Healthcare Vision: How healthcare systems in Europe are managing change


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Healthcare Vision is a Canon magazine commissioned from the Economist Intelligence Unit. It seeks to examine how healthcare systems in Europe are managing change, from demographic shift to data systems and patient involvement in care. All articles, except where indicated otherwise, were written by the Economist Intelligence Unit, based on interviews, desk research and a survey of more than 400 European healthcare professionals in the United Kingdom, France, Germany, Spain, Italy, the Netherlands, Denmark, Austria, Russia and Sweden.

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Healthcare Vision: How healthcare systems in Europe are managing change

  1. 1. ISSUE 1 Written in co-operation with the Economist Intelligence Unit EMPOWERING PATIENTS Encouraging patients to take control of their own health SHARING AND CARING How electronic health record systems are improving healthcare ALL CHANGEFOR HEALTHCARE How innovative providers are staying competitive in today’s changing landscapes
  2. 2. 2 Healthcare vision | issue 1 Contents Cover Stories 04 All change for healthcare How innovative providers are staying competitive in today’s changing landscapes 08 Empowering patients Healthcare Vision is a Canon Encouraging patients to take control of their own health magazine commissioned from o4 16 Sharing and caring How electronic health record systems the Economist Intelligence Unit. It seeks to examine how healthcare are improving healthcare systems in Europe are managing change, from demographic shift to Featured data systems and patient involvement in care. All articles, except where 03 Flash poll results indicated otherwise, were written by o8 12 Problems shared 14 The innovation imperative the Economist Intelligence Unit, based on interviews, desk research and a survey of more than 400 European 20 Active ageing healthcare professionals in the United Kingdom, France, Germany, Spain, 23 Why your office is the new Italy, the Netherlands, Denmark, health frontier Austria, Russia and Sweden. Our 16 thanks are due to the interviewees 24 Ten trends in healthcare and survey participants for their time and insight. Final word 26 The long view on health The Economist Intelligence Unit bears full responsibility for the content of its articles, and the findings expressed do not necessarily reflect the views of Canon. Foreword H ealthcare organisations are under constant pressure to improve the quality of care; but this challenge is becoming increasingly difficult to achieve. Like businesses the world over, healthcare organisations are facing a future with shrinking budgets. IT departments must operate and integrate more systems than ever before and manage an increasing amount of patient data to ensure their organisations comply with stricter regulations concerning patient confidentiality. eHealth, including the digitisation of patient records, has often been championed as a solution to these problems. Showing a significant commitment to technology, the European Commission is investing up to 100 million euros a year on electronic processes and communication research, with aims for these types of solutions to become widespread by 2020. At Canon, we strongly believe that technology has a key role to play in making organisations more patient-centric and improving the quality of care. We have been working closely with healthcare organisations for over 70 years to develop innovative technological solutions to meet different needs, from better document management to dedicated eye care and digital radiography solutions. We commissioned the Economist Intelligence Unit to develop Healthcare Vision, which brings together the views and opinions of the global healthcare community and explores the principle challenges facing the industry today. The Economist Intelligence Unit spoke with global experts and asked the industry as a whole, through a survey of 400 healthcare professionals across Europe, what policies and strategies they believe can improve citizens’ health and overcome the main challenges they face. I sincerely hope that you find the insights offered of great interest and value to your organisation. Yoshiyuki Masuko, Senior Director, Canon Medical Imaging Group
  3. 3. issue 1 | Healthcare VISION 3MANAGING CHANGE INHEALTHCAREWho should be responsible for making sure citizens stay healthy?NATIONAL GOVERNMENTS INDIVIDUAL CITIZENS EMPLOYERSHow can healthcare policymakers improve citizens’ health while controlling costs? encourage people to take responsibility for their own health improve health infrastructure cut back on frontline healthcare staffWhat are the barriers to improving your country’s healthcare system? 44% only 38% 16% not enough money ineffective leadership think citizens are in the healthcare system resistant to changeInfographics depict the results of a survey of 405 European healthcare professionals conducted by the Economist Intelligence Unit in June 2012.Percentages may not add up to 100% as respondents were allowed to select more than one option.
  4. 4. 4 Healthcare VISION | issue 1 All change for healthcare Anyone working in a healthcare system today knows that change is one of the only constants
  5. 5. issue 1 | Healthcare VISION 5 “ rganisational change only occurs when the individual O is willing and able to make the changes required in order to achieve system-wide change.” Sharon Gabrielson, Vice-Chair of the US Mayo Clinic Health SystemR eforming a healthcare system Engaging with frontline staff These same staff worked with technical is often compared with turning But top-level rhetoric will only be effective with support teams to transfer knowledge about around an aircraft carrier: painfully buy-in from individual employees or patients. the re-designed system to other appointmentslow and logistically difficult. But all over According to Sharon Gabrielson, Vice-Chair of the schedulers. “Frontline staff drove the process US Mayo Clinic Health System, change occurs on and owned it,” Ms Gabrielson says. “They providedthe world, policymakers are rising to the two levels, organisational and individual – and it is the requirements for design and processes of thechallenge and implementing sweeping the latter that needs to occur first. “Organisational future scheduling system. Their desire for changereforms of their country’s healthcare. grew as they saw the potential for improvement change only occurs when the individual is willing and able to make the changes required in order in their workflow.”The consequences of the UK’s Health and SocialCare Bill, which became law in April, and the to achieve system-wide change,” she says. The end result, she says, was that schedulingUS’s Patient Protection and Affordable Care Act staff numbers were reduced by 40 full-time(‘Obamacare’) are likely to be far-reaching. In 2007, Ms Gabrielson was charged with improving the patient appointment scheduling positions, 370 square metres of space wereAt the very least they signal changes ahead for reallocated to other institutional use, andhealthcare managers. system at Mayo Clinic, through which 1.4 million patients pass annually. Identifying a number patients’ waiting time was reduced by an of fundamental barriers in the way of good average of 60 per cent.Bupa, a UK-headquartered, global healthcareservice provider, sensed the prevailing customer service, and armed with information Reflecting on change management generally,conditions early and now employs a team of gleaned from focus group meetings with staff, Ms Gabrielson believes that many maturechange managers. Danielle Spencer, the patients and physicians, Ms Gabrielson built organisations have become complacent:company’s Director of Organisational a case for change. their external environment changes andDevelopment, reports that over the last ten years they are not able to adapt quickly enough.the healthcare sector has had to keep pace with But her primary focus was in helping frontline staff to understand that the risk of not changing Ms Spencer agrees.evolving macro-economic factors such as ageingpopulations, economic uncertainty and was greater than the risk of change itself. “This “Like any ambitious organisation, Bupa needs totechnological progress. “To remain competitive, helped us move from a state of passive to active continue to evolve and adapt,” she says. “In ourorganisations need to be agile in adapting to support,” she explains. markets around the world, the cost of healthcarechange,” she says. is rising year on year, yet we need to keep health insurance affordable. We need to deliver quality while responding to the external environment to keep our business competitive.” “ o remain competitive, organisations T need to be agile in adapting to change.” Danielle Spencer, Director of Organisational Development, Bupa
  6. 6. 6 Healthcare VISION | issue 1 Clinical drivers At the same time, the German government had created a new reimbursement Of course, the need for change within a healthcare system is as likely system for integrated care for chronic diseases. Sensing an opportunity, to be driven by clinical issues as economic or logistical factors. In 2005, clinical teams at the hospital established an integrated headache care a headache centre at University Hospital, in Essen, Germany, was approached system, boosting its capabilities further by hiring neurologists, behavioural by an insurance company which wanted to address the high costs associated psychologists, physical and sports therapists, headache nurses and with treating patients with severe or chronic headaches. Problems included consultants from psychosomatic medicine, psychiatry and dentistry. excessive diagnostic testing, referral to a number of specialists resulting The results have been remarkable, in terms of improved treatment outcomes, in conflicting diagnoses, frequent visits to emergency departments, patient satisfaction, patients’ adherence to sport, and relaxation therapies – and hospital admissions. and in costs. Total annual costs per patient treated in integrated headache care dropped as low as ¤2,750 per year, whilst for other patients costs were above ¤4,400.
  7. 7. issue 1 | Healthcare vision 7 On the Flying TrapezeHuge amounts of time and energy are spent on planning change, but many organisationalchange initiatives still fail to deliver to expectations. Ursula Franklin, a change managementand leadership coach, explains why – and how to be a star acrobat in the arena of change.Ursula Franklin, founder of f4 Leadership Imagine, Ms Franklin says, that you When a change is announced in anDevelopment, a European organisation have just been promoted to your first organisation, people are desperate forfocused on the human change process, management role, and how that feels: communication to find out how theirpoints out that around 65 per cent of all “You’ve desperately wanted it, you’re personal situation will be altered. “Lack ofchange initiatives in organisations fail finally promoted, but when you enter a information leads to speculation, and ifto deliver on expectations, and the single room the people who used to be your uncertainty exists, there is an inevitable dipbiggest reason for this is people issues. team-mates stop talking. Also, you used to in productivity despite the typical ‘business“Change derails people. It takes effort be regarded as the expert in your field but as usual’ instruction from the top,”to alter habits that have formed over now you’re the new kid on the block.” Ms Franklin explains. During this periodmany years and replace them with of uncertainty, managers must supportnew behaviours,” she explains. If that is a positive change, imagine the their people, and then, as the road ahead effects of a perceived negative change. becomes clearer, provide inspirationalAccording to Ms Franklin, one of the The emotions people go through during leadership to embed the new behaviourssecrets to effective change management change can mirror a grieving process, in the organisation for successful helping people understand why they Ms Franklin says. A person may experienceneed to change. As dramatic as it sounds, a sequence of events: denial, anger, Ms Franklin visualises the change as anpainting a picture of a near-crisis scenario bargaining, depression and finally individual going through a flying trapezecan be extremely effective. “If people are acceptance. Effective change management act. The person undergoing the change isgoing to put the effort into change, then requires managers to anticipate potential the acrobat. “You let go of one trapeze andthey need to perceive the rationale as losses for each individual affected by the fly through the air in an ‘oh no!’ momentworthwhile,” she says. “They must also be change. They need to think about the before you grasp the next trapeze, whenabsolutely clear on the vision for the future potential impact on, for example, job you are safe again,” she says. “The clearerand their individual role in it. Effective content, work-relationships, autonomy, the problem is in terms of the rationale forcommunication with employees at every authority, status, job satisfaction, incentives the ending, and the clearer the vision oflevel in the organisation is critical to and career prospects. the future, then the faster people can movesuccessful change.” more effectively through the period of “When you implement a change, transition and deliver successfulOne reason change is so difficult to you need to get involved at an individual organisational change.”manage is that even when it is positive, level to anticipate, acknowledge andit involves a loss for someone. then help people deal with these losses,” Ms Franklin adds.
  8. 8. 8 Healthcare VISION | issue 1 Empowering patients When it comes to the relationship between healthcare systems and citizens, the hardest thing is letting go. That has to change “ ll industrialised nations A T he idea that patients should be Easier said than done empowered to take control of their Despite this will, patient empowerment has not currently run healthcare own conditions – improving their own always proved easy to achieve, at least on a wide health as well as helping to take pressure off systems focused on disease healthcare systems – is being actively scale. The European Union is attempting to address that problem by funding the European pursued around the world. management. A radical Patients Forum, which represents 150 million people with chronic conditions across the change to focus on health Healthcare professionals themselves are keen on the idea. According to a survey conducted by continent. The forum aims to provide comprehensive information – not only about maintenance is imperative.” the Economist Intelligence Unit in June 2012, medication and therapy, but also self- nearly 60 per cent of European healthcare management, quality of life, social and peer professionals believe policymakers should support, and reimbursement options. The encourage citizens to take more responsibility initiative is required not least because without it for their own health. health services are at risk of imploding under the sheer burden of demand.
  9. 9. issue 1 | Healthcare vision 9Responsibility is certainly needed. An increasing In America, the National Health Councilnumber of Europeans are living longer, with one (NHC), a powerful patients’ advocacy agency,or more chronic diseases. One-fifth of the population is campaigning for better health education,of Europe will be older than 65 within the next as well as individualised care plans, greater 58%decade. There is a need to keep more people fit patient support in making treatment decisionsand working in later life, to pay for those unable and incentive payments to organisations whichto do so. try to co-ordinate care. “Patients are much more engaged in their own healthcare when they have of European healthcare“Healthcare costs can no longer be covered more information, says Myrl Weinberg, NHCby insurance or taxes,” says Wolfram-Arnim President. “There is plenty of evidence that can professionals believeCandidus, President of the Deutsche Gesellschaft be given electronically, but at the same time it isfür Versicherte und Patienten (DGVP), a thriving policymakers should not helpful to tell them their health problems arepatient group. “Patients must be educated from all their fault.” encourage citizens tochildhood that they are responsible for themaintenance of their own bodies, and offered take more responsibilityincentives to maintain or restore health. for their own health.Unfortunately, all industrialised nations currentlyrun healthcare systems focused on diseasemanagement. A radical change to focus onhealth maintenance is imperative.”
  10. 10. 10 Healthcare vision | issue 1 42% of Americans will be classed as obese by 2030 Jo Groves, the CEO of the International Alliance In the face of the rise of ‘lifestyle’ diseases, of Patient Organisations, which operates in 60 healthcare providers will find themselves more countries, insists that education about the link often having to navigate the treacherous waters between lifestyle, behaviour and disease has to around personal responsibility and blame. Paul be the answer to truly empowering patients to McArdle, a spokesman for the British Dietetic manage their own health. “Schools are a massive Association, acknowledges that up to 90 per cent gap for us,” she says. “Little or nothing is taught of type 2 adult diabetes are weight-related. “It is in any education system about the importance perfectly feasible to prevent the symptoms of of diet and exercise, or where non-communicable diabetes by losing weight, but not many people diseases such as diabetes, heart disease and can achieve that level of weight control,” he says. cancer actually come from.” Many frontline health workers are sceptical that Preventive care patient empowerment will have an impact on this But how much information do you need in order situation. “People are having blood pressure drugs to make a difference? A plethora of authoritative and cholesterol-lowering treatment pushed at websites already provide advice for patients on them every week,” says one American primary how to reduce the severity of their symptoms. care nurse in Seattle. “Why would you bother to Innovative, entrepreneurial organisations such eat the right food and stop drinking alcohol if you as Patients Like Me and Health Consumer are being encouraged just to pop a pill to counter Powerhouse provide comparative information the effect of your poor lifestyle?” on treatment options or outcome-based data, and the efficacy of different treatments. Incentives to stay healthy Despite all this, citizens do not seem inclined to Ann Smith, a primary care nurse in the village take more charge of their own health – possibly of Cookham, west of London – one of the best- because healthcare systems are characterised educated and most affluent communities in the by their curative culture. Duke University’s Global UK – is equally pessimistic. “A lot of our patients Health Institute estimates that 42 per cent of want everyone else to own their health problem Americans will be classed as obese by 2030, and make it better for them,” she says. “They are driving up rates of chronic and debilitating isolated, don’t have family networks any more, illnesses such as type 2 diabetes, heart and they like coming to their general practitioner disease, stroke, cancer and sleep apnoea. for advice. Of course, they could easily take control of their own blood pressure monitoring, but they don’t want the responsibility. It will take decades for current attitudes to change.” Indeed, when asked who should be most responsible to ensure citizens stay healthy, half of respondents to our poll point to national governments and 39 per cent to primary care workers. “ hy would you bother to W eat the right food and stop drinking alcohol if you are being encouraged just to pop a pill to counter the effect of your poor lifestyle?”
  11. 11. issue 1 | Healthcare vision 11 “t’s as if I had I just woken up”However, more than 40 per cent believe that Most people’s lives, says Waltercitizens should be responsible for their ownhealth, and only 16 per cent identify citizens’ Zolnacz, are out of control. They eatresistance to change as a barrier to improving and drink too much, watch TV insteadtheir country’s healthcare system. of moving about, and hope they willVanessa Bourne has more experience than most of somehow escape the ill health whichpatient empowerment. As Chairman of the British almost inevitably follows.Patients Association and as a Chairman of threehealth authorities, she has spent almost three When they become ill they resentfully put themselvesdecades travelling the world and observing different in the hands of healthcare systems which often lack theapproaches. Some of the systems in place in organisation, enterprise or funding to offer optimumAmerica, she notes, lead the world in efforts to treatment. As disempowered patients, people often becomegenuinely put the patient first and ensure there is truculent and difficult, and are subject to all sorts of subtle forms of discrimination by equally irritated medical staff.consultation on every step of the treatment. But sheagrees that there is still little real encouragement Mr Zolnacz, 52, who runs a large kitchen installationor motivation offered to make people take more business in the North of England, is one of a growingresponsibility not to get sick in the first place, and to minority who have demonstrated that people do not havelook after minor complaints themselves. “There is to resign themselves to being the unquestioning recipientsmuch that could be done in terms of incentives of healthcare directed and dictated by the medical stay out of the healthcare system and to offer He had already suffered three heart attacks and a hearteducation about illness and nutrition, but it’s just by-pass operation. He weighed more than 120 kg and hadnot happening,” she says. “We need to encourage recently been diagnosed with type 2 diabetes, but insteadresponsible use of health services, including the of resigning himself to a slow death as one of the world’suse of small payments up front.” burgeoning population of more than 285 million overweight diabetics, he spent a holiday at a health farm in Spain.The hip pocket approach has been put to workin France and Germany, among other countries, Within a month, the diet and exercise treatment prescribedwhich have introduced co-payments systems. meant he was able to give up the ten different medicationsA ¤25 fee for a doctor’s consultation can be claimed he previously needed to control his soaring blood sugar andback, but will discourage the time-wasting patient. blood pressure rates. He had lost more than 18 kg. In theBut getting this form of incentive right is not a intervening six months, he took up swimming and yoga and got two puppies. Walking the dogs every day led to a steadystraightforward matter. Research has shown that continuation in weight loss.the downside of the deterrent effect may end upcosting the healthcare insurer more, because an “It’s as if I had just woken up. I have so much more energyuntreated trivial problem becomes an expensive I can’t believe it,” he says. “I monitor my blood pressureserious one later. and blood sugar at home and only discuss it with the doctor about every three weeks. I am determined to keep it up.Nonetheless, financial incentives to stay healthy If every sick or unfit person could just have one day of beingmay prove to be the best way forward, particularly fit, energetic and healthy, they would know what that gainwhen combined with concerted efforts to educate feels like and have something to aim for.”children about health maintenance. Without thatknowledge, the lack of personal responsibilitywill persist.
  12. 12. 12 Healthcare VISION | issue 1 Problems shared Reaching out more to customers will make it easier, not harder, for healthcare organisations to manage their reputations Patient Opinion aims to give policymakers a way to become more effective, by providing them with a chance to respond to issues quickly.
  13. 13. issue 1 | Healthcare VISION 13T hings can go wrong in healthcare. British hospitals, for example, are considering they want to know something has happened as The same is true for any system – implementing a ‘friends and family test’, asking a result of their comments.” so why does healthcare see itself as patients whether they would recommend thea special case when it comes to reputation hospital as a place to receive treatment. The US is The model has been adopted in France, Italy,management? The fact that lives are at stake well ahead of Europe in this regard, meanwhile – the Spain and other regions. It has not always workedcan equally apply to a range of industries, medical sector has had to evolve to address a small – the Spanish site, for example, was abandoned inbut healthcare has a reputation as one of the explosion in the number of ‘rate my doctor’ sites. 2011 when too few hospitals signed up to make itsectors most likely to pull up the barricades financially viable. “We managed to get the patientin response to a crisis. “ he cost of having a public T feedback but not the business model,” says Dr Oriol Ramis, a Spanish consultant who worksThat culture, however, is being forced to change. voice has fallen to zero, with community-based groups. “Hospitals wereTraditional complaints mechanisms are becoming not prepared to pay. They found it very difficult toincreasingly irrelevant in the brave new world of and power is transferring get the funds and felt this kind of feedback wasfaster, louder social media. According to a recentPew Internet survey, 80 per cent of Internet users from big hierarchical better if it was in their control.”have searched for health information online, organisations to citizens.” But it can also be seen that patients are reluctantmaking it one of the most searched topics. to be coerced into making their voices heard. TheBut fewer than half of respondents to that survey Dr Hodgkin, Sheffield GP Netherlands has a well-established infrastructuresaid the information they found was of any help. of formal patient councils and focus groups toCan healthcare organisations take advantage gather patient experience, backed by a healthy Some practitioners regard these sites as the bane ofof this to manage their reputation, devolving social media network. All well and good – but it their existence. But Dr Paul Hodgkin, a Sheffield GP,responsibility for answering complaints to is becoming increasingly apparent that Dutch saw value in making what he calls “the wisdom offrontline staff and empowering them to make patients” available to the NHS, and established an patients are weary of being asked for their storiesthe changes demanded by the public? online forum, Patient Opinion, to capture their and opinions. experiences. “The cost of having a public voice hasRaised stakes fallen to zero, and power is transferring from big “Patients are saying ‘we are research tired’,” says hierarchical organisations to citizens,” he says. Sam Adams, an assistant professor at ErasmusWhen any system undergoes reform, its “But the costs for organisations have not dropped University Rotterdam. “They do not have thepractitioners can be exposed to risks, including totheir reputation. The seismic changes now taking as they still have to listen. It’s difficult for them to energy to join another group or tell their in healthcare systems, aimed at meeting respond to conversations happening across social Every time we ask patients to do this, it demandsthe twin challenges of an ageing population and networks.” And it is likely to become even harder – time and effort from an already vulnerable grouptightening public finances, have raised the stakes. according to the European Commission, the whole of people who are telling us that they just want toA 2009 Economist Intelligence Unit survey of of the EU population is expected to have access sit back and get better.”medical professionals in the UK and Germany to some kind of commercially viable broadbandfound that 33 per cent of the former and 60 per service by 2013. Yet there are encouraging signs of patientscent of the latter thought that healthcare in their engaging with health practitioners across Europe, Ongoing financial pressure on healthcare systems rather than just being asked for their feedback.countries had grown less efficient in recent years, caused by the eurozone crisis is not helping, Andrew Spong, a social business developercompared with 20 per cent and 10 per cent Dr Hodgkin says: “There is likely to be extreme focusing on health communication, launchedrespectively who thought it had improved. tension between the public voicing their a self-edited directory of European professionals,In a 2009 guide to reputation management, dissatisfaction with disintegrating public which includes their specialty, location, twitterDavid Stout, the Deputy Chief Executive of the NHS services and the ability of big hierarchical handle, and blog or website. The directory nowConfederation (which represents organisations organisations to respond to that.” has over 70 professionals from all across Europe.operating under the umbrella of the UK’s National Mr Spong is also the man behind the healthcareHealth Service), said: “The public and healthcare Competing on quality social media Europe Tweetchat sessions (usingworkers alike are often sceptical about the value Patient Opinion aims to give policymakers a way the hashtag #hcsmeu), which every week getof healthcare reforms, and worried about the to become more effective, by providing them patients and practitioners talking about currentprospect of closing hospital departments. If you with a chance to respond to issues quickly. healthcare challenges in Europe.lose your local staff and public, then you have Encouragingly, 250 healthcare organisationsno chance of implementing changes.” Traditionally, around the UK have now paid to tap into the Dr Hodgkin believes that the era of the patienthealthcare systems have at times seemed to take insights it has gathered from 40,000 opinions, voice as an influencer of services is here. Knowingan overly defensive stance in the face of risks to and help to manage their reputations accordingly. how to listen and respond to that voice will betheir reputation. But signs are that a new way of “It’s about using transparency to drive staff crucial for healthcare providers to manage theirthinking is coming into play, in which the towards responding and making service performance and improve patient care.experience of patients within healthcare systems improvements,” Dr Hodgkin explains. “Peopleis seen as crucial to reputation management. don’t want a letter from a heartless bureaucrat – According to a recent Pew Internet survey, 80 per cent of Internet users have searched for health information online, making it one of the most searched topics. But fewer than half of respondents to that survey said the information they found was of any help.
  14. 14. 14 Healthcare VISION | issue 1 The innovation imperative The story of healthcare is a story of innovation. So why is it so hard to innovate within healthcare systems themselves? A sked to name the most important innovations in Ineffective leadership was also cited as a barrier by 38 per cent healthcare, people would more often than not opt of respondents. Take the development of new anticoagulants for technological answers – penicillin, for example, prescribed for people who have had a stroke. The old drug, or X-rays, or genomics. It’s true that these and other such warfarin, has been around for decades but is difficult breakthroughs have saved millions of lives, but often to administer; troublesome side-effects often lead to overlooked are the innovations in health services that hospitalisation among users. The newer drugs are have allowed them to be implemented. As Miles Ayling, much simpler to administer, have fewer side-effects Director of Innovation and Service Improvement at the and could be managed in the community. But in local UK Department of Health, puts it: “People think about health authorities, there is no incentive for hospitals innovation as the very latest genomic drug or robotic to redesign the service and lose an income stream. surgery, but if only we did more of what we already know works then things would be far better.” The system does not know how to respond, says Stephen Whitehead, Chief Executive of the Association Every crisis needs a hero, and in health systems right now of the British Pharmaceutical Industry. “Spreading the big hope is pinned on less-lauded kinds of innovation. innovation is not just a matter of new drugs and In national and Europe-wide forums, academics, industry technologies getting the green light from regulators and healthcare managers are joining forces to talk about more quickly, but also one of aligning the incentives how innovation gives them the opportunity not just to do and tackling vested interests,” he explains. more for less, but to do something radically different that will make health systems sustainable, produce better Much of healthcare spending is still directed towards health outcomes and stimulate economic growth. treating diseases after they occur rather than trying to prevent them from occurring. According to the Organisation for Economic Co-operation and “ eople think about innovation P Development (OECD), only 3 per cent of current as the very latest genomic drug health expenditure in Europe is invested in prevention and public health programmes. Focusing more on or robotic surgery, but if only prevention will be key for healthcare systems to remain cost-effective. we did more of what we already know works then things would Industry groups recognise be far better.” that healthcare systems Miles Ayling, Director of Innovation and Service that are better at Improvement at the UK Department of Health adapting and adopting Out of the way, leaders innovations will be Health systems are notoriously bad at nurturing innovation. Shortcomings in funding are identified as a concern by a better for business poll of European healthcare professionals conducted by the in the long term. Economist Intelligence Unit in June 2012, in which 44 per cent of respondents blame the lack of money as the biggest barrier to improving their country’s healthcare system. A report published by the European Commission in 2011, “Innovation in Healthcare: from Research to Market”, found that Europe is lagging behind the US in terms of patient groups and venture philanthropy, which play a significant role in financing research and development.
  15. 15. issue 1 | Healthcare vision 15“ Spreading innovation is not just a matter of new drugs and technologies getting the green light from regulators more quickly, but also one of aligning the incentives and tackling vested interests.” Stephen Whitehead, Chief Executive of the Association of the British Pharmaceutical Industry Joined-up thinking European countries are now embarking on a strategy to support faster adoption of innovation. The German government has been tackling chronic lifestyle diseases by subsidising more integrated care. This has created 6,000 integrated care contracts in the country and significantly improved patient outcomes, while cutting costs. In France, new regional healthcare arrangements aim to create a highly co-ordinated healthcare system, with agencies responsible at the regional level for almost everything relating to health. Industry groups recognise that healthcare systems that are better at adapting and adopting innovations will be better for business in the long term. Pharmaceutical firms AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline and Johnson Johnson have joined forces with policymakers, patient groups and others to form the European Healthcare Innovation Leadership Network, which aims to drive healthcare innovation in an era of budgetary pressure. Non-healthcare firms are getting onboard too – French railway operator SNCF launched ‘Healthier Life’ in 2012, a new healthcare scheme focusing on reducing absenteeism. It screens workers for body mass index and provides those who need it with advice on diet and exercise. But the issue is also being taken seriously at senior policy level. In April 2012 the European Commission (EC) convened a conference, Innovation in Healthcare without Borders, in which industry, healthcare and political leaders called for SME-friendly regulation, reimbursement policies and procurement practices that would support the spread of healthcare innovation. Sharon Higgins, director of the Irish Medical Devices Association and Chair of the SME taskforce at Eucomed (the European medical technology industry association), says there is clear evidence that Europe’s estimated 7,000 health technology SMEs are driving innovation but struggling to spread it. “These are small companies that have the relationships with individual clinicians who know what problems need to be solved,” she says. “The sector is very much about bedside to bench, not bench to bedside – that is, clinicians helping SMEs, not the other way around.” The industry points to a range of frontline-led achievements, from new prostheses designed by orthopaedic surgeons, to forceps developed by obstetricians, to patient-monitoring software designed by doctors. But it complains that tough regulation coupled with complex reimbursement systems and procurement practices often inhibit wider uptake of innovation or growth of SMEs. There is clearly a growing recognition in Europe of the need to promote innovation in healthcare, but without concerted action from policymakers, healthcare providers and private companies on a wider scale, innovating efforts to innovate will go in vain.
  16. 16. 16 Healthcare VISION | issue 1 Sharing and caring: How electronic health record systems are improving healthcare Yoshiyuki Masuko, Senior Director, Canon Medical Imaging Group W hen patients arrive at the hospital information available whenever and wherever it is As well as improving patient care, it also has emergency department, the time it needed reduces medical errors, prevents doctors the potential to improve efficiency and reduce takes for doctors to build a picture of from repeating diagnostic procedures that have healthcare costs. A 2009 eHealth Initiative Survey their lifelong medical history can have a major already been undertaken and provides life-saving of health information exchanges in the US found impact on their treatment. This makes electronic documentation when a patient is unable to that clinicians using the data-sharing system health records, which can be accessed instantly communicate. This is backed by the findings of a reported improved access to test results, fewer from any location, a key medical tool. Over the last poll conducted by the Economist Intelligence Unit problems in finding information, and a reduction decade the European Union’s eHealth Initiative in June 2012, where respectively 43 per cent and in administration time spent handling lab results, and the EPSOS (European Patients – Smart open 31 per cent of Austrian and German healthcare radiology reports and clerical tasks. The same Services) pilot scheme have made considerable professionals think making patient data more survey in 2010 found that more organisations progress in making instant access a reality. The fluid and secure is the best way to improve had achieved savings through reduced staff benefits of web-based data-sharing are largely citizens’ health while controlling costs. admin time. agreed on: making relevant healthcare
  17. 17. issue 1 | Healthcare vision 17The ultimate data-sharingobjective of the EU’seHealth Initiative is fornational EHR systemsto support cross-borderinteroperability.
  18. 18. 18 Healthcare vision | issue 1 “ ithout embracing W eHealth, our health systems will simply not work tomorrow.” Neelie Kroes, Vice-Presendent of the European Commission for the Digital Agenda Concerted action Sweden’s National Patient Summary (NPÖ) Crucial to the development of data-sharing systems European countries committed to improve was launched in 2008 and contains personal is the technology that allows different health IT data-sharing in 2004 by signing up to the eHealth information, emergency contact details and systems to co-operate and talk to each other. In its Action Plan, endorsed by the European Council. information on allergies, current diagnostic most comprehensive form, the lifelong medical It included an objective to address common test results and a list of dispensed drugs. record is a library of different bits of data from many challenges such as the interoperability of health different systems and vendors, such as an X-ray The ultimate data-sharing objective of the from a radiology department at a hospital, a referral information systems and electronic health records. EU’s eHealth initiative is for national EHR systems letter from a GP or a dental scan from a dentist. Up until 2004 most projects in Europe had been to support cross-border interoperability. The aim small-scale and hospital-based, but the Action Plan is to improve the safety and quality of patient care showed that national governments were motivated Improving shared information for citizens travelling or working within Europe, to develop nationwide health data-sharing by making it possible for an EU citizen’s health Integrating the Healthcare Enterprise (IHE) is an initiatives, and ultimately to share data across history to be accessed by any relevant medical international initiative by healthcare professionals borders in Europe. centre in Europe. Twenty three member states and IT vendors to improve the way that healthcare are currently involved in EPSOS, a large-scale computer systems share information. IHE The 2010 eHealth Strategies Report summarises project to design, build and evaluate a data- promotes the co-ordinated use of established progress across the member states since 2004 sharing infrastructure. standards such as DICOM and HL7 and is now and offers some promising examples of focusing on the development of systems to share data-sharing and electronic health record (EHR) In its first phase, EPSOS is testing the use of documents between multiple organisations. initiatives. In Scotland, a central Emergency Care a ‘Patient Summary,’ which gives access to Record (ECR) was set up in 2007 and is important medical data for patient treatment. IHE recently defined an architectural infrastructure automatically updated twice a day by GP systems As well as improving patient care it aims to for data-sharing, the Cross-Enterprise Document throughout the country. It covers nearly all of boost the competitiveness of European health Sharing (XDS) integration profile. The XDS Scotland’s five million citizens and totals 200,000 solutions globally and strengthen the internal architecture lets multiple health IT systems share views per month. European health market. As Neelie Kroes, patient information in the form of documents, Vice-Presendent of the European Commission while the XDS-I integration profile enables the The Czech Republic has a national web-based EHR for the Digital Agenda, stressed earlier this sharing of images and reports. XDS is based on system called IZIP63, which provides information year, “without embracing eHealth, our health a central registry which maintains metadata on lab results, radiology reports and emergency systems will simply not work tomorrow.” describing every published document. The registry care, among other data. Twenty per cent of the is responsible for answering queries about population are currently included in the scheme. documents meeting specific criteria but doesn’t
  19. 19. issue 1 | Healthcare VISION 19 Crucial to the development of data-sharing systems is the technology that allows different health IT systems to co-operate and talk to each other.actually store the documents. Instead, its metadata Using this system speeds up reporting time and 47 per centincludes information about where to retrieve helps service-level management and monitoring of citizens anddocuments, which are stored by the separate ensure that quality targets are being met. 95 per cent ofhealth IT systems or repositories. doctors. Citizens can log on to theSeveral XDS-based projects are currently underway Let the patients choose ePatient portal using anin Canada and Europe. Canon recently acquired Clinicians are not the only ones to benefit from ID card and access theirNetherlands-based medical solutions specialist shared workflow systems. Systems that support medical records, radiologicalDelft Diagnostic Imaging, which specialises in XDS cooperation between a greater number of images and appointments,for sharing digital images and medical records and locations mean patients could have greater choice request appointments andwill be developing new Healthcare ICT solutions over where they are treated. The XDW (cross- reminders, and make payments.including XDS solutions. document workflow) profile will keep track of all stages in a clinical journey so that a referral can Giving patients access to their own recordsOnce an EHR system is in place, data-sharing happen in one place, treatment and reporting in fits within a wider open-data agenda enabledtechnology creates opportunities for healthcare another, and follow-up treatment at still another by technology and driven by citizens andinstitutions to work in a more efficient way. The location, while the central health IT system governments across Europe to make publicpractise of ‘shared workflow’ means that clinicians remains completely up-to-date. services as transparent as possible. While citizensand administrative staff from different sites can should always retain their right to opt out ofuse medical databases and electronic health Freedom of choice may soon extend not only to medical data-sharing and define the geographicalrecords at the same time and share their workload hospitals within a patient’s local area or country boundaries within which theirbetween geographical locations. but across Europe. Pan-European healthcare is data can be shared, true the goal behind the European Union Directive sharing and instant accessFor example, in medical imaging, the process of on cross-border healthcare, which was released by citizens and cliniciansgetting a patient X-rayed – which involves a referral in 2008. Its aim is to create a framework for to patients’ lifelongletter from a GP, records of previous scans, the cross-border healthcare and remove the obstacles medical history hasexamination, the X-ray images and report and that patients face if they wish to travel for the potential topossibly a second opinion – may originate from treatment in other EU countries. revolutionise thedifferent locations, but all of these sources are quality of healthcaresaved to a central health IT system, which In addition to giving patients greater choice, and the way iteveryone can access. data-sharing and shared workflow systems make is delivered. it easier for patients to access their own data.Shared workflow platforms can be developed to This gives the patient more control making it lessinclude capacity management, where activities difficult, for example, to get a second opinioncan be assigned to groups of clinicians based from a separate provider if they are unhappyin different locations. For example, some about a proposed treatment. It can also speedteleradiology service companies use an automatic up the treatment process. Nearly three-fifths ofcapacity management platform to share X-ray respondents to the EIU poll think policymakersexams amongst a group of radiologists based on should encourage citizens to take morethe urgency of the exam, its complexity, and who responsibility for their own health. In Estonia,has time to undertake it. a data-sharing system is currently used by
  20. 20. 20 Healthcare VISION | issue 1 Active ageing Policymakers worry about how to pay for the healthcare of ageing citizens. But they should focus instead on how to keep citizens active as they age. P eople are living longer, happier, healthier The Alzheimer’s Research Trust estimates that Changing perceptions lives than at any time in human history. 800,000 people in the UK now have a formal But Sarah Harper, Director of the Oxford Institute of Considering the medical and societal diagnosis of dementia, and the UK’s Office for Population Ageing and a professor of gerontology, leaps that have engineered in order to Budget Responsibility has predicted that looking believes that view is too simplistic. Falling birth rates make that possible, perhaps at least a little after this group will raise the national debt to over and a chronic skills shortage in Europe and the West self-congratulation would be allowed. 100 per cent of GDP by the middle of the century. are equally to blame. She points out that even if But the language used to describe ageing developed countries allowed free migration, people societies today is incendiary: ‘demographic Standard Poor’s (SP), an international credit with the required skills would not want to come. time-bomb’; ‘growing burden’. rating agency, predicts that colossal government Europe is not as attractive as it used to be to the debt will be generated by healthcare costs educated youth of Asia, who take the view they associated with ageing in the G20 economies. “ e are going to have W Other predictions indicate that output in the can have a better life in the new and vibrant cities emerging in their own region of the world. to take care of twice the high-growth markets of China, India, Brazil and Russia may also be stalled by demographic shift. “We just have to change people’s attitudes,” number of people with SP warns that many countries will have to find she says. “We retire because we live in a society “ways to encourage their people to remain active a falling budget, and members of the labour force for many more years which allows us to withdraw and funds us to do so. We need to foster an environment where telehealth is the way than is the norm today,” if they are to avoid financial catastrophe. active healthy adults are expected to contribute by working, whatever their age.” to do it.” It is an attitude shared by Nortin Hadler, Professor Mark Blatt, Global Medical Director at Intel of Medicine at the University of North Carolina and author of Rethinking Ageing, who argues that There is no doubt that demographic shift has elderly Americans have been encouraged to take created growing numbers of people who are seriously their most trivial ailments, as the natural dependent on others for care. By some measures, effects of ageing are pathologised, to the benefit this is expected to create pressure on healthcare of the medical profession. As a result, many retire budgets. The Organisation for Economic Co-operation from work unnecessarily. “We should actually be and Development (OECD) estimates that overall viewing this population ageing as a demographic healthcare costs between 2005 and 2050 in the miracle, not a disaster,” he says. “For the first time eurozone – one in four Europeans will be over in human history we have a generation of people 65 by 2030 – will rise by almost 4 per cent of GDP, who can hit 60 and ask themselves what they long-term care costs by more than 2 per cent of want to do for the next 25 years. To me this has GDP, and public pension costs by 3 per cent of the potential to be a tremendous advance.” GDP, as a result of population ageing. Meanwhile, One in four Europeans longer life expectancy means that people are surviving long enough to develop dementia. will be over 65 by 2030
  21. 21. issue 1 | Healthcare vision 21Even if, over the next few years a society can be In a 2012 survey of doctors and executives workforces will need to be retrained in thecreated where people will still be welcome in from payer organisations conducted by the technology, as well as learn how to supportthe workforce in their 80s, there still remains Economist Intelligence Unit for PwC, 60 per cent the patients using it. “The point is that we can’tthe problem of keeping out of what Mr Hadler of respondents said they see widespread afford healthcare in the way we have beencalls the costly ‘warehouses’ of nursing homes. adoption of mobile health – healthcare supported delivering it. We are going to have to take careThe number of over-85s in America is set to rise by mobile technology – as inevitable in the of twice the number of people with a fallingrapidly from 6 million now to at least 19 million near future. budget, and telehealth is the way to do it,”by 2050. Most of us want to die in our own he says. “The technology is available, cheaphomes, but many of us will end up It is envisaged that social networks will begin and ubiquitous, but it requires a completelyin institutions because there is simply not the to emerge as a telehealth spin-off: people with different mindset.”support structure to allow anything else. similar conditions will support each other and exchange healthcare information. In time, Ageing populations plus tighter healthcare there will be fully functioning interfaces in budgets do not necessarily add up to a bleakRetaining autonomy homes, so that elderly people can be readily future. More people will remain fitter and ableOf course, many people simply fail to look after connected by videoconferencing any time to keep working as they age, and technologythemselves as they get older. To address this, they want company. will increasingly provide solutions to keeptechnology – such as self-tracking devices, those in failing health in their own homes.telemedicine, and helper robots – is seen as However, Mark Blatt, Global Medical Director The question will be how long it takes forbeing important in helping people to retain at Intel, a computing firm, warns that older people to experience a change ina sense of autonomy. implementing the telehealth revolution will mindset, and to feel a social pressure to not necessarily be easy. Medical and nursing stay at work.“ or the first time in human history we have a generation of people who can hit F 60 and ask themselves what they want to do for the next 25 years. To me this has the potential to be a tremendous advance.” Nortin Hadler, Professor of Medicine at the University of North Carolina
  22. 22. 22 Healthcare VISION | issue 1 Doing more than keeping busy Every morning Edward Gerjuoy, He pursued a successful career as an In the UK, a charity, the Prince’s a 94-year-old emeritus professor attorney specialising in environmental Initiative for Mature Enterprise of physics, goes to his office at law until he was 85. By that time the (PRIME), is helping thousands of the University of Pittsburgh. At the rules on retirement had changed and older people with advice on setting moment he is putting together he was able to return to his old job. up a new business. One beneficiary the material for an undergraduate is Valeri Bennett, 68, a former art course in physics and society. The He can see and hear well, and teacher from Cornwall who found course has never previously been keeps fit by climbing the stairs to his herself without an adequate pension taught so Mr Gerjuoy is preparing fourth floor office, leaving his young when her marriage ended in late the content from scratch. In between students to take the elevator. “I am middle age. She was faced with the times, he is actively campaigning for lucky enough to be at the extreme prospect of either enduring the the rights of dissident scientists in end of the fitness curve for people my decades ahead in miserable poverty, repressed regimes of the world, age and as long as I’m still capable or doing something about it. Now and writing valedictory obituaries and accomplishing something that’s with a new partner, who is 57, she of deceased colleagues for an of some value to society, I will has channelled her skills into Farne American physics journal. continue to work,” he says. Designs, a fabrics and craft business. Now in its third year of trading, it is In the 1980s, when Mr Gerjuoy It is less exceptional now for people on track to turn over £25,000 and is was approaching retirement age, still to be working into old age. growing steadily. “Neither of us has universities could still force their staff Moreover, not only are older people a pension, but in ten years time we to retire. So at 59 he embarked on a staying in work, but increasing hope to be rich,” Ms Bennett says. law degree to extend his working life. numbers are also sufficiently “The business is going from strength energetic to embark on entirely to strength, and it is pushing me to new ventures. do things I wouldn’t otherwise do.” Edward Gerjuoy, 94 year old Professor of Physics, University of Pittsburgh. Source: The Center for Technology and Ageing of the SCAN (Senior Care Action Network) Foundation, Oakland, California. Technologies to maintain health and independence: Smart phones: Remote patient Assistance Remote training Disease Brain training: Social managing monitors: technology: and supervision management: to prevent or delay networking: dispensing and weighing scales, voice recognition for care workers: use of data mining Alzheimer’s and creation of online adherence using glucose monitors software to provide use of Internet, to identify high-risk other forms of communities to messages to and blood pressure monitoring and interactive patients, use of dementia by using help older people provide timely monitors may alert systems to videoconferencing evidence-based computer or communicate and reminders about stand alone to detect and report and satellite to guidelines to Internet-based share information what medication collect and report environmental provide distance support and treat thinking games and interests. should be taken. health data, or they hazards or learning, patients, and cognitive may become part personal crises. simulation co-ordinated challenges, of a fully integrated exercises for outreach, feedback including an system for practical tasks, and response. assessment or collecting, and video-guided tracking analysing and tutorials, so that component. reporting data. more low-skilled home assistants can be trained and remotely supervised.