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E-sant : tlsant, sant numrique et sant connecte

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E-sant : tlsant, sant numrique ou sant connecte

Bibliographie : septembre 2016

Sommaire

En guise dintroduction : une solution pertinente aux nombreux dfis des systmes de sant ............ 3
Un essai de dfinition .............................................................................................................................. 4
La e- sant : Une vision densemble ........................................................................................................ 8
Etudes franaises ................................................................................................................................. 8
Ouvrages.......................................................................................................................................... 8
Articles ............................................................................................................................................. 9
Rapports ........................................................................................................................................ 19
Etudes trangres ............................................................................................................................. 26
Ouvrages........................................................................................................................................ 26
Articles ........................................................................................................................................... 28
Rapports ........................................................................................................................................ 37
La tlddecine : de la tlmdecine informative la tlmdecine mdicale ................................... 41
Etudes franaises ............................................................................................................................... 41
Ouvrages........................................................................................................................................ 41
Congrs .......................................................................................................................................... 43
Articles ........................................................................................................................................... 43
Rapports ........................................................................................................................................ 61
Etudes trangres ............................................................................................................................. 70
Ouvrages........................................................................................................................................ 70
Articles ........................................................................................................................................... 72
Rapports ...................................................................................................................................... 162
Les systmes dinformation en sant : dossiers mdicaux, prescription lectronique, rseaux ..... 164
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Etudes franaises ............................................................................................................................. 164

Ouvrages...................................................................................................................................... 164
Articles ......................................................................................................................................... 168
Rapports ...................................................................................................................................... 191
Thses .......................................................................................................................................... 212
Documents de travail .................................................................................................................. 213
Etudes trangres ........................................................................................................................... 213
Ouvrages...................................................................................................................................... 213
Articles ......................................................................................................................................... 214
Rapports ...................................................................................................................................... 243
Documents de travail .................................................................................................................. 251
Ressources lectroniques .................................................................................................................... 253

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En guise dintroduction : une solution pertinente aux nombreux dfis des

systmes de sant

Le terme de e-sant (e-health en anglais) - avec ses quivalents : tlsant, sant numrique, sant
connecte - dsigne tous les domaines o les technologies de linformation et de la communication
(TIC) sont mises au service de la sant, telle quelle a t dfinie par lOrganisation mondiale de la
sant (OMS) en 1945 : La sant est un tat de complet bien-tre physique, mental et social, et ne
consiste pas seulement en une absence de maladie ou dinfirmit . Cela concerne des domaines
comme la tlmdecine, la prvention, le maintien domicile, le suivi dune maladie chronique
distance (diabte, hypertension, insuffisance cardiaque ), les dossiers mdicaux lectroniques ainsi
que les applications et la domotique.

La e-sant apparat de plus en plus comme une solution pertinente pour rpondre aux dfis que
doivent relever les systmes de sant : volution de la dmographie mdicale, ingalits territoriales
daccs aux soins, hausse de la prvalence des maladies chroniques ou encore vieillissement de la
population et prise en charge de la dpendance. En revanche, une incertitude demeure quant sa
capacit rduire les cots, du moins dans un premier temps : si elle laisse esprer plus defficience,
elle pourrait aussi offrir de nouveaux services, entranant des dpenses supplmentaires. Lenjeu du
dploiement de la tlsant est donc moins conomique que qualitatif.

Toutefois, malgr lintrt suscit, la e-sant est longtemps demeure sous -exploite. Ce constat est
vrai pour lensemble des pays de lOCDE, 1mme si certains pays nordiques disposaient dun systme
dordonnances lectroniques, dun portail national dinformation sur la sant en ligne et dun dossier
patient numris au dbut des annes 2000. En France, de nombreux programmes informatiques ont
fait lobjet dinvestissements dans les hpitaux dans le cadre dune modernisation du
fonctionnement administratif, qui ne concourait pas directement la qualit des soins. 2

Le contexte a beaucoup volu ces dernires annes, et la sant numrique semble tre la solution
alliant lefficacit des soins apports la matrise des dpenses de sant, mais sa gnralisation
implique de trouver des rponses des questions de tous ordres telles que : la confidentialit des
donnes personnelles, la gestion du dploiement des solutions techniques pour couvrir lensemble
de la population, le basculement vers le numrique des services de sant actuels, la
responsabilisation, la formation, lautonomie, le suivi des patients lorsque les solutions de e-sant
leur permettront de rester domicile pour leur traitement.

En France, loutil technologique nest certes pas la rponse unique aux difficults de prise en charge
du patient. Toutefois, correctement mise au service du dcloisonnement des secteurs sanitaire et
mdico-social, hospitalier et ambulatoire, mdical et paramdical, la e-sant pourra servir de levier
pour encourager la prvention et les soins primaires, tout en garantissant un principe constitutif du
systme de sant franais depuis 1945 : laccs des soins de qualit pour tous grce un maillage
effectif du territoire. De plus, la tlsant permettra de replacer lusager au cur du dispositif et de
rpondre sa volont dautonomie, dsormais reconnue comme un droit des malades. 3 Longtemps
considre comme un pays la trane en matire de e-sant, la France semble avoir pris la mesure,
depuis les annes 2010, de lutilit dune vritable politique de sant numrique. Il est noter
galement que le march de la e-sant grandit principalement en dehors de lhpital (plutt orient
vers la future mise en place du dossier mdical personnel), au plus prs des patients dans leur lieu de

1
OCDE (2009). Obtenir un meilleur qualit-prix dans les soins de sant.
2
OCDE (2010). Amliorer lefficacit du secteur de la sant : le rle des technologies de linformation et de la
communication.
3
Daprs la note du Centre danalyse stratgique. Quelles opportunits pour loffre de soins de demain : la tlsant. (N
255, dcembre 2011).
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domicile, avec deux cibles clairement identifies qui sont : les patients atteints de maladies
chroniques (diabte, insuffisance cardiaque,), les sniors ou les personnes handicapes vivant
domicile et ncessitant une assistance spcifique.

Si les attentes sont nombreuses, les dfis le sont aussi. Les TIC vont-elles permettre de mieux
protger les donnes mdicales ou vont-elles au contraire, en donnant la possibilit daccrotre la
mobilit de linformation et des services, rendre ces donnes plus vulnrables ? Est-ce quil existe des
mthodologies dvaluation de la e-sant ? Quel cadre lgislatif supplmentaire pour son
dveloppement ? Quelles sont les nouvelles responsabilits des professionnels de sant ? Une
mobilisation de tous les acteurs et une nouvelle coordination de leurs actions au niveau rgional,
national, europen semblent indispensable pour que la e-sant remplisse ses promesses, ainsi
quune bonne intgration de ces nouvelles technologies dans la politique de sant globale.

Lobjectif de cette bibliographie est de recenser des sources dinformation (ouvrages, rapports,
articles scientifiques, littrature grise, sites institutionnels) dans le domaine de la e-sant pour la
priode stendant de 2000 2016/07.

Le primtre gographique retenu concerne la France, lEurope, les Etats-Unis, le Canada et

lAustralie.

Les recherches bibliographiques ont t ralises sur les bases suivantes : Base bibliographique de
lIrdes, Banque de donnes sant publique (BDSP), Medline.

Lorsque les requtes de recherches rapportaient plus de 1 000 rfrences dans la littrature
scientifique notamment anglo-saxonne, la slection s'est oriente vers les revues de la littrature
(review, systematic review, literature review, scopus review) et les documents accompagns de
rsum.

Les rfrences sont prsentes par types de documents, puis par ordre alphabtique de titres et/ou
dauteurs. Elles sont prcdes dune dfinition de la e-sant, ainsi que dune dlimitation de ses
domaines daction.

Nombre de rfrences slectionnes

Thmes/ Champs gographiques France Pays trangers

Dfinition
Etudes densemble sur la e-sant 94 52
Tlmdecine 121 124
Systmes dinformation en sant 210 134

Un essai de dfinition
La littrature regorge dexpressions consacres la sant numrique ou connecte. Les
professionnels de sant parlent essentiellement de tlmdecine, alors que les ingnieurs
informaticiens ou du numrique parlent surtout de-sant. Beaucoup de termes franais sont la
traduction de mots utiliss dans la littrature anglo-saxonne. E-health se traduit en franais par e-
sant , telehealth par tlsant . En France, le terme tlsant intgre tous les domaines de la

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sant numrique, mais dans les pays anglo-saxons, telehealth est surtout utilis pour dcrire les
services de la tlmdecine informative.4

Elle est aussi nomme : TIC sant et, depuis plus de dix ans, lutilisation des TIC dans le domaine de la
sant est aborde dans de nombreux travaux acadmiques et institutionnels.

Le premier usage du terme e-sant remonte vraisemblablement 1999. Lors dune prsentation
au 7e congrs international de la tlmdecine ou mdecine distance John Mitchell, un
consultant australien dans le domaine de la sant, le dfinit comme lusage combin de linternet
et des technologies de linformation des fins cliniques, ducationnelles et administratives, la fois
localement et distance .5

Selon lOrganisation mondiale de la sant (OMS), la e-sant se dfinit comme les services du
numrique au service du bien-tre de la personne cest--dire comme lapplication des
technologies de linformation et de la communication (TIC) au domaine de la sant et du bien-tre.
La tlmdecine est une activit professionnelle qui met en uvre des moyens de
tlcommunications numriques permettant des mdecins et dautres membres du corps
mdical de raliser distance des actes mdicaux, alors que la tlsant concerne lutilisation des
systmes de communication pour protger et promouvoir la sant.

Le primtre de la e-sant

Pour pallier cette large dfinition de la e-sant, il est ncessaire den dterminer les frontires en
faisant linventaire des disciplines et concepts qui sen rclament.6

Premier domaine majeur : les systmes dinformation de sant (SIS) ou hospitaliers (SIH), qui
forment le socle sur lequel repose la e-sant : ils organisent, au niveau informatique, les changes
dinformations entre la mdecine de ville et lhpital, ou entre services au sein dun mme hpital.
Cest sur ces systmes que reposent le dossier mdical partag (DMP), le systme de carte vitale

Deuxime domaine : la tlsant qui reproupe notamment la tlmdecine et la m-sant.

En France, la tlmdecine a t dfinie par la loi Hpital Patients Sant Territoire (HPST) n 2009-
879 du 21 juillet 2009 comme une pratique mdicale distance faisant intervenir au moins un
mdecin. Sa dfinition et sa mise en uvre sont prcises par le dcret n 2010-1229 du 19 octobre
2010 (Journal officiel du 21 octobre). La tlmdecine se dtermine comme les actes mdicaux
raliss distance au moyen dun dispositif utilisant les technologies de linformation et de la
communication.

Cinq types dactes sont ainsi concerns :

- la tlconsultation : un mdecin donne une consultation distance un patient, un

professionnel de sant ou un psychologue peut tre prsent auprs du patient et, le cas
chant, assister le mdecin au cours de cet acte ;

4
Simon P. (2016). Tlmdecine et enjeux pratiques
5
E-sant : la mdecine lre du numrique. Science & Sant, n 29, 2016
6
E-sant : la mdecine lre du numrique. Science & Sant, n 29, 2016

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- la tl-expertise : un mdecin sollicite distance lavis dun ou de plusieurs de ses confrres

en raison de leurs formations ou de leurs comptences particulires, sur la base des
informations lies la prise en charge dun patient ;
- la tlsurveillance mdicale : un mdecin interprte distance les donnes ncessaires au
suivi mdical dun patient et, le cas chant, prend des dcisions relatives sa prise en
charge. Lenregistrement et la transmission des donnes peuvent tre automatiss ou
raliss par le patient lui-mme, ou par un professionnel de sant ;
- la tl-assistance mdicale : un mdecin assiste distance un autre professionnel de sant
au cours de la ralisation dun acte ;
- la rponse mdicale apporte dans le cadre de la rgulation mdicale des urgences ou de la
permanence des soins.

La France reprend ainsi la dfinition formule par lOMS. Le juriste Jean-Michel Croels va plus loin en
diffrenciant la tlmdecine mdicale et la tlmdecine informative, qui ne relvent pas du mme
droit. Les services de la tlmdecine informative sont des prestations du systme de la socit de
linformation, rgies par le droit de la concurrence (directives europennes de 1998 et 2000 sur le e-
commerce), alors que la tlmdecine mdicale relve du droit de la sant et est inscrite au Code de
la sant publique.7 La tlmdecine mdicale permet aux professions de sant de raliser distance
des actes mdicaux pour des patients. La tlmdecine informative organise la diffusion du savoir
mdical et des protocoles de prise en charge des malades et des soins dans le but de soutenir et
damliorer lactivit mdicale.

Quant la m-sant (pour mobile-sant), il sagit de la sant via les smartphones, domaine le plus
connu du grand public. Ainsi, en France, selon un sondage ralis par Odoxa en janvier 2015, un tiers
de la population possde un appareil connect permettant de mesurer des donnes physiologiques
ou lactivit physique. Toutefois, lautomesure est un phnomne bien antrieur larrive de la
connexion puisque, si trois Franais sur quatre possdaient un objet de mesure chez eux en 2013,
seulement 11 % disposent dune version connecte en 2015.

Un document de la Communaut europenne dcrit un primtre assez proche de celui-ci.8 La e-

sant comprend :

- Les rseaux rgionaux et nationaux dinformation pour la sant et les systmes de dossier
lectronique distribus y compris les systmes dinformation pour les professionnels de
sant et les hpitaux, les services en ligne tels que la prescription lectronique, les bases de
donnes, portails et les systmes de promotion en ligne pour la sant.
- Les systmes de tlmdecine et les services associs (tlconsultation, tlradiologie,
tlsurveillance)
- Les outils spcialiss pour les professionnels de sant et les chercheurs (robotique et
environnements avancs pour le diagnostic et la chirurgie, outils pour la simulation et la
modlisation, grilles pour la sant, outils de formation.

Il sagit donc dun ensemble trs vaste de techniques et de services, impliquant un large ventail
dacteurs et couvrant de nombreux domaines relevant de la sant ; un march fort potentiel de

7
Croels J. (2006). Le droit des obligations lpreuve de la tlmdecine. Presses universitaires de Marseille
8
La e-sant, une solution pour les systmes de sant europens. Les dossiers europens, n 17, 2009
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croissance qui pse environ 20 milliards deuros au niveau europen, ce qui le porte au troisime
rang des marchs de la sant.

Le primtre de la e-sant

Extrait de : Tlmdecine : enjeux et pratiques / Simon P. (2015) Editions Le Coudrier

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La e- sant : Une vision densemble

Etudes franaises

Ouvrages

Reynaudi, M. et Sauneron, S. (2011). "Quelles opportunits pour l'offre de soins de demain ? (volet 2). La
tlsant." Note D'analyse (La)(255): 11 , graph.
[Link]
A quoi ressemblera loffre de sant en France dans vingt ans ? Les dfis sanitaires sont nombreux :
hausse des maladies chroniques, vieillissement de la population, volution de la dmographie
mdicale, etc. Pour y rpondre, deux leviers daction sont disponibles. Dune part, le dveloppement
des cooprations entre professionnels de sant, sujet trait dans le premier volet de ce mini-dossier
consacr la sant demain. Dautre part, la production de soins distance grce aux technologies de
linformation et de la communication (TIC) : on parle alors de tlsant. Aujourdhui, son potentiel
reste exploiter. Elle demeure un secteur mergent, confront des freins juridiques, conomiques
et culturels. Lever ces obstacles permettra de passer dexpriences parses, nes sous limpulsion de
quelques acteurs, un dploiement plus ambitieux. Dans un schma idal, lapport de la tlsant ne
se cantonnera pas la dmatrialisation des procdures existantes. Elle sera aussi lorigine dun saut
qualitatif en engendrant de nouveaux services, des pratiques plus collgiales et une rorganisation des
structures sanitaires selon leur degr de spcialisation. Ainsi, la tlsant donnera corps un
continuum de soins, contribuant lorientation optimale du patient dans un systme intgr couvrant
domicile, soins primaires et aigus, soins de suite et mdico-sociaux. Enfin, les TIC contribueront faire
de lusager un coproducteur de sant.

(2010). Rsultats de questionnaire. Technologies mdicales : quels regards des patients et des mdecins sur
l'innovation, Courbevoie : Snitem
[Link]
Ce questionnaire a t ralis par le SNITEM au mois de novembre 2010 auprs d'acteurs de sant
renomms : mdecins, prsidents de socits savantes et prsidents d?associations de patients,
runis lors des RPM2 du 30 novembre 2010. Ces derniers ont t interrogs sur l'apport des
technologies mdicales la prise en charge de maladies qui reprsentent des enjeux de sant
publique importants : maladies cardiovasculaires, diabte, obsit, cancer, maladies neurologiques
(en particulier la maladie de Parkinson), insuffisance rnale chronique.

Brechat, P. H., et al. (2016). Sauvons notre systme de sant et d'assurance

maladie[Link]
Cet ouvrage est n dun constat accablant : si le systme de sant et dassurance maladie franais tait
lun des meilleurs au monde au dbut des annes 2000, aujourdhui il semble avoir perdu de vue sa
mission premire qui est laccs tous et partout la sant et des soins de haute qualit au meilleur
cot. Augmentation des ingalits daccs aux soins et la sant, faiblesse des politiques de
prvention, dconstruction du secteur mdico-social, remise en cause des principes dgalit, de
solidarit et de fraternit Les motifs dinquitude saccroissent. Un autre systme de sant est
possible : cest ce que dmontre Pierre-Henri Brchat en sappuyant sur des russites trangres et de
nombreuses donnes socio-conomiques, politiques et juridiques. Autour de 34 axes, il propose des
rformes structurelles et lgislatives conciliant impratifs conomiques, amlioration de ltat de
sant de la population, accroissement continu de la qualit des soins et satisfaction des usagers et des
soignants.

Degos, L., et al. (2011). Les nouveaux patients. Rles et responsabilits des usagers du systme de sant en
2025. Rapport 2011, Paris : Editions de sant ; Paris : Les Presses de Sciences Po

Cet ouvrage se penche sur la place, le rle et les responsabilits des patients dans les volutions du
secteur de la sant. Quatre tendances lourdes structurent l'avenir dans le champ de la sant : le
progrs technique, les volutions dmographiques et pidmiologiques, les transformations sociales
et les enjeux du financement. Le patient, usager du systme de sant, consommateur de soins,
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cotisant, est, sous ses diverses figures, au coeur des volutions. Cet ouvrage livre une analyse
prospective qui a pour objet d'identifier quelques tendances susceptibles d'clairer ce que seront les
patients en 2025 et d'analyser les enjeux des changements en perspective (d'aprs l'intro).

Venot, A. (2013). Information mdicale, e-sant. Fondements et applications, Paris : Springer-Verlag France

Linformatique mdicale est devenue au fil des annes une vraie discipline scientifique dont les bases
et applications sont enseignes non seulement dans tous les domaines de sant (mdecine,
odontologie, pharmacie, maeutique, sciences sanitaires et sociales, cole de soins infirmiers et de
kinsithrapie, coles de sant publique) mais galement dans de nombreux autres cursus (Sciences
de la vie, coles dingnieur et dconomie, etc.). Ce livre est le fruit du travail collectif de nombreux
auteurs appartenant principalement au Collge franais des enseignants chercheurs de cette
discipline. Il est compos de 19 chapitres qui comportent tous des objectifs pdagogiques, des conseils
pour approfondir les connaissances dans le domaine et des exercices.

Vigneron, E., et al. (2003). Sant et territoires, une nouvelle donne, La Tour d'Aigues : Editions de l'Aube Paris :
Datar

L'actualit politique sur la dcentralisation et la " rgionalisation exprimentale" a une incidence sur la
recomposition territoriale de l'offre de soins. Cette approche territoriale de la sant est aborde sous
les aspects suivants : dmographie mdicale, intercommunalit hospitalire, politique du
mdicament, dmarche qualit, transport sanitaire, rseaux de soins, tlmdecine, systmes
d'information, dveloppement de grands ples rgionaux de recherche et valorisation en
biotechnologies.

Articles

(1999). "Sant et nouvelles technologies de l'information et de la communication. Internet, RSS, tlmatique et

tlmdecine." Technologie Et Sante(36): 144.

[BDSP. Notice produite par ORS-MIP rR0x20e8. Diffusion soumise autorisation]. Nouvelles
technologies de l'information et de communication : enjeux et perspectives ; tlmdecine et
tlmatique de sant : les expriences ; les enjeux juridiques et dontologiques ; le rseau sant social
; les critres de qualit de l'information de sant.

(2012). "Technologies et avance en ge." Gerontologie Et Societe(141): 219.

[BDSP. Notice produite par FNG kR0xsplt. Diffusion soumise autorisation]. Alors que l'introduction
des aides techniques au domicile des personnes ges en perte d'autonomie continue de rencontrer
de nombreux obstacles, les technologies de l'information et de la communication (TIC) ont largement
pntr au coeur des usages de presque toutes les tranches d'ge de la population. Cette rvolution a
pu se faire grce la fiabilit des quipements, leur large distribution et la satisfaction de besoins
anciens et nouveaux qu'elles permettent. Toutefois, la dclinaison de ces technologies grand public
pour des personnes aux besoins physiologiques ou cognitifs spcifiques en reste encore trop souvent
au stade de l'exprimentation et du prototype et sans rflexion approfondie des industriels sur les
utilisateurs finaux et leurs modes de vie. Dans le champ de la grontologie, les TIC connaissent depuis
quelques annes des dveloppements importants centrs sur les enjeux de scurit du malade g et
de son parcours de vie. Les rticences commencent se lever en partie grce une rflexion thique
qui inclut l'ensemble des acteurs de la dmarche. (extrait du RA).

(2015). "La e-sant." Gestions Hospitalieres(551): 594-623.

[BDSP. Notice produite par EHESP R0xrmIo9. Diffusion soumise autorisation]. Le dossier propose
plusieurs tmoignages d'expriences russies en e-sant : celle du rseau Vigilance, cr en 2007 dans
les Deux-Svres, pour l'aide au maintien domicile des personnes dpendantes ; celle du Rseau
Vercors Sant, lanc en 2001 et destin pallier la pnurie de professionnels de sant sur le territoire
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du Vercors ; celle du rseau de sant grontologique Cormadom Lyon, cr en 2004, ou bien encore
celles du projet Infomed dans le canton du Valais en Suisse ; des plateformes Medaviz et MesVaccins.
net. Toutes ces expriences ont en commun le fait d'tre assez anciennes et de perdurer, et d'avoir
t inities par des professionnels dj sensibiliss par leur pratique et leur engagement aux
problmatiques de coopration et de coordination. Ces professionnels ont su s'approprier les outils
adquats pour amliorer les situations existantes. Cependant, malgr la volont des acteurs de
terrain, certains obstacles demeurent la mise en oeuvre de projets de e-sant, comme les clivages
institutionnels, le fonctionnement bureaucratique de l'offre de soins.

Alajouanine, G. (2010). "Tic et Territoires. Un label Haute Scurit Sant." Gestions Hospitalieres(495): 222-.

[BDSP. Notice produite par EHESP HR0xoItG. Diffusion soumise autorisation]. Ghislaine
ALAJOUANINE, Prsidente de la commission Galien, Haut Conseil pour la tlsant et des cooprations
francophones, dcrit la tlsant en sept vertus : 1. Un enjeu, une ambition ; 2. Une force de
mobilisation ; 3. La croissance pour faire de la France un leader mondial dans le domaine de la
tlsant au service du citoyen ; 4. Un dveloppement durable pour une prise en charge et des soins
srs, sains et durables via le concept du HS2 ; 5. La rponse une meilleure prise en charge, un mieux
tre du patient et 6/7 L'quilibre entre vie sociale et vie conomique.

Astier, K. (2010). "Tic et Territoires. Projet Hpital virtuel." Gestions Hospitalieres(495): 230.

[BDSP. Notice produite par EHESP m8R0x9mn. Diffusion soumise autorisation]. Cet article prsente
brivement le projet Hpital virtuel ralis dans le cadre du programme d'ducation et de formation
tout au long de la vie de l'Union europenne (LLL2007-2013). Cette plateforme d'e-learning est une
vritable innovation technique pour la formation initiale des infirmiers. Identification des enjeux
pdagogiques et professionnels pour ce nouvel outil arriv l'IFSI.

Baratta, N. (2001). "E-Sant : comment contrler les informations vhicules par les rseaux informatiques ?"
Decision Sante(171): 31-34.

[BDSP. Notice produite par ENSP rfROR0x5. Diffusion soumise autorisation]. Qu'elles soient
transmises par Intranet dans le cadre des rseaux de soins territoriaux et par l'intermdiaire de la CPS,
ou mises disposition du grand public via internet, les informations mdicales circulant sur les NTIC
soulvent de plus en plus de questions lies la confidentialit, la scurisation et la traabilit des
donnes, la qualit de l'information et la responsabilit des professionnels de sant participant aux
rseaux ou aux sites sant Internet. Si les rflexions concernant la scurit des informations mdicales
en Intranet sont dj bien avances - sinon rsolues - il apparat une majorit d'experts du secteur
que toute dmarche de labellisation des sites sant sur Internet semble pour l'heure illusoire. Une
problmatique que l'Association des lves de l'Ecole centrale de Paris a tenu explorer lors d'un
rcent colloque. Dans ce numro : la scurisation des donnes mdicales circulant dans un rseau de
soins.

Beau, P. et Marceau, J. (2014). "Sant et numrique, le passage l'acte !" Espace Social Europeen(1058): 4-7.

[BDSP. Notice produite par EHESP nAR0xHGC. Diffusion soumise autorisation]. La France va t-elle
s'investir, enfin, dans la transformation numrique de son conomie ? Le secteur de la sant, 12% du
PIB, prendra-t-il sa part dans cette mutation majeure ? Celle-ci dtient des atouts considrables
comme la personnalisation, l'autonomie et l'efficience des soins, mais comporte galement des
risques dont l'emploi, la scurit des donnes et les missions des professionnels ne sont pas les
moindres.

Beguin-Kerboul, M., et al. (2014). "Numrique en sant. Dans l'ocan Indien, des applications diversifies."
Revue Hospitaliere De France(561): 28-33.

[BDSP. Notice produite par EHESP AR0xJ89m. Diffusion soumise autorisation]. Petit tour d'horizon
des diffrentes applications de la tlmdecine dans l'ocan indien, et plus particulirement sur l'Ile
de la Runion : le dploiement de la tlmdecine rpond une problmatique rcurrente du secteur
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gographique, qui est celui de l'accs aux soins en territoire montagneux. Elle permet galement de
renforcer le systme de soins par le dveloppement de la tlsurveillance dans la prvention des
maladies chroniques telles que le diabte. Le CHU de La Runion et d'autres tablissements
hospitaliers tmoignent des expriences mises en place.

Beranger, J. (2015). "E-sant, m-health, big data mdicaux : Vers une hirarchisation des donnes mdicales."
Revue Hospitaliere De France(562): 70-74.

[BDSP. Notice produite par EHESP 8R0x79l8. Diffusion soumise autorisation]. Face la dferlante des
donnes mdicales numriques via les objets connects (e-sant), les applications mobiles (m-health),
la tlmdecine et les big data mdicaux, il importe de rester vigilant. O sont stockes les donnes
mdicales personnelles ? Sont-elle scurises ? Quelles donnes sont accessibles au patient ? La
solution de hirarchisation slective des donnes de sant vue travers le prisme thique permet de
mieux apprhender l'quilibre instable entre la disponibilit et la protection des donnes.

Bergeron, S. (2005). "Le bracelet anti-disparition Columba pour personnes avec dficits cognitifs et le systme
d'alarme cardiaque portable VPS - des perces dans le domaine de la tlscurit mdicale
personnelle." Gerontologie Et Societe(113): 71-81, fig.

[BDSP. Notice produite par FNG zR0xHyZk. Diffusion soumise autorisation]. Les perces
technologiques dans le domaine de la miniaturisation permettent l'arrive d'une nouvelle vague en
tlmdecine : la tlscurit mdicale personnelle. Ce nouveau domaine en mergence est fond sur
l'utilisation d'appareils mdicaux portables de monitoring pour utilisation domicile, comportant des
logiciels intelligents d'analyse, et permettant la transmission automatise d'alertes des centrales
d'assistance mdicalises lors de la reconnaissance d'anomalies srieuses, sans intervention de la part
du patient. Les premiers domaines viss par les entreprises qui oeuvrent dans ce secteur touchent
principalement les personnes ges, et les premiers appareils de la compagnie Medical Intelligence, le
VPS - un systme d'alarme cardiaque portable ECG 12 drivations, et le Columba - un bracelet anti-
disparition pour personne prsentant des dficits cognitifs, devraient tre disponibles dans les
prochains mois en France.

Boudy, J. (2007). "Recherche et dveloppement. Technologies de l'information, handicap et grontologie."

Revue Hospitaliere De France(515): 54-59, graph.

[BDSP. Notice produite par ENSP 5R0xpraW. Diffusion soumise autorisation]. Face au double dfi du
vieillissement de la population et de la monte en charge des dpenses de sant, l'emploi des
technologies de l'information et de la communication ouvre un champ d'applications nouvelles dans
l'assistance et le suivi de personnes malades, dpendantes, handicapes ou mobilit rduite. Le
Groupe des coles des tlcommunications (GET) a dvelopp une trs forte comptence en systmes
lectroniques, rseaux, traitement de signal et d'images et en sociologie des TIC. Plusieurs projets de
recherche sont pilots par ses laboratoires dans les domaines de l'assistance : tlmdecine et
tlsurveillance mdicale, assistance au handicap, maintien du lien social. Le dveloppement de ces
systmes exige un partenariat troit entre les quipes mdicales (INSERM, hpitaux, CHU...), les
laboratoires et les industriels. Il soulve, outre les problmes techniques, des questions
d'acceptabilit, de confidentialit, de modles conomiques et de rgulation. Ses chercheurs
prsentent titre d'exemple, l'application des TIC la tlvigilance (ou tlsurveillance mdicale).

Bubien, Y., et al. (2015). "E-sant : Groupe de recherche et d'applications hospitalires (Graph) Mditerrane -
Octobre 2015." Gestions Hospitalieres(551): 624-633.

[BDSP. Notice produite par EHESP pR0x8n7o. Diffusion soumise autorisation]. Le sminaire du
Groupe de recherche et d'applications hospitalires (Graph) Mditerrane qui s'est tenu du 15 au 17
octobre 2015 avait pour thmatique le dveloppement et les usages de l'e-sant en France. Les trois
articles de ce dossier rendent compte de faon synthtique des rflexions qui ont anim cette
rencontre : la sant connecte porte de nombreux progrs et rponses face aux volutions
pidmiologiques, dmographiques et socitales, et transforme le rle des acteurs traditionnels de
sant, cependant elle se heurte des obstacles d'ordre thiques, ou bien culturels et conomiques.
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Chambaud, L. (2016). "Le systme de sant franais lpreuve des transitions." Socio : La Nouvelle Revue Des
Sciences Sociales(6): 157-170.
[Link]
Cet article sintresse au concept dintegrated care, traduit par la notion d intgration des soins et
des services qui tend simposer dans la littrature des tudes sur la sant, la maladie, les soins. Ce
concept, qui peut tre rapproch de la notion de parcours de soins actuellement prn en France,
aide dpasser le clivage habituel entre le cure et le care, entre le soin et laccompagnement. Sa mise
en uvre sappuie sur un changement paradigmatique en cours partir dun phnomne de
transition combinant cinq domaines : transition pidmiologique avec la chronicisation de la plupart
des maladies graves ; transition dmographique, qui promeut la notion de service la personne,
prventif/curatif, accompagnement ; transition professionnelle, qui passe par les jeunes
professionnels de sant ; transition technologique, non spcifique au monde de la sant mais qui la
ralise, ne serait-ce quavec les technologies qui bousculent les prises en charge, ou le dpistage ;
transition dmocratique, dont on retrouve la trace dans le droit des malades des annes 2000 et lors
de lmergence de concepts nouveaux comme le malade-expert ou lducation thrapeutique. Les
enjeux actuels et les obstacles cette volution de notre systme de sant sont discuts.

[BDSP. Notice produite par EHESP R0xrF7mG. Diffusion soumise autorisation]. Illustration du rle
que peut jouer la tlmdecine dans la gradation des soins avec le cas du traitement par dialyse du
patient en insuffisance rnale chronique. L'article prsente galement l'exprience dveloppe en
Franche-Comt et Midi-Pyrnes dans le champ de la neurologie.

Chevallaz-Perrier, C. et Blouet, P. (2012). "L'engagement d'une entreprise dans le champ de la sant et des
nouvelles technologies." Gerontologie Et Societe(141): 147-162, fig.

[BDSP. Notice produite par FNG mrsR0xAp. Diffusion soumise autorisation]. L'volution des
technologies est une formidable opportunit pour offrir des solutions innovantes pour permettre
d'accompagner de faon efficace et humaine les populations vieillissantes. Les socits de haute
technologie se mettent de plus en plus l'coute des diffrents acteurs des mondes mdicaux et
mdico-sociaux pour offrir des solutions intgrables et adaptes. Cette volont socitale et
industrielle s'accompagne d'une recherche d'efficacit en rutilisant les expriences et les produits du
march grand public tout en s'intgrant un nouvel cosystme o les diffrents acteurs apprennent
travailler ensemble. (R.A.).

Comyn, G. (2009). "La e-sant : une solution pour les systmes de sant europens." Dossiers Europeens
(Les)(17).

Aprs une dfinition du champ de la sant numrique, ce dossier aborde ces multiples applications
dans le domaine mdical, les attentes ainsi que les dfis suscits par ces nouvelles technologies.

Cornet, G. (2005). "Technologies au service du soin." Gerontologie Et Societe(113): 160.

[BDSP. Notice produite par FNG rR5R0xrx. Diffusion soumise autorisation]. Les technologies au
service du soin et de l'autonomie des personnes ges, et leur potentiel de dveloppement, offrent
une population vieillissante des perspectives pour une meilleure qualit de vie au quotidien. Ce
fascicule fait le point sur certaines technologies disponibles et mergentes et claire le dbat sur ses
diffrents aspects. Conu partir de la journe universitaire organise, en mai 2004, la Piti
Salptrire, sous l'gide de l'Institut Universitaire de Grontologie Yves Mmin, de la Socit Franaise
de Griatrie et de Grontologie et de l'Universit Paris-VI, il reprend et complte l'essentiel des
contributions.

Dahan, C. et Benzaken, S. (2015). "Accompagner la rvolution numrique : Former les professionnels et les
patients." Gestions Hospitalieres(544): 137-139.

[BDSP. Notice produite par EHESP 9ooR0xGl. Diffusion soumise autorisation]. L'environnement
numrique dans le domaine de la sant bouleverse les pratiques des professionnels. Cette rvolution
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des outils, des modes de raisonnement et des modles relationnels ncessite un accompagnement. En
2014, la communaut interhospitalire PACA-Est a organis des formations sur la "e-sant" ouvert
un public large runissant professionnels de sant hospitaliers ou libraux, personnels hospitaliers
administratifs ou techniques, patients, reprsentants d'usagers. Trois thmes ont t abords au cours
de modules d'une demi-journe organiss au CHU de Nice : la e-sant dans la relation thrapeutique,
la scurit et la confidentialit des donnes numriques en sant, l'hpital numrique dans le
processus de certification dans les tablissements de sant.

Dangaix, D. et Rolland, C. (2012). "La tlphonie-sant est un outil qui fait partie d'un ensemble Interview."
Sante De L'homme (La)(422): 26-.

[BDSP. Notice produite par INPES ntsBR0xE. Diffusion soumise autorisation]. Au service d'coute
tlphonique de l'association Asthme & Allergies, les patients appellent pour en savoir plus sur leur
maladie et tre conseills et orients quant leur prise en charge thrapeutique. Des patients souvent
dboussols, en manque d'information. Entretien avec Christine Rolland, directrice de l'association.

Darracq, J.-P. et Blanchard, S. (2011). "Dispositif de soins. Tlsant en prison." Gestions Hospitalieres(506):
334-335.

[BDSP. Notice produite par EHESP j8tsqR0x. Diffusion soumise autorisation]. Prsentation du
projet'Tlsant en prison'dvelopp dans les trois units de consultations et de soins ambulatoires
(Ucsa) de la Dordogne et dans leurs centres hospitaliers de rfrence sur le plan somatique et
psychiatrique. Ce projet, qui s'est appuy sur la plateforme Tlsant Aquitaine, a permis
d'informatiser certaines fonctions et de faciliter les changes d'informations, confidentielles, de
manire scurise, entre professionnels de sant.

De, Block, C. K. M. (2015). "Optimipstic. Une stratgie territoriale e-sant." Revue Hospitaliere De France(567):
14-16.

[BDSP. Notice produite par EHESP oR0xJIG8. Diffusion soumise autorisation]. Les apports de la
tlmdecine la lutte contre les dserts mdicaux sont aujourd'hui reconnus par les mdias
spcialiss et un grand public inform. Les stratgies communment dnommes "e-sant" sont-elles,
pour autant, une vidence pour les tablissements de sant ? L'exprience du centre hospitalier de
Troyes (CHT) illustre l'importance des prrequis, et d'un processus d'volution, pour le dploiement de
ces stratgies.

Dunand, J. M. et Dreyer, P. (2012). "Faciliter l'usage des nouvelles technologies pour tous et dans la e-sant."
Gerontologie Et Societe(141): 163-170.

[BDSP. Notice produite par FNG InGR0xD7. Diffusion soumise autorisation]. Oprateur connu de
tlphonie mobile ou fixe, SFR est aussi un oprateur de services Internet et de nouvelles
technologies. Comptant un Franais sur deux client de l'entreprise, cette dernire se doit de dcrypter
les nouvelles technologies, d'en faciliter les usages et de les rendre accessibles au plus grand nombre
(technophiles ou non, individus en bonne sant ou fragiliss, jeunes ou moins jeunes, etc.) et ce, dans
tous les domaines, y compris celui de la sant. Prsente sur les diffrents marchs, Grand Public, Pro
et TPE, PME et Grandes Entreprises, Institutionnels et Collectivits, l'entreprise cherche constamment
apporter chacun de ses clients des solutions adaptes. (R.A.).

Durand--Salmon, F. et Le, Tallec, L. (2016). "La E-sant, quels nouveaux usages ?" Problemes
Economiques(3127): 33-37, tab., graph.

Cet article est une reprise partielle d'un article paru dans les Annales des Mines - Ralits industrielles
de novembre 2014. La sant mobile englobe l'ensemble des technologies individuelles en matire de
sant. Elle bnficie du dveloppement des rseaux, des nouvelles solutions de communication et de
la cration de nombreux objets connects. Le vieillissement de la population et l'augmentation des
maladies chroniques relguent dsormais au second rang les traditionnelles maladies transmissibles
infectieuses, obligeant modifier l'approche en sant publique. Cette nouvelle approche replace
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l'individu-patient au coeur de la prvention et du soin et rclame de ce dernier une participation

active. Elle modifie galement la relation entre le patient et les professionnels de sant qui
l'accompagnent.

Durousseaud, J.-C. (2014). "Numrique en sant. Tlmdecine. Homo connectus." Revue Hospitaliere De
France(561): 26-27.

[BDSP. Notice produite par EHESP qFR0xpkA. Diffusion soumise autorisation]. Les entretiens
mdicaux d'Enghien runissent chaque anne les acteurs du monde de la sant, de l'innovation et les
dcideurs de la sphre politique. L'dition 2014 tait consacre la tlmdecine et a t l'occasion
de dbats entre les "pour" et les "contre" - Freins, opportunits et volutions sont rsums ici et
laissent au final une vision optimiste et positive du dveloppement de la tlmdecine pour le
systme de sant franais.

Favereau, E., et al. (2006). "Information et sant : dossier." Seve : Les Tribunes De La Sante(9): 21-91.

La socit de l'information submerge le systme de sant. Les digues difies sur le secret mdical et
le colloque singulier menacent de cder sous le dferlement de l'information sanitaire. L'e-sant est
un des moteurs du dveloppement d'internet, la presse sant envahit les kiosques, l'informatisation
des dossiers mdicaux se gnralise dans de nombreux pays. L'volution se fait non sans mal : la carte
vitale a mis douze ans s'imposer, l'accs direct au dossier mdical date de 2002. Sve souhaite, dans
ce numro, apporter sa contribution l'indispensable analyse critique des enjeux et des effets de la
transformation qui s'accomplit depuis plusieurs annes. La socit d'Hippocrate pourra-t-elle
cohabiter avec la socit de l'information.

Gagneux, M., et al. (2010). "Construire l'hpital numrique." Gestions Hospitalieres(495): 200-275, tabl., fig.,
carte.

[BDSP. Notice produite par EHESP B9R0x9DC. Diffusion soumise autorisation]. Depuis la mise en
place en avril 2009 du Programme de relance du DMP et des systmes d'information partags de
sant, la modernisation et le dveloppement des systmes d'information de sant sont devenus des
priorits nationales. C'est dans ce contexte que la rforme de la gouvernance des systmes
d'information de sant a alors commenc. Elle a notamment permis la cration de l'Agence des
systmes partags de sant (ASIP sant) et de l'Agence Nationale d'appui la performance
hospitalire (ANAP), toutes deux charges de la matrise d'ouvrage publique du dveloppement des
ces nouveaux systmes. Depuis le 14 avril 2010, cette nouvelle politique publique est lance. La
premire runion du comit stratgique du programme "hpital numrique" a fix les priorits
d'action pour la mise en oeuvre de ce plan dont les enjeux pour le soin deviennent capitaux :
organisation et gestion des tablissements de sant, performance du systme de soins, partage des
donnes mdicales, coordination des diffrents acteurs sant, qualit et scurit du soins.... Ce
dossier prsente une vingtaine d'articles organiss en trois thmatiques. Le premier thme "Tic et
territoires" revient sur les enjeux de la mise en place des systmes d'information de sant au niveau
rgional. Ceci notamment travers le Dossier Mdical Personnel et le dveloppement de la tl
mdecine. Le deuxime thme "Tic et Hpital" s'attache identifier les enjeux de l'utilisation des
nouvelles technologies de l'information au sein des hpitaux sur diffrents angles de vue : conception
architecturale, investissement, formation du personnel, valuation de la performance, droit mdical...
Le dernier thme "Tic et Gouvernance" porte sur la gouvernance du risque lie l'utilisation des
nouvelles technologies de l'information en sant.

Gharbi, L., et al. (2015). "Ouverture de la journe "Enjeux et opportunits du numrique". Dossier." Regards De
La Fhp(34): 6-37, ill.

[BDSP. Notice produite par EHESP 88R0xtCr. Diffusion soumise autorisation]. Ce dossier est consacr
la journe d'information sur les "Enjeux et opportunits du numrique". Il fait le bilan mi-parcours
du programme Hpital numrique.

Girault, D., et al. (2013). "Dossier. L'hpital numrique." Gestions Hospitalieres(526): 272-316.
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[BDSP. Notice produite par EHESP A897AR0x. Diffusion soumise autorisation]. La bonne sant de
l'conomie constitue un facteur cl de l'amlioration de la sant de la population. Le sminaire
organis conjointement par le centre hospitalier de l'universit de Montral et "Gestions
hospitalires" les 10 et 11 juin traitera de l'volution du modle conomique de rfrence et de la
cration de richesse, notamment du cot de la sant et de sa valorisation conomique. Les articles de
ce numro font une large place au dveloppement de l'e. sant, vcu la fois comme une opportunit
de dveloppement conomique et une rponse la dsertification de certains territoires et la
progression des pathologies chroniques de populations vieillissantes.

Gouget, B., et al. (2004). "TIC, tlsant et e-sant : hpital expo-intermdica 2004." Techniques
Hospitalieres(688): 9-22, phot.

[BDSP. Notice produite par APHPDOC jZ5R0xhq. Diffusion soumise autorisation]. "Parmi les
innovations russies de l'e-sant en ligne figurent notamment les rseaux d'information mdicale, les
dossiers mdicaux lectroniques, les cartes de soins de sant, les services de tlmdecine, les
systmes portables et ambulatoires dots de fonctions de communication qui fournissent des outils
d'assistance la prvention, au diagnostic, au traitement, au monitorage de la sant et la gestion du
mode de vie, et les portails sur la sant." Ce dossier comporte les thmes suivants : - E-sant, enjeu de
sant publique, - l'observatoire des rseaux de tlsant, - domotique et technologies de tl-
assistance mdico-sociale au domicile : une vision d'avenir, - rvolution ou volution : le mobile
urgence mdicale.

Gros, J. (2002). "Sant et nouvelles technologies de l'information." Avis Et Rapports Du Conseil Economique Et
Social(5): 92 , ann.

Les nouvelles technologies de l'information - tlmdecine, e-sant, cartes puces - bouleversent

profondment les pratiques dans le secteur de la sant. Cette volution est riche de potentialits pour
tous les acteurs, mais suscite aussi des apprhensions. Les moyens mettre en oeuvre pour
encourager ces progrs, le respect des droits de la personne, la scurit informatique, la qualit des
services proposs sur le web, la finalit mme de ces outils constituent autant d'interrogations. Le
Conseil conomique et social dfinit huit axes de propositions, afin que les NTIC contribuent
pleinement l'amlioration de la sant.

Hagenmuller, J. B., et al. (2008). "L'hospitalisation domicile : 50 ans de liens entre l'hpital et la ville."
Gestions Hospitalieres(478): 479-511.

Ce cahier spcial rassemble les communications d'un colloque organis l'Assistance publique de
Paris sur les cinquante ans de l'hospitalisation domicile, en avril 2008. Aprs un aperu historique,
ces commuciations abordent les principales problmatiques lies l'had : organisation des soins,
articulation avec la ville et l'hopital, formation des acteurs...

Hansske, A. (2013). "Tendances et stratgies en systmes d'information de sant." Revue Hospitaliere De

France(550): 14-15.

[BDSP. Notice produite par EHESP R0xqBptr. Diffusion soumise autorisation]. L'autre prsente
quelques axes et principes en matire de "e-mutation" en sant et revient sur les stratgies et
tendances observes travers les thmatiques et communications proposes par les salons
internationaux du secteur des technologies et systmes d'information en sant.

Hansske, A. et Boutet-Rixe, C. (2013). "Innovations et numrique en sant." Revue Hospitaliere De France(552):

30-35.

[BDSP. Notice produite par EHESP CGR0x8Bk. Diffusion soumise autorisation]. L'agence rgionale de
sant de Picardie a retenu le dploiement de la tlmdecine comme axe prioritaire de son
programme rgional de tlmdecine. Ce chantier est confi au groupement de coopration sanitaire
e-sant Picardie, qui dploie la plateforme urbanise de tlmdecine Comedi-e (coopration
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mdicale innovante en e-sant). Lance en dcembre 2011, Comedi-e est une plateforme de services
e-sant qui s'adresse aux tablissements sanitaires et mdico-sociaux, professionnels de sant et
patients dont l'accs aux soins est fragilis par l'isolement, ou le manque de praticiens.

Hermesse, J., et al. (2002). "Accessibilit aux soins et nouvelles technologies." Sante Et Systemique 6(1-2-3):
347.

Ce fascicule prsente des contributions originales sur quatre problmes qui sont actuellement au
centre des proccupations de tous ceux qui travaillent sur le thme du systme de sant, quel que soit
leur champ disciplinaire principal, qu'ils soient producteurs de soins, gestionnaires, conomistes,
juristes ou sociologues : accessibilit aux soins et nouvelles technologies, scurit et qualit des soins,
place du patient dans le systme de sant, conomie des nouvelles technologies en sant. En amont
se situe le problme de l'accessibilit aux soins. Contrairement ce qu'on pourrait penser, mme
aujourd'hui dans les pays dvelopps, l'galit d'accs aux soins est loin d'tre acquise et il est tout
fait possible de mettre en vidence certains des facteurs limitatifs de cet accs.

Kleinebreil, L., et al. (2010). "Tic et Territoires. Le programme e-Diabte." Gestions Hospitalieres(495): 228-229.

[BDSP. Notice produite par EHESP GlR0x8Hp. Diffusion soumise autorisation]. Dvelopp par
l'Universit numrique francophone mondiale (UNFM), le programme e-diabte vise combler le
dficit de formation des professionnels de sant en Afrique, o le diabte constitue un nouveau
fardeau prendre compte. Comme l'ensemble des maladies chroniques, l'incidence du diabte ne
cesse d'augmenter en Afrique, et il est urgent que les professionnels de sant soient en mesure de le
diagnostiquer et de le traiter, quel que soit leur niveau dans la pyramide sanitaire. L'enjeu est la
rduction de la mortalit par diabte, ainsi que ses consquences les plus svres comme
l'amputation ou les maladies cardio-vasculaires. Pour rpondre cette urgence sanitaire, l'UNFM s'est
associe au Rseau en Afrique francophone pour la tlmdecine (Raft) dont la couverture s'tend
une quinzaine de pays, pour mettre en place un cycle de tlconfrences mensuelles pouvant tre
suivies par les professionnels de sant. (R.A.).

Le, Calve, L. (2010). "Tic et Hpital. Le droit mdical sous l'angle de la tlmdecine." Gestions
Hospitalieres(495): 264-266.

[BDSP. Notice produite par EHESP 8HmR0x8J. Diffusion soumise autorisation]. Depuis la loi n2009-
279 du 21 juillet 2009, Hpital, Patients, Sant, Territoires, la tlmdecine est rentre officiellement
dans le code de la sant publique. Le tlmdecine, un acte de mdecine ralis distance, reste
comme tout acte mdical assujettie des rgles dontologiques et des obligations appliques aux
professionnels de sant. Cet article rappelle les principes de la relation patient-mdecin : Secret
mdical, information et consentement du patient qui, au-del de la virtualisation des donnes
mdicales, restent les fondamentaux de la pratiques mdicales.

Le, Guen, T., et al. (2010). "Place et perspectives de la tlmdecine en Guyane." Revue Hospitaliere De
France(532): 32-34, tabl.

[BDSP. Notice produite par EHESP 9nnn8R0x. Diffusion soumise autorisation]. Le dveloppement de
la tlmdecine dans les dpartements et territoires d'outre-mer fait partie des priorits du plan
Sant outre-mer, dont les dispositions sont parues en juillet 2009. La Guyane peut se prvaloir d'une
exprience dans ce domaine depuis 2001 : sa distribution gographique particulire, aux nombreux
sites isols, implique une dmarche volontariste pour offrir aux populations un meilleur accs aux
soins. Tandis que les applications de tlcardiologie, tldialyse et tlradiologie fait l'objet d'un
projet ambitieux : des robots d'chographie seront bientt installs sur des sites distants de plus de
450 km du centre hospitalier du Cayenne, permettant de dater une grossesse ou de donner un avis sur
l'vacuation sanitaire hliporte.

Lestienne, A., et al. (2001). "Sant 2020 : l'apport des technologies nouvelles dans le systme de soins."
Technologie Et Sante(44): 96 , tabl.

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[BDSP. Notice produite par ENSP 2WR0xAE6. Diffusion soumise autorisation]. Ce numro
"Technologie de Sant" apporte des lments sur ce que pourrait tre la mdecine de 2020 grce la
collaboration de courageux experts.

Messner, L., et al. (2013). "Systme d'information en sant. Dossier." Revue Hospitaliere De France(550): 10-25,
fig.

[BDSP. Notice produite par EHESP E7mER0xq. Diffusion soumise autorisation]. Programme "hpital
numrique" pilot par la direction gnrale des soins, plan europen e-sant 2012-2020, projet
Mines-Tlcom relatif aux quipements e-sant dans les EHPAD. ce dossier prsente les diffrents
projets nationaux ou europens en cours dans le domaine des systmes d'information en sant, se
penche sur les freins aux partages d'information entre secteurs sanitaire et mdico-social et offre
galement un regard sur une exprience trangre la pointe : la mise en place d'un dossier patient
informatis de territoire au Danemark.

Pinaud, F. (2014). "E-sant : mieux soigner les malades et la Scu." Tribune (La)(73): 14-19, tabl., graph., fig.
[Link]
Cet article de la Tribune, solidement document, dresse un tableau panoramique du numrique de
sant. Astucieusement intitul E-sant : Mieux soigner le malade et la scu , son auteure y
rappelle la situation conomique du systme de sant, voque les dboires des grands projets en
cours ou prvus annoncs par les pouvoirs publiques, mais galement les formidables opportunits
portes par le savoir-faire des entreprises franaises. En outre, si plus de la moiti des Franais voient
dans les outils technologiques un levier pour mieux grer leur sant, les obstacles ne manquent pas,
entre autres concernant linefficacit de la gouvernance et linertie de certains des acteurs concerns.
Heureusement le ciel commence se dgager, sous la pression combine dune mobilisation
croissante des patients et des ralits conomiques. Avec lappui de la capacit dinnovation des
entreprises franaises.

Puech, M. (2012). "E-sant : De l'innovation "TIC" l'innovation thique." Revue Hospitaliere De France(546):
76-77.

[BDSP. Notice produite par EHESP 9HGCR0x8. Diffusion soumise autorisation]. Ce texte propose
d'apporter une contribution sur les questions de l'e-sant en interrogeant la part thique et
philosophique de ces innovations technologiques. Si nous innovons technologiquement, nous devons
aussi innover thiquement, or souvent, nous sous-estimons la dimension "philosophique" de
l'innovation technologique. L'auteur prne une "alliance souhaitable entre Hippocrate et e-Socrate".

Salengro, B. (2011). "La rvolution industrielle du traitement de l'information la Caisse nationale d'Assurance
maladie'." Regards(40): 10-19.
[Link]
Cet article prsente le bilan et les projets de la Caisse nationale d'Assurance maladie en matire de
traitement de l'information.

Savoldelli, M. et Lareng, L. (2010). "Tlmdecine et pratique mdicale collaborative : enjeux et pralables."

Revue Hospitaliere De France(532): 19-24, carte.

[BDSP. Notice produite par EHESP qR0xn8k8. Diffusion soumise autorisation]. Enjeux et pralables de
la tlmdecine dans l'exercice mdical : En quoi impacte-t-elle les pratiques et cultures mdicales,
mais aussi paramdicales ? L'organisation de l'offre de soins ? La relation au patient ? Quelles sont ses
modalits oprationnelles ? Les missions et activits de support ? Sa place dans les futurs espaces
numriques rgionaux de sant ?

Scala, B. (2016). "E-sant : la mdecine l're du numrique." Science & Sant(29): 33-33, tab., graph., fig.

Pour le grand public, la e-sant - pour "sant lectronique" - voque essentiellement la sant
connecte, celle qui fait appel l'internet des objets et aux applications pour smartphones. Et pour
cause, ces nouvelles technologies sont majoritairement destines au grand public, en bonne sant, et
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non aux malades. Cependant, c'est aussi par ce biais que ce mme grand public se familiarise avec un
pan plus mdical de la e-sant. Ce dossier fait le point sur ce sujet.

Simon, P., et al. (2011). "HIT Paris 2011. Systmes d'information en sant et TIC." Revue Hospitaliere De
France(539): 64-93, ill., graph.

[BDSP. Notice produite par EHESP mJR0xnFA. Diffusion soumise autorisation]. Le dossier propose six
interventions l'occasion du congrs HIT 2011 qui a cette anne pour thme'Les systmes
d'information de sant et cooprations'Systmes d'information et gestion de projet, tlmdecine, e-
sant, mutualisation et coopration entre tablissements dans le dploiement de systmes
d'information sont les thmes abords ici.

Tarriere, J. (2010). "Tic et Territoires. La tlsant." Gestions Hospitalieres(495): 219-221.

[BDSP. Notice produite par EHESP oIq8R0xk. Diffusion soumise autorisation]. Constatant que "malgr
l'arrive maturit d'un certain nombre de technologies et de services, le dveloppement de la
tlsant reste en de des besoins et des attentes", le premier ministre a confi, en juin 2009,
Pierre Lasbordes, dput et vice-prsident de l'Office parlementaire d'valuation des choix
scientifiques et technologiques, auteur du rapport sur le Dossier Mdical Personnel, une mission pour
mettre en place les conditions de dploiements de ce types de services. Cet article prsente
brivement les engagements pris par le plan quinquennal 2010-2014 pour dvelopper la tlsant :
recommandations, maladies prioritaires, dploiement pluriannuel rgional de projets pilotes et type
de gouvernance.

Vallin, X., et al. (2014). "Dossier Territoires, systmes d'information et e-sant." Revue Hospitaliere De
France(557): 40-55, fig.

[BDSP. Notice produite par EHESP sDG7R0xG. Diffusion soumise autorisation]. Afin d'assurer une
meilleure qualit et scurit des soins, de nombreux projets dans le domaine des nouvelles
technologies de l'information et de la communication se dveloppent actuellement au niveau national
ou local. Aprs avoir abord de faon gnrale les enjeux et problmatiques de ces projets,
notamment pour favoriser l'change d'information et passer d'un systme d'information hospitalier
un systme d'information de sant, ce dossier prsente plusieurs ralisations en cours : la mise en
place d'un dossier patient partag au sein des communauts hospitalires de territoire Hpital Nord-
Ouest et Centre Manche, le projet IRIS bti par le CHU de Bordeaux visant l'interconnexion de rseaux
d'images entre plusieurs tablissements aquitains, le projet MSSant port par l'ASIP visant runir
toutes les messageries scurises et leurs utilisateurs au sein d'un mme espace de confiance, le
terminal multimdia dploy par le centre hospitalier de Calais dans l'objectif d'une meilleure
information du patient, le dispositif de vido-assistance dvelopp la Rochelle pour scuriser la
prparation des chimiothrapies.

Vayssette, P. (2013). "GCS e-sant : un appui e-sant dans 23 rgions sur 26." Reseaux Sante & Territoire(50):
14-23, graph.

[BDSP. Notice produite par EHESP 7m8kR0xD. Diffusion soumise autorisation]. Dans presque toutes
les rgions, des groupements de coopration sanitaire (GCS) en systme d'information en sant (SIS)
se sont crs et proposent un appui la mise en oeuvre de services numriques de sant leurs
membres. Ces GCS sont adosss aux ARS qui assurent prs de la moiti de leur financement. Un
exemple prsent ici est le GCS Tlsant Aquitaine, qui assure la matrise d'ouvrage en e-sant
auprs de diffrents acteurs de la sant. L'Asip Sant a lanc plusieurs appels projets ces dernires
annes pour dvelopper l'e-sant en rgions. Quatre axes sont viss : le DMP, la matrise d'ouvrage
rgionale, la tlmdecine et les logiciels de bureautique des tablissements mdico-sociaux.

Vercaemer, J., et al. (2012). "A la croise des tlcoms et de la sant. M-Health, un march en pleine closion."
Techniques Hospitalieres(732): 55-72.

[BDSP. Notice produite par EHESP 8BR0xkBm. Diffusion soumise autorisation]. Ce dossier runit les
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rsums des interventions de la premire dition de "M-Health, le rendez-vous des tlcoms et de la

sant", qui a propos en 2011 un tour d'horizon sur l'tat de la recherche, les solutions techniques et
les projets en cours dans le domaine de la sant mobile. En effet, le march de la sant mobile est en
plein dveloppement. A titre d'exemple, depuis 2008, dix-sept mille applications de "m-sant" ont
dj t cres pour les smartphones. Face au vieillissement de la population, la forte volution des
maladies chroniques et l'augmentation du cot des soins, le dveloppement des services de m-sant
apporte des rponses concrtes aux attentes des patients et des professionnels.

Rapports

(2003). Rapport annuel 2002. Paris Editions des journaux officiels: 240.

Ce rapport annuel rend compte des activits du Conseil Economique et Social pour l'anne 2002, soit
17 avis et trois tudes. L'activit de ses deux dlgations : "pour l'Union europenne" et "aux droits
des femmes et l'galit des chances entre hommes et femmes" s'est particulirement intensifie
cette anne. En outre, le Conseil a engag une rflexion sur la reprsentation instituionnelle de la
socit civile et a organis un certain nombre de forums et manifestations. En ce qui concerne la
section des affaires sociales, la thmatique portait sur la sant et les nouvelles technologies de
l'information.

(2007). valuation de la qualit des sites e-sant et de la qualit de l'information de sant diffuse sur Internet.
Revue de la littrature des outils d'valuation. Enqutes et tudes.: 87.
[Link]
[BDSP. Notice produite par HAS H7FR0xHk. Diffusion soumise autorisation]. Ce document est un
catalogue non exhaustif des "outils" et critres d'valuation de la qualit des sites e-sant. Il
diffrencie schmatiquement les outils comme suit : - les recommandations et/ou codes de bonne
conduite destins essentiellement aux promoteurs de sites Web dans le cadre d'un processus
d'attribution d'un label ou d'une procdure de certification ; - les codes de bonne conduite et
recommandations destins a priori aux promoteurs de sites et aux professionnels de sant ; - les
grilles d'valuation donnant lieu une cotation et des recommandations destines l'internaute ou
au promoteur d'un site ou encore aux tudiants et professionnels de sant.

(2008). L'informatisation de la sant. Le livre blanc du Conseil national de l'Ordre des mdecins. Paris CNOM:
16.
[Link]
Les technologies de linformation participent aujourdhui lamlioration de la qualit des soins. En
jouant de manire positive sur la tenue des dossiers mdicaux, en facilitant lchange et le partage des
donnes utiles la dcision mdicale, en augmentant la disponibilit et la rapidit daccs ces
informations, ces technologies contribueront de plus en plus aux progrs de la mdecine. Elles ne
doivent pas pour autant tre mises en uvre sans la rflexion thique quimposent les risques quelles
feraient peser sur les donnes individuelles de sant et, partant de l, sur la confiance accorde aux
mdecins, garants de leur confidentialit. Par son rle de fdrateur des mdecins, de toutes
disciplines et de tous secteurs, runis autour des mmes principes dontologiques, le CNOM a la
responsabilit de sengager dans les projets de systme dinformation de sant au nom de lavenir
scientifique, mais dans le respect absolu des liberts individuelles. Il se mobilise aujourdhui
totalement et concrtement. Totalement : en soulignant que sa coopration passe ncessairement
par une association troite au dispositif rnov de gouvernance des systmes dinformation qui se
mettra en place. Concrtement : en apportant sa vision des lments fondateurs aptes faire entrer
les mdecins dans un systme communicant la hauteur des enjeux de la socit de linformation.
Cest par cette double implication que lordre entend soutenir une relance du projet de dossier
mdical lectronique scuris oriente dans une voie conforme la relation mdecin- patient et la
ralit des pratiques professionnelles. Larchitecture propose par lordre des mdecins est fonde sur
le respect des droits des patients : droit daccs aux donnes partages, droit de choisir les
professionnels autoriss partager ces donnes, droit loubli. Elle est galement conue de faon
favoriser lappropriation des technologies de linformation par les mdecins. La russite du dossier
mdical lectronique exige quil soit ralis pour les patients, par les mdecins.
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(2010). Rapport d'activit d'ASIP Sant 2009. Paris ASIP Sant: 81.
[Link]
Dans son premier rapport d'activit, l'ASIP Sant fait tat des missions de l'agence pour rpondre aux
enjeux de dveloppement des systmes d'information de sant, et dresse le bilan des actions menes
au cours de l'anne 2009. Ce document tablit galement le paysage de la e-sant en France, au
regard de la nouvelle gouvernance institue, des attentes des patients et des besoins des
professionnels de sant, et met en lumire le travail men par les acteurs qui uvrent aujourd'hui
son dveloppement.

(2012). Direction gnrale de l'offre de soins. Rapport d'activit 2011. Paris DGOS: 116.
[Link]
Ce rapport prsente les domaines d'activits et le bilan des actions menes par la Direction gnrale
de l'offre de soins (DGOS). L'anne 2011 restera la premire anne de mise en oeuvre de la nouvelle
organisation sanitaire rgionale, avec la signature de l'ensemble des contrats pluriannuels d'objectifs
et de moyens qui tracent la feuille de route des ARS jusqu'en 2013, ainsi que la fixation de leurs
territoires de sant, qui en dcoulent. Elle marque aussi la poursuite des efforts de dcloisonnement
entre le monde hospitalier et le monde libral, d'amlioration de la qualit et de la scurit des soins,
sans oublier les premiers signes du dveloppement tangible de prises en charge alternatives comme la
chirurgie ambulatoire et la tlmdecine, selon le directeur gnral de l'offre de soins. Cette dition
2011 accorde une place rcurrente aux tmoignages de quelques agences rgionales de sant dans
des domaines structurants : promotion des droits des usagers de la sant, respect de l'gal accs aux
soins pour tous, renforcement de la qualit et de la scurit des soins, valorisation des professionnels
de sant, amlioration de la performance des acteurs et, pour l'essentiel, des tablissements de sant.

(2012). Rapport d'activit 2011. Paris ASIP: 108, tabl., graph., fig.
[Link]
L'Agence des systmes d'informations partags de sant (ASIP Sant) publie son 3e rapport d'activit
consacr l?anne 2011. En 2011, l'ASIP Sant s'est attache favoriser le dploiement des outils
ncessaires une appropriation par les patients comme par les professionnels de sant des
possibilits offertes par la e-sant. Mise en oeuvre du DMP, dveloppement de la tlmdecine,
services numriques pour la sant et l'autonomie, simplification administrative, autant de thmes
prioritaires qui participent tous d'une mme volont : dployer des services de e-sant favorisant une
prise en charge de qualit, pour chacun et partout en France. Sont proposs dans ce document, les
tmoignages et points de vue de 25 personnalits du secteur sur le dveloppement de la e-sant.

(2013). Accs aux soins : en finir avec la fracture territoriale. Paris Institut Montaigne: 73 , tabl., fig.
[Link]
Trs onreux, d'une grande complexit institutionnelle et administrative, le systme de soins franais
pche galement par l'archasme de son organisation, caractris par de forts cloisonnements entre
ville et hpital comme entre professionnels de sant. Au-del des problmes vidents de rpartition
sur le territoire des professionnels de sant, la question est sans doute plutt celle du modle
d'organisation des soins en France, qui ne correspond plus aux exigences sociales, dmographiques et
technologiques de notre pays. Face ces dfis et dans un contexte de finances publiques contraint,
comment adapter notre systme de sant ? C'est vers une organisation dcloisonne, rgionalise,
construite autour des besoins des patients qu'il faut s'orienter. Le systme de sant doit galement
s'adapter aux exigences des nouvelles gnrations de professionnels de sant et leur offrir les moyens
d'exercer leur mtier de faon regroupe, en bnficiant de l'apport des nouvelles technologies.

(2013). Direction gnrale de l'offre de soins. Rapport d'activit 2012. Paris DGOS: 88.
[Link]
Ce rapport retrace la mise en oeuvre des nombreuses actions conduites par la Direction gnrale de
l'offre de soins (DGOS) dans le champ de l'offre de soins en 2012. Il apporte un clairage utile et prcis
sur la diversit des missions qui sont remplies au quotidien par cette direction et ses quelque 300
agents au service de la sant des Franais.

(2014). Prconisations e-sant 2014. Livre blanc du Catel. Paris CATEL: 72.
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[Link]
[Link]
Cet ouvrage constitue une synthse de rflexions collectives et de prconisations pour le
dveloppement de la e-sant, identifies entre janvier et dcembre 2013 par le groupe de travail
multidisciplinaire coordonn par le Club des acteurs de la tlsant (CATEL) et constitu
dinstitutionnels, de chercheurs, dassociations, de professionnels de sant et dindustriels. 12
prconisations rsultent des analyses dtailles. Elles ont t labores partir des 5 thmatiques
suivantes : La e-sant: un concept global et volutif ; La e-sant: un paradigme nouveau centr sur les
usages ; La e-sant: un cadre lgislatif, rglementaire et conomique complter ; Une gouvernance
et une mthode adaptes la e-sant ; Innovation et industrialisation pour une e-sant ouverte et
internationale.

(2014). Vade-Mecum des objets connects: 102.

[Link]
Ce document, publi par l'Association pour la promotion de la scurit des systmes d'information de
sant (APSSIS), est compos de 12 chapitres. Il rappelle d'abord le contexte lgislatif et rglementaire
du march, donne la parole quatre experts sur le sujet : le Dr Jacques Lucas, vice-prsident du
Conseil national de l'Ordre des mdecins, Grard Peliks et Herv Lehning, de l'Association des
rservistes du chiffre et de la scurit de l'information (ARCSI), et Uwe Diegel, vice-prsident de la
socit iHealthLabs. Sont prsentes ensuite 120 applications destines aux professionnels de sant
ou au grand public, dtailles dans quatre chapitres : "Welcome dans la e-sant", "Sport et sant: le e-
mariage", "La e-sant de nos enfants" et "La e-sant de nos seniors". Une partie paroles d'experts, de
mdecins, chiffres, statistiques et tendances complte ce document.

(2015). GT 33 CSIS---CSF : Permettre lmergence dune stratgie industrielle en matire de e-sant, En soutien
de la politique de sant publique, en associant les industriels. Lever les freins au dploiement de la
tlmdecine. Paris CSIS: (261), annexes.

Le Contrat de Filire Industries et Technologies de Sant, conclu en juillet 2013 entre lEtat et les
reprsentants de fdrations industrielles, comporte une mesure (dite mesure 33 ) ddie
faciliter le dveloppement de la e-sant, reconnue comme filire davenir stratgique fort potentiel
de dveloppement. Le groupe de travail mixte ( GT 33 ), charg de la mise en uvre de ces
engagements a associ les reprsentants des pouvoirs publics (DGOS, DSSIS, DGE, DGRI, ASIP Sant,
ANAP, HAS, CNAMTS, ANSM) et des syndicats industriels (SNITEM, Syntec Numrique) sous la co-
prsidence de Pierre LEURENT (Syntec Numrique et SNITEM) et de Philippe BURNEL (ministre des
Affaires sociales, de la Sant et des Droits des femmes). Il rend public aujourdhui son rapport
dactivit et annonce un ensemble dengagements visant faciliter le dploiement de la tlmdecine.

(2015). La sant : bien commun de la socit numrique. Construire le rseau du soin et du prendre soin. Paris
Conseil National du numrique: 125.
[Link]
la-soci%C3%A9t%C3%A9-num%C3%[Link]
Ce rapport est consacr au rle du numrique dans la refondation de notre de systme de sant. Il
formule 15 propositions pour que la transformation numrique de notre systme de sant favorise
lmergence dune socit plus solidaire, quitable et innovante , en cohrence avec la Stratgie
nationale du numrique. Elles inspireront notamment trois chantiers en cours: la construction du futur
service public dinformation en sant, lmergence de nouveaux espaces de co-innovation en sant et
les travaux sur le futur dossier mdical dmatrialis.

(2015). Livre blanc : De la e-sant la sant connecte. Paris Conseil National de l'Ordre des mdecins: 34.
[Link]
Le CNOM observe avec intrt que le dbat sur la sant connecte sest ouvert la CNIL, dans des
cercles de rflexion consacrs au numrique, dans les institutions du monde de la sant et au sein
mme de la Commission europenne. Ce livre blanc a vocation enrichir le dbat public. Il napporte
pas des rponses premptoires. Il pose des interrogations thiques et dontologiques dans
laccompagnement des volutions de nos socits et y apporte des lments de rflexion. Il propose
six recommandations, pour une " rgulation adapte, gradue et europenne " du traitement des
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donnes issues des objets ou " applis " de sant. et une valuation scientifique " neutre " d'experts "
sans lien d'intrt avec les fournisseurs " spcifique la tlmdecine. (d'aprs rsum de lditeur).

(2016). E-sant : faire merger loffre franaise en rpondant aux besoins prsents et futurs des acteurs de
sant. Paris Pipame: 116, fig., tabl.

Soigner autrement est un impratif de sant publique dans un contexte de vieillissement de la

population, daugmentation des maladies chroniques, dhyperspcialisation de la mdecine, de
dsertification mdicale et dexigence accrue des patients. Cest galement un impratif conomique
qui touche particulirement la France dont les dpenses de sant croissent aujourdhui plus fortement
que le PIB. Le systme de sant franais qui sest bti autour de lhpital fait face, comme beaucoup
dautres secteurs conomiques, une transformation de son activit impulse par le numrique. Au-
del de linformatisation des tablissements de sant ou des dossiers patients, les technologies
numriques permettent aujourdhui le dveloppement de nouveaux services dans lensemble des
domaines de la chane de valeur : bien-tre, information, prvention, soins ou accompagnement du
patient. Ltude dresse un tat des lieux des diffrents segments du march de le-sant, existants ou
en dveloppement, qui constitueront demain la croissance industrielle de cette activit encore
mergente que ce soit en France, en Europe ou dans le monde. Elle value les diffrents points forts et
points faibles de loffre industrielle franaise et se penche sur les bonnes pratiques de plus dune
vingtaine de pays. Ltude identifie lensemble des leviers structurants permettant de dvelopper une
filire industrielle de le-sant en France. Elle montre ainsi que la France dispose de tous les atouts
pour russir. Pour autant, de nombreux obstacles demeurent dans les domaines rglementaire et
institutionnel, mais galement dans lappropriation des usages par les patients et les professionnels de
sant. Comme souvent avec ces technologies, lusage par le plus grand nombre constitue la cl de la
transformation (rsum de lditeur).

(2016). Rapport du Conseil stratgique des industries de sant. Paris CSIS: 63.

Le Conseil stratgique des industries de sant, espace de concertation et dchanges entre les
industriels du secteur et les pouvoirs publics, est le lieu o se dessine une vision stratgique partage.
A la suite du sminaire du 17 avril 2015, ouvert par le Premier ministre, trois groupes de travail ont t
mis en place : ils ont runi les industriels et les pouvoirs publics, autour des principaux enjeux du
secteur : la lisibilit et la prvisibilit, laccs linnovation et lattractivit de lindustrie franaise. Les
orientations du 7e CSIS devront rpondre aux dfis auxquels sont confrontes les industries de sant.

(2016). Stratgie nationale pour le dveloppement de l'e-sant. Paris, Ministre charg de la sant.
[Link]
Le Ministre des Affaires sociales et de la Sant vient de publier la Stratgie nationale e-sant 2020.
Lobjectif de cette stratgie est dintgrer, de manire innovante, les nouvelles technologies pour
amliorer le fonctionnement de notre systme de sant. Il sarticule autour de quatre axes. Le premier
axe vise mettre le citoyen au cur du systme de sant, notamment en simplifiant laccs aux soins
et en dveloppant des services favorisant lautonomie des patients. Le deuxime axe consiste
soutenir linnovation des professionnels de sant. Il sagit de dvelopper des cursus de formation
autour du numrique, de soutenir les projets en faveur de linnovation numrique, mais aussi de
dvelopper des outils daide la dcision mdicale. Les mesures du troisime axe entendent simplifier
le cadre dactions pour les acteurs conomiques, en clarifiant, notamment, les voies daccs au
march des solutions e-sant. Enfin, le quatrime et dernier axe concerne la modernisation des outils
de notre systme de sant, avec lamlioration des systmes dinformation, de la veille et de la
surveillance sanitaire.

Amat, T. et Bassede, J. (1985). Systme de production, conditions de vie et systme de sant en milieu agricole
- Tome IV : Articulation agriculture-sant. "S.L." "S.N.": 93 , graph.

Bernard, C., et al. (2013). La Silver Economie, une opportunit de croissance pour la France. Rapports &
documents. Paris CGSP: 112.
[Link]
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En 2005, un Franais sur cinq tait g de plus de 60 ans. En 2035, la proportion sera de un sur trois.
Le nombre des seniors devrait connatre une hausse de 80 %. Ce vieillissement de nos socits a
suscit de nombreux travaux mettant en vidence les enjeux et les risques que reprsente une telle
mutation dmographique. La plupart abordent la question par langle socital ou mdicosocial. Ce
rapport a pour originalit de se fixer pour objet la valeur conomique que peut receler le
vieillissement. La proportion accrue de seniors va-t-elle servir de levier des pans entiers de notre
conomie, quil sagisse des services ou des technologies avances, du type robotique ou domotique ?
Peut-on envisager de btir une industrie , au sens large du terme, qui valorise au mieux cette
volution majeure ? Si oui, quel rle ltat doit-il y jouer ? (rsum d'auteur).

Beuscart, R. (2000). Rapport sur les enjeux de la socit de l'information dans le domaine de la sant. Paris
PAGSI (http //[Link]/dossiers/documents/schema/[Link]: (50 ).
[Link]
L'objectif de ce rapport est de dresser un tat des lieux de la socit de l'information dans le domaine
de la sant, et d'analyser plus particulirement le dveloppement des NTIC (nouvelles technologies de
l'information et de la communication). Il examine quatre dimensions essentielles : la tlmdecine,
qui permet plusieurs professionnels de sant de communiquer pour favoriser la prise en charge d'un
patient donn dans le cadre d'une dmarche diagnostique ou thrapeutique ; les filires et rseaux de
professionnels de sant, qui facilitent la communication d'information entre professionnels et malades
; la e-sant, qui donne accs au grand public et aux patients au monde de la sant grce internet ; la
formation mdicale continue grce aux NTIC. Il termine sur des recommandations.

Brun, N., et al. (2011). Rapport de la mission Nouvelles attentes du citoyen, acteur de sant . Paris Ministre
charg de la sant, Paris La documentation Franaise: 46.
[Link]
Le prsent rapport fait partie des trois missions confies dans le cadre du dispositif 2011, anne des
patients et de leurs droits , dont le thme principal porte sur le droit des patients et de leurs proches
dans les tablissements de sant. Le rapport s'intresse la place des patients dans le systme de
sant, aux nouveaux comportements (usage de l'Internet) et aux nouvelles attentes concernant la
gestion de leur sant. Un chapitre est consacr l'ducation thrapeutique et aux programmes
d'accompagnement pour les personnes atteintes d'une maladie chronique. Le rapport fait galement
le point sur les transformations lies aux nouvelles technologies de la sant, dont la tlmdecine.

Dini, E. F., et al. (2011). Sant et logement : comment accompagner la Martinique et la Guyane ? Paris Snat :
tabl.
[Link]
Dans le cadre de ses travaux de contrle et d'information, la commission a dcid l'envoi d'une
dlgation en Martinique et en Guyane pour tudier les questions spcifiques de la sant et du
logement. En Martinique, la situation financire trs dgrade des hpitaux a conduit les acteurs
locaux, au premier rang desquels l'agence rgionale de sant, dcider la fusion des trois principaux
tablissements en un seul compter du 1er janvier 2012. A l'approche de l'examen par le Snat d'une
proposition de loi relative la lutte contre l'habitat indigne dans les dpartements d'outre-mer, qui a
eu lieu dbut mai, la dlgation s'est galement attache comprendre les spcificits de
l'urbanisation de Fort-de-France, marque par l'dification anarchique et sans droit, partir des
annes cinquante, de logements sur des terrains escarps ou conquis sur la mangrove. En Guyane, la
dlgation a t frappe par le caractre singulier des problmes qui se posent un territoire qui est
pourtant un dpartement depuis 1946. Le niveau des services publics y est clairement insuffisant. La
situation de l'offre de soins n'y est pas acceptable : dficit de professionnels de sant ; vtust et
exigut des centres hospitaliers. Rare signe encourageant, la Guyane fait figure de pionnire en
matire de tlmdecine et l'hexagone pourrait judicieusement s'en inspirer. Par ailleurs, le territoire
est parsem de vritables bidonvilles qui ne font pas honneur la Rpublique. Aprs le processus de
dpartementalisation, qui a eu tendance uniformiser les politiques publiques mises en ?uvre en
mtropole et en outre-mer, le temps est venu de les adapter radicalement aux spcificits locales
(rsum de l?diteur)

Dionis, D. Usejour, J. et Etienne, J. C. (2004). Les tlcommunications haut dbit au service du systme de
sant (2 tomes). Paris Assemble Nationale: 2 vol. (138 +127).
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[Link] [Link]
[Link]
Au moment o l'assurance maladie connat l'une des crises les plus graves de son histoire et o tous
les acteurs du systme de soins vont devoir traverser des mutations trs importantes, il est important
d'valuer l'apport potentiel des nouvelles technologies de l'information au systme de sant franais
et de cibler les obstacles leur dveloppement. Ce rapport sur l'internet haut dbit et les systmes
de sant se trouve au c?ur de l'actualit. Le dbat sur la matrise des dpenses du systme de soins
impose de revoir en profondeur l'architecture du systme de sant franais, qui intgre peu ou pas les
nouvelles technologies de l'information.. La premire partie porte sur l'outil internet en tant qu'outil
de formation et d'information. La deuxime partie aborde la tlmdecine sous ces divers aspects :
tlsurveillance, tlconsultation, tlchirurgie? Le rapport termine sur des recommandations.

Fasquelle, D. (2008). Rapport d'information sur l'application des droits des patients en matire de soins de
sant transfrontaliers. Rapport d'information; 1308. Paris Assemble nationale: 85 , ann.
[Link]
Ralis dans le cadre de la rflexion engage par la Commission europenne sur les soins
transfrontaliers, ca rapport dresse tout d'abord un tat des lieux de la rglementation existante dans
ce domaine. Il analyse ensuite les failles des dispositifs de financement des soins actuels et met
plusieurs propositions pour amliorer les conditions et processus de prise en charge dans un souci
d'amlioration de la qualit des soins.

Fay, A. F. et Fery-Lemonnier, E. (2000). Innovations technologiques et plan stratgique 2001-2004. Dossier

CEDIT : 99-12. Paris CEDIT: 23 , tabl.

Le Comit d'Evaluation et de Diffusion des Innovations Technologiques (CEDIT) a t saisi par la

Directrice de la Politique mdicale de l'Assistance publique de Paris pour une identification des
grandes volutions technologiques susceptibles d'merger ou de se dvelopper de faon importante
pendant la priode du plan stratgique 2001-2004 de l'AP - HP. Il a t prvu de s'efforcer d'identifier
celles ncessitant un accompagnement au cours du plan stratgique, notamment par la constitution
de dossiers de demandes de financements ou d'autorisations auprs des tutelles. Ce petit document a
donc pour objectif de prsenter les rsultats de cette mission : dfinition du champ de travail, collecte
d'informations, ralisation de listes de technologies innovantes, et parmi ces listes, choix de spcialits
mdicales les plus concernes par le dveloppement technologique.

Gattaz, P. (2008). Une stratgie industrielle pour les marchs du futur : la croissance se construit ensemble.
Paris FIEEC: 113 +110.
[Link]
%20partie%201%20-%[Link] -
[Link]
[Link]
Et si la rponse au marasme de l'conomie numrique, entre autres dans le domaine de la sant,
venait d'un partenariat entre le public et le priv ? A en juger par la synthse qu'en fait le site de
Lessis, c'est la certitude qui apparat clairement dans le rapport publi par la puissante Fdration des
industries Electriques, Electroniques et de Communication (FIEEC), qui regroupe prs de 2000
entreprises spcialises. Ce rapport, command par le gouvernement et remis le 24 juin Luc Chatel,
ministre dlgu l'Industrie, visait identifier les vecteurs d'innovation dans le domaine des TIC et
de l'lectronique. La sant est l'un des trois secteurs d'innovation porteurs identifis. Focaliss sur les
retards de la France, les experts du groupe Sant ont mis en vidence la ncessit d'un pilotage
commun entre le gouvernement et les industriels. La leve des obstacles juridiques et administratifs
qui entravent le dveloppement de la sant distance constitue galement un pralable au
dveloppement de ce march. Enfin, selon les auteurs, une prosprit du march des TIC de sant est
conditionne la mise en oeuvre d'une gouvernance interministrielle paritaire public/priv.

Hubert, J. et Martineau, F. (2016). Mission Groupements Hospitaliers de Territoire - Rapport de fin de mission.
Paris Ministre charg de la Sant: 51.
[Link]
Instaurs par la loi Sant, les GHT ont vocation dvelopper une prise en charge gradue des
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patients en mutualisant les moyens des tablissements au niveau dun territoire. Le rapport
intermdiaire prsentait les 20 cls de russite des GHT avec des premires orientations quant leur
traduction en loi et en dcret. Ce rapport final a pour objectif de prsenter les orientations dfinitives
pour les textes dapplication.

Lopez, A. et Compagnon, C. (2015). Pertinence et efficacit des outils de politique publique visant favoriser
l'observance. Paris, Igas.
[Link]
037R_Pertinence_et_efficacite_des_outils_de_politique_publique2_.pdf
En novembre 2014, le Conseil d'Etat avait annul "pour incomptence" les deux arrts dcris qui
liaient la prise en charge de la Scurit sociale la bonne utilisation d'un dispositif mdical dit
pression positive continue (PPC) pout le traitement des apnes du sommeil. Il s'agissait de placer tous
les patients portant ce masque la nuit sous "tl-observance", avec l'emploi des objets connects.
Aprs cet pisode, la ministre de la Sant Marisol Touraine avait missionn l'IGAS sur l'observance des
traitements par les patients, notamment lorsque ils sont atteints d'une maladie chronique. Dans son
rapport de juillet 2015, rendu public seulement un an plus tard, la mission "dconseille fortement" de
moduler les remboursements des soins en fonction de l'observance des traitements. Outre les
difficults qui seraient rencontres, notamment pour mesurer l'observance, ce serait s'engager sur
une pente dont le terme et les consquences sont difficiles apprcier.
En revanche, l'IGAS prconise de dvelopper l'ducation thrapeutique et l'accompagnement des
patients, et de "dvelopper une offre de tl-suivi-accompagnement" s'appuyant sur l'essor des
appareils connects, qui vont "profondment modifier l'exercice de la mdecine". Le financement de
ces services de tl-suivi-accompagnement dpendrait de leur performance, "faisant de la bonne
observance et de la fidlisation des patients des marqueurs de la qualit de l'accompagnement".

Picard, R. et Salgues, B. (2007). TIC et sant: quelle politique publique? Paris CGTI: 19 +annexes.
[Link]
Ce rapport analyse la situation de l'emploi des technologies de l'information et des communications
(TIC) dans le domaine de la sant. Il est compos de trois parties. Il propose tout d'abord une synthse
des rponses des industriels sur leur vision de la situation franaise autour des thmes suivants :
forces, faiblesses, opportunits, menaces pour la France; conomies possibles par les TIC ; politique
industrielle souhaitable. Dans une seconde partie, les lments prcdents sont repris et discuts
selon les thmes rcurrents : l'attitude du patient et du mdecin, les politiques de sant, de recherche
et d'industrie, l'volution technologique, le cadre rglementaire. Enfin, quelques propositions sont
formules concernant la suite souhaite par les industriels de ce travail de concertation.

Picard, R. et Vial, A. (2013). Prospective organisationnelle pour un usage performant des technologies nouvelles
en Sant. Paris C.G.E.I.E.T.: 27.
[Link]
Ce rapport apporte un clairage prospectif sur les conditions organisationnelles pour un usage
performant des technologies nouvelles en Sant, avec un regard particulier sur la tlmdecine et plus
largement sur la tlsant.

Rennaissance Numrique. (2014). D'un systme de sant curatif un modle prventif grce aux outils
numriques : livre blanc. Paris Renaissance numrique: 124.
[Link]
un-modele-preventif-grace-aux-outils-numeriques-
[Link]
[Link]
Le numrique a permis un saut quantitatif et qualitatif jamais gal dans notre connaissance des
individus, de leurs pratiques sant et bien tre, et dans leur accompagnement personnel au quotidien.
Alors que les assurances semparent aujourdhui des nouvelles technologies objets connects,
applications mobiles et Big Data, lAssurance Maladie pourrait, elle aussi, investir ces outils
numriques pour constituer un levier efficace afin d'orienter son modle vers un paradigme
davantage prventif. Dans ce livre blanc, Renaissance Numrique fournit un tat des lieux des
pratiques internationales et un tmoignage dexperts permettant danalyser les moyens daction
possibles pour que lacteur public opre une telle transition numrique vers un modle prventif. Le
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think tank formule 16 propositions couvrant un large spectre de problmatiques pour assurer la
transition vers un systme de sant prventif, allant de la formation des professionnels de sant des
solutions Big Data de lutte contre la fraude la Scurit sociale. Parmi les mesures phares de ce
rapport : tablir un systme de labellisation des applications mobiles sant, des objets connects et
des dispositifs machine to machine pour garantir leur fiabilit et permettre leur utilisation par les
professionnels de sant; Donner aux communauts de patients la possibilit, selon des critres dfinis,
dobtenir un statut dassociation de patients pour leur permettre de devenir des acteurs de la
dmocratie sanitaire; Organiser une concertation nationale avec les acteurs publics, la CNIL, les
reprsentants professionnels des assurances et les associations de patients et consommateurs pour
encadrer le risque de pratiques bonus-malus sant par les assurances prives, qui pourraient induire
des ingalits dans laccs aux soins.

Etudes trangres

Ouvrages

(2015). Atlas of eHealth contry profiles. Genve : the use of eHealth support of universal health coverage.
Genve : OMS
[Link]
The third global survey on eHealth conducted by the WHO Global Observatory for eHealth (GOe) has a special
focus the use of eHealth in support of universal health coverage. eHealth plays a vital role in promoting
universal health coverage in a variety of ways. For instance, it helps provide services to remote populations and
underserved communities through telehealth or mHealth. It facilitates the training of the health workforce
through the use of eLearning, and makes education more widely accessible especially for those who are
isolated. It enhances diagnosis and treatment by providing accurate and timely patient information through
electronic health records. And through the strategic use of ICT, it improves the operations and financial
efficiency of health care systems. This Atlas presents data collected on 125 WHO Member States. The survey
was undertaken between April and August 2015 and represents the most current information on the use of
eHealth in these countries.

(2011). The Atlas of eHealth Country Profiles, Genve : OMS

[Link]
This publication presents data on the 114 WHO Member States that participated in the 2009 global
survey on eHealth. Intended as a reference to the state of eHealth development in Member States,
the publication highlights selected indicators in the form of country profiles. The objectives of the
country profiles are to describe the current status of the use of ICT for health in Member States; and
provide information concerning the progress of eHealth applications in these countries. (rsum des
diteurs)

(2011). MHealth: New horizons for health through mobile technologies, Genve : OMS
[Link]
The use of mobile and wireless technologies to support the achievement of health objectives
(mHealth) has the potential to transform the face of health service delivery across the globe. A
powerful combination of factors is driving this change. These include rapid advances in mobile
technologies and applications, a rise in new opportunities for the integration of mobile health into
existing eHealth services, and the continued growth in coverage of mobile cellular networks.
According to the International Telecommunication Union (ITU), there are now over 5 billion wireless
subscribers; over 70% of them reside in low- and middle income countries. The GSM Association
reports commercial wireless signals cover over 85% of the world?s population, extending far beyond
the reach of the electrical grid. For the first time the World Health Organization?s (WHO) Global
Observatory for eHealth (GOe) has sought to determine the status of mHealth in Member States; its
2009 global survey contained a section pecifically devoted to mHealth. Completed by 114 Member
States, the survey documented for analysis four aspects of mHealth: adoption of initiatives, - types of
initiatives, status of evaluation, and - barriers to implementation. Fourteen categories of mHealth
services were surveyed: health call centres, emergency toll-free telephone services, managing
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emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization

and health promotion, treatment compliance, mobile patient records, information access, patient
monitoring, health surveys and data collection, surveillance, health awareness raising, and decision
support systems.

(2016). From innovation to implementation eHealth in the WHO European Region, Copenhague : OMS
Bureau rgional de l'Europe
[Link]
european-region-2016
Ce rapport dcrit le dveloppement de la sant lectronique (cybersant) dans la Rgion europenne
de l'OMS en 2016, ainsi que les nouvelles tendances cet gard. Son contenu et ses messages cls se
basent sur les donnes de l'enqute mondiale sur la cybersant ralise en 2015. Plusieurs acteurs
importants dans ce domaine ont galement contribu au projet. Le rapport prsente des exemples de
cas afin d'illustrer les russites rencontres dans les pays ainsi que l'application pratique de la
cybersant dans divers contextes. Les principales conclusions indiquent un enthousiasme accru pour la
cybersant, et font tat de progrs tangibles dans l'intgration des solutions technologiques en vue
d'amliorer la sant publique et la prestation des services de sant dans la Rgion europenne.
Ensemble, les conclusions et l'analyse prsentes dans ce rapport donnent un aperu dtaill de
l'volution de la cybersant en Europe. Grce aux recommandations et aux mesures proposes, l'OMS
tmoigne de son engagement soutenir les tats membres dans leurs efforts visant instaurer un
environnement national de la cybersant comme lment stratgique dans la ralisation de la
couverture universelle en sant, et des objectifs politiques de Sant 2020 dans la Rgion europenne
(rsum de l'diteur).

Morgan, D., et al. (2009). Obtenir un meilleur rapport qualit-prix dans les soins de sant. Paris OCDE: 182 ,
ann., graph., tabl.
[Link]
La hausse des dpenses publiques de sant reste un problme dans pratiquement tous les pays de
l'OCDE et de l'Union europenne. C'est pourquoi lattention se porte de plus en plus sur les mesures
qui attnueront ces pressions en amliorant la performance des systmes de sant. Ce rapport
prsente un ensemble de politiques pouvant aider les pays amliorer l'efficience des systmes de
sant et ainsi obtenir un meilleur rapport qualit-prix dans les soins. Un large ventail dinstruments
d'action est examin en tirant parti de donnes et d'tudes de cas portant sur de nombreux pays. Les
thmes suivants sont traits : le rle de la concurrence sur les marchs de la sant ; les possibilits
d'amlioration de la coordination des soins ; une tarification plus adapte des produits
pharmaceutiques ; un contrle plus pouss de la qualit s'appuyant sur une utilisation plus intensive
des technologies de linformation et de la communication pour les soins ; et un plus large partage des
cots.

Pikhart, H. et Pikhartova, J. (2015). Promoting better integration of health information systems: best practices
and challenges, Copenhague : OMS Bureau rgional de l'Europe
[Link]
systems-best-practices-and-challenges
Ce rapport aborde les tendances actuellement observes dans les tats membres de lUnion
europenne (UE) et de lAssociation europenne de libre-change (AELE) quant la manire de
promouvoir une meilleure intgration des systmes dinformation sanitaire. Afin den sonder les
aspects pragmatiques, des experts de 13 tats membres de lUE ont t soumis un entretien, dont
les rsultats ont t combins aux conclusions dune recherche documentaire. Le rapport de synthse
identifie les options stratgiques et les besoins suivants pour un examen plus approfondi, savoir :
continuer le travail sur certaines notions de base (tels que la disponibilit et la qualit des donnes, les
inventaires de donnes et les registres, la normalisation, la lgislation, les infrastructures physiques et
les capacits de la main-duvre) et sur des ensembles dindicateurs davantage axs sur des concepts
; dfinir la notion de meilleure intgration et en dmontrer les avantages concrets ; dvelopper le
leadership en matire de renforcement des capacits en vue de poursuivre lintgration des systmes
dinformation sanitaire ;poursuivre les changes internationaux concernant les activits en cours dans
ce domaine.(rsum de l'diteur).

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Articles

(2008). "Focus on continuity in care, evaluation techniques, IT for health." Health Policy Developments(6): 111 ,
tabl., graph., fig.
[Link]
This issue discusses and examines the following subjects : Evaluation in health care ; continuity of care
: concepts of integrated care, disease management and strategies ; information and comunication
technologies ; human resources in health....

Aldehaim, A. Y., et al. (2016). "The Impact of Technology-Based Interventions on Informal Caregivers of Stroke
Survivors: A Systematic Review." Telemed J E Health 22(3): 223-231.

OBJECTIVE: This article is a systematic review of the impact of technology-based intervention on

outcomes related to care providers for those who survived a stroke. MATERIALS AND METHODS:
Literature was identified in the PubMed, PsycINFO, Scopus, and Cochrane databases for evidence on
technology-based interventions for stroke survivors' caregivers. The search was restricted for all
English-language articles from 1970 to February 2015 that implied technology-based interventions.
This review included studies that measured the impact of these types of approaches on one or more
of the following: depression and any of the following-problem-solving ability, burden, health status,
social support, preparedness, and healthcare utilization by care recipient-as secondary outcomes.
Telephone or face-to-face counseling sessions were not of interest for this review. The search strategy
yielded five studies that met inclusion criteria: two randomized clinical trials and three
pilot/preliminary studies, with diverse approaches and designs. RESULTS: Four studies have assessed
the primary outcome, two of which reported significant decreases in caregivers' depressive symptoms.
Two studies had measured each of the following outcomes-burden, problem-solving ability, health
status, and social support-and they revealed no significant differences following the intervention. Only
one study assessed caregivers' preparedness and showed improved posttest scores. Healthcare
services use by the care recipient was assessed by one study, and the results indicated significant
reduction in emergency department visits and hospital re-admissions. CONCLUSIONS: Despite various
study designs and small sample sizes, available data suggest that an intervention that incorporates a
theoretical-based model and is designed to target caregivers as early as possible is a promising
strategy. Furthermore, there is a need to incorporate a cost-benefit analysis in future studies.

Black, A. D., et al. (2011). "The Impact of eHealth on the Quality and Safety of Health Care: A Systematic
Overview." Plos Medicine 8(1): 16.
[Link]
There is considerable international interest in exploiting the potential of digital solutions to enhance
the quality and safety of health care. Implementations of transformative eHealth technologies are
underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions
on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we
undertook a systematic review of systematic reviews assessing the effectiveness and consequences of
various eHealth technologies on the quality and safety of care. We systematically reviewed the
preexisting systematic review literature on eHealth technologies and their impact on the quality and
safety of health care delivery. We synthesised and contextualised our findings with the broader
theoretical and methodological literature with a view to producing a comprehensive and accessible
overview of the field. We present here a synopsis and updated version of a much larger recently
published report covering the period 1997?2010.

Bonhomme, C. (2014). "Cinq questions Gilles Babinet : Digital champion franais auprs de la Commission
europenne." Revue Hospitaliere De France(559): 54-55.

[BDSP. Notice produite par EHESP D8R0xIFr. Diffusion soumise autorisation]. Gilles Babinet a t
nomm "Digital champion" et reprsente, ce titre, la France auprs de la Commission europenne
pour les enjeux du numrique. Auteur de deux ouvrages, il identifie cinq domaines intrinsquement
lis au numrique : la connaissance, l'ducation, la sant, l'industrialisation/production et l'Etat.

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Brennan, J., et al. (2015). "National Health Models and the Adoption of E-Health and E-Prescribing in Primary
Care - New Evidence from Europe." J Innov Health Inform 22(4): 399-408.

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.

de la Torre Diez, I., et al. (2016). "Monitoring and Follow-up of Chronic Heart Failure: a Literature Review of
eHealth Applications and Systems." J Med Syst 40(7): 179.

In developed countries heart failure is one of the most important causes of death, followed closely by
strokes and other cerebrovascular diseases. It is one of the major healthcare issues in terms of
increasing number of patients, rate of hospitalizations and costs. The main aim of this paper is to
present telemedicine applications for monitoring and follow-up of heart failure and to show how
these systems can help reduce costs of administering heart failure. The search for e-health
applications and systems in the field of telemonitoring of heart failure was pursued in IEEE Xplore,
Science Direct, PubMed and Scopus systems between 2005 and the present time. This search was
conducted between May and June 2015, and the articles deemed to be of most interest about
treatment, prevention, self-empowerment and stabilization of patients were selected. Over 100
articles about telemonitoring of heart failure have been found in the literature reviewed since 2005,
although the most interesting ones have been selected from the scientific standpoint. Many of them
show that telemonitoring of patients with a high risk of heart failure is a measure that might help to
reduce the risk of suffering from the disease. Following the review conducted, in can be stated that via
the research articles analysed that telemonitoring systems can help to reduce the costs of
administering heart failure and result in less re-hospitalization of patients.

Demiris, G. (2016). "Consumer Health Informatics: Past, Present, and Future of a Rapidly Evolving Domain."
Yearb Med Inform 25(Suppl. 1).

OBJECTIVES: Consumer Health Informatics (CHI) is a rapidly growing domain within the field of
biomedical and health informatics. The objective of this paper is to reflect on the past twenty five
years and showcase informatics concepts and applications that led to new models of care and patient
empowerment, and to predict future trends and challenges for the next 25 years. METHODS: We
discuss concepts and systems based on a review and analysis of published literature in the consumer
health informatics domain in the last 25 years. RESULTS: The field was introduced with the vision that
one day patients will be in charge of their own health care using informatics tools and systems.
Scientific literature in the field originally focused on ways to assess the quality and validity of available
printed health information, only to grow significantly to cover diverse areas such as online
communities, social media, and shared decision-making. Concepts such as home telehealth, mHealth,
and the quantified-self movement, tools to address transparency of health care organizations, and
personal health records and portals provided significant milestones in the field. CONCLUSION:
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Consumers are able to actively participate in the decision-making process and to engage in health care
processes and decisions. However, challenges such as health literacy and the digital divide have
hindered us from maximizing the potential of CHI tools with a significant portion of underserved
populations unable to access and utilize them. At the same time, at a global scale consumer tools can
increase access to care for underserved populations in developing countries. The field continues to
grow and emerging movements such as precision medicine and the sharing economy will introduce
new opportunities and challenges.

Demiris, G. et Kneale, L. (2015). "Informatics Systems and Tools to Facilitate Patient-centered Care
Coordination." Yearb Med Inform 10(1): 15-21.

INTRODUCTION: There is a growing international focus on patient- centered care. A model designed to
facilitate this type of care in the primary care setting is the patient-centered medical home. This model
of care strives to be patient-focused, comprehensive, team-based, coordinated, accessible, and
focused on quality and safety of care. OBJECTIVE: The objective of this paper is to identify the current
status and future trends of patient-centered care and the role of informatics systems and tools in
facilitating this model of care. METHODS: In this paper we review recent scientific literature of the
past four years to identify trends and state of current evidence when it comes to patient-centered
care overall, and more specifically medical homes. RESULTS: There are several studies that indicate
growth and development in seven informatics areas within patient-centered care, namely clinical
decision support, registries, team care, care transitions, personal health records, telehealth, and
measurement. In some cases we are still lacking large randomized clinical trials and the evidence base
is not always solid, but findings strongly indicate the potential of informatics to support patient-
centered care. CONCLUSION: Current evidence indicates that advancements have been made in
implementing and evaluating patient-centered care models. Technical, legal, and practical challenges
still remain. Further examination of the impact of patient-centered informatics tools and systems on
clinical outcomes is needed.

Gagnon, M. P., et al. (2016). "e-Health Interventions for Healthy Aging: A Systematic Review Protocol." Stud
Health Technol Inform 225: 954-955.

e-Health interventions could contribute to healthy aging (HA) but their effectiveness has not been
synthesised. This study aims to systematically review the effectiveness of e-health interventions for
supporting HA. We will perform standardized searches to identify experimental and quasi-
experimental studies evaluating the effectiveness of e-health interventions for HA. Outcomes of
interest are: wellbeing, quality of life, activities of daily living, leisure activities, knowledge, evaluation
of care, social support, skill acquisition and healthy behaviours. We will also consider adverse effects
such as social isolation, anxiety, and burden on informal caregivers. Two reviewers will independently
assess studies for inclusion and extract data using a standardised tool. We will calculate effect sizes
related to e-health interventions. If not possible, we will present the findings in a narrative form. This
systematic review will provide unique knowledge on the effectiveness of e-health interventions for
supporting HA.

Garel, P. (2010). "Sant en ligne : nouvelles tapes europennes." Revue Hospitaliere De France(532): 35-36.

[BDSP. Notice produite par EHESP 8ER0xBF7. Diffusion soumise autorisation]. Les antcdents
mdicaux d'un ressortissant de l'Union europenne voyageant ou rsidant hors de son pays seront-ils
bientt accessibles en ligne ? Le 1er dcembre 2009, le Conseil des ministres de l'Emploi, des Affaires
sociales et de la Sant des tats membres de l'UE adoptait des "conclusions sur la contribution de la
sant en ligne la scurit et l'efficacit des soins de sant". La sant en ligne, ou e-sant, recouvre
l'ensemble des technologies et services pour les soins mdicaux bass sur les technologies de
l'information et de la communication. Constatant ses avantages en termes de scurit et d'efficacit,
les reprsentants des tats membres de l'UE prconisaient en fvrier 2009 la mise en oeuvre de
mesures destines crer un espace europen de sant en ligne et instaurer un processus d'actions
coordonnes et de gouvernance de l'e-sant.

Garel, P. (2011). "E-sant. tat des lieux europen." Revue Hospitaliere De France(539): 78-80.
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[BDSP. Notice produite par EHESP rEp9R0xn. Diffusion soumise autorisation]. Avec l'article 13 de la
directive sur les soins transfrontaliers, l'e-sant est devenue un sujet lgislatif au sein de l'Union
europenne. La coopration et l'change d'informations entre les Etats membres, runis dans un
rseau d'administrations nationales responsables de l'e-sant, seront dsormais soutenus par l'UE sur
un fondement juridique. L'article prsente les programmes de recherche europens dvelopps pour
la mise en place des outils et systmes d'e-sant.

Garel, P. (2013). "L'e-sant dans l'agenda de la Fdration europenne des hpitaux (HOPE)." Revue
Hospitaliere De France(550): 18-.

[BDSP. Notice produite par EHESP 8sR0xrrE. Diffusion soumise autorisation]. La Fdration
europenne des hpitaux et soins de sant (HOPE) participe activement depuis 2005 aux travaux e-
sant de la Commission europenne, et plus particulirement aux missions de sa direction gnrale,
Connect. La Commission a dvoil dbut dcembre 2012 un nouveau plan d'actions.

Goodridge, D. et Marciniuk, D. (2016). "Rural and remote care: Overcoming the challenges of distance." Chron
Respir Dis 13(2): 192-203.

The challenges of providing quality respiratory care to persons living in rural or remote communities
can be daunting. These populations are often vulnerable in terms of both health status and access to
care, highlighting the need for innovation in service delivery. The rapidly expanding options available
using telehealthcare technologies have the capacity to allow patients in rural and remote communities
to connect with providers at distant sites and to facilitate the provision of diagnostic, monitoring, and
therapeutic services. Successful implementation of telehealthcare programs in rural and remote
settings is, however, contingent upon accounting for key technical, organizational, social, and legal
considerations at the individual, community, and system levels. This review article discusses five types
of telehealthcare delivery that can facilitate respiratory care for residents of rural or remote
communities: remote monitoring (including wearable and ambient systems; remote consultations
(between providers and between patients and providers), remote pulmonary rehabilitation,
telepharmacy, and remote sleep monitoring. Current and future challenges related to telehealthcare
are discussed.

Hecketsweiler, C. (2016). "Les docteurs 3.0 de la Silicon Valley (Le Monde Eco & entreprise)." Problemes
Economiques(3127): 25-32, tab., graph.

Cet article est une reprise partielle d'un article paru dans le Monde Eco & entreprise du 8 septembre
2015 avec en sus, l'clairage apport par Problmes conomiques. Les nouvelles technologies de
l'information sont aujourd'hui en passe de rvolutionner la mdecine et la recherche pharmaceutique.
Les gants de l'informatique et de l'internet comme Google, Amazon, Apple, Microsoft se sont en effet
lanc la conqute du secteur de la sant.

Hemsley, B., et al. (2016). "Use of the My Health Record by people with communication disability in Australia: A
review to inform the design and direction of future research." Him j.

BACKGROUND: People with communication disability often struggle to convey their health
information to multiple service providers and are at increased risk of adverse health outcomes related
to the poor exchange of health information. OBJECTIVE: The purpose of this article was to (a) review
the literature informing future research on the Australian personally controlled electronic health
record, 'My Health Record' (MyHR), specifically to include people with communication disability and
their family members or service providers, and (b) to propose a range of suitable methodologies that
might be applied in research to inform training, policy and practice in relation to supporting people
with communication disability and their representatives to engage in using MyHR. METHOD: The
authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply
sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults
with communication disability. RESEARCH OUTCOMES: This article outlines a range of research
methods suitable for investigating the use of MyHR by people who have communication disability
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associated with a range of acquired or lifelong health conditions, and their family members, and direct
support workers. CONCLUSION: In planning the allocation of funds towards the health and well-being
of adults with disabilities, both disability and health service providers must consider the supports
needed for people with communication disability to use MyHR. There is an urgent need to focus
research efforts on MyHR in populations with communication disability, who struggle to communicate
their health information across multiple health and disability service providers. The design of studies
and priorities for future research should be set in consultation with people with communication
disability and their representatives.

Hendy, J., et al. (2012). "An organisational analysis of the implementation of telecare and telehealth: the whole
systems demonstrator." Bmc Health Services Research 12: (21 ), fig.
[Link]
Cette tude examine les facteurs organisationnels associs l'implantation de services de tlsant.
L'analyse est base sur des tudes de cas provenant des trois sites qui forment le Whole Systems
Demonstrator (WSD), programme du ministre de la Sant britannique.

Hermanowski, T. R., et al. (2015). "Institutional framework for integrated Pharmaceutical Benefits
Management: results from a systematic review." Int J Integr Care 15: e036.

OBJECTIVES: In this paper, we emphasised that effective management of health plans beneficiaries
access to reimbursed medicines requires proper institutional set-up. The main objective was to
identify and recommend an institutional framework of integrated pharmaceutical care providing
effective, safe and equitable access to medicines. METHOD: The institutional framework of drug policy
was derived on the basis of publications obtained by systematic reviews. A comparative analysis
concerning adaptation of coordinated pharmaceutical care services in the USA, the UK, Poland, Italy,
Denmark and Germany was performed. RESULTS: While most European Union Member States
promote the implementation of selected e-Health tools, like e-Prescribing, these efforts do not
necessarily implement an integrated package. There is no single agent who would manage an insured
patients' access to medicines and health care in a coordinated manner, thereby increasing the
efficiency and safety of drug policy. More attention should be paid by European Union Member States
as to how to integrate various e-Health tools to enhance benefits to both individuals and societies.
One solution could be to implement an integrated "pharmacy benefit management" model, which is
well established in the USA and Canada and provides an integrated package of cost-containment
methods, implemented within a transparent institutional framework and powered by strong
motivation of the agent.

Keijser, W., et al. (2016). "Physician leadership in e-health? A systematic literature review." Leadersh Health
Serv (Bradf Engl) 29(3): 331-347.

Purpose: This paper aims to systematically review the literature on roles of physicians in virtual teams
(VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-
health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords
and criteria, including snowball sampling. They were synthesized with existing theoretical models on
VT research, healthcare team competencies and medical leadership. Findings Six domains for further
PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs,
virtual physician-patient relationship and change management. We show that, to date, PeL studies on
socio-technical dynamics and their consequences on e-health are found underrepresented in the
health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual
healthcare work was identified. Research limitations/implications E-health practices could benefit
from organization-behavioral type of research for discerning effective physicians' roles and inter-
professional relations and their (so far) seemingly modest but potent impact on e-health
developments. Practical implications Although best practices in e-health care have already been
identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-
depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so,
what (dis)advantages may this have for current e-health investments and how can they best become
involved in (leading) e-health applications' design and implementation in the field? Originality/value If
effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new
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proposition needs urgent empirical scrutiny.

Koutras, C., et al. (2015). "Socioeconomic impact of e-Health services in major joint replacement: A scoping
review." Technol Health Care 23(6): 809-817.

BACKGROUND: e-Health is a widespread healthcare practice in the medical community, supported by

technology-based applications aiming to deliver health services in an efficient manner, improving the
quality of life and providing a wide range of health and socio-economic benefits to patients.
OBJECTIVE: To investigate the use of e-Health and mobile applications for the follow-up of major joint
arthroplasty patients and the socio-economic impact of e-Health services on arthroplasty patients.
METHODS: Studies published after 2000 in English language, enrolling patients who underwent total
knee or hip replacement, applying e-Health solutions and highlighting the economic benefits obtained
by patients, doctors and healthcare systems were considered for inclusion in the present study.
RESULTS: Five studies satisfied our inclusion criteria and were included in qualitative analysis. In this
paper, the use of e-Health for the follow-up of major joint arthroplasty patients and the positive
impact in terms of cost, time and hospital visits reduction by applying e-Health solutions on
arthroplasty patients are reviewed in detail as reported in the included studies. CONCLUSION: The
majority of the included studies reported a positive impact in terms of cost, time and hospital visits
reduction.

Kruse, C. S., et al. (2016). "Mobile health solutions for the aging population: A systematic narrative analysis." J
Telemed Telecare.

INTRODUCTION: The ubiquitous nature of mobile technology coupled with the acceptance of mobile
health (mHealth) among the elderly offers an opportunity to augment the existing medical workforce
in long-term care. The objective of this review and narrative analysis is to identify and analyse
facilitators and barriers to adoption of mHealth for the elderly. METHODS: Studies over the last year
were identified in multiple database indices, and three reviewers examined abstracts (k = 0.82) and
analysed articles for themes which were tallied in affinity diagrams to identify frequency of occurrence
in the literature (n = 36). RESULTS: The three facilitators mentioned most often were independence
(18%), understanding (13%), and visibility (13%). The three barriers mentioned most often were
complexity (21%), limited by users (12%) and ineffective (12%). DISCUSSION AND CONCLUSIONS: The
reviewers concluded that the work done so far illustrates that mHealth enables a perception of
independence. Future research should focus on the barriers of complexity of technology and
improving existing medical literacy in order to facilitate further adoption.

Liu, L., et al. (2016). "Smart homes and home health monitoring technologies for older adults: A systematic
review." Int J Med Inform 91: 44-59.

BACKGROUND: Around the world, populations are aging and there is a growing concern about ways
that older adults can maintain their health and well-being while living in their homes. OBJECTIVES: The
aim of this paper was to conduct a systematic literature review to determine: (1) the levels of
technology readiness among older adults and, (2) evidence for smart homes and home-based health-
monitoring technologies that support aging in place for older adults who have complex needs.
RESULTS: We identified and analyzed 48 of 1863 relevant papers. Our analyses found that: (1)
technology-readiness level for smart homes and home health monitoring technologies is low; (2) the
highest level of evidence is 1b (i.e., one randomized controlled trial with a PEDro score >/=6); smart
homes and home health monitoring technologies are used to monitor activities of daily living,
cognitive decline and mental health, and heart conditions in older adults with complex needs; (3)
there is no evidence that smart homes and home health monitoring technologies help address
disability prediction and health-related quality of life, or fall prevention; and (4) there is conflicting
evidence that smart homes and home health monitoring technologies help address chronic
obstructive pulmonary disease. CONCLUSIONS: The level of technology readiness for smart homes and
home health monitoring technologies is still low. The highest level of evidence found was in a study
that supported home health technologies for use in monitoring activities of daily living, cognitive
decline, mental health, and heart conditions in older adults with complex needs.

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Martenstein, I. et Wienke, A. (2016). "[Current legislation in the healthcare system 2015/2016]." Anaesthesist
65(5): 391-396.

The energy of the legislator in the healthcare system was barely stoppable in 2015. Many new laws
have been brought into force and legal initiatives have also been implemented. The Hospital Structure
Act, the Treatment Enhancement Act, amendments of the official medical fee schedules for
physicians, the Prevention Act, the E-Health Act, the Anti-corruption Act, the hospital admission
guidelines and amendments of the model specialty training regulations are just some of the essential
alterations that lie ahead of the medical community. This article gives a review of the most important
new legislative regulations in the healthcare system and presents the fundamental consequences for
the practice.

May, R. C., et al. (2011). "Integrating telecare for chronic disease management in the community: What needs
to be done ?" Bmc Health Services Research 11(131): 11 , fig.
[Link]
The study reported in this paper had two objectives. First, it sought to identify, describe and
understand the factors that promote or inhibit the implementation and integration of telecare
systems for chronic disease management in the community, with reference to the views of four key
stakeholder groups: patients and carers; healthcare managers and professionals; social care managers
and professionals; and telecare systems manufacturers and suppliers. Second, it sought to identify a
set of principles, grounded in the experiences and perspectives of participants, which could be used to
inform policy and practice around telecare implementation in the context of a ?whole systems?
approach that is, across boundaries of the private, public and domestic sectors, all of which are playing
an increasingly important role in the management of chronic disease. The study reported here may be
the largest and most comprehensive qualitative study in this sphere to date.

McConnochie, K. M. (2015). "Pursuit of Value in Connected Healthcare." Telemed J E Health 21(11): 863-869.

INTRODUCTION: Potential for direct patient care through remote exchange of health-related
information has expanded enormously with the proliferation of technologies leveraging ubiquitous
connectivity, but implementation of connected care has been slow and controversial. MATERIALS AND
METHODS: This review demonstrates that controversy regarding connected care arises largely from
the fact that proponents and critics are generally considering distinctly different care models.
Differences are highlighted to mitigate controversy and to distinguish capacities of these different
models. RESULTS: Distinguishing capacities is essential for establishing the evidence base supporting
safety, effectiveness, and efficiency. In care of a particular patient's problem, value is achieved when
resources allocated meet requirements for diagnosis and intervention but do not exceed them. Robust
evidence supports the value of some well-defined connected care models, exemplified by the Health-
e-Access Telemedicine Model. CONCLUSIONS: The pursuit of value in connected care is fundamentally
the same as with in-person care. Provider organizations, legislators, regulators, and payers face not
only a complex task in defining standards and enabling appropriate use, but also a heavy burden of
responsibility for unleashing connected care that will benefit the entire community.

Meurk, C., et al. (2016). "Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of
Challenges and A Call For Policy-Focussed Research." J Med Internet Res 18(1): e10.

BACKGROUND: Growing evidence attests to the efficacy of e-mental health services. There is less
evidence on how to facilitate the safe, effective, and sustainable implementation of these services.
OBJECTIVE: We conducted a systematic review on e-mental health service use for depressive and
anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base.
METHODS: Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-
mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such
as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL,
Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and
level of policy relevance. RESULTS: The search yielded 1081 studies; 30 studies were included for
analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate
that e-mental health services are predominantly used by females, and those who are more educated
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and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining
consumer preferences found a preference for face-to-face therapy over e-therapies, but not an
aversion to e-therapy. Content relevant to governance was predominantly related to the
organizational dimensions of e-mental health services, followed by implications for community
education. Financing and payment for e-services and governance of the information communication
technology were least commonly discussed. CONCLUSIONS: Little research focuses explicitly on policy
development and implementation planning; most research provides an e-services perspective.
Research is needed to provide community and policy-maker perspectives. General population studies
of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative
preferences for all treatment modalities are necessary.

Mitchell, J. (2000). "Increasing the cost-effectiveness of telemedicine by embracing e-health." J Telemed

Telecare 6 Suppl 1: S16-19.

In 1999 a national study of telemedicine in Australia led to the promotion of the concept of 'e-health',
the health sector's equivalent of 'e-commerce'. A new study explored the view that, with the
convergence of technologies and the consequent increase in ability to perform multiple functions with
those technologies, it is unwise to promote telemedicine in isolation from other uses of technologies
in health-care. The major sources of information for the study were the presentations and discussions
at five national workshops held to discuss the findings of the original report on telemedicine. Nineteen
case studies were identified. The case studies showed that with the convergence of technologies
telehealth is becoming part of e-health. The cost-effectiveness of both telehealth and telemedicine
improves considerably when they are part of an integrated use of telecommunications and
information technology in the health sector.

Olson, C. M. (2016). "Behavioral Nutrition Interventions Using e- and m-Health Communication Technologies: A
Narrative Review." Annu Rev Nutr 36: 647-664.

e- and m-Health communication technologies are now common approaches to improving population
health. The efficacy of behavioral nutrition interventions using e-health technologies to decrease fat
intake and increase fruit and vegetable intake was demonstrated in studies conducted from 2005 to
2009, with approximately 75% of trials showing positive effects. By 2010, an increasing number of
behavioral nutrition interventions were focusing on body weight. The early emphasis on interventions
that were highly computer tailored shifted to personalized electronic interventions that included
weight and behavioral self-monitoring as key features. More diverse target audiences began to
participate, and mobile components were added to interventions. Little progress has been made on
using objective measures rather than self-reported measures of dietary behavior. A challenge for
nutritionists is to link with the private sector in the design, use, and evaluation of the many electronic
devices that are now available in the marketplace for nutrition monitoring and behavioral change.

Palm, W., et al. (2014). "Electing health : the Europe we want." Eurohealth 20(3): 60 , tab., graph., fig.

This issues Eurohealth addresses many topics covered in the European Health Forum Gastein.
Interviews with health leaders from World Health Organization, the European Union and other
important institutions are included. The Observer section covers: Health and European integration;
Building EU health policy for the future; Telemedicine; Taking change seriously; and the EUs
contribution to health system performance. The International Section contains an article on: From
Millennium Development Goals to the post-2015 agenda; Leadership in public health; Development of
an R&D Roadmap; Caring for people with multiple chronic conditions; and Personalised medicines.
The Systems and Policies section looks at: care coordination and patient choice (Austria); health
system trends (FSU countries); and quality of inpatient care (Germany).

Vegesna, A., et al. (2016). "Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic
Review." Telemed J E Health.

BACKGROUND: We conducted a systematic literature review to identify key trends associated with
remote patient monitoring (RPM) via noninvasive digital technologies over the last decade.
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MATERIALS AND METHODS: A search was conducted in EMBASE and Ovid MEDLINE. Citations were
screened for relevance against predefined selection criteria based on the PICOTS (Population,
Intervention, Comparator, Outcomes, Timeframe, and Study Design) format. We included studies
published between January 1, 2005 and September 15, 2015 that used RPM via noninvasive digital
technology (smartphones/personal digital assistants [PDAs], wearables, biosensors, computerized
systems, or multiple components of the formerly mentioned) in evaluating health outcomes compared
to standard of care or another technology. Studies were quality appraised according to Critical
Appraisal Skills Programme. RESULTS: Of 347 articles identified, 62 met the selection criteria. Most
studies were randomized control trials with older adult populations, small sample sizes, and limited
follow-up. There was a trend toward multicomponent interventions (n = 26), followed by
smartphones/PDAs (n = 12), wearables (n = 11), biosensor devices (n = 7), and computerized systems
(n = 6). Another key trend was the monitoring of chronic conditions, including respiratory (23%),
weight management (17%), metabolic (18%), and cardiovascular diseases (16%). Although substantial
diversity in health-related outcomes was noted, studies predominantly reported positive findings.
CONCLUSIONS: This review will help decision makers develop a better understanding of the current
landscape of peer-reviewed literature, demonstrating the utility of noninvasive RPM in various patient
populations. Future research is needed to determine the effectiveness of RPM via noninvasive digital
technologies in delivering patient healthcare benefits and the feasibility of large-scale
implementation.

Volker, D., et al. (2013). "Blended E-health module on return to work embedded in collaborative occupational
health care for common mental disorders: Design of a cluster randomized controlled trial."
Neuropsychiatric Disease and Treatment 9: 529-537, tabl., fig.
[Link]
[Link]
Background: Common mental disorders (CMD) have a major impact on both society and individual
workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational
physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-
based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An
intervention supporting the occupational physician in guidance of sicklisted workers combined with
specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative
occupational health care is now available, and comprises a decision aid supporting the occupational
physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process.
The cost-effectiveness of this intervention will be evaluated in this study and compared with that of
care as usual. Methods: This study is a two-armed cluster randomized controlled trial, with
randomization done at the level of occupational physicians. Two hundred workers with CMD on
sickness absence for 4?26 weeks will be included in the study. Workers whose occupational physician
is allocated to the intervention group will receive the collaborative occupational health care
intervention. Occupational physicians allocated to the care as usual group will give conventional
sickness guidance. Follow-up assessments will be done at 3, 6, 9, and 12 months after baseline. The
primary outcome is duration until RTW. The secondary outcome is severity of symptoms of CMD. An
economic evaluation will be performed as part of this trial. Conclusion: It is hypothesized that
collaborative occupational health care intervention will be more (cost)-effective than care as usual.
This intervention is innovative in its combination of a decision aid by email sent to the occupational
physician and an E-health module aimed at RTW for the sick-listed worker.

Wake, D. J., et al. (2016). "MyDiabetesMyWay: An Evolving National Data Driven Diabetes Self-Management
Platform." J Diabetes Sci Technol.

MyDiabetesMyWay (MDMW) is an award-wining national electronic personal health record and self-
management platform for diabetes patients in Scotland. This platform links multiple national
institutional and patient-recorded data sources to provide a unique resource for patient care and self-
management. This review considers the current evidence for online interventions in diabetes and
discusses these in the context of current and ongoing developments for MDMW. Evaluation of
MDMW through patient reported outcomes demonstrates a positive impact on self-management.
User feedback has highlighted barriers to uptake and has guided platform evolution from an education
resource website to an electronic personal health record now encompassing remote monitoring,
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communication tools and personalized education links. Challenges in delivering digital interventions
for long-term conditions include integration of data between institutional and personal recorded
sources to perform big data analytics and facilitating technology use in those with disabilities, low
digital literacy, low socioeconomic status and in minority groups. The potential for technology
supported health improvement is great, but awareness and adoption by health workers and patients
remains a significant barrier.

Whiteman, K. L., et al. (2016). "Systematic Review of Integrated General Medical and Psychiatric Self-
Management Interventions for Adults With Serious Mental Illness." Psychiatr Serv: appips201500521.

OBJECTIVE: Adults with serious mental illness are disproportionately affected by general medical
comorbidity, earlier onset of disease, and premature mortality. Integrated self-management
interventions have been developed to address both general medical and psychiatric illnesses. This
systematic review examined evidence about the effect of self-management interventions that target
both general medical and psychiatric illnesses and evaluated the potential for implementation.
METHODS: Databases, including CINAHL, Cochrane Central, Ovid MEDLINE, PsycINFO, and Web of
Science, were searched for articles published between 1946 and July 2015. Studies evaluating
integrated general medical and psychiatric self-management interventions for adults with
schizophrenia spectrum or mood disorders and general medical comorbidity were included. RESULTS:
Fifteen studies (nine randomized controlled trials and six pre-post designs) reported on nine
interventions: automated telehealth, Health and Recovery Peer program, Helping Older People
Experience Success, Integrated Illness Management and Recovery, Life Goals Collaborative Care, Living
Well, Norlunga Chronic Disease Self-Management program, Paxton House, and Targeted Training in
Illness Management. Most studies demonstrated feasibility, acceptability, and preliminary
effectiveness; however, clinical effectiveness could not be established in most studies because of
methodological limitations. Factors identified that may deter implementation included operating
costs, impractical length, and workforce requirements. CONCLUSIONS: Integrated general medical and
psychiatric illness self-management interventions appear feasible and acceptable, with high potential
for clinical effectiveness. However, implementation factors were rarely considered in intervention
development, which may contribute to limited uptake and reach in real-world settings.

Yunkap, K. W. A. N. K. A. M. S., et al. (2004). "What e-Health can offer." Bulletin of the World Health
Organization 82(10): 800-802.

[BDSP. Notice produite par INIST-CNRS hhmfFR0x. Diffusion soumise autorisation].

Rapports

(2002). Rapport sur l'e-sant en Allemagne, en Belgique, au Danemark, aux Etats-Unis, en Finlande, en Grande-
Bretagne, en Irlande, en Italie, en Norvge, aux Pays-Bas, en Sude et en Suisse. Le Mans MRI: 229.

Le prsent rapport rsulte d'une demande de la direction gnrale de la Cnamts, en date de fvrier
2001. L'objet de cette demande est l'e-sant et concerne les pays couverts par la Mission Recherche
Internationale (MRI). Cette tude comparative a pour but d'apprcier l'utilisation d'internet par les
professionnels de sant et le public, de connatre leurs attentes vis vis de ce nouvel outil de
communication, d'en retirer les lments les plus intressants et des recommandations adaptes la
situation franaise.

(2010). Chronic diseases. A clinical and managerial challenge. Bruxelles HOPE: 53, tabl., fig.
[Link]
Chronic_diseases-October_2010.pdf
The present report has the specific objective of presenting the content and findings of the Hope Agora
2010. Il is covering the presentation of two days discussion and is also integrating information from
the most relevant international sources, in particular the WHO publications on the issue of the chronic
disease. Chapter 1 gives a brief introduction and a general overview of the issue of chronic disease.
Chapter 2 illustrates the main initiative and innovation countries are putting in place to overcome this
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issue. Chapter 3 reports the context of the presentation heald by each team during the last event of
the Exchange programs.

(2011). eHealth Benchmarking III. Bruxelles Communaut europenne: 274.

The study provides the result of a survey on Benchmarking deployment of eHealth services in acute
hospitals in 30 European countries. Chief Information Officers were asked about the availability of
eHealth infrastructure and applications in their hospitals whereas Medical Directors were asked about
priority areas for investment, impacts and perceived barriers to the further deployment of eHealth.
Applying state of the art multivariate statistical analysis to the data of survey of eHealth deployment in
Acute European Hospitals funded by DG INFSO, JRC-IPTS researchers have constructed a composite
indicator of take up and usage of eHealth in European hospitals, as well as a typology of impacts.

(2010). Tendance et ruptures dans le domaine de la sant en Europe l'horizon 2030 - synthse. sl Accenture:
20.
[Link]
Cette note de synthse repose principalement sur la revue d'un nombre significatif d'tudes publies
en Europe sur la sant et les facteurs d'environnement tels que la dmographie, l'conomie, la
sociologie ou encore l'volution technologique touchant directement ou indirectement la sant. La
trs grande majorit des tudes met en lumire des tendances fondes sur un pass rcent et en
dduit des projections moyen terme. Rares sont celles qui raisonnent un horizon 20 ans. La
projection des tendances de sant cet horizon ncessite donc de complter ces tudes par des essais
vise davantage prospective et de prendre des risques. Cette synthse rsume les problmatiques
dterminantes pour rendre compte de l'volution de la sant dans les pays europens l'horizon
2030. Cinq tendances ont t dgages : vieillir jeune deviendra une priorit et un objectif partags
par tous les europens; le "risque sant" sera de plus en plus individualis; Les patients seront au
coeur d'un cosystme largi de nouveaux acteurs; l'hpital sera recentr sur les soins grce une
diffusion massive des nouvelles technologies; La sant sera un vecteur de croissance pour l'conomie
europenne.

(2013). ICTs and the Health Sector. Towards Smarter Health and Wellness Models. Paris OCDE: 177 , fig.
[Link]
This report examines the challenges facing health care systems and the strategic directions for a
smarter health and wellness future, from both technological and policy viewpoints. It looks at the role
of information and communication technologies (ICTs) and discusses the research and policy options
that could further the development of smarter health and wellness systems.

(2013). Socio-economic impact of mHealth. An assessment report for the European Union. Neuily-sur Seine
Pricewaterhousecoopers: 28.
[Link]
_union.pdf
Selon cette tude prospective, le dploiement de la technologie mobile dans le domaine de la sant,
ou m-Sant, permettrait daugmenter le PIB de lUnion europenne de 93 milliards deuros en 2017
grce lamlioration de ltat de sant qui rduirait la perte de jours de travail et les retraites
anticipes. Les conomies ralises faciliteraient l'accs aux soins de 24,5 millions patients
supplmentaires. Une gnralisation de lutilisation des solutions mobiles contribuerait une gestion
optimise des maladies chroniques et des consquences lies au vieillissement de la population, deux
des priorits de lUnion europenne. Selon PwC, latteinte de ces effets positifs suppose nanmoins
lintgration rapide de la m-Sant dans la stratgie de sant publique de lUnion europenne. Pour ce
faire, les tats membres doivent lever de nombreux freins dordre rglementaire, conomique,
structurel et technologique, qui limitent actuellement son dveloppement.

(2013). Toward New Models for Innovative Governance of Biomedecine and Health Technologies. OECD
Science, Technology and Industry Policy Papers ; 11. Paris OCDE: 42 ,fig.
[Link]
biomedecine-and-health-technologies_5k3v0hljnnlr-en
This report examines examples of new and emerging governance models that aim to support the
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responsible development of diagnostics and treatments based on the latest advances in biomedicine.
In particular, it presents programmes and initiatives that aim to manage uncertainty in the
development and approval of new medical products and thereby to improve the understanding of the
risk/benefit balance. It also identifies some of the main challenges for policy makers, regulators and
other communities involved in the translation of biomedical innovation and health technologies from
the laboratory bench to point of care.

Anderson, G., et al. (2011). Health reform: meeting the challenge of ageing and multiple morbidities. Paris
OCDE: 221 , fig., tabl., annexes.
[Link]
The ageing of our societies is at the same time one of our greatest achievements and one of our
biggest challenges. A longer lifespan is something few people would spurn and it opens up great
opportunities in our personal, social and economic lives; yet in practice it is often accompanied by
living with disease. Indeed, increasingly people ? and the health systems that serve them ? have to
cope with more than one chronic disease at a time, a situation known as multimorbidity. How to
reorient health systems to meet the challenge of multimorbidity was the theme of a conference held
by the OECD and the Business and Industry Advisory Committee (BIAC) to the OECD as part of the
OECDs 50th anniversary celebrations. This present volume contains five of the papers prepared for
this conference, along with a sixth, on measuring quality in the presence of multimorbidity, on a topic
which there was not enough time to address.

Fonkych, K. et Taylor, R. (2005). The State and Pattern of Health Information Technology Adoption. Santa
Monica Rand corporation: 52 , tabl., graph.
[Link]
Innovations in information technology (IT) have improved efficiency and quality in many industries.
Healthcare has not been one of them. Although some administrative IT systems, such as those for
billing, scheduling, and inventory management, are already in place in the healthcare industry, little
adoption of clinical IT, such as Electronic Medical Record Systems (EMR-S) and Clinical Decision
Support tools, has occurred. Government intervention has been called for to speed the adoption
process for Health Information Technology (HIT), based on the widespread belief that its adoption, or
diffusion, is too slow to be socially optimal. In this report, we estimate the current level and pattern of
HIT adoption in the different types of healthcare organizations, and we evaluate factors that affect this
diffusion process. First, we make an effort to derive a population-wide adoption level of administrative
and clinical HIT applications according to information in the Healthcare Information and Management
Systems Society (HIMSS)-Dorenfest database (formerly the Dorenfest IHDS+TM Database, second
release, 2004) and compare our estimates to alternative ones. We then attempt to summarize the
current state and dynamics of HIT adoption according to these data and briefly review existing
empirical studies on the HIT-adoption process. By comparing adoption rates across different types of
healthcare providers and geographical areas, we help focus the policy agenda by identifying which
healthcare providers lag behind and may need the most incentives to adopt HIT. Next, we employ
regression analysis to separate the effects of the provider's characteristics and factors on adoption of
Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), and Picture Archiving
Communications Systems (PACS), and compare the effects to findings in the literature.

Footman, K., et al. (2014). Cross-border health care in Europe. Copenhague OMS Bureau rgional de l'Europe:
39 , tabl., graph., fig.
[Link]
This new policy summary explores how European health systems are responding to increasing patient
and professional mobility across the European Union. Recent legislative changes which clarify patient
entitlements to cross-border care are likely to have important impacts on national and EU-wide
policies. However, measures to optimise implementation of clinical guidelines, discharge summaries,
use of technologies and regulation of professional standards are all likely to be beneficial for patients
receiving care in their home country as well as for those who travel abroad.

Giordano, R., et al. (2011). Perspectives on telehealth and telecare. Learning from the 12 Whole System
Demonstrator Action Network (WSDAN) sites. Londres King's Fund Institute: 43 , tabl.
[Link]
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This briefing paper, assembled by The Kings Fund for the British Ministry of Health, looks at Britain's
Whole System Demonstrator Action Network (WSDAN), an online telecare and telehealth action
research program. The paper examines the experiences of the WSDAN network's 12 sites in
implementing telehealth and telecare.

Martin, R., et al. (2005). Outpatient services and primary care : a scoping review of research into strategies for
improving outpatient effectiveness and efficiency. Manchester NPCRDC: 169 , tabl.
[Link]
A key government objective in NHS reform is to reduce waiting times for specialist care. Broadly
speaking there are two strategic approaches to achieving this objective. The first is to increase hospital
capacity and so achieve faster throughput of patients. The second is to reduce demand for specialist
care by finding alternatives to outpatient treatment. This review is focused on the latter of these two
strategies.

Morgan, D., et al. (2009). Obtenir un meilleur rapport qualit-prix dans les soins de sant. Paris OCDE: 182 ,
ann., graph., tabl.
[Link]
La hausse des dpenses publiques de sant reste un problme dans pratiquement tous les pays de
l'OCDE et de l'Union europenne. C'est pourquoi lattention se porte de plus en plus sur les mesures
qui attnueront ces pressions en amliorant la performance des systmes de sant. Ce rapport
prsente un ensemble de politiques pouvant aider les pays amliorer l'efficience des systmes de
sant et ainsi obtenir un meilleur rapport qualit-prix dans les soins. Un large ventail dinstruments
d'action est examin en tirant parti de donnes et d'tudes de cas portant sur de nombreux pays. Les
thmes suivants sont traits : le rle de la concurrence sur les marchs de la sant ; les possibilits
d'amlioration de la coordination des soins ; une tarification plus adapte des produits
pharmaceutiques ; un contrle plus pouss de la qualit s'appuyant sur une utilisation plus intensive
des technologies de linformation et de la communication pour les soins ; et un plus large partage des
cots.

Picard, R. et Vial, A. (2013). Prospective organisationnelle pour un usage performant des technologies nouvelles
en Sant. Paris C.G.E.I.E.T.: 27.
[Link]
Ce rapport apporte un clairage prospectif sur les conditions organisationnelles pour un usage
performant des technologies nouvelles en Sant, avec un regard particulier sur la tlmdecine et plus
largement sur la tlsant.

Sabes-Figuera, R. et Abadie, F. (2013). European Hospital Survey: Benchmarking deployment of e-Health

services (20122013) Country reports. Luxembourg Publications Office of the European Union: 240 ,
tabl., fig.
[Link]
A widespread uptake of eHealth technologies is likely to benefit European Healthcare systems both in
terms of quality of care and financial sustainability and European society at large. This is why eHealth
has been on the European Commission policy agenda for more than a decade. The objectives of the
latest eHealth action plan developed in 2012 are in line with those of the Europe 2020 Strategy and
the Digital Agenda for Europe. This report, based on the analysis of the data from the "European
Hospital Survey: Benchmarking deployment of e-Health services (20122013)" project, presents policy
relevant results and findings for each of the 28 EU Member States as well as Iceland and Norway. The
results highlighted here are based on the analysis of the survey descriptive results as well as two
composite indicators on eHealth deployment and eHealth availability and use that were developed
based on the survey's data.

Sabes-Figuera, R. et Maghiros, I. (2013). European Hospital Survey: Benchmarking Deployment of e-Health

Services (20122013) - Composite Indicators on eHealth Deployment and on Availability and Use of
eHealth Functionalities. Luxembourg Publications Office of the European Union: 39 , tabl., fig.
[Link]
The objective of this document is to present results of a benchmarking exercise on the level of eHealth
adoption and use in acute hospitals in all 27 EU Member States and Croatia, Iceland and Norway
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(EU27+3). This exercise is based on data from two surveys carried out in 2010 (Deloitte/Ipsos 2011)
and 2012 (PWC 2013) that gathered data on eHealth indicators in acute hospitals. These indicators
have been compiled into two different composite indicators on: 1) eHealth deployment and 2) eHealth
Availability and Use. The composite indicators are calculated at Hospital level before obtaining
average country values, allowing the analysis to build rankings of countries for both composite
indicators. Given that the mentioned two surveys gathered comparable information in relation to
eHealth deployment, it was possible to compute the related composite indicator for both years and
therefore explore its evolution over this 2 year period. However, the questions that gathered
information on availability and use of eHealth specific functionalities were introduced in the 2012
survey questionnaire which is why no comparison can be made with the 2010 survey. The structure of
the report is as follows. The next section presents the data and methods used. The results section then
reports and discusses the main findings. Finally, main conclusions are discussed in the last section

La tlddecine : de la tlmdecine informative la tlmdecine mdicale

Etudes franaises

Ouvrages

(2012). Le pacte territoire-sant pour lutter contre les dserts mdicaux, Paris : MSSPS
[Link]
L'accs de tous les Franais sur l'ensemble du territoire des soins de qualit est une priorit absolue
pour le gouvernement. Depuis 5 ans, 2 millions de Franais supplmentaires sont touchs par la
dsertification mdicale. Les ingalits entre les territoires ne cessent d'augmenter. Les dlais pour
accder un mdecin spcialiste sont de plus en plus longs. Pour faire face cet enjeu majeur, la
Ministre a prsent un pacte territoire-sant , compos de 12 engagements et d'une mthode
volontariste. Les 12 engagements proposs s'articulent autour de 3 objectifs : Changer la formation et
faciliter l'installation des jeunes mdecins, Transformer les conditions d'exercice des professionnels de
sant, Investir dans les territoires isols.

(2015). Fiches pdagogiques daide la qualification dun projet de tlmdecine, Paris : Asip Sant

Afin daccompagner les acteurs qui dmarrent un projet de tlmdecine (professionnels de sant,
porteurs de projets, ARS, industriels), des fiches pratiques pdagogiques ont t labores de faon,
notamment, prciser le champ de la tlmdecine, les critres ncessitant la mise en uvre dun
protocole de coopration, la caractrisation dun contexte dducation thrapeutique des patients, la
dfinition des dispositifs mdicaux, les critres de lauthentification forte, et la ncessit du recours
un hbergeur agr de donnes de sant.

(2015). Pacte territoire sant 2, Paris : Ministre charg de la Sant

[Link]
Le pacte territoire sant 2 propose des mesures innovantes pour sadapter aux besoins des
mdecins et des territoires . Il se dcline en 10 engagements autour de deux axes. Le premier axe
sattache prenniser et amplifier les actions menes depuis le Pacte territoire sant savoir :
dvelopper les stages des futurs mdecins en cabinet de ville; faciliter linstallation des jeunes
mdecins dans les territoires fragiles ; favoriser le travail en quipe, notamment dans les territoires
ruraux et priurbains; assurer laccs aux soins urgents en - de 30 minutes. Le second axe est centr
sur linnovation pour sadapter aux besoins des professionnels et des territoires : augmenter de
manire cible le numerus clausus rgional pour laccs aux tudes de mdecine ; augmenter le
nombre de mdecins libraux enseignants ; soutenir la recherche en soins primaires Innover dans les
territoires ; mieux accompagner les professionnels de sant dans leur quotidien ; favoriser laccs la
tlmdecine pour les patients chroniques et pour les soins urgents ; soutenir une organisation des
soins de ville adapte chaque territoire et chaque patient

D'Audiffret, D. (2009). Optimisation de la prise en charge domicile en France. Quelles propositions ?, Paris :
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Alcimed Technologies

L'objectif principal de cette tude est d'mettre des propositions oprationnelles pour optimiser la
prise en charge domicile en France cibles sur les personnes atteintes de maladies chroniques et les
personnes ges dpendantes. L'ambition est d'apporter les lments pour constituer une nouvelle
ingnierie du systme de prise en charge domicile avec des outils et des indicateurs (tir de
l'introduction).

De, Haas, P. (2015). Monter et faire vivre une maison de sant, Brignais : Le coudrier ditions
[Link]
[Link]/produit/5/9782919374052/Monter%20et%20faire%20vivre%20une%20maison%20de%2
0sante
Mode dexercice attrayant pour les libraux, les maisons de sant pallient les difficults daccs aux
soins dans les zones o les soignants se rarfient, tout en permettant damliorer la continuit et la
qualit des soins en ambulatoire. Pour autant, mener bien de tels projets se rvle complexe. Dans
cet ouvrage, lauteur dcortique le mcanisme de la construction dune maison de sant partir de
quatre expriences rcentes. Aprs une prsentation des parties prenantes, il dtaille les six briques
porteuses de ldifice : approche territoriale, dynamique dquipe, montage juridique, financement,
immobilier, projet de sant et projet professionnel. Il dveloppe ensuite toutes les facettes du
fonctionnement de la structure et trace les perspectives de ce mode dexercice (4me de couv.)

Depinoy, D. (2011). Maisons de sant, une urgence citoyenne, Paris : Editions de sant
Le systme de sant est en plein changement et les dfis lis aux volutions dmographiques,
comportementales, pidmiologiques et des pratiques mdicales imposent une nouvelle organisation.
La structuration du premier niveau des soins - appel le premier recours - peut apporter des rsultats
concrets rapides en matire de rduction des ingalits, damlioration de la qualit du service rendu
et defficience. Sattacher de manire volontariste soutenir lmergence des modes dexercice
pluriprofessionnels et regroups peut permettre de relever les enjeux majeurs de notre systme de
sant. Au-del dun effet de mode qui pousse vouloir construire rapidement des maisons de sant, il
y a matire soutenir galement dautres formes de regroupement pluriprofessionnel pour constituer
le socle dune nouvelle mdecine de premier recours. Il est ncessaire daccompagner le changement
pour donner une chance ces nouvelles formes dexercice en quipe mais aussi et surtout de faire
preuve daudace pour mener ces expriences lchelon national. Cet ouvrage dtaille les enjeux de
lorganisation du premier recours et propose des leviers de russite des projets. Il sadresse tous les
professionnels de sant qui dsirent se lancer dans un projet de maison ou ple de sant mais aussi
aux lus et aux institutionnels qui ont besoin de clefs pour participer.

Ferraud-Ciandet, N. (2011). Droit de la tlsant et de la tlmdecine : jour du dcret du 19 dcembre sur la

tlmdecine, Paris : Editions Heures de France
[Link]
Les applications de tlsant s'tendent chaque jour et incluent notamment : la gestion des donnes
de sant, la prescription en ligne, la tlmdecine, la tlassistance, la tlchirurgie. Cet ouvrage
rassemble des conseils qui permettront de passer des intentions aux actes et de dvelopper ainsi un
systme de sant bas sur les nouvelles technologies de l'information et de la communication (NTIC).
Avec l'appui du gouvernement, l'infrastructure des donnes de sant, le soutien de l'Agence des
systmes d'information de sant (ASIP Sant) et le lancement d'appels projets dans le cadre du
grand emprunt, la tlsant merge rapidement comme l'un des secteurs les plus dynamiques de
l'industrie des soins de sant. Cette industrie fortement rglemente, de plus en plus dpendante des
NTIC, confronte les professionnels des questions juridiques nouvelles. Centr sur la protection des
applications de tlsant et la responsabilit mdicale, ce livre s'adresse la fois aux industriels du
secteur et aux professionnels de sant. Les premiers y trouveront des orientations concernant la
conception et l'exploitation des produits et services de tlsant. Les seconds percevront comment la
tlsant s'inscrit dans leur pratique, qu'elle soit librale, salarie ou au sein du service public
hospitalier, et les responsabilits encourues (4e de couverture).

Simon, P. (2015). Tlmdecine : enjeux et pratiques, Brignais : Editions Le Coudrier

[Link]
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%20Enjeux%20et%20pratiques
n mdecine comme dans dautres secteurs, les technologies modernes de communication ont ouvert
de nouvelles possibilits. Grce elles, de nombreuses pratiques distance ont vu le jour depuis les
annes 1990. Quelles sont ces pratiques ? Ont-elles fait leurs preuves ? Quapportent-elles aux
patients, aux soignants et la sant publique ? Feront-elles bientt partie de notre quotidien ? Ce livre
offre un point complet sur le sujet. Aprs avoir dfini le champ et prcis les termes et les enjeux de la
tlmdecine, lauteur raconte lhistoire des pays pionniers, dont fait partie la France. Il prsente
ensuite ce quil faut savoir des pratiques de tlmdecine : la politique nationale, les cinq actes
reconnus depuis 2010, les responsabilits engages et la faon de mettre en uvre un projet. Il
termine louvrage en dtaillant les applications dveloppes dans chaque spcialit et en prsentant
une slection darticles scientifiques pour chacune dentre elles. Un ouvrage de rfrence pour tous
ceux qui sinterrogent sur les enjeux et les pratiques de la tlmdecine.

Vercauteren, R., et al. (2000). Une architecture nouvelle pour l'habitat des personnes ges, Ramonville-Saint-
Agne : Ers

Dfinir une nouvelle forme de sociabilit travers la notion de chez soi demande de se pencher
sur de multiples expriences qui, travers l'Europe, ont marqu de leur originalit l'volution de
l'habitat des personnes ges. La monte d'un recours l'informatique, l'exprience de la domotique
ou encore l'utilisation de nouveaux matriaux changent totalement les conceptions de l'architecture.
L'ensemble de ces lments est tudi dans cet ouvrage, qui interroge la naissance d'une nouvelle
conception " plurige" pour les rsidences de demain. Dpassant les anciens modles, qui aboutissent
trop souvent isoler les personnes ges, les auteurs donnent des exemples de ralisations (petites
units de vie ou grandes structures), qui permettent aux diffrents ges de la vie de cohabiter en une
mme rsidence. Ils proposent galement la cration d'aires d'accueil qui associent le maintien
domicile et l'institution dans l'organisation de parcours pour les personnes dmentes.

Vigneron, E., et al. (2003). Sant et territoires, une nouvelle donne, La Tour d'Aigues : Editions de l'Aube Paris :
Datar

L'actualit politique sur la dcentralisation et la " rgionalisation exprimentale" a une incidence sur la
recomposition territoriale de l'offre de soins. Cette approche territoriale de la sant est aborde sous
les aspects suivants : dmographie mdicale, intercommunalit hospitalire, politique du
mdicament, dmarche qualit, transport sanitaire, rseaux de soins, tlmdecine, systmes
d'information, dveloppement de grands ples rgionaux de recherche et valorisation en
biotechnologies.

Congrs

Kerleau, M., et al. (2001). La dynamique de l'innovation en sant, Paris : Collge des Economistes de la Sant.

Ce document prsente les actes du 2me colloque International des Economistes de la Sant : "La
dynamique de l'innovation en sant" organis par le Collge des Economistes de la Sant en fvrier
2001.

Articles

(2004). "Rseaux d'imagerie mdicale et systmes d'information au service du patient." Gestions

Hospitalieres(434): 184-190.

[BDSP. Notice produite par ENSP R0xP8RIB. Diffusion soumise autorisation]. L'association Imagerie
Sant Avenir a pour mission de promouvoir les atouts et les spcificits de l'imagerie mdicale dans sa
contribution aux solutions conomiques et scientifiques utiles l'amlioration de la sant des
Franais. Dans cet article, elle montre que le dveloppement des rseaux d'imagerie mdicale
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constitue une priorit, leurs enjeux principaux tant l'amlioration de la qualit des soins et
l'augmentation de la productivit des services de sant. Aprs une prsentation des enjeux et des
modalits d'installation (mthode, cot) d'un tel rseau, elle value le taux d'quipement en Europe
et s'inquite du retard pris par la France.

(2009). "Tlmdecine et territoire : dossier." Reseaux Sante & Territoire(28): 36 , fig., phot.
[Link]

(2011). "Tlmdecine : repres." Reseaux Sante & Territoire(40): 30.

La loi Hpital Patients Sant et Territoires (HPST) de 2009 a donn une dfinition lgale la
tlmdecine (article 78) et le dcret d'application du 10 octobre 2010 en a prcis le contenu. Les
projets de tlmdecine se dveloppent surtout l'hpital. En ville, l'essor est beaucoup plus timide.
Au niveau national, des priorits ont t fixes, et cela va tre le tour des rgions d'tablir leurs
programmes d?actions.

(2012). "Tlmdecine : beaucoup d'hpital, peu de ville." Reseaux Sante & Territoire(44): 26-27.

Comme pour lducation thrapeutique et les protocoles de coopration drogatoires, le

dveloppement de la tlmdecine se fait surtout lhpital. Selon un tat des lieux dress par la
Direction gnrale de loffre de soins (DGOS) en mars dernier, on compte 130 projets oprationnels ou
en exprimentation et presque autant au stade de la conception. A terme, tout le monde ne fera sans
doute pas de la tlmdecine, mais beaucoup de professionnels de sant pourraient connatre des
volutions dans lorganisation de leur mtier en raison du dveloppement de cet outil.

(2015). "Parcours de soins, parcours de sant." Risques & Qualite En Milieu De Soins 12(3): 88 , tab., graph., fig.
[Link]
de-soins-parcours-de-sante/
Ce numro spcial de la revue Risques & Qualit rassemble une srie d'articles sur la thmatique du
parcours de soins, fruit de la contributions d'une quarantaine de rdacteurs. Les articles portent sur
des programmes de parcours de soins mis en oeuvre par la Cnamts, le ministre charg de la sant, la
Has... mais aussi sur des expriences rgionales ou locales. Ils couvrent des situations mdicales
complexes : les soins aux ans, la cancrologie, l'insuffisance cardiaque...et plus gnralement la
sortie de l'hpital et le retour domicile, la coopration ville-hpital, l'organisation territoriale.

Akrich, M. et Meadel, C. (2004). "Problmatiser la question des usages." Sciences Sociales Et Sante 22(1): 5-20.

Les technologies de l'information et de la communication (TIC) ont connu, dans le domaine de la

sant, un dveloppement considrable. Celui d'Internet est spectaculaire. A cot du web, on distingue
un certain nombre d'applications qui, dfaut de s'tre massivement rpandues, ont fait l'objet d'une
abondante littrature professionnelle, spculant sur les retombes possibles et s'efforant d'valuer
les expriences menes. On peut citer l'informatisation des dossiers mdicaux, la tlsurveillance ou
le tlmonitoring de patients maintenus domicile, la tlconsultation, le tldiagnostic, les " staffs "
distance, la tlchirurgie ou le tl-enseignement. Certains auteurs ont tent de construire des
typologies de ces applications, les unes tant bases sur la logique des activits mdicales, les autres
sur la logique qui prside leur dveloppement. L'ambition de ce dossier n'est pas d'aller dans un sens
ou un autre, mais plutt de proposer des mthodes et des cadres conceptuels permettant d'analyser
la manire dont l'implantation des TIC dans le domaine de la sant est susceptible de transformer les
pratiques, les savoirs, les relations entre les diffrents acteurs impliqus. Le propos de cette
introduction est de resituer, de ce point de vue, les articles prsents dans la trs ample littrature
consacre aux relations entre TIC et sant et de montrer ce en quoi ils constituent des contributions
originales ces questions.

Allaert, F. A. et Quantin, C. (2012). "Responsabilits et rmunrations des actes de tl-expertise." Journal De

Gestion Et D'economie Medicales 30(4): 219-229.

[BDSP. Notice produite par ORSRA 9l8HR0xI. Diffusion soumise autorisation]. La tl-expertise, c'est
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dire l'aide au diagnostic apporte un mdecin par un autre mdecin situ distance du premier
qui lui fait parvenir des informations l'aide d'un dispositif tlmatique, est un acte mdical qui doit
tre reconnu comme tel pour son rle dans l'amlioration de la qualit des soins. Cet article analyse
les responsabilits respectives des mdecins impliqus dans un acte de tl-expertise et les modalits
de rmunration propre la tlassistance afin de dfinir le cadre conventionnel ou contractuel qui
pourrait tre envisag.

Allaert, F.-A. et Quantin, C. (2009). "Responsabilits et modes de rmunration des actes de tlexpertise."
Gestions Hospitalieres(488): 403-409.

[BDSP. Notice produite par EHESP s9mAR0x8. Diffusion soumise autorisation]. Si la tlmdecine est
reconnue par la loi Hpital, patients, sant, territoires, le partage des responsabilits des mdecins et
la rmunration de leurs actes ne sont toujours pas clairement tablis. Les auteurs analysent ici le cas
de la tlexpertise, c'est dire l'aide au diagnostic apport un mdecin par un mdecin'expert'dans
le cadre de la prise en charge du patient.

Allermoz, E. (2013). "Des tlconsultations en psychiatrie (Seine-Maritime)." Medecins : Bulletin D'information

De L'ordre National Des Medecins(31): 8-9.
[Link]
La Seine-Maritime compte deux fois moins de psychiatres que la moyenne nationale. Un dispositif de
tlconsultation en psychiatrie griatrique, coordonn par le centre hospitalier du Rouvray, tente de
pallier ce dficit. Ce genre d'initiative est encore rare en France.

Andre-Cormier, J. (2009). "L'offre de sant dans les collectivits ultramarines." Avis Et Rapports Du Conseil
Economique Et Social: 284.
[Link]
Les onze collectivits franaises d'Outre-mer se caractrisent par un certain nombre de points
communs quant l'tat de sant de leurs populations et l'offre de soins dont elles bnficient. Ce
rapport prsente la situation sanitaire de chaque collectivit et propose des amliorations communes
plusieurs d'entre elles (promotion et dveloppement de la prvention, de la tlmdecine,
coopration sanitaire interrgionale et internationale, amlioration du recrutement mdical et du
financement des hpitaux...), avant d'analyser les amliorations apporter au cas par cas, selon les
problmes spcifiques rgionaux.

Anfosso, A. et Rebaudo, S. (2011). "Grontechnologies et contrle de l'environnement au service du maintien

domicile : le projet Gerhome." Gerontologie Et Societe(136): 119-131, ill., phot.

[BDSP. Notice produite par FNG HGn9IR0x. Diffusion soumise autorisation]. Le Centre Scientifique et
Technique du Btiment (CSTB) travaille au dveloppement de techniques dont l'objectif est
d'amliorer le confort, la scurit et de favoriser le maintien domicile des personnes ges. Dans
cette perspective, un projet d'tude nomm Gerhome est men depuis 2006. Pour cela, un
quipement de tests en laboratoire permet de dvelopper et d'exprimenter des produits et des
services capables de dtecter certaines fragilits ou pathologies du vieillissement par un suivi des
activits de la personne ge dans son logement. Les dveloppements portent sur la prochaine
gnration de systmes de tlsurveillance ou de tl-alarme. (extrait intro.).

Barlet, M., et al. (2012). "Sant en milieu rural : ralits et controverses. Dossier." Pour(214): 85-171.
[Link]
Ralis par le Groupe de recherche pour l'ducation et la prospective (Grep) avec le concours des
acteurs de terrain (lus locaux, professions de sant?), ce numro de la revue POUR, paru en juillet
2012, propose d'abord un tat des lieux, o il n'est pas seulement question de l'accessibilit des
mdecins gnralistes, mais aussi des difficults rencontres par les pharmacies rurales ou des
mesures prises pour quilibrer l'offre de soins infirmiers sur le territoire. Il est ensuite question des
mesures prises ou prendre pour amliorer l'offre de soins mais surtout en amliorer l'accs pour les
habitants des zones rurales. Ce dossier invite ne pas se focaliser sur la notion de distance ou de
temps de trajet pour se rendre l'hpital ou chez le mdecin, mais considrer l'tat de sant de la
population (proportion de personnes ges et d'enfants, plus vulnrables), sa mobilit et sa situation
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sociale. Ainsi, pour l'association Mdecins du Monde, "l'enjeu majeur de la sant en milieu rural n'est
pas celui du dsert mdical mais celui de l'accs aux soins de populations prcaires". Il prsente aussi
des arguments pour ou contre les mesures d'incitation l'installation de jeunes mdecins la
campagne. Si les contrats (incitatifs) d'engagement de service public semblent faire leurs preuves en
Bourgogne, la rgulation (coercitive) de l'offre de soins infirmiers aussi. Et quand certains fustigent de
simples "effets d'aubaine", d'autres dnoncent la complexit de dispositifs mal connus des principaux
concerns : 95% des internes interrogs au niveau national semblent ne pas connatre ce type de
mesures... Plus largement, ce dossier invite adopter une dmarche qualitative, pour valuer
correctement les besoins mais surtout apporter une rponse adapte. En effet les lus, professionnels
de sant et autres acteurs de terrain s'accordent tous pour souligner : l'importance et l'intrt de
toutes les initiatives de coordination entre acteurs sanitaires et sociaux, via des maisons de sant, des
rencontres rgulires, des dispositifs de transmission d'information... ; le poids de facteurs non
conomiques dans le choix d'installation des mdecins : attractivit du cadre de vie et prsence de
services, possibilit de travailler en relation avec d'autres professionnels, poids des tches
administratives et de gestion dans l'activit...Quelques retours d'expriences illustrent ce point de
vue.

Bazex, J. et Godeau, P. (2006). "La tldermatologie en Midi-Pyrnes. Discussion : La tlmdecine." Bulletin

De L'academie Nationale De Medecine 190(2): 331-337.

[BDSP. Notice produite par INIST-CNRS 8vR0xt73. Diffusion soumise autorisation]. La pratique de la
tlmdecine en Midi-Pyrnes est devenue courante depuis la cration du Centre Europen de
Tlmdecine. Les dermatologues ont pu prcocement avoir accs au centre et dvelopper la
tldermatologie. Le service de dermatologie est impliqu pour trois activits diffrentes : -
Participation au Rseau Rgional Midi-Pyrnes (Groupement d'intrt Public). Ce rseau permet aux
praticiens privs et hospitaliers qui le souhaitent, d'interroger le spcialiste du CHU et de prsenter
leurs patients en temps rel. - Organisation de sances de tlmdecine consacres aux discussions de
dossiers, confrontations anatomocliniques, changes d'informations entre spcialistes de diffrents
domaines au sein de la discipline. Plusieurs services franais et trangers (europens, amricains,
francophones) participent rgulirement ces rencontres. Enseignement avec notamment la mise en
place pour l'inter-rgion de runions destines aux tudiants et pour la rgion Midi-Pyrnes de
sances de formation mdicale continue l'attention des mdecins privs. Les avantages que la
tlmdecine peut apporter au quotidien ne peuvent tre contests et sont de grand intrt pour le
patient, le mdecin et la socit. La "communaut mdicale hospitalire et prive de Midi-Pyrnes"
offre ainsi un visage trs innovant et adapt au progrs mdical accompagn d'une relle amlioration
de la qualit du service gnral de sant. Cette approche de la prise en charge mdicale ne peut
toutefois se soustraire une valuation constante de qualit.

Bonan, B., et al. (2008). "Chimiothrapies domicile et soins de support. Limites et espoirs." Techniques
Hospitalieres(707): 29-34.

[BDSP. Notice produite par EHESP nsR0xr7E. Diffusion soumise autorisation]. Avec la mise en place
du plan Cancer en 2003, confort par la circulaire du 22 fvrier 2005 relative l'organisation des soins
en cancrologie, la chimiothrapie domicile se situe dsormais comme tant l'une des priorits
nationales. Elle implique une organisation des soins qui permet une prise en charge globale et
continue domicile. La scurisation du circuit des chimiothrapies devant tre valide de la
prescription l'administration et inclure l'ensemble des acteurs, des actes et des mdicaments, elle
devra tre conforte par une informatisation fiable.

Bonhomme, C. (2013). "Qualit de vie en EHPAD. Vers le dploiement d'un projet Mines-Tlcom." Revue
Hospitaliere De France(550): 24-25.

[BDSP. Notice produite par EHESP R0x7F88E. Diffusion soumise autorisation]. Enseignant chercheur
au sein de la filiale Tic & sant Montpellier de l'institut Mines-Tlcom, Mounir Mokhtari travaille sur
les quipements e-sant et assistance. Il vient de passer quatre ans Singapour dans un laboratoire
CNRS (IPAL, unit mixte internationale) de la ville Etat, dont les 5 200 000 habitants figurent au 2e
rang des plus connects au monde. Objectif : dvelopper une e-qualit de vie pour les personnes
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ges dpendantes.

Bourgueil, Y., et al. (2010). "Dossier Insuffisance cardiaque. Une "pidmie" contrlable ?" Concours Medical
132(6): 231-247, fig., tabl.

[BDSP. Notice produite par ORSRA 9R0xBEB9. Diffusion soumise autorisation]. L'insuffisance
cardiaque, dont la prvalence et l'incidence augmentent, lies l'ge et aux comorbidits, reprsente
un problme de sant publique volution pidmique. Ce dossier aborde le cot de la maladie, sa
prvalence en France, la prise en charge par les rseaux ville-hpital, le tlmonitoring, le diagnostic
de l'insuffisance cardiaque, le parcours thrapeutique et le suivi des patients par les professionnels de
sant (cardiologue, gnraliste et infirmire).

Caillette-Beaudoin, A., et al. (2014). "La tlsurveillance en dialyse pritonale." Gestions Hospitalieres(534):
141-142.

[BDSP. Notice produite par EHESP R0xpBD8k. Diffusion soumise autorisation]. Calydial,
tablissement de sant lyonnais, s'est lanc dans le dveloppement d'un programme de tlmdecine
sur tous ses domaines d'activit autoriss : dialyse pritonale, hmodialyse et insuffisance rnale
chronique non dialyse. Convaincu que la coconstruction joue un rle majeur dans la cration de
solutions innovantes, Calydial participe un "living lab" pour le dveloppement de la tlsurveillance
en dialyse pritonale.

Caillette-Beaudoin, A., et al. (2010). "Maladies chroniques cardiovasculaires et mtaboliques : apports de la

tlmdecine." Revue Hospitaliere De France(532): 29-31, graph.

[BDSP. Notice produite par EHESP R0xBD888. Diffusion soumise autorisation]. La tlsurveillance des
maladies chroniques montre sa capacit optimiser la qualit et la scurit des soins dans de
nombreuses pathologies. Illustration avec une exprience mene en Rhne-Alpes auprs de patients
insuffisants rnaux chroniques.

Chassagnes J. (2016/07-08). "Cardiauvergne : service de tlsurveillance et de coordination des soins des

insuffisants cardiaques." Technoqies Hospitalires(758). 6p.

Cardiauvergne est un service de tlsurveillance et de coordination des soins ouvert en dcembre

2011. Deux principes : des professionnels de sant matres du jeu et une tlsurveillance simple.
Le dossier patient informatis (DPI) est accessible grce la carte de professionnel de sant (CPS). Un
systme expert analyse les donnes et gnre des alertes ou alarmes. Une valuation aprs quatre ans
et 1 084 patients montre un taux de dcs de 12,1 % par an (versus 25 % avec prise en charge
conventionnelle en Auvergne), des rhospitalisations pour nouvelle pousse dinsuffisance cardiaque
rduites 13,8 % par an (vs 21 % avant Cardiauvergne ) avec raccourcissement de la dure moyenne
de sjour de 11,5 9,4 jours. Lconomie est estime 5 430 /patient/an moins le cot de
Cardiauvergne chi r 672 /patient/an. Le taux de satisfaction est unanimement favorable. Un travail
de recherche sur de nouveaux capteurs est en cours. Mots-cls : insu isance cardiaque ;
tlsurveillance ; ducation thrapeutique ; rhospitalisation ; valuation mdico-conomique.

Cosquer, P. et Guezou, T. (2005). "Systme Sro'z dvelopp par la socit Aphycare Technologies."
Gerontologie Et Societe(113): 83-96, fig.

[BDSP. Notice produite par FNG O95CR0xO. Diffusion soumise autorisation]. La gamme Sro'z a t
spcialement dveloppe par Aphycare Technologies pour rpondre aux besoins lis la scurisation
des personnes en institution et domicile. Le bracelet assure une surveillance automatique 24h/24. Il
dtecte des anomalies : chutes ou chocs violents ; paramtres vitaux (pouls et temprature cutane).
Le systme est disponible aussi bien domicile que pour les institutions.

Chanliau, J. et Simon, P. (2010). "Apports de la tlmdecine dans la gradation des soins." Revue Hospitaliere
De France(532): 25-28, graph.

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Daudelin, G., et al. (2008). "La recomposition des patients et des pratiques mdicales en tlnphrologie. Les
prsences dcales." Sciences Sociales Et Sante 26(3): 81-104.

La tlmdecine apparat comme un moyen sduisant de rendre prsents les uns aux autres, patients
et spcialistes. Toutefois, si les acteurs peuvent mobiliser les technologies dans des projets cliniques
spcifiques, les technologies leur imposent leurs propres possibilits et limites et, ce faisant, agissent
sur eux, recomposant les pratiques mdicales d?une manire potentiellement problmatique. La
reconstitution des patients et des pratiques mdicales par les technologies de l?information et de
communication est au centre de l?analyse d?un cas de tlnphrologie. Elle montre comment
l?introduction de technologies peut tre lourde de possibles, parfois incompatibles avec les projets de
ses acteurs, ce qui pourrait expliquer la sous-utilisation de ces technologies.

De, Goer, B., et al. (2011). "Tlmdecine entre hpital et centre pnitentiaire. Mise en oeuvre et premier bilan
Aiton (73)." Techniques Hospitalieres(725): 18-21.

[BDSP. Notice produite par EHESP R0xJ88pA. Diffusion soumise autorisation]. Le centre pnitentiaire
d'Aiton comprend une maison d'arrt et un centre de dtention, situ 45km du centre hospitalier de
Chambry. Afin de limiter les extractions qui comportent un risque scuritaire et un cot financier
important, un projet de tlmdecine a t dvelopp entre l'Unit de consultation et de soins
ambulatoires (UCSA) du centre pnitentiaire d'Aiton et le centre hospitalier de Chambry. Cet article
dresse un premier bilan des tlconsultations mises en place depuis 2009 dans le cadre de ce projet.

Dumoulin, L. (2008). ""Parlez dans le visiophone !" La distance dans l'exercice des activits mdicales et
judiciaires. Commentaire." Sciences Sociales Et Sante 26(3): 107-114.

Escano, G. (2007). "La difficile valuation des rseaux de sant - Bilan et perspectives 8 ans aprs les
ordonnances "Jupp"." Notes Et Documents(47): 107.
[Link]
L'auteur de ce document fait le point sur le concept et les finalits des rseaux de sant avec, au coeur
du systme de soins, un patient qui n'est pas ncessairement un malade car le systme de sant
intgre l'ducation sanitaire et la prvention. Ensuite, l'auteur replace les rseaux dans les cadres
lgaux et rglementaire des "ordonnances Jupp" la loi "Kouchner" relative aux droits des malades
et la qualit du systme de sant en passant par les lois de financement de la scurit sociale. Il
expose galement d'autres modalits d'organisation innovante avec l'hospitalisation domicile, les
maisons mdicales, les agents de sant, la valorisation du rle du mdecin gnraliste.

Espinoza, P. (2010). "Territoires de sant et tlmdecine. Les facteurs cls du dploiement." Revue
Hospitaliere De France(533): 40-42.

[BDSP. Notice produite par EHESP JER0xFnt. Diffusion soumise autorisation]. L'exprience de cinq
ans de tlmdecine et plus de 600 consultations spcialises distance ont conduit les praticiens
hospitaliers du Ple urgence de l'hpital europen Georges Pompidou, voquer les facteurs cls du
dploiement. Cet article a pour objet d'ouvrir un dbat. Les deux projets qui ont t conduit :
Tlgria ADSL ou 3G et Tlgria haute dfinition ou CiscoHealthPresence ont permis de comprendre
les enjeux sur les rseaux informatiques, sur les outils, les pratiques et d'identifier le rle cl des
acteurs sur le terrain. Les questions que soulve le dploiement sont multiples : quelles difficults,
quels enjeux, quels processus mettre en oeuvre dans la conduite de projets ? Quelle hirarchie entre
les enjeux technologiques, scientifiques, juridiques, organisationnels et mdico-conomiques ? Une
manire de rpondre est d'aborder ces questions sous un angle oprationnel : comment organiser les
nouvelles pratiques, les nouveaux mtiers, la valorisation de l'activit, les nouvelles organisations ?

Espinoza, P., et al. (2011). "Dploiement de la tlmdecine en territoire de sant : Tlgria, un modle
exprimental prcurseur." Techniques Hospitalieres(725): 9-17, fig.

[BDSP. Notice produite par EHESP BlR0xmon. Diffusion soumise autorisation]. Mis en place dans le
cadre de l'Assistance publique-Hpitaux de Paris (AP-HP), Tlgria est un rseau de tlmdecine
runissant des tablissements de sant pour personnes ges en liaison avec des hpitaux de court
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sjour MCO (mdecine, chirurgie, obsttrique). Cet article dcrit le projet mis en place dans le cadre
de Tlgria entre l'Hpital europen Georges-Pompidou (HEGP) et l'hpital griatrique Vaugirard
Gabriel-Pallez, projet qui a permis de raliser environ 700 sessions de tlmdecine en quinze mois
concernant plusieurs spcialits : orthopdie, chographie cardiaque et vasculaire, dermatologie,
cardiovasculaire, hmatologie.

Espinoza, P. et Lebourgeois, F. (2010). "Tlgria, de l'ADSL la haute dfinition : rflexions et propositions

pour l'amnagement des territoires de sant." Revue Hospitaliere De France(532): 43-46.

[BDSP. Notice produite par EHESP IR0xAI98. Diffusion soumise autorisation]. L'article prsente le
rseau de tlmdecine Tlgria, qui ralise des consultations spcialises distance, sur un rseau
scuris, entre hpitaux et tablissements hbergeant des personnes ges dpendantes.
L'exprimentation permet de dgager des conclusions sur la mise en oeuvre technique, sur les
perspectives d'utilisations cliniques, sur la prise en compte de l'aspect thique et organisationnel.

Esterle, L., et al. (2011). "L'impact des consultations distance sur les pratiques mdicales : vers un nouveau
mtier de mdecin." Revue Francaise Des Affaires Sociales(2-3): 65-80.

[BDSP. Notice produite par MIN-SANTE 7CR0xJoB. Diffusion soumise autorisation]. La tlmdecine
est encourage en France pour rpondre aux enjeux actuels de sant : dmographie mdicale,
vieillissement de la population, galit d'accs aux soins. Au-del des problmes techniques,
dontologiques et financiers qu'elle peut poser, la tlmdecine n'est pas sans consquences sur
l'organisation des soins et la pratique mdicale. L'observation de tlconsultations menes entre un
hpital de griatrie et un centre hospitalier universitaire, grce un dispositif de tlprsence, a
permis d'tudier les impacts de son usage sur les pratiques professionnelles et les relations entre
professionnels de sant. Elle rvle, notamment, que la mise en place d'un tel dispositif, son
dveloppement et son utilisation prenne ncessitent de recourir de nouvelles comptences, qui
pourraient tre celles d'un mdecin coordonnateur en tlmdecine.

Faure, H. et Rossignol, G. (1999). "La tlmdecine en France." Technologie Et Sante(36): 34-40.

La tlmatique de sant est une des applications des nouvelles technologies qui dsigne les activits,
les services et systmes lis la sant, pratiqus distance au moyen des technologies de
l'information et des communications. La tlmdecine est une des composantes de la tlmatique de
sant dont les expriences se multiplient pour mieux servir les institutionnels et le particulier : liaisons
avec le patient domicile, les professionnels de la sant, les tablissements de soins et de recherche.
Ds lors deux visions diffrentes de la tlmdecine s'expriment, l'une tire par des intrts financiers
et commerciaux, l'autre imprgne de la notion de service public, plus oriente vers les acteurs de la
sant et l'amlioration des soins. L'article dtaille les diffrentes actions entreprises par l'Etat, depuis
l'enqute cartographie ralise en 1997, jusqu'aux initiatives visant l'amnagement du territoire,
puis tire des conclusions en termes de perspectives pour l'avenir.

Finet, P. (2012). "Tlsant : exemples de ralisations dans l'Orne." Techniques Hospitalieres(733): 52-57, fig.

[BDSP. Notice produite par EHESP o9DB8R0x. Diffusion soumise autorisation]. Cet article prsente
deux projets de recours la tlmdecine dvelopps dans le dpartement de l'Orne. Il s'agit de la
mise en place d'un systme de tltransmission de l'examen ECG (lectrocardiogramme) lors des
interventions Smur "primaires" et de la mise en oeuvre d'un systme de tlconsultation et
tlexpertise au sein de l'unit de consultations et de soins ambulatoires (UCSA) d'une prison de haute
scurit prs d'Alenon.

Finkel, S., et al. (2008). "Les accidents vasculaires crbraux." Info En Sante (Fhf)(16): 1-23, , graph., carte, tabl.
[Link]
Dans ce numro : les chiffres-cls des AVC, Les units crbrovasculaires : sorganiser pour prendre
immdiatement en charge les AVC o quils soient; les accidents crbrovasculaires.

Fisch, S. (2014). "Tlmdecine : une politique publique au service d'une rvolution dans l'offre de soins."
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Actualite Et Dossier En Sante Publique(89): 9-11.

[BDSP. Notice produite par EHESP q79mR0xs. Diffusion soumise autorisation]. Le dveloppement de
la tlmdecine dans l'offre de soins franais est porteur de beaucoup d'espoirs, tant au niveau de la
qualit, de l'accessibilit, que de l'efficience de notre systme de sant.

Flahault, A. (2011). "Tlmdecine, faux nez des carences d'un systme de soins." Cahiers De Sante Publique Et
De Protection Sociale (Les): 19.

Cet article commente les rsultats d'une revue systmatique des tudes publies sur l'impact de la
tlmdecine dans les units de soins intensifs.

Fontaine, M., et al. (2005). "Prinatalit." Technologie Et Sante(57): 100 , tabl., fig.

[BDSP. Notice produite par APHPDOC R0xLCmeC. Diffusion soumise autorisation]. Ce numro
consacr la prinatalit est compos en trois grandes parties : la premire partie porte sur le suivi de
la grossesse : procration mdicalement assiste et diagnostic primplantatoire ; les nouvelles
techniques de monitoring de la grossesse et de l'accouchement ; la prvention de la prmaturit ; le
transfert in utero. La deuxime partie porte sur les soins postnatals : le rchauffement du nouveau-n
; la ventilation nonatale ; le traitement des dtresses respiratoires par le monoxyde d'azote ; le
dpistage nonatal ; l'imagerie pdiatrique ; l'installation et le confort du nouveau-n ; le pronostic de
la grande prmaturit et le suivi des nouveaux-ns ; la sortie prcoce de maternit et le suivi
postnatal. La troisime partie traite de l'organisation de la prise en charge du nouveau-n, et
notamment de la place donne aux familles dans les services de nonatologie.

Fournereau, F. et Tandy, L. (2013). "La tl-imagerie : un atout majeur pour la prise en charge des AVC."
Gestions Hospitalieres(526): 293-295, graph.

[BDSP. Notice produite par EHESP pJnR0xBr. Diffusion soumise autorisation]. Amliorer l'offre de
soins, en utilisant au mieux la ressource mdicale, c'est l'objectif pos par les professionnels de sant,
le ministre de la Sant et la agences rgionales de sant (ARS). L'auteur dcrit ici l'utilisation de la
tl-imagerie dans la prise en charge des accidents vasculaires crbraux (AVC), un outil appel
favoriser l'accessibilit aux soins.

Fournereau, F. et Tandy, L. (2014). "La tl-imagerie : un atout majeur pour la prise en charge des AVC."
Gestions Hospitalieres(535): 204-206, graph.

[BDSP. Notice produite par EHESP qR0xJFI7. Diffusion soumise autorisation]. Amliorer l'offre de
soins, en utilisant au mieux la ressource mdicale, c'est l'objectif pos par les professionnels de sant,
le ministre de la Sant et les agences rgionales de sant (ARS). L'auteur dcrit ici l'utilisation de la
tl-imagerie dans la prise en charge de accidents vasculaires crbraux (AVC), un outil appel
favoriser l'accessibilit aux soins.

Franco, A., et al. (2003). "Grontechnologies, ge et handicap." Revue Hospitaliere De France(491): 28-35.

[BDSP. Notice produite par ENSP WqR0xAo0. Diffusion soumise autorisation]. Sommaire de
l'intervention, le matin : Introduction : Les enjeux de la grontechnologie Bien vieillir domicile,
habitat service : - Nouvelles technologies et domicile, les enjeux.. - De la tlsurveillance la plate-
forme multiservice. - Age d'or services : de l'accompagnement dans les dplacements la demande de
coordination des autres services. Rseau informatique et CLIC : - Rseau informatique et centres
locaux d'information et de coordination. - Point de vue d'un oprateur. - Point de vue d'un fournisseur
de logiciels. Sommaire intervention de aprs-midi : Technologies de l'information au service des soins
griatriques : - Information des structures griatriques. - La prescription mdicale informatise. -
Tlsurveillance domicile et soutien intergnrations. - Tlmdecine en hospitalisation domicile :
VISADOM. - Libert " la carte" pour les personnes sujettes l'errance. - Actimtrie. - Attentes et
ralisations au centre hospitalier d'Embrun. Partage des connaissances et technologies : -
Dveloppement de la formation grontechnologie. - Le potentiel de l'universit virtuelle et son
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application la formation grontechnologique et griatrique des communauts d'usagers. Cet article

reprend le rsum de certaines de ces interventions.

Gagnon, M. P., et al. (2001). "La tlmdecine au service des rgions : tude valuative d'un projet de tlsant
aux Iles-de-la-Madeleine." Ruptures : Revue Transdisciplinaire En Sante 8(2): 53-70, graph.

La tlmdecine au service des rgions visait la conception et la mise l'essai d'un rseau de tlsant
afin de rpondre aux besoins de la population des Iles-de-la Madeleine. La dmarche d'valuation
employe dans le cadre de ce projet ainsi que les principaux constats qui se dgagent de
l'exprimentation value au regard de la mise en ouvre et du droulement du projet, de l'utilisation
de la tlsant et de ses effets sont prsents dans cet article. La pertinence d'une dmarche
d'valuation intgre un projet d'introduction d'une nouvelle technologie comme la tlsant
ressort clairement de l'exprience rapporte, o l'valuation a identifi plusieurs des conditions
associes au contexte, aux organisations et acteurs permettant de favoriser la prennit du projet et
la diffusion de cette technologie dans le systme de services de sant.

Gallin, X. (2000). "La tlmdecine en pratique aujourd'hui." Decision Sante(168): 24-26.

[BDSP. Notice produite par ENSP kYqR0xT6. Diffusion soumise autorisation]. La tlmdecine s'est
fortement dveloppe ces dernires annes, notamment grce aux progrs des tlcommunications
et l'essor de la technologie des rseaux. Deux rcentes manifestations sont venues tmoigner de
cette volution, les journes de l'ADEMA (Agence de Dveloppement Economique du Mans) et le
colloque Tlmdecine 2000 du CATEL. L'occasion de faire le point sur la "nouvelle mdecine".

Garcia, E. (2001). "Mise en place d'un rseau Tlmdecine : enseignements et pistes de travail." Journal
D'economie Medicale 19(5-6): 391-400, rs.

[BDSP. Notice produite par ORSRA NR0xaXVc. Diffusion soumise autorisation]. L'objet de ce papier
est de prsenter un cas pratique de ralisation d'un projet partir de la mise en place d'un rseau
Tlmdecine entre la ville et l'hpital. Ce projet, ayant pour finalit l'instauration d'un systme de
communication reposant sur les nouvelles technologies de l'information et de la communication, sera
approch par l'intermdiaire de ses objectifs, ses ressources, ses activits avant d'en mesurer les
rsultats obtenus sur le terrain, les difficults rencontres et les pistes de travail qui se dessinent
aujourd'hui pour sa prennisation et son dveloppement. (R.A.).

Gay, D., Elsanto, J. (2011). "Lozre : organiser et renforcer les soins de premier recours en milieu rural."
Reseaux Sante & Territoire(36): 24-28, carte.

Enclave en zone de moyenne montagne, loigne des ples urbains, la Lozre prsente toutes les
problmatiques des territoires ruraux : dsertification mdicale, isolement des mdecins, dlais
d'intervention relativement longs des urgences. L'Association lozrienne des urgences mdicales et de
la permanence de soins (Alumps), par l'intermdiaire de son charg de mission Laurent Crozat, s''est
empare de ces questions afin d'y apporter une rponse globale en accompagnant les professionnels
de sant pour le dveloppement de la tlmdecine et de la formation.

Gimbert, V. et Lemoine, S. (2010). "Mdecine de ville : quelles nouvelles pratiques pour quels gains d'efficience
?" Note D'analyse (La)(204): 11.
[Link]
pratiques-pour-quels-gains-d%E2%80%99efficien
Dans un contexte marqu par limportance croissante des maladies chroniques, par la modification
des attentes des patients et des nouvelles gnrations de mdecins, et par des tensions accrues sur
les finances sociales, la rgulation des dpenses en mdecine de ville est au cur des enjeux. Elle
implique avant tout un encadrement quilibr des pratiques des professionnels de sant. Par ailleurs,
on constate que lassurance maladie se positionne de plus en plus comme un accompagnateur pour le
professionnel de sant, mais aussi pour le patient. Cela pose la question des modalits de coopration
optimales entre assureurs (public et priv) et professionnels. Enfin, la rorganisation de loffre de soins
elle-mme peut permettre daccroitre lefficience globale des dpenses de sant, comme en
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tmoignent plusieurs exprimentations ltranger. Il conviendrait alors dexaminer dans quelle

mesure elles peuvent nourrir les rflexions sur lavenir du systme franais en matire de mdecine de
ville.

Goli, D. (2006). "Les maux de la nuit : tmoignage d'une personne aide." Gerontologie Et Societe(116): 183-
185.

[BDSP. Notice produite par FNG R0xQfid0. Diffusion soumise autorisation]. Le handicap, c'est un
combat au quotidien. Ce dernier peut cependant tre attnu grce une prise en charge efficace. La
nuit touche la personne handicape au coeur de sa vulnrabilit. Par exemple, la personne ayant des
dficiences motrices angoissera de devoir aller aux toilettes et de faire une chute alors qu'elle est
seule. Comment fera celle souffrant de maladie respiratoire, si personne n'est l pour changer les
canules de son appareil de ventilation ? Pour que la personne se sente un peu moins handicape, il
faudrait multiplier les interventions nocturnes d'auxiliaires de vie et de personnels de sant,
dvelopper la tlsurveillance et la domotique ainsi que tous les systmes concourant amliorer
l'indpendance du patient. (R.A.).

Gondry, J. et Marque, C. (2005). "Les nouvelles techniques de monitoring de la grossesse et de

l'accouchement." Technologie Et Sante(57): 19-27, fig.

[BDSP. Notice produite par APHPDOC dkR0xYNw. Diffusion soumise autorisation]. Cet article
prsente les diffrentes technologies mdicales qui permettent une surveillance du rythme cardiaque
pendant la grossesse et lors de l'accouchement. Grce aux appareils prsents, la souffrance foetale,
l'hypoxie et l'asphyxie prnatale peuvent tre suivis et mieux prvenus.

Holue, C. (2010). "Tlmdecine : coup d'envoi de la gnralisation." Seve : Les Tribunes De La Sante(29): 23-
31.

Le dcret du 19 octobre 2010 dfinit et fixe les conditions de mise en uvre des activits de
tlmdecine, qui seront portes et finances essentiellement, dans leur phase exprimentale, par les
agences rgionales de sant (ARS). Quatre types d'actes sont ainsi amens se dvelopper dans les
annes venir, au service des patients : la tlconsultation, la tl-expertise, la tlsurveillance
mdicale et la tl-assistance mdicale. Avant d'y parvenir, de nombreuses questions techniques,
juridiques, conomiques et thiques doivent encore tre dbattues et trouver des rponses. Mais
l?exemple des pionniers inspire les diffrents acteurs (rsum de l'diteur).

Karout, P. (2005). "Service vigilance : solution de veille prventive distance pour l'accompagnement
domicile de personnes en perte d'autonomie." Gerontologie Et Societe(113): 25-35, fig.

[BDSP. Notice produite par FNG vSovR0x4. Diffusion soumise autorisation]. Vivre son grand ge
domicile est un enjeu actuel : 98% des plus de 75 ans souhaiteraient pouvoir continuer vivre chez
eux le plus longtemps possible mme lorsqu'ils sont seuls. Face cette situation, l'entreprise Vicineo a
travaill avec plusieurs quipes de professionnels de l'accompagnement domicile pour envisager
grce aux "technologies Internet" un nouveau service de veille distance complmentaire des
interventions domicile et plus riche que la traditionnelle tl-alarme : le "Service Vigilance".

Lamothe, L., et al. (2013). "L'utilisation des tlsoins domicile pour un meilleur suivi des maladies
chroniques." Sante Publique 25(2): 203-211.

[BDSP. Notice produite par EHESP lDkr9R0x. Diffusion soumise autorisation]. Cette tude vise
comprendre comment les technologies de tlsoins domicile peuvent concourir une amlioration
des services offerts aux personnes atteintes de maladies chroniques. Une technologie de tlsoins
domicile a t utilise par des personnes ges canadiennes ayant au moins une des maladies
chroniques cibles. Des observations participatives, une analyse documentaire et des entrevues ont
permis de recueillir les donnes ncessaires l'analyse du processus d'implantation et au monitorage
des rsultats, qui montrent que l'utilisation de cette technologie permet de mettre en place plusieurs
conditions auxquelles l'organisation des services doit rpondre pour amliorer l'offre de services aux
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personnes atteintes de maladies chroniques, notamment en termes de collaboration

interprofessionnelle, d'accs des professionnels l'information et l'expertise ncessaires ou de
participation active du patient. Le succs de son implantation dpend toutefois d'une analyse dtaille
du contexte local dans lequel elle est introduite.

Lard, B. d., et al. (2010). "Loi HPST : un an dj ! Mise en perspective. Dossier." Actualites Jurisante(71): 36 ,
tabl.

Ce dossier fait le bilan de la loi Hpital Patients Sant Territoire aprs une anne de mise en place.
Sans prtende l'exhaustivit, le Centre de droit de Jurisant a prfr consacrer l'analyse certaines
problmatiques particulires : la gouvernance hospitalire, la coopration des professionnels de
sant, le nouveau statut des ESPCI (Etablissements de sant privs d'intrt collectif) et la
tlmdecine.

Lareng, L. (2002). "Rseau tlmdecine et rseau Samu." Technologie Et Sante(46-47): 22-28.

[BDSP. Notice produite par APHPDOC WR0x7I8Y. Diffusion soumise autorisation]. Il a fallu attendre
1992 pour assister une augmentation des changes mdicaux interactifs distance. La
tlmdecine, considre ses dbuts comme un progrs exclusif des tlcommunications
permettant de soigner distance, s'est rvle comme une nouvelle pratique mdicale susceptible de
traiter simultanment la sant et la qualit de vie. Cet article porte sur les aspects suivants : - La
tlmdecine dans la pratique mdicale ; - Typologie de la tlmdecine en France ; - Disciplines
mdicales et tlmdecine ; - Les rseaux de sant et l'amnagement du territoire (soins, prvention
et formation) ; - Le rseau tlmdecine et le rseau Samu ; - Le niveau rgional, lieu privilgi de la
tlmdecine au service du citoyen ; - La dimension humaine et humanitaire.

Lareng, L. et al. (2006). "La gense de la loi sur la tlmdecine. Discussion : La tlmdecine." Bulletin De
L'academie Nationale De Medecine 190(2): 323-330.

[BDSP. Notice produite par INIST-CNRS XR0xKP2U. Diffusion soumise autorisation]. Ds la cration
de l'Institut Europen de Tlmdecine le 10 juillet 1989 l'Universit Paul Sabatier de Toulouse, il est
apparu qu'une loi serait ncessaire pour prenniser cette nouvelle pratique mdicale. La dcision du
gouvernement en 1993, de faire de la Rgion Midi-Pyrnes un terrain exprimental pour crer un
rseau de tlmdecine gradu et coordonn runissant l'ensemble des tablissements de sant
publics, privs et les gnralistes, nous incite grer la tlmdecine l'image d'un service
hospitalier. Il en est rsult la cration de systmes institutionnels adapts au fonctionnement pluri-
tablissements ncessitant des dispositions rglementaires particulires, sur le plan des
responsabilits des professionnels de sant, du financement, de la scurit des donnes ainsi que du
recours aux nouvelles technologies de l'information et de la communication. Cela explique
l'laboration d'une loi, pour faciliter la pratique de la tlmdecine. Les articles spcifiques la
tlmdecine ont t intgrs dans la loi du 13 aot 2004 relative la rforme de l'assurance maladie.

Launois, R., et al. (2006). "Les aspects conomiques de la tlmdecine. Discussion : La tlmdecine." Bulletin
De L'academie Nationale De Medecine 190(2): 367-379.

[BDSP. Notice produite par INIST-CNRS R0x70me7. Diffusion soumise autorisation]. Les valuations
des technologies de sant se proposent d'tudier l'impact diffrentiel des actions de sant dans un
systme de soins complexe qui est caractris par la dynamique interactive des comportements et la
diversit des institutions. Les cadres d'valuation de la tlmdecine actuellement disponibles se
limitent le plus souvent une simple comparaison du cot de celle-ci par rapport au cot des modes
de prises en charge traditionnels qui occultent les bnfices associs la mise en rseau. Les schmas
actuels de collecte de l'information se prtent toutefois mal une recherche rigoureuse de l'efficacit
de cette innovation organisationnelle majeure en situation relle d'usage. Les essais randomiss
s'efforcent de neutraliser toute interfrence parasitaire qui pourrait compromettre la recherche d'un
lien de causalit entre l'action de sant et le rsultat obtenu. Leur mthodologie qui rige la clause
"ceteris paribus" en principe de bonnes pratiques sont peu propices l'analyse des comportements et
des structures. Les enqutes observationnelles descriptives partent des ralits de terrain pour les
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dpeindre le plus fidlement possible. Mais par dfinition, elles supposent que le cours naturel des
choses ne soit inflchi par aucune intervention. L'absence de plan exprimental multiplie les risques
de biais et rend impossible la recherche des causalits. Ces enqutes interdisent toute estimation de
l'efficacit diffrentielle. Pour valuer la tlmdecine, la gestion de projet et les tudes quasi
exprimentales sont les deux outils privilgier en premire intention. La premire technique permet
au rseau de vrifier en interne si les objectifs qu'ils se sont fixs ont bien t atteints. Les secondes
introduisent un comparateur dans l'analyse, puisque tous les schmas d'tude qui sont envisageables
dans leur cadre, reposent sur la distinction exposs/non exposs. Les unes et les autres reposent sur la
ralit des comportements du prescripteur et des patients. Leur mise en oeuvre squentielle permet
de s'assurer de la bonne mise en place d'un espace nouveau de coordination et de justifier la diffusion
de la tlmdecine par rapport aux prises en charge traditionnelles.

Le, Guen, J. M. (2011). ""La loi HPST, une tatisation du systme de sant"." Reseaux Sante & Territoire(40): 9-
11.

Cet article rapporte le point de vue de Jean-Marie Le Guen, dput de Paris, sur la loi HPST (Hpital,
Patients Sant et Territoires). Selon lui, cette loi a favoris une tatisation de la sant avec la cration
des agences rgionales de sant, a nglig l'aspect sant publique et n'a pas rpondu la question
cruciale de la dsertification mdicale.

Le, Guen, T., et al. (2003). "La tlmdecine en Guyane : une approche concrte." Techniques
Hospitalieres(678): 16-18, ill.

[BDSP. Notice produite par ANFH 7ymR0xY1. Diffusion soumise autorisation]. En matire de
tlmdecine en Guyane, la tlconsultation entre 4 sites isols et l'hpital de Cayenne a t
exprimente dans trois spcialits : dermatologie, parasitologie et cardiologie, depuis novembre
2001.

Lemire, M. (2010). "La participation de l'usager la production de soins : l'exemple des nouveaux modles de
suivi distance fonds sur les technologies de tl-soins." Sante Societe Et Solidarite : Revue De
L'observatoire Franco-Quebecois(2/2009): 93-97.
[Link]
La participation de l'usager la production de soins revt une importance particulire avec le
dveloppement de nouveaux modles de suivi domicile des maladies chroniques. Cet article cherche
comprendre comment ces nouveaux modles impliquent l'usager dans la production de soins, et
dans quelle mesure ils favorisent la responsabilit personnelle. L'analyse s'appuie sur une tude de cas
ayant port sur un service de tl-soins dploy au Qubec. L'tude rvle que les caractristiques
favorables du service au plan de la responsabilisation dfinie en termes d'habilitation et ses limites par
rapport une responsabilisation dfinie en fonction de l'idal type du "patient expert". Dans les faits,
le service de tl-soins favorise plutt le renforcement des processus de contrle et de normalisation
qui caractrisent l'approche mdicale conventionnelle. Pour l'usager en convalescence ou risque, il
s'agit nanmoins d'un dispositif de scurisation important (rsum d'auteur).

Lemoine, S., et al. (2014). "Parcours de soin : Hypertension artrielle, un parcours optimis pour contrler 7
hypertendus sur 10 en 2015." Concours Medical 136(4): 273-308.

[BDSP. Notice produite par ORSRA rR0xlCkE. Diffusion soumise autorisation]. Ce dossier s'intresse
un parcours optimis pour contrler 7 hypertendus sur 10 en 2015 : il expose la qualit du dpistage
comme premire condition de la prvention, la place des mesures ambulatoires dans la confirmation
du diagnostic, l'annonce du diagnostic comme prrequis indispensable, la gestion de l'urgence
hypertensive, l'initiation du traitement, les particularits du sujet g, le suivi court terme comme
investissement pour l'avenir, comment motiver le patient par une Education Thrapeutique du Patient
de proximit, le rle cl du mdecin gnraliste dans le combat contre l'inertie mdicale, la ncessit
du contrle tensionnel en prvention secondaire, la place des infirmires spcialises dans le suivi
ducatif sur le long terme, le tlsuivi comme effet actif possible sur le contrle tensionnel. On fait
alors le constat suivant : il existe deux philosophies diffrentes, celle de la Socit franaise
d'hypertension artrielle (SFHTA), et celle des Socits europennes d'hypertension et de cardiologie
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(ESH/ESC). Le dossier se termine sur Le Comit franais de lutte contre l'hypertension artrielle
comme relais d'information, les centres d'excellence europens en HTA, la Fdration franaise de
Cardiologie et les associations dans leur combat pour un plan coeur.

Lutzler, P., et al. (2010). "Apports de la tlmdecine dans les prises en charge griatriques. Dploiement du
systme de visiophonie. Vis-AGES dans l'arc alpin." Revue Hospitaliere De France(532): 40-42.

[BDSP. Notice produite par EHESP JR0x9Hp9. Diffusion soumise autorisation]. Situ dans les Hautes-
Alpes, aux confins de la rgion Provence-Alpes-Ctes-d'Azur, le bassin de population du Queyras, du
Guillestrois, de l'Embrunais et du Savinois est compos de quatre cantons regroupant 19 000
habitants. 20% sont gs de plus de 65 ans, et 10% ont plus de 75 ans. Cet article prsente la
dmarche qui a prvalu l'utilisation d'un systme de visiophonie adapt aux soins entre deux
structures sanitaires loignes de 45 km, ce qui reprsente presque une heure de trajet sur routes
difficiles : l'hpital d'Aiguilles et celui d'Embrun.

Mace, J. M., et al. (2002). "Prise en charge mdicale du patient cardiaque." Technologie Et Sante(46-47): 139.

[BDSP. Notice produite par APHPDOC I5NwfR0x. Diffusion soumise autorisation]. Au sommaire de ce
numro consacr la prise en charge mdicale du patient cardiaque : - Les statistiques ; - La prise en
charge diagnostique initiale : cabinet priv ; - La prise en charge thrapeutique en situation de crise
(Samu) ; - La prise en charge diagnostique : investigations approfondies ; - La prise en charge
interventionnelle : investigations approfondies ; - La prise en charge chirurgicale ; Anesthsie du
patient cardiaque ; - Surveillance de l'anesthsie cardiologique ETO et du segment ST ; - Ranimation
cardiaque ; - Accueil en service froid ; - Rducation du patient cardiaque ; - Prise en charge du patient
cardiaque sa sortie (interview).

Manrique, G. (2005). "Les soins de demain s'inventent aujourd'hui. La vision d'un industriel : IBM Division Sant
& Sciences du vivant." Gerontologie Et Societe(113): 89-96, fig.

[BDSP. Notice produite par FNG Bx9mR0xs. Diffusion soumise autorisation]. Cet article dcrit l'action
d'IBM dans le domaine de la tlmdecine. Les nouvelles possibilits des NTIC (nouvelles technologies
de l'information et de la communication) permettent distance, un meilleur suivi de la sant des
populations jusqu'aux ges avancs de la vie, pas seulement vise curative mais galement vise
prventive. Les solutions techniques aujourd'hui existent. Mais cela ouvre en grontologie des
perspectives importantes qui exigent de la part des industriels comme des institutions, d'oser des
partenariats public-priv ambitieux pour tester et valider de nouveaux modles socio-conomiques de
prise en charge.

Marsault, C., et al. (2006). "Le rseau TELIF l'Assistance Publique : Hpitaux de Paris. Discussion : La
tlmdecine." Bulletin De L'academie Nationale De Medecine 190(2): 349-355.

[BDSP. Notice produite par INIST-CNRS yCzR0xOd. Diffusion soumise autorisation]. Aprs une tude
portant sur l'intrt et la faisabilit de la mise en place d'un rseau dans le cadre de la grande garde
de neurochirurgie de la Rgion Ile-de-France, le rseau TELIF a t cr en novembre 1994. Encore
aujourd'hui, sa principale activit concerne la prise en charge des urgences neurochirurgicales en Ile-
de-France. Le bilan du rseau est trs positif ayant atteint son objectif de rduction de plus de 70%
des transports inutiles de patients entre hpitaux. Si le rseau TELIF n'a pas t trs utilis dans le
cadre de la tl-expertise, il apporte une aide trs importante aux hpitaux de griatrie dans
l'interprtation et le dcloisonnement des activits d'imagerie. Ce rseau a t exemplaire, puisqu'il a
t le premier rseau ayant comport une valuation annuelle de son activit. Aujourd'hui, la
technologie qu'il utilise est obsolte et il devrait rapidement voluer, en utilisant les technologies
modernes, dans le cadre d'une intgration dans le dossier du patient informatis, en conservant ses
activits importantes (neurochirurgie et griatrie) et en s'ouvrant non seulement vers l'ensemble des
hpitaux publics de la rgion Ile-de-France, comme c'est le cas aujourd'hui, mais galement vers les
diffrentes modalits de prise en charge des patients en ville.

Mathieu-Fritz, A., et al. (2012). "Tlmdecine et griatrie. La place du patient g dans le dispositif de
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consultations mdicales distance du rseau Tlgria." Gerontologie Et Societe(141): 117-127.

[BDSP. Notice produite par FNG R0x9DrpG. Diffusion soumise autorisation]. A partir d'une
perspective combinant analyses sociologique et thique et valuation mdicale, les auteurs rendent
compte des usages de la tlmdecine en griatrie, observables dans la cadre de tlconsultations
mdicales, pour comprendre la place qui est faite aux patients gs. Ils montrent que celle-ci dpend
principalement de l'organisation pratique de la consultation et des modalits d'usage concrtes des
dispositifs techniques, qui ne sont, en eux-mmes, ni dshumanisants ni humanisant. Les auteurs
mettent ainsi en vidence l'importance des valuations socio-organisationnelles in situ de ces
nouvelles formes d'exercice mdical. (R.A.).

Mondada, L. (2004). "Tlchirurgie et nouvelles pratiques professionnelles : les enjeux interactionnels

d'oprations chirurgicales raliss par visioconfrence." Sciences Sociales Et Sante 22(1): 95-126,
phot., enc.

La tlchirurgie est, par excellence, un des domaines dans lequel se pose la question de la mutation
des pratiques professionnelles dans de nouveaux environnements technologiques. Pour y rpondre,
une analyse approfondie des pratiques mdicales semble indispensable. Cet article propose donc une
analyse dtaille des activits des quipes chirurgicales en salle d'opration. En se basant sur un
corpus d'enregistrement vido d'oprations ralises avec la collaboration distance d'un expert dans
le cadre d'un projet de tlchirurgie, l'auteur se penche plus particulirement sur les modes
d'organisation de l'interaction durant les oprations et sur la faon dont le recours aux nouvelles
technologies, la redfinition des collectifs dans l'action distance et la reconfiguration des espaces de
travail s'articulent dans cette pratique professionnelle (Extrait du rsum d'auteur).

Morin, A., et al. (2000). "Tlmdecine : Etat des lieux." Techniques Hospitalieres(644): 40-42.

[BDSP. Notice produite par ENSP bO0R0xl0. Diffusion soumise autorisation]. Le terme de
tlmdecine est maintenant consacr pour dsigner la tlmatique de sant. L'tat de rceptivit de
ce nouvel outil a sensiblement volu, tant du ct du professionnel de sant que de celui du public
qu'il s'agisse des patients ou des usagers. Une condition indispensable : dvelopper des contenus de
qualit correspondant rellement aux besoins et demandes des utilisateurs.

Normand, Y., et al. (2010). "Hpital, patient, systme d'information. Dossier." Techniques Hospitalieres(721):
65-87, fig.

[BDSP. Notice produite par EHESP s9mDR0xp. Diffusion soumise autorisation]. La 18me journe
nationale Athos qui est tenue Pau en novembre 2009 a permis de rassembler 250 personnes autour
du thme "Hpital, patient, systme d'information" et d'changer sur les exprimentations et
pratiques de plusieurs centres hospitaliers. Cet article nous en prsente quelques extraits qui traitent
de : - la politique de scurit des systmes d'information et la confidentialit des informations
mdicales - la plateforme "Tlsant Aquitaine" qui favorise les changes ville-hpital - l'volution des
systmes d'information hospitaliers face aux territoires de sant et aux communauts hospitalires de
territoire - l'informatisation du dossier patient au centre hospitalier de Mont-de-Marsan et l'hpital
local de Maulon-Soule - la mise en place de trois units de dialyse mdicalise tlsurveille (UDMT)
sur le territoire des Ctes d'Armor par le centre hospitalier de Saint-Brieuc.

Noury, N. r. (2005). "AILISA : plateformes d'valuations pour des technologies de tlsurveillance mdicale et
d'assistance en grontologie." Gerontologie Et Societe(113): 89-96, fig.

[BDSP. Notice produite par FNG 1R0xqRxz. Diffusion soumise autorisation]. Le projet AILISA a pour
objectif de mettre en place des plateformes prennes pour l'valuation de technologies de
tlsurveillance mdicale et d'assistance en grontologie. Les plateformes seront installes dans deux
services griatriques : l'un l'hpital Charles Foix (Ivry-sur-Seine) et l'autre au CHU La Grave
(Toulouse), et dans deux appartements d'un foyer logement pour personnes ges (Grenoble). Les
sites d'valuation disposeront de trois technologies mises au point dans les laboratoires de la
recherche publique franaise : l'Habitat Intelligent pour la Sant (TIISAD), le vtement de Tl-
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Assistance Mdicale Nomade (VTAMN) et le robot dambulateur (MONIMAD). Il s'agit ici d'valuer ces
technologies sur les plans technologique, mdical et aussi sur le plan de l'usage et de l'thique.

Pauchard, P., et al. (2008). "Tlmdecine en Guyane." Revue Hospitaliere De France(521): 42-44.

[BDSP. Notice produite par EHESP R0xtAnAF. Diffusion soumise autorisation]. La Guyane est un
grand dpartement d'outre-mer (86 000 km) recouvert 80% par la fort quatoriale. Rgion ctire
et villes concentrent les trois hpitaux et les principales ressources de sant. A l'intrieur des terres,
les ressources mdicales sont plus modestes. Vingt-et-un postes de sant tenus par du personnel
paramdical assurent la couverture sanitaire d'une population dissmine. Aprs une premire phase
d'exprimentation lance en 2001, la Guyane s'est engage dans l'laboration d'un vritable rseau de
tlmdecine qui permet de rompre l'isolement des populations et d'viter des vacuations sanitaires
coteuses.

Rauly, A. (2013). "Dispositifs de rmunration de la tlmdecine : de la diversit des propositions de contrats

la singularit du systme de sant franais." Journal De Gestion Et D'economie Medicales 31(7-8):
473-486, tabl.

[BDSP. Notice produite par ORSRA pFJ7JR0x. Diffusion soumise autorisation]. L'objectif de ce travail
est d'apporter des lments de comprhension au dbat actuel concernant la forme que doit prendre
la rmunration des actes de tlmdecine pratiqus par les mdecins libraux. Depuis la
reconnaissance juridique de la pratique en 2009, aucun compromis entre la tutelle et les
reprsentants des mdecins n'a t trouv. La question principale est donc de savoir sur quels
lments repose le dbat. Si les pouvoirs publics proposent de s'appuyer sur les expriences
trangres russies de dploiement de la tlmdecine, le corps mdical prfre voir la tlmdecine
s'intgrer dans des contrats existants. Ainsi, deux grandes tendances peuvent tre mises en vidence.
Dans un premier cas les recommandations faites pour le dploiement de la tlmdecine prconisent
une rorganisation profonde du mode de rmunration et d'organisation du systme de sant.
L'objectif tant avant tout de rduire l'asymtrie d'information entre les acteurs du systme. Dans un
second cas il est propos de mettre en application des rformes limites mais suscitant l'adhsion
d'un plus grand nombre de mdecins en vue de ne pas dgrader leurs reprsentations de la
profession. (Rsum auteur).

Richard, R. (2010). "Grand ge : la tlmdecine comme remde aux difficults de dplacement." Concours
Medical 132(12): 492-493.

[BDSP. Notice produite par EHESP 8R0x7lpJ. Diffusion soumise autorisation]. L'tude PLEIAD, ralise
par le Grontople de Toulouse, confirme que les hospitalisations rptes des personnes ges
rsidant en tablissement entranent une fragilisation accrue de ces personnes et reprsentent un
risque d'augmentation de leur dpendance. Parmi les solutions mises en avant pour viter les
hospitalisations, figure le dveloppement de la tlmdecine, comme le montre le projet Tlgria
Paris qui a mis en place des tlconsultations en griatrie l'hpital Europen Georges-Pompidou.

Richard, S. (2015). "AVC : premiers rsultats concluants pour la tl-expertise lorraine." Revue Hospitaliere De
France(562): 75-.

[BDSP. Notice produite par EHESP R0xA98mC. Diffusion soumise autorisation]. Le pronostic de
l'accident vasculaire crbral ischmique, en termes de survie et de handicap, dpend en partie de la
rapidit de ralisation des valuations cliniques et radiologiques. Ces investigations peuvent conduire
la prescription d'un traitement thrombolytique visant restaurer la perfusion crbrale. Plus ce
traitement est administr tt et plus son bnfice est important pour le patient. Le risque de
complications gravissimes - qui lui est inhrent-s'en trouve considrablement rduit. Un modle
d'expertise et de traitement distance a t mis en place en Lorraine sous l'gide de l'agence
rgionale de sant et du service de neurologie du CHRU de Nancy.

Robin, J.-Y. (2010). "Tlmdecine : un rle cl pour l'ASIP Sant." Revue Hospitaliere De France(532): 17-18,
carte.
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[BDSP. Notice produite par EHESP CrFR0xJs. Diffusion soumise autorisation]. Qu'il s'agisse du rapport
Simon/Acker, du livre blanc de l'Ordre des mdecins ou du rapport Gagneux sur les systmes
d'information de sant, le constat est partag sur les opportunits que la tlmdecine peut offrir
l'amlioration de la prise en charge et, par consquent, celle de la qualit des soins. Focus sur cette
nouvelle pratique mdicale qui connatra, en 2010, un vritable essor grce un cadre rglementaire
abouti, et sur le rle de l'ASIP Sant en la matire.

Roncari, J.-C. (2010). "Grontellim : le rseau limousin de tlmdecine griatrique." Revue Hospitaliere De
France(532): 47-48, graph.

[BDSP. Notice produite par EHESP 8GBlR0xt. Diffusion soumise autorisation]. L'association pour la
GERONtologie et TELmdecine en LIMousin (Grontellim) est ne en aot 2009 de la volont de
professionnels de sant. Objectif : dvelopper la recherche et promouvoir la pratique mdicale dans
les domaines o la tlmdecine apporte une valeur ajoute la prise en charge griatrique des
patients.

Rumeau, P., et al. (2007). "La tlmdecine directe : de la dmonstration dans le cadre du projet europen
Healthware la rflexion organisationnelle." Techniques Hospitalieres(701): 27-30.

[BDSP. Notice produite par ENSP R0xeAFhY. Diffusion soumise autorisation]. Le projet Healthware,
financ dans le cadre du sixime projet cadre europen dans le chapitre aronautique et espace, fait
le lien entre des besoins de sant publique, le dveloppement conomique d'une rgion et la
recherche et dveloppement en matire d'utilisation des satellites. Il regroupe, sous la bannire
fdratrice de l'Institut europen de tlmdecine et d'Alcatel Alenia Space, des praticiens de terrain
(mdecins, techniciens, directeurs), le prfet et des lus locaux du dpartement des Hautes-Pyrnes.
Les sites locaux de dmonstration ont t choisis en fonction de leur pertinence dans le tissu socio-
conomique local. A Luz-Saint-Sauveur, un cabinet de mdecins traitants a t directement connect
une maison de retraite dont ils suivent les rsidents. A Lannemezan et Bagnres de Bigorre, un centre
mdico-psychologique (CMP) est directement connect au service d'hospitalisation du secteur
psychiatrique correspondant.

Simon, P. (2005). "La tldialyse. Une application de la tlmdecine la surveillance mdicale de sances
d'hmodialyse ralises distance." Techniques Hospitalieres(692): 60-64, phot.

[BDSP. Notice produite par ENSP Mq43R0xx. Diffusion soumise autorisation]. La tldialyse, devenue
lgale par la loi du 14 aot 2004 de l'assurance maladie (article 12), est l'usage de la tlmdecine
pour la ralisation distance de l'acte mdical de surveillance des insuffisants rnaux traits dans un
centre de dialyse loign du centre de rfrence. Elle est exprimente depuis l't 2001 entre les
centres hospitaliers de Saint-Brieuc et de Lannion. Le but de cet article est de faire le point sur le
dveloppement actuel et venir de cette mthode, notamment pour faire face au problme de la
dmographie mdicale nphrologique.

Simon, P. (2010). "Tlmdecine : un levier pour la restructuration de l'offre de soins." Revue Hospitaliere De
France(532): 12-16, graph.

[BDSP. Notice produite par EHESP R0xFComt. Diffusion soumise autorisation]. Co-auteur du rapport
sur la place de la tlmdecine dans l'organisation des soins paru en novembre 2008, Pierre Simon
prsente ici les nouvelles pratiques mdicales et paramdicales par tlmdecine. Il en dfinit les
actes, analyse les responsabilits engages, soulignant celles de nouveaux acteurs : le ou les tiers
technologiques qui ralisent les dispositifs techniques de tlmdecine. Il dcrit les nouvelles
organisations des soins bnficiaires de ces pratiques : la gradation des soins et la tlsurveillance
mdicale domicile qui, via la tlmdecine, se rvlent un atout pour la radiologie publique, les
patients de toutes pathologies (MCO, chroniques, gs et handicaps pensionnaires de maisons de
retraite et d'EHPAD), et la collaboration pluriprofessionnelle.

Simon, P. (2011). "Tlmdecine. Impacts du dcret, volutions, perspectives, enjeux." Revue Hospitaliere De
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France(539): 68-74, ill.

[BDSP. Notice produite par EHESP R0xF8FBE. Diffusion soumise autorisation]. La parution du dcret
le 9 octobre 2010 relatif la tlmdecine dfinit les actes de tlmdecine et les conditions de mise
en oeuvre de ces diffrentes applications. L'auteur dtaille les impacts du dcret sur l'exercice mdical
(dfinition de la tlmdecine, qualit et scurit du dispositif, relations avec le patient, obligations du
mdecin...) et prsente les organisations pilotes oprationnelles en France, qui devront tre mises en
conformit avant le 20 avril 2012. Enfin, les enjeux pour les soins primaires et pour les soins de second
recours sont exposs, l'accent tant mis sur la continuit des soins.

Simon, P. (2013). "Ressources humaines et tlmdecine." Revue Hospitaliere De France(554): 12-18, tabl.,
graph., fig.

L'utilisation de la tlmdecine impose une adaptation des organisations de soins. En modifiant ces
organisations, la pratique de la tlmdecine impacte directement les ressources humaines. Dans cet
article, les ressources humaines en tlmdecine sont analyses sous trois aspects : pratiques
professionnelles, nouvelles organisations professionnelles, cooprations entre professionnels de
sant.

Simon, P. (2015). "Tlmdecine et parcours de soins." Revue Hospitaliere De France(566): 14-20.

[BDSP. Notice produite par EHESP rjo7BR0x. Diffusion soumise autorisation]. Cet article se rfre
ce que la Haute Autorit de Sant (HAS) crivait sur le parcours de soins en 2012. Il analyse
successivement la place du mdecin traitant dans le parcours de soins d'une maladie chronique,
l'apport de la tlmdecine pour les diffrents acteurs professionnels mdicaux et non mdicaux qui
interviennent dans ce parcours, ainsi que l'apport de la tlmdecine pour les patients pris en charge.
Il apporte, enfin, des exemples de parcours de soins bnficiant de la tlmdecine. (introd.).

Simon, P., et al. (2013). "Dossier RH. Tlmdecine : quels impacts sur les pratiques soignantes ?" Revue
Hospitaliere De France(554): 12-30, ill.

[BDSP. Notice produite par EHESP 99R0xoop. Diffusion soumise autorisation]. Le dossier permet de
mesurer l'impact sur la gestion des ressources humaines que peut avoir l'introduction de la
tlmdecine dans les pratiques mdicales, travers quatre contributions : la premire montre
d'abord que la tlmdecine impose une adaptation des organisations de soins. L'article analyse les
ressources humaines en tlmdecine sous trois aspects : les pratiques professionnelles, les
organisations professionnelles nouvelles, les cooprations entre professionnels de sant, favorises
par la tlmdecine. La deuxime contribution, intitule "tlsurveillance mdicale domicile, quels
apports patients et professionnels ?", offre un tmoignage de mise en place de pratique de la
tlmdecine au centre hospitalier de Saint-Yrieix, en Haute-Vienne. Le troisime article prsente
l'unit d'enseignement tlmdecine propose par l'universit Picardie Jules Verne ddie aux
tudiants en mdecine. Enfin, le dernier article, qui s'intitule "tlfibrinolyse en Bourgogne, une
russite organisationnelle au bnfice des patients atteints d'AVC", illustre le bnfice que peut
reprsenter la pratique de la tlmdecine pour des territoires ruraux o la densit mdicale reste
faible.

Simon, P., et al. (2010). "Dossier. Tlmdecine, l'heure "H" ?" Revue Hospitaliere De France(532): 12-36,
graph., tabl.

[BDSP. Notice produite par EHESP 7R0xFIl9. Diffusion soumise autorisation]. Au sommaire du dossier
: Tlmdecine : un levier pour la restructuration de l'offre de soins - Un rle cl pour l'ASIP Sant -
Tlmdecine et pratique mdicale collaborative : enjeux et pralables - Apports de la tlmdecine
dans la gradation des soins - Maladies chroniques cardiovasculaires et mtaboliques : apports de la
tlmdecine - Place et perspectives de la tlmdecine en Guyane - Sant en ligne : nouvelles tapes
europennes.

Suarez, C. (2002). "La tlmdecine : quelle lgitimit d'une innovation radicale pour les professionnels de
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sant ?" Revue De L'ires (La)(39): 157-186.

[Link]
Aprs une dfinition de la tlmdecine extraite des tudes de l'Organisation Mondiale de la Sant,
cet article dresse un historique de l'mergence de la tlmdecine en Europe. Il fait ensuite un bilan
des expriences menes dans certains pays europens : France, Italie, Royaume-Uni, Portugal?

Suarez, C. (2008). "Quelle organisation sanitaire alternative pour le systme sanitaire franais ?" Revue De
L'ires (La)(59): 41-74.
[Link]
Les lments d?organisation alternative exposs ici reposent sur un principe stratgique fondamental
: la responsabilisation privilgie des instances politiques dans la mise en ?uvre d?une politique de
sant publique. Il nous parat en effet essentiel de re-politiser (au sens noble du terme) les enjeux
stratgiques d?une politique de sant et de clairement distinguer ce qui est de l?ordre de l?expertise
technique de ce qui est de l?ordre du choix politique : quelle stratgie de la sant, quels objectifs,
quels moyens, quels rsultats escompts ? Voici donc quelques propositions structurelles dbattre.

Talbot, L. R. et Vincent, C. (2005). "Les technologies dans le soutien domicile des personnes ges : d'une
exprience de tlsurveillance vers un programme de tlsoins domicile." Gerontologie Et
Societe(113): 51-61, fig.

[BDSP. Notice produite par FNG dxASTR0x. Diffusion soumise autorisation]. Cet article prsente les
rsultats d'une tude ayant pour but d'valuer les effets de l'utilisation d'une nouvelle technologie de
surveillance sur les habitudes et qualit de vie des personnes ges et de leurs proches aidants. Ils
montrent que l'utilisation de cette technologie n'a pas d'effet sur la qualit de vie et sur l'autonomie
des personnes ges mais qu'elle rduit la frquence des hospitalisations et l'anxit des proches. Les
auteurs dcrivent ensuite les avantages attendus d'un nouveau programme de tlsoins domicile.

Varroud-Vial, M. (2012). "Dossier : Le traitement du diabte de type 2 par l'insuline." Concours Medical 134(6):
439-459.

[BDSP. Notice produite par ORSRA 9GR0x9CI. Diffusion soumise autorisation]. Ce dossier permet de
mettre en vidence les enjeux que reprsente le traitement par insuline pour les mdecins
gnralistes. L'tude ENTRED ralise en 2007 a montr que le contrle mtabolique est difficile et les
complications frquentes. La prescription de l'insuline soit par le mdecin gnraliste soit par le
diabtologue se heurte l'insulinorsistance psychologique et l'htrognit du diabte type 2.
Ainsi, l'ducation thrapeutique du patient est une tape indispensable lors du passage
l'insulinothrapie et pour les personnes ges, il peut tre facilit grce l'intervention d'une
infirmire.

Vayssette, P. (2011). "Tlsant : deux ans aprs le rapport Labordes." Reseaux Sante & Territoire(40): 28-29.

Deux ans aprs la parution de son rapport sur la tlsant, Pierre Laborde fait un bilan de son
dveloppement actuel en France. Si certaines ralisations concrtes se sont mises en place,
notamment en tlsurveilllance (suivi du diabte) et en tl-assistance, il existe encore des freins
juridiques ainsi que des rflexions en cours sur les modes de rmunration.

Viens-Bitker, C., et al. (2000). "Tlmdecine." Revue Europeenne De Technologie Biomedicale (Rbm) 21(5):
265-328, tabl., graph.

Depuis 1990, la tlmdecine a progressivement pris son essor. Elle s'organise aujourd'hui autour de
trois thmes majeurs : les rseaux et filires, c'est--dire la communication entre professionnels
aboutissant la mise en commun de bases de donnes et de connaissances ; la tl-expertise
distance, synchrone ou asynchrone ; et plus rcemment, la tlmdecine adresse directement aux
patients ou au grand public, pour les actions de prvention, en particulier au travers des portails
sant . Les articles originaux prsents dans ce numro tmoignent de l'activit de nombreuses
quipes de recherche de l'Association Franaise pour l'Informatique Mdicale (AIM) travaillant dans le
domaine, et de l'intrt suscit par les nouvelles technologies d'information et de communication en
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informatique mdicale. On trouve, en autre, dans ce fascicule deux articles relatifs la trajectoire des
patients.

Vincent, W. (2001). "L'explosion de la tlmdecine : les radiologues sont prsents." Lettre Du Medecin
Radiologue(356): 15-16, carte.

Williatte-Pellitteri, L. et Flauraud-Grandjean, V.-A. (2012). "Tlmdecine et responsabilits juridiques." Revue

Hospitaliere De France(549): 62-66.

[BDSP. Notice produite par EHESP G9sBR0xA. Diffusion soumise autorisation]. La loi Hpital,
patients, sant, territoire a donn pour la premire fois un cadre juridique l'exercice de l'art mdical
via la tlmdecine. Le dcret de 2010 prcise ce cadre en identifiant les obligations de ses
organisateurs et acteurs. Une question se pose : la tlmdecine doit-elle tre perue comme une
nouvelle source de responsabilit juridique pour les organisateurs ou les professionnels de sant qui
l'exercent ?

Rapports

(2003). Etat des lieux de la tlimagerie mdicale en France et perspectives de dveloppement. St Denis la
Plaine ANAES: 95 , 10 ann., 12 tabl.
[Link] => Publications => Imagerie -
radiologie
La tlimagerie est caractrise par la transmission d'images entre deux sites distants dans un but
d'interprtation et de consultation. Elle fait partie intgrante de la tlmdecine. Elle concerne des
spcialits diverses telles que la radiologie, l'chographie, l'anatomopathologie ou l'endoscopie. Dans
ce rapport, la tlimagerie mdicale a t limite la tlradiologie, incluant la neuroradiologie pour
lesquelles la faisabilit a t dmontre, en particulier dans le domaine des urgences, et la
transmission d'chographies obsttricales. Le dveloppement des technologies de l'information et
l'volution des modes d'exercice de la mdecine devraient conduire un dploiement de ces
technologies en France. Dans ce contexte, la DHOS et l'Anaes ont souhait recenser les facteurs
d'checs et de succs intervenant dans la mise en oeuvre de la tlimagerie mdicale, partir d'une
analyse critique de la littrature, complte d'une enqute de terrain. Les facteurs qui interviennent
dans la mise en oeuvre, le fonctionnement et la prennit d'une application de tlimagerie mdicale
sont d'ordre mdical, technique, organisationnel, conomique et rglementaire (incluant les aspects
dontologique et juridique). Aprs avoir tudi tous les aspects participant la mise en ?uvre de la
tlimagerie, l'Anaes liste quelques points cls de ce bilan et expose quelques perspectives cette
technologie.

(2004). Compte-rendu d'activit de la Mission Nationale d'Appui en Sant Mentale. Paris MNASM: 62.
[Link] -
[Link] -
[Link]
La MNASM (Mission nationale d'appui en sant mentale) assure une triple mission : une mission d'aide
la planification en Sant Mentale "sur site" qui se traduit concrtement par la ralisation d'tudes
conduites de faon pluri-professionnelle sur des tablissements hospitaliers et services spcialiss
dans la prise en charge de la sant mentale, et qui donnent lieu des propositions d'organisation ou
de mode de fonctionnement destines optimiser les rponses en terme de sant publique, dans le
domaine de la sant mentale ; une mission d'expertise auprs de l'Administration Centrale, pour
enrichir sa rflexion, son action, voire construire avec elle des outils partir de problmatiques
observes sur le terrain, et participe en appui technique, des groupes de travail (offre de soins,
urgences, mtiers, etc.) au niveau national ou rgional, auprs des ARH ; une mission de
communication et d'information, par le biais notamment d'une publication ("Pluriels") et la
participation des journes d'information et de communication. Ce document prsente dans un
premier temps le bilan d'activit de la MNASM, puis dans un second temps, ses considrations
gnrales concernant l'volution de la sant mentale aujourd'hui.

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(2008). Les hpitaux de petites villes : une composante indispensable pour une offre de soins de qualit sur
tout le territoire : Troisime livre blanc de l'Association des Petites Villes de France. Paris APVF: 37.
[Link]
0petites%20villes%20-%[Link]
Pour la troisime fois en moins de dix ans, lassociation des Petites Villes de France publie un livre
blanc portant des propositions visant dfendre et prenniser les petites structures hospitalires. Il
y a dix ans, il sagissait de rpondre une campagne de dnigrement systmatique et un certain
acharnement mdiatique assimilant inscurit sanitaire et petits hpitaux. Il y a cinq ans, il sagissait
de dmontrer que les hpitaux de proximit ne sont pas plus coteux que les grosses structures
hospitalires, bien au contraire. Ces deux attaques subsistent aujourdhui, relayes pas de puissants
lobbies du corps hospitalo-universitaire et aggraves par lvolution trs ngative de la dmographie
mdicale, qui est un rel problme pos notre pays. Fidle sa vocation de force de propositions,
lAPVF a souhait sinscrire dans la perspective de la future rforme hospitalire que doit prsenter la
Ministre de la Sant et qui sera dbattue devant le Parlement, car une rforme est bel et bien
ncessaire, nous lavons toujours dit. Elle se doit de concilier rationalisation des dpenses, qualit de
la prise en charge et galit daccs aux soins sur tout le territoire. Cette dernire assertion ne doit
surtout pas tre oublie dans la future loi (rsum dauteur).

(2009). Dploiement des systmes de tlradiologie. Panorama des initiatives en rgion et recommandations.
Paris Asip Sant: 33.
[Link]
La publication de ce rapport formalise le travail d?tat des lieux men par l?ASIP Sant auprs de plus
de 80 acteurs sur le terrain, en concertation avec la Mission pour l?informatisation du systme de
sant (MISS), la Direction de l?hospitalisation et de l?organisation des soins (DHOS) et l?Agence
nationale d?appui la performance des tablissements de sant et mdico-sociaux (ANAP). A partir de
cet tat des lieux des initiatives existantes en matire de tlradiologie, des recommandations ont t
proposes, qui viendront nourrir la construction d?un cadre national d?exigences fonctionnelles et
techniques.

(2009). Les conditions de mise en oeuvre de la tlmdecine en unit de dialyse mdicalise. Evaluation des
programmes et politiques de sant publique.: 177.
[Link]
01/argumentaire_conditions_telemedecine_udm_vf.pdf
[BDSP. Notice produite par HAS R0xEJHFF. Diffusion soumise autorisation]. Le contexte dans lequel
s'inscrit cette demande est caractris par l'augmentation continue du nombre de patients en
insuffisance rnale chronique terminale traits par puration extrarnale et la volont de procder
un dploiement oprationnel de la tlmdecine dans la restructuration de l'offre de soins. La HAS
dcrit dans ses recommandations l'ensemble des conditions de mise en oeuvre de la tlmdecine
dans le fonctionnement d'une UDM permettant de garantir la qualit des soins et la scurit de la
prise en charge : modle organisationnel li la tldialyse, modalits d'organisation et d'implantation
des UDM, organisation des soins par tlmdecine et procdures face aux urgences, aspects
techniques du systme de tldialyse, aspects conomiques, juridiques, dontologiques. Un cadre
global pour l'valuation des projets pilotes est galement propos. Ces recommandations pourront
servir de support la mise en place de projets pilotes autoriss par les agences rgionales de sant.
Elles pourront galement voluer en fonction de la dfinition du cadre rglementaire d'exercice de la
tlmdecine, des retours d'expriences et de l'largissement du champ de dveloppement de la
tlmdecine aux autres modalits de traitement de l'insuffisance rnale chronique terminale.

(2009). Tlradiologie : Pour un dploiement rapide et efficient de solutions scurises. Livre blanc GIXEL-
LESSIS. Neuilly sur Seine LESSIS: 17.
[Link]
[Link]
Dans un contexte budgtaire tendu, les risques de dsertification mdicale et d?ingalit de
traitement des patients deviennent trs proccupants. Ces risques, qui n?pargnent pas plus les
grandes villes que les zones rurales, peuvent tre matriss en repensant les organisations en
concertation avec les professionnels de la sant. La tlradiologie, qui constitue une dclinaison de la
tlsant, peut constituer un soutien technologique au service de la collectivit, tout en s?insrant
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dans le dveloppement d?une conomie numrique exportatrice pour notre pays.

(2010). Dmographie mdicale, rpartition des mdecins sur le territoire. Enjeux pour l'accs aux soins et la
scurit des usagers. Cahiers; 1. Paris CISS: 43 +annexes.
[Link]
g/sites/default/files/101117_ANNEXES_DesertsMedicaux_Cahier2.pdf
L'enqute ralise par le CISS, la FNATH et l'UNAF a consist, cette anne, rassembler le plus grand
nombre dlments disponibles sur la dmographie mdicale, la rpartition des mdecins sur le
territoire, lvolution prvisible de ces installations et a galement port sur les aides linstallation et
au maintien mises en place par lassurance maladie en direction des mdecins afin de les inciter
sinstaller ou se maintenir sur les zones rputes sous denses par les ex-Missions rgionales de
sant. Les donnes exploites dans ce dossier proviennent la fois de celles qui ont fait lobjet dune
publication, en 2010, du Conseil national de lordre des Mdecins, sous la forme datlas rgionaux, et
de celles qui nous ont t transmises par la cinquantaine de CPAM (sur cent) qui ont donn suite aux
requtes formules par nos reprsentants prsents au sein de leurs conseils. Le CISS, la FNATH et
lUnaf souhaitent ainsi exprimer les inquitudes des usagers qui, pour nombre dentre eux, sont
confronts au pril de lloignement de la mdecine de premier recours. (Extrait de la synthse).

(2011). Efficience de la tlmdecine : tat des lieux de la littrature internationale et cadre d'valuation. Note
de cadrage. St Denis La Plaine HAS: 41 , tabl., fig.
[Link]
Cette note de cadrage concerne la mise en uvre dune valuation mdico-conomique de la
tlmdecine par un tat des lieux de la littrature internationale. Cette valuation sinscrit dans une
optique daide la dcision publique. Elle vise apporter des lments de cadrage sur le dploiement
de la tlmdecine en France concernant les trois objectifs suivants : Contribuer la dfinition daxes
prioritaires de dploiement de la tlmdecine partir de lidentification des projets pilotes et
exprimentations les plus efficients ; proposer un cadre dvaluation mdico-conomique en fonction
des indicateurs recenss et dune classification des projets de tlmdecine ; identifier des modles
conomiques afin de proposer des lments permettant dorienter la politique de financement. La
ralisation de cette valuation a pour origine la volont des pouvoirs publics et des acteurs de terrain
de dployer la tlmdecine en France. A la suite du dcret relatif la tlmdecine publi en octobre
2010, la Direction Gnrale de lorganisation des soins a annonc, dbut 2011, la mise en place dun
plan triennal de dploiement national de la tlmdecine. Dans cette dynamique actuelle, les attentes
du demandeur sont doubles : dune part, contribuer alimenter les axes dorientation de la politique
de dploiement de la tlmdecine, et, dautre part, proposer des outils dvaluation des
exprimentations et projets pilotes concernant les aspects mdico-conomiques

(2012). Fonds d'intervention pour la qualit et la coordination des soins (FIQCS). Rapport d'activit 2011. Paris
FIQCS: 77 , tabl., fig.
[Link]
Ce rapport retrace dans une premire partie les lments d'analyse de l'activit gnrale du Fonds
d'intervention pour la qualit et la coordination des soins (FIQCS), puis il reprend chacune des
thmatiques finances par le FIQCS. Enfin, il prsente des fiches exposant, par rgion, l'implantation
des structures finances par le FIQCS eu gard l'offre de soins locale. L'autorisation de dpenses
2011 du FIQCS a t fixe 266 millions d'euros. Le taux de consommation des crdits a t de 98 %.
La nature des actions finances par le FIQCS est trs stable, avec un financement principalement
consacr au niveau national, au DMP (17 % des dpenses globales du FIQCS) et au niveau rgional aux
rseaux de sant (64 % des dpenses globales) et la permanence des soins ambulatoire (7 % des
dpenses globales). Le FIQCS a galement permis aux ARS de soutenir des actions favorisant la
coordination des soins en ville, par un financement accru de projets d'exercice regroup, de nouveaux
modes d'exercice et d'actions de tlmdecine ou sur les systmes d'information.

(2012). La tlmdecine en action : 25 projets passs la loupe. Un clairage pour le dploiement national.
Tome 1 : les grands enseignements. Paris ANAP: 76 , fig., annexes.
[Link]
Destin aux porteurs de projet tlmdecine et aux Agences rgionales de sant (ARS), ce document a
pour ambition de les aider consolider des organisations de tlmdecine existantes ou mettre en
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place de nouveaux projets, au travers du retour d'exprience et de la capitalisation raliss partir de

25 projets matures. Ces derniers sont analyss en portant une attention particulire au projet mdical,
aux aspects organisationnels, techniques, juridiques, financiers, aux ressources humaines, la
gouvernance, la gestion de projet et l'valuation, et dclins en fonction des priorits nationales.
L'analyse met en vidence des situations trs diverses, lies la maturit des organisations. Toutefois,
ce document identifie 5 facteurs cls de succs : un projet mdical rpondant un besoin, un portage
mdical fort soutenu par un coordonnateur, une organisation adapte et protocolise, des nouvelles
comptences valuer et un modle conomique construit. Le document vise galement favoriser
la mise en uvre du Plan national de dploiement de la tlmdecine (rsum de l'diteur).

(2012). Rapport d'analyse des projets article 70. Saint-Denis HAS: 53 , tabl., annexes.
[Link]
03/rapport_analyse_projets_article_70.pdf
L'article 70 de la LFSS 2012 propose des exprimentations visant amliorer l'organisation et la
coordination des parcours de sant des personnes ges afin de prvenir les recours vitables
l'hospitalisation (module 1) et de coordonner les soins en sortie d'hospitalisation (module 2). En tant
qu'valuateur de ces projets, la HAS accompagne les acteurs des projets, ARS et promoteurs. Dans ce
cadre, elle a labor un premier Rapport d'analyse des projets article 70 qui prsente l'analyse globale
des onze projets tels qu'ils ont t adresss la HAS, en s'attachant identifier la prsence des
diffrentes activits et stratgies mises en uvre dans les projets, leur dclinaison et leur cohrence.
Cette analyse a t prsente aux acteurs de projets et discute avec eux, afin de les aider dans leur
travail de maturation des projets.

(2013). Accs aux soins : en finir avec la fracture territoriale. Paris Institut Montaigne: 73 , tabl., fig.
[Link]
Trs onreux, d'une grande complexit institutionnelle et administrative, le systme de soins franais
pche galement par l'archasme de son organisation, caractris par de forts cloisonnements entre
ville et hpital comme entre professionnels de sant. Au-del des problmes vidents de rpartition
sur le territoire des professionnels de sant, la question est sans doute plutt celle du modle
d'organisation des soins en France, qui ne correspond plus aux exigences sociales, dmographiques et
technologiques de notre pays. Face ces dfis et dans un contexte de finances publiques contraint,
comment adapter notre systme de sant ? C'est vers une organisation dcloisonne, rgionalise,
construite autour des besoins des patients qu'il faut s'orienter. Le systme de sant doit galement
s'adapter aux exigences des nouvelles gnrations de professionnels de sant et leur offrir les moyens
d'exercer leur mtier de faon regroupe, en bnficiant de l'apport des nouvelles technologies.

(2013). Efficience de la tlmdecine : tat des lieux de la littrature internationale et cadre d'valuation. Note
de cadrage. St Denis La Plaine HAS: 154 , tabl., fig.
[Link]
La tlmdecine est une forme de pratique mdicale distance fonde sur lutilisation des
technologies de linformation et de la communication, qui fait lobjet depuis 2011 dune stratgie
nationale de dploiement. Les attentes autour de la tlmdecine sont aujourdhui trs importantes
et son dveloppement confronte les pouvoirs publics, les patients et les professionnels de nouvelles
problmatiques, en particulier celle de lvaluation mdico-conomique des projets. La demande de la
DGOS lorigine de ce rapport sinscrit dans une optique daide la dcision publique. A partir dune
revue de la littrature internationale portant sur lvaluation mdico-conomique de la tlmdecine,
sans dlimitation du champ un domaine dapplication spcifique, lobjectif de ce rapport est double :
Raliser un tat des lieux des tudes dvaluation mdico-conomique de la tlmdecine et
apprcier lapport de cette littrature pour alimenter les rflexions concernant la question de
lefficience de cette forme de pratique mdicale, la dfinition daxes de dploiement et lidentification
de modles de financement ; Proposer un cadre dvaluation mdico-conomique afin de favoriser la
mise en uvre dvaluations dans le contexte franais.

(2013). Efficience de la tlmdecine : tat des lieux de la littrature internationale et cadre d'valuation.
Annexes : Elaboration de matrices d'impact des effets attendus de la tlmdecine : applications aux
chantiers prioritaires. Note de cadrage. St Denis La Plaine HAS: 36 , tabl., fig., ann.
[Link]
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La tlmdecine est une forme de pratique mdicale distance fonde sur lutilisation des
technologies de linformation et de la communication, qui fait lobjet depuis 2011 dune stratgie
nationale de dploiement. Les attentes autour de la tlmdecine sont aujourdhui trs importantes
et son dveloppement confronte les pouvoirs publics, les patients et les professionnels de nouvelles
problmatiques, en particulier celle de lvaluation mdico-conomique des projets. La demande de la
DGOS lorigine de ce rapport sinscrit dans une optique daide la dcision publique. A partir dune
revue de la littrature internationale portant sur lvaluation mdico-conomique de la tlmdecine,
sans dlimitation du champ un domaine dapplication spcifique, lobjectif de ce rapport est double :
Raliser un tat des lieux des tudes dvaluation mdico-conomique de la tlmdecine et
apprcier lapport de cette littrature pour alimenter les rflexions concernant la question de
lefficience de cette forme de pratique mdicale, la dfinition daxes de dploiement et lidentification
de modles de financement ; Proposer un cadre dvaluation mdico-conomique afin de favoriser la
mise en uvre dvaluations dans le contexte franais. Ce document rassemble les annexes de ce
rapport d'valuation.

(2014). Vademecum tlmedecine. Paris Conseil National de l'Ordre des mdecins: 21.
[Link]
[Link]/sites/default/files/cn_pdf/septembre2014/master/sources/projet/MEDECINS-
[Link]
Ce Vade-mcum constitue un guide comment sur les aspects juridiques et dontologiques
respecter lors de la construction des projets de tlmdecine et dans sa pratique. Il comporte deux
parties : Lanalyse du CNOM pour lapplication pratique du cadre rglementaire, afin de constituer une
base de doctrine dontologique pour lexamen des contrats de Tlmdecine prvus par le dcret; La
position du CNOM sur des prestations mdicales qui se situent aux confins du cadre rglementaire et
que le CNOM estime ncessaire de rguler.

(2016). La Tlmdecine en action : Construire un projet de tlmdecine. Paris ANAP: 25 , fig., annexes.
[Link]
un-projet-de-telemedecine/
La tlmdecine est un acte mdical distance permettant denvisager des organisations innovantes
au service du patient. Elle permet selon les besoins de rpondre des carences de loffre de soins, de
faciliter laccs lexpertise ou mme damliorer la performance des organisations en place. Aussi,
afin de rpondre aux besoins des porteurs de projets de tlmdecine, quelle que soit la pathologie
ou la population dont ils cherchent amliorer la prise en charge et quels que soient les actes de
tlmdecine mobiliss, lANAP a cherch dfinir une dmarche centre sur la dfinition dun projet
mdical et un processus de prise en charge qui soient adapts toutes les situations.

(2016). Tlmdecine et autres prestations mdicales lectroniques. Paris Conseil National de l'Ordre des
mdecins: 15.
[Link]
Le CNOM constate quau terme de la Grande consultation quil a conduite, 70% des mdecins
indiquent la ncessit dintgrer le numrique dans lorganisation des soins sur les territoires. En
revanche les innovations technologiques ne doivent pas conduire lubrisation des prestations
mdicales. Le CNOM demande donc la fois : - une simplification de la rglementation de la
tlmdecine pour quelle soit intgre concrtement dans les parcours de soins des patients et les
pratiques quotidiennes des mdecins, linstauration dune rgulation des offres numriques en sant,
dans le respect de principes thiques et dontologiques dans le champ sanitaire.

Bapt, G., et al. (2015). Quelle sant domicile pour demain ? Paris Fdration des PSAD: 2 vol (35; 18 ).
[Link] - [Link]
[Link]
La Fdration des PSAD a men un travail prospectif pour comprendre les volutions prvisibles de la
sant domicile dans les prochaines annes. Les traitements domicile sont appels se dvelopper
et des solutions nouvelles vont merger pour accompagner ces volutions. Il apporte un clairage
global autour de 6 dimensions essentielles : le patient son domicile, la coordination des soins, la
tlsant, laccs aux soins, des conomies pour le systme de sant et linnovation du domicile. Sur la
base des conclusions de ce rapport, la fdration a formul trente et une propositions regroupes en
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neuf axes structurants: rpondre l'aspiration des patients et de leur famille tre traits chez eux;
dvelopper la qualit et la scurit des soins et prestations domicile ; promouvoir lgal accs aux
soins domicile sur tout le territoire ; faire bnficier lducation thrapeutique au plus grand nombre
; structurer une offre efficiente dans le parcours de soins du patient ; dvelopper des logiques de
performance et de remboursement en fonction de lutilisation ou de lefficacit ; accompagner la
diffusion de linnovation ; mettre en uvre la tlmdecine ; contribuer au partage des donnes de
sant.

Berland, Y. (2002). La dmographie des professions de sant. Paris MSSPS: 113.

[Link]
Ce rapport sur la dmographie mdicale en France rend compte des rsultats de la Mission
Dmographie des Professions de sant. Bien qu'il constate qu'il n'y a jamais eu autant de
professionnels de sant qu'actuellement, il souligne, pour les annes venir, des risques de pnuries
gographiques et disciplinaires, puisque le numerus clausus 2002 estim 4700 aurait pour
consquence de diminuer de 20 % le nombre des mdecins. De plus, le vieillissement de la population
et le consumrisme mdical ne cessent d'accrotre la demande de soins. Paradoxalement, le rapport
note qu' ct d'un sureffectif provisoire, "de forts contrastes gographiques" apparaissent. Si les
zones urbaines ont une forte densit mdicale, les zones pri-urbaines et rurales sont sous-
mdicalises. Plusieurs voies d'exploration sont proposes pour pallier cette volution : la mise en
place d'incitations financires prennes, la cration d'un collaborateur salari et la multiplication des
autorisations d'exercice en cabinet secondaire. Mais il faudrait lutter contre l'isolement du mdecin en
zone rurale notamment par la tlmdecine, en permettant un maillage des zones concernes par un
rseau haut dbit facilitant le transport rapide d'informations et d'images numrises. Ce document
est disponible sur le site du ministre charg de la sant : [Link] => Actualits /
presse => Les rapports du gouvernement actuel => 2002.

Berland, Y. (2005). Rapport de la Commission dmographie mdicale. Paris MSSPS: 61 , tabl., graph., carte.
[Link]
Ce rapport sur la dmographie mdicale en France rend compte des rsultats de la Commission
dmographie mdicale. Il est articul autour d'une premire partie, qui dessine un tat des lieux de la
rpartition de l'offre de soins mdicaux sur le territoire national ; d'une deuxime partie, qui rsume
les mesures prises au cours des dernires annes, d'une part pour se doter d'outils de pilotage de la
dmographie mdicale, d'autre part pour inciter un exercice dans les territoires dficitaires. La
troisime partie nonce les propositions d'amlioration de la Commission.

Bruguiere, M. T. (2011). Les territoires de sant : rapport d'information. Paris Snat: 81 , ann.
[Link]
L'offre de soins, dans nombre de territoires franais, n'est plus au diapason de la demande. En
s'emparant, son tour, de cette question, la Dlgation du Snat aux collectivits territoriales et la
dcentralisation a souhait l'aborder avec un regard diffrent : celui des lus locaux. Estimant qu'une
politique efficace de protection de la sant ne peut se concevoir sans prendre en compte leur rle et
leurs attentes en la matire, le rapport avance une vingtaine de propositions pour assurer une
rpartition quilibre de l'offre de soins sur l'ensemble des territoires.

Descours, C. (2003). Propositions en vue d'amliorer la rpartition des professionnels de sant sur le territoire.
Paris MSSPS: 40 , ann.
[Link]
Les perspectives dmographiques des professionnels de sant font ds prsent apparatre un
vieillissement et une diminution des effectifs avec, en filigrane, l'apparition de phnomnes de
pnurie sur certains territoires, si aucune mesure n'tait prise. Cette relative dsertification, qui peut
dj tre constate notamment dans certaines zones rurales et priurbaines, s'inscrit dans une
volution plus gnrale de la socit et de la place que les professionnels de sant y occupent. Ce
rapport dresse d'abord un tat des lieux de la rpartition des professionnels de sant sur le territoire
franais, puis analyse les raisons de cette ingale rpartition. Il propose ensuite une panoplie de
mesures incitatives s'adaptant la diversit des situations locales.

Hazebroucq, V. (2003). Rapport sur l'tat des lieux en 2003 de la tlmdecine franaise. Paris Ministre charg
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de la Recherche: 30.
[Link]
Ce rapport rpond 3 objectifs principaux : dcrire et catgoriser les applications existantes en France
mtropolitaine, dcrire les rseaux de tlcommunication et les dbits utiliss, faire le point sur l'offre
industrielle franaise existante en termes de matriels.

Hubert, E. (2010). Rapport de la Mission de concertation sur la mdecine de proximit. Paris La documentation
franaise: 186.
[Link]
Mme Elisabeth Hubert, ancien ministre, a t charge par le Prsident de la Rpublique d'une mission
portant sur la mdecine de proximit, autour de trois objectifs : relancer le dialogue avec les mdecins
libraux, permettre un trs large change avec les professionnels concerns et apporter des rponses
aux volutions structurelles que connait la mdecine ambulatoire depuis de nombreuses annes. Sur
la base de nombreuses rencontres et de dplacements sur le terrain, l'auteur prsente un tat des
lieux des conditions d'exercice de la mdecine de proximit, et propose un ensemble de mesures :
simplification des conditions d'exercice, modernisation des systmes d'information, appui l'exercice
regroup des professionnels, valorisation de la formation initiale de mdecine gnrale, aide
l'installation dans les zones sous-mdicalises.

Kornblum, C., et al. (2000). Tlmdecine & Urgences. Paris MSSPS: pag. mult , 2 ann.
[Link]
De nombreux services d'urgence ou de radiologie utilisent dj les technologies de l'information et de
la communication, notamment dans le domaine de la neurochirurgie et de la traumatologie. Pour
concourir une diffusion encore plus grande de la tlmdecine et son extension l'ensemble de
l'activit des services d'urgence, la direction de l'hospitalisation et de l'organisation des soins a fait
raliser une tude intitule "Principes directeurs de l'utilisation de la tlmdecine pour les urgences".
L'analyse dveloppe par la socit Expertech et pilote par un comit runissant des professionnels
de services d'urgences, a eu pour objectif d'tudier et d'valuer les applications de tlmdecine
existantes en France et l'tranger. Elle est riche d'enseignements. Le triple intrt de la
tlmdecine pour les urgences est clairement dmontr. Son utilisation est tout fait approprie aux
diffrentes squences de la chane des urgences qui va du pr-hospitalier, l'accueil dans les services
d'urgence o sont pratiqus les examens, jusqu' la prise en charge sur le mme site ou le transfert
dans un autre tablissement et mme jusqu'au post-hospitalier facilitant une coordination des soins
entre les multiples intervenants. L'interoprabilit des sous-systmes d'information est donc
prioritaire. C'est pourquoi un cahier des charges concernant la mise en ?uvre de la tlmdecine dans
les services d'urgence est actuellement en cours de rdaction par un groupe d'experts hospitaliers
partir de cette tude. Il sera prochainement publi et aidera les structures de soins effectuer leurs
appels d'offres. Mais de nombreuses recommandations figurent ds maintenant dans le prsent
document. Elles intresseront l'ensemble des acteurs du terrain, professionnels de sant et directions
d'tablissements : dans le domaine complexe des urgences, il est clair, que notamment, l'organisation
fonctionnelle doit prcder la mise en place des outils techniques. Ces recommandations seront
galement utiles aux agences rgionales de l'hospitalisation et services dconcentrs du ministre qui
suivent la mise en ?uvre des SROS Urgences (d'aprs la prface).

Lasbordes, P. (2009). La tlsant : un nouvel atout au service de notre bien-tre. Un plan quinquennal co-
responsable pour le dploiement de la tlsant en France. Paris Ministre de la sant: 247.
[Link]
Aprs avoir prsent les enjeux et les bnfices attendus de la tlsant, et men une analyse critique
de plus de six cent rfrences mondiales, la mission s'est attache prsenter : 15 recommandations
concrtes pour un dploiement immdiat de la tlsant ; une structure de gouvernance forte ; une
feuille de route 2010-2014.

Laurent, P. et Schroeder, J. B. (2012). Tlmdecine 2020 : modles conomiques pour le tlsuivi des maladies
chroniques. Courbevoie Snitem: 64 , tabl., graph., fig.
[Link]
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Les industriels du matriel mdical, runis au sein du Snitem, et les entreprises du numrique,
reprsentes par le Syntec Numrique, ont prsent hier un Livre blanc sur la tlmdecine focalis
sur le suivi des pathologies chroniques (diabte, bronchite chronique, insuffisance cardiaque, etc.).
Maintenant que les technologies existent et que le cadre rglementaire a t clairci, les industriels
demandent aux autorits de sant certaines garanties afin de sortir du stade exprimental actuel et de
commencer des oprations pilotes de plus grande envergure. En s'appuyant sur des expriences
trangres, les auteurs du Livre blanc esquissent cinq scnarios de prise en charge, qui supposent des
volutions plus ou moins importantes. Dans tous les cas, ces programmes aboutissent une
amlioration du confort de vie des patients et une baisse du nombre d'hospitalisations. De plus, des
rductions de cots sont constates grce une moindre consommation des ressources hospitalires.
Ce livre blanc prsente 6 projets europens et amricains, axs sur la prise en charge de maladies
chroniques. Cette revue aborde les organisations et dispositifs dploys, les modles conomiques
mis en place et l'valuation mdico-conomique effectue. Les auteurs identifient enfin des facteurs
cls de succs, ncessaires au dploiement grande chelle de la tlmdecine pour le suivi de
maladies chroniques : une vision stratgique porte par une impulsion politique forte et continue dans
le temps ; l'implication de l'organisme payeur dans la structuration de la filire ; le portage du projet
par les professionnels de sant ; le rle pivot du mdecin traitant (ou spcialiste) dans l'inclusion du
patient, et son suivi tout au long du parcours au travers le dossier mdical informatis.

Legmann, M. (2010). Dfinition d'un nouveau modle de la mdecine librale. Paris La documentation
Franaise: 46, graph., annexes.
[Link]
Le Docteur Michel Legmann, Prsident du Conseil national de l'Ordre des mdecins, a t charg par
le Prsident de la Rpublique de mener une rflexion concernant la dfinition d'un nouveau modle
de la mdecine librale qui prenne en compte les aspirations des futurs mdecins et permette de
rpondre de faon plus efficiente la demande de soins de la population. La mission prsente un tat
des lieux de l'exercice de la mdecine en France qui confirme la crise profonde que connat la
mdecine librale : vieillissement des mdecins en exercice, manque d'attractivit de l'activit
librale, baisse inluctable des effectifs mdicaux dans les dix prochaines annes compte tenu de
l'volution la baisse du numerus clausus de 1972 1999, etc. Sur cette base, la mission propose un
certain nombre de mesures qui s'articulent autour de trois axes : la formation, initiale et continue,
l'installation et les conditions d'exercice.

Lopez, A. et Compagnon, C. (2015). Pertinence et efficacit des outils de politique publique visant favoriser
l'observance. Paris, Igas.
[Link]
037R_Pertinence_et_efficacite_des_outils_de_politique_publique2_.pdf
En novembre 2014, le Conseil d'Etat avait annul "pour incomptence" les deux arrts dcris qui
liaient la prise en charge de la Scurit sociale la bonne utilisation d'un dispositif mdical dit
pression positive continue (PPC) pour le traitement des apnes du sommeil. Il s'agissait de placer tous
les patients portant ce masque la nuit sous "tl-observance", avec l'emploi des objets connects.
Aprs cet pisode, la ministre de la Sant Marisol Touraine avait missionn l'IGAS sur l'observance des
traitements par les patients, notamment lorsque ils sont atteints d'une maladie chronique. Dans son
rapport de juillet 2015, rendu public seulement un an plus tard, la mission "dconseille fortement" de
moduler les remboursements des soins en fonction de l'observance des traitements. Outre les
difficults qui seraient rencontres, notamment pour mesurer l'observance, ce serait s'engager sur
une pente dont le terme et les consquences sont difficiles apprcier.
En revanche, l'IGAS prconise de dvelopper l'ducation thrapeutique et l'accompagnement des patients, et
de "dvelopper une offre de tl-suivi-accompagnement" s'appuyant sur l'essor des appareils
connects, qui vont "profondment modifier l'exercice de la mdecine". Le financement de ces
services de tl-suivi-accompagnement dpendrait de leur performance, "faisant de la bonne
observance et de la fidlisation des patients des marqueurs de la qualit de l'accompagnement".

Lucas, J. (2009). La tlmedecine. Les prconisations de l'Ordre national des mdecins. Paris CNOM: 21,
annexes.
[Link]
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pratiques les innovations technologiques, afin d'amliorer l'exercice de leur art au service de la qualit
des soins et de la prise en charge des patients. La diffusion de ces technologies a toujours conduit de
nouvelles faons d'exercer la mdecine. La tlmdecine, qui n'est que l'application des technologies
de l'information et de la communication (TIC) l'exercice de la mdecine, apparat donc aujourd'hui
comme l'un des moyens de faire face de nouveaux besoins. Faire face aux dfis qui doivent
dsormais tre relevs par notre systme de sant, contribuer une amlioration d'un accs
quitable aux soins, leur coordination, leur qualit en termes d'expertise, au maintien dans leur
lieu de vie et en autonomie de patients gs ou atteints de pathologies chroniques. Sous ce double
aspect, le dveloppement de l'utilisation des TIC dans le domaine de la sant jouera la fois sur les
pratiques mdicales et sur l'organisation du systme de soins. C'est la raison pour laquelle le Conseil
national de l'ordre des mdecins dveloppe dans ce Livre Blanc son analyse de ce nouveau mode de
pratique et, plus encore, les conditions ncessaires pour garantir la qualit de la mdecine et le
respect des droits des patients, ce qui est le propre de la dontologie mdicale qu'il a la charge de
faire respecter. A cet gard, le Conseil national de l'ordre des mdecins souligne d'emble que les
nouvelles technologies ne sont que des outils supplmentaires au service de la mdecine qui est elle
mme au service des malades. Tout en considrant la tlmdecine comme l'un des moyens de faire
face aux dfis poss notre systme de sant, l'Ordre souligne que sa mise en ?uvre doit tre
exclusivement guide par des besoins et une ncessit justifis. La pratique de la tlmdecine ne
saurait venir contribuer une dshumanisation de la relation avec le patient. Aucune technologie ne
peut venir remplacer la relation humaine, interpersonnelle et singulire qui doit rester le fondement
mme de l'exercice de la mdecine. C'est pourquoi, aux yeux de l'Ordre, la place de la tlmdecine
dans notre systme de sant doit tre dfinie en troite concertation avec les mdecins et les autres
professionnels de sant, avec le concours des patients et de leurs reprsentants. Cette concertation
doit s'largir vers les industriels spcialiss et les organisations qui les reprsentent afin de vrifier
l'adquation et la fiabilit des dispositifs envisags avec l'tat de l'art technologique.

Maurey, H., et Fichet, J. L. (2013). Rapport d'information sur la prsence mdicale sur l'ensemble du territoire.
Paris Snat: 133, ann.
[Link]
Ralis dans le cadre de la commission du dveloppement durable, qui a notamment en charge les
questions d'amnagement du territoire, ce rapport d'information du Snat sur la prsence mdicale
sur l'ensemble du territoire fait le constat d'une situation inacceptable et qui ne va pas en s'amliorant
- difficults dans l'accs aux soins, ingalits dans la rpartition territoriale de l'offre de soins et baisse
significative de la dmographie mdicale. Les snateurs proposent plusieurs mesures radicales pour
lutter contre le flau des dserts mdicaux. Ils voquent notamment une extension aux mdecins du
conventionnement slectif en fonction de la nature des zones d'installation ainsi que l'obligation pour
les spcialistes, la fin de leurs tudes, d'exercer pendant deux ans dans les hpitaux sous-dots. Ils
ne croient plus aux mesures incitatives, qu'ils jugent opaques, complexes et inefficaces. Ils souhaitent
flcher l'installation des professionnels de sant vers des territoires dlaisss, procd qui a dj t
appliqu aux infirmiers en 2008 avec de bons rsultats (un bond des installations de 33 % dans les
dserts mdicaux en trois ans). Mais tous les gouvernements ont recul devant le poids lectoral des
mdecins et les grves des internes. Parmi les autres recommandations retenues : la ncessit
d'intervenir ds prsent auprs des tudiants, afin de les prvenir que ce systme pourrait tre
gnralis si les dserts mdicaux s'tendent d'ici la fin de la lgislature ; rgionaliser le numerus
clausus en fonction des besoins des territoires, alors qu' l'heure actuelle ce mcanisme ne dfinit les
effectifs d'tudiants en mdecine qu'au niveau national. Les autres propositions du groupe de travail
sont plus consensuelles. Elles consistent notamment encourager le travail en quipe et la
coopration entre professionnels de sant, les nouvelles formes d'exercice, les transferts d'actes entre
professions de sant, la tlmdecine, l'allongement de la dure d'activit des mdecins en exonrant
les retraits actifs du paiement des cotisations d'assurance vieillesse, ou encore rformer les tudes
de mdecine et crer au niveau dpartemental une commission de la dmographie mdicale.

Midy, F. (1998). La tlmdecine : document de travail. Rapport Credes. Paris CREDES: 31.

A partir d'une revue de la littrature (Medline, base documentaire du Credes...), ce rapport

bibliographique tente tout d'abord une dfinition de la tlmdecine. Il en dfinit ensuite les enjeux,
et fait une valuation la fois mdicale et conomique de ces nouvelles technologies. Il comprend, en
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annexe, une liste des exprimentations en obsttrique, ainsi qu'une valuation des rsultats du point
de vue des dcideurs publics, des patientes et des praticiens.

Midy, F., et al. (2000). Tlmdecine & valuation. Aide mthodologique l'valuation de la tlmdecine.
Rapport Credes. Paris M.S.S.P.S.: 80, tabl., graph.
[Link]
Ce document a pour objectif de faire le point sur ce qu'il est raisonnable d'envisager en termes
d'valuation dans le domaine de la tlmdecine. Dans un premier chapitre, les auteurs dlimitent
leur champ de rflexion en prcisant les attendus de l'implantation de la tlmdecine ainsi que les
objectifs de l'valuation. Ils font le point dans un deuxime chapitre sur les expriences qui sont
dcrites dans la littrature internationale et qui prsentent un intrt en termes d'valuation. Les
expriences (franaises et qubcoises), pour lesquelles les auteurs ont men une observation directe
sont synthtises dans le troisime chapitre. Le quatrime chapitre dcline quelques principes
gnraux d'valuation sous la forme d'un guide d'aide l'valuation illustr par des exemples.

Pare, G., et al. (2009). Revue systmatique des effets de la tlsurveillance domicile dans le contexte du
diabte, des maladies pulmonaires et des maladies cardiovasculaires. Montreal AETMIS: 75 , tabl.,
annexes.
[Link]
Vu la croissance des maladies chroniques, la hausse du vieillissement de la population et la politique
du virage ambulatoire, un grand nombre de patients atteints de maladies chroniques pourraient
bnficier d?un suivi distance domicile au Qubec. Parmi les maladies les plus frquentes figurent
le diabte, les maladies pulmonaires, l?insuffisance cardiaque et L?hypertension artrielle. Dans ce
contexte, la question de l?efficacit d?une telle intervention se pose. La prsente revue systmatique
se donne donc pour objectif de dterminer quels sont les effets associs la tlsurveillance
domicile. Ces effets seront examins la lumire des tudes ayant port sur trois grandes catgories
de maladies et leurs associations, soit le diabte (type 1, type 2 et gestationnel), les maladies
pulmonaires (asthme et maladie pulmonaire obstructive chronique) ainsi que les maladies
cardiovasculaires (insuffisance cardiaque et hypertension). L?valuation explore galement les
conditions de russite de ce mode de prestation des soins.

Simon, O. et Acker, D. (2008). La place de la tlmdecine dans l'organisation des soins. Paris Mssps: 160, tabl.,
fig., cartes, ann.
[Link]
Ce rapport concerne l'organisation des soins par la tlmdecine, acte mdical distance tel qu'il est
dfini dans la loi du 14 aot 2004. Aprs avoir dfini le cadre dontologique et juridique de la
tlmdecine et son impact sur l'exercice professionnel (1), le rapport fera l'tat des lieux des
ralisations et des projets en France, en Europe et dans le Monde (2), analysera les enjeux court et
moyen termes, en dclinant les besoins par grands types de pathologies et par modes d'activit de
soins (3), identifiera les principaux freins son dveloppement (4), fera des recommandations pour
que sa mise en uvre soit la plus efficiente possible afin d?apporter une rponse adapte aux
attentes des patients et des professionnels de sant (5).

Etudes trangres

Ouvrages

(2010). Telemedicine : Opportunities and developments in Member States, Genve : OMS

[Link]
Telemedicine can bring the eyes of a specialist to examine a critically ill patient from halfway around
the globe. It bridges the distance between people and the best health care available and can be
applied to a vast range of situations - from home care to specialized clinical settings. This second
volume of the Global Observatory for eHealth series examines trends in the uptake of telemedicine,
from the well established to newly emerging telemedicine applications. With an emphasis on the
needs of developing countries, it looks to the future with an analysis of the strategic actions required

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to support and strengthen telemedicine in countries. The publication is targeted at telemedicine

practitioners and policymakers in health and information technology, as well as health care
practitioners interested in adopting telemedicine services. The data and information would be useful
for planning and evaluation of telemedicine service (rsum des diteurs)

Capelli, O. (2012). Primary Care at a Glance - Hot Topics and New Insights, [Link]
[Link]
[Link]
The content of the book is organized according to 5 attributes (accessibility, comprehensiveness,
coordination, continuity and accountability), to give the reader an international overview of hot topics
and new insights in Primary Care, all around the world.

Gatrell, A. C. (2011). Mobilities and health, Farnham : Asghate Publishing Limited

[Link]
1&title_id=10356&edition_id=13655
Looking at health and health care in a new way, this book examines health risks and benefits as
encountered 'on the move' rather than focusing on the risks and benefits incurred at fixed locations.
The provision and utilization of health care is also investigated, as produced/delivered and
consumed/accessed in mobile settings. Engaging with the contemporary concern with 'mobilities' this
book covers many forms of movement and flow, including movements of people, disease, information
and health care. The issues and problems which are considered - whether re-emerging infections,
displaced persons, or the 'risks' of globalised travel - are of current and ongoing concern. Drawing on
three main disciplines, geography, sociology, and epidemiology, author Tony Gatrell makes strong
connections between these areas of inquiry, drawing on (for example) social theorising, geographical
concepts, and epidemiological methods and data. The book will be of interest to the growing number
of geographers working on the geography of health, along with social scientists involved in the
mobilities 'turn'. More broadly, as issues of global public health that invariably involve the movements
of people, goods, viruses and information continue to hit the headlines, the book is both timely and of
policy relevance (4e de couverture).

Klazinga, N. (2010). Improving Value in Health Care: Measuring Quality, Paris : OCDE
[Link] -
[Link]
lse
This report is about how to improve quality in health care ? a vital objective for health systems
everywhere. Quality in health care is multifaceted and has various perspectives. Every patient has a
right to receive timely, safe and effective care. Patients also have a right to be informed about the care
process and about its risk and benefits. Those who fund and manage health care have a duty to ensure
that scarce health care resources are used judiciously and wisely for the greatest public good. The
drive to improve quality does not stem simply from the fact that it is the right thing to do. Increased
public involvement and awareness have been accompanied by a series of landmark critiques on
quality in health care. The larger role of ICTs in health care systems has also meant that information
relating to quality is now more abundant. Added to this, cost pressures on health systems have
increased dramatically and OECD countries now spend more on health than ever before. Poor-quality
health care ruins peoples lives or kills them (Institute of Medicine). It is also wasteful and expensive
and results in squandered opportunities to treat those with the greatest need and least capital. As
such, quality improvement in health care matters to the economy and to society. But how is better
quality in health care achieved? How do we ensure that the views and experience of those who use
health services promote improvements in quality? How do we measure quality and what are the
benefits of ensuring that quality improvement policies are adequately linked with other related policy
imperatives? Based on the experience of the OECD Health Care Quality Indicator Project, this report
provides a template for policy makers and officials who are interested in improving the quality of their
health care systems. The report does not advocate a-one-size-fits-all? approach to quality
improvement; rather it points to certain key elements that make up effective quality improvement
strategies ? principally, the requirement to align health care quality standards with national and local
information systems developments, and to ensure that national strategies and policies aimed at
improving quality are linked to robust quality indicators.
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Lissauer, R. . et Kendall, L. . (2002). New Practitioners in the future health service : exploring roles for
practitioners in primary and intermediate care, Londres : IPPR

This pamphlet forms part of IPPR's future health worker project, exploring the implications for the
workforce of providing patient-centred care. It draws together a set of forward-looking visions of new
types of practitioners and new roles that may be required in the future health service. Individually, the
papers will be of interest to professionals and managers within primary care, intermediate care and
public health and those involved in the development of patients' role in self-care. The roles addressed
are : the lay parson as healthcare practitioner, the telecarer, the consultant pharmacist and the
pharmacy technician, the public health leader, the intermediate care practitioner and knowledge
brokers.

Articles

Aarnio, P., et al. (2000). "A new method for surgical consultations with videoconference." Annales Chirurgiae Et
Gynaecologiae(89): 336-340, 332 tabl.

Abbott, P. A. et Liu, Y. (2013). "A scoping review of telehealth." Yearb Med Inform 8: 51-58.

OBJECTIVES: This scoping review of the telehealth literature over the past year was conducted to
provide a snapshot of some of the current developments in the field. As with any scoping review, only
a subset of papers was examined, and the rigorous methods of a systematic review are not applied.
METHODS: We surveyed selected dimensions of the current literature, specifically targeting telehealth
or eHealth interventions at the patient (or micro) level in this scoping review. Considering the lack of
clarity around the terms like mHealth, eHealth, telehealth, and telemedicine, efforts were made
understand and harmonize the terminology as part of the review process. RESULTS: A total of 171
papers that matched the search criteria were culled from the literature. After discussion and debate, a
total of 26 papers were retained and classified into at least one of 5 conceptual categories that were
derived form a concept analysis. The five categories are Preventive and Therapeutic Effects; Health
Service Utilization; Challenges & Opportunities for Enhanced User Centered Design; Low-powered
studies/inconclusive evidence; and Future trends in telehealth. Each of these 5 concept categories are
discussed to provide a better understanding of present opportunities, challenges, and the overall
prospects for telehealth advancement. CONCLUSIONS: The field is expanding and maturing rapidly.
There is a need for larger scale studies that balance rigor while reducing translational latency.
Additional attention to implementation science methods is recommended as global telehealth
projects accelerate.

Agboola, S., et al. (2015). "Heart failure remote monitoring: evidence from the retrospective evaluation of a
real-world remote monitoring program." J Med Internet Res 17(4): e101.

BACKGROUND: Given the magnitude of increasing heart failure mortality, multidisciplinary

approaches, in the form of disease management programs and other integrative models of care, are
recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone
support or telemonitoring or a combination of both, is fast becoming an integral part of many disease
management programs. However, studies reporting on the evaluation of real-world heart failure
remote monitoring programs are scarce. OBJECTIVE: This study aims to evaluate the effect of a heart
failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and
mortality in a retrospective database review of medical records of patients with heart failure receiving
care at the Massachusetts General Hospital. METHODS: Patients enrolled in the CCCP heart failure
monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care
patients. Control patients received care from similar clinical settings as CCCP patients and were
identified from a large clinical data registry. The primary endpoint was all-cause mortality and
hospitalizations assessed during the 4-month program duration. Secondary outcomes included
hospitalization and mortality rates (obtained by following up on patients over an additional 8 months
after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of
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stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary
outcomes. RESULTS: A total of 348 patients were included in the time-to-event analyses. The baseline
rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared
with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard
ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained
consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was
also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33,
95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show
residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or
hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31). CONCLUSIONS: CCCP was associated with
significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120
days of the program. However, these effects did not persist beyond the 120-day program duration.

Agrawal, A., et al. (2011). "Systematic survey of discrepancy rates in an international teleradiology service."
Emerg Radiol 18(1): 23-29.

International teleradiology services (ITS) to the United States are based on the principle of deploying
American board-certified radiologists across global time zones to optimally distribute the workload.
While errors may be reduced by circumventing the traditional night call, there is limited evidence on
the actual error rates of teleradiology groups. We have a comprehensive quality assurance (QA)
process in our practice, which includes a review of discrepancies between preliminary reports and the
final reports by the on-site radiologists. We analyzed the discrepancy QA data to determine the error
rates. Archived QA data for 126,449 cases over a period of 1 year (2008) were analyzed for the
discrepancy rate, nature of errors, and possible contributory factors. The scores ranged from 0 (no
error) to 5 (clinically significant in the acute setting) based on the level of clinical significance. A novel
modified Lorenz plot was used to estimate the degree of underreporting and to estimate the true
error rate. An internal review of 200 cases was performed to validate the findings. Of the total, there
was a total of 227 confirmed errors (0.18%, 95% CI, 0.16 to 0.20). Of these, the majority were levels 2
and 3 (minor error and error of long-term significance but not in the acute setting). Even after
correction for underreporting, error rates were less than 1% for clinically significant errors. ITS is
associated with very low rates of clinically significant errors. Due to limited feedback, particularly for
minor errors, an internal review is important.

Aguas Peris, M., et al. (2015). "Telemedicine in inflammatory bowel disease: opportunities and approaches."
Inflamm Bowel Dis 21(2): 392-399.

This review article summarizes the evidence about telemedicine applications (e.g., telemonitoring,
teleconsulting, and tele-education) in the management of patients with inflammatory bowel disease
(IBD), and we aim to give an overview of the acceptance and impact of these interventions on health
outcomes. Based on the literature search on "inflammatory bowel disease," "Crohn's disease" and
"ulcerative colitis" in combination with "e-health," "telemedicine," and "telemanagement," we
selected 58 titles and abstracts published up to June 2014 and searched in PubMed, EMBASE,
MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts were
screened for a set of inclusion criteria: e-health intervention, IBD as the main disease, and a primary
study performed. Finally, 16 were included for full reading, data extraction, and critical appraisal of
the evaluation. Most studies use telemonitoring (home telemanagement system or web portal) and
telecare (real-time telephone and image) as telemedicine applications and assessed the feasibility and
acceptance of these systems, adherence to treatment, quality of life, and patient knowledge,
particularly in patients with ulcerative colitis. Furthermore, some of these studies evaluated the
patients' empowerment, health care costs, and safety of telemonitoring in IBD. In conclusion, the
health outcomes of telemedicine applications in IBD suggest that these could be implemented in
clinical practice because they are safe and feasible applications that are well accepted by the patient
and improve adherence, quality of life, and disease knowledge. Further studies with large sample sizes
and complex diseases are needed to confirm these results.

Amatya, B., et al. (2015). "Effectiveness of telerehabilitation interventions in persons with multiple sclerosis: A
systematic review." Mult Scler Relat Disord 4(4): 358-369.
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BACKGROUND: Telerehabilitation, a service delivery model using telecommunications technology to

provide therapy at a distance, is used in persons with multiple sclerosis (pwMS), but evidence for their
effectiveness is yet to be determined. OBJECTIVE: To investigate the effectiveness and safety of
telerehabilitation intervention pwMS. METHOD: A comprehensive literature search was conducted
using medical and health science electronic databases. Three reviewers selected potential studies and
independently assessed the methodological quality. A meta-analysis was not possible due to
heterogeneity amongst included trials, and a qualitative analysis was performed for best evidence
synthesis. RESULTS: Ten RCTs and 2 observational studies (n=564 participants) investigated a wide
variety of telerehabilitation intervention in pwMS, which included: physical activity; educational,
behavioural and symptom management programmes. All studies scored "low to moderate" on the
methodological quality assessment implying high risk of bias. Overall, the review found low level
evidence for the effectiveness of telerehabilitation on reducing short-term disability and reducing
and/or improving symptoms, such as fatigue. There was low level evidence suggesting some benefit of
telerehabilitation in improving functional activities; improving symptoms in the longer-term; and
psychological outcomes and quality of life. There is limited data on safety, process evaluation and no
data on cost-effectiveness of telerehabilitation. CONCLUSIONS: A wide range of telerehabilitation is
used in pwMS, however, the quality of evidence on these interventions was low. More robust trials
are needed to build evidence about these interventions.

Arif, M. J., et al. (2014). "A review on the technologies and services used in the self-management of health and
independent living of elderly." Technol Health Care 22(5): 677-687.

As the number of aged people is rapidly growing, the need for health and living care of aged people
living alone becomes imperative. The telecare systems are able to provide flexible services for older
people suffering from chronic diseases, but are largely user group oriented. However, it is common in
elderly to show symptoms of a combination of (chronic) diseases. Moreover, elderly are totally
dependent on a third person as they are unable to perform a number of basic functions at home. They
also feel cutt off from the social fabric. Old people living in remote places typically use telephone that
dials a social alarm control center or mobile social alarm systems and monitoring systems. This study
examines the existing solutions related to elderly assistance and proposes an advanced solution based
on web technology for the self-management of health and independent living of elderly.

Armfield, N. R., et al. (2015). "The clinical use of Skype--For which patients, with which problems and in which
settings? A snapshot review of the literature." Int J Med Inform 84(10): 737-742.

BACKGROUND: Low-cost and no-cost software-based video tools may be a feasible and effective way
to provide some telemedicine services, particularly in low-resource settings. One of the most popular
tools is Skype; it is freely available, may be installed on many types of devices, and is easy to use by
clinicians and patients. While a previous review found no evidence in favor of, or against the clinical
use of Skype, anecdotally it is believed to be widely used in healthcare for providing clinical services.
However, the range of clinical applications in which Skype has been used has not been described. AIM:
We aimed to identify and summarize the clinical applications of Skype. METHODS: We reviewed the
literature to identify studies that reported the use of Skype in clinical care or clinical education. We
searched three electronic databases using the single search term "Skype". RESULTS: We found 239
unique articles. Twenty seven of the articles met our criteria for further review. The use of Skype was
most prevalent in the management of chronic diseases such as cardiovascular diseases and diabetes,
followed by educational and speech and language pathology applications. Most reported uses were in
developed countries. In all but one case, Skype was reported by the authors to be feasible and to have
benefit. However, while Skype may be a pragmatic approach to providing telemedicine services, in the
absence of formal studies, the clinical and economic benefits remain unclear.

Baak, J. P. A., et al. (2000). "Experience with a dinamic inexpensive video-conferencing system for frozen
section telepathology." Analytical Cellular Pathology(21): 169-175, 163 tabl.

Baardseng, T. (2004). "Telemedicine and eHealth in Norway: administration and delivery of services." Int J
Circumpolar Health 63(4): 328-335.
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OBJECTIVES: This article reviews the situation in Norway concerning the administration and delivery of
telemedicine and eHealth. METHODS AND RESULTS: By introducing the Norwegian hospital reform
implemented in January 2002, the review provides the background allowing to understand the shift in
strategy within this field in Norway. It also provides a historical context regarding the use and
development of telemedicine in Norway. Since the implementation of the hospital reform, it can be
argued that, presently, there has been a significant change in strategy from what can be described as a
"muddling through"-strategy to a more rational approach, based on common and clearly defined
goals. CONCLUSIONS: The hospital reform can be regarded as an important crossroads for the use of
information and communication technology in Norway. The hypothesis put forward is that the
development since the reform was implemented has strengthened both the willingness and the ability
to make rational choices and take important steps forwards regarding the use of information and
communication technology in the health sector in Norway, when discussing both telemedicine and
eHealth.

Bacigalupe, G. (2011). "Is there a role for social technologies in collaborative healthcare?" Fam Syst Health
29(1): 1-14.

The exponential growth, variety, and sophistication of the information communication technologies
(ICTs) plus their growing accessibility are transforming how clinical practitioners, patients, and their
families can work together. Social technologies are the ICTs tools that augment the ability of people to
communicate and collaborate despite obstacles of geography and time. There is still little empirical
research on the impact of social technologies in the case of collaborative health. Defining a set of
social technologies with potential for developing, sustaining, and strengthening the collaborative
health agenda should prove useful for practitioners and researchers. This paper is based on an
extensive review of the literature focusing on emerging technologies and the experience of the author
as a consultant to health care professionals learning about social technologies. A note of caution is
required: the phenomenon is complex and hard to describe in writing (a medium very different from
the technologies themselves). Hardware and software are in continuous development and the
iterative adaptation of the emergent social technologies for new forms of virtual communication.

Bahaadinbeigy, K., et al. (2010). "MEDLINE versus EMBASE and CINAHL for telemedicine searches." Telemed J E
Health 16(8): 916-919.

INTRODUCTION: Researchers in the domain of telemedicine throughout the world tend to search
multiple bibliographic databases to retrieve the highest possible number of publications when
conducting review projects. Medical Literature Analysis and Retrieval System Online (MEDLINE),
Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature
(CINAHL) are three popular databases in the discipline of biomedicine that are used for conducting
reviews. Access to the MEDLINE database is free and easy, whereas EMBASE and CINAHL are not free
and sometimes not easy to access for researchers in small research centers. OBJECTIVE: This project
sought to compare MEDLINE with EMBASE and CINAHL to estimate what proportion of potentially
relevant publications would be missed when only MEDLINE is used in a review project, in comparison
to when EMBASE and CINAHL are also used. METHODS: Twelve simple keywords relevant to 12
different telemedicine applications were searched using all three databases, and the results were
compared. RESULTS: About 9%-18% of potentially relevant articles would have been missed if
MEDLINE had been the only database used. CONCLUSIONS: It is preferable if all three or more
databases are used when conducting a review in telemedicine. Researchers from developing countries
or small research institutions could rely on only MEDLINE, but they would loose 9%-18% of the
potentially relevant publications. Searching MEDLINE alone is not ideal, but in a resource-constrained
situation, it is definitely better than nothing.

Baig, M. M., et al. (2015). "Mobile healthcare applications: system design review, critical issues and challenges."
Australas Phys Eng Sci Med 38(1): 23-38.

Mobile phones are becoming increasingly important in monitoring and delivery of healthcare
interventions. They are often considered as pocket computers, due to their advanced computing
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features, enhanced preferences and diverse capabilities. Their sophisticated sensors and complex
software applications make the mobile healthcare (m-health) based applications more feasible and
innovative. In a number of scenarios user-friendliness, convenience and effectiveness of these systems
have been acknowledged by both patients as well as healthcare providers. M-health technology
employs advanced concepts and techniques from multidisciplinary fields of electrical engineering,
computer science, biomedical engineering and medicine which benefit the innovations of these fields
towards healthcare systems. This paper deals with two important aspects of current mobile phone
based sensor applications in healthcare. Firstly, critical review of advanced applications such as; vital
sign monitoring, blood glucose monitoring and in-built camera based smartphone sensor applications.
Secondly, investigating challenges and critical issues related to the use of smartphones in healthcare
including; reliability, efficiency, mobile phone platform variability, cost effectiveness, energy usage,
user interface, quality of medical data, and security and privacy. It was found that the mobile based
applications have been widely developed in recent years with fast growing deployment by healthcare
professionals and patients. However, despite the advantages of smartphones in patient monitoring,
education, and management there are some critical issues and challenges related to security and
privacy of data, acceptability, reliability and cost that need to be addressed.

Bastardot, F., et al. (2015). "[Social networks and medicine]." Rev Med Suisse 11(493): 2050-2052, 2054.

Social networks (social media or #SoMe) have entered medical practice within the last few years.
These new media--like Twitter or Skype--enrich interactions among physicians (telemedicine), among
physicians and patients (virtual consultations) and change the way of teaching medicine. They also
entail new ethical, deontological and legal issues: the extension of the consultation area beyond the
medical office and the access of information by third parties were recently debated. We develop here
a review of some social networks with their characteristics, applications for medicine and limitations,
and we offer some recommendations of good practice.

Batterham, P. J., et al. (2015). "Developing a roadmap for the translation of e-mental health services for
depression." Aust N Z J Psychiatry 49(9): 776-784.

OBJECTIVE: e-Mental health services have been shown to be effective and cost-effective for the
treatment of depression. However, to have optimal impact in reducing the burden of depression,
strategies for wider reach and uptake are needed. METHOD: A review was conducted to assess the
evidence supporting use of e-mental health programmes for treating depression. From the review,
models of dissemination and gaps in translation were identified, with a specific focus on characterising
barriers and facilitators to uptake within the Australian healthcare context. Finally, recommendations
for promoting the translation of e-mental health services in Australia were developed. RESULTS: There
are a number of effective and cost-effective e-health applications available for treating depression in
community and clinical settings. Four primary models of dissemination were identified: unguided,
health service-supported, private ownership and clinically guided. Barriers to translation include
clinician reluctance, consumer awareness, structural barriers such as funding and gaps in the
translational evidence base. CONCLUSION: Key strategies for increasing use of e-mental health
programmes include endorsement of e-mental health services by government entities, education for
clinicians and consumers, adequate funding of e-mental health services, development of an
accreditation system, development of translation-focused activities and support for further
translational research. The impact of these implementation strategies is likely to include economic
gains, reductions in disease burden and greater availability of more interventions for prevention and
treatment of mental ill-health complementary to existing health and efficient evidence-based mental
health services.

Beach, M., et al. (2001). "Evaluating telemedicine in an accident an emergency setting." Computer Methods
and Programs in Biomedicine 64: 215-223.
[Link]

Bergmo, T. S. (2010). "Economic evaluation in telemedicine - still room for improvement." J Telemed Telecare
16(5): 229-231.

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It has been reported that economic evaluations of telemedicine are less adherent to methodological
standards than economic evaluations in other fields. Systematic reviews also show that most studies
evaluate benefits in terms of the cost savings, with no assessment of the health benefits for patients.
In a recent review of economic evaluations, I found 33 articles that measured both costs and non-
resource consequences of using telemedicine in direct patient care. This represents a considerable
increase compared to previous reviews. The articles analysed were highly diverse in both study
context and applied methods. Most studies used multiple outcome measures, such as diagnostic
accuracy, blood glucose levels, wound size or quality-adjusted life-years gained. The effectiveness
measures appeared more consistent and well reported than the costings. Objectives, study design and
choice of comparators were mostly well reported. However, most studies lacked information on
perspective and costing method, few used general statistics and sensitivity analysis to assess validity,
and even fewer used marginal analysis. These shortcomings in economic evaluation methodology are
relatively common and have been found in other fields of research.

Bergmo, T. S. (2014). "Using QALYs in telehealth evaluations: a systematic review of methodology and
transparency." BMC Health Serv Res 14: 332.

BACKGROUND: The quality-adjusted life-year (QALY) is a recognised outcome measure in health

economic evaluations. QALY incorporates individual preferences and identifies health gains by
combining mortality and morbidity into one single index number. A literature review was conducted
to examine and discuss the use of QALYs to measure outcomes in telehealth evaluations. METHODS:
Evaluations were identified via a literature search in all relevant databases. Only economic evaluations
measuring both costs and QALYs using primary patient level data of two or more alternatives were
included. RESULTS: A total of 17 economic evaluations estimating QALYs were identified. All
evaluations used validated generic health related-quality of life (HRQoL) instruments to describe
health states. They used accepted methods for transforming the quality scores into utility values. The
methodology used varied between the evaluations. The evaluations used four different preference
measures (EQ-5D, SF-6D, QWB and HUI3), and utility scores were elicited from the general population.
Most studies reported the methodology used in calculating QALYs. The evaluations were less
transparent in reporting utility weights at different time points and variability around utilities and
QALYs. Few made adjustments for differences in baseline utilities. The QALYs gained in the reviewed
evaluations varied from 0.001 to 0.118 in implying a small but positive effect of telehealth
intervention on patient's health. The evaluations reported mixed cost-effectiveness results.
CONCLUSION: The use of QALYs in telehealth evaluations has increased over the last few years.
Different methodologies and utility measures have been used to calculate QALYs. A more harmonised
methodology and utility measure is needed to ensure comparability across telehealth evaluations.

Blackburn, S., et al. (2011). "A systematic review of digital interactive television systems and their applications
in the health and social care fields." J Telemed Telecare 17(4): 168-176.

We conducted a systematic review of the applications and technical features of digital interactive
television (DITV) in the health and social care fields. The Web of Knowledge and IEEE Xplore databases
were searched for articles published between January 2000 and March 2010 which related to DITV
systems facilitating the communication of information to/from an individual's home with either a
health or social care application. Out of 1679 articles retrieved, 42 met the inclusion criteria and were
selected for review. An additional 20 articles were obtained from online grey literature sources.
Twenty-five DITV systems operating in health and social care were identified, including seven
commercial systems. The most common applications were related to health care, such as vital signs
monitoring (68% of systems) and health information or advice (56% of systems). The most common
technical features of DITV systems were two-way communication (88%), medical peripherals (68%),
on-screen messaging (48%) and video communication (36%). Digital interactive television has the
potential to deliver health and social care to people in their own homes. However, the requirement
for a high-bandwidth communications infrastructure, the usability of the systems, their level of
personalisation and the lack of evidence regarding clinical and cost-effectiveness will all need to be
addressed if this approach is to flourish.

Blignault, I. (2000). "Multipoint videoconferencing in health : a review of three years' experience in

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Queensland, Australia." Telemedicine Journal 6(2): 269-273, 261 tabl., 262 fig.
[Link]

Breen, S., et al. (2015). "The Patient Remote Intervention and Symptom Management System (PRISMS) - a
Telehealth- mediated intervention enabling real-time monitoring of chemotherapy side-effects in
patients with haematological malignancies: study protocol for a randomised controlled trial." Trials 16:
472.

BACKGROUND: Outpatient chemotherapy is a core treatment for haematological malignancies;

however, its toxicities frequently lead to distressing/potentially life-threatening side-effects
(neutropenia/infection, nausea/vomiting, mucositis, constipation/diarrhoea, fatigue). Early
detection/management of side-effects is vital to improve patient outcomes, decrease morbidity and
limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in real-
time, is regarded as the 'gold-standard' to allow rapid clinical decision-making/intervention. This paper
presents the protocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led
Telehealth intervention for remote monitoring/management of chemotherapy side-effects in
Australian haematological cancer patients. METHODS/DESIGN: Two hundred and twenty-two patients
will be recruited from two hospitals. Eligibility criteria include: diagnosis of chronic lymphocytic
leukaemia/Hodgkin's/non-Hodgkin's lymphoma; aged >/= 18 years; receiving >/= 2 cycles
chemotherapy. Patients will be randomised 1:1 to either the control or intervention arm with
stratification by diagnosis, chemotherapy toxicity (high versus low), receipt of previous chemotherapy
and hospital. Patients allocated to the control arm will receive 'Usual Care' whilst those allocated to
the intervention will receive the intervention in addition to 'Usual Care'. Intervention patients will be
provided with a computer tablet and software prompting twice-daily completion of
physical/emotional scales for up to four chemotherapy cycles. Should patient data exceed pre-
determined limits an Email alert is delivered to the treatment team, prompting nurses to view patient
data, and contact the patient to provide clinical intervention. In addition, six scheduled nursing
interventions will be completed to educate/support patients in use of the software. Patient outcomes
will be measured cyclically (midpoint and end of cycles) via pen-and-paper self-report alongside
review of the patient medical record. The primary outcome is burden due to nausea, mucositis,
constipation and fatigue. Secondary outcomes include: burden due to vomiting and diarrhoea;
psychological distress; ability to self-manage health; level of cancer information/support needs and;
utilisation of health services. Analyses will be intention-to-treat. A cost-effectiveness analysis is
planned. DISCUSSION: This trial is the first in the world to test a remote monitoring/management
intervention for adult haematological cancer patients receiving chemotherapy. Future use of such
interventions have the potential to improve patient outcomes/safety and decrease health care costs
by enabling early detection/clinical intervention. TRIAL REGISTRATION: ACTRN12614000516684 . Date
registered: 12 March 2014 (registered retrospectively).

Brunton, L., et al. (2015). "The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary
Disease (COPD): A Qualitative Meta-Synthesis." PLoS One 10(10): e0139561.

OBJECTIVE: As the global burden of chronic disease rises, policy makers are showing a strong interest
in adopting telehealth technologies for use in long term condition management, including COPD.
However, there remain barriers to its implementation and sustained use. To date, there has been
limited qualitative investigation into how users (both patients/carers and staff) perceive and
experience the technology. We aimed to systematically review and synthesise the findings from
qualitative studies that investigated user perspectives and experiences of telehealth in COPD
management, in order to identify factors which may impact on uptake. METHOD: Systematic review
and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians)
experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease.
ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to
October 2014. Reference lists of included studies and reference lists of key papers were also searched.
Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool. FINDINGS:
705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were
included in the review. Most authors of included studies had identified both positive and negative
experiences of telehealth use in the management of COPD. Through a line of argument synthesis we
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were able to derive new insights from the data to identify three overarching themes that have the
ability to either impede or promote positive user experience of telehealth in COPD: the influence on
moral dilemmas of help seeking-(enables dependency or self-care); transforming interactions
(increases risk or reassurance) and reconfiguration of 'work' practices (causes burden or
empowerment). CONCLUSION: Findings from this meta-synthesis have implications for the future
design and implementation of telehealth services. Future research needs to include potential users at
an earlier stage of telehealth/service development.

Cady, R., et al. (2009). "A telehealth nursing intervention reduces hospitalizations in children with complex
health conditions." J Telemed Telecare 15(6): 317-320.

The U Special Kids Program (USK) at the University of Minnesota provides care coordination and case
management services by telephone to children with special health-care needs. We measured the
effect of the USK programme on hospital resource utilization using a retrospective record review.
Information on hospitalizations was collected for children enrolled in the programme for at least two
years and validated for accuracy against inpatient claims data. Hospitalizations were classified as
planned, unplanned or due to lack of home care. A total of 43 children enrolled in the USK programme
between July 1996 and December 2006 met the study criteria. The children had multiple, complex
conditions. During the period of the study, there were 61 planned hospitalizations, 184 unplanned
hospitalizations and 3 hospitalizations due to lack of home care. The number of unplanned
hospitalizations decreased from 74 in the first year of enrolment to 35 in the second; this reduction
was significant (P < 0.007). In the subsequent years, the rate of unplanned admissions stabilized. In
contrast, the rate of planned hospitalizations was relatively constant over the five-year enrolment
period. Telephone-based care coordination and case management is a promising approach for
children with multiple, complex health conditions.

Caffery, L. J. et Smith, A. C. (2010). "A literature review of email-based telemedicine." Stud Health Technol
Inform 161: 20-34.

A structured analysis of peer-reviewed literature about the delivery of health services by email was
undertaken for this review. A total of 185 articles were included in the analysis. These articles were
thematically categorised for medical specialty, participants, sub-topic, study design and service-
delivery application. It was shown that email-based telemedicine can be practiced in a large number of
medical specialties and has application in primary consultation, second opinion consultation,
telediagnosis and administrative roles (e.g. e-referral). Email has niche applications in low-bandwidth,
image-based specialties (e.g. dermatology, pathology, wound care and ophthalmology) where
attached digital camera images were used for telediagnosis. Diagnostic accuracy of these images was
the predominant topic of research and results show email as a valid means of delivering these medical
services. Email is also often used in general practice as an adjunct for face-to-face consultation.
Further, a number of organisations have significantly improved the efficiency of their outpatient
services when using email as a triage or e-referral system. Email-based telemedicine provides
specialist medical opinion in the majority of reviewed services and is most likely to be instigated by the
patient's primary care giver. However, email-consultations between patient and primary care and
patient and secondary care are not uncommon. Most email services are implemented using ordinary
email. However, a number of organisations have developed purpose-written email applications to
support their telemedicine service due to impediments of using ordinary email. These impediments
include lack of management tools for: the allocation and auditing of cases for a timely response and
the co-ordination of effort in a multi-clinician, multi-disciplinary service. The ability to encrypt ordinary
email thereby securing patient confidentiality is also regarded as difficult when using ordinary email.
Hence, alternative web-based email applications where the encryption can be implemented using the
more user-friendly HTTPS have become popular. Much of the reviewed literature is descriptive or
anecdotal and hence, suffers from lack of conclusive results regarding positive patient outcomes. This
may account for email-based telemedicine generally being regarded as underutilised. However, the
potential is well recognised.

Callas, P. W., et al. (2000). "Improved rural provider access to continuing medical education through interactive
video conferencing." Telemedicine Journal and E-Health 6(4): 393-399, 391 fig., 391 tabl.
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[Link]
2003&rfr_id=ori%3Arid%[Link]&rfr_dat=cr_pub%3Dpubmed

Capner, M. (2000). "Videoconferencing in the provision of psychological services at a distance." Journal of

Telemedicine and Telecare 6(6): 311-319.

Carrasqueiro, S., et al. (2011). "Evaluation of telephone triage and advice services: a systematic review on
methods, metrics and results." Stud Health Technol Inform 169: 407-411.

Telephone triage and advice services (TTAS) have been increasingly used to assess patients' symptoms,
provide information and refer patients to appropriate levels of care (attempting to pursue efficiency
and quality of care gains while ensuring safety). However, previous reviews have pointed out for the
need for adequately evaluating TTAS. AIMS: To review TTAS evaluation studies, compile
methodologies and metrics used and compare results. Systematic search in PubMed database; data
collection and categorization by TTAS features and context, type of evaluation, methods, metrics and
results; critical assessment of studies; discussion on research needs. 395 articles screened, 55 of them
included in the analysis. In conclusion, several aspects of TTAS impact on healthcare systems remain
unclear either due to a lack of research (e.g. on long term clinical outcomes, clinical pathways, safety,
enhanced access) or because of huge disparities in existing studies on the accuracy of advice, patient
compliance, system use, satisfaction and economic evaluation. Further research on TTAS impact is
required, comprising multiple perspectives and broad range of metrics.

Chandak, A. et Joshi, A. (2015). "Self-management of hypertension using technology enabled interventions in

primary care settings." Technol Health Care 23(2): 119-128.

BACKGROUND: Self-management of hypertension by controlling Blood Pressure (BP) through

technology-based interventions can effectively reduce the burden of high BP, which affects one out of
every three adults in the United States. OBJECTIVE: The primary aim of this study is to explore the role
of technology enabled interventions to improve or enhance self-management among individuals with
hypertension. METHODS: We conducted a systematic review of the literature published between July
2008 and June 2013 on the MEDLINE database (via PubMed interface) during July 2013. The search
words were "hypertension" and "primary care" in combination with each of the terms of "technology",
"internet", "computer" and "cell phone". Our inclusion criteria consisted of: (a) Randomized
Controlled Trials (RCTs) (b) conducted on human subjects; (c) technology-based interventions (d) to
improve self-management (e) of hypertension and if the (f) final results of the study were published in
the study. Our exclusion criteria included (a) management of other conditions and (b) literature
reviews. RESULTS: The initial search resulted in 108 results. After applying the inclusion and exclusion
criteria, a total of 12 studies were analyzed. Various technologies implemented in the studies included
internet-based telemonitoring and education, telephone-based telemonitoring and education,
internet-based education, telemedicine via videoconferencing, telehealth kiosks and automated
modem device. Some studies also involved a physician intervention, in addition to patient
intervention. The outcomes of proportion of subjects with BP control and change in mean SBP and
DBP were better for the group of subjects who received combined physician and patient interventions.
CONCLUSION: Interventions to improve BP control for self-management of hypertension should be
aimed at both physicians as well as the patients. More interventions should utilize the JNC-7
guidelines and cost-effectiveness of the intervention should also be assessed.

Chronaki, C. E. et Vardas, P. (2013). "Remote monitoring costs, benefits, and reimbursement: a European
perspective." Europace 15 Suppl 1: i59-i64.

AIMS: To provide a European perspective on reimbursement issues surrounding remote monitoring of

cardiac implantable electronic devices in view of the anticipated costs and benefits. METHODS AND
RESULTS: Review of recent literature addressing clinical, economic, sociocultural, and technological
factors associated with remote monitoring. When healthcare transformation is urgently needed,
remote monitoring offers opportunities to innovate and cope with escalating costs and constrained
resources, while improving patient safety, quality, and access to care as reflected in clinical studies.
The introduction of remote monitoring into daily practice requires analysis of reimbursement policies
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to address funding scope, payment method, payer, price and allocation, and alignment with health
system objectives and goals to ensure financial and operational sustainability of resources,
infrastructure, and processes. Remote monitoring policies should gradually transition from activity-
based, added-value services in a care-and-cure setting, to performance and outcome-oriented
highlighting prevention, surveillance, and empowerment. By encouraging and rewarding innovation
and interoperability, proprietary remote monitoring technologies can open up using standards and
connect to support a growing evidence base that guides clinical decision support and planning of
future policies. CONCLUSION: Careful planning, sharing of experiences, and gradual adoption of
reimbursement models that focus on outcome, performance, and cost-effectiveness are key aspects
of containing escalating costs and improving quality and access to healthcare. Despite differences in
health systems and payment methods in Europe, policy-makers, professional societies, payers,
providers, and the industry need to join forces to transform healthcare and make innovation happen.

Chua, R., et al. (2001). "Randomised controlled trial of telemedicine for new neurological outpatient referrals."
Journal of Neurology Neurosurgery and Psychiatry(71): 63-66, 65 tabl., 61 fig.

Chung, J., et al. (2016). "Ethical Considerations Regarding the Use of Smart Home Technologies for Older
Adults: An Integrative Review." Annu Rev Nurs Res 34: 155-181.

PROBLEM: With the wide adoption and use of smart home applications, there is a need for examining
ethical issues regarding smart home use at the intersection of aging, technology, and home
environment. PURPOSE: The purpose of this review is to provide an overview of ethical considerations
and the evidence on these ethical issues based on an integrative literature review with regard to the
utilization of smart home technologies by older adults and their family members. REVIEW DESIGN AND
METHODS: We conducted an integrative literature review of the scientific literature from indexed
databases (e. g., MEDLINE, CINAHL, and PsycINFO). The framework guiding this review is derived from
previous work on ethical considerations related to telehealth use for older adults and smart homes for
palliative care. Key ethical issues of the framework include privacy, informed consent, autonomy,
obtrusiveness, equal access, reduction in human touch, and usability. RESULTS: Six hundred and thirty-
five candidate articles were identified between the years 1990 and 2014. Sixteen articles were
included in the review. Privacy and obtrusiveness issues appear to be the most important factors that
can affect smart home technology adoption. In addition, this article recommends that stigmatization
and reliability and maintenance of the system are additional factors to consider. IMPLICATIONS: When
smart home technology is used appropriately, it has the potential to improve quality of life and
maintain safety among older adults, ultimately supporting the desire of older adults for aging in place.
The ability to respond to potential ethical concerns will be critical to the future development and
application of smart home technologies that aim to enhance safety and independence.

Coleman, J. J., et al. (2015). "Assessment and Treatment of Cognition and Communication Skills in Adults With
Acquired Brain Injury via Telepractice: A Systematic Review." Am J Speech Lang Pathol 24(2): 295-315.

PURPOSE: This is a systematic review of assessment and treatment of cognitive and communicative
abilities of individuals with acquired brain injury via telepractice versus in person. The a priori clinical
questions were informed by previous research that highlights the importance of considering any
functional implications of outcomes, determining disorder- and setting-specific concerns, and
measuring the potential impact of diagnostic accuracy and treatment efficacy data on interpretation
of findings. METHOD: A literature search of multiple databases (e.g., PubMed) was conducted using
key words and study inclusion criteria associated with the clinical questions. RESULTS: Ten group
studies were accepted that addressed assessment of motor speech, language, and cognitive
impairments; assessment of motor speech and language activity limitations/participation restrictions;
and treatment of cognitive impairments and activity limitations/participation restrictions. In most
cases, equivalence of outcomes was noted across service delivery methods. CONCLUSIONS: Limited
findings, lack of diagnostic accuracy and treatment efficacy data, and heterogeneity of assessments
and interventions precluded robust evaluation of clinical implications for telepractice equivalence and
the broader area of telepractice efficacy. Future research is needed that will build upon current
knowledge through replication. In addition, further evaluation at the impairment and activity
limitation/participation restriction levels is needed.
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Columbo, F., et al. (2011). "Ageing and long-term care." Eurohealth 17(2-3): 44 , tabl., fig.
[Link]
This issue of Eurohealth looks at meeting the challenge of ageing and long-term care. Articles cover
European and OECD countries with topics including: future demand, cost projections, chronic diseases,
remote care, workforce issues, etc. Other articles include: the European Directive on cross-border
health care (England); the future of NICE (England); and the effects of hospital ownership on
performance (Germany).

Costa, M. A., et al. (2015). "Telemedicine in Cleft Care: Reliability and Predictability in Regional and
International Practice Settings." J Craniofac Surg 26(4): 1116-1120.

BACKGROUND: Regional and international cleft care providers are challenged in their ability to deliver
reliable, comprehensive care. Our institution utilizes video teleconferencing to facilitate initial
evaluation and postoperative cleft care. This study describes our experience using telemedicine,
generates a perioperative treatment algorithm using this technology, and compares cost-utility of
telemedicine to in-person ambulatory visits when regional practices are involved. METHODS: A 5-year
retrospective review of all cleft patients evaluated in an ambulatory setting was conducted. Patient
demographics and location, number, and type of telemedicine visits were recorded. Specific treatment
algorithms utilizing telemedicine for perioperative care for primary and secondary cleft lip and nasal
repair, palatoplasty, and operation for velopharyngeal insufficiency are described. A cost-utility
analysis was performed comparing distances between patient homes and primary hub versus
telemedicine clinic sites. RESULTS: Five hundred nineteen patients were identified; 18.1% attended at
least 1 teleconferencing visit. Postoperative follow-up was 100%. The majority of screening,
preoperative, and postoperative care was provided using telemedicine. In-person evaluations were
performed when intraoral assessments were necessary. Telemedicine visits were associated with an
average savings of 239 miles per visit in the United States and 578 miles per visit in Mexico.
CONCLUSIONS: Video teleconferencing can be used to provide comprehensive regional and
international cleft care to facilitate initial evaluations and consistent follow-up. This technology can
alleviate the travel burden on families and cleft care providers practicing over a large geographic
radius.

Cottrell, E., et al. (2015). "Implementation of simple telehealth to manage hypertension in general practice: a
service evaluation." BMC Fam Pract 16: 83.

BACKGROUND: Hypertension is common and conveys significant risk of morbidity and mortality.
However, inadequate control of hypertension is common. Following a successful local use of a simple
telehealth intervention ('Florence') for the diagnosis and management of hypertension, the Advice &
Interactive Messaging (AIM) for Health simple telehealth programme was launched across England in
March 2013. Four protocols were developed to diagnose and monitor blood pressure (BP). The aim of
this service evaluation was to identify the extent to which predefined service outcomes, regarding
ascertainment of a diagnosis of hypertension, and achievement of hypertension control, were met for
the hypertension protocols. METHODS: Patients with opportunistic raised BP in general practice or
diagnosed hypertension were selected by their usual primary care providers to register onto
diagnostic or monitoring hypertension protocols, respectively. Florence sent patients prompts via text
messaging to submit readings, educational messages and user satisfaction questions. Patient
responses were stored on Florence for review by their primary care health providers. This service
evaluation used data from 2963 patients from general practices across England registered onto one of
four AIM hypertension protocols from inception to January 2014. Data were extracted from Florence
and underwent descriptive analysis. RESULTS: 1166/1468 (79 %) patients were eligible to have a
diagnosis of hypertension confirmed/refuted, of which 740 (63 %) had a mean BP in the hypertensive
range from one week's readings. BP control was achieved by only 5-22 % of 1495 patients signed up to
one of the three monitoring protocols. Patient engagement with the monitoring protocols was initially
good but reduced over time. CONCLUSIONS: Although simple telehealth may be an acceptable tool for
diagnosing and monitoring hypertension among responding patient users, and can have a useful role
in diagnosis of hypertension (particularly if ambulatory blood pressure monitoring (ABPM) is not
possible or is declined), problems were identified. Reduced patient engagement over longer periods
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and acceptance of suboptimal BP control among patients on monitoring protocols need to be urgently
addressed. Empirical work is required to identify barriers to achieving BP control among hypertensive
patients using simple telehealth and, consequently, services be developed to address these issues.

Cronce, J. M., et al. (2014). "Electronic Feedback in College Student Drinking Prevention and Intervention."
Alcohol Res 36(1): 47-62.

Alcohol consumption is prevalent among college students and can be associated with serious negative
consequences. Several efficacious programs using one-on-one brief intervention techniques have
been developed to target high-risk drinking by individual students, such as the Brief Alcohol Screening
and Intervention for College Students (BASICS) (Dimeff et al. 1999). To reach a larger population (e.g.,
the incoming freshman class), researchers have adapted these interventions so that students can
access them via the Internet or in some other electronic [Link] purpose of this review is to
discuss specific alcohol intervention programs that were (1) designed to be delivered remotely (e.g.,
via the Web or on an electronic device) without interaction with a provider and (2) were tested among
college students using a randomized controlled trial design. Specific studies were drawn from earlier
reviews as well as a comprehensive literature search. Although many programs have limited research
support, and some findings are mixed, components that were directly translated from in-person
BASICS to remote-delivery mediums (i.e., personalized feedback interventions [PFIs], personalized
normative feedback [PNF] interventions), and broader programs that incorporate PFI/ PNF, show
promise in reducing alcohol use and/or negative consequences. However, more research is needed
and suggestions for how the field can move these interventions forward are discussed.

Currie, M., et al. (2015). "Attitudes towards the use and acceptance of eHealth technologies: a case study of
older adults living with chronic pain and implications for rural healthcare." BMC Health Serv Res 15:
162.

BACKGROUND: Providing health services to an ageing population is challenging, and in rural areas
even more so. It is expensive to provide high quality services to small populations who are widely
dispersed; staff and patients are often required to travel considerable distances to access services, and
the economic downturn has created a climate where delivery costs are under constant review. There
is potential for technology to overcome some of these problems by decreasing or ceasing the need for
patients and health professionals to travel to attend/deliver in-person appointments. A variety of
eHealth initiatives (for example Pathways through Pain an online course aimed to aid self-help
amongst those living with persistent pain) have been launched across the UK, but roll out remains at
an early stage. METHODS: This mixed-methods study of older adults with chronic pain examines
attitudes towards, current use of and acceptance of the use of technology in healthcare. A survey (n =
168, 40% response rate) captured broad experiences of the use of technology in health and social
care. Semi-structured interviews (four with technology and seven without technology participants)
elicited attitudes towards technology in healthcare and explored attributes of personal and social
interaction during home visits. RESULTS: People suffering from chronic pain access healthcare in a
variety of ways. eHealth technology use was most common amongst older adults who lived alone.
There was broad acceptance of eHealth being used in future care of people with chronic pain, but
older adults wanted eHealth to be delivered alongside existing in-person visits from health and social
care professionals. CONCLUSIONS: eHealth has the potential to overcome some traditional challenges
of providing rural healthcare, however roll out needs to be gradual and begin by supplementing, not
substituting, existing care and should be mindful of individual's circumstances, capability and
preferences. Acceptance of technology may relate to existing levels of personal and social contact, and
may be greater where technological help is not perceived to be replacing in-person care.

Danis, J., et al. (2016). "[Telemedicine in dermatological practice: teledermatology]." Orv Hetil 157(10): 363-
369.

Technological advances in the fields of information and telecommunication technologies have affected
the health care system in the last decades, and lead to the emergence of a new discipline:
telemedicine. The appearance and rise of internet and smart phones induced a rapid progression in
telemedicine. Several new applications and mobile devices are published every hour even for medical
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purposes. Parallel to these changes in the technical fields, medical literature about telemedicine has
grown rapidly. Due to its visual nature, dermatology is ideally suited to benefit from this new
technology and teledermatology became one of the most dynamically evolving fields of telemedicine
by now. Teledermatology is not routinely practiced in Hungary yet, however, it promises the health
care system to become better, cheaper and faster, but we have to take notice on the experience and
problems faced in teledermatologic applications so far, summarized in this review.

Davalos, M. E., et al. (2009). "Economic evaluation of telemedicine: review of the literature and research
guidelines for benefit-cost analysis." Telemed J E Health 15(10): 933-948.

Telemedicine programs provide specialty health services to remote populations using

telecommunications technology. This innovative approach to medical care delivery has been
expanding for several years and currently covers various specialty areas such as cardiology,
dermatology, and pediatrics. Economic evaluations of telemedicine, however, remain rare, and few of
those conducted have accounted for the wide range of economic costs and benefits. Rigorous benefit-
cost analyses of telemedicine programs could provide credible and comparative evidence of their
economic viability and thus lead to the adoption and/or expansion of the most successful programs.
To facilitate more advanced economic evaluations, this article presents research guidelines for
conducting benefit-cost analyses of telemedicine programs, emphasizing opportunity cost estimation,
commonly used program outcomes, and monetary conversion factors to translate outcomes to dollar
values. The article concludes with specific recommendations for future research.

Davis, M. M., et al. (2014). "A systematic review of clinician and staff views on the acceptability of incorporating
remote monitoring technology into primary care." Telemed J E Health 20(5): 428-438.

OBJECTIVE: Remote monitoring technology (RMT) may enhance healthcare quality and reduce costs.
RMT adoption depends on perceptions of the end-user (e.g., patients, caregivers, healthcare
providers). We conducted a systematic review exploring the acceptability and feasibility of RMT use in
routine adult patient care, from the perspectives of primary care clinicians, administrators, and clinic
staff. MATERIALS AND METHODS: We searched the databases of Medline, IEEE Xplore, and
Compendex for original articles published from January 1996 through February 2013. We manually
screened bibliographies of pertinent studies and consulted experts to identify English-language studies
meeting our inclusion criteria. RESULTS: Of 939 citations identified, 15 studies reported in 16
publications met inclusion criteria. Studies were heterogeneous by country, type of RMT used, patient
and provider characteristics, and method of implementation and evaluation. Clinicians, staff, and
administrators generally held positive views about RMTs. Concerns emerged regarding clinical
relevance of RMT data, changing clinical roles and patterns of care (e.g., reduced quality of care from
fewer patient visits, overtreatment), insufficient staffing or time to monitor and discuss RMT data,
data incompatibility with a clinic's electronic health record (EHR), and unclear legal liability regarding
response protocols. CONCLUSIONS: This small body of heterogeneous literature suggests that for
RMTs to be adopted in primary care, researchers and developers must ensure clinical relevance,
support adequate infrastructure, streamline data transmission into EHR systems, attend to changing
care patterns and professional roles, and clarify response protocols. There is a critical need to engage
end-users in the development and implementation of RMT.

de la Vega, R. et Miro, J. (2014). "mHealth: a strategic field without a solid scientific soul. a systematic review of
pain-related apps." PLoS One 9(7): e101312.

BACKGROUND: Mobile health (mHealth) has undergone exponential growth in recent years. Patients
and healthcare professionals are increasingly using health-related applications, at the same time as
concerns about ethical issues, bias, conflicts of interest and privacy are emerging. The general aim of
this paper is to provide an overview of the current state of development of mHealth. METHODS AND
FINDINGS: To exemplify the issues, we made a systematic review of the pain-related apps available in
scientific databases (Medline, Web of Science, Gale, Psycinfo, etc.) and the main application shops
(App Store, Blackberry App World, Google Play, Nokia Store and Windows Phone Store). Only
applications (designed for both patients and clinicians) focused on pain education, assessment and
treatment were included. Of the 47 papers published on 34 apps in scientific databases, none were
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available in the app shops. A total of 283 pain-related apps were found in the five shops searched, but
no articles have been published on these apps. The main limitation of this review is that we did not
look at all stores in all countries. CONCLUSIONS: There is a huge gap between the scientific and
commercial faces of mHealth. Specific efforts are needed to facilitate knowledge translation and
regulate commercial health-related apps.

de Waure, C., et al. (2012). "Telemedicine for the reduction of myocardial infarction mortality: a systematic
review and a meta-analysis of published studies." Telemed J E Health 18(5): 323-328.

INTRODUCTION: Advances in electronics and communications have changed modern medicine:

telemedicine allows patient assessment and monitoring to facilitate healthcare at a distance. The aim
of this study was to perform a systematic review and meta-analysis to assess how telemedicine
systems, including early telemetry of electrocardiograms, can improve health outcomes in patients
with coronary artery disease and, in particular, acute myocardial infarction (AMI). METHODS: Studies
dealing with telemedicine applications in managing AMI that were conducted before January 22, 2010,
published in English or Italian, were identified in PubMed and ISI Web of Knowledge searches. The
meta-analysis was performed to assess the efficacy of telemedicine versus standard measures in
reducing mortality. Relative risk (RR) with 95% confidence interval was used to report results and the
I(2) test to evaluate heterogeneity. RESULTS: Five of the 39 articles retrieved were selected; all studies
demonstrated the efficacy of telemedicine applications. Only three studies were judged to be
comparable and suitable for combining data. This meta-analysis showed that the RR for in-hospital
mortality from AMI was 0.65 (95% confidence interval, 0.42-0.99) for the telemedicine group, without
heterogeneity. CONCLUSIONS: Telemedicine may improve health outcomes of patients with AMI.
However, heterogeneity in study design and end points of most studies limited the number of articles
that could be subjected to our meta-analysis.

Debnath, D. (2004). "Activity analysis of telemedicine in the UK." Postgrad Med J 80(944): 335-338.

BACKGROUND: Telemedicine is a new way of delivering health care to people, particularly in remote
areas. The UK has experienced a surge of telematic projects in recent years. However, there is little
information available in the literature regarding the past and present of telemedicine in the UK.
OBJECTIVES: To evaluate the state of telemedicine in the UK. METHODS: All the projects that took
place in UK since 1991 were considered for the study and evaluated according to the population and
area served. RESULTS: A total of 216 projects were identified. The number of projects was highest in
England (172). Emergency medicine, medical specialties, and educational projects received most
consideration (9.7% each). With the exception of Wales, the number of projects increased steadily
with time. The projects, when correlated in accordance with the area (per 10 000 sq km) and
population (per million), were found to be highest in England (49.5%) and Northern Ireland (36.2%)
respectively. No dedicated educational project took place in Scotland, Northern Ireland, and Wales.
CONCLUSIONS: The UK embraced telemedicine in the early 1990s and the overall growth had been
steady. Scotland, in spite of being the most likely beneficiary in UK, has lagged behind in telemedicine
schemes and merits more projects. The issue of tele-education needs urgent review. Multisite trials
and a combined approach involving the government, health professionals, technologists, and patients'
representatives would facilitate such developments and help widen the application of telemedicine.

DeKoekkoek, T., et al. (2015). "mHealth SMS text messaging interventions and to promote medication
adherence: an integrative review." J Clin Nurs 24(19-20): 2722-2735.

AIMS AND OBJECTIVES: This article is an integrative review of the evidence for mobile health Short
Message Service text messages as an innovative and emerging intervention to promote medication
adherence. Authors completed this review to draw conclusions and implications towards establishing
a scientific foundation for use of text messages to promote medication adherence, thus informing
clinical practice. BACKGROUND: The World Health Organization has identified medication adherence
as a priority global problem. Text messages are emerging as an effective means of improving health
behaviours and in some diseases to promote medication adherence. However, a gap in the literature
indicates lack of evidence in guiding theories and content of text messages, which should be
synthesised prior to use in clinical practice. DESIGN: Integrative review. METHODS: Cumulative Index
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to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Scopus, the Cochrane Library and
PubMed were searched for relevant studies between 2004-2014. Inclusion criteria were (1)
implementation of a text-message intervention and (2) medication adherence to a prescribed oral
medication as a primary outcome. Articles were assessed for quality of methodology and measures of
adherence. An integrative review process was used to perform analysis. RESULTS: Thirteen articles
meeting the inclusion criteria are included in this review. Nine of 13 studies found adherence rates
improved between 15.3-17.8% when using text messages to promote medication adherence. Text
messages that were standardised, tailored, one- or two-way and timed either daily to medication
regimen, weekly or monthly showed improvement in medication adherence. CONCLUSIONS: This
review established a scientific basis for text messages as an intervention to improve medication
adherence across multiple diseases. Future large rigorous randomised trials are needed to further test
text messaging interventions. RELEVANCE TO CLINICAL PRACTICE: This review provides clinicians with
the state of the science with regard to text messaging interventions that promote medication
adherence. A description of intervention components are provided to aid nurses in development of
text messages and in translating evidence into practice.

Demartines, N., et al. (2000). "An evaluation of telemedicine in surgery. Telediagnosis compared with direct
diagnosis." Archives of Surgery 135: 849-853.
[Link]

DeMonte, C. M., et al. (2015). "Future implications of eHealth interventions for chronic pain management in
underserved populations." Pain Manag 5(3): 207-214.

Many underserved communities, especially those in rural settings, face unique challenges that make
high quality healthcare less accessible. The implementation of eHealth technologies has become a
potentially valuable option to disseminate interventions. The authors' work in rural Alabama Federally
Qualified Health Centers provide insights into the access to technology as well as the likelihood of
utilizing eHealth technology in underserved communities. This paper will review current challenges
related to digital dissemination of behavioral health interventions for chronic pain. Two major
concerns are the lack of technological resources and the lack of appropriate materials for patients who
may have low levels of reading, health and/or digital literacy. We will propose some recommendations
to address common barriers faced by those providing care.

Deshayes, J. L. et Philippe, H. J. (2000). "Internet use for telemedicine : fetal medicine applications." Journal De
Radiologie(81): 441-444.

Deslich, S. A., et al. (2013). "Telepsychiatry in correctional facilities: using technology to improve access and
decrease costs of mental health care in underserved populations." Perm J 17(3): 80-86.

OBJECTIVE: It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health

care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The
purpose of this investigation was to determine how utilization of telepsychiatry affected access to care
and costs of providing mental health care in correctional facilities. METHODS: A literature review
complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic
databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were
searched for this research, and 49 sources were referenced. The literature review examined
implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio,
Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health
services and the costs of providing mental health care in correctional facilities. RESULTS:
Telepsychiatry provided improved access to mental health services for inmates, and this increase in
access is through the continuum of mental health care, which has been instrumental in increasing
quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more
than $1 million. The semistructured interview with the telepsychiatry practitioner supported
utilization of telepsychiatry to increase access and lower costs of providing mental health care in
correctional facilities. CONCLUSIONS: Increasing access to mental health care for this underserved
group through telepsychiatry may improve living conditions and safety inside correctional facilities.
Providers, facilities, and state and federal governments can expect increased savings with utilization of
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telepsychiatry.

Devi, B. R., et al. (2015). "mHealth: An updated systematic review with a focus on HIV/AIDS and tuberculosis
long term management using mobile phones." Comput Methods Programs Biomed 122(2): 257-265.

OBJECTIVE: To evaluate the utilization of mobile phone technology for treatment adherence,
prevention, education, data collection, monitoring long-term management of HIV/AIDS and TB
patients. METHODS: Articles published in English language from January 2005 until now from
PubMed/MEDLINE, EMBASE, Web of Science, WHO databases, and clinical trials were included. Data
extraction is based on medication adherence, quality of care, prevention, education, motivation for
HIV test, data collection from HIV lab test results and patient monitoring. Articles selected for the
analysis cover RCTs and non RCTs related to the use of mobile phones for long-term care and
treatment of HIV/AIDS and TB patients. RESULTS: Out of 90 articles selected for the analysis, a large
number of studies, 44 (49%) were conducted in developing countries, 24 (26%) studies from
developed countries, 12 (13%) are systematic reviews and 10 (11%) did not mention study location.
Forty seven (52.2%) articles focused on treatment, 11 (12.2%) on quality of care, 8 (9%) on prevention,
13 (14.4%) on education, 6 (6.6%) on data collection, and 5 (5.5%) on patient monitoring. Overall, 66
(73%) articles reported positive effects, 21 (23%) were neutral and 3 (4%) reported negative results.
CONCLUSIONS: Mobile phone technology is widely reported to be an effective tool for HIV/AIDS and
TB long-term care. It can substantially reduce disease burden on health care systems by rendering
more efficient prevention, treatment, education, data collection and management support.

Di Napoli, W. A., et al. (2015). "Can clinical use of Social Media improve quality of care in mental Health? A
Health Technology Assessment approach in an Italian mental health service." Psychiatr Danub 27
Suppl 1: S103-110.

Clinical use of modern Information and Communication Technologies such as Social Media (SM) can
easily reach and empower groups of population at risk or affected by chronic diseases, and promote
improvement of quality of care. In the paper we present an assessment of SM (i.e. e-mails, websites,
on line social networks, apps) in the management of mental disorders, carried out in the Mental
Health Service of Trento (Italy) according to Health Technology Assessment criteria. A systematic
review of literature was performed to evaluate technical features, safety and effectiveness of SM. To
understand usage rate and attitude towards new social technologies of patients and professionals, we
performed a context analysis by a survey conducted over a group of 88 psychiatric patients and a
group of 35 professionals. At last, we made recommendations for decision makers in order to promote
SM for the management of mental disorders in a context of prioritization of investments in health
care.

Donoghue, K., et al. (2014). "The effectiveness of electronic screening and brief intervention for reducing levels
of alcohol consumption: a systematic review and meta-analysis." J Med Internet Res 16(6): e142.

BACKGROUND: Electronic screening and brief intervention (eSBI) has been shown to reduce alcohol
consumption, but its effectiveness over time has not been subject to meta-analysis. OBJECTIVE: The
current study aims to conduct a systematic review and meta-analysis of the available literature to
determine the effectiveness of eSBI over time in nontreatment-seeking hazardous/harmful drinkers.
METHODS: A systematic review and meta-analysis of relevant studies identified through searching the
electronic databases PsychINFO, Medline, and EMBASE in May 2013. Two members of the study team
independently screened studies for inclusion criteria and extracted data. Studies reporting data that
could be transformed into grams of ethanol per week were included in the meta-analysis. The mean
difference in grams of ethanol per week between eSBI and control groups was weighted using the
random-effects method based on the inverse-variance approach to control for differences in sample
size between studies. RESULTS: There was a statistically significant mean difference in grams of
ethanol consumed per week between those receiving an eSBI versus controls at up to 3 months (mean
difference -32.74, 95% CI -56.80 to -8.68, z=2.67, P=.01), 3 to less than 6 months (mean difference -
17.33, 95% CI -31.82 to -2.84, z=2.34, P=.02), and from 6 months to less than 12 months follow-up
(mean difference -14.91, 95% CI -25.56 to -4.26, z=2.74, P=.01). No statistically significant difference
was found at a follow-up period of 12 months or greater (mean difference -7.46, 95% CI -25.34 to
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10.43, z=0.82, P=.41). CONCLUSIONS: A significant reduction in weekly alcohol consumption between
intervention and control conditions was demonstrated between 3 months and less than 12 months
follow-up indicating eSBI is an effective intervention.

Doupi, P., et al. (2005). "eHealth in Europe: towards higher goals." World Hosp Health Serv 41(2): 35-39, 41, 43.

Significant events are unfolding in the field of eHealth in Europe. eHealth has been a strategic priority
of the European Commission in both the eEurope 2002 and 2005 Action Plans. But how are
developments on the national level progressing? The authors contrast the status-quo of eHealth in the
EU-15 with the latest trends and key action priorities in the EU-25 after the Union's latest enlargement
in May 2004. The initiatives and actions of the European Commission are presented vis-a-vis those of
national Member States, particularly in terms of strategic priorities and implementation actions. The
review is accompanied by an analysis of expert feedback on eHealth drivers and barriers.

Duplaga, M. (2007). "E-health development policies in new member states in Central Europe." World Hosp
Health Serv 43(2): 34-38.

The paper brings insights on the process of e-health development in countries of Central and Eastern
Europe, which joined European Union in 2004 years. The main part of the activities resulting in this
review were carried out within the eHealth European Research Area (eHealth ERA) project established
under the EU 6. Framework Programme. The research team involved in the project activities in the
Centre of Innovation, Technology Transfer and University Development, Jagiellonian University
focused the inquiries on the six countries: Poland, Czech Republic, Slovakia, Hungary, Lithuania and
Latvia. The tool for data collection elaborated by the STAKES, Finland was applied. The main areas
covered within the analysis included: health system characteristics, e-health policies definition process
and deployment, specific activities in e-health subdomain as well as research and development
programmes held in European countries. It seems that general background and intensive process of
system and economy transformation was key factor influencing greatly the perception and status of
the e-health domain in these countries. The opportunities related to the inclusion in the European
Union was another essential factor bringing additional important impact on the e-health formation. All
these countries started painful reform in early 90s after the fall of the communist governments. The
health care system in general was not the prime benefactors of these changes.

Eedy, D. J. et Wootton, R. (2001). "Teledermatology : a review." British Journal of Dermatology(144): 696-707,

693 tabl., 697 fig.

Eisenberg, D., et al. (2015). "Telephone follow-up by a midlevel provider after laparoscopic inguinal hernia
repair instead of face-to-face clinic visit." Jsls 19(1): e2014.00205.

BACKGROUND AND OBJECTIVES: The need for more cost- and time-efficient provision of medical care
has prompted an interest in remote or telehealth approaches to delivery of health care. We present a
study examining the feasibility and outcomes of implementation of a telephone follow-up program for
laparoscopic inguinal hernia repair. METHODS: This is a retrospective review of consecutive patients
who prospectively agreed to undergo telephone follow-up after laparoscopic inguinal hernia repair
instead of standard face-to-face clinic visits. Patients received a telephone call from a dedicated
physician assistant 2 to 3 weeks after surgery and answered a predetermined questionnaire. A face-to-
face clinic visit was scheduled based on the results of the call or on patient request. RESULTS: Of 62
patients who underwent surgery, all agreed to telephone follow-up instead of face-to-face clinic visits.
Their mean round-trip distance to the hospital was 122 miles. Fifty-five patients (88.7%) successfully
completed planned telephone follow-up. Three patients (4.8%) were lost to follow-up, and 4 (6.5%)
were erroneously scheduled for a clinic appointment. Of the 55 patients who were reached by
telephone, 50 (90.9%) were satisfied and declined an in-person clinic visit. Five patients (9.1%)
returned for a clinic appointment based on concerns raised during the telephone call. Of these, 1 was
found to have an early hernia recurrence and 1 had a seroma. CONCLUSION: Telephone follow-up by a
midlevel provider after laparoscopic inguinal hernia repair is feasible and effective and is well received
by patients.

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Ekeland, A. G., et al. (2010). "Effectiveness of telemedicine: a systematic review of reviews." Int J Med Inform
79(11): 736-771.

OBJECTIVES: To conduct a review of reviews on the impacts and costs of telemedicine services.
METHODS: A review of systematic reviews of telemedicine interventions was conducted. Interventions
included all e-health interventions, information and communication technologies for communication
in health care, Internet based interventions for diagnosis and treatments, and social care if important
part of health care and in collaboration with health care for patients with chronic conditions were
considered relevant. Each potentially relevant systematic review was assessed in full text by one
member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice
and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was
informed by principles of realist review. RESULTS: In total 1593 titles/abstracts were identified.
Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty-one
reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete
and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic
nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and
telemedicine as complex and ongoing collaborative achievements in unpredictable processes.
CONCLUSIONS: The emergence of new topic areas in this dynamic field is notable and reviewers are
starting to explore new questions beyond those of clinical and cost-effectiveness. Reviewers point to a
continuing need for larger studies of telemedicine as controlled interventions, and more focus on
patients' perspectives, economic analyses and on telemedicine innovations as complex processes and
ongoing collaborative achievements. Formative assessments are emerging as an area of interest.

Ekeland, A. G., et al. (2012). "Methodologies for assessing telemedicine: a systematic review of reviews." Int J
Med Inform 81(1): 1-11.

BACKGROUND AND OBJECTIVES: Previous reviews have expressed concerns about the quality of
telemedicine studies. There is debate about shortcomings and appropriate methodologies. The aim of
this review of systematic reviews of telemedicine is to summarize methodologies used in telemedicine
research, discuss knowledge gaps and recommendations and suggest methodological approaches for
further research. METHODS: We conducted a review of systematic reviews of telemedicine according
to a protocol listing explicit methods, selection criteria, data collection and quality assessment
procedures. We included reviews where authors explicitly addressed and made recommendations for
assessment methodologies. We did a qualitative analysis of the reviews included, sensitized by two
broad methodological positions; positivist and naturalistic approaches. The analysis focused on
methodologies used in the primary studies included in the reviews as reported by the review authors,
and methodological recommendations made by the review authors. RESULTS: We identified 1593
titles/abstracts. We included 50 reviews that explicitly addressed assessment methodologies. One
group of reviews recommended larger and more rigorously designed controlled studies to assess the
impacts of telemedicine; a second group proposed standardisation of populations, and/or
interventions and outcome measures to reduce heterogeneity and facilitate meta-analysis; a third
group recommended combining quantitative and qualitative research methods; and others applying
different naturalistic approaches including methodologies addressing mutual adaptations of services
and users; politically driven action research and formative research aimed at collaboration to ensure
capacity for improvement of services in natural settings. CONCLUSIONS: Larger and more rigorous
studies are crucial for the production of evidence of effectiveness of unambiguous telemedicine
services for pre defined outcome measures. Summative methodologies acknowledging telemedicine
as complex innovations and outcomes as partly contingent on values, meanings and contexts are also
important. So are formative, naturalistic methodologies that acknowledge telemedicine as ongoing
collaborative achievements and engage with stakeholders, including patients to produce and
conceptualise new and effective telemedicine innovations.

Elford, R., et al. (2000). "A randomized, controlled trial of child psychiatric assessments conducted using
videoconferencing." Journal of Telemedicine and Telecare 6(2): 73-82, 74 tabl., 72 fig.

Fares, A. et Bernstein, D. A. (2016). "Organization of the Swiss model of primary care telemedicine. Is adoption by
the French health system possible?" Techniques Hospitalires(758): 2 p.
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La Fdration franaise de tlmdecine prsente un extrait darticle publi dans la revue European
Research in Telemedicine, qui pourrait intresser les lecteurs de Techniques hospitalires (voir le
sommaire dans la "Description" ci-dessous). Larticle prsent ici a t publi dans le numro de mars
2016 par Asma Fares et David Nathan Bernstein, qui dveloppent le modle suisse de tlmdecine de
premier recours et suggrent son adaptabilit la France (Fares A, Bernstein DN. Organization of the
Swiss model of primary care telemedicine: Is adoption by the French health system possible? Eur Res
Telemed. 2016 Mar;5(1) :38. [Link]

Fatehi, F., et al. (2014). "Clinical applications of videoconferencing: a scoping review of the literature for the
period 2002-2012." J Telemed Telecare 20(7): 377-383.

We conducted a scoping review of the literature on the clinical applications of videoconferencing.

Electronic searches were performed using the PubMed, Embase and CINHAL databases to retrieve
papers published from 2002 to 2012 that described clinical applications of videoconferencing. The
initial search yielded 4923 records and after removing the duplicates and screening at title/abstract
level, 505 articles met the inclusion criteria and were reviewed at full-text level. The countries with the
highest number of papers were the US, Australia and Canada. Most studies were non-randomised
controlled trials. The discipline with highest number of published studies (39%) was mental health,
followed by surgery (7%) and general medicine (6%). The type of care delivered via video comprised
acute, sub-acute and chronic care, but in 44% of the papers, the intervention was used for a
combination of these purposes. Videoconferencing was used for all age groups but more frequently
for adults (20%). Most of the papers (91%) reported using videoconferencing for several clinical
purposes including management, diagnosis, counselling and monitoring. The review showed that
videoconferencing has been used in a wide range of disciplines and settings for different clinical
purposes. The practical value of published papers would be improved by following standard guidelines
for reporting research projects and clinical trials.

Fatehi, F. et Wootton, R. (2012). "Telemedicine, telehealth or e-health? A bibliometric analysis of the trends in
the use of these terms." J Telemed Telecare 18(8): 460-464.

The terms 'telemedicine', 'telehealth' and 'e-health' are often used interchangeably. We examined the
occurrence of these terms in the Scopus database. A total of 11,644 documents contained one of the
three terms in the title or abstract. Telemedicine was the most common term, with 8028 documents
referring to it, followed by e-health (n = 2573) and then telehealth (n = 1679). Telemedicine was
referred to in documents from 126 countries; the terms telehealth and e-health were found in
publications from 55 and 99 countries, respectively. Documents with telemedicine in their title or
abstract first appeared in 1972, and continued to appear at a low rate until 1994 when they started to
increase rapidly; telehealth showed a similar pattern, but with the growth beginning about five years
later. Although articles containing the term e-health appeared later than the other two terms, the rate
of increase was higher. Articles (journal papers) were the most common type for the three key terms,
followed by conference papers and review articles. Publication rates for telemedicine or telehealth or
e-health were compared with two other relatively new fields of study: Minimally Invasive Surgery
(MIS) and Highly Active Antiretroviral Therapy (HAART). Publications concerning HAART seem to have
reached a peak and are now declining, but those with the three key terms and those concerning MIS
are both growing. The variation in the level of adoption for the three terms suggests ambiguity in their
definition and a lack of clarity in the concepts they refer to.

Feltner, C., et al. (2014). "Transitional care interventions to prevent readmissions for persons with heart failure:
a systematic review and meta-analysis." Ann Intern Med 160(11): 774-784.

BACKGROUND: Nearly 25% of patients hospitalized with heart failure (HF) are readmitted within 30
days. PURPOSE: To assess the efficacy, comparative effectiveness, and harms of transitional care
interventions to reduce readmission and mortality rates for adults hospitalized with HF. DATA
SOURCES: MEDLINE, Cochrane Library, CINAHL, [Link], and World Health Organization
International Clinical Trials Registry Platform (1 January 1990 to late October 2013). STUDY SELECTION:
Two reviewers independently selected randomized, controlled trials published in English reporting a
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readmission or mortality rate within 6 months of an index hospitalization. DATA EXTRACTION: One
reviewer extracted data, and another checked accuracy. Two reviewers assessed risk of bias and
graded strength of evidence (SOE). DATA SYNTHESIS: Forty-seven trials were included. Most enrolled
adults with moderate to severe HF and a mean age of 70 years. Few trials reported 30-day
readmission rates. At 30 days, a high-intensity home-visiting program reduced all-cause readmission
and the composite end point (all-cause readmission or death; low SOE). Over 3 to 6 months, home-
visiting programs and multidisciplinary heart failure (MDS-HF) clinic interventions reduced all-cause
readmission (high SOE). Home-visiting programs reduced HF-specific readmission and the composite
end point (moderate SOE). Structured telephone support (STS) interventions reduced HF-specific
readmission (high SOE) but not all-cause readmissions (moderate SOE). Home-visiting programs, MDS-
HF clinics, and STS interventions produced a mortality benefit. Neither telemonitoring nor primarily
educational interventions reduced readmission or mortality rates. LIMITATIONS: Few trials reported
30-day readmission rates. Usual care was heterogeneous and sometimes not adequately described.
CONCLUSION: Home-visiting programs and MDS-HF clinics reduced all-cause readmission and
mortality; STS reduced HF-specific readmission and mortality. These interventions should receive the
greatest consideration by systems or providers seeking to implement transitional care interventions
for persons with HF. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Flodgren, G., et al. (2015). "Interactive telemedicine: effects on professional practice and health care
outcomes." Cochrane Database Syst Rev(9): Cd002098.

BACKGROUND: Telemedicine (TM) is the use of telecommunication systems to deliver health care at a
distance. It has the potential to improve patient health outcomes, access to health care and reduce
healthcare costs. As TM applications continue to evolve it is important to understand the impact TM
might have on patients, healthcare professionals and the organisation of care. OBJECTIVES: To assess
the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual
care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS: We searched the Effective
Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE,
five other databases and two trials registers to June 2013, together with reference checking, citation
searching, handsearching and contact with study authors to identify additional studies. SELECTION
CRITERIA: We considered randomised controlled trials of interactive TM that involved direct patient-
provider interaction and was delivered in addition to, or substituting for, usual care compared with
usual care alone, to participants with any clinical condition. We excluded telephone only interventions
and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS: For each
condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-
analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes,
and mean differences (MD) for continuous outcomes. MAIN RESULTS: We included 93 eligible trials (N
= 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to
(32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as
compared to usual care [Link] included studies recruited patients with the following clinical
conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or
substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3),
urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2),
neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer
(1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38
studies), which was used either alone or in combination. The main TM function varied depending on
clinical condition, but fell typically into one of the following six categories, with some overlap: i)
monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and
advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive
behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for
example nurses delivering education to patients with diabetes or providing support to parents of very
low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for
diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-
operative assessment after minor operation or follow-up after solid organ transplantation (8) vi),
screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer,
(e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider
varied across studies, as did the type of healthcare provider/s and healthcare system involved in
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delivering the [Link] found no difference between groups for all-cause mortality for patients
with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate
to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies;
N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up
(moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N
= 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those
allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting
participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %)
levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)=
42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some
evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P <
0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD:
SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001;
I(2) = 45% (moderate certainty evidence), in TM as compared with usual [Link] studies that
recruited participants with different mental health and substance abuse problems, reported no
differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face
delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring
via TM improved blood pressure control in participants with hypertension, and a few studies reported
improved symptom scores for those with a respiratory condition. Studies recruiting participants
requiring mental health services and those requiring specialist consultation for a dermatological
condition reported no differences between groups. AUTHORS' CONCLUSIONS: The findings in our
review indicate that the use of TM in the management of heart failure appears to lead to similar
health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve
the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by
patients and healthcare professionals, is not clear due to limited data reported for these outcomes.
The effectiveness of TM may depend on a number of different factors, including those related to the
study population e.g. the severity of the condition and the disease trajectory of the participants, the
function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to
diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the
intervention.

Foster, M. V. et Sethares, K. A. (2014). "Facilitators and barriers to the adoption of telehealth in older adults: an
integrative review." Comput Inform Nurs 32(11): 523-533; quiz 534-525.

Telehealth offers a great opportunity to provide follow-up care and daily monitoring of older adults in
their homes. Although there is a significant body of literature related to telehealth in regard to design
and adoption, little attention has been given by researchers to the perceptions of the older-adult end
users of telehealth. As the numbers of older adults increases, there is a need to evaluate the
perceptions of this population as they will most likely be the major users of telehealth. This review
identified the current telehealth technologies that are available to older adults with a discussion on
the facilitators of and barriers to those technologies. Literature published between 2003 and 2013 was
reviewed using MEDLINE, PsycINFO, and CINAHL. A total of 2387 references were retrieved, but only
14 studies met the inclusion criteria. This review indicates that 50% of the studies did not specifically
address facilitators of and barriers to adopting telehealth with older adults. Also, studies in this
population did not address caregivers' perceptions on the facilitators of and barriers to telehealth. The
use of telehealth among older adults is expected to rise, but effective adoption will be successful if the
patient's perspective is kept at the forefront.

Free, C., et al. (2013). "The effectiveness of mobile-health technology-based health behaviour change or
disease management interventions for health care consumers: a systematic review." PLoS Med 10(1):
e1001362.

BACKGROUND: Mobile technologies could be a powerful media for providing individual level support
to health care consumers. We conducted a systematic review to assess the effectiveness of mobile
technology interventions delivered to health care consumers. METHODS AND FINDINGS: We searched
for all controlled trials of mobile technology-based health interventions delivered to health care
consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK
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NHS HTA (Jan 1990-Sept 2010). Two authors extracted data on allocation concealment, allocation
sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates
and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of
mobile technologies to improve disease management and 26 trials investigated their use to change
health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk
of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence,
use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI
0.72-0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47-1.32]). In a second,
a PDA based intervention increased scores for perceived self care agency in lung transplant patients.
Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging
smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77-
2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results
were not consistent. No evidence of publication bias was demonstrated on visual or statistical
examination of the funnel plots for either disease management or health behaviours. To address the
limitation of the older search, we also reviewed more recent literature. CONCLUSIONS: Text
messaging interventions increased adherence to ART and smoking cessation and should be considered
for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high
quality adequately powered trials of optimised interventions are required to evaluate effects on
objective outcomes.

Free, C., et al. (2013). "The effectiveness of mobile-health technologies to improve health care service delivery
processes: a systematic review and meta-analysis." PLoS Med 10(1): e1001363.

BACKGROUND: Mobile health interventions could have beneficial effects on health care delivery
processes. We aimed to conduct a systematic review of controlled trials of mobile technology
interventions to improve health care delivery processes. METHODS AND FINDINGS: We searched for
all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE,
PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two
authors independently extracted data on allocation concealment, allocation sequence, blinding,
completeness of follow-up, and measures of effect. We calculated effect estimates and we used
random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had
low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding
appropriate disease management, of which 11 showed statistically significant benefits. One trial
reported a statistically significant improvement in nurse/surgeon communication using mobile
phones. Two trials reported statistically significant reductions in correct diagnoses using mobile
technology photos compared to gold standard. The pooled effect on appointment attendance using
text message (short message service or SMS) reminders versus no reminder was increased, with a
relative risk (RR) of 1.06 (95% CI 1.05-1.07, I(2) = 6%). The pooled effects on the number of cancelled
appointments was not significantly increased RR 1.08 (95% CI 0.89-1.30). There was no difference in
attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94-1.02, respectively). To
address the limitation of the older search, we also reviewed more recent literature. CONCLUSIONS:
The results for health care provider support interventions on diagnosis and management outcomes
are generally consistent with modest benefits. Trials using mobile technology-based photos reported
reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders
have modest benefits and may be appropriate for implementation. High quality trials measuring
clinical outcomes are needed. Please see later in the article for the Editors' Summary.

French, B., et al. (2013). "The challenges of implementing a telestroke network: a systematic review and case
study." BMC Med Inform Decis Mak 13: 125.

BACKGROUND: The use of telemedicine in acute stroke care can facilitate rapid access to treatment,
but the work required to embed any new technology into routine practice is often hidden, and can be
challenging. We aimed to collate recommendations and resources to support telestroke
implementation. METHODS: Systematic search of healthcare databases and the Internet to identify
descriptions of the implementation of telestroke projects; interviews with key stakeholders during the
development of one UK telestroke network. Supporting documentation from existing projects was
analysed to construct a framework of implementation stages and tasks, and a toolkit of documents.
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Interviews and literature were analysed with other data sources using Normalisation Process Theory
as described in the e-Health Implementation Toolkit. RESULTS: 61 telestroke projects were identified
and contacted. Twenty projects provided documents, 13 with published research detailing four stages
of telestroke system development, implementation, use, and evaluation. Interviewees identified four
main challenges: engaging and maintaining the commitment of a wide range of stakeholders across
multiple organisations; addressing clinicians perceptions of evidence, workload, and payback;
managing clinical and technical workability across diverse settings; and monitoring how the system is
used and reconfigured by users. CONCLUSIONS: Information to guide telestroke implementation is
sparse, but available. By using multiple sources of data, sufficient information was collated to
construct a web-based toolkit detailing implementation tasks, resources and challenges in the
development of a telestroke system for assessment and thrombolysis delivery in acute care. The
toolkit is freely available online.

Frueh, B. C., et al. (2000). "Procedural an methodological issues in telepsychiatry research and program
development." Psychiatric Services 51(12): 1522-1527.

Gammon, D., et al. (2015). "The chronic care model and technological research and innovation: a scoping
review at the crossroads." J Med Internet Res 17(2): e25.

BACKGROUND: Information and communication technologies (ICT) are key to optimizing the outcomes
of the Chronic Care Model (CCM), currently acknowledged as the best synthesis of available evidence
for chronic illness prevention and management. At the same time, CCM can offer a needed framework
for increasing the relevance and feasibility of ICT innovation and research in health care. Little is
known about how and to what extent CCM and ICT research inform each other to leverage mutual
strengths. The current study examines: What characterizes work being done at the crossroads of CCM
and ICT research and innovation? OBJECTIVE: Our aim is identify the gaps and potential that lie
between the research domains CCM and ICT, thus enabling more substantive questions and
opportunities for accelerating improvements in ICT-supported chronic care. METHODS: Using a
scoping study approach, we developed a search strategy applied to medical and technical databases
resulting in 1054 titles and abstracts that address CCM and ICT. After iteratively adapting our
inclusion/exclusion criteria to balance between breadth and feasibility, 26 publications from 20
studies were found to fulfill our criteria. Following initial coding of each article according to predefined
categories (eg, type of article, CCM component, ICT, health issue), a 1st level analysis was conducted
resulting in a broad range of categories. These were gradually reduced by constantly comparing them
for underlying commonalities and discrepancies. RESULTS: None of the studies included were from
technical databases and interventions relied mostly on "old-fashioned" technologies. Technologies
supporting "productive interactions" were often one-way (provider to patient), and it was sometimes
difficult to decipher how CCM was guiding intervention design. In particular, the major focus on ICT to
support providers did not appear unique to the challenges of chronic care. Challenges in facilitating
CCM components through ICT included poorly designed user interfaces, digital divide issues, and lack
of integration with existing infrastructure. CONCLUSIONS: The CCM is a highly influential guide for
health care development, which recognizes the need for alignment of system tools such as ICT. Yet,
there seem to be alarmingly few touch points between the subject fields of "health service
development" and "ICT-innovation". Bridging these gaps needs explicit and urgent attention as the
synergies between these domains have enormous potential. Policy makers and funding agencies need
to facilitate the joining of forces between high-tech innovative expertise and experts in the chronic
care system redesign that is required for tackling the current epidemic of long-term multiple
conditions.

Garabedian, L. F., et al. (2015). "Mobile Phone and Smartphone Technologies for Diabetes Care and Self-
Management." Curr Diab Rep 15(12): 109.

Mobile and smartphone (mHealth) technologies have the potential to improve diabetes care and self-
management, but little is known about their effectiveness and how patients, providers, and payers
currently interact with them. We conducted a systematic review and found only 20 peer-reviewed
articles, published since 2010, with robust evidence about the effectiveness of mHealth interventions
for diabetes. The majority of these interventions showed improvement on primary endpoints, such as
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HbA1c; mHealth technologies that interacted with both patients and providers were more likely to be
effective. There was little evidence about persistent use by patients, use by a patient's health care
provider, or long-term effectiveness. None of the studies discussed regulatory oversight of mHealth
technologies or payer reimbursement for them. No robust studies evaluated the more than 1100
publicly available smartphone apps for diabetes. More research with valid study designs and longer
follow-up is needed to evaluate the impact of mHealth technologies for diabetes care and self-
management.

Gee, P. M., et al. (2015). "The eHealth Enhanced Chronic Care Model: a theory derivation approach." J Med
Internet Res 17(4): e86.

BACKGROUND: Chronic illnesses are significant to individuals and costly to society. When
systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to
improve health outcomes for people with chronic conditions. Since the development of the original
CCM, tremendous information management, communication, and technology advancements have
been established. An opportunity exists to improve the time-honored CCM with clinically efficacious
eHealth tools. OBJECTIVE: The first goal of this paper was to review research on eHealth tools that
support self-management of chronic disease using the CCM. The second goal was to present a revised
model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to
increase efficiency of how patients manage their own chronic illnesses. METHODS: Using Theory
Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a
thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as
well as government reports, industry reports, legislation using search terms "CCM or Chronic Care
Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness
Self-management support" AND "Technology" AND several identified eHealth tools were also used as
search terms. We then used a review of the literature and specific components of the CCM to create
the eCCM. RESULTS: We identified 260 papers at the intersection of technology, chronic disease self-
management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the
components of CCM, self-management support, delivery system design, clinical decision support, and
clinical information systems. In general, results showed that eHealth tools make important
contributions to chronic care and the CCM but that the model requires modification in several key
areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed
within the context of community and enhanced with the benefits of the eCommunity or virtual
communities, and (3) a complete feedback loop is needed to assure productive technology-based
interactions between the patient and provider. CONCLUSIONS: The revised model, eCCM, offers
insight into the role of eHealth tools in self-management support for people with chronic conditions.
Additional research and testing of the eCCM are the logical next steps.

Gelber, H. et Alexander, M. (1999). "An evaluation of an australian videoconferencing project for child and
adolescent telepsychiatry." Journal of Telemedicine and Telecare 5(supp. 1): S21-S23, 21 fig.

Glasgow, R. E., et al. (2014). "Implementation science approaches for integrating eHealth research into practice
and policy." Int J Med Inform 83(7): e1-11.

PURPOSE: To summarize key issues in the eHealth field from an implementation science perspective
and to highlight illustrative processes, examples and key directions to help more rapidly integrate
research, policy and practice. METHODS: We present background on implementation science models
and emerging principles; discuss implications for eHealth research; provide examples of practical
designs, measures and exemplar studies that address key implementation science issues; and make
recommendations for ways to more rapidly develop and test eHealth interventions as well as future
research, policy and practice. RESULTS: The pace of eHealth research has generally not kept up with
technological advances, and many of our designs, methods and funding mechanisms are incapable of
providing the types of rapid and relevant information needed. Although there has been substantial
eHealth research conducted with positive short-term results, several key implementation and
dissemination issues such as representativeness, cost, unintended consequences, impact on health
inequities, and sustainability have not been addressed or reported. Examples of studies in several of
these areas are summarized to demonstrate this is possible. CONCLUSIONS: eHealth research that is
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intended to translate into policy and practice should be more contextual, report more on setting
factors, employ more responsive and pragmatic designs and report results more transparently on
issues important to potential adopting patients, clinicians and organizational decision makers. We
outline an alternative development and assessment model, summarize implementation science
findings that can help focus attention, and call for different types of more rapid and relevant research
and funding mechanisms.

Gokalp, H. et Clarke, M. (2013). "Monitoring activities of daily living of the elderly and the potential for its use
in telecare and telehealth: a review." Telemed J E Health 19(12): 910-923.

OBJECTIVE: This review was designed to determine whether telemonitoring activities of daily living
(ADL) of elderly people can improve quality of life and be beneficial to their healthcare. MATERIALS
AND METHODS: Electronic databases were searched for studies that monitored ADL of elderly people
and preferably measured some clinical outcomes such as ability to predict key events that require
intervention and for studies that assessed perception of elderly people of such telemonitoring
systems. The articles were reviewed and assessed independently by two reviewers. RESULTS: One
hundred seventy-five unique studies were found. Sixty-seven of these were identified for potential
inclusion, and 25 studies were finally included. Study characteristics, parameters monitored,
outcomes, and problems encountered were summarized and discussed. The main focus was on the
potential benefits of ADL monitoring on the care of elderly people. CONCLUSIONS: Although most
studies reported on technical improvements in methods for detecting changes in ADL, few, if any,
determined the benefits to the patient of telemonitoring for changes in ADL or correlation with any
physiological changes. We propose sensor and system characteristics for improved user acceptance
and deployment in a large-scale care plan. We present areas requiring further investigation.

Gorst, S. L., et al. (2014). "Home telehealth uptake and continued use among heart failure and chronic
obstructive pulmonary disease patients: a systematic review." Ann Behav Med 48(3): 323-336.

BACKGROUND: Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive
pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. PURPOSE:
The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD
and the factors that determine whether patients do or do not accept and continue to use telehealth.
METHODS: This research performs a narrative synthesis of the results from included studies. RESULTS:
Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or
withdrawal found that almost one third of patients who were offered telehealth refused and one fifth
of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of,
home telehealth use were identified. CONCLUSIONS: Research reports need to provide more details
regarding telehealth refusal and abandonment, in order to understand the reasons why patients
decide not to use telehealth.

Gray, J. E., et al. (2000). "Baby CareLink : using the internet and telemedicine to improve care for high-risk
infants." Pediatrics 106(6): 1318-1324, 1313 tabl., 1313 fig.
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Guise, V., et al. (2014). "Patient safety risks associated with telecare: a systematic review and narrative
synthesis of the literature." BMC Health Serv Res 14: 588.

BACKGROUND: Patient safety risk in the homecare context and patient safety risk related to telecare
are both emerging research areas. Patient safety issues associated with the use of telecare in
homecare services are therefore not clearly understood. It is unclear what the patient safety risks are,
how patient safety issues have been investigated, and what research is still needed to provide a
comprehensive picture of risks, challenges and potential harm to patients due to the implementation
and use of telecare services in the home. Furthermore, it is unclear how training for telecare users has
addressed patient safety issues. A systematic review of the literature was conducted to identify
patient safety risks associated with telecare use in homecare services and to investigate whether and
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how these patient safety risks have been addressed in telecare training. METHODS: Six electronic
databases were searched in addition to hand searches of key items, reference tracking and citation
tracking. Strict inclusion and exclusion criteria were set. All included items were assessed according to
set quality criteria and subjected to a narrative synthesis to organise and synthesize the findings. A
human factors systems framework of patient safety was used to frame and analyse the results.
RESULTS: 22 items were included in the review. 11 types of patient safety risks associated with
telecare use in homecare services emerged. These are in the main related to the nature of homecare
tasks and practices, and person-centred characteristics and capabilities, and to a lesser extent,
problems with the technology and devices, organisational issues, and environmental factors. Training
initiatives related to safe telecare use are not described in the literature. CONCLUSIONS: There is a
need to better identify and describe patient safety risks related to telecare services to improve
understandings of how to avoid and minimize potential harm to patients. This process can be aided by
reframing known telecare implementation challenges and user experiences of telecare with the help
of a human factors systems approach to patient safety.

Hailey, D., et al. (2011). "Evidence of benefit from telerehabilitation in routine care: a systematic review." J
Telemed Telecare 17(6): 281-287.

We systematically reviewed the evidence on the effectiveness of telerehabilitation (TR) applications.

The review included reports on rehabilitation for any disability, other than mental health conditions,
and drug or alcohol addiction. All forms of telecommunications technology for TR and all types of
study design were considered. Study quality was assessed using an approach that considered both
study performance and study design. Judgements were made on whether each TR application had
been successful, whether reported outcomes were clinically significant, and whether further data
were needed to establish the application as suitable for routine use. Sixty-one scientifically credible
studies that reported patient outcomes or administrative changes were identified through
computerized literature searches on five databases. Twelve clinical categories were covered by the
studies. Those dealing with cardiac or neurological rehabilitation were the most numerous. Thirty-one
of the studies (51%) were of high or good quality. Study results showed that 71% of the TR
applications were successful, 18% were unsuccessful and for 11% the status was unclear. The reported
outcomes for 51% of the applications appeared to be clinically significant. Poorer-quality studies
tended to have worse outcomes than those from high- or good-quality studies. We judged that further
study was required for 62% of the TR applications and desirable for 23%. TR shows promise in many
fields, but compelling evidence of benefit and of impact on routine rehabilitation programmes is still
limited. There is a need for more detailed, better-quality studies and for studies on the use of TR in
routine care.

Hameed, A. S., et al. (2014). "The impact of adherence on costs and effectiveness of telemedical patient
management in heart failure: a systematic review." Appl Clin Inform 5(3): 612-620.

OBJECTIVE: This paper analyzes evidence of the impact of patients' adherence to pharmacological and
non-pharmacological recommendations on the treatment costs of heart failure (HF) patients.
METHODS: A systematic review was performed based on the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement. Papers were searched using various combinations of
the following keywords: 'telemedicine', 'telemonitoring', 'telehealth', 'eHealth', 'remote monitoring',
'adherence', 'compliance', 'cost-effectiveness', 'cost-benefit', 'heart failure', 'healthcare costs',
'hospitalization', and 'drug costs'. We included only papers written in English or German, published
between 1998 and 2014, and having one of our search terms in the title. RESULTS: Initially, 73 papers
were selected. After a detailed review, these were narrowed done to 9 that reported an association
between adherence and/or compliance and costs. However, none established a quantitative
relationship between adherence and total healthcare costs. CONCLUSION: A model-based cost-
effectiveness analysis that appropriately considers adherence has not been carried out so far, but is
needed to fully understand the potential economic benefits of telehealth.

Hamine, S., et al. (2015). "Impact of mHealth chronic disease management on treatment adherence and
patient outcomes: a systematic review." J Med Internet Res 17(2): e52.

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BACKGROUND: Adherence to chronic disease management is critical to achieving improved health

outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues
to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being
used in health care and public health practice (mHealth) for patient communication, monitoring, and
education, and to facilitate adherence to chronic diseases management. OBJECTIVE: We conducted a
systematic review of the literature to evaluate the effectiveness of mHealth in supporting the
adherence of patients to chronic diseases management ("mAdherence"), and the usability, feasibility,
and acceptability of mAdherence tools and platforms in chronic disease management among patients
and health care providers. METHODS: We searched PubMed, Embase, and EBSCO databases for
studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus,
cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest
included effect of mHealth on patient adherence to chronic diseases management, disease-specific
clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence
tools and platforms in chronic disease management among target end-users. RESULTS: In all, 107
articles met all inclusion criteria. Short message service was the most commonly used mAdherence
tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for
mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high.
A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on
adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of
the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements
between groups were reported in 16 studies (39%). CONCLUSIONS: There is potential for mHealth
tools to better facilitate adherence to chronic disease management, but the evidence supporting its
current effectiveness is mixed. Further research should focus on understanding and improving how
mHealth tools can overcome specific barriers to adherence.

Hasselberg, M., et al. (2014). "Image-based medical expert teleconsultation in acute care of injuries. A
systematic review of effects on information accuracy, diagnostic validity, clinical outcome, and user
satisfaction." PLoS One 9(6): e98539.

OBJECTIVE: To systematically review the literature on image-based telemedicine for medical expert
consultation in acute care of injuries, considering system, user, and clinical aspects. DESIGN:
Systematic review of peer-reviewed journal articles. DATA SOURCES: Searches of five databases and in
eligible articles, relevant reviews, and specialized peer-reviewed journals. ELIGIBILITY CRITERIA:
Studies were included that covered teleconsultation systems based on image capture and transfer
with the objective of seeking medical expertise for the diagnostic and treatment of acute injury care
and that presented the evaluation of one or several aspects of the system based on empirical data.
Studies of systems not under routine practice or including real-time interactive video conferencing
were excluded. METHOD: The procedures used in this review followed the PRISMA Statement.
Predefined criteria were used for the assessment of the risk of bias. The DeLone and McLean
Information System Success Model was used as a framework to synthesise the results according to
system quality, user satisfaction, information quality and net benefits. All data extractions were done
by at least two reviewers independently. RESULTS: Out of 331 articles, 24 were found eligible.
Diagnostic validity and management outcomes were often studied; fewer studies focused on system
quality and user satisfaction. Most systems were evaluated at a feasibility stage or during small-scale
pilot testing. Although the results of the evaluations were generally positive, biases in the
methodology of evaluation were concerning selection, performance and exclusion. Gold standards
and statistical tests were not always used when assessing diagnostic validity and patient management.
CONCLUSIONS: Image-based telemedicine systems for injury emergency care tend to support valid
diagnosis and influence patient management. The evidence relates to a few clinical fields, and has
substantial methodological shortcomings. As in the case of telemedicine in general, user and system
quality aspects are poorly documented, both of which affect scale up of such programs.

Heidbuchel, H., et al. (2015). "EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a
provider perspective in five European countries on costs and net financial impact of follow-up with or
without remote monitoring." Eur Heart J 36(3): 158-169.

AIM: Remote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits
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in combination with earlier detection of relevant findings. Its implementation requires investment and
reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The
primary end-point of this randomized prospective multicentre health economic trial was the total FU-
related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU
(HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers
(taking national reimbursement into account) and costs from a healthcare payer perspective were
evaluated. METHODS AND RESULTS: A total of 312 patients with VVI- or DDD-ICD implants from 17
centres in six EU countries were randomised to HM ON or OFF, of which 303 were eligible for data
analysis. For all contacts (in-office, calendar- or alert-triggered web-based review, discussions, calls)
time-expenditure was tracked. Country-specific cost parameters were used to convert resource use
into monetary values. Remote FU equipment itself was not included in the cost calculations. Given
only two patients from Finland (one in each group) a monetary valuation analysis was not performed
for Finland. Average age was 62.4 +/- 13.1 years, 81% were male, 39% received a DDD system, and
51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 +/-
1.67 vs. 5.53 +/- 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 +/- 1.50 vs. 0.62
+/- 1.25; P < 0.005), more non-office-based contacts (1.95 +/- 3.29 vs. 1.01 +/- 2.64; P < 0.001), more
Internet sessions (11.02 +/- 15.28 vs. 0.06 +/- 0.31; P < 0.001) and more in-clinic discussions (1.84 +/-
4.20 vs. 1.28 +/- 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 +/- 1.18 vs. 0.85 +/-
1.43, P = 0.23) and shorter length-of-stay (6.31 +/- 15.5 vs. 8.26 +/- 18.6; P = 0.27), although not
significant. For the whole study population, the total FU cost for providers was not different for HM
ON vs. OFF [mean (95% CI): euro204 (169-238) vs. euro213 (182-243); range for difference (euro-36 to
54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient
(including other physician visits, examinations, and hospitalizations) was numerically (but not
significantly) lower. There was no difference in the net financial impact on providers [profit of euro408
(327-489) vs. euro400 (345-455); range for difference (euro-104 to 88), NS], but there was
heterogeneity among countries, with less profit for providers in the absence of specific remote FU
reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases
where such reimbursement exists (Germany and UK). Quality of life (SF-36) was not different.
CONCLUSION: For all the patients as a whole, FU-related costs for providers are not different for
remote FU vs. purely in-office FU, despite reorganized care. However, disparity in the impact on
provider budget among different countries illustrates the need for proper reimbursement to ensure
effective remote FU implementation.

Hendy, J., et al. (2012). "An organisational analysis of the implementation of telecare and telehealth: the whole
systems demonstrator." BMC Health Serv Res 12: 403.

BACKGROUND: To investigate organisational factors influencing the implementation challenges of

redesigning services for people with long term conditions in three locations in England, using remote
care (telehealth and telecare). METHODS: Case-studies of three sites forming the UK Department of
Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used
to obtain data from various sources, including semi-structured interviews, observation of meetings
over the course programme and prior to its launch, and document review. Participants were managers
and practitioners involved in the implementation of remote care services. RESULTS: The
implementation of remote care was nested within a large pragmatic cluster randomised controlled
trial (RCT), which formed a core element of the WSD programme. To produce robust benefits
evidence, many aspect of the trial design could not be easily adapted to local circumstances. While
remote care was successfully rolled-out, wider implementation lessons and levels of organisational
learning across the sites were hindered by the requirements of the RCT. CONCLUSIONS: The
implementation of a complex innovation such as remote care requires it to organically evolve, be
responsive and adaptable to the local health and social care system, driven by support from front-line
staff and management. This need for evolution was not always aligned with the imperative to gather
robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-
based scaling-up of remote care are to be realised.

Hidalgo-Mazzei, D., et al. (2015). "Internet-based psychological interventions for bipolar disorder: Review of
the present and insights into the future." J Affect Disord 188: 1-13.

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BACKGROUND: In the last decade, there has been an increasing advent of innovative concepts in
psychological interventions aimed at empowering bipolar patients by means of technological
advancements and taking advantage of the proliferation of the Internet. Since the adoption of these
technologies for behavioral monitoring and intervention is not trivial in clinical practice, the main
objective of this review is to provide an overview and to discuss the several initiatives published so far
in the literature related to the Internet-based technologies aimed to deliver evidence-based
psychological interventions for bipolar disorder patients. METHODS: We conducted a comprehensive
systematic review of the literature from multiple technological, psychiatric and psychological domains.
The search was conducted by applying the Boolean algorithm "BIPOLAR AND DISORDER AND
(treatment OR intervention) AND (online OR Internet OR web-based OR smartphone OR mobile)" at
MEDLINE, SCOPUS, EMBASE, ClinicalTrials, ISI Web of Science and Google Scholar. RESULTS: We
identified over 251 potential entries matching the search criteria and after a thorough manual review,
29 publications pertaining to 12 different projects, specifically focusing on psychological interventions
for bipolar patients through diverse Internet-based methods, were selected. LIMITATIONS: Taking into
consideration the diversity of the initiatives and the inconclusive main outcome results of the studies,
there is still limited evidence available to draw firm conclusions about the efficacy of interventions
using Internet-based technologies for bipolar disorder. CONCLUSIONS: However, considering the high
rates of retention and compliance reported, they represent a potential highly feasible and acceptable
method of delivering this kind of interventions to bipolar patients.

Holtz, B. et Lauckner, C. (2012). "Diabetes management via mobile phones: a systematic review." Telemed J E
Health 18(3): 175-184.

BACKGROUND: This study sought to understand the most common uses and functions of mobile
phones in monitoring and managing diabetes, their potential role in a clinical setting, and the current
state of research in this area. METHODS: We identified peer-reviewed articles published between
2000 and 2010. Twenty-one articles were analyzed for this systematic literature review. RESULTS: The
majority of studies examined the use of mobile phones from the patient's perspective. Subjects with
type 1 diabetes were enrolled exclusively in over 50% of the studies. Seventy-one percent of the
studies used a study-specific application, which had supplemental features in addition to text
messaging. The outcomes assessed varied considerably across studies, but some positive trends were
noted, such as improved self-efficacy, hemoglobin A1c, and self-management behaviors.
CONCLUSIONS: The studies evaluated showed promise in using mobile phones to help people with
diabetes manage their condition effectively. However, many of these studies lacked sufficient sample
sizes or intervention lengths to determine whether the results might be clinically or statistically
significant. Future research should examine other key issues, such as provider perceptions, integration
into a healthcare practice, and cost, which would provide important insight into the use of mobile
phones for chronic disease management.

Huang, K., et al. (2015). "Telehealth interventions versus center-based cardiac rehabilitation of coronary artery
disease: A systematic review and meta-analysis." Eur J Prev Cardiol 22(8): 959-971.

BACKGROUND: Cardiac rehabilitation (CR) is an evidence-based recommendation for patients with

coronary artery disease (CAD). However, CR is dramatically underutilized. Telehealth interventions
have the potential to overcome barriers and may be an innovative model of delivering CR. This review
aimed to determine the effectiveness of telehealth intervention delivered CR compared with center-
based supervised CR. METHOD: Medline, Embase, the Cochrane Central Register of Controlled Trials
(CENTRAL) in the Cochrane Library and the Chinese BioMedical Literature Database (CBM), were
searched to April 2014, without language restriction. Existing randomized controlled trials, reviews,
relevant conference lists and gray literature were checked. Randomized controlled trials that
compared telehealth intervention delivered CR with traditional center-based supervised CR in adults
with CAD were included. Two reviewers selected studies and extracted data independently. Main
clinical outcomes including clinical events, modifiable risk factors or other endpoints were measured.
RESULTS: Fifteen articles reporting nine trials were reviewed, most of which recruited patients with
myocardial infarction or revascularization. No statistically significant difference was found between
telehealth interventions delivered and center-based supervised CR in exercise capacity (standardized
mean difference (SMD) -0.01; 95% confidence interval (CI) -0.12-0.10), weight (SMD -0.13; 95% CI -
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0.30-0.05), systolic and diastolic blood pressure (mean difference (MD) -1.27; 95% CI -3.67-1.13 and
MD 1.00; 95% CI -0.42-2.43, respectively), lipid profile, smoking (risk ratio (RR) 1.03; 95% CI 0.78-1.38),
mortality (RR 1.15; 95% CI 0.61-2.19), quality of life and psychosocial state. CONCLUSIONS: Telehealth
intervention delivered cardiac rehabilitation does not have significantly inferior outcomes compared
to center-based supervised program in low to moderate risk CAD patients. Telehealth intervention
offers an alternative deliver model of CR for individuals less able to access center-based cardiac
rehabilitation. Choices should reflect preferences, anticipation, risk profile, funding, and accessibility
to health service.

Huang, V. W., et al. (2014). "Distance management of inflammatory bowel disease: systematic review and
meta-analysis." World J Gastroenterol 20(3): 829-842.

AIM: To review the effectiveness of distance management methods in the management of adult
inflammatory bowel disease (IBD) patients. METHODS: A systematic review and meta-analysis of
randomized controlled trials comparing distance management and standard clinic follow-up in the
management of adult IBD patients. Distance management intervention was defined as any remote
management method in which there is a patient self-management component whereby the patient
interacts remotely via a self-guided management program, electronic interface, or self-directs open
access to clinic follow up. The search strategy included electronic databases (Medline, PubMed,
CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE, KTPlus, Web of Science, and
SCOPUS), conference proceedings, and internet search for web publications. The primary outcome
was the mean difference in quality of life, and the secondary outcomes included mean difference in
relapse rate, clinic visit rate, and hospital admission rate. Study selection, data extraction, and risk of
bias assessment were completed by two independent reviewers. RESULTS: The search strategy
identified a total of 4061 articles, but only 6 randomized controlled trials met the inclusion and
exclusion criteria for the systematic review and meta-analysis. Three trials involved telemanagement,
and three trials involved directed patient self-management and open access clinics. The total sample
size was 1463 patients. There was a trend towards improved quality of life in distance management
patients with an end IBDQ quality of life score being 7.28 (95%CI: -3.25-17.81) points higher than
standard clinic follow-up. There was a significant decrease in the clinic visit rate among distance
management patients mean difference -1.08 (95%CI: -1.60--0.55), but no significant change in relapse
rate or hospital admission rate. CONCLUSION: Distance management of IBD significantly decreases
clinic visit utilization, but does not significantly affect relapse rates or hospital admission rates.

Huibers, L., et al. (2011). "Safety of telephone triage in out-of-hours care: a systematic review." Scand J Prim
Health Care 29(4): 198-209.

OBJECTIVE: Telephone triage in patients requesting help may compromise patient safety, particularly
if urgency is underestimated and the patient is not seen by a physician. The aim was to assess the
research evidence on safety of telephone triage in out-of-hours primary care. METHODS: A systematic
review was performed of published research on telephone triage in out-of-hours care, searching in
PubMed and EMBASE up to March 2010. Studies were included if they concerned out-of-hours
medical care and focused on telephone triage in patients with a first request for help. Study inclusion
and data extraction were performed by two researchers independently. Post-hoc two types of studies
were distinguished: observational studies in contacts with real patients (unselected and highly urgent
contacts), and prospective observational studies using high-risk simulated patients (with a highly
urgent health problem). RESULTS: Thirteen observational studies showed that on average triage was
safe in 97% (95% CI 96.5-97.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.7-
90.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that
on average 46% (95% CI 42.7-49.8%) were safe. Adverse events described in the studies included
mortality (n = 6 studies), hospitalisations (n = 5), attendance at emergency department (n=1), and
medical errors (n = 6). CONCLUSIONS: There is room for improvement in safety of telephone triage in
patients who present symptoms that are high risk. As these have a low incidence, recognition of these
calls poses a challenge to health care providers in daily practice.

Husebo, A. M. et Storm, M. (2014). "Virtual visits in home health care for older adults." ScientificWorldJournal
2014: 689873.
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BACKGROUND: This review identifies the content of virtual visits in community nursing services to
older adults and explores the manner in which service users and the nurses use virtual visits. DESIGN:
An integrative literature review. METHOD: Data collection comprised a literature search in three
databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert
consultation were performed. A total of 12 articles met the inclusion criteria. The articles were
reviewed in terms of study characteristics, service content and utilization, and patient and health care
provider experience. RESULTS: Our review shows that in most studies the service is delivered on a
daily basis and in combination with in-person visits. The findings suggest that older home-dwelling
patients can benefit from virtual visits in terms of enhanced social inclusion and medication
compliance. Service users and their nurses found virtual visits satisfactory and suitable for care
delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found.
CONCLUSIONS: The findings can inform the planning of virtual visits in home health care as a
complementary service to in-person visits, in order to meet the increasingly complex needs of older
adults living at home.

Hussein, R. (2015). "A Review of Realizing the Universal Health Coverage (UHC) Goals by 2030: Part 1- Status
quo, Requirements, and Challenges." J Med Syst 39(7): 71.

This paper is the first part of a review of how to realize the Universal Health Coverage (UHC) goals by
2030. The objective of this review is to investigate the role of eHealth and technology in achieving
UHC, focusing on four aspects: 1) identifying the importance of UHC and highlighting how UHC is
influenced by health systems and eHealth, 2) investigating the current status of UHC worldwide and
indicating the current challenges facing the realization of UHC, 3) reviewing the current research
activities in the UHC domain and emphasizing the role of eHealth and technology in achieving UHC,
and 4) discussing the results of the review to identify the current gaps in UHC implantation and the
corresponding research lines for future [Link] part covers the first two aspects through:
providing the required background on UHC, highlighting the potential benefits of eHealth utilization in
UHC, addressing the current status quo of UHC implementation worldwide, and finally concluding the
lessons learned in terms of the UHC challenges and [Link] part also described the used
search methodology and selection criteria to synthesize this review. It also indicates the limitations of
conducting a systematic review in this early stage of deploying UHC-oriented eHealth solutions.

Hussein, R. (2015). "A Review of Realizing the Universal Health Coverage (UHC) Goals by 2030: Part 2- What is
the Role of eHealth and Technology?" J Med Syst 39(7): 72.

This paper is the second part of a review of how to realize the Universal Health Coverage (UHC) goals
by 2030. The objective of this review is to investigate the role of eHealth and technology in achieving
UHC, focusing on four aspects: 1) identifying the importance of UHC and highlighting how UHC is
influenced by health systems and eHealth, 2) investigating the current status of UHC worldwide and
indicating the current challenges facing the realization of UHC, 3) reviewing the current research
activities in the UHC domain and emphasizing the role of eHealth and technology in achieving UHC,
and 4) discussing the results of the review to identify the current gaps in UHC implantation and the
corresponding research lines for future investigation. This part covers the last two aspects through
providing a comprehensive understanding of the role of eHealth in the current research activities in
the UHC domain. Specifically, eHealth can be extensively deployed in connecting the healthcare
information systems, strengthening the health systems, building the health workforce capacity, in
addition to forming frameworks of integrated mHealth strategies for achieving UHC.

Huston, J. L. (2005). "Information governance standards for managing e-health information." J Telemed
Telecare 11 Suppl 2: S56-58.

Integrity of patient information, from both a quality and a security perspective, is critical to patient
care. In the UK, the information governance initiative of the National Health Service (NHS) provides a
framework to monitor and control the management of confidential patient data. Information
governance standards grew out of the Data Accreditation Programme, first proposed in the 1998 NHS
document Information for Health. The Data Accreditation Programme was based on a three-stage
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assessment of data quality in acute hospitals. Stage one required internal review of policy and
procedures for data input into computerized patient administration systems. Stage two involved an
external audit to verify compliance with the standards. Stage three mandated audits of data outputs,
focusing on clinical coding quality. Before stage three of the programme was fully implemented, the
standards were incorporated into the information governance initiative, in which standards were
expanded to include primary care and other health-care settings. These standards address many
information management issues, including security and data quality, which are key concerns in
telemedicine and e-health applications. Compliance is essential for the successful implementation of
the NHS Care Records Service, which will allow sharing of electronically stored patient information
across the UK.

Hutchesson, M. J., et al. (2015). "eHealth interventions for the prevention and treatment of overweight and
obesity in adults: a systematic review with meta-analysis." Obes Rev 16(5): 376-392.

A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of
eHealth interventions for the prevention and treatment of overweight and obesity in adults. Eight
databases were searched for studies published in English from 1995 to 17 September 2014. Eighty-
four studies were included, with 183 intervention arms, of which 76% (n = 139) included an eHealth
component. Sixty-one studies had the primary aim of weight loss, 10 weight loss maintenance, eight
weight gain prevention, and five weight loss and maintenance. eHealth interventions were
predominantly delivered using the Internet, but also email, text messages, monitoring devices, mobile
applications, computer programs, podcasts and personal digital assistants. Forty percent (n = 55) of
interventions used more than one type of technology, and 43.2% (n = 60) were delivered solely using
eHealth technologies. Meta-analyses demonstrated significantly greater weight loss (kg) in eHealth
weight loss interventions compared with control (MD -2.70 [-3.33,-2.08], P < 0.001) or minimal
interventions (MD -1.40 [-1.98,-0.82], P < 0.001), and in eHealth weight loss interventions with extra
components or technologies (MD 1.46 [0.80, 2.13], P < 0.001) compared with standard eHealth
programmes. The findings support the use of eHealth interventions as a treatment option for obesity,
but there is insufficient evidence for the effectiveness of eHealth interventions for weight loss
maintenance or weight gain prevention.

Hyman, J. L., et al. (2012). "Online professional networks for physicians: risk management." Clin Orthop Relat
Res 470(5): 1386-1392.

BACKGROUND: The rapidly developing array of online physician-only communities represents a

potential extraordinary advance in the availability of educational and informational resources to
physicians. These online communities provide physicians with a new range of controls over the
information they process, but use of this social media technology carries some risk.
QUESTIONS/PURPOSES: The purpose of this review was to help physicians manage the risks of online
professional networking and discuss the potential benefits that may come with such networks. This
article explores the risks and benefits of physicians engaging in online professional networking with
peers and provides suggestions on risk management. METHODS: Through an Internet search and
literature review, we scrutinized available case law, federal regulatory code, and guidelines of conduct
from professional organizations and consultants. We reviewed the [Link] site as a case
example because it is currently the only online social network exclusively for orthopaedic surgeons.
RESULTS: Existing case law suggests potential liability for orthopaedic surgeons who engage with
patients on openly accessible social network platforms. Current society guidelines in both the United
States and Britain provide sensible rules that may mitigate such risks. However, the overall lack of a
strong body of legal opinions, government regulations as well as practical experience for most
surgeons limit the suitability of such platforms. Closed platforms that are restricted to validated
orthopaedic surgeons may limit these downside risks and hence allow surgeons to collaborate with
one another both as clinicians and practice owners. CONCLUSIONS: Educating surgeons about the pros
and cons of participating in these networking platforms is helping them more astutely manage risks
and optimize benefits. This evolving online environment of professional interaction is one of few
precedents, but the application of risk management strategies that physicians use in daily practice
carries over into the online community. This participation should foster ongoing dialogue as new
guidelines emerge. This will allow today's orthopaedic surgeon to feel more comfortable with online
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professional networks and better understand how to make an informed decision regarding their
proper use.

Inglis, S. C., et al. (2011). "Which components of heart failure programmes are effective? A systematic review
and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary
component of chronic heart failure management in 8323 patients: Abridged Cochrane Review." Eur J
Heart Fail 13(9): 1028-1040.

AIMS: Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver
specialized management to more patients with chronic heart failure (CHF), but their efficacy is still to
be proven. The aim of this meta-analysis was to review randomized controlled trials (RCTs) of TM or
STS for all-cause mortality and all-cause and CHF-related hospitalizations in patients with CHF, as a
non-invasive remote model of a specialized disease-management intervention. METHODS AND
RESULTS: We searched all relevant electronic databases and search engines, hand-searched
bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers
independently extracted all data. Randomized controlled trials comparing TM or STS to usual care in
patients with CHF were included. Studies that included intensified management with additional home
or clinic-visits were excluded. Primary outcomes (mortality and hospitalizations) were analysed;
secondary outcomes (cost, length of stay, and quality of life) were tabulated. Thirty RCTs of STS and
TM were identified (25 peer-reviewed publications (n= 8323) and five abstracts (n= 1482)). Of the 25
peer-reviewed studies, 11 evaluated TM (2710 participants), 16 evaluated STS (5613 participants) with
two testing both STS and TM in separate intervention arms compared with usual care. Telemonitoring
reduced all-cause mortality {risk ratio (RR) 0.66 [95% confidence interval (CI) 0.54-0.81], P< 0.0001
}and STS showed a similar, but non-significant trend [RR 0.88 (95% CI 0.76-1.01), P= 0.08]. Both TM
[RR 0.79 (95% CI 0.67-0.94), P= 0.008], and STS [RR 0.77 (95% CI 0.68-0.87), P< 0.0001] reduced CHF-
related hospitalizations. Both interventions improved quality of life, reduced costs, and were
acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional
class were observed. CONCLUSION: Telemonitoring and STS both appear effective interventions to
improve outcomes in patients with CHF. Systematic Review Number: Cochrane Database of Systematic
Reviews. 2008:Issue 3. Art. No.: CD007228. DOI: 10.1002/14651858.CD007228.

Ismail, S. A., et al. (2013). "Reducing inappropriate accident and emergency department attendances: a
systematic review of primary care service interventions." Br J Gen Pract 63(617): e813-820.

BACKGROUND: Inappropriate attendances may account for up to 40% of presentations at accident and
emergency (A&E) departments. There is considerable interest from health practitioners and
policymakers in interventions to reduce this burden. AIM: To review the evidence on primary care
service interventions to reduce inappropriate A&E attendances. DESIGN AND SETTING: Systematic
review of UK and international primary care interventions. METHOD: Studies published in English
between 1 January 1986 and 23 August 2011 were identified from PubMed, the NHS Economic
Evaluation Database, the Cochrane Collaboration, and Health Technology Assessment databases. The
outcome measures were A&E attendances, patient satisfaction, clinical outcome, and intervention
cost. Two authors reviewed titles and abstracts of retrieved results, with adjudication of
disagreements conducted by the third. Studies were quality assessed using the Scottish Intercollegiate
Guidelines Network checklist system where applicable. RESULTS: In total, 9916 manuscripts were
identified, of which 34 were reviewed. Telephone triage was the single best-evaluated intervention.
This resulted in negligible impact on A&E attendance, but exhibited acceptable patient satisfaction
and clinical safety; cost effectiveness was uncertain. The limited available evidence suggests that
emergency nurse practitioners in community settings and community health centres may reduce A&E
attendance. For all other interventions considered in this review (walk-in centres, minor injuries units,
and out-of-hours general practice), the effects on A&E attendance, patient outcomes, and cost were
inconclusive. CONCLUSION: Studies showed a negligible effect on A&E attendance for all
interventions; data on patient outcomes and cost-effectiveness are limited. There is an urgent need to
examine all aspects of primary care service interventions that aim to reduce inappropriate A&E
attendance.

Iyngkaran, P., et al. (2015). "Technology-assisted congestive heart failure care." Curr Heart Fail Rep 12(2): 173-
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186.

The interface between eHealth technologies and disease management in chronic conditions such as
chronic heart failure (CHF) has advanced beyond the research domain. The substantial morbidity,
mortality, health resource utilization and costs imposed by chronic disease, accompanied by
increasing prevalence, complex comorbidities and changing client and health staff demographics, have
pushed the boundaries of eHealth to alleviate costs whilst maintaining services. Whilst the intentions
are laudable and the technology is appealing, this nonetheless requires careful scrutiny. This review
aims to describe this technology and explore the current evidence and measures to enhance its
implementation.

Jang-Jaccard, J., et al. (2014). "Barriers for delivering telehealth in rural australia: a review based on Australian
trials and studies." Telemed J E Health 20(5): 496-504.

BACKGROUND: Australians in rural and remote areas live with far poorer health outcomes than those
in urban areas. Telehealth services have emerged as a promising solution to narrow this health gap, as
they improve the level and diversity of health services delivery to rural and remote Australian
communities. Although the benefits of telehealth services are well studied and understood, the
uptake has been very slow. MATERIALS AND METHODS: To understand the underpinning issues, we
conducted a literature review on barriers to telehealth adoption in rural and remote Australian
communities, based on the published works of Australian clinical trials and studies. RESULTS: This
article presents our findings using a comprehensive barrier matrix. This matrix is composed of four
stakeholders (governments, technology developers and providers, health professionals, and patients)
and five different categorizations of barriers (regulatory, financial, cultural, technological, and
workforce). We explain each cell of the matrix (four stakeholdersxfive categories) and map the
reported work into the matrix. CONCLUSIONS: Several exemplary barrier cases are also described to
give more insights into the complexity and dilemma of adopting telehealth services. Finally, we outline
recent technological advancements that have a great potential to overcome some of the identified
barriers.

Johnston, B. (2011). "UK telehealth initiatives in palliative care: a review." Int J Palliat Nurs 17(6): 301-308.

This review paper explores the use of telehealth in relation to palliative care in the UK. Information
technology (IT) developments are being harnessed throughout society, and there is growing interest in
the ways in which they can be used to meet and support patients' health needs in the community. The
aim of the literature review was to scope the information available from published and unpublished
research, with particular reference to older people. The evidence suggests that, despite the
challenges, there are numerous examples of good practice in relation to telehealth, palliative and end-
of-life care, and older people. Developments in technology that have increased the capacity to
improve care, through reaching greater numbers of people of all age groups, mean that telehealth has
much to offer people living with and dying from advanced illness. However, some of the evaluative
evidence is limited and further rigour is needed when evaluating future telehealth innovations.

Kalyanpur, A. (2014). "The role of teleradiology in emergency radiology provision." Radiol Manage 36(3): 46-49.

Teleradiology has had a major impact in decreasing report turnaround time, and in improving service
levels in the emergency setting. Teleradiology in the emergency setting is usually associated with a
strong peer review and quality assurance process. It has generated a cadre of specialized generalists,
who excel in acute care interpretation. Hence report quality is enhanced. By using the centralized
reading room coupled with the night-day model, radiologist productivity is increased and healthcare
costs are reduced. Communication levels between clinicians and radiologists remain high,
commensurate with on-site radiology. The cons are related to insufficient adherence to regulations,
corporatization and predatory practices, which are economic and investor-driven rather than in the
interests of patient care. Insufficient clinical history and large imaging datasets present a challenge.

Kamei, T., et al. (2013). "Systematic review and meta-analysis of studies involving telehome monitoring-based
telenursing for patients with chronic obstructive pulmonary disease." Jpn J Nurs Sci 10(2): 180-192.
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AIM: This systematic review evaluated the effects of telehome monitoring-based telenursing (THMTN)
on health outcomes and use of healthcare services and compared them with the effects of
conventional treatment in patients with severe and very severe chronic obstructive pulmonary disease
(COPD). METHODS: An extensive published work search of several databases was performed in May
and October 2011. Randomized controlled trials and non-randomized controlled clinical trials were
evaluated. Parameters included hospitalization rate, number of visits to the emergency department,
exacerbations, mean number of hospitalizations, mean duration of bed days of care, mortality, and
health-related quality of life by the duration of THMTN and COPD severity. A random effects model
was applied. Risk ratio and mean difference were calculated. Heterogeneity was assessed using the
I(2) statistic. RESULTS: Nine original articles involving 550 participants were identified in the meta-
analysis. THMTN decreased hospitalization rates, emergency department visits, exacerbations, mean
number of hospitalizations, and mean duration of bed days of care in severe and very severe COPD
patients. Hospitalization rates and emergency department visits were comparable between patients
undergoing THMTN of different durations. In addition, THMTN had no effect on mortality.
CONCLUSION: THMTN significantly decreases the use of healthcare services; however, it does not
affect mortality in severe and very severe COPD patients.

Kaner, E., et al. (2007). "Medical communication and technology : a video-based process study of the use of
decision aids in primary care consultations." Bmc Medical Informatics and Decision Making 7(2): 1-11.
[Link]

Kassam-Adams, N., et al. (2015). "A new method for assessing content validity in model-based creation and
iteration of eHealth interventions." J Med Internet Res 17(4): e95.

BACKGROUND: The advent of eHealth interventions to address psychological concerns and health
behaviors has created new opportunities, including the ability to optimize the effectiveness of
intervention activities and then deliver these activities consistently to a large number of individuals in
need. Given that eHealth interventions grounded in a well-delineated theoretical model for change
are more likely to be effective and that eHealth interventions can be costly to develop, assuring the
match of final intervention content and activities to the underlying model is a key step. We propose to
apply the concept of "content validity" as a crucial checkpoint to evaluate the extent to which
proposed intervention activities in an eHealth intervention program are valid (eg, relevant and likely to
be effective) for the specific mechanism of change that each is intended to target and the intended
target population for the intervention. OBJECTIVE: The aims of this paper are to define content validity
as it applies to model-based eHealth intervention development, to present a feasible method for
assessing content validity in this context, and to describe the implementation of this new method
during the development of a Web-based intervention for children. METHODS: We designed a practical
5-step method for assessing content validity in eHealth interventions that includes defining key
intervention targets, delineating intervention activity-target pairings, identifying experts and using a
survey tool to gather expert ratings of the relevance of each activity to its intended target, its likely
effectiveness in achieving the intended target, and its appropriateness with a specific intended
audience, and then using quantitative and qualitative results to identify intervention activities that
may need modification. We applied this method during our development of the Coping Coach Web-
based intervention for school-age children. RESULTS: In the evaluation of Coping Coach content
validity, 15 experts from five countries rated each of 15 intervention activity-target pairings. Based on
quantitative indices, content validity was excellent for relevance and good for likely effectiveness and
age-appropriateness. Two intervention activities had item-level indicators that suggested the need for
further review and potential revision by the development team. CONCLUSIONS: This project
demonstrated that assessment of content validity can be straightforward and feasible to implement
and that results of this assessment provide useful information for ongoing development and iterations
of new eHealth interventions, complementing other sources of information (eg, user feedback,
effectiveness evaluations). This approach can be utilized at one or more points during the
development process to guide ongoing optimization of eHealth interventions.

Keane, M. G. (2009). "A review of the role of telemedicine in the accident and emergency department." J
Telemed Telecare 15(3): 132-134.
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A literature search was conducted for articles on the role of telemedicine in accident and emergency
work. The search yielded 39 relevant papers, which came from 21 independent groups that had used
telemedicine in an emergency medicine setting. The articles showed that telemedicine has been
applied in a variety of ways from medical advice for paramedics in the disaster setting, to patient
follow-up in the fracture clinic. A variety of communications equipment has been tried, including radio
links, telephone, email and mobile wireless videoconferencing devices. All such links have been found
to transfer information effectively, but success has sometimes been limited by technical failure and by
staff lacking confidence in using the systems. Telemedicine has been used widely to support
emergency nurse practitioners in minor injury units. Telemedicine has also been suggested as a way
for paramedics to communicate with regional coronary care units quickly, hence enabling them to
provide pre-hospital thrombolysis in the field when appropriate. The accident and emergency setting
is well suited to the application of telemedicine. Larger trials and cost-effectiveness studies are
required in this area.

Kew, K. M. et Cates, C. J. (2016). "Remote versus face-to-face check-ups for asthma." Cochrane Database Syst
Rev 4: Cd011715.

BACKGROUND: Asthma remains a significant cause of avoidable morbidity and mortality. Regular
check-ups with a healthcare professional are essential to monitor symptoms and adjust
[Link] services worldwide are considering telephone and internet technologies as a way
to manage the rising number of people with asthma and other long-term health conditions. This may
serve to improve health and reduce the burden on emergency and inpatient services. Remote check-
ups may represent an unobtrusive and efficient way of maintaining contact with patients, but it is
uncertain whether conducting check-ups in this way is effective or whether it may have unexpected
negative consequences. OBJECTIVES: To assess the safety and efficacy of conducting asthma check-ups
remotely versus usual face-to-face consultations. SEARCH METHODS: We identified trials from the
Cochrane Airways Review Group Specialised Register (CAGR) up to 24 November 2015. We also
searched [Link], the World Health Organization (WHO) trials portal, reference lists of
other reviews and contacted trial authors for additional information. SELECTION CRITERIA: We
included parallel randomised controlled trials (RCTs) of adults or children with asthma that compared
remote check-ups conducted using any form of technology versus standard face-to-face consultations.
We excluded studies that used automated telehealth interventions that did not include personalised
contact with a health professional. We included studies reported as full-text articles, as abstracts only
and unpublished data. DATA COLLECTION AND ANALYSIS: Two review authors screened the literature
search results and independently extracted risk of bias and numerical data. We resolved any
disagreements by consensus, and we contacted study authors for missing [Link] analysed
dichotomous data as odds ratios (ORs) using study participants as the unit of analysis, and continuous
data as mean differences using the random-effects models. We rated all outcomes using the Grading
of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS:
Six studies including a total of 2100 participants met the inclusion criteria: we pooled four studies
including 792 people in the main efficacy analyses, and presented the results of a cluster
implementation study (n = 1213) and an oral steroid tapering study (n = 95) separately. Baseline
characteristics relating to asthma severity were variable, but studies generally recruited people with
asthma taking regular medications and excluded those with COPD or severe asthma. One study
compared the two types of check-up for oral steroid tapering in severe refractory asthma and we
assessed it as a separate question. The studies could not be blinded and dropout was high in four of
the six studies, which may have biased the [Link] could not say whether more people who had a
remote check-up needed oral corticosteroids for an asthma exacerbation than those who were seen
face-to-face because the confidence intervals (CIs) were very wide (OR 1.74, 95% CI 0.41 to 7.44; 278
participants; one study; low quality evidence). In the face-to-face check-up groups, 21 participants out
of 1000 had exacerbations that required oral steroids over three months, compared to 36 (95% CI nine
to 139) out of 1000 for the remote check-up group. Exacerbations that needed treatment in the
Emergency Department (ED), hospital admission or an unscheduled healthcare visit all happened too
infrequently to detect whether remote check-ups are a safe alternative to face-to-face consultations.
Serious adverse events were not reported separately from the exacerbation [Link] was no
difference in asthma control measured by the Asthma Control Questionnaire (ACQ) or in quality of life
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measured on the Asthma Quality of Life Questionnaire (AQLQ) between remote and face-to-face
check-ups. We could rule out significant harm of remote check-ups for these outcomes but we were
less confident because these outcomes are more prone to bias from lack of [Link] larger
implementation study that compared two general practice populations demonstrated that offering
telephone check-ups and proactively phoning participants increased the number of people with
asthma who received a review. However, we do not know whether the additional participants who
had a telephone check-up subsequently benefited in asthma outcomes. AUTHORS' CONCLUSIONS:
Current randomised evidence does not demonstrate any important differences between face-to-face
and remote asthma check-ups in terms of exacerbations, asthma control or quality of life. There is
insufficient information to rule out differences in efficacy, or to say whether or not remote asthma
check-ups are a safe alternative to being seen face-to-face.

Khan, F., et al. (2015). "Telerehabilitation for persons with multiple sclerosis." Cochrane Database Syst Rev(4):
Cd010508.

BACKGROUND: Telerehabilitation, an emerging method, extends rehabilitative care beyond the

hospital, and facilitates multifaceted, often psychotherapeutic approaches to modern management of
patients using telecommunication technology at home or in the community. Although a wide range of
telerehabilitation interventions are trialed in persons with multiple sclerosis (pwMS), evidence for
their effectiveness is unclear. OBJECTIVES: To investigate the effectiveness and safety of
telerehabilitation intervention in pwMS for improved patient outcomes. Specifically, this review
addresses the following questions: does telerehabilitation achieve better outcomes compared with
traditional face-to-face intervention; and what types of telerehabilitation interventions are effective,
in which setting and influence which specific outcomes (impairment, activity limitation and
participation)? SEARCH METHODS: We performed a literature search using the Cochrane Multiple
Sclerosis and Rare Diseases of the Central Nervous System Review Group Specialised Register( 9 July,
2014.) We handsearched the relevant journals and screened the reference lists of identified studies,
and contacted authors for additional data. SELECTION CRITERIA: Randomised controlled trials (RCTs)
and controlled clinical trials (CCTs) that reported telerehabilitation intervention/s in pwMS and
compared them with some form of control intervention (such as lower level or different types of
intervention, minimal intervention, waiting-list controls or no treatment (or usual care); interventions
given in different settings) in adults with MS. DATA COLLECTION AND ANALYSIS: Two review authors
independently selected studies and extracted data. Three review authors assessed the methodological
quality of studies using the GRADEpro software (GRADEpro 2008) for best-evidence synthesis. A meta-
analysis was not possible due to marked methodological, clinical and statistical heterogeneity
between included trials and between measurement tools used. Hence, we performed a best-evidence
synthesis using a qualitative analysis. MAIN RESULTS: Nine RCTs, one with two reports, (N = 531
participants, 469 included in analyses) investigated a variety of telerehabilitation interventions in
adults with MS. The mean age of participants varied from 41 to 52 years (mean 46.5 years) and mean
years since diagnosis from 7.7 to 19.0 years (mean 12.3 years). The majority of the participants were
women (proportion ranging from 56% to 87%, mean 74%) and with a relapsing-remitting course of
MS. These interventions were complex, with more than one rehabilitation component and included
physical activity, educational, behavioural and symptom management [Link] studies scored
'low' on the methodological quality assessment. Overall, the review found 'low-level' evidence for
telerehabilitation interventions in reducing short-term disability and symptoms such as fatigue. There
was also 'low-level' evidence supporting telerehabilitation in the longer term for improved functional
activities, impairments (such as fatigue, pain, insomnia); and participation measured by quality of life
and psychological outcomes. There were limited data on process evaluation (participants'/therapists'
satisfaction) and no data available for cost effectiveness. There were no adverse events reported as a
result of telerehabilitation interventions. AUTHORS' CONCLUSIONS: There is currently limited evidence
on the efficacy of telerehabilitation in improving functional activities, fatigue and quality of life in
adults with MS. A range of telerehabilitation interventions might be an alternative method of
delivering services in MS populations. There is insufficient evidence to support on what types of
telerehabilitation interventions are effective, and in which setting. More robust trials are needed to
build evidence for the clinical and cost effectiveness of these interventions.

Khan, F., et al. (2015). "Telerehabilitation for persons with multiple sclerosis. A Cochrane review." Eur J Phys
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Rehabil Med 51(3): 311-325.

A wide range of telerehabilitation interventions are trialled in persons with multiple sclerosis (pwMS).
However, the evidence for their effectiveness is unclear. Aim of the review was to systematically
assess the effectiveness and safety of telerehabilitation intervention in pwMS, the types of
approaches that are effective (setting, type, intensity) and the outcomes (impairment, activity
limitation and participation) that are affected. The search strategy comprised: Cochrane Multiple
Sclerosis and Rare Diseases of the Central Nervous System Review Group Specialised Register (up to 9
July, 2014). Relevant journals and reference lists of identified studies were screened for additional
data. Selected studies included randomized and controlled clinical trials that compared
telerehabilitation intervention/s in pwMS with a control intervention (such as lower level or different
types of intervention, minimal intervention; waiting-list controls, no treatment or usual care;
interventions given in different settings). Best evidence synthesis was based on methodological quality
using the GRADEpro software. Nine RCTs (N.=531 participants, 469 included in analyses) investigated a
variety of telerehabilitation interventions in adults with MS. The interventions evaluated were
complex, with more than one rehabilitation component and included physical activity, educational,
behavioural and symptom management programmes. All studies scored "low" on the methodological
quality assessment. Evidence from included studies provides 'low-level' evidence for reduction in
short-term disability (and symptoms) such as fatigue. There was also "low-level" evidence supporting
telerehabilitation in the longer term for improved functional activities, impairments (such as fatigue,
pain, insomnia); and participation. There were limited data on process evaluation
(participants'/therapists' satisfaction) and no data available for cost effectiveness. There were no
adverse events reported as a result of telerehabilitation intervention. There is limited evidence to
date, on the efficacy of telerehabilitation in improving functional activities, fatigue and quality of life in
adults with MS. There is also insufficient evidence to support what types of telerehabilitation
interventions are effective, and in which setting. More robust trials are needed to build evidence for
the clinical and cost effectiveness of these interventions.

Kirkwood, K. T., et al. (2000). "The consistency of neuropsychological assessments performed via
telecommunication and face to face." Journal of Telemedicine and Telecare 6(3): 147-151, 141 tabl.

Kitsiou, S., et al. (2015). "Effects of home telemonitoring interventions on patients with chronic heart failure: an
overview of systematic reviews." J Med Internet Res 17(3): e63.

BACKGROUND: Growing interest on the effects of home telemonitoring on patients with chronic heart
failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar
research questions with a concomitant increase in discordant findings. Differences in the scope,
methods of analysis, and methodological quality of systematic reviews can cause great confusion and
make it difficult for policy makers and clinicians to access and interpret the available evidence and for
researchers to know where knowledge gaps in the extant literature exist. OBJECTIVE: This overview
aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the
effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to
inform policy makers, practitioners, and researchers. METHODS: A comprehensive literature search
was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-
reviewed systematic reviews published between January 1996 and December 2013. Reviews were
searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to
extract data and the methodological quality of included reviews was appraised using the AMSTAR
(assessing methodological quality of systematic reviews) instrument. Summary of findings tables were
constructed for all primary outcomes of interest, and quality of evidence was graded by outcome
using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system.
Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various
types of home telemonitoring technologies included in the systematic reviews and the impact of these
technologies on clinical outcomes. RESULTS: A total of 15 reviews published between 2003 and 2013
were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis
indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-
cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with
usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively.
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Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable

HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-
cause hospitalizations appeared to be greater in patients who had been recently discharged (</=28
days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR
0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from
moderate to low suggesting that further research is very likely to have an important impact on our
confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis
identified five main types of non-invasive telemonitoring technologies included in the systematic
reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring,
(3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based
telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring
were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More
research data are required for interactive voice response systems, video-consultation, and Web-based
telemonitoring to provide robust conclusions about their effectiveness. CONCLUSIONS: Future
research should focus on understanding the process by which home telemonitoring works in terms of
improving outcomes, identify optimal strategies and the duration of follow-up for which it confers
benefits, and further investigate whether there is differential effectiveness between chronic HF
patient groups and types of home telemonitoring technologies.

Knowles, S. R. et Mikocka-Walus, A. (2014). "Utilization and efficacy of internet-based eHealth technology in

gastroenterology: a systematic review." Scand J Gastroenterol 49(4): 387-408.

OBJECTIVE: While there have been several reviews exploring the outcomes of various eHealth studies,
none have been gastroenterology-specific. This paper aims to evaluate the research conducted within
gastroenterology which utilizes internet-based eHealth technology to promote physical and
psychological well-being. MATERIAL AND METHODS: A systematic literature review of internet-based
eHealth interventions involving gastroenterological cohorts was conducted. Searched databases
included: EbSCOhost Medline, CINAHL, and PsycINFO. Inclusion criteria were studies reporting on
eHealth interventions (both to manage mental health problems and somatic symptoms) in
gastroenterology, with no time restrictions. Exclusion criteria were non-experimental studies, or
studies using only email as primary eHealth method, and studies in language other than English.
RESULTS: A total of 17 papers were identified; seven studies evaluated the efficacy of a psychologically
oriented intervention (additional two provided follow-up analyses exploring the original published
data) and eight studies evaluated disease management programs for patients with either irritable
bowel syndrome, inflammatory bowel disease (IBD) or celiac disease. Overall, psychological eHealth
interventions were associated with significant reductions in bowel symptoms and improvement in
quality of life (QoL) that tended to continue up to 12 months follow up. The eHealth disease
management was shown to generally improve QoL, adherence, knowledge about the disease, and
reduce healthcare costs in IBD, although the studies were associated with various methodological
problems, and thus, this observation should be confirmed in well-designed interventional studies.
CONCLUSIONS: Based on the evidence to date, eHealth internet-based technology is a promising tool
that can be utilized to both promote and enhance gastrointestinal disease management and mental
health.

Kotb, A., et al. (2015). "Comparative effectiveness of different forms of telemedicine for individuals with heart
failure (HF): a systematic review and network meta-analysis." PLoS One 10(2): e0118681.

BACKGROUND: Previous studies on telemedicine have either focused on its role in the management of
chronic diseases in general or examined its effectiveness in comparison to standard post-discharge
care. Little has been done to determine the comparative impact of different telemedicine options for a
specific population such as individuals with heart failure (HF). METHODS AND FINDINGS: Systematic
reviews (SR) of randomized controlled trials (RCTs) that examined telephone support, telemonitoring,
video monitoring or electrocardiographic monitoring for HF patients were identified using a
comprehensive search of the following databases: MEDLINE, EMBASE, CINAHL and The Cochrane
Library. Studies were included if they reported the primary outcome of mortality or any of the
following secondary outcomes: all-cause hospitalization and heart failure hospitalization. Thirty RCTs
(N = 10,193 patients) were included. Compared to usual care, structured telephone support was found
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to reduce the odds of mortality(Odds Ratio 0.80; 95% Credible Intervals [0.66 to 0.96]) and
hospitalizations due to heart failure (0.69; [0.56 to 0.85]). Telemonitoring was also found to reduce
the odds of mortality(0.53; [0.36 to 0.80]) and reduce hospitalizations related to heart failure (0.64;
[0.39 to 0.95]) compared to usual post-discharge care. Interventions that involved ECG monitoring also
reduced the odds of hospitalization due to heart failure (0.71; [0.52 to 0.98]). LIMITATIONS: Much of
the evidence currently available has focused on the comparing either telephone support or
telemonitoring with usual care. This has therefore limited our current understanding of how some of
the less common forms of telemedicine compare to one another. CONCLUSIONS: Compared to usual
care, structured telephone support and telemonitoring significantly reduced the odds of deaths and
hospitalization due to heart failure. Despite being the most widely studied forms of telemedicine, little
has been done to directly compare these two interventions against one another. Further research into
their comparative cost-effectiveness is also warranted.

Krauss, M., et al. (2015). "[Big Data- challenges and risks]." Orv Hetil 156(49): 1979-1986.

The term "Big Data" is commonly used to describe the growing mass of information being created
recently. New conclusions can be drawn and new services can be developed by the connection,
processing and analysis of these information. This affects all aspects of life, including health and
medicine. The authors review the application areas of Big Data, and present examples from health and
other areas. However, there are several preconditions of the effective use of the opportunities: proper
infrastructure, well defined regulatory environment with particular emphasis on data protection and
privacy. These issues and the current actions for solution are also presented.

Kumar, G., et al. (2013). "The costs of critical care telemedicine programs: a systematic review and analysis."
Chest 143(1): 19-29.

BACKGROUND: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient

outcomes, but the costs of these programs are unknown. We performed a systematic literature review
to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of
implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. METHODS:
We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011,
reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then
obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these
costs in light of the existing literature. RESULTS: Our systematic review identified eight studies
reporting tele-ICU costs. These studies suggested combined implementation and first year of
operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care
costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital
cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000
to $87,000 per ICU-bed, depending on the depreciation methods applied. CONCLUSIONS: The cost of
tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profits is
unclear. Until additional data become available, clinicians and administrators should carefully weigh
the clinical and economic aspects of tele-ICUs when considering investing in this technology.

Kvedar, J., et al. (2014). "Connected health: a review of technologies and strategies to improve patient care
with telemedicine and telehealth." Health Aff (Millwood) 33(2): 194-199.

With the advent of national health reform, millions more Americans are gaining access to a health care
system that is struggling to provide high-quality care at reduced costs. The increasing adoption of
electronic technologies is widely recognized as a key strategy for making health care more cost-
effective. This article examines the concept of connected health as an overarching structure for
telemedicine and telehealth, and it provides examples of its value to professionals as well as patients.
Policy makers, academe, patient advocacy groups, and private-sector organizations need to create
partnerships to rapidly test, evaluate, deploy, and pay for new care models that use telemedicine.

Lacasta Tintorer, D., et al. (2013). "Impact of the implementation of an online network support tool among
clinicians of primary health care and specialists: ECOPIH Project." BMC Fam Pract 14: 146.

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BACKGROUND: There has been created an online communication tool with the objective to improve
the communication among different levels of care, between Primary Care clinicians and Specialists.
This tool is web 2.0 based technology (ECOPIH project). It allows to review clinical cases and to share
knowledge. Our study will evaluate its impact in terms of reduction on the number of referrals to
three specialties two years after the use of this tool. METHODS/DESIGN: Open, multicenter,
controlled, non random intervention study over 24 months. Study population includes 131 Primary
Care Physicians assigned to nine health centers. The study will compare the clinicians that use the
ECOPIH with the ones that do not use the tool. Also, professionals that start to use the tool during the
period time of the study will be [Link] number of annual referrals during the first and second
year will be analyzed and retrospectively compared with the previous year to the implementation of
the tool. Moreover, it will be assessed the level of satisfaction of the professionals with the tool and to
what extend the tool responds to their needs. DISCUSSION: The implementation of ECOPIH in the field
of Primary Health Care can decrease the number of referrals from primary care to specialist [Link] is
expected that the reduction will be more noticeable in the group of professionals that use more
intensively the tool. Furthermore, we believe that it can be also observed with the professionals that
read the contributions of the [Link] anticipate high degree of customer satisfaction as it is a very
helpful resource never used before in our environment.

Lai, J. S., et al. (2015). "A patient-centered symptom monitoring and reporting system for children and young
adults with cancer (SyMon-SAYS)." Pediatr Blood Cancer 62(10): 1813-1818.

BACKGROUND: This study evaluated the feasibility of implementing a patient-centered, technology-

based symptom monitoring and reporting system (SyMon-SAYS) in pediatric oncology clinics using
fatigue as a prototypic symptom. Timely identification of symptoms related to multi-modal therapy for
children with cancer is fundamental to the overall success of cancer treatment. SyMon-SAYS was
developed to address this need. PROCEDURE: Patients with a cancer diagnosis, ages 7-21 years,
currently on treatment, or off treatment within 6 months, were eligible. Patients/parents completed
weekly fatigue assessments over 8 weeks via the internet or interactive voice response (IVR) by phone.
Alert emails were generated when pre-defined fatigue score thresholds were met, and fatigue reports
were forwarded to clinicians accordingly. Clinicians and parents/patients received cumulative graphic
reports of fatigue scores prior to clinic visits at 4 and 8 weeks post-baseline to facilitate discussion.
Parents/patients completed an exit survey at their last visit. RESULTS: Fifty-seven patients/parents
completed the study. The majority of patients (93%) and parents (78%) felt it was very/extremely easy
to complete SyMon-SAYS; 95% of parents were satisfied with the system; 60% reported it helped deal
with their child's fatigue; 70% reported that clinicians didn't discuss fatigue with them; 81% would be
willing to use SyMon-SAYS to manage fatigue and other symptoms. Clinicians reported insufficient
time to review reports, yet 71% were willing to receive the report on a monthly basis. CONCLUSION:
SyMon-SAYS is feasible and acceptable to patients and parents. Future efforts should focus on better
integrating the system into the clinical workflow to improve clinicians' acceptance.

Lal, S. et Adair, C. E. (2014). "E-mental health: a rapid review of the literature." Psychiatr Serv 65(1): 24-32.

OBJECTIVE: The authors conducted a review of the literature on e-mental health, including its
applications, strengths, limitations, and evidence base. METHODS: The rapid review approach, an
emerging type of knowledge synthesis, was used in response to a request for information from policy
makers. MEDLINE was searched from 2005 to 2010 by using relevant terms. The search was
supplemented with a general Internet search and a search focused on key authors. RESULTS: A total of
115 documents were reviewed: 94% were peer-reviewed articles, and 51% described primary
research. Most of the research (76%) originated in the United States, Australia, or the Netherlands.
The review identified e-mental health applications addressing four areas of mental health service
delivery: information provision; screening, assessment, and monitoring; intervention; and social
support. Currently, applications are most frequently aimed at adults with depression or anxiety
disorders. Some interventions have demonstrated effectiveness in early trials. Many believe that e-
mental health has enormous potential to address the gap between the identified need for services
and the limited capacity and resources to provide conventional treatment. Strengths of e-mental
health initiatives noted in the literature include improved accessibility, reduced costs (although start-
up and research and development costs are necessary), flexibility in terms of standardization and
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personalization, interactivity, and consumer engagement. CONCLUSIONS: E-mental health applications

are proliferating and hold promise to expand access to care. Further discussion and research are
needed on how to effectively incorporate e-mental health into service systems and to apply it to
diverse populations.

Lamminen, H., et al. (2000). "A feasibility study of realtime teledermatology in Finland." Journal of
Telemedicine and Telecare 6(2): 102-107, 107 tabl.

Lee, S. H., et al. (2016). "Effectiveness of mHealth interventions for maternal, newborn and child health in low-
and middle-income countries: Systematic review and meta-analysis." J Glob Health 6(1): 010401.

OBJECTIVE: To assess the effectiveness of mHealth interventions for maternal, newborn and child
health (MNCH) in low- and middle-income countries (LMIC). METHODS: 16 online international
databases were searched to identify studies evaluating the impact of mHealth interventions on MNCH
outcomes in LMIC, between January 1990 and May 2014. Comparable studies were included in a
random-effects meta-analysis. FINDINGS: Of 8593 unique references screened after de-duplication, 15
research articles and two conference abstracts met inclusion criteria, including 12 intervention and
three observational studies. Only two studies were graded at low risk of bias. Only one study
demonstrated an improvement in morbidity or mortality, specifically decreased risk of perinatal death
in children of mothers who received SMS support during pregnancy, compared with routine prenatal
care. Meta-analysis of three studies on infant feeding showed that prenatal interventions using
SMS/cell phone (vs routine care) improved rates of breastfeeding (BF) within one hour after birth
(odds ratio (OR) 2.01, 95% confidence interval (CI) 1.27-2.75, I(2) = 80.9%) and exclusive BF for
three/four months (OR 1.88, 95% CI 1.26-2.50, I(2) = 52.8%) and for six months (OR 2.57, 95% CI 1.46-
3.68, I(2) = 0.0%). Included studies encompassed interventions designed for health information
delivery (n = 6); reminders (n = 3); communication (n = 2); data collection (n = 2); test result
turnaround (n = 2); peer group support (n = 2) and psychological intervention (n = 1). CONCLUSIONS:
Most studies of mHealth for MNCH in LMIC are of poor methodological quality and few have
evaluated impacts on patient outcomes. Improvements in intermediate outcomes have nevertheless
been reported in many studies and there is modest evidence that interventions delivered via SMS
messaging can improve infant feeding. Ambiguous descriptions of interventions and their mechanisms
of impact present difficulties for interpretation and replication. Rigorous studies with potential to
offer clearer evidence are underway.

Lehmann, S., et al. (2010). "[Telephone case management: is it beneficial for the care of depression patients in
Germany? A systematic literature survey]." Gesundheitswesen 72(5): e33-37.

BACKGROUND: Strategies are needed to effectively improve the management of depression in

Germany. Can telephone case management (TCM) be a promising strategy to improve depression care
in the German health-care system? METHODS: A systematic literature review in PubMed, Cochrane
Library, ISI Web of Science, PsycINFO and PSYNEXplus for randomised controlled trials (RCT) that
evaluate TCM was carried out. RESULTS: Ten RCTs that compared TCM to treatment as usual were
found. TCM was more effective in reducing depressive symptoms and in increasing satisfaction with
care than treatment as usual. Whether TCM was capable of significantly improving pharmacotherapy
compliance remained controversial. DISCUSSION: The effectiveness of TCM seemed to be related to
the health-care system structure in which it was implemented. Most studies on TCM were conducted
in US-American Health Maintenance Organizations. Thus, it is unclear to what extent these results can
be transferred to the German health system. However, in the light of the promising results of these
studies it seems to be worthwhile to test TCM also under conditions of the German health-care
system.

Lepard, M. G., et al. (2015). "Diabetes self-management interventions for adults with type 2 diabetes living in
rural areas: a systematic literature review." Curr Diab Rep 15(6): 608.

In rural communities, high rates of diabetes and its complications are compounded by limited access
to health care and scarce community resources. We systematically reviewed the evidence for the
impact of diabetes self-management education interventions designed for patients living in rural areas
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on glycemic control and other diabetes outcomes. Fifteen studies met inclusion criteria. Ten were
randomized controlled trials. Intervention strategies included in-person diabetes (n = 9) and telehealth
(n = 6) interventions. Four studies demonstrated between group differences for biologic outcomes,
four studies demonstrated changes in behavior, and three studies demonstrated changes in
knowledge. Intervention dose was associated with improved A1c or weight loss in two studies and
session attendance in one study. Interventions that included collaborative goal-setting were
associated with improved metabolic outcomes and self-efficacy. Telehealth and face-to-face diabetes
interventions are both promising strategies for rural communities. Effective interventions included
collaborative goal-setting. Intervention dose was linked to better outcomes and higher attendance.

Linde, K., et al. (2015). "Effectiveness of psychological treatments for depressive disorders in primary care:
systematic review and meta-analysis." Ann Fam Med 13(1): 56-68.

PURPOSE: We performed a systematic review of the currently available evidence on whether

psychological treatments are effective for treating depressed primary care patients in comparison with
usual care or placebo, taking the type of therapy and its delivery mode into account. METHODS:
Randomized controlled trials comparing a psychological treatment with a usual care or a placebo
control in adult, depressed, primary care patients were identified by searches in MEDLINE, Embase,
Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO up to December 2013. At least
2 reviewers extracted information from included studies and assessed the risk of bias. Random effects
meta-analyses were performed using posttreatment depression scores as outcome. RESULTS: A total
of 30 studies with 5,159 patients met the inclusion criteria. Compared with control, the effect
(standardized mean difference) at completion of treatment was -0.30 (95% CI, -0.48 to -0.13) for face-
to-face cognitive behavioral therapy (CBT), -0.14 (-0.40 to 0.12) for face-to-face problem-solving
therapy, -0.24 (-0.47 to -0.02) for face-to-face interpersonal psychotherapy, -0.28 (-0.44 to -0.12) for
other face-to-face psychological interventions, -0.43 (-0.62 to -0.24) for remote therapist-led CBT, -
0.56 (-1.57 to 0.45) for remote therapist-led problem-solving therapy, -0.40 (-0.69 to -0.11) for guided
self-help CBT, and -0.27 (-0.44 to -0.10) for no or minimal contact CBT. CONCLUSIONS: There is
evidence that psychological treatments are effective in depressed primary care patients. For CBT
approaches, substantial evidence suggests that interventions that are less resource intensive might
have effects similar to more intense treatments.

Linn, A. J., et al. (2011). "Effects of eHealth interventions on medication adherence: a systematic review of the
literature." J Med Internet Res 13(4): e103.

BACKGROUND: Since medication nonadherence is considered to be an important health risk,

numerous interventions to improve adherence have been developed. During the past decade, the use
of Internet-based interventions to improve medication adherence has increased rapidly. Internet
interventions have the potential advantage of tailoring the interventions to the needs and situation of
the patient. OBJECTIVE: The main aim of this systematic review was to investigate which tailored
Internet interventions are effective in improving medication adherence. METHODS: We undertook
comprehensive literature searches in PubMed, PsycINFO, EMBASE, CINAHL, and Communication
Abstracts, following the guidelines of the Cochrane Collaboration. The methodological quality of the
randomized controlled trials and clinical controlled trials and methods for measuring adherence were
independently reviewed by two researchers. RESULTS: A total of 13 studies met the inclusion criteria.
All included Internet interventions clearly used moderately or highly sophisticated computer-tailored
methods. Data synthesis revealed that there is evidence for the effectiveness of Internet interventions
in improving medication adherence: 5 studies (3 high-quality studies and 2 low-quality studies)
showed a significant effect on adherence; 6 other studies (4 high-quality studies and 2 low-quality
studies) reported a moderate effect on adherence; and 2 studies (1 high-quality study and 1 low-
quality study) showed no effect on patients' adherence. However, most studies used self-reported
measurements to assess adherence, which is generally perceived as a low-quality measurement. In
addition, we did not find a clear relationship between the quality of the studies or the level of
sophistication of message tailoring and the effectiveness of the intervention. This might be explained
by the great difference in study designs and the way of measuring adherence, which makes results
difficult to compare. There was also large variation in the measured interval between baseline and
follow-up measurements. CONCLUSION: This review shows promising results on the effectiveness of
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Internet interventions to enhance patients' adherence to prescribed long-term medications. Although

there is evidence according to the data synthesis, the results must be interpreted with caution due to
low-quality adherence measurements. Future studies using high-quality measurements to assess
medication adherence are recommended to establish more robust evidence for the effectiveness of
eHealth interventions on medication adherence.

Ludwig, W., et al. (2012). "Health-enabling technologies for the elderly--an overview of services based on a
literature review." Comput Methods Programs Biomed 106(2): 70-78.

BACKGROUND: Services for the elderly based on health-enabling technologies promise to contribute
significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last
years the scientific community has designed a complex variety of these valuable innovations. A
systematic overview of the developed services would help to better understand their opportunities
and limitations. OBJECTIVE: To obtain a systematic overview of services for the elderly based on
health-enabling technologies and to identify archetypical service categories. METHODS: We conducted
a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27
key publications that describe typical service archetypes. RESULTS: We present six archetypical service
categories, namely handling adverse conditions, assessing state of health, consultation and education,
motivation and feedback, service ordering and social inclusion and describe their implementation in
current research projects.

Lundell, S., et al. (2015). "Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes
and dyspnea." Respir Med 109(1): 11-26.

BACKGROUND: Only a minority of patients with chronic obstructive pulmonary disease (COPD) have
access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used
in efforts to make PR more available. The aim of this systematic review was to investigate the effects
of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and
to describe the interventions used. METHODS: Randomized controlled trials were identified through
database searches, reference lists and included authors. Articles were reviewed based on eligibility
criteria by three authors. Risk of bias was assessed by two authors. Standardized mean differences
(SMD) or mean differences (MD) with 95% CI were calculated. Forest plots were used to present data
visually. RESULTS: Nine studies (982 patients) were included. For physical activity level, there was a
significant effect favoring telehealthcare (MD, 64.7 min; 95% CI, 54.4-74.9). No difference between
groups was found for physical capacity (MD, -1.3 m; 95% CI, -8.1-5.5) and dyspnea (SMD, 0.088; 95%
CI, -0.056-0.233). Telehealthcare was promoted through phone calls, websites or mobile phones,
often combined with education and/or exercise training. Comparators were ordinary care, exercise
training and/or education. CONCLUSIONS: The use of telehealthcare may lead to improvements in
physical activity level, although the results should be interpreted with caution given the heterogeneity
in studies. This is an important area of research and further studies of the effect of telehealthcare for
patients with COPD would be beneficial. REGISTRATION: In PROSPERO 2012: CRD42012003294. STUDY
PROTOCOL: [Link]

Maass, M., et al. (2000). "Transportation savings and medical benefits of a teleneuroradiological network."
Journal of Telemedicine and Telecare 6(3): 142-146, 141 tabl., 141 fig.

MacFarlane, A., et al. (2006). "Telemedicine services in the Republic of Ireland: an evolving policy context."
Health Policy 76(3): 245-258.

The Republic of Ireland is characterised by few urban conurbations and a high rural population,
including significant numbers of island dwellers. Information communication technologies (ICT),
including telemedicine, present opportunities to address rural health-service delivery issues. As in
other countries, the recent National Health Information Strategy is regarded as pivotal to the
modernisation of the Irish health care system. There is, however, a dearth of research about
telemedicine in Ireland. This paper reports, to the best of our knowledge, the first systematic review
of telemedicine in the two regional health boards in the Republic of Ireland. Details of 11 telemedicine
services, all initiated by local policy, will be presented. Results of an interview study with service
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providers about their experiences of the practices and processes involved in telemedicine service
delivery are also provided. The focus of our analysis is two-fold. We assess the resonance of these Irish
data with the international literature with particular reference to a recently developed model for the
normalisation of telemedicine. For the first time, this model which was developed in the United
Kingdom is applied to a fresh set of empirical data in a different health care context. We then discuss a
number of health information policy issues for Ireland and elsewhere arising from our analysis.

Maeder, A., et al. (2015). "Patient Compliance in Home-Based Self-Care Telehealth Projects." J Telemed
Telecare 21(8): 439-442.

This paper presents the findings of a literature review on patient compliance in home-based self-care
telehealth monitoring situations, intended to establish a knowledge base for this aspect which is often
neglected alongside more conventional clinical, economic and service evaluations. A systematic search
strategy led to 72 peer-reviewed published scientific papers being selected as most relevant to the
topic, 58 of which appeared in the last 10 years. Patient conditions in which most evidence for
compliance was found were blood pressure, heart failure and stroke, diabetes, asthma, chronic
obstructive pulmonary disease and other respiratory diseases. In general, good compliance at the start
of a study was found to drop off over time, most rapidly in the period immediately after the start.
Success factors identified in the study included the extent of patient health education, telehealth
system implementation style, user training and competence in system usage, active human support
from the healthcare provider and maintaining strong participant motivation.

Mair, F. et Whitten, P. (2000). "Systematic review of studies of patient satisfaction with telemedicine." British
Medical Journal 320: 1517-1520, 1511 tabl.
[Link]

Mair, F. S., et al. (2012). "Factors that promote or inhibit the implementation of e-health systems: an
explanatory systematic review." Bull World Health Organ 90(5): 357-364.

OBJECTIVE: To systematically review the literature on the implementation of e-health to identify: (i)
barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the
subject. METHODS: MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched
for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic
reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health
implementation. Abstracts and papers were double screened and data were extracted on country of
origin; e-health domain; publication date; aims and methods; databases searched; inclusion and
exclusion criteria and number of papers included. Data were analysed qualitatively using
normalization process theory as an explanatory coding framework. FINDINGS: Inclusion criteria were
met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009.
Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13
did not indicate the precise number of articles screened. The use of normalization process theory as a
conceptual framework revealed that relatively little attention was paid to: (i) work directed at making
sense of e-health systems, specifying their purposes and benefits, establishing their value to users and
planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii)
effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation
processes might be reconfigured by user-produced knowledge. CONCLUSION: The published literature
focused on organizational issues, neglecting the wider social framework that must be considered
when introducing new technologies.

Marcin, J. P., et al. (2016). "Addressing health disparities in rural communities using telehealth." Pediatr Res
79(1-2): 169-176.

The regionalization of pediatric services has resulted in differential access to care, sometimes creating
barriers to those living in underserved, rural communities. These disparities in access contribute to
inferior healthcare outcomes among infants and children. We review the medical literature on
telemedicine and its use to improve access and the quality of care provided to pediatric patients with
otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the
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provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and
inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies
gained with models of care that use telemedicine. By providing pediatric subspecialty care in more
convenient settings such as local primary care offices and community hospitals, pediatric patients are
more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can
significantly improve provider, patient, and family satisfaction, increase measures of quality of care
and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the
potential to address pediatric specialists' geographic misdistribution and address disparities in the
quality of care delivered to children in underserved communities.

Marcus, H. J., et al. (2014). "Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review
of existing systems and proposed specifications for new robotic platforms." Neurosurgery 10 Suppl 1:
84-95; discussion 95-86.

BACKGROUND: Over the past decade, advances in image guidance, endoscopy, and tube-shaft
instruments have allowed for the further development of keyhole transcranial endoscope-assisted
microsurgery, utilizing smaller craniotomies and minimizing exposure and manipulation of unaffected
brain tissue. Although such approaches offer the possibility of shorter operating times, reduced
morbidity and mortality, and improved long-term outcomes, the technical skills required to perform
such surgery are inevitably greater than for traditional open surgical techniques, and they have not
been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve
visualization and increase dexterity, therefore has the potential to enhance surgical performance.
OBJECTIVE: To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted
microsurgery. METHODS: The technical challenges faced by surgeons utilizing keyhole craniotomies
were reviewed, and a thorough appraisal of presently available robotic systems was performed.
RESULTS: Surgical robotic systems have the potential to incorporate advances in augmented reality,
stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact the field of
keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical
procedures. The vast majority of these robots are best described as supervisory controlled, and are
designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole
neurosurgical approaches, and none are in widespread clinical use in the field. CONCLUSION: New
robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages
over conventional approaches if they are to achieve significant clinical penetration.

Martinez-Perez, B., et al. (2015). "Privacy and security in mobile health apps: a review and recommendations." J
Med Syst 39(1): 181.

In a world where the industry of mobile applications is continuously expanding and new health care
apps and devices are created every day, it is important to take special care of the collection and
treatment of users' personal health information. However, the appropriate methods to do this are not
usually taken into account by apps designers and insecure applications are released. This paper
presents a study of security and privacy in mHealth, focusing on three parts: a study of the existing
laws regulating these aspects in the European Union and the United States, a review of the academic
literature related to this topic, and a proposal of some recommendations for designers in order to
create mobile health applications that satisfy the current security and privacy legislation. This paper
will complement other standards and certifications about security and privacy and will suppose a
quick guide for apps designers, developers and researchers.

McDonald, K., et al. (2015). "Role of Monitoring Devices in Preventing Heart Failure Admissions." Curr Heart Fail
Rep 12(4): 269-275.

This review aims to discuss and summarize the evidence base for devices that have a role in
monitoring patients with heart failure for the purpose of attempting to prevent heart failure-related
admissions. Despite contemporary heart failure service provision, many patients continue to need
acute admission for decompensation. There is a clinical need for a better strategy for predicting
decompensation earlier so that appropriate therapeutic interventions can be commenced sooner in
order to prevent the need for acute hospital admission. Between clinical assessment visits, the
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contemporary approach to management is based primarily on daily home monitoring of weight by

patients; while this has proved useful, it falls short. For example, substantial weight gain was seen in
only 20% of ADHF admission patients according to data collected in the TEN-HMS home
telemonitoring study. Monitoring devices offer the possibility of tracking additional physiological or
haemodynamic parameters that may allow for earlier detection and more accurate identification of
patients at risk of acute decompensation.

McKee, M., et al. (2013). "EU Crossborder health care collaboration." Eurohealth 19(4): 2-36.
[Link]
This issue of Eurohealth explores various topics related to the European Directive on the application of
patients rights in cross-border health care. Ten case studies look at specific aspects of EU cross-border
health care collaboration, particularly at potential obstacles not fully covered by the Directive. Other
articles look at dispensing prescriptions across EU Member States, European public health strategies,
oral health in Europe, reporting health care waste in the Netherlands, the chronic care system in
Spain, scaling-up e-health in Catalonia and dental health services for migrants in Cyprus..

McLean, S., et al. (2011). "Telehealthcare for asthma: a Cochrane review." Cmaj 183(11): E733-742.

BACKGROUND: Telehealthcare has the potential to provide care for long-term conditions that are
increasingly prevalent, such as asthma. We conducted a systematic review of studies of telehealthcare
interventions used for the treatment of asthma to determine whether such approaches to care are
effective. METHODS: We searched the Cochrane Airways Group Specialised Register of Trials, which is
derived from systematic searches of bibliographic databases including CENTRAL (the Cochrane Central
Register of Controlled Trials), MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied
Health Literature) and PsycINFO, as well as other electronic resources. We also searched registers of
ongoing and unpublished trials. We were interested in studies that measured the following outcomes:
quality of life, number of visits to the emergency department and number of admissions to hospital.
Two reviewers identified studies for inclusion in our meta-analysis. We extracted data and used
fixedeffect modelling for the meta-analyses. RESULTS: We identified 21 randomized controlled trials
for inclusion in our analysis. The methods of telehealthcare intervention these studies investigated
were the telephone and video- and Internet-based models of care. Meta-analysis did not show a
clinically important improvement in patients' quality of life, and there was no significant change in the
number of visits to the emergency department over 12 months. There was a significant reduction in
the number of patients admitted to hospital once or more over 12 months (risk ratio 0.25 [95%
confidence interval 0.09 to 0.66]). INTERPRETATION: We found no evidence of a clinically important
impact on patients' quality of life, but telehealthcare interventions do appear to have the potential to
reduce the risk of admission to hospital, particularly for patients with severe asthma. Further research
is required to clarify the cost-effectiveness of models of care based on telehealthcare.

McLean, S., et al. (2011). "Telehealthcare for chronic obstructive pulmonary disease." Cochrane Database Syst
Rev(7): Cd007718.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways

obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need
hospital care: telehealthcare has the potential to reduce admission to hospital when used to
administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness
of telehealthcare for COPD compared with usual face-to-face care. SEARCH STRATEGY: We searched
the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and
PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials
which assessed telehealthcare, defined as follows: healthcare at a distance, involving the
communication of data from the patient to the health carer, usually a doctor or nurse, who then
processes the information and responds with feedback regarding the management of the illness. The
primary outcomes considered were: number of exacerbations, quality of life as recorded by the St
George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA
COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted
data. We combined data into forest plots using fixed-effects modelling as heterogeneity was low (I(2)
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< 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a
complex intervention, including nurse case management and other interventions. Telehealthcare was
associated with a clinically significant increase in quality of life in two trials with 253 participants
(mean difference -6.57 (95% confidence interval (CI) -13.62 to 0.48); minimum clinically significant
difference is a change of -4.0), but the confidence interval was wide. Telehealthcare showed a
significant reduction in the number of patients with one or more emergency department attendances
over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and
the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in
six trials with 604 participants. There was no significant difference in the OR for deaths over 12
months for the telehealthcare group as compared to the usual care group in three trials with 503
participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears
to have a possible impact on the quality of life of patients and the number of times patients attend the
emergency department and the hospital. However, further research is needed to clarify precisely its
role since the trials included telehealthcare as part of more complex packages.

McLean, S., et al. (2012). "Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and
meta-analysis." Br J Gen Pract 62(604): e739-749.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is common. Telehealthcare, involving

personalised health care over a distance, is seen as having the potential to improve care for people
with COPD. AIM: To systematically review the effectiveness of telehealthcare interventions in COPD to
improve clinical and process outcomes. DESIGN AND SETTING: Cochrane Systematic Review of
randomised controlled trials. METHODS: The study involved searching the Cochrane Airways Group
Register of Trials, which is derived from the Cochrane Central Register of Controlled Trials, MEDLINE,
embase, and CINAHL, as well as searching registers of ongoing and unpublished trials. Randomised
controlled trials comparing a telehealthcare intervention with a control intervention in people with a
clinical diagnosis of COPD were identified. The main outcomes of interest were quality of life and risk
of emergency department visit, hospitalisation, and death. Two authors independently selected trials
for inclusion and extracted data. Study quality was assessed using the Cochrane Collaboration's risk of
bias method. Meta-analysis was undertaken using fixed effect and/or random effects modelling.
RESULTS: Ten randomised controlled trials were included. Telehealthcare did not improve COPD
quality of life: mean difference -6.57 (95% confidence interval [CI] = -13.62 to 0.48). However, there
was a significant reduction in the odds ratios (ORs) of emergency department attendance (OR = 0.27;
95% CI = 0.11 to 0.66) and hospitalisation (OR = 0.46; 95% CI = 0.33 to 0.65). There was a non-
significant change in the OR of death (OR = 1.05; 95% CI = 0.63 to 1.75). CONCLUSION: In COPD,
telehealthcare interventions can significantly reduce the risk of emergency department attendance
and hospitalisation, but has little effect on the risk of death.

McLean, S., et al. (2013). "The impact of telehealthcare on the quality and safety of care: a systematic
overview." PLoS One 8(8): e71238.

BACKGROUND: Telehealthcare involves the use of information and communication technologies to

deliver healthcare at a distance and to support patient self-management through remote monitoring
and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and
costs of telehealthcare. METHODS AND FINDINGS: Two reviewers searched for relevant systematic
reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE,
LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using
the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were
identified, from which 80 systematic reviews were selected for inclusion. These covered a range of
telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward)
interactions between provider and patients. Many studies showed no differences in outcomes
between telehealthcare and usual care. Several reviews highlighted the large number of short-term
(<12 months) feasibility studies with under 20 participants. Effects of telehealthcare on health service
indicators were reported in several reviews, particularly reduced hospitalisations. The reported clinical
effectiveness of telehealthcare interventions for patients with long-term conditions appeared to be
greatest in those with more severe disease at high-risk of hospitalisation and death. The failure of
many studies to adequately describe the intervention makes it difficult to disentangle the
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contributions of technological and human/organisational factors on the outcomes reported. Evidence

on the cost-effectiveness of telehealthcare remains sparse. Patient safety considerations were absent
from the evaluative telehealthcare literature. CONCLUSIONS: Policymakers and planners need to be
aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is
likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is
a need for longer-term studies in order to determine whether the benefits demonstrated in time
limited trials are sustained.

Mechael, P., et al. (2012). "Capitalizing on the characteristics of mHealth to evaluate its impact." J Health
Commun 17 Suppl 1: 62-66.

The field of mHealth has made significant advances in a short period of time, demanding a more
thorough and scientific approach to understanding and evaluating its progress. A recent review of
mHealth literature identified two primary research needs in order for mHealth to strengthen health
systems and promote healthy behaviors, namely health outcomes and cost-benefits (Mechael et al.,
2010 ). In direct response to the gaps identified in mHealth research, the aim of this paper is to
present the study design and highlight key observations and next steps from an evaluation of the
mHealth activities within the electronic health (eHealth) architecture implemented by the Millennium
Villages Project (MVP) by leveraging data generated through mobile technology itself alongside
complementary qualitative research and costing assessments. The study, funded by the International
Development and Research Centre (IDRC) as part of the Open Architecture Standards and Information
Systems research project (OASIS II) (Sinha, 2009 ), is being implemented on data generated by 14 MVP
sites in 10 Sub-Saharan African countries including more in-depth research in Ghana, Rwanda,
Tanzania, and Uganda. Specific components of the study include rigorous quantitative case-control
analyses and other epidemiological approaches (such as survival analysis) supplemented by in-depth
qualitative interviews spread out over 18 months, as well as a costing study to assess the impact of
mHealth on health outcomes, service delivery, and efficiency.

Merriel, S. W., et al. (2014). "Telehealth interventions for primary prevention of cardiovascular disease: a
systematic review and meta-analysis." Prev Med 64: 88-95.

OBJECTIVE: To assess the effectiveness of telehealth interventions in the primary prevention of

cardiovascular disease in adult patients in community settings. METHODS: Systematic literature review
of randomised controlled trials comparing the effectiveness of telehealth interventions to reduce
overall cardiovascular disease (CVD) risk and/or to reduce multiple CVD risk factors compared with a
non-telehealth control group was conducted in June 2013. Study quality was assessed using the
Cochrane Risk of Bias tool. Fixed and random effects models were combined with a narrative synthesis
for meta-analysis of included studies. RESULTS: Three of 13 included studies measured Framingham
10-year CVD risk scores, and meta-analysis showed no clear evidence of reduction in overall risk (SMD
-0.37%, 95% CI -2.08, 1.33). There was weak evidence for a reduction in systolic blood pressure (SMD -
1.22 mmHg 95% CI -2.80, 0.35) and total cholesterol (SMD -0.07 mmol/L 95% CI -0.19, 0.06). There
was no change in High-Density Lipoprotein cholesterol or smoking rates. CONCLUSION: There is
insufficient evidence to determine the effectiveness of telehealth interventions in reducing overall
CVD risk. More studies are needed that consistently measure overall CVD risk, directly compare
different telehealth interventions, and determine cost effectiveness of telehealth interventions for
prevention of CVD.

Meurk, C., et al. (2016). "Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of
Challenges and A Call For Policy-Focussed Research." J Med Internet Res 18(1): e10.

BACKGROUND: Growing evidence attests to the efficacy of e-mental health services. There is less
evidence on how to facilitate the safe, effective, and sustainable implementation of these services.
OBJECTIVE: We conducted a systematic review on e-mental health service use for depressive and
anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base.
METHODS: Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-
mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such
as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL,
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Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and
level of policy relevance. RESULTS: The search yielded 1081 studies; 30 studies were included for
analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate
that e-mental health services are predominantly used by females, and those who are more educated
and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining
consumer preferences found a preference for face-to-face therapy over e-therapies, but not an
aversion to e-therapy. Content relevant to governance was predominantly related to the
organizational dimensions of e-mental health services, followed by implications for community
education. Financing and payment for e-services and governance of the information communication
technology were least commonly discussed. CONCLUSIONS: Little research focuses explicitly on policy
development and implementation planning; most research provides an e-services perspective.
Research is needed to provide community and policy-maker perspectives. General population studies
of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative
preferences for all treatment modalities are necessary.

Meyer, J. et Pare, G. (2015). "Telepathology Impacts and Implementation Challenges: A Scoping Review." Arch
Pathol Lab Med 139(12): 1550-1557.

CONTEXT: Telepathology is a particular form of telemedicine that fundamentally alters the way
pathology services are delivered. Prior reviews in this area have mostly focused on 2 themes, namely
technical feasibility issues and diagnosis accuracy. OBJECTIVES: To synthesize the literature on
telepathology implementation challenges and broader organizational and societal impacts and to
propose a research agenda to guide future efforts in this domain. DATA SOURCES: Two
complementary databases were systematically searched: MEDLINE (PubMed) and ABI/INFORM
(ProQuest). Peer-reviewed articles and conference proceedings were considered. The final sample
consisted of 159 papers published between 1992 and 2013. CONCLUSIONS: This review highlights the
diversity of telepathology networks and the importance of considering these distinctions when
interpreting research findings. Various network structures are associated with different benefits.
Although the dominant rationale in single-site projects is financial, larger centralized and decentralized
telepathology networks are targeting a more diverse set of benefits, including extending access to
pathology to a whole region, achieving substantial economies of scale in workforce and equipment,
and improving quality by standardizing care. Importantly, our synthesis reveals that the nature and
scale of encountered implementation challenges also varies depending on the network structure. In
smaller telepathology networks, organizational concerns are less prominent, and implementers are
more focused on usability issues. As the network scope widens, organizational and legal issues gain
prominence.

Mistry, H. (2012). "Systematic review of studies of the cost-effectiveness of telemedicine and telecare. Changes
in the economic evidence over twenty years." J Telemed Telecare 18(1): 1-6.

A systematic review of studies of the cost-effectiveness of telemedicine and telecare was undertaken
from 1990 until September 2010. Twelve databases were searched, using economic evaluation terms
combined with telemedicine terms. The search identified 80 studies which were classed as full
economic evaluations; the majority (38) were cost-consequence analyses. There were 15 cost-
effectiveness analyses (CEA) and seven cost-utility analyses (CUA). In the period January 2004 to
September 2010 there were 47 studies. Eleven were CEA and seven were CUA. Economic tools are
being increasingly used for telemedicine and telecare studies, although better reporting of the
methodologies and findings of the economic evaluations is required. Nonetheless, the results of the
review were consistent with previous findings, i.e. there is no further conclusive evidence that
telemedicine and telecare interventions are cost-effective compared to conventional health care.

Mistry, N., et al. (2015). "Technology-mediated interventions for enhancing medication adherence." J Am Med
Inform Assoc 22(e1): e177-193.

BACKGROUND: Despite effective therapies for many conditions, patients find it difficult to adhere to
prescribed treatments. Technology-mediated interventions (TMIs) are increasingly being used with the
hope of improving adherence. OBJECTIVE: To assess the effects of TMI, intended to enhance patient
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adherence to prescribed medications, on both medication adherence and clinical outcomes.

METHODS: A secondary in-depth analysis was conducted of the subset of studies that utilized
technology in at least one component of the intervention from an updated Cochrane review on all
interventions for enhancing medication adherence. We included studies that clearly described an
information and communication technology or medical device as the sole or major component of the
adherence intervention. RESULTS: Thirty-eight studies were eligible for in-depth review. Only seven
had a low risk of bias for study design features, primary adherence, and clinical outcomes. Eighteen
studies used a TMI for education and/or counseling, 11 studies used a TMI for self-monitoring and/or
feedback, and nine studies used electronic reminders. Studies used a variety of TMIs, with telephone
the most common technology in use. Studies targeted a wide distribution of diseases and used a
variety of adherence and clinical outcome measures. A minority targeted children and adolescents.
Fourteen studies reported significant effects in both adherence and clinical outcome measures.
CONCLUSIONS: This review provides evidence for the inconsistent effectiveness of TMI for medication
adherence and clinical outcomes. These results must be interpreted with caution due to a lack of high-
quality studies.

Moffatt, J. J. et Eley, D. S. (2010). "The reported benefits of telehealth for rural Australians." Aust Health Rev
34(3): 276-281.

OBJECTIVE: A literature review was conducted to identify the reported benefits attributed to
telehealth for people living and professionals working in rural and remote areas of Australia. DATA
SOURCES: Scopus and relevant journals and websites were searched using the terms: telemedicine,
telehealth, telepsychiatry, teledermatology, teleradiology, Australia, and each state and territory.
Publications since 1998 were included. STUDY SELECTION: The initial search resulted in 176 articles,
which was reduced to 143 when research reporting on Australian rural, regional or remote
populations was selected. DATA SYNTHESIS: A narrative review was conducted using an existing
'benefits' framework. Patients are reported to have benefited from: lower costs and reduced
inconvenience while accessing specialist health services; improved access to services and improved
quality of clinical services. Health professionals are reported to have benefits from access to
continuing education and professional development; provision of enhanced local services; experiential
learning, networking and collaboration. DISCUSSION: Rural Australians have reportedly benefited from
telehealth. The reported improved access and quality of clinical care available to rural Australians
through telemedicine and telehealth may contribute to decreasing the urban-rural health disparities.
The reported professional development opportunities and support from specialist through the use of
telehealth may contribute to improved rural medical workforces recruitment and retention.

Moghaddasi, H., et al. (2012). "E-Health: a global approach with extensive semantic variation." J Med Syst
36(5): 3173-3176.

In recent years, there has been considerable attention towards the development of information and
communication technology (ICT) in health care delivery known as 'E-Health'. The term "E-Health" is
almost a new concept and the E-Health projects mainly aim to improve service delivery to people,
though different countries might have different approaches in using E-Health. The focus of this study
is to review factors influencing the development of E-Health projects, as these factors could lead to an
extensive semantic variation. This study reviews the E-Health status in different countries based on
existing reports and documents about E-health projects in developed and developing countries and
also based on the reports and documents provided by WHO, International Telecommunication Union
(ITU); and World Bank. The review of the documents showed that the E-Health status in different
countries is depended upon three key factors including the potential of ICT, economic capacity and the
level of health status. The review of the documents indicated that there might be different meanings
for the concept of E-Health in different countries, and the semantic variation in E-Health concept is
related to the level of E-Health developments and implementations. Therefore, developing a clear
definition of E-Health is needed.

Mohr, D. C., et al. (2011). "Supportive accountability: a model for providing human support to enhance
adherence to eHealth interventions." J Med Internet Res 13(1): e30.

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The effectiveness of and adherence to eHealth interventions is enhanced by human support. However,
human support has largely not been manualized and has usually not been guided by clear models. The
objective of this paper is to develop a clear theoretical model, based on relevant empirical literature,
that can guide research into human support components of eHealth interventions. A review of the
literature revealed little relevant information from clinical sciences. Applicable literature was drawn
primarily from organizational psychology, motivation theory, and computer-mediated communication
(CMC) research. We have developed a model, referred to as "Supportive Accountability." We argue
that human support increases adherence through accountability to a coach who is seen as
trustworthy, benevolent, and having expertise. Accountability should involve clear, process-oriented
expectations that the patient is involved in determining. Reciprocity in the relationship, through which
the patient derives clear benefits, should be explicit. The effect of accountability may be moderated by
patient motivation. The more intrinsically motivated patients are, the less support they likely require.
The process of support is also mediated by the communications medium (eg, telephone, instant
messaging, email). Different communications media each have their own potential benefits and
disadvantages. We discuss the specific components of accountability, motivation, and CMC medium in
detail. The proposed model is a first step toward understanding how human support enhances
adherence to eHealth interventions. Each component of the proposed model is a testable hypothesis.
As we develop viable human support models, these should be manualized to facilitate dissemination.

Moore, S. E., et al. (2015). "Exploring mHealth as a new route to bridging the nursing theory-practice gap." Res
Theory Nurs Pract 29(1): 38-52.

The purpose of this article is to evaluate mHealth as a tool for research and development of nursing
theories. Mobile health (mHealth) is one of the most promising new advances in health care
technology. mHealth is defined as the use of mobile technology in the provision of health care delivery
or health promotion (Qiang, Yamamichi, Hausman, & Altman, 2011). The need for innovative and
effective interventions for the prevention and management of chronic illness is evident. The use of
mHealth interventions in the treatment and monitoring of chronic illness is still young but shows great
promise. Currently, the public health and psychological sciences are using their theories to guide
interventional studies by operationalizing concepts through mHealth's multifaceted capabilities for
patient interaction. Outcomes measures from chronic illness-mHealth studies are thematically
evaluated by using theoretical nursing outcome-related concepts of Meleis's transitions theory and
Mishel's uncertainty in illness theory. Despite a small sample of articles, there are strong themes of
activation and engagement within this literature review. The application of nursing theory in mHealth
offers a new method to operationalize theoretical concepts, test theory-based interventions, and gain
new contextual insight into the health-illness patient experience.

Moorhead, S. A., et al. (2013). "A new dimension of health care: systematic review of the uses, benefits, and
limitations of social media for health communication." J Med Internet Res 15(4): e85.

BACKGROUND: There is currently a lack of information about the uses, benefits, and limitations of
social media for health communication among the general public, patients, and health professionals
from primary research. OBJECTIVE: To review the current published literature to identify the uses,
benefits, and limitations of social media for health communication among the general public, patients,
and health professionals, and identify current gaps in the literature to provide recommendations for
future health communication research. METHODS: This paper is a review using a systematic approach.
A systematic search of the literature was conducted using nine electronic databases and manual
searches to locate peer-reviewed studies published between January 2002 and February 2012.
RESULTS: The search identified 98 original research studies that included the uses, benefits, and/or
limitations of social media for health communication among the general public, patients, and health
professionals. The methodological quality of the studies assessed using the Downs and Black
instrument was low; this was mainly due to the fact that the vast majority of the studies in this review
included limited methodologies and was mainly exploratory and descriptive in nature. Seven main
uses of social media for health communication were identified, including focusing on increasing
interactions with others, and facilitating, sharing, and obtaining health messages. The six key
overarching benefits were identified as (1) increased interactions with others, (2) more available,
shared, and tailored information, (3) increased accessibility and widening access to health
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information, (4) peer/social/emotional support, (5) public health surveillance, and (6) potential to
influence health policy. Twelve limitations were identified, primarily consisting of quality concerns and
lack of reliability, confidentiality, and privacy. CONCLUSIONS: Social media brings a new dimension to
health care as it offers a medium to be used by the public, patients, and health professionals to
communicate about health issues with the possibility of potentially improving health outcomes. Social
media is a powerful tool, which offers collaboration between users and is a social interaction
mechanism for a range of individuals. Although there are several benefits to the use of social media
for health communication, the information exchanged needs to be monitored for quality and
reliability, and the users' confidentiality and privacy need to be maintained. Eight gaps in the literature
and key recommendations for future health communication research were provided. Examples of
these recommendations include the need to determine the relative effectiveness of different types of
social media for health communication using randomized control trials and to explore potential
mechanisms for monitoring and enhancing the quality and reliability of health communication using
social media. Further robust and comprehensive evaluation and review, using a range of
methodologies, are required to establish whether social media improves health communication
practice both in the short and long terms.

Moreira Tde, C., et al. (2014). "Non-adherence to telemedicine interventions for drug users: systematic
review." Rev Saude Publica 48(3): 521-531.

OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug

addiction. METHODS A systematic review was conducted of randomized controlled trials investigating
different telemedicine treatment methods for drug addiction. The following databases were consulted
between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library),
Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment,
Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated
were: appropriate sequence of data generation, allocation concealment, blinding, description of losses
and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were
analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions
evaluated were of at least three months duration and, although they all used telemedicine as support,
treatment methods differed. Regarding the quality of the studies, the values also varied from very
poor to high quality. High quality studies showed better adherence rates, as did those using more than
one technique of intervention and a limited treatment time. Mono-user studies showed better
adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving
telemedicine on the part of users of psycho-active substances differed considerably, depending on the
country, the intervention method, follow-up time and substances used. Using more than one
technique of intervention, short duration of treatment and the type of substance used by patients
appear to facilitate adherence.

Mueller, K. J., et al. (2014). "Lessons from tele-emergency: improving care quality and health outcomes by
expanding support for rural care systems." Health Aff (Millwood) 33(2): 228-234.

Tele-emergency services provide immediate and synchronous audio/video connections, most

commonly between rural low-volume hospitals and an urban "hub" emergency department. We
performed a systematic literature review to identify tele-emergency models and outcomes. We then
studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one
hospitals that used the service and received 292 replies. We also conducted telephone interviews and
site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants
reported that tele-emergency improves clinical quality, expands the care team, increases resources
during critical events, shortens time to care, improves care coordination, promotes patient-centered
care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base.
However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations
hinder tele-emergency implementation. New value-based payment systems have the potential to
reduce these barriers and accelerate tele-emergency expansion.

Muench, F. (2014). "The Promises and Pitfalls of Digital Technology in Its Application to Alcohol Treatment."
Alcohol Res 36(1): 131-142.
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Individuals seeking to change their alcohol use form a heterogeneous group with varied treatment
goals-including moderation and abstinence-that therefore requires flexible treatment options. The
availability of alcohol in the United States, and the pervasive social pressure to drink, warrant
treatments that support individuals outside the treatment environment and that foster coping and
self-regulation in the face of these demands. Emerging digital technologies show promise for helping
both to hone therapies to clients' individual needs and to support clients in settings beyond the clinic.
In the broader health care arena, digital health technologies (DHTs) are transforming how health
professionals assess, prevent, and treat both physical and mental health problems. DHTs include
assessments and interventions delivered via computer, Internet, mobile phone, and wireless or
wearable device technologies. The emerging literature examining within-treatment and mobile DHTs
highlights an opportunity to create personalized alcohol treatments for every person seeking care.
Despite the promises DHTs may hold, however, there still are many potential risks to using them and a
number of challenges regarding how to integrate them into treatment successfully. This article will
review the current and potential advantages of DHTs in alcohol treatment and the technological,
personal, organizational, and systemic limitations of integrating various technology-based assessment
and intervention programs into care.

Muessig, K. E., et al. (2015). "A systematic review of recent smartphone, Internet and Web 2.0 interventions to
address the HIV continuum of care." Curr HIV/AIDS Rep 12(1): 173-190.

eHealth, mHealth and "Web 2.0" social media strategies can effectively reach and engage key
populations in HIV prevention across the testing, treatment, and care continuum. To assess how these
tools are currently being used within the field of HIV prevention and care, we systematically reviewed
recent (2013-2014) published literature, conference abstracts, and funded research. Our searches
identified 23 published intervention studies and 32 funded projects underway. In this synthesis we
describe the technology modes applied and the stages of the HIV care cascade addressed, including
both primary and secondary prevention activities. Overall trends include use of new tools including
social networking sites, provision of real-time assessment and feedback, gamification and virtual
reality. While there has been increasing attention to use of technology to address the care continuum,
gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy.

Muller, R. P. et Eich, H. T. (2005). "The development of quality assurance programs for radiotherapy within the
German Hodgkin Study Group (GHSG). Introduction, continuing work, and results of the radiotherapy
reference panel." Strahlenther Onkol 181(9): 557-566.

BACKGROUND AND PURPOSE: The German Hodgkin Study Group (GHSG), including more than 500
participating centers, established a central radiotherapy (RT) reference center to improve quality of
treatment, starting with the first study generation in 1978. More than 11,000 patients with Hodgkin's
lymphoma (HL) have been enrolled into these trials. Extensive continuing quality assurance programs
(QAPs) during the study generations have been performed. The purpose of the present article is to
summarize the experiences and results of the performed and ongoing QAPs. MATERIAL AND
METHODS: A panel of expert radiation oncologists (second study generation HD4-6, 1988-1994, and
third study generation HD7-9, 1993-1998) retrospectively evaluated the adequacy of treatment fields,
applied radiation doses, treatment time, and technical parameters. Furthermore, a detailed analysis of
relapses in correlation with the performed RT was conducted. For the fourth study generation (HD10-
12, 1998-2002), the RT reference center changed from Munich to Cologne. New RT QAPs were
initiated according to the demands of the new trials and former programs were enhanced: (1) central
prospective radiation oncologic review of cross-sectional imaging (HD10, HD11) to create the
individual radiation treatment plan; (2) retrospective analysis of the adequacy of the performed
involved-field (IF) RT (HD10, HD11); (3) the multidisciplinary HD12 panel (radiation oncologists,
medical oncologists, diagnostic radiologists); (4) initiation and integration of a teleradiotherapy
network into the GHSG trials. RESULTS: A strong achievement of these activities in the era of
extended-field RT was to show that major deviations of radiation treatment portals and radiation dose
from prospective treatment prescriptions revealed to be unfavorable prognostic factors for patients
with early-stage HL (HD4). The central prospective radiation oncological review of all diagnostic
imaging (HD10, HD11) showed that corrections of disease involvement in 49% of patients (593/1,214)
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with early stages (HD10) and in 67% of patients (936/1,397) with intermediate stages (HD11) were
necessary. These procedures had a significant impact on the correctness of stage definition, allocation
to treatment groups and on the extension of the IF treatment volume. Until now, 1,080 patients in
HD10 and HD11 have been evaluated retrospectively with regard to the adequacy of the performed IF-
RT. Although the participating institutions got a precise RT prescription, interim results reveal
deviations in a significant number of cases. In the HD12 trial (advanced stages), a multidisciplinary
panel of radiation oncologists, radiologists and medical oncologists reviewed all the diagnostic imaging
from diagnosis throughout the treatment in comparison to the documentation forms. For patients
with poor response to chemotherapy, the panel recommended RT independent of the randomization.
This procedure ensured that patients with a poor response to chemotherapy received additional RT.
1,080 of 1,594 randomized patients (68%) could be analyzed. After chemotherapy, 599 patients (56%)
showed residual disease (> 1.5 cm), and in 145/1,080 patients (13.5%) the panel recommended
additional RT independent of the randomization arm. The introduction of electronic image transfer
optimized and simplified the workflow of the QAPs. Rapid online consultation and real-time
teleconferences regarding disease involvement, patient management and communication of the RT
prescription with connected hospitals proved to be extremely helpful. CONCLUSION: Today, radiation
oncologists in the GHSG perform a continuous and efficient QAP to improve treatment quality of study
patients. For early favorable and unfavorable HL a central prospective review of all diagnostic imaging
is performed by expert radiation oncologists to control the disease extension and to define the IF
treatment volume. Retrospective analysis of RT portals by an expert panel detects faults in the applied
irradiation. Participants are trained on the definition of IF-RT by workshops on the occasion of annual
GHSG meetings and on the annual meetings of the German Society of Therapeutic Radiation Oncology
(DEGRO). For the advanced stages a multidisciplinary panel evaluates the treatment response to
chemotherapy. Patients with a poor response receive additional RT due to the panel's
recommendation. The introduction of teleradiotherapy into the GHSG trials improves the dialogue
between the central RT reference center and study participants and thus contributes to high RT
quality for study patients.

Mushcab, H., et al. (2015). "Web-Based Remote Monitoring Systems for Self-Managing Type 2 Diabetes: A
Systematic Review." Diabetes Technol Ther 17(7): 498-509.

This systematic review aims to evaluate evidence for viability and impact of Web-based
telemonitoring for managing type 2 diabetes mellitus. A review protocol included searching Medline,
EMBASE, CINAHL, AMED, the Cochrane Library, and PubMed using the following terms:
telemonitoring, type 2 diabetes mellitus, self-management, and web-based Internet solutions. The
technology used, trial design, quality of life measures, and the glycated hemoglobin (HbA1c) levels
were extracted. This review identified 426 publications; of these, 19 met preset inclusion criteria. Ten
quasi-experimental research designs were found, of which seven were pre-posttest studies, two were
cohort studies, and one was an interrupted time-series study; in addition, there were nine randomized
controlled trials. Web-based remote monitoring from home to hospital is a viable approach for
healthcare delivery and enhances patients' quality of life. Six of these studies were conducted in South
Korea, five in the United States, three in the United Kingdom, two in Taiwan, and one each in Spain,
Poland, and India. The duration of the studies varied from 4 weeks to 18 months, and the participants
were all adults. Fifteen studies showed positive improvement in HbA1c levels. One study showed high
acceptance of the technology among participants. It remains challenging to identify clear evidence of
effectiveness in the rapidly changing area of remote monitoring in diabetes care. Both the technology
and its implementations are complex. The optimal design of a telemedicine system is still uncertain,
and the value of the real-time blood glucose transmissions is still controversial.

Nangalia, V., et al. (2010). "Health technology assessment review: remote monitoring of vital signs--current
status and future challenges." Crit Care 14(5): 233.

Recent developments in communications technologies and associated computing and digital

electronics now permit patient data, including routine vital signs, to be surveyed at a distance. Remote
monitoring, or telemonitoring, can be regarded as a subdivision of telemedicine - the use of electronic
and telecommunications technologies to provide and support health care when distance separates the
participants. Depending on environment and purpose, the patient and the carer/system surveying,
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analysing or interpreting the data could be separated by as little as a few feet or be on different
continents. Most telemonitoring systems will incorporate five components: data acquisition using an
appropriate sensor; transmission of data from patient to clinician; integration of data with other data
describing the state of the patient; synthesis of an appropriate action, or response or escalation in the
care of the patient, and associated decision support; and storage of data. Telemonitoring is currently
being used in community-based healthcare, at the scene of medical emergencies, by ambulance
services and in hospitals. Current challenges in telemonitoring include: the lack of a full range of
appropriate sensors, the bulk weight and size of the whole system or its components, battery life,
available bandwidth, network coverage, and the costs of data transmission via public networks.
Telemonitoring also has the ability to produce a mass of data - but this requires interpretation to be of
clinical use and much necessary research work remains to be done.

Nasi, G., et al. (2015). "The performance of mHealth in cancer supportive care: a research agenda." J Med
Internet Res 17(1): e9.

BACKGROUND: Since the advent of smartphones, mHealth has risen to the attention of the health care
system as something that could radically change the way health care has been viewed, managed, and
delivered to date. This is particularly relevant for cancer, as one of the leading causes of death
worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing
side effects. Given adequate knowledge, they are able to expect appropriate assessments and
interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health
care professionals; for enabling early detection and intervention; for lowering costs; and achieving
better quality of life. Given its great potential, it is important to evaluate the performance of mHealth.
This can be considered from several perspectives, of which organizational performance is particularly
relevant, since mHealth may increase the productivity of health care providers and as a result even the
productivity of health care systems. OBJECTIVE: This paper aims to review studies on the evaluation of
the performance of mHealth, with particular focus on cancer care and cancer supportive care
processes, concentrating on its contribution to organizational performance, as well as identifying
some indications for a further research agenda. METHODS: We carried out a review of literature,
aimed at identifying studies related to the performance of mHealth in general or focusing on cancer
care and cancer supportive care. RESULTS: Our analysis revealed that studies are almost always based
on a single dimension of performance. Any evaluations of the performance of mHealth are based on
very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails
to consider the real contribution that mHealth can offer for improving the performance of health care
providers, health care systems, and the quality of life in general. CONCLUSIONS: Further research
should start by stating and explaining what is meant by the evaluation of mHealth's performance and
then conduct more in-depth analysis in order to create shared frameworks to specifically identify the
different dimensions of mHealth's performance.

Nasi, G., et al. (2015). "The role of mobile technologies in health care processes: the case of cancer supportive
care." J Med Internet Res 17(2): e26.

BACKGROUND: Health care systems are gradually moving toward new models of care based on
integrated care processes shared by different care givers and on an empowered role of the patient.
Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care
processes where the patient has a particularly enhanced role, as is the case of cancer supportive care.
OBJECTIVE: This paper aims to review existing studies on the actual role and use of mobile technology
during the different stages of care processes, with particular reference to cancer supportive care.
METHODS: We carried out a review of literature with the aim of identifying studies related to the use
of mHealth in cancer care and cancer supportive care. The final sample size consists of 106 records.
RESULTS: There is scant literature concerning the use of mHealth in cancer supportive care. Looking
more generally at cancer care, we found that mHealth is mainly used for self-management activities
carried out by patients. The main tools used are mobile devices like mobile phones and tablets, but
remote monitoring devices also play an important role. Text messaging technologies (short message
service, SMS) have a minor role, with the exception of middle income countries where text messaging
plays a major role. Telehealth technologies are still rarely used in cancer care processes. If we look at
the different stages of health care processes, we can see that mHealth is mainly used during the
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treatment of patients, especially for self-management activities. It is also used for prevention and
diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-
up activities. CONCLUSIONS: Since mHealth seems to be employed only for limited uses and during
limited phases of the care process, it is unlikely that it can really contribute to the creation of new care
models. This under-utilization may depend on many issues, including the need for it to be embedded
into broader information systems. If the purpose of introducing mHealth is to promote the adoption
of integrated care models, using mHealth should not be limited to some activities or to some phases
of the health care process. Instead, there should be a higher degree of pervasiveness at all stages and
in all health care delivery activities.

Naslund, J. A., et al. (2015). "Emerging mHealth and eHealth interventions for serious mental illness: a review
of the literature." J Ment Health 24(5): 321-332.

BACKGROUND: Serious mental illness (SMI) is one of the leading causes of disability worldwide.
Emerging mobile health (mHealth) and eHealth interventions may afford opportunities for reaching
this at-risk group. AIM: To review the evidence on using emerging mHealth and eHealth technologies
among people with SMI. METHODS: We searched MEDLINE, PsychINFO, CINAHL, Scopus, Cochrane
Central, and Web of Science through July 2014. Only studies which reported outcomes for mHealth or
eHealth interventions, defined as remotely delivered using mobile, online, or other devices, targeting
people with schizophrenia, schizoaffective disorder, or bipolar disorder, were included. RESULTS:
Forty-six studies spanning 12 countries were included. Interventions were grouped into four
categories: (1) illness self-management and relapse prevention; (2) promoting adherence to
medications and/or treatment; (3) psychoeducation, supporting recovery, and promoting health and
wellness; and (4) symptom monitoring. The interventions were consistently found to be highly feasible
and acceptable, though clinical outcomes were variable but offered insight regarding potential
effectiveness. CONCLUSIONS: Our findings confirm the feasibility and acceptability of emerging
mHealth and eHealth interventions among people with SMI; however, it is not possible to draw
conclusions regarding effectiveness. Further rigorous investigation is warranted to establish
effectiveness and cost benefit in this population.

Nepal, S., et al. (2014). "A framework for telehealth program evaluation." Telemed J E Health 20(4): 393-404.

Evaluating telehealth programs is a challenging task, yet it is the most sensible first step when
embarking on a telehealth study. How can we frame and report on telehealth studies? What are the
health services elements to select based on the application needs? What are the appropriate terms to
use to refer to such elements? Various frameworks have been proposed in the literature to answer
these questions, and each framework is defined by a set of properties covering different aspects of
telehealth systems. The most common properties include application, technology, and functionality.
With the proliferation of telehealth, it is important not only to understand these properties, but also
to define new properties to account for a wider range of context of use and evaluation outcomes. This
article presents a comprehensive framework for delivery design, implementation, and evaluation of
telehealth services. We first survey existing frameworks proposed in the literature and then present
our proposed comprehensive multidimensional framework for telehealth. Six key dimensions of the
proposed framework include health domains, health services, delivery technologies, communication
infrastructure, environment setting, and socioeconomic analysis. We define a set of example
properties for each dimension. We then demonstrate how we have used our framework to evaluate
telehealth programs in rural and remote Australia. A few major international studies have been also
mapped to demonstrate the feasibility of the framework. The key characteristics of the framework are
as follows: (a) loosely coupled and hence easy to use, (b) provides a basis for describing a wide range
of telehealth programs, and (c) extensible to future developments and needs.

Nesbitt, T. S., et al. (2000). "Development of a telemedicine program." Western Journal of Medicine 173: 169-
174, 165 tabl.
[Link]

Nicholas, J., et al. (2015). "Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content
Quality." J Med Internet Res 17(8): e198.
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BACKGROUND: With continued increases in smartphone ownership, researchers and clinicians are
investigating the use of this technology to enhance the management of chronic illnesses such as
bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation,
supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible,
anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there
has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the
self-management of BD is only feasible if apps are of appropriate quality. OBJECTIVE: Our aim was to
identify the types of apps currently available for BD in the Google Play and iOS stores and to assess
their features and the quality of their content. METHODS: A systematic review framework was applied
to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS
stores for English-language apps developed for people with BD. The comprehensiveness and quality of
information was assessed against core psychoeducation principles and current BD treatment
guidelines. Management tools were evaluated with reference to the best-practice resources for the
specific area. General app features, and privacy and security were also assessed. RESULTS: Of the 571
apps identified, 82 were included in the review. Of these, 32 apps provided information and the
remaining 50 were management tools including screening and assessment (n=10), symptom
monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82,
22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information
covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-
practice guidelines. Only a third (10/32, 31%) cited their information source. Neither
comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice
guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring
apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35,
51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%).
CONCLUSIONS: In general, the content of currently available apps for BD is not in line with practice
guidelines or established self-management principles. Apps also fail to provide important information
to help users assess their quality, with most lacking source citation and a privacy policy. Therefore,
both consumers and clinicians should exercise caution with app selection. While mHealth offers great
opportunities for the development of quality evidence-based mobile interventions, new frameworks
for mobile mental health research are needed to ensure the timely availability of evidence-based apps
to the public.

Nielssen, O., et al. (2015). "Procedures for risk management and a review of crisis referrals from the MindSpot
Clinic, a national service for the remote assessment and treatment of anxiety and depression." BMC
Psychiatry 15: 304.

BACKGROUND: The MindSpot Clinic (MindSpot) provides remote screening assessments and therapist-
guided treatment for anxiety and depression to adult Australians. Most patients are self-referred. The
purpose of this study was to report on the procedures followed to maintain the safety of patients and
to examine the circumstances of urgent referrals to local services made by this remote mental health
service. METHOD: A description of the procedures used to manage risk, and an audit of case
summaries of patients who were urgently referred for crisis intervention. The reported measures were
scores on self-report scales of psychological distress (K-10) and depression (PHQ-9), the number
reporting suicidal thoughts and plans, and the number of acute referrals. RESULTS: A total of 9061
people completed assessments and consented for analysis of their data in the year from 1 July, 2013
to 30 June, 2014. Of these, 2599 enrolled in online treatment at MindSpot, and the remainder were
supported to access local mental health services. Suicidal thoughts were reported by 2366 (26.1 %)
and suicidal plans were reported by 213 (2.4 %). There were 51 acute referrals, of whom 19 (37.3 %)
lived in regional or remote locations. The main reason for referral was the patients' self-report of
imminent suicidal intent. The police were notified in three cases, and in another case an ambulance
attended after the patient reported taking an overdose. For the remaining acute referrals, MindSpot
therapists were able to identify a local mental health service or a general practitioner, confirm receipt
of a written case summary, and confirm that the patient had been contacted, or that the local service
intended to contact the patient. CONCLUSIONS: Around 0.6 % of the people seeking assessment or
treatment by MindSpot were referred to local mental health services for urgent face to face care. The
procedures for identifying and managing those patients were satisfactory, and in every case, either
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emergency services or local mental health services were able to take over the patient's care. This
review suggests that the uncertainty associated with taking responsibility for the remote treatment of
patients who disclose active suicidal plans is not a major impediment to providing direct access online
treatment for severe forms of anxiety and depression.

Oldenburg, B., et al. (2015). "Using new technologies to improve the prevention and management of chronic
conditions in populations." Annu Rev Public Health 36: 483-505.

Lifestyle factors are important in the development of chronic diseases, such as heart disease,
respiratory disease, and diabetes, and chronic disease risk can be reduced by changes in lifestyle
behaviors linked to these conditions. The use of mass media and community-wide strategies targeting
these behaviors has been extensively evaluated since the 1970s. This review summarizes some
examples of interventions and their use of media conducted within the old communications landscape
of the 1970s and 1980s and the key lessons learned from their design, implementation, and
evaluation. We then consider the potential and evidence base for using contemporary technology
applications and platforms-within the new communications landscape-to improve the prevention and
management of lifestyle-related chronic diseases in the future. We discuss the implications and
adaptation of lessons derived from the ways in which new technologies are being used in commercial
and political contexts and their relevance for public health. Finally, we consider some recent examples
of applying new technologies to public health issues and consider some of the challenges in this
rapidly developing field.

Oliver, D. P., et al. (2012). "A systematic review of the evidence base for telehospice." Telemed J E Health 18(1):
38-47.

Abstract The use of telehealth technologies to overcome the geographic distances in the delivery of
hospice care has been termed telehospice. Although telehospice research has been conducted over
the last 10 years, little is known about the comprehensive findings within the field. The purpose of this
systematic article was to focus on available research and answer the question, What is the state of the
evidence related to telehospice services? The article was limited to studies that had been published in
the English language and indexed between January 1, 2000 and March 23, 2010. Indexed databases
included PubMed and PsycINFO and contained specified key words. Only research published in peer
review journals and reporting empirical data, rather than opinion or editorials, were included. A two-
part scoring framework was modified and applied to assess the methodological rigor and pertinence
of each study. Scoring criteria allowed the evaluation of both quantitative and qualitative
methodologies. Twenty-six studies were identified with the search strategy. Although limited in
number and in strength, studies have evaluated the use of a variety of technologies, attitudes toward
use by providers and consumers, clinical outcomes, barriers, readiness, and cost. A small evidence
base for telehospice has emerged over the last 10 years. Although the evidence is of medium strength,
its pertinence is strong. The evidence base could be strengthened with randomized trials and
additional clinical-outcome-focused research in larger randomized samples and in qualitative studies
with better-described samples.

Olver, I. N. et Selva-Nayagam, S. (2000). "Evaluation of a telemedicine link between Darwin an Adelaide to

facilitate cancer management." Telemedicine Journal 6(2): 213-218, 214 tabl.
[Link]

Omboni, S. et Ferrari, R. (2015). "The role of telemedicine in hypertension management: focus on blood
pressure telemonitoring." Curr Hypertens Rep 17(4): 535.

This review aims at updating and critically assessing the role of telemedicine, and in particular, of
home blood pressure telemonitoring (HBPT), in the management of the hypertensive patient. Result
from several randomized trials suggest that HBPT represents a promising tool for improving blood
pressure (BP) control of hypertensive patients, in particular, those at high risk. Most studies
documented a significant BP reduction with regular HBPT compared to usual care. HBPT interventions
showed a very high degree of acceptance by patients, helped improving the patients' quality of life,
and were associated with lower medical costs than standard care, even though such costs were offset
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by those of the technology, thus reducing the overall cost-effectiveness of HBPT. The high
heterogeneity of the technologies, study designs, and type of patients in the various studies suggest
that further well-designed, large cohort, prospective studies are needed to identify key elements of
HBPT approach to be able to give impact on specific outcomes. Likely, patients who need a constant
monitoring of multiple vital signs and a tight BP control, such as high risk patients with chronic
diseases (ischemic heart disease or heart failure, diabetes, etc.), as well as non-adherent patients, may
particularly benefit from HBPT. In general, HBPT can be an advantageous choice when a network
among healthcare professionals (doctors, nurses, and pharmacists) is needed to improve the screening
and management of hypertension and related comorbidities and to achieve an effective prevention of
cardiovascular diseases in the community.

Owsley, C., et al. (2015). "Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for
adults at risk for glaucoma: study rationale and design." Int J Equity Health 14: 135.

BACKGROUND: Primary open angle glaucoma is a chronic, progressive eye disease that is the leading
cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about
10 years earlier in African Americans as compared to whites. African Americans are also less likely to
receive comprehensive eye care when glaucoma could be detected before irreversible blindness.
Screening and follow-up protocols for managing glaucoma recommended by eye-care professional
organizations are often not followed by primary eye-care providers, both ophthalmologists and
optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care
for African Americans. Telemedicine may be an effective solution for improving management and
diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically
transmitted to remote reading centers where tertiary care specialists can examine the results. We
describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY),
set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving
communities with a large percentage of African Americans. METHODS/DESIGN: We conducted an
observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by
primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for
glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations
and diagnostic testing for glaucoma, followed by the optometrist's diagnosis and a preliminary
management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who
completed fellowship training in glaucoma review results and provide feedback to the optometrist,
who manages the care of the patient. Patients also receive eye health education about glaucoma and
comprehensive eye care. Research questions include diagnostic and management agreement between
providers, the impact of eye health education on patients' knowledge and adherence to follow-up and
medication, patient satisfaction, program cost-effectiveness, and EQUALITY's impact on Walmart
pharmacy prescription rates. DISCUSSION: As eye-care delivery systems in the US strive to improve
quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as
EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-
risk for chronic blinding diseases.

Oyeyemi, S. O. et Wynn, R. (2015). "The use of cell phones and radio communication systems to reduce delays
in getting help for pregnant women in low- and middle-income countries: a scoping review." Glob
Health Action 8: 28887.

BACKGROUND: Delays in getting medical help are important factors in the deaths of many pregnant
women and unborn children in the low- and middle-income countries (LMIC). Studies have suggested
that the use of cell phones and radio communication systems might reduce such delays. OBJECTIVES:
We review the literature regarding the impact of cell phones and radio communication systems on
delays in getting medical help by pregnant women in the LMIC. DESIGN: Cochrane Library, PubMed,
Maternity and Infant care (Ovid), Web of Science (ISI), and Google Scholar were searched for studies
relating to the use of cell phones for maternal and child health services, supplemented with hand
searches. We included studies in LMIC and in English involving the simple use of cell phones (or radio
communication) to either make calls or send text messages. RESULTS: Fifteen studies met the
inclusion criteria. All the studies, while of various designs, demonstrated positive contributory effects
of cell phones or radio communication systems in reducing delays experienced by pregnant women in
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getting medical help. CONCLUSIONS: While the results suggested that cell phones could contribute in
reducing delays, more studies of a longer duration are needed to strengthen the finding.

Palsson, T. et Valdimarsdottir, M. (2004). "Review on the state of telemedicine and eHealth in Iceland." Int J
Circumpolar Health 63(4): 349-355.

This article provides an overview of telemedicine and other eHealth activities in Iceland. Several
telemedicine projects, which have been running since 1996, are described. The projects include
teleradiology, teleobstetrics, telepsychiatry, maritime telemedicine, telemedicine in surgery,
telepathology and a project for the use of telemedicine in various consultations. The role of the
Icelandic Health-net for telemedicine, including projects for teleobstetrics and telemedicine for
emergency medicine, is described with the projects included:. A few other eHealth activities, including
electronic patient record and information systems, are also described.

Panait, L., et al. (2004). "A review of telemedicine in Romania." J Telemed Telecare 10(1): 1-5.

Romania is an eastern European country that is undergoing rapid reform of its medical system. We
conducted an assessment of the potential for telemedicine in the country, through a literature review,
personal visits to Romania and discussions with individuals from academia, the Ministry of Health and
Family, and businesses. The results suggest that telemedicine has the potential to accelerate health-
care reform. The main hospitals and universities could promote the wider distribution and
development of telemedicine within Romania, which in turn would bring benefits to the Romanian
people, 46% of whom live in rural areas.

Pandor, A., et al. (2013). "Home telemonitoring or structured telephone support programmes after recent
discharge in patients with heart failure: systematic review and economic evaluation." Health Technol
Assess 17(32): 1-207, v-vi.

BACKGROUND: Remote monitoring (RM) strategies have the potential to deliver specialised care and
management to patients with heart failure (HF). OBJECTIVE: To determine the clinical effectiveness
and cost-effectiveness of home telemonitoring (TM) or structured telephone support (STS) strategies
compared with usual care for adult patients who have been recently discharged (within 28 days) from
acute care after a recent exacerbation of HF. DATA SOURCES: Fourteen electronic databases (including
MEDLINE, EMBASE, PsycINFO and The Cochrane Library) and research registers were searched to
January 2012, supplemented by hand-searching relevant articles and contact with experts. The review
included randomised controlled trials (RCTs) or observational cohort studies with a contemporaneous
control group that included the following RM interventions: (1) TM (including cardiovascular
implanted monitoring devices) with medical support provided during office hours or 24/7; (2) STS
programmes delivered by human-to-human contact (HH) or human-to-machine interface (HM).
REVIEW METHODS: A systematic review and network meta-analysis (where appropriate) of the clinical
evidence was carried out using standard methods. A Markov model was developed to evaluate the
cost-effectiveness of different RM packages compared with usual care for recently discharged HF
patients. TM 24/7 or using cardiovascular monitoring devices was not considered in the economic
model because of the lack of data and/or unsuitability for the UK setting. Given the heterogeneity in
the components of usual care and RM interventions, the cost-effectiveness analysis was performed
using a set of costing scenarios designed to reflect the different configurations of usual care and RM in
the UK. RESULTS: The literature searches identified 3060 citations. Six RCTs met the inclusion criteria
and were added to the 15 trials identified from the previous systematic reviews giving a total of 21
RCTs included in the systematic review. No trials of cardiovascular implanted monitoring devices or
observational studies met the inclusion criteria. The methodological quality of the studies varied
widely and reporting was generally poor. Compared with usual care, RM was beneficial in reducing all-
cause mortality for STS HH [hazard ratio (HR) 0.77, 95% credible interval (CrI) 0.55 to 1.08], TM during
office hours (HR 0.76, 95% CrI 0.49 to 1.18) and TM 24/7 (HR 0.49, 95% CrI 0.20 to 1.18); however,
these results were statistically inconclusive. The results for TM 24/7 should be treated with caution
because of the poor methodological quality of the only included study in this network. No favourable
effect on mortality was observed with STS HM. Similar reductions were observed in all-cause
hospitalisations for TM interventions, whereas STS interventions had no major effect. A sensitivity
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analysis, in which a study was excluded because it provided better-than-usual support to the control
group, showed larger beneficial effects for most outcomes, particularly for TM during office hours. In
the cost-effectiveness analyses, TM during office hours was the most cost-effective strategy with an
estimated incremental cost-effectiveness ratio (ICER) of pound11,873 per quality-adjusted life-year
(QALY) compared with usual care, whereas STS HH had an ICER of pound228,035 per QALY compared
with TM during office hours. STS HM was dominated by usual care. Similar results were observed in
scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs
of TM during office hours. LIMITATIONS: The RM interventions included in the review were
heterogeneous in terms of monitored parameters and HF selection criteria and lacked detail in the
components of the RM care packages and usual care (e.g. communication protocols, routine staff
visits and resources used). As a result, the economic model developed scenarios for different RM
classifications and their costs were estimated using bottom-up costing methods. Although the users
can decide which of these scenarios is most representative of their setting, uncertainties still remain
about the assumptions made in the estimation of these costs. In addition, the model assumed that the
effectiveness of the interventions was constant over time, irrespective of the duration of deployment,
and that the intervention was equally effective in different age/severity groups. CONCLUSION: Despite
wide variation in usual care and RM strategies, cost-effectiveness analyses suggest that TM during
office hours was an optimal strategy (in most costing scenarios). However, clarity was lacking among
descriptions of the components of RM packages and usual care and there was a lack of robust
estimation of costs. Further research is needed in these areas. STUDY REGISTRATION: PROSPERO
registration no. CRD42011001368. FUNDING: The National Institute for Health Research Health
Technology Assessment programme.

Parmar, P., et al. (2015). "Use of telemedicine technologies in the management of infectious diseases: a
review." Clin Infect Dis 60(7): 1084-1094.

Telemedicine technologies are rapidly being integrated into infectious diseases programs with the aim
of increasing access to infectious diseases specialty care for isolated populations and reducing costs.
We summarize the utility and effectiveness of telemedicine in the evaluation and treatment of
infectious diseases patients. The use of telemedicine in the management of acute infectious diseases,
chronic hepatitis C, human immunodeficiency virus, and active pulmonary tuberculosis is considered.
We recapitulate and evaluate the advantages of telemedicine described in other studies, present
challenges to adopting telemedicine, and identify future opportunities for the use of telemedicine
within the realm of clinical infectious diseases.

Pedone, C. et Lelli, D. (2015). "Systematic review of telemonitoring in COPD: an update." Pneumonol Alergol
Pol 83(6): 476-484.

Telemedicine may support individual care plans in people with chronic obstructive pulmonary disease
(COPD), potentially improving the clinical outcomes. To-date there is no clear evidence of benefit of
telemedicine in this patients. The aim of this study is to provide an update on the effectiveness of
telemedicine in reducing adverse clinical outcomes. We searched the Pubmed database for articles
published between January 2005 and December 2014. We included only randomized controlled trials
exclusively focused on patients with COPD and with a telemedicine intervention arm. Evaluated
outcomes were number of exacerbations, ER visits, COPD hospitalizations, length of stay and death.
We eventually included 12 randomized controlled trials. Most of them had a small sample size and
was of poor quality, with a wide heterogeneity in the parameters and technologies used. Most studies
reported a positive effect of telemonitoring on hospitalization for any cause, with risk reductions
between 10% and 63%; however only three studies reached statistical significance. The same trend
was observed for COPD-related hospital admission and ER visits. No significative effects of
telemedicine was evidenced in reducing length of hospital stay, improving quality of life and reducing
deaths. In conclusion, our study confirms that the available evidence on the effectiveness of
telemedicine in COPD does not allow to draw definite conclusions; most evidence suggests a positive
effect of telemonitoring on hospital admissions and ER visits. More trials with adequate sample size
and with adequate consideration of background clinical services are needed to definitively establish its
effectiveness.

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Peeters, J. M., et al. (2011). "Costs and financial benefits of video communication compared to usual care at
home: a systematic review." J Telemed Telecare 17(8): 403-411.

We conducted a systematic review of video communication in home care to provide insight into the
ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE,
COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at
home (up to December 2009). Studies were only included when data about the costs of video
communication as well as the financial benefits were presented. The methodological quality of the
included studies was assessed. Nine studies, mainly conducted in the US, met the inclusion criteria.
The methodological quality was poor, except for one study. Most studies (8 of the 9) did not
demonstrate that the financial benefits were significantly greater than the costs of video
communication. One study - the only one with a high methodological quality - found that costs for
patients who received video communication were higher than for patients who received traditional
care. The review found no evidence that the cost of implementing video communication in home care
was lower than the resulting financial benefits. More methodologically well conducted research is
needed.

Peetoom, K. K., et al. (2015). "Literature review on monitoring technologies and their outcomes in
independently living elderly people." Disabil Rehabil Assist Technol 10(4): 271-294.

PURPOSE: To obtain insight into what kind of monitoring technologies exist to monitor activity in-
home, what the characteristics and aims of applying these technologies are, what kind of research has
been conducted on their effects and what kind of outcomes are reported. METHODS: A systematic
document search was conducted within the scientific databases Pubmed, Embase, Cochrane,
PsycINFO and Cinahl, complemented by Google Scholar. Documents were included in this review if
they reported on monitoring technologies that detect activities of daily living (ADL) or significant
events, e.g. falls, of elderly people in-home, with the aim of prolonging independent living. RESULTS:
Five main types of monitoring technologies were identified: PIR motion sensors, body-worn sensors,
pressure sensors, video monitoring and sound recognition. In addition, multicomponent technologies
and smart home technologies were identified. Research into the use of monitoring technologies is
widespread, but in its infancy, consisting mainly of small-scale studies and including few longitudinal
studies. CONCLUSIONS: Monitoring technology is a promising field, with applications to the long-term
care of elderly persons. However, monitoring technologies have to be brought to the next level, with
longitudinal studies that evaluate their (cost-) effectiveness to demonstrate the potential to prolong
independent living of elderly persons. [Box: see text].

Pereira-Azevedo, N., et al. (2015). "mHealth in Urology: A Review of Experts' Involvement in App
Development." PLoS One 10(5): e0125547.

INTRODUCTION: Smartphones are increasingly playing a role in healthcare and previous studies
assessing medical applications (apps) have raised concerns about lack of expert involvement and low
content accuracy. However, there are no such studies in Urology. We reviewed Urology apps with the
aim of assessing the level of participation of healthcare professionals (HCP) and scientific Urology
associations in their development. MATERIAL AND METHODS: A systematic search was performed on
PubMed, Apple's App Store and Google's Play Store, for Urology apps, available in English. Apps were
reviewed by three graders to determine the app's platform, target customer, developer, app type, app
category, price and the participation of a HCP or a scientific Urology association in the development.
RESULTS: The search yielded 372 apps, of which 150 were specific for Urology. A fifth of all apps had
no HCP involvement (20.7%) and only a third had been developed with a scientific Urology association
(34.7%). The lowest percentage of HCP (13.4%) and urological association (1.9%) involvement was in
apps designed for the general population. Furthermore, there was no contribution from an Urology
society in "Electronic Medical Record" nor in "Patient Information" apps. A limitation of the study is
that only Android and iOS apps were reviewed. CONCLUSIONS: Despite the increasing Mobile Health
(mHealth) market, this is the first study that demonstrates the lack of expert participation in the
design of Urology apps, particularly in apps designed for the general public. Until clear regulation is
enforced, the urological community should help regulate app development. Maintaining a register of
certified apps or issuing an official scientific seal of approval could improve overall app quality. We
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propose that urologists become stakeholders in mHealth, shaping future app design and promoting
peer-review app validation.

Pessus, N. (2011). "La Nouvelle-Zlande Paris. Un dbat fructueux sur la sant en France." Gestions
Hospitalieres(511): 625-630.

[BDSP. Notice produite par EHESP CF9R0x7p. Diffusion soumise autorisation]. Si la Nouvelle-Zlande
est rpute pour ses paysages immaculs, son mode de vie sain et son sens de l'innovation, elle joue
aussi un rle de tout premier plan dans le domaine de l'e-sant. Chai Chuah, directeur national du
Health Board du gouvernement no-zlandais, est venu Paris le 17 octobre 2011 pour prononcer un
discours sur l'avenir du secteur de la sant dans le contexte de l'adoption par la France du dossier
mdical personnalis (DMP), un domaine dans lequel la nouvelle-Zlande continue de s'investir
fortement.

Peterson, A. (2014). "Improving type 1 diabetes management with mobile tools: a systematic review." J
Diabetes Sci Technol 8(4): 859-864.

This study aims to provide a better understanding of the ability of mobile health tools to offer
glycemic control for patients with type 1 diabetes mellitus. Data gained from research articles
searched in PubMed, Ovid (Medline), and CINAHL from 2005 to 2013 focused on interventions
introduced to a type 1 diabetic population. Articles were screened to identify interventions that
examined mobile health tools effect on glycemic control using %A1C as a proxy. Fourteen articles were
included in this study. Descriptive data, %A1C difference, and statistical significance, if available, were
extracted for comparison. Five major categories were identified across the spectrum of interventions,
including "Internet," "Mobile," "Mobile and Internet," "Phone," and "Videoconference and phone."
Seven of the 14 articles reported statistically significant decreases in measured outcomes. Seven
studies examine a single cohort, and 7 examined a double cohort. Eleven of the 14 authors (79%)
reported success with their intervention. Twelve studies reported a decrease in %A1C values in their
intervention groups. Initial results for glycemic control through these tools appear promising, though
inconclusive. Additional measures of mobile health tool efficacy should be assessed more directly.
More rigorous study methods are also needed to improve the reliability of results.

Piette, J. D., et al. (2015). "The potential impact of intelligent systems for mobile health self-management
support: Monte Carlo simulations of text message support for medication adherence." Ann Behav
Med 49(1): 84-94.

BACKGROUND: Mobile health (mHealth) services cannot easily adapt to users' unique needs.
PURPOSE: We used simulations of text messaging (SMS) for improving medication adherence to
demonstrate benefits of interventions using reinforcement learning (RL). METHODS: We used Monte
Carlo simulations to estimate the relative impact of an intervention using RL to adapt SMS adherence
support messages in order to more effectively address each non-adherent patient's adherence
barriers, e.g., forgetfulness versus side effect concerns. SMS messages were assumed to improve
adherence only when they matched the barriers for that patient. Baseline adherence and the impact
of matching messages were estimated from literature review. RL-SMS was compared in common
scenarios to simple reminders, random messages, and standard tailoring. RESULTS: RL could produce a
5-14% absolute improvement in adherence compared to current approaches. When adherence
barriers are not accurately reported, RL can recognize which barriers are relevant for which patients.
When barriers change, RL can adjust message targeting. RL can detect when messages are sent too
frequently causing burnout. CONCLUSIONS: RL systems could make mHealth services more effective.

Piette, J. D., et al. (2015). "Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and
Disease Management." Circulation 132(21): 2012-2027.

We examined evidence on whether mobile health (mHealth) tools, including interactive voice
response calls, short message service, or text messaging, and smartphones, can improve lifestyle
behaviors and management related to cardiovascular diseases throughout the world. We conducted a
state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since
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2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk
factors, but included other reports when they represented the best available evidence. The search
emphasized reports on the potential benefits of mHealth interventions implemented in low- and
middle-income countries. Interactive voice response and short message service interventions can
improve cardiovascular preventive care in developed countries by addressing risk factors including
weight, smoking, and physical activity. Interactive voice response and short message service-based
interventions for cardiovascular disease management also have shown benefits with respect to
hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal
interventions including Web-based communication with clinicians and mHealth-enabled clinical
monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of
interventions using smartphones and social media is still developing. Studies of mHealth interventions
have been conducted in >30 low- and middle-income countries, and evidence to date suggests that
programs are feasible and may improve medication adherence and disease outcomes. Emerging
evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors
and disease management. Next-generation mHealth programs developed worldwide should be based
on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting
systems automatically to patients' unique and changing needs.

Purcell, R., et al. (2014). "Telemonitoring can assist in managing cardiovascular disease in primary care: a
systematic review of systematic reviews." BMC Fam Pract 15: 43.

BACKGROUND: There has been growing interest regarding the impact of telemonitoring and its ability
to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on
healthcare systems. A number of randomised trials have been undertaken internationally and
synthesised into various systematic reviews to establish an evidence base for this model of care. This
study sought to synthesise and critically evaluate this large body of evidence to inform clinicians,
researchers and policy makers. METHODS: A systematic review of systematic reviews investigating the
impact of telemonitoring interventions in the primary care management of CVD was conducted.
Reviews were included if they explored primary care based telemonitoring in either CVD, heart failure
or hypertension, were reported in the English language and were published between 2000 and 2013.
Data was extracted by one reviewer and checked by a second reviewer using a standardised form. Two
assessors then rated the quality of each review using the Overview Quality Assessment Questionnaire
(OQAQ). RESULTS: Of the 13 included reviews, four focused on telemonitoring interventions in
hypertension or CVD management and the remaining 9 reviews investigated telemonitoring in HF
management. Seven reviews scored a five or above on the OQAQ evidencing good quality reviews.
Findings suggest that telemonitoring can contribute to significant reductions in blood pressure,
decreased all-cause and HF related hospitalisations, reduced all-cause mortality and improved quality
of life. Telemonitoring was also demonstrated to reduce health care costs and appears acceptable to
patients. CONCLUSION: Telemonitoring has the potential to enhance primary care management of
CVD by improving patient outcomes and reducing health costs. However, further research needs to
explore the specific elements of telemonitoring interventions to determine the relative value of the
various elements. Additionally, the ways in which telemonitoring care improves health outcomes
needs to be further explored to understand the nature of these interventions.

Puskin, D. S., et al. (2010). "Implementation and evaluation of telehealth tools and technologies." Telemed J E
Health 16(1): 96-102.

In June 2009, the National Center for Research Resources (NCRR), National Institutes of Health (NIH),
convened a conference of experts to discuss future directions for research in addressing healthcare
disparities through the use of telehealth technologies. As part of this conference, a panel was
convened to review the status of current efforts to assess, implement, and evaluate telehealth
technologies, and to recommend future directions for research. The panel members provided a series
of practical recommendations to those who are contemplating establishing a telehealth service, as
well as recommendations to the NIH on future funding for telehealth research. The recommendations
to the NIH focused on three broad areas of concern: (1) technology assessment, (2) evaluation, and (3)
technical assistance, education, and dissemination. The panel members emphasized the need for NIH
to support research in areas that have been seriously underfunded in the past, including but not
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limited to primary care research, multisite collaborative telehealth studies, nonphysician telehealth
services, and methodological development to develop a "gold standard" for telehealth studies.

Quanbeck, A., et al. (2014). "Mobile Delivery of Treatment for Alcohol Use Disorders: A Review of the
Literature." Alcohol Res 36(1): 111-122.

Several systems for treating alcohol-use disorders (AUDs) exist that operate on mobile phones. These
systems are categorized into four groups: text-messaging monitoring and reminder systems, text-
messaging intervention systems, comprehensive recovery management systems, and game-based
systems. Text-messaging monitoring and reminder systems deliver reminders and prompt reporting of
alcohol consumption, enabling continuous monitoring of alcohol use. Text-messaging intervention
systems additionally deliver text messages designed to promote abstinence and recovery.
Comprehensive recovery management systems use the capabilities of smart-phones to provide a
variety of tools and services that can be tailored to individuals, including in-the-moment assessments
and access to peer discussion groups. Game-based systems engage the user using video games.
Although many commercial applications for treatment of AUDs exist, few (if any) have empirical
evidence of effectiveness. The available evidence suggests that although texting-based applications
may have beneficial effects, they are probably insufficient as interventions for AUDs. Comprehensive
recovery management systems have the strongest theoretical base and have yielded the strongest
and longest-lasting effects, but challenges remain, including cost, understanding which features
account for effects, and keeping up with technological advances.

Radhakrishnan, K., et al. (2016). "Barriers and Facilitators for Sustainability of Tele-Homecare Programs: A
Systematic Review." Health Serv Res 51(1): 48-75.

OBJECTIVE: To identify the barriers and facilitators for sustainability of tele-homecare programs
implemented by home health nursing agencies for chronic disease management. DATA SOURCES:
English-language articles on home telehealth in the CINAHL, PubMed/MEDLINE, PsychInfo, Web of
Science, and Cochrane Reviews databases published from January 1996 to December 2013. STUDY
DESIGN: We performed a systematic literature review. Data extraction using PRISMA guidelines and
quality appraisal using the Mixed Methods Appraisal Tool (MMAT) were conducted on relevant
empirical studies. Thematic analysis across the studies and narrative summaries were used to
synthesize the findings from the included studies. PRINCIPAL FINDINGS: Of the initial 3,920 citations,
we identified 16 articles of moderate quality meeting our inclusion criteria. Perceptions on
effectiveness of tele-homecare programs for achieving intended outcomes; tailoring of tele-homecare
programs to patient characteristics and needs; relationship and communication between patient,
nurse, and other health care professional users of tele-homecare; home health organizational process
and culture; and technology quality, capability, and usability impacted the sustainability of tele-
homecare programs. CONCLUSIONS: The findings of this systematic review provide implications for
sustained usage of tele-homecare programs by home health nursing agencies and can help such
programs realize their potential for chronic disease management.

Raison, N., et al. (2015). "Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the
Potential?" Curr Urol Rep 16(7): 43.

Since the first telegraphic transmission of an electrocardiogram in 1906, technological developments

have allowed telemedicine to flourish. It has become a multi-billion pound industry encompassing
many areas of medical practice and education. Telemedicine is now widely used in surgery from
performing operations to teaching and can be divided into three main components; telesurgery,
telementoring and teleconsultation. Developments across these fields have led to remarkable
achievements such as intercontinental telesurgery and telementoring. However, barriers to the
further implementation of telemedicine remain. In this review, the developments and recent advances
of telemedicine across the three domains are discussed together with the challenges and limitations
that need to be overcome.

Rasekaba, T. M., et al. (2015). "Telemedicine interventions for gestational diabetes mellitus: A systematic
review and meta-analysis." Diabetes Res Clin Pract 110(1): 1-9.
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OBJECTIVE: To evaluate the effect of telemedicine on GDM service and maternal, and foetal
outcomes. METHODS: A systematic review and meta-analysis of randomised controlled trials (RCT) of
telemedicine interventions for GDM was conducted. We searched English publications from
01/01/1990 to 31/08/2013, with further new publication tracking to June 2015 on MEDLINE, EMBASE,
PUBMED, CINAHL, the Cochrane Central Register of Controlled Trials and the World Health
Organization International Clinical Trials Registry electronic databases. Findings are presented as
standardised mean difference (SMD) and odds ratios (OR) or narrative and quantitative description of
findings where meta-analysis was not possible. RESULTS: Our search yielded 721 abstracts. Four met
the inclusion criteria; two publications arose from the same study, resulting in three studies for
review. All studies compared telemedicine to usual care. Telemedicine was associated with
significantly fewer unscheduled GDM clinic visits, SMD. Quality of life, glycaemic control (HbA1c, pre
and postprandial blood glucose level (BGL)), and caesarean section rate were similar between the
telemedicine and usual care groups. None of the studies evaluated costs. CONCLUSIONS: Telemedicine
has the potential to streamline GDM service utilisation without compromising maternal and foetal
outcomes. Its advantage may lie in the convenience of reducing face-to-face and unscheduled
consultations. Studies are limited and more trials that include cost evaluation are required.

Reeve, C., et al. (2015). "A comprehensive health service evaluation and monitoring framework." Eval Program
Plann 53: 91-98.

OBJECTIVE: To develop a framework for evaluating and monitoring a primary health care service,
integrating hospital and community services. METHOD: A targeted literature review of primary health
service evaluation frameworks was performed to inform the development of the framework
specifically for remote communities. Key principles underlying primary health care evaluation were
determined and sentinel indicators developed to operationalise the evaluation framework. This
framework was then validated with key stakeholders. RESULTS: The framework includes Donabedian's
three seminal domains of structure, process and outcomes to determine health service performance.
These in turn are dependent on sustainability, quality of patient care and the determinants of health
to provide a comprehensive health service evaluation framework. The principles underpinning primary
health service evaluation were pertinent to health services in remote contexts. Sentinel indicators
were developed to fit the demographic characteristics and health needs of the population.
Consultation with key stakeholders confirmed that the evaluation framework was applicable.
CONCLUSION: Data collected routinely by health services can be used to operationalise the proposed
health service evaluation framework. Use of an evaluation framework which links policy and health
service performance to health outcomes will assist health services to improve performance as part of
a continuous quality improvement cycle.

Renton, T., et al. (2014). "Web-based intervention programs for depression: a scoping review and evaluation." J
Med Internet Res 16(9): e209.

BACKGROUND: Although depression is known to affect millions of people worldwide, individuals

seeking aid from qualified health care professionals are faced with a number of barriers to treatment
including a lack of treatment resources, limited number of qualified service providers, stigma
associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such
as transportation and clinic locations. The delivery of depression interventions through the Internet
may provide a practical solution to addressing some of these barriers. OBJECTIVE: The purpose of this
scoping review was to answer the following questions: (1) What Web-delivered programs are
currently available that offer an interactive treatment component for depression?, (2) What are the
contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and
research evidence are available for each identified program? METHODS: Using the popular search
engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for
interactive Web-based interventions targeting the treatment of depression. The Beacon website, an
information portal for online health applications, was also consulted. For each identified program,
accessibility, usability, tools, support, and research evidence were evaluated and programs were
categorized as evidence-based versus non-evidence-based if they had been the subject of at least one
randomized controlled trial. Programs were scored using a 28-point rating system, and evidence-
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versus non-evidence-based programs were compared and contrasted. Although this review included
all programs meeting exclusion and inclusion criteria found using the described search method, only
English language Web-delivered depression programs were awarded an evaluation score. RESULTS:
The review identified 32 programs meeting inclusion criteria. There was a great deal of variability
among the programs captured in this evaluation. Many of the programs were developed for general
adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel,
older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the
programs described. Program interactive components included mood assessments and supplementary
homework sheets such as activity planning and goal setting. Only 12 of the programs had published
evidence in support of their efficacy and treatment of depressive symptoms. CONCLUSIONS: There are
a number of interactive depression interventions available through the Internet. Recommendations
for future programs, or the adaptation of existing programs include offering a greater selection of
alternative languages, removing registration restrictions, free trial periods for programs requiring user
fees, and amending programs to meet the needs of special populations (eg, those with cognitive
and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target
audience while also enhancing overall user control would contribute to a more accessible intervention
tool.

Reponen, J. (2004). "Radiology as a part of a comprehensive telemedicine and eHealth network in Northern
Finland." Int J Circumpolar Health 63(4): 429-435.

Oulu University Hospital is the northernmost tertiary hospital in Finland and its responsibility area is
the largest in the country, covering nearly half of the Finnish territory, also including the arctic regions.
Because of vast distances and a sparse population, Oulu has been a forerunner in developing
telemedicine and eHealth services in the country. The development started in 1990 and has resulted
in the establishment of teleradiology and televideoconferencing services, distance education and a
multimedia medical record with remote access capabilities. Wireless technology has been a special
focus area, as has the development of an efficient communication between primary care and
secondary care. This review highlights some of the key success elements.

Rigby, M. (1999). "The management and policy challenges of the globalisation effect of informatics and
telemedecine." Health Policy 46(2): 97-103, tabl.
[Link]
Le dveloppement rcent des nouvelles technologies (tlmdecine, informatique mdicale, internet)
a compltement boulevers l'organisation du systme de soins. L'objectif de cet article est d'tudier
ces changements radicaux, et la manire dont les dcideurs doivent y faire face, pour que cette
nouvelle socit d'information ne devienne pas un cauchemar pour des victimes innocentes. Ce papier
se base sur une communication donne lors de la confrence annuelle de l'European Healthcare
Management Association , Dublin, juin 1998.

Roberts, A., et al. (2012). "Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth
Programme." Scott Med J 57(1): 33-37.

Policy-makers consider telehealth to be a potential solution to delivery of care in rural Scotland.

Telehealth can support patients in the community and may reduce emergency admissions to hospital.
The Argyll & Bute telehealth initiative, which commenced in 2007, trialled home telehealth monitoring
of patients with chronic obstructive pulmonary disease (COPD), and community- and surgery-based
monitoring of general wellbeing and hypertension. An evaluation in 2010 assessed staff and patient
satisfaction by questionnaire, impact on hospital and general practice attendance by case record
review and detailed opinions on the programme by qualitative interviews with key staff. Home
monitoring for COPD was associated with high levels of patient satisfaction and a reduction in hospital
admissions and other health service contacts. Delays in implementation and some technical challenges
compromised evaluation of the surgery and community initiatives. Patients and staff were generally
enthusiastic but also identified potential barriers to development. This paper describes the
implementation and outcomes of the initiative and identifies issues that clinicians embarking on
telehealth programmes must consider: technical factors; governance and security; staff profiling and
training; clinical outcomes; and scalability.
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Ross, J., et al. (2015). "Exploring the challenges of implementing e-health: a protocol for an update of a
systematic review of reviews." Bmj Open 5(4): e006773.

INTRODUCTION: There is great potential for e-health to deliver cost-effective, quality healthcare and
spending on e-health systems by governments and healthcare systems is increasing worldwide.
However, the literature often describes problematic and unsuccessful attempts to implement these
new technologies into routine clinical practice. To understand and address the challenges of
implementing e-health, a systematic review was conducted in 2009, which identified several
conceptual barriers and facilitators to implementation. As technology is rapidly changing and new e-
health solutions are constantly evolving to meet the needs of current practice, an update of this
review is deemed necessary to understand current challenges to the implementation of e-health. This
research aims to identify, summarise and synthesise currently available evidence, by undertaking a
systematic review of reviews to explore the barriers and facilitators to implementing e-health across a
range of healthcare settings. METHODS AND ANALYSIS: This is a protocol for an update of a systematic
review of reviews. We will search MEDLINE, EMBASE, CINAHL, PSYCINFO and The Cochrane Library for
studies published between 2009 and 2014. We will check reference lists of included studies for further
studies. Two authors will independently screen the titles and abstracts identified from the search; any
discrepancies will be resolved by discussion and consensus. Full-text papers will be obtained and
relevant reviews will be selected against inclusion criteria. Eligible reviews have to be based on the
implementation of e-health technologies. Data from eligible reviews will be extracted using a data
abstraction form. A thematic analysis of barriers and facilitators to e-health implementation will be
conducted. ETHICS AND DISSEMINATION: Ethical approval is not required. The permission of the
original authors to update the review was sought and granted. TRIAL REGISTRATION NUMBER:
PROSPERO CRD42015017661.

Rosser, B. A., et al. (2009). "Technologically-assisted behaviour change: a systematic review of studies of novel
technologies for the management of chronic illness." J Telemed Telecare 15(7): 327-338.

A systematic review was conducted to investigate the use of technology in achieving behaviour change
in chronic illness. The areas reviewed were: (1) methods employed to adapt traditional therapy from a
face-to-face medium to a computer-assisted platform; (2) targets of behaviour change; and (3) level of
human (e.g. therapist) involvement. The initial literature search produced 2032 articles. A total of 45
articles reporting 33 separate interventions met the inclusion/exclusion criteria and were reviewed in
detail. The majority of interventions reported a theoretical basis, with many arising from a cognitive-
behavioural framework. There was a wide range of therapy content. Therapist involvement was
reported in 73% of the interventions. A common problem was high participant attrition, which may
have been related to reduced levels of human interaction. Instigating successful behaviour change
through technological interventions poses many difficulties. However, there are potential benefits of
delivering therapy in this way. For people with long-term health conditions, technological self-
management systems could provide a practical method of understanding and monitoring their
condition, as well as therapeutic guidance to alter maladaptive behaviour.

Rubin, M. N., et al. (2013). "A systematic review of telestroke." Postgrad Med 125(1): 45-50.

BACKGROUND: The use of 2-way audiovisual (AV) technology for delivery of acute stroke evaluation
and management, termed "telestroke," is supported by a rapidly growing literature base. A systematic
review that provides a comprehensive, easily digestible overview of telestroke science and practice is
lacking. PURPOSE: To conduct a systematic review of the published literature on telemedical
consultation for the purposes of providing acute stroke evaluation and management. DATA SOURCES:
The Ovid Medline, Embase, PsychINFO, CINAHL, PubMed, and Cochrane databases were searched with
numerous keywords relevant to telestroke from January 1996 through July 2012. STUDY SELECTION:
Studies were included if the title or abstract expressed use of 2-way AV communication for acute
stroke evaluation and management. DATA EXTRACTION: Each article was classified using a novel
scoring rubric to assess the level of Functionality, Application, Technology, and Evaluative stage
(FATE). DATA ANALYSIS: The search yielded 1405 potentially eligible articles, which were
independently reviewed by 2 investigators. There were 344 unique studies that met eligibility criteria
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and underwent full-text review. Ultimately, 145 unique studies underwent FATE assessment and
scoring. RESULTS: Most telestroke studies evaluated functionality in the context of acute stroke
assessment of adults in emergency departments. Nearly half of all published articles on telestroke
were narrative reviews. After exclusion of these reviews, the median FATE score for telestroke primary
data was 4. CONCLUSION: Telestroke technology is now part of mainstream clinical stroke practice in
North America and internationally. Telestroke reliability, validity, efficacy, safety, clinical, and cost-
effectiveness studies reflect maturity in the field, and new post-implementation studies in the pre-
hospital setting present welcome and sophisticated advancements in the field.

Ruhdel, I. (2007). "[Revision of the EU Directive 86/609/EEC: results of the Internet consultations of the
European Commission]." Altex 24(1): 41-45.

In the context of the process of revising EU Directive 86/609/EEC on the protection of animals used in
experiments, the European Commission conducted a public internet consultation for EU citizens in
mid-2006. Simultaneously, the Commission requested opinions from experts on specific animal
welfare issues. The results of both consultations were published in the internet in December 2006. An
overwhelming majority of EU citizens answered that the protection of laboratory animals currently is
poor and that efforts are needed to improve the level of welfare for these animals. Additionally, they
request increased transparency and public participation in the determination when and how the use
of animals in experiments is to be considered acceptable. They also asked for an increased promotion
of the research for replacing animal experiments. Amongst other issues, the experts called for an
extension of the scope of the Directive to also cover animals used in basic research and the
establishment of a compulsory authorization procedure which should include a concrete ethical
review process. The estimations put forward on the consequences of introducing a retrospective
analysis of projects with animal experiments were controversial just as the opinions submitted
regarding different options regarding a ban to using wild caught primates and their direct offspring. All
in all, both the responses of the citizens and experts consultations are a promising basis to justify the
need to improve the protection of animals used in experiments within the EU.

Russell, K. W., et al. (2015). "Transition from grant funding to a self-supporting burn telemedicine program in
the western United States." Am J Surg 210(6): 1037-1042; discussion 1042-1034.

BACKGROUND: Many Americans have limited access to specialty burn care, and telemedicine has been
proposed as a means to address this disparity. However, many telemedicine programs have been
founded on grant support and then fail once the grant support expires. Our objective was to
demonstrate that a burn telemedicine program can be financially viable. METHODS: This retrospective
review from 2005 to 2014 evaluated burn telemedicine visits and financial reimbursement during and
after a Technology Opportunities Program grant to a regional burn center. RESULTS: In 2005, we had
12 telemedicine visits, which increased to 458 in 2014. In terms of how this compares to in-person
clinic visits, we saw a consistent increase in telemedicine visits as a percentage of total clinic visits
from .26% in 2005 to 14% in 2014. Median telemedicine reimbursement has been equivalent to in-
person visits. CONCLUSIONS: Specialty telemedicine programs can successfully transition from grant-
funded enterprises to self-sustaining. The availability of telemedicine services allows access to
specialty expertise in a large and sparsely populated region without imposing an undue financial
burden.

Sabesan, S., et al. (2014). "Timely access to specialist medical oncology services closer to home for rural
patients: experience from the Townsville Teleoncology Model." Aust J Rural Health 22(4): 156-159.

PROBLEM: Prior to 2009, the teleoncology model of the Townsville Cancer Centre (TCC) did not
achieve its aims of equal waiting times for rural and urban patients and the provision of reliable, local
acute cancer care. From 2007-2009, 60 new patients from Mt Isa travelled to TCC for their first
consultation and their first dose of chemotherapy. Six of these patients required inter-hospital
transfers and eight required urgent flights to attend outpatient clinics. Only 50% these rural patients
(n = 30) were reviewed within one week of their referral, compared with 90% of Townsville patients.
DESIGN: A descriptive study. SETTING: TCC provides teleoncology services to 21 rural towns; the
largest is Mt Isa, Qld. KEY MEASURES FOR IMPROVEMENT: Specialist review of 90% of urgent cases
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within 24 hours, and 90% of non-urgent cases within one week of referral via videoconferencing. A
50% reduction in inpatient inter-hospital transfers from Mt Isa to Townsville. STRATEGIES FOR
CHANGE: Employment of a half-time medical officer and a half-time cancer care coordinator, and
implementation of new policies. EFFECTS OF CHANGE: Between 2009 and 2011, TCC provided cancer
care to 70 new patients from Mt Isa. Of these new patients, 93% (65/70) were seen within one week
of referral. All 17 patients requiring urgent reviews were seen within 24 hours of referral and managed
locally thus eliminating the need for inpatient inter-hospital transfers. LESSONS LEARNT: Provision of
timely acute cancer care closer to home requires an increase in the rural case complexity and human
resources.

Saliba, V., et al. (2012). "Telemedicine across borders: a systematic review of factors that hinder or support
implementation." Int J Med Inform 81(12): 793-809.

PURPOSE: Innovative technologies to deliver health care across borders have attracted both
evangelists and sceptics. Our aim was to systematically identify factors that hinder or support
implementation of cross-border telemedicine services worldwide in the last two decades. METHODS:
Two reviewers independently searched ten databases including MEDLINE and EMBASE, in June 2011
including citations from 1990 onwards when at least an abstract was available in English. We also
searched ELDIS and INTUTE databases and Internet search engines to identify grey literature. We
included studies which (a) described the use of telemedicine to deliver cross-border healthcare and, or
(b) described the factors that hinder or support implementation of cross-border telemedicine services.
All study designs were included. Two reviewers independently assessed titles and abstracts of articles
identified. Papers were allocated to one of four reviewers who extracted relevant data and validated
it. We took a qualitative approach to the analysis, conducting a narrative synthesis of the evidence.
RESULTS: 6026 records were identified of which 5806 were excluded following screening of titles and
abstracts. We assessed 227 full text articles, excluding 133 because they were fatally flawed or did not
meet the inclusion criteria, producing a final sample of 94. They involved 76 countries worldwide,
most involving collaborations between high and low or middle income countries. Most described
services delivering a combination of types of telemedicine but specialties most represented were
telepathology, telesurgery, Emergency and trauma telemedicine and teleradiology. Most link health
professionals, with only a few linking professionals directly to patients. A main driver for the
development of cross-border telemedicine is the need to improve access to specialist services in low
and middle income countries and in underserved rural areas in high income countries. Factors that
hinder or support implementation clustered into four main themes: (1) legal factors; (2) sustainability
factors; (3) cultural factors; and (4) contextual factors. CONCLUSIONS: National telemedicine
programmes may build infrastructure and change mindsets, laying the foundations for successful
engagement in cross-border services. Regional networks can also help with sharing of expertise and
innovative ways of overcoming barriers to the implementation of services. Strong team leadership,
training, flexible and locally responsive services delivered at low cost, using simple technologies, and
within a clear legal and regulatory framework, are all important factors for the successful
implementation of cross-border telemedicine services.

Salisbury, C., et al. (2015). "TElehealth in CHronic disease: mixed-methods study to develop the TECH
conceptual model for intervention design and evaluation." Bmj Open 5(2): e006448.

OBJECTIVE: To develop a conceptual model for effective use of telehealth in the management of
chronic health conditions, and to use this to develop and evaluate an intervention for people with two
exemplar conditions: raised cardiovascular disease risk and depression. DESIGN: The model was based
on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative
evidence on telehealth for chronic conditions; a qualitative study of patients' and health professionals'
experience of telehealth; a quantitative survey of patients' interest in using telehealth; and review of
existing models of chronic condition management and evidence-based treatment guidelines. Based on
these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a
telehealth intervention ('Healthlines') was designed by incorporating strategies to address each of the
model components. The model also provided a framework for evaluation of this intervention within
parallel randomised controlled trials in the two exemplar conditions, and the accompanying process
evaluations and economic evaluations. SETTING: Primary care. RESULTS: The TElehealth in CHronic
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Disease (TECH) model proposes that attention to four components will offer interventions the best
chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease
management (including subcomponents of self-management, optimisation of treatment, care
coordination), (3) partnership between providers and (4) patient, social and health system context.
Key intended outcomes are improved health, access to care, patient experience and cost-effective
care. CONCLUSIONS: A conceptual model has been developed based on multiple sources of evidence
which articulates how telehealth may best provide benefits for patients with chronic health
conditions. It can be used to structure the design and evaluation of telehealth programmes which aim
to be acceptable to patients and providers, and cost-effective.

Salmoiraghi, A. et Hussain, S. (2015). "A Systematic Review of the Use of Telepsychiatry in Acute Settings." J
Psychiatr Pract 21(5): 389-393.

Telepsychiatry is increasingly being used in many parts of the world. We performed a systematic
review of the literature on the use of telepsychiatry in acute treatment settings using MEDLINE,
EMBASE, and PsycINFO from inception to June 2013 using the following key words: acute
telepsychiatry, teleconsultation, teleconferencing, telemedicine, emergency telepsychiatry, and e-
mental health. Only articles in English were included. All study abstracts were reviewed by both
authors independently to assess whether the topic of the paper was relevant to the review.
References were selected independently until no new papers were found. If there was a
disagreement, a discussion between the authors took place. A leading expert in this field was
contacted to check for gray literature. The review included 23 papers. No meta-analyses or systematic
reviews were found. The main results are (1) that patients have a positive attitude toward the
technology and show a high level of satisfaction with telepsychiatry, (2) that the use of telepsychiatry
is correlated with decreased admissions to psychiatric inpatient units, (3) that the quality of clinical
interaction in telepsychiatry is similar to that in face-to-face care, and (4) that telepsychiatry seems to
be cost effective. The use of telepsychiatry seems to be a viable and relatively inexpensive option for
use in places where access to emergency services is difficult.

Sankaranarayanan, J. et Sallach, R. E. (2014). "Rural patients' access to mobile phones and willingness to
receive mobile phone-based pharmacy and other health technology services: a pilot study." Telemed J
E Health 20(2): 182-185.

OBJECTIVE: This pilot study explores the patient-centered demand for mobile phone-based health
(mobile health [m-health]) services in the rural United States by documenting rural patients' access to
mobile phones and patients' willingness to receive m-health services. SUBJECTS AND METHODS: An
anonymous institutional review board-approved survey was completed by patients visiting two rural
pharmacies in Nebraska from August to October 2011. Patients who volunteered to complete the
survey provided their demographic data, disease state information, health status, mobile phone
access, and willingness to receive (in terms of using and giving time to) m-health services. RESULTS:
The majority of the 24 survey respondents were 19-40 years old (52%), female (88%), married (63%),
with excellent to very good health status (63%), with no comorbidities (83%), with </=$100 monthly
medication expenses (80%), with private insurance (78%), living within 5 miles of their pharmacy
(71%), and reporting that m-health services are important to them (75%; 12/16). Approximately 95%,
81%, 73%, and 55% of respondents reported access to a mobile phone, voice mails, text messaging,
and mobile phone applications, respectively. Of the respondents, 65%, 57%, 52%, and 48% were
willing to receive prerecorded messages for appointment reminders from the doctor, disease
information, medication use/self-care information, and symptom monitoring information,
respectively. In total, 70%, 63%, 61%, 54%, and 50% were willing to receive prerecorded messages
from the pharmacist containing contact requests, new/refill prescription reminders, information on
medication problems, reviewing/monitoring of medication use, and medication self-
management/preventive screenings/immunizations, respectively. Of 44% (7/16) respondents willing
to give time for m-health services, 83% were willing to give 15 min, and 17% were willing to give 30
min every month. CONCLUSIONS: By demonstrating rural patients' demand for m-health (including
pharmacy) services, this is one of the first pilot studies showing rural patients have access to mobile
phones and may be willing to use and give time to m-health services. Further research is needed on
delivery and coordination of transitions in patient-centered care in the United States with m-health
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services.

Santoso, F. et Redmond, S. J. (2015). "Indoor location-aware medical systems for smart homecare and
telehealth monitoring: state-of-the-art." Physiol Meas 36(10): R53-87.

This paper presents a comprehensive literature review of current progress in the application of state-
of-the-art indoor positioning systems for telecare and telehealth monitoring. This review is the first in
the literature that provides a comprehensive discussion on how existing wireless indoor positioning
systems can benefit the development of home-based care systems. More specifically, this review
provides an in-depth comparative study of how both system users and medical practitioners can get
benefit from indoor positioning technologies; e.g. for real-time monitoring of patients suffering
chronic cardiovascular conditions, general monitoring of activities of daily living (ADLs), fall detection
systems for the elderly as well as indoor navigation systems for those suffering from visual
impairments. Furthermore, it also details various aspects worth considering when choosing a certain
technology for a specific healthcare application; e.g. the spatial precision demanded by the
application, trade-offs between unobtrusiveness and complexity, and issues surrounding compliance
and adherence with the use of wearable tags. Beyond the current state-of-the-art, this review also
rigorously discusses several research opportunities and the challenges associated with each.

Schmidt, S. et Grimm, A. (2009). "[Health service research of telemedicine applications]."

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 52(3): 270-278.

The current descriptive review summarizes health service research in the area of telemedicine and
health telematics with respect to the increasing, but slow implementation of health telematics in
medical care. Findings of the review are summarized under three areas: the prevalence and use of
three selected applications (computerized physician prescriptions, electronic health records, and
electronic decision support). Findings of the review show that there is only very limited research on
the impact of telemedicine on routine care in the selected study areas. In general, only a small
percentage of physicians actively use the more comprehensive functions of electronic health records
or electronic prescribing and there is almost no evidence showing a relationship between outcomes of
health care and the implementation of electronic health records on a broad level despite some
evidence concerning the impact of clinical decision support.

Schneider, P. J. (2013). "Evaluating the impact of telepharmacy." Am J Health Syst Pharm 70(23): 2130-2135.

PURPOSE: The impact of remote pharmacist review of medication orders in three small community
hospitals in California was evaluated. METHODS: A longitudinal study was conducted in three
community hospitals without 24-hour pharmacy services before and after the implementation of
telepharmacy services. Override reports from automated dispensing cabinets were reviewed. Charts
were reviewed for errors and potential adverse drug events. Pharmacist interventions during times
when the pharmacy was closed were evaluated. Cost estimates were based on a proprietary
intervention tracking program. Surveys were administered to staff nurses and pharmacists to assess
concerns about medication-use safety and job satisfaction. RESULTS: The number of times that nurses
obtained and administered medications without pharmacist review declined by 35.3% after
implementation of the telepharmacy service. There was a significant reduction in the percentage of
high-risk medications obtained without a pharmacist review. Three potential adverse drug events
were discovered before implementing remote order review versus none in the postimplementation
period. The number of pharmacist interventions increased from 15 to 98 per week after implementing
remote order review by pharmacists. Estimated cost savings resulting from preventing, identifying,
and resolving medication-related problems were $261,109 per hospital in total cost saved or avoided.
Nurses' survey scores reflected increased comfort with the medication-use system, patient safety, and
job satisfaction. CONCLUSION: Remote review of medication orders by pharmacists when the hospital
pharmacy was closed decreased the number of potential adverse drug events reported and improved
job satisfaction among nurses.

Seko, Y., et al. (2014). "Youth mental health interventions via mobile phones: a scoping review." Cyberpsychol
Behav Soc Netw 17(9): 591-602.
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Mobile phone technologies have been hailed as a promising means for delivering mental health
interventions to youth and adolescents, the age group with high cell phone penetration and with the
onset of 75% of all lifetime mental disorders. Despite the growing evidence in physical health and
adult mental health, however, little information is available about how mobile phones are
implemented to deliver mental health services to the younger population. The purpose of this scoping
study was to map the current state of knowledge regarding mobile mental health (mMental Health)
for young people (age 13-24 years), identify gaps, and consider implications for future research.
Seventeen articles that met the inclusion criteria provided evidence for mobile phones as a way to
engage youth in therapeutic activities. The flexibility, interactivity, and spontaneous nature of mobile
communications were also considered advantageous in encouraging persistent and continual access to
care outside clinical settings. Four gaps in current knowledge were identified: the scarcity of studies
conducted in low and middle income countries, the absence of information about the real-life
feasibility of mobile tools, the need to address the issue of technical and health literacy of both young
users and health professionals, and the need for critical discussion regarding diverse ethical issues
associated with mobile phone use. We suggest that mMental Health researchers and clinicians should
carefully consider the ethical issues related to patient-practitioner relationship, best practices, and the
logic of self-surveillance.

Sezeur, A., et al. (2001). "Teleconsultation before chemotherapy for recently operated on patients." American
Journal of Surgery (the) 182: 49-51.

Shalowitz, D. I., et al. (2015). "Teleoncology for gynecologic cancers." Gynecol Oncol 139(1): 172-177.

Teleoncology describes cancer care provided remotely to improve access to care in rural or
underserved areas. In the United States, 14.8 million women live more than 50 miles away from the
closest gynecologic oncologist; 4.3 million women live more than 100 miles distant. Teleoncology may
therefore partially relieve the geographic barriers to high-quality gynecologic cancer care these
women experience. Little has been published on the feasibility of remote provision of high-quality care
for gynecologic cancers, perhaps owing to the particular difficulties inherent in remote management
of patients who may require both medical and surgical intervention. In this article, we review the data
supporting the use of telemedicine in the treatment of cancer patients with a specific focus on
applicability to management of gynecologic malignancies. We further add our group's experience with
the treatment of rural, underserved gynecologic cancer patients. We believe that development of
teleoncologic systems is critical to ensure that all women have access to high-quality gynecologic
cancer care, regardless of where they reside.

Shi, L., et al. (2015). "Telemedicine for detecting diabetic retinopathy: a systematic review and meta-analysis."
Br J Ophthalmol 99(6): 823-831.

OBJECTIVE: To determine the diagnostic accuracy of telemedicine in various clinical levels of diabetic
retinopathy (DR) and diabetic macular oedema (DME). METHODS: PubMed, EMBASE and Cochrane
databases were searched for telemedicine and DR. The methodological quality of included studies was
evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2). Measures of
sensitivity, specificity and other variables were pooled using a random effects model. Summary
receiver operating characteristic curves were used to estimate overall test performance. Meta-
regression and subgroup analyses were used to identify sources of heterogeneity. Publication bias was
evaluated using Stata V.12.0. RESULTS: Twenty articles involving 1960 participants were included.
Pooled sensitivity of telemedicine exceeded 80% in detecting the absence of DR, low- or high-risk
proliferative diabetic retinopathy (PDR), it exceeded 70% in detecting mild or moderate non-
proliferative diabetic retinopathy (NPDR), DME and clinically significant macular oedema (CSME) and
was 53% (95% CI 45% to 62%) in detecting severe NPDR. Pooled specificity of telemedicine exceeded
90%, except in the detection of mild NPDR which reached 89% (95% CI 88% to 91%). Diagnostic
accuracy was higher with digital images obtained through mydriasis than through non-mydriasis, and
was highest when a wide angle (100-200 degrees ) was used compared with a narrower angle (45-60
degrees , 30 degrees or 35 degrees ) in detecting the absence of DR and the presence of mild NPDR.
No potential publication bias was detected. CONCLUSIONS: The diagnostic accuracy of telemedicine
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using digital imaging in DR is overall high. It can be used widely for DR screening. Telemedicine based
on the digital imaging technique that combines mydriasis with a wide angle field (100-200 degrees ) is
the best choice in detecting the absence of DR and the presence of mild NPDR.

Shivapathasundram, G., et al. (2012). "Using smart phone video to supplement communication of radiology
imaging in a neurosurgical unit: technical note." Neurol Res 34(3): 318-320.

BACKGROUND: The use of smart phones within medicine continues to grow at the same rate as
mobile phone technology continues to evolve. One use of smart phones within medicine is in the
transmission of radiological images to consultant neurosurgeons who are off-site in an emergency
setting. In our unit, this has allowed quick, efficient, and safe communication between consultant
neurosurgeon and trainees, aiding in rapid patient assessment and management in emergency
situations. OBJECTIVE: To describe a new means of smart phone technology use in the neurosurgical
setting, where the video application of smart phones allows transfer of a whole series of patient
neuroimaging via multimedia messaging service to off-site consultant neurosurgeons.
METHOD/TECHNIQUE: Using the video application of smart phones, a 30-second video of an entire
series of patient neuroimaging was transmitted to consultant neurosurgeons. With this information,
combined with a clinical history, accurate management decisions were made. RESULTS: This technique
has been used on a number of emergency situations in our unit to date. Thus far, the imaging received
by consultants has been a very useful adjunct to the clinical information provided by the on-site
trainee, and has helped expedite management of patients. CONCLUSION: While the aim should always
be for the specialist neurosurgeon to review the imaging in person, in emergency settings, this is not
always possible, and we feel that this technique of smart phone video is a very useful means for rapid
communication with neurosurgeons.

Siddika, A., et al. (2015). "Remote surveillance after colorectal cancer surgery: an effective alternative to
standard clinic-based follow-up." Colorectal Dis 17(10): 870-875.

AIM: Most colorectal cancer recurrences are asymptomatic and are detected through routine
postoperative clinic surveillance programmes with associated investigations. However, attendance at
these clinics has a financial cost and may be associated with an increase in patient anxiety and
dissatisfaction. The results of a remote follow-up system developed for selected patients are reported.
METHOD: A remote surveillance programme has been in place in our institution for over 9 years.
Patients having elective and emergency treatment for colorectal cancer were enrolled. The timeliness
of the investigation, detection of local recurrence and distant metastases and overall 5-year survival
rates were determined. A cost review and patient satisfaction survey were performed. RESULTS: The
programme was suitable for over 900 patients who had received surgery for colorectal cancer
between 2004 and 2012, representing some 50% of the total number of patients treated in this
period. Of these, 811 (90%) had investigations carried out on time. Five-year survival rates were
comparable with national data. Cost-minimization analysis demonstrated a financial saving of 63% and
a 75% reduction in clinic appointments. High levels of overall patient satisfaction (97%) were noted
with the programme. CONCLUSION: A remote surveillance system after colorectal cancer surgery is a
safe and cost-effective alternative to traditional clinic-based follow up and has high patient
satisfaction.

Silva, B. M., et al. (2015). "Mobile-health: A review of current state in 2015." J Biomed Inform 56: 265-272.

Health telematics is a growing up issue that is becoming a major improvement on patient lives,
especially in elderly, disabled, and chronically ill. In recent years, information and communication
technologies improvements, along with mobile Internet, offering anywhere and anytime connectivity,
play a key role on modern healthcare solutions. In this context, mobile health (m-Health) delivers
healthcare services, overcoming geographical, temporal, and even organizational barriers. M-Health
solutions address emerging problems on health services, including, the increasing number of chronic
diseases related to lifestyle, high costs of existing national health services, the need to empower
patients and families to self-care and handle their own healthcare, and the need to provide direct
access to health services, regardless of time and place. Then, this paper presents a comprehensive
review of the state of the art on m-Health services and applications. It surveys the most significant
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research work and presents a deep analysis of the top and novel m-Health services and applications
proposed by industry. A discussion considering the European Union and United States approaches
addressing the m-Health paradigm and directives already published is also considered. Open and
challenging issues on emerging m-Health solutions are proposed for further works.

Simpson, J., et al. (2000). "Evaluation of a routine telepsychiatry service." Journal of Telemedicine and Telecare
7(2): 90-98, 98 tabl., 92 fig.

Singh, R. et Goebel, L. J. (2016). "Rural Disparities in Cancer Care: A Review of Its Implications and Possible
Interventions." W V Med J 112(3): 76-82.

Cancer care has greatly improved in the last few decades, as evidenced by a 22% decline in the overall
cancer-related death rate in the United States since 1991. However, the question presents itself
whether rural residents, for whom the latest advancements are not as accessible, are also realizing
these benefits as much as their urban counterparts. The aim of this study is to provide a review of the
literature regarding the disparities in cancer care facing rural Appalachia and specifically West Virginia
(WV) as well as possible solutions towards bridging this gap. We find that WV has a higher cancer
incidence and mortality rate with fewer oncologists per resident, while rural areas in general have
lower clinical trial participation and different treatment regimens. Though programs have been put in
place such as mobile mammography clinics and local outreach, more work can be done in WV in the
realms of teleoncology, virtual tumor boards, patient support groups, and physician training programs.

Slusser, W., et al. (2016). "Multidisciplinary Pediatric Obesity Clinic via Telemedicine Within the Los Angeles
Metropolitan Area: Lessons Learned." Clin Pediatr (Phila) 55(3): 251-259.

Telemedicine has been shown to be effective for rural populations, but little is reported on pediatric
obesity care via telemedicine in urban settings. This study aims to assess feasibility and acceptability of
multidisciplinary pediatric obesity care via telemedicine within the same metropolitan area in terms of
information technology, coordination, patient care, and clinical outcomes. All project notes and
communications were reviewed to extract key lessons from implementation. Patient and Provider
Satisfaction Questionnaires were conducted to assess overall satisfaction; baseline and follow-up
information were collected from chart reviews to evaluate clinical outcomes. Based on the
questionnaires, 93% of responding patients (n = 28) and 88.3% of referring providers (n = 17) felt
satisfied with the appointment. Chart review indicated a trend for decreased or stabilized body mass
index and blood pressure (n = 32). Implementation of telemedicine for tertiary multidisciplinary
pediatric obesity care in urban settings is both feasible and acceptable to patients and health care
providers.

Smith, A. C., et al. (2012). "A review of Medicare expenditure in Australia for psychiatric consultations delivered
in person and via videoconference." J Telemed Telecare 18(3): 169-171.

We examined the activity (services recorded) and cost (benefits paid) of reimbursement associated
with telepsychiatry services in the Australian public health-care sector. We reviewed the activity and
costs administered through the government's Medicare Benefits Schedule (MBS) from July 2002 to
June 2011. During this nine-year-period, almost 14 million psychiatric consultations were funded
through Medicare at a cost of $1.6 billion. Of these, 8003 were telepsychiatry consultations which cost
$934,000, i.e. the video consultations subgroup represented 0.06% of all psychiatric consultations
provided and 0.06% of the total cost to the government for these services. Despite telepsychiatry
being a widely reported and successful example of telehealth internationally, the uptake of
telepsychiatry in Australia has been slow.

Solli, H., et al. (2012). "Principle-based analysis of the concept of telecare." J Adv Nurs 68(12): 2802-2815.

AIM: To report a concept analysis of telecare. BACKGROUND: Lately telecare has become a worldwide,
modern way of giving care over distance by means of technology. Other concepts, like telemedicine, e-
health, and telehealth, focus on the same topic though the boundaries between them seem to be
blurred. DATA SOURCES: Sources comprise 44 English language research articles retrieved from the
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database of Medline and Cinahl (1995-October 2011). DESIGN: Literature Review. METHOD: A
principle-based analysis was undertaken through content analysis of the definitions, attributes,
preconditions, and outcomes of the concept. RESULTS: The attributes are well described according to
the use of technology, caring activity, persons involved, and accessibility. Preconditions and outcomes
are well described concerning individual and health political needs and benefits. The concept did not
hold its boundaries through theoretical integration with the concept of telemedicine and telehealth.
The definition of telecare competes with concepts like home-based e-health, telehomecare,
telephonecare, telephone-based psychosocial services, telehealth, and telemedicine. Assessment of
the definitions resulted in a suggestion of a new definition: Telecare is the use of information,
communication, and monitoring technologies which allow healthcare providers to remotely evaluate
health status, give educational intervention, or deliver health and social care to patients in their
homes. CONCLUSION: The logical principle was assessed to be partly immature, whereas the
pragmatical and linguistical principles were found to be mature. A new definition is suggested and this
has moved the epistemological principle forward to maturity.

Spohr, S. A., et al. (2015). "Efficacy of SMS Text Message Interventions for Smoking Cessation: A Meta-
Analysis." J Subst Abuse Treat 56: 1-10.

BACKGROUND: Mobile technology provides new opportunities for health promotion communication.
The purpose of this study was to conduct a current and extensive meta-analytic review of SMS (short
message service) text message-based interventions for individual smoking cessation. METHODS:
Academic Search Complete, PsycINFO, PubMed, and Scopus were reviewed for articles meeting
selection criteria: 1) randomized controlled trials, 2) measured smoking cessation, and 3) intervention
primarily delivered through SMS text messaging. Three and 6month follow-up of 7-day point
prevalence or continuous abstinence was considered from studies meeting criteria. All analyses were
conducted with intention-to-treat. Both fixed and random effects models were used to calculate the
global outcome measure and confidence intervals. RESULTS: Thirteen studies were identified that met
inclusion criteria. The studies were found to be homogeneous [Q12=12.47, p=0.14]. Odds ratios based
on the random effects models suggested that interventions generally increased quit rates compared
to controls, 1.36 [95% CI=1.23, 1.51]. Intervention efficacy was higher in studies with a 3month follow-
up compared to 6month follow-up. Text plus programs (e.g., text messaging plus Web or in-person
intervention modalities) performed only slightly better than text only programs. Pooled results also
indicate message frequency schedule can affect quit rates, in which fixed schedules performed better
than decreasing or variable schedules. The use of quit status assessment messages was not related to
intervention efficacy. CONCLUSION: Smoking quit rates for the text messaging intervention group
were 36% higher compared to the control group quit rates. Results suggest that SMS text messaging
may be a promising way to improve smoking cessation outcomes. This is significant given the relatively
wide reach and low cost of text message interventions. Identifying the components that make
interventions efficacious will help to increase the effectiveness of such interventions.

Srivastava, S., et al. (2015). "The Technological Growth in eHealth Services." Comput Math Methods Med 2015:
894171.

The infusion of information communication technology (ICT) into health services is emerging as an
active area of research. It has several advantages but perhaps the most important one is providing
medical benefits to one and all irrespective of geographic boundaries in a cost effective manner,
providing global expertise and holistic services, in a time bound manner. This paper provides a
systematic review of technological growth in eHealth services. The present study reviews and analyzes
the role of four important technologies, namely, satellite, internet, mobile, and cloud for providing
health services.

Stoyanov, N. et Paul, V. (2012). "Clinical use of telemonitoring in chronic heart failure: keeping up with the
times or misuse of time?" Curr Heart Fail Rep 9(1): 75-80.

Close follow-up of patients with severe heart failure, especially after hospital discharge, has been
shown to impact the mortality and readmission rates in this patient population. Monitoring of the
patients' physiological status is important for predicting a potential heart failure decompensation.
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Earlier studies on structured telephone support and telemonitoring suggested a clear benefit on
mortality and heart failure admissions, though recent large randomized controlled trials have been
neutral. This review looks into the possible reasons for discrepancies in the outcomes. Remote
monitoring of implantable cardiac devices is becoming increasingly utilized in a proportion of patients
for device follow-up, and recent technology advances have suggested utility of certain device
algorithms in detecting heart failure decompensations. Implantable hemodynamic monitors also show
promise in this sphere, though have limited evidence at this stage, and further development in the
technology is likely before they become part of routine practice.

Struijk, D. G. (2012). "e-Health: remote health care models in peritoneal dialysis." Contrib Nephrol 178: 74-78.

A general review is given on advantages and disadvantages of the various forms of e-Health. The
sparse available literature on e-Health and peritoneal dialysis is discussed. It is concluded that in
general e-Health interventions lead to small but to moderate positive effects on primary health
outcomes, although the evidence still is not fully convincing.

Syburra, T. et Genoni, M. (2008). "[Use of telemedicine in Switzerland]." Rev Med Suisse 4(182): 2652-2654,
2656.

In the 21st century, telemedicine has become daily business. Nevertheless, they are still a lack of
precise definitions of telemedicine. Legal and financial implications of telemedical applications are
complex, with lots of local restrictions, far beyond global technological aspects. In the United States,
telemedicine is a reality since decades, and is basically defined as the provision of health care when
distance separates the participants. Technology and networks for telemedicine are universally
globalized, but the legal and financial implications are diametrically more local based. Any CT-scan
made at midnight in Switzerland can be accurately assessed within minutes by any Australian
radiologist, for whom it will be the morning, and so far around the globe at any time of the day or the
night. But how will the billing work intercontinentally? And what about legal implications of this
telemedical service? In this paper, we review the actual definitions of telemedicine, check our local
legal responsibilities, and present the Tarmed financial positions for billing.

Tang, W. K., et al. (2001). "Telepsychiatry in psychogeriatric service : a pilot study." International Journal of
Geriatric Psychiatry 16(1): 88-93, 81 tabl.

Taylor, P., et al. (2001). "Evaluating a telemedicine system to assist in the management of dermatology
referrals." British Journal of Dermatology(144): 328-333, 328 tabl.

Tomlinson, J., et al. (2013). "How does tele-learning compare with other forms of education delivery? A
systematic review of tele-learning educational outcomes for health professionals." N S W Public Health
Bull 24(2): 70-75.

Telecommuniciation technologies, including audio and videoconferencing facilities, afford

geographically dispersed health professionals the opportunity to connect and collaborate with others.
Recognised for enabling tele-consultations and tele-collaborations between teams of health care
professionals and their patients, these technologies are also well suited to the delivery of distance
learning programs, known as tele-learning. AIM: To determine whether tele-learning delivery methods
achieve equivalent learning outcomes when compared with traditional face-to-face education delivery
methods. METHODS: A systematic literature review was commissioned by the NSW Ministry of Health
to identify results relevant to programs applying tele-learning delivery methods in the provision of
education to health professionals. RESULTS: The review found few studies that rigorously compared
tele-learning with traditional formats. There was some evidence, however, to support the premise
that tele-learning models achieve comparable learning outcomes and that participants are generally
satisfied with and accepting of this delivery method. CONCLUSION: The review illustrated that tele-
learning technologies not only enable distance learning opportunities, but achieve comparable
learning outcomes to traditional face-to-face models. More rigorous evidence is required to
strengthen these findings and should be the focus of future tele-learning research.

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Touati, F. et Tabish, R. (2013). "u-Healthcare system: state-of-the-art review and challenges." J Med Syst 37(3):
9949.

With the increase of an ageing population and chronic diseases, society becomes more health
conscious and patients become "health consumers" looking for better health management. People's
perception is shifting towards patient-centered, rather than the classical, hospital-centered health
services which has been propelling the evolution of telemedicine research from the classic e-Health to
m-Health and now is to ubiquitous healthcare (u-Health). It is expected that mobile & ubiquitous
Telemedicine, integrated with Wireless Body Area Network (WBAN), have a great potential in
fostering the provision of next-generation u-Health. Despite the recent efforts and achievements,
current u-Health proposed solutions still suffer from shortcomings hampering their adoption today.
This paper presents a comprehensive review of up-to-date requirements in hardware, communication,
and computing for next-generation u-Health systems. It compares new technological and technical
trends and discusses how they address expected u-Health requirements. A thorough survey on various
worldwide recent system implementations is presented in an attempt to identify shortcomings in
state-of-the art solutions. In particular, challenges in WBAN and ubiquitous computing were
emphasized. The purpose of this survey is not only to help beginners with a holistic approach toward
understanding u-Health systems but also present to researchers new technological trends and design
challenges they have to cope with, while designing such systems.

Triantafyllidis, A., et al. (2015). "A personalised mobile-based home monitoring system for heart failure: The
SUPPORT-HF Study." Int J Med Inform 84(10): 743-753.

BACKGROUND: Despite their potential for improving health outcomes, mobile-based home monitoring
systems for heart failure have not yet been taken up widely by the patients and providers.
OBJECTIVES: To design and iteratively move towards a personalised mobile health monitoring system
for patients living with heart failure, according to their health care and usability needs. METHODS: We
present an iterative approach to refining a remote health monitoring system that is based on
interactions between different actors (patients, clinicians, social scientists and engineers) and supports
the collection of quantitative and qualitative information about user experience and engagement.
Patients were provided with tablet computers and commercially available sensing devices (a blood
pressure monitor, a set of weighing scales, and a pulse oximeter) in order to complete physiological
measurements at home, answer symptom-specific questionnaires, review their personal readings,
view educational material on heart failure self-management, and communicate with their health
professionals. The system supported unobtrusive remote software upgrades via an application
distribution channel and the activation or deactivation of functional components by health
professionals during run-time operation. We report early findings from the application of this
approach in a cohort of 26 heart failure patients (mean age 72+/-15 years), their caregivers and
healthcare professionals who participated in the SUPPORT-HF (Seamless User-centred Proactive
Provision Of Risk-stratified Treatment for Heart Failure) study over a one-year study period (mean
patient follow-up duration=270+/-62 days). RESULTS: The approach employed in this study led to
several system upgrades dealing in particular with patient requirements for better communication
with the development team and personalised self-monitoring interfaces. Engagement with the system
was constantly high throughout the study and during the last week of the evaluation, 23 patients
(88%) used the system at least once and 16 patients (62%) at least three times. CONCLUSIONS:
Designers of future mobile-based home monitoring systems for heart failure and other chronic
conditions could leverage the described approach as a means of meeting patients' needs during
system use within the home environment and facilitating successful uptake.

Trnka, P., et al. (2015). "A retrospective review of telehealth services for children referred to a paediatric
nephrologist." BMC Nephrol 16: 125.

BACKGROUND: Telemedicine has emerged as an alternative mode of health care delivery over the last
decade. To date, there is very limited published information in the field of telehealth and paediatric
nephrology. The aim of this study was to review our experience with paediatric telenephrology in
Queensland, Australia. METHODS: A retrospective audit of paediatric nephrology telehealth
consultations to determine the nature of the telehealth activity, reasons for referral to telehealth, and
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to compare costs and potential savings of the telehealth service. RESULTS: During a ten-year period
(2004 - 2013), 318 paediatric telenephrology consultations occurred for 168 patients (95 male) with
the median age of 8 years (range 3 weeks to 24 years). Congenital anomalies of the kidney and urinary
tract (30 %), followed by nephrotic syndrome (16 %), kidney transplant (12 %), and urinary tract
infection (9 %) were the most common diagnoses. The estimated cost savings associated with
telehealth were $31,837 in 2013 (average saving of $505 per consultation). CONCLUSIONS: Our study
suggests that paediatric telenephrology is a viable and economic method for patient assessment and
follow up. The benefits include improved access to paediatric nephrology services for patients and
their families, educational opportunity for the regional medical teams, and a substantial cost saving
for the health care system.

Tsan, G. L., et al. (2015). "Assessment of diabetic teleretinal imaging program at the Portland Department of
Veterans Affairs Medical Center." J Rehabil Res Dev 52(2): 193-200.

We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging
performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs
(VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging
program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal
imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that
time, all teleretinal imaging patients should have been referred for a dilated retinal examination the
following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye
examinations, but the imagers scheduled appointments for only 80% of these patients. The
redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the
duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the
eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging
programs, particularly when teleretinal imaging and eye clinics were colocated at the same
community-based outpatient clinic, were higher than those without a teleretinal imaging program. We
concluded that the Portland VA Medical Center's teleretinal imaging program was successful in
increasing the screening rate for diabetic retinopathy.

Tseng, K. C., et al. (2008). "Travel distance and the use of inpatient care among patients with schizophrenia."
Administration and Policy in Mental Health 35(5): 346-356, tabl., fig.
[Link]
This study examines the variations in the use of inpatient care that can be explained by travel distance
among patients with schizophrenia living in Taiwan. Data were drawn from the Psychiatric Inpatient
Medical Claims Database. We used mediation analysis and multilevel analysis to identify associations.
Travel distance did not significantly account for lower readmission rates after an index admission, but
significantly explained the longer length of stay of an index admission by 9.3 days (P<0.001, 85% of
variation) between remote and non-remote regions. Policies are discussed aimed at reducing the
impact of travel distance on rural mental health care through inter-disciplinary collaboration and
telepsychiatry.

Vallury, K. D., et al. (2015). "Computerized Cognitive Behavior Therapy for Anxiety and Depression in Rural
Areas: A Systematic Review." J Med Internet Res 17(6): e139.

BACKGROUND: People living in rural and remote communities have greater difficulty accessing mental
health services and evidence-based therapies, such as cognitive behavior therapy (CBT), than their
urban counterparts. Computerized CBT (CCBT) can be used to effectively treat depression and anxiety
and may be particularly useful in rural settings where there are a lack of suitably trained practitioners.
OBJECTIVE: To systematically review the global evidence regarding the clinical effectiveness and
acceptability of CCBT interventions for anxiety and/or depression for people living in rural and remote
locations. METHODS: We searched seven online databases: Medline, Embase Classic and Embase,
PsycINFO, CINAHL, Web of Science, Scopus, and the Cochrane Library. We also hand searched
reference lists, Internet search engines, and trial protocols. Two stages of selection were undertaken.
In the first, the three authors screened citations. Studies were retained if they reported the efficacy,
effectiveness or acceptability of CCBT for depression and/or anxiety disorders, were peer reviewed,
and written in English. The qualitative data analysis software, NVivo 10, was then used to run
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automated text searches for the word "rural," its synonyms, and stemmed words. All studies identified
were read in full and were included in the study if they measured or meaningfully discussed the
efficacy or acceptability of CCBT among rural participants. RESULTS: A total of 2594 studies were
identified, of which 11 met the selection criteria and were included in the review. The studies that
disaggregated efficacy data by location of participant reported that CCBT was equally effective for
rural and urban participants. Rural location was found to both positively and negatively predict
adherence across studies. CCBT may be more acceptable among rural than urban participants-studies
to date showed that rural participants were less likely to want more face-to-face contact with a
practitioner and found that computerized delivery addressed confidentiality concerns. CONCLUSIONS:
CCBT can be effective for addressing depression and anxiety and is acceptable among rural
participants. Further work is required to confirm these results across a wider range of countries, and
to determine the most feasible model of CCBT delivery, in partnership with people who live and work
in rural and remote communities.

van de Ven, R. M., et al. (2015). "The effect of computer-based cognitive flexibility training on recovery of
executive function after stroke: rationale, design and methods of the TAPASS study." BMC Neurol 15:
144.

BACKGROUND: Stroke survivors frequently suffer from executive impairments even in the chronic
phase after stroke, and there is a need for improved rehabilitation of these functions. One way of
improving current rehabilitation treatment may be by online cognitive training. Based on a review of
the effectiveness of computer-based cognitive training in healthy elderly, we concluded that cognitive
flexibility may be a key element for an effective training, which results in improvements not merely on
trained tasks but also in untrained tasks (i.e., far transfer). The aim of the current study was to track
the behavioral and neural effects of computer-based cognitive flexibility training after stroke. We
expected that executive functioning would improve after the cognitive flexibility training, and that
neural activity and connectivity would normalize towards what is seen in healthy elderly.
METHODS/DESIGN: The design was a multicenter, double blind, randomized controlled trial (RCT) with
three groups: an experimental intervention group, an active control group who did a mock training,
and a waiting list control group. Stroke patients (3 months to 5 years post-stroke) with cognitive
complaints were included. Training consisted of 58 half-hour sessions spread over 12 weeks. The
primary study outcome was objective executive function. Secondary measures were improvement on
training tasks, cognitive flexibility, objective cognitive functioning in other domains than the executive
domain, subjective cognitive and everyday life functioning, and neural correlates assessed by both
structural and resting-state functional Magnetic Resonance Imaging. The three groups were compared
at baseline, after six and twelve weeks of training, and four weeks after the end of the training.
Furthermore, they were compared to healthy elderly who received the same training. DISCUSSION:
The cognitive flexibility training consisted of several factors deemed important for effects that go
beyond improvement on merely the training task themselves. Due to the presence of two control
groups, the effects of the training could be compared with spontaneous recovery and with the effects
of a mock training. This study provides insight into the potential of online cognitive flexibility training
after stroke. We also compared its results with the effectiveness of the same training in healthy
elderly. TRIAL REGISTRATION: The Netherlands National Trial Register NTR5174. Registered 22 May
2015.

van den Berg, N., et al. (2012). "Telemedicine and telecare for older patients--a systematic review." Maturitas
73(2): 94-114.

Telemedicine is increasingly becoming a reality in medical care for the elderly. We performed a
systematic literature review on telemedicine healthcare concepts for older patients. We included
controlled studies in an ambulant setting that analyzed telemedicine interventions involving patients
aged >/=60 years. 1585 articles matched the specified search criteria, thereof, 68 could be included in
the review. Applications address an array of mostly frequent diseases, e.g. cardiovascular disease
(N=37) or diabetes (N=18). The majority of patients is still living at home and is able to handle the
telemedicine devices by themselves. In 59 of 68 articles (87%), the intervention can be categorized as
monitoring. The largest proportion of telemedicine interventions consisted of measurements of vital
signs combined with personal interaction between healthcare provider and patient (N=24), and
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concepts with only personal interaction (telephone or videoconferencing, N=14). The studies show
predominantly positive results with a clear trend towards better results for "behavioral" endpoints,
e.g. adherence to medication or diet, and self-efficacy compared to results for medical outcomes (e.g.
blood pressure, or mortality), quality of life, and economic outcomes (e.g. costs or hospitalization).
However, in 26 of 68 included studies, patients with characteristic limitations for older patients (e.g.
cognitive and visual impairment, communication barriers, hearing problems) were excluded. A
considerable number of projects use rather sophisticated technology (e.g. videoconferencing), limiting
ready translation into routine care. Future research should focus on how to adapt systems to the
individual needs and resources of elderly patients within the specific frameworks of the respective
national healthcare systems.

van Gurp, J., et al. (2013). "Connecting with patients and instilling realism in an era of emerging communication
possibilities: a review on palliative care communication heading to telecare practice." Patient Educ
Couns 93(3): 504-514.

OBJECTIVE: Appropriate palliative care communication is pivotal to optimizing the quality of life in
dying patients and their families. This review aims at describing communication patterns in palliative
care and discussing potential relations between communication patterns and upcoming telecare in the
practice of palliative care. METHODS: This review builds on a systematic five-step qualitative analysis
of the selected articles: 1. Development of a 'descriptive table of studies reviewed' based on the
concept of genre, 2. Open coding of table content and first broad clustering of codes, 3. Intracluster
categorization of inductive codes into substantive categories, 4. Constant inter- and intracluster
comparison results in identification of genres, and 5. Labeling of genres. RESULTS: This review includes
71 articles. In the analysis, two communication genres in palliative care proved to be dominant: the
conversation to connect, about creating and maintaining a professional-patient/family relationship,
and the conversation to instill realism, about telling a clinical truth without diminishing hope.
CONCLUSION: The abovementioned two genres clarify a logical intertwinement between
communicative purposes, the socio-ethical background underlying palliative care practice and
elements of form. PRACTICE IMPLICATIONS: Our study supports understanding of current
communication in palliative care and anticipates future communicative actions in an era of new
communication technologies.

van Limburg, M., et al. (2011). "Why business modeling is crucial in the development of eHealth technologies."
J Med Internet Res 13(4): e124.

The impact and uptake of information and communication technologies that support health care are
rather low. Current frameworks for eHealth development suffer from a lack of fitting infrastructures,
inability to find funding, complications with scalability, and uncertainties regarding effectiveness and
sustainability. These issues can be addressed by defining a better implementation strategy early in the
development of eHealth technologies. A business model, and thus business modeling, help to
determine such an implementation strategy by involving all important stakeholders in a value-driven
dialogue on what the technology should accomplish. This idea also seems promising to eHealth, as it
can contribute to the whole development of eHealth technology. We therefore suggest that business
modeling can be used as an effective approach to supporting holistic development of eHealth
technologies. The contribution of business modeling is elaborated in this paper through a literature
review that covers the latest business model research, concepts from the latest eHealth and
persuasive technology research, evaluation and insights from our prior eHealth research, as well as
the review conducted in the first paper of this series. Business modeling focuses on generating a
collaborative effort of value cocreation in which all stakeholders reflect on the value needs of the
others. The resulting business model acts as the basis for implementation. The development of
eHealth technology should focus more on the context by emphasizing what this technology should
contribute in practice to the needs of all involved stakeholders. Incorporating the idea of business
modeling helps to cocreate and formulate a set of critical success factors that will influence the
sustainability and effectiveness of eHealth technology.

Vassilev, I., et al. (2015). "Assessing the implementability of telehealth interventions for self-management
support: a realist review." Implement Sci 10: 59.
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BACKGROUND: There is a substantial and continually growing literature on the effectiveness and
implementation of discrete telehealth interventions for health condition management. However, it is
difficult to predict which technologies are likely to work and be used in practice. In this context,
identifying the core mechanisms associated with successful telehealth implementation is relevant to
consolidating the likely elements for ensuring a priori optimal design and deployment of telehealth
interventions for supporting patients with long-term conditions (LTCs). METHODS: We adopted a two-
stage realist synthesis approach to identify the core mechanisms underpinning telehealth
interventions. In the second stage of the review, we tested inductively and refined our understanding
of the mechanisms. We reviewed qualitative papers focused on COPD, heart failure, diabetes, and
behaviours and complications associated with these conditions. The review included 15 papers
published 2009 to 2014. RESULTS: Three concepts were identified, which suggested how telehealth
worked to engage and support health-related work. Whether or not and how a telehealth intervention
enables or limits the possibility for relationships with professionals and/or peers. Telehealth has the
potential to reshape and extend existing relationships, acting as a partial substitute for the role of
health professionals. The second concept is fit: successful telehealth interventions are those that can
be well integrated into everyday life and health care routines and the need to be easy to use,
compatible with patients' existing environment, skills, and capacity, and that do not significantly
disrupt patients' lives and routines. The third concept is visibility: visualisation of symptoms and
feedback has the capacity to improve knowledge, motivation, and a sense of empowerment; engage
network members; and reinforce positive behaviour change, prompts for action and surveillance.
CONCLUSIONS: Upfront consideration should be given to the mechanisms that are most likely to
ensure the successful development and implementation of telehealth interventions. These include
considerations about whether and how the telehealth intervention enables or limits the possibility for
relationships with professionals and peers, how it fits with existing environment and capacities to self-
manage, and visibility-enabling-enhanced awareness to self and others.

Vedel, I., et al. (2013). "Health information technologies in geriatrics and gerontology: a mixed systematic
review." J Am Med Inform Assoc 20(6): 1109-1119.

OBJECTIVE: To review, categorize, and synthesize findings from the literature about the application of
health information technologies in geriatrics and gerontology (GGHIT). MATERIALS AND METHODS:
This mixed-method systematic review is based on a comprehensive search of Medline, Embase,
PsychInfo and ABI/Inform Global. Study selection and coding were performed independently by two
researchers and were followed by a narrative synthesis. To move beyond a simple description of the
technologies, we employed and adapted the diffusion of innovation theory (DOI). RESULTS: 112
papers were included. Analysis revealed five main types of GGHIT: (1) telecare technologies
(representing half of the studies); (2) electronic health records; (3) decision support systems; (4) web-
based packages for patients and/or family caregivers; and (5) assistive information technologies. On
aggregate, the most consistent finding proves to be the positive outcomes of GGHIT in terms of clinical
processes. Although less frequently studied, positive impacts were found on patients' health,
productivity, efficiency and costs, clinicians' satisfaction, patients' satisfaction and patients'
empowerment. DISCUSSION: Further efforts should focus on improving the characteristics of such
technologies in terms of compatibility and simplicity. Implementation strategies also should be
improved as trialability and observability are insufficient. CONCLUSIONS: Our results will help
organizations in making decisions regarding the choice, planning and diffusion of GGHIT implemented
for the care of older adults.

Vegni, E., et al. (1999). "The video recording of medical visits for the study of physician-patient rapport in
general medicine. An experimental experience in Italy." Recenti Progressi in Medicina 90(1): 9-12.

Veras, M., et al. (2016). "Outcome Measures in Tele-Rehabilitation and Virtual Reality for Stroke Survivors:
Protocol for a Scoping Review." Glob J Health Sci 8(1): 79-82.

Despite the increased interest about tele-rehabilitation, virtual reality and outcome measures for
stroke rehabilitation, surprisingly little research has been done to map and summarize the most
common outcome measures used in tele-rehabilitation. For this review, we propose to conduct a
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systematic search of the literature that reports outcome measures used in tele-rehabilitation or virtual
reality for stroke rehabilitation. Specific objectives include: 1) to identify the outcome measures used
in tele-rehabilitation studies; 2) to describe the psychometric properties of the outcome measures in
the included studies; 3) to describe which parts of the International Classification of Functioning are
measured in the studies. METHODS: we will conduct a comprehensive search of relevant electronic
databases (e.g., PUBMED, CINAHL, EMBASE, PSYCOINFO, Cochrane Central Register of Controlled Trial
and PEDRO). The scoping review will include all study designs. Two reviewers will pilot-test the data
extraction forms and will independently screen all the studies and extract the data. Disagreements
about inclusion or exclusion will be resolved by consensus or by consulting a third reviewer. The
results will be synthesized and reported considering the implications of the findings within the clinical
practice and policy context. Dissemination: we anticipate that this scoping review will contribute to
inform researchers and end-users (ie, clinicians and policy-makers), regarding the most appropriate
outcome measures for tele-rehabilitation or virtual reality as well as help to identify gaps in current
measures. Results will be disseminated through reports and open access journals, conference
presentations, as well as newsletters, podcasts and meetings targeting all the relevant stakeholders.

Von Bargen, T., et al. (2013). "Disease patterns addressed by mobile health-enabling technologies--a literature
review." Stud Health Technol Inform 190: 141-143.

Health-enabling technologies can contribute to a better living with diverse disease patterns, especially
at home. Ambient Assisted Living (AAL) provides security and convenience at the main place of
residence, but usually cannot be taken on the road. Mobile health-enabling technologies could
overcome this barrier of immobility and enable its' users to take advantages of assistive technology
with them. The presented literature review examines disease patterns, which can be addressed by
mobile health-enabling technologies. Especially chronic diseases, like diabetes, are very responsive for
continuous support by portable support technology.

Voss, H., et al. (2005). "The Baltic Health Network - Taking Secure, Internet-based Healthcare Networks to the
Next Level." Stud Health Technol Inform 116: 421-426.

Internet-based health care networks are a step forward compared to first generation health care
networks, which has been limited to pushing text-based messages between different systems. An
Internet-based network can also "pull" data - and not only text but any digital data - for instance
images and video sequences. The Internet-based networks can more effectively fulfil the vision of
access to relevant data regardless of time and location. Although far from identical, the health delivery
systems of Denmark, Norway and Sweden are similar. They also share a shortage of specialized health
personnel - not least radiologists and in some regions obstetricians. Furthermore, over the past ten
years they have implemented an IT-strategy to increase efficiency in the delivery of healthcare
services. Part of this strategy has been to build three national networks on top of the existing regional,
secure and Internet-based healthcare networks. These national networks connect not only all
hospitals in the three countries, but also a majority of the other stakeholders in the healthcare sector
(GPs, private specialists, laboratories, homecare services etc.). The organizations behind the three
networks are now working on creating a trans-national network, the Baltic Health Network (BHN),
which will be one of the outcomes of the Baltic eHealth project and will not only connect the three
national networks but also add two hospital networks from Lithuania and Estonia. The BHN is
expected to be operational by June 2005. One of major advantages of the BHN is that the many rural
hospitals of the Baltic Sea Area with a few mouse clicks can reach a specialist for second opinion in any
of the approximately 200 hospitals connected to the network. For instance the midwives in the rural
areas of Vasterbottan County, Sweden, are awaiting the establishment of BHN to get access to second
opinions from specialists at National Center for Foetal Medicine at the University Hospital of
Trondheim, Norway. The BHN will remove a very important technical barrier for collaboration
between health professionals and the Baltic eHealth project hopes that this and other project
initiatives will facilitate the large-scale usage of second opinion from available health care experts
regardless of institutional, regional and even national borders. This will lift the quality of service to
patients in the Baltic Sea Region - especially in the rural areas where highly specialized health
professionals tend to be geographically far away.

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Wade, V. A., et al. (2010). "A systematic review of economic analyses of telehealth services using real time
video communication." BMC Health Serv Res 10: 233.

BACKGROUND: Telehealth is the delivery of health care at a distance, using information and
communication technology. The major rationales for its introduction have been to decrease costs,
improve efficiency and increase access in health care delivery. This systematic review assesses the
economic value of one type of telehealth delivery--synchronous or real time video communication--
rather than examining a heterogeneous range of delivery modes as has been the case with previous
reviews in this area. METHODS: A systematic search was undertaken for economic analyses of the
clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth
comparator were included. Cost analyses, non-comparative studies and those where patient
satisfaction was the only health outcome were excluded. RESULTS: 36 articles met the inclusion
criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative,
11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the
perspective of the health services, 12 were societal, and one was from the patient perspective. In
three studies of telehealth to rural areas, the health services paid more for telehealth, but due to
savings in patient travel, the societal perspective demonstrated cost savings. In regard to health
outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not
significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes
differed according to patient group. The organisational model of care was more important in
determining the value of the service than the clinical discipline, the type of technology, or the date of
the study. CONCLUSION: Delivery of health services by real time video communication was cost-
effective for home care and access to on-call hospital specialists, showed mixed results for rural
service delivery, and was not cost-effective for local delivery of services between hospitals and
primary care.

Wallace, D. L., et al. (2012). "A systematic review of the evidence for telemedicine in burn care: with a UK
perspective." Burns 38(4): 465-480.

A comprehensive systematic review of telemedicine in burn care was carried out. Studies published
between 1993 and 2010 were included. The main outcome measures were the level of evidence,
technical feasibility, clinical feasibility, clinical management and cost effectiveness. The search strategy
yielded 24 studies, none of which were randomised. There were only five studies with a control group,
and in three of these the patients act as their own controls. Four studies performed quantitative cost
analysis, and five more provide qualitative cost analysis. All studies demonstrate technical and clinical
feasibility. If the significant potentials of telemedicine to assist in the acute triage, management
guidance and outpatient care are to be realised, then research needs to be undertaken to provide
evidence for such investment.

Wallis, L. A., et al. (2016). "A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency
Care." PLoS One 11(2): e0147253.

BACKGROUND: Each year more than 10 million people worldwide are burned severely enough to
require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert
clinical advice on acute injuries can play a determinant role and there is a need for novel approaches
that allow for timely access to advice. We developed an interactive mobile phone application that
enables transfer of both patient data and pictures of a wound from the point-of-care to a remote
burns expert who, in turn, provides advice back. METHODS AND RESULTS: The application is an
integrated clinical decision support system that includes a mobile phone application and server
software running in a cloud environment. The client application is installed on a smartphone and
structured patient data and photographs can be captured in a protocol driven manner. The user can
indicate the specific injured body surface(s) through a touchscreen interface and an integrated
calculator estimates the total body surface area that the burn injury affects. Predefined standardised
care advice including total fluid requirement is provided immediately by the software and the case
data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who
then can access the cloud server with the smartphone app or a web browser, review the case and
pictures, and respond with both structured and personalized advice to the health care professional at
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the point-of-care. CONCLUSIONS: In this article, we present the design of the smartphone and the
server application alongside the type of structured patient data collected together with the pictures
taken at point-of-care. We report on how the application will be introduced at point-of-care and how
its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system
are identified that may help materialising or hinder the expected outcome to provide a solution for
remote consultation on burns that can be integrated into routine acute clinical care and thereby
promote equity in injury emergency care, a growing public health burden.

Wang, J., et al. (2014). "Smartphone interventions for long-term health management of chronic diseases: an
integrative review." Telemed J E Health 20(6): 570-583.

INTRODUCTION: Long-term health management is challenging for the rapidly growing number of
patients with chronic diseases. Smartphone interventions offer promising solutions. This article
presents features of smartphone interventions for long-term chronic condition management,
illustrating how these applications benefit patients with chronic diseases. MATERIALS AND METHODS:
Systematic searches for smartphone health interventions were conducted in five publication
databases. Articles were included only if (1) the smartphone application (app) was exclusively
developed for patients with chronic diseases and (2) the article incorporated a defined outcome
measurement to evaluate the effects of the implemented intervention. Sixteen articles were included
in the final review, including studies in diabetes, mental health problems, overweight, cancer, and
chronic obstructive pulmonary disease. RESULTS: These studies found that the smartphone
intervention was a completely or at least partially effective tool to assist in managing some chronic
diseases. With the help of health-related smartphone apps, patients with chronic conditions (1) felt
secure in the knowledge that their illnesses were closely monitored, (2) participated in their own
health management more effectively, and (3) felt that they had not been forgotten by their doctors
and were taken good care of even outside the hospital/clinic. CONCLUSIONS: However, there are
limited smartphone apps for the long-term health management of chronic diseases. More smartphone
apps need to be developed to help people manage chronic diseases.

Ward, M. M., et al. (2015). "Systematic review of telemedicine applications in emergency rooms." Int J Med
Inform 84(9): 601-616.

CONTEXT: Despite the frequency of use of telemedicine in emergency care, limited evidence exists on
its impacts at the patient, provider, organization, and system level. Hospital-based applications of
telemedicine present a potentially important solution, particularly for small and rural hospitals where
access to local specialists is rarely available. PURPOSE: We conducted a systematic review of
telemedicine applications for hospital-based emergency care, which aims to synthesize the existing
evidence on the impact of tele-emergency applications that could inform future efforts and research
in this area. BASIC PROCEDURES: A search of four databases (PubMed, CINAHL, EMBASE, Cochrane)
using a combination of telemedicine and emergency room (ER) keywords for publications yielded 340
citations. Four coders independently determined eligibility based on initial criteria and then extracted
information on the 38 resulting articles based on four main categories: study setting, type of
technology, research methods, and results. MAIN FINDINGS: Of the 38 articles, 11 studies focused on
telemedicine for diffuse patient populations that typically present in ERs, 8 studies considered
telemedicine in the context of minor treatment clinics for patients presenting with minor injuries or
illnesses, and 19 studies focused on the use of telemedicine to connect providers in ERs to medical
specialists for consultations on patients with specific conditions. Overwhelmingly, tele-emergency
studies reported positive findings especially in terms of technical quality and user satisfaction. There
were also positive findings reported for clinical processes and outcomes, throughput, and disposition,
but the rigor of studies using these measures was limited. Studies of economic outcomes are
particularly sparse. PRINCIPAL CONCLUSIONS: Despite limitations in their research methodology, the
studies on tele-emergency indicate an application with promise to meet the needs of small and rural
hospitals to address infrequent but emergency situations requiring specialist care. Similarly, studies
indicate that tele-emergency has considerable potential to expand use of minor treatment clinics to
address access issues in remote areas and overcrowding of urban ERs.

Watterson, J. L., et al. (2015). "Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and
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Immunization: A Systematic Review of the Literature." Biomed Res Int 2015: 153402.

Mobile health (mHealth) technologies have been implemented in many low- and middle-income
countries to address challenges in maternal and child health. Many of these technologies attempt to
influence patients', caretakers', or health workers' behavior. The purpose of this study was to conduct
a systematic review of the literature to determine what evidence exists for the effectiveness of
mHealth tools to increase the coverage and use of antenatal care (ANC), postnatal care (PNC), and
childhood immunizations through behavior change in low- and middle-income countries. The full text
of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority
of studies used text or voice message reminders to influence patient behavior change (80%, n = 8) and
most were conducted in African countries (80%, n = 8). All studies showed at least some evidence of
effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance,
or childhood immunization rates. However, many of the studies were observational and further
rigorous evaluation of mHealth programs is needed in a broader variety of settings.

Whited, J. D. (2015). "Quality of life: a research gap in teledermatology." Int J Dermatol 54(10): 1124-1128.

An important outcome in healthcare, and in particular for dermatologic healthcare, is quality of life.
Whereas the literature is well represented by quality of life assessments in dermatology, very little
information is available that specifically addresses teledermatology's impact on quality of life. This gap
in our knowledge of teledermatology is noteworthy precisely because of the importance that quality
of life plays in dermatologic disease and healthcare delivery. The goal of this review is to briefly outline
the concept of quality of life and its importance to dermatology, describe the different type of
instruments that are used to assess quality of life, and to review studies that implemented
teledermatology interventions and made quality of life assessments. The available literature has
shown that teledermatology interventions do result in improved quality of life, and those changes
correlate with improvements in disease severity and clinical course. Integrating quality of life
assessments in future evaluations of teledermatology interventions would be valuable to provide a
more comprehensive depiction of teledermatology's impact on patients receiving dermatology care
via telemedicine.

Widmer, R. J., et al. (2015). "Digital health interventions for the prevention of cardiovascular disease: a
systematic review and meta-analysis." Mayo Clin Proc 90(4): 469-480.

OBJECTIVE: To assess the potential benefit of digital health interventions (DHIs) on cardiovascular
disease (CVD) outcomes (CVD events, all-cause mortality, hospitalizations) and risk factors compared
with non-DHIs. PATIENTS AND METHODS: We conducted a systematic search of PubMed, MEDLINE,
EMBASE, Web of Science, Ovid, CINHAL, ERIC, PsychINFO, Cochrane, and Cochrane Central Register of
Controlled Trials for articles published from January 1, 1990, through January 21, 2014. Included
studies examined any element of DHI (telemedicine, Web-based strategies, e-mail, mobile phones,
mobile applications, text messaging, and monitoring sensors) and CVD outcomes or risk factors. Two
reviewers independently evaluated study quality utilizing a modified version of the Cochrane
Collaboration risk assessment tool. Authors extracted CVD outcomes and risk factors for CVD such as
weight, body mass index, blood pressure, and lipid levels from 51 full-text articles that met validity
and inclusion criteria. RESULTS: Digital health interventions significantly reduced CVD outcomes
(relative risk, 0.61; 95% CI, 0.46-0.80; P<.001; I(2)=22%). Concomitant reductions in weight (-2.77 lb
[95% CI, -4.49 to -1.05 lb]; P<.002; I(2)=97%) and body mass index (-0.17 kg/m(2) [95% CI, -0.32
kg/m(2) to -0.01 kg/m(2)]; P=.03; I(2)=97%) but not blood pressure (-1.18 mm Hg [95% CI, -2.93 mm
Hg to 0.57 mm Hg]; P=.19; I(2)=100%) were found in these DHI trials compared with usual care. In the
6 studies reporting Framingham risk score, 10-year risk percentages were also significantly improved (-
1.24%; 95% CI, -1.73% to -0.76%; P<.001; I(2)=94%). Results were limited by heterogeneity not fully
explained by study population (primary or secondary prevention) or DHI modality. CONCLUSION:
Overall, these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a
positive impact on risk factors for CVD.

Wilcox, M. E. et Adhikari, N. K. (2012). "The effect of telemedicine in critically ill patients: systematic review and
meta-analysis." Crit Care 16(4): R127.
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INTRODUCTION: Telemedicine extends intensivists' reach to critically ill patients cared for by other
physicians. Our objective was to evaluate the impact of telemedicine on patients' outcomes.
METHODS: We searched electronic databases through April 2012, bibliographies of included trials, and
indexes and conference proceedings in two journals (2001 to 2012). We selected controlled trials or
observational studies of critically ill adults or children, examining the effects of telemedicine on
mortality. Two authors independently selected studies and extracted data on outcomes (mortality and
length of stay in the intensive care unit (ICU) and hospital) and methodologic quality. We used
random-effects meta-analytic models unadjusted for case mix or cluster effects and quantified
between-study heterogeneity by using I(2) (the percentage of total variability across studies
attributable to heterogeneity rather than to chance). RESULTS: Of 865 citations, 11 observational
studies met selection criteria. Overall quality was moderate (mean score on Newcastle-Ottawa scale,
5.1/9; range, 3 to 9). Meta-analyses showed that telemedicine, compared with standard care, is
associated with lower ICU mortality (risk ratio (RR) 0.79; 95% confidence interval (CI), 0.65 to 0.96;
nine studies, n = 23,526; I2 = 70%) and hospital mortality (RR, 0.83; 95% CI, 0.73 to 0.94; nine studies,
n = 47,943; I(2) = 72%). Interventions with continuous patient-data monitoring, with or without alerts,
reduced ICU mortality (RR, 0.78; 95% CI, 0.64 to 0.95; six studies, n = 21,384; I(2) = 74%) versus those
with remote intensivist consultation only (RR, 0.64; 95% CI, 0.20 to 2.07; three studies, n = 2,142; I2 =
71%), but effects were statistically similar (interaction P = 0.74). Effects were also similar in higher (RR,
0.83; 95% CI, 0.68 to 1.02) versus lower (RR, 0.69; 95% CI, 0.40 to 1.19; interaction, P = 0.53) quality
studies. Reductions in ICU and hospital length of stay were statistically significant (weighted mean
difference (telemedicine-control), -0.62 days; 95% CI, -1.21 to -0.04 days and -1.26 days; 95% CI, -2.49
to -0.03 days, respectively; I2 > 90% for both). CONCLUSIONS: Telemedicine was associated with lower
ICU and hospital mortality among critically ill patients, although effects varied among studies and may
be overestimated in nonrandomized designs. The optimal telemedicine technology configuration and
dose tailored to ICU organization and case mix remain unclear.

Wildevuur, S. E. et Simonse, L. W. (2015). "Information and communication technology-enabled person-

centered care for the "big five" chronic conditions: scoping review." J Med Internet Res 17(3): e77.

BACKGROUND: Person-centered information and communication technology (ICT) could encourage

patients to take an active part in their health care and decision-making process, and make it possible
for patients to interact directly with health care providers and services about their personal health
concerns. Yet, little is known about which ICT interventions dedicated to person-centered care (PCC)
and connected-care interactions have been studied, especially for shared care management of chronic
diseases. The aim of this research is to investigate the extent, range, and nature of these research
activities and identify research gaps in the evidence base of health studies regarding the "big 5"
chronic diseases: diabetes mellitus, cardiovascular disease, chronic respiratory disease, cancer, and
stroke. OBJECTIVE: The objective of this paper was to review the literature and to scope the field with
respect to 2 questions: (1) which ICT interventions have been used to support patients and health care
professionals in PCC management of the big 5 chronic diseases? and (2) what is the impact of these
interventions, such as on health-related quality of life and cost efficiency? METHODS: This research
adopted a scoping review method. Three electronic medical databases were accessed: PubMed,
EMBASE, and Cochrane Library. The research reviewed studies published between January 1989 and
December 2013. In 5 stages of systematic scanning and reviewing, relevant studies were identified,
selected, and charted. Then we collated, summarized, and reported the results. RESULTS: From the
initial 9380 search results, we identified 350 studies that qualified for inclusion: diabetes mellitus
(n=103), cardiovascular disease (n=89), chronic respiratory disease (n=73), cancer (n=67), and stroke
(n=18). Persons with one of these chronic conditions used ICT primarily for self-measurement of the
body, when interacting with health care providers, with the highest rates of use seen in chronic
respiratory (63%, 46/73) and cardiovascular (53%, 47/89) diseases. We found 60 relevant studies
(17.1%, 60/350) on person-centered shared management ICT, primarily using telemedicine systems as
personalized ICT. The highest impact measured related to the increase in empowerment (15.4%,
54/350). Health-related quality of life accounted for 8%. The highest impact connected to health
professionals was an increase in clinical outcome (11.7%, 41/350). The impacts on organization
outcomes were decrease in hospitalization (12.3%, 43/350) and increase of cost efficiency (10.9%,
38/350). CONCLUSIONS: This scoping review outlined ICT-enabled PCC in chronic disease
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management. Persons with a chronic disease could benefit from an ICT-enabled PCC approach, but
ICT-PCC also yields organizational paybacks. It could lead to an increase in health care usage, as
reported in some studies. Few interventions could be regarded as "fully" addressing PCC. This review
will be especially helpful to those deciding on areas where further development of research or
implementation of ICT-enabled PCC may be warranted.

Williams, A. R., et al. (2015). "The development and application of an oncology Therapy-Related Symptom
Checklist for Adults (TRSC) and Children (TRSC-C) and e-health applications." Biomed Eng Online 14
Suppl 2: S1.

BACKGROUND: Studies found that treatment symptoms of concern to oncology/hematology patients

were greatly under-identified in medical records. On average, 11.0 symptoms were reported of
concern to patients compared to 1.5 symptoms identified in their medical records. A solution to this
problem is use of an electronic symptom checklist that can be easily accessed by patients prior to
clinical consultations. PURPOSE: Describe the oncology Therapy-Related Symptom Checklists for
Adults (TRSC) and Children (TRSC-C), which are validated bases for e-Health symptom documentation
and management. The TRSC has 25 items/symptoms; the TRSC-C has 30 items/symptoms. These items
capture up to 80% of the variance of patient symptoms. Measurement properties and applications
with outpatients are presented. E-Health applications are indicated. METHODS: The TRSC was
developed for adults (N = 282) then modified for children (N = 385). Statistical analyses have been
done using correlational, epidemiologic, and qualitative methods. Extensive validation of
measurement properties has been reported. RESULTS: Research has found high levels of
patient/clinician satisfaction, no increase in clinic costs, and strong correlations of TRSC/TRSC-C with
medical outcomes. A recently published sequential cohort trial with adult outpatients at a Mayo Clinic
community cancer center found TRSC use produced a 7.2% higher patient quality of life, 116% more
symptoms identified/managed, and higher functional status. DISCUSSION, IMPLICATIONS, AND
FOLLOW-UP: An electronic system has been built to collect TRSC symptoms, reassure patients, and
enhance patient-clinician communications. This report discusses system design and efforts made to
provide an electronic system comfortable to patients. Methods used by clinicians to promote comfort
and patient engagement were examined and incorporated into system design. These methods
included (a) conversational data collection as opposed to survey style or standardized questionnaires,
(b) short response phrases indicating understanding of the reported symptom, (c) use of open-ended
questions to reduce long lists of symptoms, (d) directed questions that ask for confirmation of
expected symptoms, (e) review of symptoms at designated stages, and (d) alerting patients when the
computer has informed clinicians about patient-reported symptoms. CONCLUSIONS: An e-Health
symptom checklist (TRSC/TRSC-C) can facilitate identification, monitoring, and management of
symptoms; enhance patient-clinician communications; and contribute to improved patient outcomes.

Wootton, R., et al. (2011). "Estimating travel reduction associated with the use of telemedicine by patients and
healthcare professionals: proposal for quantitative synthesis in a systematic review." BMC Health Serv
Res 11: 185.

BACKGROUND: A major benefit offered by telemedicine is the avoidance of travel, by patients, their
carers and health care professionals. Unfortunately, there is very little published information about
the extent of avoided travel. We propose to undertake a systematic review of literature which reports
credible data on the reductions in travel associated with the use of telemedicine. METHOD: The
conventional approach to quantitative synthesis of the results from multiple studies is to conduct a
meta analysis. However, too much heterogeneity exists between available studies to allow a
meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings.
We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting
a linear model which takes into account the relevant factors in the circumstances of the studies
performed. We propose the use of stepwise multiple regression to identify which factors are
significant. DISCUSSION: Our proposed approach is illustrated by the example of teledermatology. In a
preliminary review of the literature we found 20 studies in which the percentage of avoided travel
through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel
reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study
with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality
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of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use
of store and forward teledermatology alone was associated with 43% of avoided travel. The increase
in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed
was significant (P = 0.014). Service planners can use this information to weigh up the costs and
benefits of the two approaches.

Wootton, R., et al. (2000). "Multicentre randomised control trial comparing real time teledermatology with
conventional outpatient dermatological care : societal cost-benefit analysis." British Medical Journal
320: 1252-1256, 1255 tabl.
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Wu, Y., et al. (2010). "TeleOph: a secure real-time teleophthalmology system." IEEE Trans Inf Technol Biomed
14(5): 1259-1266.

Teleophthalmology (TeleOph) is an electronic counterpart of today's face-to-face, patient-to-specialist

ophthalmology system. It enables one or more ophthalmologists to remotely examine a patient's
condition via a confidential and authentic communication channel. Specifically, TeleOph allows a
trained nonspecialist in a primary clinic to screen the patients with digital instruments (e.g., camera,
ophthalmoscope). The acquired medical data are delivered to the hospital where an ophthalmologist
will review the data collected and, if required, provide further consultation for the patient through a
real-time secure channel established over a public Internet network. If necessary, the ophthalmologist
is able to further sample the images/video of the patient's eyes remotely. In order to increase the
productivity of the ophthalmologist in terms of number of patients reviewed, and to increase the
efficiency of network resource, we manage the network bandwidth based on a Poisson model to
estimate patient arrival at the clinics, and the rate of ophthalmologist consultation service for better
overall system efficiency. The main objective of TeleOph is therefore to provide the remote patients
with a cost-effective access to specialist's eye checkups at primary healthcare clinics, and at the same
time, minimize unnecessary face-to-face consultation at the hospital specialist's center.

Zapata, B. C., et al. (2015). "Empirical studies on usability of mHealth apps: a systematic literature review." J
Med Syst 39(2): 1.

The release of smartphones and tablets, which offer more advanced communication and computing
capabilities, has led to the strong emergence of mHealth on the market. mHealth systems are being
used to improve patients' lives and their health, in addition to facilitating communication between
doctors and patients. Researchers are now proposing mHealth applications for many health conditions
such as dementia, autism, dysarthria, Parkinson's disease, and so on. Usability becomes a key factor in
the adoption of these applications, which are often used by people who have problems when using
mobile devices and who have a limited experience of technology. The aim of this paper is to
investigate the empirical usability evaluation processes described in a total of 22 selected studies
related to mHealth applications by means of a Systematic Literature Review. Our results show that the
empirical evaluation methods employed as regards usability could be improved by the adoption of
automated mechanisms. The evaluation processes should also be revised to combine more than one
method. This paper will help researchers and developers to create more usable applications. Our
study demonstrates the importance of adapting health applications to users' need.

Zhai, Y. K., et al. (2014). "Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: a
systematic review and meta-analysis." Medicine (Baltimore) 93(28): e312.

Emerging telemedicine programs offer potential low-cost solutions to the management of chronic
disease. We sought to evaluate the clinical effectiveness and cost effectiveness of telemedicine
approaches on glycemic control in patients with type 2 diabetes mellitus. Using terms related to type 2
diabetes and telemedicine, MEDLINE, Cochrane, EMBASE, and CINAHL Plus were searched to identify
relevant studies published through February 28, 2014. Data from identified clinical trials were pooled
according to telemedicine approach, and evaluated using conventional meta-analytical methods. We
identified 47 articles, from 35 randomized controlled trials, reporting quantitative outcomes for
hemoglobin A1c (HbA1c). Twelve of the 35 studies provided intervention via telephone, either in the
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form of a call or a text message; 19 studies tested internet-based programs, employing video-
conferencing and/or informational websites; and four studies used interventions involving
electronically transmitted recommendations made by clinicians in response to internet-based
reporting by patients. Overall, pooled results from these studies revealed a small, but statistically
significant, decrease in HbA1c following intervention, compared to conventional treatment (pooled
difference in means=-0.37, 95% CI=-0.49 to -0.25, Z=-6.08, P<0.001). Only two of the 35 studies
included assessment of cost-effectiveness. These studies were disparate, both in terms of overall
expense and relative cost-effectiveness. Optimization of telemedicine approaches could potentially
allow for more effective self-management of disease in type 2 diabetes patients, though evidence to-
date is unconvincing. Furthermore, significant publication bias was detected, suggesting that the
literature should be interpreted cautiously.

Zhou, M., et al. (2012). "The utilization of telephone follow-up in the advanced cancer population: a review of
the literature." J Comp Eff Res 1(6): 509-517.

BACKGROUND: Palliative cancer patients often require clinic or hospital follow-up after any treatment
intervention they may have received. This is typically done in person at either a hospital or a clinic. In
these advanced cancer patients, this may be burdensome and result in attrition. Telephone follow-up
is becoming more frequently used as an adjunct to clinical follow-up. It can be conducted for both
clinical trials, as well as interventional purposes. The purpose of this study was to review the literature
and examine the utility and effectiveness of telephone follow-up in the advanced cancer population.
METHODS: A literature search was conducted on Medline (1980 - April week 4 2012), Embase (1980 -
week 17 2012), the Cochrane Central Register of Controlled Trials (April 2012) and CINAHL (1981-July
31 2012). RESULTS: A total of 11 studies were identified that were published between 2001 and 2011.
All studies were in the clinical trial setting. Studies that utilized telephone follow-up in the advanced
cancer population, as well as studies that compared the feasibility of telephone follow-up with
hospital follow-up, were included in this review. Follow-up at week 4 (month 1) was the most common
interval for patient contact. Information collected during the contact varied with the study; however,
the most commonly used tool was the Edmonton Symptom Assessment System. Other information
included analgesic diary, patient feedback, satisfaction with the care and post-treatment side effects,
along with a variety of quality of life questionnaires. Some studies provided information to the patient
about protocols for care, advice and coping strategies. Attrition was common even with the use of
telephone contact in place of clinical follow-up. CONCLUSION: Telephone follow-up is a feasible
alternative to traditional hospital follow-ups for assessment of symptom palliation. There are fewer
burdens on the patient, allowing for a better maintenance of quality of life and lower rates of attrition
in clinical trials. Patients had an overall positive opinion of the use of this alternative approach with no
common disadvantages. A combination of follow-up strategies, such as clinic follow-up and telephone
contact for those not attending, may result in a more comprehensive assessment.

Rapports

(2003). Communication de la commission : suivi du processus de rflexion haut niveau sur la mobilit des
patients et l'volution des soins de sant dans l'Union europenne. Bruxelles Conseil de l'Union
Europenne: 28 , 21 ann., 21 graph.
[Link]
Bien que les services de sant et soins mdicaux soient essentiellement du ressort des tats membres,
la coopration au niveau europen est largement susceptible de profiter la fois aux patients
individuels et aux systmes de sant en gnral. L'union europenne s'est donc accord reconnatre
qu'un cadre tait ncessaire, au niveau europen, pour favoriser la coopration et faonner cette
volution, mais faisait actuellement dfaut. C'est ce qui est ressorti des conclusions adoptes par le
Conseil " Sant " du 26 juin 2002 concernant la mobilit des patients et l'volution des soins de sant
dans l'Union europenne. Le Conseil a reconnu qu'il serait utile que la Commission entame, en troite
collaboration avec le Conseil et tous les tats membres - en particulier les ministres de la sant et
d'autres intervenants cls - un processus de rflexion haut niveau. La Commission a donc runi les
ministres de la sant de toute l'Union, des reprsentants des patients, des professionnels de la sant,
des prestataires et acheteurs de soins de sant, ainsi que le Parlement europen, au sein d'un
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processus de rflexion haut niveau, qui a abouti un vaste rapport comportant dix-neuf
recommandations spcifiques
([Link] La prsente
communication donne suite au rapport du processus de rflexion sur la mobilit des patients et
l'volution des soins de sant dans l'Union europenne et constitue la rponse de la Commission aux
recommandations. Elles s'inscrivent dans une stratgie plus vaste. Une communication distincte sur
l'extension de la mthode ouverte de coordination aux soins de sant et aux soins de longue dure
prsente des propositions concernant la mise en place d'une coordination europenne l'appui des
stratgies nationales destines rorganiser et dvelopper les soins de sant et les soins de longue
dure (COM(2004) 304 final).

(2010). Casebook of Primary Healthcare Innovations. Ottawa Canadian Health Services Research Foundation.:
47 , tabl., graph.
[Link]
After almost three decades in the doldrums, primary healthcare renewal has accelerated dramatically
in Canada since 2000. However, progress has been uneven across the country, with some jurisdictions
striding boldly forward while others have been more tentative in undertaking reform. Although
innovation in primary healthcare is occurring in every province and territory, what sets the past
decade apart is the implementation and scaling up of innovations in the organization, funding and
delivery of primary healthcare to the system level in several provinces. This casebook documents
many of the innovations being implemented across Canada.

(2012). Personalised Medicine in European Hospitals. Bruxelles HOPE: 47 , cartes.

[Link]
Better_health_October_2011.pdf
Si elle est encore aux prmices de son dploiement, la mdecine personnalise est dj une ralit. De
la prvention jusqu'au soin, elle a vocation fournir le plus rapidement possible un diagnostic et un
traitement personnaliss aux patients. Elle regroupe les produits et services qui s'appuient sur la
gnomique et la protomique et exploitent les tendances actuelles orientes vers le bien-tre et le
patient acteur de sa sant. Selon l'tude PwC ralise en association avec HOPE (European Hospital
and Healthcare Federation) dans six pays europens : France, Hongrie, Slovnie, Espagne, Danemark,
Finlande, de nombreux hpitaux europens ont labor, chacun avec une conception diffrente, une
stratgie de dploiement de la mdecine personnalise. En France, le CHU de Dijon, a opt pour le
dveloppement de plateformes d'optimisation des diagnostics et des traitements ainsi que pour des
programmes de tlmdecine en pathologie et en neurologie. Son dveloppement constitue un dfi
majeur pour l'ensemble du secteur de la sant. L'tude dfinit ainsi trois priorits : investir de
nouveaux champs de recherche, par exemple dans le domaine de la gntique ; intgrer de nouvelles
technologies comme l'imagerie ; faire voluer la culture et les comportements des professionnels de
sant et du patient pour en faire un acteur de sa sant.

(2013). The European health report 2013: research for universal health coverage. Copenhague OMS Bureau
rgional de l'Europe: 9 + 168 , tabl., graph., fig., index.
[Link]
Universal health coverage, with full access to high-quality services for health promotion, prevention,
treatment, rehabilitation, palliation and financial risk protection, cannot be achieved without evidence
from research. Research has the power to address a wide range of questions about how we can reach
universal coverage, providing answers to improve human health, well-being and development. All
nations should be producers of research as well as consumers. The creativity and skills of researchers
should be used to strengthen investigations not only in academic centres but also in public health
programmes, close to the supply of and demand for health services. Research for universal health
coverage requires national and international backing. To make the best use of limited resources,
systems are needed to develop national research agendas, to raise funds, to strengthen research
capacity, and to make appropriate and effective use of research findings (4e de couverture).

Dal, Grande, E. (2009). Telehealth Literature Review. Kingston Canadian Society of Telehealth: 96.
[Link]
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Cette revue de la littrature a t prpare pour les membres de la Socit canadienne de tlsant.
Elle prsente un portrait des dveloppements qui sont survenus dans le domaine de la tlsant au
cours des deux dernires annes. Le rapport classe ces dveloppements selon diffrentes
thmatiques.

Zamora, B. (2012). Strategic Intelligence Monitor on Personal Health Systems, Phase 2. Impact Assessment
Final Report. Luxembourg Publications Office of the European Union: 44 , tabl., fig.
[Link]
This report aims to assess the economic impacts of deployment of eHealth technologies in the EU
through projections of Member State eHealth expenditures (i.e. on telehealth and telecare, savings in
hospitalisation costs, decrease in mortality, and other health care costs).

Les systmes dinformation en sant : dossiers mdicaux, prescription

lectronique, rseaux

Etudes franaises

Ouvrages

(2000). An 2000, quels mdecins, pour quels patients, pour quelle mdecine ?, Paris : SmithKline Beecham
SmithKline Beecham, Dpartement d'Information et d'Accueil Mdical (DIAM), 6 esplanade Charles-de-Gaule
92731 Nanterre - tl. : 01 46 98 48 48 - Fax : 01 46 98 48 00 - E-mail : [Link]@[Link] -
[Link]
Ce Livre blanc tmoigne du bouillonnement des ides qui agite la profession mdicale en
mutation, bien dcide prendre en charge son destin. Le mdecin doit-il devenir - s'il ne l'est pas
dj - gestionnaire de la sant publique ? A partir de leur exprience de terrain, de nombreux
praticiens donnent ici leur avis, en dcrivant l'antinomie qui rgne souvent entre le souci de l'intrt
des patients et celui des finances publiques. Confronts aux difficults administratives, matrielles et
humaines, beaucoup s'inquitent de l'tat actuel du systme de sant. A travers ces tmoignages, ils
peignent par petites touches leur vie quotidienne la rencontre des patients. A l're de la
communication et de l'information tous azimuts, le dialogue n'est pas forcment facile, mais chacun
s'efforce de trouver la bonne mthode pour conduire le malade vers la gurison.

(2000). Guide des rseaux de soins et des systmes d'information l'usage du mdecin libral : questions cls,
Paris : URMLIF

La modification profonde des besoins de soins observe depuis quelques annes, accompagne de
l'volution du dispositif de prise en charge, entranent une ncessaire rvision des modes
d'organisation dans la prise en charge des patients. De plus en plus de mdecins, conscients de cette
ralit, tentent de s'organiser sur des formes nouvelles, telles que les rseaux de soins. Cet ouvrage
est une version courte du "guide des rseaux de soins et des systmes d'information l'usage du
mdecin libral". Il aborde les questions pratiques lies aux diffrentes problmatiques juridiques
souleves par la mise en ouvre d'un rseau de soins (forme du rseau, modalits d'adhsion et de
sortie...) tout en formulant des propositions et recommandations tenant la conduite juridique du
projet de rseau de soins (contractualisation des liens entre les partenaires, les professionnels de
sant et les patients...) et aux consquences pratiques de ce nouveau mode d'exercice de la mdecine
en rseau (gestion du dossier mdical partag, informatisation des professionnels de sant...)

(2000). Guide des rseaux de soins et des systmes d'information l'usage du mdecin libral : texte intgral,
Paris : URMLIF
[Link]
La modification profonde des besoins de soins observe depuis quelques annes, accompagne de
l'volution du dispositif de prise en charge, entranent une ncessaire rvision des modes
d'organisation dans la prise en charge des patients. De plus en plus de mdecins, conscients de cette

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ralit, tentent de s'organiser sur des formes nouvelles, telles que les rseaux de soins. Cet ouvrage
aborde les questions pratiques lies aux diffrentes problmatiques juridiques souleves par la mise
en ouvre d'un rseau de soins (forme du rseau, modalits d'adhsion et de sortie...) tout en
formulant des propositions et recommandations tenant la conduite juridique du projet de rseau de
soins (contractualisation des liens entre les partenaires, les professionnels de sant et les patients...)
et aux consquences pratiques de ce nouveau mode d'exercice de la mdecine en rseau (gestion du
dossier mdical partag, informatisation des professionnels de sant...)

(2008). Le dossier pharmaceutique (DP), Paris : CNOP

[Link], rubrique "Point presse"
Ce dossier de presse fait un bilan de l'tat d'avancement du dossier pharmaceutique, alors que
l'exprimentation vient d'tre gnralise par la Cnil en mars 2008.

(2011). Dossier mdical personnel : le DMP en questions, Paris : CISS

[Link]
A travers ce dpliant, le Collectif Interassociatif Sur la Sant (CISS) accompagne la mise en place du
dossier mdical personnel (Dmp), qui vise amliorer et faciliter la coordination des soins entre les
professionnels de sant amens intervenir auprs d'une mme personne. Dans ce dpliant, sont
expliqus ce qu'est ce nouvel outil pour l'usager, comment y accder, ? comment a marche ?
(Rsum de l'diteur).

(2011). La diffusion publique des indicateurs de qualit et de scurit de soins 2010 sur les sites platines : jeudi
22 septembre 2011, Paris : Ministre charg de la sant
[Link]
09/dp_indicateurs_qualite__platines_22.[Link]
[BDSP. Notice produite par MIN-SANTE 9pR0xDmA. Diffusion soumise autorisation]. Ce dossier
prsente les rsultats des indicateurs de qualit issus du dossier du patient et les indicateurs du
tableau de bord des infections nosocomiales par l'intermdiaire d'un site Platines plus accessible au
grand public. En annexe, on trouve les 12 indicateurs gnraliss obligatoires et diffuss, le calendrier
de gnralisation des indicateurs, les rsultats 2010 des indicateurs de qualit de prise en charge du
patient (QUALAS) ainsi que la prsentation du site Platines.

(2015). Le dossier mdical partag au service de la coordination des soins. Point d'tape, Paris : Cnamts

En prvision de lapplication de larticle 25 de la loi Sant qui confie lAssurance Maladie la

responsabilit de gestion du Dossier Mdical Partag (DMP), la Cnamts a explor les modalits de
mise en uvre de cet outil de coordination des soins, attendu par tous, patients comme
professionnels de sant.

Buxeraud, J., et al. (2000). Informatique et internet l'officine, Paris : Elsevier

Ralis avec le concours de [Link], ce rpertoire prsente les principaux sites de sant et les
perspectives offertes aux pharmaciens sur le net, selon une prsentation thmatique : sites portail,
sites institutionnels et universitaires, sits ddis aux mdicaments, sites diteurs et priodiques en
ligne, sites de l'industrie pharmaceutique, sites des rpartiteurs.

Calderan, L., et al. Big data : nouvelles partitions de l'information. Actes du sminaire IST Inria, octobre 2014,
Louvain-la-Neuve : De Boeck ; Paris : ADBS
[Link]
Le Big Data est omniprsent dans les mdias. Qualifi de source d'innovation, de richesses, de cration
d'emplois, d'enjeu dmocratique quand il est open , le Big Data fascine et effraye la fois. Mais de
quoi parle-t-on exactement ? Ces donnes massives sont-elles du seul domaine des informaticiens,
des statisticiens, des politiques et des crateurs d'entreprises ? Les professionnels de l'information-
documentation n'ont-ils pas un rle jouer dans ce nouveau paysage : identification, qualification,
archivage, classification ? Cet ouvrage rassemble les contributions de spcialistes issus de diverses
disciplines et runis au colloque Inria en octobre 2014. Dans le flou li la mutation profonde que
connat actuellement le paysage informationnel, ils donnent les cls pour apprhender ce nouveau
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domaine et pour percevoir la place rserve aux comptences mtier de l'information-

documentation.

Cartau, C. (2014). Stratgies du systme d'information vers l'hpital numrique, Rennes : Presses de l'EHESP

[BDSP. Notice produite par EHESP sqlR0xFj. Diffusion soumise autorisation]. Les tablissements de
sant n'chapperont pas la marche vers la numrisation et l'informatisation massive qui a dj
touch les autres secteurs conomiques. Si certains domaines sont informatiss depuis de
nombreuses annes (laboratoires, imagerie) dans d'autres (prescription connecte, tl-imagerie
rgionale), il s'agit pour nombre d'tablissements d'une vritable rvolution qui suscite craintes et
espoirs. Complment indispensable des deux manuels prcdents (Guide pratique du systme
d'information et La scurit du systme d'information des tablissements de sant), ce guide,
l'intention des managers, propose cette fois des outils concrets permettant de mesurer les enjeux de
ce tournant numrique et de mieux valuer l'impact des stratgies adoptes. Qu'il soit dcideur,
professionnel de l'informatique ou cadre de sant, le lecteur tirera profit de l'approche globale et
systmatique propose ici : la notion d'hpital numrique n'est pas seulement aborde sous l'angle
technique mais mise en perspective par rapport aux vritables enjeux du monde de la sant.

Dupuy, O. (2005). La gestion des informations relatives au patient : dossier mdical et dossier mdical
personnel, Bordeaux : Les Etudes hospitalires
[Link]
Les rgles qui rgissent la gestion des dossiers mdicaux diffrent selon qu'elles s'appliquent
l'exercice au sein de structures hospitalires ou, au contraire, la mdecine individuelle. Ce cadre
juridique htrogne est le rvlateur d'une prise en charge cloisonne des patients. La loi du 4 mars
2002, relative aux droits des malades, n'a pas apport de relle rponse ce sujet. Les progrs des
technologies de l'information permettent dsormais d'envisager la rforme des modes de gestion des
donnes de sant. La cration d'un dossier mdical personnel (DMP) constitue une tape majeure
dans la dmarche de coordination des soins. Parce qu'il doit permettre tout professionnel de sant
intervenant dans le processus de soins d'accder tout moment, y compris en urgence, l'ensemble
des informations pertinentes concernant le patient qu'il prend en charge, le DMP entrouvre la voie
une gestion centre sur le patient. L'auteur, Olivier Dupuy, docteur en droit, propose une tude
objective et argumente des rgles juridiques qui rgissent la gestion des donnes de sant. La clart
du propos permet au lecteur, usager comme professionnel de sant, de bnficier d'une information
prcise et intelligible sur le sujet.

Kervasdoue, J. d. d. (2012). Carnet de sant de la France en 2012 : conomie, droit et politiques de sant, Paris :
FNMF Paris : Economica

Ce 7e Carnet de sant est publi l'occasion du 40e Congrs national de la Mutualit Franaise. Parmi
les sujets rcurrents figurent le dficit de l'assurance maladie et son financement ainsi que
l'aggravation des ingalits, notamment dans l'accs aux soins (partie 1). Et si les qualits du systme
franais, internationalement reconnues, restent remarquables, son classement recule ! Introduction
d'une rgle d'or en matire de Scurit sociale, fusion des rgimes d'assurance maladie double
d'une budgtisation des branches maladie et famille, utilisation approprie des nouvelles technologies
de l'information, volutions possibles de la mdecine gnrale au regard des nouvelles attentes des
jeunes praticiens dont les femmes constituent une majorit, constituent les voies d'avenir possibles
prsentes dans la deuxime partie. Au titre des nouveaux thmes traits dans ce Carnet 2012, deux
politologues analysent la manire dont les ides viennent aux politiques. Le premier, amricain,
traitera du cas gnral, quand le second, franais, l'illustrera partir de l'exemple de notre pays
(d'aprs la 4me de couv.)

Lafitte, M. (2007). Les systmes d'information en sant, Paris : Les Editions de sant

Cet ouvrage est un plaidoyer en faveur du rle majeur et structurant des technologies de l'information
et de la communication dans la mise en place d'un nouveau paradigme organisationnel, en voie
d'mergence, celui de l'exercice mdical en rseau.

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Larcher, P. et Polomeni, P. (2001). La sant en rseaux : objectifs et stratgie dans une collaboration ville-
hpital, Paris : Masson

Deux circulaires ont lanc ds 1991 le concept de rseaux ville hpital et en 1994 celui de
rseaux de sant . C'est lors de la rforme hospitalire de 1996 qu'est apparue dans la loi l'expression
rseaux de soins , autre concept qui figurait galement dans l'ordonnance relative la matrise
mdicalise des dpenses de soins avec un sens encore diffrent. Cet ouvrage, faisant le lien entre la
thorie et la pratique, a pour but de permettre aux professionnels des mondes mdical et mdico-
social de retrouver leurs marques dans cette confusion smantique pour assurer au patient une
meilleure orientation, coordination, continuit des soins et une meilleure qualit des prestations dans
ses allers-retours entre les professionnels des systmes de soins de ville et l'hpital. Sont galement
abords les enjeux thiques, techniques, financiers, et de politique de sant rsultant d'une telle
organisation, ainsi que l'volution des textes pour s'adapter cette transversalit nouvelle entre ville
et hpital.

Ngouyombo, B. (2010). Russir le DMP, Paris : Institut Montaigne

[Link]
Le dossier mdical personnel (DMP) est dfini par le ministre de la Sant comme : un ensemble de
services permettant aux patients et aux professionnels de sant autoriss par celui-ci de partager,
sous forme lectronique, des informations de sant juges utiles et pertinentes pour amliorer la
prvention, la continuit, la coordination et la qualit des soins. Personnel et partag, il est accessible
en tout point du territoire et tout moment . Introduit par la loi du 13 aot 2004, le DMP aurait d
tre mis en place en 2007, il y a trois ans dj. Aprs de nombreux cueils, les autorits ont dlaiss le
projet alors que fleurissaient des initiatives locales innovantes. En avril 2009, le ministre de la Sant
annonce une relance du DMP en promettant le dploiement d?une premire version nationale avant
fin 2010. Meilleure coordination des soins, matrise des dpenses, accs facilit l?ensemble des
informations concernant les patients? Les difficults rencontres lors de la mise en ?uvre du DMP ont
t la hauteur des enjeux.

Routier, C., et Arripe, A. (2010). Communication & sant : enjeux contemporains, Villeneuve d'Asq : Presses
universitaires du Septentrion
[Link]
La communication est au cur de la sant contemporaine depuis les politiques publiques jusqu la
relation patient -soignant, derrire la mdiatisation de notre systme de sant et ses volutions, dans
la rencontre de publics htrognes par des professionnels multiples. Linterdisciplinarit est
dsormais le matre mot et la communication, le carrefour des questions mergentes du monde de la
sant. Considrer chacun dans son vcu de la maladie, tracer lvolution des conceptions et des
modles de la sant, dvelopper le travail en rseau pour une sant globalise, partager linformation
et les connaissances mdicales avec le plus grand nombre. Tels sont quelques-uns des enjeux abords
dans cet ouvrage. En dialogue avec les professionnels et avec la socit civile, une trentaine de
chercheurs dveloppent ici leurs analyses des rseaux de sant, du discours des mdias, de lusage des
TIC (technologies de linformation et de la communication) et des lieux de soin. Les tudiants et
enseignants en Sciences de linformation et de la Communication seront directement interpells par
ces analyses. Par la varit des travaux rassembls, cet ouvrage est une contribution indite qui
sduira galement tout lecteur universitaire intress aux apports des sciences humaines et des
sciences sociales en sant. Enfin, les cadres intermdiaires et suprieurs du monde de la sant y
trouveront galement des perspectives (4e de couverture).

Venot, A. . (2013). Information mdicale, e-sant. Fondements et applications, Paris : Springer-Verlag France

Linformatique mdicale est devenue au fil des annes une vraie discipline scientifique dont les bases
et applications sont enseignes non seulement dans tous les domaines de sant (mdecine,
odontologie, pharmacie, maeutique, sciences sanitaires et sociales, cole de soins infirmiers et de
kinsithrapie, coles de sant publique) mais galement dans de nombreux autres cursus (Sciences
de la vie, coles dingnieur et dconomie, etc.). Ce livre est le fruit du travail collectif de nombreux
auteurs appartenant principalement au Collge franais des enseignants chercheurs de cette
discipline. Il est compos de 19 chapitres qui comportent tous des objectifs pdagogiques, des conseils
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pour approfondir les connaissances dans le domaine et des exercices.

Articles

(2009). "Feuilles de soins papier ou lectroniques ? Les pratiques des mdecins et des professionnels de sant."
Point D'information (Cnamts): 11.
[Link]
Certains professionnels restant encore rticents la tltransmission, l'Assurance Maladie a voulu
comprendre pourquoi de telles disparits de pratiques subsistaient d'un professionnel de sant
l'autre. L'objectif tant de faire un point sur les pratiques des professionnels de sant, et en particulier
des mdecins, pour cerner d'ventuels freins au recours la feuille de soins lectronique, dans le
contexte des dispositions de l'article 53 de la loi Hpital Sant Patients Territoires du 21 juillet 2009.

(2011). "L'informatique au service de la Scurit sociale." Regards(40): 238.

[Link]
Ce fascicule aborde l'informatique au service de la Scurit sociale sous les angles suivants :
informatique et offre de services, informatique et efficience, informatique et contrles.

(2015). "Parcours de soins, parcours de sant." Risques & Qualite En Milieu De Soins 12(3): 88 , tab., graph., fig.
[Link]
de-soins-parcours-de-sante/
Ce numro spcial de la revue Risques & Qualit rassemble une srie d'articles sur la thmatique du
parcours de soins, fruit de la contributions d'une quarantaine de rdacteurs. Les articles portent sur
des programmes de parcours de soins mis en oeuvre par la Cnamts, le ministre charg de la sant, la
Has... mais aussi sur des expriences rgionales ou locales. Ils couvrent des situations mdicales
complexes : les soins aux ans, la cancrologie, l'insuffisance cardiaque...et plus gnralement la
sortie de l'hpital et le retour domicile, la coopration ville-hpital, l'organisation territoriale.

Adda, D. (2010). "Tic et Hpital. Le retour sur investissement, au service de l'quilibre budgtaire." Gestions
Hospitalieres(495): 261-263.

[BDSP. Notice produite par EHESP R0x8m7Gr. Diffusion soumise autorisation]. Le groupement pour
la modernisation du systme d'information hospitalier (GMSIH) a publi un guide destination des
tablissements pour les aider dans leur choix de dpenses d "investissement". Dans le cadre de la
rforme hospitalire et du programme "hpital 2012", les dcisions et moyens mis en oeuvre
concernant le dveloppement ou la modernisation des systmes d'informations hospitaliers doivent
dsormais s'inscrire dans une dmarche de bonnes pratiques d'achat. Le retour sur investissement (ou
return on Investment, ROI) fait naturellement partie des outils d'analyses intgres dans la gestion de
ces grands projets. Il fait partie du processus dcisionnel, se rvle un critre de choix et un outil de
gestion de projet dans le cadre des relations hpitaux/fournisseurs.

Aleksy, B., et al. (2011). "Modlisation des systmes hospitaliers : des laboratoires de recherche en
informatique et des CHU unissent leurs comptences." Techniques Hospitalieres(729): 43-46.

[BDSP. Notice produite par EHESP Al9R0x8B. Diffusion soumise autorisation]. En 2004, le CHRU de
Clermont-Ferrand a fait appel au laboratoire d'informatique, de modlisation et d'optimisation des
systmes (Limos) du Centre national de la recherche scientifique, unit mixte de recherche 6158, afin
de modliser une partie de son organisation. L'ide tait de construire une base de connaissance
suffisamment dtaille qui permette une simulation et une analyse prcise des organisations, qui
fournisse un ensemble d'outils d'aide la dcision et qui assure un accompagnement au changement
pour les professionnels de sant. Ces tudes de modlisation ont fait apparatre des problmes
nouveaux et difficiles rsoudre et ont conduit les CHRU de Clermont-Ferrand, Montpellier, Marseille
et des laboratoires de recherche en informatique construire un partenariat intertablissements sur
les domaines de l'informatique, des systmes d'information et de l'organisation. Cet article fait le
point sur la mthodologie de recherche et les rsultats obtenus dans le cadre du premier partenariat
et dcline les objectifs et axes de travail dvelopps dans le second projet.
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Alexandre, L., et al. (2001). "L'avenir de l'internet sant et sa place dans le systme de sant." Technologie Et
Sante(44): 71-76.

Assyag, P., et al. (2009). "RESICARD: East Paris network for the management of heart failure: absence of effect
on mortality and rehospitalization in patients with severe heart failure admitted following severe
decompensation." Arch Cardiovasc Dis 102(1): 29-41.

BACKGROUND: Heart failure presents a major public health problem due to its high prevalence and
the increasing number of hospital admissions for this condition. A coordinated healthcare network
involving general practitioners and cardiologists was set up in the east of Paris in an effort to improve
the management and outcomes of patients with severe heart failure. AIMS: To reinforce patient
education, improve compliance with medications and identify symptoms requiring treatment
modification. METHODS: In this 'before and after' study, the control group comprised patients
hospitalized for severe heart failure who received conventional management in the year preceding the
network set-up. The comparative group consisted of patients hospitalized for severe heart failure who
underwent network-led care. RESULTS: No significant differences were found between rates of first
rehospitalization and all-cause mortality at 1 year between control and network groups, or between
rates of first hospitalization due to cardiac causes, time to the first event, duration of hospitalization,
rates of cardiac death or time to death. CONCLUSIONS: In this non-randomized study, we found no
benefit from management according to the RESICARD healthcare network in terms of mortality or
hospitalization in patients with severe chronic heart failure.

Auquier, L. (2000). "Informatisation des donnes mdicales et confidentialit." Bulletin De L'academie

Nationale De Medecine 184(4): 827-845.

Cet article est le rsultat d'une rflexion d'un groupe de travail constitu de mdecins appartenant au
Conseil National de l'Ordre des Mdecins et l'Acadmie Nationale de Mdecine. Il prsente diverses
recommandations relatives aux points suivants : - le langage de l'informatique appliqu l'exercice de
la mdecine ; - la transmission informatique des donnes mdicales ; - le respect de la confidentialit
et du secret mdical ; - la dlimitation du dossier mdical et du carnet de sant.

Baratta, N. (2001). "Systme d'information de sant : Comment passer l're de l'interconnexion des
applications." Decision Sante(174): 18-23.

[BDSP. Notice produite par ENSP u9R0x5tD. Diffusion soumise autorisation]. Les professionnels de
sant sont dsormais incits - voire contraints - s'adonner, bon gr mal gr, aux joies de la
tltransmission des FSE, des changes d'images numriques ou de la communication de donnes
mdicales. Pourtant, malgr l'effort des organismes de normalisation pour homogniser les
protocoles aux plans national et international, malgr la monte en puissance de la carte Vitale, le
parc informatique libral et hospitalier franais reste un amas de dispositifs disparates et htrognes.
Des lacunes dont sont bien conscients les industriels du SNIIS, lesquels avaient organis, en
collaboration avec Dcision et Stratgie Sant, un sminaire dans le cadre d'Informedica 2001 sur
"l'informatisation des donnes sant".

Barberousse, P., et al. (2010). "Tic et Territoires. SIH rgional : l'exprience de la Franche-Comt." Gestions
Hospitalieres(495): 206-211.

[BDSP. Notice produite par EHESP 8R0xl8Gr. Diffusion soumise autorisation]. Dans le contexte actuel
de rforme du systme de gouvernance des systmes d'information de sant, le dveloppement d'un
Systme d'Information Hospitalier (SIH) rgional semble une piste d'innovation. Cet article prsente
l'exprience de la Franche-Comt dans la mise en oeuvre de son SIH rgional. Diffrentes tapes du
projets sont dtailles : projet de mutualisation autour du SIH ; Projet de soutien au dveloppement
de processus mdicaux et projets de dveloppement du socle d'infrastructure de la plateforme
rgionale. Un retour d'exprience permet d'apprcier les facteurs cls de succs en ce qui concerne la
mutualisation.

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Baudot, P. Y., et al. (2015). "Open et big data." Informations Sociales(191): 115.
[Link]
Le mouvement douverture des donnes administratives, appel open data ou donnes ouvertes
, participe la rforme de ltat. La notion de big data ( donnes massives ), souvent associe
au terme dopen data, relve dune toute autre dmarche. Celle-ci vise exploiter sous un angle
nouveau des donnes cres lorigine pour une finalit dtermine. Le big data dsigne galement le
travail denrichissement des donnes par leur croisement, par exemple en appariant diffrentes
sources statistiques pour lier lobservation de comportements dusage et des donnes sur le profil
socio--conomique des personnes. Ce numro de la revue Informations sociales cherche tout dabord
comprendre les raisons de louverture des donnes mais aussi valuer limpact de ce mouvement
sur les acteurs de laction publique. Le soutien politique cette dmarche est motiv par la
relgitimation des pratiques de gouvernement que permettrait louverture des donnes, celles-ci
rendant plus transparente laction des pouvoirs publics. Les oprations dinformatisation ncessaires
la production de donnes de qualit impliquent une transformation des modalits dorganisation et
des primtres professionnels des administrations comme de leur contrle. La spcificit du secteur
social en matire douverture des donnes publiques et dusage des donnes massives peut ainsi tre
interroge tant sur le plan juridique quconomique.

Baudot, P.-Y., et al. (2015). "Open et big data." Informations Sociales(191): 1-105.

[BDSP. Notice produite par APHPDOC E9nR0xr7. Diffusion soumise autorisation]. La rvolution
numrique transforme nos socits et nos vies. Entre autres caractristiques, elle gnre la
production d'immenses quantits de donnes. L'effet conjugu de l'augmentation exponentielle de la
puissance de calcul et de stockage des ordinateurs permet ainsi aux acteurs publics et privs de
disposer de moyens ingals dans l'histoire pour analyser et diffuser leurs donnes. Ce mouvement
d'ouverture des donnes administratives, appel "open data" ou "donnes ouvertes", est souvent
prsent comme une voie de la rfome de l'Etat. La notion de "big data" ("donnes massives"),
souvent associes au terme d'open data, relve d'une toute autre dmarche. Ce numro cherche tout
d'abord comprendre les raisons de l'ouverture des donnes mais aussi valuer l'impact de ce
mouvement sur les acteurs de l'action publique. (Premire partie). Le soutien politique cette
dmarche est motiv par la relgitimation des pratiques de gouvernement que permettrait l'ouverture
des donnes, celles-ce rendant plus transparente l'action des pouvoirs publics (Deuxime partie). Les
opration d'informatisation ncessaires la production de donnes de qualit impliquent une
transformation des modalits d'organisation et des primtres professionnels des administrations
comme de leur contrle. La spcificit du secteur social en matire d'ouverture des donnes publiques
et d'usage des donnes massives peut ainsi tre interroge tant sur le plan juridique qu'conomique
(Troisime partie). (Extrait du R.A.).

Bayat, S., et al. (2008). "Modelling access to renal transplantation waiting list in a French healthcare network
using a Bayesian method." Stud Health Technol Inform 136: 605-610.

Evaluation of adult candidates for kidney transplantation diverges from one centre to another. Our
purpose was to assess the suitability of Bayesian method for describing the factors associated to
registration on the waiting list in a French healthcare network. We have found no published paper
using Bayesian method in this domain. Eight hundred and nine patients starting renal replacement
therapy were included in the analysis. The data were extracted from the information system of the
healthcare network. We performed conventional statistical analysis and data mining analysis using
mainly Bayesian networks. The Bayesian model showed that the probability of registration on the
waiting list is associated to age, cardiovascular disease, diabetes, serum albumin level, respiratory
disease, physical impairment, follow-up in the department performing transplantation and past
history of malignancy. These results are similar to conventional statistical method. The comparison
between conventional analysis and data mining analysis showed us the contribution of the data
mining method for sorting variables and having a global view of the variables' associations. Moreover
theses approaches constitute an essential step toward a decisional information system for healthcare
networks.

Berbain, X. et Minvielle, E. (2001). "L'informatique dans la gestion quotidienne des units de soins : la barrire
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de l'apprentissage." Sciences Sociales Et Sante 19(3): 77-106.

L'informatisation des units de soins constitue un enjeu affich pour amliorer l'organisation de la
prise en charge des malades. Mais comment se dcline cet enjeu dans les faits ? A partir d'une tude
de cas ralise dans quatre units de soins d'un mme hpital, cette recherche rvle les
dysfonctionnements quotidiens qui accompagnent l'introduction de l'informatique dans les collectifs
de travail. Ces dysfonctionnements illustrent les dfaillances d'une dmarche d'apprentissage dont les
modalits actuelles reposent pour l'essentiel sur la valeur d'usage que les professionnels de soins
prtent l'informatique. Une grande partie d'entre eux ont beaucoup de mal s'abstraire du niveau
instrumental de l'outil. L'accs d'autres niveaux d'apprentissage, gestionnaire et organisationnel, est
limite. En miroir, ces rsultats conduisent dfinir les conditions d'une introduction plus rationnelle
de l'informatique de gestion dans les units de soins. Cet article est complt par un commentaire
critique d'Armand Hatchuel, professeur en gestion de l'Ecole des Mines de Paris (pp. 107-108).

Besselere, R., et al. (2011). "Vingt ans de communication l'hpital." Techniques Hospitalieres(727): 40-59,
graph., ill.

[BDSP. Notice produite par EHESP 8lR0xHlm. Diffusion soumise autorisation]. Les XIXmes Journes
nationales de l'association des technologies de communication hospitalire Athos se sont droules
les 7 et 8 octobre 2010 Saint-Raphal (83). Ces journes ont t l'occasion de prsenter plusieurs
expriences et projets mis en place dans des centres hospitaliers. Parmi ces projets : - la sensibilisation
de onze tablissements de la rgion Picardie la scurit de l'information - la dmatrialisation des
comptes rendus d'hospitalisation au centre hospitalier universitaire de Rennes - l'intgration de la
tlradiologie dans l'activit quotidienne du centre hospitalier du Val-de-Sane Pierre-Vitter Gray -
la mise en place d'une information tactile au lit du patient au CH de Valence - la mise en place d'un
rseau wifi multi-applications au sein du ple mre-enfant du groupe hospitalier du Havre. D'autres
thmes ont t galement abords durant ces journes : l'volution des technologies au service des
soignants, du minitel l'application web, a t voque ainsi que les finalits et enjeux de la go-sant
ou "systme d'information gographique" (SIG).

Bonhomme, C. (2014). "Cinq questions Gilles Babinet : Digital champion franais auprs de la Commission
europenne." Revue Hospitaliere De France(559): 54-55.

[BDSP. Notice produite par EHESP D8R0xIFr. Diffusion soumise autorisation]. Gilles Babinet a t
nomm "Digital champion" et reprsente, ce titre, la France auprs de la Commission europenne
pour les enjeux du numrique. Auteur de deux ouvrages, il identifie cinq domaines intrinsquement
lis au numrique : la connaissance, l'ducation, la sant, l'industrialisation/production et l'Etat.

Bossi, J. (2013). "Secteur mdico-social et systmes d'information. Les enjeux." Revue Hospitaliere De
France(550): 16-17.

[BDSP. Notice produite par EHESP R0xoBnCp. Diffusion soumise autorisation]. Alors que la
coordination des acteurs sanitaire et mdico-sociaux apparat indispensable une qualit de prise en
charge globale de la personne et conduit l'mergence de nouveaux modes d'exercice au sein de
maisons, centres et rseaux de sant, de nombreux freins de diverses natures limitent encore cette
coordination : outils de messagerie rarement scuriss, dossiers patients informatiss non
interoprables, etc.

Bourquard, K. (2007). "Dossier mdical partag ou personnel : situation internationale." Pratiques Et

Organisation Des Soins 38(1): 55-67.
[Link]
[BDSP. Notice produite par CNAMTS mhR0x9Fm. Diffusion soumise autorisation]. Afin d'apporter un
clairage international aux questions poses en France par la mise en oeuvre du DMP, l'auteur a
analys les aspects d'organisation du territoire, de stratgie, de conduite du changement et de cadre
technique. Les pays abords sont les tats europens, les tats-Unis et le Canada, l'Australie et le
Japon.

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Brion, P. (2000). "Une stratgie gagnante de mise en place d'un dossier de soins informatis." Gestions
Hospitalieres(392): 33-36.

[BDSP. Notice produite par ENSP QJBmeR0x. Diffusion soumise autorisation]. En 1992, la mise en
place d'un dossier de soins individualis et complet l'hpital Fernand-Widal (AP-HP) paraissait une
mission presque impossible. Aujourd'hui tout semble avoir t trs simple. Pourquoi cet cart ? Nous
insisterons ici sur la stratgie de mise en place et sur les diffrents lments du dossier de soins en
laissant volontairement de ct les aspects qualitatifs et quantitatifs des rsultats obtenus ainsi que
leur interprtation.

Brouchet, J., et al. (2005). "Dossier mdical personnel : du projet la ralit. Numro spcial." Bulletin De
L'ordre Des Medecins(3): 3-16.

[BDSP. Notice produite par ORSIF mMJpR0xh. Diffusion soumise autorisation]. Deux nouvelles lois
structurent l'avenir du systme de sant franais : la loi de sant publique du 9 aot 2004 et la loi
relative l'Assurance maladie du 13 aot 2004. Un nouvel quilibre est maintenant construire entre
des forces issues de la volont de planification et la dynamique du march. Ce numro spcial du
Bulletin de l'Ordre des Mdecins est consacr au "Dossier mdical personnel" et doit permettre de
coordonner la trajectoire de soins du malade par le mdecin traitant, et en particulier le suivi du
malade et de la maladie chronique. Diffrents aspects du sujet sont abords par des articles tels que : -
les enjeux du dossier mdical personnel - la confidentialit, condition sine qua non - peut-il exister un
"droit l'oubli" ? - comment les donnes de sant sont-elles conserves ? - sur le terrain : - l'hpital
europen Georges Pompidou - Addica, un rseau en Champagne-Ardenne - l'exprimentation de la
Mayenne - le contexte europen : et demain, un dossier mdical europen ? En plus de ces articles,
des petits entretiens, points de vue et commentaires sont donns par divers mdecins ou personnes
du milieu mdical.

Brudieu, E., et al. (2005). "Place de l'informatisation du circuit du mdicament dans la stratgie de lutte contre
l'iatrognie mdicamenteuse : exprience du CHU de Grenoble." Techniques Hospitalieres(690): 38-
45, ill.

[BDSP. Notice produite par ENSP R0x88XPU. Diffusion soumise autorisation]. Le CHU de Grenoble
s'est engag depuis 1994 dans une dmarche de scurisation du circuit du mdicament s'appuyant sur
son informatisation. Outre le respect du cadre rglementaire, cette dmarche permet de limiter
l'iatrognie par l'optimisation de la circulation de l'information entre les diffrents acteurs de soins et
par une "rappropriation de tche" pour les trois acteurs majeurs de ce circuit que sont le mdecin, le
soignant et le pharmacien.

Burg, S., et al. (2005). "Informatisation de l'acquisition et de l'archivage des images d'chographie : intrt
conomique et organisationnel." Techniques Hospitalieres(690): 66-69.

[BDSP. Notice produite par ENSP HRFegR0x. Diffusion soumise autorisation]. Cet article nous
prsente la mise en place d'un systme informatis d'acquisition, de sauvegarde et d'impression
d'images d'chographies (vidos et images statiques) par le service de mdecine nuclaire du CHU de
Poitiers. La solution technique adopte a permis de librer un quivalent temps plein personnel et de
raliser des conomies substantielles au niveau des consommables.

Caillol, H. (2015). "Ouverture des donnes de sant : l'exprience de l'Assurance maladie." Informations
Sociales(191): 60-67.

[BDSP. Notice produite par APHPDOC mR0xmqAo. Diffusion soumise autorisation]. L'Assurance
maladie met disposition des donnes ouvertes sur les professionnels de sant et les assurs, qui
prsentent un fort potentiel. L'objectif est d'largir le primtre des donnes centralises et celui des
destinataires tout en garantissant la protection des donnes individuelles. Ralise progressivement,
l'ouverture s'est appuye sur un accompagnement des utilisateurs qui a volu vers la coopration et
le partenariat. (R.A.).

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Carrier, N., et al. (2004). "Banque de donnes hospitalires de France : module mdico-pharmaceutique -
Exercice 2002. Activit et dpense mdicales : un outil d'analyse et de comparaison." Revue
Hospitaliere De France(497): 58-63.

[BDSP. Notice produite par ENSP THHsRR0x. Diffusion soumise autorisation]. La dmarche engage
par une centaine d'tablissements publics participant l'chantillon du module mdico-
pharmaceutique constitue un observatoire original de la dpense mdicale hospitalire, permettant
ses adhrents de se comparer entre eux et d'analyser leur propre volution. Les donnes prsentes
par l'quipe BDHF de la Fdration hospitalire de France permettent de comparer les pratiques, et
donc de sensibiliser et responsabiliser les ordonnateurs de la dpense mdicale que sont les
prescripteurs.

Cauhape, J. et Raveneau, V. (2008). "Mise en place d'un Systme Dcisionnel Informatis : vers un outil de
pilotage commun aux ples d'activit et la direction." Journal D'economie Medicale 26(1-2): 79-90,
fig.

[BDSP. Notice produite par ORSRA 7R0xtqJj. Diffusion soumise autorisation]. La mise en place, au CHI
Elbeuf Louviers, d'un Systme Dcisionnel Informatis, a t valide dans le projet d'tablissement
2006-2011. Cette communication fait le point sur les tapes mises en oeuvre fin 2007, sur les raisons
du succs et les cueils viter.

Coignard, B., et al. (2011). "e-SIN : un nouvel outil au service du signalement des infections nosocomiales."
Bulletin Epidemiologique Hebdomadaire(15-16-17): 204-.
[Link]
[BDSP. Notice produite par InVS 9nJ9JR0x. Diffusion soumise autorisation].

Colin, C., et al. (2007). "Le dossier mdical personnel." Actualite Et Dossier En Sante Publique(58): 17-56.

[BDSP. Notice produite par ENSP 0F8W4R0x. Diffusion soumise autorisation]. Ce dossier runit en
quelques pages tout ce que le systme de sant franais porte comme espoir : une meilleure vie pour
tous, et comme contraintes : l'ensemble mal arrang de systmiques stratifies et de comportements
individuels divergents, qui surprend plus d'un observateur extrieur. Gageons que la constance avec
laquelle sont appliques les rformes dans le systme de sant nous conduise au progrs sanitaire et
social.

Cordier, M. (2009). "Enqute " Changements organisationnels et informatisation " dans le secteur de la sant
COI-H." Serie Sources Et Methodes - Document De Travail - Drees(8): 29 , tabl., fig., ann.
[Link]
Les hpitaux ont connu, linstar des entreprises du secteur marchand, des changements de grande
ampleur tant sur le plan de leur organisation, que des outils informatiques utiliss : utilisation de
systmes dinformation mdicaliss, traabilit des actes raliss, certification, etc. Ces changements
doivent pouvoir tre apprcis, de manire conjointe, du point de vue des directions hpitaux et de
cliniques qui les mettent en ?uvre, et du point de vue des agents. Lenqute COI-H ralise par la
Direction de la recherche, des tudes, de lvaluation et des statistiques (Drees) en collaboration avec
le Centre dtudes de lemploi (CEE) est lextension dans le secteur hospitalier du dispositif denqute
COI 2006. Il sagit dune premire dans le secteur de la sant, qui a ncessit une adaptation
importante du questionnaire du volet employeurs pour correspondre aux situations rencontres
par les tablissements de sant. Ce travail a t men sur la base dentretiens approfondis auprs
dune vingtaine de directeurs et responsables de structures hospitalires et a fait lobjet dune large
concertation au sein du ministre de la sant. Ce document prsente la dmarche, les traitements et
les rsultats de lenqute.

Coudreau, D. (2006). "Hbergeur de donnes mdicales, un nouvel acteur de la rgulation des soins." Seve : Les
Tribunes De La Sante(10): 51-57.

Cet article s'appuie sur l'opration de mise en place du dossier mdical personnel (DMP) et ses
conditions de ralisation pour illustrer concrtement la fonction " d'hbergement de donnes de
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sant caractre personnel ". Aprs avoir dcrit le cadre juridique strict qui entoure la qualit
d'hbergeur de donnes, il examine le rle qui leur est attribu dans la monte en charge du DMP,
avant de s'interroger sur la mise en place que ces nouveaux venus pourraient tre amens occuper
dans le paysage, au demeurant encombr , de tous ceux qui entendent jouer un rle dans la
rgulation du systme de soins franais (d'aprs l'introduction du l'auteur).

Coudreau, D., et al. (2007). "Dossier mdical personnel : vers un partage de l'information." Regards De La
Fhp(48): 17-41.

[BDSP. Notice produite par EHESP 7B8D8R0x. Diffusion soumise autorisation]. Malgr les retards pris
pour sa gnralisation, le projet "Dossier Mdical Personnel" apparat comme tant le plus important
chantier relatif aux Systmes d'Information de Sant que le pays ait jamais entrepris. Les larges
concertations organises par le GIP-DMP ainsi que le bilan des exprimentations qui se sont droules
en 2006 ont t riches d'enseignement pour la future phase de gnralisation. Cependant ce jour, le
cadre lgislatif n'est pas encore dfinitivement tabli et certains aspects techniques restent en cours
de discussion, notamment au niveau des changes d'informations entre les tablissements de sant et
le DMP. La FHP a souhait recueillir les tmoignages de diffrents intervenants afin d'apporter un
nouvel clairage dans la faon d'apprhender la gnralisation du DMP. Ces lments peuvent
galement alimenter la rflexion des cliniques prives sur les orientations donner pour le
dveloppement de leur Systme d'Information Hospitalier.

Couray, Targe, S., et al. (2001). "Les donnes du PMSI vise stratgique : mthodes de segmentation." Journal
D'economie Medicale 19(7-8): 463-471, rs., tabl.

[BDSP. Notice produite par ORSRA 7jR0xTFO. Diffusion soumise autorisation]. Dans le cadre du PMSI,
en sus des traditionnels casemix par GHM, deux grandes catgories d'outils d'analyse d'activit ont t
dvelopps en France ces dernires annes. La premire catgorie englobe les mthodes utilisant les
regroupements de GHM, le plus souvent labors dans le cadre des Comits Techniques rgionaux
d'information mdicale : les groupes fonctionnels et les groupes d'activit, les G-GHM, les OAP. La
seconde catgorie comprend des mthodes dveloppes au niveau local dans un objectif
d'amlioration de la description des prises en charge hospitalires, ce sont le plus souvent des
segments de diagnostics et/ou d'actes. L'objectif de ce travail est double : d'une part, prsenter ces
diffrentes mthodes et d'autre part, en discuter les limites respectives. (R.A.).

Courbis, T. (2010). "Tic et Hpital. Le design organisationnel." Gestions Hospitalieres(495): 239-240.

[BDSP. Notice produite par EHESP jH888R0x. Diffusion soumise autorisation]. Pour matriser les cots
de sant tout en offrant les soins les plus efficients, les technologies de l'information et de la
communication (TIC) doivent dsormais tre associes aux autres technologies hospitalires. Il devient
ainsi indispensable de concevoir l'intgration du "tout numrique" ds les phases architecturales
d'une construction ou reconstruction hospitalire. Pour atteindre cet objectif, il faut rinventer
l'hpital, ses organisations et ses murs autour des technologies. Nous appellerons "design
organisationnel" l'une des tapes essentielles de la russite d'un projet novateur. (R.A.).

Couvreur, C. (2010). "Projet de dossier mdical personnel et cadre national d'interoprabilit." Revue
Hospitaliere De France(536): 60-62.

[BDSP. Notice produite par EHESP tIR0xB9p. Diffusion soumise autorisation]. Le cadre
d'interoprabilit des systmes d'information de sant (CI-SIS) a t mis en place en octobre 2009 par
l'Agence nationale des systmes d'information partags de sant (ASIP Sant). Le projet de dossier
mdical personnel, sur lequel travaille l'ASIP sant depuis plusieurs mois, intgre aujourd'hui les
principes du CI-SIS. Cette intgration permet de prciser les conditions de sa mise en oeuvre, la
responsabilit des acteurs et ses modalits d'accs par les hospitaliers.

Crespel, A. et Gelisse, P. (2008). "[Healthcare networks in the Languedoc-Roussillon region]." Neurochirurgie

54(3): 475-478.

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Epilepsies Languedoc-Roussillon, a healthcare network in epileptology, was created in 1994 with all
practitioners interested in epileptology in this region of southern France. This network is autonomous,
receives no subsidies and works within the existing healthcare system. It proposes best practices for
epilepsy management from diagnosis to epilepsy surgery and continuing education. This network
provides patients with rapid accessibility to management of their epilepsy. In this paper, the history of
this network in southern France, its organization, actions and goals are discussed.

Curien, N. et Muet, P. A. (2004). "La socit de l'information." Rapport Du Conseil D'analyse Economique(47):
311.

La rvolution numrique constitue-t-elle une troisime rvolution industrielle ? Nous fait-elle basculer
dans la socit de l'information ? Quelles politiques pour lutter contre la fracture numrique ? Quelle
gouvernance mondiale de l'Internet ? Telles sont les questions que Nicolas Curien et Pierre-Alain Muet
abordent dans leur rapport, labor dans le cadre de la prparation au Sommet mondial sur la socit
de l'information, organis par l'ONU et l'UIT, qui se tient Genve en dcembre 2003 puis Tunis au
printemps 2005. Le rapport soutient que la rvolution numrique n'est pas seulement une rvolution
de l'information et de la communication, mais bien une troisime rvolution industrielle et que
l'mergence de l'entreprise en rseau, l'autonomisation croissante du travail, le rle accru des
marchs financiers dans l'innovation, la recomposition de la gestion des savoir et de la connaissance
en sont des phnomnes moteurs. Il met aussi en vidence un nouveau paradoxe de l'conomie
numrique : alors que les technologies de l'information et de la communication devaient en principe
favoriser un fonctionnement plus efficace de l'conomie de march, elles distillent en fait les
ingrdients d'une conomie publique. Les auteurs avancent galement diffrentes propositions afin
que la France et l'Europe du Sud rattrapent leur retard face aux Etats-Unis et l'Europe du Nord en
amplifiant et soutenant notamment l'effort des collectivits locales en matire d'quipement des
coles. Ils recommandent enfin qu' la suite du Sommet mondial, soit mise en place une vritable "
corgulation multi-acteurs ", sous la forme de groupe de travail runissant la puissance publique, les
industriels et les utilisateurs, en charge de faire des propositions dans la perspective du Sommet
mondial de Tunis.

De, Block, M. (2016). "MY GHT : Portail collaboratif patients/professionnels du bassin aubois." Revue
Hospitaliere De France(569): 54-55, fig.

[BDSP. Notice produite par EHESP C8HpR0x9. Diffusion soumise autorisation]. Prsentation du projet
OPTIMIPSTIC (OPTIMIsation du Parcours de Soins par les Technologies de l'Information et de la
Communication) mis en oeuvre aux Hpitaux Champagne Sud. Le projet a pour fer de lance un portail
ville-hpital ouvert en 2016 : le portail scurit My GHT. Dj actif pour les changes pharmaceutiques
aux patients et professionnels de sant, ce portail couvrira progressivement les activits mdicales et
paramdicales.

De, Montalembert, P. (2010). "Systmes d'information hospitaliers. Pas seulement un problme informatique."
Gestions Hospitalieres(500): 591-594.

[BDSP. Notice produite par EHESP m9R0xpsA. Diffusion soumise autorisation]. Notre revue ne s'est
pas d'emble intresse aux systmes d'information hospitaliers (SIH) : en 1960, le thme parat
encore trop difficilement cernable et les utilisations de l'informatique, certes dj prometteuses, ne
sont pas assez fiables pour pouvoir faire l'objet d'analyses rgulires. Les SIH ont ainsi d'abord vcu
une sorte de "prhistoire", une histoire floue.

Degoulet, P. et Fagon, J.-Y. (2004). "L'hpital communicant (1re partie) - Stratgies de mise en oeuvre des
systmes d'information cliniques." Gestions Hospitalieres(441): 793-800, graph., tabl.

[BDSP. Notice produite par ENSP R0xT3XR5. Diffusion soumise autorisation]. Aprs un bref rappel
historique du dveloppement des systmes d'informations cliniques, les auteurs passent en revue
plusieurs dimensions stratgiques de leur mise en oeuvre. Ils exposent les bnfices d'une approche
"horizontale" de l'informatique organise autour des processus de soins par comparaison aux risques
des systmes "verticaux" organiss autour des disciplines mdicales ou des mtiers. A partir de
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l'exprience de l'hpital europen Georges Pompidou, ils prnent une stratgie de dploiement
globale, par paliers successifs, par opposition l'approche parcellaire autour d'units pilotes. Ils
soulignent enfin le rle cl de la matrise d'ouvrage et le besoin de rappropriation par les dcideurs et
les utilisateurs de solutions trop souvent dictes par la recherche de la toute dernire technologie
informatique.

Delle-Vergini, N., et al. (2000). "Le dossier du patient et l'organisation des soins." Gestions Hospitalieres(392):
13-52.

[BDSP. Notice produite par ENSP rR0xBNfx. Diffusion soumise autorisation]. Dans ce dossier les
articles suivants sont dvelopps : La gestion prvisionnelle des soins GPS, le protocole de soins :
mthodes et stratgies ? l'anonymat des informations mdicales existe-t-il ? du dossier de soins papier
au dossier patient informatis, une stratgie gagnante de mise en place d'un dossier de soins
informatis, l'valuation des apports de l'informatisation des dossiers de soins, le dossier du patient
en tablissement psychiatrique, l'actualit de la coopration hospitalire en matire de soins.

Dimeglio, C., et al. (2015). "Big data et sant publique : plus que jamais, les enjeux de la connaissance."
Actualite Et Dossier En Sante Publique(93): 5-7.

[BDSP. Notice produite par EHESP A8ER0x9s. Diffusion soumise autorisation]. De nombreuses bases
de donnes existent dans le domaine de la sant. Quelles donnes intgrer ? Comment s'assurer de
leur fiabilit ? Pour quelle utilit avec quels risques ? (introd.).

Duhamel, S., et al. (2016). "Nouveaux projets d'organisation professionnelles : l'ambulatoire demain ?"
Medecine : De La Medecine Factuelle a Nos Pratiques 12(1): 26-28.

Les mdecins gnralistes ont t confronts ds 1996 aux changements technologiques touchant
leur pratique dans le cadre de linformatisation du systme de sant. Lavnement dun dossier
mdical informatis a permis la tltransmission, contrainte par le systme conventionnel. Le Dossier
Mdical Partag (DMP) na pas connu le succs escompt. Les dploiements de ces deux volutions
sont ns dexprimentations et de sites pilotes. Si des messageries scurises deviennent
oprationnelles aujourdhui, la simplicit nest pas au rendez vous, le service au patient peu visible.

Duhot, D., et al. (2009). "L'Observatoire de la Mdecine Gnrale. Un rseau et une base de donnes au service
de la mdecine gnrale en France." Primary Care 9(2): 41-45, tabl.
[Link]
Dvelopp pas pas depuis 15 ans, le rseau de la Socit Franaise de Mdecine Gnrale (SFMG)
rassemble prs de 600 mdecins gnralistes dont le quart dispose, ce jour, des outils informatiques
permettant d?alimenter la base de donnes de l?Observatoire. Les informations concernant les prises
en charge de prs de 700 000 patients sur la priode 1993-2008 sont la disposition de la recherche
mdicale et mdicoconomique, en France et l'international, mais aussi de la formation mdicale
initiale et continue. Cet outil est au service de tous, en particulier par l?intermdiaire de son site
Internet, accessible gratuitement ([Link]

Ebele, F. (2011). "Synergie et mutualisation en informatique de sant hospitalire. Une stratgie

d'tablissement (s)." Revue Hospitaliere De France(539): 82-88, graph.

[BDSP. Notice produite par EHESP CtR0xI8G. Diffusion soumise autorisation]. Le centre hospitalier de
Rouffach (Haut-Rhin) a initi ds 2000 la mutualisation en matire de gestion des systmes
d'information hospitaliers et mdico-sociaux. La certification intgre ISO 9001-ISO 20000 obtenue en
dcembre 2009 par la direction des systmes d'information du centre hospitalier, et son intgration le
1er janvier 2011 au groupement d'intrt public Sym@ris ouvrent de nouvelles perspectives. L'article
prsente cette exprience innovante et donne la place six tmoignages.

Ebele, F. et Trouche, J. (2000). "Du dossier de soins papier au dossier mdical informatis." Gestions
Hospitalieres(392): 26-32, graph.

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[BDSP. Notice produite par ENSP A4dLR0xC. Diffusion soumise autorisation]. Au dbut des annes
80, l'volution des soins infirmiers a amen les quipes infirmires du centre hospitalier de Rouffach
prciser leur conception des soins, rflchir leur pratique et restructurer l'organisation des soins.
Ainsi sous l'impulsion de Serge Gaubert, directeur du service de soins infirmiers, une vritable
politique du service infirmier a t mene. Elle englobe l'organisation, les moyens, les outils, les
rfrences thoriques, la formation, avec pour objectif de promouvoir des soins de qualit. Le dossier
de soins t progressivement mis en place dans les units de soins de l'tablissement entre 1983 et
1987. Durant la mme priode, un groupe de soignants a labor un outil d'valuation de la charge de
travail intitul "Evaluation des besoins en soins infirmiers (EBSI)" partir des soins requis par patient
en se rfrant au PRN 80. L'ensemble des soins infirmiers dispenss a t recens, dcrit, codifi,
quantifi et une valuation mensuelle de la charge de travail est ralise depuis 1986. En 1995,
l'quipe du service informatique a ralis, avec un groupe de soignants de l'tablissement, l'analyse
des donnes destines prparer l'informatisation du dossier de soins. Cette analyse s'inscrit dans le
cadre plus gnral du systme d'information hospitalier avec pour objectif de crer un logiciel traitant
du "dossier mdical du patient". Celui-ci intgre toutes les facettes de l'activit lie l'hospitalisation
du patient.

El, Sarra, J. L., et al. (2011). "Entrept de donnes autour du PMSI pour le pilotage d'tablissements
hospitaliers." Techniques Hospitalieres(729): 49-52.

[BDSP. Notice produite par EHESP l89R0x87. Diffusion soumise autorisation]. Pour mettre en place la
tarification l'activit (T2A), les gestionnaires hospitaliers doivent pouvoir analyser selon diffrentes
perspectives les donnes gres par le Programme de mdicalisation des systmes d'information
(PMSI) et les croiser avec des donnes externes celui-ci. Dans ce contexte, l'laboration d'un
entrept de donnes partir des donnes du PMSI mais intgrant d'autres sources de donnes est
indispensable. Cet article prsente une recherche en cours, mene dans le cadre d'une collaboration
CHU-laboratoires de recherche, relative l'laboration d'un entrept de donnes, en prenant en
compte la fois la spcificit des donnes et les besoins en analyse des gestionnaires hospitaliers.

Falise-Mirat, B., et al. (2010). "Tic et Hpital. Tic et performance des organisation des sant." Gestions
Hospitalieres(495): 245-249.

[BDSP. Notice produite par EHESP R0xponrC. Diffusion soumise autorisation]. La performance des
organisations de sant-dfinie par la qualit du service rendu la population, la ractivit des
organisations et l'quit des financements-dpend largement de la capacit mesurer, suivre et
piloter le systme. Pour ce faire, les technologies de l'information et de la communication (TIC) en
sont l'instrument privilgi, disposant de plus d'un potentiel majeur pour appuyer la transformation
du systme de sant. Nanmoins, malgr son impact dmontr sur la qualit des soins et
l'accessibilit, ce levier reste peu utilis, sans doute cause de la difficult apprhender la porte
conomique des investissements dans les TIC, en particulier la complexit de la rpartition des gains
engendrs. La condition pralable l'apparition de ces gains est de scuriser les projets de systmes
d'information, par leur cadrage, la mise en oeuvre de bonnes pratiques de gouvernance et la mise en
place d'une communication permettant de dvelopper l'usage des technologies implantes. RA.

Favereau, E., et al. (2006). "Information et sant : dossier." Seve : Les Tribunes De La Sante(9): 21-91.

La socit de l'information submerge le systme de sant. Les digues difies sur le secret mdical et
le colloque singulier menacent de cder sous le dferlement de l'information sanitaire. L'e-sant est
un des moteurs du dveloppement d'internet, la presse sant envahit les kiosques, l'informatisation
des dossiers mdicaux se gnralise dans de nombreux pays. L'volution se fait non sans mal : la carte
vitale a mis douze ans s'imposer, l'accs direct au dossier mdical date de 2002. Sve souhaite, dans
ce numro, apporter sa contribution l'indispensable analyse critique des enjeux et des effets de la
transformation qui s'accomplit depuis plusieurs annes. La socit d'Hippocrate pourra-t-elle
cohabiter avec la socit de l'information.

Fortune, F. (2011). "Scurit des donnes informatiques : trois tapes ncessaires." Techniques
Hospitalieres(725): 29-30.
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[BDSP. Notice produite par EHESP ADR0x8o9. Diffusion soumise autorisation]. Afin de diminuer les
atteintes la scurit des donnes confidentielles des patients, il est important de mettre en place
une stratgie globale de scurit dpassant le cadre de la conformit. Cet article prsente brivement
les trois tapes ncessaires pour la mise en place d'une telle stratgie.

Fouillet, A., et al. (2012). "La certification lectronique des dcs, France, 2007-2011." Bulletin Epidemiologique
Hebdomadaire(1): 7-10.
[Link]
numeros-et-archives/Archives/2012/BEH-n-1-2012
[BDSP. Notice produite par InVS 8rnR0xqH. Diffusion soumise autorisation]. Introduction - Depuis
2007, un nouveau mode de certification des dcs par voie lectronique est la disposition des
mdecins. Cette tude constitue la premire analyse pidmiologique des donnes collectes par ce
systme. Mthodes - La progression du dploiement de la certification lectronique a t value de
janvier 2007 septembre 2011. Une analyse comparative des dcs par ge, sexe, dpartement et par
cause mdicale de dcs selon le mode de certification (papier/lectronique) a t mene sur l'anne
2010. L'utilisation des donnes pour la surveillance sanitaire en temps rel est illustre travers
l'exemple de la grippe. Rsultats - En juin 2011, prs de 5% de la mortalit nationale tait certifie
lectroniquement, avec une rpartition htrogne par dpartement. Quatre vingt quatre pour cent
(84%) des certificats lectroniques taient enregistrs l'hpital (vs. 48% sur certificat papier). Les
dcs des personnes ges de plus de 85 ans taient les moins frquemment certifis par voie
lectronique. Quatre -vingt dix pour cent (90%) des dcs taient certifis dans le jour suivant le
dcs. Conclusion - Accessibles aux pidmiologistes quelques heures aprs le dcs, les donnes
issues de la certification lectronique constituent une amlioration considrable pour la surveillance
sanitaire. Toutefois, l'utilisation de ce systme pour une surveillance fiable un niveau national
impose une forte participation des tablissements de sant. (R.A.).

Fournereau, F. et Gadenne, A. (2016). "La dmatrialisation en marche : vers la troisime re des systmes
d'information en sant." Gestions Hospitalieres(555): 205-207, fig.

[BDSP. Notice produite par EHESP sqR0x8pp. Diffusion soumise autorisation]. Mise en oeuvre dans le
monde industriel et des services, la dmatrialisation a fait irruption dans le monde hospitalier avec
l'obligation rglementaire impose par le ministre des Finances pour la gestion des flux entre
ordonnateurs et comptables publics - flux PES V2, signature lectronique, dmatrialisation des pices
justificatives. (introd.).

Gagneux, M., et al. (2010). "Construire l'hpital numrique." Gestions Hospitalieres(495): 200-275, tabl., fig.,
carte.

[BDSP. Notice produite par EHESP B9R0x9DC. Diffusion soumise autorisation]. Depuis la mise en
place en avril 2009 du Programme de relance du DMP et des systmes d'information partags de
sant, la modernisation et le dveloppement des systmes d'information de sant sont devenus des
priorits nationales. C'est dans ce contexte que la rforme de la gouvernance des systmes
d'information de sant a alors commenc. Elle a notamment permis la cration de l'Agence des
systmes partags de sant (ASIP sant) et de l'Agence Nationale d'appui la performance
hospitalire (ANAP), toutes deux charges de la matrise d'ouvrage publique du dveloppement des
ces nouveaux systmes. Depuis le 14 avril 2010, cette nouvelle politique publique est lance. La
premire runion du comit stratgique du programme "hpital numrique" a fix les priorits
d'action pour la mise en oeuvre de ce plan dont les enjeux pour le soin deviennent capitaux :
organisation et gestion des tablissements de sant, performance du systme de soins, partage des
donnes mdicales, coordination des diffrents acteurs sant, qualit et scurit du soins.... Ce
dossier prsente une vingtaine d'articles organiss en trois thmatiques. Le premier thme "Tic et
territoires" revient sur les enjeux de la mise en place des systmes d'information de sant au niveau
rgional. Ceci notamment travers le Dossier Mdical Personnel et le dveloppement de la tl
mdecine. Le deuxime thme "Tic et Hpital" s'attache identifier les enjeux de l'utilisation des
nouvelles technologies de l'information au sein des hpitaux sur diffrents angles de vue : conception
architecturale, investissement, formation du personnel, valuation de la performance, droit mdical...
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Le dernier thme "Tic et Gouvernance" porte sur la gouvernance du risque lie l'utilisation des
nouvelles technologies de l'information en sant.

Georges-Picot, A., et al. (2008). "Capgemini Consulting. Rencontres Healthcare Information and Management
Systems Society (HIMSS)." Gestions Hospitalieres(480): 673-681.

[BDSP. Notice produite par EHESP pslBR0xE. Diffusion soumise autorisation]. Le congrs des
systmes d'information de sant aux USA (HIMSS) est un moment exceptionnel pour mesurer, anne
aprs anne, les tendances dans la mise en oeuvre et l'utilisation des systmes d'information dans la
sant aux USA et ce qui fondamentalement nous diffrencie nous, Europens, des approches des
acteurs nord-amricains. Cette session HIMSS Orlando - qui a fait suite celles de Dallas, San Diego
et la Nouvelle-Orlans - nous a fait percevoir quatre points majeurs : la place du retour sur
investissement ("return on investment" (ROI) dans les processus de dcision SIH ; la question du
"business model" du dossier mdical partag (DMP) reste ouverte : les projets de dossier mdical
personnel/partag ville/hpital existent aussi aux USA ; les alertes dans la lutte contre les "mdical
errors" ; la conduite du changement dans l'investissement projet : elle est au centre des
proccupations des responsables, car c'est elle la seule vraie garantie du retour sur investissement des
projets SIH. Tmoignages sur les utilisations du systmes d'information de sant aux USA : Plates-
formes rgionales de sant. Rencontre avec St Luke's Health System ; Optimisation du parcours
patient. La solution Awarix ; Florida Hospital Celebration Health. Visite guide... ; Une approche
territoriale de la sant : les RHIO (Regional Health Integration Organization). Jaxcare, le RHIO de
Jacksonville ; Epicenter d'EPIC. Un progiciel intgr de production de soins.

Gerbod, D. (2004). "L'hpital communicant (1re partie) - L'approche sectorielle sant. Facteur de convergence
de la technologie et des progiciels." Gestions Hospitalieres(441): 801-802.

[BDSP. Notice produite par ENSP PG01DR0x. Diffusion soumise autorisation]. Si les progiciels de
gestion intgrs - ou Enterprise Ressource Planning (ERP) - se sont imposs dans le secteur industriel,
leur diffusion dans les autres secteurs, et en particulier le secteur public, n'est pas aussi vidente.

Gervais, J.-B., et al. (2007). "Systme d'informations hospitaliers. Dossier." Decision Sante(239): 8-13.

[BDSP. Notice produite par ENSP LW6OR0xO. Diffusion soumise autorisation]. En matire de SIH, les
Etats-Unis font figure de mtre talon. Les chiffres parlent d'eux-mmes : alors que les hpitaux
publics franais ne consacraient qu'1,8% de leur budget aux SIH, les hpitaux amricains, eux,
caracolaient entre 5 et 8%. Quant au taux d'quipement en dossier patient informatis en France,
"20% des chu ont un DJI fiable, 40% sont en train de s'informatiser, et 20% en sont encore la phase
projet". Pas de quoi pavoiser... Pourtant, les performances amricaines cache un tat des lieux plus
nuanc, selon Denis Ducasse "l'association des hpitaux amricains tablit 30% de leurs
tablissements de sant n'ont pas de DMP, 11% l'on mis en oeuvre, et 50% seulement en partie". Des
statistiques proches de celles des CHU franais. Mais les pays scandinaves ont une longueur d'avance
81% des hpitaux sudois sont quips d'un dossier patient informatis. En France manque
d'interoprabilit, manque de comptence, manque de financement : les systmes d'information
hospitaliers font grise mine l'ore de la mise en place du plan Hpital 2012. Tour d'horizon des
blocages. Mais aussi des solutions. Qui va quiper les hpitaux franais. La tension a t forte ces
derniers mois sur le march des systmes d'information hospitaliers, et plus prcisment des
systmes cliniques.

Gimbert, V. (2012). "Les recommandations mdicales : un outil pertinent pour faire voluer les pratiques des
professionnels de sant ?" Note D'analyse (La)(291): 12.
[Link]
[Link]
Les recommandations mdicales se prsentent comme des documents crits destins aider le
praticien, ventuellement le patient, choisir la prise en charge la plus approprie en fonction d'une
situation clinique donne. Outil d'aide la dcision, ces recommandations visent aussi encadrer les
pratiques professionnelles, afin de rduire leur htrognit. Si les effets de ces rfrentiels sont trs
difficiles valuer, ils dpendent troitement de leur appropriation par les mdecins.
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Girault, D. (2013). "Programme Hpital numrique : le nouveau schma directeur des systmes d'information
hospitaliers ?" Gestions Hospitalieres(526): 273-275, graph.

[BDSP. Notice produite par EHESP kn8C8R0x. Diffusion soumise autorisation]. Dans les cours
d'informatique mdicale dispenss l'hpital Broussais par le Pr. Patrice Degoulet et son quipe, des
composants transversaux taient prconiss pour remplacer les applicatifs verticaux. (Dans l'article,
schma datant de 2002 prsentant une modlisation des composants d'authentification des
utilisateurs, d'identification des patients, de prescription informatise multimodale pour les mdecins,
de planification de ressources et d'agenda du patient, de pilotage mdico-conomique). En 2011, les
concepteurs du programme Hpital numrique (PHN) ont concrtis les concepts de production
hospitalire dcrits par Patrice Degoulet ; les trois prrequis et les cinq domaines prioritaires les
dclinent en trente-deux indicateurs mesurables et comprhensibles par la communaut hospitalire.
Leur mode de calcul est clairement dfini dans le "Guide des indicateurs" publi par la Direction
gnrale de l'offre de soins (DGOS).

Grall, J. Y., et al. (2008). "Rappels informatiques et recommandation. L'tude URIAP en mdecine." Medecine :
Revue De L'unaformec 4(10): 473-476.

La mise en oeuvre de pratiques fondes sur les donnes scientifiques est l'un des enjeux actuels. Mais
il est impossible au gnraliste, supposer mme qu'il connaisse toutes ces donnes, de les utiliser
dans le temps de la consultation. Des systmes informatiques d'aide la dcision mdicale (SIAD)
pourraient l'y aider. Objectifs : Montrer que l'utilisation de SIAD labors partir de recommandations
augmente le recours habituel ces recommandations. Mthode : Il est prvu deux tapes : 1)
identification et extraction des donnes utiles et pertinentes de recommandations pour former un
corpus de rappels (phase termine en juin 2008), 2) valuation de l'utilisation de ce corpus (fin prvue
avant juin 2009). Rsultats : L'outil a t dvelopp pour 3 recommandations : migraine (qui a servi de
pilote pour laborer le projet), insomnie de l'adulte et dpression. La premire phase de l'tude a
permis de prparer des rappels informatiques dans les 3 champs o ils sont habituellement reconnus
comme efficaces : alarmes, aide-mmoire pour la dcision et documents types. L'valuation d'impact
se fera par deux types d'audit, prospectif et rtrospectif, comparant un groupe intervention (utilisant
les rappels) un groupe tmoin (qui aura seulement lu les recommandations). Discussion : Si
l'efficacit des rappels pour la pratique est connue, leur utilit pour implmenter des
recommandations ne l'est pas. La participation active du mdecin leur mise au point devrait
favoriser l'appropriation des recommandations. La slection des seuls rappels utiles la pratique
devrait en viter la multiplication, contre-productive.

Gros, J. (2002). "Sant et nouvelles technologies de l'information." Avis Et Rapports Du Conseil Economique Et
Social(5): 92 , ann.

Les nouvelles technologies de l'information - tlmdecine, e-sant, cartes puces - bouleversent

profondment les pratiques dans le secteur de la sant. Cette volution est riche de potentialits pour
tous les acteurs, mais suscite aussi des apprhensions. Les moyens mettre en oeuvre pour
encourager ces progrs, le respect des droits de la personne, la scurit informatique, la qualit des
services proposs sur le web, la finalit mme de ces outils constituent autant d'interrogations. Le
Conseil conomique et social dfinit huit axes de propositions, afin que les NTIC contribuent
pleinement l'amlioration de la sant.

Guicheteau, J., et al. (2008). "Dossier patient informatis : une solution de dploiement originale." Revue
Hospitaliere De France(521): 35-37.

[BDSP. Notice produite par EHESP Eor89R0x. Diffusion soumise autorisation]. L'informatisation de la
production de soins et du dossier patient est un objectif prioritaire des tablissements de sant. Les
cots de dveloppement et de maintenance peuvent tre optimiss, le paramtrage partag et les
dlais de mise en oeuvre rduits par un nouveau mode de dploiement : l'Application Service
Provider. Le centre hospitalier de Valenciennes et le groupe Association hospitalire Nord Artois
cliniques, tablissement participant au service public hospitalier, ont conjugu leurs efforts. Ils
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dploient aujourd'hui sur ce mode leur solution de dossier unique du patient. (R.A.).

Hamel, M. B. et Marguerit, D. (2013). "Analyse des big data. Quels usages, quels dfis ?" Note D'analyse (La)(8):
11.
[Link]
La multiplication croissante des donnes produites et le dveloppement doutils informatiques
permettant de les analyser offre dinnombrables possibilits tant pour ltat que pour les entreprises.
Il ne fait aucun doute que le traitement de ces masses de donnes, ou big data, jouera un rle
primordial dans la socit de demain, car il trouve des applications dans des domaines aussi varis que
les sciences, le marketing, les services client, le dveloppement durable, les transports, la sant, ou
encore lducation. Par ailleurs, le potentiel conomique de ce secteur est indniable et les retombes
en termes demploi et de cration de richesse seront non ngligeables. Son dveloppement ncessite
toutefois de bien comprendre les enjeux qui y sont lis. C'est l'objectif de cette note, qui s'attache
dtailler ce qu'est l'analyse des big data et prsente les usages possibles de ces technologies, qu'il
s'agisse de rendre la gestion plus efficace, d'amliorer les services rendus ou de prvenir des
phnomnes nuisibles (pidmies, criminalit, etc.). Elle expose les principales difficults associes
ces usages : garantir la confidentialit et le respect de la vie prive. Enfin, elle montre comment
diffrents pays et entreprises ont dores et dj investi dans ce secteur (rsum d'auteur).

Hansske, A. (2013). "Tendances et stratgies en systmes d'information de sant." Revue Hospitaliere De

France(550): 14-15.

[BDSP. Notice produite par EHESP R0xqBptr. Diffusion soumise autorisation]. L'autre prsente
quelques axes et principes en matire de "e-mutation" en sant et revient sur les stratgies et
tendances observes travers les thmatiques et communications proposes par les salons
internationaux du secteur des technologies et systmes d'information en sant.

Jacquinot, C. et Letondel, F. (2005). "L'hpital communicant (2me partie) - Informatisation des plannings et du
temps de travail : une petite rvolution culturelle pour les agents et le management hospitalier."
Gestions Hospitalieres(442): 57-59.

[BDSP. Notice produite par ENSP 4R0xVS8Y. Diffusion soumise autorisation]. Depuis dix-huit mois, un
nouveau logiciel de gestion des temps de travail et des activits (GTA) est install dans deux
tablissements de 1 000 agents du Jura : le CH de Lons-le-Saunier et le CH Louis-Pasteur de Dole. Ce
logiciel gre les plannings et les compteurs des agents (balance horaire, congs annuels, RTT...). Cet
article prsente un bilan d'utilisation de ce logiciel et tire la leon d'une telle exprience.

Jolivaldt, F. et Le, Gloan, C. (2016). "Pralables pour un SIH convergent au sein des GHT." Revue Hospitaliere De
France(569): 48-50.

[BDSP. Notice produite par EHESP pHR0xEDs. Diffusion soumise autorisation]. L'article 107 de la loi
de modernisation de notre systme de sant prvoit la cration de groupements hospitaliers de
territoire au 1er juillet 2016 et le transfert de plusieurs activits l'tablissement support du GHT,
notamment la gestion d'un systme d'information hospitalier convergent. Cette mesure peut susciter
certaines interrogations : pourquoi transfrer et mutualiser cette activit ? Qu'entend-t-on par "SIH
convergent" et comment y parvenir ? Nos rponses permettent, d'une part de prciser le concept de
SIH convergent et son rle stratgique dans l'volution de nos organisations hospitalires, d'autre part
de dissiper certaines inquitudes quant aux impacts de sa mise en oeuvre.

Labreze, L., et al. (2000). "[Case report forum: the example of French sarcoma group multidisciplinary
discussion tools. Sarcomes de la FNCLCC]." Bull Cancer 87(4): 341-347.

Within the Rubis 4th framework of European project is led a pilot experiment of tools and services for
health professionals in prospect for the Aquitanian healthcare network. The sarcoma group of the
FNCLCC (47 people) uses on its web site a multidisciplinary dialogue with a specific discussion forum.
This service allows the anonymous publication of a imaging clinical case and to start a take care
discussion. 87 cases were published in 13 months involving 261 answers from February 1999 to
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February 2000. A case is published every 4 days on average and the deadlines for replies regularly
drop (15 days in February 1999 down 1.1 day in February 2000). The cases are published either for a
diagnosis or treatment request (30%) or for the physical preparation of meeting or for the continuous
medical training (70%). There are many advantages in comparison with the other possibilities of
discussion: availability, autonomy of publication, cost, number of experts participating. These NTIC
services will be developing within the regional healthcare oncology networks and are already tested
by other regional groups (Lymphoma) considering the simplicity of use, management and training of
the functionality.

Le, Garlantezec, P., et al. (2009). "Le dossier pharmaceutique. Un nouvel outil dans la lutte contre l'iatrognie
mdicamenteuse ?" Gestions Hospitalieres(485): 228-233, tabl.

[BDSP. Notice produite par EHESP C9qnjR0x. Diffusion soumise autorisation]. Les nouvelles
technologies de l'information et des communications vont bientt permettre de dployer le dossier
mdical partag et le dossier pharmaceutique, deux supports informatiss distincts, accessibles en
rseau par les professionnels de sant. Le dossier pharmaceutique, dploy dans un premier temps
dans les pharmacies de ville, devrait s'tendre l'hpital et permettre de dcloisonner ces deux
domaines d'activit. L'anamnse mdicamenteuse du patient deviendrait ainsi accessible l'hpital et
concernerait les traitements avant l'admission ou prescrits pendant l'hospitalisation. Le suivi
thrapeutique par le contrle de l'observance est aussi une plus-value indniable, de mme que la
contribution aux diffrentes mesures de pharmacovigilance. Le dossier pharmaceutique peut ainsi
tre vu comme un moyen d'optimiser la prise en charge du patient en tentant de lui assurer un
maximum d'efficacit dans l'acte de dispensation et de suivi thrapeutique.

Lebigre, M., et al. (2009). "SIH/NTIC. Dossier." Techniques Hospitalieres(715): 17-35.

[BDSP. Notice produite par EHESP o9GDrR0x. Diffusion soumise autorisation]. Quatre articles sont
consacrs au thme de l'informatique hospitalire. Le premier article propose le rsum des
interventions des 17mes journes nationales des technologies de communication hospitalire qui se
sont droules le 13-14 novembre 2008 Avignon. Ces interventions ont port notamment sur le
partage de l'information en cancrologie, la mise en place d'un EAI (Enterprise Application
Intgration), l'informatisation de la production de soins, le travail collaboratif en ligne et l'valuation
des pratiques professionnelles, les dispositifs d'e-formation, la visiophonie inter-tablissements. Le
deuxime article prsente le dveloppement du logiciel Easydore au CHU de Nantes, logiciel de suivi
des budgets du bureau Recherche. Les troisime et quatrime articles s'intressent aux nouvelles
technologies dans le domaine des achats : bilan d'une plateforme commune d'e-procurement (Aurea)
utilise par 11 CHU aujourd'hui dans le cadre d'un groupement d'achat, prsentation du groupement
UniHA (Union des hpitaux pour les achats) et de sa filire NTIC-SI cre en novembre 2006 et
coordonne par la direction informatique de l'Assistance publique-Hpitaux de Marseille.

Lehmann, M., et al. (2015). "Enhancing medical coding through nurses'notes." Journal De Gestion Et
D'economie Medicales 33(1): 61-71.

[BDSP. Notice produite par ORSRA R0xjn88l. Diffusion soumise autorisation]. Introduction : Le
codage de l'information mdicale est une fonction stratgique des tablissements de soins qui tend
se renforcer partir de diffrentes sources de donnes. Le CHU de Montpellier a mis en place en 2013
un outil d'optimisation du codage bas sur les transmissions infirmires. L'objectif de l'tude tait
d'valuer l'impact de cet outil sur l'incidence de certains diagnostics associs significatifs et sur la
valorisation des sjours. Mthodes : L'outil gnre automatiquement des alertes bases sur la
recherche de mots cls dans les transmissions infirmires. Les RSS concerns sont ensuite revus et
modifis le cas chant par le DIM. Rsultats : Les deux-tiers des 13 977 RSS contrls en 2013 par le
DIM ont fait l'objet d'au moins une alerte et au moins un DAS a t ajout pour 1 480 d'entre eux
(16.2%). L'incidence des DAS concerns a augment de plus de 50% par rapport 2012. Le diffrentiel
de valorisation moyen tait de 1 122 Euros par RSS modifi. Conclusion : L'utilisation des transmissions
infirmires pour optimiser le codage PMSI est prometteuse et constitue un moyen de valoriser le
travail soignant. En revanche sa gnralisation est dpendante de l'volution des systmes
d'information hospitaliers. (rsum auteur).
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Leroux, V. (2010). "Tic et Gouvernance. Qualit, scurit et continuit. Dfis et bonnes pratiques." Gestions
Hospitalieres(495): 268-272.

[BDSP. Notice produite par EHESP BBIo7R0x. Diffusion soumise autorisation]. Les informations de
sant sont considres sensibles sur les plans personnel, professionnel et financier. La question des
bonnes pratiques en matire de qualit, de scurit et de continuit d'activit des systmes et rseaux
d'information (voix, donne, image) en sant et de l'e-sant (tlmdecine, tlsant...) est pose.
Cette article propose une rflexion en la matire et intgre cette problmatique dans le cadre plus
large de la gouvernance des risques en sant.

Lesteven, P. (2008). "Systmes d'information : au coeur du pilotage." Revue Hospitaliere De France(520): 12-13.

[BDSP. Notice produite par EHESP 9s7pR0x8. Diffusion soumise autorisation]. Dans cet article, la
Fdration Hospitalire de France prsente ses souhaits en matire d'organisation du systme
d'information en sant. cartant l'ide d'une structure unique qui aurait en charge oprationnelle
l'ensemble du systme d'information en sant, la FHF appelle la mise en place d'un dispositif
constitu de plusieurs acteurs avec notamment un conseil stratgique des systmes d'information
rattach aux services du Premier ministre et un comit oprationnel rattach au ministre de la Sant.
Elle estime que l'organisation mettre en place doit prserver au maximum la capacit d'adaptation
et de responsabilisation et que certaines actions sont conduire de toute urgence : publication de
cahiers des charges par fonction et par type d'tablissement, incitation financire l'interoprabilit,
poursuite des exprimentations, formation et recrutement des comptences ncessaires au
dploiement des technologies de l'information.

Lestienne, A., et al. (2001). "Sant 2020 : l'apport des technologies nouvelles dans le systme de soins."
Technologie Et Sante(44): 96 , tabl.

[BDSP. Notice produite par ENSP 2WR0xAE6. Diffusion soumise autorisation]. Ce numro
"Technologie de Sant" apporte des lments sur ce que pourrait tre la mdecine de 2020 grce la
collaboration de courageux experts.

Lorrain, P., et al. (2001). "L'information et le patient : les illusions de la transparence." Pratiques : Les Cahiers
De La Medecine Utopique(12): 57.

Lucas, J. (2008). "Russir l'informatisation en sant - un dfi : dossier." Bulletin De L'ordre Des Medecins(1): 8-
12.
[Link]
Dossier mdical personnel, dossier pharmaceutique, web mdecin, messageries scurises, sites e-
sant : l'informatisation de la sant est dsormais partout. Pour quels bnfices, quels cots et quels
risques ? Ce dossier ralis par le docteur Jacques Lucas, vice-prsident du Conseil national de l'Ordre
tente de faire le point sur ces diffrents aspects.

Messner, L. (2012). "Systmes d'information. Tout savoir sur le programme Hpital numrique." Revue
Hospitaliere De France(545): 82-83.

[BDSP. Notice produite par EHESP sR0xmAsA. Diffusion soumise autorisation]. Le programme Hpital
numrique, lanc en novembre 2011, constitue la feuille de route cinq ans (2012-2016) pour les
systmes d'information hospitaliers. Son ambition est d'amener l'ensemble des tablissements vers un
premier niveau de maturit de leurs systmes d'information. Pour ce faire, il propose un plan d'actions
agissant sur quatre leviers actionner de manire coordonne.

Messner, L. et Jolivaldt, F. (2013). "Hpital numrique, un programme en marche." Revue Hospitaliere De

France(550): 10-12.

[BDSP. Notice produite par EHESP AIHR0xjp. Diffusion soumise autorisation]. Le programme Hpital
numrique, pilot par la Direction gnrale de l'offre des soins, a t lanc voici un peu plus d'un an.
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En novembre 2011, paraissaient la feuille de route et le guide des indicateurs en termes de prrequis
et domaines fonctionnels prioritaires. Le point dans cet article sur l'tat d'avancement des chantiers
partir des quatre axes stratgiques du programme (gouvernance, comptences, offre, financement)
ainsi que sur les outils oprationnels mis disposition des agences rgionales de sant et des
tablissements de sant (guide, outils d'autodiagnostic.).

Messner, L., et al. (2013). "Systme d'information en sant. Dossier." Revue Hospitaliere De France(550): 10-25,
fig.

[BDSP. Notice produite par EHESP E7mER0xq. Diffusion soumise autorisation]. Programme "hpital
numrique" pilot par la direction gnrale des soins, plan europen e-sant 2012-2020, projet
Mines-Tlcom relatif aux quipements e-sant dans les EHPAD. ce dossier prsente les diffrents
projets nationaux ou europens en cours dans le domaine des systmes d'information en sant, se
penche sur les freins aux partages d'information entre secteurs sanitaire et mdico-social et offre
galement un regard sur une exprience trangre la pointe : la mise en place d'un dossier patient
informatis de territoire au Danemark.

Meyer, R. et Degoulet, P. (2010). "Tic et Hpital. L'conomie des systmes d'information hospitaliers." Gestions
Hospitalieres(495): 250-255, tabl., fig.

[BDSP. Notice produite par EHESP R0xEI9mH. Diffusion soumise autorisation]. Peu d'tudes ont t
entreprises pour valuer les bnfices financiers des systme d'information hospitaliers (SIH), en
particulier dans le contexte d'une stratgie globale d'informatisation des processus. A partir
d'exemples significatifs, les auteurs illustrent et discutent les rsultats et les limites des tudes visant
quantifier le retour sur investissement des SIH. Ils militent pour le dveloppement, l'chelon franais
comme europen, d'un observatoire de l'tat d'informatisation des hpitaux, seul mme de
mesurer, moyen et long termes, l'impact des investissements qui devront ncessairement tre
effectus pour combler le retard franais dans le secteur. (R.A.).

Olesen, F. et Markussen, R. (2004). "Du stylo l'ordinateur : la mdication comme pratique sociotechnique."
Sciences Sociales Et Sante 22(1): 69-94, 61 graph., 63 tabl.

Cet article est consacr l'analyse de ce qui pourrait apparatre premire vue comme une micro-
innovation dans le domaine de l'informatique mdicale, savoir l'introduction, dans un hpital danois,
d'un module lectronique destin la prescription mdicamenteuse. En s'appuyant sur une analyse
smiotique fouille du module et de ses usages, les auteurs montre que, mme dans ce cas, pour que
le module puisse fonctionner correctement et remplir son objectif de simplification, il est ncessaire
que soit accomplie toute une srie de transformations locales : ces transformations concernent aussi
bien les savoirs et les pratiques mis en ?uvre par l'ensemble des professionnels impliqus dans les
tches coordonnes par le module que les relations entre ces professionnels jusqu' la vie mme des
patients (Extrait du rsum d'auteur).

Omnes, L. (2010). "Tic et Hpital. Investir plus dans la Toile et moins dans le bton." Gestions
Hospitalieres(495): 241-244.

[BDSP. Notice produite par EHESP 8BtlDR0x. Diffusion soumise autorisation]. Cet article revient sur
les bnfices attendus des technologies de l'information et de la communication TIC appliques au
domaine hospitalier suivant deux composantes : Celle de l'espace de sant et du soins, en terme de
coordination, qualit, rapidit et scurit du soins ; Et celle de l'hpital comme entreprise de service
en terme de valeur ajoute, d'organisation sociale et d'expertise. Cependant, dans le contexte du plan
ministriel "hpital numrique", les frilosits d'investissement dans ces nouvelles technologies
persistent. C'est l'occasion pour l'auteur de rappeler les conditions ncessaires la russite de la mise
en place de telles technologies.

Oussar, E. (2005). "L'hpital communicant (2me partie) - Troisime forum des DSIO. Mutualisation : l'avenir
des systmes d'information ? Ou de l'envol des systmes d'information de sant." Gestions
Hospitalieres(442): 34-39.
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[BDSP. Notice produite par ENSP Y8mxOR0x. Diffusion soumise autorisation]. Le troisime forum des
Directeurs des systmes d'information et d'organisation (DSIO) des centres hospitaliers a t consacr
la mutualisation des systmes d'information. Aprs avoir rappel que la mutualisation a de longue
date t exprimente et qu'il existe des contraintes sa mise en oeuvre, le forum s'est intress
son renouveau d un contexte juridique, stratgique et financier modifi. En effet, l'volution des
rgles juridiques en la matire a enrichi les possibilits pour les tablissements de sant de recourir
cette modalit de fonctionnement : le groupement de coopration sanitaire (GCS) a vu notamment
son champ d'actions et d'acteurs s'largir au fil des textes lgislatifs rcents et constitue un cadre
juridique de flux entre tablissements, de quelque nature juridique qu'il soit. Ce renouveau de la
mutualisation correspond galement un besoin de plus en plus clairement affirm face la
rorganisation des systmes d'information qui implique le partage d'information et l'change
rciproque de mthodes et de procds.

Penhouet, D. (2010). "Tic et Territoires. Espace rgional, territoires et systmes d'information de sant."
Gestions Hospitalieres(495): 201-205.

[BDSP. Notice produite par EHESP skR0xGGE. Diffusion soumise autorisation]. La mise en oeuvre de
la loi Hpital, patients, sant, territoires invite fortement les systmes d'information apporter des
rponses concrtes aux enjeux de l'organisation sanitaire. Sur fond d'amnagement numrique du
territoire, l'information des acteurs de sant dpasse la somme des dcisions d'investissements de
chacun et invite s'inscrire dans la cohrence d'un projet rgional de systme d'information,
concrtement conu et mis au service des patients et des professionnels de sant. Les enjeux sont lis
l'optimisation de l'organisation et la qualit des soins, et la conduite du changement. Les projets
rgionaux doivent tre confis une matrise d'ouvrage forte, port institutionnellement par une
agence veillant sa cohrence avec les priorits de sant rgionales et pilote par une structure
fdrant l'ensemble des acteurs de sant de la rgion. (R.A.).

Perrin, B. (2004). "L'hpital communicant (1re partie) - Assistance publique-Hpitaux de Paris. Un schma
cible pour le systme d'information." Gestions Hospitalieres(441): 783-785.

[BDSP. Notice produite par ENSP ZR0xZ4Wm. Diffusion soumise autorisation]. L'AP-HP a t amene
conduire une tude de schma cible de son systme d'information. Pilote au plus haut niveau de
l'institution, mene dans un dlai limit et avec une trs forte mobilisation interne, cette opration a
conduit un programme de dveloppement couvrant de nombreux domaines fonctionnels et
induisant une forte volution de son architecture technique avec une recherche de gains
d'exploitation.

Pierron, A., et al. (2015). "valuation de la qualit mtrologique des donnes du programme de mdicalisation
du systme d'information (PMSI) en prinatalit : tude pilote ralise dans 3 CHU." Revue
D'epidemiologie Et De Sante Publique 63(4): 237-246, tabl., rs.
[Link]
[BDSP. Notice produite par ORSRA J9CJR0xl. Diffusion soumise autorisation]. Position du problme :
La France est l'un des derniers pays europens ne pas pouvoir fournir d'informations prinatales
fiables, indispensables la ralisation de travaux de recherche et la production d'indicateurs
nationaux. Le systme d'information prinatale en France est fragment et les donnes, difficiles
regrouper, ne rpondent pas aux exigences d'Europeristat. Les donnes du PMSI offrent la potentialit
de fournir des informations systmatiques et standardises pour l'ensemble des naissances. L'objectif
tait d'tudier la qualit mtrologique des donnes du PMSI pour construire des indicateurs de base
en sant prinatale dans trois centres hospitaliers universitaires, avant de mener une tude nationale.
Mthode : Les donnes du PMSI ont t confrontes celles des dossiers patients en 2012 pour 300
naissances vivantes aprs 22 semaines d'amnorrhe, dans trois centres hospitaliers et universitaires
(Dijon, Port-Royal et Nancy). Les variables analyses ont t slectionnes partir des indicateurs du
projet Europeristat et de l'enqute nationale prinatale de 2010. Les informations recueillies dans les
dossiers patients ont t confrontes aux donnes PMSI et la qualit des donnes PMSI a t estime
par le calcul de la valeur prdictive positive (VPP) et par la sensibilit. Rsultats : Les distributions de
l'ge maternel, de la parit pour les accouchements par voie basse, du mode d'accouchement, ainsi
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que le nombre de naissances prmatures sont trs voisines entre les deux sources. La VPP pour
l'anesthsie pridurale est de 96,2% et 94,3% pour les dchirures prinales. Elle s'lve 100,0%
pour le diabte prexistant et 88,9% pour le diabte gestationnel. L'hypertension artrielle est sous-
estime dans le PMSI, gale 9,0% dans les dossiers versus 6,3% dans le PMSI, avec cependant une
VPP 100,0%. La VPP pour l'hmorragie de la dlivrance est de 89,5% et de 68% pour la rupture
prmature des membranes. Conclusion : Il nous semble ralisable de mener une tude nationale
dans le contexte actuel voluant vers une plus grande fiabilit des donnes du PMSI, d'une part, du
fait de l'importance de ces donnes pour la valorisation budgtaire des tablissements et, d'autre
part, du fait de l'utilisation accrue de ces informations des fins statistiques et pidmiologiques.

Poutout, G. (2012). "[An assessment of healthcare networks in 2012]." Rev Infirm(183): 14-16.

In twenty years, healthcare networks have developed specific new solutions in order to meet the
population's healthcare needs. They enrich the general practice-hospital link, notably in the
coordination of complex patient pathways. However, neither their funding nor their position within
the system are guaranteed.

Quantain, C. (2008). "Systme d'Information hospitalier et pidmiologie." Revue D'epidemiologie Et De Sante

Publique 56: 58.

[BDSP. Notice produite par ORSRA l9IrJR0x. Diffusion soumise autorisation]. Ce fascicule prsente les
communications orales (rsums) et les communications affiches du Colloque organis les 3 et 4 avril
2008 Saint-Malo, sur le thme du PMSI et de l'pidmiologie.

Quin, F., et al. (2007). "Quelle politique pour la gestion des donnes mdicales numrises ?" Techniques
Hospitalieres(701): 31-36.

[BDSP. Notice produite par ENSP 8R0xTha1. Diffusion soumise autorisation]. A l'occasion des
deuximes assises de l'informatique en sant qui se sont tenues le 7 novembre 2006, nouvelles
tendances et enjeux de la numrisation des donnes mdicales ont t abords. La numrisation va
notamment amliorer la coordination des soins entre les acteurs de sant, faciliter l'archivage,
amliorer la qualit des prescriptions, responsabiliser et mieux informer le patient et, par consquent,
rduire les cots de l'assurance maladie. Mais il faut cependant tre attentif la confidentialit des
donnes ainsi qu'au risque de ne devenir qu'un "mdecin informatique". Aujourd'hui, la tendance au
niveau mondial est la mise en commun de l'information mdicale dans un dossier patient partag
par un grand nombre d'acteurs. En France, la loi du 13 aot 2004 relative l'assurance maladie, a cr
le dossier mdical personnel (DMP), un projet informatique dont l'architecture logicielle est volutive
et repose sur des technologies standards. Actuellement test sur dix-sept sites pilotes, le DMP devrait
tre dploy ds juillet 2007 et prvoit une enveloppe de vingt millions d'euros destine la
formation des professionnels de sant et l'accompagnement au changement. Mais son dploiement
justifie un niveau d'quipement adapt des professionnels de sant qui tarde encore. Si les aides
accordes par l'assurance maladie ont permis d'quiper en matriel informatique entre 80% et 85%
des mdecins libraux, seuls 40% d'entre eux ont aujourd'hui recours des dossiers mdicaux
lectroniques et seuls 20% disposent d'un accs internet haut dbit. De mme, d'importants
investissements restent faire au niveau des hpitaux qui ne consacrent que 0,5% et 1% de leur
budget l'informatisation, contre 2,5% pour les hpitaux universitaires amricains et canadiens.

Riondet, J. (2010). "Tic et Territoires. DMP et territoires." Gestions Hospitalieres(495): 206-211.

[BDSP. Notice produite par EHESP 9ER0xAFB. Diffusion soumise autorisation]. A travers l'exprience
du rseau sant griatrique Cormadom, l'auteur, directeur du rseau, dresse une analyse des
perspectives en ce qui concerne l'adoption des nouveaux outils informationnels de sant par les
professionnels. Cet exemple de rseau coordonn de soins, entre tablissements hospitaliers et
mdecine de ville, permet d'identifier les conditions de russite d'un outil tel que le Dossier Mdical
Personnel ou un Systme d'Information de sant rgionalis.

Riou, C., et al. (2015). "Contrle automatis de l'exhaustivit du registre breton des malformations congnitales
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partir des donnes des bases mdico-administratives des tablissements de sant." Revue
D'epidemiologie Et De Sante Publique 63(4): 223-235, tabl., fig., rs.
[Link]
[BDSP. Notice produite par ORSRA oCR0xn8A. Diffusion soumise autorisation]. Position du problme
: Un registre se dfinit comme un enregistrement exhaustif de cas. Le registre breton des
malformations congnitales s'appuie sur une dclaration des cas la source. Les rsums de sjour
hospitaliers du programme de mdicalisation des systmes d'information (PMSI) permettent de
vrifier la compltude des dclarations. Nous prsentons dans cet article un outil informatis de
contrle d'exhaustivit des cas. Mthodes : Le contrle d'exhaustivit est ralis une fois par an selon
le mme protocole pour tous les tablissements de la rgion. La slection des sjours porte sur les
enfants ns vivants jusqu' l'ge de 1 an et sur les sjours des mres pour les enfants mort-ns et les
interruptions mdicales de grossesse. Les donnes d'identit sont obtenues par croisement avec les
bases administratives. Les fichiers sont transmis par messagerie scurise et traits sur un serveur
scuris. Un algorithme de rapprochement d'identits est implment. Les cas non rapprochs avec
un cas du registre donnent lieu un retour au dossier mdical. L'exhaustivit thorique du registre est
value par la mthode de capture recapture. L'valuation de l'algorithme de rapprochement
d'identits est base sur le nombre de rapprochements manuels. Rsultats : En ce qui concerne les
annes 2011 et 2012 sur le dpartement d'le-et-Vilaine, le nombre de cas potentiels reprs par le
PMSI tait de 470 pour 2011 et de 538 pour 2012 ; 35 nouveaux cas ont t dtects pour 2011 (32
enfants ns vivants et 3 mort-ns ou IMG) et 33 pour 2012 (enfants ns vivants). Il y avait 85 faux
positifs pour 2011 et 137 pour 2012. Le taux d'exhaustivit thorique tait de 91% chaque anne. Un
rapprochement parfait a t retrouv pour 68% des cas PMSI, 6% des cas ont t rapprochs
manuellement. Conclusion : Les bases de donnes de RSS du PMSI des tablissements contribuent
amliorer la qualit du registre bien qu'il y ait une dclaration des cas la source. L'outil dvelopp
facilite le travail des enquteurs. Le croisement entre les cas registre et les cas PMSI pourrait tre
facilit par l'utilisation du numro d'inscription au Rpertoire national d'identification des personnes
physiques.

Rives, V., et al. (2004). "L'hpital communicant (1re partie) - Rsultats d'enqutes. Les systmes d'information
de 900 hpitaux europens passs au crible. Position de la France et orientations futures." Gestions
Hospitalieres(441): 772-776, tabl.

[BDSP. Notice produite par ENSP 1R0xF5xI. Diffusion soumise autorisation]. En dpit de
l'augmentation des dpenses dans les nouvelles technologies des tablissements, beaucoup
d'observateurs sont pessimistes quant au dveloppement des systmes d'information. Les auteurs
s'appuient sur les donnes de l'enqute HINE 2004 afin de prsenter la situation actuelle, en France,
des technologies de l'information dans les tablissements de soins, en comparaison avec d'autres
tats europens, et de proposer des lments de perspective.

Robin, J.-Y. (2010). "Tic et Territoires. Amliorer la coordination des soins en tablissement." Gestions
Hospitalieres(495): 214-217.

[BDSP. Notice produite par EHESP 7mtR0xE7. Diffusion soumise autorisation]. Dans le secteur
hospitalier, l'informatisation est encore ses dbuts. Or, son dveloppement est une condition de
russite majeure des volutions actuelles en matire de qualit et de coordination des soins. Les
travaux de l'ASIP (Agence des Systmes Partags de Sant) s'inscrivent dans cette perspectives et
visent favoriser le dveloppement de l'usage des systmes d'information jusqu'au coeur mme du
systme de soins hospitaliers. Cet article revient sur le contexte de la naissance de cette Agence et
nous prsente ses grands chantiers. Elle sera notamment responsable de la relance du DMP,
l'aboutissement du plan Bureautique Sant tout comme la diversification des procds de scurisation
des donnes de sant dont la CPS fait partie.

Robin, J.-Y. (2011). "Organisation des soins primaires et systmes d'information. Des outils au service de la
pratique professionnelle." Revue Hospitaliere De France(538): 17-19.

[BDSP. Notice produite par EHESP F99AR0xA. Diffusion soumise autorisation]. Les systmes
d'information font partie des outils stratgiques d'appui aux nouveaux modes organisationnels
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introduits par la loi HPST et la rforme de l'organisation des soins. L'ASIP Sant s'est engage auprs
des acteurs du soins pour mener une rflexion sur le dveloppement des systmes d'information, au
service de leurs pratiques. L'objectif final est l'amlioration constante de la qualit et de la continuit
des soins dlivrs aux patients.

Sauret, J. (2010). "conomie des nouveaux systmes dinformation en sant." Seve : Les Tribunes De La
Sante(29): 59-68.

Annoncs comme trs prometteurs, les systmes dinformation en sant n'ont pas dbouch en
France sur toutes les amliorations attendues. L'analyse de la situation montre que les avances ont
t significatives, mais trs htrognes. La France accuse aujourd'hui un vrai retard sur les pays
quivalents. Pour autant, les gains que pourraient apporter des systmes d'information performants
restent trs importants, tant pour la qualit des soins que pour les aspects financiers ou pour le
pilotage du systme. Cependant, la ralisation de ces gains est soumise certaines conditions, non
encore runies (rsum de l'diteur).

Segade, J.-P. et Ponties, O. (2004). "L'hpital communicant (1re partie) - L'informatique hospitalire. Du temps
des quivoques au temps des certitudes." Gestions Hospitalieres(441): 769-771.

[BDSP. Notice produite par ENSP KDR0xZol. Diffusion soumise autorisation]. La mise en place de la
tarification l'activit va susciter une forte demande en informatique d'autant plus accentue que les
impratifs d'une gestion par ples et centres de responsabilits se mettent en place en parallle avec
la rforme de la comptabilit analytique. Comment se situera la rencontre entre les quipes
informatiques en voie de structuration et une demande en forte expansion ? La rponse cette
question suppose leves les multiples quivoques qui caractrisent le dbat toujours brlant de
l'informatique hospitalire, mais aussi les certitudes qui s'imposent nous.

Segade, J.-P. et Ponties, O. (2006). "Technologies d'information et de communication (TIC) : un investissement

hospitalier, pour quoi faire ?" Gestions Hospitalieres(455): 266-269.

[BDSP. Notice produite par ENSP cR0xFSBf. Diffusion soumise autorisation]. Malgr des
investissements consquents et des problmatiques de gestion, le dveloppement des TIC est une
dmarche importante pour l'hpital. Outre des conomies de fonctionnement, les TIC poussent les
hpitaux rflchir leur organisation et permet aux acteurs de sant de se recentrer sur la fonction
soin en les librant du travail administratif. Selon la formule des auteurs : "Plus d'investissements
aujourd'hui, c'est plus de soins demain. Plus de TIC aujourd'hui, c'est plus de temps consacr aux soins
de demain".

Simon, P. et Michel, R. (2010). "Tic et Territoires. Tlmdecine et amnagement du territoire sanitaire."

Gestions Hospitalieres(495): 219-221.

[BDSP. Notice produite par EHESP DR0xpmCo. Diffusion soumise autorisation]. La loi n2009-879 du
21 juillet 2009 portant rforme de l'hpital et relative aux patients, la sant et aux territoires (HPST)
autorise de nouvelles organisations de soins et de nouvelles pratiques professionnelles. Cet article
porte sur le dveloppement de la tlmdecine, acte mdical distance, aujourd'hui autorise et
prconise par la loi. Il revient sur les actes concerns par la tlmdecine, les responsabilits
mdicales mises en jeux et les consquences sur l'amnagement du territoire de sant. Un
amnagement au service du parcours de soins et notamment du soin domicile. La tlmdecine se
dfinie ainsi comme un enjeu de dveloppement sanitaire et mdico-social pour les territoires.

Sohier, R., et al. (2014). "Systme d'information hospitalier et pidmiologie." Revue D'epidemiologie Et De
Sante Publique 62(S3): 41.

[BDSP. Notice produite par ORSRA E9plR0xH. Diffusion soumise autorisation]. Le colloque "Systme
d'information hospitalier et pidmiologie" a t organis conjointement par l'Association des
pidmiologistes de langue franaise (Adelf) et l'Association valuation, management, organisations,
sant (Emois). Il examine la qualit des pratiques et des soins (valuation, indicateurs, pertinence des
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actes et des stratgies), le lien PMSI et pidmiologie, les systmes d'informations et d'aide la
dcision, la production et de la confidentialit de l'information mdicale, les parcours de soin du
sanitaire au mdico-social, des rles dans la chane de facturation, l'utilisation de l'information
mdicale pour le prvision de l'activit (analyse de l'activit, stratgie et contractualisation), les
professionnels dans le DIM et leurs rles. Il analyse galement d'autres expriences internationales,
d'autres secteurs (activit interne, HAD, SSR, psychiatrie), et le rseau REDSIAM.

Spido, G. (2012). "Prmices d'un systme d'information en sant." Revue Hospitaliere De France(544): 41-43.

[BDSP. Notice produite par EHESP BBR0xA8s. Diffusion soumise autorisation]. L'article prsente les
problmatiques auxquelles sont confronts les tablissements de sant pour l'installation et le
dploiement de leur systme d'information en sant. L'mergence d'un march national suppose de
stimuler l'offre et la demande et de procder des choix de logiciels. Or de nombreux directeurs
d'hpitaux ne voient pas encore leur intrt agir en investissant dans des SI inter et intra-
hospitaliers, la fois interoprables et scuriss.

Tetard, J. P. (2002). "Les donnes mdicales (image, biologie, diagnostic, soins) et leur mise en rseau, coeur
des systmes d'informations hospitaliers." Techniques Hospitalieres(669): 15-16.

[BDSP. Notice produite par ANFH JwdR0xmp. Diffusion soumise autorisation]. Intervention reprise
d'Hopitech 2001 qui pose le problme de la centralisation des informations concernant le malade,
d'abord dans les lieux de soins eux-mmes, puis entre-eux, et propose une vision de l'informatisation
hospitalire 10 ans.

Thabalard, J. C. et Fieschi, M. (2014). "Donnes de sant : donnes sensibles." Statistique Et Societe 2(2): 67 ,
tabl., fig.
[Link]
Ce numro s'intresse l'accs aux donnes de sant. Ces dernires, parmi lesquelles beaucoup
manent dun systme de scurit sociale ancien et trs organis, se dmultiplient de faon
impressionnante elles semblent assurment big aujourdhui - et quen outre elles deviennent de
plus en plus aisment accessibles. Mais quelle est la nature exacte de ces donnes ? Qui y a accs et
qui ne devrait pas avoir accs ? Pour quoi faire ? Telles sont les questions auxquels nos auteurs se sont
attachs fournir des lments de rponse. Ce dossier est accompagn dun article mthodologique
et dune prsentation des dbats tenus aux Cafs de la statistique, qui savrent tous les deux lis au
sujet du dossier. La mthode multimodale, en plein essor, oblige valuer la qualit des donnes
rcoltes selon plusieurs modes de collecte, comme le sont trs souvent les big data . De son ct,
le Caf de la statistique a trait, sous deux angles diffrents, des effets sociaux du vieillissement de la
population, assurment une question de sant publique. (tir de l'dito).

Thepot, P., et al. (2008). "Mobilite@CH-Arras. fr : l'information nomade." Revue Hospitaliere De France(521):
39-40.

[BDSP. Notice produite par EHESP kHHR0xtl. Diffusion soumise autorisation]. L'hpital a migr de
l'information sdentaire l'information nomade. Ouvert en 2007, le nouveau centre hospitalier
d'Arras a fait le choix de la mobilit. Architecture physique, systme d'information tout IP, outils de
communication, worflows et management fonctionnent en synergie. Objectif : une structure plus
performante et plus ouverte sur son environnement, o la technologie, place au service de l'homme,
prfigure l'hpital de demain. Cet article nous prsente les points forts du systme d'information du
CH d'Arras rcompens par le grand prix 2008 des trophes entreprise et socit de l'information :
meilleur recueil de l'information relative l'admission des patients avec la dcentralisation du service
d'accueil, dmatrialisation du dossier administratif, numrisation totale du dossier mdical pour le
service de gyncologie-obsttrique.

Thiebaut, R., et al. (2014). "L'analyse des "Big Data" en recherche clinique." Revue D'epidemiologie Et De Sante
Publique 62(1): 1-4.
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dans l're des "Big Data", comme en atteste une recherche du mot cl sur Google Trends. Il s'agit de la
production massive de donnes avec un dbit toujours plus important : 90% des donnes mondiales
ont t produites au cours des deux dernires annes. Les plus gros pourvoyeurs sont connus :
acclrateur de particules (Large Hadron Collider [LHC]), le futur tlescope (Large Synoptic Survey
Telescope [LSST]), Facebook, Youtube, les courriels. En biologie-mdecine, les "Big Data" font en
premier lieu rfrence aux donnes "omiques", en particulier gnomiques, avec un dbit de
production des donnes de squenage de plus en plus rapide pour un cot de moins en moins lev.

Tixier, F. (2008). "Le portail ville-hpital des Hospices civils de Beaune." Techniques Hospitalieres(711): 53-56,
tabl.

[BDSP. Notice produite par EHESP 9R0xplt9. Diffusion soumise autorisation]. Depuis plusieurs
annes, les Hospices civils de Beaune s'attachent mettre le patient au coeur de leur systme
d'information et de communication. Ils apportent galement leur contribution dans la dynamique
d'change et de partage de l'information au sein de leur zone d'attraction. La ralisation du premier
portail ville-hpital, l'un de leurs rcents projets, s'inscrit dans cette dmarche. Il a t prsent aux
professionnels de sant du secteur beaunois (praticiens de ville et hospitalier) en fvrier 2007
l'htel-Dieu o il y a reu un vif succs et a suscit beaucoup d'intrt de la part des participants.

Tron, D. Ebouchony, E. (2014). "Big data et mdecine hospitalire : un march en plein boom, un dfi pour la
camp de l'mancipation." Cahiers De Sante Publique Et De Protection Sociale (Les)(14): 10-11.

Prendre la mesure des enjeux des big data et de la tlmdecine dans la mdecine hospitalire, c'est
dessiner les racines du monde de demain... et le potentiel d'asservissement du service public de sant
aux entreprises prives. Cet artilce fait un point sur les enjeux pour le grand public et la
rglementation en vigueur.

Trouessin, G. (2005). "L'hpital communicant (2me partie) - Btir la confiance dans les systmes d'information
et de communication hospitaliers." Gestions Hospitalieres(442): 19-25.

[BDSP. Notice produite par ENSP rP6X2R0x. Diffusion soumise autorisation]. Dans cet article, l'auteur
prsente tout d'abord l'volution ralise en matire de scurit des systmes d'information de sant
(SIS) et hospitaliers (SIH) en rappelant notamment les divers travaux et normes raliss en la matire.
Puis, il dtaille les tendances essentielles qui se vont jour dans le domaine hospitalier. Ces tendances
doivent permettre de btir la confiance dans les SIH et touchent la scurit travers diffrentes
notions : innocuit, confidentialit, discrtion, auditabilit.

Tsamo, P. (2010). "Tic et Hpital. Performance et systme d'information." Gestions Hospitalieres(495): 256-
260, tabl.

[BDSP. Notice produite par EHESP DR0xk8on. Diffusion soumise autorisation]. La performance d'un
tablissement de sant se situe dans sa capacit rpondre aux besoins de la sant, assurer la
qualit des soins et optimiser l'efficience conomique et organisationnelle. Pour rpondre ces
enjeux, le systme d'information (SI) est un outil essentiel car il permet de mettre disposition des
dcideurs des lments ncessaires la prise de dcision, de coordonner les actions par le traitement
de l'information et surtout de dynamiser l'action oprationnelle. A partir de la dmarche du centre
hospitalier intercommunal des Portes de l'Oise, l'auteur montre comment le SI devient la colonne
vertbrale de la coordination des hommes et de surcrot l'outil de management capable de favoriser la
mobilisation des quipes autour des projets de transformation pour une prise en charge de qualit,
scuris, efficace et efficiente. (R.A.).

Vallet, G., et al. (2006). "Technique d'information et de communication. Une charte pour protger les liberts
individuelles." Gestions Hospitalieres(454): 193-200.

[BDSP. Notice produite par ENSP YxXWiR0x. Diffusion soumise autorisation]. L'usage abusif possible,
voire frauduleux, de donnes caractre personnel suscite depuis longtemps de relles inquitudes
auprs des personnes amenes confier des informations prives des professionnels.
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L'augmentation de la puissance des technologies mises disposition de ces mmes professionnels a

ouvert des possibilits de dtournement venant conforter lgitimement cette inquitude. L'hpital
doit tre un lieu gouvern par la confiance : sans elle, la relation du patient son mdecin, et plus
gnralement de l'usager son institution, ne peut que nuire la qualit du soin. Mais l'hpital est
aussi un lieu de travail collectif et collgial o se ctoient des professionnels de nombreuses
disciplines, toutes axes sur une seule ambition : gurir. Voil pourquoi l'utilisation des technologies
d'information et de communication (TIC) et son cortge potentiel d'atteintes ce capital de confiance
est une question qui mrite d'tre aborde franchement.

Varin, C., et al. (2012). "Innovation. La tumorothque l'heure virtuelle." Gestions Hospitalieres(515): 228-229.

[BDSP. Notice produite par EHESP IjsoIR0x. Diffusion soumise autorisation]. Le cancrople Nord-
Ouest a dvelopp un outil informatique commun quatre rgions franaises couvrant un bassin de
population de 9 millions de personnes : la tumorothque virtuelle du cancrople Nord-Ouest assure
aujourd'hui la gestion des chantillons cryoprservs au service des tablissements spcialiss dans
les soins et la recherche en cancrologie.

Weidmann, C., et al. (2000). "Evaluation des apports de l'informatisation du dossier de soins." Gestions
Hospitalieres(392): 37-42.

[BDSP. Notice produite par ENSP 1f59RR0x. Diffusion soumise autorisation]. Depuis juin 1996 a
dbut aux hpitaux universitaires de Strasbourg (HUS) la mise en place progressive d'un dossier de
soins informatis. Cet outil labore un plan de soins, exhaustif et dtaill. Il permet le recueil de la
prescription (avec le prrequis d'une prescription mdicale et soignante correcte), ainsi qu'une
communication facilite avec les diffrents prestataires (laboratoire, pharmacie).

Wlodyka, P. (2012). "Systmes d'information, stratgie et gouvernance hospitalire." Revue Hospitaliere De

France(545): 68-71, fig.

[BDSP. Notice produite par EHESP R0x9Er8C. Diffusion soumise autorisation]. Cet article s'intresse
au rle du directeur des systmes d'information (DSI). Au-del de la composante technique du mtier,
le directeur doit dvelopper une stratgie propre pour mieux servir l'tablissement et doit agir en
force de proposition travaillant en permanence crer de la valeur, voire mme, dvelopper un
volet de politique industrielle.

Wlodyka, P., et al. (2012). "Systmes d'information en sant. Spcial HIT 2012." Revue Hospitaliere De
France(545): 68-88.

[BDSP. Notice produite par EHESP BGI98R0x. Diffusion soumise autorisation]. Cinq points sont
dvelopps dans ce dossier consacr au systme d'information hospitalier : - le rle du directeur des
systmes d'information (DSI) - la mesure de la maturit des niveaux d'informatisation des structures
de sant travers notamment l'chelle EMRAM - la procdure d'agrment des hbergeurs de donnes
de sant caractre personnel par l'Asip - le plan d'action du programme "Hpital numrique" pour la
priode 2012-2016 - l'utilisation de smartphones pour scuriser le circuit des produits de sant en
hospitalisation domicile.

Rapports

(2016). Atlas 2015 des systmes d'information hospitaliers (SIH) : Etat des lieux des systmes d'information
hospitaliers. Paris DGOS: 126 , tabl., graph.
[Link]
La direction gnrale de loffre de soins (DGOS) publie chaque anne latlas des systmes
dinformation hospitaliers (SIH) qui rassemble les donnes principales et tendances de lvolution des
systmes dinformation hospitaliers sur le territoire. En 2015, lATIH participe la rdaction de cet
atlas, notamment en laborant la partie 5 Charges et ressources consacres au systme
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dinformation hospitalier , sur la base des donnes issues de lenqute Charges et ressources SIH
2013 diligente auprs des tablissements de sant antrieurement sous dotation globale (ouverte
le 15 avril 2014 sur la plateforme ANCRE et clture le 23 fvrier 2015).

(2000). Evaluation clinique de la numrisation en mammographie pour le diagnostic et le dpistage du cancer

du sein. Paris ANAES: 71 , 78 tabl., 72 sch.

A la demande de la Direction de l'Hospitalisation et de l'Organisation des Soins, l'ANAES a ralis une

tude d'valuation technologique intitule valuation clinique de la numrisation en mammographie
pour le diagnostic et le dpistage des cancers du sein afin d'examiner les performances diagnostiques
des mammographes numriques. Sur la base de l'analyse de la littrature, l'tude conclut que les
dernires techniques de numrisation plein champ en mammographie ont des performances
diagnostiques quivalentes celles des techniques conventionnelles.

(2000). L'information des malades et l'accs au dossier mdical. Les documents de travail du Sant ; Srie
"lgislation compare". Paris Snat: 25.

Alors que la France s'interroge nouveau sur le droit d'accs du patient son dossier mdical dans le
cadre du projet de loi sur la modernisation sociale, cette tude analyse comment l'information des
malades et l'accs au dossier mdical sont organiss chez plusieurs de nos voisins : Allemagne,
Belgique, Danemark, Grande-Bretagne et Pays-Bas. Elle permet notamment de mettre en vidence
que l'accs au dossier mdical est prvu par la loi au Danemark, en Grande-Bretagne et aux Pays-Bas,
et par la jurisprudence dans les autres pays ; que les patients disposent de plus de droits dans les pays
qui ont lgifr. Ce document constitue un instrument de travail labor l'intention des Snateurs
par la Division des Etudes de Lgislation Compare du Service des Affaires Europennes. Il a un
caractre informatif et ne contient aucune prise de position susceptible d'engager le Snat

(2003). Evaluation des pratiques professionnelles dans les tablissements de sant. Dossier du patient :
rglementation et recommandations. Saint Denis ANAES: 56.
[Link]
Ce document est destin apporter aux professionnels des tablissements de sant un outil
d'valuation de la qualit de la tenue de leurs dossiers l'aide de la mthode de l'audit clinique.
L'audit passe par la slection de critres pertinents tablis partir de la rglementation et de
recommandations. Cette phase indispensable est souvent dlicate pour les professionnels. Elle
constitue la premire partie du document avant que soit abord l'audit lui-mme puis les mthodes
d'amlioration utilisables l'issue de l'audit.

(2003). Nomie O.C./Inter-rgimes : norme ouverte d'changes entre la maladie et les intervenants extrieurs :
cahier des charges. Paris CNAMTS,CCMSA,AMPI,UNRS: 210 , tabl.
[Link]
Le cahier des charges Norme Ouverte d'Echange entre la Maladie et les Intervenants Extrieurs :
Organismes Complmentaires (NOEMIE O.C.) dfinit la norme d'changes informatiques avec les
organismes complmentaires ainsi que les conditions pratiques de sa mise en place. Cette version
intgre la gestion de la Classification commune des actes mdicaux (CCAM).

(2005). Accs aux informations concernant la sant d'une personne. Modalits pratiques et accompagnement.
(Nouvelle version modifie des recommandations de l'Anaes de fvrier 2004, suite une dcision du
Conseil d'tat en date du 26 septembre 2005). Paris HAS: 27 , pdf.
[Link]
[BDSP. Notice produite par EHESP mn7CR0xJ. Diffusion soumise autorisation]. Les recommandations
concernent les modalits et l'accompagnement de l'accs aux informations de sant relatives une
personne, dtenues par des professionnels de sant, des tablissements de sant, publics ou privs,
ou des hbergeurs. Elles sont destines l'ensemble des professionnels de sant quel que soit leur
mode d'exercice (libral, public, en tablissements de sant, en structures sanitaires ou mdico-
sociales, etc.) et l'ensemble des personnels de ces tablissements et structures, qui sont tous
directement concerns par leur mise en oeuvre. Elles peuvent tre utiles galement aux personnes
ayant recours au systme de sant pour leur permettre d'tre informes des modalits d'accs aux
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informations concernant leur sant. Elles visent faciliter l'application des articles L. 1111-7, L. 1112-1
et R. 1111-1 R. 1112-9 du Code de la sant publique (loi n 2002-303 du 4 mars 2002 relative aux
droits des malades et la qualit du systme de sant et dcret n 2003-462 du 21 mai 2003 relatif
aux dispositions rglementaires des parties I, II et III du Code de la sant publique). Il s'agit de
contribuer par des mesures organisationnelles et de bonnes pratiques l'exercice d'un droit reconnu
par la loi et d'organiser, si besoin, un accompagnement personnalis de l'accs aux informations de
sant. Les points suivants sont abords : - Les principes gnraux ; Le dossier : un lment de la qualit
des soins ; L'information de la personne sur l'accs au dossier ; La communication du dossier
(rception et gestion de la demande, modalits de communication du dossier et accompagnement de
l'accs, cot de l'accs au dossier) ; Cas particulier des mineurs. Ces recommandations, tablies en
dcembre 2005, actualisent et remplacent les recommandations sur le mme thme rendues
publiques par l'Anaes en fvrier 2004.

(2007). Le DMP au point mort. Pour la relance d'un projet d'intrt national. Recommandations l'usage des
dcideurs de l'excutif, des professionnels de sant et des associations de sant. Neuilly sur Seine
LESSIS: 11.
[Link]
Aprs avoir rappel l'analyse de l'actuelle ministre de la Sant qui estime le dossier DMP "au point
mort" et ncessitant d'tre "rapidement relanc", les auteurs retracent dans la premire partie du
document l'historique tourment de ce dossier : objectif initial dvoy, absence de visibilit et de
concertation, erreurs rptes de la matrise d'ouvrage et retards conscutifs. Cette partie
introductive s'achve avec un rappel des objectifs compars de l'historique des remboursements (alias
Web mdecin). Pointant les limites de l'outil de la CNAMTS, les auteurs rappellent qu'il ne saurait
constituer une alternative au DMP en raison de la finalit loigne des deux projets. La seconde partie
droule un scnario qualifi de "raliste" pour relancer le chantier au point mort. Estimant que
l'absence d'identifiant national de sant ne constitue pas un obstacle la relance du DMP, les
rdacteurs recommandent la mise en oeuvre d'un socle de spcifications fonctionnelles opposable
tous, drouls dans une dynamique de rupture positive articule autour d'un engagement des
industriels sur des objectifs contractuellement dfinis.

(2007). Le projet DMP : Rapport d'activit 2006/2007. Paris G.I.P. - D.M.P.: 35.
[Link]
Cette publication dresse un bilan d'tape dtaill de l'tat d'avancement du projet DMP. Aprs un
rappel des enjeux et des objectifs de ce grand projet de sant publique, ce rapport d'activit passe en
revue les chantiers dj mens bien (environnement lgislatif et juridique, exprimentations, etc.) et
ceux qui restent mettre en oeuvre pour assurer la gnralisation du DMP en 2008. Vous y trouverez
aussi de nombreux tmoignages des acteurs de notre systme de sant sur le DMP: patients,
professionnels de sant, responsables et dirigeants des structures concernes, etc. Le GIP-DMP
entend en effet placer la concertation et la participation active des acteurs de terrain au coeur de son
action et de sa stratgie.

(2008). Avis n104. Le dossier mdical personnel et linformatisation des donnes de sant. Paris CCNE: 16.
[Link]
Le Comit Consultatif National d'thique (CCNE) a t saisi le 19 mars 2008 par Madame le Ministre de
la sant Roselyne Bachelot propos du dveloppement des technologies de l'information dans le
champ mdical. La saisine voque les risques induits par l'accs lectronique des dossiers du patient
par les personnels de sant au regard du respect de son droit la confidentialit des donnes. Elle
interroge le Comit sur les mesures concrtes susceptibles de concilier la ncessit d'un accs des
acteurs de soin aux informations qui s'y trouvent consignes avec le droit du patient garder le
contrle de leur diffusion.

(2008). L'informatisation de la sant. Le livre blanc du Conseil national de l'Ordre des mdecins. Paris CNOM:
16.
[Link]
Les technologies de linformation participent aujourdhui lamlioration de la qualit des soins. En
jouant de manire positive sur la tenue des dossiers mdicaux, en facilitant lchange et le partage des
donnes utiles la dcision mdicale, en augmentant la disponibilit et la rapidit daccs ces
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informations, ces technologies contribueront de plus en plus aux progrs de la mdecine. Elles ne
doivent pas pour autant tre mises en uvre sans la rflexion thique quimposent les risques quelles
feraient peser sur les donnes individuelles de sant et, partant de l, sur la confiance accorde aux
mdecins, garants de leur confidentialit. Par son rle de fdrateur des mdecins, de toutes
disciplines et de tous secteurs, runis autour des mmes principes dontologiques, le CNOM a la
responsabilit de sengager dans les projets de systme dinformation de sant au nom de lavenir
scientifique, mais dans le respect absolu des liberts individuelles. Il se mobilise aujourdhui
totalement et concrtement. Totalement : en soulignant que sa coopration passe ncessairement
par une association troite au dispositif rnov de gouvernance des systmes dinformation qui se
mettra en place. Concrtement : en apportant sa vision des lments fondateurs aptes faire entrer
les mdecins dans un systme communicant la hauteur des enjeux de la socit de linformation.
Cest par cette double implication que lordre entend soutenir une relance du projet de dossier
mdical lectronique scuris oriente dans une voie conforme la relation mdecin- patient et la
ralit des pratiques professionnelles. Larchitecture propose par lordre des mdecins est fonde sur
le respect des droits des patients : droit daccs aux donnes partages, droit de choisir les
professionnels autoriss partager ces donnes, droit loubli. Elle est galement conue de faon
favoriser lappropriation des technologies de linformation par les mdecins. La russite du dossier
mdical lectronique exige quil soit ralis pour les patients, par les mdecins.

(2008). Organisation du secours la personne et de l'aide mdicale urgente. Paris Ministre charg de la sant:
64 , ann.
[Link]
Ce rapport prsente le rfrentiel commun qui permettra de mieux organiser la prise en charge des
appels arrivant au 15 et/ou au 18. Ce rfrentiel a t labor dans le cadre d'un groupe de travail
quadripartite associant les reprsentants des structures de mdecine d'urgence, des services
d'incendie et de secours et des services des ministres concerns.

(2008). Perceptions et usages des NTIC dans la sant en France. Rsultats de l'enqute IPSOS. Confrence de
presse du 28 octobre 2008. Paris Ipsos: 29 , tabl.
[Link]
Ce document prsente les rsultats d'une enqute d'opinion mene en France afin d'obtenir un tat
des lieux prcis des perceptions et des pratiques relatives l'intgration des technologies de
l'information et de la communication en matire de sant. Les questions suivantes ont t poses :
Quel est le niveau de confiance des Franais en matire de sant et comment a-t-il volu depuis 2007
? Les Franais sont-ils prts participer financirement leurs dpenses de sant et de bien-tre ? Les
Franais et la dpendance : quelle est l?opinion des Franais sur la prise en charge des personnes
dpendantes et quel est le rle des nouvelles technologies dans l?hospitalisation domicile ? Quelle
est l?utilisation d?Internet par les Franais en matire de sant ? Etat des pratiques actuelles et
volutions depuis 2007 ? Quelle est l?utilisation d?Internet par les mdecins en matire de sant ?
Etat des pratiques actuelles et volutions depuis 2007? Les Franais seraient-ils intresss par un site
Internet ddi la sant et au bien-tre ? Quelles rubriques les intresseraient le plus ? Orange dans
le domaine de la sant : quelles sont les attentes des Franais ?

(2009). Etat des lieux et perspectives de plate-formes rgionales de services. Programme de relance du DMP et
des systmes d'information de sant. Paris Mission de Prfiguration de l'Agence des Systmes
d'Information Partags de Sant: 70.
[Link]
La prsente tude s'inscrit dans le cadre d'une commande passe au GIP DMP et au GMSIH
(Groupement pour la modernisation du systme d?information hospitalier) par la MISS (Mission pour
l?informatisation du systme de sant) et la DHOS (Direction de l?hospitalisation et de l?organisation
des soins) - Cf. lettre de mission date du 9 janvier 2008. Elle propose les bases d?une organisation et
d?un cadre de relations renouvels entre les rgions et les acteurs nationaux pour le dveloppement,
sur tout le territoire, des systmes d'information partags de sant . Elle s?appuie sur les
enseignements d?une histoire commune et d?une analyse partage. Le prsent document aborde la
question du dveloppement des plate-formes de services et la possibilit d'une modernisation
coordonne des systmes d'information de sant par la fourniture : d'un tat des lieux de l'existant,
d'une synthse des attentes exprimes par les acteurs institutionnels, oprationnels et industriels,
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d'une analyse des expriences conduites au regard de la construction d'un systme de porte
nationale, de recommandations aux acteurs afin de mettre en cohrence les actions nationales et
rgionales, de conseils pratiques l'attention des matrises d'ouvrage.

(2009). Gie Sesam-vitale. Rapport annuel 2008. Le Mans Gie Sesam-vitale: 36.
[Link]
Le Gie Sesam-vitale consolide son mtier d'oprateur d'infrastructures mutualises dans le champ
vaste des services de l'Assurance maladie obligatoire et complmentaire destination des
professionnels de sant. Ce rapport d'activit prsente les chiffres-cls 2008, l'infrastructure, la carte
vitale 2, l'extension du bouquet de services des complmentaires sant, l'offre de services aux
tablissements hospitaliers et cliniques, le support aux utilisateurs de Sesam-vitale, la collaboration
avec les partenaires europens...

(2009). Le dossier mdical en sant au travail. Consensus formalis. Recommandations professionnelles. Saint-
Denis HAS: 96.
[Link]
_dossier_medical_en_sante_au_travail_-_argumentaire.pdf
[BDSP. Notice produite par HAS C9HrR0x9. Diffusion soumise autorisation]. Ces recommandations
ont pour objectif d'amliorer la qualit des informations du dossier mdical en sant au travail (DMST)
afin de permettre d'valuer le lien entre l'tat de sant du travailleur et le (s) poste (s) et les
conditions de travail actuels et antrieurs. L'accent est mis sur la traabilit des expositions
professionnelles, des donnes de sant et des informations, propositions et avis dlivrs au travailleur
par le mdecin du travail. Les questions auxquelles rpondent les recommandations sont les suivantes
: 1. Quels sont la dfinition et les objectifs du DMST ? 2. Quelle est la nature des donnes qui doivent
figurer dans un DMST (structure du dossier, contenu du dossier) ? 3. Quels sont les principes de tenue
et d'utilisation du DMST ? Rgles gnrales concernant la tenue et le remplissage du DMST -
Utilisation des thsaurus - Modalits et critres de choix du logiciel de gestion du DMST - Conservation
et archivage du DMST La question des modalits de transmission du DMST n'est pas aborde. En
complment des recommandations, est galement publie une liste de quinze critres de qualit
utiles pour les professionnels de sant souhaitant valuer leurs pratiques.

(2009). Programme de relance du DMP et des systmes d'information partags de sant - Orientations
stratgiques et principes de mise en oeuvre. Paris ASIP SANTE: 112.
[Link]
Le prsent document prsente les orientations stratgiques relatives au dveloppement des systmes
dinformation partags de sant et les principes de mise en uvre du DMP. Il contient ncessairement
des dveloppements consacrs aux modalits de conduite de projet, dont le caractre parfois
technique ne doit pas conduire penser que les finalits mdicales et d'usage du projet seraient
ngliges au profit de sa dimension technologique. Le service aux utilisateurs, qu'ils soient
professionnels de sant ou patients, demeure la proccupation premire et constante de ce
programme de relance et sous-tend chacune de ses composantes. De par la diversit et la complexit
des sujets abords, ce programme de relance ne saurait prtendre apporter sur chacun d'eux une
rponse dfinitive. Sur la base des axes stratgiques qui fondent ce programme, un travail de
concertation sera conduit avec l?ensemble des acteurs afin den prciser les modalits de ralisation
et d?en engager la mise en uvre sur une base consensuelle (rsum d'auteur).

(2010). Livre blanc : l'hpital numrique l'heure de l'ouverture : des SIH vers un systme d'information et de
communication en sant. Paris Syntec: 72.
[Link]
Syntec informatique, porte-parole de l'industrie des logiciels et services, a profit du salon pour
prsenter son livre blanc : L'Hopital Numrique l'heure de l'ouverture : Parcours patient, pratiques
mdicales, lien avec la mdecine de ville, rseaux de soins, collectivits, professionnels de sant,
fournisseurs... L'hpital se transforme et ncessite d'tre accompagn dans sa transformation,
notamment au niveau de la fluidification des informations du suivi des patients. L'ouvrage propose un
certain nombre de pistes de rflexion afin d'intgrer la question des nouveaux outils technologiques
dans cette transformation du monde de la sant.

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(2011). Guide pratique du projet DMP en tablissement de sant et plan projet associ. Paris ASIP Sant: 81 ,
ill.
[Link]
associe
Le Dossier Mdical Personnel (DMP) doit aider amliorer la coordination des soins grce une
meilleure circulation de linformation mdicale entre les professionnels de sant de lhpital et de la
ville. Il existe plusieurs faons de mettre en uvre ce projet dans les tablissements de sant. Ce
guide est destin accompagner les chefs de projet DMP dans les tablissements et les matrises
douvrage rgionales. Cest un document pratique dont les prconisations oprationnelles reposent
sur les retours dexpriences des tablissements et matrises douvrage rgionales dans les rgions
pilotes, ainsi que sur un travail concert avec les responsables de systmes dinformation en
tablissements et plus globalement avec la Direction gnrale de loffre de soins (DGOS), lAgence
Nationale dappui la performance (ANAP), les Fdrations Hospitalires et quelques diteurs et
personnes qualifies. Chaque type dtablissement, quels que soient son statut, sa taille, son niveau
de connaissance du DMP et sa situation dinformatisation, y trouvera des lments permettant de
dfinir sa trajectoire de mise en uvre du DMP.

(2011). Rapport : Indicateur sur la qualit du dossier d'anesthsie - Campagne 2010 - Analyse descriptive des
rsultats agrgs 2010. Etudes et enqutes.: 20.
[Link]
[BDSP. Notice produite par HAS 9R0x9D9s. Diffusion soumise autorisation]. Le rapport prsente les
rsultats nationaux et rgionaux agrgs. Prs de 1000 tablissements ont valu la qualit de leur
dossier d'anesthsie. - Depuis 2008, le score national ne cesse de progresser : 17 points en 3 ans : Il
atteint le score de 80 en 2010. - Dans 6 tablissements sur 10, le dossier, d'au moins 8 patients sur 10,
contient les lments qualitatifs indispensables la matrise du risque anesthsique - Les
tablissements de sant continuent de progresser grce l'implication des professionnels dans
l'amlioration de la qualit de leur dossier. Nanmoins certains tablissements ont des rsultats en
baisse. La HAS intgrera ces informations dans la cartographie des risques des tablissements afin de
cibler les visites de certification. - Les rsultats restant tout de mme trs variables d'un tablissement
l'autre confirment la pertinence de la poursuite du recueil de cet indicateur. - Il existe une variabilit
de rsultats pour certains lments de la matrise du risque anesthsique qui tmoignent d'une
htrognit des pratiques. La HAS et le Collge Franais des Anesthsistes-Ranimateurs (CFAR) se
sont engags dans un travail commun d'analyse des facteurs explicatifs de cette variabilit des
rsultats, qui compltera les rsultats prsents dans ce rapport.

(2011). Rapport : Indicateurs de qualit du dossier du patient gnraliss en MCO - Campagne 2010 - Analyse
descriptive des rsultats agrgs 2010 et analyse des facteurs associs la variabilit des rsultats.
Etudes et enqutes.: 60.
[Link]
En 2010, la HAS a coordonn la troisime campagne de recueil gnralise des cinq indicateurs du
dossier du patient (Qualit de la tenue du dossier patient, dlai d?envoi du courrier de fin
d?hospitalisation, valuation de la douleur, dpistage des troubles nutritionnels, valuation du risque
d?escarre) impliquant les tablissements ayant une activit de mdecine, chirurgie et obsttrique
(MCO). Aprs chaque campagne de recueil, la HAS rend compte des rsultats agrgs dans un rapport
d?analyse mis en ligne sur son site Internet. Ce rapport prsente les principaux constats et faits
marquants issus de l?analyse des rsultats de la campagne 2010. Il permet notamment d?analyser
l?volution des rsultats sur 3 annes conscutives. Cette analyse permet plusieurs constats : - une
amlioration gnrale pour tous les indicateurs du thme "Dossier du patient" en 3 ans. - une
variabilit inter-tablissements et interrgionale, qui tmoigne de la persistance d'une htrognit
des pratiques. - l'informatisation des dossiers amliore la qualit des prescriptions mdicamenteuses.
- les personnes ges ont une moins bonne valuation de la douleur avec une chelle, et une moins
bonne mesure du poids.

(2011). Rapport : Indicateurs de qualit du dossier du patient gnraliss en SSR - Campagne 2010 - Analyse
descriptive des rsultats agrgs 2010 et analyse des facteurs associs la variabilit des rsultats.
Etudes et enqutes.: 62.
[Link]
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En 2010, la HAS a coordonn la deuxime campagne de gnralisation des cinq indicateurs du dossier
du patient (qualit de la tenue du dossier patient, dlai d?envoi du courrier de fin d?hospitalisation,
valuation de la douleur, dpistage des troubles nutritionnels, valuation du risque d?escarre)
impliquant les tablissements ayant une activit de soins de suite et de radaptation (SSR). Aprs
chaque campagne de recueil, la HAS rend compte des rsultats agrgs dans un rapport danalyse mis
en ligne sur son site Internet. Ce rapport prsente les principaux constats et faits marquants issus de
l?analyse des rsultats de la campagne 2010. Il permet de porter une premire apprciation sur
l?volution des rsultats entre 2009 et 2010 pour les tablissements de sant SSR, et apporte un
premier clairage sur les facteurs associs permettant d?expliquer le rsultat des indicateurs. Cette
analyse permet plusieurs constats : - une amlioration pour tous les indicateurs du thme "Dossier du
patient" entre les campagnes 2009 et 2010 ; - l'informatisation des dossiers amliore le rsultat des
indicateurs "Tenue du dossier patient", "Dlai d'envoi du courrier" et "valuation de la douleur" ; - les
personnes ges ont une moins bonne valuation de la douleur avec une chelle ; - une structure SSR
mono-activit obtient de meilleurs scores pour la "Tenue du dossier patient" et l' "valuation de la
douleur".

(2011). Rapport : Indicateurs de qualit et de scurit des soins gnraliss en HAD. Campagne 2010. Analyse
descriptive des rsultats agrgs 2010 et des facteurs associs la variabilit des rsultats. Etudes et
Rapports.: 44.
[Link]
[BDSP. Notice produite par HAS R0xAAo9D. Diffusion soumise autorisation]. En 2010, la HAS a
coordonn la premire campagne de gnralisation des cinq indicateurs du dossier du patient (qualit
de la tenue du dossier patient, dlai d'envoi du courrier de fin d'hospitalisation, valuation de la
douleur, dpistage des troubles nutritionnels, valuation du risque d'escarre) impliquant les
tablissements ayant une activit d'hospitalisation domicile (HAD). Aprs chaque campagne de
recueil, la HAS rend compte des rsultats agrgs dans un rapport d'analyse mis en ligne sur son site
Internet. Ce rapport prsente les principaux constats et faits marquants issus de l'analyse des rsultats
de la campagne 2010. Il apporte un premier clairage sur les facteurs associs permettant d'expliquer
le rsultat des indicateurs.

(2012). Comment dployer la prescription lectronique ? Note d'orientation. Paris CNOM: 7.

[Link]
La prescription lectronique devient incontournable car elle comporte un fort impact positif pour
faciliter la scurit des exercices professionnels et leur qualit tant au titre de chaque professionnel de
sant qu'au titre des bnfices en sant publique, pour amliorer la scurit et la qualit des
prescriptions. Les ordres des professions de sant runis au sein du CLIO Sant considrent que le
temps est venu d'agir et dressent dans cette note une liste des grandes options qu?il convient de
proposer au plus vite tous les acteurs concerns (d'aprs le rsum d'auteur).

(2012). Indicateurs de qualit gnraliss en MCO - Campagne 2011 - Analyse descriptive des rsultats agrgs
et analyse des facteurs associs la variabilit des rsultats. Etudes et Rapports. Saint-Denis HAS: 60.
[Link]
[BDSP. Notice produite par HAS 8CA8qR0x. Diffusion soumise autorisation]. En 2011, la HAS a
coordonn la quatrime campagne de recueil gnralise des cinq indicateurs du dossier du patient
(Qualit de la tenue du dossier patient, dlai d'envoi du courrier de fin d'hospitalisation, valuation de
la douleur, dpistage des troubles nutritionnels, valuation du risque d'escarre) impliquant les
tablissements ayant une activit de mdecine, chirurgie et obsttrique (MCO). Aprs chaque
campagne de recueil, la HAS rend compte des rsultats agrgs dans un rapport d'analyse mis en ligne
sur son site Internet. Ce rapport prsente les principaux constats et faits marquants issus de l'analyse
des rsultats de la campagne 2011. Il permet notamment d'analyser l'volution des rsultats sur 4
annes conscutives.

(2012). Rfrentiel de certification par essai de type des logiciels hospitaliers d'aide la prescription.
Rfrentiels de certification. Saint-Denis HAS: 42.
[Link]
06/referentiel_certification_lap_hospitalier_juin12.pdf
[BDSP. Notice produite par HAS CR0xlHFq. Diffusion soumise autorisation]. Le champ d'application
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du rfrentiel de juin 2012 concerne les LAP destins aux tablissements de sant. Il a pour objectif de
promouvoir des fonctionnalits susceptibles : - d'amliorer la qualit de la prescription ; - de faciliter le
travail du prescripteur et de favoriser la conformit rglementaire des prescriptions ; - de diminuer le
cot du traitement qualit gale. Le rfrentiel de certification traite essentiellement de la
prescription mdicamenteuse et aborde des questions comme le mode de choix des mdicaments (
partir de la dnomination commune internationale, du nom de marque.), les alertes de contre-
indication et d'interaction, la disponibilit de diffrentes informations sur le mdicament, les
prescriptions pour les patients hospitaliss et les prescriptions destines aux patients externes.
L'ergonomie et les observations des utilisateurs ont galement t prises en compte dans l'laboration
de ce rfrentiel. Le document "Prcisions sur la certification des LAP" prcise certains points de la
procdure, par exemple les mdicaments pour lesquels l'utilisation de la Dnomination Commune
Internationale n'est pas exige par cette certification. Les fonctions de scurit d'un LAP ne sont
vritablement efficaces que si l'information sur les mdicaments mise sa disposition est de qualit.
Un LAP ne peut donc postuler cette certification que s'il s'appuie sur une Base de donnes sur les
Mdicaments agre par la HAS. La HAS publie un scnario de tests de certification et mettra
disposition des questions-rponses autour de cette procdure. Cette certification est ralise par des
organismes certificateurs accrdits par le Comit franais d'accrditation (Cofrac). Les organismes
certificateurs peuvent faire leurs demandes d'information relatives : - au rfrentiel de certification
auprs de la HAS ; - au programme d'accrditation auprs du Cofrac. Les rfrences des organismes
accrdits par le Cofrac pour cette certification seront disponibles sur cette page.

(2012). Sesam-vitale. Rapport d'activit 2011. Le Mans Gie Sesam-vitale: 18.

[Link]
Le rapport d'Activit 2011 du GIE SESAM-Vitale est en ligne. Il illustre les volutions en cours au GIE et
anticipe son principal challenge pour les annes venir : en relation troite avec les industriels,
accompagner la mutation stratgique vers les services en ligne valeur ajoute, tout en garantissant
en permanence un niveau de services lev pour l'infrastructure actuelle, essentielle notre systme
de sant. Quelques chiffres : 1,15 milliard de Feuilles de Soins Electroniques (rgimes obligatoires)
certifies (soit 6 % de plus qu'en 2010) avec une qualit de service de 99,92% sans rejet technique .
53 % des FSE sont ralises partir d'un logiciel en version 1.40. 7,6 millions de Demandes de
Remboursements Electroniques mises destination des complmentaires sant, soit deux fois plus
qu'en 2010 (rsum d'auteur).

(2013). Accs aux soins : en finir avec la fracture territoriale. Paris Institut Montaigne: 73 , tabl., fig.
[Link]
Trs onreux, d'une grande complexit institutionnelle et administrative, le systme de soins franais
pche galement par l'archasme de son organisation, caractris par de forts cloisonnements entre
ville et hpital comme entre professionnels de sant. Au-del des problmes vidents de rpartition
sur le territoire des professionnels de sant, la question est sans doute plutt celle du modle
d'organisation des soins en France, qui ne correspond plus aux exigences sociales, dmographiques et
technologiques de notre pays. Face ces dfis et dans un contexte de finances publiques contraint,
comment adapter notre systme de sant ? C'est vers une organisation dcloisonne, rgionalise,
construite autour des besoins des patients qu'il faut s'orienter. Le systme de sant doit galement
s'adapter aux exigences des nouvelles gnrations de professionnels de sant et leur offrir les moyens
d'exercer leur mtier de faon regroupe, en bnficiant de l'apport des nouvelles technologies.

(2014). Audit des Systmes d'Information Hospitaliers auprs d'tablissements reprsentatifs : Rapport final.
Paris ANAP: 41 , tabl., fig.
[Link]
Laudit des SIH de treize tablissements, men par lANAP au premier trimestre 2014, complt par
une tude des bases de donnes disponibles, a permis de constater : (1) que le march franais de
linformatique hospitalire, troisime par la taille en Europe, est excessivement fragment tant du
ct de loffre que du ct de la demande et, par consquent, est structurellement fragile ; (2) que
linformatisation de la production des soins est trs largement engage dans les hpitaux franais et
que lusage de linformatique est gnralis lhpital, dans tous les secteurs ; (3) que les spcialits
mdicales et louverture des SIH sur leur territoire sont des thmes mergents. Les dterminants du
succs du dploiement des SIH sont trs largement externes, en particulier par les politiques
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publiques. En interne, les SIH doivent sappuyer sur la stratgie, les hommes et les organisations, les
mthodes et les outils et leur interoprabilit. Le rapport propose trois axes de travail pour acclrer
le dploiement et lusage des SIH : (1) les actions visant renforcer les capacits des tablissements
en matrise douvrage des SI et les prparer intgrer leur systme dans le parcours coordonn du
patient ; (2) les actions de structuration de loffre de SIH ; (3) les actions visant renforcer laction
publique et accroitre la lisibilit des actions.

(2014). Comment amliorer la qualit et la scurit des prescriptions de mdicaments chez la personne ge.
Fiche points cls - Note mthodologique et de synthse documentaire. Saint-Denis HAS: 2 vol. (12;56 ),
fig., annexes.
[Link]
prescriptions-de-medicaments-chez-la-personne-agee
Cette fiche a pour objectif de fournir une information afin de sensibiliser tous les acteurs la ncessit
de prvenir la frquence et la gravit des problmes de mdicaments chez la personne ge fragile.
Cette fiche est complte par une note de problmatique et une synthse bibliographique. La
synthse bibliographique porte sur la prvention et la gestion des problmes associs aux
mdicaments (PAM). Lanalyse dcrit la population expose aux problmes de mdicaments, les
mcanismes professionnels et organisationnels en cause et les consquences sur le systme de soins
(sollicitation des structures hospitalires) et sur ltat de sant du patient (vnement indsirable li
aux mdicaments [EIM] et perte de chances par sous-traitement). Elle rappelle les notions de bonnes
pratiques de prescription et les caractristiques des prescriptions (au sens prises en charge)
inappropries. Labondance de la littrature sur le mdicament permet un point actualis sur les
interventions et les programmes damlioration de la qualit et de la scurit des prescriptions de
mdicaments chez la personne ge et lapport de linformatique mdicale(rsum de l'diteur).

(2014). Le Dossier Pharmaceutique Rapport d'activit 2013 de l'Ordre national des pharmaciens. Paris Ordre
National des pharmaciens: 36 , graph.
[Link]
activite-2013
Utilis par 22 300 officines (98,7 %) et 32,8 millions de Franais, le dossier pharmaceutique (DP) aurait
permis la modification de 2,5 millions de traitements grce au partage d'informations entre officines. Il
a aussi permis de rappeler des lots de mdicaments (58 l'an dernier), de diffuser des alertes sanitaires
(24 au cours de l'anne) et d'informer sur les ruptures d'approvisionnement. De nouvelles
fonctionnalits sont attendues dans la lutte contre les mdicaments falsifis et le suivi des
vaccinations. Un dcret visant augmenter la dure de conservation des donnes dans le DP 21 ans
pour les vaccins est en prvision.

(2014). Le numrique et les droits fondamentaux : Etude annuelle 2014 du Conseil d'Etat. Paris La
Documentation franaise: 446.
[Link]
Le numrique, parce qu'il conduit la mise en donnes et la mise en rseau du monde, pose
problme aux droits fondamentaux : il met en question leur contenu et leur rgime. S'il renforce la
capacit des individus jouir de certains droits, comme la libert d'expression, la libert
d'entreprendre, il en fragilise d'autres, comme le droit la vie prive ou le droit la scurit. L'tude
annuelle du Conseil d'tat intervient alors qu'un triple basculement se manifeste dans les innovations
techniques, dans l'conomie et dans l'apprhension du numrique par la socit. Face ces
bouleversements, l'tude s'attache repenser la protection des droits fondamentaux et rpondre
aux questions en dbat : la neutralit d'internet, sa gouvernance, le droit l'oubli, la proprit des
donnes, leur exploitation et agrgation en Big Data, le rle indit des grandes plateformes. L'tude
prsente 50 propositions de l'tude dont l'objectif est de mettre le numrique au service des droits
individuels et de l'intrt gnral.

(2014). Rapport de la Commission Open data en sant. Paris Ministre charg de la Sant: 63 +59 , ann.
[Link] -
[Link]
La Commission " open data en sant ", qui s'est runie de novembre 2013 mai 2014, avait pour
mission de dbattre, dans un cadre pluraliste associant les parties prenantes, des enjeux et des
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propositions en matire d'accs aux donnes de sant. Son rapport, remis le 9 juillet 2014 la ministre
de la Sant, retrace les travaux et discussions de la Commission. Adopt consensuellement par
l'ensemble des membres de la commission, qui partagent des attentes communes et fortes, il dresse
tout d'abord un panorama de l'existant : dfinitions des concepts, tat du droit, prsentation de la
gouvernance, prsentation de l'accs aux donnes du SNIIRAM et du PMSI, cartographie des donnes
de sant et enseignements tirs des expriences trangres. Dans une seconde partie, il voque les
enjeux pour l'avenir. Enfin, il identifie les actions mener : donnes ouvrir en open data,
orientations en matire de donnes ridentifiantes, donnes relatives aux professionnels et aux
tablissements.

(2014). Vade-Mecum des objets connects: 102.

[Link]
Ce document, publi par l'Association pour la promotion de la scurit des systmes d'information de
sant (APSSIS), est compos de 12 chapitres. Il rappelle d'abord le contexte lgislatif et rglementaire
du march, donne la parole quatre experts sur le sujet : le Dr Jacques Lucas, vice-prsident du
Conseil national de l'Ordre des mdecins, Grard Peliks et Herv Lehning, de l'Association des
rservistes du chiffre et de la scurit de l'information (ARCSI), et Uwe Diegel, vice-prsident de la
socit iHealthLabs. Sont prsentes ensuite 120 applications destines aux professionnels de sant
ou au grand public, dtailles dans quatre chapitres : "Welcome dans la e-sant", "Sport et sant: le e-
mariage", "La e-sant de nos enfants" et "La e-sant de nos seniors". Une partie paroles d'experts, de
mdecins, chiffres, statistiques et tendances complte ce document.

(2015). La sant : bien commun de la socit numrique. Construire le rseau du soin et du prendre soin. Paris
Conseil National du numrique: 125.
[Link]
la-soci%C3%A9t%C3%A9-num%C3%[Link]
Ce rapport est consacr au rle du numrique dans la refondation de notre de systme de sant. Il
formule 15 propositions pour que la transformation numrique de notre systme de sant favorise
lmergence dune socit plus solidaire, quitable et innovante , en cohrence avec la Stratgie
nationale du numrique. Elles inspireront notamment trois chantiers en cours: la construction du futur
service public dinformation en sant, lmergence de nouveaux espaces de co-innovation en sant et
les travaux sur le futur dossier mdical dmatrialis.

Babinet, G. et Vassoyan, R. (2015). Big data et objets connects Faire de la France un champion de la rvolution
numrique. Paris Institut Montaigne: 211 , fig.
[Link]
La rvolution du Big data et des objets connects cre dimmenses perspectives de cration de valeur
mais suscite galement des interrogations nouvelles sur la protection des droits des individus. Pour
renforcer la confiance entre les acteurs et soutenir le dveloppement de modles conomiques
innovants, les diffrentes parties prenantes doivent saisir les opportunits offertes et travailler en
confiance. Les rflexions de ce rapport portent sur cinq axes majeurs : les enjeux conomiques pour la
France ; la ncessit dune gouvernance adapte intgrant notamment les sujets de transparence et
de standardisation ; ladaptation des comptences et des ressources humaines aux besoins nouveaux
lis au dveloppement des objets connects et du Big data ; lamlioration de la performance et de la
prennit des solutions technologiques ; la rgulation des usages et la protection de la vie prive et
des donnes sensibles destine maintenir la confiance comme facteur clef de succs de la rvolution
des objets et du Big data.

Babusiaux, C., et al. (2003). L'accs des assureurs complmentaires aux donnes de sant des feuilles de soins
lectroniques. Paris Ministre charg de la Sant: 90 , ann.
[Link]
Les assureurs complmentaires souhaitent, depuis plusieurs annes, accder aux donnes de sant
contenues dans les feuilles de soins lectroniques, que seuls reoivent aujourd'hui les assureurs
complmentaires. Une telle demande soulve des problmes juridiques et techniques, ainsi que des
questions d'organisation et de cot. Elle touche des sujets essentiels comme le respect des liberts
individuelles et la prservation du secret mdical. Ce rapport a donc pour objectif d'tudier la
faisabilit du projet et d'en prciser les modalits. Il analyse, tout d'abord, la demande des assureurs
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complmentaires pour en prciser les diffrentes composantes. Il tudie ensuite les diverses rgles
applicables et leur articulation, de manire dgager la nature et les limites des solutions juridiques
possibles pour que la tltransmission des donnes nominatives puisse tre effectue par le
professionnel de sant. Les limites et difficults de ces voies amnent examiner si d'autres solutions
qu'une tltransmission nominative par les professionnels de sant sont possibles. Sont alors
prcises les contraintes techniques et les modalits d'organisation qui s'imposeraient dans tous les
cas. Cet examen amne aux recommandations sur le choix entre les solutions pour la transmission des
donnes individuelles et sur les modalits de mise en ?uvre. Enfin, est suggre la possibilit pour les
assureurs complmentaires d'accder aux donnes statistiques du systme national d'information
interrgimes de l'assurance maladie. L'ensemble a t men indpendamment de toute volution
ventuelle de la ligne de partage entre assurance obligatoire et assurance complmentaire, en
prcisant seulement comment la pondration de certains lments du raisonnement se trouverait
modifie si cette rpartition voluait. Ce rapport fait suite au rapport de M. Fieschi de janvier 2003.

Babusiaux, C. p. (2015). Rapport au Parlement 2015. Ouverture, qualit, partage : des avances. Charenton-Le-
Pont Institut des donnes de sant: 72.
[Link]
Ce rapport, que lInstitut des donnes de sant remet comme chaque anne au Parlement aprs
adoption par son Assemble Gnrale conformment la loi du 13 aot 2004, traduit des progrs
importants dans trois domaines dactions : Louverture des donnes pour la recherche sest acclre.
LIDS en a approuv 161 depuis 2009, dont 83 depuis dbut 2014. Lutilisation des donnes par prs
de 200 chercheurs devrait permettre la recherche de progresser dans des domaines majeurs de
lpidmiologie (cancer, diabte, asthme, etc.), des effets des mdicaments et des interactions
mdicamenteuses, et de lvaluation mdico-conomique (dispositifs mdicaux, ingalits territoriales
etc.). Le service daide la dcision est pass 39 tableaux de bord couvrant les champs ambulatoires
et hospitaliers et permettant le suivi dindicateurs essentiels. Ce service, aujourdhui la disposition
des membres de lIDS et dautres organismes uvrant dans le domaine de la sant, favorise la
connaissance et le partage dinformations essentielles entre les grands acteurs de la sant et de la
protection sociale. La qualit et la cohrence des bases de donnes publiques ont t nouveau
amliores. LIDS a ralis 20 rapports depuis 2011 et a propos 154 amliorations afin que ces bases
rpondent mieux aux besoins des acteurs et de la recherche. Dans le mme temps, lIDS s'est assur
du respect de lanonymat des personnes, du secret mdical, ainsi que de lthique et de la dontologie
auxquels veille le Comit dExperts prsid par Didier Sicard , dont laudition annuelle devant
lAssemble Gnrale est retrace dans le prsent rapport.(daprs lditorial).

Bellanger, A., et al. (2009). Synthse nationale sur les tableaux de bord 2007 des rseaux rgionaux de
cancrologie. Rapports & synthses. Boulogne-Billancourt Inca: 85.
[Link]
Ce rapport concerne les donnes d?activit 2007 des rseaux rgionaux de cancrologie (RRC) et fait
suite la premire synthse nationale des tableaux de bord1 (TdB) des RRC (activit 2006). Il revt le
double intrt de constituer d?une part, une photographie de la situation des RRC un instant donn
et d?autre part, de permettre des comparaisons de rsultats d?une anne l?autre et entre les
rgions. Le rapport d?activit 2007 des RCC volue et il intgre les donnes du TdB standardis des
centres de coordination en cancrologie (3C). Ces derniers, cellules qualit oprationnelles,
produisent des informations sur les activits cancrologiques des tablissements de sant et

Beuscart, R. (2000). Rapport sur les enjeux de la socit de l'information dans le domaine de la sant. Paris
PAGSI (http //[Link]/dossiers/documents/schema/[Link]: (50 ).
[Link]
L'objectif de ce rapport est de dresser un tat des lieux de la socit de l'information dans le domaine
de la sant, et d'analyser plus particulirement le dveloppement des NTIC (nouvelles technologies de
l'information et de la communication). Il examine quatre dimensions essentielles : la tlmdecine,
qui permet plusieurs professionnels de sant de communiquer pour favoriser la prise en charge d'un
patient donn dans le cadre d'une dmarche diagnostique ou thrapeutique ; les filires et rseaux de
professionnels de sant, qui facilitent la communication d'information entre professionnels et malades
; la e-sant, qui donne accs au grand public et aux patients au monde de la sant grce internet ; la
formation mdicale continue grce aux NTIC. Il termine sur des recommandations.
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Blanchard, P., et al. (2014). Evaluation de la coordination d'appui aux soins. Rapport Igas ; 2014-010R. Paris
IGAS: 123.
[Link]
A la demande de la ministre en charge de la sant, l'IGAS a t charge de procder un inventaire
et une analyse de l'ensemble des coordinations d'appui aujourd'hui dployes . Cette mission a t
envisage dans le cadre de la Stratgie nationale de sant (SNS). Aprs un diagnostic de la situation, le
rapport propose une nouvelle organisation de la coordination d'appui aux soins, reposant sur
l'initiative des mdecins. La coordination d'appui aux soins propose est ainsi destine viter toute
rupture dans la prise en charge globale des patients grce la mobilisation de l'ensemble des
professionnels qui peuvent y concourir. Concrtement, la mission propose que ce soit le mdecin de
premier recours, et lui seul, qui puisse la dclencher en concertation avec le patient. Le mdecin de
premier recours pourrait ainsi choisir de recourir diffrentes modalits en fonction de sa pratique et
de ses habitudes.

Blanchet, P., et al. (2014). Identifier les enjeux de larticulation entre dossier patient commun et dossiers de
spcialits. Paris ANAP: 52.
[Link]
on%20entre%20dossier%20patient%20commun%20et%20dossiers%20de%[Link]
La constitution d'une informatique mdicale et administrative a donn lieu des cohabitations de
logiciels complexes avec dune part un dossier patient commun et des outils ou dossiers de spcialit,
sur mesure. Leur articulation est un vritable enjeu pour ltablissement de sant avec des
amliorations attendues en termes de qualit de la prise de charge des patients, de conditions de
travail des professionnels de sant et de valorisation de lactivit. Ce rapport explique lorigine des
articulations insatisfaisantes souvent observes aujourdhui ainsi que les risques et inconvnients
induits. Il prsente diffrentes prconisations, issues de lexprience des membres du groupe de
travail ainsi que des tmoignages des 5 tablissements de sant visits, privs et publics.

Boaretto, Y., et al. (2007). Rapport sur le dossier mdical personnel (DMP). Paris IGAS: 85 , ann.
[Link]
Institu par la loi n2004-810 du 13 aot 2004, le dossier mdical personnel (DMP) avait pour but de
favoriser la coordination, la qualit et la continuit des soins. Compte tenu de la complexit du
dispositif, un GIP, compos de l'Etat, de la Caisse des dpts et consignations et de l'assurance-
maladie, avait t constitu en avril 2005 pour piloter la mise en place du DMP. Celui-ci devait tre
gnralis tous les bnficiaires de l'assurance maladie pour le 1er juillet 2007. La mission conjointe
IGAS-IGF-CGTI, mise en place en juillet 2007, fait le point sur l'tat d'avancement et le pilotage de ce
projet ainsi que sur sa capacit rpondre aux objectifs initiaux. Elle estime notamment que le
dispositif s'est vu, d'emble, dot d'objectifs irralistes, aussi bien dans le calendrier impos, le cot
du projet que dans le modle conomique choisi, modle dont le potentiel d'conomies attendu pour
l'assurance maladie ne s'est pas vrifi. Elle observe par ailleurs que le projet DMP souffre d'une perte
de crdibilit et de lisibilit et prsente d'importantes zones de risques et d'incertitudes. Sur la base
de ce constat, la mission prsente une srie de recommandations pour sauvegarder les acquis,
restaurer la confiance et relancer le projet de DMP .

Bouchoux, C. (2014). L'accs aux documents administratifs et aux donnes publiques. 2 tomes. Paris Snat: 2
vol. (215; 359 ), tabl., fig.
[Link] - [Link]
En 1978, le Parlement reconnaissait toute personne le droit dobtenir communication des
documents de ladministration (loi Cada). Il ouvrait ainsi aux citoyens, en rupture avec la
confidentialit caractristique de la culture administrative franaise, la possibilit danalyser et de
comprendre les dcisions publiques et de les contester. lheure du numrique, laccs aux
informations produites et recueillies par ladministration ainsi que la possibilit de les rutiliser
prennent une dimension entirement nouvelle, dont les enjeux sont la fois stratgiques,
dmocratiques et conomiques : la possibilit de rutiliser les donnes publiques ouvre en effet des
perspectives encore largement inexploites en matire de contrle de laction publique,
damlioration de son efficacit et de sa qualit ou de dveloppement de nouveaux services. La
mission commune dinformation a donc souhait, dune part, sassurer de leffectivit du droit formul
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il y a 35 ans et, dautre part, valuer la pertinence et lefficacit des politiques engages depuis
quelques annes par les pouvoirs publics en matire de diffusion de linformation publique et, plus
rcemment, douverture des donnes publiques (open data) (tir de la synthse).

Bras, P. L., et al. (2011). Pharmacies d'officines : rmunration, missions, rseau. Rapport Igas ; RM2011-090P.
Paris Igas: 208 , tabl., annexes.
[Link]
Comment se porte le secteur de la pharmacie d'officine en France et quel est son avenir ? L'Inspection
gnrale des affaires sociales (IGAS) livre son diagnostic notamment partir de l'enqute nationale
qu'elle a mene sur les pratiques officinales, premire du genre en France et propose des pistes pour
diversifier le rle des pharmaciens, les rmunrer comme des professionnels de sant et optimiser le
rseau des officines sur le territoire.

Bras, P. L. et Loth, A. (2013). Rapport sur la gouvernance et l'utilisation des donnes de sant. Paris Ministre
charg de la Sant: 128 , tabl., ann.
[Link]
1. Par lettre du 16 avril 2013, la ministre des Affaires sociales et de la sant a saisi l'auteur de ce
rapport, Pierre-Louis Bras d'une mission sur la gouvernance et l'utilisation des donnes de sant. Le
sujet est complexe. Il concerne surtout la plus importante des bases de donnes publiques de sant
dans notre pays, voire dans le monde, le Systme national d'information inter-rgime de l'assurance
maladie (SNIIRAM). Issues des feuilles de soins et des rsums de sortie hospitaliers, dont on a retir
tous les lments directement identifiants, les donnes du SNIIRAM dcrivent l'offre et la
consommation de soins ainsi que l'tat de sant des quelques 65 millions d'habitants de notre pays
dans la priode rcente. Le prsent rapport propose les voies et les moyens pour mettre en place un
dispositif d'accs et d'utilisation des bases de donnes mdico-administratives, adapt aux besoins de
sant publique et de scurit sanitaire, dans des conditions fiables et scurises, respectant
notamment le strict anonymat des patients. Le rapport s'inscrit dans le cadre plus gnral de la
rflexion mene sur l'ouverture de l'accs aux donnes de sant. Il complte ainsi le rapport sur la
pharmaco-surveillance remis le 15 septembre 2013 la ministre par les Professeurs Bgaud et
Costagliola - qui recommandait la cration d'une structure regroupant et analysant l'ensemble des
donnes de sant sur l'utilisation des mdicaments et produits de sant. Il s'articule par ailleurs avec
la mission Open data sur la politique d'ouverture des donnes publiques.

Brun, N., et al. (2011). Rapport de la mission Nouvelles attentes du citoyen, acteur de sant . Paris Ministre
charg de la sant, Paris La documentation Franaise: 46.
[Link]
Le prsent rapport fait partie des trois missions confies dans le cadre du dispositif 2011, anne des
patients et de leurs droits , dont le thme principal porte sur le droit des patients et de leurs proches
dans les tablissements de sant. Le rapport s'intresse la place des patients dans le systme de
sant, aux nouveaux comportements (usage de l'Internet) et aux nouvelles attentes concernant la
gestion de leur sant. Un chapitre est consacr l'ducation thrapeutique et aux programmes
d'accompagnement pour les personnes atteintes d'une maladie chronique. Le rapport fait galement
le point sur les transformations lies aux nouvelles technologies de la sant, dont la tlmdecine.

Cecchi-Tenerini, R., et al. (2002). Evaluation du systme d'information des professionnels de sant. Paris IGAS,
Paris La documentation franaise: 68 , ann.
[Link]
Les systmes d'information se sont fortement dvelopps au cours des vingt dernires annes dans le
monde de la sant. Le rapport dresse dans un premier temps un bilan du systme en place, de ses
lacunes par rapport aux objectifs fixs, des obstacles qu'il a rencontrs. Puis dans un deuxime temps
il met des propositions visant permettre de mieux dfinir le rle de l'Etat et l'organisation du
ministre de la sant, dvelopper les instruments au service de la politique de sant et poursuivre
le dveloppement des principaux outils actuels du systme d'information. NOTE : Les fichiers
compatibles avec le matriel de synthse vocale utilis par le public malvoyant pourront tre adresss
sur simple demande la section des rapports de l'IGAS l'adresse internet suivante : igas-section-
rapports@[Link]

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Chevreul, K., et al. (2006). Faisabilit d'un systme d'information public sur la mdecine de ville. Rapport Irdes ;
1648. Paris IRDES: 205 , tabl.
[Link]
Cette tude s'inscrit dans le cadre d'une rflexion sur le dveloppement d'un systme d'information
public permanent sur la mdecine librale en France. En effet, il n'existe actuellement aucun systme
public permettant de connatre les motifs de recours de la population aux mdecins libraux et de les
lier avec les prescriptions. En l'absence de cette information, un volet entier des pratiques
professionnelles chappe l'valuation, alors mme que les diffrents acteurs du systme de sant
s'accordent pour dire toute l'importance qu'il y aurait le faire. Dans cette tude, nous faisons le point
sur les diffrents recueils informatiss existant en France dbut 2005, qu'ils proviennent de sources
administratives, de socits prives ou de socits savantes. Nous recensons et dcrivons galement
les diffrents systmes mis en place l'tranger et accessibles aux pouvoirs publics. Enfin, en fonction
des niveaux d'informations souhaits, nous dveloppons diffrentes propositions allant de la cration
d'un nouvel observatoire des pratiques mdicales l'utilisation de bases de donnes existantes.

Couty, E. p. (2001). L'informatisation du circuit du mdicament dans les tablissements de sant - approche par
l'analyse de la valeur : quels projets pour quel objectifs ? Paris DHOS: 128 , 127 ann., 123 fig.
[Link]
L'informatisation du circuit du mdicament constitue une voie privilgie pour l'amlioration des
pratiques, condition toutefois que cette dmarche ne soit pas limite une simple automatisation
de procdures, sans une indispensable rflexion sur les organisations mettre en place. C'est avec
cette proccupation que la DHOS a lanc la ralisation d'une tude sur l'informatisation du circuit du
mdicament, avec l'objectif de mesurer, l'aide de la mthode de " l'analyse de la valeur "
frquemment utilise dans l'industrie, les retours qualitatifs et quantitatifs que chacun des acteurs
concerns peut attendre de l'informatisation du circuit du mdicament, que celle-ci soit totale ou
partielle. Ce rapport s'attache mettre en vidence les principaux enjeux de cette dmarche, ainsi que
les gains attendus valoriss sur la base d'exemples concrets, tirs du terrain. Il constitue ainsi un
apport mthodologique original sur l'approche du retour d'investissement d'un projet
d'informatisation, dont la principale finalit est cependant d'assurer la scurit des malades (extrait du
rsum d'auteur). Ce document est disponible sur internet la page :
[Link]

Dionis, [Link], J. et Etienne, J. C. (2004). Les tlcommunications haut dbit au service du systme de
sant (2 tomes). Paris Assemble Nationale: 2 vol. (138 +127 ).
[Link] [Link]
[Link]
Au moment o l'assurance maladie connat l'une des crises les plus graves de son histoire et o tous
les acteurs du systme de soins vont devoir traverser des mutations trs importantes, il est important
d'valuer l'apport potentiel des nouvelles technologies de l'information au systme de sant franais
et de cibler les obstacles leur dveloppement. Ce rapport sur l'internet haut dbit et les systmes
de sant se trouve au c?ur de l'actualit. Le dbat sur la matrise des dpenses du systme de soins
impose de revoir en profondeur l'architecture du systme de sant franais, qui intgre peu ou pas les
nouvelles technologies de l'information.. La premire partie porte sur l'outil internet en tant qu'outil
de formation et d'information. La deuxime partie aborde la tlmdecine sous ces divers aspects :
tlsurveillance, tlconsultation, tlchirurgie? Le rapport termine sur des recommandations.

Door, J. P. (2008). Rapport d'information sur le dossier mdical personnel. Rapport d'information ; 659. Paris
Assemble Nationale: 179 , ann.
[Link]
Ralis suite la tenue de vingt runions et l?organisation de trente-deux auditions, ce rapport
prsente les quinze propositions de la mission Door pour relancer le dossier mdical personnel (ou
partag). Le retard dans la mise en ?uvre du projet est expliqu par la conception et la ralisation du
DMP (qui) impliquaient des rponses pralables de nombreuses questions techniques et juridiques,
ce qui a rendu sa ralisation beaucoup plus complexe que prvu et a finalement empch son
aboutissement dans les dlais fixs. La mission d'information pointe notamment un pilotage beaucoup
trop distant de la part de l'administration centrale, l'existence d'une multiplicit de projets
concurrents, la parcimonie des moyens accords initialement au GIP-DMP, les multiples problmes
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lis au changement de stratgie du GIP. Le rapport de la mission dresse galement un bilan des acquis
du projet, tels qu'ils sont apparus au fur et mesure de ses auditions. Cette relance pourra en effet
s'appuyer sur une infrastructure de communication qui est en voie de ralisation, sur la clarification en
cours des questions d'organisation et de pilotage et sur une certaine maturation des dcisions
prendre concernant la structure et le contenu du DMP, de mme que les normes d'interoprabilit. La
mission formule la fin de son rapport une quinzaine de propositions pour relancer ce projet,
notamment : Reprendre les exprimentations pendant un minimum de neuf mois orientes vers les
usages du DMP (avec l'laboration titre transitoire d'un prototype polyvalent sur un support crypt
et scuris de type mmoire USB ou autre) ; Consolider et valoriser les acquis du projet (le portail
unique d'accs et l'identifiant de sant) ; Renforcer le pilotage du projet (prenniser le financement du
DMP, confirmer le GIP-DMP dans sa fonction de conduite oprationnelle du projet, affermir le
ministre de la Sant dans son rle de pilotage stratgique, impliquer la HAS et la CNAMTS) ;
Dvelopper les changes lectroniques de donnes entre les professionnels de sant, en vue de
prparer l?interoprabilit de leurs systmes informatiques ; Faire du DMP un outil simple et utile tant
pour les professionnels que pour les patients ; Prvoir une gnralisation progressive du DMP, cible
en priorit sur certaines populations (maladies chroniques ou graves). Ces quinze propositions
contribueront clairer les travaux de l'quipe resserre ? la task force ? constitue par le
gouvernement, dont les conclusions sont attendues pour le printemps, espre le rapporteur qui
prvoit une priode de sept ans pour que le DMP soit oprationnel. Il faudra entre un an et dix-huit
mois pour rgler la question de l'identifiant de sant et lancer les exprimentations, entre trois et
quatre annes pour la mise niveau de toutes les infrastructures informatiques et pour tout ce qui a
trait au portail d'accs unique, l'interoprabilit, au langage numrique professionnel, et au bout de
cinq sept ans, avoir le retour des exprimentations. De plus, il faut tre bien conscient que, dans le
cadre d'un march mondial de l'informatique mdicale, l'informatisation des donnes de sant
pourrait tre effectue par des oprateurs privs comme Microsoft, Google ou Yahoo, et que l'on
serait ainsi bien loin de l'objectif poursuivi au moment de l?adoption de la loi de 2004. Si l'on veut
garantir la scurit et la protection des donnes de la population, il est donc impratif que le
Gouvernement poursuive le chantier du DMP .

Dourgnon, P., et al. (2000). Rsultats de l'enqute sur l'apport de l'informatique dans la pratique mdicale
librale. Rapport Credes. Paris CREDES: 26 , carte, graph.

Le Comit de Gestion du Fonds de Rorientation et de Modernisation de la Mdecine Librale

(F.O.R.M.M.E.L.) avec le concours du Conseil Suprieur des Systmes d'Information de Sant
(C.S.S.I.S.) et du Centre de Recherche d'Etude et de Documentation en Economie de la Sant
(C.R.E.D.E.S.) a mis en place une tude sur l'apport de l'informatique dans la pratique mdicale
librale. Ce fascicule prsente les premiers rsultats de cette enqute qui a t conduite partir de
l'exprience quotidienne de mdecins volontaires. Ces rsultats permettent de connatre l'utilisation
effective de l'informatique par les mdecins, d'orienter leur choix parmi les possibilits actuelles et
aussi d'inciter les industriels proposer des services plus accessibles et mieux adapts.

Dourgnon, P., et al. (2001). L'apport de l'informatique dans la pratique mdicale librale. Rapport Credes. Paris
CREDES: 139 , 118 tabl., 104 graph.
[Link]
Le Comit de Gestion du Fonds de Rorientation et de Modernisation de la Mdecine Librale
(F.O.R.M.M.E.L.) avec le concours du Conseil Suprieur des Systmes d'Information de Sant
(C.S.S.I.S.) et du Centre de Recherche d'Etude et de Documentation en Economie de la Sant
(C.R.E.D.E.S.) a mis en place une tude sur l'apport de l'informatique dans la pratique mdicale
librale. Ce rapport prsente les rsultats de cette enqute qui a t conduite partir de l'exprience
quotidienne de mdecins volontaires. La premire partie de ce document prsente la mthodologie
de l'enqute, l'chantillon de mdecins participants, leur environnement informatique, dcrit les
fonctions tudies et comment les mdecins les utilisent. Les quatre parties suivantes prsentent les
valuations de chacune des fonctions, de la plus utilise (gestion du dossier mdical du patient) la
moins usite. Dans la sixime partie, les auteurs prsentent un classement des modules en fonction de
critres de satisfaction et d'utilisation des mdecins valuateurs. Une dernire partie dveloppe, sur
un plan plus global, l'influence de l'arriv de l'informatique dans le cabinet libral au travers des
rponses aux questions d'valuation (l'utilit et l'acceptabilit pour le patient, l'impact sur la qualit
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de la pratique, le confort de travail, la scurit des donnes) et aux questions d'opinion du

questionnaire qui clture l'enqute (le rle de l'informatique, le bilan de l'informatisation des
mdecins, l'avenir de l'informatique dans la pratique librale).

Dourgnon, P., et al. (2000). "Apport de l'informatique dans la pratique mdicale. Premiers rsultats d'un
enqute indite via internet." Questions D'economie De La Sante (Credes)(26): 6 , 3 graph., 1 enc.
[Link]
Le Comit de Gestion du Fonds de Rorientation et de Modernisation de la Mdecine Librale
(F.O.R.M.M.E.L.) avec le concours du Conseil Suprieur des Systmes d'Information de Sant
(C.S.S.I.S.) et du Centre de Recherche d'Etude et de Documentation en Economie de la Sant
(C.R.E.D.E.S.) a mis en place une tude sur l'apport de l'informatique dans la pratique mdicale
librale. Ce fascicule prsente les premiers rsultats de cette enqute qui a t conduite partir de
l'exprience quotidienne de mdecins volontaires. Ces rsultats permettent de connatre l'utilisation
effective de l'informatique par les mdecins, d'orienter leur choix parmi les possibilits actuelles et
aussi d'inciter les industriels proposer des services plus accessibles et mieux adapts.

Fagniez, P. L. (2007). Le masquage d'informations par le patient dans son DMP. Paris MSSPS: 15.
[Link]
L'article 38 de la loi informatique et liberts du 6 janvier 1978 permet toute personne de s'opposer "
pour des raisons lgitimes " ce que des donnes caractre personnel la concernant fassent l'objet
d'un traitement. La partie lgislative du code de la sant publique dfinit par ailleurs le principe
gnral du droit des patients au secret sur leurs informations de sant ; elle prvoit notamment, dans
son article L. 1110-4, un droit d'opposition du patient l'change d'informations entre deux
professionnels qui le prennent en charge. Sur la base d'entretiens avec des professionnels de sant et
des associations de patients, le rapport pose la question de la conciliation entre la bonne marche du
processus de soins et le " droit de masquage " offert au patient dans le dossier mdical personnalis
(DMP).

Faroudja, J. M., et al. (2005). Questions sur l'informatisation des dossiers mdicaux, le partage et
l'hbergement des donnes. Paris CNOM: 66.
[Link] [Link]
Dans une premire partie, ce rapport aborde quelques questions lmentaires comme les avantages
et les inconvnients de l'informatisation ou les problmes poss par la multiplication des dossiers
(papier, lectroniques, personnels). La suite du rapport est centre sur le dossier mdical personnel
(DMP) : le DMP et la loi ; thique et dontologie du DMP ; questions pratiques et principes
incontournables. Dans sa conclusion, le rapporteur insiste sur la distinction que le praticien doit faire
entre le DMP et son dossier professionnel (qui peut " rester le lieu des confidences intimes " et tre
organis " selon sa mthode, ses habitudes et ses convictions ").

Fieschi, M. (2003). Les donnes du patient partages : la culture du partage et de la qualit des informations
pour amliorer la qualit des soins. Paris Ministre charg de la Sant: 45, ann.
[Link]
Afin de suivre les demandes d'volution de la socit, de rpondre aux nouveaux droits des patients,
de favoriser la coordination des soins et d'encourager l'mergence de nouvelles modalits d'exercice
pour les professionnels de sant, il est ncessaire de mettre en place des systmes d'information de
sant adapts. Ces nouvelles modalits doivent concourir une plus grande responsabilisation des
mdecins et des patients, devenus davantage acteurs dans des situations touchant leur sant. Ce
rapport est le rsultat d'une mission exploratoire confie, en dcembre 2003, Monsieur Fieschi, afin
d'laborer des propositions sur le dveloppement des dossiers mdicaux partags. Une premire
partie, centre sur une prsentation du contexte, de l'volution des pratiques mdicales et du
dveloppement des technologies de l'information et de la communication dans le domaine de sant,
prsente un bilan des forces et faiblesses de la situation en France afin de cadrer la faisabilit
organisationnelle, juridique, technique et conomique du projet. Une deuxime partie prsente les
recommandations. Elle portent sur une mthode exprimentale conduisant court terme une
valuation permettant de dfinir le cadre dfinitif du projet ; les modalits de pilotage du projet ; un
calendrier prvisionnel de l'exprimentation propose. Des propositions pour le moyen terme et des
mesures d'accompagnement sont galement avances.
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Gagneux, M. (2009). Refonder la gouvernance de la politique d'informatisation du systme de sant - Douze

propositions pour renforcer la cohrence et l'efficacit de l'action publique dans le domaine des
systmes d'information de sant. Paris Ministre de la sant: 38.
[Link]
Les difficults de mise en oeuvre du dossier mdical personnel ont contribu mettre en vidence les
faiblesses de la gouvernance du systme d'information de sant : rticences psychologiques et
culturelles chez certains professionnels de sant, complexit d'organisation du systme de sant et
rigidits de sa gouvernance ont t des freins la pleine utilisation des technologies de l'information
et de la communication dans le domaine de la sant. Tel est le constat du prsent rapport qui
prsente douze propositions visant poser un nouveau cadre de gouvernance et de rgulation ,
compte tenu des rformes structurelles en prparation ou mises en oeuvre (cration des agences
rgionales de sant, rforme de la gouvernance hospitalire, mise en place de la tarification l'activit
l'hpital, plan d'investissement "hpital 2012", programme de relance du DMP et des systmes
d'informations partags de sant...).

Gagneux, M., et al. (2008). Pour un dossier patient virtuel et partag et une stratgie nationale des systmes
d'information de sant. Paris Mission de relance du DMP: 120.
[Link]
La mission de relance du projet de DMP a t constitue en dcembre 2007 pour tablir des
propositions sur le cadre stratgique, l'amlioration de la gouvernance et l'organisation de la
concertation sur le DMP, aprs la publication d'un rapport d'audit trs svre sur le pilotage du
dispositif. Le rapport s'organise en huit chapitres, abordant les "enjeux stratgiques des systmes
d'information mdicale partage", les principes d'actions de relance du DMP, les concepts de dossier
mdical, la "valeur d'usage" et les services offerts par le DMP, le consentement du patient,
l'architecture du "systme DMP", la relance et le dploiement du dispositif et la gouvernance des
systmes d'information de sant. Ce rapport plaide pour une relance rapide du DMP et annonce une
feuille de route lisible, afin de rpondre aux "attentes fortes" et aux "doutes" des diffrents acteurs du
monde de la sant sur le projet, dont le processus de dploiement, initialement prvu au 1er janvier
puis au 1er juillet 2007, avait t suspendu l'arrive de Roselyne Bachelot au ministre de la sant en
mai 2007.

Gorce, G. et Pillet, F. (2014). Rapport d'information sur lopen data et la protection de la vie prive. Rapport
d'information du Snat ; 469. Paris Snat: 84.
[Link]
La France s'est rsolument engage sur la voie de l'ouverture et du partage des donnes publiques,
plus connue sous le nom d'open data. Deux ides animent cette politique. Comptables de leur gestion
auprs des citoyens, les administrations leur ouvrent leurs fichiers. Elles leur donnent ainsi le moyen
de mieux les contrler. Par ailleurs, l're du numrique, o l'information est source de richesse, elles
leur offrent l'opportunit d'exploiter le formidable gisement que constituent ces donnes. En crant
une mission d'information charge d'tudier l'open data et la protection de la vie prive de nos
concitoyens, la commission des lois a souhait poursuivre sa rflexion sur les nouveaux usages
numriques et la faon dont ils peuvent se concilier avec les principes fondamentaux que le lgislateur
a poss ds la fin des annes 1970. L'open data soulve cet gard une question spcifique : en
principe, il exclut toute diffusion de donnes caractre personnel, mais bien souvent, les donnes
dtenues par les administrations ont t labores partir d'informations individuelles, qui peuvent
tre retrouves grce aux formidables capacits de traitement que permet l'informatique moderne.
L'impratif de protection de la vie prive est-il en mesure de toujours prvaloir ? Comment s'en
assurer ? l'issue de leurs travaux, les rapporteurs de la mission d'information, les snateurs Gatan
Gorce et Franois Pillet jugent aujourd'hui ncessaire de faire d'une exigence fondamentale -la
protection de la vie prive de nos concitoyens- une opportunit pour donner une nouvelle impulsion
au dploiement de l'open data (rsum dditeur).

Gratieux, L. et Ollivier, R. (2006). Audit de l'organisation et du pilotage des organismes oeuvrant

l'informatisation du systme de sant. Rapport IGAS ; 2006 113. Paris Igas: 121.
[Link]
La modernisation de la gestion du systme de sant implique, selon le prsent rapport, la mise en
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place de dispositifs d'changes de donnes informatises entre les acteurs, professionnels et

tablissements de sant, usagers et organismes d'assurance maladie obligatoire et complmentaire.
Pour mettre en place ces dispositifs, la multiplicit des acteurs concerns et la technicit du domaine
ont conduit crer des structures spcialises constitues sous forme de groupements d'intrt
public (GIP) ou d'intrt conomique (GIE). Ce rapport prsente l'organisation de la mise en oeuvre
des systmes d'information dans le domaine de la sant et de l'assurance maladie. Il constate que
l'organisation structure verticalement par projet est susceptible de donner lieu des redondances
avec l'mergence de nouveaux systmes d'information. Il propose d'engager une redistribution des
fonctions des organismes fondes sur la reconnaissance de leur "coeur de mtier". Il expose ensuite
les modalits de pilotage des organismes et des projets et propose de clarifier l'attribution des
responsabilits en laborant une stratgie partage et en redfinissant les moyens et l'organisation.
Est jointe au rapport une note complmentaire sur les perspectives de fusion ou de regroupement
d'organismes oeuvrant l'informatisation du systme de sant.

Hubert, E. (2010). Rapport de la Mission de concertation sur la mdecine de proximit. Paris La documentation
franaise: 186.
[Link]
Mme Elisabeth Hubert, ancien ministre, a t charge par le Prsident de la Rpublique d'une mission
portant sur la mdecine de proximit, autour de trois objectifs : relancer le dialogue avec les mdecins
libraux, permettre un trs large change avec les professionnels concerns et apporter des rponses
aux volutions structurelles que connait la mdecine ambulatoire depuis de nombreuses annes. Sur
la base de nombreuses rencontres et de dplacements sur le terrain, l'auteur prsente un tat des
lieux des conditions d'exercice de la mdecine de proximit, et propose un ensemble de mesures :
simplification des conditions d'exercice, modernisation des systmes d'information, appui l'exercice
regroup des professionnels, valorisation de la formation initiale de mdecine gnrale, aide
l'installation dans les zones sous-mdicalises.

Jegou, J. J. (2005). L'informatisation dans le secteur de la sant. Paris Snat: 65.

[Link]
Ce rapport prsente, la ralit contraste de l'informatisation du secteur de la sant en France et
analyse ses faiblesses (dfaillance du pilotage global de la politique d'informatisation, retard des
tablissements publics de sant dans ce domaine, cloisonnement des systmes d'information et
inadquation de la formation des professionnels de sant). Ce rapport insiste galement sur les
difficults de mise en place du dossier mdical personnel. Dix propositions sont formules par le
rapporteur.

Jegou, J. J. (2007). Rapport d'information sur le suivi du rfr de la Cour des Comptes concernant
l'introprabilit des systmes d'information de sant. Rapport d'information ; n 35. Paris Snat: 327
, ann.
[Link]
Le prsent rapport prsente, tout d'abord, les observations de la Commission des finances sur le
systme actuel d'information de sant franais. Puis, il comporte trois annexes : - le rfr n 46485 de
la Cour des comptes sur l'interoprabilit des systmes d?information en sant, accompagn de la
lettre d?envoi du Premier prsident de la Cour des comptes au ministre de la sant et des solidarits ;
- la rponse du directeur de cabinet du ministre de la sant et des solidarits au rfr prcit ; - enfin,
le chapitre X du rapport de la Cour des comptes sur l?application des lois de financement de la
scurit sociale, paru en septembre 2007, intitul le partage des donnes entre les systmes
d'information de sant . Les rponses adresses aux observations de la Cour des comptes par les
ministres, les administrations et les organismes concerns ne sont pas reproduites dans le cadre du
prsent rapport.

Khennouf, M. et Ruol, V. (2011). Evaluation du dveloppement de l'offre en matire de systmes d'information

hospitaliers et d'analyse stratgique du positionnement des filires publiques du SIH. Rapport Igas ;
RM2011-029P. Paris IGAS: 65.
[Link]
Par lettre du 20 mai 2010, la ministre de la sant et des sports a saisi le chef de l'IGAS d'une mission
portant sur l'valuation du dveloppement de l'offre en matire de systme d'information
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hospitalier (SIH) et sur l'analyse stratgique du positionnement des oprateurs publics en SIH . Cette
mission s'inscrit dans le cadre de la mise en place d'un comit de pilotage stratgique des SIH, charg
d'laborer un programme d'action moyen terme en faveur du dveloppement des systmes
d'information des tablissements de sant (rsum d'auteur).

Lasbordes, P. (2009). Rapport sur le Dossier Mdical Personnel (DMP) : quel bilan d'tape pour quelles
perspectives ? (compte rendu de l'audition publique du 30 avril 2009). Rapport de l'Assemble
Nationale ; 1847 ; Rapport du Snat ; 567. Paris Assemble nationale ; Paris Snat: 110.
[Link]
L'Office parlementaire d'evaluation des choix scientifiques et technologiques (OPECST) a organis le
30 avril 2009 une audition publique sur le Dossier mdical personnel (DMP) dont la cration est
prvue depuis l'adoption d'une loi en 2004 et dont les enjeux sont jugs essentiels, tant pour la qualit
des soins que pour la protection des donnes personnelles de sant. Cette audition publique avait
pour objet, d'une part, de faire le point sur l'exprimentation telle qu'elle a t mene jusqu'
prsent, en examinant les avances ralises ainsi que les difficults rencontres, et d'autre part,
d'tudier les perspectives d'avenir du projet, la lumire notamment du plan de relance annonce par
le ministre de la sant et des sports et en prenant en compte les solutions technologiques offertes
dans ce domaine. En runissant, sur une journe, les principaux acteurs du projet, les auteurs de
rapports visant en valuer l'tat de ralisation, la CNIL, des reprsentants du ministre, des
professionnels de sant et des usagers, ainsi que des entreprises du secteur, l'audition se proposait de
confronter les analyses portant sur les conditions dans lesquelles le projet a t conduit, ainsi que les
recommandations formules la suite de ce retour d'exprience.

Le, Menn, J. et Milon, A. (2012). Rapport d'information sur le financement des tablissements de sant.
Rapport d'information du Snat ; n 703. Paris Snat: 340 , tabl., graph.
[Link]
Huit ans aprs l'introduction du principe de la tarification l'activit (T2A) en MCO qui a, de l'avis
unanime, bouscul la communaut hospitalire, la Mecss a souhait valuer cet outil de rpartition
des ressources frquemment dcri, comprendre la faon dont il a t mis en oeuvre et tracer des
pistes pour son volution. Quels ont t les effets de cette rforme systmique sur les dcisions de
soins et sur le fonctionnement des tablissements ? Comment se rpartissent aujourd'hui leurs
recettes ? Comment sont construits les tarifs et quoi correspondent-ils ? La T2A a-t-elle entran une
dtrioration de la qualit des prises en charge ? Aprs une vingtaine d'auditions et six dplacements
permettant de visiter neuf tablissements publics et privs, le prsent rapport fournit des rponses
ces questions et propose des mesures d'amlioration, afin de prendre en charge non plus la maladie,
comme le fait trop la T2A aujourd'hui, mais le malade dans la globalit de son parcours.

Lucas, J. (2010). Dmatrialisation des documents mdicaux. Crer la confiance pour favoriser
l'informatisation. 1- Les dossiers mdicaux et leurs correspondances. Paris Ordre national des
mdecins: 37.
[Link]
[Link]/sites/default/files/Dematerialisation%20des%20documents%[Link]
Par son engagement dans la construction du systme dinformation de sant, le CNOM poursuit un
double objectif : acclrer l?usage des technologies de l?information et de la communication pour
amliorer la qualit des soins et contribuer garantir les fondements de la confiance des mdecins et
des patients dans le nouvel espace numrique de sant. En passant lre de la dmatrialisation, les
mdecins se retrouvent confronts des questions pratiques nouvelles sur les plans dontologique et
rglementaire. Cest pourquoi le CNOM a souhait, en publiant ce rapport, rappeler et synthtiser les
principes et recommandations qui rpondent aux exigences dontologiques de leur exercice. Bien que
les exercices professionnels soient divers, tant dans les secteurs de soins que dans les autres secteurs
d?activits mdicales, le CNOM rappelle que tous les mdecins sont soumis aux mmes rgles de
dontologie professionnelle qui s?attachent ici principalement la protection et la prservation de la
confidentialit des donnes personnelles de sant. Cest, avec la reconnaissance confirme de leurs
comptences, le socle de la confiance massive dont les mdecins disposent prs des patients (tir de
l'intro).

Morgan, D., et al. (2009). Obtenir un meilleur rapport qualit-prix dans les soins de sant. Paris OCDE: 182 ,
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ann., graph., tabl.

[Link]
La hausse des dpenses publiques de sant reste un problme dans pratiquement tous les pays de
l'OCDE et de l'Union europenne. C'est pourquoi l?attention se porte de plus en plus sur les mesures
qui attnueront ces pressions en amliorant la performance des systmes de sant. Ce rapport
prsente un ensemble de politiques pouvant aider les pays amliorer l'efficience des systmes de
sant et ainsi obtenir un meilleur rapport qualit-prix dans les soins. Un large ventail dinstruments
d'action est examin en tirant parti de donnes et d'tudes de cas portant sur de nombreux pays. Les
thmes suivants sont traits : le rle de la concurrence sur les marchs de la sant ; les possibilits
d'amlioration de la coordination des soins ; une tarification plus adapte des produits
pharmaceutiques ; un contrle plus pouss de la qualit s'appuyant sur une utilisation plus intensive
des technologies de l?information et de la communication pour les soins ; et un plus large partage des
cots.

Picard, R. et Dardayrol, J. P. (2011). Les conditions de cration de valeur des logiciels sociaux en sant et
autonomie. Paris CGIET: 164.
[Link]
Ce rapport ralis par le Conseil Gnral de l'Industrie, de l'Energie et des Technologies, la demande
du ministre de la Sant, analyse, au-del du discours des promoteurs de la Sant 2.0, la valeur
potentielle des logiciels sociaux dans le secteur sant-social, en s'appuyant sur la ralit sociale et
l'observation des communauts constitues utilisatrices de ces outils. A la suite du Mdiator, la
Puissance publique s'interroge sur les conditions d'une information mdicale publique fiable,
indpendante et accessible. Les rsultats de ce rapport sont riches d'enseignements. L'usage croissant
de ces logiciels dits sociaux dans ces secteurs peut contribuer une dissmination rapide des
connaissances et l'mergence de nouveaux savoirs issus de la ralit quotidienne des patients, des
aidants, des professionnels. Mais ces outils ont aussi un impact significatif sur la relation entre le
patient, ses proches et le mdecin et les professionnels de sant.

Picard, R. et Salgues, B. (2007). TIC et sant: quelle politique publique? Paris CGTI: 19 +annexes.
[Link]
Ce rapport analyse la situation de l'emploi des technologies de l'information et des communications
(TIC) dans le domaine de la sant. Il est compos de trois parties. Il propose tout d'abord une synthse
des rponses des industriels sur leur vision de la situation franaise autour des thmes suivants :
forces, faiblesses, opportunits, menaces pour la France; conomies possibles par les TIC ; politique
industrielle souhaitable. Dans une seconde partie, les lments prcdents sont repris et discuts
selon les thmes rcurrents : l'attitude du patient et du mdecin, les politiques de sant, de recherche
et d'industrie, l'volution technologique, le cadre rglementaire. Enfin, quelques propositions sont
formules concernant la suite souhaite par les industriels de ce travail de concertation.

Picard, R. et Vial, A. c. (2013). Prospective organisationnelle pour un usage performant des technologies
nouvelles en Sant. Paris C.G.E.I.E.T.: 27.
[Link]
Ce rapport apporte un clairage prospectif sur les conditions organisationnelles pour un usage
performant des technologies nouvelles en Sant, avec un regard particulier sur la tlmdecine et plus
largement sur la tlsant.

Preel, J. L. (2012). Rapport d'information sur la prvention sanitaire. Paris Assemble nationale: 394.
[Link]
Malgr les objectifs ambitieux fixs dans la loi de sant publique d'aot 2004 et l'intervention de trs
nombreux acteurs, au premier rang desquels l'assurance maladie, les rsultats de la politique de
prvention sont dcevants. Le systme de sant orient essentiellement vers le curatif aurait nglig
le prventif. Aprs trois mois d'audition et avec l?assistance de la Cour des comptes, la MECSS a pu
identifier plusieurs difficults : des priorits trop nombreuses et mal identifies, une absence de
pilotage tant national que local, une coordination insuffisante entre les acteurs qui concourent la
prvention, une diffusion parcellaire des donnes de sant. Pour pallier ces difficults, la MECSS fait
trente-six recommandations. Elle prconise de redfinir un vritable pilotage politique sur le
fondement d'une nouvelle loi quinquennale de sant publique qui fixera quatre priorits : la lutte
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contre le tabac, l'alcool, la sdentarit et la surcharge pondrale. Charg de mettre en oeuvre ces
priorits, la mission recommande d'instituer un dlgu interministriel la prvention sanitaire
rattach au Premier ministre qui coordonnera l'ensemble des acteurs. La MECSS recommande
galement de favoriser l'chelon local, le plus mme d'agir au plus prs des besoins de la population.
Pour ce faire, la mission d'valuation des expriences locales et de coordination confie aux agences
rgionales de sant doit tre renforce et le rle des confrences rgionales de la sant et de
l'autonomie doit tre confort. La complmentarit entre les diffrents acteurs doit aussi tre
renforce dans les domaines de la sant au travail et de la sant scolaire. L'ensemble ne pourra
fonctionner que si les changes des donnes de sant sont facilits. Par ailleurs, au quotidien, la
prvention doit privilgier des approches innovantes en matire d'ducation la sant ou d'ducation
thrapeutique, tout en amliorant les actions traditionnelles. Comme le prvoit l'article L.O. 111-9-3
du code de la scurit sociale, les prconisations de la MECSS sont notifies au Gouvernement et aux
organismes de scurit sociale concerns, lesquels sont tenus d'y rpondre dans un dlai de deux
mois.

Ravignon, B., et al. (2013). Les cots de gestion de l'assurance maladie. Paris IGAS: 112 +annexes.
[Link]
La ministre des affaires sociales et de la sant et le ministre dlgu charg du budget ont demand
lInspection gnrale des affaires sociales (IGAS) et lInspection gnrale des finances (IGF) de
conduire une mission relative la gestion de lassurance maladie obligatoire (AMO) et
complmentaire (AMC). Cette mission sinscrit dans le cadre des travaux lancs pour mettre en uvre
la dmarche de modernisation de laction publique (MAP) initie par le Gouvernement. Aprs
avoir tabli un diagnostic de la structuration et des cots de gestion de lassurance maladie obligatoire
et complmentaire, le rapport dtaille les recommandations de la mission en matire damlioration
des processus mtier, de recherche defficience par comparaison aux meilleures pratiques constates
et de rorganisation structurelle de lassurance maladie. Puis, il conclut sur la combinaison de ces
diffrents axes, sur le calendrier de dploiement des actions entreprendre et sur les gains en
attendre court terme (2017) et moyen terme (2020) (rsum de l'diteur).

Simon, F. (2008). Maisons de sant pluriprofessionnelles et dontologie mdicale. Paris CNOM: 3.

[Link]
Les sites ou maisons de sant interprofessionnelles sont prsents par les pouvoirs publics comme la
solution pour les secteurs dficitaires. De faon plus gnrale, ce concept dpasse largement ces
zones pour devenir une forme de l'offre de soins. La coexistence de diffrents professionnels de sant,
voire de travailleurs sociaux, au sein d?une mme structure a conduit les conseils dpartementaux et
rgionaux de l'Ordre mais aussi les URML questionner le Conseil national de l'Ordre des mdecins
sur leur compatibilit avec nos principes dontologiques et les rgles dictes dans le code de
dontologie mdicale. C?est ces questions que le Conseil national de l'Ordre des mdecins s'efforce
aujourd?hui de rpondre (extrait de l'intro.)

Taib, G. (2003). Mission d'appui convergence entre cartes ordinales et cartes de professionnels de sant. Paris
IGAS: 86.

Ce rapport prsente les rsultats de la Mission confie Monsieur Tab, en mai 2002, en vue d'tudier
l'volution de la carte professionnelle de sant (CPS) mise en ?uvre dans le cadre du projet Sesam-
Vitale, en carte d'identit professionnelle, telle que le souhaitaient les ordres professionnels et le
Prsident de la Cnamts. Aprs une analyse contextuelle, il met un ensemble de recommandations
s'appuyant sur un argumentaire historique et technique sous forme d'annexes thmatiques.

Tajahmady, A. et Cauterman, M. (2009). Le dossier patient dans les hpitaux et les cliniques. Rapport final.
Paris Meah: 32.
[Link]
_patient_-_MeaH_-_Rapport_final.pdf
La Mission nationale d'expertise et d'audit hospitaliers (MeaH) a men une mission
daccompagnement de 8 tablissements de sant franais durant 18 mois sur le thme du dossier
patient. La mthodologie employe comprenait 4 phases : diagnostic, plans dactions, mise en oeuvre,
valuation capitalisation. Cinq axes de travail ont t retenus : politique, circuit (archivage),
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contenant, contenu et usages (comptes-rendus dhospitalisation, loi du 4 mars 2002). Le rapport final
prsente les principales ralisations et enseignements du chantier. A travers des actions
organisationnelles et managriales simples, et lutilisation doutils classiques de gestion de projet, les
tablissements du groupe de travail ont russi amliorer la conformit du contenu de leur dossier
patient, et les dlais denvoi des comptes-rendus dhospitalisation. Dautres ralisations, sur la
rduction du volume des archives, la mise en place dun dossier patient papier unique ou
linformatisation du dossier patient ont t atteintes. Les rsultats obtenus montrent tout lintrt
qu?une dmarche projet centre sur les aspects organisationnels du dossier patient peut avoir. Ils
soulignent aussi les dangers que labsence dune telle rflexion peut prsenter lorsquun
tablissement sengage dans une dmarche dinformatisation ou de numrisation de son dossier
patient.

Woronoff-Lemsi, M. C., et al. (2003). Le mdicament l'hpital. Paris Ministre charg de la Sant: 81 , tabl.,
ann.
[Link] -
[Link] -
[Link]
Aprs un large tour d'horizon quant aux modalits d'utilisation du mdicament dans les
tablissements de sant sous dotation globale, ce rapport rend compte des rflexions de la Mission
sur le mdicament l'hpital. Il nonce les constats suivants : il existe des risques de restriction de
l'offre de soins et d'ingalit d'accs l'innovation en lien avec les difficults budgtaires croissantes
des tablissements ; une rgulation complexe de l'accs aux mdicaments au niveau national favorise
les stratgies commerciales de l'industrie ; l'approche des professionnels est dissocie ; le circuit du
mdicament est encore peu optimis au sein des tablissements ; l'environnement rglementaire est
contraignant voire strilisant. (cf code des marchs publics). Sur les bases de ces constations, la
mission place le patient au c?ur des propositions qu'elle formule selon trois principes : donner
chaque citoyen l'galit d'accs un traitement innovant et adapt, permettre le dveloppement et la
diffusion rapide des innovations, tout en mettant en place un dispositif d'valuation de l'apport
thrapeutique, tablir les conditions d'une scurisation optimale du circuit du mdicament.

Thses

Saiche, D. (2008). Dossier mdical personnel (DMP) en phase d'exprimentation nationale : rsultats obtenus
en Alsace en secteur libral et hospitalier. Strasbourg Universit Louis Pasteur, Universit Louis
Pasteur. Facult de Mdecine. Strasbourg. FRA. Thse de doctorat en mdecine.: 204 , tabl.
[Link]
Le Dossier Mdical Personnel (DMP) est un dossier mdical informatis, accessible par Internet et
stock par un hbergeur agr et scuris, dont le seul propritaire est le patient. Le DMP sinscrit
dans la loi de rforme de l?Assurance Maladie du 13 aot 2004, ce nouvel outil devant contribuer
l?amlioration de la qualit de soins et la matrise des dpenses de sant. Il sagit dun projet
ambitieux et trs complexe mettant en scne de nombreux intervenants : les reprsentants du
gouvernement, le systme de soins libral, le systme de soins hospitalier, les industriels et les
utilisateurs (les patients). Face la complexit et au caractre innovant de ce dossier, il paraissait
indispensable de lancer une phase dexprimentation avant d?envisager sa gnralisation,
initialement prvue au 1er juillet 2007. L?exprimentation s?est oriente vers le secteur de sant
libral et le secteur de sant hospitalier. Le Groupement dIntrt Public du DMP (GIP-DMP) a t cr
en avril 2005 afin de manager cette premire phase. Ainsi 17 sites pilotes rpartis au sein de 13
rgions franaises ont t retenus par le GIP-DMP en fvrier 2006. Chaque site pilote est rattach un
hbergeur parmi les 6 consortiums slectionns en octobre 2005 puis agrs, la rgion Alsace ayant
choisi le groupement Thals- Cegedim. Lexprimentation a officiellement t lance au 1er juin 2006,
pour se bousculer lautomne, et tre clture le 31 dcembre de cette mme anne. En Alsace, un
premier groupe de 72 mdecins libraux, dont 62 mdecins gnralistes, a ouvert 881 DMP. Seuls 50
% dentre eux (36) ont utilis des DMP : 1294 documents ont t soumis et 445 documents ont t
consults, lensemble de ces documents correspond dans prs de la moiti des cas des comptes-
rendus de consultation. Outre quelques dysfonctionnements d?ordre technique (difficults
d?installation et d?utilisation des interfaces DMP, problmes d?accs aux dossiers), il a t relev une
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lenteur et des erreurs d?ordre administratif lors de la procdure d?ouverture des dossiers (problmes
lis aux AQS); un bon nombre de mdecins actifs souhaiteraient par ailleurs une meilleure ergonomie
du DMP. Un deuxime groupe de mdecins hospitaliers du CHU de Strasbourg et du CH de Saverne,
dont le nombre n?a pu tre dfini, a ouvert 1600 DMP. Mais seuls 9 documents ont t consult et
aucun document n?a t soumis aux DMP. La non utilisation hospitalire des DMP est principalement
lie des dfauts techniques et une priode trop restreinte de ?exprimentation. A lissue de cette
phase exprimentale, il semble vident que le DMP n?est pas oprationnel, et quil faille se donner le
temps ncessaire l?amlioration et la mise au point de cet outil, afin d?esprer sa gnralisation
prochaine tous les Franais.

Zorn-Macrez, C. (2010). Donnes de sant et secret partag : pour un droit de la personne la protection de
ses donnes de sant partages. Nancy Presses Universitaires de Nancy. Thse ; Doctorat en Droit
priv et sciences criminelles ; Facult de Droit de Nancy.: 502 , index.
[Link]
Le secret partag est une exception lgale au secret professionnel, permettant ceux qui prennent en
charge le patient d'changer des informations le concernant, sans tre sanctionns du fait de cette
rvlation d'informations protges. Si les soignants depuis toujours communiquent au sujet du
patient dans son intrt, il n'y en a pas moins un quilibre trouver entre l'change d'informations
ncessaire la pratique mdicale, et le respect de la vie prive qu'un partage trop large peu
compromettre. Or, l'mergence de l'outil informatique, multipliant les possibilits de partage de
donnes de sant, remet en cause un quilibre fond sur des mcanismes traditionnels de protection
de l'intimit de la personne. Le traitement de donnes de sant partages doit alors s'analyser au
regard des rgles du secret partag, des rgles de la lgislation "Informatique et Liberts", mais
galement au jour d'un foisonnement vertigineux de normes relatives la mise en oeuvre de dossiers
spcifiques comme le Dossier mdical personnel, le Dossier pharmaceutique ou l'Historique des
remboursements. La mise en relief systmatique de la place du consentement de la personne
concerne conduit au constat de l'imprative inscription la Constitution du droit de la personne la
protection de ses donnes de sant partages.

Documents de travail

Mousques, J. et Sermet, C. (2003). Evaluation des rappels informatiques dans l'instauration et le suivi de
l'ducation dittique de patients diabtiques de type 2, obses ou en surpoids. Rapport d'tude.
Document de travail Irdes. Paris IRDES: 119.
[Link]
Ce rapport de projet de recherche a t ralis dans le cadre de l?appel projet de recherche de
l?Agence Nationale d?Accrditation et d?Evaluation en Sant 2000-2001 et remis l?ANAES en
dcembre 2003. Cette tude s?inscrit dans le cadre de recherches menes depuis plusieurs annes au
sein de l?IRDES afin, tout d?abord, de comprendre les dterminants de la variabilit des pratiques
mdicales, puis, aujourd?hui, d?valuer l?impact de certaines interventions ayant pour objectif de
promouvoir des pratiques mdicales plus efficaces ou plus efficientes. Il s?agit ici d?valuer l?impact,
dans le contexte spcifique de la mdecine gnrale franaise, d?un type d?intervention novateur
consistant rappeler au mdecin, au moment de sa rencontre avec un patient diabtique et par le
biais d?une alerte gnre par son logiciel informatique, les recommandations relatives l?ducation
dittique des patients diabtiques de type 2. L?tude a t ralise en collaboration avec la socit
BKL-Thales entre 2001 et 2003, partir des donnes de leurs panels de gnralistes informatiss.

Etudes trangres

Ouvrages

Pikhart, H. et Pikhartova, J. (2015). Promoting better integration of health information systems: best practices
and challenges, Copenhague : OMS Bureau rgional de l'Europe
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[Link]
systems-best-practices-and-challenges
Ce rapport aborde les tendances actuellement observes dans les tats membres de lUnion
europenne (UE) et de lAssociation europenne de libre-change (AELE) quant la manire de
promouvoir une meilleure intgration des systmes dinformation sanitaire. Afin den sonder les
aspects pragmatiques, des experts de 13 tats membres de lUE ont t soumis un entretien, dont
les rsultats ont t combins aux conclusions dune recherche documentaire. Le rapport de synthse
identifie les options stratgiques et les besoins suivants pour un examen plus approfondi, savoir :
continuer le travail sur certaines notions de base (tels que la disponibilit et la qualit des donnes, les
inventaires de donnes et les registres, la normalisation, la lgislation, les infrastructures physiques et
les capacits de la main-duvre) et sur des ensembles dindicateurs davantage axs sur des concepts
; dfinir la notion de meilleure intgration et en dmontrer les avantages concrets ; dvelopper le
leadership en matire de renforcement des capacits en vue de poursuivre lintgration des systmes
dinformation sanitaire ;poursuivre les changes internationaux concernant les activits en cours dans
ce domaine.(rsum de l'diteur).

Articles

(2008). "Focus on continuity in care, evaluation techniques, IT for health." Health Policy Developments(6): 111 ,
tabl., graph., fig.
[Link]
This issue discusses and examines the following subjects : Evaluation in health care ; continuity of care
: concepts of integrated care, disease management and strategies ; information and comunication
technologies ; human resources in health....

(2013). "Emission et diffusion de la carte europenne d'assurance maladie." Decryptages(13): 12.

[Link]
Ce numro de Dcryptages fait un bilan de la petite carte bleue, la Carte Europenne d'Assurance
Maladie, dlivre prs de 5,5 millions de personnes en France en 2012 et qui n'en reste pas moins
une facilit encore mal connue des assurs. Le bulletin rpond galement deux questions principales
: Comment les assurs des rgimes franais se servent-ils de leur CEAM au sein de l'Union
europenne-EEE-Suisse ? Qui sont les assurs des rgimes trangers qui ont utilis leur CEAM en
France entre 2008 et 2012 et comment l'ont-ils employe ?

Abbas, A. et Khan, S. U. (2014). "A review on the state-of-the-art privacy-preserving approaches in the e-health
clouds." IEEE J Biomed Health Inform 18(4): 1431-1441.

Cloud computing is emerging as a new computing paradigm in the healthcare sector besides other
business domains. Large numbers of health organizations have started shifting the electronic health
information to the cloud environment. Introducing the cloud services in the health sector not only
facilitates the exchange of electronic medical records among the hospitals and clinics, but also enables
the cloud to act as a medical record storage center. Moreover, shifting to the cloud environment
relieves the healthcare organizations of the tedious tasks of infrastructure management and also
minimizes development and maintenance costs. Nonetheless, storing the patient health data in the
third-party servers also entails serious threats to data privacy. Because of probable disclosure of
medical records stored and exchanged in the cloud, the patients' privacy concerns should essentially
be considered when designing the security and privacy mechanisms. Various approaches have been
used to preserve the privacy of the health information in the cloud environment. This survey aims to
encompass the state-of-the-art privacy-preserving approaches employed in the e-Health clouds.
Moreover, the privacy-preserving approaches are classified into cryptographic and noncryptographic
approaches and taxonomy of the approaches is also presented. Furthermore, the strengths and
weaknesses of the presented approaches are reported and some open issues are highlighted.

Bassi, J. et Lau, F. (2013). "Measuring value for money: a scoping review on economic evaluation of health
information systems." J Am Med Inform Assoc 20(4): 792-801.

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OBJECTIVE: To explore how key components of economic evaluations have been included in
evaluations of health information systems (HIS), to determine the state of knowledge on value for
money for HIS, and provide guidance for future evaluations. MATERIALS AND METHODS: We searched
databases, previously collected papers, and references for relevant papers published from January
2000 to June 2012. For selection, papers had to: be a primary study; involve a computerized system
for health information processing, decision support, or management reporting; and include an
economic evaluation. Data on study design and economic evaluation methods were extracted and
analyzed. RESULTS: Forty-two papers were selected and 33 were deemed high quality (scores >/=
8/10) for further analysis. These included 12 economic analyses, five input cost analyses, and 16 cost-
related outcome analyses. For HIS types, there were seven primary care electronic medical records, six
computerized provider order entry systems, five medication management systems, five immunization
information systems, four institutional information systems, three disease management systems, two
clinical documentation systems, and one health information exchange network. In terms of value for
money, 23 papers reported positive findings, eight were inconclusive, and two were negative.
CONCLUSIONS: We found a wide range of economic evaluation papers that were based on different
assumptions, methods, and metrics. There is some evidence of value for money in selected healthcare
organizations and HIS types. However, caution is needed when generalizing these findings. Better
reporting of economic evaluation studies is needed to compare findings and build on the existing
evidence base we identified.

Bassi, J., et al. (2012). "Perceived impact of electronic medical records in physician office practices: a review of
survey-based research." Interact J Med Res 1(2): e3.

BACKGROUND: Physician office practices are increasingly adopting electronic medical records (EMRs).
Therefore, the impact of such systems needs to be evaluated to ensure they are helping practices to
realize expected benefits. In addition to experimental and observational studies examining objective
impacts, the user's subjective view needs to be understood, since ultimate acceptance and use of the
system depends on them. Surveys are commonly used to elicit these views. OBJECTIVE: To determine
which areas of EMR implementation in office practices have been addressed in survey-based research
studies, to compare the perceived impacts between users and nonusers for the most-addressed areas,
and to contribute to the knowledge regarding survey-based research for assessing the impact of
health information systems (HIS). METHODS: We searched databases and systematic review citations
for papers published between 2000 and 2012 (May) that evaluated the perceived impact of using an
EMR system in an office-based practice, were based on original data, had providers as the primary end
user, and reported outcome measures related to the system's positive or negative impact. We
identified all the reported metrics related to EMR use and mapped them to the Clinical Adoption
Framework to analyze the gap. We then subjected the impact-specific areas with the most reported
results to a meta-analysis, which examined overall positive and negative perceived impacts for users
and nonusers. RESULTS: We selected 19 papers for the review. We found that most impact-specific
areas corresponded to the micro level of the framework and that appropriateness or effectiveness and
efficiency were well addressed through surveys. However, other areas such as access, which includes
patient and caregiver participation and their ability to access services, had very few metrics. We
selected 7 impact-specific areas for meta-analysis: security and privacy; quality of patient care or
clinical outcomes; patient-physician relationship and communication; communication with other
providers; accessibility of records and information; business or practice efficiency; and costs or
savings. All the results for accessibility of records and information and for communication with
providers indicated a positive view. The area with the most mixed results was security and privacy.
CONCLUSIONS: Users sometimes were likelier than nonusers to have a positive view of the selected
areas. However, when looking at the two groups separately, we often found more positive views for
most of the examined areas regardless of use status. Despite limitations of a small number of papers
and their heterogeneity, the results of this review are promising in terms of finding positive
perceptions of EMR adoption for users and nonusers. In addition, we identified issues related to
survey-based research for HIS evaluation, particularly regarding constructs for evaluation and quality
of study design and reporting.

Berbatis, C. G., et al. (2009). "Linked electronic medication systems in community pharmacies for preventing
pseudoephedrine diversion: a review of international practice and analysis of results in Australia."
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Drug Alcohol Rev 28(6): 586-591.

INTRODUCTION AND AIMS: Pseudoephedrine is a precursor often diverted into the illegal
manufacture of amphetamine type substances (ATS). The aim of this study was to evaluate the
effectiveness of a linked electronic medication recording system (LEMS) established in Australian
pharmacies in 2005 for preventing the diversion of pseudoephedrine. DESIGN AND METHODS: The
number of illegal ATS laboratories detected in each jurisdiction of Australia from 1996-1997 to 2004-
2005 were analysed by linear regression nationally and by each jurisdiction. The statistical significance
of seizures in 2005-2006 was based on the comparison of the observed value to the 95% prediction
confidence intervals calculated from the historical data for each jurisdiction and nationally. RESULTS:
Pharmacies in Queensland commenced an LEMS in late 2005 to minimise retail pseudoephedrine
diversion. The number of ATS laboratories seized in 2005-2006 in Queensland was significantly lower
(P < 0.05) than predicted by historical data. For all other jurisdictions and nationally the totals of
laboratories seized in 2005-2006 were not significantly different from predicted values. DISCUSSION
AND CONCLUSIONS: The significant decline in ATS illegal laboratories seized in Queensland in 2005-
2006 suggests the effective use of LEMS in pharmacies to minimise pseudoephedrine diversion. In
order to evaluate a national LEMS, more frequent data on numbers of linked pharmacies, ATS
laboratories seized and indicators of pseudoephedrine sales and misuse are required. Testing the use
of LEMS by pharmacies for preventing the diversion of other medicines seems appropriate.

Bhuyan, S. S., et al. (2014). "Do service innovations influence the adoption of electronic health records in long-
term care organizations? Results from the U.S. National Survey of Residential Care Facilities." Int J Med
Inform 83(12): 975-982.

OBJECTIVE: Healthcare organizations including residential care facilities (RCFs) are diversifying their
services to meet market demands. Service innovations have been linked to the changes in the way
that healthcare organizations organize their work. The objective of this study is to explore the
relationship between organizational service innovations and Electronic Health Record (EHR) adoption
in the RCFs. METHODS: We used the data from the 2010 National Survey of Residential Care Facilities
conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF
adopted EHR or not, and the predictors were the organizational service innovations including
provision of skilled nursing care and medication review. We also added facility characteristics as
control variables. Weighted multivariate logistic regressions were used to estimate the relationship
between service innovation factors and EHR adoption in the RCFs. RESULTS: In 2010, about 17.4% of
the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service
innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing
services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs
with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-
1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid
certification were significantly associated with EHR adoption. CONCLUSIONS: Our findings suggest that
service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a
strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health
care organizations, where quality of care and interoperability of patients' records might play a vital
role under the current healthcare reform. Future research could examine the relationship between
service innovations and use of different EHR functionality in RCFs.

Biro, S., et al. (2016). "Utility of linking primary care electronic medical records with Canadian census data to
study the determinants of chronic disease: an example based on socioeconomic status and obesity."
BMC Med Inform Decis Mak 16: 32.

BACKGROUND: Electronic medical records (EMRs) used in primary care contain a breadth of data that
can be used in public health research. Patient data from EMRs could be linked with other data sources,
such as a postal code linkage with Census data, to obtain additional information on environmental
determinants of health. While promising, successful linkages between primary care EMRs with
geographic measures is limited due to ethics review board concerns. This study tested the feasibility of
extracting full postal code from primary care EMRs and linking this with area-level measures of the
environment to demonstrate how such a linkage could be used to examine the determinants of
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disease. The association between obesity and area-level deprivation was used as an example to
illustrate inequalities of obesity in adults. METHODS: The analysis included EMRs of 7153 patients
aged 20 years and older who visited a single, primary care site in 2011. Extracted patient information
included demographics (date of birth, sex, postal code) and weight status (height, weight).
Information extraction and management procedures were designed to mitigate the risk of individual
re-identification when extracting full postal code from source EMRs. Based on patients' postal codes,
area-based deprivation indexes were created using the smallest area unit used in Canadian censuses.
Descriptive statistics and socioeconomic disparity summary measures of linked census and adult
patients were calculated. RESULTS: The data extraction of full postal code met technological
requirements for rendering health information extracted from local EMRs into anonymized data. The
prevalence of obesity was 31.6 %. There was variation of obesity between deprivation quintiles; adults
in the most deprived areas were 35 % more likely to be obese compared with adults in the least
deprived areas (Chi-Square = 20.24(1), p < 0.0001). Maps depicting spatial representation of regional
deprivation and obesity were created to highlight high risk areas. CONCLUSIONS: An area based socio-
economic measure was linked with EMR-derived objective measures of height and weight to show a
positive association between area-level deprivation and obesity. The linked dataset demonstrates a
promising model for assessing health disparities and ecological factors associated with the
development of chronic diseases with far reaching implications for informing public health and
primary health care interventions and services.

Blobel, B., et al. (2001). "Enhanced security services for enabling pan-European healthcare networks." Stud
Health Technol Inform 84(Pt 2): 1234-1238.

Establishing the Shared Care environment, communication and co-operation between healthcare
establishments involved must be provided in a trustworthy way. This challenge is even more
important for health networks using the Internet. In that context, services assuring both
communication security and application security must be provided. Especially in the e-health
environment, additionally to identity-related services certifying data or properties of principals,
trustworthiness or authorisation for objects, components and functions must be established by
Trusted Third Parties (TTP). Within the European Commission's Information Society Technologies (IST)
Programme, the HARP project provides the "HARP Cross-Security Platform (HCSP)" needed in the open
Web environment of pan-European networks. The solutions are under implementation and evaluation
in the German ONCONET enabling a trustworthy framework for both health professionals and patients
as well as supporting clinical studies.

Bolle, S., et al. (2015). "Online Health Information Tool Effectiveness for Older Patients: A Systematic Review of
the Literature." J Health Commun 20(9): 1067-1083.

Online health information tools (OHITs) have been found to be effective in improving health
outcomes. However, the effectiveness of these tools for older patients has been far from clear. This
systematic literature review therefore provides an overview of online health information tool
effectiveness for older patients using a two-dimensional framework of OHIT functions (i.e., providing
information, enhancing information exchange, and promoting self-management) and outcomes (i.e.,
immediate, intermediate, and long-term outcomes). Comprehensive searches of the PubMed,
EMBASE, and PsycINFO databases are conducted to identify eligible studies. Articles describing
outcomes of patient-directed OHITs in which a mean sample or subgroup of age >/=65 years was used
are included in the literature review. A best evidence synthesis analysis provides evidence that OHITs
improve self-efficacy, blood pressure, hemoglobin levels, and cholesterol levels. Limited evidence is
found in support of OHIT effects on knowledge, perceived social support, health service utilization,
glycemic control, self-care adherence, exercise performance, endurance, and quality of life. OHITs
seem promising tools to facilitate immediate, intermediate, and long-term outcomes in older patients
by providing information, enhancing information exchange, and promoting self-management.
However, future studies should evaluate the effectiveness of OHITs for older patients to achieve
stronger levels of evidence.

Bonhomme, C. (2013). "Au Danemark, un dossier patient informatis de territoire." Revue Hospitaliere De
France(550): 20-22.
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[BDSP. Notice produite par EHESP mm9R0xmC. Diffusion soumise autorisation]. La rgion danoise de
Midtjylland investit environ 40 euros par habitant chaque anne dans le dveloppement de ses
systmes d'information en sant. Autant dire qu'avec 1,2 million d'habitants, la deuxime rgion du
royaume se positionne en pointe dans un secteur forte croissance. Son dossier patient informatis
est considr comme l'un des plus aboutis du Danemark. Ses huit mille utilisateurs territoriaux -
professionnels de ville et hospitaliers-bnficient d'une plateforme d'changes sur rseau social.

Boonstra, A., et al. (2014). "Implementing electronic health records in hospitals: a systematic literature review."
BMC Health Serv Res 14: 370.

BACKGROUND: The literature on implementing Electronic Health Records (EHR) in hospitals is very
diverse. The objective of this study is to create an overview of the existing literature on EHR
implementation in hospitals and to identify generally applicable findings and lessons for
implementers. METHODS: A systematic literature review of empirical research on EHR implementation
was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant
references in the selected articles were also analyzed. Search terms included Electronic Health Record
(and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following
requirements: (1) written in English, (2) full text available online, (3) based on primary empirical data,
(4) focused on hospital-wide EHR implementation, and (5) satisfying established quality criteria.
RESULTS: Of the 364 initially identified articles, this study analyzes the 21 articles that met the
requirements. From these articles, 19 interventions were identified that are generally applicable and
these were placed in a framework consisting of the following three interacting dimensions: (1) EHR
context, (2) EHR content, and (3) EHR implementation process. CONCLUSIONS: Although EHR systems
are anticipated as having positive effects on the performance of hospitals, their implementation is a
complex undertaking. This systematic review reveals reasons for this complexity and presents a
framework of 19 interventions that can help overcome typical problems in EHR implementation. This
framework can function as a reference for implementers in developing effective EHR implementation
strategies for hospitals.

Bruun-Rasmussen, M., et al. (2003). "Collaboration--a new IT-service in the next generation of regional health
care networks." Int J Med Inform 70(2-3): 205-214.

During the past 10-15 years, Regional Health Care Networks (RHCN) have been established in many
regions throughout the world. RHCN build on well-known techniques, methodologies and appropriate
standards. Most of the European Countries today have set up IT strategic plans that focus on the
establishment of RHCN. The benefits of having access to all relevant information are tremendous and
contribute to cost-effective and coherent health services. By the rapid spread and use of Internet,
technology has made it possible to interconnect all kinds of applications. In 2000, the most
experienced regions in Europe joined PICNIC, a European project to develop the Next Generation
Regional Health Care Networks and to support their new ways of providing health and social care. The
previous generation of Regional Health Care Networks supported the interconnection of applications
by transfer of messages. Messaging is an effective means of integration for isolated high-specialised
systems that only need to exchange data. This service will continue to be one of the most important
services in the future health care networks. However, tighter coupling may be desirable in some
instances to avoid replicating the same functionality in several applications. In other words, certain
services can be common and used by a number of applications instead of building that service inside
each application. These common services are called middleware services. In PICNIC
([Link] a new middleware Collaboration IT service has been identified and
developed. This service allows the end users to perform real-time clinical collaboration, with exchange
of text, structured data, voice and images across the limits of a single region. A clinical collaboration is
associated with the shared clinical context to provide a record of relevant clinical information and
facilitates synchronous as well as asynchronous collaboration. This new IT service builds on the
increasing popularity of instance messaging and presence systems that facilitate smooth transition
between synchronous and asynchronous interaction. The new Collaboration IT service is expected to
have a strong impact on the practice of health care in the next generation of Regional Health Care
Networks.
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Carrion Senor, I., et al. (2012). "[Access control management in electronic health records: a systematic
literature review]." Gac Sanit 26(5): 463-468.

OBJECTIVE: This study presents the results of a systematic literature review of aspects related to
access control in electronic health records systems, wireless security and privacy and security training
for users. METHODS: Information sources consisted of original articles found in Medline, ACM Digital
Library, Wiley InterScience, IEEE Digital Library, Science@Direct, MetaPress, ERIC, CINAHL and Trip
Database, published between January 2006 and January 2011. A total of 1,208 articles were extracted
using a predefined search string and were reviewed by the authors. The final selection consisted of 24
articles. RESULTS: Of the selected articles, 21 dealt with access policies in electronic health records
systems. Eleven articles discussed whether access to electronic health records should be granted by
patients or by health organizations. Wireless environments were only considered in three articles.
Finally, only four articles explicitly mentioned that technical training of staff and/or patients is
required. CONCLUSION: Role-based access control is the preferred mechanism to deploy access policy
by the designers of electronic health records. In most systems, access control is managed by users and
health professionals, which promotes patients' right to control personal information. Finally, the
security of wireless environments is not usually considered. However, one line of research is eHealth
in mobile environments, called mHealth.

Cassidy, A. (2010). "Patient-Centered Medical Homes." Health Policy Brief: 6.

[Link]
Patient-centered medical homes are considered by many to be among the most promising approaches
to delivering higher-quality, cost effective primary care, especially for people with chronic health
conditions. Although there is no single standard definition of a medical home, there is an agreed upon
set of principles behind the concept, and most medical homes share common elements. For example,
each patient has close contact with a clinician (physician, nurse practitioner, or physician assistant) for
continuing care, and that clinician takes the lead when referring the patient to specialists. Medical
homes also make extensive use of electronic health records and seek active participation of the
patient and his or her family. Health care reform legislation authorizes the Department of Health and
Human Services (HHS) to test medical homes among other new care-delivery models. Supporters hope
patient-centered medical homes will help refocus the U.S. health care system on the benefits of
primary care. This brief describes recent projects that have applied patient-centered medical home
concepts, as well as concerns about widespread adoption of the model before results are definitive.

Castillo, V. H., et al. (2010). "A knowledge-based taxonomy of critical factors for adopting electronic health
record systems by physicians: a systematic literature review." BMC Med Inform Decis Mak 10: 60.

BACKGROUND: The health care sector is an area of social and economic interest in several countries;
therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is
evidence suggesting that these systems have not been adopted as it was expected, and although there
are some proposals to support their adoption, the proposed support is not by means of information
and communication technology which can provide automatic tools of support. The aim of this study is
to identify the critical adoption factors for electronic health records by physicians and to use them as a
guide to support their adoption process automatically. METHODS: This paper presents, based on the
PRISMA statement, a systematic literature review in electronic databases with adoption studies of
electronic health records published in English. Software applications that manage and process the
data in the electronic health record have been considered, i.e.: computerized physician prescription,
electronic medical records, and electronic capture of clinical data. Our review was conducted with the
purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health
records, that can be addressed by means of information and communication technology; in particular
with the information technology roles of the knowledge management processes. Which take us to the
question that we want to address in this work: "What are the critical adoption factors of electronic
health records that can be supported by information and communication technology?". Reports from
eight databases covering electronic health records adoption studies in the medical domain, in
particular those focused on physicians, were analyzed. RESULTS: The review identifies two main
issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by
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physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the
design of knowledge-based systems, to assist the adoption process of electronic health records in an
automatic fashion. From our review, six critical adoption factors have been identified: user attitude
towards information systems, workflow impact, interoperability, technical support, communication
among users, and expert support. The main limitation of the taxonomy is the different impact of the
adoption factors of electronic health records reported by some studies depending on the type of
practice, setting, or attention level; however, these features are a determinant aspect with regard to
the adoption rate for the latter rather than the presence of a specific critical adoption factor.
CONCLUSIONS: The critical adoption factors established here provide a sound theoretical basis for
research to understand, support, and facilitate the adoption of electronic health records to physicians
in benefit of patients.

Chan, K. S., et al. (2010). "Review: electronic health records and the reliability and validity of quality measures:
a review of the literature." Med Care Res Rev 67(5): 503-527.

Previous reviews of research on electronic health record (EHR) data quality have not focused on the
needs of quality measurement. The authors reviewed empirical studies of EHR data quality, published
from January 2004, with an emphasis on data attributes relevant to quality measurement. Many of the
35 studies reviewed examined multiple aspects of data quality. Sixty-six percent evaluated data
accuracy, 57% data completeness, and 23% data comparability. The diversity in data element, study
setting, population, health condition, and EHR system studied within this body of literature made
drawing specific conclusions regarding EHR data quality challenging. Future research should focus on
the quality of data from specific EHR components and important data attributes for quality
measurement such as granularity, timeliness, and comparability. Finally, factors associated with poor
or variability in data quality need to be better understood and effective interventions developed.

Chen, H., et al. (2014). "A review of data quality assessment methods for public health information systems."
Int J Environ Res Public Health 11(5): 5170-5207.

High quality data and effective data quality assessment are required for accurately evaluating the
impact of public health interventions and measuring public health outcomes. Data, data use, and data
collection process, as the three dimensions of data quality, all need to be assessed for overall data
quality assessment. We reviewed current data quality assessment methods. The relevant study was
identified in major databases and well-known institutional websites. We found the dimension of data
was most frequently assessed. Completeness, accuracy, and timeliness were the three most-used
attributes among a total of 49 attributes of data quality. The major quantitative assessment methods
were descriptive surveys and data audits, whereas the common qualitative assessment methods were
interview and documentation review. The limitations of the reviewed studies included inattentiveness
to data use and data collection process, inconsistency in the definition of attributes of data quality,
failure to address data users' concerns and a lack of systematic procedures in data quality assessment.
This review study is limited by the coverage of the databases and the breadth of public health
information systems. Further research could develop consistent data quality definitions and attributes.
More research efforts should be given to assess the quality of data use and the quality of data
collection process.

Chen, H., et al. (2014). "Methods for assessing the quality of data in public health information systems: a critical
review." Stud Health Technol Inform 204: 13-18.

The quality of data in public health information systems can be ensured by effective data quality
assessment. In order to conduct effective data quality assessment, measurable data attributes have to
be precisely defined. Then reliable and valid measurement methods for data attributes have to be
used to measure each attribute. We conducted a systematic review of data quality assessment
methods for public health using major databases and well-known institutional websites. 35 studies
were eligible for inclusion in the study. A total of 49 attributes of data quality were identified from the
literature. Completeness, accuracy and timeliness were the three most frequently assessed attributes
of data quality. Most studies directly examined data values. This is complemented by exploring either
data users' perception or documentation quality. However, there are limitations of current data
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quality assessment methods: a lack of consensus on attributes measured; inconsistent definition of

the data quality attributes; a lack of mixed methods for assessing data quality; and inadequate
attention to reliability and validity. Removal of these limitations is an opportunity for further
improvement.

Cheraghi-Sohi, S., et al. (2015). "Missed diagnostic opportunities and English general practice: a study to
determine their incidence, confounding and contributing factors and potential impact on patients
through retrospective review of electronic medical records." Implement Sci 10: 105.

BACKGROUND: Patient safety research has focused largely on hospital settings despite the fact that in
many countries, the majority of patient contacts are in primary care. The knowledge base about
patient safety in primary care is developing but sparse and diagnostic error is a relatively understudied
and an unmeasured area of patient safety. Diagnostic error rates vary according to how 'error' is
defined but one suggested hallmark is clear evidence of 'missed opportunity' (MDOs) makes a correct
or timely diagnosis to prevent them. While there is no agreed definition or method of measuring
MDOs, retrospective manual chart or patient record reviews are a 'gold standard'. This study protocol
aims to (1) determine the incidence of MDOs in English general practice, (2) identify the confounding
and contributing factors that lead to MDOs and (3) determine the (potential) impact of the detected
MDOs on patients. METHODS/DESIGN: We plan to conduct a two-phase retrospective review of
electronic health records in the Greater Manchester (GM) area of the UK. In the first phase, clinician
reviewers will calibrate their performance in identifying and assessing MDOs against a gold standard
'primary reviewer' through the use of 'double' reviews of records. The findings will enable a
preliminary estimate of the incidence of MDOs in general practice, which will be used to calculate the
number of records to be reviewed in the second phase in order to estimate the true incidence of MDO
in general practice. A sample of 15 general practices is required for phase 1 and up to 35 practices for
phase 2. In each practice, the sample will consist of 100 patients aged >/=18 years on 1 April 2013 who
have attended a face-to-face 'index consultation' between 1 April 2013 and 31 March 2015. The index
consultation will be selected randomly from each unique patient record, occurring between 1 July
2013 and 30 June 2014. DISCUSSION: There are no reliable estimates of safety problems related to
diagnosis in English general practice. This study will lay the foundation for safety improvements in this
area by providing a more reliable estimate of MDOs, their impact and their contributory factors.

Coorevits, P., et al. (2013). "Electronic health records: new opportunities for clinical research." J Intern Med
274(6): 547-560.

Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining
an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at
present, as discussed in this review, new improved systems and emerging research infrastructures are
being developed to ensure that EHRs can be used for secondary purposes such as clinical research,
including the design and execution of clinical trials for new medicines. EHR systems should be able to
exchange information through the use of recently published international standards for their
interoperability and clinically validated information structures (such as archetypes and international
health terminologies), to ensure consistent and more complete recording and sharing of data for
various patient groups. Such systems will counteract the obstacles of differing clinical languages and
styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss
some of the legal and ethical concerns of clinical research data reuse and technical security measures
that can enable such research while protecting privacy. In the emerging research landscape,
cooperation infrastructures are being built where research projects can utilize the availability of
patient data from federated EHR systems from many different sites, as well as in international
multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising
method for clinical research. One of the first achievements of this project was the development of a
protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple
sources.

de Bruin, J. S., et al. (2014). "Data use and effectiveness in electronic surveillance of healthcare associated
infections in the 21st century: a systematic review." J Am Med Inform Assoc 21(5): 942-951.

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OBJECTIVE: As more electronic health records have become available during the last decade, we
aimed to uncover recent trends in use of electronically available patient data by electronic surveillance
systems for healthcare associated infections (HAIs) and identify consequences for system
effectiveness. METHODS: A systematic review of published literature evaluating electronic HAI
surveillance systems was performed. The PubMed service was used to retrieve publications between
January 2001 and December 2011. Studies were included in the review if they accurately described
what electronic data were used and if system effectiveness was evaluated using sensitivity, specificity,
positive predictive value, or negative predictive value. Trends were identified by analyzing changes in
the number and types of electronic data sources used. RESULTS: 26 publications comprising
discussions on 27 electronic systems met the eligibility criteria. Trend analysis showed that systems
use an increasing number of data sources which are either medico-administrative or clinical and
laboratory-based data. Trends on the use of individual types of electronic data confirmed the
paramount role of microbiology data in HAI detection, but also showed increased use of biochemistry
and pharmacy data, and the limited adoption of clinical data and physician narratives. System
effectiveness assessments indicate that the use of heterogeneous data sources results in higher
system sensitivity at the expense of specificity. CONCLUSIONS: Driven by the increased availability of
electronic patient data, electronic HAI surveillance systems use more data, making systems more
sensitive yet less specific, but also allow systems to be tailored to the needs of healthcare institutes'
surveillance programs.

de Lusignan, S., et al. (2014). "Patients' online access to their electronic health records and linked online
services: a systematic interpretative review." Bmj Open 4(9): e006021.

OBJECTIVES: To investigate the effect of providing patients online access to their electronic health
record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The
objectives are also to identify and understand: barriers and facilitators for providing online access to
their records and services for primary care workers; and their association with organisational/IT
system issues. SETTING: Primary care. PARTICIPANTS: A total of 143 studies were included. 17 were
experimental in design and subject to risk of bias assessment, which is reported in a separate paper.
Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. PRIMARY
AND SECONDARY OUTCOME MEASURES: Our primary outcome measure was change in quality or
safety as a result of implementation or utilisation of online records/transactional services. RESULTS:
No studies reported changes in health outcomes; though eight detected medication errors and seven
reported improved uptake of preventative care. Professional concerns over privacy were reported in
14 studies. 18 studies reported concern over potential increased workload; with some showing an
increase workload in email or online messaging; telephone contact remaining unchanged, and face-to
face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change
was hard to predict. 10 studies reported how online access offered convenience, primarily for more
advantaged patients, who were largely highly satisfied with the process when clinician responses were
prompt. CONCLUSIONS: Patient online access and services offer increased convenience and
satisfaction. However, professionals were concerned about impact on workload and risk to privacy.
Studies correcting medication errors may improve patient safety. There may need to be a redesign of
the business process to engage health professionals in online access and of the EHR to make it
friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW
REGISTRATION NUMBER: PROSPERO CRD42012003091.

de Lusignan, S. et Seroussi, B. (2013). "A comparison of English and French approaches to providing patients
access to Summary Care Records: scope, consent, cost." Stud Health Technol Inform 186: 61-65.

Online access to records is part of the process of empowering patients. National health services in
both France and England have introduced systems to provide online access to summary health data.
The English system was called the "Summary Care Record (SCR)," made accessible to patients through
"HealthSpace". The French system Dossier Medical Personnel (DMP) is a patient controlled record
clinicians enter data into. The objective was to compare the programmes and lessons from the
introduction of patient access. We carried out a literature review. The English system has been
progressively de-scoped, with HealthSpace due to close in 2013, only 0.01% of the population signing
up for "advanced accounts". The French system slowly grows as more documents are added; though
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only 0.31% of the population have opened a DMP. The English SCR has an opt-out consent model,
whereas the French DMP is patient controlled opt-in consent model. The SCR sits within an NHS
intranet while the DMP sits on the Internet. Both systems have costs of around 200 million Euro.
Providing patients online access to their medical records is potentially empowering. However, the
English HealthSpace and SCR have failed to deliver and are due to be withdrawn as methods of
providing patients online access. The French system is still in operation but much criticized for its high
costs and low uptake. The design of these systems does not appear to have met patients' needs or
been readily integrated into physicians workflow.

Dean, B. B., et al. (2009). "Review: use of electronic medical records for health outcomes research: a literature
review." Med Care Res Rev 66(6): 611-638.

This review assessed the use of electronic medical record (EMR) systems in outcomes research. We
systematically searched PubMed to identify articles published from January 2000 to January 2007
involving EMR use for outpatient-based outcomes research in the United States. EMR-based outcomes
research studies (n = 126) have increased sixfold since 2000. Although chronic conditions were most
common, EMRs were also used to study less common diseases, highlighting the EMRs' flexibility to
examine large cohorts as well as identify patients with rare diseases. Traditional multi-variate
modeling techniques were the most commonly used technique to address confounding and potential
selection bias. Data validation was a component in a quarter of studies, and many evaluated the
EMR's ability to achieve similar results previously achieved using other data sources. Investigators
using EMR data should aim for consistent terminology, focus on adequately describing their methods,
and consider appropriate statistical methods to control for confounding and treatment-selection bias.

Denecke, K. (2014). "Ethical aspects of using medical social media in healthcare applications." Stud Health
Technol Inform 198: 55-62.

The advances in internet and mobile technologies and their increased use in healthcare led to the
development of a new research field: health web science. Many research questions are addressed in
that field, starting from analysing social-media data, to recruiting participants for clinical studies and
monitoring the public health status. The information provided through this channel is unique in a
sense that there is no other written source of experiences from patients and health carers. The
increased usage and analysis of health web data poses questions on privacy, and ethics. Through a
literature review, the current awareness on ethical issues in the context of public health monitoring
and research using medical social media data is determined. Further, considerations on the topic were
collected from members of the IMIA Social Media Working group.

Doupi, P., et al. (2005). "Implementing interoperable secure health information systems." Stud Health Technol
Inform 115: 187-214.

Ensuring the privacy and confidentiality of individuals has made security an indispensable component
of health information systems. Delivery of healthcare services beyond the enterprise level to the
regional, national or cross-border area places new challenges for security implementation. We review
the current status and uptake of security measures in healthcare settings across European countries
and examine in more detail some of the leading eHealth applications. Drawing on the findings of this
analysis, we propose a generic model for streamlining the security implementation process on any
level -local, regional, national or cross-border. Finally, we address the future prospects and
requirements for advancing secure delivery of healthcare services across European borders.

Emmanouilidou, M. et Burke, M. (2013). "A thematic review and a policy-analysis agenda of Electronic Health
Records in the Greek National Health System." Health Policy 109(1): 31-37.

The increasing pressure to improve healthcare outcomes and reduce costs is driving the current
agenda of governments at worldwide level and calls for a fundamental reform of the status quo of
health systems. This is especially the case with the Greek NHS (National Health System), a system in
continuous crisis, and with the recent ongoing financial turbulence under intensive scrutiny.
Technological innovations and Electronic Health Records (EHR) in particular, are recognised as key
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enablers in mitigating the existing burdens of healthcare. As a result, EHR is considered a core
component in technology-driven reform processes. Nonetheless, the successful implementation and
adoption of EHR proves to be a challenging task due to a mixture of technological, organisational and
political issues. Drawing upon experiences within the European Union (EU) healthcare setting and the
Greek NHS the paper proposes a conceptual framework as a policy-analysis agenda for EHR
interventions in Greece. While the context of discussion is Greece, the paper aims to also derive useful
insights to healthcare policy-makers around the globe.

Fiander, M., et al. (2015). "Interventions to increase the use of electronic health information by healthcare
practitioners to improve clinical practice and patient outcomes." Cochrane Database Syst Rev(3):
Cd004749.

BACKGROUND: There is a large volume of health information available, and, if applied in clinical
practice, may contribute to effective patient care. Despite an abundance of information, sub-optimal
care is common. Many factors influence practitioners' use of health information, and format
(electronic or other) may be one such factor. OBJECTIVES: To assess the effects of interventions aimed
at improving or increasing healthcare practitioners' use of electronic health information (EHI) on
professional practice and patient outcomes. SEARCH METHODS: We searched The Cochrane Library
(Wiley), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and LISA (EBSCO) up to November 2013.
We contacted researchers in the field and scanned reference lists of relevant articles. SELECTION
CRITERIA: We included studies that evaluated the effects of interventions to improve or increase the
use of EHI by healthcare practitioners on professional practice and patient outcomes. We defined EHI
as information accessed on a computer. We defined 'use' as logging into EHI. We considered any
healthcare practitioner involved in patient care. We included randomized, non-randomized, and
cluster randomized controlled trials (RCTs, NRCTs, CRCTs), controlled clinical trials (CCTs), interrupted
time series (ITS), and controlled before-and-after studies (CBAs).The comparisons were: electronic
versus printed health information; EHI on different electronic devices (e.g. desktop, laptop or tablet
computers, etc.; cell / mobile phones); EHI via different user interfaces; EHI provided with or without
an educational or training component; and EHI compared to no other type or source of information.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the
risk of bias for each study. We used GRADE to assess the quality of the included studies. We
reassessed previously excluded studies following our decision to define logins to EHI as a measure of
professional behavior. We reported results in natural units. When possible, we calculated and
reported median effect size (odds ratio (OR), interquartile ranges (IQR)). Due to high heterogeneity
across studies, meta-analysis was not feasible. MAIN RESULTS: We included two RCTs and four CRCTs
involving 352 physicians, 48 residents, and 135 allied health practitioners. Overall risk of bias was low
as was quality of the evidence. One comparison was supported by three studies and three
comparisons were supported by single studies, but outcomes across the three studies were highly
heterogeneous. We found no studies to support EHI versus no alternative. Given these factors, it was
not possible to determine the relative effectiveness of interventions. All studies reported practitioner
use of EHI, two reported on compliance with electronic practice guidelines, and none reported on
patient [Link] trial (139 participants) measured guideline adherence for an electronic versus
printed guideline, but reported no difference between groups (median OR 0.85, IQR 0.74 to 1.08). One
small cross-over trial (10 participants) reported increased use of clinical guidelines when provided with
a mobile versus stationary, desktop computer (mean use per shift: intervention group (IG) 3.6,
standard deviation (SD) 1.7 vs. control group (CG) 2.0 (SD 1.9), P value = 0.033). One cross-over trial
(203 participants) reported that using a customized versus a generic interface had little impact on
practitioners' use of EHI (mean difference in adjusted end-of-study rate: 0.77 logins/month/user, 95%
confidence interval (CI) CI 0.43 to 1.11). Three trials included education or training and reported
increased use of EHI by practitioners following training. AUTHORS' CONCLUSIONS: This review
provided no evidence that the use of EHI translates into improved clinical practice or patient
outcomes, though it does suggest that when practitioners are provided with EHI and education or
training, the use of EHI increases. We have defined use as the activity of logging into an EHI resource,
but based on our findings use does not automatically translate to the application of EHI in practice.
While using EHI may be an important component of evidence-based medicine, alone it is insufficient
to improve patient care or clinical practices. For EHI to be applied in patient care, it will be necessary
to understand why practitioners' are reluctant to apply EHI when treating people, and to determine
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the most effective way(s) to reduce this reluctance.

Fontaine, P., et al. (2010). "Systematic review of health information exchange in primary care practices." J Am
Board Fam Med 23(5): 655-670.

BACKGROUND: Unprecedented federal interest and funding are focused on secure, standardized,
electronic transfer of health information among health care organizations, termed health information
exchange (HIE). The stated goals are improvements in health care quality, efficiency, and cost.
Ambulatory primary care practices are essential to this process; however, the factors that motivate
them to participate in HIE are not well studied, particularly among small practices. METHODS: We
conducted a systematic review of the literature about HIE participation from January 1990 through
mid-September 2008 to identify peer-reviewed and non-peer-reviewed publications in bibliographic
databases and websites. Reviewers abstracted each publication for predetermined key issues,
including stakeholder participation in HIE, and the benefits, barriers, and overall value to primary care
practices. We identified themes within each key issue, then grouped themes and identified supporting
examples for analysis. RESULTS: One hundred and sixteen peer-reviewed, non-peer-reviewed, and
web publications were retrieved, and 61 met inclusion criteria. Of 39 peer-reviewed publications, one-
half reported original research. Among themes of cost savings, workflow efficiency, and quality, the
only benefits to be reliably documented were those regarding efficiency, including improved access to
test results and other data from outside the practice and decreased staff time for handling referrals
and claims processing. Barriers included cost, privacy and liability concerns, organizational
characteristics, and technical barriers. A positive return on investment has not been documented.
CONCLUSIONS: The potential for HIE to reduce costs and improve the quality of health care in
ambulatory primary care practices is well recognized but needs further empiric substantiation.

Gallego, A. I., et al. (2010). "Assessing the cost of electronic health records: a review of cost indicators."
Telemed J E Health 16(9): 963-972.

We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic
health record (EHR) implementations and their associated benefit indicators. We provide a set of the
most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall
estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation
showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-
year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a
few studied implementations. Distinctions in reporting fixed and variable costs are suggested.

Garel, P. (2011). "E-sant. tat des lieux europen." Revue Hospitaliere De France(539): 78-80.

[BDSP. Notice produite par EHESP rEp9R0xn. Diffusion soumise autorisation]. Avec l'article 13 de la
directive sur les soins transfrontaliers, l'e-sant est devenue un sujet lgislatif au sein de l'Union
europenne. La coopration et l'change d'informations entre les Etats membres, runis dans un
rseau d'administrations nationales responsables de l'e-sant, seront dsormais soutenus par l'UE sur
un fondement juridique. L'article prsente les programmes de recherche europens dvelopps pour
la mise en place des outils et systmes d'e-sant.

Garel, P. (2013). "L'e-sant dans l'agenda de la Fdration europenne des hpitaux (HOPE)." Revue
Hospitaliere De France(550): 18-.

[BDSP. Notice produite par EHESP 8sR0xrrE. Diffusion soumise autorisation]. La Fdration
europenne des hpitaux et soins de sant (HOPE) participe activement depuis 2005 aux travaux e-
sant de la Commission europenne, et plus particulirement aux missions de sa direction gnrale,
Connect. La Commission a dvoil dbut dcembre 2012 un nouveau plan d'actions.

Garrett, N. Y., et al. (2011). "Characterization of public health alerts and their suitability for alerting in
electronic health record systems." J Public Health Manag Pract 17(1): 77-83.

Public health agencies including federal, state, and local governments routinely send out public health
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advisories and alerts via e-mail and text messages to health care providers to increase awareness of
public health events and situations. Agencies must ensure that practitioners have timely and
accessible information at the critical point-of-care. Electronic health record (EHR) systems have the
potential to alert physicians of emerging health conditions deemed important for public health at the
most critical time of need. To understand how public health agencies can leverage existing alerting
mechanisms in EHR systems, it is important to understand characteristics of public health alerts to
determine their suitability for alerting in EHR systems. Authors conducted a review and analysis of
public health alerts for a 3-year period to identify critical data attributes necessary to support public
health alerting in EHR systems. The alerts were restricted to those most relevant for clinical care. The
results showed that there is an opportunity for disseminating actionable information to clinical
practitioners at the point of care to guide care and reporting. Public health alerts in EHR systems can
be useful in reporting, recommending specific tests, as well as suggesting secondary prevention.

Georgoulas, A., et al. (2003). "RESHEN, a best practice approach for secure healthcare networks in Europe."
Stud Health Technol Inform 96: 51-59.

Electronic communication of healthcare related information (in the framework of Regional Healthcare
Information Networks), introduces a number of security risks with regard to confidentiality, integrity
and availability, which can become quite crucial taking into account its sensitive nature. Public Key
Infrastructure (PKI) is acknowledged as an appropriate means for dealing with such risks, as long as all
the involved critical factors are first practically assessed. This paper presents a best-practice approach
for secure regional healthcare networks in Europe, examining all the identified crucial parameters
(technical, organisational, legal/regulatory, medical and business). Our approach is conducted at two
levels (the regional and the European), including the integration of PKI-aware security mechanisms
(strong authentication, encryption, digital signature, time-stamping) in three regional pilot sites in
Greece, Finland and Germany and demonstrating their interconnection in a pan-European
architecture. Following the above approach, some major conclusions are excluded, pointing out
existing open issues and possible steps forward.

Gibson, M., et al. (2005). "Multi-tasking in pratice : coordinated activities in the computer supported doctor-
patient consultation." International Journal of Medical Informatics 74(6): 425-436.

Goldwater, J. C., et al. (2014). "Open source electronic health records and chronic disease management." J Am
Med Inform Assoc 21(e1): e50-54.

OBJECTIVE: To study and report on the use of open source electronic health records (EHR) to assist
with chronic care management within safety net medical settings, such as community health centers
(CHC). METHODS AND MATERIALS: The study was conducted by NORC at the University of Chicago
from April to September 2010. The NORC team undertook a comprehensive environmental scan,
including a literature review, a dozen key informant interviews using a semistructured protocol, and a
series of site visits to CHC that currently use an open source EHR. RESULTS: Two of the sites chosen by
NORC were actively using an open source EHR to assist in the redesign of their care delivery system to
support more effective chronic disease management. This included incorporating the chronic care
model into an CHC and using the EHR to help facilitate its elements, such as care teams for patients, in
addition to maintaining health records on indigent populations, such as tuberculosis status on
homeless patients. DISCUSSION: The ability to modify the open-source EHR to adapt to the CHC
environment and leverage the ecosystem of providers and users to assist in this process provided
significant advantages in chronic care management. Improvements in diabetes management,
controlled hypertension and increases in tuberculosis vaccinations were assisted through the use of
these open source systems. CONCLUSIONS: The flexibility and adaptability of open source EHR
demonstrated its utility and viability in the provision of necessary and needed chronic disease care
among populations served by CHC.

Goldzweig, C. L., et al. (2013). "Electronic patient portals: evidence on health outcomes, satisfaction, efficiency,
and attitudes: a systematic review." Ann Intern Med 159(10): 677-687.

BACKGROUND: Patient portals tied to provider electronic health record (EHR) systems are increasingly
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popular. PURPOSE: To systematically review the literature reporting the effect of patient portals on
clinical care. DATA SOURCES: PubMed and Web of Science searches from 1 January 1990 to 24 January
2013. STUDY SELECTION: Hypothesis-testing or quantitative studies of patient portals tethered to a
provider EHR that addressed patient outcomes, satisfaction, adherence, efficiency, utilization,
attitudes, and patient characteristics, as well as qualitative studies of barriers or facilitators, were
included. DATA EXTRACTION: Two reviewers independently extracted data and addressed
discrepancies through consensus discussion. DATA SYNTHESIS: From 6508 titles, 14 randomized,
controlled trials; 21 observational, hypothesis-testing studies; 5 quantitative, descriptive studies; and
6 qualitative studies were included. Evidence is mixed about the effect of portals on patient outcomes
and satisfaction, although they may be more effective when used with case management. The effect
of portals on utilization and efficiency is unclear, although patient race and ethnicity, education level
or literacy, and degree of comorbid conditions may influence use. LIMITATION: Limited data for most
outcomes and an absence of reporting on organizational and provider context and implementation
processes. CONCLUSION: Evidence that patient portals improve health outcomes, cost, or utilization is
insufficient. Patient attitudes are generally positive, but more widespread use may require efforts to
overcome racial, ethnic, and literacy barriers. Portals represent a new technology with benefits that
are still unclear. Better understanding requires studies that include details about context,
implementation factors, and cost.

Gray, B. H., et al. (2011). "Electronic Health Records: An International Perspective on Meaningful Use." Issues in
International Health Policy: 15 , graph., tabl.
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Research has shown that the United States lags many other countries in the adoption of electronic
health records (EHRs). The U.S. has now embarked on a major effort to achieve meaningful use of
health information technology by clinicians and hospitals. This issue brief describes the extent of
meaningful use in three countries with very high levels of health information technology
adoption?Denmark, New Zealand, and Sweden. While all three have achieved high levels of
meaningful use, none has reached 100 percent in all categories. The brief find high levels of
meaningful use for EHR items and substantial information- sharing with other organizations or health
authorities, although less information is shared with patients. Insights that may prove useful to the
United States include providing economic incentives to encourage adoption and designating an
organization to take responsibility for standardization and interoperability.

Grenier, C. (2011). "Structuring an integrated care system: interpreted through the enacted diversity of the
actors involved-the case of a French healthcare network." Int J Integr Care 11: e003.

RESEARCH QUESTION: We are looking at the process of structuring an integrated care system as an
innovative process that swings back and forth between the diversity of the actors involved, local
aspirations and national and regional regulations. We believe that innovation is enriched by the
variety of the actors involved, but may also be blocked or disrupted by that diversity. Our research
aims to add to other research, which, when questioning these integrated systems, analyses how the
actors involved deal with diversity without really questioning it. CASE STUDY: The empirical basis of
the paper is provided by case study analysis. The studied integrated care system is a French healthcare
network that brings together healthcare professionals and various organisations in order to improve
the way in which interventions are coordinated and formalised, in order to promote better detection
and diagnosis procedures and the implementation of a care protocol. We consider this case as
instrumental in developing theoretical proposals for structuring an integrated care system in light of
the diversity of the actors involved. RESULTS AND DISCUSSION: We are proposing a model for
structuring an integrated care system in light of the enacted diversity of the actors involved. This
model is based on three factors: the diversity enacted by the leaders, three stances for considering the
contribution made by diversity in the structuring process and the specific leading role played by those
in charge of the structuring process. Through this process, they determined how the actors involved in
the project were differentiated, and on what basis those actors were involved. By mobilising enacted
diversity, the leaders are seeking to channel the emergence of a network in light of their own
representation of that network. This model adds to published research on the structuring of
integrated care systems.
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Gvozdanovic, D., et al. (2007). "National healthcare information system in Croatian primary care: the
foundation for improvement of quality and efficiency in patient care." Inform Prim Care 15(3): 181-
185.

In order to improve the quality of patient care, while at the same time keeping up with the pace of
increased needs of the population for healthcare services that directly impacts on the cost of care
delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social
Welfare, has formed a strategy and campaign for national public healthcare system reform. The
strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the
enterprise information systems that will aim to support end-to-end business processes in the
healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related
data management in support of decision-making processes; (2) to support a continuous process of
healthcare resource spending optimisation. The first project is the Integrated Healthcare Information
System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care
facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute
of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all
other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single
enterprise healthcare network. This article gives an overview of Croatian public healthcare system
strategy aims and goals, and focuses on properties and characteristics of the primary care project
implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand
opening of the project with 350 GPs already fully connected to the integrated healthcare information
infrastructure based on the IHCIS solution.

Hage, E., et al. (2013). "Implementation factors and their effect on e-Health service adoption in rural
communities: a systematic literature review." BMC Health Serv Res 13: 19.

BACKGROUND: An ageing population is seen as a threat to the quality of life and health in rural
communities, and it is often assumed that e-Health services can address this issue. As successful e-
Health implementation in organizations has proven difficult, this systematic literature review
considers whether this is so for rural communities. This review identifies the critical implementation
factors and, following the change model of Pettigrew and Whipp, classifies them in terms of "context",
"process", and "content". Through this lens, we analyze the empirical findings found in the literature
to address the question: How do context, process, and content factors of e-Health implementation
influence its adoption in rural communities? METHODS: We conducted a systematic literature review.
This review included papers that met six inclusion and exclusion criteria and had sufficient
methodological quality. Findings were categorized in a classification matrix to identify promoting and
restraining implementation factors and to explore whether any interactions between context, process,
and content affect adoption. RESULTS: Of the 5,896 abstracts initially identified, only 51 papers met all
our criteria and were included in the review. We distinguished five different perspectives on rural e-
Health implementation in these papers. Further, we list the context, process, and content
implementation factors found to either promote or restrain rural e-Health adoption. Many
implementation factors appear repeatedly, but there are also some contradictory results. Based on a
further analysis of the papers' findings, we argue that interaction effects between context, process,
and content elements of change may explain these contradictory results. More specifically, three
themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects
of geographical isolation, the targeting of underprivileged groups, and the changes in ownership
required for sustainable e-Health adoption. CONCLUSIONS: Rural e-Health implementation is an
emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating
implementation factors and their interactions. We argue that rural e-Health implementation only
leads to sustainable adoption (i.e. it "sticks") when the implementation carefully considers and aligns
the e-Health content (the "clicks"), the pre-existing structures in the context (the "bricks"), and the
interventions in the implementation process (the "tricks").

Harris, C., et al. (2015). "Development, implementation and evaluation of an evidence-based program for
introduction of new health technologies and clinical practices in a local healthcare setting." BMC
Health Serv Res 15: 575.
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BACKGROUND: This paper reports the process of establishing a transparent, accountable, evidence-
based program for introduction of new technologies and clinical practices (TCPs) in a large Australian
healthcare network. Many countries have robust evidence-based processes for assessment of new
TCPs at national level. However many decisions are made by local health services where the resources
and expertise to undertake health technology assessment (HTA) are limited and a lack of structure,
process and transparency has been reported. METHODS: An evidence-based model for process change
was used to establish the program. Evidence from research and local data, experience of health
service staff and consumer perspectives were incorporated at each of four steps: identifying the need
for change, developing a proposal, implementation and evaluation. Checklists assessing characteristics
of success, factors for sustainability and barriers and enablers were applied and implementation
strategies were based on these findings. Quantitative and qualitative methods were used for process
and outcome evaluation. An action research approach underpinned ongoing refinement to systems,
processes and resources. RESULTS: A Best Practice Guide developed from the literature and
stakeholder consultation identified seven program components: Governance, Decision-Making,
Application Process, Monitoring and Reporting, Resources, Administration, and Evaluation and Quality
Improvement. The aims of transparency and accountability were achieved. The processes are explicit,
decisions published, outcomes recorded and activities reported. The aim of ascertaining rigorous
evidence-based information for decision-making was not achieved in all cases. Applicants proposing
new TCPs provided the evidence from research literature and local data however the information was
often incorrect or inadequate, overestimating benefits and underestimating costs. Due to these
limitations the initial application process was replaced by an Expression of Interest from applicants
followed by a rigorous HTA by independent in-house experts. CONCLUSION: The program is
generalisable to most health care organisations. With one exception, the components would be
achievable with minimal additional resources; the lack of skills and resources required for HTA will
limit effective application in many settings. A toolkit containing details of the processes and sample
materials is provided to facilitate replication or local adaptation by those wishing to establish a similar
program.

Hayashi, Y., et al. (2016). "Reduction in the numbers of drugs administered to elderly in-patients with
polypharmacy by a multidisciplinary review of medication using electronic medical records." Geriatr
Gerontol Int.

AIM: Polypharmacy is a major problem for elderly patients in developed countries. We investigated
whether a multidisciplinary medication review using electronic medical records could reduce the
number of drugs administered to elderly patients receiving polypharmacy. METHODS: The present
study included 432 elderly patients (188 women, 244 men; 267 patients aged 65-74 years and 165
patients aged >/=75 years) who were admitted to and discharged from the Department of Neurology
and Geriatrics, Gifu University Hospital, between 2004 and 2011; those who died at the hospital were
excluded. The names, categories, and numbers of orally administered drugs at admission and
discharge were examined retrospectively using electronic medical records. The histories of continuous
oral immunotherapy use at the hospital, falls during the 2 years before hospital admission and the
presence of fall risk factors were also evaluated. P-values <0.05 were considered statistically
significant. RESULTS: On average 1.14 +/- 3.07 fewer types of drugs were given to patients at discharge
than at admission in patients receiving polypharmacy (P < 0.001). However, the number of drugs given
to patients undergoing continuous oral immunotherapy increased by 1.67 +/- 3.47 (P < 0.001). The
number of drugs was reduced in 33.1% of fallers, and 36.3% of non-fallers. In both fallers and non-
fallers, there was a reduction in drug categories associated with falls. CONCLUSIONS: Multidisciplinary
medication review using electronic medical records could significantly reduce the numbers of drugs
taken by elderly inpatients receiving polypharmacy, including drugs associated with falls, in both
fallers and non-fallers Geriatr Gerontol Int 2016; **: **-**.

Holroyd-Leduc, J. M., et al. (2011). "The impact of the electronic medical record on structure, process, and
outcomes within primary care: a systematic review of the evidence." J Am Med Inform Assoc 18(6):
732-737.

BACKGROUND: The electronic medical record (EMR)/electronic health record (EHR) is becoming an
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integral component of many primary-care outpatient practices. Before implementing an EMR/EHR

system, primary-care practices should have an understanding of the potential benefits and limitations.
OBJECTIVE: The objective of this study was to systematically review the recent literature around the
impact of the EMR/EHR within primary-care outpatient practices. MATERIALS AND METHODS:
Searches of Medline, EMBASE, CINAHL, ABI Inform, and Cochrane Library were conducted to identify
articles published between January 1998 and January 2010. The gray literature and reference lists of
included articles were also searched. 30 studies met inclusion criteria. RESULTS AND DISCUSSION: The
EMR/EHR appears to have structural and process benefits, but the impact on clinical outcomes is less
clear. Using Donabedian's framework, five articles focused on the impact on healthcare structure, 21
explored healthcare process issues, and four focused on health-related outcomes.

Johansen, M. A. et Henriksen, E. (2014). "The evolution of personal health records and their role for self-
management: a literature review." Stud Health Technol Inform 205: 458-462.

A literature review has been conducted to gain an overview of the evolution of personal health
records (PHR) and their role for self-management. This paper presents this evolution overview, based
on review of abstracts from relevant publications in addition to full-text review of reviews. A search in
the Medline database for 'PHR' and 'self-management' identified 62 unique publications. Of these, 90
% met the inclusion and exclusion criteria. The number of studies per year has increased heavily since
the PHR and self-management context originated in the early 1990s. Nine studies described messaging
functionality, eleven studies described shared access functionalities, and four described both.
However, the general evidence remains sparse to document the value of PHR for self-management.
Most PHRs are not based on patients' needs and do not support self-management. To be adopted by
the users, and to be useful for self-management, PHRs need to be integrated with physicians' EHR
systems and provide shared access both ways in addition to secure e-mail communication and
educational modules.

Kaner, E., et al. (2007). "Medical communication and technology : a video-based process study of the use of
decision aids in primary care consultations." Bmc Medical Informatics and Decision Making 7(2): 1-11.
[Link]

Keltie, K., et al. (2014). "Identifying complications of interventional procedures from UK routine healthcare
databases: a systematic search for methods using clinical codes." BMC Med Res Methodol 14: 126.

BACKGROUND: Several authors have developed and applied methods to routine data sets to identify
the nature and rate of complications following interventional procedures. But, to date, there has been
no systematic search for such methods. The objective of this article was to find, classify and appraise
published methods, based on analysis of clinical codes, which used routine healthcare databases in a
United Kingdom setting to identify complications resulting from interventional procedures. METHODS:
A literature search strategy was developed to identify published studies that referred, in the title or
abstract, to the name or acronym of a known routine healthcare database and to complications from
procedures or devices. The following data sources were searched in February and March 2013:
Cochrane Methods Register, Conference Proceedings Citation Index - Science, Econlit, EMBASE, Health
Management Information Consortium, Health Technology Assessment database, MathSciNet,
MEDLINE, MEDLINE in-process, OAIster, OpenGrey, Science Citation Index Expanded and
ScienceDirect. Of the eligible papers, those which reported methods using clinical coding were
classified and summarised in tabular form using the following headings: routine healthcare database;
medical speciality; method for identifying complications; length of follow-up; method of recording
comorbidity. The benefits and limitations of each approach were assessed. RESULTS: From 3688
papers identified from the literature search, 44 reported the use of clinical codes to identify
complications, from which four distinct methods were identified: 1) searching the index admission for
specified clinical codes, 2) searching a sequence of admissions for specified clinical codes, 3) searching
for specified clinical codes for complications from procedures and devices within the International
Classification of Diseases 10th revision (ICD-10) coding scheme which is the methodology
recommended by NHS Classification Service, and 4) conducting manual clinical review of diagnostic
and procedure codes. CONCLUSIONS: The four distinct methods identifying complication from codified
data offer great potential in generating new evidence on the quality and safety of new procedures
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using routine data. However the most robust method, using the methodology recommended by the
NHS Classification Service, was the least frequently used, highlighting that much valuable
observational data is being ignored.

Kruse, C. S., et al. (2015). "Patient and provider attitudes toward the use of patient portals for the management
of chronic disease: a systematic review." J Med Internet Res 17(2): e40.

BACKGROUND: Patient portals provide patients with the tools to better manage and understand their
health status. However, widespread adoption of patient portals faces resistance from patients and
providers for a number of reasons, and there is limited evidence evaluating the characteristics of
patient portals that received positive remarks from patients and providers. OBJECTIVE: The objectives
of this systematic review are to identify the shared characteristics of portals that receive favorable
responses from patients and providers and to identify the elements that patients and providers
believe need improvement. METHODS: The authors conducted a systematic search of the CINAHL and
PubMed databases to gather data about the use of patient portals in the management of chronic
disease. Two reviewers analyzed the articles collected in the search process in order remove irrelevant
articles. The authors selected 27 articles to use in the literature review. RESULTS: Results of this
systematic review conclude that patient portals show significant improvements in patient self-
management of chronic disease and improve the quality of care provided by providers. The most
prevalent positive attribute was patient-provider communication, which appeared in 10 of 27 articles
(37%). This was noted by both patients and providers. The most prevalent negative perceptions are
security (concerns) and user-friendliness, both of which occurred in 11 of 27 articles (41%). The user-
friendliness quality was a concern for patients and providers who are not familiar with advanced
technology and therefore find it difficult to navigate the patient portal. The high cost of installation
and maintenance of a portal system, not surprisingly, deters some providers from implementing such
technology into their practice, but this was only mentioned in 3 of the 27 articles (11%). It is possible
that the incentives for meaningful use assuage the barrier of cost. CONCLUSIONS: This systematic
review revealed mixed attitudes from patients and their providers regarding the use of patient portals
to manage their chronic disease. The authors suggest that a standard patient portal design providing
patients with the resources to understand and manage their chronic conditions will promote the
adoption of patient portals in health care organizations.

Kushniruk, A. W., et al. (2013). "National efforts to improve health information system safety in Canada, the
United States of America and England." Int J Med Inform 82(5): e149-160.

OBJECTIVE: In this paper we review progress as well as challenges encountered in Canada, the United
States and England with regard to ensuring safety of health information technology. METHOD: A
review of major programs and initiatives for ensuring safety of health information technology in the
three countries was conducted. Published literature and Web resources from national programs were
reviewed for relevant information. RESULTS: It was found that in all three countries the issue of
technology-induced error has been recognized as being of critical importance. The three countries
have developed approaches for dealing with the issue that have some commonalities; however, they
are at varying different stages of maturity, with England having the longest standing and most well
developed safety programs, while Canada and the United States are at earlier stages. The types of
approaches employed have included work on developing standards related to usability and interface
design, certifications, directives from regulatory bodies, educational initiatives in health information
technology (HIT) safety as well as research into safer HIT design and implementation methods.
CONCLUSIONS: HIT promises to lead to improved patient safety. However, it has become recognized
that if not designed and deployed appropriately, such systems can lead to new types of errors. Based
on this recognition, a variety of initiatives are being undertaken in Canada, the United States and
England to promote the safe design, procurement and deployment of HIT. It is concluded that
improved approaches to system design, testing, regulation, error reporting, safety education and
cross-country collaboration will be needed to further promote safer HIT.

Lin, J., et al. (2013). "Application of electronic medical record data for health outcomes research: a review of
recent literature." Expert Rev Pharmacoecon Outcomes Res 13(2): 191-200.

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Electronic medical records (EMRs) have become a common source of data for outcomes research. This
review discusses trends in EMR data use for outcomes research as well as strengths and limitations,
and likely future developments to help optimize value and use of EMR data for outcomes research.
EMR-based studies reporting treatment outcomes published between 2007 and 2012 were
predominantly from the USA and Europe. There has been a substantial increase in the number of
EMR-based outcomes studies published from 2007-2008 (n = 28) to 2010-2011 (n = 55). Many studies
evaluated biometric and laboratory test outcomes in common chronic conditions. However,
researchers are expanding the scope of evaluated diseases and outcomes using advanced techniques,
such as natural language processing and linking EMRs to other patient-level data to overcome issues
with missing data or data that cannot be accessed using standard queries. These advances will help to
expand the scope and sophistication of outcomes research in the coming years.

Lizano-Diez, I., et al. (2014). "Evaluation of electronic prescription implementation in polymedicated users of
Catalonia, Spain: a population-based longitudinal study." Bmj Open 4(11): 1-9.
[Link]
To assess whether electronic prescribing is a comprehensive health management tool that may
contribute to rational drug use, particularly in polymedicated patients receiving 16 or more
medications in the public healthcare system in the Barcelona Health Region (BHR).

Ludwick, D., et al. (2010). "Primary care physicians' experiences with electronic medical records:
implementation experience in community, urban, hospital, and academic family medicine." Can Fam
Physician 56(1): 40-47.

OBJECTIVE: To understand how remuneration and care setting affect the implementation of electronic
medical records (EMRs). DESIGN: Semistructured interviews were used to illicit descriptions from
community-based family physicians (paid on a fee-for-service basis) and from urban, hospital, and
academic family physicians (remunerated via alternative payment models or sessional pay for
activities pertaining to EMR implementation). SETTING: Small suburban community and large urban-,
hospital-, and academic-based family medicine clinics in Alberta. All participants were supported by a
jurisdictional EMR certification funding mechanism. PARTICIPANTS: Physicians who practised in 1 or a
combination of the above settings and had experience implementing and using EMRs. METHODS:
Purposive and maximum variation sampling was used to obtain descriptive data from key informants
through individually conducted semistructured interviews. The interview guide, which was developed
from key findings of our previous literature review, was used in a previous study of community-based
family physicians on this same topic. Field notes were analyzed to generate themes through a
comparative immersion approach. MAIN FINDINGS: Physicians in urban, hospital, and academic
settings leverage professional working relationships to investigate EMRs, a resource not available to
community physicians. Physicians in urban, hospital, and academic settings work in larger
interdisciplinary teams with a greater need for interdisciplinary care coordination, EMR training, and
technical support. These practices were able to support the cost of project management or technical
support resources. These physicians followed a planned system rollout approach compared with
community physicians who installed their systems quickly and required users to transition to the new
system immediately. Electronic medical records did not increase, or decrease, patient throughput.
Physicians developed ways of including patients in the note-taking process. CONCLUSION: We studied
physicians' procurement approaches under various payment models. Our findings do not suggest that
one remuneration approach supports EMR adoption any more than another. Rather, this study
suggests that stronger physician professional networks used in information gathering, more complete
training, and in-house technical support might be more influential than remuneration in facilitating
the EMR adoption experience.

Mair, F. S., et al. (2012). "Factors that promote or inhibit the implementation of e-health systems: an
explanatory systematic review." Bull World Health Organ 90(5): 357-364.

OBJECTIVE: To systematically review the literature on the implementation of e-health to identify: (i)
barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the
subject. METHODS: MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched
for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic
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reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health

implementation. Abstracts and papers were double screened and data were extracted on country of
origin; e-health domain; publication date; aims and methods; databases searched; inclusion and
exclusion criteria and number of papers included. Data were analysed qualitatively using
normalization process theory as an explanatory coding framework. FINDINGS: Inclusion criteria were
met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009.
Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13
did not indicate the precise number of articles screened. The use of normalization process theory as a
conceptual framework revealed that relatively little attention was paid to: (i) work directed at making
sense of e-health systems, specifying their purposes and benefits, establishing their value to users and
planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii)
effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation
processes might be reconfigured by user-produced knowledge. CONCLUSION: The published literature
focused on organizational issues, neglecting the wider social framework that must be considered
when introducing new technologies.

Mastebroek, M., et al. (2014). "Health information exchange in general practice care for people with
intellectual disabilities--a qualitative review of the literature." Res Dev Disabil 35(9): 1978-1987.

Many barriers to the provision of general practice (GP) care for people with intellectual disabilities (ID)
relate to problems in exchanging health information. Deficits in the exchange of health information
may have an adverse impact on healthcare access and health outcomes in individuals with ID. The aim
of this paper is to report how health information exchange (HIE) in GP care for people with ID is being
described in the ID healthcare literature. Thematic analysis of 19 included articles resulted in six major
themes: (1) communication skills; (2) organisational factors; (3) record keeping and sharing; (4) health
literacy and self-advocacy; (5) carers and health professionals' knowledge; and (6) third parties. The
results indicate that HIE takes place in a chain of events happening before, during, and after a medical
consultation, depending on specific contextual care factors. The included papers lack a broad focus on
the entire HIE process, and causes and effects of gaps in health information are described only
marginally or on a very general level. However, a study of the HIE process in its entirety is imperative
in order to identify weak links and gaps in information pathways. The themes presented here provide
a starting point for an in-depth study on the HIE process in GP care for individuals with ID that may
facilitate future research on health interventions in this setting.

McGinn, C. A., et al. (2012). "Users' perspectives of key factors to implementing electronic health records in
Canada: a Delphi study." BMC Med Inform Decis Mak 12: 105.

BACKGROUND: Interoperable electronic health record (EHR) solutions are currently being
implemented in Canada, as in many other countries. Understanding EHR users' perspectives is key to
the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context
the applicability, the importance, and the priority of pre-identified factors from a previous mixed-
methods systematic review of international literature. METHODS: A three-round Delphi study was
held with representatives of 4 Canadian EHR user groups defined as partners of the implementation
process who use or are expected to use EHR in their everyday activity. These groups are: non-
physician healthcare professionals, health information professionals, managers, and physicians. Four
bilingual online questionnaire versions were developed from factors identified by the systematic
review. Participants were asked to rate the applicability and the importance of each factor. The main
outcome measures were consensus and priority. Consensus was defined a priori as strong (>/= 75%) or
moderate (>/= 60-74%) according to user groups' level of agreement on applicability and importance,
partial (>/= 60%) when participants agreed only on applicability or importance, or as no consensus (<
60%). Priority for decision-making was defined as factors with strong consensus with scores of 4 or 5
on a five-point Likert scale for applicability and importance. RESULTS: Three Delphi rounds were
completed by 64 participants. Levels of consensus of 100%, 64%, 64%, and 44% were attained on
factors submitted to non-physician healthcare professionals, health information professionals,
managers, and physicians, respectively. While agreement between and within user groups varied, key
factors were prioritized if they were classified as strong (>/= 75% from questionnaire answers of user
groups), for decision-making concerning EHR implementation. The 10 factors that were prioritized are
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perceived usefulness, productivity, motivation, participation of end-users in the implementation

strategy, patient and health professional interaction, lack of time and workload, resources availability,
management, outcome expectancy, and interoperability. CONCLUSIONS: Amongst all factors
influencing EHR implementation identified in a previous systematic review, ten were prioritized
through this Delphi study. The varying levels of agreement between and within user groups could
mean that users' perspectives of each factor are complex and that each user group has unique
professional priorities and roles in the EHR implementation process. As more EHR implementations in
Canada are completed it will be possible to corroborate this preliminary result with a larger population
of EHR users.

McGinn, C. A., et al. (2011). "Comparison of user groups' perspectives of barriers and facilitators to
implementing electronic health records: a systematic review." BMC Med 9: 46.

BACKGROUND: Electronic health record (EHR) implementation is currently underway in Canada, as in

many other countries. These ambitious projects involve many stakeholders with unique perceptions of
the implementation process. EHR users have an important role to play as they must integrate the EHR
system into their work environments and use it in their everyday activities. Users hold valuable, first-
hand knowledge of what can limit or contribute to the success of EHR implementation projects. A
comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This
systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators
influencing shared EHR implementation among its various users. METHODS: Covering a period from
1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if
they reported on users' perceived barriers and facilitators to shared EHR implementation, in
healthcare settings comparable to Canada. Studies in all languages with an empirical study design
were included. Quality and relevance of the studies were assessed. Four EHR user groups were
targeted: physicians, other health care professionals, managers, and patients/public. Content analysis
was performed independently by two authors using a validated extraction grid with pre-established
categorization of barriers and facilitators for each group of EHR users. RESULTS: Of a total of 5,695
potentially relevant publications identified, 117 full text publications were obtained after screening
titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met
the inclusion criteria. The most frequent adoption factors common to all user groups were design and
technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity
and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of
time and workload. Each user group also identified factors specific to their professional and individual
priorities. CONCLUSIONS: This systematic review presents innovative research on the barriers and
facilitators to EHR implementation. While important similarities between user groups are highlighted,
differences between them demonstrate that each user group also has a unique perspective of the
implementation process that should be taken into account.

McGrath, J. M., et al. (2007). "The influence of electronic medical record usage on non verbal communication in
the medical interview." Health Informatics Journal 13(2): 105-118.

Merandi, J., et al. (2013). "Improvement of medication event interventions through use of an electronic
database." Am J Health Syst Pharm 70(19): 1708-1714.

PURPOSE: Patient safety enhancements achieved through the use of an electronic Web-based system
for responding to adverse drug events (ADEs) are described. SUMMARY: A two-phase initiative was
carried out at an academic pediatric hospital to improve processes related to "medication event
huddles" (interdisciplinary meetings focused on ADE interventions). Phase 1 of the initiative entailed a
review of huddles and interventions over a 16-month baseline period during which multiple databases
were used to manage the huddle process and staff interventions were assigned via manually
generated e-mail reminders. Phase 1 data collection included ADE details (e.g., medications and staff
involved, location and date of event) and the types and frequencies of interventions. Based on the
phase 1 analysis, an electronic database was created to eliminate the use of multiple systems for
huddle scheduling and documentation and to automatically generate e-mail reminders on assigned
interventions. In phase 2 of the initiative, the impact of the database during a 5-month period was
evaluated; the primary outcome was the percentage of interventions documented as completed after
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database implementation. During the postimplementation period, 44.7% of assigned interventions

were completed, compared with a completion rate of 21% during the preimplementation period, and
interventions documented as incomplete decreased from 77% to 43.7% (p < 0.0001). Process changes,
education, and medication order improvements were the most frequently documented categories of
interventions. CONCLUSION: Implementation of a user-friendly electronic database improved
intervention completion and documentation after medication event huddles.

Merrill, J. A., et al. (2013). "A system dynamics evaluation model: implementation of health information
exchange for public health reporting." J Am Med Inform Assoc 20(e1): e131-138.

OBJECTIVE: To evaluate the complex dynamics involved in implementing electronic health information
exchange (HIE) for public health reporting at a state health department, and to identify policy
implications to inform similar implementations. MATERIALS AND METHODS: Qualitative data were
collected over 8 months from seven experts at New York State Department of Health who
implemented web services and protocols for querying, receipt, and validation of electronic data
supplied by regional health information organizations. Extensive project documentation was also
collected. During group meetings experts described the implementation process and created
reference modes and causal diagrams that the evaluation team used to build a preliminary model.
System dynamics modeling techniques were applied iteratively to build causal loop diagrams
representing the implementation. The diagrams were validated iteratively by individual experts
followed by group review online, and through confirmatory review of documents and artifacts.
RESULTS: Three casual loop diagrams captured well-recognized system dynamics: Sliding Goals,
Project Rework, and Maturity of Resources. The findings were associated with specific policies that
address funding, leadership, ensuring expertise, planning for rework, communication, and timeline
management. DISCUSSION: This evaluation illustrates the value of a qualitative approach to system
dynamics modeling. As a tool for strategic thinking on complicated and intense processes, qualitative
models can be produced with fewer resources than a full simulation, yet still provide insights that are
timely and relevant. CONCLUSIONS: System dynamics techniques clarified endogenous and exogenous
factors at play in a highly complex technology implementation, which may inform other states
engaged in implementing HIE supported by federal Health Information Technology for Economic and
Clinical Health (HITECH) legislation.

Michalowsky, B., et al. (2016). "[Financing Regional Dementia Networks in Germany: Determinants of
Sustainable Healthcare Networks]." Gesundheitswesen.

Objectives: Analysis of practice-based financing concepts in German dementia networks (DN);

Provision of sustainable financing structures and their determinants in DN. Materials and Methods:
Qualitative expert interviews with leaders of 13 DN were conducted. A semi-structured interview
guide was used to analyse four main topics: Finance-related organization, cost, sources of funding and
financial sustainability. Results: DN were primarily financed by membership fees, earnings of services
provided, public funds and payments by municipalities or health care providers. 63% of the DN
reported a financial sustainability. Funds to support the interpersonal expanding, a mix of internal and
external financing sources and investments of the municipality were determinants of a sustainable
financing. Overall, DN in rural areas seemed to be disadvantaged due to a lack of potential linkable
service providers. Conclusion: DN in urban regions are more likely able to gather sustainable funding
resources. A minimum funding of 50.000 euro/year for human resources coordinating the DN, seems
to be a threshold for a sustainable DN.

Millard, P. S., et al. (2012). "Open-source point-of-care electronic medical records for use in resource-limited
settings: systematic review and questionnaire surveys." Bmj Open 2(4).

BACKGROUND: Point-of-care electronic medical records (EMRs) are a key tool to manage chronic
illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their
applicability to primary care, technical requirements and clinical functionalities are largely unknown.
OBJECTIVES: This study aimed to address the needs of clinicians from resource-limited settings
without reliable internet access who are considering adopting an open-source EMR. STUDY ELIGIBILITY
CRITERIA: Open-source point-of-care EMRs suitable for use in areas without reliable internet access.
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STUDY APPRAISAL AND SYNTHESIS METHODS: The authors conducted a comprehensive search of all
open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician
users and technical implementers from a single site and technical developers of each software
product. The authors evaluated availability, cost and technical requirements. RESULTS: The hardware
and software for all six systems is easily available, but they vary considerably in proprietary
components, installation requirements and customisability. LIMITATIONS: This study relied solely on
self-report from informants who developed and who actively use the included products.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Clinical functionalities vary greatly among the
systems, and none of the systems yet meet minimum requirements for effective implementation in a
primary care resource-limited setting. The safe prescribing of medications is a particular concern with
current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by
global funding agencies to move beyond disease-specific EMR systems and develop a universal open-
source health informatics platform.

Minard, J. P., et al. (2010). "Asthma electronic medical records in primary care: an integrative review." J Asthma
47(8): 895-912.

BACKGROUND: Quality management, evaluation, and surveillance of asthma may be enhanced by

access to and utilization of an asthma electronic medical record (EMR) in primary care. PURPOSE: To
describe the current status, support tools, and utility of asthma EMRs in primary care. METHODS: An
integrative review of the literature published between 1996 and 2008 was completed using Ovid
MEDLINE, EMBASE, and CINAHL databases. Key search terms included asthma, medical records,
computerized, primary health care, primary care, family physician, family practice, chronic disease,
COPD, neoplasm, diabetes mellitus, and cardiovascular disease. Articles related to concepts, systems
in development, and sources such as acute care and pharmacy EMRs were excluded. Each article was
reviewed by two reviewers. RESULTS: Of 309 articles identified, 76 met the inclusion criteria. Twenty-
two percent were specific to asthma, 78% pertained to other chronic diseases and/or the overall
status of an EMR in primary care. The literature varied in methodology, topics of discussion and value
of data. Articles describing an asthma EMR most often reported on decision support tools (n = 3)
and/or utility (n = 14), specifically the ability to predict mortality and assess severity and timeliness of
diagnosis. A primary care EMR containing a validated asthma minimum data set was not found. Three
themes emerged from the review: status (description of users, functionalities and adoption issues),
tools (decision support tools to enhance knowledge uptake), and utility (data quality, extraction and
outcomes). CONCLUSIONS: There is a paucity of asthma elements in EMRs in primary care, with the
exception of discussion of decision support tools and utility. Integration of a more robust asthma EMR
in primary care, including a minimum data set, standardized terminology, and validated indicators,
may further enhance care and enable outcomes monitoring.

Minshall, S. (2013). "A review of healthcare information system usability & safety." Stud Health Technol Inform
183: 151-156.

Healthcare information systems have been designed to increase the efficiency and safety of
healthcare processes. Systems such as electronic health records and pervasive computing devices
have been shown to improve the safety of healthcare. However, increasing research has indicated that
the design of such systems, in particular the user interface, may be related to increased incidence of
other types of error. In this review, the relationship between human factors and usability will be
considered in the context of designing safe and effective healthcare applications, with a focus on
hand-held computing devices. Medline was searched for the specific terms listed below and restricted
to the date ranges 2006-01-01 through to 2011-03-03: (error AND technology AND human factors);
(error AND (CPOE OR (Computerized AND provider AND order AND entry))); (Technology AND Induced
AND Error). The returned list of papers was screened by examining titles and abstracts to select
candidate papers for further review. The initial search yield was 239 papers. On reviewing the title and
abstract, 186 were rejected and 51 papers remained for analysis. New technology, such as CPOE,
offers improvements over traditional paper tools and it is shown to have a positive effect on patient
safety. New technology also creates the opportunity for new errors to occur and lead to the coining of
the term "technology-induced error". The magnitude of the usability-testing needs is larger than it
may seem.
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Moorman, P. W., et al. (2009). "An inventory of publications on electronic medical records revisited." Methods
Inf Med 48(5): 454-458.

OBJECTIVES: In this short review we provide an update of our earlier inventories of publications
indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. METHODS: We
retrieved and analyzed all references to English articles published before January 1, 2008, and indexed
in PubMed with the MeSH term 'Medical Records Systems, Computerized'. RESULTS: We retrieved a
total of 11,924 publications, of which 3937 (33%) appeared in a journal with an impact factor. Since
2002 the number of yearly publications, and the number of journals in which those publications
appeared, increased. A cluster analysis revealed three clusters: an organizational issues cluster, a
technically oriented cluster and a cluster about order-entry and research. CONCLUSIONS: Although
our previous inventory in 2003 suggested a constant yearly production of publications on electronic
medical records since 1998, the current inventory shows another rise in production since 2002. In
addition, many new journals and countries have shown interest during the last five years. In the last
15 years, interest in organizational issues remained fairly constant, order entry and research with
systems gained attention, while interest in technical issues relatively decreased.

Nguyen, L., et al. (2014). "Electronic health records implementation: an evaluation of information system
impact and contingency factors." Int J Med Inform 83(11): 779-796.

OBJECTIVE: This paper provides a review of EHR (electronic health record) implementations around
the world and reports on findings including benefits and issues associated with EHR implementation.
MATERIALS AND METHODS: A systematic literature review was conducted from peer-reviewed
scholarly journal publications from the last 10 years (2001-2011). The search was conducted using
various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and
Medical Complete. This paper reports on our analysis of previous empirical studies of EHR
implementations. We analysed data based on an extension of DeLone and McLean's information
system (IS) evaluation framework. The extended framework integrates DeLone and McLean's
dimensions, including information quality, system quality, service quality, intention of use and usage,
user satisfaction and net benefits, together with contingent dimensions, including systems
development, implementation attributes and organisational aspects, as identified by Van der Meijden
and colleagues. RESULTS: A mix of evidence-based positive and negative impacts of EHR was found
across different evaluation dimensions. In addition, a number of contingent factors were found to
contribute to successful implementation of EHR. LIMITATIONS: This review does not include white
papers or industry surveys, non-English papers, or those published outside the review time period.
CONCLUSION: This review confirms the potential of this technology to aid patient care and clinical
documentation; for example, in improved documentation quality, increased administration efficiency,
as well as better quality, safety and coordination of care. Common negative impacts include changes
to workflow and work disruption. Mixed observations were found on EHR quality, adoption and
satisfaction. The review warns future implementers of EHR to carefully undertake the technology
implementation exercise. The review also informs healthcare providers of contingent factors that
potentially affect EHR development and implementation in an organisational setting. Our findings
suggest a lack of socio-technical connectives between the clinician, the patient and the technology in
developing and implementing EHR and future developments in patient-accessible EHR. In addition, a
synthesis of DeLone and McLean's framework and Van der Meijden and colleagues' contingent factors
has been found useful in comprehensively understanding and evaluating EHR implementations.

Norman, I. D., et al. (2011). "Ethics and electronic health information technology: challenges for evidence-
based medicine and the physician-patient relationship." Ghana Med J 45(3): 115-124.

OBJECTIVES: The National Health Insurance Scheme (NHIS), and the National Identification Authority
(NIA), pose ethical challenges to the physician-patient relationship due to interoperability. This paper
explores (1) the national legislation on Electronic Health Information Technology (EHIT), (2) the ethics
of information technology and public health and (3) the effect on the Physician-patient relationship.
METHOD: This study consisted of systematic literature and internet review of the legislation,
information technology, the national health insurance program, and the physician-patient
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relationship. RESULT: The result shows that (1) EHIT have eroded a big part of the confidentiality
between the physician and patient; (2) The encroachment on privacy is an inevitable outcome of EHIT;
(3) Legislation on privacy, the collection, storage and uses of electronic health information is needed
and; (4) the nexus between EHIT, NHIS, NHA, Ethics, the physician-patient relationship and privacy.
CONCLUSION: The study highlights the lack of protection for physician-patient relationship as medical
practice transitions from the conventional to the modern, information technology driven domain.

Nutley, T. et Reynolds, H. W. (2013). "Improving the use of health data for health system strengthening." Glob
Health Action 6: 20001.

BACKGROUND: Good quality and timely data from health information systems are the foundation of
all health systems. However, too often data sit in reports, on shelves or in databases and are not
sufficiently utilised in policy and program development, improvement, strategic planning and
advocacy. Without specific interventions aimed at improving the use of data produced by information
systems, health systems will never fully be able to meet the needs of the populations they serve.
OBJECTIVE: To employ a logic model to describe a pathway of how specific activities and interventions
can strengthen the use of health data in decision making to ultimately strengthen the health system.
DESIGN: A logic model was developed to provide a practical strategy for developing, monitoring and
evaluating interventions to strengthen the use of data in decision making. The model draws on the
collective strengths and similarities of previous work and adds to those previous works by making
specific recommendations about interventions and activities that are most proximate to affect the use
of data in decision making. The model provides an organizing framework for how interventions and
activities work to strengthen the systematic demand, synthesis, review, and use of data. RESULTS: The
logic model and guidance are presented to facilitate its widespread use and to enable improved data-
informed decision making in program review and planning, advocacy, policy development. Real world
examples from the literature support the feasible application of the activities outlined in the model.
CONCLUSIONS: The logic model provides specific and comprehensive guidance to improve data
demand and use. It can be used to design, monitor and evaluate interventions, and to improve
demand for, and use of, data in decision making. As more interventions are implemented to improve
use of health data, those efforts need to be evaluated.

Pearce, C., et al. (2006). "Analysing the doctor-patient-computer relationship : the use of video data."
Informatics in Primary Care 14(4): 221-226.

Phillips, K., et al. (2010). "Electronic medical records in long-term care." J Hosp Mark Public Relations 20(2):
131-142.

Long-term care (LTC) facilities possess unique characteristics in terms of implementation and
utilization of electronic medical records (EMRs). The focus of LTC is on a population requiring care
encompassing all aspects associated with quality of life rather than simply acute treatment. Because
this focus is of a larger scale than traditional medical facilities, the priorities in the implementation and
utilization of EMRs are higher in accessing patient history information. The purpose of this study was
to determine the EMR utilization in the chronic care settings. In conclusion, the literature review
performed does not support the fact that EMRs are currently being effectively and widely used in the
LTC facilities.

Pliskie, J. et Wallenfang, L. (2014). "How geographical information systems analysis influences the continuum of
patient care." J Med Pract Manage 29(5): 282-285.

As the vast repository of data about millions of patients grows, the analysis of this information is
changing the provider-patient relationship and influencing the continuum of care for broad swaths of
the population. At the same time, while population health management moves from a volume-based
model to a value-based one and additional patients seek care due to healthcare reform, hospitals and
healthcare networks are evaluating their business models and searching for new revenue streams.
Utilizing geographical information systems to model and analyze large amounts of data is helping
organizations better understand the characteristics of their patient population, demographic and
socioeconomic trends, and shifts in the utilization of healthcare. In turn, organizations can more
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effectively conduct service line planning, strategic business plans, market growth strategies, and
human resource planning. Healthcare organizations that use GIS modeling can set themselves apart by
making more informed and objective business strategy decisions.

Plu, I., et al. (2009). "[Principles and stakes of external communication of healthcare networks: the case of
heathcare networks for health services accessibility]." Sante Publique 21(2): 173-181.

Healthcare networks which purpose is to manage patients through better coordination of the care,
need to develop a communication strategy to be recognized by the public and by healthcare
professionals and to be inserted in the healthcare landscape. We firstly will present legal requirements
related to external communication of healthcare networks. Then, we will describe the different tools
which can be used to communicate about healthcare networks in its area, with the example from a
healthcare network for health services accessibility. In the French Public health code, the legal status
and the ethical charter of the healthcare network have to be delivered to the healthcare professionals
in its area and to the patients. Moreover, the example healthcare network informed collectively and
individually the healthcare professionals of its area about its activities. It made it known to the public
by the way of departmental prevention manifestations and health education sessions in community
social associations. From these examples, we will conduct an ethical reflection on the modalities and
stakes of the external communication of healthcare networks.

Rudin, R. S., et al. (2014). "Usage and effect of health information exchange: a systematic review." Ann Intern
Med 161(11): 803-811.

BACKGROUND: Health information exchange (HIE) is increasing in the United States, and it is
incentivized by government policies. PURPOSE: To systematically review and evaluate evidence of the
use and effect of HIE on clinical care. DATA SOURCES: Selected databases from 1 January 2003 to 31
May 2014. STUDY SELECTION: English-language hypothesis-testing or quantitative studies of several
types of data exchange among unaffiliated organizations for use in clinical care that addressed health
outcomes, efficiency, utilization, costs, satisfaction, HIE usage, sustainability, and attitudes or barriers.
DATA EXTRACTION: Data extraction was done in duplicate. DATA SYNTHESIS: Low-quality evidence
from 12 hypothesis-testing studies supports an effect of HIE use on reduced use or costs in the
emergency department. Direct evidence that HIEs were used by providers was reported in 21 studies
involving 13 distinct HIE organizations, 6 of which were located in New York, and generally showed
usage in less than 10% of patient encounters. Findings from 17 studies of sustainability suggest that
approximately one quarter of existing HIE organizations consider themselves financially stable.
Findings from 38 studies about attitudes and barriers showed that providers, patients, and other
stakeholders consider HIE to be valuable, but barriers include technical and workflow issues, costs,
and privacy concerns. LIMITATION: Publication bias, possible selective reporting of outcomes, and a
dearth of reporting on context and implementation processes. CONCLUSION: Health information
exchange use probably reduces emergency department usage and costs in some cases. Effects on
other outcomes are unknown. All stakeholders claim to value HIE, but many barriers to acceptance
and sustainability exist. A small portion of operational HIEs have been evaluated, and more research is
needed to identify and understand success factors. PRIMARY FUNDING SOURCE: U.S. Department of
Veterans Affairs. (PROSPERO registration number: CRD42014007469).

Salzano, G. et Bourret, C. (2003). "Healthcare networks services for patients and large public: methodological
and engineering issues." Stud Health Technol Inform 95: 492-497.

In this paper, we analyse the services supplied by innovative and transversal healthcare organisations
to satisfy patients and large public requirements and we illustrate them with the French healthcare
networks. We classify these services in two groups, healthcare delivery services and health related
information services, and we define three layers for their possible contexts. We will use an
Information System perspective to investigate about various methodological approaches to realise
each group of services and we compare their challenges and difficulties. Finally, we identify
methodological and engineering issues common to both groups.

Secginli, S., et al. (2014). "Attitudes of health professionals towards electronic health records in primary health
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care settings: a questionnaire survey." Inform Health Soc Care 39(1): 15-32.

PURPOSE: This study aimed to assess the attitudes of health professionals towards electronic health
records (EHRs) in primary health care settings in Turkey. METHODS: A survey was administered to 754
health professionals working in Family Health Centres (FHCs) in seven districts in Istanbul, Turkey. The
survey was developed based on extensive literature review, and consisted of 33 statements rated on a
five-point Likert-scale. RESULTS: A total of 325 completed questionnaires were received, representing
a 43% response rate, with 97% of respondents being satisfied with the EHR system in the FHCs. There
were significant differences between health professional groups (physicians and nurses/midwives) in
their perceptions of EHRs decreasing paper-based records, data security in EHRs, and costs of EHRs (p
< 0.05). Narrative responses indicated ongoing needs in software development, further support of
nursing documentation and training. CONCLUSIONS: Overall positive attitudes towards EHRs among
primary care health professionals in Turkey suggest strong acceptance and use. Recommendations
based on the findings include EHR technology refinements, improved clinical documentation using
standardized terminologies, and health professional-informed EHR training.

Stolee, P., et al. (2010). "The use of electronic health information systems in home care: facilitators and
barriers." Home Healthc Nurse 28(3): 167-179; quiz 180-161.

Electronic health information systems (EHIS) containing standardized assessment data (e.g., RAI-Home
Care, Outcome and Assessment Information Set [OASIS]) hold considerable promise, but their
potential has yet to be fully realized. Literature was searched for strategies on implementing and using
EHIS, including barriers and facilitators of their use in home care. Results of this review will be
discussed in terms of their implications for the future development and use of EHIS in home care, and
for future research.

Thompson, G., et al. (2015). "Impact of the Electronic Medical Record on Mortality, Length of Stay, and Cost in
the Hospital and ICU: A Systematic Review and Metaanalysis." Crit Care Med 43(6): 1276-1282.

OBJECTIVE: To evaluate effects of health information technology in the inpatient and ICU on mortality,
length of stay, and cost. Methodical evaluation of the impact of health information technology on
outcomes is essential for institutions to make informed decisions regarding implementation. DATA
SOURCES: EMBASE, Scopus, Medline, the Cochrane Review database, and Web of Science were
searched from database inception through July 2013. Manual review of references of identified
articles was also completed. STUDY SELECTION: Selection criteria included a health information
technology intervention such as computerized physician order entry, clinical decision support systems,
and surveillance systems, an inpatient setting, and endpoints of mortality, length of stay, or cost.
Studies were screened by three reviewers. Of the 2,803 studies screened, 45 met selection criteria
(1.6%). DATA EXTRACTION: Data were abstracted on the year, design, intervention type, system used,
comparator, sample sizes, and effect on outcomes. Studies were abstracted independently by three
reviewers. DATA SYNTHESIS: There was a significant effect of surveillance systems on in-hospital
mortality (odds ratio, 0.85; 95% CI, 0.76-0.94; I=59%). All other quantitative analyses of health
information technology interventions effect on mortality and length of stay were not statistically
significant. Cost was unable to be quantitatively evaluated. Qualitative synthesis of studies of each
outcome demonstrated significant study heterogeneity and small clinical effects. CONCLUSIONS:
Electronic interventions were not shown to have a substantial effect on mortality, length of stay, or
cost. This may be due to the small number of studies that were able to be aggregately analyzed due to
the heterogeneity of study populations, interventions, and endpoints. Better evidence is needed to
identify the most meaningful ways to implement and use health information technology and before a
statement of the effect of these systems on patient outcomes can be made.

Thrasher, E. H. et Revels, M. A. (2012). "The role of information technology as a complementary resource in

healthcare integrated delivery systems." Hosp Top 90(2): 23-32.

As in many industries, it is recognized that there is a need to increase the use of information
technology (IT) in the healthcare industry. However, until now, this has not occurred. In fact, some say
that IT in healthcare has consistently fallen far short of expectations. The purpose of this study was to
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illuminate the need for a more holistic view of healthcare network integration and demonstrate that
simply applying the latest technology to the network is not adequate for improving overall
effectiveness. The study results showed that the more holistic view has to include management
commitment, of complementarity between IT integration and organizational integration, and
continued investments.

Topaz, M. et Ash, N. (2013). "[Overview of the US policies for health information technology and lessons
learned for Israel]." Harefuah 152(5): 262-266, 310, 309.

The heaLthcare system in the United States (U.S.) faces a number of significant changes aimed at
improving the quality and availability of medical services and reducing costs. Implementation of health
information technologies, especiaLly ELectronic Health Records (EHR), is central to achieving these
goals. Several recent Legislative efforts in the U.S. aim at defining standards and promoting wide scale
"Meaningful Use" of the novel technologies. In Israel, the majority of heaLthcare providers adopted
EHR throughout the Last decade. Unlike the U.S., the process of EHR adoption occurred
spontaneously, without governmental control or the definition of standards. In this article, we review
the U.S. health information technology policies and standards and suggest potential lessons Learned
for Israel. First, we present the three-staged Meaningful Use regulations that require eligible
healthcare practitioners to use EHR in their practice. We also describe the standards for EHR
certification and national efforts to create interoperable health information technology networks.
Finally, we provide a brief overview of the IsraeLi regulation in the field of EHR. Although the adoption
of health information technology is wider in Israel, the Lack of technology standards and
governmental control has Led to Large technology gaps between providers. The example of the U.S.
Legislation urges the adoption of several critical steps to further enhance the quality and efficiency of
the Israeli healthcare system, in particular: strengthening health information technology regulation;
developing Licensure criteria for health information technology; bridging the digital gap between
healthcare organizations; defining quality measures; and improving the accessibility of health
information for patients.

van Velthoven, M. H., et al. (2016). "Feasibility of extracting data from electronic medical records for research:
an international comparative study." BMC Med Inform Decis Mak 16(1): 90.

BACKGROUND: Electronic medical records (EMR) offer a major potential for secondary use of data for
research which can improve the safety, quality and efficiency of healthcare. They also enable the
measurement of disease burden at the population level. However, the extent to which this is feasible
in different countries is not well known. This study aimed to: 1) assess information governance
procedures for extracting data from EMR in 16 countries; and 2) explore the extent of EMR adoption
and the quality and consistency of EMR data in 7 countries, using management of diabetes type 2
patients as an exemplar. METHODS: We included 16 countries from Australia, Asia, the Middle East,
and Europe to the Americas. We undertook a multi-method approach including both an online
literature review and structured interviews with 59 stakeholders, including 25 physicians, 23
academics, 7 EMR providers, and 4 information commissioners. Data were analysed and synthesised
thematically considering the most relevant issues. RESULTS: We found that procedures for information
governance, levels of adoption and data quality varied across the countries studied. The required time
and ease of obtaining approval also varies widely. While some countries seem ready for secondary
uses of data from EMR, in other countries several barriers were found, including limited experience
with using EMR data for research, lack of standard policies and procedures, bureaucracy,
confidentiality, data security concerns, technical issues and costs. CONCLUSIONS: This is the first
international comparative study to shed light on the feasibility of extracting EMR data across a
number of countries. The study will inform future discussions and development of policies that aim to
accelerate the adoption of EMR systems in high and middle income countries and seize the rich
potential for secondary use of data arising from the use of EMR solutions.

Walton, R. T., et al. (2003). "Computerised advice on drug dosage to improve prescribing practice." Cochrane
Library (the)(6): 22.

Webster, P. C. (2011). "Go local, European review of electronic health records advises." Cmaj 183(9): E535-536.
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Weinfeld, J. M., et al. (2012). "Electronic health records improve the quality of care in underserved populations:
a literature review." J Health Care Poor Underserved 23(3 Suppl): 136-153.

Organizations in underserved settings are implementing or upgrading electronic health records (EHRs)
in hopes of improving quality and meeting Federal goals for meaningful use of EHRs. However, much
of the research that has been conducted on health information technology does not study use in
underserved settings, or does not include EHRs. We conducted a structured literature search of
MEDLINE to find articles supporting the contention that EHRs improve quality in underserved settings.
We found 17 articles published between 2003 and 2011. These articles were mostly in urban settings,
and most study types were descriptive in nature. The articles provide evidence that EHRs can improve
documentation, process measures, guideline-adherence, and (to a lesser extent) outcome measures.
Providers and managers believed that EHRs would improve the quality and efficiency of care. The
limited quantity and quality of evidence point to a need for ongoing research in this area.

West, V. L., et al. (2015). "Innovative information visualization of electronic health record data: a systematic
review." J Am Med Inform Assoc 22(2): 330-339.

OBJECTIVE: This study investigates the use of visualization techniques reported between 1996 and
2013 and evaluates innovative approaches to information visualization of electronic health record
(EHR) data for knowledge discovery. METHODS: An electronic literature search was conducted May-
July 2013 using MEDLINE and Web of Knowledge, supplemented by citation searching, gray literature
searching, and reference list reviews. General search terms were used to assure a comprehensive
document search. RESULTS: Beginning with 891 articles, the number of articles was reduced by
eliminating 191 duplicates. A matrix was developed for categorizing all abstracts and to assist with
determining those to be excluded for review. Eighteen articles were included in the final analysis.
DISCUSSION: Several visualization techniques have been extensively researched. The most mature
system is LifeLines and its applications as LifeLines2, EventFlow, and LifeFlow. Initially, research
focused on records from a single patient and visualization of the complex data related to one patient.
Since 2010, the techniques under investigation are for use with large numbers of patient records and
events. Most are linear and allow interaction through scaling and zooming to resize. Color, density,
and filter techniques are commonly used for visualization. CONCLUSIONS: With the burgeoning
increase in the amount of electronic healthcare data, the potential for knowledge discovery is
significant if data are managed in innovative and effective ways. We identify challenges discovered by
previous EHR visualization research, which will help researchers who seek to design and improve
visualization techniques.

Wollersheim, D., et al. (2009). "Archetype-based electronic health records: a literature review and evaluation of
their applicability to health data interoperability and access." Him j 38(2): 7-17.

Health Information Managers (HIMs) are responsible for overseeing health information. The change
management necessary during the transition to electronic health records (EHR) is substantial, and
ongoing. Archetype-based EHRs are a core health information system component which solve many of
the problems that arise during this period of change. Archetypes are models of clinical content, and
they have many beneficial properties. They are interoperable, both between settings and through
time. They are more amenable to change than conventional paradigms, and their design is congruent
with clinical practice. This paper is an overview of the current archetype literature relevant to Health
Information Managers. The literature was sourced in the English language sections of ScienceDirect,
IEEE Explore, Pubmed, Google Scholar, ACM Digital library and other databases on the usage of
archetypes for electronic health record storage, looking at the current areas of archetype research,
appropriate usage, and future research. We also used reference lists from the cited papers, papers
referenced by the openEHR website, and the recommendations from experts in the area. Criteria for
inclusion were (a) if studies covered archetype research and (b) were either studies of archetype use,
archetype system design, or archetype effectiveness. The 47 papers included show a wide and
increasing worldwide archetype usage, in a variety of medical domains. Most of the papers noted that
archetypes are an appropriate solution for future-proof and interoperable medical data storage. We
conclude that archetypes are a suitable solution for the complex problem of electronic health record
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storage and interoperability.

Wright, E., et al. (2015). "Sharing Physician Notes Through an Electronic Portal is Associated With Improved
Medication Adherence: Quasi-Experimental Study." J Med Internet Res 17(10): e226.

BACKGROUND: In surveys, interviews, and focus groups, patients taking medications and offered Web
portal access to their primary care physicians' (PCPs) notes report improved adherence to their
regimens. However, objective confirmation has yet to be reported. OBJECTIVE: To evaluate the
association between patient Internet portal access to primary care physician visit notes and
medication adherence. METHODS: This study is a retrospective comparative analysis at one site of the
OpenNotes quasi-experimental trial. The setting includes primary care practices at the Geisinger
Health System (GHS) in Danville, Pennsylvania. Participants include patients 18 years of age or older
with electronic portal access, GHS primary care physicians, and Geisinger health plan insurance, and
taking at least one antihypertensive or antihyperlipidemic agent from March 2009 to June 2011.
Starting in March 2010, intervention patients were invited and reminded to read their PCPs' notes.
Control patients also had Web portal access throughout, but their PCPs' notes were not available.
From prescription claims, adherence was assessed by using the proportion of days covered (PDC).
Patients with a PDC >/=.80 were considered adherent and were compared across groups using
generalized linear models. RESULTS: A total of 2147 patients (756 intervention participants, 35.21%;
1391 controls, 64.79%) were included in the analysis. Compared to those without access, patients
invited to review notes were more adherent to antihypertensive medications-adherence rate 79.7%
for intervention versus 75.3% for control group; adjusted risk ratio, 1.06 (95% CI 1.00-1.12).
Adherence was similar among patient groups taking antihyperlipidemic agents-adherence rate 77.6%
for intervention versus 77.3% for control group; adjusted risk ratio, 1.01 (95% CI 0.95-1.07).
CONCLUSIONS: Availability of notes following PCP visits was associated with improved adherence by
patients prescribed antihypertensive, but not antihyperlipidemic, medications. As the use of fully
transparent records spreads, patients invited to read their clinicians' notes may modify their behaviors
in clinically valuable ways.

Rapports

(2007). eHealth priorities and strategies in European countries. eHEALTH ERA REPORT. Luxembourg Office des
Publications officielles des Communauts europennes: 96.
[Link]
This report presents fact sheets of all European countries for which validated information about their
eHealth strategies and implementation was available by the end of January 2007. Les pays concerns
sont les suivants : Autriche, Finlande, Roumanie, France, Royaume-Uni et Slovaquie.

(2008). Standards and Guidelines for Physician Practice Connections? Patient-Centered Medical Home (PPC-
PCMH). Washington DC National Committee for Quality Assurance: 68 +annexes, tabl.
[Link]
NCQA's Physician Practice Connections- Patient-Centered Medical Home (PPC-PCMH) program
assesses whether physician practices are functioning as medical homes. Building on the joint principles
developed by the primary care specialty societies, the PPC-PCMH standards emphasize the use of
systematic, patient-centered, coordinated care management processes. The Patient Centered Medical
Home is a health care setting that facilitates partnerships between individual patients, and their
personal physicians, and when appropriate, the patient?s family. Care is facilitated by registries,
information technology, health information exchange and other means to assure that patients get the
indicated care when and where they need and want it in a culturally and linguistically appropriate
manner. There are nine PPC standards, including 10 must pass elements, which can result in one of
three levels of recognition.

(2010). Achieving Efficiency Improvements in the Health sector through ICTs - Final report. Paris OCDE: 117 ,
tabl., fig.
[Link]
This report presents an analysis of OECD countries efforts to implement information and
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communication technologies (ICTs) in health care systems. It provides advice on the range of policy
options, conditions and practices that policy makers can adapt to their own national circumstances to
accelerate adoption and effective use of these technologies. The analysis draws upon a considerable
body of recent literature and in, particular, lessons learned from case studies in six OECD countries
(Australia, Canada, the Netherlands, Spain, Sweden, and the United States), all of which reported
varying degrees of success deploying health ICT solutions.

(2010). Chronic diseases. A clinical and managerial challenge. Bruxelles HOPE: 53 , tabl., fig.
[Link]
Chronic_diseases-October_2010.pdf
The present report has the specific objective of presenting the content and findings of the Hope Agora
2010. Il is covering the presentation of two days discussion and is also integrating information from
the most relevant international sources, in particular the WHO publications on the issue of the chronic
disease. Chapter 1 gives a brief introduction and a general overview of the issue of chronic disease.
Chapter 2 illustrates the main initiative and innovation countries are putting in place to overcome this
issue. Chapter 3 reports the context of the presentation heald by each team during the last event of
the Exchange programs.

(2010). Health care delivery : Features of Integrated Systems Support Patient Care Strategies and Access to
Care, but Systems Face Challenges. Washington GAO: 28 , annexes.
[Link]
The Health Care Safety Net Act of 2008 directed GAO to report on integrated health system models
that integrate primary, specialty, and acute care and serve uninsured and medically underserved
populations. This report provide more in-depth information on organizational features that IDSs use to
support strategies to improve patient care; approaches IDSs use to facilitate access to care for
underserved populations; and challenges IDSs encounter in providing care, including care provided to
underserved populations.

(2010). The National Programme for IT in the NHS: an update on the delivery of detailed care records systems.
Londres NAO: 46 , 19 fig.
[Link]
Ce rapport prsente le troisime bilan du programme national pour les technologies de l'information
(National programme for information technology, NPFIT) en cours de mise en oeuvre en Angleterre
depuis 2002 par le National health service (NHS) et critique svrement les Electronic care records
(sorte de DMP) qui sont le pivot du NHS IT project. 2,3 milliards d'euros ont t dpenss sans gnrer
les conomies attendues, et le National Accounting Office (NAO) ne croit pas que les 4,6 milliards
d'euros restants investir amlioreront la situation. Parmi les critiques sont cits les retards sur le
calendrier, le peu de bnfice pour le patient, les difficults de fonctionnement, et le nombre
important de professionnels de sant et d'"hospital trusts" qui renoncerait rejoindre le dispositif. Le
projet va tre rvis par le gouvernement britannique.

(2011). eHealth Benchmarking III. Bruxelles Communaut europenne: 274.

The study provides the result of a survey on Benchmarking deployment of eHealth services in acute
hospitals in 30 European countries. Chief Information Officers were asked about the availability of
eHealth infrastructure and applications in their hospitals whereas Medical Directors were asked about
priority areas for investment, impacts and perceived barriers to the further deployment of eHealth.
Applying state of the art multivariate statistical analysis to the data of survey of eHealth deployment in
Acute European Hospitals funded by DG INFSO, JRC-IPTS researchers have constructed a composite
indicator of take up and usage of eHealth in European hospitals, as well as a typology of impacts.

(2011). A Vision for Canada: Family Practice: The Patient's Medical Home. Mississauga Collge des Mdecins de
Famille au Canada: 61 , fig.
[Link]
The history of health care in Canada is linked to the vital role played by family practice and our
nations family physicians. As we deliberate the future of our health care system it is essential that we
contemplate the place that will be assumed by family physicians and their practices. The vision of
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family practices serving as Patients? Medical Homes is intended for the consideration of all who are
concerned about the health of Canadians and the health care provided for them. This includes not
only family physicians, nurses, and the health professionals and staff who work with them in their
practices but also a broad range of other stakeholders in governments, medical schools, and other
health care organizations whose responsibilities and commitments intersect with those delivering
family practice services. Most important, this vision is intended for the people of Canada, over 30
million of whom are currently cared for by family physicians in urban and rural family practices
throughout the nation, as well as the four to five million who do not yet have family physicians. In
October 2009, the College of Family Physicians of Canada (CFPC) presented its discussion paper
Patient-Centred Primary Care in Canada: Bring it on Home.3 It described the pillars of a model of
family practice focused on meeting patient needs. Feedback from a broad cross-section of
stakeholders including family physicians, other health professionals and their associations,
governments, and the public provided important perspectives that are now incorporated into this
vision paper describing family practices throughout Canada serving as Patients? Medical Homes.

(2012). Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington DC
The National Academies Press: 200 , tabl., fig.
[Link]
The United States has the highest per capita spending on health care of any industrialized nation. Yet
despite the unprecedented levels of spending, harmful medical errors abound, uncoordinated care
continues to frustrate patients and providers, and U.S. healthcare costs continue to increase. The
growing ranks of the uninsured, an aging population with a higher prevalence of chronic diseases, and
many patients with multiple conditions together constitute more complicating factors in the trend to
higher costs of care. A variety of strategies are beginning to be employed throughout the health
system to address the central issue of value, with the goal of improving the net ratio of benefits
obtained per dollar spent on health care. However, despite the obvious need, no single agreed-upon
measure of value or comprehensive, coordinated systemwide approach to assess and improve the
value of health care exists. Without this definition and approach, the path to achieving greater value
will be characterized by encumbrance rather than progress. To address the issues central to defining,
measuring, and improving value in health care, the Institute of Medicine convened a workshop to
assemble prominent authorities on healthcare value and leaders of the patient, payer, provider,
employer, manufacturer, government, health policy, economics, technology assessment, informatics,
health services research, and health professions communities. The workshop, summarized in this
volume, facilitated a discussion of stakeholder perspectives on measuring and improving value in
health care, identifying the key barriers and outlining the opportunities for next steps.

(2013). ICTs and the Health Sector. Towards Smarter Health and Wellness Models. Paris OCDE: 177 , fig.
[Link]
This report examines the challenges facing health care systems and the strategic directions for a
smarter health and wellness future, from both technological and policy viewpoints. It looks at the role
of information and communication technologies (ICTs) and discusses the research and policy options
that could further the development of smarter health and wellness systems.

(2013). Socio-economic impact of mHealth. An assessment report for the European Union. Neuily-sur Seine
Pricewaterhousecoopers: 28.
[Link]
mHealth_EU_14062013V2.pdf
Selon cette tude prospective, le dploiement de la technologie mobile dans le domaine de la sant,
ou m-Sant, permettrait daugmenter le PIB de lUnion europenne de 93 milliards deuros en 2017
grce lamlioration de ltat de sant qui rduirait la perte de jours de travail et les retraites
anticipes. Les conomies ralises faciliteraient l'accs aux soins de 24,5 millions patients
supplmentaires. Une gnralisation de lutilisation des solutions mobiles contribuerait une gestion
optimise des maladies chroniques et des consquences lies au vieillissement de la population, deux
des priorits de lUnion europenne. Selon PwC, latteinte de ces effets positifs suppose nanmoins
lintgration rapide de la m-Sant dans la stratgie de sant publique de lUnion europenne. Pour ce
faire, les tats membres doivent lever de nombreux freins dordre rglementaire, conomique,
structurel et technologique, qui limitent actuellement son dveloppement.
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(2013). Strengthening Health Information Infrastructure: Matters for Quality Health Care: Good Practices, New
Opportunities and Data Privacy Protection Challenges. Paris OCDE: 188 , tabl., graph., fig.
[Link]
version_2April2013.pdf
Privacy-respectful uses of data for health, health care quality and health system performance
monitoring and research must become widespread, regular activities. This report examines the
progress OECD countries have made in developing and linking health and health care data for statistics
and research, including the use of data from electronic health record systems. It signals differences
among countries, as well as the opportunities that exist in all countries to continue to strengthen their
infrastructure.

(2013). Toward New Models for Innovative Governance of Biomedecine and Health Technologies. OECD
Science, Technology and Industry Policy Papers ; 11. Paris OCDE: 42 ,fig.
[Link]
[Link]/docserver/download/[Link]?expires=1469544638&id=id&accname=guest&chec
ksum=6CFE9126CE408A51503CFFF82CD743E6
This report examines examples of new and emerging governance models that aim to support the
responsible development of diagnostics and treatments based on the latest advances in biomedicine.
In particular, it presents programmes and initiatives that aim to manage uncertainty in the
development and approval of new medical products and thereby to improve the understanding of the
risk/benefit balance. It also identifies some of the main challenges for policy makers, regulators and
other communities involved in the translation of biomedical innovation and health technologies from
the laboratory bench to point of care.

(2014). Unleashing the Power of Big Data for Alzheimer's Disease and Dementia Research : Main Points of the
OECD Expert Consultation on Unlocking Global Collaboration to Accelerate Innovation for Alzheimer's
Disease and Dementia. OECD Digital Economy Papers; No. 233. Paris OCDE: 40 , fig.
10.1787/5jz73kvmvbwb-en
More than 35 million people worldwide had dementia in 2010, when annual costs were estimated at
USD 604 billion; the number of people with dementia is expected to exceed 115 million by 2050.
Alzheimers disease is today considered the prototype problem for the Grand Global Challenge in
healthcare. Despite decades of intensive research, the causal chain of mechanisms behind Alzheimers
has remained elusive as reflected in recent failures of well-designed clinical trials on promising
investigational new drugs. The multi-factorial nature of the disease requires the collection, storage
and processing of increasingly large and very heterogeneous datasets (behavioural, genetic,
environmental, epigenetic, clinical data, brain imaging, etc.). No one nation has all the assets to pursue
this type of research independently. In an effort to tackle this huge challenge, the OECD held a
consultation on "Unlocking Global Collaboration to Accelerate Innovation for Alzheimers Disease and
Dementia" which looked at ways to harness developments in life sciences and information
technologies to accelerate innovation in the prevention and treatment of the disease. This paper
reports on the opportunities offered by the informatics revolution and big data. Creating and using big
data to change the future of Alzheimers and dementia requires careful planning and multi-
stakeholder collaboration. Numerous technical, administrative, regulatory, infrastructure and financial
obstacles emerge and will need to be hurdled to make this vision a reality.

(2014). Which doctors take up promising ideas? New insights from open data. Londres Nesta: 64 , tabl., graph.,
fig.
[Link]
The report looks at early adoption of promising new ideas across primary care in England and argues
that analysing open data can help public services gain a greater understanding of their take up of
innovations. This report demonstrates a rising opportunity to inform practitioners and patients by
making use of open data. Analysis of primary care open data shows the potential to chart GP
surgeries uptake of promising innovations in technologies, drugs and practices. Using open data, this
report charts where, when and which GP practices across England have taken-up promising
innovations. As well as showing the varied uptake of certain proven drugs, technologies and practices
by GP surgeries, the report explores how making use of open data can help people understand trends
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and differences in service within primary care, and inform patient and practitioner priorities and
[Link] report is based on the analysis of open datasets from the Health and Social Care
Information Centre, demographic data, as well as qualitative and quantitative research.

(2010). Tendance et ruptures dans le domaine de la sant en Europe l'horizon 2030 - synthse. sl Accenture:
20.
[Link]
Cette note de synthse repose principalement sur la revue d'un nombre significatif d'tudes publies
en Europe sur la sant et les facteurs d'environnement tels que la dmographie, l'conomie, la
sociologie ou encore l'volution technologique touchant directement ou indirectement la sant. La
trs grande majorit des tudes met en lumire des tendances fondes sur un pass rcent et en
dduit des projections moyen terme. Rares sont celles qui raisonnent un horizon 20 ans. La
projection des tendances de sant cet horizon ncessite donc de complter ces tudes par des essais
vise davantage prospective et de prendre des risques. Cette synthse rsume les problmatiques
dterminantes pour rendre compte de l'volution de la sant dans les pays europens l'horizon
2030. Cinq tendances ont t dgages : vieillir jeune deviendra une priorit et un objectif partags
par tous les europens; le "risque sant" sera de plus en plus individualis; Les patients seront au c?ur
d'un cosystme largi de nouveaux acteurs; l'hpital sera recentr sur les soins grce une
diffusion massive des nouvelles technologies; La sant sera un vecteur de croissance pour l'conomie
europenne.

Anderson, G., et al. (2011). Health reform : meeting the challenge of ageing and multiple morbidities. Paris
OCDE: 221 , fig., tabl., annexes.
[Link]
The ageing of our societies is at the same time one of our greatest achievements and one of our
biggest challenges. A longer lifespan is something few people would spurn and it opens up great
opportunities in our personal, social and economic lives; yet in practice it is often accompanied by
living with disease. Indeed, increasingly people and the health systems that serve them ? have to cope
with more than one chronic disease at a time, a situation known as multimorbidity. How to reorient
health systems to meet the challenge of multimorbidity was the theme of a conference held by the
OECD and the Business and Industry Advisory Committee (BIAC) to the OECD as part of the OECDs
50th anniversary celebrations. This present volume contains five of the papers prepared for this
conference, along with a sixth, on measuring quality in the presence of multimorbidity, on a topic
which there was not enough time to address.

Davis, K., et al. (2006). Slowing the growth of U.S. health care expenditures : what are the options ? New York
Commonwealth Fund: 34 , tabl., fig.
[Link]
Health care expenditures are expected to continue to rise rapidly over the next decade, outpacing
income and imposing stress on families, businesses, and public budgets. Evidence indicates that the
U.S. should be able to achieve savings and better value for this investment by creating more efficient
and effective health care and insurance systems. This report reviews factors contributing to high
expenditures and examines strategies that have the potential to achieve savings, slow spending
growth, and improve health system performance. These strategies cluster into six areas: 1) increasing
the effectiveness of markets with better information and greater competition; 2) reducing high
insurance administrative overhead and achieving more competitive prices; 3) providing incentives to
promote efficient and effective care; 4) promoting patient-centered primary care; 5) investing in
infrastructure such as health information technology; and 6) investing strategically to improve access,
affordability, and equity.

Devers, K. J., et al. (2013). The Feasibility of Using Electronic Health Records (EHRs) and Other Electronic Health
Data for Research on Small Populations. Washington The Urban Institute: 120.
[Link]
[Link]
This report explores the feasibility of using electronic health record (EHR) and other electronic health
data for research on small populations. The first part of the report illustrates the challenges and
limitations of using existing federal surveys and federal claims databases for studying small
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populations. The second part explores the potential of the increasingly available EHR and other
existing electronic health data to complement federal data sources, as well as potential next steps to
demonstrate and improve the feasibility of using EHRs for research on small populations.

Fleming, D., et al. (2008). Electronic Health Indicator Data (eHID). Bruxelles Commission europenne: 112 ,
tabl., graph., ann.

Le projet eHID (Electronic Health Indicator Data) conduit par la Commission europenne a pour
objectif de collecter des indicateurs de prvalence en soins de sant primaire partir de rseaux de
mdecins gnralistes de l'Union europenne. Ce rapport final prsente des indicateurs de prvalence
et d?incidence pour trois pathologies : diabte, maladie ischmique et sant mentale. Neuf pays ont
particip cette enqute. Les dfinitions ont t soigneusement choisies pour valuer la prvalence et
l?incidence explicitement reconnues et releves par les mdecins.

Fonkych, K. et Taylor, R. (2005). The State and Pattern of Health Information Technology Adoption. Santa
Monica Rand corporation: 52 , tabl., graph.
[Link]
Innovations in information technology (IT) have improved efficiency and quality in many industries.
Healthcare has not been one of them. Although some administrative IT systems, such as those for
billing, scheduling, and inventory management, are already in place in the healthcare industry, little
adoption of clinical IT, such as Electronic Medical Record Systems (EMR-S) and Clinical Decision
Support tools, has occurred. Government intervention has been called for to speed the adoption
process for Health Information Technology (HIT), based on the widespread belief that its adoption, or
diffusion, is too slow to be socially optimal. In this report, we estimate the current level and pattern of
HIT adoption in the different types of healthcare organizations, and we evaluate factors that affect this
diffusion process. First, we make an effort to derive a population-wide adoption level of administrative
and clinical HIT applications according to information in the Healthcare Information and Management
Systems Society (HIMSS)-Dorenfest database (formerly the Dorenfest IHDS+TM Database, second
release, 2004) and compare our estimates to alternative ones. We then attempt to summarize the
current state and dynamics of HIT adoption according to these data and briefly review existing
empirical studies on the HIT-adoption process. By comparing adoption rates across different types of
healthcare providers and geographical areas, we help focus the policy agenda by identifying which
healthcare providers lag behind and may need the most incentives to adopt HIT. Next, we employ
regression analysis to separate the effects of the provider's characteristics and factors on adoption of
Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), and Picture Archiving
Communications Systems (PACS), and compare the effects to findings in the literature.

Garber, S., et al. (2014). Redirecting Innovation in U.S. Health Care. Options to Decrease Spending and Increase
Value. Santa-Monica The Rand: 103.
[Link]
New medical technologies are a leading driver of U.S. health care spending. This report identifies
promising policy options to change which medical technologies are created, with two related policy
goals: (1) Reduce total health care spending with the smallest possible loss of health benefits, and (2)
ensure that new medical products that increase spending are accompanied by health benefits that are
worth the spending increases. The analysis synthesized information from peer-reviewed and other
literature, a panel of technical advisors convened for the project, and 50 one-on-one expert
interviews. The authors also conducted case studies of eight medical products. The following features
of the U.S. health care environment tend to increase spending without also conferring major health
benefits: lack of basic scientific knowledge about some disease processes, costs and risks of U.S. Food
and Drug Administration (FDA) approval, limited rewards for medical products that could lower
spending, treatment creep, and the medical arms race.

Hillestad, R., et al. (2008). Identity crisis : An Examination of the Costs and Benefits of a Unique Patient
Identifier for the U.S. Health Care System. Santa Monica Rand corporation: 71 , tabl., annexes.
[Link]
Correctly linking patients to their health data is a vital step in quality health care. The two primary
approaches to this linking are the unique patient identifier (UPI) and statistical matching based on
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multiple personal attributes, such as name, address, and Social Security number (SSN). Lacking a UPI,
most of the U.S. health care system uses statistical matching methods. There are important health,
efficiency, security, and safety reasons for moving the country away from the inherent uncertainties of
statistical approaches and toward a UPI for health care. In this monograph, we compare the linking
alternatives on the basis of errors, cost, privacy and information security, and political considerations.
We also discuss operational efficiency, ease of implementation, and some implications for improved
health care.

Miani, C., et al. (2014). Health and Healthcare: Assessing the Real-World Data Policy Landscape in Europe.
Santa-Monica Rand Corporation: 99 , tabl., annexes.
[Link]
Real-world data (RWD) is an umbrella term for different types of data that are not collected in
conventional randomised controlled trials. RWD in the healthcare sector comes from various sources
and includes patient data, data from clinicians, hospital data, data from payers and social data. There
are already examples of ways in which research has contributed to the provision, construction and
capture of RWD to improve health outcomes. However, to maximise the potential of these new pools
of data in the healthcare sector, stakeholders need to identify pathways and processes which will
allow them to efficiently access and use RWD in order to achieve better research outcomes and
improved healthcare delivery. Current efforts to improve access to RWD and facilitate its use take
place in a context of resource scarcity. Based on a literature review, case studies, a small set of
interviews of experts from public and private organisations and a scenario based workshop, the study
outlined possible strategies to illustrate how RWD standards development could facilitate RWD-based
research. By investigating the current forms and uses of RWD in Europe, this study has highlighted
their significant potential for assessing the (short- or long-term) impact of different drugs or medical
treatments and for informing and improving healthcare service delivery. Although the potential of
RWD use seems quite clear, this research reveals barriers that restrict further development towards
its full exploitation: the absence of common standards for defining the content and quality of RWD;
methodological barriers that may limit the potential benefits of RWD analysis; governance issues
underlying the absence of standards for collaboration between stakeholders; privacy concerns and
binding data protection legislation which can be seen to restrict access and use of data.

Vretveit, J. (2009). Does improving quality save money? A review of evidence of which improvements to
quality reduce costs to health service providers. Londres Health Foundation: 95 , fig., tabl.
[Link]
e%[Link]
This review presents evidence of a variety of quality problems in healthcare, found by research, and of
their financial costs (the potential savings). It then presents evidence of solutions, their effectiveness,
and the intervention costs. Evidence of the subsequent savings, losses or increased revenue is then
presented, where there is proof that quality was maintained or increased at the same time. Parts 3
and 4 consider the challenges for enablers to save through improving quality, make research-based
recommendations, and propose ways to increase usable knowledge about the subject.

Porter, M., et al. (2009). The Finnish Health Care System : A Value-Based Perspective. Sitra report; 82. Helsinki
Sitra: 115 , tabl.
[Link]
This report applies a value-based framework of health care delivery in order to provide a holistic view
of the current state of Finnish health care. This report consists of three parts. Section 2 presents a
brief overview of the general principles of value-based care delivery. Sections 3 to 7 then utilize these
principles to analyze the Finnish health care system as it looks today. While the text aims to cover the
essential features of the Finnish system, special attention is paid to aspects that are crucial from a
value-based perspective. Finally, Section 8 proposes a set of general conclusions and
recommendations for Finland.

Sabes-Figuera, R. et Abadie, F. (2013). European Hospital Survey: Benchmarking deployment of e-Health

services (20122013) Country reports. Luxembourg Publications Office of the European Union: 240 ,
tabl., fig.
[Link]
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A widespread uptake of eHealth technologies is likely to benefit European Healthcare systems both in
terms of quality of care and financial sustainability and European society at large. This is why eHealth
has been on the European Commission policy agenda for more than a decade. The objectives of the
latest eHealth action plan developed in 2012 are in line with those of the Europe 2020 Strategy and
the Digital Agenda for Europe. This report, based on the analysis of the data from the "European
Hospital Survey: Benchmarking deployment of e-Health services (20122013)" project, presents policy
relevant results and findings for each of the 28 EU Member States as well as Iceland and Norway. The
results highlighted here are based on the analysis of the survey descriptive results as well as two
composite indicators on eHealth deployment and eHealth availability and use that were developed
based on the survey's data.

Sabes-Figuera, R. et Maghiros, I. (2013). European Hospital Survey: Benchmarking Deployment of e-Health

Services (20122013) - Composite Indicators on eHealth Deployment and on Availability and Use of
eHealth Functionalities. Luxembourg Publications Office of the European Union: 39 , tabl., fig.
[Link]
The objective of this document is to present results of a benchmarking exercise on the level of eHealth
adoption and use in acute hospitals in all 27 EU Member States and Croatia, Iceland and Norway
(EU27+3). This exercise is based on data from two surveys carried out in 2010 (Deloitte/Ipsos 2011)
and 2012 (PWC 2013) that gathered data on eHealth indicators in acute hospitals. These indicators
have been compiled into two different composite indicators on: 1) eHealth deployment and 2) eHealth
Availability and Use. The composite indicators are calculated at Hospital level before obtaining
average country values, allowing the analysis to build rankings of countries for both composite
indicators. Given that the mentioned two surveys gathered comparable information in relation to
eHealth deployment, it was possible to compute the related composite indicator for both years and
therefore explore its evolution over this 2 year period. However, the questions that gathered
information on availability and use of eHealth specific functionalities were introduced in the 2012
survey questionnaire which is why no comparison can be made with the 2010 survey. The structure of
the report is as follows. The next section presents the data and methods used. The results section then
reports and discusses the main findings. Finally, main conclusions are discussed in the last section

Verhulst, S., et al. (2014). The open data era in health and social care. Londres NHS: 81 , tabl., fig.
[Link]
The central premise of this paper is that as the NHS moves to release data systematically, it needs to
put in place a strategy for measuring the value of open data for the various stakeholders involved in
the nations healthcare systemand, indeed, for citizens in general. In todays budgetary climate, it is
not enough to assess the value of expensive and complicated government programmes after the fact.
We need to enhance our ability to marshal an arsenal of evidence in order to protect investments in
innovative and potentially important new programmes. By becoming more agile in how we measure
innovations in governance like open data, we can make government more efficient, and more
effective. To aid in this goal, this draft whitepaper articulates recommendations for the NHS to follow
as it seeks to measure the impact of open data empirically. By laying out a research agenda to
accompany the NHSs open data strategy, our hope is to ensure that public investment in open data is
supported by concrete evidence of its value, which, in turn, can be used to guide and evolve the
ambitious plan to shift an entire nations bureaucracy to more evidence-based decision-making. We
are releasing this as a draft in order to encourage discussion and additional insights from interested
readers. The paper is divided into four parts: Part I explains open data as a driver of innovation. We
summarize the open data plans of the NHS, including the data the NHS holds, what it is planning to
release and when, and the challenges to implementing a nationwide open data plan. Part II lays out
the arguments in favor of using open data in a healthcare setting (six value propositions), such as
improving patient choice and strengthening provider accountability, and outlines the empirical
evidence we currently have in support of each. Part III presents a series of metrics that can help the
NHS measure its performance and improve its use of open data. It establishes a conceptual framework
to use for continuously evolving and accelerating the ability to measure the impact of open data in
healthcare. Finally Part IV concludes with specific principles and recommendations to establish an
Open Data Learning Environment (ODLE)--the practices and platforms by which to operationalize agile
assessment and enable programme evolution

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Vilpert, S. (2012). Mdecins de premier recours ? Situation en Suisse et comparaison internationale. Dossier ;
22. Neuchatel Observatoire Suisse de la Sant. (O.B.S.A.N.): 88 , tabl., fig., annexes.
[Link]
Pour la troisime anne conscutive, la Suisse a pris part l'enqute internationale du
Commonwealth Fund sur la politique de sant. En 2012, l'enqute a port sur les mdecins de premier
recours qui ont t interrogs sur trois principaux thmes : leur satisfaction concernant le systme de
sant et la pratique mdicale, leur activit mdicale et le systme dinformation utilis dans leur
cabinet. Ce rapport, ralis sur mandat de l'OFSP, prsente l'ensemble des rsultats pour la Suisse et
les compare ceux des neuf autres pays ayant galement particip l'enqute. De manire globale, la
Suisse se profile plutt en tte de liste pour ce qui est de la satisfaction. Elle se situe dans la moyenne
concernant lactivit mdicale. Finalement si la gestion des informations mdicales n'est pas
mauvaise, la Suisse reste faiblement quipe de systmes lectroniques.

Documents de travail

Baker, L. C., et al. (2013). Expanding Patients' Property Rights In Their Medical Records. NBER Working Paper
series : n20565. Cambridge NBER: 32 , tabl.
[Link]
Although doctors and hospitals own their patients' medical records, state and federal laws require
that they provide patients with a copy at "reasonable cost." We examine the effects of state laws that
cap the fees that doctors and hospitals are allowed to charge patients for a copy of their records. We
test whether these laws affected patients' propensity to switch doctors and the prices of new- and
existing-patient visits. We also examine the effect of laws on hospitals' adoption of electronic medical
record (EMR) systems. We find that patients from states adopting caps on copy fees were significantly
more likely to switch doctors, and that hospitals in states adopting caps were significantly more likely
to install an EMR. We also find that laws did not have a systematic, significant effect on prices.

Dranove, D., et al. (2013). Investment Subsidies and the Adoption of Electronic Medical Records in Hospitals.
NBER Working Paper series : n20553. Cambridge NBER: 16 ,+annexes, tabl., fig.
[Link]
In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for
Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and
appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which
HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all
independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives,
we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider
that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the
cost of generating an additional adoption was $48 million. We also estimate that in the absence of
HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after
the date achieved due to HITECH.

Freedman, S., et al. (2015). Information Technology and Patient Health: Analyzing Outcomes, Populations, and
Mechanisms. NBER Working Paper Series ; n 21389. Cambridge NBER: 50 , tabl., fig., annexes.
[Link]
We study the effect of hospital adoption of electronic medical records (EMRs) on health outcomes,
particularly patient safety indicators (PSIs). We find evidence of a positive impact of EMRs on PSIs via
decision support rather than care coordination. Consistent with this mechanism, we find an EMR with
decision support is more effective at reducing PSIs for less complicated cases, using several different
metrics for complication. These findings indicate the negligible impacts for EMRs found by previous
studies focusing on the Medicare population and/or mortality do not apply in all settings.

Hemant, K. B. et Mishra, A. (2011). Electronic Medical Records and Physician Productivity: Evidence from Panel
Data Analysis. Rochester Social Science Electronic Publishing: 39 , tabl., fig.
[Link]
Physician productivity is an important driver of key healthcare outcomes, such as quality of care,
treatment costs and patient satisfaction, because physicians influence a vast majority of treatment
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decisions, and are central to the care delivery process. Thus, it is critical for researchers to understand
how transformation technologies, such as electronic medical records (EMRs) impact physician
productivity. While researchers and policy makers in the United States have suggested that the
implementation of EMRs can have significant beneficial impacts on patient safety, health care quality
and overall costs of care delivery, the effects of EMRs on physicians themselves have been
understudied in the literature. This paper examineS the productivity impacts of EMR implementation
on physicians. Its focus is to investigate if productivity impacts of EMR implementation depend on
physician specialties and the duration for which the EMR has been implemented. This research is
informed by extant work in physician productivity, IT productivity and task-technology fit theory. It
uses a unique panel dataset comprising 87 physicians specializing in internal medicine, pediatrics and
family practice in 12 primary care clinics of an academic hospital in a large state in the western United
States. Its dataset contains 3,186 physician-month productivity observations collected over 39
months. It employs random effects model on this panel dataset to estimate the impact of EMR
implementation on physician productivity. It finds that productivity impacts of EMR are contingent
upon physician specialty and the time period for which an EMR has been implemented. Furthermore,
we find that the stable stage impacts of EMR on various specialties are different from those in the
transitory learning stage. These results emphasize the need for fine-grained analyses of productivity
impacts of EMR implementation on physicians. It postulates that the fit provided by an EMR to the
task requirements of physicians of various specialties is key to disentangling the productivity
dynamics. It contributes to the nascent but emerging stream of literature that examines productivity
implications of various information technologies among white color knowledge workers in the service
industries.

Hurley, E., et al. (2009). The Australian health care system : the potential for efficiency gains. A review of the
literature. Canberra Australian Government: 66 , fig.
[Link]
ile/Potential%20Efficiency%20Gains%20-%20NHHRC%20Background%[Link]
A key component of performance is efficiency. Other dimensions of performance include quality, effectiveness
and equity. This paper reviews the available literature on the efficiency of the Australian health care
system and the potential areas where gains might be made. The reform directions proposed in this
Interim Report seek to improve efficiency in a variety of ways. These include: Using activity-based
funding to drive the efficient delivery of services and other key outputs in the health system, including
clinical education; Using economic assessments of the cost effectiveness of interventions to ensure
funding goes to those interventions that will deliver the best outcomes for a given level of resources;
Performance-based payments to encourage the achievement of high quality outcomes; and a
rebalancing of the type of interventions delivered so that fewer people become ill and to ensure that
when people need care they can receive the most appropriate service.

Lee, J., et al. (2012). The Impact of Health Information Technology on Hospital Productivity. NBER Working
Paper Series ; n 18025. Cambridge NBER: 37 , tabl., annexes.
[Link]
The US health care sector is, by most accounts, extraordinarily inefficient. Health information
technology (IT) has been championed as a tool that can transform health care delivery. Recently, the
federal government has taken an active role in promoting health IT diffusion. There is little systematic
analysis of the causal impact of health IT on productivity or whether private and public returns to
health IT diverge thereby justifying government intervention. We estimate the parameters of a value-
added hospital production function correcting for endogenous input choices in order to assess the
private returns hospitals earn from health IT. Despite high marginal products, the potential benefits
from expanded IT adoption are modest. Over the span of our data, health IT inputs increased by more
than 210% and contributed about 6% to the increase in value-added. Virtually all the increase in value-
added is attributable to the increased use of inputs{there was little change in hospital multi-factor
productivity. Not-for-profits invested more heavily and differently in IT than for-profit hospitals.
Finally, we find no evidence of labor complementarities or network externalities from health IT.

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Ressources lectroniques
En France :

> Ministre charg de la sant

Stratgie nationale e-sant

Le Ministre des Affaires sociales et de la Sant vient de publier la Stratgie nationale e-sant 2020.
Lobjectif de cette stratgie est dintgrer, de manire innovante, les nouvelles technologies pour
amliorer le fonctionnement de notre systme de sant. Il sarticule autour de quatre axes. Le
premier axe vise mettre le citoyen au cur du systme de sant, notamment en simplifiant laccs
aux soins et en dveloppant des services favorisant lautonomie des patients. Le deuxime axe
consiste soutenir linnovation des professionnels de sant. Il sagit de dvelopper des cursus de
formation autour du numrique, de soutenir les projets en faveur de linnovation numrique, mais
aussi de dvelopper des outils daide la dcision mdicale. Les mesures du troisime axe entendent
simplifier le cadre dactions pour les acteurs conomiques, en clarifiant, notamment, les voies
daccs au march des solutions e-sant. Enfin, le quatrime et dernier axe concerne la
modernisation des outils de notre systme de sant, avec lamlioration des systmes dinformation,
de la veille et de la surveillance sanitaire.

Territoires de soins numriques

Lanc dans le cadre des Investissements davenir et dot de 80 millions deuros, le programme
Territoire de soins numrique vise moderniser le systme de soins en exprimentant, dans
certaines zones pilotes, les services et les technologies les plus innovants en matire de-sant. Sur
les 18 projets ports par les Agences rgionales de sant (ARS), 5 ont t slectionns pour leur
caractre innovant et prenne, leur adaptation aux ralits territoriales, leur capacit mobiliser une
majorit dacteurs et leur impact escompt sur le dveloppement des filires industrielles de le-
sant. Au terme du programme, les solutions qui auront dmontr leur efficacit seront
gnralises.

Dautres dossiers sont disponibles cette url.

> Institut Montaigne

Ranimer le systme de sant franais : propositions 2017

Big data et objets connect : Faire de la France un champui de la rvolution numrique

La rvolution du Big data promet galement de fortes opportunits damlioration de loffre de

soins, et pourrait tre davantage mise au service des professionnels de sant en permettant
notamment de faire voluer lapproche sanitaire vers une mdecine prdictive et pidmiologique.
Ainsi, par exemple, lexploitation des donnes anonymiss des patients pourrait permettre
danalyser la tolrance et lefficacit des traitements, dindividualiser les prises de dcision
thrapeutiques et de construire une mdecine fonde sur des preuves (evidence-based medecine).La
rvolution du Big data et des objets connects cre dimmenses perspectives de cration de valeur
mais suscite galement des interrogations nouvelles sur la protection des droits des individus. Pour
renforcer la confiance entre les acteurs et soutenir le dveloppement de modles conomiques
innovants, les diffrentes parties prenantes doivent saisir les opportunits offertes et travailler en
confiance.

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Voir aussi :

>Asip Portail e-sant

> LESISS (Les Entreprises des Systmes dInformation Sanitaires et Sociaux)

> TICSANTE

> [Link]

La e-sant le vent en poupe

A ltranger :

> OMS Technologies de la sant

(2015). The Atlas of eHealth Country Profiles, Genve : OMS

(2011). MHealth: New horizons for health through mobile technologies, Genve : OMS

(2016). From innovation to implementation eHealth in the WHO European Region

> Communaut europenne

Comyn, G. (2009). "La e-sant : une solution pour les systmes de sant europens." Dossiers Europens
(Les)(17).

> OCDE

(2013). ICTs and the Health Sector. Towards Smarter Health and Wellness Models. Paris OCDE: 177 , fig.

(2013). Toward New Models for Innovative Governance of Biomedecine and Health Technologies. OECD
Science, Technology and Industry Policy Papers ; 11. Paris OCDE: 42 ,fig.

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