1. Mobile and eHealth Platforms for
Chronic Disease Management
Dr. Sinisa Varga, HZZO

2. • Chronic diseases account for 80% of total
healthcare expenditures
• Incidence is growing on yearly basis due to
aging and lifestyle behaviors
• Demand on quality and speed of treatment is
rising
Key issues from national insurance
viewpoint

3. Numbers worldwide
• 1.6 billion adults overweight
• Iincreasing number of chronic and long term
patients
– 300 mill people suffer from asthma
– 220 mill people suffering from diabetes
– 210 mill people with COPD
– 17.1 mill deaths from cardiovascular diseases
• Ssteadily increasing elderly population (65+)
– 2007 – 7% of world population
– 2025 – 10%
– 2050 – 16%
Source: World health Organization; Population Reference Bureau

4. Numbers Croatia
• 20,37% (900.000) adults overweight
• Increasing number of chronic and long term
patients
– 2% (90.000) people suffer from asthma
– 11% (0,5 mill) people suffering from diabetes
– 200.000 people with COPD
– 25.000 deaths from cardiovascular diseases
• Steadily increasing elderly population (65+)
– 2007 – 17% of Croatian population
– 2025 – 25%
– 2050 – 35%

5. Tackling chronic diseases
• Education on
self-care
• A need for long term involvment of all stakeholders
with focus on individual approach to patient and
continuous follow-up
› Conservative
treatment
› Social support programes
› Nutrition & physical
theraphy programes
› Remote patient
monitoring

6. Successful chronic disease
management includes
 Multidisciplinary teams involvement highly interactive
with patient
 High quality disease management program creation and
follow-up
 Adaptable supporting tools and ICT systems

7. • Enhance chronic disease management programs
in long run perspective from process and delivery
perspective
• Utilize IT as key asset in CD management
• Focus on behavior change and prevention
through primary care integrated service and
patient empowerment
• Croatia Healthcare Strategy 2012-2020
Key objectives for chronic disease
management in Croatia

8. • National health insurance fund is key driver of
national eHealth strategy development and
implementation
• eHealth is considered as basic tool for
supporting the fund mission: to provide and
continuously enhance health delivery for all
citizens
eHealth in Croatia

9. • Provide faster healthcare service delivery in all
aspects
• Provide better and faster communication
between all stakeholders in healthcare system
through central patient management system
• Connect all healthcare related registers and
databases and implement central process
management workplace
eHealth implementation goals

10. • Croatia has implemented
– ePrescription
– eReferral
– eBooking, eWaiting lists
• National interconnectivity includes all GPs,
hospitals, labs, specialists
IT is already on right track

11.  137.000 prescriptions issued daily
 8483 referrals issued monthly (Feb 2013)
 eBooking operational to all hospitals
Facts

12. • Foster moving to patient self-care through:
– prevention
– education
– inclusion in e2e process of CDM
• Provide adequate tools to patients to engage
on daily basis
Step forward in CDM

13. – Preventive panels
• Prevention and monitoring of BMI
• Prevention of diabetes
• Prevention of smoking
• Prevention of alcohol consumption
– Chronic disease panels
• COPD
• Hypertension
• Diabetes
Focus on chronic diseases both from prevention and management
aspect implemented at GP level with financial incentives for
continuous follow-up
Prevention and chronic disease info
already at GP level

14. • Chronic disease patients age 50+
• Quality of life jeopardized and goes down
• Early disease detection needed
• Tools for enhancing QoL needed
• Tools for communication and interaction with
system needed
• Patients are and should be the central point of
healthcare system
– Croatia ranking 5. (out of 34) in EHCI report for 2012 in
patient rights and information access
Patients and chronic diseases

15. • Technology area for faster healthcare services
delivery
• Services to offer for patients:
– Remote monitoring
– Education
– Consulting
– Involvement in own health management
mHealth

16. •Proven that having medical data over time
increases the likelihood of more optimal overall
patient treatment thus impacting overall costs
•Need to tackle prevention from start – education
is slow but most powerful tool
•Patient motivation – one of most critical factors of
success
mHealth - chronic disease aspect

17. •Remote monitoring
– Field nurse approach (many patients)
– Individual approach
•Organizational setup determines the starting point –
field nurse setup to start with
•Interconnecting patients, family caretakers and primary
care through field nurses – first step in making it national
mHealth – delivery aspect

18. •mHealth platform needs to be integrated to
existing healthcare IT system and interoperable
•Security – ensuring patients as well as health
workers have access to same data in reliable
and secure manner – privacy , data protection
•Single platform, many applications, targeted
delivery processes followed
mHealth – technology aspect

19. mHealth benefits for HC service
providers
• mHealth provides the ability to optimize
overall patient health status through
prevention, on-time diagnosis and influence
on risk factors
• mHealth should decrease healthcare staff
workload and influence overall cost structure

20. mHealth benefits for insurance
• mHealth enables the road towards
personalized treatment thus influencing
overall cost reduction mainly in curative
aspects (hospital days, procedures,...)
• with relevant and accurate patient health data
collection over time, an enormous asset can
be created for prevention practicing, risk
behavior influence, early disease detection
thus overall impacting HC expenditures

21. •Piloting some of crucial chronic disease areas:
– COPD,CHF and Diabetes
•Developing and deploying
process changes
•Implementing mHealth platform within national IT
system and opening the platform to industry
applications and devices
mHealth – activities

22. • Health IT is basis for chronic disease
management program implementation and
long term success in optimizing healthcare
outcomes
• mHealth is step towards patients self-care and
technology enabler for new patient-centric
healthcare services
Summary

23. Please visit
Croatian eHealth
Industry Team
1st floor
booth 1000
Thank you!
sinisa.varga@hzzo.hr