Dalibor Stanimirovic and Mirko Vintar
predominantly on economic issues and stringent austerity measures, lack of support and incentives for legislative amendment in the field is likely to remain unchanged for some time.
The observed deficiencies within the development of e‐health in Slovenia, which obviously extend to several areas( policy‐regulatory, financial, institutional and technological area) have significant impact on overall performance of e‐health, and consequently do not allow its effective utilization for improvement of health care services and evidence‐based management of the health care system. The most significant deficiencies revealed by our research are summarized below:
• Absence of top‐down support for implementation of e‐health;
• Poorly defined health care policies and e‐health project objectives;
• Unadjusted and hyper‐regulated normative framework;
• Insufficient funding, lack of management skills and human resources;
• Fragmentation and large number of diverse legacy IS on all three levels of health care system;
• Partially defined communication network standards and data exchange standards;
• Lack of standardized definitions of health and social data required for development and management of EHR, PHR and DRG;
• Disregarding interoperability perspective while procuring an increasing number of narrowly specialized IS;
• Inadequate and vague evaluation practice in the field of major ICT projects;
• Lack of experience in the execution of complex and long‐term national( ICT) projects;
• Unawareness of the potential benefits of e‐health and lack of skills within the scope of ICT by the health care professionals;
• Lack of consensus on development priorities as well as cooperation and coordination between key stakeholders.
4. Lessons learned and guidelines
Evaluating the development of e‐health has proven to be a very difficult task, given the complexity of the e‐ health project itself, lack of appropriate evaluation metrics, and loosely defined project objectives. Notwithstanding the rather chaotic state of affairs in the research field, certain preliminary conclusions can be drawn. It is evident that problems in the development of Slovenian e‐health extend to various areas, reflecting in the unsatisfactory development level of individual infrastructure components and overall e‐health project, whereas on‐going financial and economic crisis just revealed the magnitude of pertaining problems, additionally undermining public trust and stakeholders’ engagement. Health care systems which strive for the successful development and implementation of e‐health projects have to generally overcome difficulties with the political, legal / regulatory and technical constraints, provide appropriate funding for material and immaterial resources, and precisely specify the course and objectives of the e‐health projects. Analysing current situation in the field of e‐health in Slovenia, we identified various deficiencies which have in our opinion substantially affected the development of e‐health. Synthesis of the research results and derived deductions are presented in the form of guidelines:
• Acquire political support, bring together stakeholders from the public sector, not‐for‐profit organizations and the private sector, and prepare viable strategy documents and action plans( assess the current ICT infrastructure, departmental IS, legacy IS, interoperability issues, specify the health information standards, education and training of the medical staff, analyse different informational needs of primary, secondary and tertiary health care level, check the financial construction and financial projections related to the budget of e‐health in the medium and long‐term, examine the potential obstacles to e‐health realization and conduct a sensitivity analysis, etc.);
• Examine current and projected health care issues, incorporate country specificities, determine national health care priorities, and provide an action plan clearly specifying how e‐health will contribute to the solution of national health care priorities, as well as enable desired reorganization and restructuration of the health care system itself;
• Select a top manager and a quality project team with experience in large ICT projects, clearly structure the project plan, project phases and deliverables for each phase, determine the timeline of the project by
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