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What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?

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What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?. Crawford J. eHealth week 2010 (Barcelona: CCIB …

What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?. Crawford J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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  • 1. COCIR session eHealth Market? Present and Prospects, A View from Industrial Players What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare ‘transformational’ imperatives? John Crawford COCIR HealthCare IT Committee Member
  • 2. The pressing need for healthcare system transformation Cost Quality Productivity Cost rising at a rate higher than GDP; One size fits all treatments Too little patient involvement e.g., US costs projected to reach 20% Fee-for-service payment models; Slow and inefficient processes US GDP by 2017 (world highest) money does not buy quality Little best-of-breed methodologies Aging population; most of the cost is Lack of Comparative Effectiveness and processes during the last 2 years data No quantitative and comparative Disease centered versus wellness value options centered Preventable errors; too many deaths caused by preventable mistakes Complexity
  • 3. eHealth supports the entire spectrum of benefits from productivity gains, through improved patient access, to high quality care and health maintenance Basic Intermediate Advanced Productivity for Access for Quality for Providers & Payers Patients Citizens & Consumers Wellness & Welfare Chronic Disease Public Health Surveillance Electronic Health Records Telemedicine Clinical Information Systems Hospital Information Systems
  • 4. eHealth can enable cost reduction, improve quality of care through systemic evidence generation and use, and supports new payment and delivery models Tomorrow eHealth Transformation Bridge Molecular Diagnostics / “-omics” Today Evidence-based practice ICT Education Personalized medicine Intuitive medical practice Improved Clinical Pathways Patient-centered & collaborative „One-size-fits-all‟ Electronic Patient Records Outcome-based payment Institution-based care Electronic Health Records Fee for service New Payment Models Lower costs, activated patients, Improved outcomes New Delivery Models
  • 5. Recognising the importance of ICT in healthcare transformation, there has been a recent surge of eHealth programmes and key investments worldwide, based on a strong vision, political will, and sustained funding Europe England (NPfIT) - ₤12B Asia North America China – $4.2B US (ARRA) – $20.4B Singapore – $1.1B SIN Canada (InfoWay) –$3.1B CDN Middle East Saudi Arabia – $14B Worldwide EPR/EHR investments >$10B in 2010 rising to >$30B by 2019
  • 6. What eHealth strategies work and do not work? • Successful approaches share the following attributes: • A strong vision of the goal, political will and sustained funding • Consistency of policy across all stakeholder organisations • Willingness to change care processes to take advantage of ICT, supported by new legislation, business and financing models • A clear set of priorities for implementing eHealth projects, including expected benefits, incentives and additional support where needed • A steady step-by-step adoption of change, with realistic expectations defined, and successes clearly communicated • A robust governance model to set the agenda, establish technical standards and architectures, and monitor implementation
  • 7. What eHealth strategies work and do not work? • Failing approaches share the following attributes: • Constantly changing goals, weak consensus between political factions, and lack of investment (healthcare as a political football) • Lack of joined-up health policy, misaligned incentives • Innovation held back because of medical conservatism, fears about loss of revenue or status, and previous failed ICT projects • Confusion and disagreement about how health information will be exchanged, and how eHealth services will be funded • Unrealistic timescales, limited public perception of improved service, bad press about money being „wasted‟ • Fragmentation and duplication of effort, focus on technology-driven projects rather than safety, efficiency or outcome improvements
  • 8. Some examples of the transformative power of eHealth supported by a vision, strong political will, and sustained investment Canada Health InfoWay Denmark Healthcare Data Network “By 2010, 50 per cent of Canadians and by 2016, 100 Universal EHR use; 98% GPs, majority of specialists, per cent of Canadians will have their electronic health all 73 hospitals, all 331 pharmacies and about half the record available to their authorized professionals…” 98 local authorities Widespread use of PACS has increased radiologist Incentives for standards-based EHR adoption, plus productivity by 23 percent, saving an estimated $1B a year. national eHealth portal (sundhed.dk) for patients In 2009 the PharmaNet system in British Columbia avoided Cumulative present value cost of prior to YE2005 was 2.5M potential cases of drug interactions. €536M , benefit was €872M (Empirica) Typical GP serving 1,300 patients, saves In Alberta, WebSMR has reduced post- 30 hour/week of secretarial work by using surgical reporting from 1 month to 1 hour eHealth standards (Empirica) Success factors: • Develop a strong vision for the way healthcare will be structured, organized, managed, financed, delivered and monitored, and how ICT will support this. • Share a collective vision of eHealth in order to assist users, health professionals, suppliers and procurers in signing up to the benefits of eHealth. • Integrate the policy process, as issues will cut across the remit of different government departments and agencies.
  • 9. Some examples of the transformative power of eHealth supported by a change in business & financing models Geisinger ProvenCare Kaiser Permanente Implemented EHR in 1995, Clinical Decision Support Pre-paid plans and emphasis on preventive care; full (CDIS) in 2009, to „hard wire‟ best practice into systems deployment of EHR and CPOE in 2003 ProvenCare care program provides 90 day warranty on 8% reduction in doctor visits and 14% reduction in phone outcomes calls among My Health Manager (patient portal) users. Re-admission within 30 days has fallen from 6.9% to 3.8% Kaiser members in California have 30% less chance of Average total length of stay (LOS) down from 6.2d to 5.7d dying of heart failure compared to the US population “We are quickly approaching a situation where working Kaiser members have 12% improvement in survival rates without an electronic infrastructure will be impossible…” for colon cancer compared to SEER Medicare averages Dr Ronald A Paulus, CTIO, May 2009 Success factors: • Address the fragmented nature of care i.e. “continuum of care” versus “episodic care” (e.g. introducing disease management, case management, participatory medicine etc) • Align interests between the party making the investment and the beneficiary. • Develop financial incentives, reward health outcomes (quality, safety, prevention), and nurture the innovative business models that are made possible through the use of eHealth.