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Volume 18, No. 2, June 2008

Table of Contents


Building Foundations for eHealth: Progress of Member States


WHO Global Observatory for eHealth WHO Press, 2006, 90 pp., ISBN: 978-92-4-156335-4

Review by

Dr. K. Ganapathy, Apollo Specialty Hospital

Published in Indian Journal of Medical Research, Vol. 126, No. 5, Pp. 490-493, November 2007

The World Health Assembly in May 2005 called on WHO to integrate eHealth in all health systems globally. This resulted in the birth of the Global Observatory for eHealth. This was set up to provide high quality information to Member States, increase awareness and commitment of governments, establish indicators for monitoring, promote best services, assess impact of eHealth on health systems and disseminate research findings. One of the first projects of the Global Observatory for eHealth was to embark on a fact-finding study to determine the present status of eHealth globally.  

This 86-page compendium is based on inputs from 700 eHealth experts worldwide from 112 countries (60% of the 192 WHO Member States, representing 80% of the world's population). Response to questionnaires between mid 2005 to mid 2006 led to this report, the first of its kind. This survey provides an important foundation on which future studies and actions are based, focusing on processes and outcomes. Considerable coordination, technical inputs and design of survey instruments at regional and national levels have gone into compiling this report. The methodology adopted to ensure the reliability of the information obtained, from each Member State, is described in detail including quality assurance steps. The copy of publication is indeed a pleasure to possess. Excellent quality of paper, eminently readable formats, a superb layout, good illustrations, adequate tables and graphs, appropriate eye catching photographs to break the seriousness of the material published, all contribute to the end product - an outstanding publication. The CD-ROM provided with the publication describes the eHealth country profiles of the various regions - Africa, Americas, South East Asia, Europe, Eastern Mediterranean and Western Pacific.  

This report clearly demonstrates that the eHealth landscape is rapidly changing universally. The digital divide is rapidly reducing. Developing countries no longer have to follow the advanced countries. eHealth eventually will be integrated into the mainstream of health care delivery worldwide. This report will be useful for governments, policy makers and international organizations to identify eHealth trends, opportunities and emerging challenges. However one should remember that global trends mask the huge variation between countries and across regions.  

Some of the key findings are as follows:

§      eHealth standards have been gaining recognition since 2000. Industrialized countries have advanced much farther than developing countries

§     Strong growth has occurred in eHealth since 2000 and this is likely to continue

§     Developed countries are more advanced in eHealth

§      eHealth policies in developing countries are likely to be in place by 2008 but will require more guidance and support

§      Implementation of enabling actions e.g., standardization and interoperability need support

§      Online health information for general public showed highest rate of adoption

§      e Learning in health sciences is expected to expand

§      National long term strategic plans for e Health, need to be drawn up by Member States, assisted by tools, guidelines, best practices including public private partnerships, one Health policy provided by WHO

§      eHealth legal and ethics committee of WHO is likely to accelerate development.

§      Translation and cultural adaptation of existing health materials to suit individual countries requirements is in the offing.

§      Computers capable of multilingual use have been developed and promoted in India by Center for Development of Advanced Computing. Information is being provided in local languages for health workers in various disease programmes.

§      eHealth standards are more prevalent in advanced countries. By 2008, 80 per cent of countries will have such standards. The Baltic Health Network consisting of Norway, Denmark and Sweden will be joined by Estonia and Lithuania. This may eventually become a universal European model for the next generation health network.

§      ICT training for health science students and continuing education in ICT is likely to be available in 80 per cent of Member States of the WHO.

§      Use of ICT in support of human resources for health is one of the key areas of WHO.

§      Electronic eHealth information for the general public is steadily increasing worldwide and 90 percent of countries surveyed will have this by 2008.

§      Web presence is not widespread in developing countries. In developed countries “access” is giving way to “quality”.

§      Professional training in health informatics is necessary to break the fear of technology and the resistance to change.

§      eHealth applications include public services, knowledge services and providing services.

§      Most WHO regions have provision for international electronic journals, national electronic journals and national open archives.  By the end of 2008,70 to 100 per cent of the surveyed countries are likely to have international electronic journals including those in the low income group.

§     eHealth governance and technology roadmaps to assist with the planning process have already started in most countries.

§      It is stressed that a multi stakeholder, national level eHealth authority, to provide leadership and direction, the adoption of a e  Health policy to define the vision and action are required, the development of a funding framework and mechanisms to develop ICT infrastructure for provision of eHealth services is mandatory.

§      Governance policies in eHealth, as a measurement of potential success were available only in 50 per cent of the countries surveyed and mainly in the higher income countries.

§      Public funding remains the primary means of support for eHealth activities though there is an increase in public private  partnerships.

§      Equitable access to eHealth is low, particularly in developing countries.

§      Securing public and professional confidence in information governance arrangements, and privacy and confidentiality measures   in holding and processing sensitive health information electronically, is a major issue.

§      50 per cent of 112 countries surveyed do not legally protect the confidential medical data nor do citizens have legal recourse. Should their privacy be compromised while using eHealth services? WHA eHealth resolution calls on Member States to advance the principles of confidentiality of information and privacy in the eHealth domain.

§      Creation of culturally sensitive electronic health content in the local language is not high in the agenda of most governments.

§      Ministry of Finance, Government of India, had mandated that 3 per cent of the budget of all government spending will go to ICT.

§      The concept of eHealth for all by 2015 may well be an addendum to the Millennium Development Goals (MDG).