0
Global&challenges&[1&of&3]&
Increasing*healthcare*cost*and*leveling*of*health*impact*
1"
Healthcare)costs)spiral…)
…as)hea...
Global&challenges&[2&of&3]&
There’s*huge*value*left*on*the*table…*
2"
Cost)of)NCDs)
US$47)trillion)
Cumula3ve"lost"
output...
Global&challenges&[3&of&3]&
Data*innovation*today*is*very*siloed*
3"
Siloed&data&systems&cannot&talk&to&
each&other…&
!
1....
Abu&Dhabi&was&an&ideal&market&for&
innovation&in&tackling&chronic&disease&
4"
2.6m"lives:"“Big"enough"to"ma?er,"small"
eno...
“Closing&the&health&loop”&within&a&plural&
healthcare&market,&at&population&scale&
Baseline)assessment)
•  Secure"ID"(NHS"...
ClosedFloop&public&health&works&
Abu*Dhabi*case*example*
6"Source&&Weqaya,!Abu!Dhabi;!Presented!at!the!IDF!World!Diabetes!...
Sustainable&business&models&distribute&risk&of&
future&health&costs&and&align&incentives&for&health&
7"
Range&of&Disease&
...
Significant&Health&IT&innovation&in&a&wide&range&
of&countries&
8"
•  UNRWA,!
Jordan!
•  Baobab,!
Malawi!
•  Text!for!
Chan...
Data&innovation&remains&siloed&
9"
Siloed&data&systems&cannot&talk&to&
each&other…&
!
1.  Huge!complexity!for!buyers!
2. M...
WHOBITU)Joint)
IniFaFve)in)mHealth)
Developing!the!technology,!
delivering!the!promise!
10"
Brings!eight!countries!that!
m...
Open&Health&Platforms&joinsFup&silos&whilst&
maintaining&security&and&commercial&boundaries&
11"
Transformative&
change!
1...
Taking&the&first&steps&
1.  Interoperability!standards:!
-  How*to*exchange*data:!HL7,!ITUTT!H.810!(Continua!Health!Allianc...
Transforming&healthcare&delivery:&
Success&stories&
&&
Abu*Dhabi*and*WHOKITU*mHealth*Joint*Initiative*
Wednesday,!26!Febru...
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Petra Wilson Global Challenges #MWC14 #mHealth

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Transcript of "Petra Wilson Global Challenges #MWC14 #mHealth"

  1. 1. Global&challenges&[1&of&3]& Increasing*healthcare*cost*and*leveling*of*health*impact* 1" Healthcare)costs)spiral…) …as)health)outcomes)plateau) “Without"precise" measurement" innova3on"is"doomed"to" be"rare"and"erra3c…"" With"it,"inven3on" becomes" commonplace”" ) 2013"Annual"Le?er"from"Bill"Gates" (quo3ng"The$Most$Powerful$Idea$in$the$ World,"by"William"Rosen)"
  2. 2. Global&challenges&[2&of&3]& There’s*huge*value*left*on*the*table…* 2" Cost)of)NCDs) US$47)trillion) Cumula3ve"lost" output"in"all" developing" countries"due"to" NCD"2011L2025" NCDs"were"the"second"ever"health"issue"addressed"at"a"special"mee3ng"of"the" United"Na3ons"General"Assembly Cost)to)fix)it) US$170)billion) Overall"cost"for"all" developing" countries"to" implement"WHO" "best"buy"" interven3ons"for" NCD"2011L2025"
  3. 3. Global&challenges&[3&of&3]& Data*innovation*today*is*very*siloed* 3" Siloed&data&systems&cannot&talk&to& each&other…& ! 1.  Huge!complexity!for!buyers! 2. Market!cannot!put!a!price!to!a! product! 3. Reinventing!the!wheel! 4. Increased!development!costs!! 5. Limited!market!size! 6. Limited!data!aggregation! Results' Uptake' •  >650,000&unique&patient&IDs&issued&in&Malawi& •  >6,000&patients&with&diabetes& •  Enthusiastic&clinicians&response& & Health'outcomes' •  Lower&patient&drop=out&and&death&rates& •  Reduction&of&drug&errors& Scalability' •  Fully&open=source&system& Additional'benefits' •  Automated&diabetes&registry,&enabling& –  More&accurate&government&drug& forecasting&& –  Better&referral&and&planning&of&surgically& necessary&treatments&(amputations,&foot& ulcers&etc.)& •  Low=cost&power&backup&systems&& •  Hardware&for&information&storage&and& transfer& Background' & •  Data&critical&for&high&quality&patient&care,& programme&monitoring&and&evaluation,& preventing&drug&stock=outs,&etc.& •  Manual&paper=based&aggregation&of&data& and&compilation&of&reports&now&unfeasible& Approach' & •  User=friendly,&graphics=based&touchscreen& incorporating&(in&one&shot):& 1.  Basic&patient&medical&history&& 2. Clinician&alerts&and&decision&support& 3. Fully=automated&reports&for&M&E& 4. Data&collection&for&secondary&uses& Examples'we’ve'explored:'Baobab&A'Harries' 11" Source' &Douglas&GP,&Gadabu&OJ,&Joukes&S,&Mumba&S,&McKay&MV,&Ben=&Smith&A,&Jahn&A,&Schouten&EJ,&Lewis&ZL,&van&Oosterhout&JJ,&Allain&TJ,&Zachariah&R,&Berger&SD,&Harries&AD,&Chimbwandira&F&(2010=.&& Using'Touchscreen'Electronic'Medical'Record'Systems'to'Support'and'Monitor'National'Scale?Up'of'Antiretroviral'Therapy'in'Malawi.'PLoS&One&Medicine,&August&2010,&Volume&7,&Issue&8& &Allain&TJ,&van&Oosterhout&JJ,&Douglas&GP,&Joukes&S,&Gadabu&OJ,&Darts&C,&Kapur&A,&Harries&AD&(2011).&&Applying'lessons'learnt'from'the'‘DOTS’'Tuberculosis'Model'to'monitoring'and'evaluating' persons'with'diabetes'mellitus'in'Blantyre,'Malawi.&&Tropical&Medicine&and&International&Health,&volume&16&no&9&pp&1077–1084& Results' Uptake' •  13#centres#already#use#eHealth# •  System#consolidation#underway#for#others# # Health'outcomes' •  XX# Scalability' •  XX# Additional'benefits' •  XX# Background' •  24#centres#for#MCH/Diabetes#with#>200,000# patients/year#attend#them# # # Approach' •  Possibility#of#using#eHealth#to#monitor# mother#and#child#care#and#take#more# detailed#medical#records,#and#also#the# organisation’s#desire#to#expand#the#services# surrounding#diabetes#and#hypertension# •  Mobile#health#initiative## Examples'we’ve'explored:'Jordan'A'Harries' 12# Source' #XX# Results' Uptake' •  94%$eligible$population$within$<18$months$ •  >190,000$ $ Health'outcomes' •  Discovered$‘silent$killer’$risk$factors$ –  1/3$diabetes$=$11,000$ –  1/2$high$blood$pressure$=$27,000$ –  2/3$high$cholesterol$=$$ •  24%$increase$in$patient$engagement$with$care$ •  18%$increase$in$good$control$of$diabetes$ •  20%$increase$in$good$control$of$cholesterol$ Scalability' •  Fully$openKsource$system$ Additional'benefits' •  Secure$patient$access$web$portal$ •  CloudKbased$ •  Multimedia$(web,$call$centre,$mobile,$smartphone$ apps,$etc.)$ •  Rockefeller$implementation$OpenHDD$ •  Platform$Health$ITU$standard$(H.MEDX)$ Background' $ •  UAE$second$highest$prevalence$of$type$2$ diabetes$in$the$World$ •  Comprehensive$health$reform$with$universal$ health$insurance$ Approach' •  Innovative,$lowKcost,$secure$eHealth$system$ (Shafafiya)$ •  Pioneering$eHealthKenabled$population$NCD$ programme$(Weqaya)$ •  Weqaya$logo$on$healthy$products$ •  Open,$secure$mobile$Cloud$ •  API$creates$market$for$Weqaya$apps$ •  Disease$Management$Programme$market$ Examples'we’ve'explored:'Abu'Dhabi'O'Harrison' 13# Source''Podolak$I,$Vetter$P,$and$Harrison$O$(2012).$$Measuring'Health'Data'Management'Maturity'in'Abu'Dhabi'Health'Policy'and'Technology.$$Health$Policy$and$Technology$ $Hajat$C,$Harrison$O,$Al$Siksek$Z$(2011).$Weqaya:'A'Whole'Population'Cardiovascular'Screening'Programme'in'Abu'Dhabi.$$AJPH$2011,$22$September$ $Hajat$C,$Harrison$O$(2010).$The'Abu'Dhabi'Cardiovascular'Program:'The'Continuation'of'Framingham.$$Prog.$Cardiovasc.$Dis.,$Vol$53,$Issue$1,$JulyKAugust$2010,$pp28K38$ $See$http://www.jointlearningnetwork.org/content/openhdd$and$http://www.jointlearningnetwork.org/content/dayKoneKsiteKvisitKabuKdhabi$ $Weqaya$materials$available$online$at$URL$www.weqaya.ae$$ Source!!Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pp759T760!
  4. 4. Abu&Dhabi&was&an&ideal&market&for& innovation&in&tackling&chronic&disease& 4" 2.6m"lives:"“Big"enough"to"ma?er,"small" enough"to"manage…”" Highly"strategic"government"with"broadL based"popular"trust" Extreme"pace"and"depth"of"socioLeconomic" development"–"very"high"burden"of"NCDs" Plural"and"diverse"payers"and"providers" Rela3vely"wellLresourced"health"system" enabling"innova3on" Source )Weqaya,"Abu"Dhabi;"presented"in"public"at"the"IDF"World"Diabetes"Congress,"Dubai"2011"
  5. 5. “Closing&the&health&loop”&within&a&plural& healthcare&market,&at&population&scale& Baseline)assessment) •  Secure"ID"(NHS"number)" •  CVD"risk"(e.g.,"NHS"Health"Check)" Clinical)care) +) SelfBcare) Monitoring) +) evaluaFon) Amendment) to)treatment) plan) Reassess! Shared)data) 5"
  6. 6. ClosedFloop&public&health&works& Abu*Dhabi*case*example* 6"Source&&Weqaya,!Abu!Dhabi;!Presented!at!the!IDF!World!Diabetes!Congress,!Dubai!2011! Everyone&can&know&their&numbers…& M A M J J A S O N D J F M A M J J A S O N D J F 2008! 2009! 2010! …&and&the&numbers&can&change&health&outcomes& %&engaged&with& care*& %&with&HbA1c&<7.5%& %&with&LDL:HDL&ratio& <3.5& 100%*=*±220,000* 94%$$ uptake$
  7. 7. Sustainable&business&models&distribute&risk&of& future&health&costs&and&align&incentives&for&health& 7" Range&of&Disease& Management&Providers& & ! ! ! Consent&for&data& Pay&for&health& Tariff*set*as*a* proportion*of*the* avoidable*cost*of* complications* Range&of&Apps& and&services&
  8. 8. Significant&Health&IT&innovation&in&a&wide&range& of&countries& 8" •  UNRWA,! Jordan! •  Baobab,! Malawi! •  Text!for! Change,! Uganda! Low* Medium* Low* Income& Previous& eHealth& capability& High* •  Arogya,!india!Medium* •  Weqaya,!Abu! Dhabi! •  Text!to!Quit,! New!Zealand! High* •  SHINTNY,!New! York! •  FoodSwitch,! Australia! •  Text4Baby,! USA!
  9. 9. Data&innovation&remains&siloed& 9" Siloed&data&systems&cannot&talk&to& each&other…& ! 1.  Huge!complexity!for!buyers! 2. Market!cannot!put!a!price!to!a! product! 3. Reinventing!the!wheel! 4. Increased!development!costs!! 5. Limited!market!size! 6. Limited!data!aggregation! Results' Uptake' •  >650,000&unique&patient&IDs&issued&in&Malawi& •  >6,000&patients&with&diabetes& •  Enthusiastic&clinicians&response& & Health'outcomes' •  Lower&patient&drop=out&and&death&rates& •  Reduction&of&drug&errors& Scalability' •  Fully&open=source&system& Additional'benefits' •  Automated&diabetes&registry,&enabling& –  More&accurate&government&drug& forecasting&& –  Better&referral&and&planning&of&surgically& necessary&treatments&(amputations,&foot& ulcers&etc.)& •  Low=cost&power&backup&systems&& •  Hardware&for&information&storage&and& transfer& Background' & •  Data&critical&for&high&quality&patient&care,& programme&monitoring&and&evaluation,& preventing&drug&stock=outs,&etc.& •  Manual&paper=based&aggregation&of&data& and&compilation&of&reports&now&unfeasible& Approach' & •  User=friendly,&graphics=based&touchscreen& incorporating&(in&one&shot):& 1.  Basic&patient&medical&history&& 2. Clinician&alerts&and&decision&support& 3. Fully=automated&reports&for&M&E& 4. Data&collection&for&secondary&uses& Examples'we’ve'explored:'Baobab&A'Harries' 11" Source' &Douglas&GP,&Gadabu&OJ,&Joukes&S,&Mumba&S,&McKay&MV,&Ben=&Smith&A,&Jahn&A,&Schouten&EJ,&Lewis&ZL,&van&Oosterhout&JJ,&Allain&TJ,&Zachariah&R,&Berger&SD,&Harries&AD,&Chimbwandira&F&(2010=.&& Using'Touchscreen'Electronic'Medical'Record'Systems'to'Support'and'Monitor'National'Scale?Up'of'Antiretroviral'Therapy'in'Malawi.'PLoS&One&Medicine,&August&2010,&Volume&7,&Issue&8& &Allain&TJ,&van&Oosterhout&JJ,&Douglas&GP,&Joukes&S,&Gadabu&OJ,&Darts&C,&Kapur&A,&Harries&AD&(2011).&&Applying'lessons'learnt'from'the'‘DOTS’'Tuberculosis'Model'to'monitoring'and'evaluating' persons'with'diabetes'mellitus'in'Blantyre,'Malawi.&&Tropical&Medicine&and&International&Health,&volume&16&no&9&pp&1077–1084& Results' Uptake' •  13#centres#already#use#eHealth# •  System#consolidation#underway#for#others# # Health'outcomes' •  XX# Scalability' •  XX# Additional'benefits' •  XX# Background' •  24#centres#for#MCH/Diabetes#with#>200,000# patients/year#attend#them# # # Approach' •  Possibility#of#using#eHealth#to#monitor# mother#and#child#care#and#take#more# detailed#medical#records,#and#also#the# organisation’s#desire#to#expand#the#services# surrounding#diabetes#and#hypertension# •  Mobile#health#initiative## Examples'we’ve'explored:'Jordan'A'Harries' 12# Source' #XX# Results' Uptake' •  94%$eligible$population$within$<18$months$ •  >190,000$ $ Health'outcomes' •  Discovered$‘silent$killer’$risk$factors$ –  1/3$diabetes$=$11,000$ –  1/2$high$blood$pressure$=$27,000$ –  2/3$high$cholesterol$=$$ •  24%$increase$in$patient$engagement$with$care$ •  18%$increase$in$good$control$of$diabetes$ •  20%$increase$in$good$control$of$cholesterol$ Scalability' •  Fully$openKsource$system$ Additional'benefits' •  Secure$patient$access$web$portal$ •  CloudKbased$ •  Multimedia$(web,$call$centre,$mobile,$smartphone$ apps,$etc.)$ •  Rockefeller$implementation$OpenHDD$ •  Platform$Health$ITU$standard$(H.MEDX)$ Background' $ •  UAE$second$highest$prevalence$of$type$2$ diabetes$in$the$World$ •  Comprehensive$health$reform$with$universal$ health$insurance$ Approach' •  Innovative,$lowKcost,$secure$eHealth$system$ (Shafafiya)$ •  Pioneering$eHealthKenabled$population$NCD$ programme$(Weqaya)$ •  Weqaya$logo$on$healthy$products$ •  Open,$secure$mobile$Cloud$ •  API$creates$market$for$Weqaya$apps$ •  Disease$Management$Programme$market$ Examples'we’ve'explored:'Abu'Dhabi'O'Harrison' 13# Source''Podolak$I,$Vetter$P,$and$Harrison$O$(2012).$$Measuring'Health'Data'Management'Maturity'in'Abu'Dhabi'Health'Policy'and'Technology.$$Health$Policy$and$Technology$ $Hajat$C,$Harrison$O,$Al$Siksek$Z$(2011).$Weqaya:'A'Whole'Population'Cardiovascular'Screening'Programme'in'Abu'Dhabi.$$AJPH$2011,$22$September$ $Hajat$C,$Harrison$O$(2010).$The'Abu'Dhabi'Cardiovascular'Program:'The'Continuation'of'Framingham.$$Prog.$Cardiovasc.$Dis.,$Vol$53,$Issue$1,$JulyKAugust$2010,$pp28K38$ $See$http://www.jointlearningnetwork.org/content/openhdd$and$http://www.jointlearningnetwork.org/content/dayKoneKsiteKvisitKabuKdhabi$ $Weqaya$materials$available$online$at$URL$www.weqaya.ae$$ Source!!Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pp759T760!
  10. 10. WHOBITU)Joint) IniFaFve)in)mHealth) Developing!the!technology,! delivering!the!promise! 10" Brings!eight!countries!that! may!implement!Open! Health!Platforms!to!help! refine!the!approach!and! technology!
  11. 11. Open&Health&Platforms&joinsFup&silos&whilst& maintaining&security&and&commercial&boundaries& 11" Transformative& change! 1.  Unification!of!effort! 2.  Clarity!for!buyers!! 3.  Open!market!for! devices,!Apps!and! services! 4.  Scalability!(national! and!transnational)! 5.  (A)!scalable! business!model(s)! Source&&Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pages!759T760!
  12. 12. Taking&the&first&steps& 1.  Interoperability!standards:! -  How*to*exchange*data:!HL7,!ITUTT!H.810!(Continua!Health!Alliance)! -  Which*data*to*exchange:!ITUTT!H.MEDX!(Platform!Health)! 2.  PopulationTscale!demonstrators!(“early!adopters”)! 3.  Dissemination!of!best!practice! -  Implementation!toolkits! -  WriteTups! -  Informed!commissioners! -  Private!Sector!incentives!for!growth! 12"
  13. 13. Transforming&healthcare&delivery:& Success&stories& && Abu*Dhabi*and*WHOKITU*mHealth*Joint*Initiative* Wednesday,!26!February!2014!
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