Cristiano Codagnone

Future e-Government Research: 13 Research Themes Identified in the eGovRTD2020 Project

E-government research has become a recognized research domain and many policies and strategies are formulated for e-government implementations. Most of these target the next few years and limited attention has been giving to the long term. The eGovRTD2020, a European Commission co-funded project, investigated the future research on e-government driven by changing circumstances and the evolution of technology. This project consists of an analysis of the state of play, a scenario-building, a gap analysis and a roadmapping activity. In this paper the roadmapping methodology fitting the unique characteristics of the e-government field is presented and the results are briefly discussed. The use of this methodology has resulted in the identification of a large number of e-government research themes. It was found that a roadmapping methodology should match the unique characteristics of e-government. The research shows the need of multidisciplinary research.

Patient Use of Email for Health Care Communication Purposes Across 14 European Countries: An Analysis of Users According to Demographic and Health-Related Factors

Background The use of the Internet for health purposes is growing steadily, yet the use of asynchronous communication tools for health care purposes remains undeveloped. The introduction of email as a method of communication in health care has the potential to impact on both patients and health care professionals. Objective This study aims to describe the characteristics of people who have sent or received an email to or from their doctor, nurse, or health care organization, by country and in relation to demographics, health care resource use, and health status factors. Methods We conducted a secondary analysis of data (N=14,000) collected from the online Citizens and Information Communication Technology for Health survey, a project undertaken in 2011 by the Institute for Prospective Technology Studies of the European Commission’s Joint Research Centre. The survey was developed to understand and characterize European citizens’ use of information communication technologies for health. Descriptive and statistical analyses of association were used to interpret the data. Results Denmark reported the highest level of emails sent/received (507/1000, 50.70%). The lowest level reported was by participants in France (187/1000, 18.70%). Men used email communication for health care more than women, as did respondents in the 16-24 age group and those educated to tertiary level or still within the education system. As self-reported health state worsens, the proportion of people reporting having sent or received an email within the context of health care increases. Email use, poor health, multimorbidity, and number of visits to a physician are positively correlated. Conclusions The use of email communication within the context of European health care is extremely varied. The relationship between high email use, poor health, doctor visits, and multimorbidity is especially pertinent: provision of asynchronous communication for such groups is favored by policymakers. Low reported email use by country may not necessarily reflect low interest in using email for health care: local health policies and technical infrastructures may be significant factors in the delay in implementation of alternative forms of routine health communication.

From Practice to Theory and back to Practice: Reflexivity in Measurement and Evaluation for Evidence-based Policy Making in the Information Society ☆

This article presents a comprehensive review of literature and practice on the measurement and evaluation of ICT impact in general and of selected public eServices (eGovernment, eHealth, and eInclusion), within the context of the Information Society paradigm. It calls for a sustained meta-level analysis, in which it is important to have a self-reflexive layer where we evaluate and measure how we evaluate and measure, and what the implications and the trade-offs are. The analysis justifies the call for reflexivity as a necessary step towards advancing our understanding of the impact of ICT within the Information Society domains observed. The article concludes presenting some possible ways of re-coupling the conceptual and technical dimensions of the measurement process and linking the production of measurement data more closely with impact evaluation causal models and hypotheses. It suggests that this could be achieved by refocusing on the micro level and stimulating a gradual micro-macro link through an intermediate (meso) level, which effects need to be described using different measurements and evaluation paradigms. In order to do so it is required to refine and test our theories and models to find out where it would be most feasible to scale up to the global (macro) level and to shape and inform the production of more valid measurement indicators for better informing evidence-based policy making in the Information Society

Developing an e-government research roadmap: method and example from E-GovRTD2020

Modern governments using innovative ICT have become an increasingly important factor of competitiveness and growth in the European Information Society. Public institutions are forced to improve their operation to become more efficient and effective. As a consequence, modern ICT heavily impacts and forms Government activities in cooperating and interacting with their constituencies. The use of ICT is expected to enable performance of business processes, integration of back-office systems among public (and private) sector, and provision of fully customized and personalized electronic services to the different stakeholders. To investigate what kind of research is needed to spur innovation in the public sector, the European Commission has funded eGovRTD2020, a specific support action in the 6th Framework Program of IST. This contribution introduces the roadmapping methodology developed in the course of the project. Its application is exemplified with the description of a future research theme for advancing eGovernment towards innovative governments in 2020.

Using Data Envelopment Analysis to Analyse the Efficiency of Primary Care Units

In this paper we analyse the efficiency of primary care centres (PCCs) adopting Information and Communication Technology (ICT) devices, using a new database on primary care centres in the Basque Region in Spain. Using a four-stage Data Envelopment Analysis methodology, we are able to explicitly take into account the role of ICT in affecting the efficiency of primary care centres. We understand that this is the first time that ICT enters into the determination of efficiency of the health sector. The role of exogenous factors is explicitly considered in this analysis and shows that including these variables is not neutral to the efficiency evaluation, but leads to an efficiency indicator that only encompasses the effect of managerial skills. The paper provides some useful policy implications regarding the role of ICT in improving the efficiency of primary care units.

Pathos & ethos: emotions and willingness to pay for tobacco products

In this article we use data from a multi-country Randomized Control Trial study on the effect of anti-tobacco pictorial warnings on an individual’s emotions and behavior. By exploiting the exogenous variations of images as an instrument, we are able to identify the effect of emotional responses. We use a range of outcome variables, from cognitive (risk perception and depth of processing) to behavioural (willingness to buy and willingness to pay). Our findings suggest that the odds of buying a tobacco product can be reduced by 80% if the negative affect elicited by the images increases by one standard deviation. More importantly from a public policy perspective, not all emotions behave alike, as eliciting shame, anger, or distress proves more effective in reducing smoking than fear and disgust. JEL Classification C26, C99, D03, I18 PsycINFO classification 2360; 3920

The challenges and opportunities of ‘nudging’

Consider the following selective evidence of human behaviour in the domain of healthcare. The numeric-cognition feeds typically provided during public vaccination campaigns are less effective than affect-based perception of risk.1 It is common to avoid seeing doctors and/or doing health checks because of anxiety and fear of receiving bad results. The latter means that a perceived ‘loss today’ in the health status has a stronger impact than a ‘gain tomorrow’, namely preventing or curing a potential disease.2 Clinicians fail to act on available knowledge and guidelines despite the intention to do so.3 Instead, consider now the following couple of examples of choice architectures capable of offsetting erroneous conducts. Recent trial studies show that it is enough to change the default settings of electronic order sets to dramatically ‘improve’ clinicians prescribing behaviours.4 A lottery-based financial incentive increased warfarin adherence and anticoagulation control.5 What do these examples have in common? They exemplify the heuristics and biases and the counteracting ‘nudges’ that in the past decade have been presented as part of a behavioural sciences-dictated policy agenda. Altering prescription activities by changing defaults in electronic order sets, for instance, is just a very simple example of a ‘nudge’ leveraging the ‘status quo bias’ to steer clinicians toward a ‘normatively’ defined ‘better’ behaviour. This is achieved by framing the choice set without restricting available options, in other words, acting over presentation of the decision problem, and not on the constraints for the decision maker. This philosophy of policy intervention has been labelled ‘libertarian paternalism’ because by not affecting the options available in the choice set it can be deemed to be libertarian from a consequentialist point of view, while being paternalistic in the sense of trying to induce ‘better’ choices.6 The approach is grounded in behavioural economics (BE), …

Strategic Intelligence Monitor on Personal Health Systems (SIMPHS) Market Structure and Innovation Dynamics

Personal Health Systems (PHS) and Remote Patient Monitoring and Treatment (RMT) have the potential to alter the way healthcare is provided by increasing the quantity and quality of care. This report explores the current status of PHS and, more specifically, of the RMT market in Europe. It addresses the question of how these technologies can contribute to dealing with some of the challenges facing the European healthcare delivery systems caused by higher pressure of demand through chronic diseases and demographic change, combined with diminishing resources for health care. Uptake and diffusion of these services would potentially reduce death rates, and avoid recurring hospitalisation in a cost-effective manner. However, the report identifies various barriers which hamper the full deployment of RMT in Europe. In the conclusion, the report provides a number of tentative policy options which aim specifically to foster EU-wide deployment of RMT/PHS.

International health IT benchmarking: learning from cross-country comparisons.

Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning. Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking. Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist. Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons. Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.

The Future of Work in the ‘Sharing Economy’. Market Efficiency and Equitable Opportunities or Unfair Precarisation?

This critical and scoping review essay analyses digital labour markets where labour-intensive services are traded by matching requesters (employers and/or consumers) and providers (workers). It focuses on digital labour markets which allow the remote delivery of electronically transmittable services (i.e. Amazon Mechanical Turk, Upwork, Freelancers, etc.) and those where the matching and administration processes are digital but the delivery of the services is physical and requires direct interaction. The former broad type is called Online Labour Markets (OLMs) and is potentially global. The latter broad type is termed Mobile Labour Markets (MLMs) and is by definition localised. The essay defines and conceptualises these markets proposing a typology which proves to be empirically valid and heuristically useful. It describes their functioning and the socio-demographic profiles of the participants, reviews their economic and social effects, discusses the possible policy implications, and concludes with a research agenda to support European level policy making. It alternates the discussion of ‘hard’ findings from experimental and quasi-experimental studies with analysis of ‘softer’ issues such as rhetorical discourses and media ‘hyped’ accounts. This triangulation is inspired by, and a tribute to, the enduring legacy of the work of Albert O. Hirschman and his view that ideas and rhetoric can become endogenous engines of social change, reforms, and policies. This essay tries to disentangle the rhetoric with available empirical evidence in order to enable a more rational debate at least in the discussion of policies, if not in the public arena. To do so, an in depth analysis of 39 platforms was undertaken together with a formal review of 70 scientific sources. These two main sources have been integrated with: a) an exploration of 100 media accounts (business press, newspapers, magazines, and blogs); b) 50 reports and surveys produced by ‘interested parties’ (industrial associations, platforms own reports and public relation materials, think tanks with a clear political orientation, NGOs, trade unions, etc.); and c) about 200 indirectly relevant scientific contributions and policy reports (used as sources to contextualise and integrate the above sources, and to derive theoretical and interpretative insights). While the evidence is limited and inconclusive with respect to various dimensions, the findings of this essay show, among other things, that: a) individuals engage in these activities primarily for money, for a large segment of them this work is their primary source of income, and most are under-employed and self-employed and fewer are unemployed and inactive; b) matching frictions and hiring inefficiencies are widespread and even the OLMs are far from being globalised online meritocracies; c) a behavioural approach to big data exploration should be further applied because there is emerging evidence of heuristic and biases contributing to hiring inefficiencies.