E-Health

Another major application area of ICT in public institutions is the health sector. Health care is responsible for a large amount of administrative and financial efforts. In Austria health care accounted for about 30 billion EUR in the year 2009, which represents about 11 percent of the gross domestic product (GDP) of Austria [1]. The high costs of public health care are the main reason why governments seek methods to achieve efficiency gains in this area. One possibility in this context is the extensive use of information technology. E-health is a subset of e-government [2], but is often discussed in separate, due to its high economical and social relevance. Improvements by electronic support systems in health care are expected from optimized management of medication and a more efficient use of available information [3]. Beside cost efficiency, the e-health approach aims at improving the quality of health care by advanced accessibility, enhanced rapidity in processing and treatment and increased effectiveness of treatments [2]. A more comprehensive use of ICT should bring benefits to all stakeholders in health care, including health professionals, patients, hospital operators and financiers. Especially information management of patient data and medical records provides a large potential of improvements in the current state of the art of health care. An example proofing this argument is the fact, that the inappropriate use of medicine in public hospitals accounts for high costs and additionally can be harmful to patients. Studies in Australia came to the conclusion, that faulty medication accounts for about 600 million Dollar a year [3]. More than half of the mistakes made in medication are considered as “definitely preventable” and furthermore 35 percent of the referrals to hospital are regarded as inappropriate [3].
There are several ICT applications in development or already in use, which address the inefficiencies of current “paper-based, fragmented and duplicated patient management systems” [3] and inaccurate medication:

• Electronic medical records [4] can substitute paper-based medical records of patients, providing the benefit of a lower administration effort of electronic systems compared to traditional record systems. The storage device of electronic medical records usually is a unique smart card per patient, which has to be presented by the patient at any treatment. This e-health card combines the functionalities of confirmation of insurance, electronic billing and storage of medical records. The benefits of such card-based systems are faster patient registration processes, summarized care records available to medicals and easier insurance accounting. Additionally e-health cards reduce the risk of “fraudulent reimbursement claims” [5] compared to the use of paper documents. 
• Medication management systems could address the problem of medication mistakes. Such systems could support the decision on medication types and dosing and therefore ensure adequate medication and prevent errors, that lead to preventable medical incidents and increased costs [3]. Basically such systems provide summarized medication records of patients, listing prescriptions by several medicals involved in treatment [4]. This overview of medication together with detailed patient data could prevent adverse effects and incompatibilities. 
• Decision Support Systems provided to medicals are aiming to achieve significant improve- ments in treatment. Examples of systems offering additional information and knowledge to medical professionals are knowledge enrichment systems or Clinical Decision Support Systems(CDSS), which can be used for decision on treatments, prevention and monitoring, drug prescribing or the calculation of medication doses and scheduling [4]. 
• ICT provides significant improvements to administrative systems applied in health care. Patient management systems and electronic scheduling [4] can reduce the average length of hospital stays and prevent multiple visits in some cases, which enables the optimization of capacity utilization in hospitals. These patient management systems are usually based on e-health cards. This combination allows faster processing of administrative tasks together with reducing intermediate steps, resulting in reduced work load [5]. 
• A rather new approach is telemedicine, which aims at providing health services via ICT networks. The aspired applications of telemedicine can be divided into three categories [6]: 
• Tele-visits are remotely conducted visits of medicals with patients. Tele-visit applications include audio and video communication, as well as the option to share patient data [6]. 
• Tele-consults are consultations of several medicals about a common patient. These systems allow communication as well as shared access to patient data and medical records [6]. Tele-consults should provide the benefit of combined know-how and could enable a more integrated treatment. 
• Tele-monitoring allows patients to collect health data (e.g. weight, blood pressure) and provide it to medicals via ICT networks. Special medical devices assist the patient in data collection and allows the patient to access medical care from home. Tele-monitoring is also termed as patient self-monitoring and is generally used for the treatment of chronical deseases [6]. 

A significant environmental benefit of e-health applications is the reduction in paper use. This starts at providing online health information instead of using information leaflets. One of the most effective applications of ICT regarding to environmental improvements is the use of smart cards, applied as e-health cards for insurance verification and the storage of medical records. Examples of e-health cards are the e-card established in Austria as national insurance card, or the carte vitale, constituting the equivalent in France [2]. E-health card systems are already in use in countries all over the world, for example in Germany, Algeria, Slovenia, Gabon, Azerbaijan, Mexico, Bulgaria [5] and many others. Smart cards in health care bring the benefit of electronic invoicing. The environmental benefit arising from the utilization of smart cards mainly is based on reductions in paper use. Data from France showed that in 2007, 60 percent of all medical care related invoices were processed electronically due to the distribution of 55 million e-health cards [2]. The positive environmental impact of reduced paper use is not restricted to slow down deforestation, because the production of paper consumes energy and therefore causes greenhouse gas emissions. Estimations show that using a computer for about 4 hours accounts for the same CO2 emissions as the production of 150 grams of paper [2]. According to this the dematerialization by e-health applications can enable significant savings of carbon emissions.
Another benefit of telemedicine is the ability to provide health services remotely in rural areas, overcoming long distances with rather low effort. As an example Australia was already considered to be a leader in the advancement of telemedicine already in 2002 [4]. The early development of medical services provided via ICT networks can be related to the large share of remote areas of this country. A positive environmental implication of telemedicine is that it has the potential to reduce travel routes for visits and consultations [6].

References

[1] Statistik Austria. Gesundheitsausgaben in Österreich. http://www.statistik.at/web_de/statistiken/gesundheit/gesundheitsausgaben/index.html. Accessed: 2013-03-05.

[2] Bio Intelligence Service. Impacts of information and communication technologies on energy efficiency, final  report. ftp://ftp.cordis.europa.eu/pub/fp7/ict/docs/sustainable-growth/ict4ee-final-report_en.pdf, September 2008. Accessed: 2013-02-12.

[3] G. Philipson. Ict’s role in the low carbon economy. Technical report, Australian Information Industry Association (AIIA), 2010.

[4] J. Houghton. Information technology and the revolution in healthcare. Working Paper. Victoria University, Melbourne, 2002.

[5] Gemalto. Electronic healthcare solutions - putting the patient at the center of modernization. http://www.gemalto.com/brochures/download/electronic_healthcare.pdf, August 2010. Accessed: 2013-03-05.

[6] CSC Healthcare Group. Telemedicine: An Essential Technology for Reformed Healthcare. http://www.ehealthnews.eu/images/stories/pdf/csc_telemedicine.pdf, May 2011. Accessed: 2013-03-05.