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eHealth. Patient First, time for change JAN- ERIC SLOT MB MBA MSc CHCIO

CIO and CMIO at Bernhoven Hospital

UDEN, The Netherlands

Transforming health through IT 2 www.himss.eu

My personal Journey

• Chief Information Officer and Chief Medical Information Officer and member of the Executive Board at Bernhoven Hospital since December 2013.

• CHCIO (Certified CIO) and member of the Board of CHIME since 2015.

• CEO of SNOMED International in Denmark (2010-2013)

• CIO at the Academic Medical Center in Amsterdam (2005-2010)

• HIMSS Governing Council Member (2009-2014)

• Teaching IT Governance at Medical Informatics, University of Amsterdam (since 2007)

30 years experience

in Healthcare IT

Transforming health through IT 3 www.himss.eu

Session Topics

• What is Digital Transformation?

• What does it mean for Healthcare sector?

• User Centric Approach

• User Centric vs Patient Centered Approach

• Bernhoven Dream journey in Digital Transformation

• Next challenges

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Digital Transformation, the 9 elements.

The use of technology to radically improve performance or reach of enterprises

(definition MIT SLOAN, Westerman)

• MIT Sloan approach: look at 100’s of example and look for the elements, traits and patterns in successful environments

• 157 interviews in 50 companies

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Digital Transformation, the 9 elements.

The use of technology to radically improve performance or reach of enterprises

(definition MIT SLOAN, Westerman)

• Transforming Customer Experience

–Customer understanding

–Top-line growth

–Customer touch points

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Digital Transformation, the 9 elements.

The use of technology to radically improve performance or reach of enterprises

(definition MIT SLOAN, Westerman)

• Transforming Operational Processes

–Process digitization

–Worker enablement

–Performance Management

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Digital Transformation, the 9 elements.

The use of technology to radically improve performance or reach of enterprises

(definition MIT SLOAN, Westerman)

• Transforming Business Models

–Digitally Modified Business

–New Digital Business

–Digital Globalization

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DIGITAL TRANSFORMATION What does it mean for the healthcare sector?

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Digital Transformation, the 9 elements in healthcare

• Transforming Customer Experience

–Customer understanding

–Top-line growth

–Customer touch points

• Get patient data before encounter

• Care for the Silver Tsunami • Not just a table

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Digital Transformation, the 9 elements in healthcare

• Transforming Operational Processes

–Process digitization

–Worker enablement

–Performance Management

• Patient as input for record • Redistribute tasks • Use the data for analysis

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Digital Transformation, the 9 elements.

• Transforming Business Models

–Digitally Modified Business

–New Digital Business

–Digital Globalization

• Redesign care delivery • Extend services to the

home • Extend services elsewhere

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DIGITAL TRANSFORMATION User-Patient-Person Centric Approach

• Physicians

• Patients

• Citizens/ persons

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Physicians leading means talking about patients:

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Patient experience

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Patient experience

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Patient First

• Overtreatment

• Failure of care delivery

• Failure of care coordination

Patient experience

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DIGITAL TRANSFORMATION User: Physician vs Patient/ Citizen Centered

• Continuity of Care is Integrated Care

• Some barriers: - Separate information systems or

ones not interoperable

- No single assessment process

- Money doesn’t follow the patient

- Highly risk averse organizations

- Clinical responsibility is not clear

- Unwillingness to transfer care

- Culture: Where is the power?

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DIGITAL TRANSFORMATION in the Netherlands: putting the patient really in control

• Healthsuite Labs session 50 players in the Ecosystem

• Results bundled in booklet

• Pledge made at the HIMSS Amsterdam E-health week June ‘16

• Minister of Health provides 105M€ over three years to hospitals to provide a Digitally Transformed Interaction between Patient and the medical Professional (VIPP program)

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HIMSS Patient Engagement Framework

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DIGITAL TRANSFORMATION at Bernhoven Hospital

• Objectives:

- Progressing towards a paperless environment

- Reach the EMRAM Stage 6 for Bernhoven Hospital

- Use Continuity of Care Model to assess starting point and create roadmap for implementation (Governance, Clinical, IT)

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Regional Patient Platform: Personal Health Environment

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2016 2017 2018

Q3 Q4 Q1 Q2 Q3 Q4 Q1 timeboxen

VIPP

system integration

EHR

governance & patient participation

integration xCare - platform

PGO 1.0 & ReumaNet

structured documentation

integration Bernhoven-systems - platform

COPD

timebox

timebox

timebox

timebox

Roadmap Bernhoven

business case

business case

business case

business case

hartfailure

scheduling an appointment

etc business case

questionnaires

business case COPD-integrated care plan

Shared decision making tools

diabetes

samenwerking/kennisdeling

VIPP; patient & information

VIPP; patient & medication

governance

participation patient-general practitioner-hospital

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SCREENSHOTS

patient

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Patient first, Bernhoven’s Dream

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Rationale and Droom strategy

Critical success factors & experiences

New organizational model

ICT & Continuity of Care

▪ Own strength as starting point of Dream (rather change ourselves than be changed)

▪ Quailty improvement and volume reduction ▪ Organize along the functions and 4 care models

▪ Create environment that supports these changes ▪ Dream = docter in the lead ▪ 4 initiatives showcases ▪ Challenges

▪ Dream needs another organizational structure (C. Christensen) ▪ 4 Care models have different dynamics and management models

▪ From patients in between our 4 walls to 400,000 citizens in the region

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Bernhoven creates health specific value in 4 ‘’care-models’’

3 2 4

1 Acute zorg: Op de SEH het beste van Bernhoven laten zien Intensiveren van de

samenwerking met HAP Versterken inhoudelijke

expertise op de SEH Inrichten van een

mensgerichte SEH Bijdragen aan regiovisie

hoog-complexe acute zorg

Interventie zorgstraten: Selectief aanbod met boven-regionale allure. Alleen voldoende volume

interventies aanbieden Apart organiseren van

interventies in zorgstraten Samenwerken met de regio

voor laag volume verrichtingen

Personaliseren van zorgproces

Diagnose- en indicatiestelling: Breed aanbod van gepersonaliseerde en gezamenlijke besluitvorming Meer mogelijk maken in en ondersteunen van de 1e lijn Verhogen van de kwaliteit van (monodisciplinaire)

besluitvorming Inzetten op integrale diagnostiek

Chronische zorg: Netwerkzorg binnen en buiten ziekenhuismuren Organiseren van zorg samen met 1e lijn Integraal begeleiden multimorbide ouderen Uitbreiden van netwerk zorg

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The Vicious Circle of Efficiency To Quality as the driver

More procedures And services Less time for patient

Less time for quality

Efficiency drive

Higher cost

Less cost Less overtreatment:

diagnostics, procedures

Quality

More time for patient More time for quality

The Dream strategy is based on the conviction that quality is the recipe for cost reduction.

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Our strategy is supported by growing awareness that more healthcare is not always better

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Dream is from, for and by docters

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Dream strategy & initiatives

Organisation design

Ownership

Docter in the lead on 3 levels

Dream strategy started with the docters

All initiatives owned by medical docter

Dream transformation carried by 2 Chief Medical Officers

Medical Leaders in charge of 4 Care models

Participation model: specialists employees as well as

owners

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Three major activities for the healthcare professional; and their translation into 4 care models (Clayton Christensen, Harvard)

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Diagnostics

Acute zorg

Chronic care

Intervention carepaths

Activity

Separating acute and elective patient streams in proces

and organization creates calm, peace of mind

Rational for care model Care model

Advice & Treat (in acute setting)

Treat

Support

Advice In Diagnostics there is time to reflect (do the right thing,

decision making with the patient)

After joint decision making, efficiency and outcome

oriented (doing things right)

Supporting patients takes place in the Continuity of Care,

(Hospital, GP and at home)

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Implementation of organizational model (matrix) for Bernhoven based on the 4 care models

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Directie

Ondersteunende staf diensten

Medisch ondersteunende diensten

D&I Interventie zorgstraten Chronische zorg

ML BL ML BL

Acute zorg

Acute en intensieve

zorg

Acuut bedden-huis

Poli omgeving

ML BL ML 2 BL

Verlos-kunde/ kind

Opname/ ontslag

OK interventies

Niet-OK interventies

Electief beddenhuis

Chronische zorg poli

Transmurale netwerkzorg

ML BL

Vakgroepen

Vakgroep

Vakgroep

Vakgroep

Vakgroep

Vakgroep

Vakgroep

VGL (per vg)

Diagn. Bedrijf

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Complex IT landscape (lots of legacy)

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Now: start of continuity of care

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HIMSS Analytics by numbers

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DIGITAL TRANSFORMATION Next Challenges

• Reach EMRAM level 6 (October 2017)

• Reach CCMM level 4 (End 2019)

• Outcome measurement (ICHOM)

• Scaling up the HIE (Personal Health Environment) and create an on-going financial structure and governance

• Creating a new business model for Chronic Care model

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Conclusions

Panel discussion

Thank you!

JAN-ERIC SLOT