Transcript Kein Folientitel - Instituto Edumed

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Where there‘s health,
there‘s hope!
The GlobalView
Health
Network
Bringing
Economy
to Health
by Creating
Healthy
Economies
Using commerce
to serve the needs
of humanity!
The Electronic
Public / Private
Procurement System
Today‘s problems
can‘t be solved with yesterday‘s tools!
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Mission Statement
.
 To prevent Human Crisis in the face of worldwide Financial Crisis. Not
just for a small group of people - but the whole family of mankind and those yet to be born. To counter the enormous increase in human
misery in crisis-stricken countries that threatens to spawn social and
political unrest, desperation, hopelessness, decline and mass confusion.
 To bring about humanitarian benefit and economic improvement
through creative transformation of public and private commerce with
adequate attention given to meeting long-term development needs that
promote health, education, nutrition and infrastructure building.
 To establish an international information infrastructure that links all
public/private sector trading partners to enable a global e-commerce
approach that generates self-sustaining funding mechanisms to support
value-added state reform and modernization programs / infrastructure.
 To provide more resources, new strategies, better decisions throughout
all sectors accelerating integration in the ongoing globalization.
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GlobalView. Overview
 A humanitarian project of planetary proportion to be deployed and
operated in each nation by an alliance of multinational and local firms.
 A common, secure, computer-based network that can offer significant
savings by organizing information infrastructure requirements in
support of growth in standard-based networked applications.
 Designed to meet the critical business process needs of government
and private sector trading partners for e-commerce and data transfer
for social and fiscal programs.
 An Electronic Public / Private Procurement System adapted to the
opportunities and risks of globalization that will replace the complex,
diverse, redundant, and costly multiple communication / EDI
connections that currently exist throughout the supply chain.
 Preserves and strengthens national and global flows of trade both in
developing and industrialized nations.
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GlobalView’s.Global View
 Regardless of today’s financial setbacks (recession, devaluation,
currency flight, slowdown in demand. GDP growth swings moving from
plus to minus percent, etc.) governments must continue to provide
adequate funding for meeting basic social needs and financing
infrastructure building that promotes health, nutrition and education.
 GlobalView is devoting its energies to the creation of a new architecture
for developing vast flows of capital to help governments provide
uninterrupted universal access to these basic services regardless of how
destabilized economies may become – in developing, industrial and
post-industrial nations.
 Everyone agrees with GlobalView that there needs to be better
information generation, information gathering, and information sharing
throughout all public sectors for better decision making. Timely and
appropriate information can even strengthen the global flows of trade
and foreign investment.
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GlobalView’s Blueprint
.
for Change
 GlobalView has created a blueprint of dramatic reforms in the way
governments conduct their business dealings to ensure that life-saving
and life-enhancing programs are not reduced or eliminated. A blueprint
that shows governments how they can deploy The GlobalView Network
throughout their nation – immediately – without any financing required.
 GlobalView is moving toward a planetary information infrastructure for
the whole global economy and all the governments and systems within
it. A series of short- and intermediate-term actions that GlobalView can
help execute can help governments with specific problems:
© H.C., C. R.
Improvements in public procurement and public sector management
An internationally supported public procurement adjustment program
Immediate procurement supervisory and training steps for each nation
Vigorous, accelerated efforts to structure domestic / global e-commerce
Improved arrangements focusing on greater public / private coordination
Redefining roles and responsibilities for pragmatic design, integration and
implementation of GlobalView’s structural reform programs
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A GlobalView
. Thought
 On our planet vast gulfs exist between one man’s (or woman’s) reality
and another’s. Even so, each man is born with the yearning to make
the most of his life regardless of the environment in which he lives. An
individual’s state of health is often a determining factor between a life
of fulfillment or a life of frustration. A life of success or a life of despair.
 Where there’s health, there’s hope!
 With health a person can reap benefits in their life that now would
seem unattainable throughout many parts of the world.
 With health a person’s experience can be extended providing far
greater resources at their command.
 Family relationships can show the greatest changes.
 There can be a metamorphosis liberating many who will rise above
economic and political circumstances to develop their abilities to live
© H.C., C. R. happier, more fulfilling lives.
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The Information
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Age
 The transition from industrial to post-industrial societies requires even
the most advanced nations to adapt their institutions and mentality to
the Information Age.
 The Information Age requires pragmatic, conceptual and philosophical
solutions for coping with the problems of post-industrial society. It is
not confined to the material evolution of society itself, but builds on
such an evolution the appropriate political and humanitarian elements
that make Information Age societies more efficient and agreeable
 The Information Age recognizes the private sector as the engine of
growth. Government interdependence, the necessity to compete, equal
opportunity and mutual responsibility are all elements that have
universal application.
 Alan Greenspan, U.S. Federal Reserve Board Chairman, says higher
levels of growth in the U.S. probably can be credited to productivity
increases made possible through better use of information technology.
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Areas That Must. Be Addressed
 To take part in the global economy it is critical governments have in
place the information and communication infrastructure that will permit
their countries and people to develop successfully. Social and political
development is influenced by access to affordable communications.
People must have access to telephony, computers and networks.
The access must be affordable, such that a much larger percentage of
people from all strata within society are able to use these technologies.
Information must be provided in a manner that makes it easy to use and
useful in that it provides real value in their work, social and political lives.
An enabling environment must be established that encourages all elements
in society to engage in building an Information Society focused on meeting
the needs of the people in each nation, region and worldwide.
 World leaders must call for development of National Information
Infrastructure Plans to help guide public/private entities that are active
and often must collaborate. Multilateral Banks should provide technical
support to facilitate national, as well as regional and global plans.
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Information.is a Product
 Information is the product of a well-defined production process. It is a
product with a life cycle. Properly managed information adds value.
 The information-as-product approach has one clear goal: to deliver
quality information to the information consumer- as a total product:
Intrinsic Information Quality - Accuracy, Objectivity, Believablility, Reputation
Accessibility Information Quality - Accessibility, Ease of Operatons, Security
Contextual Information Quality - Relevancy, Value Added, Timeliness,
Completeness, Amount of Information
Representational Information Quality - Ease of Understanding, Concise and
Consistent Rrepresentation, Interpretability,
 The information-as-product approach requires the need to understand
the needs of each information consumer in their different functional
departments in order to design and develop standardized and
controlled procedures for collecting and updating data.
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TCP/IP - GlobalView’s .Connectivity Cure-all
 With the ubiquity of the Internet, GlobalView’s goal is to move each of
our world’s government information systems, their public procurement
entities, and all their in-country and cross-border trading partners to
TCP/IP-based connections to all applications, at all levels, in all areas.
Increases “total-cost-of-ownership” savings. Eliminates redundancies.
 GlobalView’s commitment to TCP/IP and Internet-based communication
strategies will provide faster access, allow common applications to run
worldwide, and deliver information to information consumers around
the globe or around the corner at the highest performance and lowest
network costs. Intranet / Extranet / Internet / E-commerce all in one.
 GlobalView’s approach will leverage the Internet over time:
© H.C., C. R.
Finding a balance between centralized and local flexibility.
Providing application development tools that can leverage core
information manufacturers to better serve their consumer’s needs.
Developing a fast way to update standards and practices
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Realizing GlobalView’s
Vision
.
 Today’s trading partner networks are complex, redundant and costly.
Individual applications and business processes often use aging,
proprietary protocols. Each trading partner may require other trading
partners to use specific communications methods and service providers.
A common network infrastructure for all public procurement frees
resources and lowers costs. Current problems are organizational.
 GlobalView’s envisions all data communications between trading
partners using the TCP/IP protocol suite. This would simplify
networking issues and help contain the costs associated with trading
partner data communications. A single logical TCP/IP communication
link that will provide users with access to all other trading partners.
 The logical line may consist of multiple physical links to one or many
service providers to supply access diversity. As more applications are
offered, trading partners will be able to eliminate many of their current
multiple connections, thus gaining economies of scale. The size or
speed of the connection can vary to meet each trading partner’s needs.
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Primary Requirements. and Pertinent Metrics
 The Public Internet is not the place for governments and their trading
partners to conduct serious business among themselves. GlobalView
will provide a central overseer to certify and monitor its Internet Service
Providers, assist with resolution, manage security, and provide useful
information to trading partners on ISP performance and services.
 Reliability - Trading partners must be reachable 24/365.
Primary reliability requirement is high service availability.
Pertinent metrics include physical route diversity; routing protocol
convergence times; error and disaster recovery plans; backbone, exchange
point and access circuit availability; replacement of failed customer premises
equipment.
 Performance - Speed and responsiveness must be constant.
Primary requirements include minimal network congestion and efficient and
predictable routing.
Pertinent metrics are latency, packet cell loss, link utilization, throughput,
and efficient exchange of routing information.
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Knowledge-Sharing Solutions-Oriented
Approach
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 Application Evolution
Procurement process communications and collaboration
Requirements planning and scheduling, collaborative design
 Applications Commonality
Develop business cases for standardization / conduct transaction set pilots
Application headers for protocols to identify destination or recipient
Common look and feel for web-enabled industry applications
Identification of which technologies are appropriate for a given application
or business process
Use of security at the application level, interoperability and scalability
 Barriers to Implementation
© H.C., C. R.
Education and training
Timing and coordination
Audit trails and security
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Electronic Commerce
.
Principles
 Using as a model the recommendations of various US and European
commissions on Electronic Commerce and the Global Information
Infrastructure the following principles must be taken into consideration:
Development of the Global Information Infrastructure should be led by the
private sector. The rapid evolution expected in the next decade, in Electronic
Commerce and the Internet, will only be possible in a market-driven
economy not in a regulated industry. This holds true for almost every issue
including: telecommunications, payment methods, information technology,
Internet accessibility, etc.)
Governments should provide a suitable legal environment to buy and sell
products and services through the Internet. However, they should not
impose unnecessary regulations, restrictions or taxes on commercial
activities that take place via electronic commerce or the Internet.
© H.C., C. R.
Minimal Regulations and a simple legal environment will ensure competition,
protect intellectual property and privacy, prevent fraud and support
electronic transactions for this new medium in which there are no state,
national or international borders.
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Some Global
. Statistics
 Hospital Ownership - Of 173 nations reporting on hospital ownership:
68 nations 100% owned by government
47 nations 75% owned by government
25 nations 50% owned by government
 Selected Languages
© H.C., C. R.
English (including India)
Spanish
French
Portuguese
Arabic
Assorted Eastern Europe
Chinese
German
Russian (and CIS)
Japanese
# Nations
43
20
21
6
21
9
1
3
10
1
Total Population
1,690,000,000
319,000,000
198,000,000
186,000,000
228,000,000
198,000,000
1,210,000,000
97,000,000
250,000,000
125,000,000
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Public/Private. Partnership
 GlobalView will form a public / private partnership and planetary
trading alliance to maximize its integration with information technology
investments being made by individual governments and corporations.
Streamlined / strengthened administrative efficiency in public institutions
Enhanced government decentralization, privatization and planning
Diffused best practices in health, education, training, commerce sectors
 Multilateral Development Banks will recommend The GlobalView
Network as a “value-added multiplier” to enable and assist government
borrowers reach their state reform and modernization program goals.
 Some Public / Private Partnership Participants
Sun Microsystems, EDS, AT Kearney
Efficient Healthcare Consumer Response Consortium
US Department of Commerce / International Trade Administration
US Federal Electronic-Commerce Program (Policy Office)
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Not-for-Profit Non-Governmental Organization
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(NGO)
 The GlobalView Network, a not-for-profit humanitarian effort, has been
researching and developing The GlobalView Health Network and
Electronic Public Procurement System for most of this decade. During
this time, GlobalView has identified not only numerous humanitarian
service opportunities but also put together a framework to help
promote and provide “Health for All in the 21st Century” – a founding
vision of the World Health Organization and a recognized goal within all
nations for all populations.
 The GlobalView Network is supported by the Florida Atlantic University
Research Corporation and will operate in each nation and worldwide as
a Non-Governmental Organization (NGO). GlobalView will coordinate its
university research projects through The State University System of
Florida which provides expertise in all areas of health and informatics:
© H.C., C. R.
Medical Schools, Schools of Public Health, Nursing and Health Sciences
Colleges of Engineering and Computer Sciences
Centers for International Business and Trade, Environmental Studies, etc.
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The
GlobalView
Network
The Electronic
Public / Private
Procurement System
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The Electronic Procurement
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System
Public
Business to Government
Government
Private
Business to Business
Private Sector
The
GlobalView
Network
Trading
Trading
Partners
Partners
© H.C., C. R.
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Public Entities /Trading Partners
.
to be Connected
Energy
Agriculture &
Fisheries
Judical
Industry & Mining
Education
Credit &
Finance
Environment
Health &
Nutrition
Urban &
Development
Sanitation
Transportation &
Communication
Tourism
Trade &
Commerce
The
GlobalView
Network
Domestic
Domestic
Trading Partners
Trading Partners
© H.C., C. R.
International
International
Trading Partners
Trading Partners
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Present “Proprietary” One
.
To One Connectivity
Industry & Mining
Agriculture &
Fisheries
Energy
Education
Environment
Judical
Credit &
Finance
Ministerial
Telecom
Networks
Supplier
© H.C., C. R.
Ministerial
Telecom
Networks
Supplier
Urban &
Development
Sanitation
Transportation &
Communication
Health &
Nutrition
Ministerial
Telecom
Networks
Supplier
Ministerial
Telecom
Networks
Supplier
Tourism
Trade &
Commerce
Ministerial
Telecom
Networks
Supplier
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GlobalView “Open” Any
. To Any Connectivity
Industry & Mining
Agriculture &
Fisheries
Energy
Education
Environment
Judical
Credit &
Finance
Urban &
Development
Sanitation
Transportation &
Communication
Health &
Nutrition
Tourism
Trade &
Commerce
The
GlobalView
Network
Supplier
© H.C., C. R.
Supplier
Supplier
Supplier
Supplier
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Worldwide Public Procurement
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Initiatives
 Our world governments spend approximately $ 5 trillion of our total
$ 35 trillion Gross World Product (GWP) on Public Procurement.
The GlobalView Network is working together with representatives of the
following public procurement initiatives:
World Trade Organization
European Union “SIMAP“
Free Trade Area of the Americas (FTAA)
V. P. Gore‘s Partnership for Reinventing Government
U.S. Federal E-Commerce Program
G-8 Nations Global Marketplace for Small and Medium Enterprises
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National Partnership for .Reinventing Government
 The National Partnership for Reinventing Government is the ClintonGore Administration's initiative to reform the way the federal
government works. Its mission is to create a government that "works
better, costs less, and gets results Americans care about.”
 Begun in the early days of the Administration, and with Vice President
Al Gore at its helm, the task force has operated the duration of the
Administration through several phases of initiatives. It is the tenth
federal reform effort this century and has been the longest-running
federal reform effort to date.
 Most importantly, public trust in the federal government is finally
increasing after a 30-year decline. Various polls have shown a clear and
steady increase over the past four years.
 While it is not clear this is directly linked to reinvention, we like to think
it is an important contribution.
© H.C., C. R.
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National Partnership for .Reinventing Government

© H.C., C. R.
Accomplishments in Brief (As of March 1998) - measures of progress:
The size of the federal civilian workforce has been cut by 348,000 -- the
smallest since Kennedy held office and, as a percentage of the national
workforce, the smallest since 1931.
Recommended about 1,500 actions. Agencies completed about 58 percent.
Of the original 1,250 recommendations, they report 66 percent completed.
President Clinton signed 43 Presidential Directives and 83 laws to implement
these recommendations.
Over 325 Reinvention Labs have been created to pilot innovations.
Recommended about $177 billion in savings over a 5-year period. Agencies
locked into place about $137 billion with estimated savings or cost
avoidances of about $31 billion because of these actions.
Agencies eliminated about 640,000 pages of internal rules, about 16,000
pages of Federal Regulations, are rewriting 31,000 pages into Plain English.
Agencies are sponsoring 850 labor-management partnerships. Employees in
organizations that promote reinvention are twice as satisfied with their jobs.
Over 570 federal organizations have committed to more than 4,000
customer service standards.
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Federal Electronic Commerce
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Program Office
 The Federal Electronic Commerce Program Office provides central
leadership and management for the use of EC in the U.S. Federal
Government. The Office of Electronic Commerce consists of 3 teams:
The EC Coordination Team works with Federal agencies, OMB, and others to
coordinate, monitor, and report on government-wide implementation of EC.
The EC Policy Team works with Federal agencies, OMB, the Electronic
Process Initiatives Committee, and others to develop a policy framework to
support key government-wide EC applications.
The Card Technology Team works with Federal agencies and industry to
coordinate, monitor, and report on the government-wide implementation of
card technologies.
 Electronic Commerce - the Future of Government Business
With the spread of computer and Internet use throughout American society,
consumers can buy nearly everything on-line: from electricity to books;
airline tickets to movie tickets; futures contracts to insurance policies;
automobiles to flowers.
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Federal Electronic Commerce
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Program Office
 Electronic Commerce is becoming the preferred way of doing business
with government, as well. Over the next several years,
Federal agencies will buy and pay for most products and services
electronically.
Universities and research centers will seek grants and deliver reports online.
Citizens will use smart cards to receive a range of benefits.
Vendors will have real time access to government business opportunities
and government buyers will find what they need on electronic catalogs.
 Electronic Commerce is actually the use of many core technology tools the Web, electronic data interchange, electronic mail, electronic funds
transfer, electronic benefits transfer, electronic catalogs, credit cards,
smart cards, and other techniques - to deliver citizen services and
conduct government business.
 The Federal Electronic Commerce Office is Co-chaired by officials from
the General Services Administration and the Department of Defense.
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Understanding the. Transformation
to Electronic Government
 “Networks, not hierarchies will define government in the 21st century.”
- VP Al Gore (Picture of a fully electronic 21st Century government).
Service delivery is shifted to serve the citizen.
Instant access: anytime, anywhere, in any format, in any medium. Access is
available at home, at the library, at a corner telephone/information booth.
National Infrastructure: but local robust government networks interoperate,
delivering online services across all hardware platforms, database
structures, application programs. One access to Federal/state/local govts.
Citizens have control to find what they need - interactive contact and realtime data and information.
 The face of government becomes open and consistent to its commercial
partners. Standard, predictable electronic procurement processes
employed across all government organizations. Each citizen can access
only to public information and whatever information is needed to
conduct business with government. Only the affected individual has the
power to use and release information.
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Understanding the. Transformation
to Electronic Government
 Government and private business will merge services where it benefits
the citizen. Transactions can be completed at one sitting.
Buying a car includes payment of sales tax, purchase and creation of the
license plate, and signing up for the proper level of insurance;
Planning a trip with a travel agent updates or creates a passport as well as
an itinerary of lodging, transportation, and amusements.
 Single procurement opportunity access- CBDNET and move toward
CBDPlus
© H.C., C. R.
Supporting interoperable web catalogs and other single face efforts.
CommerceNet Catalog Interoperability Pilot. CommerceNet, a premier
industry association for promoting and building electronic global commerce
solutions on the Internet. Federal Government is working with
CommerceNet on electronic catalog interoperability - a commercial solution.
ARNet. Officially sanctioned source for government procurement
information and electronic acquisition tools. Ties Federal procurement
electronic efforts to a virtual single point.
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Understanding the. Transformation
to Electronic Government
 EBT - Electronic Benefits Transfer. Automation of the massive $500
billion a year transfer of monetary benefits from the Federal-to-stateto-local government for distribution and direct Federal government-tocitizen distribution of entitlement funds. There are currently 143
systems and methods to transfer funds from the Federal treasury to the
citizen recipient. It is shared system delivery, based on a commercially
developed infrastructure.
 Efforts towards integrated search facilities
© H.C., C. R.
The government is supporting new ways to organize and search for
information using the customer-centered view.
A number of university efforts supported with government grant funds, to
develop new ways to search for information. There is a lot of research and
development in this area. e.g. MIT Media Labs
GOVBOT. A powerful tool enables fast, accurate, and timely searches of US
government web pages, documents, statistics, agencies, departments and
resources. This method of access to government information can only grow
more sophisticated and powerful.
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Understanding the. Transformation
to Electronic Government
 Broad approaches to solving security problems.
Security on the Internet, on your home computer, in the company's
accounting system have all taken on new challenges with the astronomical
growth of users and information prepared, transmitted and used in an
electronic form.
The Identity issue -"On the Internet, no one knows you are a dog." (Privacy
Concerns)
ACES: transaction-based, supports citizen-government on-line transactions,
strong ID without compromising privacy.
Smart Cards-allow strong ID for a variety of applications and mobility
 To Sum Up- The Government's Goal
Common Approach is Value Added by Government
Seamless, single face approach
Working with industry on solutions
Secure access with privacy
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Globalization of Public
.
Procurement
 The majority of current public procurement is based on traditional
administrative practices and means of communication – mainly a paperbased system of notification, dissemination and tendering.
 The GlobalView Network will revolutionize the awarding of contracts. An
”electronic marketplace” in which suppliers list products and prices in
electronic catalogues; contracting entities compare prices and
conditions; order electronically best value items that meet their needs.
 Electronic procurement will be more transparent, more open to
dialogue with suppliers, and more efficient than paper-based systems.
 Worldwide use of GlobalView‘s Network will greatly diminish the
dangers that incompatible national electronic public procurement
systems could create. Major new problems of technical incompatibility
among systems could make it more difficult to communicate and
consequently we may not be able to reap the expected benefits of
electronic public procurement.
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Strategies and
. Tactics
 The GlobalView Network‘s strategy is to move industries toward a datacentered trading environment by redesigning each industry‘s supply
chain so that all participants can simultaneously share information
electronically instead of generating information each time a product
passes from trading partner to trading partner.
 Trading partners in each nation will be linked immediately to The
Network to facilitate efficient order management that will improve
information exchanges and interdependencies existing among partners
Online product directories and interactive catalogs
Automatic bidding opportunities / Pre-negotiated supplier discounts
An electronic library of RFP's, RFQ's, and ITB's
Electronic customer identification / Electronic product identification
Electronic order management and processing
Electronic shipping / Electronic receiving
Electronic billing / Electronic funds transfer / EDI transaction sets.
© H.C., C. R.
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Catalysts for
. Support
Technical Reasons:





Single, secure, reliable, managed network
Open system and standards (interoperability)
Less complex than today‘s variety ot methods
Simpler deployment of new technologies
Lower barriers to electronic exchange of information
Business Reasons:






© H.C., C. R.
New and existing government / business to business functions
More efficient business cycles
Significant transformation of competition in all industries
Common global network solution to reduce current costs
Faster information exchange
Business continuity and disaster recovery
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Public Procurement
.
Training
 Changing traditional procurement practices will succeed when there is a
change in management ethos away from closed relationships with limited
suppliers to a transparent and truly commercial environment open to
other bidders and value for money is the primary motivation.
 Training on procurement rules and best practice may well be the best
and least costly way to achieve such a change. The GlobalView Network
will provide systematic and rigorous training for officials in order to give
them the tools that effective procurement demands.
 The Network will spread a global program of training worldwide. Steps
must be taken now to stimulate the training of procurement officers in
the new and evolving skills they need to better perform their new role.
 The Network will provide tools and methods needed to improve Small
and Medium Enterprise (SME) access to public and private procurement
markets and to fulfill their training needs in relation to information
technology and related challenges such as security and confidentiality.
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Multilateral Banks (Project
.
Procurement)
 After a loan is approved, funds are available to implement the project
and purchase the items, works and expertise needed. Implementation
of the project is the responsibility of the borrower, as is procurement of
goods and services. The Multilateral Development Banks are not a party
to any contract, but they do require that procurement follow agreed
procedures as reflected in the legal documents. These include, among
others:
The criteria for packaging the contracts
The various methods of procurement that may be used
The thresholds within which those methods apply
Rules for prior and subsequent review of specifications
Bid documents
Evaluations
© H.C., C. R.
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Multilateral Banks (Project
.
Procurement)
 They carefully supervise implementation and the procurement process
to ensure that procedures are followed and the process is fair and
impartial. While specific procurement rules and procedures may differ
depending on the type of project, the Banks have three basic concerns
that govern their procurement policies:
To ensure that the loan is used to buy only those goods and services
needed to carry out the project, and that they are procured in the most
efficient and economical manner possible.
To give all qualified bidders from the Banks’ member countries an equal
opportunity to compete for Bank-financed contracts.
To encourage development of local contractors and manufacturers in
borrowing countries.
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Multilateral Banks (Project
.
Procurement)
 The Banks’ experience has shown that these objectives can best be
achieved through an international competitive bidding process (ICB)
with a margin of preference given to domestic goods and, under certain
conditions, to domestic contracting services in developing countries.
They have some special features and requirements that prospective
bidders should note, including the following:
Public Advertising – All goods or works to be procured through ICB must be
advertised internationally and in at least one major local newspaper. For
large, specialized contracts, invitations should also be advertised in technical
magazines, newspapers, trade publications of wide international circulation.
Currency of Bid – Bidders are entitled to bid in their own currency or other
currencies in which they would incur expenditures, or in an international
currency specified by the borrower in the bidding documents.
© H.C., C. R.
Payments – Successful bidders are entitled to receive payments in the
currencies of their bid, thereby minimizing the bidders’ exposure to
exchange rate fluctuations. Bidders in Bank-financed contracts are not
required to accept any portion of their payments in countertrade.
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Transforming European Public Procurement
.
(SIMAP)
 Quoting Mario Monti (member of the European Commission –
Directorate General XV):
 “Developing and applying an effective public procurement policy is an
essential element in delivering the best possible services at the lowest
cost to the public. It is also of prime importance to helping EU suppliers
to compete in an increasingly competitive world procurement market.”
 “However, the benefits for procurement authorities, utilities, taxpayers,
customers and suppliers will be more effectively secured if we can
extend and improve our systems for collecting and disseminating
information about contracting opportunities to potential suppliers across
the Union.”
 “We must also continue to build confidence and commitment among
suppliers and contracting entities. To do this we need to provide both
purchasers and suppliers with relevant, accessible and comprehensive
information in the right form and at the right time.”
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Transforming European Public Procurement
.
(SIMAP)
 “Today’s Information Technology advances provide the tools to not only
create significant improvements in the supply of relevant information,
but also revolutionize the whole way of doing business between
procurement entities (government authorities and utilities) and
suppliers.”
 “SIMAP (systeme d’Information pour les Marches Publics) represents a
major step in this direction. Although it is starting with two relatively
modest pilot projects, the Commission expects it to be extended
ultimately to all suppliers and procurement entities in the EU and
beyond.”
 “Public procurement markets represent a significant proportion of the
European Union’s economy (an estimated 10 – 12% of the EU’s GDP),
so that opening up these markets to competition is of crucial
importance to the success of the Single Market as a whole.”
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Transforming European Public Procurement
.
(SIMAP)
 SIMAP is the European Union’s initiative to promote, coordinate and
manage that process of change in the world of public procurement.
Take advantage of the opportunities that IT offers to create a Europe-wide
electronic environment for the whole procurement process
Encourage the rapid introduction of these technologies so that from the
internal planning stage, through electronic tendering to invoicing and
payment will in the future be a seamless, paperless chain.
Provide coordination both within the EU and internationally to ensure that
additional information will increasingly be made available electronically.
Facilitate the transition to a streamlined, less cumbersome and more
focused procurement process in such a way that all players, whether
purchasers or suppliers, will benefit from the use of new electronic tools
with European public procurement.
Simple and speedy access to information giving suppliers the necessary
added knowledge and expertise required to compete at the EU level.
Allow participating procurement entities to disseminate more and better
information to potential suppliers throughout the Union.
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Transforming European Public Procurement
.
(SIMAP)
 At their February 1995 Summit on the Information Society the leaders
of the G7 nations decided that electronic tendering should be
developed as a priority application for the new information
superhighways.
 In a few years the whole procurement process could take place
electronically, from internal planning through electronic tendering to
invoicing and payment, offering enormous savings in time and
efficiency.
 It is not only in the context of relations between purchasers and
suppliers that change is occurring. Inside purchasing organizations,
procurement practices are undergoing far-reaching re-engineering, with
a view toward greater streamlining, reduction in manual procedures,
significant cost savings and enhanced user friendliness at all levels of
the organization. More generally, access to external databases and
advisory services is enhanced by electronic tools.
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Transforming European Public Procurement
.
(SIMAP)
 New electronic tools provide opportunities to purchasing bodies to
cooperate via the exchange of information, ideas, and experience.
Information on topics of previous work for other procuring entities will
be easily accessible help decision-makers decide on contract awards.
 European Commission has launched an initiative to use new electronic
tools in order to make public procurement more efficient. This initiative
is known as SIMAP. Two pilot projects have already been launched to
demonstrate and develop tools for use in public procurement. These
projects involve 75 procurement entities (from all 15 Member States)
which issue a large number of procurement notices.
 The use of a Common Procurement Vocabulary developed by the
Commission, which attributes a nine digit code to some 6,000
commonly used terms, allows tender opportunities to be translated into
the EU’s eleven official languages for publication in the Official Journal
of the EU and in its online equivalent TED (Tenders Electronic Daily) in
accordance with the Union’s procurement legislation.
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Transforming European Public Procurement
.
(SIMAP)
 Suppliers need tools to provide easier online access to tender
opportunities and contracts awarded, plus other information already
available in the Member States which can help them respond more
competitively to public procurement opportunities. This includes
information on tenders with a value lower that of the thresholds
specified in EU legislation.
 Further work is underway on enhancing access to information areas
such as:
© H.C., C. R.
Environmental issues
Information on local conditions
Business practices
Price levels
Help for business to find local partners when bidding for contracts in other
Member States
Help in the translation of call for tender, standards and electronic product
catalogues
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The Free Trade Area of. the Americas (FTAA)
 The effort to unite the economies of the Western Hemisphere into a
single free trade arrangement was initiated at the 1994 Miami Summit
of the Americas and renewed at the 1998 Santiago Summit of the
Americas. The Heads of State of the 34 democracies in the region
agreed to construct a "Free Trade Area of the Americas" or FTAA and to
complete negotiations for the agreement by 2005.
 The effort to build the FTAA is a dynamic process that involves three
key components:
The Trade Ministers of the Western Hemisphere, who have developed the
overall work plan for the FTAA;
The 12 FTAA Working Groups established by the Trade Ministers that are
gathering and compiling information on the current status of trading
relations in the Hemisphere;
© H.C., C. R.
The Vice-Ministers of Trade of the Western Hemisphere, who coordinate the
efforts of the working groups and make policy recommendations to the
Trade Ministers.
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FTAA Working Group on .Government Procurement
 Terms of reference:
© H.C., C. R.
Collect, systematize and create an inventory of the legislation, regulations,
and procedures in the countries of the Hemisphere regarding government
procurement, starting at the central government level, including, among
other, state-owned enterprises. On the basis of that inventory, undertake a
study of barriers to access to procurement by the public sector.
Create an inventory and analysis of regulations on government procurement
included in integration schemes and other existing agreements to which
countries in the Hemisphere are signatories.
Compile available data on purchases of goods and services by central
governments, including, state-owned enterprises, in the Hemisphere.
Identify areas of commonality and divergence among government
procurement systems in countries of the Hemisphere.
Recommend methods to promote transparency in government procurement.
Make specific recommendations on how to proceed in the construction of
the FTAA in this area.
Recommend methods to promote understanding of the WTO Government
Procurement Agreement.
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Overview of WTO Agreement on
.
Government Procurement
 Procurement of products and services by government agencies for their
own purposes represents an important share of total government
expenditure and thus has a significant role in domestic economies.
 While ensuring best value for money will be secured through an open
and non-discriminatory procurement regime, governments sometimes
seek to achieve certain other domestic policy goals through their
purchasing decisions, such as promotion of local industrial sectors.
 Measures to this effect may be either explicitly prescribed in national
legislation, for example prohibitions against the purchase of foreign
goods or services or from foreign suppliers, preference margins, setasides and offsets, or measures or practices which have the effect of
denying foreign products, services and suppliers the opportunity to
compete in domestic government procurement markets, including
selective tendering, non-open technical specification requirements and,
lack of transparency in tendering procedures including contract awards.
 Such discriminatory government procurement procedures and practices
© H.C., C. R. can lead to distortions in international trade.
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Overview of WTO Agreement on
.
Government Procurement
 Government procurement has been effectively omitted from the scope
of the multilateral trade rules under the WTO, in the areas of both
goods and services. In the General Agreement on Tariffs and Trade,
originally negotiated in 1947, government procurement was explicitly
excluded from the key national treatment obligation. More recently,
government procurement has been carved out of main commitments of
the General Agreement on Trade in Services.
 Since it is estimated that government procurement typically represents
10-15% of GDP, this represents a considerable gap in the multilateral
trading system.
 The trade-restrictive effects of discriminatory procurement policies and
of the desirability of fulfilling these gaps in the trading system resulted
in a first effort to bring government procurement under internationally
agreed trade rules in the Tokyo Round of Trade Negotiations. As a
result, the first Agreement on Government Procurement was signed in
1979 and entered into force in 1981. It was amended in 1987, with this
amended version entering into force in 1988.
© H.C., C. R.
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Overview of WTO Agreement on
.
Government Procurement
 The GPA establishes an agreed framework of rights and obligations
among its Parties with respect to their national laws, regulations,
procedures and practices in the area of government procurement. The
cornerstone of the rules in the Agreement is non-discrimination.
© H.C., C. R.
Government Parties to the Agreement are required to give the products,
services and suppliers of any other Party to the Agreement treatment "no
less favorable" than that they give to their domestic products, services and
suppliers and not to discriminate among goods, services and suppliers of
other Parties.
Each Party is required to ensure that its entities do not treat one locallyestablished supplier less favorably than another locally-established supplier
on the basis of degree of foreign affiliation or ownership nor discriminate on
the basis of country of production of the good or service being supplied.
In order to ensure that the basic principle of non-discrimination is followed
and that access to procurement is available to foreign products, services
and suppliers, the Agreement lays heavy emphasis on procedures for
providing transparency of laws, regulations, procedures and practices
regarding government procurement.
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G7 Initiative "A Global Marketplace for
.
Small and Medium Enterprises (SMEs)
 Early in 1995 the G-7 nations launched a group of eleven initiatives
that collectively aim to demonstrate the potential of the information
society and stimulate its deployment. One of these initiatives, "A
Global Marketplace for SMEs", has the overall objective of facilitating
increased competitiveness and participation in global trade for SMEs
by exploiting the opportunities offered by the development of the
global information society. Electronic commerce enables companies to
be more efficient and flexible in their internal operations, to work more
closely with their suppliers, and to be more responsive to the needs
and expectations of their customers. It allows companies to select the
best suppliers regardless of their geographical location and to sell to a
global market.
 One special case of Electronic Commerce is electronic trading, in
which a supplier provides goods or services to a customer in return
for payment.
 The initiative is open to participation by non-G-7 countries and
international organizations.
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G7 Initiative "A Global Marketplace for
.
Small and Medium Enterprises (SME’s)
 The initiative has three themes:
Theme 1 - global information network for SMEs -This will contribute to the
development of an open non- discriminatory environment enabling SMEs to
access information they need and disseminate information on their
products, technologies, etc., using international information networks.
Theme 2 - SME requirements - legal, institutional and technical This
aims to ensure that the systemic issues associated with an open global
marketplace for SMEs are addressed, and will provide a framework
based on the systematic issues that will ensure that the project as a
whole responds to the explicit needs of SMEs.
© H.C., C. R.
Theme 3 - international test-beds for Electronic Commerce -This
theme will: (i) promote awareness of the issues that must be
addressed to realize a "global marketplace for SMEs" through global
Electronic Commerce; (ii) encourage the development of test-beds,
pilot projects, cooperative ventures that evaluate or demonstrate
approaches to addressing the issues; (iii) publicize successful
demonstrations of global Electronic Commerce involving SMEs.
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The
GlobalView
Network
The GlobalView Network
will implement and operate its
Electronic Procurement System
to create the funding mechanism
to deploy and operate
The GlobalView Health Network
and other proposed public sector networks
in each nation and worldwide.
© H.C., C. R.
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Industry & Mining
Agriculture &
Fisheries
Energy
Education
Environment
Judical
Credit &
Finance
Urban &
Development
Sanitation
Transportation &
Communication
Health &
Nutrition
Tourism
Trade &
Commerce
The
GlobalView
Network
13 Channels of Content
in each Sector
© H.C., C. R.
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Approach to World’s Governments
and Ministries
.
 Make presentations to Minister of Health, all other government Ministers,
other appropriate public procurement entities.
Explain how The GlobalView Network can be deployed throughout all health
facilities and public procurement entities as a national public service “utility”
with no government or private sector capital expenditure required.
Explain how GlobalView’s Electronic Procurement System will generate a
“transaction-based-fee revenue stream” to offset deployment / operating
costs.
Analyze past, present and future government budgets to determine total
amount of annual health and other public sector procurement expenditures.
Estimate all private sector procurement Network can facilitate.
Determine “total annual amount of transaction-based-fees generated” by
public and private procurement. Present proposal outlining extent of Network
deployment based upon multi-year Procurement System fee revenue stream.
© H.C., C. R.
Explain how the total of these fees can be pre-identified and will represent
only a small percentage of overall savings generated by using the Network.
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The
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The GlobalView
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Network
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The GlobalView Health
.
Network
 The GlobalView Health Network will be deployed and operated as a
public service in each nation available for use by all public and private
sector health stakeholders and all health procurement entities.
 The Network will assure the patient needs by:
Linking each nation's health assets/facilities (all of which feed data into the
national and global health system) in order to improve communication and
interoperability of assets;
Providing manageable and maintainable structured access to these assets
enabling end-users to access information and tools when and where
needed;
Integrating evolving tools and methods to assist health sector personnel
make informed decisions that impact areas of strategic planning, health
administration and clinical care.
“The fast lane to world health on the global information superhighway“
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Nationwide Intranet
.
Linking All Health Facilities/Assets
Hospital
Clinic
Medical School
Home Health
Pharmacy
Alternate Site
Laboratory
Insurer
Imaging
Gov‘t.
The
GlobalView
Network
13 Channels of Content of
The GlobalView Health Network
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13 Channels .of Content
Channel 1: Data for Decision-Making (Strategic Planning for Public Policy)
Channel 2: Multimedia Reference Library (Selected WWW sites, CD-ROMS, etc.)
Channel 3: Telemedicine (Consultation/Teleradiology/Distance Learning)
Channel 4: Computer-based Interactive Medical Education/Staff Training Courses
Channel 5: Electronic Public Procurement System/Logistics/EHCRTM
Channel 6: Medical Search Service (International and Country-Specific)
Channel 7: National Data Banks (Management/Outcomes/Comparative)
Channel 8: Priority Care Program (Prioritization/Protocols/Universal Access)
Channel 9: Clinical Applications/Clinical Expert Medical Decision Systems/Others
Channel 10: Administrative Applications/Materials Management/Business Support
Channel 11: Health Service Programs (Monitoring and Migrating of Pilot Projects)
Channel 12: Disease Management Programs/Managed Care Programs
Channel 13: Multilateral Hotline (Linking All Health Facilities on the Planet)
© H.C., C. R.
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EHCR - Efficient Healthcare
.
Consumer Response
 Efficient Healthcare Consumer Response (EHCR™) is a consortium of
North American suppliers, distributors and providers formed to reduce
healthcare supply chain costs by $11 billion annually
EHCR™ is an example of the industry’s commitment to cut waste and
improve the quality of patient care
EHCR’s™ objective is to encourage decision makers all along the healthcare
supply chain to join the consortium and agree to implement improvement
programs to move the industry toward the goal of eliminating $11 billion in
avoidable process costs
EHCR’s™ target audience is decision makers in healthcare suppliers,
providers, manufacturers and distributors of all sizes — senior management
as well as heads of logistics, materials management, supply chain and
related services.
© H.C., C. R.
Senior executives / management of 20+ prominent healthcare organizations
are members of EHCR’s™ Executive /Strategic Operating Committees
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Channel 5 - EHCRTM Strategies
.
and IT Solution Sets
Public / Private Purchasing Entities
Efficient Product Movement
 Inventory Management Control Systems
 Continuous Replenishment Processes
 Product Packaging and Handling
Efficient Order Management
 Contract / Pricing Administration
 Purchase Order to Payment
 Sales Activated Settlement
Efficient Information Sharing
 Electronic Product Information
 Point-of-Use Data Capture
 Electronic Customer Information
Distributors
Distributosr
© H.C., C. R.
Manufacturers
Manufacturesr
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Present “Proprietary” One
. To One Connectivity
Home Health
Hospital
Medical
School
Nursing Home
Clinic
Pharmacy
Alternate Site
Laboratory
Physician Office
School Nurse
Ministerial
Telecom
Networks
Supplier
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Ministerial
Telecom
Networks
Supplier
Imaging
Private Insurer
Government
Ministry of Health
Social Security
Ministerial
Telecom
Networks
Supplier
Ministerial
Telecom
Networks
Supplier
Ministerial
Telecom
Networks
Supplier
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GlobalView “Open” Any. To Any Connectivity
Hospital
Medical School
Home Health
Nursing Home
Pharmacy
Alternate Site
Imaging
Clinic
Physician Office
School Nurse
Government
Ministry of Health
Social Security
Laboratory
Private
Insurer
The
GlobalView
Network
Supplier
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Supplier
Supplier
Supplier
Supplier
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Integrated Partnership. Serving Patient Needs
Patient
Re-Insurer
Insurer
Govt.
Payer
Research &
Development
Provider
The
GlobalView
Network
Retailer
Distributor
Manufacturer
Converter
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The GlobalView Health
.
Network
 The GlobalView Health Network can assist (in an unprecedented way)
the decision-making processes pivotal to all policy, administration and
clinical aspects of the daily and long-term operation of national health
systems and the more efficient, effective management and operation of
our world's $3 trillion health establishment.
 The GlobalView Health Network will provide 24/365 access to 13
digitized channels (categories) of tools, methods, software applications,
knowledgebases, training programs, and communications capabilities
that treat information as a strategic priority necessary to ensure that
essential public health functions are maintained worldwide.
 Such functions build on existing primary health care services: Guiding
sustainable health systems; Ensuring active surveillance; Making care
available across the life span; Preventing and controlling disease, and
protecting health; Fostering the use of, and innovation in, science and
technology; Building and maintaining human resources for health;
Securing adequate financing for sustainable health systems
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The GlobalView Health
.
Network
 The GlobalView Health Network will develop and continually evolve an
adaptable global healthcare system architecture at multiple levels of
resolutions to assist stakeholders at all levels of the health system
manage and operate health assets more efficiently and productively.
 The GlobalView Health Network will be custom-designed (language and
content) to support the validated and approved strategic, clinical,
management, educational and other end-user needs of each nation’s
health system.
 Enable faster, more precise decision making; more accurate diagnosis;
faster treatment delivery; training of health professionals and personnel
to facilitate, access, and interpret data from multiple sources (health
sector information systems, software packages, value-added services
and data bases). Also, to collect, process, analyze, and utilize data
efficiently.
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The GlobalView Health
.
Network
 Enable health sector decision makers to adjust more quickly to
changing health demands and conditions, and to capitalize on change
by controlling health costs and increasing operational efficiencies.
 Enable each nation’s Ministry of Health and other health stakeholders to
collect, analyze, share and act upon real time health, medical, and
resource data – making it possible for health information to be
recorded, collected, analyzed and acted upon with immediacy and
foresight.
 Data based decision making contributes to the enactment of policies
and programs that allocate health resources to priority problems as
supported by epidemiological and demographic data (at national and
local levels – particularly in the present environment of
decentralization).
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Universal Product Numbers
.
(UPN/EAN)
 The Network supports the adoption of the use of universal product
numbers, industry-wide numbering systems for supplies that can solve
the product identification quagmire found along the supply chain.
 UPN/EAN provides a common language that simplifies all distribution
processes from ordering to receipt of products. The product number
can be used by all trading partners throughout the supply chain:
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Ensure more accurate and reliable product and pricing information for
managing just-in-time and continuous replenishment agreements.
Eliminate product identification errors in purchase orders, shipments,
invoices and price/sales catalogs
Facilitate accurate tracking, scheduling and cost accounting of products and
billing
Enable full use of bar code technology in materials management
Provide basis for electronic compilation and analysis of product utilization
information
Enhance accuracy and efficiency of EDI between all trading partners
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Linking UPN/EANs
. to CPT and ICD
 Linking UPNs to CPT and/or ICD will provide a better understanding of
supplies used for medical procedures as well as for diagnosis and
results in analyzing
underutilization
overutilization
most efficient use
cost effective use
fraud
 Linking UPNs to CPTs/ICDs documents the complete supply chain from
the maufacturer to the patient respectively to the health care plan.
 Providers and Insurer will gain a better understanding of supplies used
on the procedure and diagnosis level to develop new policies and best
practice guidelines for most efficient use and best quality of care.
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Coding: UPN/EAN,
.
CPT, ICD
 UPN: The Universal Product Number uniquely identifies healthcare
products. It is derived either from HIBCC-LIC or UCC/EAN barcode
labeling data sructures. The UPN is to be universally used as a key
identifier on each inventory unit of all products and also used as the
key identifier to communicate product information between all trading
partners in the supply chain.
 CPT: Physicians' Current Procedural Terminology is used by physicians
and other health care professionals to code their services for
administrative transactions.
 ICD-9-CM: The International Classification of Diseases, Ninth Revision,
Clinical Modification, classifies both diagnoses (Volumes 1 and 2) and
procedures (Volume 3). All hospitals and ambulatory care settings use it
to capture diagnoses for administrative transactions. The procedure
system is used for all in-patient procedure coding for administrative
transactions.
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Linking UPN/EAN. to CPTand ICD
Diagnosis (ICD)
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Procedures (CPT)
Supplies (UPN)
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GlobalView’s Living
Laboratory
.
 GlobalView plans to establish a Living Laboratory at the Multimedia
Laboratory of the Florida Atlantic University College of Engineering.
 To develop a useful GlobalView Health Network on a wide scale there
are challenges at all levels of systemness from the basic hardware
platforms, communications, operating systems, applications, databases,
networks, user interfaces and to the level of the health assets
themselves. In order to drive the development of GlobalView’s Health
Network we need to be able to add health assets in a meaningful way
and provide the framework for these assets to become interoperable
and synergistic.
 This requires an adaptive application architecture that allows for growth
and evolution of the system dynamically over time. In order to develop
and deploy on a large scale such an interoperable Network we must
fully understand the requirements that such a system and its assets
impose. The Living Laboratory will identify and clarify the technical,
business, implementation, deployment and operations requirements.
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GlobalView’s Living
Laboratory
.
 The Living Laboratory will:
integrate assets from various asset classes and be able to retrieve
information from remote sites to help determine communications
requirements and requirements at the asset site to make the asset available
develop a common interface which will allow a user to easily traverse the
asset classes and provide a user interface framework within each class
drive the more detailed user interface requirements as more assets within
each class are added.
 Technical goals include testing the integration of technologies for:
reliable storage/retrieval of medical information for varied applications
real-time, data-driven medical decisions
real-time global transport of medical records with accuracy/speed/security
computer-based medical training, diagnostic, and reference tools
electronic procurement and just-in-time delivery (logistics) systems
telemedicine, telehealth and teleradiology applications.
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Capabilities Integration. & Assessment Program
 To identify the products, technologies & services offered by vendor
companies to determine how these fit into The GlobalView Health
Network's 13 Channels of Content.
 Product, technologies & service architectural implications
Obtain base information on each vendor's products, technologies & services
Review base information for architectural issues
Layout base workflow as a result of the vendor's offering
Integrate vendor's workflow into overall GVHN architecture
Build base simulator and run initial tests using vendor's offering and
workflow
Refine workflow and simulation assumptions based on vendor's offering working with vendor company.
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Capabilities Integration. & Assessment Program
 Cost & revenue implications for both GVHN and Vendor
Obtain base product, technology and/or service costs from vendor
Integrate costs into architectural / workflow simulation model
From end-customer needs analysis obtain forecasted load/usage levels
relevant to vendor's offerings.
Integrate load/usage data into architectural / workflow simulation model
From simulation obtain ranges for costs and revenue and feed them to
business plans and supply-chain analysis.
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Capabilities Integration. & Assessment Program
 Identification of base work required to integrate with GVHN program
for both GVHN and Vendor
From the architectural / workflow model identify GVHN changes required to
integrate the vendor's offering
For the top three changes outline detailed work/tasks required along with
skills required and effort.
From the architectural / workflow model identify vendor changes required to
integrate the vendor's offering
For the top three vendor changes outline detailed work/tasks required along
with skills required and effort - interact with vendor to assess.
From the architectural / workflow model identify impact on core consortium
partners which require changes to integrate the new vendor offering.
For the top impacted vendor changes - outline detailed work/tasks required
along with skills required and effort - interact with vendor to assess.
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Capabilities Integration. & Assessment Program
 Integration of the needs assessment into the cost and workflow
analysis
Obtain needs {functionality and costs} from needs assessment effort-needs
are grouped on a subsystem basis {e.g. Procurement}
Map needs and sub-solution provider offerings if available
Modify architectural / workflow model based on the needs and costs
assessments
Where sub-solution vendor not identified - detail the sub-solution
requirements prior to obtaining a vendor - details in terms of minimum work
to integrate a sub-solution provider.
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The G-7 Global Healthcare
. Applications Project:
 Sub-project 1, "Towards a Global Public Health Network"
Investigates linking existing and emerging public health data telematics
networks to ensure systems are inter-operable across the world, userfriendly, fast, and cost-effective.
 Sub-project 2, "Improving Prevention, Early Detection, and
Treatment of Cancer" aims at establishing multimedia databases
which will enable health professionals across the world to seek
decisional support for patient management and referral.
 Sub-project 3, "Improving the Prevention, Diagnosis and
Treatment of Major Cardiovascular Diseases" aims at establishing
centers of excellence providing tele-consultation services and access to
multimedia databases providing peripheral centers and health
professionals access to information and expertise.
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The G-7 Global Healthcare
. Applications Project:
 Sub-project 4, "A 24-hour Multilingual Telemedicine
Surveillance and Emergency System Around the World"
providing the basis for a 24-hour multilingual emergency teleconsultation service to benefit travelers, workers in isolated places and
those living in regions with less developed healthcare service.
 Sub-project 5, "Enabling mechanisms for global health
networks" aims to identify the most efficient tools and communication
infrastructure for accessing and navigating health networks focusing on
online translation and the harmonization of security standards for
patient related data exchange.
 Sub-Project 7, “Evidence and effectiveness” where evidencelinked information is delivered to the point-of-care, while at the same
time enabling the retrieval of patient-related information from the
point-of-care which contributes to updating the published information.
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Europe's Health
Future
.
 There are wide variations between European healthcare systems but
there are many shared perspectives and themes in their reform
programs - because they are responding to common pressures and the
possibilities offered by modern information systems.
 The starting point for most healthcare reforms has been the concern to
control escalating costs, but other objectives, such as to ensure
equitable access and to improve quality of care have been major
determinants of European health reforms.
 While central measures to control cost have had an important impact,
the main aim of health reforms has been to change the way decisions
are made about the direction and management of health services. The
aim is to create a self-regulating system, which reflects an appropriate
balance between the desired level and quality of service and the
resources which are affordable.
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Europe's Health
Future
.
 The impact of European healthcare reforms can be seen at these levels
in decision making:
Health objectives, policy and responsibilities are more clearly defined
Management of health service provision integrates the management of
medical practice and of resources, in response to patient needs
The management of patient treatment and care is based upon evidence of
best medical practice regardless of setting
 At each level reformed decision processes are dependent upon
information. Better information systems and better use of information
are the keystone for European healthcare reforms. Healthcare reforms
are primarily dependent upon developments in information
management and technology.
 European healthcare information prior to reform was typically based
upon central returns recording activity categorized by ICD code, plus
financial and personnel information.
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Europe's Health
Future
.
 Within healthcare providers a range of separate systems would support
each department, with separate systems also supporting general
practice offices and community based services. Reforms to healthcare
have required a common method for identifying patients with similar
health needs and requirements.
 Most nations have opted for a Diagnosis Related Group (DRG) based
system. This provides a basis for managing services with hospitals and
contracts between purchasers and providers.
 It is questionable whether DRGs will provide a good basis for outcomes
measurement.
 The development of inter-operable information systems will permit a
seamless management of patient treatment and care primarily across
community boundaries.
 Within healthcare providers this can be achieved by an integrated
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Europe's Health
Future
.
 However, the need for interoperability requires a framework of
standards and policies. Many European countries are establishing
national health information management strategies. These strategies
must provide integration of medical and administrative data, while
establishing safeguards for privacy of confidential patient information.
 It is also important to improve the data quality and to establish clear
pathways for information flows within the healthcare system. There are
many advantages to establishing a European-wide / worldwide
approach to information management.
 The basis is the creation of The GlobalView Health Network. It would
provide a larger market for information system suppliers to meet
European and world-wide healthcare needs and would enable exchange
of medical knowledge and patient-based information. The European
Commission is addressing this need through its Directorate-General (DG
XIII) for telematics under the Advanced Informatics in Medicine (AIM)
program.
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Pan American Health Organization
.
Recommended Application/Content List
 Surveillance and epidemiological information - information on the
patterns and trends of diseases and related healthcare measures.
 Management information - for day-to-day management needs and for
planning, programming, budgeting, operations, monitoring, evaluation.
 Clinical data / information - to support diagnosis/ treatment.
 Literature search / retrieval - documentation, reports, publications.
 Knowledge - information readily usable to support a technical task or
health-related decision, such as solution of a public health matter or the
diagnosis of a medical problem, conduction of a laboratory test and
related proposed treatment, timely / appropriate prescribing of drugs.
 Telemedicine - the ability to bring remote consultation by specialists
and to assist in linking teachers and students in continuing medical
education and employee training.
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1998 Summit of the Americas
Health Initiative
.
 The proposed 1998 Summit of the Americas Initiative "Health
Technology Linking the Americas", a single proposal with 3 well linked
components will foster the wide application of these health
technologies to improve health conditions and contribute to human
development, helping to define the inequities more clearly as well as
providing the possibilities of reducing them. The governments will:
 1. Endorse a Regional Initiative for Vaccines that will address research,
development, production and utilization of vaccines, and support the
harmonization efforts in the area of pharmaceutical products, with
special emphasis on essential drugs. This initiative builds on the
success of national immunization programs and regional efforts that
resulted in the polio eradication and a new initiative to eliminate
measles and neonatal tetanus, maintenance of high immunization
coverage, and would help move the countries into the technological
developments that will bring new and improved vaccines into their
immunization programs.
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1998 Summit of the Americas
Health Initiative
.
 This initiative will foster the technology exchange within the Region and
with industrialized countries. Special attention will be given to the
development of the following vaccines: triple viral vaccine (measles,
mumps, rubeola), and polysaccharide vaccines against typhoid (S.
Typhi), meningitis hemophilus M. Meningitides), and pneumonia (S.
Pneumonia), by means of promoting multinational projects for research
and technological development.
 Together with the above, and taking into consideration the ongoing
processes of economic integration, will be the support to countries in
their efforts to harmonize regulatory requirements and procedures for
the approval, registration and marketing of pharmaceutical products,
with special emphasis on essential drugs. Regulatory harmonization will
improve the availability of quality drugs and prevent the marketing of
ineffective or dangerous products. Finally, this initiative will stimulate
collaboration among the countries providing a concrete area of
common interest to the private sector, international agencies and the
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1998 Summit of the Americas
Health Initiative
.
 2. Strengthen and improving the existing regional networks of health
information technologies and surveillance systems, such that all
stakeholders have access to data to help them make correct decisions.
 Countries must address existing and emerging issues through increased
use of health communication technology and surveillance. It is
necessary to take advantage of this opportunity in order to improve the
collection, analysis and dissemination the data that countries can
produce about their own health situation.
 Countries will support all the efforts towards developing more effective
health information, epidemiological surveillance, networks of laboratory,
and vital statistics systems which, among other objectives, are essential
in reducing maternal mortality in adolescence and throughout the
reproductive years.
 There is no doubt that the rapid development of information technology
will revolutionize our approach to health.
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1998 Summit of the Americas
Health Initiative
.
 Partnership in the area of telecommunications will generate networks
which will allow for the exchange of information among countries and
the use of telemedicine for increasing access to some services.
 In addition, it will contribute to building institutional capacity for
undertaking health care technology assessment. This constitutes the
basis for the rational adoption of and investment in, new health care
technologies.
 It is an area of increasing importance in the field of health systems
development, and an instrumental piece for advancing the agendas of
health sector reforms processes in the countries of the Region.
 It is aimed at assessing the safety, efficacy and cost of procedures and
interventions, and bears direct implications for improving quality of
care, for resource allocation practices, and for the definition of
investment priorities in the health sector
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1998 Summit of the Americas
Health Initiative
.
 3. Develop and utilization of effective low-cost technologies to provide
Basic Sanitation Services, ensuring safe water supply, sanitation and
solid waste management.
 Governments can ensure the safety of the water sources in the
conventional distribution systems. In some countries the systems that
are proposed are no doubt efficient, but are costly.
 Development and utilization of proven effective low-cost technologies in
this field:
Will expand the provision of basic sanitation services
Will diminish the health risks associated to this problem
Would have a positive impact in the poor population segments of the
countries, especially in the rural areas.
 It would reinforce as well the goals of the 1990 World Summit for
Children by fostering declines in infant and child mortality.
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1998 Summit of the Americas
Health Initiative
.
 There are also newer developments in the field of solid waste disposal,
sanitary disposal of garbage, and promising ideas for returning waste
to agricultural areas, thereby in the medium term, enhancing food
production.
 Several of these technologies already exist, requiring further
dissemination and application.
 This effort would be complemented with an intense program of
technical cooperation for the application of these technologies.
 This approach will allow to support the items of the Plan of Action for
the Sustainable Development of the Americas that accompanied the
Declaration of Santa Cruz de la Sierra, in terms of identifying and
adapting these technologies to the concrete realities of our countries.
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World Health Organization:
.
Health for All in the 21st Century Vision and Policy
 The GlobalView Health Network will facilitate deployment of projects
that support the values and help to achieve the goals of the World
Health Organization’s “Health for All in the 21st Century” vision.
 The official Health for All policy was written into WHO's 1946
constitution, initiated as a goal for all societies in 1977 and renewed in
1995. WHO health partners (Multilateral Banks, United Nations, World
Trade Organization, NGOs, Academia, Researchers, and the Private
Sector) emphasize "Health for All remains the central vision for health
in the 21st century".
 Embracing Health for All policy values will influence the type of choices
made by governments and national and local health stakeholders when
Selecting among their policy options
The way these choices are made
The interests they serve
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World Health Organization:
.
Health for All Goals and Values
 The goals of Health for All are to achieve:
An increase in healthy life expectancy for all people
Universal access to quality health care
Health equity between and within countries
 These goals will be realized through the implementation of three
interrelated policy directions:
Embracing the values of Health for All
Making health central to development
Developing sustainable health systems

Health for All is based on the following values:
Universal right to health / equity-oriented policies and strategies
The application of ethics to health policy, research and service provision
The incorporation of a gender perspective into health policies and strategies
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World Health Organization
.
Essential Public Health Functions
 Health for All presents the values and principles to guide action and
policy for health at global, regional, national and local levels.
 The GlobalView Health Network will provide 24/365 access to health
informatics tools, methods, approaches and training programs that
ensure World Health Organization Health for All essential public health
functions are maintained in each nation and worldwide.
 Such functions build on existing primary health care services
Guiding sustainable health systems
Ensuring active surveillance
Making care available across the life span
Preventing and controlling disease, and protecting health
Fostering the use of, and innovation in, science and technology
Building and maintaining human resources for health
Securing adequate financing for sustainable health systems
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1. Guiding Sustainable
.
Health Systems
 According to Health for All, if public health policy makers and
practitioners are to be able to make informed decisions for public
health; they need to use epidemiological, economic, management,
demographic, and other types of information. This information is most
timely and appropriate when derived from health- and managementinformation systems, public health surveillance systems, special
registries, surveys, and studies.
 In support of WHO's Health for All, The GlobalView Health Network
would provide access to tools, methods and training programs to
improve skills for informed decision making using epidemiological,
demographic, economic, and management information for:
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Obtaining and allocating resources
Developing strategies to regulate and support private sector contributions to
national health goals
Resource planning models
Population projections
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1. Guiding Sustainable
. Health Systems
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Geographic information systems
Budget tracking systems
National integrated health facilities data banks
Identifying information needs and knowing how to obtain, validate, and
analyze data from different sources
Building decision making capacity to use information for: identifying and
setting priorities; formulating health policies; identifying cost-effective health
interventions; planning, implementing, monitoring, and evaluating public
health programs.
Strengthening information systems and enhancing use of tools to facilitate:
availability of needed data; access to multi-source data; management of
data; quality of timeliness of data; and interpretation and presentation of
data
Enhancing skills of technical advisors in: collecting valid data; improving the
quality of data; conducting appropriate analysis; and communicating with
decision makers about technical information
Identifying and communicating with senior decision makers about program
achievements and resource needs clearly and compellingly
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2. Ensuring Active
. Surveillance
 According to Health for All, a hallmark of a sustainable health system is
its emphasis on active surveillance and monitoring. Global, regional,
national and local surveillance, monitoring and early warning systems
will alert the public to impending threats to health, thus allowing
appropriate action to be taken. Enhanced linkages between local
settings, national organizations and WHO will be made possible by
improved
information
and
communications
technologies.
Complementary mechanisms that monitor States' implementation of
agreed obligations will be part of global surveillance.
 National and local information systems for health such as The
GlobalView Health Network are a prerequisite for the development of
effective, efficient, equitable and quality health systems. National and
local monitoring, surveillance and evaluation need to provide timely
information to decision-makers and the public that will facilitate
evaluation and management of health systems and facilitate the best
use of resources.
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2. Ensuring Active
. Surveillance
 An integrated system of active surveillance and monitoring for health
will focus, at least, on the following areas:
Infectious diseases
Health status and trends, including birth and death rates
Implementation of international norms, standards and regulations
Progress in reducing health inequities
Performance of the essential public health functions
The impact of various lifestyles on health status
Transnational health problems and sectoral impacts on health
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3. Making Care Available
. Across the Life Span
 According to Health for All, a life span approach to health care
acknowledges the complex and interrelated effects of many factors on
the health of individuals and their children. Life span care emphasizes
interventions with a preventive potential that extends from birth to
death. The life span approach is based on evidence of intergenerational
effects, and on linking early factors - present from before conception to
childhood - with health in adolescence and later life. There are many
examples of conditions and behavior whose early prevention is
important for later health.
 A life span approach to health promotion, prevention and care has the
potential to limit disability and enhance the quality of life in later years.
Health care settings in the twenty-first century will differ from today. A
greater focus on incorporating scientific evidence into clinical practice,
combined with an emphasis on quality of care, should reduce variations
in diagnoses and outcomes. A wider range of care and specific services
in community settings should be available directly or indirectly, such as
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3. Making Care Available
. Across the Life Span
 The GlobalView Health Network would provide capacities for the
conversion of raw, disparate streams of patient data into uniform,
actionable, comparative clinical information - one of the best ways for
the world's medical community to track the effectiveness of different
therapies. Also, the objectivity and inherent fairness of informatics
systems provide what all health professionals crave: feedback.
 Health care providers at all levels of the system can now look at various
processes, costs and quality components of the care they deliver and
the sum of these components can now be calculated to determine
which clinical approaches are clearly better, more cost-effective and less
risky.
 Cutting edge databases can report how effectively patients have
responded to various procedures. Monitoring and measuring medical
practices and the ability to form a consensus about what tests and
procedures will be allowed will translate into better health for everyone
across their life span - and into Health for All.
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3. Making Care Available
. Across the Life Span
 In support of WHO's Health for All, The GlobalView Health Network
would provide assistance that would:
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Establish two-way communication among all facilities and professionals to
enable collection of relevant patient data to create life-span computerized
patient records and to provide 24/365 access to these records on a secure
basis to all appropriate health personnel.
Institutionalize the capacity to reengineer by developing concrete processes,
tools and methods for detecting external changes; determining what those
changes mean; modifying or transforming the health system accordingly.
Enable communication among NGOs to discuss global expansion of
successful community-based, problem-focused approaches to health
services based upon community-wide assessment of health care needs and
collaborative implementation of solutions
Facilitate expansion of community-based, primary health care services for
specific population segments receiving inadequate health services (infants
and children; adolescents; the elderly; rural families; urban poor). Develop
extensive networks, and coalitions with health care and social agencies to
develop cooperative efforts to meet the medical needs of the underserved.
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4. Preventing and Controlling Disease
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Protecting Health
 According to Health for All, disease prevention for populations is crucial
to human development. Disease prevention and disease management
across the life span benefits individuals and communities. Communitybased disease prevention and health protection services benefit all,
with implementation demanding minimum individual participation.
Maintenance and extension of such services, where needed, should be
a priority of local government.
 The auditing of preventive actions and disease management programs
can be vastly improved through the usage of The GlobalView Health
Network. The opportunity exists to yield improved health and a
reduction of costs through these actions. The bottom line of prevention
is to reduce the incidence of disease (infectious or chronic). The
Network would monitor and audit the determination of incidence locally
and nationally. Disease management programs offer great potential to
reduce costs while improving outcomes and are great opportunities for
improvement and savings.
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4. Preventing and Controlling Disease
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Protecting Health
 In support of WHO's Health for All, The GlobalView Health Network
would provide assistance that would:
Encourage governments to set priorities for establishing community-based
disease prevention and health protection services emphasizing delivery,
maintenance and extension of such services, where needed.
Encourage delivery of primary care health services as an important
instrument for achieving stronger emphasis on (a) health promotion and
disease prevention, and (b) care of the chronically ill, especially among the
elderly with multiple problems. Primary care allows for disease prevention,
health promotion, and early detection of disease.
Provide access to tools and methods to enable worldwide efforts for
surveillance and control for diseases of global importance through
collaboration with WHO and its international partners.
© H.C., C. R.
Provide access to tools and methods enabling decisions regarding global
eradication to be based upon global consensus so that any action is taken
only after consideration of the likely direct and indirect benefits.
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Protecting Health
Determine simplest and quickest means of linking all points of care for:
collection of relevant data, making relevant data available to medical
decision makers and measuring outcomes in support of prevention and
disease management programs.
Facilitate provision of 24/365 two-way communication among all facilities
and professionals for planning, implementing, monitoring, managing and
evaluating public and private sector health care, prevention and diseasecontrol interventions and programs.
Collaborate with public health services, pharmaceutical, health insurance
and managed care industries worldwide to institute prevention and disease
management programs throughout all health facilities in each nation.
Provide access to and distribution of community-based disease prevention
and disease management programs as well as health protection services.
Provide access to tools, methods and training programs that prioritize
assisting the poorest countries and communities deal with the burden of
childhood infectious diseases, maternal mortality and undernutrition.
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4. Preventing and Controlling Disease
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Protecting Health
 Provide access to tools, methods and training programs as well as the
two-way communication needed for developing and expanding
community-based health care programs emphasizing child survival and
other infant, child and adolescent health services including:
Providing assistance to numerous public and private voluntary organizations
to strengthen children's health care interventions including training health
workers and physicians and developing local and regional capacities to
deliver primary care services.
Helping develop information systems that increase management, evaluation
and planning abilities of local health agencies for children's health care.
Conducting demographic and health surveys which provide data on the
status of children's health interventions.
Disseminating information on health care financing and sustainability.
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Finding better, more economical methods of diagnosis, treatment,
prevention and control of diseases that affect women and children.
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Protecting Health
Providing field and applied research support to improve maternal and
neonatal care, behavior and pregnancy outcomes.
Working with underserved communities to improve health service delivery
and community and home health practices (nutrition, education, preventive
programs, early diagnosis, etc.).
Mobilizing health teams to provide care / train community health workers.
Developing an information exchange among country leaders and health
providers on all aspects of children's health care.
Providing non-degree and degree training for health workers and
professionals through short-term training courses.
Providing technical assistance for appropriate feeding services to improve
the nutritional status of women, infants and children including nutrition
education programs.
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Training service delivery personnel and providing technical assistance on the
prevention of selected diseases and deficiencies.
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5. Fostering the Use Of, and Innovation
.
In Science and Technology
 According to Health for All, closer partnerships between science and
technology, between users and innovators, and between the private
and public sectors will increase the chances that innovations in science
will contribute to improved health worldwide through the development
of technology and the implementation of research.
 The scope of technologies for health extends from those that provide a
direct benefit to health such as genetic modification, biologicals,
pharmaceuticals and medical devices to those that are supportive of
health system functions, such as telecommunications, information
technologies, devices for environmental protection, and food
technologies.
 Communications and electronic information technologies, for instance,
offer opportunities for the most remote researchers to participate fully
and contribute to scientific progress. The GlobalView Health Network
would provide the 24/365 two-way communication needed for voice,
data, video and the ability to share images of all kinds.
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5. Fostering the Use Of, and Innovation
.
In Science and Technology
 The Network's data collection and analysis capabilities will assist
governments to collaborate with various individuals, agencies, NGOs,
and institutions in identifying specific health needs and finding quality,
cost-effective solutions for each of them (pilot programs). This will
foster community-based, primary health care services for selected age
groups which are subject to frequent problems, and for specific
segments of the population that receive inadequate health services.
 This would assist governments to focus on creative health projects that
involve a wide representation of community interests. The value of
collecting information and analyzing data from a set of given projects
lies in putting it to use by disseminating it to local officials, institutional
leaders and other policy makers. Policy makers may then make better,
more knowledgeable decisions about health care for people if they have
information from several successful, proven projects. Information, for
example, on the costs and benefits of preventive community health
care for the elderly, as opposed to the costs and drawbacks of treating
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5. Fostering the Use Of, and Innovation
.
In Science and Technology
 In support of WHO's Health for All, The GlobalView Health Network
would provide assistance that would:
© H.C., C. R.
Provide tools and methods that allow poorer countries to take maximal
advantage of developments in technology and benefit from the experiences
of other countries.
Support country-specific research priorities and action, through which
countries will work towards improved national and global health.
Promote primary care research, clinical trials and access to publication of
results.
Promote original research that encompasses evaluations of model and
demonstration projects to improve rural health, statistical comparisons of
rural-urban differences, and mathematical models examining the service
utilization patterns of rural residents.
Provide access to databases, knowledgebases, and global reference
sources, identify tools to transfer knowledge, technical support, exchange of
experiences, and foster use of appropriate technology and knowledge
assets. Improve treatment outcomes based on best available scientific
evidence.
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6. Building and Maintaining
.
Human Resources for Health
 According to Health for All, a well-trained and motivated workforce is
essential for health systems to function well. The health workforce of
the twenty-first century must be capable of providing quality health
services based on Health for All values. A culture of health that respects
and supports the right to health, ethics, equity, and gender sensitivity,
and analysis in protecting and promoting public health is fundamental.
 GlobalView’s well-designed computer-based courseware provides
enhanced ease of access to instructional courses and sequences. With
interactive multimedia consistent, high-quality training presentations
could be given at a time that is convenient for each worker’s schedule.
For staff with wide ranging computer skills and training needs the
courses allow users or their supervisors to customize training or “pick
and choose” as needed. High demands and narrow budgets are a
genuine challenge for computer-based training. As the systems mature
and health providers cope with the changes in their training and
educational needs, interactive multimedia will become the trainer-of© H.C., C. R. choice in health care.
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6. Building and Maintaining
.
Human Resources for Health
 In support of WHO's Health for All, The GlobalView Health Network
would provide assistance that would:
© H.C., C. R.
Expand human resources planning's current emphasis on medical and
nursing personnel to be complemented by a cadre of people capable of
working in a multidisciplinary and collaborative fashion.
Extend the boundaries of existing developmental, environmental, social,
public health and medical disciplines to include members of the community
who will increasingly provide care for people at home and in the community.
Constantly upgrade health worker's skills to utilize new technologies. Give
greater attention to training in communications and health promotion skills
to serve the public need for better information about health.
Use telecommunications linkages to offer new opportunities for distance
learning and diagnostic support in many settings and allow accelerated
development of human resources in poor countries and communities.
Address broader human resource issues, such as transnational movement of
health professionals, availability of training, need for international
harmonization of education and service standards through broad global and
national policies.
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7. Securing Adequate Financing
.
for Sustainable Health Systems
 According to Health for All, government action and regulation are
needed:
To secure an adequate level of financing (through public or private sources)
To promote cost containment and fiscal discipline
To provide essential drug and technology lists
To ensure that national resources are utilized equitably to meet health
needs.
 Close collaboration between health, finance and planning departments
in government is required to achieve these objectives. When the
government is the main funder of health systems, it follows that equity
of access, efficiency, and cost containment is more likely.
 The GlobalView Health Network would make it possible for health
information to be recorded, collected, analyzed and acted upon with
immediacy and foresight.
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7. Securing Adequate Financing
.
for Sustainable Health Systems
 Data-based decision-making contributes to the enactment of policies
and programs that allocate health resources to priority problems as
supported by epidemiological and demographic data.
 In today's health care environment, epidemiological data collection is
principal to creating priorities for the delivery of care and management
of finances.
 Additionally, epidemiological data helps health care providers make
educated decisions relevant to budgetary planning and long-term
forecasting.
 Future trends suggest that this form of data collection will drive much
of healthcare decision making and will determine how funds are
allocated.
 Being able to monitor and respond to changing health conditions,
whenever and wherever they happen, are keys to health success.
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7. Securing Adequate Financing
.
for Sustainable Health Systems
 In support of WHO's Health for All, The GlobalView Health Network
would provide assistance that would:
Encourage improvement of analytic capabilities to ensure the equitable and
efficient use of financial resources.
Ensure costs of providing access to essential health system functions, as
well as the burden of rationing, will be distributed fairly across the
population.
Help secure adequate levels of financing for sustainable health systems
from community sources and international donors (poorest countries) –
ensuring that a large share of financing derives from a pre-paid source of
revenue to improve the chances of achieving equitable and efficient health
services; and from cost containment measures.
Create pre-identifiable funding streams (from procurement savings and
other sources) to sustain on-going costs to deploy and maintain The Health
for All Network in each nation and worldwide in order to help bring Health
for All in the 21st Century to not just a small group of people, but the whole
family of mankind - and those yet to be born.
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Primary Health. Care System
 The World Health Organization's Health for All Program emphasizes
Primary Health Care (and Prevention) as the centerpiece of health
system reform worldwide because PHC programs are more costeffective than curative programs.
 WHO believes PHC should constitute the core of an affordable basic
health package accessible to all citizens.
 PHC prevents disease, promotes healthy lifestyles and stimulates
community participation.
 Even in developed nations, such as the United States, after decades of
relative neglect in a health care system that placed most of its
emphasis on specialization, high technology, and acute care medicine,
the value of PHC is again being recognized as vital to the reform
sweeping the U.S. health care industry.
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Primary Health. Care System
 The GlobalView Health Network’s definition of primary care is presented
in terms of the function of primary care, not solely in terms of who
provides it. The critical elements include:
Integrated and accessible health care services
Services provided by primary care clinicians – generally considered to be
physicians, nurse practitioners, and physician assistants – but involving a
broader array of individuals in a primary care team
Accountability of clinicians and systems for quality of care, patient
satisfaction, efficient use of resources, and ethical behavior
The majority of personal health care needs, which include physical, mental,
emotional, and social concerns
A sustained partnership between patients and clinicians
Primary care in the context of family and community
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Primary Health. Care System
 The GlobalView Health Network’s road map for reaching its goals are
reflected in five assumptions:
Primary care is the logical foundation of an effective health care system
because primary care can address the large majority of the health problems
present in a population.
Primary care is essential to achieving the objectives that together constitute
value in health care / quality of care (including achievement of desired
health outcomes), patient satisfaction, and efficient resource use.
Personal interactions that include trust and partnership between patients
and clinicians are central to primary care.
Primary care is an important instrument for achieving stronger emphasis on
(a) health promotion and disease prevention and (b) care of the chronically
ill, especially among the elderly with multiple problems.
The trend toward integrated health care systems in a managed care
environment will provide opportunities/challenges for primary care.
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Primary Health.Care System
 To bring this PHC vision closer to reality, The GlobalView Health
Network intends to address the opportunities for and challenges of
reorienting primary health care in our world:
Give a clear definition of the function of primary care that can guide public
and private actions to improve health care.
Encourage certain organizational arrangements for health care, built on a
foundation of strong primary care that will facilitate the coordination of the
full array of services essential for maintaining and improving patient health
status.
Argue for development and dissemination of improved information systems
and quality assurance programs for primary care.
Suggest financing mechanisms that encourage good primary care rather
than episodic interventions late in the disease process.
© H.C., C. R.
Enhance the knowledge base for primary care based on clinical and health
services research.
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Primary Health. Care System
Encourage support for training of a primary care workforce sufficient in
numbers to meet the needs for primary care; equipped with the skills and
competencies that match the function as The GlobalView Health Network
has defined it; and prepared to work in the context of a team that includes
primary care physicians, nurse practitioners, physician assistants,
community health workers, and other health professionals.
Advocate development and sustained support of means to make primary
care available to all people, regardless of economic status, geographic
location, or language and cultural differences.
Speak to the development of primary care as a continually improving
system in an era of rapid change through program evaluations and
dissemination of innovations.
The World Health Organization's Health for All Program emphasizes Primary
Health Care (and Prevention) as the centerpiece of health system reform
worldwide because PHC programs are more cost-effective than curative
programs.
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Primary Health Care
. Steering Group
 The GlobalView Health Network envisions a Best Practice Primary
Health Care System that can be customized for integration into any
of our world's national health systems – electronically supported by The
GlobalView Health Network. Coordinated implementation by many
participants over time is unlikely to take place unless an entity exists
whose purposes are to build appropriate coalitions, stimulate action,
and monitor and facilitate implementation.
 The GlobalView Health Network suggests the formation of a Primary
Health Care Steering Group to coordinate efforts to promote and
enhance primary care, conduct research and development projects,
provide technical assistance, disseminate information on primary care
infrastructure, innovative models of primary care, and methods to
monitor primary care performance. Important parts of the Health for All
agenda require government action, but for many elements the key
decision makers are to be found in in health care plans, in educational
institutions, in professions, and in private foundations and NGOs. Many
© H.C., C. R. of these are committed to a renewed emphasis on primary care.
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Primary Health Care
. Steering Group
 This is a time when creative effort and collaboration can influence the
forces driving health care change in the directions defined by Health for
All. The climate for moving ahead on a global Health for All agenda
emphasizing primary care is quite favorable.
 In support of WHO's Health for All, The GlobalView Health Network and
the Primary Health Care Steering Group will work with
governments to initiate national policies that support these
recommendations, especially those that:
Address the long-term needs for a health workforce
Develop institutional and individual leadership
Strengthen managerial capacity
Improve the management, infrastructure and institutional environment with
a special emphasis on primary healthcare:
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Values Guiding Network
.
Establishment
Patient Care:
 Enhance timely access to medical care and other health services.
 Maximize resource allocation to direct patient-care services.
 Facilitate health promotion, disease prevention, and early diagnosis.
 Enhance appropriate patient referral and service utilization.
 Keep patient-care decision making as close as possible to the patient.
 Promote horizontal, patient-focused processes.
 Minimize disruption of the present system during implementation.
 Provide compassionate, comprehensive, well coordinated healthcare
with equal access to equal services regardless of racial, ethnic,
economic or geographical considerations - especially for women,
children and the elderly.
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Values Guiding Network
.
Establishment
Quality:
 Facilitate the development of integrated systems of care.
 Ensure systemwide consistency in quality and coverage.
 Minimize fragmentation of functions.
 Enhance capacity for continuance improvement.
 Facilitate systemwide data acquisition and performance measurement.
Flexibility:
 Facilitate sharing and collaborative agreements.
 Accommodate national and local healthcare reform initiatives.
 Facilitate local flexibility and decision making.
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Values Guiding Network
.
Establishment
Efficiency:
 A combined clinical and management information system that is firmly
based on gathering information during the course of clinical care and
deriving management data as a by-product of these interactions.
 Gives each health facility immediate access to consolidated data at the
regional / national levels and foster sharing of data between facilities.
 Maximize timeliness of information flow to appropriate decision makers
and internal and external stakeholders to maximize responsiveness to
individual patient needs and outside stakeholders.
 Provide clear lines of authority and responsibility, enhance managerial
accountability, minimize redundancies, maximize administrative
efficiencies.
 Ensure each organizational layer / higher level oversight provides
“added value”.
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Benefits to Ministry
.
of Health
 Quality Improvement - conducting an ongoing review of how to improve
the quality of care and of administrative services.
 Utilization Management - monitoring and reporting on all aspects of
health care service use across all provider groups.
 Patient Services - providing problem-solving assistance and guidance on
how to use the health system.
 Citizen Satisfaction - providing (patient/provider) satisfaction surveys
 Medical services - overseeing clinical services such as those offered at
health plan facilities.
 Outcome measurement - ongoing evaluation of outcome data.
 Provider relations – developing / maintaining productive relationships.
 Regulatory compliance - making sure that all health plans maintain
licensure, certification and accreditation.
 Administration - overseeing all health plan operations
 Claims processing - receiving claims information
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Benefits to Health
.
Providers
 Better care of the patient by using the Network due to:
Diagnostic aids, clinical pathway protocols / science-based guidelines
Initial patient assessment / severity satisfaction
Disease management programs / real-time use of outcomes
Provider education, profiling and feedback
 Real-time second opinion:
Computer-based sophisticated medical algorithms
Access to telemedicine
 Continuous updated education for best available medical service.
 Easier electronic administration of health operations including more
efficient electronic medical records instead of using paper records.
 More efficient claims processing, transmission of claims information,
faster reimbursement of claims due to real-time exchange of information.
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Benefits to Third. Party Payers

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








© H.C., C. R.
Controlling costs and managing risks
Authorizing appropriate treatment
Providing individual attention to members
Adding value through an ongoing dialogue
Communicating with potential subscribers
Facilitating enrollment processes
Benefits management
Premium billing and accounts receivable
Provider contract and pricing management
Capitation
Claims management (medical / hospital / drug / dental / other provider)
Claims payable
Customer / provider service
Correspondence generation
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Benefits to Third. Party Payers
 Medical management
Certification / authorization
Case management / disease management
Concurrent review
Discharge planning
Provider credentialing
Quality improvement
Appeals
 Data warehouse
Utilization database / membership database
Utilization reports
Outcome indicators
Practice providers
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More GlobalView Health
. Network Benefits
 The Network will provide those who finance health care (The Ministry of
Health, multilateral organizations and third party payer organizations)
with more information about the cost, effectiveness and quality of the
services they are buying. The Network will provide more information with
which to manage costs and improve healthcare.
© H.C., C. R.
Eliminate medical tests and operations that are unnecessary - decreasing
duplicative and erroneous tests.
Persuade doctors to prescribe only the most cost-effective drugs and surgical
procedures.
Provide a computerized mechanism through which doctors will have to
demonstrate that their work is effective.
Encourage hospitals/clinics to treat more people as out-patients or at home to
curb health care costs; shorten hospital stays; reduce visits per illness.
Evaluate new alternatives available in the area of commercial or proprietary
criteria guidelines.
Increase productivity of healthcare providers by shifting time from paperwork
to patient care.
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More GlobalView Health
Network Benefits
.
Become doctors’ helpmates to manage data, combine information services,
eliminate unnecessary patient record duplication and advise on trade-offs
using something more than enlightened guesswork (instinctive decision
making involves greater risk than does decision making based on qualitative
information).
Improve financial / management information handling; generating and
updating the value-for-money appraisals that the Ministry of Health and
insurers require.
Automate all hospital operational and clinical departments (Pharmacy,
Imaging, Laboratory, Surgery, Nurse Services. Scheduling, Business Office,
Materials Management, etc.).
Allow concurrent review of performed care.
Provide the electronic storage of all medical records with systems that
facilitate access, retrieval and information sharing.
Provide more careful assessment of the benefits of medical treatment
(including many new technologies which although they are expensive will
yield off-setting savings by reducing need for hospitals, doctors and nurses).
Education and preventive care (with major implications for cost reduction).
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© H.C., C. R.
Create country-specific expert-intelligence software programs to aid in
medical decision making. These systems examine patient data, such as
symptomology, medical background, diet, drug history and laboratory test
results and then apply this data against a knowledge base, measuring it
against the rules of judgment and providing physicians with clinical indicators
to assist in diagnosis as well as user-established protocols. This information
helps improve the speed and effectiveness of patient care. The established
data bases within each nation can lead to creation of customized expert
systems to serve the entire population.
Provide chronic disease management (e.g. diabetes, asthma) - a holistic,
integrated, systematic approach to managing when, where, how and by
whom key disease states can be best and most efficiently prevented,
diagnosed, treated and maintained for the benefit of all concerned.
Dramatic improvements in productivity / job satisfaction.
Allow physicians and their staff to manage the patient care / practice
enhancement aspects of their practices more effectively (physician / hospital
networking).
Provide clinical oversight to identify when to modify, develop and approve
clinical compliance with the government or an accreditation committee.
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