Conclusions
The study of the development of Lithuanian eGovernment and eHealth services leads to the conclusion that services in these two domains are at different levels of maturity. eGovernment services have surpassed the first stage of being made ready and accessible and have already moved on to a stage where a policy focus should be placed on the usage and impact. eHealth development, however, is still in the first stage of service accessibility where service supply and the level of service interactivity are the prime targets of the policy.
eGovernment in Lithuania has already reached a stage where the essential infrastructure is in place, and the public are aware of its existence. Though further public education and awareness raising are still necessary, this is being carried out, and further developed, through initiatives by private and public institutions, NGOs, education institutions, joint private and public sector initiatives, and individuals themselves.
eGovernment development has already reached a certain level of service supply: most of the public administration institutions provide some eServices and are improving them gradually. Lithuania’s ranking among EU member states in general eGovernment service availability is very close to the average (68% and 75% respectively. Business usage of eGovernment services is also at the average EU level, although the usage by individuals and Internet access at home remain far lower than in EU25 (13% and 24% respectively for eGovernment usage by individuals and 35% and 51% respectively for Internet access at home; however, these figures are constantly rising) as does the population’s ability to use eGovernment services in terms of skills.
The environment for eGovernment development can be described as rather favourable. The goal to provide efficient eGovernment services is recognized and is among the policy priorities. The legal background for the provision of eGovernment services is in place: an eGovernment conceptual framework and an implementation plan were prepared and updated and are currently being carried out. Legislation or eSignature, eSecurity, personal data protection, state registers and other related issues are in effect. The Strategy for Public Administration Development has been adopted and is being implemented. eGovernment and broader issues of the information society have been incorporated into the general political agenda (government programme, long-term state development strategy, Lisbon strategy implementation plan, etc.). The institutional background is also in place: responsibility for information society policy is distributed horizontally among the ministries; the Ministry of Internal Affairs being responsible for eGovernment. Public administration lies within the competence of the same ministry. A specialised institution – the Information Society Development Committee (ISDC) – is coordinating and facilitating all issues to do with the information society. Communication infrastructure is well-developed on both the supply and user side and is being improved constantly, mainly by means of EU structural funds.
The main shortfall in eGovernment development currently is that it does not provide for full achievement of the eService targets, i.e. efficiency and transparency. eGovernment does not change the prevailing outdated public administration framework and tradition, but rather adapts to it. Though a number of services have been implemented formally, they do not simplify public administration procedures by themselves. On the other hand, the supply of eGovernment services is not an outcome of user demand or a cost-efficiency decision within public administration, but merely the consequence of EU recommendations. The eGovernment implementation process has been burdened by lack of motivation and skills in project management among public administration officials, poor and fragmented monitoring of implementation and, above all, slow public administration reform.
In eHealth, the supply of services is clearly insufficient, though needed and wanted by users. Many eHealth projects are currently being implemented in Lithuania at national and local levels, core eServices have started to emerge, separate modern international eHealth pilot networks are being created and cooperation projects are underway. Regrettably, as mentioned above, ICT activities in healthcare are sporadic and poorly coordinated and little information about the results achieved is available. Awareness of eHealth benefits is increasing among healthcare providers. Today, the main focus is on the development of a national health information system which will have Electronic Patient Records, ePresciption, eReferrals, and eBooking functions. The absence of this system was the main excuse made by healthcare providers for the scarce supply of eServices.
The majority of experts interviewed recognised that the slow development of eHealth services results mainly from politicians and healthcare providers’ limited understanding of what kind of services should be developed and their limited motivation to do it. There is no document on eHealth development policy at a national level so far, which impedes eHealth development and opens space for non-coordinated activities. Therefore, as the first step, an eHealth strategy should be approved at national level and there could be broader discussion on these issues in society. Second, the implementation process should be managed and supported at national level by selecting necessary standards and managing the national infrastructure and certain general databases/registers. The implementation of these tasks will require good institutional capacities. It has been generally admitted that, at the moment, the Ministry of Health’s ability to coordinate ongoing eHealth projects is insufficient. Therefore, the establishment of a centralized coordinating institution, a National Centre of Competence, which would ensure both the implementation of the strategy and the administration of a newly-created national health information system at the primary stage of implementation, should be considered.
However, the ultimate facilitator for eHealth-friendly motivation among healthcare providers can only be structural healthcare reform tailored for the needs of patients and competition among providers and directed to attain specific results, i.e. incentives should emerge within the system to suit the patient, to expand access to services and improve their quality.
The aspiration for efficient public administration and healthcare services and EU initiatives in this field, coupled with financial support from EU structural funds, are the two major forces driving forward the development of both eGovernment and eHealth in Lithuania.
An overall reform of public administration is the most essential measure for further successful development of eServices. This would change the prevailing model of the public administration system which, according to numerous local and international analysts, is static, closed and hierarchic. The new system should be flexible, user-oriented, flatter in the decision-making hierarchy and interactive. This reform would have to change the motivation and function of public administration completely to reinforce the achievement of the aims and user-orientation. Better user-orientation would indicate which eServices should be implemented, and allow a complete life cycle approach to the service, including training, improving, and promoting. It would also allow correct pricing or favourable treatment for online users; and the use of the best business models and technologies to save costs and serve the user. Furthermore, it would encourage investment in training and increase qualifications.
This is valid for the entire public administration system, including national and municipal levels and all public healthcare institutions. It should be noted that, in order to achieve client-orientation and efficient operation of the healthcare sector, a number of structural changes should be carried out in the sector itself (such as legalizing co-payments, allocating public funding on the grounds of competition, creating conditions for supplementary insurance and private suppliers to operate, etc.). Otherwise, eSolutions will not be able to deliver the required results. In healthcare, eSolutions are potential instruments for improving access to services and their quality and safety, ensuring healthcare based on scientific evidence, seeking continuity of services and utilizing more effectively, rationally and with greater transparency the restricted resources allocated for healthcare.
Currently, public administration reform is multilayered. It has been designed to increase the overall efficiency of the public sector, with no particular focus on eGovernment or eHealth. We believe that stimulating the public sector’s motivation for greater efficiency would in itself very strongly set eGovernment and eHealth as priority measures. The results, in terms of consumer satisfaction and cost-saving rates, of the operation of public institutions should be evaluated and announced annually. Similar monitoring of eHealth service provision should take place. Institutions which achieve high scores should be rewarded. This measure should make the institutions compete among themselves not only for political influence, but also in the quality of their performance, transparency, and accountability to society.
In order to identify cases where overall reforms of public administration and healthcare systems are not carried out successfully enough, indicators of user-satisfaction and service costs should be monitored and introduced in a number of more advanced institutions, providing services to business and citizens (such as the Tax Inspectorate, Customs Office and certain healthcare institutions). These indicators could then be used to evaluate the performance of these institutions and help to expand the monitoring system to other institutions later. This would be a much weaker driver for changing motivation, bearing in mind the reluctance of bureaucracies and closed systems to reform themselves and also the amount of political will and know-how needed. However, it could turn out to be a partial but practical solution.
So far, it is the supply side of eServices that has received significant emphasis at EU level. The lists of EU-benchmarked eGovernment services have kick-started the process of eGovernment and eHealth development in Lithuania, while EU structural funds are sustaining the continuation of the process. Now, when some experience of eGovernment service implementation exists in all member states, the emphasis should clearly move to the user side. We suggest that users should be allowed to evaluate eServices themselves. Within the scope of eGovernment and eHealth, a set of indicators, should be agreed upon.
EU institutions (the Commission particularly) could prove very helpful in assisting national administrations to find measurable factors to assess the quality of public administration services and these services online. In this way, the indicators would be comparable among the countries and could help to increase the value of public services and to curb bureaucracy across Europe. The process of eService direct evaluation by users could also serve as a promotion tool for these services.
Another clear issue, though it has been neglected up till now, is the scope of the concept ‘on-line’ (or ‘e-’). At present, only services provided via the Internet are regarded as eServices, while telephone services, though they exist and are being used, are not given the same importance and are not included in benchmarking. Taking into account the constant development of electronic devices and technological convergence, we believe that all electronic means in terms of eServices should be included in an eService concept on an equal basis.
