Case Studies: Executive Summary and Introduction

The EU*US eHealth Work Project Case Studies aim to capture examples from institutions and organizations with strategies that showcase and demonstrate real world issues, challenges and/or gaps identified in the Survey of Current State and Needs of the eHealth Workforce survey and Gap Analysis.

Case study methodology was derived from Survey of Current State and Needs of the eHealth Workforce survey and Gap Analysis deliverables' findings. The 22 compiled global studies illustrate and deepen those findings while bringing current states and future needs to life in practical ways that share important examples and insights meant to be learned from and built upon. These studies also provide detailed information about the cause of as well as the impacts of the 10 identified gaps shared in the Gap Analysis. In many instances, they propose remedies and often identify concepts or solutions to help bridge gaps and overcome challenges in key areas within the eHealth infrastructure and for access to education. 

With the survey findings, we distinguished between Europe and North America predominantly, but at times included worldwide results for comparison. This was also our approach when it came to the open call recruiting authors in order to bring findings to life. In providing studies from the major areas throughout the European Union (EU), we also strived to include studies that reflect on-the-ground realities and challenges in the United States (US) as well as in developing countries and regions. The studies are very diverse in nature, but are also highly comparable in many instances.

In all, the reader will find examples of successes and best practices as well as deficiencies and needs when it comes to eHealth education and training, skills preparation, competency assessment and workforce development.

Case Studies II was merged Case Studies I, which was originally planned to be submitted as two separate and distinct deliverables.  Due to several factors, including the downtime of HITComp, which impacted the timing and distribution of the survey and led to a later conclusion of the survey, as well as the need for further recruitment of European participants, in addition to the change in timing of the survey results and gap analysis, it became necessary to merge the content of both case studies deliverables into one.  However, the goals of building upon work originally begun by HIMSS TIGER as a coordinated effort was felt to be even better fulfilled by compiling all the results into a common framework and consolidated document rather than in two separate iterations.

The details of this compilation of information-rich global case studies, with an emphasis on a large representation of states within the EU, are comprehensively reviewed in this report.


With the increasing implementation and use of health information technology (IT) in complex environments, new opportunities as well as new risks have emerged. While electronic access to patient information has become less cumbersome due to the adoption of electronic health record (EHR) systems, unintended consequences of using health IT have been reported . Exploiting the opportunities and avoiding the risks is not simply a matter of hardware and software but strongly includes the individual professionals involved. All types of healthcare professionals (e.g., nurses and physicians), engineers and systems developers as well as health informatics (HI) specialists, who are bridging the gap between the healthcare providers and the technical specialists, are involved. Furthermore, board members, executives and other high-level decision makers are also involved and belong to the group of key stakeholders and decision makers who contribute to the success or failure of a system. All these groups require competencies to use, manage or leverage health IT in their particular role.

New informatics challenges also arise when different disciplines and professions form a team to care for a patient. There can be a lack of communication and coordination between different groups, which can negatively affect the care delivered . Much of this inter-professional effort also requires the collaborative use of eHealth and the cooperative development of new electronic systems and applications to ensure high quality patient care.

Although the HI knowledge-base is global, education is local and particularly benefits from case studies that reflect local realities as blueprints. Due to the global nature of eHealth knowledge, there are great opportunities for synergy in cross-country learning. While HI recommendations on competencies and education – particularly international recommendations – serve as highly valuable guides for designing curricula and courses, they cannot show how the content should be situated in a specific and local context due to their generic nature. For this purpose, case studies are a more suitable format. Case studies usually describe a complex phenomenon from multiple perspectives within the unit or environment where the study takes place. The case study tells the story of this unit with regard to key questions about this phenomenon and illustrates it so that it becomes clearer, more tangible and more understandable . Case studies also lend themselves as stimulation for discussions and are ideal material to learn from.

The Technology Informatics Guiding Education Reform (TIGER) Initiative has been addressing educational issues for more a decade worldwide . During this span of time, TIGER has brought many instrumental stakeholders together – in the early days with a focus on nursing, today with a wide scope integrating all health professional groups. The results of TIGER activities have been published as various recommendations on HI education . In the last three years, the TIGER international competencies synthesis project (ICSP) compiled the learning priorities and core competencies from a global perspective. Most recently, the TIGER ICSP has been presented at global scientific conferences and thus combines global expert views about core competency areas with local case studies . It is important to note that findings from the ICSP were leveraged to serve as a foundation upon which the EU*US eHealth Work Project began in September 2016. This deliverable builds upon existing experience in compiling and interpreting case studies and directs the scope to European case studies. In addition, case studies from other non-European countries are included to contrast the findings from Europe.  

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Renfro, C. P., Ferreri, S., Barber, T. G., & Foley, S. (2018). Development of a Communication Strategy to Increase Interprofessional Collaboration in the Outpatient Setting. Pharmacy (Basel), 6(1). doi: 10.3390/pharmacy6010004

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