The application of new technologies and IT in Health: standards as infrastructure for innovation
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Patient summaries have a key role to play in Pharmacies sharing information with General Practitioners and making the life of citizens better
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The application of new technologies and IT in Health: standards as infrastructure for innovation
- 1. Unlocking the power of health information The application of new technologies and IT in Health: standards as infrastructure for innovation Catherine Chronaki Secretary General HL7 Europe Foundation PHARMACISTS’ CONTRIBUTION TO ENSURING HEALTHCARE SUSTAINABILITY AND ACCESSIBILITY IN EUROPE, Brussels 21 March 2018
- 2. 2 HL7 Foundation: who we are.. HL7 the best and most widely-used eHealth standards since 1986 HL7 v2, Clinical Document Architecture, HL7 FHIR 19 National Affiliates in Europe (~38 wordwide) European HL7 foundation established in 2010 European Funded Research Projects eHGI, Antilope, Semantic Healthnet, Trillium Bridge, Expand, Trillium-II PHC34: ASSESS CT, OpenMedicine, eStandards Annual HL7 in Europe Newsletter Website: www.HL7.eu eHealth policy & Research eHealth stakeholders group; mHealth Guidelines; ENISA expert group EFMI council (2012-): eHealth Week EFMI Board (2016) HIMSS Europe SDO Joint Initiative Council HL7 Vision: A world in which everyone can securely access and use the right health data when and where they need it. The application of new technologies and IT in Health:
- 3. Forces shaping health systems: Risk • Shift of risk and medical expenses • Misalignment between categories of risk • Need for new management models • Need for closer partnerships
- 4. Forces facing health systems: consumers • Consumers become more health aware • Community pharmacies engage directly with health consumers • Support the patient’s health journey:
- 5. Forces facing health systems: technology • Rapid progress in analytics and digitization • Innovation in medicine
- 6. Focus and disruption in the business models of medical practice Christensen, Clayton M.; Grossman M.D., Jerome H.; Hwang M.D., Jason (2008-12-25). The Innovator's Prescription: A Disruptive Solution for Health Care . McGraw-Hill Education. Kindle Edition.
- 7. Patient summary standards Think Patient summary as vaccinations medications encounters Identification allergies Implantable devices Health team Security preferences Security preferences problems The application of new technologies and IT in Health:
- 8. What is the patient summary in practice? • Source study of patient summary implementations
- 9. Patient summaries help build trust and improve quality of services in community services • Interacting with the patient and the family • Quality assurance • Health goals • Early warnings • Transitions of Care: Smooth discharge, transitions, and hand-offs • Emergency or Urgent episodes: Safe care • Risk Assessment
- 10. eStandards as infrastructure for innovation • Massive health data accumulated in silo EHR systems for documentation – Need to move from passive documentation to active use of information and knowledge creation: activation! – Need to move from cross border exchange to engagement of communities and individuals: empowerment! • Standards and profiles address a predefined exchange of information. – Need sharing and use of content & structure, across national, regional, local jurisdictions: trust & flow! The application of new technologies and IT in Health: 10
- 11. eStandards project vision is that of a global eHealth ecosystem Where: people have navigation tools for safe and informed health care interoperability assets fuel creativity, entrepreneurship, and innovation eStandards: nurture digital health innovation strengthen Europe’s voice & impact enable co-creation and trusted provider-user relationships www.estandards-project.eu The application of new technologies and IT in Health: Source: eStandards D3.1 11
- 12. eStandards Project Highlights • Problem: Standards roadmap to support large-scale eHealth deployment • Ambition: standards organizations as the authority and shepherd of high quality standards to advance and sustain cost effective integrated health services. Key outcomes: – eStandards lifecycle model – Cookbook of best practices for interoperability practitioners – Co-creation, Governance, Alignment (CGA) Framework – Applications on Patient summaries The application of new technologies and IT in Health: 12
- 13. Making Digital Work for health with Trust and Flow • Co-create – to make it real using standards • Governance – to make it scale for large-scale deployment • Alignment – to make it flourish in a sustainable way The application of new technologies and IT in Health: 13
- 14. 14 Reflecting on the application of new technologies and IT in Health The application of new technologies and IT in Health: 14 Healthy communities and community pharmacies Patient summaries in the pharmacy.. What would be the Impact on productivity and quality of services? Digitization: data-driven service innovation Big Data and Artificial Intelligence serving community pharmacies – where are the limits? Skills? Law? Trust? Standards? Codes of conduct? Time for design thinking: empathize, define, ideate, prototype, test, implement (understand, explore, materialize)
Editor's Notes
- The portion of healthcare spending devoted to classic insurable medical risk is decreasing (28%) Governments might impose regulations that eliminate core aspects of the insurance market e.g. flexibility in underwriting and pricing or replance insurance with public programs so that private insurance offers only supplementary products Need for new business models: e.g. risk impaired annuity from chronic disease Risk category, Consumer discretion, Consumer ability to absorb risk/expense, Potential financial approach, Potential reimbursement Routine, H, H, Saving, credit/prepaid cards, fee for services Preventive, H, H, Free, Fee for services Chronic Care, H, M (Catastrophic H, L) Insurance with incentives for proper management and risk impaired annuity, nested episodes with population health models Discretionary, H, M, Savings and credit cards, Episodes Purely elective, H, M, Savings and credit cards, Episodes Catastrophic non chronic, L, L, Insurance, Episodes End of Life, L, M, Savings, viatical, reverse mortage, Episodes
- The transparency into care dlivery performance makes possible very different payment and risk intermediation models: expansion of episode and bundled payment modesl, incentives baded on population health, complete capitated risk, transfer levels of financial risk to providers. Potential for transparency in the care delivery performance can test bundled payment modes, incentives based on population health, eliminate 30 day -readmission costs Wearable trackers quantify personal activity generating valuable data for private payors: measures collected, fully automated visualization and longitudinal evaluation, comparison with family, friends, and the online community. AXA partner with Samsung to provide discounts for healthy behavior John Hancock uses fitbit for life insurance offering 15% discound Generali uses discovery health, and offers vouchers and gifts for activity and prevention exams
- Figure 4.1 maps how the business models of physician practices will evolve disruptively. It suggests that the typical primary care physician's business consists of four different categories of healthcare delivery, enumerated in the figure as follows: 1 The straightforward diagnosis and treatment of disorders (generally acute ones) that are in the realm of precision medicine. Examples: ear ache, pink eye, sore throat. 2 Ongoing oversight of patients with chronic diseases. Examples: diabetes, high cholesterol, lupus, tobacco addiction, obesity. 3 Ongoing wellness examinations and disease prevention, which lead to: 4 Preliminary identification of disorders that are in the realm of intuitive medicine—some that might be handled by the primary care physician, but many of which are referred to specialists. Examples: osteoporosis, asthma, appendicitis, cancer, restless leg syndrome. Christensen, Clayton M.; Grossman M.D., Jerome H.; Hwang M.D., Jason (2008-12-25). The Innovator's Prescription: A Disruptive Solution for Health Care (p. 113). McGraw-Hill Education. Kindle Edition. Herodotus, the Greek historian who wrote The History of the Persian Wars in the fifth century BC (ca. 484 BC to 425 BC), observed what appears to have been a precursor to these sorts of networks during his travels through Babylonia: The following custom seems to me the wisest of their institutions . . . They have no physicians, but when a man is ill they lay him in the public square, and the passersby come up to him, and if they have ever had his disease themselves or have known anyone who has suffered from it, they give him advice, recommending him to do whatever they found good in their own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is.23
- In case of Emergency, the patient summary is there in our mobile phone and can be understood anywhere in the world Emergency response teams can use the patient summaries to capture accurately the aggregate and individual needs of a community hampered by disaster.
- Systems of record – SQL / CDA/CCD / Systems of differentiation – IHE Profiles / PCHA/Continua Profiles Systems of innovation – FHIR / OpenEHR Archetypes Data drive a wave of automation aspiring to improve care forge connections of health & wellness, medical research, and clinical decision support. Healthcare systems can rely on digital technologies to sustain costs, improve access, provide quality care facing dwindling resources and increasing demand offer mobile patient- and provider-facing apps mix patient-generated data with provider medical notes use data to shape personalized care pathways provide just-in time access to health services in person or online Health information technology standards are at the core of the compass, to tap the potential of shared aggregate data and sustain trust.
- At a rapid face of just-in-time disruption, Standards Developing Organizations need to cooperate to deliver quality, interoperability, and knowledge timely at an affordable cost. to look outside to listen to the users to rethink standards and tools that support their full lifecycle To deliver live eStandards a digital health compass can support safety, prevent harmful events, and assist in managing efficient, connected services of high quality and relevance in the digital health ecosystem. Health data standards, open interfaces, and a culture of sharing increase trust. Complementary initiatives to health information technology standards are the Dublin Core Metadata Initiative (DCMI) headings, the HONCode labelling online health resources, and W3C guidelines for usability and accessibility building confidence in navigation. Health information technology standards are required to provide common metadata about digital health products and assemble fragmented information scaling up and sustaining digital health literacy [5, 9]. Standards developing organizations work together on standards to meet the health information needs of people within and across health facilities. The value of data and the increasing focus on patient experience, dictates global cooperation on open standards emphasizing mobile use. Health System – government and regulators Rules to abide by for sustaining and innovating the health system Public health reporting and analysis Communication and coordination across health systems Workforce Communication and coordination of care Dissemination and availability of knowledge (CDSS) Citizens Active involvement in health maintenance and decisions Navigating the health system (or systems) they are involved in eHealth Market Creating opportunities for new health and IT services
- To develop, deliver, test and deploy standards sets which are properly adapted to a dynamic healthcare system, we need a constant flow of interaction between three types of activities: Co-creation between all relevant stakeholders to make it real using standards A supportive and appropriate governance system to make it scale toward large-scale deployment The flexibility to adapt and align as needs and requirements change to make it stay in a sustainable way =============== Alignment of eHealth standards accelerate knowledge-sharing, and promote wide adoption of standards. Evidence-based Roadmap Convergence, iterative consolidation, broad acceptance of eStandards Quality Management System interoperability testing & certification of eHealth systems. Coexistence of standards in large-scale eHealth deployment Go global: EU/US MoU roadmap Influence global standards Boost competiveness Fuel innovation Socio-economic aspects of interoperability language for user/vendor co-making’ in trust
- To develop, deliver, test and deploy standards sets which are properly adapted to a dynamic healthcare system, we need a constant flow of interaction between three types of activities: Co-creation between all relevant stakeholders to make it real using standards A supportive and appropriate governance system to make it scale toward large-scale deployment The flexibility to adapt and align as needs and requirements change to make it stay in a sustainable way Goal: identify the required clinical data, vocabulary and value sets for an international patient summary. Scope: “The IPS specification shall focus on a minimal and non-exhaustive Patient Summary, which is specialty-agnostic and condition-independent, but still clinically relevant.” The primary use case is to provide support for cross-border or cross-juridictional emergency and unplanned care: Cross-jurisdictional patient summaries (through adaptation/extension for multi-language and realm scenarios, including translation). Emergency and unplanned care in any country, regardless of language. Value sets based on international vocabularies that are usable and understandable in any country. Data and metadata for document-level provenance.