CC BY-NC-ND 4.0 · Methods Inf Med 2020; 59(S 02): e46-e63
DOI: 10.1055/s-0040-1715796
Original Article

International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study

Elske Ammenwerth
1   Institute of Medical Informatics, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
Georg Duftschmid
2   Section for Medical Information Management, Medical University of Vienna, Vienna, Austria
Zaid Al-Hamdan
3   Faculty of Nursing/WHO Collaborating Center, Jordan University of Science and Technology, Irbid, Jordan
Hala Bawadi
4   Maternal and Child Health Nursing Department, The University of Jordan, Amman, Jordan
Ngai T. Cheung
5   Hospital Authority, Hong Kong
Kyung-Hee Cho
6   Seoul National University, Korea
Guillermo Goldfarb
7   Medical Informatics, Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
Kemal H. Gülkesen
8   Department of Biostatistics and Medical Informatics, Medical Faculty, Akdeniz University, Antalya, Turkey
Nissim Harel
9   Department of Computer Science, Holon Institute of Technology, Holon, Israel
Michio Kimura
10   Medical Informatics Department, School of Medicine, Hamamatsu University, Shizuoka, Japan
Önder Kırca
11   Department of Clinical Oncology, Memorial and Medstar Oncology Center, Antalya, Turkey
Hiroshi Kondoh
12   Department of Medical Informatics, Tottori University Hospital, Yonago, Japan
Sabine Koch
13   Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, KarolinskaInstitutet, Stockholm, Sweden
Hadas Lewy
14   Digital Health Ventures, Holon Institute of Technology, Holon, Israel
Dara Mize
15   Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
Sari Palojoki
16   Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
Hyeoun-Ae Park
17   College of Nursing, Seoul National University, Seoul, South Korea
Christopher Pearce
18   Director of Research, Outcome Health, Blackburn, Australia
Fernan G. B. de Quirós
19   Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Kaija Saranto
20   Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
Christoph Seidel
21   Division of eHealth, Digitalisation and Social Health Economy, Lower Saxony Ministry for Social Affairs, Health and Equal Opportunities, Hannover, Germany
Vivian Vimarlund
22   Department of Computer and Information Science, Linköping University, Linköping, Sweden
Martin C. Were
23   Vanderbilt University Medical Center, Nashville, Tennessee, United States
Johanna Westbrook
24   Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie, Australia
Chung P. Wong
25   Hong Kong Society of Medical Informatics, Hong Kong
Reinhold Haux*
26   Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Braunschweig, Germany
Christoph U. Lehmann*
27   Clinical Informatics Center, Department of Pediatrics, Bioinformatics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, United States
› Author Affiliations


Background Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare.

Objectives This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined “availability of patient data” as the ability to access data in and to add data to the patient record in the respective country.

Methods The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators.

Results Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden.

Conclusion Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.

* Joint senior authorship.

Publication History

Received: 14 March 2020

Accepted: 21 June 2020

Article published online:
18 November 2020

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