By the 1990 's, the focus of healthcare in developed countries, where the health IT investment was occurring, had changed from dealing primarily from acute, short-term interventions to primarily dealing with long-term, chronic conditions that required input from a wide range of specializations provided from both hospitals and community-based settings. The IT focus moved to linkages between organizations; digitization and integration of lifelong patient records; and greater granularity of and structure for clinical data. Health IT moved beyond hospitals (although this happened much more quickly in places like the U.K., the Scandinavian countries and Australia than in North America). This was the transition to "e-health”.
By the 2000 's, advances in information and communication technologies were beginning to allow massive, distributed health databases and the development of comprehensive, nation-wide health information infrastructures. I was Director, National Health Information Infrastructure for Australia from 2002-2005. International knowledge sharing was high on the agenda - for example, I chaired two international working groups on electronic health records, one based in Europe and one in the U.S.A.
In addition, patients/consumers became directly involved. Health became the one of most frequently sought information ...
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...ave been developed, but their adoption is as yet very patchy. Improved health literacy, including in highly developed nations, is also required to enable patients/consumers to notice when something may be wrong.
Technology dependence. Particularly in settings where the human infrastructure is relatively thin, outages can bring services to a halt or heighten the ever-present risk of clinical error. Prevention requires investment in redundant network infrastructures as well as well-developed training and contingency planning.
Opportunism. Just as many companies have "dumped” products into developing markets that have been deemed inappropriate in developed nations (Cultural Survival, n.d.), there is substantial risk that the legacy e-health products referred to above will be sold into developing markets, introducing unnecessary barriers to health system improvements.
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