Delivering Smart Healthcare with ICT Innovations Disruptive Technologies and Healthcare Transformation Pawel Suwinski 2010 HIMSS APAC Congress and Leadership Summit Daegu, Korea
“The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it”Mark Weiser M.Weiser, The Computer for the Twenty-First Century, Scientific American, 265 (3), (1991). 2
Introduction• Despite Healthcare Delivery Industry having much to gain from Information and Communication Technologies, it is the slowest from all industries in the adoption. There are many reasons for IT failures in healthcare environment, but the single most important cause is the HIT capability mismatch to address work processes within healthcare service organisation.• Until today, for more than 20 years ICT and healthcare service organisations have been locked in a Love-&-Hate affair with neither being able the break the stalemate. It could be down to that we spent too much time on design and implementation and not on how end user react to already implemented HIT solutions.• HIT investment will only be successful if the fit between IT and clinical processes will be close to matching, which will be reflected by the acceptance or rejection of end users.• In the short history of HIT the emergence of new, disruptive technologies play a crucial role in closing the capability gap and gaining more acceptance from the main users.• The latest innovations are changing not only how the medical care is organised, practiced and delivered but are also redefining host of other qualities including changing patient-physician model and facilitating the emergence of new industry players within the value chain.• Will these Innovations be successful in delivering better, smarter care? 3
Evolution of Healthcare Information Technologies 80’ 90’ 00’ 2010 2015 Health Smart PMI EMR eHealth Informatics eHealthStand Alone Applications Stand Alone Applications Hospital Information E-Health – Lifetime Personalised E-Health System – Single EMR Health record Personalised Health RecordLimited Functionality Extended Functionality Full Functionality Full Functionality, POC Full Functionality, Home MonitoringNo interoperability Limited interoperability Full interoperability within Country and regional Full Interoperability First Healthcare Standards The same location interoperabilityFocused on Back-office Focused on Administrative Focused on advanced Focused on KnowledgeFlow: Financial, Focused on integration of Flow :ADT, Scheduling Clinical Flow and Management/ ComplexInventory & Patient Administrative and Clinical Pharmacy Business Intelligence BI and AI SystemsMaster Index Flows Systems
Complex Environment of HITHealthcare Information Technologies can be defined as any computer based products and services that are specifically designed anddeveloped for Healthcare Industry. This broad classification includes infrastructure, software, devices, and services that are used by all theparticipants within the healthcare value chain. As we later will see, the major consumer of HIT are the healthcare services organisation – thecare givers, and their will be our main focus when discussing the HIT. HEALTH INFORMATION SYSTEMS Financial Resource Clinical Patient Life Management related Sciences GL Inventory CIS ADT Bio-Informatics AR HR Hospital PMI Gene-Sequencing AP Scheduling Departmental EMR Gene-Analytics Billing Facility Systems HER Library IS PO Management LIS PHR College IS Third Party Payer Reporting RIS Health Portal Research IS Insurance Business PACS Intelligence Pharmacy Decision Support System 5
Collaboration and Sharing is the Key Function of EntireHealthcare Value Chain 6
Capability Gap Industry Practice Unmet Needs Met Needs Characteristics Large quantity of Full capture. POC Capture/ Retrieval Partial Capture/Store/Retrieval data/information Non-disruptive to work processes/ Relevant Retrieval Partial Security/ Confidentiality/ Sensitive Data/ Information Full Security/ Confidentiality/ Privacy Privacy (PKI, Biometrics, SSL) Non-disruptive to work processes and Mobile Devices/ Wireless Mobility lifestyle. Remote sensors and automated Connectivity capture/ retrieval/ alertsLimited integration – not all processes Follow work processes : improve on but doautomated. Long implementation times Complexity not disrupt. Easy to implement andand high failure ratio. Limited customize by the user.customisability. Limited Interoperability mostly at One lifelong health record collating all local level – EHR/PHR Collaboration wellness and illness parameters. Partial analytics (mostly non-clinical) Analytics that deliver accurate and relevant Mission Critical information at the POC. Non-disruptive to work processes. Capability Gap 7
HIT Development/Adoption Cycle Source: Frost & Sullivan. Customer SatisfiedThe ICT has entered intoHealthcare DeliveryIndustry with “big bang”of excitement . Excitement Requirements fully Implemented Requirements not Disappointment Threshold Implemented With new innovations on the horizon, the credibility credit has been rebuilt. We might be Decade later, the moods were looking upwards and finally running low as the climbing the slope. technologies failed to meet the expectations. The ride has been continuously Customer downwards. Dissatisfied 1980 1990 2000 2010 2020
Despite HIT Shortcomings Sustained and Long Term Demand for Healthcare Services will support HIT Growth Demand Drivers Increased Supply of HIT Changing • Increase in population Demographics • Population AgeingChanging Disease • Increase in life style diseases Patterns • Increase in chronic diseases Political • Consumer expectations toward s governments Importance • Politicization of stakeholder groups Increased Demand for Changing • Change in value system: health is valued more • Healthcare consumerism: consumers are making decisions Healthcare Services Consumer about their own care needs Behaviour • Medical Tourism Technological • Cheaper drugs Advances • Cheaper diagnostics • New treatments are becoming very expensive Cost Pressures • Practice insurance drives cost of services high Increased Supply of Healthcare Services 9
Global Trends on Expenditure on HIT License Software Spent by Healthcare• The delivery of care depends on information made available to both: the caregivers and executives. Providers in 2010 in USD Billion The more accurate and timely data the better decision-making processes, and therefore better operational strategies and clinical outcomes can be attained.• The adoption of Information and Communication Technologies (ICT) is essential for modern healthcare delivery systems to gain greater efficiency, reduce overall healthcare costs and improve patient safety.• In recent years, the acquisition of computer technologies by healthcare organizations has increased substantially with the spending showing upward tendency placing the industry as one of the major consumer of ICT products and services.• In 2009, the Global expenditure on Healthcare Licensed Applications by healthcare providers stood at USD 3Billion for North America, USD 1.9 Billion for Western Europe, and USD 0.8 Billion for Asia Pacific. All three regions will experience high growth rate (on average CAGR ~10%) due to increased demand for healthcare services. 10
Asia Pacific Life sciences and Health IT Market* Interoperability challenges hinder adoption Lifesciences & Healthcare IT, US$ Bn, 2009-2012 Market Drivers 80 Strong and sustained demand for healthcare CAGR 7% services 70 62.5 58.4 60 54.6 Demand for higher quality of healthcare and 50.6 access to information 50 Rest of the 52.7 World 40 43.5 46.7 49.6 APAC 30 20 CAGR 10 11.3% Market Restraints 7.1 7.9 8.8 9.8 0 2009 2010 2011 2012 Interoperability of discrete medical equipment 14.5% APAC Share 15.7% Bandwidth Lack of skilled resources for implementation*Healthcare IT includes: Software, Hardware, IT services and Lifesciences IT Note: All figures are rounded; the base year is 2009. Source: Frost and Sullivan 11
APAC License Software Market (TMP) By Country US $ (MM) and 4 Year CAGR (%)Licensed Software Spend in US $ (MM) 4 Year CAGR (%) Japan, Australia and China are the biggest markets while China, Malaysia and Thailand presents the most significant market growth in APJ 2010 – 13.
Extending Care Beyond Hospitals - Connected Healthcare• Connected Healthcare is a care delivery model that uses technology enabled solutions to expand the care capabilities beyond healthcare institutions to natural human habitats.• The main aim of Connected Healthcare is to maximize healthcare resources, increase preventive and predictive component of care with the expectation of keeping individuals as healthy as possible and less dependent on curative care.• It works through deploying sensor – monitoring devices, data storage and analytics, and communication channels to healthcare providers for decision making process, care planning and delivery. It empowers the individuals to self manage medical needs, and provide cannels for more interactive communications with healthcare professionals.• At present, It is directed at chronic diseases, aged population, and dependency. The scope, however, is rapidly expanding to include entire population to mange health rather than to monitor illness. Smart homes, the mush up of real estate and healthcare is a natural expansion of Connected Healthcare. 13
Connected Healthcare – Uses and Benefits Products/Services Maturity/Adoption Level Growth Potential• Telehealth 3 2 2 3• Wired/wireless sensors• Nursing Alarms/Alerts 1 4 1 4• Enterprise Mobility Solutions• GSM/Wimax healthcare 2.0 4.0 applications 0 5 5• Voice Communication 0• Pagers Maturity/Adoption Level Growth Potential Practical Applications• Outreach Programmes for underserved locations: Telehealth and Telemedicine• In-building Communication – providing common infrastructure for all voice and data communication• Preventive and predictive measures against Hospital Acquired Infections• Patient monitoring within hospital and outside (home monitoring)• Remote consultation and supervision.• Emergency medicine – alerts/alarms 14
Empowering Patients/Individuals - Interactive Healthcare• With the adoption of Web 2.0, collaborative technologies were introduced allowing unprecedented level of social interactivity. The use of Web 2.0 applications and resources for health related purposes is called Health 2.0• Health 2.0 has become very popular and important platform for patients and consumers to find health information, interact with each other in virtual communities, and communicate with care givers. It empowers individual to manage own health according to personal preferences.• Health 2.0 provides communication platform to healthcare organisations to reach out to their existing and potential clients. Hospital Portals and presence in the Social Networking Medias (e. g. Facebook, Twitter) has redefined marketing and sales strategies.• According to the Pew Internet & American Life Project, 83 percent of Internet users have looked online for health information. New data released by Pew this week show many people are now using cell phones to search for health information - 29 percent of cell phone owners age 18 to 29, and 17 percent of cell owners overall. Its the first time Pew has surveyed health searches on cell phones. 15
Interactive Healthcare – Uses and Benefits Products/Services Maturity/Adoption Level Growth Potential• Email 2 3 2 3• Instant Messenger• Blog 1 4 1 4• PHR• Analytics Applications (Health 1.5 3.5 3.0) 0 5 0 5• Web – Mobile Devices interfaces• Wikis Maturity/Adoption Level Growth Potential Practical Applications• Provider – Consumer Relationship: influence on Consumer by providing relevant information• Provider: Promotion and Marketing Activities• Medical Tourism : enabling decision making about the desired destination• Consumer: source of information on healthcare related topics• Consumer: Support groups• Provider/Researcher: analytical tools 16
Making Care More Efficient - Cloud Healthcare• Cloud Computing is an IT architecture model that virtualises computing resources to deliver them on demand and in required quantities. These resources are highly scalable (almost infinite) and highly available (24/7).• The main characteristics of cloud computing are: – User does not own hardware, network, and application resources – Computing resources are provided through remote data centres on a subscription basis (on demand). – The infrastructure and services are delivered, accessed by user, via web browser (cloud).• In cloud computing architecture, user is running services not on the local terminal but remotely. It means that instead of transferring data from remote host to be processed on the local terminal all transactions take place outside the local terminal.• Healthcare industry is just exploring the capabilities and benefits of cloud computing. The main concern is over security of medical information as all is residing off-site in remote datacenter. However, the economic advantages to healthcare providers are making some to venture into the virtual realm of cloud computing. 17
Cloud Healthcare – Uses and Benefits Products/Services Maturity/Adoption Level Growth Potential• Software as a service (SaaS) 2 3 2 3• Infrastructure as a service (IaaS)• Platform as a service (PaaS) 1 4 1 4 0.5 1.5 0 5 0 5 Maturity/Adoption Level Growth Potential Practical Applications/Benefits• Back office applications (Resource Management) , Office Automation and Productivity Tools can be easily accessed already without costly investments.• Providers do not need to maintain infrastructure• Clinical Applications and Patient Management can be delivered using Private Cloud where all data is protected. Such network can be created with data-centre within organisation.• Payment Model is based on subscription or pay-as-you-go. 18
Knowledge care - Business Intelligence in Healthcare• Business Intelligence (BI) is a broad concept describing the process of transforming data into actionable knowledge. In recent years the term has became a label for information technologies: software and infrastructure that facilitate the BI process. Such applications capture, collate, store, transfer, retrieve, and analyse data to generate best choices for strategic decisions in the form of “what- if” analysis, predictive analytics, and multi dimensional data mining that in a blink of an eye deliver, insightful advises for managerial and clinical use.• BI applications act as integration platform across the entire organisation. They connect together disparate systems to collect and exchange needed data. They glue the “silo” environment together to provide a seamless framework for information exchange and processing.• Can be used as Health 2.0 and 3.0 applications linking data sources with analytical capabilities.• By linking applications that otherwise were not communicating freely the BI is able to reduce the manual process effort used to facilitate exchange of information. The automation significantly can reduce access to data as well the occurrence of unintentional human errors while handling the data.• BI solutions provide dedicated informational path linking the source of request/query with timely and relevant information. 19
Intelligence in Healthcare - Impact and Uses Products/Services Maturity/Adoption Level Growth Potential• Reporting 2 3 2 3• Analytics• Predictive information modelling 1 4 1 4• Integration• Visualisation - Dashboards 2.0 4.5 0 5 0 5 Maturity/Adoption Level Growth Potential Practical Uses/Benefits• Administrators: timely and accurately information on organizational economic performance and resource utilisation.• Care Givers: timely and relevant information delivered at the point of care• Patients: Improved quality of care• Organisation: creating platform for virtual organisation.• Public/scientists: utilisation of Health 2.0 analytical capability to conduct custom research 20
Moving Beyond Reality - Virtual Healthcare• Virtual Reality is the ability to create artificial environment with the ability to act as it was real. It used advanced technologies to generate space and physical fabric and applies artificial intelligence to add interactive component. It is experienced by two senses (presently): sight and sound.• Lighter version of Virtual Reality – Simulation has been well adopted by most industries including healthcare.• The major users of these technology are gaming and military industries. It has also been successfully adopted by healthcare for simulations, 3D Image modelling for laparoscopic procedures, treatments, rehabilitation, and assessment.• Virtual reality can be divided into: – The simulation of a real environment for workflow processes analysis and design, training, education, therapies. – The development of an imagined environment for health assessment, capability assessment, and therapies. 21
Virtual Healthcare – Uses and Benefits Products/Services Maturity/Adoption Level Growth Potential• Simulators 2 3 2 3• Virtual Reality• Augmented Reality 1 4 1 4• 3D Modelling• Games 1.5 3.0 0 5 0 5 Maturity/Adoption Level Growth Potential Practical Uses/Benefits• Training for healthcare professionals• Simulation for work processes and facility design• Disease Control: spread of contagious diseases• 3D preoperative and perioperative modelling• Treatment (phobias, rehabilitation, compliance to medication) 22
Technology Impact on Stakeholders and Care Quality Total Provider Consumer Outcomes 15 PointsConnected Low High Low High Low High 10.0Healthcare 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5Cloud Healthcare Low High Low High Low High 8.0 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5InteractiveHealthcare Low High Low High Low High 12.0 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5Intelligent Low High Low High Low HighHealthcare 12.0 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5Virtual Healthcare Low High Low High Low High 8.0 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Key : Low High Source: Frost & Sullivan.
Technology Strategic Roadmap 6 Intelligent HealthcareHigh Connected Healthcare 5Outcomes Impact 4 Virtual Healthcare 3 Interactive Healthcare Cloud Healthcare 2 1 Bubble size shows Impact on Consumer Low Large Size = High 0 Small Size = Low 0 1 2 3 4 5 6 Low Providers Impact High 24
Smart Healthcare: Communication Trends HOME CARE Smart Model: Continuum of Care & Patient Smart Homes Focused. Telehealth Aged Care Critical Alarms Assisted Living Home Monitoring Current Model: Curative & Provider Focused INSTITUTIONAL CARE Communication/Data Nursing Homes Communication/Voice Specialty Clinic Tracking/Resource Hospitals Management Connectivity Source: Frost & Sullivan, Motorola 25
HIT Future Trends Knowledge Management Interoperability: Clinical & Business HIS/EHR Intelligence & AI Enterprise Wireless Solutions Resource Planning Future HIT Trends Mobile Devices & Virtualisation & Robotics Virtual Reality Preventive, Proactive, Personalised Healthcare Services 26
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