DOCSLIB.ORG

Building Consensus on the Readiness for EHR in Lebanon Are Lebanon Hospitals Ready to Get Rid of Papers?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Building Consensus on the Readiness for EHR in Lebanon Are Lebanon Hospitals Ready to Get Rid of Papers? Building Consensus on the Readiness for EHR in Lebanon Are Lebanon Hospitals ready to get rid of papers? July 2019 Prepared for: Ministry of Public Health (MoPH) – Policy Support Observatory (PSO) World Health Organization (WHO) – Lebanon Office Prepared by: Ghassan Hamadeh1, Joe Max Wakim1, Ali Romani2, Hossein Hamam1, Najla Daher1, and Rita Nassar1 1 American University of Beirut Medical Center (AUBMC), Beirut, Lebanon 2 Ministry of Public Health of Lebanon Acknowledgements This work has been supported by WHO – Lebanon Office (WHO Registration 2019/882381-0) The authors are grateful to all their collaborators and focus groups and conference participants for their valuable contributions. We acknowledge in particular, Dr. Yousef Bassim, Mr. Karim Hatem (Ylios-France), Mr. Ghassan Lahham (EHSI-Jordan), the Syndicate of Hospitals in Lebanon and the information technology teams at the Ministry of Public Health and the American University of Beirut Medical Center. Notice to readers This document is intended solely for the information and use of Ministry of Public Health of Lebanon. The authors assume no responsibility to any user of the document other than the MoPH. Any other persons who choose to rely on this analysis do so entirely at their own risk. Correspondence Ghassan Hamadeh, MD – CMIO, AUBMC. email: [email protected] Citation Hamadeh, G., et al., Consensus about EMR in Lebanon. 2019, Ministry of Public Health Policy Support Observatory: Beirut, Lebanon Website: https://aub.edu.lb/fm/CME/Pages/EHR-Readiness.aspx https://www.moph.gov.lb/en/Pages/6/18521/policy-support-observatory-pso- 2 Table of Contents Acknowledgements .......................................................................................................................... 2 Table of Contents .............................................................................................................................. 3 List of Tables, Figures & Boxes .......................................................................................................... 4 Abbreviations and Acronyms ............................................................................................................ 5 Executive Summary .......................................................................................................................... 6 Section One: White Paper on EHR adoption in Lebanon ................................................................... 8 Introduction .................................................................................................................................. 8 What is eHealth ............................................................................................................................. 9 Value from eHealth........................................................................................................................ 9 What do we really want out of EHRs? .......................................................................................... 10 Digital Maturity ........................................................................................................................... 12 Health Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Model (EMRAM) ....................................................................................................... 13 Digital Hospital ........................................................................................................................ 14 Certified EHR ............................................................................................................................... 15 Readiness Assessment ................................................................................................................. 17 Section Two: Lebanon Readiness & Consensus 2019 Activity Overview ......................................... 19 Focus Group Discussions .............................................................................................................. 19 Online Survey .............................................................................................................................. 21 General Meeting .......................................................................................................................... 23 Section Three: Model Request for Proposal / Information ............................................................. 26 Statement of Purpose .................................................................................................................. 26 Background and Overview ........................................................................................................... 27 High Level Requirements ............................................................................................................. 29 EHR Modules / Features .......................................................................................................... 29 Interoperability ........................................................................................................................ 35 Infrastructure requirements .................................................................................................... 36 Information to complete .............................................................................................................. 37 Terms and Instructions ................................................................................................................ 41 Information review process ......................................................................................................... 43 Definitions ................................................................................................................................... 45 Appendices ..................................................................................................................................... 46 Appendix 1: Healthcare Interoperability Glossary ........................................................................ 46 Appendix 2: Lebanon eHealth country profile (WHO Survey) ....................................................... 57 Appendix 3: A checklist in preparing for hospital-wide electronic medical record implementation and digital transformation ........................................................................................................... 60 Appendix 4: Focus Group Discussion Results ................................................................................ 61 Dimension 1: Governmental Regulations and Roles ................................................................. 61 Dimension 2: User Access and Accessibility Policies and Infrastructure .................................... 62 3 Dimension 3: Standardization, Policies, Protocols and Procedures ........................................... 62 Dimension 4: Information Communication Technologies Architecture/Infrastructure .............. 63 Appendix 5: Hospital Readiness Survey Results ............................................................................ 64 Part I - General Information ..................................................................................................... 64 Part II - EHR Current Status ...................................................................................................... 65 Part III - Organizational Alignment ........................................................................................... 66 Part IV - Human resources readiness ........................................................................................ 68 Part V - Operational Readiness ................................................................................................. 70 Part VI - Technology Readiness ................................................................................................ 71 Part VII - eHealth Readiness ..................................................................................................... 73 Appendix 6: Consensus Conference Presentations ....................................................................... 74 Appendix 7: Lebanon Health IT Stakeholders who participated in this activity ............................ 119 References .................................................................................................................................... 123 List of Tables, Figures & Boxes Table 1: E Benefits of EHRs – the 10E’s ............................................................................................ 11 Table 2: EHR FUNCTIONALITY REQUIREMENTS ................................................................................ 11 Table 3: Respondents characteristics ............................................................................................... 21 Table 4: EHR current Status in Lebanese Health Institutions ............................................................ 21 Table 5: Organizational alignment ................................................................................................... 21 Table 6: Operational & Technology Readiness ................................................................................. 22 Table 7: Awareness of eHealth issues .............................................................................................. 22 Figure 1: Suggested roadmap for transforming patient care documentation in Lebanon hospitals ..... 7 Figure 2: Price’s Model of EMR Adoption ........................................................................................
Load more

Recommended publications
  • Media and Muslim Women Empowerment
    DIPARTIMENTO DI SCIENZE POLITICHE Cattedra di Cultura e Politica dell'Islam MEDIA AND MUSLIM WOMEN EMPOWERMENT RELATORE Prof.ssa Francesca Maria Corrao CANDIDATA Julia del Papa Matr. 613772 CORRELATORE Prof.ssa Emiliana De Blasio ANNO ACCADEMICO 2011-2012 Table of Contents Abstract .................................................................................................... 3 Introduction ............................................................................................. 4 Women and Islam ................................................................................... 7 Women in Islam ....................................................................................................... 7 Women in the Quran and the Sunna ........................................................................ 7 Motherhood in Islam .............................................................................................. 11 Islam in Different Countries ................................................................................... 14 Brief History of Islam in Relation to the Role of Muslim Women ........................ 20 Interpretations of the Quran ................................................................................... 22 Islamic Feminism ................................................................................................... 24 Final Considerations............................................................................................... 26 Women in the Arab World Today ......................................................
    [Show full text]
  • AMO Cover-F-Eng
    1 ss;s; PRODUCTION TABLE OF CONTENTS ACKNOWLEDGEMENTS 02 Project Team Foreword: Dubai Press Club 04 Foreword: Deloitte Maryam Bin Fahad, Executive Director 06 Acknowledgements Nadin Al Lahham, Business Development Supervisor 08 Executive Summary Adel Ibrahim, Senior Manager Operations 12 Methodology Muna Busamra, Deputy Manager Arab Journalism Award Sadiq Jarrar, Communications & PR Manager Section 1: Arab Media in a Global Context 15 Jasim Al Shemsi, Deputy Project Manager Mohab Mazen, Deputy Events Manager 1. Print 25 Afra Matar, Brand Executive 2. TV 41 Khalid Jamal, PR Coordinator 3. Digital 57 Ahmad Khalid, Events Coordinator 4. Other Platforms 77 Khulood Alkhoory, Media Relations Coordinator 5. TV Series 81 Rajeev Kandathil, Administrative Executive 6. Movies 95 Mohamed Al Hosany, Events Coordinator 7. Sports 109 Ahmed Al Muhairbi, Media Relations Coordinator 8. Music 123 Ahmed Al Hashimi, Media Relations Coordinator Abdul Hani Aliouat, Arabic Editor & Proofreader Section 2: Regional Update 135 Dana Beydoun, Senior Editor In-focus countries 137 Sireen Jannoun, Senior Editor Country-by-country update 175 Section 3: The Media Revolution For Feedback and Review 1. Introduction 223 Dr. Hessa Lootah, Assistant Professor Department of Public Media and Communications - Emirates University 2. Social Media 224 Mamoon Sbeih, Managing Director - Arab Region, APCO Worldwide 3. Satellite TV 229 Craig D`Silva, Project Consultant, APCO Worldwide 4. Implications for the Future 232 Musab Zakarya – For translation 5. Conclusion 238 For Deloitte Glossary
    [Show full text]
  • Tesi Doctoral Ruben Gomez Muns
    LA WORLD MUSIC EN EL MEDITERRÁNEO (1987-2007): 20 AÑOS DE ESCENA MUSICAL, GLOBALIZACIÓN E INTERCULTURALIDAD Rubén Gómez Muns ADVERTIMENT. L'accés als continguts d'aquesta tesi doctoral i la seva utilització ha de respectar els drets de la persona autora. Pot ser utilitzada per a consulta o estudi personal, així com en activitats o materials d'investigació i docència en els termes establerts a l'art. 32 del Text Refós de la Llei de Propietat Intel·lectual (RDL 1/1996). Per altres utilitzacions es requereix l'autorització prèvia i expressa de la persona autora. En qualsevol cas, en la utilització dels seus continguts caldrà indicar de forma clara el nom i cognoms de la persona autora i el títol de la tesi doctoral. No s'autoritza la seva reproducció o altres formes d'explotació efectuades amb finalitats de lucre ni la seva comunicació pública des d'un lloc aliè al servei TDX. Tampoc s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX (framing). Aquesta reserva de drets afecta tant als continguts de la tesi com als seus resums i índexs. ADVERTENCIA. El acceso a los contenidos de esta tesis doctoral y su utilización debe respetar los derechos de la persona autora. Puede ser utilizada para consulta o estudio personal, así como en actividades o materiales de investigación y docencia en los términos establecidos en el art. 32 del Texto Refundido de la Ley de Propiedad Intelectual (RDL 1/1996). Para otros usos se requiere la autorización previa y expresa de la persona autora.
    [Show full text]
  • Rhythms and Rhymes of Life: Music and Identification Processes of Dutch-Moroccan Youth Gazzah, Miriam
    www.ssoar.info Rhythms and rhymes of life: music and identification processes of Dutch-Moroccan youth Gazzah, Miriam Veröffentlichungsversion / Published Version Monographie / phd thesis Zur Verfügung gestellt in Kooperation mit / provided in cooperation with: OAPEN (Open Access Publishing in European Networks) Empfohlene Zitierung / Suggested Citation: Gazzah, M. (2008). Rhythms and rhymes of life: music and identification processes of Dutch-Moroccan youth. (ISIM Dissertations). Amsterdam: Amsterdam Univ. Press. https://nbn-resolving.org/urn:nbn:de:0168-ssoar-271792 Nutzungsbedingungen: Terms of use: Dieser Text wird unter einer CC BY-NC-ND Lizenz This document is made available under a CC BY-NC-ND Licence (Namensnennung-Nicht-kommerziell-Keine Bearbeitung) zur (Attribution-Non Comercial-NoDerivatives). For more Information Verfügung gestellt. Nähere Auskünfte zu den CC-Lizenzen finden see: Sie hier: https://creativecommons.org/licenses/by-nc-nd/4.0 https://creativecommons.org/licenses/by-nc-nd/4.0/deed.de RHYTHMSRHYMES AND RHYTHMS AND RHYMES OF LIFE Rhythms and Rhymes of Life: Music and Identification Processes of Dutch- Moroccan Youth is a comprehensive anthropological study of the social significance of music among Dutch-Moroccan youth. In the Netherlands, a Dutch-Moroccan music scene has emerged, including events and websites. Dutch-Moroccan youth are often pioneers in the Dutch hip- OF hop scene, using music as a tool to identify with or distance themselves from others. They (re)present and position themselves in society through LIFE music and musical activities. The chapters deal with the development of the Dutch-Moroccan music scene, the construction of Dutch-Moroccan identity, the impact of Islam on female artists and the way Dutch- Moroccan rappers react to stereotypes about Moroccans.
    [Show full text]
  • 1,646,307 Vehicles in Lebanon
    CDR after 33 years: Overshadowed ministries and shortcomings Squandering of public funds: ESCWA building February 2010 | Municipal and ikhtiariah elections in the Beqa’a 91 The Monthly interviews German Ambassador Birgitta Maria Siefker-Eberle issue number www.iimonthly.com • Published by Information International sal 1,646,307 VEHICLES IN LEBANON 50% of new cars are mortgaged 76.5% of vehicles are more than 10 years old Lebanon 5,000LL | Saudi Arabia 15SR | UAE 15DHR | Jordan 2JD| Syria 75SYP | Iraq 3,500IQD | Kuwait 1.5KD | Qatar 15QR | Bahrain 2BD | Oman 2OR | Yemen 15YRI | Egypt 10EP | Europe 5Euros INDEX 4 LEADER: Vehicles in Lebanon 7 LEADER: Special License Plate Numbers 9 LEADER: From USD 5,000 to USD 50,000 10 CDR after 33 years: Overshadowed ministries and many shortcomings 14 Squandering of public funds-case study: ESCWA building 16 Municipal and ikhtiariah elections in the Beqa’a 23 Criminal liability 25 Syndicate of Professional Artists Page 10 27 Louise Wegmann (CLW) 29 ALBA University 31 Foreign and Arab companies in 2009 32 Chronic cough by Dr. Hanna Saadah 33 Science in the media Page 38 Page 25 by Antoine Boutros 34 Phoenicia in the Hellenistic era by Dr. Hassan Salameh Sarkis 35 The Monthly interviews German Ambassador Birgitta Maria Siefker-Eberle 47 Real estate index in Lebanon-2009 37 Popular culture 48 Food Price Index 2009: Stability and decline 38 Myth #30: Paul Guiragossian: A Lebanese or Palestinian artist? 50 Children around the world 39 Must-read books: The Spirit of the Pot 50 Beirut Rafic Hariri International
    [Show full text]
  • December 2014
    The Maronite Voice A Publication of the Maronite Eparchies in the USA Volume X Issue No. XI December 2014 Come Home for Christmas! ed up with self-righteous people? I am too, but there is a problem: the worst offender is me! The famous FEnglish philosopher and critic G.K.Chesterton used to ask: "What's wrong with the world?" And he would answer, "I am!" There are two kinds of self-righteous people: those who come to Church, and those who do not. Those who go to Church, and are bent on their own self-righteousness, look down on everyone else, and sometimes think they leave justified - a little like the Pharisee in the Temple, who in Jesus' story looked down on the tax collector. You know the story. Modern day Pharisees also compare themselves to others and say, "I'm in much better shape than this or that one!" But are they? Just because they have succeeded morally, where others have failed, does that make them better than others? Regarding someone who morally has fallen, Saint Francis used to say: "There, but for the grace of God, go I!" Thus, because everyone is capable of making major mistakes in life, it would be far better if the self-righteous Church-goer would reach out a helping hand to the struggling person, rather than look down on them. Nonetheless, there is hope for the self-righteous Church-goer. He can always repent and correct his mistake, because he hears the Gospel, receives Holy Communion, shares the same table, and spends time under the same roof with other sinners.
    [Show full text]
  • American University of Beirut Interdialectal Communication and Code Switching in Pan-Arab Reality Television the Case of Arab Idol
    AMERICAN UNIVERSITY OF BEIRUT INTERDIALECTAL COMMUNICATION AND CODE SWITCHING IN PAN-ARAB REALITY TELEVISION THE CASE OF ARAB IDOL by GENEVIEVE MARIE HECKEL A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts to the Center for Arab and Middle Eastern Studies of the Faculty of Arts and Sciences at the American University of Beirut Beirut, Lebanon September 2014 _• .. • . _ . c . .". - '- ---- ._-._---- _. - -"-. -,- -._... "- - --- --"- -,"..:.., .. AMERICAN UNIVERSITY OF BEIRUT INTERDIALECTAL COMMUNICATION AND CODE SWITCHING IN PAN-ARAB REALITY TELEVISION THE CASE OF ARAB IDOL by GENEVIEVE MARIE HECKEL Dr. David Wilmsen, Associate Professor Advisor Department of Arabic and Near Eastern Languages Dr. Nabil Dajani, Professor Member of Committee Department of Sociology, Anthropology and Media Studies Dr. Micha rmy, Assistant Professor Member of Committee Department of English Date of thesis defense: September 12,2014 AMERICAN UNIVERSITY OF BEIRUT THESIS, DISSERTATION, PROJECT RELEASE FORM Student Name: ---Heckel._---- Genevieve----------' Marie ---­ Last First Middle • Master's Thesis o Master's Project o Doctoral Dissertation [K] I authorize the American University ofBeirut to: (a) reproduce hard or electronic copies ofmy thesis, dissertation, or project; (b) include such copies in the archives and digital repositories ofthe University; and (c) make freely available such copies to third parties for research or educational purposes. o I authorize the American University ofBeirut, three years after the date of submitting my thesis, dissertation, or project, to: (a) reproduce hard or electronic copies ofit; (b) include such copies in the archives and digital repositories ofthe University; and (c) make freely available such copies to third parties for research or educational purposes.
    [Show full text]
  • P38-39Sp Layout 1
    lifestyle TUESDAY, JANUARY 7, 2014 Features ‘Shop at Your Best’ at Dubai Shopping Festival 2014 By Nawara Fattahova culture including international shows, concerts, shopping promotions and mega raffles offering prizes worth millions of dirhams. This is a true manifestation of the whole month of shopping, special offers, and many entertaining events festival theme “Shop at your Best” that is bound to make DSF 2014 the most mem- await visitors to Dubai at the Dubai Shopping Festival (DSF) 2014 from orable edition yet since the shopping and entertainment extravaganza was Jan 2 to Feb 2, 2014. The festival is sparkling with over 150 attractions launched in 1996. Athemed “Shop at Your Best”. Monthly spending in Dubai is about 14 million dirhams by four million visitors. The 19th edition of the Dubai Shopping Festival has exciting activities high- “About 25-30 percent of these visitors are international visitors, while the rest are lighting Dubai as an international family tourism destination that offers unique residents of the United Arab Emirates. More than 6,000 stores are participating in shopping experiences. More than 100 million dirhams’ worth of prizes are waiting the festival, all offering special discounts, and an inspection committee is control- for the lucky winners of various raffle draws in different locations including a Rolls- ling the stores to make sure the sales are real. The inspectors also check the raffle Royce, Lamborghini, 8 BMWs, Infinity, Nissan Patrol, 32 diamond rings, kilos of draws and the prizes given away. The annual growth of the festival is 5-10 percent,” gold and many others.
    [Show full text]
  • ABU DHABI | AL AIN | SHARJAH © Asteco Property Management, 2015 Asteco.Com Customer Services: 600 54 7773 ASSET MANAGEMENT SALES LEASING
    ASSET MANAGEMENT SALES LEASING VALUATION & ADVISORY SALES MANAGEMENT OWNERS ASSOCIATION DUBAI | ABU DHABI | AL AIN | SHARJAH © Asteco Property Management, 2015 asteco.com Customer Services: 600 54 7773 ASSET MANAGEMENT SALES LEASING VALUATION & ADVISORY SALES MANAGEMENT OWNERS ASSOCIATION Carpet & Arts Oasis 2015 Find amazing floor coverings and antique souvenirs at this annual event. Date: Thursday, 1st January - Sunday, 1st February 2015 Duration: 1 month 2 days Category: Arts / Culture / Theatre Venue: Dubai Festival City Admission: Open to public A unique annual bonanza which now draws in thousands of tourist and visitors from all around the world to Dubai. It offers a treasure trove of carpets, with traders from all over the world offering good value on a comprehensive range of floor coverings. It covers a massive space of 12,000 square metres and contains around 100,000 carpets from around the world, including products from Iran, Turkey, Pakistan, Afghanistan, China, and East Europe. Carpet Oasis also offers a large collection of antique souvenirs. Dubai Shopping Festival 2015 The largest shopping and entertainment extravaganza in the Middle East. Date: Thursday, 1st January - Sunday, 1st February 2015 Duration: 1 month 2 days Category: Community, Family, Lifestyle Telephone: + 971 600 555 559 + 971 600 555 559 Celebrating its 20th anniversary in 2015, the Dubai Shopping Festival (DSF) is the largest shopping and entertainment extravaganza in the Middle East. Drawing visitors from across the globe, DSF kicks off Dubai’s calendar of events each year with a wide variety of events, activities and promotions. From international concerts, musicals and shows, to sports, outdoor, and fashion events, Dubai Shopping Festival caters to every age segment.
    [Show full text]
  • Our Company Profile
    What Do We Spread We spread love stamps to the world Powered By Who We Are Founded in Egypt in 2016. We are a group of enthusiastic individuals who live and breathe all things online and digital. Although we understand that with experience comes wisdom and insight. Mixing a genuine love for digital marketing and all things development, the team is a great blend of experience and new talent, which means our house is a buzz with ideas, creativity and hard work. Over the business' lifetime, we have worked with some great clients, both big and small. One of the things we pride ourselves on is our client retention rate and client satisfaction. As a full service digital marketing agency. Get in touch now so we can discuss your needs. Powered By What We Do? Aim to be globally competitive. We're pioneered in providing new and creative ideas and strategic planning for all our clients. We believe that with hard work, nothing is impossible to reach. Always strive to be the leaders in the industry as we work with businesses and non-profits entities to magnify the growing power and market of digital marketing. Helping and working with clients to deliver an increase in leads, brand awareness, growing sales and support other business goals. Do believe that understanding customer’s needs through WE building long lasting strong relationship with them is the core of any effective communication. Have a great mix of clientele which includes some of the world’s most famous brands and local (Small and medium-sized enterprises) who operate across many sectors.
    [Show full text]
  • Symbolism of the Planting of the Union Tree
    eVisions Symbolism of the planting of the Union Tree This issue coincides with our overwhelming joy marking the 41st anniversary of the UAE federation; a joy that we see in the eager eyes of our citizens and residents. We stand witness to the wisdom of our early leaders, whose foresight allows us to take pride in the UAE’s achievements in all walks of life. Let us therefore take this opportunity to reflect on the presence of our wise leadership, whose actions go beyond mere words to achieve excellence in all spheres including political, economic, education and social. We also think of all UAE nationals whose love for their homeland is limitless. The anniversary springs forth from the vision of our founding fathers, the late Sheikh Zayed Bin Sultan Al Nahyan, the late Sheikh Rashid Bin Saeed Al Maktoum and their brethren, the Rulers of the Emirates when they all agreed to establish the federation. From the very beginning, the focus was on the development of the citizen and state, so as to enable the country to be placed amongst the advanced countries of the world. Although this objective seemed a pure fantasy to some people at the time, persistence and determination were behind the bid to build a nation that sought wellbeing and This interaction in the electronic world, which was caused prosperity for its citizens and residents. It became an by one tweet by HH Sheikh Mohammed, clearly shows ongoing process by the leaders who followed with the same that the UAE society has become a knowledge society that firm will, perseverance and sincerity, thereby proving to be a depends for information and communication on the modern worthy successor to our founding fathers.
    [Show full text]
  • Cultural Policies in Algeria, Egypt, Jordan, Lebanon, Morocco, Palestine, Syria and Tunisia an Introduction
    Cultural Policies in Algeria, Egypt, Jordan, Lebanon, Morocco, Palestine, Syria and Tunisia An Introduction Cultural Policies in Algeria, Egypt, Jordan, Lebanon, Morocco, Palestine, Syria and Tunisia An Introduction Culture Resource (Al Mawred Al Thaqafy) European Cultural Foundation Boekmanstudies 5 Foreword by Odile Chenal and Philipp Dietachmair Interesting dynamics are at play on the cultural scene in the Arab world. Not only a rapid expansion of the contemporary art market and a growing interest of international art experts and dealers for the artistic creativity in the Arab region can be observed, but also, more profoundly, the development of an independent cultural sector. In a political context, which remains very difficult in most of the Arab countries, a new generation of internationally connected cultural players has managed to open independent spaces for contemporary artistic creation throughout the whole region, and to create the first frameworks and tools for cultural leadership and management. These changes cannot remain without impact on governments’ role and accountability in cultural life; and these cultural actors will start questioning public cultural policies more loudly. Unlike what many in the “West” probably think, cultural policies do indeed exist in the Arab world. In most of the Arab countries Ministries of Culture were established in the 1950s and 1960s, earlier than in several of their European neighbours. This does not mean, however, that these ministries and their sometimes prolific administration produce consistent cultural strategies. Generally speaking, there is very little or no transparency about decision making mechanisms, and very little or no consultation about needs and priorities. There is an evident lack of public information and public debate with a free exchange of arguments.
    [Show full text]