Data for decision making in networked health

In developed countries, nowadays we live in a networked society: a society of information, knowledge and services (Castells, 1996), with strong specificities in the Health field (Bourret, 2003, Silber, 2003). The World Health Organization (WHO) has outlined the importance of information for improving health for all. However, financial resources remain limited. Health costs represent 11% of GNP in France, Germany, Switzerland and Canada, 14% in the USA, and 7.5% in Spain and the United Kingdom. Governments, local powers, health or insurance organizations therefore face difficult choices in terms of opportunities and priorities, and for that they need specific and valuable data. Firstly, this paper provide a comprehensive overview of our networked society and the appointment of ICT (Information and Communication Technologies) and Health (in other words e-Health) in a perspective of needs and uses at the micro, meso, and macro levels. We point out the main challenges of development of Nationwide Health Information Network both in the US, UK and France. Then we analyze the main issues about data for Decision Making in Networked Health: coordination and evaluation. In the last sections, we use an Information System perspective to investigate the three interoperability layers (micro, meso and macro). We analyze the requirements and challenges to design an interoperability global architecture which supports different kinds of interactions; then we focus on the harmonization efforts provided at several levels. Finally, we identify common methodological and engineering issues.