1

Why Digital Health? Hal Wolf III President & CEO

2

Global HIMSS

North America

Latin America

Europe

UK

3

HIMSS is a global voice, advisor and

thought leader of health transformation

through health information and technology.

With a unique breadth and depth of

expertise and capabilities, we work to

improve the quality, safety, and efficiency

of health, healthcare and care outcomes.

Our Vision

Our Mission

To realize the full

health potential of

every human,

everywhere.

Reform the global

health ecosystem

through information

AND technology.

With more than 76,000 members 400 employees,

HIMSS operates in:

North America I Asia Pacific I Europe I The Middle East I United Kingdom

4

HIMSS is a global voice, advisor and

thought leader of health transformation

through health information and technology.

With a unique breadth and depth of

expertise and capabilities, we work to

improve the quality, safety, and efficiency

of health, healthcare and care outcomes.

Our Vision

Our Mission

To realize the full

health potential of

every human,

everywhere.

Reform the global

health ecosystem

through information

AND technology.

With more than 76,000 members 400 employees,

HIMSS operates in:

North America I Asia Pacific I Europe I The Middle East I United Kingdom

5

Global Challenges in Most Systems

• Fastest Ageing Population

• High Chronic Disease Burden

• Geographic Displacement

• Extremely Challenging Funding System

• Highly Educated and Demanding Consumer

• Lack of Actionable Information

• Growing Staff Shortages

6

Economics of Healthcare

Source: United Nations (2015). World Population Prospects: The 2015 Revision.

Percentage of the population aged 60 years or over for the world and regions, 1980-2050 P

erc

en

tage a

ge

d 6

0 y

ea

rs o

r o

ve

r

1980 1990 2000 2010 2020 2030 2040 2050

0

10

15

20

25

30

35

World

Europe

Northern America

Oceania

Latin America and the Caribbean

Asia

Africa

7

Economics of Healthcare

Source: United Nations population statistics: McKinsey analysis

Number of workers per dependent,

Ratio of working-age population (aged 15-64) to dependent population (aged 0-14 and over 65)

Today Projected

India

Less developed economies

China

Developed economies

1.0

1.5

2.0

2.5

3.0

1950 2050 2040 2030 2020 2010 2000 1960 1970 1980 1990

8

Who Holds the Risk?

• National

• Regional

• Municipality

• Acute Facility

• Provider Group

9

Skilled Healthcare Workers Global Shortage Digital Health is a Great Equalizer

14 12.9 M

Year: 2035 Year: 2018

7.2 M

10

8

6

4

2

0

Mill

ion

s

12

Source: World Health Organization, A Universal Truth: No Health Without a Workforce, Third Global Forum on Human Resources for Health Report

10

How We Think of Care Delivery and the Medical Model

Primary

Prevention

Secondary

Prevention

Acute

Care

Chronic

Care

The Continuum of Care

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Meet Bandit and Adam

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Which Patient had the First Registry for

Prevention Based on Population Norms?

13

Population Care/

Mass Production

The Medical Model with Public Health is moving to Increased Use of Personalized

Information

Personalized

Health

Sub

Segmentation (risk & condition-

based)

Integrated

Medical

Conditions

Patient

Preferences/

Personal

Circumstances

Genomics

Medical Model

14

But There’s

a Catch

15

The Consumer is Quickly Bringing Their Own Personalized Needs and Data

Personalized

Health

Population Care/

Mass Production

Sub

Segmentation (risk & condition-

based)

Integrated

Medical

Conditions

Personal Circumstances

Genomics

Patient Preferences

Health Model

Medical Model

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How Do Weave Together the Personalization of the Two Models

Personalized

Health

Health & Medical Model

Population Care/

Mass Production

Sub

Segmentation (risk & condition-

based)

Integrated

Medical

Conditions

Patient

Preferences/

Personal

Circumstances

Genomics

17

102 99 99 96 96 94 91 91 84 81 80 80 78 77 77 77 77 74 74 64 0

20

40

60

80

100

Level of “National” EHR implementation

Weighted results, based on 5 key indicators: Availability of national Infrastructure, online use and health competency, polit ical and legal framework, EMR

implementation and usage, content and functionality. Maximum possible: 114 points

Source: Münch Foundation (editor): Amelung, Chase, Urbanski, Bertram, Binder: „Die elektronische Patientenakte“, medhochzwei Verlag, Heidelberg, first update 2018

Based on the indicators used in this study, the Nordics are the most advanced countries to support a national health information exchange – and they have even started to exchange health information across borders. Estonia and Slovakia appear to be the leading countries from “Eastern Europe”.

18

We Drive the Health IT Market in the Direction it Needs to Go

Maturity and Adoption Models

HIMSS Analytics

Hundreds of Facilities Assessed Across

Other Maturity Models

Improved Patient Care

and Health IT Insights

6,500 EMRAM Hospitals

Scored

47 Countries

318 EMRAM Stage 7

Hospitals

12 Countries

55,000 O-EMRAM Physician

Practices Scored

~2300 EMRAM Stage 6

Hospitals

33 Countries

in

in

in

19 © HIMSS Analytics 2016

EMRAM Assessments - Poland

HIMSS Analytics have been invited

by the Centre for Health Information

Systems (CSIOZ) to apply the

international EMRAM standards to

evaluate 32 hospitals supervised

by the MoH of Poland.

CSIOZ, a state budget unit

appointed by the MoH, is

responsible for monitoring of

planned, developed and maintained

ICT systems at the central and

regional levels.

This assessment has delivered a

baseline measurement / position

that can be used to accurately

assess the effect of local or central

investments either from individual

hospital or from CSIOZ.

Oct’ 17 Workshops with key stakeholders

(2 days on-site, 10/12/17 – 10/13/17)

Oct’ 17 EMRAM data collection

(10/16/17 – 11/15/17)

Nov’ 17 Quality assurance

(10/24/17 – 11/16/17)

Dec’ 17 Final presentation & report delivery

(12/15/17 & 12/19/17)

As a result of the project, HIMSS Analytics provided the Polish Ministry of Health with the following reports and presentations:

• Short gap analysis for 32 surveyed hospitals

• EMRAM assessment report, i.e. a summary of findings for all assessed hospitals, containing key findings, conclusions and recommendations as well as detailed

information about software availability, medication safety, key performance indicators and EMRAM level achievements

• On-line presentation about key findings and recommendations for key project stakeholders from CSIOZ

Selected results:

• EMR adoption is below the average EMRAM scores of

hospitals in Europe, the US and the Middle East.

• All but one hospital have an electronic medical record

(EMR) for processing clinical patient data.

• Low technology related expenditure when compared with

other European countries.

• The age of the software applications in use is relatively

young when compared with other European hospitals.

• Key software applications currently missing in many of the

hospitals surveyed are Intensive Care Unit Management

Systems, EMAR, and E-Prescribing with CDS.

• The surveyed hospitals presented highly mature

informatics environments in the areas of Pharmacy (Stock)

Management, Physician Documentation, Electronic Patient

Records, Radiology Information Systems and PACS.

• Protecting hospitals from cyber-attacks and patient data

from unauthorized access should be embedded in any

refinement of the current IT strategy.

Project time plan: 2 months, 10/12/17 – 12/19/17

20 © HIMSS Analytics 2016

EMRAM Stage 6 Validation - Russia

Oct’ 16 EMRAM Assessment

Nov’ 16 On-site Stage 6 Gap Assessment

Nov’ 17 EMRAM Stage 6 Application Form

Dec’ 17 On-site EMRAM Stage 6

Validation

Selected highlights from the 1st Russian Stage 6 hospital:

• Excellent governance arrangements are in place to

successfully manage a program of this type together with

strong clinical engagement and visible leadership from

members of the senior management team.

• A hospital that is well on the way to becoming paperless

and in which most care providers are documenting in the

system and using it to good effect.

• In recognizing the critical role of electronic medical record

technology the hospital has put in place robust business

continuity and disaster plans in order to provide near

business as usual services during system down-times.

• CLMA and Pharmacy processes are associated with safe

and effective medicines management.

• Doctors and nurses on 75% of inpatient areas are

documenting care in the EMR. Doctors also have the

benefit CDS tools, alerts and warnings and order sets in

order to promote standardized care. The doctor, using

structured data, is able to select signs and symptoms from

a drop down menu.

Location of Nikiforov Russian Center

of Emergency and Radiation

Medicine (NRCERM EMERCOM)

"After the validation procedure began, it became obvious to us that all of our medical records are static. They were

available, but they could not help us in the process of medical care. We upgraded the structure of all medical records

and were able to activate the decision support systems. Modernized EMR guarantees the safety of our patients. I am

proud to have contributed to this.“ Mikhail Bakhtin, CMIO of NRCERM EMERCOM

The Nikiforov Russian Center of

Emergency & Radiation Medicine

has achieved Stage 6 as designated

by HIMSS Analytics using the

Electronic Medical Record Adoption

Model.

This organization demonstrated its

recognition of the importance of

information and technology in

healthcare. It is successfully

establishing a foundation upon

which it can build a future of

improved care quality, safety and

efficiency.

The Nikiforov Russian Center of

Emergency & Radiation Medicine is

the first hospital in Russia that has

been successfully validated against

the EMRAM Stage 6 criteria.

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What is Digital Strategy?

Consumers,

Patients, &

Families

Physicians

& Care Team

Providers

Public Health

Other Care Continuum

&

Partners

Payors Digital Strategy is about

Health Eco-System CONNECTIVITY

Digital strategy is the use of technology

enabled innovation to extend and deepen

connectivity between the health system

and its consumers, clinicians, payors

and care continuum partners.

Source: Chartis Group 2016

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Change in Health is already at full speed

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44%

33%

10%

7%

Searching online for health information is the most well-adopted digital health category, with 40% of those who search acting directly upon the information they find.

Knowledge Management and Consumer Actions

62%

58%

56%

52%

Prescription

Drugs

Diagnosis

Supplements

Treatment

Options

Information about prescription drugs or side effects

A diagnosis based on your symptoms

Information about supplements

Treatment options based on your diagnosis

Consumer survey data, n=4,017

Source: Rock Health, Digital Health Consumer Adoption: 2016,

Se

arc

he

d fo

r IN

FO

. % Acted Upon Information

47%

56%

56%

52%

Asked his or her physician to

prescribe a specific drug or

asked to discontinue a specific

drug Proposed own diagnosis to

his/her physician

Purchased or discontinued use of

a supplement

Proposed a treatment to

his/her physician

While adoption of searching for health

information online is strong, consumers

still rank physicians, friends, and family

highest when it comes to

trustworthiness of sources.

Se

arc

he

d f

or

RE

VIE

WS

Physician

Hospital

Nursing

Home

Caregiver

Nearly half of Americans go online to find provider reviews.

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To Maximize Clinical and Personal Health We Need Information Based Platforms Driven by AI

Each System, Hospital, Clinician and Person is unique

To create the best solution to each individual, Decision Support Platforms driven by AI need:

• Clinical Data

• Relative Patient Social Determinant Data

• Financial Drivers

• Consumption of Medical Resources

• Knowledge of Available Workforce

• Inventory of available and recommended technology

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Moving Beyond Visit-Centric Medicine

• One patient at a time

• Only know about patients

who appear in your office

• No use of IT

• Limited use of data

Traditional

Encounter

Based Care

New Model

Elements

• Accountability for panel/population

• Transparency

• Use of EMR, registries, mobile

• Team care (including patient)

• Moving care out of doctor’s office

to the person

26

Moving Beyond Visit-Centric Medicine

• Accountability for panel/population

• Transparency

• Use of EMR, registries, mobile

• Team care (including patient)

• Moving care out of doctor’s office

to the person

• One patient at a time

• Only know about patients

who appear in your office

• No use of IT

• Limited use of data

Traditional

Encounter

Based Care

New Model

Elements

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Skilled

Nursing

Facility

Primary Care

Physician

PATIEN

T

In-Reach

Specialist

Outreach

Pharmacist

Case

Manager Hospital

Public Health

Mental Health

Home Health

Coordinated, Person-Centered Care

27

Person

28

Keep the Data Focus on Secure Access and Usage

• Ownership

– there will be many owners to the data needed

• Access

– Who has access to the data depends on Role

• Usage

– What anyone or entity can do with the accessed data is critical

29

Innovation Inside a Healthcare System…

Innovation only succeeds when the

interest of diverse stakeholders can be

aligned so that trade-offs are sufficiently

beneficial to overcome the cost or risk of

adopting the new “way of working”

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The Clinical Ecosystem Impacted

• Clinical Operations

• Administration

• Commissioning

• Legal

• Patients

• Mobile devices

• Patient / Clinical

• Clinical Systems

• IT Infrastructure

• Facilities

• Physicians

• Nurses

• Other Care Providers

• Patients

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It’s Not Just the Innovation

OO + NT = COO

32

It’s Not Just the Innovation

OO + NT = COO Old organization + New Technology = Costly Old Organization

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Innovation and Change Management as a focus of minds is not new

“Nothing is more difficult than to introduce a new order. Because the innovator has for enemies all those who have done well under the old conditions and lukewarm defenders in those who may do well under the new.”

Niccolo Machiavelli (1469 - 1527)

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Innovation Inside Health Eco-System…

The electric light did not come from the continuous improvement of candles

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HIMSS Global

North America

Latin America

Europe

UK

Thank You