View
212
Download
0
Tags:
Embed Size (px)
Citation preview
© Copyright IBM Corporation 2005
Prerequisites for the sustainable E-health implementation
Janko Cicin-Sain, IBM Life Sciences consultantSofia 27th of June, 2006
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Agenda
Healthcare challenges - and initiatives to address them E-health, what is it ? The Danish E-health experience Bulgaria E-health position
| |
Business Consulting Services
© Copyright IBM Corporation 2005
The main challenges faced by healthcare are probably well-known
$150
$300
$600
1998 1999 2000$0
$100
$200
$300
$400
$500
$600
$700
Mill
ions
of
dolla
rs
Source: Modern Healthcare, July 9, 2001
Annual Revenue of Disease Management Companies
In 2000, medical costs for people with chronic conditions totaled $774B and are projected to rise to $1.07T by 2020
A person with a chronic condition spends 6 times more per year than a healthy person
Those with a functional limitation can have medical expenditures more than 16 times a healthy person
A Medicare beneficiary with a chronic condition sees, on average, 8 different physicians (1999)
80% of Medicare beneficiaries have a chronic condition -- accounting for 99% of total spending for the program (1999)
157 million Americans, or half the population, are expected to have a chronic condition in 2020
Disease management companies are emerging as major players in the U.S. healthcare market
Why Disease Management is Becoming a Major Cost-control Focus in Healthcare
Aging population ! Drug costs rising ! More chronic patients
New and extended treatment offerings
| |
Business Consulting Services
© Copyright IBM Corporation 2005
The major reason for increasing drug costs is not price increases as such
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Beyond today’s challenges, the evolution to “personalized healthcare” must also be adressed
Evolutionary Practices
Rev
olu
tio
nar
y T
ech
no
log
y
Automated Systems
Non-specific(treat symptoms)
Personalized(disease prevention)
Information Correlation
1st Gen Diagnostics
Organized(error reduction)
Personalized Health Care
Translational Medicine
Molecular MedicineMolecular Medicine
Clinical GenomicsClinical Genomics
Pre-symptomatic treatmentPre-symptomatic treatment
Lifetime TreatmentLifetime Treatment
CA-DiagnosisCA-Diagnosis
Electronic Health RecordsElectronic Health Records
Genetic Predisposition TestingGenetic Predisposition Testing
Artificial Expert SystemsArtificial Expert Systems
Data and Systems IntegrationData and Systems Integration
Dis
trib
ute
d H
igh
-Th
rou
gh
pu
t A
nal
ytic
sD
istr
ibu
ted
Hig
h-T
hro
ug
hp
ut
An
alyt
ics
Health Care TodayHealth Care Today
Episodic Treatment
Digital ImagingDigital Imaging
| |
Business Consulting Services
© Copyright IBM Corporation 2005
The Big Trends
Demographic change – more elderly More chronic patients Medication and treatment costs Patient safety and quality of care More demanding, better informed consumers Clinical Genomics and Personalised Medicine
| |
Business Consulting Services
© Copyright IBM Corporation 2005
E-health initiatives in different countries
Europe and America:- U.K.: The NHS IT-initiative- Germany: Healthcard and e-prescription initiative. Also interest for shared care and disease management.- Belgium: Healthcard and e-prescription initiative.- Austria: E-health initiative- Ireland: E-health initiative- Canada: 10 years of experience on regional levels, Canadahealthinfoway as national infrastructure- USA: recent initiative
Central and Eastern Europe:- Slovenia: Healthcard solution implemented- Czech Republic and Slovakia: Planning for e-health (communication and national portal)- Bulgaria and Hungary: E-health is on the agenda- Croatia: E-health is on the agenda
The Baltics:- Lithuania: Ambitious tender – covering both National and hospital level- Estonia: E-health agenda with focus on e-prescription and medication
Asia Pasific- Singapore: Healthcare Network - New Zealand and Australia: Helthcare Network – Integrated Care Strategy
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Agenda
Healthcare challenges - and initiatives to address them E-health, what is it ? The Danish E-health experience Bulgaria E-health position
| |
Business Consulting Services
© Copyright IBM Corporation 2005
It is not possible to cope with the challenges of the future through rationalization – it will be necessary to look at demand
More treatments within the same budget:
New healthcare structure Optimised processes EPR PACS Quality improvements Wireless IT still continuous annual incerase of 10%
Reduced demand for services:
Disease management (chronically ill) Screening for early detection Wellness management (citizen health)”The virtual healthcare system”
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Targeting chronically ill patients with IT-technology in order to: Improve planning and treatment Follow the patient everywhere – in hospital, in their home, at GP Involve and motivate the patient Let the patient take more responsibility and participate more actively Strenghten GP knowledge of hospital treatments and procedures
- with the objective to create a better quality of life for the patient, improve clinical Pathways, save hospitalresources and strengthen cooperation in healthcare.
Diabetes
Heart related diseases
Resporatory diseases
Depression
Typical diseases:
Disease management is an efficient tool to target chronic patients
| |
Business Consulting Services
© Copyright IBM Corporation 2005
E-health is a number of different elements, which together can help transform healthcare continuous treatment of patients by linking patient’s clinical information between
providers and providing a life time electronic patient record (see Golden rules from Crossing the quality chasm: healthcare in 21st century) while emphasizing transparency over confidentiality,
continuous monitoring of health status of citizens - individual, by groups and profiles continuous monitoring of health status and continuous treatment of patients with chronic
diseases access to knowledge (libraries, publications, “doctor-to-doctor”) - general or case related continuous transition to target medical practice (clinical guidelines, clinical pathways,
evidence based medicine, outcome based medicine) performance monitoring and benchmarking E-business, supply chain, E-procurement Education of patients and citizens Advanced clinical decision support at the point of care
E-health is supplemented by: Electronic Patient Record at hospitals Country HIS database (patient statistics) Clinical databases Accreditation and quality improvement programs.
| |
Business Consulting Services
© Copyright IBM Corporation 2005
E-health benefits are both long term – and short term
CommonStandards/
network
Infrastructure/Portal
Quality in medication
EPR
Disease
management
• Better use of staff resources• Improved documentation• Better information accessibility• Improved patient care
• Improved communication• Better information• Better use of clinical / patient resources
• Improved data management /exchange• System interoperability• Increased security
• Better use of clinical resources• Better monitoring and prevention • Increased patient involvement• Better identification of risk groups
Healthcare
transformation • Faster patient recovery • More effective use of medication• Better supply management• Better identification of risk groups
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Agenda
Healthcare challenges - and initiatives to address them E-health, what is it ? The Danish E-health experience Croatia e-health position
| |
Business Consulting Services
© Copyright IBM Corporation 2005
MedCom and Sundhed.dk
MedCom Health Net1994 -
Sundhed.dkHealth Portal2000 -
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Who is behind ?
Ministry of Health National Association of County Councils Ministry of Social Affairs National Association of Local Authorities National Board of Health Copenhagen Hospital Corporation Danish Pharmaceutical Association
| |
Business Consulting Services
© Copyright IBM Corporation 2005
1993: The six flows EU Concerted Action on Primary Care
Primary health
So simple!So much!So similar!
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Prescriptions1039105 = 73%Prescriptions1139992 = 81%
Disch. Letters 682923 = 85 %Disch. Letters 826258 = 84 %
Lab. reports543040 = 82 %Lab. reports653974 = 97 %
Referrals64845 = 45 %
Reimbursement
15637 = 66 %
1992 2004
MedComMessages/Month
44%
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Status & Benefits
• 1995 Primary Clinics - 92%• 490 Specialists - 62%• 332 Pharmacies - 100%• 63 Hospitals - 100%• 50 Municipalities• 2,5 mill. each month• 60 – 70 % of all communication
• 50 minutes saved per day in GP practice• Telephone calls to hospitals reduced with 66%• 2,3 € saved per message = 60 million € /year
| |
Business Consulting Services
© Copyright IBM Corporation 2005
General information Information from hospitals all around Denmark Yellow-pages for the entire Danish health sector Waiting-list information Information about medicine E-booking calendar Secure communication (“e-mail”) Personal Medicine Profile Citizens event log Registration as Donor (April 2005) Clinical path-ways
-Pregnancy (March 15 2005)-Diabetes (in progress: DiaLog)
Services for Citizens
Sundhed.dk
| |
Business Consulting Services
© Copyright IBM Corporation 2005
General information Information from hospitals al around Denmark Yellow-pages for the entire Danish health sector Waiting-list information Information about medicine E-booking calendar Secure communication (“e-mail”)
General consent portlet Access laboratory test results Personal Medicine Profile for the patient Patient data from EPR in other hospitals
Clinical pathways
-Pregnancy (March 15 2005)
-Diabetes (in progress: DiaLog)
Services for Physicians
Sundhed.dk
| |
Business Consulting Services
© Copyright IBM Corporation 2005
PEM - Personal e-Medication
| |
Business Consulting Services
© Copyright IBM Corporation 2005
WEB - Laboratory Result
Den fælles offentlige sundhedsportalSide23
2d. Søgeresultat for Lab-svar
| |
Business Consulting Services
© Copyright IBM Corporation 2005
WEB - EPRRecord Overview
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Health Portal and Net
Lab
| |
Business Consulting Services
© Copyright IBM Corporation 2005
E-health status in Denmark
E-health elements: Unique patient identifier: Since 1977 Healthcare information network: Project established 1994. Now 97% coverage General e-health portal: Project established 2003. Now in phase 4 Country wide sharing of data: Medicine and EPR overview established Disease management – targeting chronic patients: Multiple projects. Wellness management – targeting general population health: Part of e-health portal Secure infrastructure – data security and privacy: PKI/digital signature – national +
hospitals
E-health is supplemented by: Electronic Patient Record at hospitals: 15% coverage Country HIS database (patient statistics): National projects Clinical databases: National projects Accreditation and quality improvement programs: Accreditation strategy and quality
improvement agency
| |
Business Consulting Services
© Copyright IBM Corporation 2005
E-health status in Denmark
E-health values: Estimated savings of over 100M EURO per year Improved the clinical content of the medical treatments performed by primary
care physicians Documented relationship between continuous education and improved quality
in healh sector (ICPC, statistics) Drastically increased the avareness of the population how to deal with typical
health symptoms and related medical / administrative procedures Improvements in quality (efficiency of outcomes, lower risk) recognized, but
not measured – lack of measurements “before and after” is common situation in European healthcare
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Agenda
Healthcare Challenges - and initiatives to address them E-health, what is it ? The Danish E-health experience Bulgaria E-health position
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Bulgariaia can obtain substantial short term benefits from E-health through a carefully designed healthcare IT-strategy
Need to strengthen primary care communication and IT-support Low ICT at hospitals – opportunity, since no legacy Focus on medicine costs and –quality Certain diseases (coronary, lung and cancer) have high proportion More activity based payment (DRG) Focus on strengthening national statistics and coding
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Challenges - funds
Similar projects in European Union countries or North America are projected at several billion EURO or US$.
WE HAVE TO FIND MORE COST EFFECTIVE APPROACH: 5-10 times less and adjusted to size of an average Central European country
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Challenges - Long term structured strategic plan
One of major obstacles with health care reforms, including E-health, in all countries in the region is that most decisions are politically motivated and survive usually only one election term.
As end result, most of funds spent on reform topics become wasted. Similar to creation of national and permanent E-health agency, there
MUST be a group of professional decision makers and designers of any component of health care reform, including E-health.
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Challenges - No defined relationship between national healthcare reform and E-health
The problem with many World Bank funded projects as components of health care reform was that there was almost no continuation after the projects have been completed. In some countries, newly elected Minister of Health completely cancelled unfinished projects.
In addition, most of times there is no national master plan, unifying all individual components – this is due to the lack of Project Management experience in government departments in general.
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Challenges – lack of proper base
Health care providers (especially hospitals) lack modern (and unavoidable prerequisite) management of information (IT and paper based) for internal management of information and subsequently the ability to share (access information, provide information, collaborate) its work with other organizations in network
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Recommended set of activities
Define national strategy for E-health – National Program for e-Health, example: “e-Health Foundation Bulgaria”
Define the stakeholders and those responsible and authorized for deployment of E-health infrastructure and components;
Find optimal balance between legislative measures, consensus based decisions and selection of pilot cases supported by believers.
Define national standards for: Core data set, Demographic Data, Health profile, Insurance plans
Define national standards for: Authorization, Authentication, Privacy Define national standards for: minimal functional and data requirements of IT
solutions for providers (hospitals, primary care doctors,...)
| |
Business Consulting Services
© Copyright IBM Corporation 2005
Recommended set of activities
Prepare a master plan with synchronized and coordinated activities between all health care sector organizations and agencies
Define the roles of strategic partners and solution providers Instead of revising current resource allocation to national institutions such as
MOH, health insurance, medical universities and schools, consider the creation of an agency (or institution) with relevant name like Health Center of Excellence
Consider to address the needs of E-health in current standards project, to make sure future work on E-health will not be slowed down because there is no agreement on those standards which are essential for effective functioning of E-health solutions