Drivers1) Operational Efficiency, Reducing Costs- Widespread adoption of Clinical Applications, EMR. Leading markets include Singapore, Australia, Taiwan, S.korea2) Consumer Demand- Are more savvy, increased internet penetration- china largest users Strong demand for healthcare services- IT has come into the core role of “essential” services and maximiseChallengesInteroperability- Most of cUS$tomers have disparate IT platforms. Integration- Connectivity issues between departments especially the pathology dept to obtain real time resultsSkilled Resources- CME programs need to being designed especially for allied staff who may not be IT savvyTake-AwaysHong Kong has US$$ 400 Mil budget for EMR implementation and Malaysia has launched..XXThe human factor, is a key impediment in HIT adoption- Change Management Programs are extremely essentialHongkong and Malaysia are the two countries to watch out in terms of the new health initiatives during 2010-2012
HEALTH INFORMATION TECHNOLOGIES Market Overview and Trends Pawel Suwinski 2nd Annual Asia EHR Conference 2010, Singapore
EMR/EHR Emotional Journey INFATUATION For technologies to be used meaningfully and be accepted they need to become invisible to the intended end-user and work-flow processes. FRUSTRATION PHYSICAL JOY What matters most is the care process and the other person that needs medical attention; anything else is just facilitation.
HIT Adoption and Growth Drivers HIT will experience healthy growth in the next 3 years. This high growth path will be possible thanks to 3 main factors Innovations Government Spending Healthcare Demand Innovations play a crucial role in blending technologies into healthcare processes. They also are drivers of healthcare services transformation. Most regional governments recognised the importance of HIT and are rolling out national programs promoting the adoption of HIT, in most cases as EHR. Healthcare Demand will be constantly on the rise as a result of Epidemiological, Demographic, and Life-Style changes.
Innovations – The Agent For Change Knowledge Management Flexible Architecture Cloud Computing Clinical & Business Intelligence & AI Social Media SMARTER HESLTHCARE Health2.0 Mobility Wireless Solutions AI Mobile Devices & Robotics Virtual Reality Preventive, Proactive, Personalised, Participatory 5
Global Trends on Governments HIT/HER Initiatives 6 South Korea USD 46 million– National Healthcare Information Infrastructure Plan to include development of EHR and interoperability standards (2007 to 2010) China USD 1.8 billion of total HIT investment pledged. Government published EHR policy in 2009. EHR projects are now expanded to each province Europe United Kingdom : USD 12 billion – The National Programme for IT (NPfIT) from 2002 for 8 to 10 years Denmark – National EHR since 2006 France –EHR mandatory by 2008 The Netherlands – 88 percent of GPs has an EHR Sweden – Developing National EHR Germany – E-Health card since January 2007 Canada USD 1.2 billion – to set up National EHR Japan In 2001, “Grand Design for the Development of Information Systems in the Health care and Medical Fields”, targeting for EHR to at least 60 % of Japan's hospitals with 400 or more beds by 2006. (Actual 10% in 2010) Hong Kong USD 184 million – E-Health Programme. The first phase of the project is budgeted at USD 98m from 2010 to 2014. E-Health Record Office to be established with total recurrent spending of about USD 45m for the years 2010 to 2012. US USD 19 billion– Meaningful Use of EHR. Thailand No legislation governing the use of EMR/EHR in the country. Less than 50% EHR utilization, mostly in public health institutions. USD 140 million – To revolutionize public hospital information system Malaysia USD 27 million – Telehealth Programme: started 1997 . Halted in 2003 and reactivated in 2007. National roll-out by 2020. Singapore USD 140 million - National Electronic Health Record (NEHR) project / 10 yrs Australia USD 470 million – Under NEHTA guidance to develop Personally Controlled Electronic Health Record.
Despite HIT Shortcomings Sustained and Long Term Demand for Healthcare Services will support HIT Growth 7 Demand Drivers Increased Supply of HIT Increased Demand for Healthcare Services Increased Supply of Healthcare Services
Acceptance of End User is the Key to HIT Implementation and Adoption Success The main challenge in HIT adoption is the resistance of end users due to lack of technological fit into operational processes. TAM2 Subjective Norm Image Perceived Usefulness Job Relevance Actual Use Behavioral Intention to Use Output Quality Perceived Ease of Use Results Demonstrability This, on the other hand, is caused by the complexity of business processes. And lastly, the beneficiaries of healthcare services still exert weak demand for the use of computerised technologies by the healthcare providers. Holden J. Richard, Karsh BenTzion. The Technology Acceptance Model: Its past and its future in health care,. Journal of Biomedical Informatics 2010; 43:59-172.
Technology Must Be Invisible to the End User 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.
Evolution of Healthcare Information Technologies 80’ 00’ 2010 90’ 2015 PMI EMR eHealth Smart eHealth Health Informatics Stand Alone Applications Stand Alone Applications Hospital Information System – Single EMR E-Health – Lifetime Health record Personalised E-Health Personalised Health Record Limited Functionality Extended Functionality Full Functionality Full Functionality, POC Full Functionality, Home Monitoring No interoperability Limited interoperability First Healthcare Standards Full interoperability within The same location Country and regional interoperability Full Interoperability Focused on Back-office Flow: Financial, Inventory & Patient Master Index Focused on Administrative Flow :ADT, Scheduling Pharmacy Focused on advanced Clinical Flow and Business Intelligence Systems Focused on Knowledge Management/ Complex BI and AI Systems Focused on integration of Administrative and Clinical Flows 11
Complex Environment of HIT Healthcare Information Technologies can be defined as any computer based products and services that are specifically designed and developed for Healthcare Industry. This broad classification includes infrastructure, software, devices, and services that are used by all the participants within the healthcare value chain. As we later will see, the major consumer of HIT are the healthcare services organisation – the care givers, and their will be our main focus when discussing the HIT. HEALTH INFORMATION SYSTEMS Life Sciences Resource Management Patient related Financial Clinical GL AR AP Billing PO Third Party Payer Insurance Bio-Informatics Gene-Sequencing Gene-Analytics Library IS College IS Research IS ADT PMI EMR HER PHR Health Portal CIS Hospital Departmental Systems LIS RIS PACS Pharmacy Decision Support System Inventory HR Scheduling Facility Management Reporting Business Intelligence
Collaboration and Sharing is the Key Function of Entire Healthcare Value Chain Financial and Billing Systems Resource Management Systems Clinical Systems Patient Management Systems Life Sciences Systems
Industry Practice Characteristics Unmet Needs Met Needs Capability Gap Full capture. POC Capture/ Retrieval Non-disruptive to work processes/ Relevant Retrieval Large quantity of data/information Partial Capture/Store/Retrieval Sensitive Data/ Information Partial Security/ Confidentiality/ Privacy (PKI, Biometrics, SSL) Full Security/ Confidentiality/ Privacy Non-disruptive to work processes and lifestyle. Remote sensors and automated capture/ retrieval/ alerts Mobility Mobile Devices/ Wireless Connectivity Limited integration – not all processes automated. Long implementation times and high failure ratio. Limited customisability. Follow work processes : improve on but do not disrupt. Easy to implement and customize by the user. Complexity One lifelong health record collating all wellness and illness parameters. Limited Interoperability mostly at local level – EHR/PHR Collaboration Partial analytics (mostly non-clinical) Analytics that deliver accurate and relevant information at the POC. Non-disruptive to work processes. Mission Critical Capability Gap
HIT Development/Adoption Cycle Source: Frost & Sullivan. Customer Satisfied The ICT has entered into Healthcare Delivery Industry with “big bang” of excitement . HIT Cycle Requirements fully Implemented Excitement Requirements not Implemented Disappointment Threshold With new innovations on the horizon, the credibility credit has been rebuilt. We might be looking upwards and finally climbing the slope. Decade later, the moods were running low as the technologies failed to meet the expectations. The ride has been continuously downwards. Customer Dissatisfied 2010 1980 1990 2000 2020 15
The delivery of care depends on information made available to both: the caregivers and executives. 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.
License Software Spent by Healthcare Providers in 2010 in USD Billion 3.0 USD 3 Billion 1.9 USD 1.9 Billion 0.8 0.8 APAC:
APAC License Software Market (TMP) By CountryUS $ (MM) and 4 Year CAGR (%) 4 Year CAGR (%) Licensed Software Spend in US $ (MM) Japan, Australia and China are the biggest markets while China, Malaysia and Thailand presents the most significant market growth in APJ 2010 – 13.
APACJapan, Australia, China, Korea, India, Malaysia, Thailand & Singapore
Key Countries Diving IT Spending
Among the APAC countries, Japan, Australia, Korea and Singapore lead the region in technological advancement in HIS systems followed by Malaysia and Thailand and lastly by India and China
Japan has the biggest market in the region (348.7 million in 2009) but is almost stagnant in terms of growth with only 2.87% CAGR
Australia is the regions second biggest market (120.88 million in 2009) with 10.32% growth rate
China, India, Thailand and Malaysia show double digit growth. In terms of market size, China leads the group followed by Malaysia, Thailand and India.
Between Korea and Singapore, Korea has a bigger market size with 6.84% growth where as Singapore with a smaller market size with 9.31% growth.
Encouraging Adoption of EMR and Move towards Centralized EHR’s
22 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 China will focus on improving the standard of its healthcare sector and government focus is key to realising the growth Low High Low High Low High Low High Low High Low High Denotes the expected market growth >>>>>>>> Denotes high CAGR (>15%) Denotes medium CAGR (10-15%) Denotes low CAGR (<10%)
23 All countries – particularly China and India – will make significant progress in relation to HIT adoption over the next 10 years >> investments will be made Present and Future HIT Adoption Level Clinical Decision Support Systems Resource management Image management PHR EMR Financial management Patient management Patient Administration CIS EHR Integrated healthcare delivery Administrative IT solutions Clinical IT solutions
Japan represents the most mature and saturated market for HIT; however, it lacks interoperability between the sites (EHR). Presently, the government is focusing on facilitating the integrative efforts to provide seamless exchange layer for the EHR.
7 – 12 years 0 years
Singapore has already implemented EMR infrastructure in public and private sectors, and currently is focusing on providing collaborative platforms to link both into nationwide EHR. The small size of the market allows for faster progress toward EHR.
5 – 10 years 0 years
Most of India’s hospitals operate some kind of HIT; however, the full blown EMR/site is still 15 years away. Assuming that India’s economy remains strong and that the medical tourism trend remains, India may progress more quickly.
0 years 15 years 20 years
South Korea is finalizing its deployment of EMR and will move very fast into interoperability phase to achieve nationwide EHR. The HIT market is mature but isolated due to cultural and language barriers.
0 years 8 – 16 years
China is in hot pursuit of the other APAC countries in terms of adoption of HIT. The large financial commitment from central government might be a factor to speed up the process.
0 years 10 years 20 years 30 years Source: F&S Research 2010
INNOVATIONS TRANSFORMING HEALTHCARE DELIVERY THROUGH DISRUPTIVE TECHNOLOGIES 24
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.
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. It's the first time Pew has surveyed health searches on cell phones.
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.
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.
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.
Intelligence in Healthcare - Impact and Uses Products/Services Maturity/Adoption Level Growth Potential
Organisation: creating platform for virtual organisation.
Public/scientists: utilisation of Health 2.0 analytical capability to conduct custom research
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.
Treatment (phobias, rehabilitation, compliance to medication)
Technology Impact on Stakeholders and Care Quality 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 1 5 2 3 4 Provider Consumer Outcomes Total 15 Points Connected Healthcare 10.0 Low High Low High Low High Cloud Healthcare 8.0 Low High Low High Low High Interactive Healthcare 12.0 Low High Low High Low High Intelligent Healthcare 12.0 Low High Low High Low High Virtual Healthcare 8.0 Low High Low High Low High Low High Key : Source: Frost & Sullivan. 35
Smart Healthcare: Communication Trends Smart Model: Continuum of Care & Patient Focused. HOME CARE Smart Homes Telehealth Aged Care Critical Alarms Assisted Living Home Monitoring Current Model: Curative & Provider Focused INSTITUTIONAL CARE Nursing Homes Communication/Data Specialty Clinic Communication/Voice Hospitals Tracking/Resource Management Connectivity Source: Frost & Sullivan, Motorola