© 2010 IBM Corporation eHealth and Europe – Why we need Smarter Healthcare John Crawford –...

© 2010 IBM Corporation

eHealth and Europe – Why we need Smarter Healthcare

John Crawford – Healthcare Solutions, IBM Europe

25 May 2010

© 2010 IBM CorporationIBM Confidential

Citizens are largely dissatisfied with their healthcare systems and spending more money does not appear to be the answer

Citizens’ views of healthcare systems and healthcare expenditures

% of citizens who believe their healthcare system requires either fundamental change or complete rebuilding, 2007 (%)

He

alt

hc

are

sp

en

d a

s a

pe

rce

nt

of

GD

P,

20

04

/5 (

%)

Source: OECD, “OCED Health Data” (2007); Commonwealth Fund, “2007 Commonwealth Fund International Health Policy Survey” (2007)

5%

10%

15%

50% 60% 70% 80%

Netherlands

United States

Germany

United Kingdom

Canada

New Zealand

Australia

© 2010 IBM Corporation3

Healthcare as a global priority and IBM’s role

Global Environment Market Response IBM’s Role

• Economic and societal demands for improved value and outcomes

• Healthcare costs outpacing GDP growth

• Aging populations

• Increasing rates of chronic conditions

• Concerns for patient safety

• National efforts to improve health system efficiency and effectiveness

• Public health improvement programmes / legislation

• Educating and activating the citizen

• Improving access to services

• Healthcare IT as a key enabler:

– EHR / Interoperability– Business Intelligence– Telemedicine– Health 2.0

• Deliver innovative solutions

– Integrate information

– Optimise workflows

– Improve flexibility• Promote collaboration

– Among stakeholders

– Policies and standards

– New care delivery models• Lead as a best practice employer

– Promote patient-centric care

– Reward healthy work-life balance


Challenges for European Health Systems

–Citizens’ expectations for high-quality care

–Demographic changes

– Increased prevalence of chronic diseases

– Increased mobility of citizens and patients

–Staff shortages, unequal territorial distribution

–Reactive model of healthcare delivery

–Rising healthcare costs

How to offer high-quality &

affordable care?

How to offer high-quality &

affordable care?


eHealth Deployment in the European Union

Over 22 countries have explicit eHealth strategies, but:

Source: www.ehealth-era.org

17

0

16

3

0

2

4

6

8

10

12

14

16

18

No. of EU Member

States

Complete EHR /interoperability

ePrescription

Priority (wish)

Reality


The European Commission view on eHealth

eHealth is a Lead Market (of ‘strategic societal and economic interest’)

European Commission – “Communication on a lead market initiative for Europe’ - COM(2007) 860 final *

eHealth can help to deliver better care for less money within citizen-centred health delivery systems. Nevertheless, the ICT investments in this area have stayed behind that of other service sectors. The take-up of technical and organisational solutions is often hindered by a strong fragmentation of the market, e.g. due to different social security systems and a lack of interoperability. This prevents economies of scale. This is aggravated by a lack of legal certainty as regards reimbursement, liability and a lack of awareness on the correct application of the legal provisions on the protection of personal data. This hampers both the product take-up and business investments.

* http://eur-lex.europa.eu/LexUriServ/site/en/com/2007/com2007_0860en01.pdf


European eHealth market size and growth

High potential for growth and jobs in the EU

Source: EU e-Health Business Models, Capgemini Consulting, Rand Europe, 2009 (Ongoing study funded by the EC)

Est. annual Growth Rate

2.3%

eHealth market eHealth market 20082008

€ € 14.3 billion14.3 billion

eHealth market eHealth market 20122012

€ € 15.6 billion15.6 billion


The EU Roadmap for eHealth in 2010 (direction of travel)

Linking all the points of care Linking all the points of care Linking all the points of care Linking all the points of care 1111

Connecting individuals Connecting individuals with Health Information Networkswith Health Information Networks

Connecting individuals Connecting individuals with Health Information Networkswith Health Information Networks2222

Towards the full picture of Towards the full picture of the individual’s health statusthe individual’s health status

Towards the full picture of Towards the full picture of the individual’s health statusthe individual’s health status3333

1990s Today


EC funding instruments (summary)

19941990 2002 20101998 2006

EU R&D Programmes

Res

earc

hIn

no

vati

on

Stand alone systemsStand alone systems(EHR, messaging, (EHR, messaging,

healthcards, VPH, PShealthcards, VPH, PSPHS)PHS)

Larger pilots with Larger pilots with online servicesonline services

(e.g. Home-based Monitoring)(e.g. Home-based Monitoring)

Large scale validationLarge scale validation(EU wide services(EU wide services

interoperability, mobility)interoperability, mobility)

Member States + EU eTen & CIP programmes

Pilots validation

Research & Technology

Development

Large scaledeployment, support to

policies

EU has supported over 500 eHealth projects with > €1 Billion since 1989 Current support (~ €100 Million a year)


Involves 12 member states: AT, CZ, DE, DK, EL, ES, FR, IT, NL, SK, SE, UK and is running from 2008 to 2011

To deploy concrete cross border services ensuring safe, secure and efficient medical treatment for citizens travelling across Europe:

Patient Summary for EU Citizens

ePrescribing for EU Citizens

To build on existing National eHealth Projects and use experiences and knowledge from all Member States

Large Scale Pilot on cross-border eHealth interoperability

epSOS (European Patient Smart Online Services)

http://www.epsos.eu/


Nine regional healthcare authorities directly responsible for the deployment of existing or planned telemedicine services.

To build up the largest multi-centre clinical trial ever deployed in Europe to measure the effectiveness and cost effectiveness of Telemedicine solutions for chronic disease management (COPD, CVD, diabetes).

Operation started in February 2010, for an expected duration of three years.

Large Scale Pilot on telehealth

Renewing Health

http://www.renewinghealth.eu/


“A Digital Agenda for Europe” published 19 May 2010 (COM (2010) 245)*

The Commission will work with Member States competent authorities and all interested stakeholders to:

– Undertake pilot actions to equip Europeans with secure online access to their medical health data by 2015 and to achieve by 2020 widespread deployment of telemedicine services

– Propose a recommendation defining a minimum common set of patient data for interoperability of patient records to be accessed or exchanged electronically across Member States by 2012

– Foster EU-wide standards, interoperability testing and certification of eHealth systems by 2015 through stakeholder dialogue

– Reinforce the Ambient Assisted Living (AAL) Joint Programme to allow older people and persons with disabilities to live independently and be active in society

* http://ec.europa.eu/information_society/digital-agenda/index_en.htm


“A Digital Agenda for Europe” published 19 May 2010 (COM (2010) 245)*

The Commission will work with Member States competent authorities and all interested stakeholders to:

– Make proposals to reform of rules on implementation of ICT standards in Europe to allow use of certain ICT fora and consortia standards

– Promote interoperability by adopting in 2010 a European Interoperability Strategy and European Interoperability Framework

– Issue a Communication in 2011 to provide guidance on the link between ICT standardisation and public procurement to help public authorities to use standards to promote efficiency and reduce lock-in

– Adopt in 2010 a Broadband Communication that lays out a common framework for actions at EU and Member State to meet the Europe 2020 broadband targets (basic broadband to all Europeans by 2013 and, by 2020, (i) all Europeans have access to internet speeds of above 30 Mbps and (ii) 50% or more of European households subscribe to internet connections above 100 Mbps)

– Review the EU data protection regulatory framework with a view to enhancing individuals' confidence and strengthening their rights, by the end of 2010

* http://ec.europa.eu/information_society/digital-agenda/index_en.htm


Smarter Healthcare

+ + =

Improve operational effectiveness

Deliver collaborative care for prevention and wellness

Achieve better quality and outcomes

A smarter health system forges partnerships in orderto deliver better care, predict and prevent disease and

empower individuals to make smarter choices.

IntelligentInstrumented Interconnected


15 04/19/23

Some IBM solution focus areas for Smarter Healthcare

1. Disease Management / Collaborative Care (Instrumented)

2. Electronic Health Records (Interconnected)

3. Healthcare Analytics (Intelligent)


PHR

EMR

DiseaseManagement

DevicesDevice

Manager

Remote Monitoring

Server

Provider Applications

Devices to collect personal health data regarding diabetes

· Collect device data· Reliable Messaging· Identification

IBM Websphere Sensor Events

· Aggregate data from large number of devices

· Perform event processing· Map into Provider

application

Wired Weighing Scale

Wired Weighing Scale

Medication PackMedication Pack

Wired Glucose MeterWired Glucose Meter

Disease Management / Collaborative Care

PAN WAN

xHR


Fact: Accessing quality medical care in remote locations is difficult and time-consuming (in this case no airstrip so 7 days travel by sea to Capetown)

What’s smart?• Using telemedicine to provide access

to clinicians in University of Pittsburgh Medical Center

• Provision of teleradiology, telepathology, doctor-to doctor, and doctor-to-patient consultations, all via satellite link

Smarter Business Outcomes• Immediate referrals and 2nd opinions• Improves quality of patient care• Eliminates need to travel (a very long

way!) for specialist consultations

Disease Management / Collaborative Care Telemedicine on the island of Tristan da Cunha

http://www-03.ibm.com/press/us/en/pressrelease/22576.wss


18 04/19/23

Electronic Health Records

• What is the problem?

• Patient records exist in many places and in multiple formats

• Care information tends to be episodic - not continuous

• Standards have not been agreed until quite recently

• Technical standards (format, message structures etc)

• Semantic standards (terminology, meaning)

• Concerns about security, patient privacy and consent


Fact: Reviewing electronic patient records can be complex and time-consuming – a simpler approach is needed.

What’s smart?• Visual representation of the health

status using a 3D avatar linked to SNOMED-CT clinical terms

• Combination of visualisation and medical record data

Smarter Business Outcomes• Allows faster assimilation of relevant

medical information by clinicians• Improves doctor/patient dialogue• Supports move to ‘paperless hospitals’

Electronic Health Records Thy-Mors Hospital (Denmark) uses visual patient records *

* IBM Research project - now available through Nhumi Technologies - http://nhumi.com/


20 04/19/23

Healthcare Analytics

•Comprehensive use of data

•Statistical and quantitative analysis

•Explanatory and predictive models

•Fact based management to drive decisions and actions

•A subset of Business Intelligence

A set of technologies and processes that use data to understand and analyse business performance

Source: Copyright 2007 - Competing on Analytics The New Science of Winning Thomas H. Davenport and Jeanne G. Harris


Fact: Geisinger Health System wanted to extract more value from its vast array of medical information

What’s smart?• Standards-based Clinical Decision

Intelligence System (CDIS) enables analysis and reporting of vital insights from millions of patient encounters

• System incorporates Geisinger's clinical, financial, operational, claims, genomic and other medical data

Smarter Business Outcomes• Provides a massive store of clinical

information, procedure and research to help doctors provide the best care

Healthcare AnalyticsGeisinger Health uses a Clinical Decision Intelligence System

http://www.ibm.com/smarterplanet/global/files/us__en_us__healthcare__sc_ny_r_paulus_v03rp.pdf


The world will continue to become smaller, flatter and smarter. We are moving into the age of the globally integrated and intelligent economy, society and planet.

To thrive in a Smarter Planet, we need a Smarter Health System that supports a healthier and more productive citizens. There’s no better time to start building a smarter health system. And there’s no better time to invest in creating the kind of society we all desire.

Let’s work together to drive real progress in our world.

We’ve only just begun touncover what is possible ona smarter planet.

© 2010 IBM Corporation eHealth and Europe – Why we need Smarter Healthcare John Crawford –...

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