Prerequisites for the sustainable E-health implementation

Janko Cicin-Sain, IBM Life Sciences consultant Sofia 27 th of June, 2006

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Agenda

  Healthcare challenges - and initiatives to address them E-health, what is it ?

  The Danish E-health experience Bulgaria E-health position | | © Copyright IBM Corporation 2005

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The main challenges faced by healthcare are probably well known

Aging population !

Drug costs rising !

More chronic patients A nnual R evenue of D isease Management C ompanies $700 $600 $600 $500 $400 $300 $300 $200 $100 $150 $0 1998 1999 2000

Source: Modern Healthcare, July 9, 2001

Disease management companies are emerging as major players in the U.S. healthcare market

Why Disease Management is Becoming a Major Cost-control Focus in Healthcare

In 2000, medical costs for people with chronic conditions totaled $774B and are projected to rise to $1.07T by 2020 A person with a chronic condition spends 6 times more per year than a healthy person Those with a functional limitation can have medical expenditures more than 16 times a healthy person A Medicare beneficiary with a chronic condition sees, on average, 8 different physicians (1999) 80% of Medicare beneficiaries have a chronic condition -- accounting for 99% of total spending for the program (1999) 157 million Americans, or half the population, are expected to have a chronic condition in 2020 New and extended treatment offerings

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The major reason for increasing drug costs is not price increases as such

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Beyond today’s challenges, the evolution to “personalized healthcare” must also be adressed

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The Big Trends

  Demographic change – more elderly More chronic patients     Medication and treatment costs Patient safety and quality of care More demanding, better informed consumers Clinical Genomics and Personalised Medicine | | © Copyright IBM Corporation 2005

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E-health initiatives in different countries



Europe and America:

-

U.K.:

The NHS IT-initiative

Germany:

Healthcard and e-prescription initiative. Also interest for shared care and disease management.

Belgium:

Healthcard and e-prescription initiative.

Austria:

E-health initiative

Ireland:

E-health initiative

Canada

: 10 years of experience on regional levels, Canadahealthinfoway as national infrastructure

USA

: recent initiative   

Central and Eastern Europe:

-

Slovenia:

Healthcard solution implemented

Czech Republic and Slovakia:

Planning for e-health (communication and national portal)

Bulgaria and Hungary:

E-health is on the agenda

Croatia:

E-health is on the agenda

The Baltics:

-

Lithuania:

Ambitious tender – covering both National and hospital level -

Estonia:

E-health agenda with focus on e-prescription and medication

Asia Pasific

-

Singapore:

Healthcare Network

New Zealand and Australia:

Helthcare Network – Integrated Care Strategy | | © Copyright IBM Corporation 2005

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Agenda

  Healthcare challenges - and initiatives to address them E-health, what is it ?

  The Danish E-health experience Bulgaria E-health position | | © Copyright IBM Corporation 2005

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It is not possible to cope with the challenges of the future through rationalization – it will be necessary to look at demand

More treatments within the same budget:

      

New healthcare structure Optimised processes EPR PACS Quality improvements Wireless IT still continuous annual incerase of 10% Reduced demand for services:

  

Disease management (chronically ill) Screening for early detection Wellness management (citizen health)



”The virtual healthcare system”

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Disease management is an efficient tool to target chronic patients

Typical diseases :



Diabetes



Heart related diseases



Resporatory diseases



Depression

  Targeting chronically ill patients with IT-technology in order to:  Improve planning and treatment Follow the patient everywhere – in hospital, in their home, at GP Involve and motivate the patient  Let the patient take more responsibility and participate more actively  Strenghten GP knowledge of hospital treatments and procedures - with the objective to create a better quality of life for the patient, improve clinical Pathways, save hospitalresources and strengthen cooperation in healthcare.

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E-health is a number of different elements, which together can help transform healthcare

         continuous treatment of patients by linking patient’s clinical information between providers and providing a life time electronic patient record (see Golden rules from Crossing the quality chasm: healthcare in 21st century) while emphasizing transparency over confidentiality, continuous monitoring of health status of citizens - individual, by groups and profiles continuous monitoring of health status and continuous treatment of patients with chronic diseases access to knowledge (libraries, publications, “doctor-to-doctor”) - general or case related continuous transition to target medical practice (clinical guidelines, clinical pathways, evidence based medicine, outcome based medicine) performance monitoring and benchmarking E-business, supply chain, E-procurement Education of patients and citizens Advanced clinical decision support at the point of care E-health is supplemented by:  Electronic Patient Record at hospitals    Country HIS database (patient statistics) Clinical databases Accreditation and quality improvement programs.

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E-health benefits are both long term – and short term

Common Standards/ network

• Improved data management /exchange • System interoperability • Increased security

Infrastructure/ Portal

• Improved communication • Better information • Better use of clinical / patient resources

Healthcare

Quality in medication EPR Disease management

• Faster patient recovery • More effective use of medication • Better supply management • Better identification of risk groups • Better use of staff resources • Improved documentation • Better information accessibility • Improved patient care

transformation

• Better use of clinical resources • Better monitoring and prevention • Increased patient involvement • Better identification of risk groups © Copyright IBM Corporation 2005 | |

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Agenda

  Healthcare challenges - and initiatives to address them E-health, what is it ?

  The Danish E-health experience Croatia e-health position | | © Copyright IBM Corporation 2005

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MedCom and Sundhed.dk

Sundhed.dk

Health Portal

2000 MedCom

Health Net

1994 -

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Who is behind ?

       Ministry of Health National Association of County Councils Ministry of Social Affairs National Association of Local Authorities National Board of Health Copenhagen Hospital Corporation Danish Pharmaceutical Association | | © Copyright IBM Corporation 2005

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1993: The six flows

EU Concerted Action on Primary Care

Primary health

So simple!

So much!

So similar!

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MedCom

Messages/Month

1200000 1100000 1000000 900000 800000 700000 600000 500000 400000 300000 200000 100000 0

92

1992

93 94 95 96 97 98 99 20

44%

O1 O2 O3

Referrals

64845 = 45 % O4

Reimbursement

15637 = 66 %

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Status & Benefits

• • • • • • •

1995 Primary Clinics - 92% 490 Specialists - 62% 332 Pharmacies - 100% 2,5 mill. each month 60 63 Hospitals - 100% 50 Municipalities – 70 % of all communication

| | • 50 minutes saved per day in GP practice • Telephone calls to hospitals reduced with 66% • 2,3 € saved per message =

60 million € /year

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Sundhed.dk

Services for Citizens            General information Information from hospitals all around Denmark Yellow-pages for the entire Danish health sector

Waiting-list information

Information about medicine

E-booking calendar

Secure communication (“e-mail”)

Personal Medicine Profile Citizens event log

Registration as Donor (April 2005) Clinical path-ways Pregnancy (March 15 2005) Diabetes (in progress: DiaLog) | | © Copyright IBM Corporation 2005

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Sundhed.dk

Services for Physicians        General information Information from hospitals al around Denmark Yellow-pages for the entire Danish health sector Waiting-list information Information about medicine E-booking calendar Secure communication (“e-mail”)    

General consent portlet Access laboratory test results Personal Medicine Profile for the patient Patient data from EPR in other hospitals



Clinical pathways

-

Pregnancy (March 15 2005)

-

Diabetes (in progress: DiaLog)

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PEM - Personal e-Medication

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WEB - Laboratory Result

2d. Søgeresultat for Lab-svar

Den fælles offentlige sundhedsportal Side23 | | © Copyright IBM Corporation 2005

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WEB - EPR Record Overview

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Health Portal and Net

| |

Lab

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E-health status in Denmark

E-health elements:  Unique patient identifier:

Since 1977

 Healthcare information network:

Project established 1994. Now 97% coverage

 General e-health portal:

Project established 2003. Now in phase 4

    Country wide sharing of data:

Medicine and EPR overview established

Disease management – targeting chronic patients:

Multiple projects.

Wellness management – targeting general population health:

Part of e-health portal

Secure infrastructure – data security and privacy:

PKI/digital signature – national + hospitals

E-health is supplemented by:  Electronic Patient Record at hospitals:

15% coverage

   Country HIS database (patient statistics):

National projects

Clinical databases:

National projects

Accreditation and quality improvement programs:

Accreditation strategy and quality improvement agency

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E-health status in Denmark

E-health values:   Estimated savings of over 100M EURO per year Improved the clinical content of the medical treatments performed by primary care physicians  Documented relationship between continuous education and improved quality in healh sector (ICPC, statistics)  Drastically increased the avareness of the population how to deal with typical health symptoms and related medical / administrative procedures  Improvements in quality (efficiency of outcomes, lower risk) recognized, but not measured – lack of measurements “before and after” is common situation in European healthcare © Copyright IBM Corporation 2005 | |

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Agenda

  Healthcare Challenges - and initiatives to address them E-health, what is it ?

  The Danish E-health experience Bulgaria E-health position | | © Copyright IBM Corporation 2005

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Bulgariaia can obtain substantial short term benefits from E health through a carefully designed healthcare IT-strategy

      Need to strengthen primary care communication and IT-support Low ICT at hospitals – opportunity, since no legacy Focus on medicine costs and –quality Certain diseases (coronary, lung and cancer) have high proportion More activity based payment (DRG) Focus on strengthening national statistics and coding © Copyright IBM Corporation 2005 | |

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Challenges - funds

 Similar projects in European Union countries or North America are projected at several billion EURO or US$.  WE HAVE TO FIND MORE COST EFFECTIVE APPROACH: 5-10 times less and adjusted to size of an average Central European country © Copyright IBM Corporation 2005 | |

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Challenges - Long term structured strategic plan

 One of major obstacles with health care reforms, including E-health, in all countries in the region is that most decisions are politically motivated and survive usually only one election term.  As end result, most of funds spent on reform topics become wasted.  Similar to creation of national and permanent E-health agency, there MUST be a group of professional decision makers and designers of any component of health care reform, including E-health. © Copyright IBM Corporation 2005 | |

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Challenges - No defined relationship between national healthcare reform and E-health

 The problem with many World Bank funded projects as components of health care reform was that there was almost no continuation after the projects have been completed. In some countries, newly elected Minister of Health completely cancelled unfinished projects.  In addition, most of times there is no national master plan, unifying all individual components – this is due to the lack of Project Management experience in government departments in general. © Copyright IBM Corporation 2005 | |

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Challenges – lack of proper base

 Health care providers (especially hospitals) lack modern (and unavoidable prerequisite) management of information (IT and paper based) for internal management of information and subsequently the ability to share (access information, provide information, collaborate) its work with other organizations in network © Copyright IBM Corporation 2005 | |

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Recommended set of activities

   Define national strategy for E-health – National Program for e-Health, example: “e-Health Foundation Bulgaria”  Define the stakeholders and those responsible and authorized for deployment of E-health infrastructure and components;  Find optimal balance between legislative measures, consensus based decisions and selection of pilot cases supported by believers.

 Define national standards for: Core data set, Demographic Data, Health profile, Insurance plans Define national standards for: Authorization, Authentication, Privacy Define national standards for: minimal functional and data requirements of IT solutions for providers (hospitals, primary care doctors,...) © Copyright IBM Corporation 2005 | |

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Recommended set of activities

   Prepare a master plan with synchronized and coordinated activities between all health care sector organizations and agencies Define the roles of strategic partners and solution providers Instead of revising current resource allocation to national institutions such as MOH, health insurance, medical universities and schools, consider the creation of an agency (or institution) with relevant name like Health Center of Excellence  Consider to address the needs of E-health in current standards project, to make sure future work on E-health will not be slowed down because there is no agreement on those standards which are essential for effective functioning of E-health solutions © Copyright IBM Corporation 2005 | |