The impact of eHealth on Healthcare Professionals and Organisations: e-health and Healthcare Organization


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The impact of eHealth on Healthcare Professionals and Organisations: e-health and Healthcare Organization. Piqué J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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The impact of eHealth on Healthcare Professionals and Organisations: e-health and Healthcare Organization

  1. 1. e-health and Healthcare Organization Josep M. Piqué, MD. Hospital Clínic, Barcelona
  2. 2. Payment systems Payment systems Traslational research & Social, demographic & Social, demographic & technology innovation epidemiologic evolution epidemiologic evolution Healthcare delivery Healthcare delivery Patient & society demands Patient & society demands ICT ICT
  3. 3. P4 Medicine Predictive, Preventive, Personalized, and Participatory
  4. 4. Fragmented healthcare systems We need to increase the efficiency and outcomes of basic, clinical and epidemiological research and facilitate faster translation into clinical practice, particularly in the field of age-related chronic diseases and conditions. It is also necessary to personalize care and to move from reactive to preventive and predictive medicine. At present, the three major hindrance to achieve the above mentioned objectives are: 1. The lack of an integrative approach to diagnose, treat, and prevent the health problems from different departments in the same healthcare level organization. 2. The huge fragmentation of organizations among primary care, social care, and specialized care. 3. The lack of communication and standardization between different healthcare electronic medical records.
  5. 5. Hospital fragmentation Competition vs Collaboration Area of potential Conflict Area Area of potential Conflict Area development development
  6. 6. Fragmented healthcare systems Behaviour and attitudes of health professionals. Lack of education for professionals promoting coordinated efficient work. Lack of citizen’s education on a rational use of healthcare systems. The payment systems that in many cases do not encourage coordinated work.
  7. 7. Increasing the efficiency of hospital organization Instituts, Departments, Services Reference physician Process Units Diagnostic Units Wards ICU Day Care
  8. 8. Hospitals vs territorial healthcare Community HOSPITAL Care Family Process Units Transplant Physician Nurse Dementia Social COPD Territorial Territorial Worker Healthcare Healthcare Home CHF Care
  9. 9. Adaptation of health services to chronic patients (shared care arrangements across the system) Hospital Consultant Emergency Case team Manager Primary Care Mobile teams Home Primary Patient Care Team Relatives & care givers
  10. 10. Territorial Health Care Comission Territorial Health Care Comission Barcelona Esquerra Barcelona Esquerra Institutions Permanent Comission representative Technical Technical Implementation Management Management Redesign & follow-up Team Team Process 1 Specialized Care Mental health Pediatric care Health Transport Pharmacy Home Care Emergencies Process 2 Social Care IT Process 3 Process 4 Operational Committees
  11. 11. Territorial Information Systems Territorial Information Systems Hospital 2 Hospital 2 Hospital 1 Hospital 1 Primary Primary care Home Home care care care Platform Platform Social Social care care Windows 2003 IIS File Server Web Server Web Network Charging Switch Firewall SQL Server IIS Administrator Web Server
  12. 12. Process management - Commorbility personalized management - Multimedia access to suport center - Patient self-management of health - Remote follow-up - Multidisciplinary working team Professionals Patients
  13. 13. What do we need? Process-oriented multidisciplinary working teams To share information based on health problems To implement evidence based clinical pathways Health outputs evaluation based on cost-benefit analysis Pay-for-performance (P4P) taking into account patient needs and new approaches to deliver healthcare
  14. 14. Working teams sharing information 100% Adoption of EHR according to the practice size 75% 50% 25% 1-3 4-5 6-10 11-50 ≥50 Size of practice (number of physicians) N Engl J Med 2010:362;192-5
  15. 15. Problem oriented information system 34569078 34569078 1975 1980 1985 1990 1995 2000 2005 IP OP OP OP OP Diverticulitis OP Eme IP OP OP OP OP Angina OP DC OP OP Breast fibrosis OP OP OP Breast cancer risk Eme IP OP Apendicitis Penicillin allergy
  16. 16. Problem oriented and evidence-based healthcare approach Problem 1 Primary physician Decision-making support Expert patient-self-care Home care Problem 2 Case-management Multidisciplinary Multidisciplinary nurse Working team Decision-making support Working team Expert patient-self-care Day-care hospital Problem 3 Social care Decision-making support Expert patient-self-care
  17. 17. Health outputs evaluation based on cost-benefit analysis Weinstein M and Skinner J. N Engl J Med 2010
  18. 18. Government Control Personalyzed and participatory care Patient or Community Control Tendency Protector Connecter (homogeneous (services organized protection for the Drivers Drivers according to the overall community community or individual based on government needs decided by a understanding) participatory approach) Who has the money Who has the money Money for what? Money for what? P P P P Education4 4 Education Information Information IT systems IT systems
  19. 19. Investment forecast in health information technology $ bn 20 Electronic health records 15 10 Health information Patient data-analysis supporting medical exchange practice and drugs research 5 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 CSC Healthcare. The Economist, April 18th 2009