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THE RILEY REPORT - August 2007
from Thomas B. Riley RTRiley6@cs.com
www.rileyis.com
Following is the Riley Report for August 2007. Please feel free to pass this on as you see fit. If you wish to use any part of the Report in an offline publication please acknowledge the author or contact the author for permission if it is to be fully republished offline. If you are not currently subscribed to the Riley Report (there is no charge) you may email RTRiley6@cs.com and simply put "subscribe" in the body of the text.
This month’s report assesses the importance of e-governance in relation to health issues in Commonwealth countries. New technologies bring increasing changes to health systems around the world, which is especially important for governments in developing countries.
Using e-Governance for Health Service Delivery Throughout the Commonwealth
Thomas B. Riley & William P. Sheridan
Commonwealth Centre for e-Governance
Ottawa, Ontario, Canada
PREFACE
“New technologies bring
increasing changes for governments around the world. This phenomenon is resulting in new challenges to governments
whose citizens want access to government through an array of technologies, sound
policies, privacy and security assurances, accessible services and other
interactive programs between government agencies and the citizenry.”
Introduction: E-Governance and E-Government
To discuss the question of health service through the
Commonwealth through the use of e-governance principles it is first important to
articulate and differentiate the differences between, and definitions of,
e-Governance and e-Government.
e-Governance and e-Government can be defined as two very
distinct terms. e-Governance is a broader topic that deals with the whole
spectrum of the relationship and networks within government regarding the usage
and application of ICTs. e-Government is a narrower discipline dealing
with the development of online services to the citizen, more the ‘e’ on any
particular government service – such as e-tax, e-transportation or e-health.
e-Governance is a wider concept that defines and assesses the impacts that
technologies are having on the practice and administration of governments and
the relationships between public servants and the wider society, and dealings
with the elected bodies or outside groups, such as not-for-profit organizations,
ngos or private sector corporate entities.
e-Governance encompasses a series of necessary steps for government
agencies to develop and administer in order to ensure successful implementation
of e-government services to the public at large.
The differences between these two important concepts are explored further
in this chapter.
The ‘e’ part of both e-government and e-governance
stands for the electronic platform or infrastructure that enables and supports
the networking of public policy development and deployment.
It is by now widely acknowledged that the original impetus for acquiring
and using electronic apparatus in government and governance arose from the
earlier successes with the same kind of strategy in commerce.
e-Commerce had previously rested on credit and debit card processing for
purchases, and on faxing of bulk orders and subsequent invoices in
business-to-business transactions. In Canada, the United States and the United
Kingdom, for example, the emergence of e-commerce by the private sector helped
to stimulate and drive the evolution of e-government within departments and
agencies. At the political
leadership level it was clear that e-commerce was reflecting the enormous
changes taking place in the economies of countries in the developed world.
e-Government has been achieved throughout the Commonwealth
through a series of important actions. These include political leadership and
input of senior public servants, cross-government departmental cooperation,
working partnerships with the private sector, especially in the IT sector, and
consultation with citizens and groups in society. The latter can be achieved
through a number of mechanisms, such as surveys and focus groups, to determine
what members of the public want in terms of online services.
It needs to be stressed here that there are vast differences in the implementation of e-government in developed and developing countries. For example, key elements of success in developed countries for “Collective Accountability” in governments are:
- Personnel
- Funding
- Resources
- Political support
-
Ability to build technology infrastructures.
Developed countries have the financial and personnel
resources to move forward quickly and efficiently in the evolution and
implementation of on-line services. In
fact, implementation programs in many countries, during the nascent era of
e-government in the early to mid 1990’s, resulted in failures in bringing
services online, which cost governments hundreds of millions of dollars.
However, countries in the English speaking world, such as the United
States, Great Britain, Canada and Australia, when confronted with overspends,
were able to absorb the losses and move on to develop effective and interactive
online services.
Essentially, many of these countries have been able to turn to donor international organizations such as the World Bank, the UN and OECD and other developed countries for finance and personnel resources. When approaching e-government implementation in developing countries a different approach is needed. Following is an example of a particular approach to e-government applications in developing countries. One of the most important sectors in all countries in the Commonwealth is the health industry. As will be shown below e-governance principles play a strong role in bringing technologies to the health industry.
Introduction – Health and
e-Governance
One of the most distinguishing aspects of the modern world
is its capacity to progressively empower wider and wider segments of society to
seek and achieve greater quality of life. The
demographic revolution is a dramatic instance of this trend.
More and more people worldwide now live longer and healthier lives.
Between the eras of Elizabeth I and George VI, the main contributors to
this trend were better nutrition and better public health practices. In the reign of Elizabeth II, the causes in the improvements
of the quality of life have shifted to genetics and medicine.
Governments are increasingly playing a role in this improvement in the
quality of life by disseminating information via the Internet.
Throughout the Commonwealth, the delivery of health-related information and knowledge is becoming one of the primary responsibilities of e-Governance. This reflects a worldwide trend. Those who track the content and use of the Internet report that websites devoted to medical information on various maladies and suggested cures rank amongst the top 5 types that are accessed. In response to this trend, government health departments and public medical institutions are increasingly supplying some of the information and knowledge being sought. On the one hand this e-Governance for Health Service Delivery represents a response to constituency requests. On the other hand, it is an opportunity for governments to assure the provision of quality information and knowledge, and counter-act any possible misinformation or unreliable knowledge that may also be available.
The Big Picture
Since Commonwealth governments now involve themselves in a
growing number of health issues and services, the need arises to plan for the
future financing, staffing, and equipping of health care facilities if these
governments are to meet their constituency’s future health care expectations.
This situation has led to the growth of a new capability, namely Health
Care Futures Forecasting. The
fields of demography and epidemiology are being cross-referenced to anticipate
how public and individual health needs will develop as populations age and
technologies (medicines, diagnostics, treatments) expand.
The Internet is playing a large role in this process.
Consultations and conferences are being organized online, to speed the
deliberation process and cut costs. When
face-to-face meetings do occur, the Internet is also helpful.
Using a website and e-mail, the pre-planning gives participants an
opportunity to share material before it is presented, and get feedback on
suggested changes. The meeting
agendas can also be posted online, as can the accommodation and transportation
provisions for the meeting. After
the meetings, the papers presented and any decisions taken can also be posted
online, enabling both professionals and the public to be appraised of the issues
covered and the actions planned.
This combination of websites and e-mails provides the public and governments with links to each other and to hospitals, research groups, extended care organizations, and special interest groups, insofar as any of them may offer health-related information to enlighten the public and update professionals.
Emergency Responses
During health-care emergencies, e-Governance via the
Internet can play a vital part in a public health strategy.
An outbreak of infectious disease is one such situation.
When these circumstances occur, it is often necessary to implement rather
strict, if only temporary, measures regarding who can have access to hospitals
and other health-care facilities, when, and under what conditions.
Commonwealth governments now often post this kind of information on
websites dedicated to that particular incident.
In a more general sense, information and knowledge bearing
on infection control in general is also made widely available on the Internet in
Commonwealth countries. The
epidemiology of most communicable diseases is often described in a general sense
so that people can identify symptoms if they occur.
When such prospective symptoms do seem to be present, people are advised
to consult a medical practitioner, and additionally to
behave in ways that will minimize the spread of the infection to others
until it is successfully treated. Those
with Internet connections can get instant access to this kind of information and
knowledge during times when and in locations where medical practitioners may not
always be readily available at the moment.
The use of Internet can also help in handling other public health threats. Relief from storms, floods, earthquakes, volcanoes, etc., is often coordinated with websites and e-mail. Relief supplies can be located, purchased or requisitioned, and then scheduled for delivery. The timetables for relief workers can be posted, the progress of relief delivery can be charted, and the accounting and billing for supplies and services can be tallied, all online. Damage reports can also be filed via the Internet, as can assistance and insurance claims, as well as rosters of those displaced and those seeking lost relatives or friends. Any and all of these types of emergency responses can be assisted with e-Governance capabilities over the Internet.
Community Health Care
Effective health service delivery often requires the coordination of efforts between various practitioners and institutions. e-Governance makes an important contribution to this process. Throughout the Commonwealth, hospitals and clinics usually have websites that post the hours and types of services to the public, the timetables of the various health-care practitioners, and the booking arrangements necessary for specialized procedures. Staff members can use these websites to schedule their hours, patient referrals, and medication prescriptions. In all of these cases that speed and ease of information delivery makes the coordination efforts much easier and more efficient.
Hospitals and clinics are able to do a great deal of their
provisioning over the Internet. Food,
drugs, medicines and other institutional supplies can be ordered directly from
suppliers, in bulk, at discount prices, and deliverable as required.
Even large equipment orders can be handled over the Internet – medical
departments can go shopping online for diagnostic and treatment facilities, as
can bedding and food preparation departments for their requirements.
Governments often help coordinate these efforts, supplying standards for
the quality and quantities of goods and services permissible, and for the budget
limits that must be adhered to.
Clinical data and information can also be over the Internet, between patients and their doctors or institutions, between doctors and laboratories, and between institutions and government data repositories. Patients may also be able to file health insurance claims, or requests for procedure approvals, where these apply. In all cases, the effectiveness of this information sharing depends upon e-Governance laws and regulations for privacy and confidentiality of patient and practitioner data. Commonwealth governments go to considerable lengths to assure that the health-related data so collected is stored securely, is used only as authorized, and is accessible to patients on demand. e-Governance is a vital aspects of all instances of effective community health service delivery.
International Health Care Considerations
In addition to local and national health care, Commonwealth
governments must also concern themselves with certain international aspects of
health. As worldwide immigration
continues to increase, movement between Commonwealth countries represents a
large proportion of this travel. Health
pre-screening at the country of origin is now a requirement for passage to
certain Commonwealth countries. The
results of these tests can be transmitted via the Internet (website electronic
forms or e-mails), thus facilitating a faster processing of travel applications.
In any cases where disease outbreaks are occurring in countries of
origin, news of these situations can be transmitted to Commonwealth countries
immediately, and decisions can be taken as to whether travel permits to or from
the designated countries may need to be temporarily restricted reflecting the
nature of the health risk.
International health cooperation is also facilitated over the Internet between Commonwealth countries. Various innovations in health care delivery are shared between both governments and health care practitioners. When success has been reported in one jurisdiction, similarities in circumstances may prompt other countries or professionals to adopt the comparable measures. Health studies and testings are also arranged and implemented with the help of the Internet. Often these include international comparability to assess whether populations have the same or different health characteristics, demographic profiles, and disease dynamics. When a combination of factors either increases or decreases health risk propensities, sharing of this information can assist other Commonwealth countries to take preventative or ameliorative actions.
Thomas Riley is available for consultations, preparation of reports, presenting workshops or delivering speeches at conferences and seminars on e-government, e-governance and e-democracy. Please contact me at the email address below for further details.
Thomas B. Riley
Executive Director and Chair
Commonwealth Centre for E-Governance
www.electronicgov.net
Visiting Professor, University of Glasgow
President, Riley Information Services Inc.
www.rileyis.com
email:
rtriley6@cs.com
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