National Health Models and the Adoption of E-Health and E-Prescribing in Primary Care – New Evidence from Europe

James Brennan, Annette McElligott, Norah Power

Abstract


OBJECTIVE:  Recent research from the European Commission (EC) suggests that the development and adoption of eHealth in primary care is significantly influenced by the context of the national health model in operation. This research identified three national health models in Europe at this time – the National Health Service (NHS) model, the social insurance system (SIS) model and the transition country (TC) model, and found a strong correlation between the NHS model and high adoption rates for eHealth. The objective of this study is to establish if there is a similar correlation in one specific application area – electronic prescribing (ePrescribing) in primary care.

METHODS: A review of published literature from 2000 to 2014 was undertaken covering the relevant official publications of the European Union and national government as well as the academic literature. An analysis of the development and adoption of ePrescribing in Europe was extracted from these data.

RESULTS: The adoption of ePrescribing in primary care has increased significantly in recent years and is now practised by approximately 32% of European general practitioners. National ePrescribing services are now firmly established in 11 countries, with pilot projects underway in most others. The highest adoption rates are in countries with the NHS model, concentrated in the Nordic area. The electronic transmission of prescriptions continues to pose a significant challenge, especially in SIS countries and TCs.

CONCLUSIONS: There is a strong correlation between the NHS model and high adoption rates for ePrescribing similar to the EC findings on the adoption of eHealth. It may be some time before many SIS countries and TCs reach the same adoption levels for ePrescribing and eHealth in primary care as most NHS countries.


Keywords


National Health Services; Health Information Systems; Electronic Health Records; E-Prescribing; Primary Health Care; Europe

Full Text:

PDF HTML

References


Currie W and Seddon J. A cross-national analysis of eHealth in the European Union: some policy and research directions. Information & Management 2014;51(6):783–97. http://dxdoiorg/101016/jim201404004.

Piha T. How Can the EU Drive Ehealth Development? Mede-Tel, Luxembourg: European Commission, DG Health and Consumers, 2014.

European-Comission. eHealth Action Plan 2012–2020 – Innovative Healthcare for the 21st Century. Brussels: European Commission, 2012.

European-Commission. Directive 2011/24/Eu of the European Parliament and of the Council of 9 March 2011 on the Application of Patients’ Rights in Cross-Border Healthcare. Brussels: European Commission, 2011.

European-Commission. Guidelines on Eprescriptions Dataset for Electronic Exchange Under Cross-Border Directive 2011/24/ EU – Release 1. Adopted by EC eHealth Network November 2014.

EPSOS. Smart Open Services for European Patients – WP 1.1: Analysis and Comparison of National Plans/Solutions. The European Commission, 2009.

EPSOS. Smart Open Services for European Patients – WP D 3.1.2: Final Definition of Functional Service Requirements – ePrescription. The European Comission Report, 2010.

Johansen I. Adoption and take up of standards and profiles for e-Health interoperability – project presentation – Antilope overview. Antilope Handover, Gent 29/1/2015: Antilope Project, 2015.

European-Commission. SIBIS Report No. 9: Benchmarking e-Health in the IS in Europe and the US. European Commission, 2003.

Codagnone C and Lupiañez-Villanueva F. Benchmarking Deployment of eHealth among General Practitioners. European Commission DG Communications Networks (Content & Technology), 2013.

Codagnone C and Lupiañez-Villanueva F. A Composite Index for the Benchmarking of eHealth Deployment in European Acute Hospitals. European Commission Joint Research Centre, Institute for Prospective Technological Studies, 2011.

Deloitte and Ipsos. eHealth Benchmarking III. European Commission: Information Society and Media Report, 2011.

Empirica. eHealth Benchmarking II. European Commission: Information Society and Media Report, 2009.

Sabes-Figuera R and Maghiros I. European Hospital Survey: Benchmarking Deployment of e-Health Services (2012–2013). European Comission, 2013.

WHO. Primary Health Care – Now More Than Ever. Geneva: World Health Organisation, 2008.

Empirica. Benchmarking ICT Use among General Practitioners in Europe. Bonn: European Commission: Information Society and Media Directorate General, 2008.

Kruse C, DeShazo J, Forest K and Fulton L. Factors associated with adoption of health information technology: a conceptual model based on a systematic review. JMIR Medical Informatics 2014;2(1).

Hage E, Roo J, Van Offenbeek M and Boonstra A. Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review. BMC Health Services Research 2013;13:19.

Esterle L and Kouroubali A. Political and Organisational Factors Influencing Large Scale Implementation of Electronic Health Records. EHR Implement Report, 2010.

Meade B, Buckley D and Boland M. What factors affect the use of electronic patient records by Irish GPs? International Journal of Medical Informatics 2009;78:551–8.

Pizzi LT, Suh DC, Barone J and Nash DB. Factors related to physicians’ adoption of electronic prescribing: results from a national survey. American Journal of Medical Quality 2005;20(1):22–32.

Protti D and Peel V. Critical success factors for evolving a hospital toward an electronic patient record system: a case study of two different sites. Journal of Healthcare Information Management 1998;12(4):29–38.

Greenhalgh T, Robert G, Macfarlane F, Bate P and Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. The Milbank Quarterly 2004;82(4):685–716.

Greenhalgh T and Stones R. Theorising big IT programmes in healthcare: strong structuration theory meets actor network theory. Social Science & Medicine 2010;70:1285–94.

Cresswell K and Sheikh A. The NHS care record service: recommendations from the literature on successful implementation and adoption. Informatics in Primary Care 2009;17(3):153–64.

Deloitte. Physician Adoption of Health Information Technology: Implications for Medical Practice Leaders and Business Partners. Deloitte Center for Health Solutions, 2013.

Fickenscher K and Bakerman M. Clinician adoption of technology. Physician Executive 2011;37(4):82.

Mäkinen M, Rautava P, Forsström J and Äärimaa M. Electronic prescriptions are slowly spreading in the European Union. Telemedicine and e-Health 2011;17(3):217–22.

Fincham JE. E-Prescribing: The Electronic Transformation of Medicine. Burlington, MA: Jones & Bartlett Publishers, 2009.

Dobrev A, Jones T, Stroetmann V, Stroetmann K, Vatter Y and Peng K. Interoperable eHealth Is Worth It. European Commission: Information Society and Media Report, 2010.

Castro D. Explaining International IT Application Leadership: Health IT. Washington, DC: The Information Technology & Innovation Foundation, 2009, pp. 24–44.

CSC. Accomplishing EHR/HIE (Ehealth): Lessons from Europe. Waltham, Massachusetts, USA: Computer Sciences Corporation, 2009, pp. 1–14.

Dobrev A, Johnes T, Stroetmann K, Vatter Y and Peng K. The Socio-Economic Impact of Interoperable Electronic Health Records (EHR) and ePrescribing Systems in Europe and Beyond. EHR Impact: European Commission: Information Society and Media, 2009, p. 54.

e-health-initiative. Electronic Prescribing: Toward Maximum Value and Rapid Adoption: Recommendations for Optimal Design and Implementation to Improve Care, Increase Efficiency and Reduce Costs in Ambulatory Care. Washington DC, USA: eHealth Initiative, 2004, p. 25.

Gartner. eHealth for a Healthier Europe!: Opportunities for a Better Use of Healthcare Resources. Stockholm, Sweden: Ministry of Health and Social Affairs in Sweden, 2009, p. 84.

IHE. Hospital Pharmacy and Community Pharmacy: Use Cases and Standards White Paper. Integrating the Healthcare Enterprise – Europe Report, 2010.

KPMG. Consultancy in Electronic Prescribing and Dispensing (ePrescribing). Department of Health and Ageing, Australian Government Report, 2008.

NHS. Electronic Prescribing in Hospitals – Challenges and Lessons Learned. NHS Connecting for Health UK Report, 2009.

Rupp MT, Simenson ST and Kaufman PN. E-Prescribing and Medication Management: The New Paradigm for Provider and Pharmacist Interaction. Agency for Healthcare Research and Quality, USA, 2009.

Stakes. eHealth of Finland. Helsinki, Finland: Stakes, 2007.

Astrand B. Medication records and ePrescribing in Sweden. EHTEL International Conference on ePrescribing and Medication Management (Ljubljana, Slovenia), 2006.

Leonardi C. Electronic prescription: the CRS-SISS Project in Regione Lombardia, Italy. Proceedings of EHTEL International Conference on ePrescribing and Medication Management (Ljubljana, Slovenia), 2006, pp. 1–12.

Tellinger K and Salmivalli L. Functionalities and implementation of EPS systems: comparison of two approaches. EHTEL International Conference on ePrescribing and Medication Management (Ljubljana, Slovenia), 2006.

Protti D, Johansen I and Perez-Torres F. Comparing the application of health information technology in primary care in Denmark and Andalucía, Spain. International Journal of Medical Informatics 2009;78(4):270–83.

Tiik M. Patient Opportunities in the Estonian Electronic Health Record System. Tartu University, Estonia: Estonian e-Health Foundation, 2010.

Hercigonja–Szekeres M and Stevanović R. e-Health in practice: e-prescription Croatian experiences. EFMI Special Topics Conference (Moscow, Russian Federation), 2012.

Nictiz. eHealth in the Netherlands: Policies, Developments and Status of Cross-Enterprise Information Exchange in Dutch Healthcare. Nictiz Report, 2009.

Jha AK, Doolan D, Grandt D, Scott T and Bates DW. The use of health information technology in seven nations. International Journal of Medical Informatics 2008;77(12):848–54.

Arts J and Koppel R. Implementation of computerized physician order entry in seven countries. Health Affairs 2009;28(2):404–14.

Protti D. Comparison of information technology in general practice in 10 countries. Healthcare Quarterly 2007;10(2):107–16.

Carnicero J and Rojas D. Application of Information and Communication Technologies for Health Systems in Belgium, Denmark, Spain, the United Kingdom and Sweden. UN Social Development Division, Santiago, Chile, 2010.

Landerdahl M. Overview of the Utilisation of Automated Decision Support Tools at Dispensing in the Pharmacies in Ten European Countries. Gothenburg, Sweden: University of Gothenburg (Thesis), 2010.

HIQA. EPrescribing and Electronic Transfer of Prescriptions: An International Review. Ireland: Health Information and Quality Authority, 2012.

Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R et al. A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Affairs 2012;31(12):2805–16.

Miller D. ePrescribing: ready for prime time. But is your government? Health Management Technology 2009;30(1):31–2.

Van Welsum D, Overmeer W and Van Ark B. Unlocking the ICT Growth Potential in Europe: Enabling People and Businesses – Using Scenarios to Build a New Narrative for the Role of ICT in Growth in Europe. European Commission, DG Communications Networks, Content & Technology, 2013.

Kiirkegaard P. E-Prescription across Europe. Health and Technology 2013;3(3):205–19.

Stroetmann K and Artmann J. The European cross-border ePrescription study: preliminary results. eMedikation Konferenz (Bern, Switzerland), 2012.

EFPC. European Forum for Primary Care, 2014.Available from: http://www.euprimarycare.org/. Accessed on 10/05/2014.

Black A, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Medicine 2011;8(1):e1000387.

Empirica. European Countries on Their Journey towards National eHealth Infrastructures. European Commission Directorate Information Society and Media, 2011.

Björnberg A, Garrofé BC and Lindblad S. European Health Consumer Index 2009. Health Consumer Powerhouse AB, 2009, pp. 13–4.

Björnberg A. European Health Consumer Index 2012. Health Consumer Powerhouse AB, 2012.

Björnberg A. European Health Consumer Index 2013. Health Consumer Powerhouse AB, 2013.

EPSOS. Epsos Participating Nations & Epsos sets sail in Athens, 2012. Available from: http://www.epsos.eu. Accessed on 02/01/2012.

Mosby. Mosby’s Medical Dictionary, 8th edition. St Louis, Missouri: Elsevier, 2009.

Kringos D, Boerma W, Hutchinson A and Saltman R. Building Primary Care In A Changing Europe – Case Studies. WHO Regional Office for Europe, Copenhagen, Denmark: The European Observatory on Health Systems and Policies, 2015.

Donaldson M, Yordy K, Lohr K and Vanselow N. Primary Care: America’s Health in a New Era. Washington, DC: Institute of Medicine, 1996.

European-Commission. eHealth in Action: Good Practice in European Countries. European Commission: Information Society and Media Directorate General Report, 2009.

Van De Wetering R and Batenburg R. A PACS maturity model: a systematic meta-analytic review on maturation and evolvability of PACS in the hospital enterprise. International Journal of Medical Informatics. 2009;78(2):127–40.

Sutton L. PACS and diagnostic imaging service delivery—a UK perspective. European Journal of Radiology 2011;78(2): 243–9.

Surescripts. The National Progress Report on e-Prescribing and Interoperable Healthcare – Year 2011. Arlington, VA, USA 2012.

Surescripts. 2013 National Progress Report and Safe-Rx Rankings. Arlington, VA, USA, 2014.

Rogers EM. Diffusion of Innovations, 5th edition. New York, USA: Free Press, 2003.

Astrand B. ePrescribing: Studies in Pharmacoinformatics. School of Pure and Applied Natural Sciences. Doctoral dissertation. Kalmar, Sweden: University of Kalmar, 2007.

Protti D, Bowden T and Johansen I. Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 2: historical comparisons. Informatics in Primary Care 2008;16(3):189–93.

Protti D and Smit C. The Netherlands: another European country where GP’s have been using EMRs for over twenty years. Healthcare Information and Communication Management Canada. 2006;20(3):8–12.

Doupi P, Giest S and Dumortier J. Country Brief: Iceland. European Commission, DG Information Society and Media, ICT for Health Unit, 2010.

Eesti-Haigekassa. Estonian Health Insurance Fund, 2012. Available from: http://www.haigekassa.ee/eng/digital_prescription. Accessed on 12/01/2012

Chronaki C, Pakarinen V, Jalonen M, Porrasmaa J, Berler A and Tarhonen T. HL7 CDA in the National ePrescription Efforts of Finland & Greece: a Comparison. EFMI STC 2012. Moscow 2012.

Ictparliament.org. Global Centre for ICT in Parliament, 2011. Available from: http://www.ictparliament.org/node/4299. Accessed on 12/01/2012.

Empirica. eHealth Strategies: Country Briefs. European Commission DG Information Society and Media, 2010.

Drăgănescu D, Lupuleasa D, Dumitrescu I, Dinu Pârvu C and Ciolan D. Evidence on e-prescribing systems worldwide – first Romanian results. Farmacia 2013;61(2).

SIVECO. An Exceptional Success for Romanian Health Insurance System and Computer Scientists at the European IT & Software Excellence Awards. SIVECORO, 2014.

Gider O, Ocak S and Top M. Evaluation of electronic prescription implications in turkey: an investigation of the perceptions of physicians. Worldviews on Evidence-Based Nursing 2015;12(2):88–97.

EHRimpact. The Socio-economic Impact of Diraya, the Regional EHR and ePrescribing System of Andalucía’s Public Health Service. European Commission, DG Information & Media Report, 2009.

Christensen T, Faxvaag A, Loerum H and Grimsmo A. Norwegians GPs’ use of electronic patient record systems. International Journal of Medical Informatics 2009;78(12):808–14.

Protti D, Bowden T and Johansen I. Adoption of information technology in primary care physician offices in New Zealand and Denmark, Part 3: Medical record environment comparisons. Informatics in Primary Care 2008;16(4):285–90.

IMF. Greece: Letter of Intent, Memorandum of Economic and Financial Policies, and Technical Memorandum of Understanding. International Monetary Fund, 2011.

IMF. Portugal: Letter of Intent, Memorandum of Economic and Financial Policies, and Technical Memorandum of Understanding. International Monetary Fund, 2011.

Codagnone C and Lupiañez-Villanueva F. Benchmarking Deployment of eHealth among General Practitioners (2013)– Annex II Country Profiles. European Commission DG Communications Networks (Content & Technology), 2013.

Ammenwerth E, Duftschmid G, Gall W, Hackl O, Hoerbst A, Janzek-Hawlat S et al. A nationwide computerized patient medication history: evaluation of the Austrian pilot project “e-Medikation”. International Journal of Medical Informatics 2014;83(9):655–69.

Polish-Government. National e-Prescribing Website for Poland, 2012. Available from: http://www.e-recepta.gov.pl. [updated 8/6/2012; cited 8/6/2012; Accessed on 8/6/2012].




DOI: http://dx.doi.org/10.14236/jhi.v22i4.97

Refbacks

  • There are currently no refbacks.


This is an open access journal, which means that all content is freely available without charge to the user or their institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal starting from Volume 21 without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open accessFor permission regarding papers published in previous volumes, please contact us.

Privacy statement: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.

Online ISSN 2058-4563 - Print ISSN 2058-4555. Published by BCS, The Chartered Institute for IT