International perspectives and initiatives
2007; Wiley; Volume: 24; Issue: 2 Linguagem: Inglês
10.1111/j.1471-1842.2007.00709.x
ISSN1471-1842
Autores Tópico(s)Education in Diverse Contexts
ResumoHealth Information & Libraries JournalVolume 24, Issue 2 p. 137-141 Free Access International perspectives and initiatives First published: 19 June 2007 https://doi.org/10.1111/j.1471-1842.2007.00709.xCitations: 3AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In my last column, I made the case for adopting a comparative approach to the capture and use of health information. The rationale of this new column, devoted to international perspectives and initiatives, is to acquaint readers with global trends in the fields of health science librarianship and health informatics. In each issue, an expert will be invited to describe significant trends in their country or region. Our first contributor, Dr Mauisz Duplaga, is a Polish doctor who has participated in several European projects focused on the use of IT use in health care. His article explains how recent social and economic changes in Poland, including recent entry to the EU, have influenced the direction of healthcare. A question which arises from his account is whether eHealth is a luxury for countries preoccupied with transforming their economies. Although the author does not touch directly on the role of health libraries, he notes that the promotion of access to health care information is a strategic target. The provision of health-related educational resources for children and adolescence is the focus of a national program. Jeannette Murphy Towards the development of e-health in Poland Mariusz Duplaga, Institute Public Health, Jagiellonian University Medical College, Krakow, Poland Introduction Poland is the largest of the 10 countries that joined the European Union in May 2004, with a population of over 38 million, and a land mass of 312 685 square kilometres. During the last 16 years, the process of economy transformation, starting with radical reforms in the early 1990s, has continued and intensified. Although the economy was growing quite steadily throughout this period, the macroeconomic changes resulted in unfavourable outcomes, with high unemployment rate posing the greatest problem. This rapid transformation of the economy did not result in immediate changes in the healthcare system; it was 10 years after the shift to market economy that the first reforms were initiated. Consecutive governments were afraid of implementing changes in the healthcare system because public opinion was opposed to any modification of the existing system. However, in 1999, the government introduced the Health Funds, which were assigned territorially to the main administrative units (voivodships). Subsequent attempts to improve the system in terms of its efficiency and quality of services were not properly targeted as evidenced by a general lack of satisfaction expressed by both the recipients and providers of health-related services. Initially, lack of clarity regarding the financing of health care resulted in cautious investment strategies related to the development of the health IT infrastructure. Later reforms did result in a greater use of information technologies for data collection and exchange by service providers. Healthcare managers started to appreciate the potential benefits of efficient information systems. The introduction of the National Health Funds also coincided with the final stage of a World Bank Project aimed at developing hospital information systems in Poland.1 Overview of the Polish healthcare system Today the organization and activities of the Polish healthcare system derive from rules laid down in the 1997 Universal Health Insurance Act (amended in later years). The basic principles include universal and mandatory participation, social solidarity, self-government and independence of healthcare funds, and, finally, state guarantee of insurance security. The Ministry of Health is responsible for designating general healthcare strategies.2 It is responsible for health policy, training, research and specialized facilities. Regional authorities are responsible for organising and financing tertiary care, and local authorities are responsible for primary and secondary care.3 The National Health Fund, with a central office situated in Warsaw and local offices in all voivodships, was established in 2003. The National Health Fund (Narodowy Fundusz Zdrowia) is the institution responsible for the provision of the healthcare services to citizens.4 It finances healthcare services and assures reimbursement of medicines. The entire population is covered by the insurance system, with equal access to healthcare services guaranteed by insurance. Persons entitled to free healthcare services in Poland (beneficiaries) include those covered by general health insurance (on either a compulsory or voluntary basis) as well as uninsured Polish nationals resident in the territory of Poland who meet income criteria set out in the area of social assistance.2 Public and non-public healthcare providers who have contracts with the National Health Fund are obliged to provide healthcare services within the general health insurance system. Healthcare providers include practising physicians and public and non-public healthcare facilities such as hospitals and surgeries (individual, individual specialist, group surgeries). Healthcare providers are obliged to provide services in the shortest possible time. The whole population has primary healthcare coverage, organized by local authorities. Primary care facilities are based on the concept of family medicine. From the 1990s this type of healthcare service provision was strongly promoted and currently the model of primary care as a first-line contact point for patients prevails. It is quite difficult to give an accurate estimate of the proportion of service provided by the public and private healthcare sectors. However, recent data indicate that more than 95% of inpatient health services are still provided by public healthcare institutions.2 Total expenditure on health care in Poland, expressed as percentage of gross domestic product, was 4.9% in 1990 and 6.5% in 2003. Total health expenditure per capita (expressed in US$ PPP) was estimated as US$296 in 1990 and US$744 in 2003. The proportion of public expenditure on health as a percentage of total expenditure on health was estimated as 91.7% in 1990, dropping to 69.9% in 2003, according to statistics issued in OECD Health Data 2005 in October 2005.5 Strategies for e-health development in Poland The Ministry of Health was responsible for drafting documents on e-health policies. The strategies developed by the Ministry of Health are part of a wider vision on the development of an information society in Poland. In September 2004, the Ministry of Health issued a document titled ‘Poland–e-Health Strategy for 2004–06’. In March 2005, the document, ‘Strategy of information infrastructure development in health care and introduction of the European Health Insurance Card’, was prepared for the Minister of Health. The issue of e-health was also included in the national programme of reforms, accepted by the Polish government in December 2005. The main strategic targets of the national e-health strategy cover: • the development of an information technology infrastructure in healthcare institutions; • the creation of central databases and registers for the healthcare system; • the promotion of access to healthcare information; • safety and security of medical data; • availability of telemedicine services; and • health-related education and health promotion. The development of an information technology infrastructure in healthcare facilities encompasses issues of the interoperability of IT solution implemented in health care institutions; the introduction of electronic communication between healthcare providers; and specific programmes such as Internet access in every healthcare institution. Central registers for healthcare system have been in place for some years. Those currently available include the Register of Health Care Providers and Medical Rescue Units; registers of pharmacies, professions and medical specialities; as well as the Central Data Base of Medical Products. The crucial areas relating to the availability of information in health care cover the development of the central healthcare portal, along with more specific tasks such as a monitoring system for waiting lists, and implementation of electronic patient registration for medical services. There are also plans to establish a training program in computer skills addressing the needs of health professionals. Another programme is focused on the provision of health-related educational resources for children and adolescents. The plans extend also to the challenge of implementing the European Health Insurance Card and the introduction of a system of registration of healthcare services. A recent important step in defining e-health-related priorities was ‘The Strategy of Development of Health in Poland for years 2007–13’. This document was prepared by the Centre of Health Information Systems on behalf of the Polish Ministry of Health. The strategy was accepted by the Council of Ministers on 21 June 2005. The context of e-health-related activities is covered in operational objective 2.2 (‘Reduction of information deficiencies in the domain of formation of health politics’). The strategy emphasizes the importance of monitoring activities undertaken by health services providers to ensure the development of efficient health policies (e.g. accessibility of health services, reducing economic and social barriers limiting access to services). There should be ongoing monitoring of changes in healthcare systems in order to trace their effect on the quality and availability of health services for patients. The main sources of information related to the organization of health care in Poland are registers and databases derived from data provided by health services providers. The system of information collection should be improved through the introduction of appropriate IT systems, as well as through the standardization and integration of existing applications. It is anticipated that these activities will eradicate deficiencies in information used for decision-making by the national government and local authorities. Another benefit of these initiatives will be to improve the quality of information on the organization and resources of the healthcare system. Methods for collecting health-related data are expected to conform to EU Directive 1400/97. Specific tasks in the arena of e-health (outlined in ‘The Strategy of Development of Health in Poland for years 2007–13’) include: • development of the national health information system, enabling analysis of the level of required health services; • promotion of access to health-related information for citizens (e.g. repositories of health-related resources, national health portal); • development and implementation of the national information system, supporting management in hospitals and other health facilities; and • development of information systems for medication orders and consumption.2 Main organizations involved in the domain of health information and e-health The ministries involved in the activities related to e-health policy is fluid, depending on changing competencies. Generally, the Ministry of Health plays the main role in shaping e-health policy in Poland. However, there are other stakeholders, namely, the Ministry of Infrastructure, the Ministry of Interior and Administration, the Ministry of Science and Information Society Technologies, and finally the Ministry of Science and Higher Education. The activities of the Ministry of Health have focused on the development of e-health objectives and implementation plans, as well as responding to European level initiatives related to e-health. The Centre of Health Information Systems is a specialized institution acting under the supervision of the Ministry of Health, focused on the harmonization of the healthcare system in Poland with recommendations issued by European Commission, including those specific to the e-health domain. The most important responsibilities of the Centre of Health Information Systems include: • maintenance of the System of Health Information used for monitoring the Polish population health status; • modelling of health-related processes; • early identification of epidemiological threats and bioterroristic emergencies; • activities aimed at semantic, technical, organizational, legal and social interoperability between information systems used in health care; • linking the health information system with central national and insurance registers and introduction of common patients identifiers; • development of electronic patient records and the introduction of health insurance card; and • support for telemedicine in the area of standardization, coordination and interoperability of the systems used in Poland and in the context of transborder cooperation. Up until November 2005, the Ministry of Science and Information Society Technologies was responsible for the co-ordination of policies on science and informatization (support for IT education, promotion of e-government development and enabling access to all public services through the Internet); co-ordinating the implementation of information technologies in public administration and infrastructure development on a national level for provision of electronic services (including e-health).6,7 With the abolition of the Ministry of Science and Information Society Technologies, from November 2005 the responsibility for co-ordination of the policy on informatization, support for IT education, promotion of e-government, enabling access to all public services in Poland was shifted to the Ministry of Interior and Administration. The Ministry of Education and Science, then transformed into the Ministry of Science and Higher Education, became responsible for coordination of policies on sciences, development of IT infrastructure for science, defining the National Framework Programme and providing support for research programmes (including e-health).8,9 It should be noted that the Ministry of Interior and Administration is involved in the drafting of the National Plan for Informatization, which covers the domain of e-health. There are several regional level centres and units focused on e-health-related technology transfer. Activities focused on technology transfer are also integrated in the scope of work of existing centres of technology transfer, centres of advanced technologies and centres of excellence established in recent years throughout the country. The issue of technology transfer in e-health was also the topic of some international projects, e.g. PRO-ACCESS (5FP).10 Examples of the institutions and organizations acting at regional and national level and focusing on e-health and telemedicine area include: • Krakow Centre of Telemedicine11 • Centre of Innovation, Technology Transfer and University Development, at Jagiellonian University, Krakow12 • Centre of Advanced Technology ‘Akcent-Malopolska’13 • Silesian Centre of Advanced Technologies14 • Polish Telemedicine Society.15 Support actions to promote e-health-related innovation on the national and international scale includes conferences, seminars, working/expert groups, and information and communication activities.16–19 Summary Although there has been an uptake in the use of information technologies in the Polish healthcare system in the past few years, there is still considerable work to be done. The e-health development strategies defined by the Polish Ministry of Health need broader promotion and acceptance. Efforts to reform the system of health services provision and financing have taken priority over e-health projects. The availability of structural funds for Poland since joining the European Union may result in more research and development. However, there are other factors that impede progress in e-health. In addition to the unstable financial situation of many public healthcare institutions, there is the unclear legal status of e-health services. For instance, there are no plans for their inclusion in reimbursements schemes offered by the national insurance organization. Another barrier is the relatively low Internet penetration in the general population. To overcome these obstacles, co-ordinated efforts across all organizations involved in the health services provision in Poland is required. References 1 Health Care Systems in Transition – Poland. 1999. Available from: http://www.euro.who.int/observatory/hits/. 2 Polish Ministry of Health Website. Available from: http://www.mz.gov.pl. 3 eContent in Poland. 2004. Available from: http://www.content-village.org/articles.asp?id=331. 4 National Health Fund Website. Available from: http://www.nfz.gov.pl. 5 Organisation for Economic Cooperation and Development. OECD Health Data. 2005. Available from: http://www.oecd.org/document/16/0,2340,en_2649_37407_2085200_1_1_1_37407,00.html. 6 Information available on the website of previous Ministry of Scientific Research and Information Society Technologies [ http://www.mnii.gov.pl]. 7 Report ‘Monitoring the status of activities within Strategy for Development of Information Infrastructure in Poland – ePoland for years 2004–06’. Available from: http://www.mnii.gov.pl . 8 Ministry Education and Science. National Research Framework Programme. Available from: http://www.mnii.gov.pl/mein/_gAllery/12/53/12535.pdf. 9 Polish Ministry of Education and Science website. Available from: http://www.mein.gov.pl. 10 The PRO-ACCESS Project Website. Available from: http://www.pro-access.org. 11 Krakow Centre of Telemedicine Available from: http://www.telemedycyna.krakow.pl/kctm.php?,p=1&m=0#/. 12 Centre of Innovation, Technology Transfer and University Development. Available from: http://www.cittru.uj.edu.pl. 13 Centre of Advanced Technologies ‘AKCENT-Malopolska’. Available from: http://www.cittru.uj.edu.pl/akcent.html. 14 Silesian Centre of Advanced Technologies. Available from: http://www.nauka.pwr.wroc.pl/dczt/. 15 Polish Telemedicine Society. Available from: http://www.amwaw.edu.pl/pttm/. 16 1st and 2nd International Conference on E-Health in Common Europe (June 2003) [http://www.pro-access.org/conference/index.html], March 2004 [http://www.pro-access.org/conference2/index.html]. 17 International Center of Hearing and Speech. 3rd International Conference on Telemedicine and Multimedia Communication (Last Edition: 21–23 October 2005). Available from: http://www.ichs.pl/32596.dhtml. 18 International Workshop on E-health in Common Europe, December 2004. Available from: http://www.pro-access.org/conference3/index.html. 19 Telemedicine. 2006. Available from: http://www.csioz.gov.pl/download/Telemedycyna2006/program.pdf. 20 Dolnośląskie Center of Advanced Technologies. Available from: http://www.nauka.pwr.wroc.pl/dczt/. Citing Literature Volume24, Issue2June 2007Pages 137-141 ReferencesRelatedInformation
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