The rapid developments in information and communication technology together with the growth of the European Union offer new opportunities for collaboration across borders. EUnetHTA (European network for Health Technology Assessment) is an open network connecting organizations with each other and developing practical tools to facilitate cross-border collaboration and to avoid duplication of efforts. The EUnetHTA Project is described in two separate articles (Reference Kristensen, Lampe and Chase11;Reference Kristensen, Mäkelä and Allgurin Neikter12). The Communication Work Package, in collaboration with the EUnetHTA Secretariat, was responsible for the external communication, as well as the internal communication between more than 300 individuals from sixty-four organizations in thirty-three countries.
OBJECTIVES AND AIMS
Communication Objectives
The communication objectives were twofold: to facilitate coherent and effective internal and external communication of the project and to explore how to support communication and work processes in HTA.
Aims
The aims were as follows: To develop and implement a communication strategy; To develop a logotype, graphic profile, and information package; To develop an Information Platform; To develop a prototype of a Clearinghouse; and To develop a running HTA Information System (added aim during the process).
STRUCTURE AND METHODS
Theoretical Background
Communication is a multidisciplinary field involving several approaches. The nature of marketing has changed in recent decades, from selling and delivering products, to include developing and maintaining mutually satisfying long-term relationships (Reference Buttle5). The modern approach views marketing as effective human communication in its widest sense (Reference Lagrosen and Svensson13).
Relationship marketing and knowledge management are two young academic disciplines with many similarities. Relationship marketing includes relationships, networks, and interaction based on information technology (Reference Gummesson9). Collaboration is central, and knowledge is the prime reason for alliances. Knowledge management involves the identification and use of knowledge to improve decisions and actions (Reference Wyatt and Liu25). Knowledge is viewed as a resource for an organization's success.
Design management forms the theoretical approach for the design aspect. The logotype and graphic profile can be described as the visual statement to the world of who and what the organization is, and how the organization views itself (Reference Melewar, Basset and Simoes17). Visual identity strengthens the sense of belonging and must reflect the organization and its objectives. A symbol makes it easier to gain recognition and to recall. Symbols are most powerful if they involve a visual metaphor (Reference Aaker1).
An unmet need can be strategically important as it offers new opportunities. However, individuals are not always aware of their needs because they are accustomed to the existing limitations. The key is to develop the technology, or apply new technology, to expose unmet needs (Reference Aaker1). Creativity can be viewed as a function of knowledge, evaluation, and imagination. It can also be a way to reorganize experience into new configurations (Reference Kreitner10). A network in itself has a structure that promotes creativity (Reference Brown and Duguid4). Creativity could be the key to achieving competitive advantages, which is also supported by research.
Communication Group
The Partners of the Communication Work Package came from different countries with different languages, cultures, and healthcare systems. The individual members involved represented different professional backgrounds, for example, HTA, medicine, health economics, information science, project management, and communication. The group also included representatives from the other Work Packages (Reference Kristensen, Lampe and Chase11;Reference Kristensen, Mäkelä and Allgurin Neikter12). The Communication Work Package, led by SBU in Sweden, was responsible for internal and external communication in collaboration with the EUnetHTA Secretariat. The Clearinghouse subgroup, led by DAHTA/DIMDI in Germany, was responsible for the Clearinghouse project.
Methodology
Development of the EUnetHTA Information Platform, and later the HTA Information System followed an iterative model (Reference Larman15). The project used a practical, interdisciplinary and creative approach. Members’ needs were the starting point for the development process. A test site was set up to enable members to follow the development, try out the tools, and to submit comments. Members described their problems and needs, during meetings, group discussions, and informal interviews—and EUnetHTA tried to solve them. Different steps in the HTA process were identified. Each step involved discussing tools that would be useful to support collaboration, speed up the HTA process, and enhance quality. New ideas and technical solutions were also added.
Technology
Electronic channels, for example, e-meetings, e-newsletters, e-mails, and the Web site, were the most common means of communication. A virtual e-meeting tool (www.saba.com/products/centra/) was provided to EUnetHTA Partners during the project.
A CMS (content management system) was used as a basic technical framework for the Information Platform, and enabled members to update information on the Web site regardless of programming skills. The chosen CMS, EpiServer (www.episerver.com), included several sets of functions to choose from and adapt to the Web site. An effort was made to develop functions that could be used in different Web-based tools. As there was a limited budget, the aim was to be self-sustained and able to develop the Web site further without help from computer programmers. For example, instead of setting up a specific database, a database tool was developed that would enable us to set up several databases ourselves. Another strategy was to develop Web-based tools that were as automated as possible, for example, to include automatic reminders when information is not updated.
RESULTS
Communication Strategy
A communication strategy was developed to guide the communication effort (Reference Allgurin Neikter and Rehnqvist3). A key component of the strategy was to focus on collaboration with Network Partners and other relevant external target groups and stakeholders. Guiding principles included focusing on practical tools, creating added value, involving stakeholders, and avoiding duplication of effort.
Counterforces facing EUnetHTA were identified early in the project and were addressed in the communication strategy. EUnetHTA clarified that the intent was to cooperate with established international HTA organizations and that the focus of communication was on the European level. EUnetHTA should not interfere with decisions made by other network organizations, and it was made clear that the communication and decision making on the national and regional levels were left to the Partners. Two supporting documents were developed: Publication Guidelines (Reference Rehnqvist and Kristensen21) and Graphic Guide (Reference Allgurin Neikter2).
Network Partners were prioritized as a target group and were viewed as an important channel to reach and influence a wider range of people and organizations, as each Partner had their own network of contacts in the HTA field. Partners were encouraged to actively participate in the communication effort and were responsible for communication on the national and regional levels. EUnetHTA, on the other hand, served as a channel for the Partners to promote themselves at the European level. Another important factor was that EUnetHTA Partners represented the prioritized target groups. This gave EUnetHTA an opportunity to reach and collaborate closely with many key target audiences.
Visual Identity
Early in the project, EUnetHTA was given a distinct visual identity with a graphic profile and a logotype to make the project stand out and become visible and recognized (Reference Allgurin Neikter2). Identity found expression in the distinct name, logotype, symbols, fonts, imagery, and colors. The logotype, a visual metaphor, suggests a network and the sun projecting energy. The logotype tells a story through its symbolic meaning and hidden message—HTA. An information package was developed to support Partners’ communication on behalf of EUnetHTA.
Information Platform
The EUnetHTA Information Platform included a public Web site (www.eunethta.net) with a members-only area and eight extranets, one for each working group. The Web site included some communication support tools, for example, calendar, news feed, discussion forums, voting function, group mail, form templates, etc. The Information Platform was developed and hosted by the Work Package Lead Partner (SBU) with input from Partners and content development and provision by the EUnetHTA Secretariat. During 2008, there were 89,646 unique visitors to the Web site.
EUnetHTA used electronic channels and modern technology to facilitate effective communication within the network and to external users. Between face-to-face meetings, more than 200 virtual e-meetings were organized during the project. The e-meeting tool included several functions, for example, document sharing, audio conferencing, text chat, and a possibility to vote.
Clearinghouse Prototype
The Clearinghouse report, prepared by the Co-Lead Partner DAHTA/DIMDI and a smaller subgroup (Reference Dauben, Rüther and Christofides7), described the future Clearinghouse as a technical system offering a single point of access to all HTA-relevant information, for example, HTA reports, databases, and different tools. A computer interface for demonstration was also set up. The Clearinghouse should facilitate communication and sharing of high-quality information in the HTA community. It should also reduce duplication of effort by connecting to existing information and databases. One challenge was to define and describe the terminology needed to achieve common understanding. The prototype also described technical options regarding tools to be developed in other Work Packages.
The Clearinghouse report was evaluated by Partner Organizations in the EUnetHTA Executive Committee (Reference Lund Håheim, Røttingen and Mørland16). The Partners decided not to endorse further development of the suggested solution for the Clearinghouse as it was described in the prototype. The full-scale Clearinghouse would have required a major investment of resources. Instead, a small-scale approach was chosen: to further develop the Web site already in place as the starting point of a HTA Information System. It was also decided that each Work Package Lead Partner should continue to develop and host its own Web-based tools, for example, the HTA Core Model (Reference Lampe14) and the Adaptation Toolkit (Reference Turner, Chase and Milne23). The project aim had been to develop a prototype of a Clearinghouse—not an operating Clearinghouse. This task was accomplished and taken one step further by starting a new project, not planned from the outset—to develop a running HTA Information System.
HTA Information System
SBU developed the HTA Information System starting from the existing Web site (Figure 1). New information, functions, and tools were added to the Web site, with a focus on developing a user-friendly system that met the Partners’ needs. An overview of the HTA Information System is given in Table 1. Previous group discussions, the Clearinghouse prototype (Reference Dauben, Rüther and Christofides7), the Communication strategy (Reference Allgurin Neikter and Rehnqvist3), and a list of prioritized functions desired by Network Partners (8) guided the process. An important guiding principle in the Communication Strategy was to avoid duplication of effort. Therefore, some requests relevant to the improvement of the HTA Database were forwarded to the International Network of Agencies for Health Technology Assessment (INAHTA).
Figure 1. Process to develop the European network for Health Technology Assessment (EUnetHTA) health technology assessment (HTA) Information System.
Table 1. HTA Information System: Overview of Structure, Web-Based Tools and Functions
HTA, health technology assessment; EUnetHTA, European network for Health Technology Assessment.
DISCUSSION
Information and communication technology has changed the way we work, providing many opportunities. EUnetHTA took advantage of the new technology and adapted it to the HTA context. Likewise, modern technologies will give other HTA organizations new opportunities to develop technical solutions, which will further change the way we work in the HTA community. How EUnetHTA was organized—as an open transparent network—was important, as the network construction is known to promote communication, ideas, and creativity.
Communication Strategy
Network Partners were identified as the most important target group and also as a communication channel. Hence, an important aspect was the partnership pool. EUnetHTA Partners represented a majority of the important HTA organizations, HTA networks, and other key organizations. One could say that communication started already when the Network Partners were recruited.
Information Platform
An observation made early in the project, supported by some research (Reference Chalon, Pretoro and Kohn6), was that many HTA doers are not used to new information and communication technology. Initially, many individuals were hesitant to work with new functions; however, throughout the project they became more accustomed to using the communication tools. The extranet editors attended a training course to learn to edit the extranets. Even so, the Webmaster and Secretariat developed and published most of the content. One hurdle was the technical requirements for editors that demanded PC (not, e.g., Macintosh) and the Web-browser Internet Explorer. Another hurdle was to encourage individuals to change habit and invest time to learn a new system, not used daily. In the future, as more people become editors, they should be provided with more support and gradually trained to take on responsibility.
Clearinghouse Prototype
The Clearinghouse project was a large effort that tried to cover many different aspects of the HTA process (Reference Dauben, Rüther and Christofides7). As the prototype covered so much, it was difficult to overview the concept. During the project time frame, it was difficult to explain and later promote the advantages of the Clearinghouse prototype. Members found it difficult to understand the Clearinghouse document, as it was thought to be overly technical and theoretical. In addition, the word “prototype” meant different things to different people. Some expected a system instead of a document. There was also a language problem, both when using English as a second language, but also when using technical terms that people from an HTA background did not understand.
HTA Information System and Working Process
A user-friendly interface was prioritized when building the new HTA Information System, to make it easy for HTA doers to use the tool, actively contribute with content, and eventually become editors. Focusing only on meeting user needs would have been insufficient, as members cannot request functions that they may not know exist. The relationship between needs and creative problem solving is twofold. New ideas and possibilities can also generate new user needs. The project was taken a step further by addressing new ideas. Had it focused only on meeting the limited specific needs expressed by the Partners, the innovative character of the project would have been less.
Research confirms that commitment and trust are important for knowledge exchange in a network. In an HTA context, this suggests that it is important for HTA agencies to trust each other to be able to use each other's information. In a long-term relationship, the parties adapt to one another (Reference Lagrosen and Svensson13). If that happens, it will become easier to work together and to use each other's reports and results in the future.
The HTA Information System can be described as an innovation, at least in the HTA context. The ability to implement and continuously develop the system and the tools will be essential to the Network's future success.
CONCLUSIONS
The EUnetHTA project developed an HTA Information System that included tools for communication and HTA processes. The aim was to support cross-border collaboration to avoid duplication of work among HTA agencies in Europe. The work focused on building structures and practical tools, providing real added value for the Partners.
EUnetHTA took advantage of contemporary technical opportunities to promote innovation in the HTA community and used modern technology as a strategic tool.
Modern information and communication technology supported the network development and collaboration between members. The EUnetHTA HTA Information System, along with technical solutions and Web-based tools developed in other HTA organizations, will offer a new information infrastructure for HTA and could change the way we work in the future.
The communication strategy guided the communication activities in the Network. As collaboration was a guiding principle, it was important that many target groups also were involved in EUnetHTA. This made it easier to collaborate closely and identify user needs.
Design was used as a strategic tool and was identified as a means to achieve and maintain visibility on a limited budget. EUnetHTA's clear visual identity helped the project to stand out from other projects.
CONTACT INFORMATION
Susanna Allgurin Neikter (allgurin@sbu.se), Marketing Director, Swedish Council on Technology Assessment in Health Care (SBU), Olof Palmes Gata 17, P.O. Box 3657, SE-103 59 Stockholm, Sweden
Nina Rehnqvist, MD, PhD (rehnqvist@sbu.se), Chairperson, Swedish Council on Technology Assessment in Health Care, P.O. Box 3657, SE-103 59 Stockholm, Sweden; Adjunct Professor, Department of Medicine, Karolinska Institute, SE-171 76 Stockholm, Sweden
Måns Rosén, PhD (rosen@sbu.se), Director, Swedish Council on Technology Assessment in Health Care, P.O. Box 3657, SE-103 59 Stockholm, Sweden; Adjunct Professor, Epidemiology and Public Health, Umeå University, SE-901 85 Umeå, Sweden
Helena Dahlgren, MBA (dahlgren@sbu.se), Deputy Director, Swedish Council on Technology Assessment in Health Care, P.O. Box 3657, SE-103 59 Stockholm, Sweden
