eHealth Governance, A Key Factor for Better Health Care: Implementation of IT Governance to Ensure Better care through Better eHealth

Introduction

The central claim of this chapter is that eHealth governance is a key factor for improved health services. Many people involved in some way with patient and health care would disagree with this claim, since IT is not always seen as one of the main components of health services, or at least is not perceived to be as crucial as, say, clinical factors. IT in the health sector is commonly regarded as a support for people to help other people. However, there is an expectation that eHealth will become more and more important in the delivery of modern health care, in areas such as preventative and curative health care, mobility, telemedicine and virtual healthcare. eHealth is expected to improve the health service in the future, adding value for practitioners, patients and carers, researchers and government in different stages of the health care journey. These expectations are introducing new pressures to ensure successful delivery of eHealth; this can be obtained by implementing IT governance approaches based on proven best practices, not only to get assurance but also to show how these expectations are to be realised.

Adopting IT Governance can help health care organisations delivering eHealth; it requires commitment and support at all levels across the health care boards. This is a medium to long term process that involves series of improvement cycles that are transitions requiring careful management of the organisational change involved.

Successful delivery of eHealth in this highly demanding scenario not only requires commitment but also determination and investment that involve all types of health care organisations, together with other stakeholders, such as patients, carers, researchers, suppliers of health informatics and government.

In countries like the UK and others in the European Union, where the health care service is mostly provided via central and local public funds, there is a risk that eHealth won’t get the level of investment required to grow at an acceptable pace, as it is competing for resources with other elements of the care system which are traditionally seen as more important for patient care. Moreover, eHealth is also commonly regarded as a net investment with a negative financial return. The good news is that this is only a narrow view of the whole financial picture. eHealth can be seen as one of the best candidates for funding in a competitive financial environment by demonstrating returns on investments based on savings in other areas of the health care system by implementing eHealth solutions.

IT governance standards and methodologies are used in non-healthcare industries and enterprises to provide a careful alignment of IT technologies and capabilities with the business goals of the enterprise. Levels of alignment can be measured; plans for improvement can be devised and implemented, with a monitoring framework in place to ensure a culture of continuous improvement. In this chapter we show how these standards and methods can be applied within a healthcare environment. We demonstrate the use of IT governance for eHealth to improve the alignment of eHealth with organisational targets, together with a monitoring process that measures what has been achieved, not only from the eHealth service balance scorecard point of view, but also working with Finance Departments to measure eHealth contribution to specific health care savings. This, then, is the challenge for eHealth: how best to adopt IT Governance for eHealth so that the necessary alignment is ensured, and so that measurable and predicted savings can be achieved.

After this introduction we present some fundamental concepts involving eHealth, health informatics, ICT, Information and Knowledge. Unfortunately there is no global consensus on many of these definitions and concepts, which increases the complexity of any attempt to “sell” eHealth in competitions for funding – or, indeed, to demonstrate expected levels of savings. It is difficult for all the involved stakeholders to accurately represent their positions without using a common speech.