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  • LET’S BUILD A SMARTER PLANET: HEALTHCARE Welcome and thank you for joining us today to discuss the future of healthcare in the context of the dynamic and increasingly demanding world around us. Our political leaders aren’t the only ones who’ve been handed a mandate for change. Leaders of businesses and institutions everywhere have a unique opportunity to transform the way the world works. The financial crisis has jolted us awake – we are more seriously focused on the nature and dangers of highly complex global markets (i.e., what can go wrong). Other looming questions include global climate change and energy, global supply chains for food and medicine, new security concerns ranging from identity theft to terrorism – all issues of a hyper-connected world – that have surfaced since the start of this decade. The world continues to get “smaller” and “flatter”. But we see now that being connected isn’t enough. Fortunately … the world is getting smarter. Intelligence is being infused into the way the world actually works – into systems, processes, infrastructures that enable physical goods to be developed, manufactured, bought and sold; services to be delivered; everything from people and money to oil, water and electrons to move; and billions of people to work, govern themselves and live. Global trends and conditions are affecting consumers, citizens, governments and enterprises around the world. Many disruptive forces are at play. Dealing with them in smarter ways will present opportunities to improve the way we deliver to all that count on us. Intelligent responses will position some to be the winners in this environment. Building a smarter planet is IBM's point of view on how interconnected technologies are changing the way the world literally works. This new reality was discussed by Sam Palmisano in his speech last year when he introduced characteristics of a smarter planet and their roles in enabling industry systems to become “smarter”: “ The world is becoming not just smaller and flatter, but also smarter. What this means is that for the first time in history, almost anything can become digitally aware and interconnected. The fact that we will all begin to transform our systems, operations, enterprises and personal lives to take advantage of a smarter planet isn’t just because we can. It’s because we must.” Since then, we’ve initiated 21 discussions on, including point of views – and invited site visitors to get involved. Perhaps you’ve seen some of the smarter planet videos on TV. And our Smarter Cities summit is occurring in Berlin this week, kicking off smarter cities summits in U.S. and European cities throughout 2009 followed by Asia. In the healthcare industry, current and emerging capabilities have tremendous potential to enable healthcare organizations to produce better results while getting growing costs under control - from electronic medical records and sensors to process integration to deep, complex analyses within single organizations and across health systems that can be applied to improve quality and outcomes. Before we move ahead, I want to point out that our discussion today will reference IBM’s Healthcare 2015 thought leadership series which provides foundational perspectives on the future of healthcare, health insurers and care delivery. Today we will share our point of view for “smarter healthcare” and invite you to explore opportunities for smarter healthcare with us. Included is a framework to help care delivery organizations and insurers to consider and evaluate the actions they can take now to prepare for the future. This is important because of the need for collaborative solutions to the systemic problems facing most healthcare systems.
  • Market forces require a new approach for the healthcare industry. Globalization Impacting country healthcare systems, as healthcare shifts from local to national to global settings Empowered Healthcare Consumers More knowledgeable, demanding and accountable Growing expectations for better quality and outcomes and more value for money Changing Demographics and Lifestyles Growing aging and overweight populations add cost to overburdened health systems Growing Cost and Threat of Disease Growing incidence and cost of treating chronic disease and re-emerging infectious diseases New Technologies and Treatments While promising to revolutionize risk assessment, diagnosis and treatments, they raise new questions (e.g., who will pay) Growing Resource Shortages Workforce shortages worldwide, particularly in nursing and medical specialty areas Changing Competitive Landscape Emerging approaches to promoting health and delivering care Non-traditional players are entering the market to meet the changing needs of patients and communities There are striking inequities around the world in health outcomes, in access to care and in what people pay for care. Examples of Staff Shoretages: PWC Study from Oct. 2010 : until 2030 – 1 Mio. People Medical Staff shortage in Germany (does not include elderly care) – (reasons : demographical changes / age structure of staff) Medical Staff will become even more an export product! OBSAN Feb 2010, Switzerland – 2020 – 25.000 People Medical Staff shortage in Switzerland
  • This mandate for change - and the sustainability of the planet - are mandates for smart. We believe SMARTER is how healthcare organizations can leverage change to their advantage. So what is a smarter health system? A smarter health system forges collaborative partnerships to deliver acute, chronic and preventive care, while activating individuals to make smarter choices. A smarter health system forges partnerships in order to overcome the challenges inherent in today’s healthcare organizations and to leverage change to build a sustainable foundation for the future. Adopting a patient-centric approach – becoming demand-driven - is top priority. Playing active roles in helping to shape a healthier society through focus on prediction, prevention and wellness. And to do this, they need to activate individuals (citizens) to become responsible for their health and care decisions. Let’s move to the next slide to understand how organizations can become “smarter”.
  • Instrumented Today, there are 1 billion transistors for each person on the planet. 7 By 2010, 30 billion RFID tags will be embedded into our world and across entire ecosystems. 7 There is a 60% reduction in hospital readmissions for patients who use remote physiological monitoring, compared with those who receive standard care. 8 Typically, hospitals over-procure mobile assets by 20-30% while critical staff spend 10-30% of their time searching for them. 9 The share of health expenses devoted to determining what works best is about one-tenth of one percent, The Learning Healthcare System: Workshop Summary (IOM Roundtable), At least 80% of premature deaths from cardiovascular heart disease and strokes could be prevented through a healthy diet, regular physical activity and avoiding the use of tobacco, 10 Facts on the Global Burden of Disease, World Health Organization, Remote patient monitoring could prevent 460,000 to 627,000 heart failure-related hospital readmissions annually in the U.S. Typically, hospitals over-procure mobile assets by 20-30% while critical staff spend 10-30% of their time searching for them Interconnected With Health 2.0, community-based information sharing may lower the rate of needless procedures, cutting into the 20 to 30 percent of elective surgeries, Panel says health 2.0 approaches can lower administrative costs, 9 out of 10 U.S. physicians believe the Internet is essential to their practice, Internet's Importance Growing Among Doctors, Patients, Research, iHealthBeat, October 22, 2009, 65% of Americans are interested in accessing their own personal health information electronically 88% of Americans say online records would help reduce the number of unnecessary or repeated tests and procedures they undergo 65% believe that having their health information online would prevent medical mistakes 60% believe that having their health information online would change the way they manage their health Intelligent Remote patient monitoring could prevent 460,000 to 627,000 heart failure-related hospital readmissions annually in the U.S. - - Research Update: Remote Physiological Monitoring, Report Identifies Savings From Remote Patient Monitoring, Jan 29, 2009, iHealthBeat, Typically, hospitals over-procure mobile assets by 20-30% while critical staff spend 10-30% of their time searching for them - -, The share of health expenses devoted to determining what works best is about one-tenth of one percent There is a 60% reduction in hospital readmissions for patients who use remote physiological monitoring, compared with those who receive standard An opportunity for health systems to think and act in new ways. The capabilities represented by Instrumented, Interconnected and Intelligent provide a framework for healthcare organizations to think more broadly about how to proceed (their choices), given the need to get through the current economic environment and thrive in the world ahead. Our vision is to live healthier lives. Smarter healthcare organizations can leverage this period of change to leapfrog ahead: to build new capabilities including partnerships. We believe focusing on these opportunities will help organizations to meet near-term financial objectives and position themselves for future success: (1) improving operational effectiveness (2) achieving better quality and outcomes and (3) delivering collaborative care for prevention and wellness. Many healthcare organizations are currently experimenting to get to more cost-effective, value-based, sustainable – and “smarter” healthcare environments. The next slides share examples of clients who are applying instrumented, interconnected and/or intelligent capabilities to make forward progress. As we review these examples, we would like to hear your thoughts on what “smart” means in your environment.
  • US: A typical 500-bed hospital will be eligible starting next year to receive $6 million for implementing digital health records, according to a report by PricewaterhouseCoopers. But if the hospital doesn't act by 2017, it would lose as much as $3.2 million a year in Medicare funding. (Source Wallstreet Journal 2.11.2010) Switzerland: In Switzerland in 2004 all healthcare providers hat to implement an new billing system for out-patient treatment. The new tariff included a penalty. From 2006 Healthcare providers could only bill the full consultation if the bill was sent out electronically.
  • APPENDIX Here is a Table of Contents showing additional information for your use. Additional IBM Focus in Healthcare Presentation Footnotes Alternative Slides and References

IBM - 9iun2011 IBM - 9iun2011 Presentation Transcript

  • The importance of Program Management and strategic Change Management in eHealth Bart de Witte CEE Healthcare Industry Leader IBM CEE Bart de Witte eHealth conference 2011 – 9.06.2011 - Intercontinental Hotel, Fortuna Conference Room - Bucharest
  • IBM’s role and commitment in Healthcare
    • Health IT services and solution provider
      • Revenue scale of Fortune 400 Company
      • >8,000 employees dedicated to healthcare
      • 56 Medical doctors, 350 health professionals
      • Broad solution portfolio and business partner ecosystem
    • Change agent
      • National level reform and eHealth ( Denmark, Norway, Germany, Ireland, Spain, Italy, Slovenia, Slovakia, Czech, ME, Canada, Singapore, Australia, China, India and US )
      • IBM Research and systems thinking
      • 600+ patents in life sciences, healthcare and medical devices
      • Commitment to standards
      • EU e-health engagements: epSOS , Renewing Health , COCIR , Continua Health Alliance , EHTEL
      • European Healthcare CoC in France, involvement in Tromso Telemedicine Centre and European Centre for Connected Health in N Ireland
  • eHealth News from the last 2 months "Unser Problem ist jedoch, wenn es kein Gesetz gibt, gibt es keinen Roll-out",
  • Industry challenges from a global perspective globalization Health care is shifting from local to national and global contexts chronic diseases Incidence and cost of chronic and re-emerging infectious diseases are increasing staff shortage Nursing and specialist shortages demand workforce productivity and efficiency consumerism Empowered consumers expect better value, quality, and outcomes demographics Changing demographics and lifestyles drive associated costs cost Growing costs for new, revolutionary technologies and treatments
  • A smarter health system forges collaborative partnerships to deliver better acute, chronic and preventive care, while activating individuals to make smarter choices. This mandate for change is a mandate for smart.
  • An opportunity for health systems to think and act in new ways. + + = Our world is becoming INSTRUMENTED Our world is becoming INTERCONNECTED Our world is becoming more INTELLIGENT
  • I am an ePatient – where and with whom can I connect?
  • I am an ePatient – where and with whom can I connect?
    • “ We can’t look at health in isolation . It’s not just in the doctor’s office. It’s got to be where we live, we work, we play and we pray”
    • US Surgeon General, Regina Benjamin, LA Times, March 13, 2011
  • eHealth in Europe (EU)
    • Status & Results
  • At the national level, progress can also be registered, but the majority (20 of 34) of European countries surveyed are still at the planning stage. State of ePrescribing in European countries, 2010 Deployment stage of patient summary and EHR-like projects in European countries, 2010 Source: eHealth Strategies study, 2010
  • Disease man. Anti Coagul. Diabetes EHR-data Lab/Rad orders/tests Referrals Discharges Medicine info. Insurance Public HC Electronic Health Record National Patient DB (eLPR) Public Healthcare Reimbursement Organ donation Life Testament NIP Quality databases Regional Services HIS / EMR Medicine Booking Pharmacies Home Care GP’s National Government services Municipality Citizens Health Portal Medical Labs Prescriptions Medicine Reimb. Prescriptions Referrals Reimbursement Radiology Quality data (DAK-E) Appointments Prescription Server Medicine and Reimbursem. Referral database DAK-E Quality Datab. Quality data (NIP) Discharges Prescriptions Referrals Reimbursement Appointments Discharges Health profess. Lab/Rad ord/test eConsultations Denmark: 20 years of e-health development
  • Qualitative Results
    • Example 1: Denmark: DAK-E Quality Database
  • Qualitative Results
    • Example 2: Denmark: Telemonitoring based in EHR
  • Denmark Diabetes Telemonitoring Solution
    • The solution is a Shared EHR for diabetes treatment.
    • A single, complete overview gives a quick outline of the current state of the individual patient as well as a status of treatments and completed examinations by all care providers.
    • Portal contains information on: Lab results, treatment, use of insulin, eye status, foot status, self-care, latest contacts, possible complications.
    • Solution is developed as a web-based service that has minimal requirements to the local infrastructure at the users and to IT support.
    • Integration to PAS, lab systems, and GP systems is done by use of standard web links and common standards.
  • Dialog – an IBM company
  • Quantitative Results
    • Canada Health Infoway
  • Canada: IBM’s Role in e-health (Infoway) BC – IBM Integrated, Implemented, Operated and Maintained PharmaNet AB – IBM Designed, Developed, Installed, Maintained, Deployed and Operated PIN SK – IBM Designed, Customized, Implemented and Maintain PIN QC – IBM Selected, Designed and Implementing SQIM e- Prescription implementations: 25,000 Users, 100M+ transactions Providing MPI for e-health for 96% population
  • Canada: Electronic Health Records The Financial Payoff Access Quality Productivity Benefits = $3.4 billion/ year 2
    • Inpatient ADE = $1.6 b/yr
    • Ambulatory ADE = $1.4 b/yr
    • Post Discharge ADE = $0.4 b/yr
    • Sources
    • Health Canada – Telehealth Evaluation
    • Booz Allen Hamilton – EHR ROI Model
    • Courtyard Group – DI ROI Model
    • Diagnostic Imaging Efficiencies = $1.1 b/yr
    • Laboratory Test Efficiencies = $0.5 b/yr
    Benefits = $1.6 billion/ year 2,3
    • Medical Transportation Savings = $30 m/yr
    Benefits = $30 million/ year 1 Infoway Electronic Health Record Demographics Diagnostic Images Laboratory Results Drug Profile Clinical Reports Immunizations Telehealth
      • Decreased medical errors
      • Improved interpretation of diagnostic and laboratory results
      • Decreased adverse drug events
      • Decreased prescription errors
      • Improved prescribing practice
      • Increased speed and accuracy in detecting infectious disease outbreaks
  • concrete deliverables on eHealth during the Swedish EU Presidency 2009
  • E-Health Program
    • Most E-Health implementations involve:
      • A program of many (10 to 50 or more) related projects
      • The projects tend to be:
        • Interrelated
        • Complex
        • Multi-stakeholder
        • Procured from multiple suppliers
        • Delivered in many different ways
        • Affecting the same client population
        • Strong influence / change on healthcare practice
        • Strong influence / change on the way of doing “business”
  • Ministry of Health – eHealth Risks Technology Lack of Stakeholder Adoption and Usage 20% 80%
  • eHealth Adoption Barriers – Fear of Change
    • Experience a loss of Personal Control
    • Have anxiety around Benchmarking (KPIs) and transparency that EHR create, on their clinical practice.
    • Fail to see value in eHealth solutions
    • Loose of Revenue due to higher documentation effort and new guidelines
    • eHealth Integration Costs
    • Lack confidence in new systems or ability to learn new skills
        • Lack confidence in eHealth tools
        • Have concerns about reassigned to physicians and not have access to physicians known to them
        • Not trust e-services which replace face to face encounters with administrative and clinical staff (ebooking for example)
        • Concerns about inappropriate information protection and sharing
    Patients may Clinical Staff may BARRIERS for eHealth Adoption
  • PMO and Strategic Change Management IBM’s approach
  • Ingredients for success in eHealth
    • Learn from the past and other countries – best practices
    • Design a rock solid PMO & Governance process
      • Direction
      • Project oversight
      • Stakeholder buy-in
      • Manage the Change
    • Use Standards and methods across the program
      • Project management
      • Common project phases & gates
      • Alignment with a national E-Health Architecture using a Design Authority
    • Coordination through an overall Program Management Office (PMO)
      • “ A "Project Office" is a centralized group consisting of one or more individuals within an organization established to perform project management functions for a single project or for a portfolio of projects that make the organization and its projects more effective.”
  • Relevance for eHealth Strategy
    • A PMO is necessary for E-Health success but may not be sufficient
    • Traditional PMO structures focus on project management issues and processes
    • E-Health requires more than project management and a PMO can support other important processes like:
      • Methods
      • Standards
      • Architecture
      • Governance
      • Benefits Realization
      • Change Management
  • People & Process & Technology
  • IBM’s Change Management Strategy Development Framework Macro Focus on Strategic Execution Micro Focus on People Change Value Realization Program Leadership & Governance Skills & Knowledge Organizational Design Stakeholders Engagement & Communications Program & Strategy Management Cultural Transform
  • Governance and stakeholder management
    • In E-Health programs, a stakeholder management & communication strategy will be defined in order to:
      • Stakeholder Management Strategy
        • Identify & Analyze stakeholder groups 
        • Analyze stakeholder groups  (Impact of Change, Reaction to Change, Degree Support required, Define Incentives)
        • Create Stakeholder Map & Define Management Strategy for each group
      • Communication Strategy
      • Stakeholder Planning
      • Communication Planning
      • Stakeholder Mobilization
  • Value & Benefits Realization Approach Realizing cost benefits and sustaining them over time requires the incorporation of a benefits realization and tracking mechanism to understand change, measure it and communicate its impact throughout the organization.
    • Key Activities include:
      • Identify benefits
      • Create benefits case
      • Define benefits owners
      • Build action plans (including Incentives)
      • Create metrics
      • Build a tracking mechanism
      • Measure and monitor
    Secure Benefits Ownership Establish and Track Benefits Measures Test Benefits Strength Build Business / Benefits Case Realize Results Execute Benefits Delivery
  • Change Management is key driver of Successful eHealth implementations The key success factors for transformation are organisational rather than technical Source : IBM Institute of Business Value
  • Summary
    • E-Health programs are among the most complex business initiatives. a well structured PMO can add tremendous value
    • The optimal approach for an E-Health PMO addresses the bigger picture
      • Change Management
      • Benefit Realization
      • Impact Analysis
      • Governance
      • Architecture
      • Methods
    • Attention to the broader picture and long term goals improves chances of success
  • We need to connect the Islands – but we can only do this together if we have a clear view of the benefits and do this smart! Picture Source : Bart de Witte – Big Belt Bridge - Denmark
  • Thank you for your attention Bart de Witte CEE Healthcare Industry Leader witte (at) sk (dot) ibm (dot) com