Health On the Net

What is the role of WHO as an intergovernmental organization in the coordination of telematics in health care?

Walter Gulbinat
World Health Organization
Geneva, Switzerland

WHO acts as the directing and co-ordinating authority on international health work (article 2 of the Constitution of WHO). The two main functions of WHO are technical cooperation with countries, and directing and coordinating international health work. Both functions are complementary and include:

The actual and potential role of telematics in WHO will be discussed briefly for each of those domains.

While the use of Internet and World-Wide Web represent important potentials for increasing the efficiency and the effectiveness and hence the relevance of WHO's work, this role of telematics in WHO is not basically different from its role other sectors of society. Therefore, the main emphasis of the presentation will be on WHO's normative function which include the development, promotion and dissemination of international standards, guidelines, nomenclatures, methods, and norms, as they apply to health informatics and telematics.

Health related data are needed and collected for many purposes, such as clinical patient management, reimbursement of health related services, hospital and health service management, health planning and resource allocation, health care system monitoring and evaluation, epidemiological and clinical research, disease prevention. It would be unrealistic to expect that a single national or international information system could be developed and used for all such purposes. In fact, many dedicated information systems exist and new ones are being created almost daily. Hence data exchange becomes mandatory. In fact, data exchange among computer-based information systems is the prerequisite for the cost-effective use of such systems. The main obstacle for this to happen, however, is that data collected at a given entry point are usually not compatible for use at another point in the health system. Therefore, the need is recognized for the development of standards, minimum data sets and a common language for health. The alternative approach, to develop interfaces or translation engines, to make communication possible, is considered less frequently but equally important.It is in these areas where WHO does have a unique role to play.

The presentation will focus on the data usually collected at clinical level related to patient care. It will refer to the classical health care model which deals with concepts of disease, treatment, and cure, where the diagnosis determines the treatment, and the result of the treatment is the cure. Unfortunately, many diseases and most chronic health problems do not fall into this category. Taking mental disorders as an example, it will be shown that the sequence underlying illness-related phenomena needs extension. This can be represented as

risk factor --> disease --> disability --> intervention --> outcome
There is reasonably good international agreement on a classification of diseases, and the International Classification of Diseases (ICD) published by WHO represents this standard. However, there are no internationally accepted classifications and standards for health risk factors, disabilities, heath service interventions, and outcome of interventions for chronic diseases.

WHO's initiatives and work in theses fields will be discussed. Finally, reference will be made to a WHO project on the development of a prestandards for (mental health) interventions on which it easier to agree, which can serve as building blocks for various classification systems, and which can be translated into different languages more easily and hence facilitate communication internationally.


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