of universal health coverage The use of eHealth in support profiles Atlas of eHealth country

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Based on the findings of the

third global survey on eHealth 2015

Global Observatory for eHealth

Atlas of eHealth country profiles

The use of eHealth in support

of universal health coverage

(2)

WHO Library Cataloguing-in-Publication Data

Atlas of eHealth country profiles: the use of eHealth in support of universal health coverage: based on the findings of the third global survey on eHealth 2015.

1.Medical Informatics. 2.Information Technology. 3.Telemedicine – trends. 4.Universal Coverage. 5.Data collection. I.WHO Global Observatory for eHealth.

ISBN 978 92 4 156521 9 (NLM classification: W 26.5)

© World Health Organization 2016

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.

who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int).

Requests for permission to reproduce or translate WHO publications –whether for sale or for non- commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/

about/licensing/copyright_form/en/index.html).

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Printed by the WHO Document Production Services, Geneva, Switzerland

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2 01 5

Based on the findings of the

third global survey on eHealth 2015

Global Observatory for eHealth

Atlas of eHealth country profiles

The use of eHealth in support

of universal health coverage

(4)

Acknowledgments

The production of this Atlas would not have been possible without the input of many eHealth experts and the support of the numerous colleagues at the World Health Organization headquarters, regional and country offices.

Our sincere gratitude goes to over 600 eHealth experts in 125 countries worldwide who helped shape the results by sharing their knowledge through completing the 2015 global survey on eHealth. We are also indebted to an extensive network of eHealth professionals and WHO staff who assisted with the design and implementation of the survey. The WHO eHealth focal points in six WHO regions played an important role in encouraging Member States to participate therefore ensuring a high response rate of 64% for the survey. eHealth focal points include Housseynou Ba, Hani Farouk, Clayton Hamilton, Mark Landry, David Novillo and Miguel Peixoto.

Special thanks go to Mohamed Nour (WHO Eastern Mediterranean Office) and Katharine Shelley (consultant) for their expert processing and analysis of the survey data. The GOe wishes to acknowledge its gratitude for the ongoing support and advice from Joan Dzenowagis, Diana Zandi and Ed Kelley (WHO Geneva).

Our appreciation to Jillian Reichenbach Ott, Genève Design, for her design and layout, and Kai Lashley, Further Consulting, for technical editing.

The global survey and this Atlas were prepared by the WHO Global Observatory for eHealth under the management of Misha Kay.

Photo credits: © iStock photos

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Acknowledgments . . . . iv

A guide to the country profiles . . . . 5

Background . . . . 5

Methodological considerations . . . . 6

Quality assurance . . . . 6

Presentation of secondary data . . . . 6

Overview of country profiles . . . . 9

Introduction . . . . 9

1 . eHealth foundations . . . . 9

2 . Legal frameworks for eHealth . . . . 10

3 . Telehealth . . . . 10

4 . Electronic health records . . . . 11

5 . Use of eLearning in health sciences . . . . 11

6 . mHealth . . . . 11

7 . Social media . . . . 11

8 . Big data . . . . 11

Afghanistan

12

Albania

15

Algeria

18

Argentina

21

Armenia

24

Australia

27

Austria

30

Azerbaijan

33

Bahrain

36

Bangladesh

39

Belarus

42

Belgium

45

Benin

48

Bhutan

51

Bosnia and Herzegovina

54

Botswana

57

Bulgaria

60

Burkina Faso

63

Burundi

66

Cabo Verde

69

Country profiles

1

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Cambodia

72

Canada

75

Central African Republic

78

Chile

81

China

84

Colombia

87

Comoros

90

Costa Rica

93

Cote D'Ivoire

96

Croatia

99

Cuba

102

Cyprus

105

Czech Republic

108

Democratic People's Republic of Korea

111

Denmark

114

Dominican Republic

117

El Salvador

120

Equatorial Guinea

123

Estonia

126

Ethiopia

129

Finland

132

Gambia

135

Georgia

138

Ghana

141

Greece

144

Guatemala

147

Guinea-Bissau

150

Honduras

153

Hungary

156

Iceland

159

Iran (Islamic Republic of)

162

Iraq

165

Ireland

168

Israel

171

Italy

174

Jamaica

177

Japan

180

Jordan

183

Kazakhstan

186

Kenya

189

Kiribati

192

Kyrgyzstan

195

Lao People's Democratic Republic

198

Latvia

201

Lebanon

204

Lesotho

207

Lithuania

210

Luxembourg

213

Madagascar

216

Malawi

219

Malaysia

222

Maldives

225

Mali

228

Malta

231

Mauritania

234

Mexico

237

Mongolia

240

Montenegro

243

Morocco

246

Netherlands

249

New Zealand

252

Niger

255

Norway

258

Oman

261

Pakistan

264

Panama

267

Paraguay

270

Peru

273

Philippines

276

Poland

279

Portugal

282

Qatar

285

Republic of Moldova

288

Romania

291

Russian Federation

294

Rwanda

297

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San Marino

300

Senegal

303

Serbia

306

Seychelles

309

Singapore

312

Slovenia

315

Somalia

318

South Africa

321

South Sudan

324

Spain

327

Sudan

330

Sweden

333

Switzerland

336

Syrian Arab Republic

339

Tajikistan

342

Timor-Leste

345

Trinidad and Tobago

348

Tunisia

351

Turkey

354

Turkmenistan

357

Uganda

360

Ukraine

363

United Kingdom of Great

Britain and Northern Ireland

366

United States of America

369

Uruguay

372

Uzbekistan

375

Viet Nam

378

Zambia

381

Zimbabwe

384

3

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Background

The third global survey on eHealth conducted by the WHO Global Observatory for eHealth (GOe)

¹

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 by the WHO Global Observatory for eHealth between April and August 2015 and represents the most current information on the use of eHealth in these countries.

The country survey tools may be downloaded from the following GOe website: http://www.who.int/goe.

All the country profiles can be accessed at http://www.who.int/goe/publications/en/.

1 Global Observatory for eHealth: http://www.who.int/goe

A guide to the country profiles

5

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Methodological considerations

A total of 125 WHO Member States, representing a 64% response rate, completed the survey, which is the highest response rate for any GOe survey to date. The scope of the survey was broad; survey questions covered diverse areas of eHealth, from electronic information systems to social media, to policy issues and legal frameworks. The survey responses were based on self-reporting by a selected group of eHealth experts for each participating country. While every effort was made by countries to select the best national experts to complete the instrument, it was not possible to determine whether they had the collective eHealth knowledge to answer each question. Similarly, while survey responses were checked for consistency and accuracy, it was not possible to verify all responses to every question.

Quality assurance

Country profiles are intended to provide a ‘snapshot’ of the eHealth landscape according to selected indicators. The Global Observatory for eHealth implemented a range of measures to assure quality.

The surveys received from participating countries were reviewed for completeness. External sources of information were used for validation of the data and to resolve inconsistencies. Data were reviewed before entry and after layout for publication.

Presentation of secondary data

The following indicators were selected for each country to complement the country profile information and to provide the country context for the eHealth data. Indicators and their sources are included below.

1. Population in thousands (per 100 000 population). World population prospects: the 2015 revision.

Key findings and advance tables. New York: United Nations Population Division; 2015 (http://esa.

un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf, accessed 27 November 2015).

2. Physician density (per 1 000 population). World health statistics. Geneva: World Health

Organization; 2012: (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_

Full.pdf, accessed 27 November 2015).

3. Nurse and midwife density (per 10 000 population). World health statistics. Geneva: World Health

Organization; 2012: (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_

Full.pdf, accessed 27 November 2015).

4. Hospital bed density (per 10 000 population).

European Region: European health for all database (HFA-DB). Copenhagen: WHO Regional Office

for Europe; 2015 (http://www.euro.who.int/en/data-and-evidence/databases/european-health-for- all-database-hfa-db, accessed 27 November 2015).

Western Pacific Region: Western Pacific Region Countries and Areas. Manila: WHO Regional Office

for the Western Pacific; 2014 (http://www.wpro.who.int/countries/en, accessed 5 January 2016).

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South-East Asia Region: South-East Asia Region Countries. New Delhi: WHO Regional Office for

South-East Asia; 2014 (http://www.searo.who.int/countries/en, accessed 5 January 2016).

Region of the Americas: Pan-American Health Organization Regional Core Health Data Initiative.

WHO Regional office for the Americas; 2014: (http://www1.paho.org/English/SHA/coredata/

tabulator/newTabulator.htm, accessed 5 January 2016).

5. Life expectancy at birth (years). WHO Mortality Database. Geneva: World Health Organization;

2014 (http://apps.who.int/healthinfo/statistics/mortality/whodpms, accessed 28 November 2015).

6. Gross national income (GNI) per capita (international $) . World development indicators.

Washington DC, World Bank: 2014 (http://data.worldbank.org, accessed 28 November 2015).

7. Total health expenditure (% GDP). World health statistics. Geneva: World Health Organization;

2010 (http://www.who.int/whosis/whostat/2010/en, accessed 28 November 2015).

8. ICT Development Index rank. Measuring the information society. Geneva: International

Telecommunication Union; 2014: (https://www.itu.int/en/ITU-D/Statistics/Documents/publications/

mis2014/MIS2014_without_Annex_4.pdf, accessed 28 November 2015).

9. Mobile-cellular subscriptions (% inhabitants). ICT-Eye: key ICT data and statistics. Geneva:

International Telecommunication Union; 2014 (http://www.itu.int/ITU-D/ICTEYE/Indicators/

Indicators.aspx, accessed 28 November 2015).

10. Internet users (% of individuals). ICT-Eye: key ICT data and statistics. Geneva: International

Telecommunication Union; 2014 (http://www.itu.int/ITU-D/ICTEYE/Indicators/Indicators.aspx, accessed 28 November 2015).

A guide to the country profiles

7

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Introduction

The data are grouped by eight eHealth themes covered by the 2015 global survey. Each grouping is intended to give the reader an overview of the eHealth landscape in individual countries in 2015 for each particular theme. For the most comprehensive overview, however, it is recommended that responses to all the themes be considered together as this will provide the most complete picture of the eHealth landscape.

Country context

These indicators are included to provide the reader with the context and background for the eHealth work being performed in the country. The country context shows indicators of population size, economic status, life expectancy, availability of health-related human resources (e.g. health-care worker), bed density and some high-level ICT indicators. Together they form a package of indicators that both describe the country and that can be used to compare countries.

1 . eHealth foundations

A selection of some of the fundamental building blocks required to create an enabling environment for eHealth are listed in this section. This includes a selection of indicators on eHealth-related policies or strategies, funding, multilingualism and capacity building. Data are reported by the individual “country

Overview of

country profiles

Overview of country profiles

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response” (yes, no or don’t know), “global yes response”, which is the average “yes” response to each indicator across all countries (expressed as a percentage), and “year adopted” for the particular indicator in the case of national policies/strategies and multilingualism. The former represent the level of planning and action around the use of eHealth in the country’s health system. The other indicators of this section are described below.

Funding sources is a vital indicator of the level of financial support available for eHealth; the survey provides four funding options. As above, the answers are expressed as “country response” and “global yes response”; it has an additional measurement for the level of funding: no funding, low <25%, medium

<50%, high <75% and very high >75%.

The survey also included a section on multilingualism as it reflects a government’s commitment to inclusion of linguistic minorities in the country with respect to eHealth activities. The indicators show policy or strategy support as well as practical support in building multilingual Internet sites.

eHealth capacity building is another significant indicator as it shows whether students or professionals are receiving training in preparation for their exposure to eHealth in clinical settings. The “proportion” of students receiving training is expressed in the same was as for the funding sources above: no funding, low

<25%, medium <50%, high <75% and very high >75%.

2 . Legal frameworks for eHealth

This group of indicators reports on the policy and legislative environment of eHealth in a country. It is measured by a series of 13 indicators which essentially aim to show the degree of protection and control that individuals have of their health-related data in a digital environment. Indicator data includes “country response” as well as “global yes response”.

3 . Telehealth

Telehealth is probably one of the most well-known and best established of all eHealth services. This section reports on the operations of five of the most common telehealth programmes globally and what level of the health system they are operating at as well as the type of programme.

Health system levels include:

International level – health entities in other countries in the world

Regional level – health entities in countries in the same geographic region

National level – referral hospitals, laboratories and health institutes (mainly public, but also private) Intermediate level, covering district or provincial facilities – public, private for-profit and private

not-for-profit (e.g. religious) hospitals and health centres

Local or peripheral level – health posts, health centres providing basic level of care

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Types of programmes include:

Informal – use of ICT for health purposes in the absence of formal processes and policies Pilot – testing and evaluating a programme

Established – an ongoing programme that has been conducted for a minimum of 2 years and is

planned to continue.

4 . Electronic health records

This section of the country profile provides an overview of the state of adoption of Electronic Health Records (EHRs) in the country. It identifies whether the country has introduced a national EHR system and if there is legislation governing its use. It identifies at what level of the health system the EHRs are being used (primary, secondary or tertiary) and what proportion (%) of the facilities are using the records. It further identifies other electronic systems that the EHR system is linked to and shows the “global yes response”

for each option. Finally it lists ICT-assisted systems, the “country response” and the “global yes response”.

5 . Use of eLearning in health sciences

The scope of the application of eLearning for pre-service education of health sciences students as well as in-service training for health professionals is covered in this section. The faculties or professions which can benefit from eLearning techniques for training are identified along with the “country response” as well as the “global yes response”.

6 . mHealth

This section aims to present a country overview of the mHealth activities being conducted by category of mHealth programme, “health system level” and “programme type” – as described above in Telehealth.

7 . Social media

The social media profile reports its policy or strategy status and year of adoption. It further lists the use of social media by health care organizations as well as by individuals and communities. Each response has a corresponding “country response” and “global yes response”.

8 . Big data

This section asks preliminary questions on whether policies or strategies have been adopted by governments to govern the use of big data (i.e. very large data sets) in the health sector or by private companies.

Overview of country profiles

11

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Afghanistan

Country context*

1 . eHealth foundations

National policies or strategies

Country response Global "yes" response^§ Year adopted

National universal health coverage policy or strategy — 75% N/A

National eHealth policy or strategy — 58% N/A

National health information system (HIS) policy or strategy Yes 66% ‡

National telehealth policy or strategy No 22% N/A

Funding sources for eHealth

Country response Global "yes" response^§ Funding source %**

Public funding No 77% Zero

Private or commercial funding Yes 40% <25%

Donor/non-public funding Yes 63% 50-75%

Public-private partnerships — 42% Zero

Multilingualism in eHealth

Policy or strategy on multilingualism No 28% N/A

Government-supported Internet sites in multiple languages Yes 48%

eHealth capacity building

Country response Global "yes" response^§ Proportion**

Health sciences students – Pre-service training in eHealth Yes 74% <25%

Health professionals – In-service training in eHealth Yes 77% <25%

Population (000s) 30,552 Life expectancy at birth (years) 61

GNI per capita (PPP Int $) 2,000 Total health expenditure (% GDP) 8.1

Physician density (per 10 000 population) 0.27 ICT Development Index rank — Nurse & midwife density (per 10 000 population) 0.50 Mobile-cellular subscriptions (% population) 60.35 Hospital bed density (per 10 000 population) 4 Internet users (% population) 5.5

2 . Legal frameworks for eHealth

Policy or legislation – purpose Country response Global "yes" response^§

Defines medical jurisdiction, liability or reimbursement of eHealth services such

as telehealth No 31%

Addresses patient safety and quality of care based on data quality, data

transmission standards or clinical competency criteria No 46%

Protects the privacy of personally identifiable data of individuals irrespective of

whether it is in paper or digital format No 78%

Protects the privacy of individuals’ health-related data held in electronic

format in an EHR No 54%

Governs the sharing of digital data between health professionals in other

health services in the same country through the use of an EHR — 34%

Governs the sharing of digital data between health professionals in health

services in other countries through the use of an EHR — 22%

Governs the sharing of personal and health data between research entities No 39%

Allows individuals electronic access to their own health-related data when

held in an EHR — 29%

Allows individuals to demand their own health-related data be corrected when

held in an EHR if it is known to be inaccurate — 32%

Allows individuals to demand the deletion of health-related data from their EHR — 18%

Allows individuals to specify which health-related data from their EHR can be

shared with health professionals of their choice — 28%

Governs civil registration and vital statistics Yes 76%

Governs national identification management systems — 65%

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13 3 . Telehealth

Telehealth programmes country overview

Health system level** Programme type**

Teleradiology National Established

Teledermatology National Established

Telepathology National ‡

Telepsychiatry National Established

Remote patient monitoring National Established

5 . Use of eLearning in health sciences

eLearning programmes country overview

Health sciences students – Pre-service Country response Global "yes" response^§

Medicine Yes 58%

Dentistry Yes 39%

Public health Yes 50%

Nursing & midwifery Yes 47%

Pharmacy No 38%

Biomedical/Life sciences No 42%

Health professionals – In-service Country response Global "yes" response^§

Medicine Yes 58%

Dentistry No 30%

Pharmacy No 31%

Biomedical/Life sciences No 34%

4 . Electronic Health Records (EHRs)

EHR country overview

Country response Year introduced

National EHR system ‡ ‡

Legislation governing the use of the national EHR system ‡

Health facilities with EHR Use EHR Facilities with EHR %**

Primary care facilities

(e.g. clinics and health care centres) N/A ‡

Secondary care facilities

(e.g. hospitals, emergency care) N/A ‡

Tertiary care facilities (e.g. specialized care, referral from

primary/secondary care) N/A ‡

Other electronic systems Country response Global "yes" response^§

Laboratory information systems N/A 35%

Pathology information systems N/A 18%

Pharmacy information systems N/A 33%

PACS N/A 26%

Automatic vaccination alerting system N/A 10%

ICT-assisted functions Country response Global "yes" response^§

Electronic medical billing systems No 58%

Supply chain management information systems No 58%

Human resources for health information systems Yes 69%

WHO Eastern Mediterranean Region

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7 . Social media

Social media and health Country response Global "yes" response^§ Year adopted

National policy or strategy on the use of social media by

government organizations — 18% N/A

Policy or strategy makes specific reference to its use in the

health domain ‡ 5%

Health care organizations – use of social media Country response Global "yes" response^§ Promote health messages as a part of health promotion campaigns Yes 78%

Help manage patient appointments Yes 24%

Seek feedback on services Yes 56%

Make general health announcements Yes 72%

Make emergency announcements Yes 59%

Individuals and communities – use of social media Country response Global "yes" response^§

Learn about health issues Yes 79%

Help decide what health services to use — 56%

Provide feedback to health facilities or health professionals Yes 62%

Run community-based health campaigns Yes 62%

Participate in community-based health forums — 59%

8 . Big data

Policy or strategy – purpose Country response Global "yes" response^§ Year adopted

Governing the use of big data in the health sector Yes 17% ‡

Governing the use of big data by private companies No 8% N/A

Afghanistan

6 . mHealth

mHealth programmes country overview

Accessing/providing health services Health system level** Programme type**

Toll-free emergency ‡ ‡

Health call centres ‡ ‡

Appointment reminders Local Pilot

Mobile telehealth Intermediate Informal

Management of disasters and emergencies National, Intermediate, Local Informal

Treatment adherence National Pilot

Accessing/providing health information Health system level** Programme type**

Community mobilization National Pilot

Access to information, databases and tools National Established

Patient records ‡ ‡

mLearning ‡ ‡

Decision support systems National Pilot

Collecting health information Health system level** Programme type**

Patient monitoring ‡ ‡

Health surveys ‡ ‡

Disease surveillance ‡ ‡

LEGENd

* Country context indicators

ICT Development Index Rank. 2015 - https://www.itu.int/net4/ITU-D/idi/2015/

All other country indicators. Global Health Observatory. 2012-2014 - http://www.who.int/gho

** Glossary

§ Indicates the percentage of participating Member States responding “Yes”

— Don’t know N/A Not applicable

‡ Indicates question was unanswered Question not asked

International level: Health entities in different geographic regions

Regional level: Health entities in countries in the same geographic region National level: Referral hospitals, laboratories and health institutes (mainly

public, but also private)

Intermediate level: District or provincial facilities: public and private hospitals and health centres

Local or peripheral level: Health posts, health centres providing basic level of care Informal: Use of ICT for health purposes in the absence of formal

processes and policies

Pilot: Testing and evaluating a programme

Established: An ongoing programme that has been conducted for a

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15 Albania

Country context*

1 . eHealth foundations

National policies or strategies

National universal health coverage policy or strategy Yes 75% 2013

National eHealth policy or strategy No 58% N/A

National health information system (HIS) policy or strategy No 66% N/A

Funding sources for eHealth

Public funding Yes 77% Zero

Private or commercial funding — 40% Zero

Donor/non-public funding Yes 63% <25%

Public-private partnerships No 42% Zero

Multilingualism in eHealth

Policy or strategy on multilingualism — 28% N/A

Government-supported Internet sites in multiple languages No 48%

eHealth capacity building

Health sciences students – Pre-service training in eHealth No 74% N/A

Health professionals – In-service training in eHealth No 77% N/A

GNI per capita (PPP Int $) 10,520 Total health expenditure (% GDP) 5.9 Physician density (per 10 000 population) 1.15 ICT Development Index rank 80 Nurse & midwife density (per 10 000 population) 3.85 Mobile-cellular subscriptions (% population) 110.69 Hospital bed density (per 10 000 population) 28 Internet users (% population) 54.7

2 . Legal frameworks for eHealth

as telehealth — 31%

transmission standards or clinical competency criteria — 46%

whether it is in paper or digital format Yes 78%

health services in the same country through the use of an EHR No 34%

services in other countries through the use of an EHR No 22%

Governs the sharing of personal and health data between research entities No 39%

held in an EHR No 29%

held in an EHR if it is known to be inaccurate No 32%

Allows individuals to demand the deletion of health-related data from their EHR No 18%

shared with health professionals of their choice No 28%

Governs civil registration and vital statistics — 76%

Governs national identification management systems — 65%

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3 . Telehealth

Telehealth programmes country overview

Teleradiology National Pilot

Teledermatology National Pilot

Telepathology National Pilot

Telepsychiatry National Pilot

Remote patient monitoring ‡ ‡

5 . Use of eLearning in health sciences

eLearning programmes country overview

Medicine N/A 58%

Dentistry N/A 39%

Public health N/A 50%

Nursing & midwifery N/A 47%

Pharmacy N/A 38%

Biomedical/Life sciences N/A 42%

Medicine N/A 58%

Dentistry N/A 30%

Pharmacy N/A 31%

4 . Electronic Health Records (EHRs)

EHR country overview

National EHR system Yes 2015

Legislation governing the use of the national EHR system Yes

(e.g. clinics and health care centres) Yes >75%

(e.g. hospitals, emergency care) Yes >75%

primary/secondary care) Yes >75%

Laboratory information systems No 35%

Pathology information systems No 18%

Pharmacy information systems No 33%

PACS No 26%

Automatic vaccination alerting system No 10%

Electronic medical billing systems — 58%

Supply chain management information systems No 58%

WHO European Region

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17 7 . Social media

government organizations Yes 18% 2013

health domain No 5%

Help manage patient appointments No 24%

Help decide what health services to use No 56%

Provide feedback to health facilities or health professionals No 62%

Participate in community-based health forums No 59%

8 . Big data

Governing the use of big data in the health sector No 17% N/A

Albania

6 . mHealth

mHealth programmes country overview

Toll-free emergency ‡ ‡

Health call centres ‡ ‡

Appointment reminders ‡ ‡

Mobile telehealth National Pilot

Management of disasters and emergencies National Pilot

Treatment adherence ‡ ‡

Community mobilization ‡ ‡

Access to information, databases and tools ‡ ‡

Patient records ‡ ‡

mLearning National Pilot

Decision support systems ‡ ‡

Patient monitoring National Pilot

LEGENd

** Glossary

Zero No funding

Established: An ongoing programme that has been conducted for a minimum of 2 years and is planned to continue

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Algeria

Country context*

1 . eHealth foundations

National policies or strategies

National eHealth policy or strategy No 58% N/A

National health information system (HIS) policy or strategy Yes 66% 2014

Funding sources for eHealth

Public funding Yes 77% >75%

Private or commercial funding Yes 40% Zero

Multilingualism in eHealth

eHealth capacity building

Health sciences students – Pre-service training in eHealth Yes 74% 50-75%

Health professionals – In-service training in eHealth Yes 77% 50-75%

GNI per capita (PPP Int $) 12,990 Total health expenditure (% GDP) 6.6 Physician density (per 10 000 population) 1.21 ICT Development Index rank 106 Nurse & midwife density (per 10 000 population) 1.95 Mobile-cellular subscriptions (% population) 97.95 Hospital bed density (per 10 000 population) 17 Internet users (% population) 15.2

2 . Legal frameworks for eHealth

whether it is in paper or digital format — 78%

health services in the same country through the use of an EHR — 34%

services in other countries through the use of an EHR — 22%

Governs the sharing of personal and health data between research entities — 39%

held in an EHR if it is known to be inaccurate No 32%

Governs civil registration and vital statistics — 76%

Governs national identification management systems Yes 65%

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19 3 . Telehealth

Telehealth programmes country overview

Teleradiology Local Established

Teledermatology ‡ ‡

Telepathology Intermediate Established

Telepsychiatry ‡ ‡

5 . Use of eLearning in health sciences

eLearning programmes country overview

Medicine Yes 58%

Dentistry Yes 39%

Pharmacy Yes 38%

Biomedical/Life sciences Yes 42%

Medicine Yes 58%

Dentistry Yes 30%

Pharmacy Yes 31%

4 . Electronic Health Records (EHRs)

EHR country overview

National EHR system No N/A

PACS N/A 26%

Electronic medical billing systems Yes 58%

Supply chain management information systems Yes 58%

WHO African Region

(24)

7 . Social media

government organizations No 18% N/A

Health care organizations – use of social media Country response Global "yes" response^§

Promote health messages as a part of health promotion campaigns No 78%

Seek feedback on services No 56%

Make general health announcements No 72%

Make emergency announcements No 59%

Run community-based health campaigns — 62%

Participate in community-based health forums Yes 59%

8 . Big data

Governing the use of big data in the health sector No 17% N/A

Algeria

6 . mHealth

mHealth programmes country overview

Toll-free emergency National Established

Health call centres National Established

Appointment reminders ‡ ‡

Mobile telehealth ‡ ‡

Management of disasters and emergencies ‡ ‡

Treatment adherence ‡ ‡

Community mobilization National Established

Access to information, databases and tools International Established

Patient records Local Established

mLearning National Established

Decision support systems National Established

Patient monitoring ‡ ‡

LEGENd

** Glossary

Established: An ongoing programme that has been conducted for a

(25)

21 Argentina

Country context*

1 . eHealth foundations

National policies or strategies

National eHealth policy or strategy Yes 58% 2014

National telehealth policy or strategy Yes 22% 2010

Funding sources for eHealth

Public funding Yes 77% 50-75%

Private or commercial funding No 40% Zero

Public-private partnerships Yes 42% Zero

Multilingualism in eHealth

Government-supported Internet sites in multiple languages No 48%

eHealth capacity building

Health professionals – In-service training in eHealth Yes 77% 25-50%

GNI per capita (PPP Int $) — Total health expenditure (% GDP) 7.3

Physician density (per 10 000 population) 3.86 ICT Development Index rank 53 Nurse & midwife density (per 10 000 population) 0.48 Mobile-cellular subscriptions (% population) 151.91 Hospital bed density (per 10 000 population) 45 Internet users (% population) 55.8

2 . Legal frameworks for eHealth

transmission standards or clinical competency criteria Yes 46%

format in an EHR Yes 54%

health services in the same country through the use of an EHR Yes 34%

services in other countries through the use of an EHR Yes 22%

Governs the sharing of personal and health data between research entities Yes 39%

held in an EHR ‡ 29%

held in an EHR if it is known to be inaccurate Yes 32%

Allows individuals to demand the deletion of health-related data from their EHR Yes 18%

shared with health professionals of their choice Yes 28%

(26)

3 . Telehealth

Telehealth programmes country overview

Teleradiology Reg, Nat, Intm, Loc Informal, Pilot

Teledermatology ‡ ‡

Telepathology National, Intermediate, Local Informal, Pilot, Established

5 . Use of eLearning in health sciences

eLearning programmes country overview

Medicine Yes 58%

Dentistry No 39%

Pharmacy No 38%

Medicine Yes 58%

Dentistry Yes 30%

Pharmacy Yes 31%

4 . Electronic Health Records (EHRs)

EHR country overview

PACS N/A 26%

Supply chain management information systems Yes 58%

WHO Region of the Americas

(27)

23 7 . Social media

government organizations No 18% N/A

Participate in community-based health forums Yes 59%

8 . Big data

Governing the use of big data in the health sector Yes 17% 2009

Argentina

6 . mHealth

mHealth programmes country overview

Toll-free emergency Reg, Nat, Intm, Loc Established

Health call centres Reg, Nat, Intm, Loc Established

Appointment reminders Regional, Intermediate, Local Informal, Pilot

Mobile telehealth National Established

Management of disasters and emergencies Intermediate Established

Treatment adherence Intermediate, Local Informal, Pilot, Established

Community mobilization Regional, Intermediate, Local Established

Access to information, databases and tools All Established

Patient records Local Pilot, Established

mLearning Local Pilot, Established

Decision support systems Local Informal

Patient monitoring Regional, Local Pilot, Established

Health surveys Intermediate Pilot

LEGENd

** Glossary

Zero No funding

Established: An ongoing programme that has been conducted for a minimum of 2 years and is planned to continue

(28)

Armenia

Country context*

1 . eHealth foundations

National policies or strategies

National eHealth policy or strategy Yes 58% 2012

National telehealth policy or strategy Yes 22% 2010

Funding sources for eHealth

Public funding No 77% Zero

Private or commercial funding Yes 40% Zero

Multilingualism in eHealth

eHealth capacity building

Health professionals – In-service training in eHealth No 77% N/A

GNI per capita (PPP Int $) 8,140 Total health expenditure (% GDP) 4.5

Physician density (per 10 000 population) 2.70 ICT Development Index rank 74 Nurse & midwife density (per 10 000 population) 4.83 Mobile-cellular subscriptions (% population) 111.91 Hospital bed density (per 10 000 population) 37 Internet users (% population) 39.2

2 . Legal frameworks for eHealth

format in an EHR Yes 54%

health services in the same country through the use of an EHR No 34%

services in other countries through the use of an EHR No 22%

Governs the sharing of personal and health data between research entities Yes 39%

held in an EHR if it is known to be inaccurate — 32%

(29)

25 3 . Telehealth

Telehealth programmes country overview

Teleradiology All Pilot

Teledermatology Local Informal

Telepathology Intermediate, Local Informal, Pilot

Remote patient monitoring Intermediate, Local Informal, Pilot

5 . Use of eLearning in health sciences

eLearning programmes country overview

Medicine N/A 58%

Dentistry N/A 39%

Pharmacy N/A 38%

Medicine N/A 58%

Dentistry N/A 30%

Pharmacy N/A 31%

4 . Electronic Health Records (EHRs)

EHR country overview

PACS N/A 26%

Supply chain management information systems — 58%

Human resources for health information systems No 69%

of universal health coverage The use of eHealth in support profiles Atlas of eHealth country

Based on the findings of the

third global survey on eHealth 2015

Global Observatory for eHealth

Atlas of eHealth country profiles

The use of eHealth in support

of universal health coverage

WHO Library Cataloguing-in-Publication Data

Atlas of eHealth country profiles: the use of eHealth in support of universal health coverage: based on the findings of the third global survey on eHealth 2015.

1.Medical Informatics. 2.Information Technology. 3.Telemedicine – trends. 4.Universal Coverage. 5.Data collection. I.WHO Global Observatory for eHealth.

ISBN 978 92 4 156521 9 (NLM classification: W 26.5)

© World Health Organization 2016

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.

who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int).

Requests for permission to reproduce or translate WHO publications –whether for sale or for non- commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/

about/licensing/copyright_form/en/index.html).

Printed by the WHO Document Production Services, Geneva, Switzerland

2 01 5

Based on the findings of the

third global survey on eHealth 2015

Global Observatory for eHealth

Atlas of eHealth country profiles

The use of eHealth in support

of universal health coverage

Acknowledgments

The production of this Atlas would not have been possible without the input of many eHealth experts and the support of the numerous colleagues at the World Health Organization headquarters, regional and country offices.

Our appreciation to Jillian Reichenbach Ott, Genève Design, for her design and layout, and Kai Lashley, Further Consulting, for technical editing.

The global survey and this Atlas were prepared by the WHO Global Observatory for eHealth under the management of Misha Kay.

Photo credits: © iStock photos

Table of contents

Acknowledgments . . . . iv

A guide to the country profiles . . . . 5

Overview of country profiles . . . . 9

Afghanistan

Albania

Algeria

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahrain

Bangladesh

Belarus

Belgium

Benin

Bhutan

Bosnia and Herzegovina

Botswana

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Country profiles

1

Cambodia

Canada

Central African Republic

Chile

China

Colombia

Comoros

Costa Rica

Cote D'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic of Korea

Denmark

Dominican Republic

El Salvador

Equatorial Guinea

Estonia

Ethiopia

Finland

Gambia

Georgia

Ghana

Greece