Roadmap to Successful Digital Health Ecosystems

A Global Perspective

1st Edition - February 12, 2022
Imprint: Academic Press
Editors: Evelyn Hovenga, Heather Grain
Language: English
Paperback ISBN:
9 7 8 - 0 - 1 2 - 8 2 3 4 1 3 - 6
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 2 3 6 3 9 - 0

Roadmap to Successful Digital Health Ecosystems: A Global Perspective presents evidence-based solutions found on adopting open platforms, standard information models, technolog… Read more

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Roadmap to Successful Digital Health Ecosystems: A Global Perspective presents evidence-based solutions found on adopting open platforms, standard information models, technology neutral data repositories, and computable clinical data and knowledge (ontologies, terminologies, content models, process models, and guidelines), resulting in improved patient, organizational, and global health outcomes. The book helps engaging countries and stakeholders take action and commit to a digital health strategy, create a global environment and processes that will facilitate and induce collaboration, develop processes for monitoring and evaluating national digital health strategies, and enable learnings to be shared in support of WHO’s global strategy for digital health.

The book explains different perspectives and local environments for digital health implementation, including data/information and technology governance, secondary data use, need for effective data interpretation, costly adverse events, models of care, HR management, workforce planning, system connectivity, data sharing and linking, small and big data, change management, and future vision. All proposed solutions are based on real-world scientific, social, and political evidence.

Cover image
Title page
Table of Contents
Copyright
About the editors and authors
Acknowledgements
Preface
References
Foreword
Chapter 1: Transforming health care
Abstract
Issues and challenges
What is an ecosystem and how does this apply to digital health?
Digital health roadmap development process
Existing foundations
Global and regional value proposition drivers
A digital health enabling environment
A national digital health roadmap
A future vision
References
Chapter 2: Global and national infrastructures supporting digital health ecosystems
Abstract
Digital health foundational needs
Digital health ecosystems
Current national examples
National digital health governance
Leading national digital health
Conclusion
References
Chapter 3: Global collaborative leadership challenges and economic drivers
Abstract
WHO is leading global digital health reformation
Digital health markets and trade
Global health security
Digital health infrastructures: Research and policies
Entities influencing global digital health
Infrastructures enabling digital health
Discussion
Conclusion
References
Chapter 4: Fragmented global standards development organisations
Abstract
Why do we need standards?
Standards development organisations (SDOs)
Health Informatics Standards Development Organisations (SDOs)
A standards profiling organisation
Communities of practice for digital health
Discussion
Conclusion
References
Chapter 5: Standards for digital health, known limitations, and procurement
Abstract
Introduction
Health informatics standards: Focus, purpose, and good practice principles
Standards versus standardisation
Why use health informatics standards?
Standards are not architectures
Overlapping or conflicting standards
Standards development processes
Health informatics standards: A fragmented, political landscape
Foundational standards harmonisation
How should a procuring organisation use standards today?
Conclusion
References
Chapter 6: The knowledge-driven platform: Strategic technologies for a platform ecosystem approach
Abstract
Introduction
Why a knowledge-driven platform?
What is a platform?
What does the platform mean for business?
Getting there
Organisational structure for platform development
Conclusion
References
Chapter 7: Are professional guidelines and regulatory standards fit for purpose?
Abstract
Introduction
Valuing infrastructure standards and guidelines
Key standards and guideline developments
Current world reality
Guideline development and provider organisations
Professional organisations/associations’ knowledge and digital health contributions
Centers for Disease Control (CDC) and prevention
Patient safety, audits and governance
Healthcare accreditation services
Regulations/legislation
Discussion
Conclusion
References
Chapter 8: Health data standards’ limitations
Abstract
Digital health ecosystem linkages
Leading health data standardisation and interoperability
Digital health data science
Ontologies and software engineering relationships
Clinical content formalisms and expressivity
Standards development organizations (SDOs), data standards and data management
Clinical content: An ontological framework
Data supply chain
Data governance and coordination
Current issues and limitations
Data sharing examples
Discussion
Conclusion
References
Chapter 9: Quality data, design, implementation, and governance
Abstract
Health data
Health data supply chain
What is quality data?
Data access and risk management
Quality management responsibilities
Data governance needs
Clinical governance and data reliance
Professional clinical knowledge leadership and governance
Health ecosystem governance frameworks
Benefits of adopting network and cross-sector collaboration
Transforming to optimise the value of this digital era
Change management
Conclusion
References
Chapter 10: Guideline and knowledge management in a digital world
Abstract
Language and communication: The data, information, knowledge, and wisdom (DIKW) continuum
Types of knowledge and knowledge management theories
Knowledge discovery and representation
Representing concepts using entities, objects, and agent formalisms
Bodies of knowledge, ontologies, and frameworks
Decision theories and artificial intelligence
Tools for knowledge processing
Use of knowledge in applications
Knowledge governance, validation, and certification
Use of global intellectual capital in this digital era
References
Chapter 11: Modelling clinical knowledge
Abstract
Introduction
Clinical model design
Clinical model quality
Benefits of a ‘whole of health’ data ecosystem
Conclusion
References
Chapter 12: Identity—What is in a name?
Abstract
Names are not enough
What is identity?
Identity infrastructure
Requirements for personal identity
Organisations
Identification of things
Other identification
Requirements for successful identity systems
References
Chapter 13: Electronic health records and essential technology paradigms
Abstract
Many shades of electronic health records (EHRs)
Health data standardisation and interoperability leadership
Documentation supporting patient journeys
EHR quality evaluation and certification
Managing EHR data access
Ecosystem data supply chain
Secondary data uses—Data supply chains
Data Lakes, data hubs, data marts, and data warehouses
Discussion and conclusion
References
Chapter 14: Health data security and privacy: Challenges and solutions for the future
Abstract
Acknowledgement
Introduction
Cybersecurity in healthcare
Health data use challenges
Secure and privacy-preserving solutions
Secure and privacy-preserving data use examples
Discussion
References
Chapter 15: The digital needs of genomics resulting from pandemics
Abstract
Introduction
A model for person-centric and population-centred precision health
Biotechnology and computational biology
Surveillance
The integrated healthcare documentation system and standards
Data mining
Artificial intelligence and machine learning
Telehealth and tele-ICU
Wrapped in an envelope of privacy and security
Challenges and future directions
References
Chapter 16: Health informatics in the Middle East and North Africa
Abstract
Diverse nations
Health information technology utilisation in the region
Digital health innovations and future directions in MENA region
Conclusion
References
Chapter 17: A framework for regional health information systems interoperability: The Asia eHealth Information Network (AeHIN) experience
Abstract
Background
About AeHIN
Where are we now: Mind the GAPS
Where do we want to go: Fill the GAPS
Country experiences
Conclusion
References
Chapter 18: The road to interoperability: openEHR modelling and implementation
Abstract
Introduction
Multilevel modelling paradigm of openEHR
Reference model (RM): A stable reference information model constitutes the first level of modelling;
openEHR modelling
The openEHR-based CDR implementation
CDS application based on openEHR CDR
Conclusion
References
Chapter 19: Evidence-based biomedical information systems: The road ahead
Abstract
The need for evidence-based systems
Norway as a representative of the challenges in European nations
Towards next generation EHR: Current challenges and requirements
OpenEHR as an open platform ecosystem
Open platforms for evidence-based adoption of health information systems
Case studies: The co-constructed national approach in Norway
Principles for developing an evidence-based open platform ecosystem
Conclusions
References
Chapter 20: Norway, Sweden, and Finland as forerunners in open ecosystems and openEHR
Abstract
Historical background and the way to organise healthcare services
Evolution of data sharing: From documents to structured openEHR data
Benefits of openEHR
Country maturity assessment
Stepwise approach is characteristic for the openEHR road map in Nordic countries
Success factors for a digital ecosystem and openEHR-based projects—A Nordic experience
The biggest challenges in the Nordic openEHR projects
References
Chapter 21: The Brazilian digital health system: Building the digital transformation to engage country citizens
Abstract
Introduction
The Brazilian healthcare system
Information and communication technology in Brazilian healthcare facilities
The National Health Data Network (RNDS)
Final considerations
References
Chapter 22: Benefits of using SNOMED CT in the UK National Health Service (NHS)
Abstract
Why SNOMED CT?
The problem … the meaning
Use of SNOMED CT in an NHS hospital
Clinical coding benefits
Benefits for the patient
Conclusion
References
Chapter 23: Primary health reform for the digital era
Abstract
Principles of primary care
An opportunity for primary care transformation
Primary care in Canada
Digital health and primary care
Digital health in Canada and regulation
Comparing digital primary care across Canadian provinces
The digital foundation of Ontario’s primary care system
Case #1: Adoption of virtual care in Ontario primary care as a result of the COVID-19 pandemic
Digital health infrastructure as a force shaping the primary care transformation
Guiding Canada into the future
References
Chapter 24: Caribbean/PAHO—Jamaican case study
Abstract
Background
What are the benefits of using OpenEHR?
Capacity building and competence in the openEHR reference model
Tooling for openEHR adoption
Skill development process, use of software, and openEHR tools
Design and develop technical documentation for core archetypes
Other archetype development activities
Further development
Investment programme components
Capacity building
Information architecture
Scope
Discussion
Conclusion
References
Chapter 25: Addressing workforce knowledge gaps in digital health
Abstract
A whole of ecosystem approach
Defining the vision, then the strategy
Identifying new knowledge and skill requirements
Building digital health workforce capacity
Process, tools, and systems—A human resource (HR) perspective
Leading a digital health workforce
Performance benefits from leadership and employee engagement
Conclusion
References
Chapter 26: Emerging digital health ecosystems
Abstract
A functional EHR environment
Defining the vision and then the strategy
Implementation strategy
Current state and enabling environment—A summary of findings
Future directions and purpose
Key requirements
A timeline to success
Our concluding recommendations and rationale
References
Index

Evelyn Hovenga

Evelyn Hovenga, RN, PhD, FACS, FANC, FIAHSI, currently manages eHealth Education, an RTO, and the not-for-profit Global eHealth Collaborative (GeHCo) and continues to work as a digital health consultant. She retired as Professor of Health Informatics in 2007, following a 25-year career in this discipline with a focus on standards development as these apply to EHRs, semantic interoperability, and terminology and is Honorary Senior Research Associate at the Centre for Health Informatics and Multiprofessional Education, University College London (http://www.chime.ucl.ac.uk/). Evelyn started her career as a registered nurse; has health executive, public service, educational and research experience; obtained a PhD in Health Administration (Nursing Informatics); initiated and hosted the first National Health Informatics Conference (HIC) in Melbourne in 1993; is one of the founders of HISA and the Australasian College of Health Informatics; and is a founding fellow of the International Academy of Health Sciences Informatics (FIAHSI), Geneva. She is also widely published. Evelyn is an honorary member of the International Medical Informatics Association’s Nursing Informatics SIG as a result of representing Australian nurses from 1984 for many years, as a member and Past Chair of this group.

Affiliations and expertise

CEO and Director, eHealth Education Pty Ltd, East Melbourne, VIC, Australia

Heather Grain

Heather Grain, ADip HIM, Dip TDD, GDip IS, MHI, FAIDH, FMU, FIAHSI, possesses international expertise in developing, implementing, and managing digital health systems and data governance. A leader in electronic health record systems, she has worked across multiple countries and held significant roles in health informatics at organizations such as ISO, HL7, and SNOMED International. Currently, she leads the Information Governance Ad Hoc Group for ISO TC215.

As an educator, Heather has guided many into health informatics, developing courses for eHealth Education and several universities. She designed the Electronic Health Records Online Learning (eHRoL) clinical coding simulation and training tool for the Global eHealth Collaborative (GeHCo). With a strong understanding of both the practical and theoretical aspects of digital health, she emphasizes the importance of data harmonization to reduce costs and improve healthcare outcomes, while working to advance skills and education strategies in digitally supported healthcare.

Affiliations and expertise

School of Public Health, La Trobe University, Bundoora, VIC, Australia

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health