SAGAR Evaluation of Covergence. The influence of epSOS I Design in the progress of corvergence of E-health strategies at European Level though the use of ePrescription

Summary Introduction The epSOS project is a pilot project, which began in 2008 with twelve participating nations (PN) united under the name of epSOS I; in 2011 eleven other countries joined the project. The evaluation of the epSOS I design highlights the consequences of implementing the epSOS project within national e-health strategies. Although convergence in e-health strategies is an incidental effect of epSOS, this thesis addresses the conceptual model of convergence in e-health strategies. The topic of this thesis is the evaluation of the degree of influence the epSOS I design has in the process of convergence in e-health strategies of the PN through the use of ePrescription (eP). Conceptual framework An unique conceptual framework has been designed in order to address the gap in knowledge on the topic of convergence in e-health strategies. An evaluation methodology and an instrument fitted for this particular evaluation has been developed. The proposed evaluation methodology is based on: (1) the scientific literature on the evaluation of e-health programs, (2) the particularities of the epSOS project, and (3) the consultation with experts in e-health area. The design of the evaluation integrated the use of a multi-perspective approach to provide a holistic framework for the evaluation of convergence in e-health strategies of the PN. The multimethod evaluation approach, integrates qualitative and quantitative research methods, as well as multiple research instruments in order to bring comprehensive results. Given that convergence is not a state per se, the multi-time perspective considered three different time-series: 2008, 2011, 2013; the joint of the three time-series determines the trend of the level of convergence. The multi-disciplinary approach considers different dimensions covering multiple indicators. The proposed evaluation methodology is named SAGAR evaluation. Methods A joint of methods have been used in order to determine the level of influence the epSOS I design has in the convergence of e-health strategies of the PN. An internet-base questionnaire has been developed as the main evaluation tool for epSOS I and epSOS II PN. A validation of the questionnaire was done through semistructured telephone interviews with six key actors with thorough knowledge on the development of the epSOS project. The descriptive, attitude and predictive questions were coded based on a pre-determined matrix with five dimensions, from ‘no influence from epSOS’ to ‘full convergence because of epSOS’. The results of the analysis are presented in graphs and charts for each dimension and time series apart. Findings The findings offered the degree of convergence at current moment for the SAGAR dimensions. The interoperability issues (Syntax and Semantics) as well as the technology design of the system (Architecture and Applications) proved convergence in 2011 due to the epSOS I design – to certain degrees. However, the Governance of e-health strategies and the Regulatory aspects confirmed the trends of the literature, and showed a low degree of convergence because of epSOS. Considering the three time-series altogether, a broad image on the degree of convergence was determined. The overall image resulted from this evaluation shows clear trends toward alignment and convergence for epSOS I countries, while for epSOS II the trends are toward convergence and full convergence. Conclusions Convergence in e-health strategies remains a topic open for research in the different programs that aim interoperability and cross-border communication. The SAGAR evaluation framework represents a corner stone in the evaluation of convergence especially for the epSOS use cases, but also for other programs in the Western world. Since convergence is not a state per se, periodic re-evaluations would complete the image and define the trajectories of convergence in e-health systems of the evaluated countries.