The LITIS conceptual framework: measuring eHealth readiness and adoption dynamics across the Healthcare Organizations

The Italian Federation of Healthcare Trusts and Municipalities promoted a national initiative, named LITIS, on the levels of technological innovation in healthcare, to assist its members in the governance of the eHealth phenomenon. The result is a toolkit (i) to compare the policies among HealthCare Organizations (HCOs) within a jurisdiction; (ii) to help negotiate and monitor the balanced evolution of eHealth solutions within and across the HCOs, and (iii) to facilitate the collaboration among HCOs to face common topics. The primary achievement is a Conceptual Framework, spanning over the complete spectrum of the support to care and administrative processes, assuming two perspectives: the Functions F (services for citizens, social/healthcare professionals, managers, administrative staff) and the Enabling Components C (prerequisites to deploy the Functions and handle the change). The framework entails a taxonomy of indicators to assess the eHealth readiness and adoption in the HCOs: at first the raw data -from a survey that involved nearly two thirds of the Italian HCOs-were transformed to yield a lower layer of 145 micro-indicators, then the micro-indicators were aggregated at an intermediate layer for two different purposes, either as 36 topics or as 12 sectors; the upmost layer was made of 3 macro-area indexes and a global index, named ICLI. The ontological structure behind the framework allows to adapt the set of microindicators to the context of any particular jurisdiction. The global index was used to classify each HCO into one out of five Classes of Innovation of increasing functional completeness. The lessons learned on presentation and interpretation of results are described.