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The LITIS conceptual framework: measuring eHealth readiness and adoption dynamics across the Healthcare Organizations

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Abstract

The Italian Federation of Healthcare Trusts and Municipalities promoted a national initiative, named LITIS, on the levels of technological innovation in healthcare, to assist its members in the governance of the eHealth phenomenon. The result is a toolkit (i) to compare the policies among HealthCare Organizations (HCOs) within a jurisdiction; (ii) to help negotiate and monitor the balanced evolution of eHealth solutions within and across the HCOs, and (iii) to facilitate the collaboration among HCOs to face common topics. The primary achievement is a Conceptual Framework, spanning over the complete spectrum of the support to care and administrative processes, assuming two perspectives: the Functions F (services for citizens, social/healthcare professionals, managers, administrative staff) and the Enabling Components C (prerequisites to deploy the Functions and handle the change). The framework entails a taxonomy of indicators to assess the eHealth readiness and adoption in the HCOs: at first the raw data – from a survey that involved nearly two thirds of the Italian HCOs—were transformed to yield a lower layer of 145 micro-indicators, then the micro-indicators were aggregated at an intermediate layer for two different purposes, either as 36 topics or as 12 sectors; the upmost layer was made of 3 macro-area indexes and a global index, named “ICLI”. The ontological structure behind the framework allows to adapt the set of micro-indicators to the context of any particular jurisdiction. The global index was used to classify each HCO into one out of five “Classes of Innovation” of increasing functional completeness. The lessons learned on presentation and interpretation of results are described.

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References

  1. A.M.A. - American Medical Association, Health IT readiness survey, Chicago, 2011. Retrieved 27/08/2011 at: http://www.ama-assn.org/ama/pub/physician-resources/health-information-technology/implementing-health-it/prepare.page.

  2. Anderson RM, Funnell MM. Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Counsel. 2005;57:153–7.

    Article  Google Scholar 

  3. Atkinson NL. Developing a questionnaire to measure perceived attributes of eHealth innovations. Am J Heal Behav. 2007;31:612–21.

    Article  Google Scholar 

  4. Australian Department of Health and Ageing. 2008. Retrieved 14/01/2011 at: http://www.health.gov.au/internet/main/publishing.nsf/Content/EHeath+Healthconnect.

  5. Berwick DM. Disseminating innovations in Health Care. JAMA. 2003;289(15):1969–75.

    Article  Google Scholar 

  6. Berwick DM, Nolan TW. Physicians as leaders in improving Health Care: a new series in Annals of Internal Medicine. Ann Intern Med. 1998;128(4):289–92.

    Google Scholar 

  7. Bradley EH, Webster TR, Baker D, Schlesinger M, Inouye SK, Barth MC, Lapane KL, Lipson D, Stone R, Koren MJ.“Translating Research into Practice: Speeding the Adoption of Innovative Health Care Programs, The commonwealth Fund, # 724. 2004. Retrieved 10/12/2010 at: www.cmwf.org.

  8. Cantù E, editor. L’aziendalizzazione della sanità in Italia. Rapporto OASI 2010. Egea: Milano; 2010.

    Google Scholar 

  9. CEN EN12264:2005. Health informatics—Categorial Structure for concept systems, CEN European Standard Organization, Bruxelles.

  10. Centers for Medicare and Medicaid Services. Medicare and Medicaid programs (CMS) 2010. Electronic Health Record Incentive Program. Retrieved 10/02/2010 at: http://cms.gov/EHrIncentivePrograms/.

  11. Dipartimento per la digitalizzazione nella PA e l’innovazione tecnologica (DDI) e Consiglio Nazionale delle Ricerche (CNR). InFSE: Infrastruttura tecnologica del Fascicolo Sanitario Elettronico - Fotografia commentata sperimentazioni esistenti su FSE. 2010. Retrieved 10/02/2011 at: http://www.innovazionepa.gov.it/i-dipartimenti/digitalizzazione-e-innovazione-tecnologica/attivita/tse/il-tavolo-permanente-per-la-sanita-elettronica-delle-regioni-e-delle-province-autonome-tse-.aspx.

  12. Deloitte and Ipsos Belgium. EU eHealth Benchmarking phase III – Final Report. 2011. Retrieved 20/05/2011 at: http://ec.europa.eu/information_society/eeurope/i2010/benchmarking/index_en.htm

  13. Empirica: Benchmarking ICT use among General Practitioners in Europe – Final Report. 2008. Retrieved 16/10/2010 at: http://ec.europa.eu/information_society/eeurope/i2010/benchmarking/index_en.htm

  14. Eng TR. Population health technologies: emerging innovations for the health of the public. Am J Prev Med. 2004;26(3):237–42.

    Article  Google Scholar 

  15. European Commission. ICT for Health - Glossary of Terms. Europe’s Information Society Thematic Portal. 2011. Retrieved 4/04/2011 at: http://ec.europa.eu/information_society/activities/health/glossary_of_terms/index_en.htm

  16. European Commission Information Society. European countries on their journey towards national eHealth infrastructures. eHealth Strategies Report. 2011. Retrieved 20/04/2011 at: http://www.ehealthnews.eu/publications/latest/2494--european-countries-on-their-journey-towards-national-ehealth-infrastructures.

  17. Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2). Retrieved 28/8/2011 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761894/.

  18. Fattore G, Cavallo MC, Tarricone R. Lo sviluppo del Health Technology Assessment in Italia: contenuti, approcci e riferimenti internazionali (Health Technology Assessment in Italy). In: Anessi Pessina E, Cantù E, editors. L’aziendalizzazione in sanità in Italia. Milano: Rapporto OASI 2008; 2008.

    Google Scholar 

  19. Federsanità-ANCI et al. LITIS. Livelli di Innovazione Tecnologica in Sanità. Executive Summary. 2010. Quaderni ForumPA, 03/10. Retrieved 03/04/2010 at: http://saperi.forumpa.it/story/42226/litis-ricerca-sui-livelli-di-innovazione-tecnologica-sanita.

  20. Fichman RG. The Diffusion and Assimilation of Information Technology Innovations. In: Zmud RW, editor. Framing the Domains of IT Management: Projecting the Future…Through the Past. Cincinnati: Pinnaflex Educational Resources, Inc; 1999.

    Google Scholar 

  21. Greenhalgh T, Robert G, MacFarlane F. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629.

    Article  Google Scholar 

  22. HIMSS Analytics. The Premier EMR Adoption Assessment Tool. 2008. Retrieved 27/04/2011 at: http://www.himssanalytics.org/docs/emram.pdf.

  23. HIMSS Analytics Europe. EMR Adoption Model. 2011. Retrieved 19/09/2011 at: https://www.himss.eu/?id=283.

  24. Jha AK, DesRoches CM, Kralovec PD, Joshi MS. A Progress Report on Electronic Health Records in U.S. Hospitals. Health Affairs. 2010;29(10).

  25. Kaiser Permanente HealthConnect. 2008. Retrieved 14/01/2011 at: http://xnet.kp.org/newscenter/aboutkp/healthconnect/index.html.

  26. Khoja S, Scott RE, Casebeer AL, Mohsin M, Ishaq AFM, Gilani S. e-Health Readiness Assessment Tools for Healthcare Institutions in Developing Countries. Telemed e-Health. 2007;13(4).

  27. Khoja S., Durrani H., Fahim A. Scope of Policy Issues for eHealth: Results from a Structured Review. 2008. Retrieved 01/09/2011 at: http://www.ehealth-connection.org/files/conf-materials/Scope%20of%20Policy%20Issues%20for%20eHealth_0.pdf.

  28. Kiess C, Brumleve R, Chang K. Measuring Organizational Readiness for the Implementation of Health Information Technology, I-631 Clinical Information Systems Final Group Project, Regenstrief Institute, Indianapolis. 2009. Retrieved 26/8/2011 at: http://www.scribd.com/doc/49657889/Measuring-Organizational-Readiness-for-the-Implementation-of-Health-Information-Technology.

  29. Li P, Bahensky JA, Jaana M, Ward MM. Role of multihospital system membership in electronic medical record adoption. Health Care Manag Rev. 2008;33(2):169–77.

    Google Scholar 

  30. MIP-Politecnico di Milano. Osservatorio ICT in Sanità: ICT in Sanità: l’innovazione in cerca d’autore. Executive Summary. 2011. Retrieved 20/08/2011 at: www.osservatori.net.

  31. Monteagudo JL, Moreno O. Report on Priority Topic Cluster two and recommendations - Patient Empowerment. Deliverable D2.5, Project eHealth ERA - Towards the Establishment of a European Research Area. 2007. Retrieved 19/12/2010 at: http://www.ehealth-era.org/documents/eH-ERA_D2.5_Patient_Empowerment_Final_31-03-2007_revised.pdf.

  32. National Health Service of England. About us - NHS Connecting for Health (NHS CFH). 2005. Retrieved 14/01/2011 at: http://www.connectingforhealth.nhs.uk/about.

  33. OECD - Directorate For Employment, Labour And Social Affairs - Health Committee - Health ICT. 2008. Indicators for international comparisons of health ICT adoption and use. DELSA/HEA(2008)15, OECD, Paris.

  34. Orchard MC, Dobrow MJ, Paszat L, Jiang H, Brown P. Access to electronic health records by care setting and provider type: perceptions of cancer care providers in Ontario, Canada. BMC Med Informat Decis Making. 2009;9(38). Retrieved 10/12/2010 at: http://www.biomedcentral.com/1472-6947/9/38.

  35. Pagliari C, Sloan D, et al. What Is eHealth (4): a scoping exercise to map the field. J Med Internet Res. 2005;7(1):e9.

    Article  Google Scholar 

  36. Parasuraman A. Technology Readiness Index (TRI): a multiple item scale to measure readiness to embrace new technologies. J Serv Res. 2000;2(4):307–20.

    Article  Google Scholar 

  37. Protti DJ. An Assessment of State of Readiness and a Suggested Approach to Evaluating “Information for Health: an Information Strategy for Modern NHS (1998–2005)”. 1999. Submitted to Peter Drury, Head of Information Policy, NHS Executive.

  38. Ricci FL, Luzi D. Analisi delle esperienze e dei progetti di Information & Communication Technology in Sanità. Primi risultati. 2003. Retrieved 10/12/2010 at: http://www.irpps.cnr.it/it/system/files/Osiris_Luzi_Ricci.pdf.

  39. Rigby M, Hill P, Koch S, Keeling D. Social care informatics as an essential part of holistic health care: a call for action. IJMI. 2011;80:544–54.

    Google Scholar 

  40. Rogers EM. Diffusion of innovations. New York: Free Press; 1995.

    Google Scholar 

  41. Rossi Mori A. The policies on Connected Health are essential to achieve accountable social and health systems. Submitted to European Journal of ePractice, Special Issue on “Policy lessons from a decade of eGovernment, eHealth & eInclusion”. 2011.

  42. Rossi Mori A, et al. RIDE: A Roadmap for Interoperability of eHealth Systems in Support of COM 356 with Special Emphasis on Semantic Interoperability. 2007. Retrieved 10/12/2010 at: http://www.srdc.metu.edu.tr/webpage/projects/ride/index.php.

  43. Rossi Mori A, Consorti F, Nardi R, Ricci FL. Un quadro di riferimento sulle tecnologie dell’informazione nel settore sanitario. Report from FIASO (Italian Federation of Local and Hospital Trusts) ICT Workgroup; 2001.

  44. Rossi Mori A, Mazzeo M, D’Auria S. Deploying Connected Health among the Actors on Chronic Conditions. European Journal of ePractice No 8. December 2009. 2009. Retrieved 31/07/2011 at: http://www.epractice.eu/files/European%20Journal%20epractice%20Volume%208_1.pdf.

  45. Rossi Mori A, Mazzeo M. Holistic health: Predicting our data future, from inter-operability among systems to co-operability among people. Submitted for publication. 2012. Int J Med Informat.

  46. Rossi Mori A, Mercurio G, Verbicaro R. Enhanced policies on Connected Health are essential to achieve accountable social and health systems. European Journal of ePractice, Special Issue on “Policy lessons from a decade of eGovernment, eHealth & eInclusion”. 2012. (in press)

  47. Seaton B. Managing eHealth Risks and Opportunities. In Proceedings of Annual OACCAC Conference (Ontario Association of Community Care Access Centres), Toronto, Ontario; 2007.

  48. Spandonaro F (ed). Rapporto CEIS-Sanità 2008. 2008. Retrieved 19/12/2010 at: http://www.grusol.it/informazioni/11-02-09.PDF.

  49. Spanjers R, Smiths M, Hasselbring W. Exploring ICT-enabled networking hospital organizations. In: Stegwee A, editor. Strategies for Healthcare Information Systems. Hershey: Idea Group Publisher; 2001. p. 164–80.

    Google Scholar 

  50. Tamburis O. The specific role of ICT: different perspectives between traditional healthcare service and e-healthcare service. Int J Electron Healthc. 2006;2(3):250–62.

    Google Scholar 

  51. Tsinakis M, Katehakis DG, Orphanoudakis SC. An open, component-based information infrastructure for integrated health information networks. Int J Med Informat. 2002;68(1):3–26.

    Article  Google Scholar 

  52. Wickramasinghe NS, Fadlalla AMA, Geisler E, Schaffer JL. A framework for assessing e-health preparedness. Int J Electron Healthcare. 2005;1(3):316–34.

    Article  Google Scholar 

  53. Wickramasinghe N, Misra SK (eds). Critical issues in assessing sustainability and feasibility of E-Health. In: Wickramasinghe N, Geisler E, editors. Encyclopedia of Healthcare Information Systems. Information Science Reference (an imprint of IGI Global): Hershey PA, USA; 2008. p. 325–330.

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Acknowledgements

The work was partially funded by the Department of Innovation of the Italian Council of Ministers and industry sponsors. The work was performed in collaboration with the Permanent Board of the CEOs of Healthcare Trust and Municipalities by Federsanità-ANCI, with the eHealth Committee of Federsanità-ANCI, and with FORUM PA. One of the Authors (GM) was partially supported by a contract of collaboration between CNR and the Ministry of Health.

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Authors and Affiliations

  1. ITB-CNR, Rome, Italy

    Oscar Tamburis, Mariangela Contenti, Gregorio Mercurio & Angelo Rossi Mori

  2. eHealth Committee, Federsanità-ANCI, Rome, Italy

    Massimo Mangia & Angelo Rossi Mori

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  1. Oscar Tamburis
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  2. Massimo Mangia
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  3. Mariangela Contenti
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  5. Angelo Rossi Mori
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Correspondence to Angelo Rossi Mori.

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Tamburis, O., Mangia, M., Contenti, M. et al. The LITIS conceptual framework: measuring eHealth readiness and adoption dynamics across the Healthcare Organizations. Health Technol. 2, 97–112 (2012). https://doi.org/10.1007/s12553-012-0024-5

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