Page 51 - Proceedings of the 2017 ITU Kaleidoscope

Challenges for a data-driven society

implementation guidelines whereas the EU adopted the 3.3. Implementation of standards
Patient Summary guideline citing European Patients Smart
Open Services (epSOS) guidelines to implement Literature on the role and effects of e-Health standards can
interoperable e-Health systems across borders [33]. The be classified under the topic of implementation in terms of
question of ‘how’ standards advance interoperability can be the adoption of standards and the application of standards
seen in the context of EHR in Korea [34]. To support the when developing standards-based technical frameworks.
implementation of interoperable Clinical Decision Support
(CDS) nationwide, standards-based CDS architecture was Standards in e-Health have to be put into real life practice to
proposed based on the identification of service features, add value to the quality and security of healthcare practices
core components and application architecture in relation to and services. To realize the known effects of e-Health
exiting approaches and also supplemented by a survey of standards, healthcare organizations intend to adopt health
major stakeholders in CDS. data standards. However, the level of adoption is reported
to remain low worldwide, especially in developing countries
In spite of the importance of interoperability clarified in the [25]. Some barriers that hinder the adoption of health data
medical and technological communities, there is a lack of standards are the complexity and incompatibility of
empirical research on the actual impact that standards-based standards, switching costs, lack of IT infrastructure, lack of
systems have on advancing interoperability. One of them is adequate policies and plans for data exchange. In other
seen in a case study of Lombardy region in Italy where a words, interplay of technological, organizational and
fully interoperable healthcare system was enabled through environmental factors affects adoption decisions of e-Health
the implementation of international health standards, first at standards [25]. Through questionnaires, critical factors
the hospital level that expanded into the regional level [35]. influencing hospitals' intention to adopt HL7 in Taiwan
Achieving interoperability is especially difficult in the were empirically investigated to discover the influence of
current situation where we have coexistence of standards organizational factors that have been relatively under-
and domain-specific processes that create different flavors examined [41]. The results showed that the critical factors
of a standard. were environmental pressure, top management attitude,
staff's technology capability, system integrity, and hospital's
There are careful considerations for technical features of e- scale. Experiences in the U.S. Department of Veterans
Health systems implemented for ensuring security and Affairs showed that the adoption of health data standards is
privacy. A systematic review on security and privacy of facilitated by internal staff with expertise in standards
EHR systems used ISO standards on privacy framework and development and adoption [42]. According to its long
security guidelines to identify key technical features history, implementation approaches tailored for different
including access control policies and consent mechanisms standards in categories of security and privacy, terminology,
that are essential for EHR security and privacy [36]. By health information exchange, and modeling tools are needed
means of the design and implementation of such features, e- to translate standards into practice.
Health standards account for improvement in the quality of
care as well as hospital performance. Evidence provides There are numerous proprietary solutions for e-Health
that structured pathology reporting in standardized format available in the market that are developed and supplied by
for cancer particularly based on international individual companies and used by health practitioners in
standardization has value in quality improvement for both which compliance to standards are not considered. Due to
clinical care and health management at the population-wide limitations in providing interoperable solutions, academic
level [37]. Compliance with Joint Commission International research is increasing in the development of frameworks
Accreditation (JCIA) standards, which are standards for the applying international standards that work at different levels
documentation of discharge summaries, provides evidence of applications. HL7 family of standards is frequently
for better quality of documentation and minimization of applied in these cases. HL7 CDA Release 2 was used as a
unnecessary delay [38]. With regards to hospital standard document to propose the architecture aimed at bi-
performance, a survey of top management of hospitals directional exchange of data between EHRs and m-Health
reveals that e-Health compatibility which is partially apps to promote patient engagement in home monitoring
explained by IT adaption, defined as the understanding and [43]. An earlier study proposed HL7-aware multi-agent
implementation of IT standards or protocols compatible system that represents both patient and service information
with hospital resources, has a positive mediating effect on based on HL7 [44]. One of the frameworks was created
hospital performance [39]. In some occasions, simple based on several international standards to transfer health
adoption of international standards may not guarantee the data collected from medical devices to health information
elimination of flaws. Literature describes that the adoption systems. Standards include IEEE 11073 for device
of Integrating the Healthcare Enterprise (IHE) communication, CEN 13606 for domain modelling, HL7
specifications for authenticating healthcare professionals and IHE profiles for communication with EHRs or PHRs
and assuring patients' safety reveals security flaw that and data storage [45].
necessitates modification in the communication protocol in
order to establish a secure EHR system [40]. Standards that are used globally are being implemented in
the process of creating new frameworks for achieving

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