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Future Health: eHealth challenges
Brussels 17th June 2009
Octavian Purcarea ocpurca@microsoft.comGlobal Solution Manager WW HealthMicrosoft Corporation
ChallengesAging populationIncreasing costs and burden of chronic diseases (affordability and sustainability)Economic growthAccess, quality and safety of healthcare (including consumer protection)Free movement of citizens and servicesEmpowerment (health and wellness issues)Change management
HealthCast 2020 – (Price Waterhouse Coopers)
High increase in Health expenditures
eHealth adoption challenges
UsabilityTrustSustainability (economic model)Implication of different actors (empowerment)
USE OF DATA FROM THE PRIMARY CARE EPR ‐ RESISTANCES AND SOLUTIONS Prof Dr Marc VANMEERBEEK DUMG 2004
Analysis of the database records of the EPR in 8 Medical Homes, 3 years, 133.0000 contacts
Belgian Study
Why we need a new generation HIT ?EPR EPR UsabilityUsability in the in the dailydaily practice practice of the of the GPsGPs
« 6, 7% of the contacts were recorded in the database »
« exasperation of the user »
« It seems illusory to continue an IT program
without a rapid response to the numerous improvement demands »
« 6, 7% of the contacts were recorded in the database »
« exasperation of the user »
« It seems illusory to continue an IT program
without a rapid response to the numerous improvement demands »
QUALITY IMPROVEMENT IN THE PRIMARY CARE BASED ON DATA COLLECTION OF DIABETES AND HYPERTENSION RELATED CONSULTATIONS Vandenberghe H., Bastiaens H., Jonckheer P., Orban T., Declercq E.,Lafontaine M.‐F.,Van Casteren V.Service d’Epidémiologie Institut Scientifique de la Santé Publique, 2003, Bruxelles
Exploration of the feasibility of data collection for quality improvement interventions .Two groups: paper based data collection and EPR based data collection
Conclusion
“40% of the physicians from the EPR based group finally didn’t send the data”
« The quality indicators are strongly divergent for the 2 methods”
Conclusion
“40% of the physicians from the EPR based group finally didn’t send the data”
« The quality indicators are strongly divergent for the 2 methods”
EPR EPR UsabilityUsability in in public public healthhealth and and qualityquality managementmanagement
Belgian Study
Why we need a new generation HIT ?
Conclusions
‐ only 20% of care networks have electronically data exchange
‐ only 9% have enough structured data
‐ only 3% can document the care processes electronically
Conclusions
‐ only 20% of care networks have electronically data exchange
‐ only 9% have enough structured data
‐ only 3% can document the care processes electronically
German Study
PRAXISNETZ STUDIE 2006 MANAGEMENT ‐PROZESSE –INFORMATIONSTECHNOLOGIEGünter Schicker und Oliver Kohlbauer , Wirtschaftsinformatik II Universität Erlangen‐Nürnberg
Analysis of the practice mangement and IT situation of GP Associations in Germany and Switzerland ; ( 72 deutsche Praxisnetze und 18 Schweizer)
EPR Usability in daily practice & quality management
Why we need a new generation HIT ?
Tesler's Law of Conservation of Complexity:
“Every application has an inherent amount of irreducible complexity.
The only question is who will have to deal with it ‐ the user, the application developer, or the platform developer?”
Larry Tesler, the inventor of the graphical user interface
USABILITYUSABILITY
Clinical Software for USABILITY
1. Software behavior should reflect the work process of the user (workflow )
2. Software objects should reflect the mental model (concepts) of the user (terminology )
1. Software behavior should reflect the work process of the user (workflow )
2. Software objects should reflect the mental model (concepts) of the user (terminology )
Usability threshold
Terminology+ ---------------------------------------------------->
Clinical Process Models
Usability threshold
Terminology+ ---------------------------------------------------->
Clinical Process Models
The Technological Convergence for USABILTY & FUNCTIONALITY
The Technological Convergence for USABILTY & FUNCTIONALITY
How clinicians spend time
Direct patient care
Otheractivities
Seekingdata
Time value of information1/8 second:
"instant"
1/4 second: "snappy"
1 second:cognitive drift
10 seconds:capture by other task
Clinical User Interfacewww.mscui.net
Why Communication is important
Caregivers preference their peers over textCommunication errors are the most common cause of preventable medical errorsBlind calls and paging
Source: J. Westbrook et al, MJA, 5 May 2008
Helping The Healthcare Workforce
Helping The Healthcare Workforce
Helping The Healthcare Workforce
Helping The Healthcare Workforce
Mobility
Data Input
Surface Computing
We See, We Feel, We Change
People change what they do less because they are given analysis that shifts their thinking than because they are shown a truth that influences their feelings. This is especially so in large-scale organizational change, where you are dealing with new technologies, new strategies, cultural transformation
The Heart of ChangeJohn P. Kotter H A R V A R D B U S I N E S S S C H O O L P R E S S 2006
The change management problem The change management problem
The magnitude of cultural change that is needed for the deployment of systematic Quality Management in Healthcare is so important that it will work only by “revelation”.
with a low number ( 5-20) but highly motivated physicians ( the micro-system model*)
train them correctly on the methodology and the information system
coach them intensively
show the new model in action and show data of improving process and outcomes .
Build an experimental “Healthcare Management & Integration Network”
The solution The solution
Trust and Change ManagementTrust and Change Management
“In the software industry it is the business, not the technology that determines success or failure.”
M.Cusumano, professor at MIT's Sloan School of Management
How can we make Health care sustainable?
Source: Intel.com Cost of Care per Day
$1 $10 $100 $1,000 $10,000
0%
Qua
lity
of L
ife
COMMUNITY CARE
Healthy,Independent Living
ChronicDisease Management
CommunityClinic
Doctor’sOffice
100%
Assisted Living
Skilled Nursing Facility
Specialty Clinic
Community Hospital
ICU
HOME CARE
ACUTE CARE
Specialty Pharmacy
‘SHIFTLEFT’
Disease Management - What is worth for the local administration (Belgium example) ?
Health care model concept Instrument Operative means Data-processing tools
Expectable Economies
/year*Individual health
care providerIsolated GP Electronic Patient Record 1. Local EPR ?
Level 1
Patient centered health care
GP networkShared health record filePatients portal for healthShared secretary
1. Secure web server2. Semantic interoperability:
Reference Information model (RIM) : Architecture Templates, Data structures, Data types,
Terminologies3. Shared platform for Secretariat
Documents management (Scan/OCR/Indexation)
Online Agenda
5%
Belgium+ 1 billion3,4
Level 2Integrated Chronic
Care ModelOptimizing the
health care systemwith Quality
management and cost containment
Providers Network
Quality Indicators Benchmarking
Drug therapy management
Guidelines Adherence
Care plansCare teamsTask delegation and managementDrugs alerts, reminders
Indications and contraind.Adverse effects
Guideline AlertsAgreed guidelines
1. Clinical process information modelActors, contexts, actions/tasks, events, rules
2. Process editor3. Web application for Orchestration of the
processes
4. Pharmacotherapy knowledge database5. Care plans editor and rules editor
10%
Belgium+2 billion,5,6
Level 3Integrated system for care management
Prevention and Chronic DiseaseManagement Quality and Safety
Management
Quality indicatorsClinical BPM -BIMining Process Re-engineering Process
15%
Belgium3 billion 7
L’Informatique dans le contexte de santé publique et d’économie de la santé (Belgique : buget soins santé 20 milliards) 1.Implmentation du projet RIPAM (Ardeche) : une « 13éme heure » de travail de plus par jour pour tenir le DMP2.La prime INAMI pour « DMI homologué »3.Bilan 2004 de la Mutuelle Knappschaft en Allemagne après introduction d’un dossier informatique partagé « Web » pour tous les médecins 4.Bilan 2006 Suisse : 10 ans des systèmes de Managed Care ; Observatoire Suisse de la Santé 20065.Infoway Canada 2005 ‐ Coût évitable des effets indésirables des médicaments par prescription informatisée avec support décisionnel6.Etude prospective , randomisé à grande echelle «Improve Compliance With Clinical Guidelines.. » Jonathan C. Javittet all ; AJMC 2005 7.Bilans Kaiser Permanente vs moyenne nationale et californienne
Consumer Empowerment
HealthVault = Health Application Platform
Application & Device ProvidersSigned and Live as of 10/29/08
Walk Me
For More Information about Microsoft Health
Health Web site: www.microsoft.com/healthcare Health Blog: www.blogs/msdn.com/healthblogEMEA Health Blog: http://blogs.msdn.com/ms_emea_health_blog/default.aspxInformation on Amalga and Health Vault can be found at: http://www.microsoft.com/hsg/You can find information on the Common User Interface and the design guides at: www.mscui.comHere is the link to the CHF (Connected Health Framework) material: http://msdn2.microsoft.com/en-us/architecture/bb525069.aspxFor MedStory (now called Live Search – Health) go to https://ssl.search.live.com/health/default.aspx or www.medstory.com.
E-mail: ocpurca@microsoft.com
© 2009 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market
conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.
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