
  • "Intel, Four Others to Insist on PHRs for Employees"
  • "Grabar las conversaciones de los médicos ayuda a los padres"
  • "ICT for better healthcare - Case Studies"
  • "Diabetic patients pilot new shared health records"
  • "Strong growth in German health IT market"
  • "Hospital Belga utilizando Medicina Digitalizada"
  • "Sheffield NHS wins plaudits for Telehealth Project"
  • "Canada’s Infoway says 254 EHR projects underway"
  • "Global market for hospital IT systems pegged at $35B by 2015"
  • "HIMSS publishes 'meaningful use' definitions"
  • "When 2+2 Equals a Privacy Question"
  • "Denmark Leads the Way in Digital Care"
  • "Report: Health Care Industry Unprepared for Data Breaches"
  • "Health IT Key to Patient Engagement, Better Care, Experts Say"


September 19, 2011

Kate Ackerman, iHealthBeat Managing Editor

The Robert Wood Johnson Foundation, the Office of the National Coordinator for Health IT and the Agency for Healthcare Research and Quality have teamed up on a new initiative aimed at boosting patient engagement in an effort to improve the quality of health care in the U.S. Health care experts argue that patient empowerment is key to driving health care improvements.

Risa Lavizzo-Mourey, president and CEO of RWJF, said in a news release, "Patients need to understand that the quality of health care varies widely across the nation -- even within communities -- and there are things they can do to ensure they and their loved ones get the best care possible." She added that "it is critical that we all do our part as patients to take responsibility for our own health and care, like learning more about our illness, taking care of ourselves and following recommendations from our doctors and nurses."

At an event on Thursday marking the midpoint of the monthlong project, called Care About Your Care, health care leaders discussed how patients can play an important role in helping to address health care cost and quality issues. Dr. Mehmet Oz -- host of the Dr. Oz show and vice chair and professor of surgery at Columbia University -- moderated the event. He said, "I honestly believe that being a smart patient is a matter of life and death." Oz added that "patients have duties" and that "empowered patients challenge doctors" to deliver the highest quality of care.

Giving Patients Access to Their Data

National Coordinator for Health IT Farzad Mostashari said one of the goals of his office is to help patients get access to information. He said that if patients are being asked to take an active role in their health care, they need to have access to their medical information.
However, he acknowledged that the effort will require a shift in thinking. Mostashari noted that some patients feel uncomfortable even asking for their health care records. He said that it is important to send the message that asking for health records "not only is your legal right, but it is the right thing to do."

Lavizzo-Mourey added that when patients use IT to track their care, the result is better care.

After hearing from Shanda Reardon -- a woman in Southeast Michigan who spoke about how her family history of diabetes drove her to take a more active role in her own health -- AHRQ Director Carolyn Clancy said that patients should feel empowered to ask questions. She added that if they do not understand the answers, they should ask again.

Role of Health IT

The health care leaders said health IT can play a key role in facilitating patient engagement and patient-centered care.
Mostashari said that his office is "helping doctors, hospitals and communities ... to use computers to take better care of people." He said that an increasing number of health care providers are electronically exchanging patient information, which can help to improve care transitions. However, he said that number still is not high enough, and, as a result, patients are being called on to fill in any gaps in their health records.
Mostashari said that new models of delivering care -- such as online visits and smartphone health care applications -- will help address the cost issue.
Clancy agreed, noting that it is possible to "spend less for high-quality care" by achieving savings through better care coordination.

Mostashari added that health IT allows health care providers and others to measure and monitor care. Lavizzo-Mourey said that communities across the country are "using information to raise the bar."

Peter McGough -- chief medical officer at the University of Washington Medicine Neighborhood Clinics in Seattle -- said that providing doctors with information at the time of care through electronic health records has led to fewer complications and lower costs.
Mostashari said that health plans -- including Medicaid and Medicare -- are beginning to recognize and reward health care providers for better quality care and care coordination.

Lavizzo-Mourey said the "transformation in health care is happening" and "consumers need to be involved." She added, "It's going to take all of us to really improve the quality of care." 


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Although health care organizations are eager to embrace new technology, the industry is not adequately prepared to address potential data breaches, according to a report by PricewaterhouseCoopers, Reuters reports.

For the report, PwC's Health Research Institute conducted 600 interviews with health care executives in the spring of 2011.
Researchers found that about 74% of health care organizations plan to expand their use of electronic health data. However, the report also found that:
- Less than 50% of health care organizations have addressed issues related to the use of mobile devices;

- About 47% of organizations have addressed issues related to health data privacy and security; and

- Less than 25% of organizations have addressed issues related to the use of social media (Selyukh, Reuters, 9/22).

Most Health Data Breaches Carried Out by Insiders

James Koenig -- co-lead of PwC's Health Information Privacy and Security Practice -- said the survey found that health data breaches often are carried out by "knowledgeable insiders -- such as people in admissions, billing, computer programmers, the janitorial staff, even in security -- who get access either to building facilities or to computer systems for information" (Eisenberg, Bloomberg Businessweek, 9/22).

Researchers found that:

- More than 50% of surveyed executives said they were aware of a privacy or security breach at their organization during the past two years (Reuters, 9/22); and

- 40% of survey respondents said they were aware of improper internal use of protected health data during the past two years.

According to the report, theft accounted for about 66% of publicly reported health data breaches (Bloomberg Businessweek, 9/22).

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Sindya N. Bhanoo - The New York Times
January 11, 2010

COPENHAGEN — Jens Danstrup, a 77-year-old retired architect, used to bike all around town. But years of smoking have weakened his lungs, and these days he finds it difficult to walk down his front steps and hail a taxi for a doctor’s appointment.

Now, however, he can go to the doctor without leaving home, using some simple medical devices and a notebook computer with a Web camera. He takes his own weekly medical readings, which are sent to his doctor via a Bluetooth connection and automatically logged into an electronic record.

“You see how easy it is for me?” Mr. Danstrup said, sitting at his desk while video chatting with his nurse at Frederiksberg University Hospital, a mile away. “Instead of wasting the day at the hospital?”

He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless — his doctors enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.

All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago. Today, virtually all primary care physicians and nearly half of the hospitals use electronic records, and officials are trying to encourage more “telemedicine” projects like the one started at Frederiksberg by Dr. Klaus Phanareth, a physician there.

Several studies, including one to be published later this month by the Commonwealth Fund, conclude that the Danish information system is the most efficient in the world, saving doctors an average of 50 minutes a day in administrative work. And a 2008 report from the Healthcare Information and Management Systems Society estimated that electronic record keeping saved Denmark’s health system as much as $120 million a year.

Now policy makers in the United States are studying Denmark’s system to see whether its successes can be replicated as part of the overhaul of the health system making its way through Congress. Dr. David Blumenthal, a professor of health care policy at Harvard Medical School who was named by President Obama as national coordinator of health information technology, has said the United States is “well behind” Denmark and its Scandinavian neighbors, Sweden and Norway, in the use of electronic health records.
Denmark’s success has much to do with the its small size, its homogeneous population and its regulated health care system — on all counts, very different from the United States. As in much of Europe, health care in Denmark is financed by taxes, and most services are free.

“It was a natural progression for us,” said Otto Larsen, director of the agency that regulates the system. “We believe in taking care of our people, and we had believed this was the right way to go.” He and others acknowledged that the system is hardly perfect. It faces budget constraints , and the country is still refining common standards for electronic health records.

“We’re trying to streamline now,” Mr. Larsen said. “There are too many systems out there.” And he is pushing to use still more information technology and to encourage more initiatives like the telemedicine project at Fredriksberg Hospital.

At Thy-Mors Hospital in the rural region of North Jutland, doctors are using I.B.M. software that pulls data from a patient’s electronic health record and superimposes it on a three-dimensional image of a human body, allowing doctors to quickly get an overview of the person’s medical history. The doctor can rotate the image, zoom in and click on ailments to get more information.

The ambulances have access to electronic medical records, so medical technicians can update them for the doctors even as patients are on their way to the emergency room. Kurt Nielsen, the hospital’s director, says that while the doctors are not particularly adept at information technology, they have gradually embraced it. And it helps that the staff was involved in developing the innovations. “My staff at the hospital is very, very satisfied,” he said. “We build these systems in an incremental way, and seek their input throughout.”

It remains an open question what lessons from Denmark, a nation of six million people, can be transferred to the United States. “Denmark is probably the most advanced country in the world that I have seen,” said Denis J. Protti, a professor of health information technology at the University of Victoria in British Columbia and an author of the Commonwealth Fund study. “Of course, it’s the same size as some of your states.”

Culturally, Danes are also different. Mr. Larsen, of Denmark’s health information agency, says his countrymen have few objections to the national patient registry — perhaps because they have different priorities from Americans when it comes to medical privacy. “As long you are a healthy man, you fear for your privacy,” he said. “It is when you are sick that you wish people knew what your problem was.” Still, Dr. Protti and other experts say the Danish experience shows that using electronic health records is efficient, cost-effective — and doable, with a little work.

Dr. John D. Halamka, another adviser to the Obama administration on electronic health records, says Denmark offers the United States a peek into the future, with some logistical variations. Dr. Halamka, the chief information officer at Harvard Medical School, doubts that the United States will ever have a national patient registry, but he thinks that electronic medical records can succeed as long as patients have control over their own records.

Beth Israel Deaconess Hospital in Boston, where Dr. Halamka is a practicing emergency room physician, was one of the first hospitals in the nation to adopt electronic health records, a decade ago. It remains in a minority — about 10 percent of American hospitals and about 17 percent of American doctors use electronic records, according to studies published in The New England Journal of Medicine.

Two of the nation’s most robust users of electronic health records are the Department of Veterans’ Affairs and the Kaiser Permanente health system. Last week, the two jointly announced that with patient authorization, electronic health records can now be shared between the systems. At Beth Israel, patients can choose to store their electronic health records using several kinds of programs — Google Health, Microsoft Healthvault or the hospital’s own software — and they control access to their records. In the veterans’ system and at Kaiser Permanente, patients have access to their own health records.

Another challenge is the United States’ sheer size, with 50 state governments and a multiplicity of privacy laws. Dr. Halamka is vice chairman of a federal advisory panel that has established national standards for electronic health records, meant to help states, hospitals, doctors and patients using various types of software to store their records to share information. “The standards have been set for parties to communicate,” he said. “There’s hope, and we’re on the right trajectory.”

In Denmark, meanwhile, advocates of information technology are eager to share advice — and enthusiasm. Mr. Nielsen, of Thy-Mors Hospital, said the transition must be gradual. “It was done throughout some years,” he said. “It is important to know that it did not happen instantly.”

Back at the 150-year-old Frederiksberg University Hospital in Copenhagen, a nurse, Steffen Hogg Christensen, was preparing medical information kits like the one Mr. Danstrup uses. Health information technology is no easy task, Mr. Christensen said. Training colleagues and elderly patients can be daunting and time-consuming.

“But isn’t it amazing, how innovative we can be?” he said, smiling broadly. “And all in these old walls.”

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By Natasha Singer - October 17, 2009  - The New York Times

Time to revisit the always compelling — and often disconcerting — debate over digital privacy. So, what might your movie picks and your medical records have in common?

How about a potentially false sense of control over who can see your user history?

While Netflix and some health care concerns say they have been able to offer study data to researchers stripped of specific personal details like your name, phone number and e-mail address, in some cases researchers may be able to re-identify you by correlating anonymous information with the digital trail that you’ve left on blogs, chat rooms and Twitter.
Of course, you may be fine with that. On the other hand, you may not want complete strangers rummaging around in your history of movie selections or medical needs.

For example, contestants in Netflix’s competition to improve its recommendation software received a training data set containing the movie preferences of more than 480,000 customers who had, as they say in the trade, been “de-identified.” But as part of a privacy experiment, a pair of computer scientists at the University of Texas at Austin decided to see if it was possible to re-identify those unnamed movie fans.

By comparing the film preferences of some anonymous Netflix customers with personal profiles on imdb.com, the Internet movie database, the researchers said they easily re-identified some people because they had posted their e-mail addresses or other distinguishing information online.

Vitaly Shmatikov, an associate professor of computer science at the University of Texas at Austin and a co-author of the “de-anonymization” study, says the researchers were able to analyze users’ public postings and connect that to their Netflix preferences — including how a person may have rated films with controversial themes. Those are choices a person may or may not want to make public, Mr. Shmatikov said.
Steve Swasey, a Netflix spokesman, disputed the study’s conclusions, saying the customers were not re-identifiable because Netflix had altered the data set before sending it to contestants.

“There is no way with certainty that anyone could link a Netflix member with the data Netflix has disclosed by linking it with any publicly available data,” he said. “The anonymity of the information is comparable to the strictest federal standards for anonymizing personal health information.”

Nevertheless, the Texas researchers say they were indeed able to positively identify Netflix customers, and some privacy advocates say their study raises questions about whether newly strengthened laws governing the security of electronic health records — which contain information on diagnoses and treatments entered by health care providers — may offer incomplete privacy protection. Leaked movie preferences might embarrass or stereotype you, they said. But information extracted from medical records and then linked back to you, they said, has the potential to cause social, professional and financial harm.

“Movie records can be sensitive in some cases; it could be embarrassing for someone to find out I like romantic comedies,” Mr. Shmatikov, the computer scientist, said in a recent phone interview. “But definitely for health records, this is a huge issue.”

And you don’t need records containing a person’s name and address to figure out to whom the records belong, he said, “As our research shows, pretty much any information that distinguishes one person from another can be used to re-identify records.”

The idea of an entirely paperless medical system holds the promise of more efficient and cost-effective care. And, with the incentive of stimulus package money, many companies are rushing to sell clinical information systems to streamline services like patient scheduling, sample tracking, and billing at hospitals and clinics.
In some cases, the same companies that sell data management systems to hospitals and physicians also store that information and then repackage it to make money on other services.

The clinical information systems market in the United States has sales of $8 billion to $10 billion annually, and about 5 percent of that comes from data and analysis, according to estimates by George Hill, an analyst at Leerink Swann, a health care investment bank.

But by 2020, when a vast majority of American health providers are expected to have electronic health systems, the data mining component alone could generate sales of up to $5 billion, Mr. Hill said. Demand for the data is likely to be robust. Policy makers and hospitals will want to dig into it to analyze physician practices and glean information about patient health trends.
Big players like the Cerner Corporation, which maintains electronic health systems for 8,000 clients, including large hospitals and retail clinics, and smaller players like Practice Fusion, which offers its Web-based health record systems free to health care providers, say they make use of patient data collected from their clients.

A spokeswoman for Cerner, whose Web site promotes its “data mining of our vast warehouse of electronic health records,” said the company shares de-identified patient data with researchers or drug companies looking for patients to participate in clinical trials. The patient records are “double scrubbed,” she said, explaining that the company removes personal data like names and addresses before it runs a search using a numbered code for each patient.
Other sensitive information, like mental health records, might be removed before the patient data is sent out, she said.

The Web site of Practice Fusion, meanwhile, quotes Ryan Howard, the chief executive, as saying that the company subsidizes its free record-keeping systems by selling de-identified data to insurance groups, clinical researchers and pharmaceutical companies. In an interview, however, Mr. Howard said Practice Fusion had not yet started selling patient information but that it intended to do so.

NEW regulations require notifying patients if their personally identifiable medical information gets loose, and they prohibit selling protected health records. But privacy advocates said electronic health records remain vulnerable because no federal law now forbids the sale of de-identified health care data.

In 1997, for example, a researcher identified the medical records of William Weld, then the governor of Massachusetts, by correlating birthdays, ZIP codes and gender in voter registration rolls and information published by the state’s government insurance commission.

There are no current federal laws against re-identification, said Dr. Deborah Peel, a psychiatrist who is a director of Patient Privacy Rights, a nonprofit watchdog group in Austin, Tex.

“Once personal health data gets out there, it’s like the Paris Hilton sex tape,” Dr. Peel said. “It is going to be out there forever.” 

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Kaiser Permanente, the US healthcare organisation often held up as a model for the NHS, is making rapid progress with electronic patient records and generating efficiencies and savings in the process. Jon Hoeksma reports on a presentation given by one of its key executives at a conference organised by right-wing think-tank 2020health.

It’s one of the largest health IT programmes in the world, designed to connect health professionals in hospital and GPs to shared electronic patient records.

The ambitious project also aims to put patients in charge of their health by providing them with online access to their health information and services such as secure email consultations with their GP.

The programme got off to slow start, had to re-award contracts and began implementation from 2004, but the finish line is now in sight and proven benefits can be shown. Sound familiar?

Think again, the organisation in question is leading US health scheme Kaiser Permanente - which says it will complete the final phases of digitising its healthcare system by spring 2010.

Strategic investment

With 8.7m members, 36 hospitals and 14,000 directly employed physicians, Kaiser has annual revenues of $40 billion. It has long been held up as an exemplar by UK policy experts and industry wonks.

It was, for example, extremely influential in shaping the government’s decision to invest in England’s National Programme for IT in the NHS.

Kaiser’s 2002 decision to make a heavy investment in electronic patient records, in a project called Kaiser Permanente Health Connect, was a strategic move, intended to enable the organisation to change the way it could deliver healthcare, making it safer and more efficient.

Speaking at a 2020health seminar in London recently, Dr Louise Liang, senior vice president of quality and clinical systems support, gave an overview of the programme.

She said Kaiser is now able to show clear clinical and business benefits from its strategic decision, including a 26% reduction in doctors’ office appointments.

It has published research in the journal Health Affairs showing that 3m of its members have made use of e-mail consultations with their family physician.

Dr Liang said that when minors and people for whom e-consultations would be inappropriate were stripped out of the figures, they showed that 47% of members who would be eligible had made use of the service.

“We find that patients who use secure email messaging make 7-10% less physician office visits and make fewer phone calls,” she added.

Scheduled telephone visits have also increased eightfold and secure email messaging risen sixfold. “We’ve also added a lot of patient education and support tools online, such as a very successful renal support tool,” said Dr Liang.

Other huge benefits were being seen through patient driven online programmes, in areas such as smoking reduction, weight and stress.

Executive support

Dr Liang said executives from NHS Connecting for Health had looked at the programme to see what lessons they could learn. She said her key message to anyone looking to emulate Kaiser was to have top level, sustained leadership and support.

Kaiser’s chief executive made the digitisation project the organisation’s number one strategic priority for four years in a row. Dr Liang stressed that senior executives also had to take responsibility; but that this needed to be underpinned by widespread involvement in decision making.

“It’s absolutely essential to involve clinicians and physician leadership in all decisions, not just the ones where someone thinks there is a clinical element,” she said. “They are all clinical decisions.”

Focus on the consumer and cost

Dr Liang said that Kaiser began in 2002 with a vision of where it wanted to get to; consumer-focused care that was both seamless and high quality. This vision was then effectively communicated to all in the organisation, with the development of electronic patient records forming the bedrock of the project.

The organisation also decided that its existing IT strategy “would not get us to where we needed to be.” Having drawn up a new strategy and awarded contracts – with IBM and Epic Systems featuring prominently - implementation work began in 2004.

“Four years later, we have completed everything expect ten hospitals, which will happen by early 2010,” said Dr Liang.

Building the Health Connect EHR has involved replacing almost all business systems and some clinical and departmental systems, although the majority were left in place and connected through integration. All these systems are underpinned by a data warehouse.

In addition, the roll out of the KP.org personal health record began in Hawaii in 2005. “KP.org is our version of the NHS’s Health Space,” Dr Liang told the conference organised by 2020health, a centre-right think tank, to discuss how IT could deliver improved patient outcomes.

The web-access portal enables members to manage their health plans, schedule appointments, create personal health records, order prescription refills and email their doctor.

Central and local

On the question of how much needs to be “uniform”, Dr Liang said the answer was not much. She said Kaiser had kept centrally made decisions on mandating data and systems to the essential minimum, about 15%, with the rest of decisions made by local organisations.

“The other 85% we didn’t need to care about,” said Dr Liang. The focus at the centre was on ensuring a standardised data model and interoperability. “I hardly made any decisions about choosing systems at all,” said Dr Liang.

The quid pro quo was that people were told they had to make a decision quickly, then live with it and make it work. It is a mistake to look at such an ambitious programme as a single IT project, said Dr Liang. “It’s not one IT project but a federated way of doing things.”

Extraído do "eHealth Europe" - 28/05/2009

Jon Hoeksma

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Healthcare IT News

April 28, 2009 - Molly Merrill, Associate Editor

The "Healthcare Information and Management Systems Society" has published two definitions of "meaningful use" as it applies to certified electronic health record technologies and hospital's use.

HIMSS officials announced the definitions Tuesday as the National Committee on Vital and Health Statistics Executive Subcommittee began hearings to define "meaningful use."

According to HIMSS officials, EHR technology is "meaningful" when it has capabilities including  e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures - and other measures - as selected by the Secretary of Health and Human Services.

Officials say physicians must meet the definition within a specified time frame, which as described in the American Recovery and Reinvestment Act of 2009.
In order for hospitals to have a reasonable chance of achieving the definition, HIMSS officials say the requirements must be introduced in incremental stages.  In order for hospitals to meet each stage, milestones must be achieved in phases of not less than two years each, commencing in FY11. In the final phase, which must commence in FY15, HIMSS officials believe the mature definition of "meaningful use of certified EHR technology" includes at least four attributes:

A functional EHR certified by the Certification Commission for Healthcare Information Technology (CCHIT);

Electronic exchange of standardized patient data with clinical and administrative stakeholders using the Healthcare Information Technology Standards Panel's (HITSP) interoperability specifications and Integrating the Healthcare Enterprise's (IHE) frameworks;

Clinical decision support providing clinicians with clinical knowledge and intelligently-filtered patient information to enhance patient care; and

Capabilities to support process and care measurement that drive improvements in patient safety, quality outcomes and cost reductions.

HIMSS officials have urged that CCHIT be named as the certifying body for EHR technology.

HIMSS developed its recommendation by drawing up an initial draft of meaningful users of certified EHR technologies in March. The draft was publicly posted with a discussion forum for a three-week period commencing April 1, 2009. The draft was then reviewed by the HIMSS membership community, which consists of more than 3,000 volunteers organized into nearly 80 groups.

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Healthcare IT News - February 19, 2009 | Bernie Monegain, Editor

The global hospital information systems market will climb past  $35 billion by 2015, according to a new forecast by Global Industry Analysts.  The United States represents the largest market in the world.The U.S. hospital information system market is experiencing an increase in acceptance of customized technology such as laboratory information systems and radiology information systems, the report notes. The market is also a promising ground for electronic medical record systems.

The Asia-Pacific region (excluding Japan) represents the fastest growing hospital information systems market, exhibiting a compounded annual growth rate of 11.5 percent over the next few years, according to analysts. Despite being a smaller market in terms of revenue, the Asia-Pacific promises excellent growth opportunities for hospital information systems, they said.

The report notes:The growth of the emerging health informatics market is high in countries such as Australia, China, Thailand, Malaysia, India and the Philippines. Emergence of a fast-growing healthcare industry in the Asia-Pacific region augurs well for the future of the global market. The United States, representing the largest market within the clinical information systems market, is projected to grow at a CAGR of about 7.2 percent over the next few years. The clinical information systems segment is set to thrive on the industry's need for key decision-making in the areas of cost reduction, workflow optimization and quality enhancement. The Asia-Pacific region is the fastest growing market in clinical information systems. Although non-clinical IT systems laid the foundation for the initial adoption of hospital IT, offering its services to the financial and administrative areas in a hospital, clinical information systems are dominating the market in terms of both popularity and revenues, thanks to increased emphasis on reducing clinical errors, workflow optimization and offering quality healthcare at reasonable cost.

The global vendors profiled in the report include McKesson, Cerner, Allscripts-Misys Healthcare Solutions, Eclipsys, Computer Programs and Systems, Siemens Medical Solutions USA, QuadraMed, Medical Information Technology, Healthland, GE Healthcare, iSOFT Group, Agfa-Gevaert, Brunie-Software, IBA Health and Integrated Medical Systems.

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14 Aug 2008 - eHealth Insider

Canada's electronic health record projects have quadrupled since 2004, according to the head of the Canadian health IT agency. Investment in EHRs is said to have increased by 12% in the past year alone.

Canada Health Infoway - an independent, not-for-profit organization funded by the Canadian government - jointly invests with every province or territory in the country to advance EHR adoption.

According to Richard Alvarez, president and CEO of Canada Health Infoway, the agency has invested a total of €980m ($1.46 billion Canadian dollars), including €196m ($311.5m Canadian dollars), in 2007-2008, in EHR adoption.

The Canadian government has allocated €1.01 billion ($1.6 billion Canadian dollars) for Canada Health Infoway. There are now 254 EHR projects under way in Canada, up from 53 projects in 2004.

Canadians want their medical information available electronically to the clinicians who care for them," said Alvarez. "And that's starting to happen in communities across Canada. Collaboration among governments is at an all-time high and with continued federal funding, we are well on our way to providing every Canadian with an electronic health record by 2016."

"The electronic health record projects the government of Canada is investing in are coming alive, bringing tangible results to Canadians and the clinicians who care for them," said the Honourable Tony Clement, Federal Minister of Health.

Examples of projects that Infoway has helped local health bodies achieve include a shared diagnostic imaging programme in Nova Scotia, which provides digital images of X-rays, MRIs, CT scans and ultrasounds to authorised health practitioners where and when they're needed.

In addition, patients in remote northern communities are connected with health care professionals in urban centres through telehealth, improving their access to care; and electronic medical records are generating much-needed efficiencies in the face of growing clinician shortages, increasing chronic disease and growing administrative demands.

Other progress has been achieved across a wide range of electronic health record programs including registries, diagnostic imaging, and laboratory and drug programs.

Infoway says it continues to target investments in replicable solutions that support health system transformation, such as telehealth and public health surveillance.

Extraído do eHealth Insider 

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14 Apr 2008

Sheffield NHS Primary Care Trust (PCT) has won the regional finals of the NHS Health and Social Care Awards in the category for Innovative Information & Communication Technology as a result of its innovative deployment of telehealth to monitor people with chronic obstructive pulmonary disease (COPD).

Sheffield PCT used Genesis monitors from Tunstall to tackle the issue of COPD in the community by monitoring patients in their own homes, which saw a massive improvement in their quality of life.
The telehealth monitors were given to 30 high-risk patients for a duration of five months, during which time they measured their own vital signs including heart rate, weight, blood pressure and oxygen saturation levels. The monitor is also capable of asking a series of clinical questions to further determine their current condition. Once measured the data is transmitted to the public health development respiratory nurses and/or the COPD nurses office within secondary care. The COPD nurse triages her ‘virtual ward’ against agreed criteria and applies an order of priority to the visitation schedule, whilst those patients in need of urgent treatment are referred to the appropriate care facility.

Sheffield’s innovative approach to managing the condition saw COPD-related hospital admissions dramatically decrease by 50%, saving the PCT between £30,000 to £40,000, which allowed them to purchase more monitors.

During the pilot, home visits by community COPD nurses were also reduced by an astonishing 80%, cutting travel costs and enabling healthcare staff to prioritise their workload, which ensured the most effective use of their time.
Sue Thackray, deputy head of development nursing for Sheffield PCT, said: “The PCT has worked very hard to make the telehealth project a success and has had a tremendous amount of support from both clinicians and other parties within primary and secondary care. We have also had a great deal of support from Tunstall, who helped ensure the project ran smoothly.”

The success of the project led to the Sheffield PCT being selected for the Innovative Information and Communications Technology award category, which recognises the development of innovative applications of information and communications technology that improve the delivery of services for patients, service users or carers.

Judges chose Sheffield PCT’s project as it was developed as a result of an identifiable problem, demonstrated a successful approach to change management and adoption, and showed an ability to integrate the solution into existing systems and architectures.

“Winning an award run by the NHS is a huge achievement for us and it helps raise the profile of the benefits of telehealth locally, within South Yorkshire and The Humber, and nationally too,” said Sue Thackray. “The award recognises the many benefits telehealth delivers, it endorses our proactive and innovative approach to caring for patients with COPD and meeting the challenge of COPD in the community. It also further strengthens our plans to roll out telehealth across a number of other long-term conditions such as heart failure within the community.” 

.   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .

O Hospital Saint Luc Bouge, na Bélgica, fica conhecido a partir de agora pelas radiografias totalmente digitalizadas. Saint Luc, localizado na província belga de Namur, e um dos principais hospitais-escola privados do país, torna-se o primeiro hospital completamente digital na região de língua francesa do país.

Em parceria com a americana Carestream Health Inc., os sistemas de comunicação e arquivamento de imagens Carestream (PACS) gerenciam todo o fluxo de trabalho, incluindo exames de mamografia e modelos para cirurgia ortopédica, totalizando mais de 6,2 terabytes de informações sobre pacientes do Saint Luc Bouge e três localidades satélites em Andenne, Ciney e Perwez.

Pela primeira vez, o sistema Carestream PACS do Saint Luc Bouge oferece uma plataforma de software centralizada para o gerenciamento de imagens médicas e informações nos quatro hospitais. A tecnologia oferece aos radiologistas, de maneira mais rápida, acesso eletrônico aos estudos das imagem e distribuição das mesmas pelos hospitais.

O Saint Luc e o Eastman Kodak Health Group já trabalham juntos há sete anos. A Carestream atualmente tem a licença das marcas do Kodak Health Group, inclusive os sistemas de captura digital Kodak Carestream PACS e Kodak Directview.

“Durante todos estes anos, temos um excelente relacionamento com a Carestream Health, antiga Kodak Health Group, que sempre atendeu nossas necessidades e tem um histórico de fornecer serviços de qualidade e suporte para nosso hospital”, diz o Dr. Jean-Paul Joris, diretor médico e chefe do departamento de imagens médicas do Saint Luc Bouge. “Queremos estar na vanguarda tecnológica da Saúde e no atendimento aos pacientes, então quando decidimos atualizar nossos sistemas e estender o alcance do PACS para nossos outros três hospitais, percebemos que a Carestream Health continuava a oferecer a melhor solução para que atingíssemos nosso objetivo”.

Três soluções definem o sistema aprimorado do Saint Luc Bouge, segundo Ignace Wautier, gerente de operações locais para a Carestream, na Bélgica. Wautier cita a primeira como sendo três bancos de dados dedicados e diferentes para arquivamento e radiologia, distribuição interna e redistribuição externa. A segunda solução é o uso da plataforma 3D mais recente, incluindo modelagem automática; e a terceira é a última palavra em tecnologia de streaming de radiografia digitalizada por computador.

“A Carestream conseguiu atender as necessidades específicas do Saint Luc Bouge, configurando nossas soluções exatamente da maneira que queríamos”, disse Wautier


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

02 Aug 2007

A new study of the German health IT market has sized the sector as being worth between Euros 1.1bn and 1.4bn, and says it is set to grow at up to 6 percent a year over the next 4 years as the German economy gathers momentum.

The study by analysts IDC paints an optimistic outlook for the German health IT market. The study “Der IT-Markt in Deutschland nach Branchen” (“The IT market in Germany in different sectors”) predicts above average growth rate in public sector IT and health IT in the years 2007 to 2011.

“We see the German health-IT-market grow at an average of about 6 per cent a year in this period”, lead analyst Joachim Benner told E-Health Europe. “This is way above the 4.5 per cent which we expect for the German IT-market as a whole”.

Even better are the projections for public sector-IT. Here the analyst expects an average annual growth rate of about 8 per cent in the years 2007 to 2011.

One of the main reasons for the good outlook in public sector IT and health IT, Benner said, was that the public sector and the health system still have to catch up with other service industries when it comes to IT investments. “The financial situation in the public sector and in the health system was desolate for years. Now the economy is gaining momentum, and the broad economic outlook for Germany is brighter. This will improve the financial scope of the public sector and the health sector.”

Another reason Benner gives for growing investments not only in health IT but in all sectors of the IT business is seen in changes in the legal framework. The corporate tax reform in Germany, in particular, will make it easier for companies or indeed hospitals to write off IT-investments from 2008 onwards.

The main industry driver of growth in health IT, according to Benner, is software services. “But unlike in many other sectors, hardware services, too, will be growing in the health-sector, although less vigorously.”

In particular, the analyst expects hospitals to increase their investments in hospital information systems and electronic medical record solutions. But with more and more hospitals becoming private and with private hospital chains growing rapidly in size, the consolidation of other IT-services like archiving systems should also have its share.

In order to calculate the percentages, Benner and his colleagues used different data sources. They asked customers for their plans in the years to come. They interviewed heads of IT companies. And they analysed balance sheets and reports about company investments.

Benner admits, though, that the projections for the health IT sector could be too high if it turned out that the German national health IT project runs further out of schedule. “We have assumed a successful implementation of the German smartcard-project when calculating the growth rates for the health-IT sector”, said Benner. He could not say, however, how much lower the growth rate would be if the “elektronische Gesundheitskarte” (“electronic health insurance card”) experienced further delays.

In total, in Germany as well as in any other country, the health IT market is still only a small slice of the cake for IT companies. Benner said: “The whole market volume for IT in Germany was around Euros 57 bn in 2006.

Between 2 and 2.5 per cent of this went into health IT.” This adds up to between Euros 1.14 bn and 1.41 bn in 2006. An annual growth rate of 6 per cent would result in a market volume of nearly Euros 1.9 bn in the year 2011.


21 May 2007 

Diabetic patients in Carmarthenshire, Wales are piloting new electronic health records which will share all information about their care and check-ups by GPs and specialists. 

Informing Healthcare, the Welsh Assembly Government programme for NHS IT, has created the shared electronic diabetes record to bring all the patient’s information together so that the whole treatment history is in one single record.

The record will be accessible to all health professionals to add to, including the GP, hospital consultant, dietician or eye specialist. 

By doing this, all the specialists can look at, add to and review the patient’s medical history, avoiding duplication and uncertainty over who is doing what, including tests and investigations.

Dr Meurig Williams diabetes consultant for Carmarthenshire NHS Trust said: “We know that good management of diabetes can reduce complications and lengthen people’s lives. The shared record allows better collaboration between the different care settings and it provides the opportunity to change how we work together to improve services for patients.”

Patients can ask for a print out of their shared record that will show which healthcare professionals are involved, and their personal medication regime to help them understand which drugs they need to take and when.

Dr Terry Davies, GP and medical director of Carmarthenshire Local Health Board said: “Sharing information will help health professionals make informed decisions about the treatment needed. Patients who have a good knowledge of their treatment options are also better equipped to understand their condition so they can better manage their own care effectively and responsibly.”

Using new technology to share diabetes health records is a first for Wales and is one of a number of service improvement programmes introduced by Informing Healthcare. Making it a reality has involved collaboration between Carmarthenshire NHS Trust, the local health board, patients, and GP practices and their suppliers in Carmarthenshire and south Ceredigion.

Leo Lewis, Informing Healthcare project manager, commented: “We have been pleased to work in partnership with our colleagues in Carmarthenshire on this project, which is a positive example of how information and technology can support patient care and improve communication between clinicians.”

The project is supported by leaflets explaining why the shared diabetes electronic record can help patient care.

Diabetes is a growing problem throughout the UK, with 127,000 people with diabetes living in Wales, of which about 8,000 are in Carmarthenshire. Without the correct care people with diabetes are at increased risk of long term complications such as heart and kidney disease, blindness and amputations.

The initiative is part of a programme to deliver an individual health record for the whole of Wales and complements a parallel Informing Healthcare project in Gwent where a new electronic patient information service is allowing medical professionals on out of hours duty to view a patient’s emergency health record.

All GP practices involved use the INPS GP computer system, with the shared diabetes electronic record stored securely, with strict controls to ensure patients’ information is protected and remains confidential. 

Informing Healthcare



Information and communication technologies for better healthcare

Case studies

Improved quality of health treatment. Better access to care. Avoidance of unnecessary public expenditure. Information and communication technologies (ICT) can greatly benefit all aspects of delivering healthcare. These 10 case studies clearly demonstrate that eHealth matters, that it is well worth the investment, and that it can lead to substantial economic and social benefits.

The case studies are included in a newlypublished European Commission study “eHealth is Worth it – The economic benefits of implemented eHealth solutions at ten European sites”. Supported by the European Commission Information Society and Media Directorate-General, the study is one of the first attempts to assess the real impact of eHealth applications, their benefits and safety aspects.

GERMANY, Rhineland – With AOK Rheinland’s GesundheitsCard Europa, around 200,000 tourists from the Rhine region of Germany who visit the Dutch and Belgium coast can receive healthcare as conveniently as at home! 14 hospitals along the Dutch and Belgium coast accept the AOK Rheinland health insurance card, the ''GCE''. The secret of this system? The AOK multilingual website helps limit paper-based bureaucratic procedures and has reduced payment settlement time from up to two years to three months.

SWEDEN, County Councils – Sweden's national pharmacy system and its county councils embark on ePrescribing. 42% of all prescriptions in Sweden are now transferred from the doctor to the pharmacy electronically via a health extranet, Sjunet, or through web-based prescribing. This innovation increases the security and quality of prescriptions, reduces prescription errors, and saves time for health provider organisations. The cumulative benefits by 2008 are estimated at € 330 million, distributed between citizens (20%) and hospitals (80%).

ROMANIA, Bucharest – The City of Bucharest turns its slow paper-based ambulance systems into a dynamic timely and highquality service. Thanks to sophisticated ICTSUPPORTED dispatching, operators can today identify the nature of the emergency, give first help and guidance, and allocate an ambulance equipped with the appropriate facilities and staff. Time savings occur thanks to location-reporting through global positioning systems. This quickly identifies the nearest free ambulance to the location of the emergency.

FRANCE, Paris – In the Institut Curie, an electronic patient record (Elios) and a search meta-engine (Prométhée) shape the hospital of tomorrow. This leading research and treatment hospital specialised in cancer treatments is implementing two eHealth applications which have created a paperless hospital. Improved productivity and a comprehensive - yet focused - access to high-quality clinical information are among its many advantages. The estimated cumulative benefits by 2008 are expected to reach € 30 million.

BELGIUM, Flanders – Vaccination rates among young Flemish children reach almost 95% thanks to new eHealth applications. How to track children’s vaccination records best or manage the vaccination stock? How to rapidly but reliably inform healthcare practitioners on changes to vaccination policies and practices? The ICT-based Flemish Vaccination Database FVD, and the vaccination programme Vaccinet, are proving to be effective responses to these challenges. The estimated benefits to citizens account for about 95% of the total benefits.

SWEDEN and SPAIN, Västernorrlands län, Västra Götalands län and Barcelona – Radiology consultations between Sweden and Spain. Not enough radiologists in the hospital? This is not a problem for Swedish hospitals. Thanks to regular tele-consultation, Swedish patients can get advice from specialists in Spain. The new system means a reduction of waiting times by up to half, and similar cost savings. This tele-radiology service is only used for non-emergency examinations.

GERMANY, Münster – an electronic ordering system in hospitals. Supplies such as pharmacological or medical products are key cost factors for hospitals. To cut the costs medicalORDER®centre offers logistics support to German hospitals. The system leads to demand-based ordering rather than expensive storage of products. The results are: a smaller stock of supplies and less waste of materials that are not used before their expiration date.

DENMARK, various regions – Danish Health Data Network - Danish patients benefit from a unique nationwide eHealth system. This system offers faster, more efficient communication between patients, general practitioners and social care professionals. The benefits include cost savings on secretarial work and on electronic prescriptions. It generates considerable net economic benefits estimated to exceed €75 million on an annual basis by 2008. 

CZECH REPUBLIC, various regions – Webbased health records: empowered citizens, better informed health-care practitioners, continuity of care. The electronic healthcare record “IZIP” compiles information on the citizens’ contact with healthcare services, from regular visits to general practitioners to dental treatments or laboratory tests. With the consent of the patient, the IZIP system enables doctors to access the central information at the time and point of care. IZIP is supported by the largest health insurer in the Czech Republic, which serves two-thirds of the Czech population. Cumulative benefits should reach approx. €180 million by 2008. Estimated productivity gains, measured in a decrease in eHealth costs per record, amount to 74%.

UNITED KINGDOM, England – Direct Online information service. The new NHS Direct Online web portal can improve your knowledge of healthy lifestyles, healthcare and self-treatment. You can even find different interactive tools and an interactive health space. With this new service, British citizens can go online and find everything they need to know about health. All this without phone calls, without waiting for a free telephone operator, and during out-of-office hours.


Extraído do HealthDay, traduzido por Hispanicare

JUEVES 30 de noviembre 2006Los padres de niños hospitalizados en unidades de cuidados intensivos a menudo están preocupados y estresados, por lo que no siempre entienden del todo lo que los médicos les dicen.

Pero al grabar las conversaciones de los médicos, los padres pueden volver a escucharlas posteriormente a fin de entender lo que los médicos quisieron decir exactamente así como las recomendaciones dadas, de acuerdo con un informe realizado por investigadores australianos.

"Los pacientes, sobre todo cuando están estresados o en estado de shock, no recuerdan la información que le dan los médicos", dijo el Dr. Tieh Hee Koh, investigador principal, neonatólogo y director clínico del Instituto de salud materno-infantil de la Facultad de medicina de la Universidad James Cook de Douglas, Queensland. "Aún cuando nosotros los médicos hablamos con todo lujo de detalles sobre la afección, no recordarán nada", agregó.

Para el estudio, los investigadores reclutaron a 200 madres que tenían bebés en la unidad neonatal de cuidados intensivos. Las mujeres se dividieron en dos grupos. Un grupo consultó con médicos que grababan la conversación y se les suministró luego una copia de la grabación. El otro grupo no recibió la grabación.

Después de 10 días, y de nuevo a los cuatro meses, se pidió a las madres que recordaran el diagnóstico, las pruebas, el tratamiento y el resultado final de sus bebés, según lo explicado por los neonatólogos.

El equipo de Koh halló que las madres que recibieron la cinta recordaron en mayor medida el diagnóstico, el tratamiento y el resultado, que las madres del grupo de control. "Seis de las 100 madres que no recibieron la cinta no recordaron para nada las conversaciones con los médicos", dijo.

El estudio aparece en la edición en línea del 2 de diciembre del British Medical Journal.

Aunque las cintas no afectaron los niveles de ansiedad o depresión de las madres, el 96 por ciento escuchó las cintas y encontró que eran útiles. Además, entre los bebés con un mal pronóstico, las madres que recibieron las cintas estaban mucho más satisfechas con las conversaciones sostenidas con los médicos que las que no recibieron las cintas, hallaron los investigadores.

Los autores del estudio creen que este método de mejorar la comunicación entre los médicos, las familias y los pacientes puede extenderse a otras áreas de la atención médica.

Koh, que ha estado usando este método durante 12 años, recomienda "comprarle a cualquiera que vaya a ser hospitalizado o los médicos amigos una grabadora".

Un experto cree que el método de grabación no es necesariamente la mejor manera de que los pacientes y sus familias reciban la información que necesitan.

"Los pacientes nunca escuchan lo que los médicos les dicen", dijo el Dr. Charles Safran, profesor clínico asociado de medicina de la Facultad de medicina de Harvard y experto en comunicación entre médico y paciente. "No es sorprendente en el caso de los neonatos, donde los padres necesitan tener un PhD en cuidados intensivos para entender al menos someramente que le ocurre a su hijo, que no recuerden lo que sus médicos le informan".

Safran cree que existe la necesidad de una mejor comunicación y la respuesta podría estar en Internet. Usar una comunicación interactiva basada en Web permite a la gente acceder a la información que necesita en el momento que la precisa y ayuda a mejorar la comunicación entre los médicos, los pacientes y sus familias.

"Esta intervención basada en Web tiene un gran valor, pues la información siempre está presente y los padres pueden acceder a ella en el momento y lugar que la necesiten, en lugar de disponer de la grabación de una larga conversación con el médico", señaló Safran. "Si hacemos esto, mejoraremos la satisfacción de los padres de manera dramática".

Artígo do HealthDay, traduzido por Hispanicare


    By Neil Versel, contributing editor

Early reactions are mixed to a multimillion-dollar plan by five major corporations to distribute personal health records (PHRs) to employees, with some calling the idea a boon to interoperability of health information, while others say such electronic records threaten patient privacy. 

On Wednesday, Applied Materials, BP America, Intel, Pitney Bowes, and Wal-Mart Stores will jointly announce "a major initiative to help employees better manage their healthcare, improve communications between doctors and patients, and reduce inefficiencies in the healthcare system," according to a media advisory. The firms will be joined at their Washington press conference by representatives from the American Academy of Family Physicians, the federal Centers for Disease Control and Prevention, the National Association of Manufacturers, and the National Consumers League.

According to a Nov. 29 story in The Wall Street Journal, the companies intend to create a standard for portable electronic health records (EHRs) and build a data warehouse to store individual patient information from hospitals, physician practices, pharmacies, and other sources. Information gleaned from the data reportedly will help individuals compare price and quality among various health providers.

This group of five say they will insist that healthcare providers move to EHRs and electronic prescribing "as a condition for future business," the Journal reports. Participation will be optional for employees, the story indicates.

Intel chairman Craig Barrett told Digital HealthCare & Productivity in late September that employers will have to start demanding quality because he does not believe the healthcare industry is "capable of modifying itself." (See http://tmlr.net/jump/?c=22876&a=296&m=4108&p=962974&t=164.)

The Journal story also indicates that each company is prepared to spend $1.5 million to build the data repository, and that about five additional large firms will sign on and contribute a similar amount of money. An Intel spokeswoman said Monday that the report was accurate, though not as "in-depth" as what will be disclosed Wednesday.

Francois de Brantes, national coordinator for Bridges to Excellence, a coalition of major employers, health plans, and others that wish to offer financial incentives to healthcare providers to deliver quality care, is enthusiastic about the idea, but says a PHR is but one piece of a much larger puzzle.

"I think it's important for those companies as an additional tool to engage their employees," de Brantes says of the employer-sponsored records and data warehouse. "This can jump-start the aggregation of data across different providers."

However, success of this or any other purchaser-driven healthcare quality program depends on employee participation, according to de Brantes. "Nothing is complete until the patient fills in the information that only the patient would know," he says. This could include personal and family medical history, as well as medication lists and even lifestyle details.

The corporate ambitions also may be premature if the employers do not put in adequate safeguards to prevent misuse of patient information, privacy advocates suggest. The Austin, Texas-based Patient Privacy Rights Foundation already is discouraging use of the planned PHRs.

"You'd be crazy to participate when you have no legal control at all over who uses your electronic records in a database you don't even own," says Deborah C. Peel, M.D., the organization's founder and one of five board members.

The companies are not commenting prior to the Wednesday press conference.

* Extraído do Digital HealthCare & Productivity - Dexembro/2006


       Por: Mark Els - 04/10/2006

Os governos federal e das províncias canadenses são unânimes: os prontuários eletrônicos (EHRs) significarão um atendimento médico mais eficiente e seguro.

Contudo, isto representa regras totalmente novas para privacidade e proteção às informações.

A Canada Health Infoway, Inc., que  inclui 14 ministros canadenses da esfera federal, provicial e territorial, busca recursos da ordem de bilhões de dólares ao longo da próxima década, para construir e tornar segura a gigantesca rede de bancos de dados interoperáveis dos Pacientes.

Como reflexo da prioridade das questões de privacidade, a Infoway contratou, no ano passado, um estrategista de privacidade chefe. Joan Roch, anteriormente principal executiva para assuntos de privacidade do Instituto Canadense para Informações de Saúde, foi incumbida de assegurar que o sistema de EHR esteja em cumprimento com a Lei Federal de Proteção a Informações Pessoais e Documentos Eletrônicos, além de várias leis de proteção a informações e à privacidade, na esfera das províncias.

Avançadas tecnologias oferecem toda a sorte de chaves e trancas para proteger informações. Incluem identificação e autenticação do usuário, controle de acesso, criptografia de dados, firewalls para redes e sistemas de prevenção a invasões.

“Quando as pessoas dizem que estão preocupadas com EHRs em razão da sua privacidade, a coisa está praticamente invertida", afirma Steven Lewis, um consultor de política e pesquisa do Conselho de Saúde canadense, na cidade de Saskatoon.

Para melhor entender os EHRs, afirma Lewis, as pessoas precisam de um contexto. “E o contexto é o seguinte: a melhor forma de proteger a privacidade das informações pessoas de saúde é tornando-as eletrônicas”.

“Se tivéssemos de optar entre os métodos em papel e eletrônico, escolheríamos o eletrônico, sem pestanejar.”

A tecnologia tem condições de construir uma fortaleza ainda melhor para proteger as informações particulares em um mundo eletrônico. Mas, na realidade, as medidas de segurança podem ir até um determinado ponto, antes que restrinjam o fluxo de trabalho do atendimento médico e até impedir a atuação dos médicos.

É preciso que médicos e enfermeiras tenham pronto acesso às informações, especialmente em situações de emergência. O acesso pode ser baseado na função de cada profissional, mas assim que um prestador de serviços médicos for admitido às informações, estas correm livremente.

“As pessoas têm o direito de esperar um sistema seguro e vigilante", afirma Lewis. “Não é razoável esperar uma certeza de 100% de que uma [quebra de segurança] nunca ocorra. As pessoas devem esperar, e os sistemas devemchegar a um nível de confiabilidade extremamente elevado”.

Defensores da privacidade, de forma geral, ainda não estão satisfeitos. Ann Cavoukian, comissária de informações e privacidade da província de Ontário, afirma que o acesso ainda é muito amplo e as definições de função ainda muito toscas.

Em um recente incidente em um hospital em Ottawa, uma enfermeira foi pega acessando prontuários de pacientes aos quais não tinha direito de acesso. Isto ilustra o problema dos EHRs e dos atuais sistemas de software, afirma Cavoukian.

“Nenhum deles tem restrição de acesso especialmente segura. Tem de haver sistemas melhores, para conceder melhor proteção. Sou um grande fã dos EHR, e não há dúvida que este é o caminho para o futuro. Mas por enquanto não temos, nem de longe, os proteções necessárias”.

“Acredito que o equilíbrio [entre proteção e acesso] ainda não é forte o suficiente. Minha opinião é que o equilíbrio, neste momento, e entendo as razões disso, está muito mais no amplo acesso ao EHR do paciente".

Os EHRs têm a vantagem de oferecer um histórico eletrônico de acessos, os chamados audit trails, mas Cavoukian quer ver um acesso mais rígido, baseado nas funções dos profissionais e no cumprimento mais severo das políticas.

“Informações médicas, diferentemente de quaisquer outras informações pessoais, são verdadeiramente bi-modias em sua natureza,” afirma. "Por um lado, as pessoas querem que todos os profissionais de saúde que as atendam tenham rápido e fácil acesso às informações; por outro lado, querem proteger essas informações da melhor forma possível contra acesso de pessoas não autorizadas.”

Cavoukian afirma que alguém tem de ser responsável pela supervisão da proteção que precisa ser embutida, acompanhando e assegurando que as políticas estejam presentes dentro dos regulamentos mais amplos do hospital.

“Um dos problemas da criação de sistemas de proteção à privacidade é que eles são novos. Isto significa que não fazem parte das políticas mais amplas já existentes em um hospital e simplesmente não são seguidos”.

A maior parte das pessoas acredita que os médicos se comportam profissionalmente. Os maiores riscos à privacidade e proteção de informações dos pacientes são encontrados quando os EHRs saem da esfera do atendimento médico, observa Frank Work, comissário de informação e privacidade da província de Alberta.

Um dos maiores problemas são os bancos de dados órfãos ou abandonados, acrescenta. “Alguns desses bancos de dados sobrevivem além de sua utilidade, e não sabemos o que acaba acontecendo com essas informações”.

“Não existe uma lei que determine o que deve ser feito com um banco de dados após sua desativação."

O governo da província de British Columbia sofreu um revés no início do ano, quando leilou algumas fitas de backup antigas, que não haviam sido devidamente apagadas, expondo milhares de registros de saúde sigilosos e identificáveis.

Bancos de dados também são utilizados para pesquisa médica. Por isso, são cobiçados por pesquisadores e empresas farmacêuticas como verdadeiras arcas do tesouro.

“A questão da pesquisa, em seu todo, é enorme, porque todos esses sistemas interconectados e interoperáveis são extremamente atraentes aos pesquisadores,” afirma Work. “Do ponto de vista social, essa será a questão mais difícil de resolver, à medida em que os registros médicos são conectados mais rapidamente e mais amplamente”.

Quaisquer solicitações para acessar informações de saúde precisam ser previamente aprovadas por conselhos de ética na pesquisa, mas Work acredita que todo o processo é motivo de preocupação. “O sistema é terrível; é um sistema muito ruim,” diz ele.

Conselhos de ética de pesquisa têm sede em hospitais e universidades, sendo constituídos de voluntários, explica Work. “Eles simplesmente não estão preparados para lidar com o porte desses bancos de dados e a complexidade das pesquisas que estão sendo propostas.”

“Nosso sistema de aprovação de pesquisas ainda é muito antiquado. Os bancos de dados estão se tornando cada vez maiores e mais atraentes. Contudo, o processo através do qual o acesso e o uso das informações de saúde é aprovado não está acompanhando este grau de complexidade”.

Os dados podem ter a identificação removida ou ser anonimizados, mas em muitos casos nenhuma das duas opções é válida para estudos longitudinais, nos quais os pesquisadores acompanham pacientes ao longo de um extenso período.

David Loukidelis, comissário de informações e privacidade da província da British Columbia, diz que os arquitetos do sistema e legisladores têm de ter uma clara noção quais serão os usos finais dos dados.

Quando fazem sua avaliação de impacto de privacidade e projetam a arquitetura do sistema, deve-se perguntar: como está sendo criado o sistema  e por que?

“Por qual motivo são necessários dados identificáveis?” pergunta Loukidelis. “Esta deveria sempre ser a primeira pergunta no ambiente eletrônico”. “Estudos longitudinais são uma questão diferente, mas parece que muito do que é feito hoje em dia poderia ser feito com dados anonimizados ou com identificação removida.”

Loukidelis concorda que os EHRs podem ser muito valiosos aos pesquisadores. “Mas, ao mesmo tempo, precisamos ter certeza que temos implementados os devidos princípios e proteções de privacidade, para políticas e tecnologias”. “São necessários, também, absoluta determinação, vontade e vigilância por parte da administração, para assumir essas coisas.”

Outra preocupação é a facilidade dos dados saírem das instalações. À medida que, cada vez mais, migramos para os ambientes on-line ou eletrônicos, teremos mais e mais dados armazenados em dispositivos portáteis, como BlackBerrys, telefones celulares inteligentes ou computadores laptop."

“É mais um exemplo de uma área na qual precisaremos começar a trabalhar com tecnologias com criptografia,” diz Loukidelis.

Recentemente, houve notícia de um laptop furtado que continha informações financeiras e pessoais sobre aproximadamente 8 mil clientes da MD Management, uma subsidiária da Associação Médica Canadense (CMA). É apenas um de inúmeros laptops furtados que colocaram informações sensíveis em risco de furto de identidade.

Mas existem vários tipos de questões envolvendo a gestão de bancos de dados, admite Bill Pascal, principal executivo de tecnologia da CMA. A questão acaba se resumindo em buscar o ponto de equilíbrio entre privacidade e acesso, e estabelecer um ambiente de política consistente em todo o Canadá.

O sistema precisa ser fácil de usado pelos médicos e criterioso com as informações particulares do paciente; de acordo com Pascal, a maior parte das políticas que cercam o atendimento terapeutico já foram decididas.

“As informações são compartilhas com base no critério de importância estabelecido pelo médico que refere um paciente a outro. A discussão agora caminha para como determinar quais informações são de fato necessárias e pertencentes a um conjunto mínimo de dados.”

“Já progredimos até um nível bem detalhado e agora estamos trabalhando nos aspectos mais sutis. Esta é a parte mais difícil, porque aborda algums questões muito éticas.”

É necessário debater muito oassunto para determinar as regras de como as informações serão utilizadas para finalidades secundárias, tais como pesquisa e gestão de sistemas administrativos.

Pascal observa que nenhuma dessas questões havia sido resolvida no mundo do papel. Agora que foram criados gigantescos bancos de dados, e estes podem ser manipulados fácil e rapidamente, existe uma demanda maior para ter acesso a estes bancos de dados.

“Temos de respeitar o fato de que o indivíduo forneceu os dados para uma finalidade e agora os estamos usando para outra."

É um mundo que requer atenção constante, afirma Pascal. “Não é algo para o qual se possa estabelecer uma série de políticas e simplesmente esquecê-las.”
                                                                                                                                  Mark Els ( mels@itworldcanada.com ) é redador sênior do NetworkWorld e contribuinte habitual da CIO Government Review.


03 Oct 2006

GP computer supplier EMIS is to roll out the next generation of its primary care software, EMIS Web, to 1,000 practices from this month.

The company says EMIS Web will provide a common clinical record that can be shared by GPs and community healthcare teams with data accessible anywhere via the web-based application.

The aim is for the software to work initially alongside GP practices’ existing systems, such as EMIS LV or PCS, with practices able to stream data into the new system from their existing software which can then be shared by others such as district nurses or health visitors and even accident and emergency departments if the practice and the patient chooses. The system includes both GP and community functionality.

The version of EMIS Web to be used by practices from this month is a “clinical record viewer” but Sean Riddell, managing director of EMIS, said the system would add new modules over the next year so that it would eventually replace LV and PCS as practices choose to move over.

He told EHI Primary Care: “Its not going to remove the functionality of LV and PCS and people can use the new software functions over a period of time that they are comfortable with.”

Rollout to 1,000 practices will begin this month and EMIS hopes it will be complete by early 2007. After a period of review the system will then be made available to the rest of EMIS’ practices in the UK.

The system will enable all practices using it to electronically exchange records when patients move to another EMIS Web practice as GP2GP functionality is built into it. Riddell added: “It will also enable practices to view their data in the most sophisticated way and the search and reporting module will mean that any changes made in the local database will be reflected in the central system.”

EMIS Web will operate from a central-hosted data centre but practices will continue to retain their local server based systems as well.

Riddell added: “To start with local server based sites will stream to the centre and then eventually when the central hosted system is their primary database, the centre will be stream back a local copy. “

The system has been piloted by practices and community teams in Kirklees and Calderdale Primary Care Trust and Tower Hamlets Primary Care Trust which have been testing out the interoperability with different clinical specialties.

Riddell said EMIS Web, which was initially called PCS Web, is part of the company’s “convergence strategy” to move practices seamlessly from one version of its software to the next.

Riddell added: “No health care company will survive in the future if you are not fully interoperable and that is what this gives us.”



Jack Beaudoin - Editorial Director  -  29/09/2006 

(extraído da Healthcare IT Word)

WASHINGTON  – The number of health information exchanges in the United States has increased over the past year, and more of the organizations are exchanging clinical data, according to survey results released Monday at the Health Information Technology Summit. 

Janet Marchibroda, executive director of the eHealth Initiative, said the “Third Annual Survey of Health Information Exchange at the State, Regional and Community Levels” presents an optimistic assessment of progress.

“The first thing we found is the level of policy activity and leadership at the state level has increased significantly,” Marchibroda said. “This is moving very, very quickly at the state level – 10 executive orders from governors, and 36 bills passed in 24 states over the last 19 months.”

The eHealth Initiative surveyed 165 health information exchanges in 49 states, the District of Columbia and Puerto Rico. More than a quarter (45) identified themselves as in the implementation stage, while 18 percent (26) claim to be fully operational – that is, they are exchanging clinical data today.

According to the eHeath Initiative’s definition, that includes claims, dictation, emergency room episodes, enrollment and eligibility data, inpatient and outpatient episodes, laboratory results and radiology results.

These findings will only fuel the debate that has arisen over conflicting findings from other studies and reports released over the past year.

In June, the Health IT Transition Group reported that about 30 percent of RHIOs, or regional health information organizations, were in the production phase and exchanging live data. About 18 percent were considered in “mature” production. But a May 2006 study conducted by Avalere Health on behalf of the Agency for Healthcare Research and Quality reached a different conclusion.

“As we pulled back the curtain on these state-based projects, it became clear that publicly available characterizations of progress are generally overstated, and few projects are exchanging actual clinical data,” said Sheera Rosenfeld, senior manager of Avalere Health and primary author of the paper.

Qualitative differences are emerging from the data. Marchibroda said community-based organizations tended to focus on implementation, while state level organizations tended to expend efforts on policy development and planning.

One key finding from the 2006 study is that health information exchanges are turning to users of their services for ongoing funding. Marchibroda said that while the federal government continues to be the primary source of cash, exchanges are now seeking revenues from data providers and data consumer.  

Of those organizations surveyed, 24 percent of respondents said they were receiving funds from hospitals, 21 percent reported receiving funds from payers, 16 percent were receiving funds from physician practices and 13 percent received funds from laboratories.

“This is the challenge of the next year, I think,” said eHI president John Glaser, CIO of Partners Healthcare in Boston. “We’ve got to find sustainable models to support these initiatives


Comissão Europeia
Direção-Geral da Imprensa e Comunicação
Manuscrito concluído em Outubro de 2002

- A UE e a sociedade do conhecimento
- Pôr a marca da Europa na Internet 
- Manter a Europa competitiva 
- eEuropa 2002: as componentes 
- Realizações até à data: eEuropa 2002 
- O futuro: eEuropa 2005  
- Próximos Passos                  


A Internet está a mudar o mundo em que vivemos. Esta mudança não é menos importante do que a revolução industrial dos séculos XVIII e XIX.    Nas últimas duas décadas, as tecnologias da informação e a Internet transformaram o modo como as empresas funcionam, os estudantes estudam, os cientistas realizam trabalhos de investigação e as administrações públicas fornecem serviços aos cidadãos.

As tecnologias digitais revelaram‑se um poderoso factor de crescimento económico e competitividade. Nos anos 90, as empresas e os consumidores nos EUA tiraram rapidamente partido desta «revolução digital». Assim, as empresas dos EUA tornaram‑se muito mais competitivas e a economia deste país teve um crescimento espectacular e sem precedentes.

Na Cimeira de Lisboa de Março de 2000, os chefes de Estado e de Governo europeus reconheceram que a Europa tinha também de se tornar uma economia muito mais digital. Nessa ocasião, estabeleceram um novo  objectivo para a União Europeia — tornar‑se a sociedade do conhecimento mais competitiva do mundo em 2010.

O êxito da UE na consecução deste objectivo é determinante para a qualidade de vida dos seus cidadãos, as condições de trabalho dos seus trabalhadores e a competitividade mundial das suas indústrias e serviços.

É tempo de agir

Já em Novembro de 1999, a Comissão Europeia avançou com a sua iniciativa eEuropa, precisamente para gerir esta transição, tanto na União Europeia como nos países candidatos da Europa Central e Oriental.

O eEuropa tem como objectivo garantir que, na União Europeia, todos – cidadãos, escolas, empresas, administrações – tenham acesso às novas tecnologias da informação e das comunicações e as explorem plenamente. Por exemplo, a Internet pode ser utilizada numa vasta gama de actividades diárias, serviços e produtos, como o ensino, a administração pública, a saúde, a cultura e o lazer.

Assim, o eEuropa não tem em vista apenas tornar as empresas europeias mais competitivas: pretende também que todos os cidadãos europeus, especialmente os que têm necessidades especiais, tenham acesso às modernas tecnologias das comunicações para melhorar a sua qualidade de vida.

Devem ter acesso em linha directo e interactivo a conhecimentos, ensino, formação, administração pública, serviços de saúde, cultura e lazer, serviços financeiros e muitas outras coisas. Na sociedade de hoje, o acesso à Internet tornou‑se um direito fundamental para todos os cidadãos, pelo que os governos responsáveis têm o dever de o garantir.


As tecnologias da informação e das comunicações fomentam o crescimento económico, proporcionam a criação de novos e melhores postos de trabalho e geram maior prosperidade. Os governos europeus pretendem que estes benefícios atinjam toda a sociedade e não apenas uma minoria privilegiada. A nova sociedade do conhecimento deve ser uma sociedade inclusiva. Também aqui a Internet oferece grandes possibilidades: quem souber utilizar um computador pode ser socialmente activo clicando simplesmente com um rato. O eEuropa e os seus programas componentes (eLearning, eHealth, eGovernment e eBusiness) incidem na plena exploração destas potencialidades com vista à inclusão social.

O alargamento da UE vem dar ainda mais importância a este processo. Prevê‑se que, por volta de 2004, dez novos países (República Checa, Estónia, Chipre, Letónia, Lituânia, Hungria, Malta, Polónia, Eslovénia e Eslováquia) adiram à União, acrescentando cerca de 75 milhões de cidadãos à nossa comunidade que conta já 375 milhões. A inclusão social é vital para o êxito deste grande alargamento, sendo a «inclusão digital» um aspecto importante deste processo.
Ao pôr em destaque a inclusão digital, a Comissão Europeia pretende fazer uma distinção entre a abordagem europeia da sociedade da informação e as de outras regiões do mundo. É sabido que os EUA ultrapassaram a Europa no ritmo inicial de adesão das empresas e dos cidadãos à Internet. No entanto, o eEuropa está a contribuir para a recuperação da Europa, canalizando esforços a nível regional, nacional e europeu para que a economia digital proporcione benefícios a todos os cidadãos europeus e que a Europa ponha a sua marca na Internet.

Os esforços da UE aproveitam e reforçam o «modelo social europeu», que garante um elevado nível de protecção social. Pretendem também preservar a diversidade linguística e cultural existente na Europa. Incidem no desenvolvimento de conteúdos europeus em línguas europeias, para que todos tenham acesso a serviços e conteúdos na sua própria língua. A Internet pode transformar o mundo numa aldeia mundial, mas a UE está empenhada em garantir que nesta aldeia as línguas e culturas continuem a ter o seu papel a nível local.


Para terem êxito no actual mercado mundial, as empresas apoiam‑se nas tecnologias da informação e das comunicações — para contactar com os seus clientes e fornecedores, efectuar a contabilidade, dirigir instalações fabris ou apresentar declarações de impostos.

Assim, as tecnologias da informação e das comunicações (TIC) tornaram‑se «tecnologias difusoras». Por outras palavras, servem de suporte à competitividade e facilitam o funcionamento de todos os sectores da economia. Deste modo, a utilização crescente das TIC fomenta o crescimento e a competitividade.

No entanto, não se obtém uma economia forte e competitiva através da simples incorporação das tecnologias digitais nas indústrias ou nos serviços: são também necessários trabalhadores altamente qualificados que trabalhem com os novos sistemas e consumidores com cultura digital que comprem os novos produtos e serviços. Tal implica formação e ensino para pessoas de todas as idades. Consequentemente, a competitividade depende do nível de investimento nas pessoas.

Os políticos estão igualmente bem cientes de que as TIC contribuem directa e fortemente para a economia da UE. Na Europa Ocidental, o sector das TIC representava 643 000 milhões de euros em 2001, ou seja 7,5% do PIB. Em 2001, cresceu 5,1% graças ao crescimento de 3,9% nas TI e de 6,4% nas telecomunicações, segundo o Observatório Europeu das Tecnologias da Informação.

Na Cimeira de Lisboa de Março de 2000, os líderes da UE reconheceram estes factos. Nas conclusões da cimeira, sublinharam que:

·          «as empresas e os cidadãos devem ter acesso a uma infra‑estrutura de comunicações pouco dispendiosa e à escala mundial, bem como a um vasto leque de serviços»;

·          «cada cidadão deve estar provido das competências necessárias para viver e trabalhar nesta nova sociedade da informação» e

·          «deve ser dada maior prioridade à aprendizagem ao longo da vida como componente básica do modelo social europeu».

 O objectivo global fixado pelos líderes da UE em Lisboa consiste em tornar a União Europeia a sociedade do conhecimento mais competitiva do mundo em 2010. Reunir‑se‑ão em cada Primavera para fazerem o ponto da situação do caminho percorrido rumo àquele objectivo e ainda para identificarem as prioridades para os 12 meses seguintes.

Mercados livres e melhor investigação

Embora o eEuropa desempenhe um papel essencial na realização do objectivo de Lisboa, a UE necessita também de investir mais na investigação e de abrir os seus mercados a uma maior concorrência — especialmente em alguns sectores essenciais que, até hoje, têm sido dominados por fornecedores nacionais.

Assim, a UE impôs a si própria calendários para, nomeadamente:

- liberalizar os mercados europeus da energia e das telecomunicações;

- criar o mercado único dos serviços financeiros;

- avançar na liberalização dos serviços postais e de transportes;

- instaurar uma patente da UE;

- lançar o sistema Galileu de navegação por satélite;

- criar o mercado único do transporte aéreo — mais conhecido como    «céu único europeu».

Os líderes da UE concordaram ainda em aumentar as despesas de investigação de modo que, em 2010, 3% do PIB seja investido em actividades de investigação e desenvolvimento tecnológico.


A iniciativa eEuropa da União Europeia baseia‑se na premissa de que a Internet é essencial para o crescimento económico, a criação de emprego e a melhoria da qualidade de vida — não apenas na Europa mas em tudo o mundo. O eEuropa é necessariamente ambicioso. Pretende pôr em linha assim que possível todos os cidadãos da UE, de modo que a utilização da Internet se torne comum — no emprego, na escola ou em casa, através dum computador, dum telemóvel ou dum aparelho para ligar ao televisor.

Pretende que a Europa adquira cultura digital e que todo o processo seja socialmente inclusivo, reforce a confiança dos consumidores e diminua o fosso entre os infofavorecidos e os infodesfavorecidos na sociedade europeia.

A Comissão Europeia lançou a configuração básica do eEuropa em Novembro de 1999. Os planos de acção subsequentes estabeleceram itinerários que definem as acções a realizar e respectivo calendário.

Até agora, houve dois planos de acção:
- o plano de acção 2002, aprovado pelos líderes da UE na Cimeira da Feira, em Junho de 2000;

- o plano de acção 2005, aprovado pelos líderes da UE em Sevilha, em Junho de 2002.

Ambos têm como objectivo criar uma sociedade da informação inclusiva, mas a situação evoluiu após o ano 2000: algumas medidas ficaram concluídas e surgiram novos desafios. Assim, o segundo plano de acção actualiza as prioridades da UE e afina o processo.

O plano de acção 2002 era de largo espectro, tendo conseguido pôr a Internet no topo da agenda política europeia. O plano de acção 2005 está mais focalizado, incidindo no acesso efectivo, na utilização e na disponibilidade da Internet.

O eEuropa 2005 coloca os utilizadores no centro. A todos os níveis e em todas as medidas de execução, põe em realce a e‑inclusão, nomeadamente a e-acessibilidade para pessoas com necessidades especiais. A e‑inclusão implica que os serviços essenciais devem estar disponíveis não só através de computadores pessoais, mas também da televisão digital interactiva, dos telemóveis de terceira geração e das redes de cabo.

Segundo os líderes da UE, o novo plano de acção deve incidir na disponibilidade e utilização generalizada das redes de banda larga em toda a União em 2005, bem como na segurança das redes e da informação, na administração pública em linha, no ensino em linha, na saúde em linha e nos negócios em linha.

Como funciona a UE?

O eEuropa não se destina a criar novas instituições ou leis. Pretende coordenar e dar um objectivo comum às acções políticas já existentes em muitos e diversos contextos:

* Competências nacionais: cada país da UE tem o direito exclusivo de decidir do modo de funcionamento dos seus sistemas de ensino e serviços públicos. No entanto, decidiram aprender mutuamente, fixando objectivos comuns e trocando informações sobre o modo como os vão realizando. Chama‑se a isto «método de coordenação aberta». As autoridades regionais ou locais são muitas vezes responsáveis pelas acções no terreno.

* Competências da União Europeia: os Tratados da UE estipulam que pode ser estabelecida legislação europeia em domínios como o comércio livre de mercadorias. Parte desta legislação é adaptada para ter em conta as novas tecnologias. O orçamento da UE financia programas que promovem o desenvolvimento nas regiões mais desfavorecidas, a investigação, o intercâmbio no ensino, etc. Uma parte deste dinheiro é reorientado para promover a utilização da Internet.


Quando o programa eEuropa foi concebido em 2000, a utilização da Internet na Europa era entravada essencialmente por:

- acesso caro, inseguro e lento;

- número insuficiente de pessoas com cultura digital em linha;                    

- ausência de uma cultura suficientemente dinâmica, empresarial e orientada para os serviços;

- apoio insuficiente do sector público ao desenvolvimento de novas aplicações e serviços.

O eEuropa identificou as medidas necessárias para resolver estes problemas. Tais medidas centravam‑se em três grandes objectivos:

- desenvolver um acesso à Internet mais barato, mais rápido e mais seguro;

- investir nas pessoas e nas qualificações;

- estimular a utilização da Internet.

O eEuropa 2002 alcançou êxitos significativos em todos estes domínios nos últimos três anos.

Acesso à Internet mais barato, mais rápido e mais seguro

Uma das grandes prioridades do eEuropa 2002 era modernizar as regras e a regulamentação aplicáveis ao acesso à Internet, com vista a criar um mercado único de todos os serviços de telecomunicações.

As condições de acesso à Internet foram influenciadas por leis e estruturas dos  tempos antigos, em que a maioria dos clientes estava dependente de uma única companhia telefónica monopolista. A liberalização teve início nos finais dos anos 80, mas não avançou suficientemente. Assim, em Março de 2002, a UE adoptou formalmente um novo quadro regulamentar. Este pacote simplificará e racionalizará o actual quadro legislativo da UE, reduzindo o número de diplomas de 23 para 8 e criando um mercado das telecomunicações verdadeiramente liberalizado em que a concorrência faz baixar os preços e melhora a qualidade dos serviços. O resultado é um acesso à Internet mais barato e mais rápido para os cidadãos e as empresas.

E a segurança? Os riscos de quebra da segurança multiplicam‑se com a explosão da Internet, pelo que a Europa, para pôr e manter os utilizadores em linha, deve assegurar a confiança dos consumidores e das empresas na Internet.

Também aqui a UE tem estado activa. A Comissão elaborou estratégias globais para a segurança das redes e da informação. Propôs também uma decisão‑quadro sobre o combate ao terrorismo (que inclui ataques a sistemas da informação) e uma decisão específica sobre ataques a sistemas informáticos. O objectivo é garantir que os diversos países da UE tomem medidas contra os autores de ataques graves.

Igualmente importante para a confiança dos consumidores é a protecção dos dados e a privacidade. Uma directiva‑quadro da UE de 1995 e uma directiva específica de 1998 (alterada posteriormente) que abrangem as comunicações electrónicas garantem um elevado grau de privacidade para os cidadãos e a livre circulação de dados pessoais dentro da UE e para países terceiros com normas semelhantes.

Resultados: Em meados de 2002, 40% das residências na UE tinham acesso à Internet, de acordo com o relatório de avaliação do desempenho do eEuropa para 2002, valor este que era de 18% em Março de 2000. Este salto enorme significa que há cerca de 150 milhões de utilizadores da Internet na Europa, número este semelhante ao que se regista nos EUA. O número de utilizadores da Internet em todo o mundo é de 404 milhões, prevendo‑se que em 2005 seja de 550 milhões.

Os custos de acesso à Internet estão a diminuir. Um inquérito da Comissão realizado em Novembro de 2001 revela que, para um utilizador doméstico típico (ou seja, 20 horas de utilização no horário económico), os custos mensais correspondentes à oferta mais barata na maioria dos Estados‑Membros situam‑se entre 10 e 20 euros, incluindo os encargos das chamadas.

Investir nas pessoas e nas qualificações

Na cimeira de Lisboa, os líderes da UE reconheceram que, no futuro, a competitividade depende de uma política de ensino renovada, incluindo o ensino em linha e a formação vocacional ao longo da vida.

Cada país da UE continua a ser plenamente responsável pela organização do seu sistema nacional de ensino e pelos conteúdos leccionados nas escolas e universidades. No entanto, a UE desempenha um papel crucial na coordenação das políticas nacionais com vista a objectivos comuns à escala da UE.

Neste domínio, entra em cena o programa eLearning, que coordena as actividades nacionais de modernização dos nossos sistemas de ensino e formação vocacional. O objectivo é que os estudantes, no fim dos seus estudos, tenham adquirido cultura informática e que os trabalhadores tenham direito a uma aprendizagem ao longo da vida, de modo a poderem acompanhar a revolução da Internet nos seus locais de trabalho.

Este movimento de modernização oferece às crianças e aos estudantes oportunidades de ensino em linha que muitas bibliotecas de escolas e universidades não poderiam oferecer de outro modo e nunca em quantidade necessária.

Entretanto, os sectores da indústria e dos serviços terão os trabalhadores altamente qualificados de que necessitam e haverá consumidores com cultura digital dispostos a comprar os novos produtos e serviços.

Os governos dos países da UE comprometeram‑se a:

·        aumentar substancialmente, todos os anos, o investimento per capita em recursos humanos (inclusive na educação), que foi, em media, de 5% do PIB em 1999 e 5,1% em 2000;

·        reduzir para metade, em 2010, o número de jovens entre os 18 e os 24 anos que têm apenas o nível básico do ensino secundário e não prosseguem os seus estudos ou formação;

·        transformar as escolas e os centros de formação, todos ligados à Internet, em centros de ensino local polivalentes acessíveis a todos;

·        aceitar um quadro europeu que define as novas qualificações de base (incluindo qualificações em TI, línguas estrangeiras, cultura tecnológica, qualificações empresariais e sociais) a fornecer através do ensino ao longo da vida.

Resultados: A meta inicial era que no final de 2001 todas as escolas na UE tivessem acesso à Internet e a recursos multimedia. Em 2002, 93% das escolas da União tinham acesso à Internet, valor este que era de 89% em 2001. Destas, 64% têm ligações RDIS, enquanto 19% têm acesso em banda larga através da tecnologia ADSL. Existem ainda grandes discrepâncias entre os diferentes países da UE, mas estão a diminuir. Em 2001, havia, em media, um computador em linha por cada 25 estudantes. Em 2002, havia já um computador em linha por cada 17 estudantes. O objectivo para o final de 2003 é que haja um computador em linha por cada 15 estudantes.

Nos locais de trabalho, o objectivo é que as pessoas possam adquirir — em qualquer altura da sua vida — novos conhecimentos e qualificações com vista à sua futura empregabilidade. Este objectivo é crucial em termos sociais, para que a UE evite a exclusão numa União Europeia em que 150 milhões de cidadãos não concluíram o escalão mais alto do ensino secundário. Assim, a garantia da aprendizagem ao longo da vida é fundamental para o nosso modelo social europeu, contribuindo para tornar possível a e‑inclusão.

Em 2002, mais de 50% dos trabalhadores na UE utilizavam computadores nos seus locais de trabalho, tendo esta percentagem aumentado em cerca de um quinto desde 2001. Três em cada quatro trabalhadores não‑manuais utilizam computadores. No entanto, é insuficiente o número de pessoas que recebem a necessária formação: só cerca de um terço da mão‑de‑obra na UE recebeu formação informática com vista a um emprego. Esta situação tem de melhorar: as qualificações digitais são essenciais para a empregabilidade dos trabalhadores em todos os sectores.

Estimular a utilização da Internet

O estímulo à adopção da Internet na UE tem‑se centrado na oferta de um ambiente favorável em que as empresas e outras organizações possam desenvolver qualificações e serviços digitais. Por exemplo, foi estabelecido um quadro jurídico para o comércio electrónico numa directiva que se tornou lei em toda a UE em Janeiro de 2002. Em Março de 2002, foi tomada a decisão formal de criar o domínio de topo «.eu» que permitirá aos cidadãos, organizações e empresas europeus ter sítios Web e endereços de correio electrónico terminados em «.eu», em vez do código que indica o país ou «.com».

No entanto, a maioria das acções da UE não tem que ver com legislação, baseando‑se antes na pressão entre homólogos e nos exames anuais da Primavera em que se verifica se cada país da UE está a fazer, de facto, o que prometeu aos outros para promover a administração pública em linha, a saúde em linha, os conteúdos electrónicos e outras iniciativas similares.

Acesso fácil aos serviços públicos

O mote do plano eGovernment é: «mais vale em linha do que em fila». O objectivo é fornecer um acesso electrónico fácil aos serviços públicos. Acabar com as filas de espera! Os governos da UE iniciaram a disponibilização em linha de 20 serviços básicos. Para os cidadãos, estes serviços incluem a apresentação da declaração de imposto sobre o rendimento e a procura de emprego; para as empresas, é possível agora utilizar a Internet para enviar as declarações de IVA, registar novas empresas, preencher as declarações aduaneiras e celebrar contratos públicos.

Resultados: Em Abril de 2002, trabalhos de investigação realizados para a Comissão Europeia revelaram que, em média, 55% dos serviços públicos básicos estavam disponíveis em linha (face a 45% em Outubro de 2001) e que a maioria dos sítios Web analisados proporcionam mais interactividade do que o simples telecarregamento de formulários.

Revelaram ainda que a oferta de serviços públicos em linha às empresas (68%) está a avançar muito mais rapidamente do que a oferta aos cidadãos (47%). A única excepção são os Países Baixos, onde os serviços públicos em linha aos cidadãos estão mais generalizados do que os serviços a empresas.

Os serviços que envolvem pagamentos ao sector público continuam a estar no topo, atingindo 79% em Abril de 2002, face a 62% em Outubro de 2001. Destes serviços, as declarações de IVA atingem o valor mais alto (88%).

Globalmente, a Irlanda obtém a melhor classificação (85%), seguida pela Suécia (81%), Finlândia (70%) e Dinamarca (69%).

Simplificar a administração pública

Lista dos 20 tipos de serviços públicos simplificados pelos governos graças às novas tecnologias:

Serviços públicos para os cidadãos:

1. Impostos sobre rendimentos: declaração, notificação de liquidação

2. Serviços de procura de emprego oferecidos pelos serviços de emprego

3. Contribuições para a segurança social

·  subsídio de desemprego

·  abono de família

·  despesas de saúde (reembolso ou pagamento directo)

·  subsídios para estudantes

4. Documentos pessoais (passaporte e carta de condução)

5. Registo de automóveis (novos, usados e importados)

6. Pedidos de licença de construção

7. Declarações à polícia (em caso de roubo)

8. Bibliotecas públicas (disponibilidade de catálogos, ferramentas de pesquisa)

9. Certificados (nascimento, casamento): pedido e entrega

10. Matrícula em escolas secundárias/universidades

11. Anúncios de mudança (mudança de endereço)

12. Serviços ligados à saúde (p.ex., aconselhamento interactivo sobre a disponibilidade de serviços em diversos hospitais; marcação de consultas, exames, etc. em hospitais)
Serviços públicos para empresas:

1. Contribuição social respeitante aos empregados

2. IRC: declaração, notificação

3. IVA: declaração, notificação

4. Registo de uma nova empresa

5. Envio de dados aos serviços de estatísticas

6. Declarações aduaneiras

7. Licenças ligadas ao ambiente (incluindo relatórios)

8. Contratos públicos


Médicos em linha (on line)

Uma outra iniciativa, eHealth, tem como objectivo utilizar as tecnologias digitais para melhorar a qualidade e a acessibilidade dos serviços de saúde. Inclui‑se aqui a e‑acessibilidade para os deficientes.

Em Março de 2002, o Conselho de Ministros da UE adoptou uma resolução concebida para facilitar o acesso à Internet de 37 milhões de deficientes na Europa, adoptando um conjunto de normas internacionalmente reconhecidas. A resolução exorta ainda os Estados‑Membros e a Comissão a estabelecerem um diálogo permanente com as organizações que representam as pessoas deficientes e os idosos, para que sejam tomados em conta os seus comentários e preocupações.

Resultados: Registaram‑se progressos consideráveis na adopção da Internet por médicos generalistas. Em Junho de 2001, 60% das entidades que prestam cuidados primários de saúde estavam equipadas com ligação à Internet, percentagem esta que era de 48% em Maio de 2000. Durante o mesmo período, a percentagem de médicos generalistas que utilizam a Internet para comunicar com os seus pacientes subiu de 12% para 34%.

O conteúdo é que conta

Uma terceira iniciativa, eContent, tem como objectivo garantir a disponibilidade de conteúdos e informações na Internet, na língua do utilizador. Actualmente, 75% das páginas Web são em inglês.

Em Abril de 2002, a Comissão apresentou uma proposta de directiva para harmonizar algumas das condições que regem a utilização da informação do sector público. A proposta tem como base o princípio segundo o qual tal informação deve ser reutilizável para fins comerciais ou não‑comerciais e exige que as autoridades públicas que fornecem tal informação apliquem tarifas baseadas nos custos. A proposta pretende estimular a criação de conteúdos para a Internet — um mercado que, segundo as estimativas, vale 433 000 milhões de euros na Europa e emprega quatro milhões de pessoas.

Resultados: A penetração da Internet nas empresas é bem mais elevada do que nas residências. De acordo com um inquérito do Eurobarómetro, perto de 90% das empresas com mais de 10 empregados têm ligação à Internet e mais de 60% têm um sítio Web. Uma excepção notável é Portugal, onde apenas dois terços das empresas têm ligação à Internet e apenas um terço tem o seu próprio sítio Web.

Em média, cerca de 20% das empresas europeias compram e vendem através da Internet, estando a Alemanha, a Irlanda e o Reino Unido à frente nas vendas e a Dinamarca e a Finlândia nas compras em linha. Em seis Estados‑Membros, mais de 30% das empresas processam os seus fornecimentos total ou parcialmente através da Internet, estando a Finlândia e a Dinamarca acima dos 40%. No outro extremo, só 5% das empresas portuguesas e 10% das francesas utilizam a Internet para os seus fornecimentos.


A criação de uma sociedade da informação constitui um alvo móvel. O processo tem de ser permanentemente afinado em função do surgimento de novos desafios e da persistência de velhos obstáculos.

A melhoria das nossas normas de ensino e aprendizagem ao longo da vida é um processo contínuo, tal como a aprendizagem da utilização da Internet de forma mais sofisticada. Embora o eEuropa 2002 tenha feito avançar a Europa para a sociedade da informação, há ainda um longo caminho a percorrer.

No entanto, o eEuropa vai paulatinamente alcançando os seus objectivos. Os custos de acesso à Internet, inicialmente identificados como um dos principais obstáculos, estão a diminuir. Os custos marginais do acesso à Internet para o proprietário de um PC tornaram‑se reduzidos, mas permanecem significativamente mais elevados do que nos EUA. Os custos do acesso à Internet em banda larga são também muito mais elevados. O lento desenvolvimento do comércio electrónico e a difícil implantação da banda larga constituem ainda desafios importantes que é necessário enfrentar.

Para superar estas deficiências, aproveitando simultaneamente os êxitos do eEuropa 2002, o eEuropa 2005 incide num número mais reduzido de prioridades, que dizem respeito à utilização efectiva da Internet para comércio electrónico e serviços públicos, incluindo escolas e empresas.

O eEuropa 2005 atribui máxima prioridade à administração pública em linha, ensino em linha e saúde em linha, bem como à criação de um ambiente dinâmico para o desenvolvimento dos negócios em linha. O plano de acção define dois grupos de acções que se reforçam mutuamente, sendo ambos essenciais para a oferta de serviços prioritários:

·        um acesso em banda larga generalizado e uma infra‑estrutura segura da informação;

·        serviços, aplicações e conteúdos, nomeadamente para os serviços públicos em linha e os negócios em linha.

Acesso em banda larga e segurança: os grandes catalisadores

O plano de acção 2005 pretende acelerar a implantação dos serviços em banda larga, ou seja, a transmissão com elevado débito de sinais de voz, dados e vídeo através de redes fixas ou móveis. Estas redes incluem ligações fixas sem fios, por fibra óptica ou satélite e ainda os telemóveis de terceira geração (UMTS), quando estes se generalizarem. No entanto, em 2002, as redes mais disponíveis são as ADSL e de modems de cabo. A sigla ADSL significa «asynchronous digital subscriber lines» (linhas de assinante digitais assíncronas). Estas linhas, mediante a compressão de dados, podem proporcionar serviços digitais em banda larga através das linhas telefónicas existentes.

Actualmente, os sistemas de banda larga fornecem acesso à Internet com débitos que atingem 1,5 milhões de bits por segundo, ou seja, cerca de 25 vezes a velocidade de um modem telefónico normal de 56 mil bits por segundo, o que permite um telecarregamento rápido de grandes ficheiros de dados. Estes sistemas permitem ainda que os utilizadores estejam permanentemente em linha (ligações sempre activas).

A implantação da banda larga exige a promoção de conteúdos, serviços e aplicações. Os consumidores não comprarão serviços em banda larga, a não ser que existam conteúdos úteis, interessantes ou recreativos, na sua própria língua, que simplifiquem ou melhorem as suas vidas. Enquanto não houver uma forte procura por parte dos utilizadores, não haverá investimentos em infra‑estruturas. Neste problema típico de «ovo e galinha», não haverá motivação para o desenvolvimento de novas aplicações e conteúdos enquanto não existirem as correspondentes infra‑estruturas de suporte.

Quanto mais as redes e os computadores se tornam um elemento central da actividade económica e da vida quotidiana, maior é a necessidade de segurança dos dados. Assim, a existência de sistemas de redes e de informação seguros é um factor essencial para os negócios em linha e um pré‑requisito da privacidade. Para responder a este desafio, a UE lançou já uma estratégia global baseada nas suas comunicações (decisões políticas estratégicas) sobre segurança das redes e cibercriminalidade e na directiva relativa à protecção dos dados no sector das comunicações electrónicas.

Acções do eEuropa 2005

·        Os países da UE irão utilizar os fundos estruturais existentes da UE (fundos sociais e regionais, etc.) para facilitar o acesso em banda larga nas zonas remotas e rurais.

·        Os países da UE devem eliminar os obstáculos legislativos e promover os investimentos na banda larga, nomeadamente diminuindo as restrições ligadas aos direitos de passagem.

·        Em meados de 2003, deverá estar criada uma Task Force Cibersegurança (TFCS), que funcionará como um centro de competência para as questões da segurança.

Administração pública em linha (eGovernment)

A iniciativa eGovernment é uma componente essencial do plano de acção 2005, dado que permite pôr grande parte da administração central em linha, arrastando assim consigo grande parte da economia.

O sector público pode funcionar como catalisador, dado que é simultaneamente fornecedor de informação e cliente que necessita de maior largura de banda para fornecer as suas informações aos cidadãos. Actualmente, o sector público é o maior detentor e produtor de conteúdos na Europa, pelo que é grande o potencial de reutilização da informação do sector público para serviços de valor acrescentado.

O plano de acção 2005 também realça a parte logística da administração em linha. O objectivo é aumentar a eficiência logística da administração central, regional e local, por se considerar que esta é a primeira etapa para melhorar a parte visível dos serviços fornecidos aos cidadãos.

Acções do eEuropa 2005:

·        No final de 2003, a Comissão avançará com um quadro de interoperabilidade que envolve especificações técnicas comuns para que os serviços nacionais da administração em linha possam ser fornecidos aos cidadãos e às empresas de toda a União Europeia.

·        No final de 2004, os governos da UE garantirão que 20 serviços básicos estejam disponíveis em linha, interactivamente. Tal inclui o acesso garantido para cidadãos com necessidades especiais.

·        No final de 2005, os Estados‑Membros da UE realizarão uma parte significativa dos seus contratos públicos por via electrónica.

Ensino em linha (eLearning)

Para que a União Europeia se torne a economia baseada no conhecimento mais competitiva do mundo em 2010, é necessário dotar‑se de uma estratégia de ensino vigorosa. Compete às autoridades educativas de cada país desenvolver as qualificações dos seus cidadãos através do ensino e da aprendizagem ao longo da vida, mas a iniciativa eLearning à escala europeia promove novas formas de aprendizagem em linha em toda a UE.

Na Cimeira de Barcelona de Março de 2002, os chefes de Estado e de Governo da UE fixaram como meta para o final de 2003 a existência de um computador em linha, utilizado para fins educativos, por cada 15 alunos nas escolas da UE.

Acções do eEuropa 2005:

·        Os governos da UE devem procurar que todas as escolas e universidades tenham acesso em banda larga no final de 2005.

·        No final de 2002, a UE deve instaurar um programa de ensino em linha para implementar o plano de acção eLearning em 2004‑2006.

·        No final de 2003, os governos da UE devem lançar programas de formação para fornecer aos adultos as qualificações de que necessitam para trabalharem na sociedade do conhecimento.

Saúde em linha (eHealth)

As tecnologias digitais estão a tornar‑se essenciais para a gestão da saúde a todos os níveis — do médico de família ao Ministério da Saúde. Com elas é possível reduzir custos, prestar cuidados de saúde à distância e tornar os registos clínicos acessíveis para as pessoas que necessitam de os consultar. Tal evitará uma duplicação desnecessária de esforços. Por exemplo, será desnecessário fazer duas vezes o mesmo exame médico só porque dois médicos diferentes necessitam da mesma informação.

O eEuropa constitui o quadro no qual estas actividades podem ser combinadas numa estratégia que proporcione resultados visíveis em 2005.

Acções do eEuropa 2005:

·        Na Primavera de 2003, a Comissão Europeia irá propor a introdução de cartões de saúde electrónicos com base em normas comuns, bem como o intercâmbio das melhores práticas.

·        No final de 2005, os governos da UE devem desenvolver redes de informações de saúde que liguem hospitais, laboratórios e residências.

·        No final de 2005, a Comissão Europeia e os governos da UE garantirão a prestação em linha de serviços de saúde, incluindo informações sobre uma vida saudável e prevenção de doenças, registos clínicos electrónicos, reembolsos electrónicos, etc.

Negócios em linha (eBusiness)

O conceito de negócios em linha abrange o comércio electrónico (compra e venda em linha) e a reestruturação de processos empresarias para optimizar a utilização das tecnologias digitais.

Os negócios em linha realizam o seu potencial justamente quando as tecnologias da informação transformam os processos, produtos e serviços empresariais tradicionais. É evidente que a responsabilidade por ambas as actividades é da indústria, mas os governos determinam o contexto regulamentar que pode estimular o desenvolvimento dos negócios em linha.

Acções do eEuropa 2005:

·        Está prevista para 2003 uma cimeira dos negócios em linha que dará aos representantes de alto nível das empresas a oportunidade de descreverem as dificuldades que encontram ao realizarem negócios em linha.

·        No final de 2003, a Comissão criará uma rede de apoio aos negócios em linha para promover a adopção das tecnologias e processos digitais por parte das PME.

·        No final de 2003, o sector privado deverá desenvolver soluções interoperáveis de negócios em linha para transacções, segurança, assinaturas, aquisições e pagamentos.

·        No final de 2003, a Comissão examinará as possibilidades de estabelecer um sistema de resolução de litígios em linha à escala da UE.



A iniciativa eEuropa da UE foi concebida como um meio de pôr a Europa em linha com a máxima rapidez. Também confere à Internet uma dimensão europeia, encorajando conteúdos multilingues e permitindo que os países europeus façam valer as suas vantagens competitivas em domínios como as tecnologias dos telemóveis e a televisão digital.

A realização dos objectivos do eEuropa contribuirá certamente para a criação de emprego e tornará as empresas europeias mais competitivas. Este processo insere‑se no esforço contínuo da UE para cumprir a sua obrigação — constante do artigo 2.º do Tratado da União Europeia — de «promoção do progresso económico e social e de um elevado nível de emprego».

O êxito do eEuropa depende não só das instituições europeias mas também das administrações nacionais, regionais e locais de toda a UE, das empresas, das escolas, dos hospitais… De facto, depende de cada um de nós, cidadãos europeus. O eEuropa foi concebido para si: cabe‑lhe aproveitá‑lo plenamente e pô‑lo ao seu serviço.

Outra documentação

É possível consultar documentos, notícias e outras informações sobre os temas abordados na presente brochura no sítio Web da Comissão Europeia dedicado ao eEuropa:



Informações centradas no ensino e na formação: http://europa.eu.int/comm/dgs/education_culture/index_pt.htm


Systems’s Chris Blenkhorn.


Traditionally, NHS patients have travelled to hospitals for tests and consultations

with clinical specialists. With the UK population set both to grow and age, however and with the consequent greater demands for new healthcare procedures and treatments - this may no longer be possible. Long-established patterns of  healthcare such as these may have to transform if the NHS is to the Government and patient expectations within its budget.

The reality, of course, is that healthcare has been changing for some time in order to reduce costs and increase efficiency. The need to liberate funds for reinvestment and to change spending priorities has been substantial. Specialist clinical resources are being relocated into regional or national centers, and an increasing number of hospitals no longer have specialists in every discipline. Patients are being monitored at health centers or in the community rather than in hospital, especially when suffering from chronic conditions.

The natural consequence of this has been some reduction in contact between the patient and the clinician. However, many believe that the innovative use of IT and network technologies can help redress this situation, and there have been many attempts to introduce telemedical and telecare services in recent years. Unfortunately many of these services have not been successful, often because of the lack of suitable network technologies. It is instructive to look at recent major advances in this area and see the huge potential for networking to drive advances in telecare.

Networking technology

Telecare services depend critically on the availability of standards, and on ready access to the right local (LAN) and wide-area network (WAN) services. In the past these have not always been available, hampering service development, but advances have recently occurred in three areas - interconnection and inter-working standards, high speed, vide-capable links between NHS sites, and high-performance network links into the home.

Interconnection and interworking standards.

Standards are critical for the development and effective delivery of all aspects of IT. Telecare requires standards for physical connection to medical devices and system end points, and for logical communication between end points. Physical connection to systems and end points is now, in practice, by Ethernet local area

network (LAN), or by lEEE 802.11 wireless connection (WiFi). Both of these can be provided easily and cost-effectively in the hospital, clinic or at home, and many hospitals have already implemented overlay wireless LANs (WLANs) for telecare and other mobility projects. Logical communication between end points uses Internet Protocol (IP) - the communications protocol that drives the Internet and most networked IT applications. The information modes used in telecare  - data, voice and video  - are all now fully standardized to operate IP.

Hígh-speed, video-capable links between NHS sites

Many attempts to introduce telecare services in the past were based on the use of NHSnet - the old NHS national network - for communication between NHS sites. This was not always successful, as NHSnet did not provide sufficient bandwidth or adequate quality of service - both being prerequisites for voice and video traffic. Projects either had to change the scope of their services, or were forced to install special-purpose network links, the cost of which often eroded business benefits.

The Government has recognized the importance of enabling network infrastructure for all aspects of healthcare delivery. The NHS National Programme the for IT (NPfIT) will deliver N3, the new national network, to provide robust, secure and standardised network connectivity to all NHS clinical locations. N3 has the ability to support multimedia traffic for telecare, and positions trusts very favorably for the development of site-to-site telecare services.

Network links into the home

In the past it was only possible to link into patients’ homes via standard telephone connections. These connections were slow and inflexible, and furthermore affected patients’ use of their telephones. The Government’s Broadband Britain initiative, however, has accelerated the availability high-speed digital subscriber-line (IDSL) connections across the country. While DSL also uses existing telephone connections, it does not affect normal telephone use and can be provided in a matter of days without any changes to home wiring. DSL has the additional benefit of ever-decreasing cost points.

Within the home, medical monitoring devices can connect to a DSL service via very simple ‘plug and play’ methods - a simple Ethernet cable, or a WiFi connection for greater flexibility. In the future, DSL may not be required at all, at least in urban areas, as medical devices in patients’ homes will be able to connect directly to WiFi broadband services.

Business need and technology driving innovation

We have mentioned the business need for more efficiency in the use of clinical resources. The very substantial developments in network technologies and the availability of enabling network services through N3 make this now possible.

This combination represents a clear platform for innovation. If fully exploited in the future, it could lead to the next major step in the transformation of healthcare services after the current deployment of the National Programme’s IT applications suite. Indeed, it is possible that telecare services such as teleconsultation, telediagnosis and telemonitoring could be incorporated into the National Programme in the future.

Linking the patient and clinician

Teleconsultation services provide direct video links between patients and clinicians. This benefits patients by increasing access to specialists and reducing the need for travel. Teleconsultation over ISDN circuits is already in use in the NHS, for example for out-of-hours consultations between community and acute hospitals, although video quality can be poor. These services are likely to become commonplace with N3, which has been designed to support high-quality video connections. Video telephony now available in a form fully integrated with voice telephony, so there is no need to provide special-purpose networks for patients to consult clinicians. Looking to the future, 3G wireless telecommunications devices will support a suitable quality of video, and it will be possible to extend consultation directly into patients’ homes.

Centralising diagnostic services

Telediagnosis services permit a patient’s scan or image to be sent to a remote specialist for diagnosis and report. The benefit to the NHS of this approach is the more effective use of skilled and centralised clinical resources. The benefit to the patient will be faster reporting following scans and tests.

Scan images may be sent over IP via file transfer or attached to emails, but image files can be very large and require significant bandwidth. Images of external, eg dermatological, conditions can be handled photographically or over video links. N3 provides high bandwidth and is video-capable, offering an excellent vehicle for the development of these telediagnosis services.

Remote monitoring in hospital, clinic and in the home

Telemonitoring often referred to as telemedicine in the past, permits medical devices attached to patients to be accessed and controlled from a central monitoring statiun. The network links connecting device and monitoring statiun may take a variety of forms - wired or wireless LAN links within hospitals, links over N3 between clinical locations, and GPRS mobile-phone-network or DSL links from patients’ homes and in the community.

Telemonitoring can be found in many guises within the NHS. ln its simplest form it can provide a link between a beside medical device and a nurses’ statiun. Nowadays medical devices are becoming WiFi capable, permitting active monitoring as a patient is moved from ward to ward, or from ward to theatre. In the future, telemonitoring will be increasingly available in the community and in patients’ homes. This will be particularly important fur successfully managing chronic conditions without taking up valuable hospital bed space.

In conclusion

The NHS is witnessing the fortunate co-incidence of business need — to deliver healthcare services more cost effectively and the tools to do so — new network technology standards and highly capable, but low-cost, network products.

This offers an excellent opportunity fur NHS trusts to exploit networking for telecare to benefit patients and clinicians, particularly as the National Programme is providing the enabling N3 infrastructure.

There are already many examples of telecare in operation, particularly teleconsultatiun and telediagnosis, and every trust should have the development of business plans high on its priority list.


Chris Blenkhorn is a Consulting Systems Engineer with Cisco Systems Ltd and a member of Cisco’s UK public sector team, where he specialists in healthcare networking.

(extraído do The British Journal of Healthcare Computing & Information Management - February 2006)


Government of Catalonia

Ministry of Health

On the reforms of Social Security systems and on reforms in the management of healthcare services

- Definition of a series of strategies and Initiatives for cooperation in healthcare matters for the Mediterranean area which could be the object of joint work in the future:

       • Study and definition of the catalogue of services covered by the public sector in different countries and an international comparison.
       • Creation and exchange of instruments for control of the system and
management of institutions. With this in mind, the following considerations of
general character were presented:
           - “Do not copy foreign models for the sake of copying them”. It is
necessary to seek the solutions that best adapt to the social reality of
each country.
           - Promote improvement of information systems and specifically, improve the follow-up of the processes for contracting, accrediting, assessment and control.
           - Accept the diversification of actors in the field of management of
healthcare services, always with the objective of improving the results.

        • Work on a common focus for some health problems: AIDS, bird flu, etc.
        • Generate initiatives to maintain health in the centre of the political debate, inspite of competition and globalisation
        • Work on a common focus for some health problems: AIDS, bird flu, etc
        • Generate initiatives to maintain health in the centre of the political debate, in spite of competition and globalisation.

On investments and the participation of private initiative and international institutions

• An innovative and interesting formula for public sector-private sector
collaboration, which shows its usefulness for the public sector provided it
maintains adequate economic and legal controls.

• At the moment the only experience is in the construction of hospitals and an evaluation of already completed experiences is proposed.

• The southern Mediterranean countries are very interested in these models for financing investments, but mention the difficulty of applying them, basically

On transformations in the models for the management of public health

• Confirmation of the progressive evolution from an administrative public health model towards a model that includes public health actions as another part of healthcare systems. Actions are progressively being taken closer to citizens, who are the references points, and on risks.

• WorkThe new models being proposed put emphasis on decentralisation, participation and communication. The latter two aspects are the real instruments for making the majority of interventions effective. Mention was also made of the increasing weight of an intersectoral and multidisciplinary approach to the development of public health.

• The models of public health presented by southern Mediterranean countries
reveal the challenges facing public health in these countries. Challenges that are closely related to the degree of social and economic development, as well as the presence of health factors that are different from those of northern Mediterranean countries.

• The experience of Catalonia shows how the integration of various processes and institutions enables advancing towards a model of reform that attempts to be both participative and effective. The new agency to be created, decentralised in the territory, is aimed at the integration of the existing series of resources to provide Public Health services as a regular part of the healthcare system.

On the control of smoking

• Today there is an important need to take global action against cigarette smoking from five different approaches:

       - Legally – regulating spaces, etc.
       - Financially – increasing taxation.
       - Controlling promotional campaigns that encourage the habit.
       - Aiding smokers to overcome their addiction, offering support.
       - Educating and informing the population – not only in prevention in the case of youths, but also directly addressed to smokers.

• On the other hand, it is necessary to combine and coordinate efforts between the areas of organised civil society (associations, charities, and not only from public health, etc.) and government.

On the strategies and models for its application

• E-health provides enormous potential for improving the mobility of patients and professionals and the access, quality, security and productivity of healthcare services.

• The advantages of the process of development of e-health initiatives on a regional level are put into evidence. The improvements in citizen accessibility and its usefulness for professionals are multiplied by the scale economies that result when the investments in ICT infrastructures exceed small geographic areas or specific suppliers.

On integral attention for patients

• Demand for priority actions on policies that encourage the spread of an integrated model for attending to patients with the support of ICT.

• This emphasis on priority must be accompanied by the definition of the
organisational aspects of the new healthcare model in regard to the interactions between professionals on different healthcare levels.

• Presentation of the importance of standardisation of clinical practice by means of clinical guidelines, as they must become the basis for articulating the new roles of professionals and patients in this healthcare model.

• Proposal for the consensuated and successful adoption of specific models  of interoperability between different agents in order to promote the sustainability of the new healthcare model.

On research, development and innovation

• We are confronted by the same problems facing other communities in the world. We form part of a global community and therefore it is necessary to combine forces to solve global problems, together. This is the commitment that we must assume.

• WorkWe are facing an unprecedented opportunity to optimise healthcare systems through e-health.

• WorkWe must make people, not patients, responsible for taking care of their own health. This self-responsibility will be much easier to assume thanks to
information technologies as they permit each person to have a very exhaustive knowledge of their state of health.

On quality, safety and satisfaction

• WorkQuality is one of the most important concerns of all current governments present. Furthermore, the mobility of people means that the subject of quality has become more relevant over the last few years.

• In 1999 the European Union began a process of reflection on the subject   of patient mobility and quality which has today led to the creation of a High Level Group to study various subjects including patient safety and mobility.

• In 2002 the WHO launched the “World Alliance for Patient Safety” which has been presented here. It mentions the objectives to be shared by all countries of the Mediterranean Area, basically clean care to reduce infections and the participation of patients and citizens in safety matters that affect them.

• Emphasis was placed on the importance of exchanging information and
experiences in the field of quality between Mediterranean countries and the
convenience of doting these forums with continuity.

On the mobility of patients and citizens

• People move between countries for different reasons and, on certain occasions use the healthcare services of the destination countries either because they become ill during one of these stays abroad, or because the movement was specifically to be able to access the healthcare services in a country other than theirs.

• There are various situations where patients are treated in countries other than their own and each requires specific consideration and treatment (tourists, longterm residents, health tourists).

• It would be a good idea for countries of the European Union to have a common basic catalogue of healthcare services to which all European citizens would have access, and know that they had a right to receive.

• It is important to establish common standards of quality in healthcare services, and that citizens be aware of them.

• Not only the countries of the northern Mediterranean area have healthcare
services to offer and it is not only for this reason that citizens move  between different countries. The countries of the southern Mediterranean area also offer quality healthcare services that could be made available to all citizens, at competitive prices, and which could be taken into consideration when designing the offers of healthcare services.

• The continuity of healthcare services is basic when there is an international
movement of patients. They have the right, and healthcare professionals and
authorities the duty, of guaranteeing that information on the healthcare provided travel with the patient so that when he/she returns to his/her country of origin they can continue with the healthcare process in an integral, coordinated and continued manner.

On the challenges of healthcare professions

• The free circulation of professionals must be based on accreditation of their
professional qualifications and that it is not necessary to homologate, but rather to harmonise academic titles.

• The planning of human resources is a very complex process that has to consider new information and communication technologies (telemedicine).

• There is a need for healthcare systems to attain a greater level of flexibility to adapt their professionals to social and technological challenges.

• Recommendations that the different countries introduce incentives to maintain the minimum number of professionals necessary to satisfy their needs.

On policies for migration and health

• The relevance of a holistic approach to migration and health, combining political, social and healthcare aspects. Adopting a multidisciplinary perspective that includes psychology, psychiatry, anthropology, sociology and other relevant disciplines, all working together, should allow the phenomenon of migration to be approached in a suitable way.

• The importance and, at the same time, need for training and technical preparation of all healthcare professionals in aspects of cultural competence.

• Specific mention of good practice in different countries, emphasising the
importance of prevention, integration and co-ordination of different healthcare and social systems when attending to the migrant population.

On models of deployment, experiences and applications

• The image is not just another element of the Electronic Medical Record (EMR), it is a critical aspect and becoming even more so. Without image there is no EMR.

• In the opinion of the experts, the best approach is to establish territorial, regional or even supraregional (European) PACS (of medical images, not only x-rays), making images available to everyone that requires them provided they are necessary, as well as making them accessible to the patient.

• The projects for digitalisation must consider:

       - TECHNOLOGY: today this is not a problem, but it is much better        to use and share a single platform than to combine multiple platforms from different suppliers.
       - ORGANISATION: integration in the workflow. This is the most complex
aspect as it affects professionals and organisations.
       - LEGAL ASPECTS: resolve international consensus.

• “Film & paper no longer work”. In a digital environment (digital image) more can be done in less time, even though there are more limitations and more complex and dispersed environments. The digital environment is also less vulnerable than the manual one (example of “Katrina”).

• Share experience: The technical errors and difficulties encountered by those who initiate the process should enable others to avoid them, saving both time and money.

On research, development and innovation

• It is necessary to have new models for investment and management of
infrastructures (ASP). Sharing infrastructures enables considerable savings,
avoids initial costly investments, and allows payment to be made in terms of use.

• The digital image contains much more information than we can process.     It enables us to increase our capacity for diagnostic detection or to present new challenges:

       - CAS: image guided surgery or “Surgical PACS”: use during the operation, in real time, interactively or for planning or simulating surgery.
       - CAD: digital mammography.
       - Combination of anatomical, functional and molecular information.

• From the point of view of service provision, working on a network enables
professionals to access knowledge, to share it, thus to eliminate the barriers of space and time.


Government of Catalonia - Ministry of Health - EUROMED 2005


Por Peter Sayer, para o IDG

Publicada: 02 de junho de 2006

Paris - Seis conglomerados tecnológicos testam sistemas que deverão integrar e padronizar o armazenamento dos dados médicos da população.

O governo da França convocou seis conglomerados tecnológicos para testarem um possível novo modelo de integração dos dados médicos de sua população. O novo sistema informatizado deverá permitir acesso a informações padronizadas a partir de um banco online.

Os testes, que envolverão 1.500 funcionários do sistema de saúde francês e 30 mil pacientes voluntários, começaram nesta quinta-feira (01/06) após aprovação do plano pela Autoridade de Proteção aos Dados Franceses. A idéia é testar o impacto das tecnologias propostas no atual sistema de saúde do país.

Os franceses já possuem uma tecnologia integrada para o pagamento dos serviços de saúde permitindo que pacientes paguem consultas e tratamentos usando um cartão inteligente.  Mas as informações médicas ainda não possuem um modelo de circulação padronizado.

Com as propostas, o governo visa criar um padrão que coloque fim às variadas formas de armazenamento e circulação das informações. Em um futuro próximo, os dados deverão ser armazenados em um sistema com uma interface comum.

O governo prevê para 2007 incentivos financeiros nos tratamentos para pacientes que permitirão aos médicos acessarem e atualizarem suas informações médicas online.

Pacientes envolvidos no teste poderão selecionar a empresa na qual confiarão seus dados, da mesma forma que escolhem seu plano de saúde, por exemplo.

Durante os testes, espera-se entender como os pacientes e os profissionais médicos usarão os dados armazenados, além de como estes dados vão interferir no diálogo entre médico e paciente.

Também está entre os planos um sistema para identificação dos pacientes, para restrição de acesso aos arquivos e de comunicação com as atuais tecnologias da informação usadas pela rede de saúde francesa.

A legislação médica francesa garante que as informações armazenadas devem ser confidenciais. Contudo, durante a fase de testes, os conglomerados terão uma brecha nessa premissa, ainda não especificada pelo Governo.

O grupos de conglomerados que participam dos testes conta com Thales e Cegedim; Microsoft, Lê Réseau Santé Social e Medcost; France Telcom, IBM, Capgemini e SNR; Accenture, La Poste, Neuf-Cegetel, Intra Call Center, Jet Multimedia e Sun Microsystems; Siemens, Bull e Eletronic Data Systems; e Atos Origin, Unimédicine, Hewlett-Packard (HP), Strateos e Cerner.

*Peter Sayer é editor do IDG News Service, em Paris.