E -Services

Alfredo M. Ronchi

e-Services
Toward a New Model
of (Inter)active Community


e-Services


Alfredo M. Ronchi

e-Services
Toward a New Model
of (Inter)active Community


Alfredo M. Ronchi
Politecnico di Milano
Milano, Italy

ISBN 978-3-030-01841-2
ISBN 978-3-030-01842-9
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(eBook)

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Preface

The editorial series “e-Citizens: Being Human in the Digital Age” aims to explore
the rich set of technologies and applications that characterise the living environment
of citizens in the digital age and is intended to call attention to fundamental transformations in social organisation and structure. The main technologies and issues
have been carefully described in volume one; applications devoted to e-Democracy
are the core of volume two; the present volume is devoted to e-Services,
encompassing Health, Learning, Culture, Media and News.
In order to introduce this volume, let us review a little bit of the history of information
technology. One of the most significant changes to occur in the field of information
technology over the last few decades was the implementation of real-time communication and information exchange between computers—in one word: networking.
A computer was originally considered to be like Leibniz’s1 “monad”, an ultimate
atom without windows and doors: a sealed entity. Intercommunication processes
enabled external access to these monads, allowing information and data exchange
between them and thus multiplying their added value; networks of computers possess

expanded functionalities and services. A number of different stand-alone proprietary
networks were gradually merged into the network of networks: the Internet.
The Internet represents one of the most successful examples of the benefits of sustained
investment and commitment to research and development of information infrastructure.
Beginning with the early research in packet switching, the government, industry and
academia have been partners in evolving and deploying this exciting new technology.2

1
Gottfried Wilhelm Leibniz (also Leibnitz or von Leibniz) was born on 1 July 1646 (Leipzig,
Germany) and died on 14 November 1716 (Hanover, Germany). School tradition: rationalism. Main
interests: metaphysics, epistemology, science, mathematics and theodicy. Notable ideas: calculus,
innate knowledge, optimism and monad. See last
accessed February 2019.
2
B. M. Leiner et al. (2003) A brief history of the Internet. Internet Society, Reston, VA (see http://
www.isoc.org/internet/history/brief.shtml, last accessed February 2019).

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Preface

Of course, one of the main drivers for Internet usage was the introduction of the
hypertext transfer protocol (http), which led to the birth of the World Wide Web,
thanks to the contributions of Tim Berners-Lee and Robert Cailliau at CERN3 in
1990 and the success of Mosaic at NCSA4 in 1992, the first web browser.
Conceived and developed by “end-users”, one of the most important characteristics of the Web community, in the first two or three years of its life, was the bottomup decision mechanism it employed. Enhancements and extensions were proposed,
discussed and implemented mainly by active members of the community of

researchers and experts involved in the process.
The Web community at that time was a mixture of ICT experts and scientific
content managers. The double role of these prosumers was probably one of the key
innovative aspects of that community during that period. The subsequent gradual
drift from technology developers to general users is a natural process that often
occurs with mature technologies. It happened, for instance, in the field of computer
graphics, where computer graphics pioneers worked side by side with creative
people and special effects (fx) designers.
The development of Internet technology unleashed creative energies, the first
generations of Websites, mainly due to volunteers often not belonging to the IT
sector; don’t forget that the cradle of the Web was CERN, the temple of physics and
subatomic particles. Web technology was for sure an enabling technology, offering
to almost everyone the opportunity to contribute to the creation of the textual and,
later on, visual cyberspace.
The Internet has incredibly facilitated access to mass communication. This
influenced even news and journalism as we will describe later. It combines a
worldwide broadcasting capability with a mechanism for information dissemination,
which offers us the opportunity to reach a wide audience with minimal effort. Before
the Internet, the only way to reach wide audiences was radio and television broadcasting, and before these were invented, mainly printed materials or heralds. In
addition, it is a medium that encourages collaborations and interactions between
individuals and their computers almost without regard for geographic location.
After the “publishing” hangover, it was the time to manage and structure and
index this blob of content and upgrade from information provision to service
provision. ICT-based innovation “is not only a matter of technology”. The main
aim of this work is to bridge the gap between technological solutions and successful
implementation and fruitful utilisation of the main set of e-Services. Different
parameters are actively influencing the success or failure of e-Services: cultural

3
The name CERN is derived from the acronym for the French “Conseil Européen pour la Recherche

Nucléaire”, or European Council for Nuclear Research, a provisional body founded in 1952 with the
mandate of establishing a world-class fundamental physics research organization in Europe. At that
time, pure physics research concentrated on understanding the inside of the atom, hence the word
“nuclear”. n, last accessed February 2019.
4
National Center for Supercomputing Applications, , last accessed
February 2019.


Preface

vii

aspects, organisational issues, bureaucracy and workflow, infrastructure and technology in general, users’ habits, literacy, capacity or merely interaction design.
This requires having a significant population of citizens willing and able to adopt
and use online services and developing the managerial and technical capability to
implement applications to meet the needs of citizens.
A selection of success stories and failures, duly commented on, will help the
reader in identifying the right approach to innovation in governmental and private
e-Services.
This volume is part of a collection of books; the first three volumes are e-Citizens:
Toward a New Model of (Inter)active Citizenry, e-Democracy: Toward a New
Model of (Inter)active Society and e-Services: Toward a New Model of (Inter)active
Community, all of them published by Springer International 2019.
Target Audience
Public authorities, decision-makers, stakeholders, solution developers, university
students.
Prerequisite Knowledge of Audience
Informed on e-Content and e-Services, basics on technology side.
Milano, Italy

Alfredo M. Ronchi


Being Human in the Digital Age

Interior laboratory—Scene 53
“The two enter a cylindrical laboratory. There is a huge glass turbine in the middle with the
metal glove inside. A DNA chain scrolls on the computer screen. . . Mactilburgh starts the
operation rolling as Munro puts his hand on the self-destruct button, ready to use
it. Thousands of cells form in the heart of the generator, an assemblage of DNA elements.
Then the cells move down a tube, like a fluid, and gather in an imprint of a HUMAN body.
Step by step bones are reconstructed, then the nervous and muscular systems. Whole veins
wrap around the muscles. An entire body is reconstructing before our very eyes. . .
ASSISTANT. . . End of reconstruction, beginning of reanimation.”
[LE CINQUIÈME ÉLÉMENT (THE FIFTH ELEMENT) IS A 1997 FRENCH SCIENCE FICTION FILM DIRECTED
BY LUC BESSON AND STARRING BRUCE WILLIS, GARY OLDMAN AND MILLA JOVOVICH.]

This scene shows the way to reconstruct human bodies starting from a minimum
portion of DNA; the science fiction machinery performs a “3D print” of an entire
body, decoding the instructions encapsulated in the DNA; the scene looks very close
to addictive 3D printing. This technology enjoyed great popularity in different fields
from dentists to hobbyists; a very special 3D printer was on display on the occasion
of the WSIS Forum 2018 in Geneva; this 3D printer used chocolate instead of
monomers, printing chocolate blocks instead of bones.
Does science fiction anticipate our near future even in the field of e-Health? Some
experiments carried out in the field of biomaterials and biotechnologies have already
tested the use of 3D printers with nanoparticles, so we never know. Anyhow 3D
graphics and printing are already in use to create different prostheses.
The field of education and learning was till now the one that didn’t benefit too

much from digital technologies, but at the same time suffered more than many other
sectors from the shift of paradigm due to cyber technologies. The young are
significantly influenced by digital technology; as we will see later in the chapter
devoted to e-Learning, the huge number of hours spent playing videogames and
watching television has trained their brains to behave in a very different way
enabling parallel processing and immediate interaction. These completely new

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Being Human in the Digital Age

abilities, together with the digitally empowered direct access to information, have
created an increasing gap in information transmission between “digital immigrant”
teachers and “digital native” pupils. They are used to processing parallel input from
audio, video and chats, incredibly improving their ability to absorb information and
rather complex concepts. They take advantage of virtual and enhanced reality to
activate the most powerful and phylogenetic learning system, the perceptive-motor
system. They learn by directly experiencing the specific subject by being virtually
immersed in that environment, by being “hands-on”, trying and trying again; in other
words, “learning by doing”.
Following the same fil rouge, we approach “Culture” as a wide territory
encompassing different humanities such as heritage in the UNESCO vision, as
described in detail in e-Culture5, but even issues and drawbacks due to the combined
action of information communication technologies and globalisation. The global
trend tends to homogenise and flatten diversities in many fields; diversities have to
be considered richness not barriers. As a consequence, a relevant number of cultural
models and languages risk being jeopardised and disappearing; they refer to “minorities”, or as better expressed by UNESCO IFAP they refer to “minoritised” languages and cultural models under the pressure of the dominant ones.

After learning and culture, the last chapter is devoted to media and news, one of
the sectors that on one side deeply took advantage of ICTs and on the other side
significantly contributed to forging the brains of young generations. This phenomenon is termed neuroplasticity by experts; social psychology offers compelling proof
that thinking patterns change depending on an individual’s experiences. It is a
common understanding that people who grow up in different cultures do not just
think about different things; they actually think differently. The environment and
culture in which people are raised affects and even determines many of their thought
processes.
A major part of the population has already started the journey from Citizens to
e-Citizens: already books medical services and downloads the reports through the
Internet or receives customised press reviews thanks to news aggregators collecting
breaking news concerning their preferred topics on the fly.
Let’s now start this journey from Health to Media.
Milano, Italy

Alfredo M. Ronchi

5
Ronchi A.M. (2009), e-Culture: Cultural Content in the Digital Age, ISBN 978-3-540-75273-8,
Springer, Berlin Heidelberg.


Contents

1

e-Health: Background, Today’s Implementation and Future
Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2
Recent Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.3
e-Health in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.4
A Global Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.5
From Medical Systems to e-Health . . . . . . . . . . . . . . . . . . . . . . .
1.6
From e-Health to m-Health . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.7
Archiving Electronic Patient’s Folders . . . . . . . . . . . . . . . . . . . .
1.8
In the Clouds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.8.1
Health in the Clouds . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.9
Ethical Dimensions of the Information Society . . . . . . . . . . . . . .
1.9.1
Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.9.2
Information Ethics (Infoethics) . . . . . . . . . . . . . . . . . . .
1.9.3
Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.9.4
Bioethical Aspects in e-Health and “m-Health” . . . . . . .
1.10 e-Health and Privacy Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.10.1 The RFID Radio Technology, Ethics and Privacy . . . . . .
1.10.2 Medical Device or Fitness Tool? . . . . . . . . . . . . . . . . . .
1.10.3 The Use of Data and Privacy . . . . . . . . . . . . . . . . . . . .

1.10.4 Informed Consent and the Warsaw Declaration . . . . . . .
1.10.5 EU General Data Protection Regulation (GDPR) . . . . . .
1.11 A Galaxy of Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.11.1 Services in the Field of Drugs . . . . . . . . . . . . . . . . . . . .
1.11.2 How to Report on Patient’s Satisfaction . . . . . . . . . . . . .
1.11.3 Education and Awareness . . . . . . . . . . . . . . . . . . . . . . .
1.11.4 Mobile Virtual Laboratories and Mobile Medical
Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.11.5 “Makers” in the Field of Health . . . . . . . . . . . . . . . . . .

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1.12

2

3

Dependency and Technological Vulnerabilities . . . . . . . . . . . . .
1.12.1 The Self-Management of Health . . . . . . . . . . . . . . . . .
1.13 “Seniors”: An Increasing User Sector . . . . . . . . . . . . . . . . . . . .
1.13.1 Social Weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.13.2 Aging in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.13.3 Most Common Chronic Diseases . . . . . . . . . . . . . . . .
1.14 MUSME: The Interactive Museum of History of Medicine . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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e-Learning: How Teaching and Training Methods Changed
in the Last 20 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.2
The European State of the Art as It Appears from Statistics . . . .
2.3
The Digital Revolution and Other Trends . . . . . . . . . . . . . . . . .
2.4
The Human Capital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.5
ICT Bottlenecks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.6
ICT and the Young . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.7
Leading the Change or Losing the Challenge? . . . . . . . . . . . . .
2.8
Dealing with Digital Natives . . . . . . . . . . . . . . . . . . . . . . . . . .
2.9
Causes and Effects: The Origin of This Pandemia . . . . . . . . . . .
2.10 Lost Something, Any Concern, Drawbacks? . . . . . . . . . . . . . . .

2.11 Some Key Aspects of Computing That Make the Difference . . .
2.12 Gamification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.13 Educational Institutions Policies . . . . . . . . . . . . . . . . . . . . . . . .
2.14 Virtual Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.15 Videocassette and On-Line Lectures . . . . . . . . . . . . . . . . . . . . .
2.16 Improvements Due to Technology . . . . . . . . . . . . . . . . . . . . . .
2.17 Future Developments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.18 It Is Time to Reshape Educational Methodology . . . . . . . . . . . .
2.19 Closing Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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e-Culture: On Culture in the Digital Age . . . . . . . . . . . . . . . . . . . . .
3.1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.2
Digital Tangible and Intangible Heritage . . . . . . . . . . . . . . . . . .
3.3
Cultural Heritage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.4
Origin of Museums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.5
Science and Technology Museums . . . . . . . . . . . . . . . . . . . . . . .
3.6
Art Collections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.7
The Culture Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.8
Entering the Digital Communication Era . . . . . . . . . . . . . . . . . .
3.9
Virtual Universes and Heritage . . . . . . . . . . . . . . . . . . . . . . . . .
3.10 Super Information Highways v/s Information Society . . . . . . . . .
3.11 The Invisible Universe of Data . . . . . . . . . . . . . . . . . . . . . . . . .
3.12 A Web of Cultural Content . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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3.13
3.14
3.15

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4

Technology and Recommendations . . . . . . . . . . . . . . . . . . . . . .
Extending the View on Heritage . . . . . . . . . . . . . . . . . . . . . . . .
European Regulations and Heritage . . . . . . . . . . . . . . . . . . . . . .
3.15.1 The Regulatory Framework . . . . . . . . . . . . . . . . . . . . .
3.15.2 EU Regulations and the Impact on Cultural Heritage . . .
3.15.3 The Economics of Cultural Heritage . . . . . . . . . . . . . . .
3.16 The Concept of “Values” and Its Potential Impact . . . . . . . . . . . .

3.17 The Economic Dimension of “Values” . . . . . . . . . . . . . . . . . . . .
3.18 The Role of Taxonomy in Information Search . . . . . . . . . . . . . .
3.19 A Taxonomy of European Cultural Heritage “Values” . . . . . . . . .
3.20 A Preliminary List of “Values” . . . . . . . . . . . . . . . . . . . . . . . . .
3.20.1 Economic Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.20.2 Cultural Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.20.3 Communicability Values . . . . . . . . . . . . . . . . . . . . . . .
3.20.4 Development Values . . . . . . . . . . . . . . . . . . . . . . . . . .
3.20.5 Accessibility and Fruition Values . . . . . . . . . . . . . . . . .
3.20.6 Value of Universality . . . . . . . . . . . . . . . . . . . . . . . . . .
3.21 From Theory to Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.22 The Role of a “Value” Platform . . . . . . . . . . . . . . . . . . . . . . . . .
3.23 Culture Value Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.24 Value Approach: Further Developments . . . . . . . . . . . . . . . . . . .
3.25 Problems and Issues: Early Experiences . . . . . . . . . . . . . . . . . . .
3.26 Making Cultural Heritage Alive: The Role of Cultural
Mediators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.27 Emerging Professional Profiles . . . . . . . . . . . . . . . . . . . . . . . . .
3.28 Closing Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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e-Journalism and Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1
The “Ws” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2

The “Information” Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3
Freedom of Expression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.4
The First “Asynchronous” Way to Communicate . . . . . . . . . . . .
4.5
Back to Journalism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.6
Characteristics of Information Products . . . . . . . . . . . . . . . . . . .
4.7
Timeliness of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.8
Short Product Lifecycles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.9
Perishability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.10 Media of the Future; Can It Be Profitable? . . . . . . . . . . . . . . . . .
4.11 Different Phases of On Line Newspapers . . . . . . . . . . . . . . . . . .
4.12 New Media: Evolution or Revolution? . . . . . . . . . . . . . . . . . . . .
4.13 Languages on the Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.13.1 Globalisation and Cultural Diversity . . . . . . . . . . . . . . .
4.13.2 ICT and the Internet in a Small World . . . . . . . . . . . . . .
4.14 Information as a Valuable Good . . . . . . . . . . . . . . . . . . . . . . . . .

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4.15
4.16
4.17
4.18
4.19

Public Domain and Copy Left . . . . . . . . . . . . . . . . . . . . . . . . . .
Unprotected Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Works That Are No Longer Protected . . . . . . . . . . . . . . . . . . . .
Works That Have Never Been Protected . . . . . . . . . . . . . . . . . . .
Market Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.19.1 Subscription or Purchase of a Single Copy . . . . . . . . . . .
4.19.2 Newspapers and Gadgets . . . . . . . . . . . . . . . . . . . . . . .
4.19.3 Free Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.19.4 Freemium, That’s to Say Free + Premium Services
Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.19.5 Key Feature of the Internet News . . . . . . . . . . . . . . . . .
4.20 The Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.21 Digital Natives: What Are They Looking For? . . . . . . . . . . . . . .
4.22 Fake News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.23 Cyber Technology and Public Opinion . . . . . . . . . . . . . . . . . . . .
4.24 Evolution of Fruition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.25 New Consumer Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.26 WSIS C9 Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.27 Public Service Broadcasting . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.28 Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

220
221
221
221
223
223
224
224
225
225
226
229
230
233
236
237

238
239
247
256

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261


List of Abbreviations

AAAA
AfDB
App
CARICOM
CDO
CIO
CPI
DESA
DPADM
EEA
EGDI
EIA
EPI
FOI
FOIAs
G2G
GCC
GFW
GIS
GNI

GODAN
GPS
HCI
HCI
HTML
ICT
ICTs
IDRC
ILO
INTOSAI

Addis Ababa Action Agenda
African Development Bank
Software Applications
Caribbean Community and Common Market
Chief Data Officer
Chief Information Officer
Corruption Perceptions Index
Department of Economic and Social Affairs
Division for Public Administration and Development Management
European Environment Agency
e-Government Development Index
Environmental Impact Assessment
e-Participation Index
Freedom of Information
Freedom of Information Acts
Government-to-Government
Gulf Cooperation Council
Global Forest Watch
Geographic Information System

Gross National Income
Global Open Data for Agriculture and Nutrition
Global Positioning System
Human Capital Index
Human–Computer Interface
Hypertext Markup Language
Information and Communication Technology
Information and Communication Technologies
International Development Research Centre
International Labour Organization
International Organization of Supreme Audit Institutions
xv


xvi

IoT
ITU
LDC
MAMA
MDGs
MENA
METEP
MFI
MYS
NEPAD
NGO
OECD
OGD
OSI

OSM
PPPP
RSS
SDGs
SIDS
SME
SMS
SWOT
TGEG
TII
UGC
UNCTAD
UNDG
UNDP
UNECA
UNECE
UNECLAC
UNEP
UNESCAP
UNESCO
UNESCWA
UN-OHRLLS

UNPOG
UNSC

List of Abbreviations

Internet of Things
International Telecommunication Union

Least Developed Country
Mobile Alliance for Maternal Action
Millennium Development Goals
Middle East and North America
Measurement and Evaluation Tool for Engagement and
e-Participation
Micro Finance Institutions
Mean Years of Schooling
New Partnership for Africa’s Development
Non-governmental Organisation
Organisation for Economic Co-operation and Development
Open Government Data
Online Service Index
Open Street Map
Public–Private–People Partnerships
Really Simple Syndication
Sustainable Development Goals
Small Island Developing States
Small and Medium Enterprise
Short Message Service
Strengths, Weaknesses, Opportunities and Threats
Task Group on e-Government
Telecommunication Infrastructure Index
User-Generated Content
United Nations Conference on Trade and Development
United Nations Development Group
United Nations Development Programme
United Nations Economic Commission for Africa
United Nations Economic Commission for Europe
United Nations Economic Commission for Latin America and the

Caribbean
United Nations Environment Programme
United Nations Economic and Social Commission for Asia and the
Pacific
United Nations Educational, Scientific and Cultural Organization
United Nations Economic and Social Commission for Western
Asia
United Nations Office of the High Representative for the Least
Developed Countries, Landlocked Developing Countries and
Small Island Developing States
United Nations Project Office on Governance
United Nations Statistical Commission


List of Abbreviations

UNU-IAS
URL
W3C
WOG
WRI
WSIS

xvii

United Nations University Institute for the Advanced Study of
Sustainability
Uniform Resource Locator
World Wide Web Consortium
Whole of Government

World Resources Institute
World Summit on the Information Society


Chapter 1

e-Health: Background, Today’s
Implementation and Future Trends

The analysis will adequately take into account the overall context including social,
ethical and technological issues. It draws a “big picture” where we consider
different regions of the world and different needs. The contribution outlines to
what extent e-Health represents true innovation, which means having positive
impact on society, making better the life of citizens in a broad sense. We all know
that the healthcare sector differs from country to country as a unique mix of public,
unlicensed private, private and even voluntary set of services; not to forget insurance companies. Starting from today’s added value applications we will try to
identify future trends and goals.

© Springer Nature Switzerland AG 2019
A. M. Ronchi, e-Services, />
1


2

1.1

1 e-Health: Background, Today’s Implementation and Future Trends

Introduction

How can we measure success in e-Health? Is it a mere question of saving money or
does it involve more? It is a foreseeable win-win strategy, better service, more
success stories, less costs? Is e-Health an opportunity to bridge the healthcare gap
around the world? What can we expect from virtual laboratories and electronic
patient folders? Do online medical services impact patient privacy? Last but not
least, do electronic patient folders last forever as usually required by law?
Moreover, very often we hear of user-centred design, and interaction design and
of the positive effects that good “design” can have, especially for industrial products
and on-line services; but what effect can a proper design have “indirectly” on the
user? How much can the “design” do for our welfare, to help us feel better in our
home or even exert a positive influence on our overall health?
The healthcare sector cannot be considered as any other “e-Sector”. What do
patients, or more simply Citizens, expect accessing healthcare premises or services?
What is really relevant for them in the different regions of the world (e.g. on-line
solution to check if a medicine is “original” or a dangerous clone)? Does the “big
brother” effect due to remote monitoring and tele-medicine1 play a positive role in
such a context?
What are the indicators of success of the operation; how do we determine the
degree of satisfaction of the user? By “commercial” success, the content of dedicated
interviews, the expressed appreciation?
The expectancy of life in the last century has significantly grown; if we consider
this aspect as a performance indicator we can probably agree on a positive trend.
Performance measuring in the healthcare sector may be related to a set of parameters
having as the main one the effect on the patient. Apart from this we can consider
organisational issues, the promotion of a culture of wellbeing as a follow-up of the
well-known motto “prevention is better than cure”, time and money savings, information and knowledge sharing and more. Applications and services will cover
information, monitoring, education, safety and more.

1.2

Recent Background

The health sector, if compared with other industries in adopting information technology, suffered a delay of 10/15 years until recent times. Early deployment of
health information technology (HIT as it was known at that time) was primarily for
financial accounting of medical transactions. Even if in some way the health sector
has been the birthplace of one of the most relevant and pervasive inventions of the
last century, the transistor, it was originally developed and patented as a device to

1

Term first coined in the 1970s by Thomas Bird.


1.2 Recent Background

3

fight deafness2. Later on, over time a number of cutting edge technologies added
value application in the Health sector: computer graphics, virtual reality, robotics,
tele-presence, artificial intelligence and of course networking, to mention the
main ones.
Experiments with computerized medical recordkeeping began in the 1960s
mainly in the US. The first electronic health records (EHRs) were designed and
deployed starting in late 1960s and early 1970s. By the middle of the 1970s
approximately 90% of the hospitals in the US used computers for business functions;
there was similar penetration in Europe. Hospitals used to access mainly big
mainframes as shared computational resources in order to manage their own
accounting systems. Later on, they extended the use to manage partial patient folders
related to medical exams. In that period of time 1743 sites in the US processed

electronic data with some medical content.
The majority of physicians adopted EHR systems in the 1980s thanks to the
diffusion in the market of the personal computer. Of course, PCs at that time they
were mainly stand-alone resources; few of them were connected to mainframes as
“intelligent” terminals. The early use of EHR systems by medical doctors was
mainly to keep a personal record of patient references, specific health conditions
and treatments and last but not least billing.
In the 1980s and 1990s incredible steps forward in diagnosis and care were due to
the increasing use of information technology; many times the re-use of computer
graphics turned into medical imaging led to cutting edge medical systems. Moreover, late in the 1990s the introduction of 3D colour graphics broke the flat, greyshaded and cryptic world of medical imaging. PACS (Picture Archiving and Communication System) and laser printers revolutionised the management of medical
images as well. Of course, the enabling technology acting as backbone of such
evolution or, better, revolution in medical imagery was the creation of local broadband networks.
Between the 1980s and the 1990s, the number of computer-based medical exams
increased significantly from CT to NMR, 3D imagery, endoscopy Nano-devices and
“cyborg” prostheses.

2

The invention of Transistors by John Bardeen, Walter Brattain, and William Shockley in 1947.
R.R. Henley and G. Widerhold, An analysis on automated ambulatory medical record systems,
AARMS Study Group, UCSF, June 1975.
3


4

1 e-Health: Background, Today’s Implementation and Future Trends

3D digital reconstruction from Medical Imagery (EC Project Argonaute 3D)

In 1991, the Institute of Medicine4 in the United States declared the computerbased patient record (CPR) as essential for health care, a message reinforced 7 years
later on the occasion of the revised version.
The use of ICT in the medical sector enabled relevant innovations: distant
assistance and information sharing. The medical system called Telehealth means
“medicine at distance”, where “medicine” includes not only medical activities—
involving ill patients—but also public health activities—involving healthy people
[1] (Wootton 1999)5. In other words, telehealth is a process and not a technology,
including many different health care activities carried out at a distance. For these
reasons, the term “e-Health” is an umbrella word used to define the electronic
enablement of the health and disability support services in order to [2, 3]:
• empower individuals and their families to manage their own health and participate better;
• improve the co-ordination and integration of care delivery to individuals; and
• allow population health initiatives such as mapping notifiable diseases to occur in
a timely fashion.
In summary, e-Health services provide a unique set of tools for overcoming many of
the challenges that health delivery systems are facing today. On one side, citizens want,
and ageing societies will need, more and better healthcare. On the other side public
funds are limited, and many citizens cannot afford, or do not want to pay more for it.
As underlined by Robinson [4], “For healthcare providers in modern healthcare
systems, this is a challenge. The right approach to developing, implementing and
using effective e-Health can help address this challenge. Healthcare providers can
use e-Health to improve quality and expand their capacity to meet this increasing
demand within available resources.”

4
Richard S. Dick, Elaine B. Steen, and Don E. Detmer, Editors—Institute of Medicine, The
computer based electronic medical record: essential technology for healthcare, National Academy
Press, Washington, DC, 1991.
5
Wootton, R. (Ed.). (1999b). European telemedicine 1998/99. London: Kensington Publications

Ltd.


1.2 Recent Background

5

According to Wootton [1] there are basically two reasons why e-Health is used:
“either because there is no alternative, or because it is in some sense better than
traditional medicine”.
Addressing this issue, the goal of the chapter is to show that a wide spectrum of
e-Health applications provided better quality and improved productivity. In particular we will focus on the actual European situation.
However, the success of e-Health is not linked to the solution of technical
problems only. e-Health is a complex process whose successful exploitation requires
a significant attention to ergonomics, human factors and organizational changes in
the structure of the relevant health service.
For quite a long time Healthcare Information Technology (HIT) has been mostly
a chimera and pioneers in the realm have faced relevant difficulties and unsuccessful
stories. Some implementations played the role of bad ambassadors, slowing down
the progress. Some European telecom operators, for instance, invested time and
resources in tele-medicine having no positive return of investment. Practitioners
have generally regarded EHR as costly, cumbersome, and offering little help for
tasks at hand.
A number of experiences were carried out in the past but these were mainly
considered as experimental services, addressing a limited number of users/patients,
having almost no real impact on the field. The incredible and quick diffusion of the
Internet and broadband connection has to be considered as a turning point in the
health care domain, as it happened in other domains such as e-Government or
e-Learning. Internet and broadband enabled a completely new scenario: e-Health
was born! The evolution trend was from one to one to one to many and many to many

and broadband made the difference.
Thanks to the characteristics of the Internet some of the early projects addressed
the need to exchange and share medical information, more specifically that related to
rare pathologies. One of the first high-level projects in this field was the so-called G7
CARDIO project (1993–95); at that time the focus in the field of networking was on
ATM connections, the “silver bullet” of the time. Back to CARDIO, the basic
concept was to share as much as possible information and medical data related to
rare heart pathologies in an attempt to combine the efforts in order to solve serious
problems. Thanks to an innovative approach, multimedia documents such as medical
standard pictures (DICOM) and medical standard video clips were available on line
for the benefit of the medical service.
Tele-medicine, remote-ECG, tele-monitoring, tele-consultation and more are
very well-known keywords. Tele-medicine and tele-consultation are still the key
approaches to providing medical care in developing countries. Telecommunication
networks and IT-enabled peer-to-peer connections and data transfer thanks to
modems and, later on, digital lines.


6

1 e-Health: Background, Today’s Implementation and Future Trends

Tiny “computers” have been embedded in a number of portable medical devices
and computer aided design systems have become the digital companions of
bio-engineers, together with nanotechnologies6 and mechatronics.
The current environment in which health care is practiced and information
technology available to its practitioners is significantly different from that which
existed in the last decades. Due to the Internet technology the overall architecture of
distance services has been reshaped and a limited set of peer-to-peer services have
become, at the end, a full set of bidirectional multimedia interactive services

including web 2.0 applications and more advanced and sophisticated solutions.
There are differences in the temporal nature of information, the responsibilities of
each member of the health care team, the need for a communications infrastructure to
facilitate coordination of care, and other logistical7 concerns which impact the
detailed design of information systems.
Changes in the health care environment produced fundamental shifts in the
delivery of health care, favouring outpatient care over impatient care, primary care
over specialty care, and guidelines-driven care over autonomous decision-making.
Technological advances have overcome some barriers to computer-based patient
records (CPRs) (e.g., World Wide Web applications that operate across distances on
many different computers) and heightened the visibility of others
(e.g. confidentiality policies and legislation).
Let’s try to better focus on this domain. A first attempt to classify the services
might be by user: medical doctors, patients/citizens, and institutions. Another potential taxonomy might be by service: web portals (hospitals, experts, medical/chemical
companies, patients, etc.), on-line or off-line medical care services (exams and
consultations, virtual reality therapies, etc.), management systems (medical unit
information systems, etc.), and educational applications (medical doctors, paramedics, employees, patients and citizens). The opportunities offered by e-Health
may benefit additional sectors such as rare pathologies, developing and emerging
countries and “travellers”.

1.3

e-Health in Europe

Healthcare is one of the most information-intensive sectors of European
economies and can greatly profit from recent advances in information and communications technology. Given that the health sector currently lags behind other

6

Researchers working in medical nanorobotics are creating technologies that could lead to novel

health-care applications, such as new ways of accessing areas of the human body that would
otherwise be unreachable without invasive surgery.
7
In principle, in order to fully benefit from the e-Health approach, a general reshape of the
organisation is needed including logistics and other infrastructure. Communication and access to
information are strictly related to organisational and infrastructural issues.


1.3 e-Health in Europe

7

sectors in the use of this technology, e-Health, there is great potential for rapid,
sustained growth8.
For more than 30 years, the European Commission has developed through R&D
programmes ways of improving the delivery of healthcare through the application of
state-of-the-art technologies, and the promotion of new systems and services based
on these9.
EU action on health is based on three key principles10: integration, sustainability
and focus on priority issues. This has led to an integrated approach to health-related
work at the Community level, making health-related policy areas work together
towards achieving health objectives.
The EU Health Strategy, set out in May 2000, aims to integrate all EU healthrelated policies and concentrate resources where the Community can provide real
added value, without duplicating the work of the Member States or international
organizations11.
General health policy lines were set out in the concept of a Europe of Health in
2002. Work was undertaken on addressing health threats, including the creation of a
European Centre for Disease Prevention and Control12 (ECDC), developing crossborder co-operation between health systems and tackling health determinants. A
short presentation of ECDC, as provided by the centre, is: “The European Centre for
Disease Prevention and Control (ECDC) was established in 2005. It is an EU

agency aimed at strengthening Europe’s defences against infectious diseases. It is
located in Stockholm, Sweden. ECDC works in three key strategic areas: it provides
evidence for effective and efficient decision-making, it strengthens public health
systems, and it supports the response to public health threats. ECDC core functions
cover a wide spectrum of activities: surveillance, epidemic intelligence, response,
scientific advice, microbiology, preparedness, public health training, international
relations, health communication, and the scientific journal Eurosurveillance. ECDC
disease programmes cover antimicrobial resistance and healthcare-associated
infections; emerging and vector-borne diseases; food- and waterborne diseases
and zoonosis; HIV, sexually transmitted infections and viral hepatitis; influenza
and other respiratory viruses; tuberculosis; and vaccine-preventable diseases. All in
all, ECDC monitors 52 communicable diseases.”
The EU Health Forum13, which brings together organizations active in health to
advise the European Commission on health policy, is also a key element of the EU
8

Stroetmann et al., 2006—Carolyn Steele Gray, Stewart W. Mercer, et al., 2017.
May you need further information, please refer to last accessed
February 2019.
10
European Commission, 2000.
11
European Commission, 2000.
12
European Centre for Disease Prevention and Control last
accessed February 2019.
13
EU Health Forum 2010 />forum/2010_en, last accessed February 2019—EU Health Forum 2017 Gastein g.
org/conference/programme/, last accessed February 2019.
9

8

1 e-Health: Background, Today’s Implementation and Future Trends

Health policy. The Forum enables the health community to participate in health
policy-making from the start.
EU health policy increasingly involves co-operation with and between the Member States, in particular on cross-border issues such as patient mobility.
In 2004, in order to review the May 2000 Health Strategy and consider whether
and how it needed to be revised in the light of developments, the Commission
launched a reflection process14. The main outcome of this work is the concept that
e-Health should be supported by the widespread dissemination of best practices.
These should include the impact on access to healthcare and on its quality, assessments of cost productivity gains, as well as examples of addressing liability in
telemedicine, reimbursement schemes, and accreditation of e-Health products and
services.
In 2005, the Commission proposed a new strategic framework: i2010. One of the
key societal challenges recognized in the i2010 strategy is to make real improvements in the provision of healthcare, when our ageing society is placing increasing
demands on the underlying services and infrastructure.
The e-Health market was in 2005 some 2% of total healthcare expenditure in
Europe but has the potential to more than double in size, almost reaching the volume
of the market for medical devices or half the size of the pharmaceuticals market.
Revenue in the “e-Health” market will amount to more than three million euros in
2018. Revenue is expected to show an annual growth rate in the period 2018–2020
of 14.3%15, resulting in a market volume of more than four million euros in 2020.
The market’s largest segment is the segment “Heart Failure”, with a market volume
of about 1200 million euros in 2018. If we compare the European market with the
United States one it is shown that most revenue is generated in the United States (US
$ 3821 million in 2018).
Research projects funded by the EU seek to develop e-Health systems and

services that focus on prevention, personalization and patient empowerment; special
care is posed on gender-related medical treatments. Current research activities focus
on: personal health systems and the prevention of illness and diseases; improving
patient safety; modelling and simulation of human physiology and disease-related
processes.

14

European Commission (2004). e-Health—making healthcare better for European citizens: An actionplan for a European e-Health area—com 356. Brussels: Commission of the European Communities.
Online: />pean-citizens-action-plan-european-e-health-area, last accessed February 2019.
15
Source Statista: last accessed February 2019.


1.4 A Global Vision

1.4

9

A Global Vision

In every country and at every level, information and communication tools are central
to health. Access to ICTs, supported by a sound enabling environment, is critical for
health services development, progress and their availability. This applies whether
e-Health is used by individuals searching for health information or support, professionals and facilities providing health care services, or public health services
ensuring monitoring, alert and response; or for strengthening citizen-centred health
systems.
There are some pillars related to the renovated vision.
(a) Encourage the adoption of national e-Health strategies focusing on integrating

ICTs to support the priorities of the health sector and to provide reliable and
affordable connectivity to benefit all citizens;
(b) Promote the use of ICTs to strengthen health care and public health services,
with special efforts to reach citizens in remote and under-served areas in
developing countries;
(c) Facilitate innovation and access to e-Health applications to support health professionals, improve local access to information, and enable the flow of information in health services and systems;
(d) Ensure public trust and confidence in e-Health, through collaboration and broad
adoption of legislations, policies, regulations and other measures that address the
concerns of the health sector, including those of a cross-border nature;
(e) Integrate the use of ICTs in preparing for, sharing information on, and
responding to disease outbreaks, disasters and other emergencies requiring
inter-sectoral collaboration and exchange of information in real-time;
(f) Encourage to creating effective funding mechanisms, business models and
partnerships to accelerate and sustain e-Health efforts beyond pilot stages and
ensure scalability;
(g) Enable access to the world’s medical knowledge through the use of ICT;
(h) Share good practice, evidence and progress on e-Health, to enable informed
development of e-Health activities worldwide;
(i) Promote the measurement of e-Health and its impact the social and economic
development at national and regional levels.
The use of digital technologies contributes even to the preservation and exploitation of traditional medicine as it happens, for instance, for both Chinese Traditional
Medicine and African natural medicine.
Beijing Traditional Chinese Medicine Digital Museum16, original title 北京中医
药数字博物馆, is a virtual museum of popular science available in both Chinese and
English aiming to spread the culture of Traditional Chinese Medicine as it relates to

16

Beijing Traditional Chinese Medicine Digital Museum (China 2011) Producer: Ms. Wang Ting—
Beijing Traditional Chinese Medicine International Exchange and Cooperating Center

(BTCMIECC), , last accessed February 2019.