Warwick Business School Professor Wendy CURRIE Director, IPTRU/WBS, UK Dr David FINNEGAN Director,...

Warwick Business School

Enabling Technologies in the Health Sector: A TEMPEST

AnalysisPresentation of the Belgian results

8 October 2010

Professor Wendy CURRIEDirector, IPTRU/WBS, UK

Dr David FINNEGANDirector, Corporate Relations, IPTRU/WBS, UK


e-Health ICT for Environmental

SustainabilityeGov Education

Just started

Enabling Technologies Projects

Coordinated by

In collaboration with Microsoft and a coalition of partners: Accenture, COCIR, EABiS, GE Healthcare, Phillips and Telefonica


Exchange of patient data: From IT....

Remote files unknown


......to Enabling Technology

A

CB

1: Where can we find data?

3: Fetch data from hub A

3: Fetch data from hub

C

Meta-Hub

All data available

2: In hub A and C


Basic serviceseHealth platform

Basic ArchitecturePatients, healthcare providers

and institutions

ADS ADSADS

eHealth platform

Portal

Health Portal

VASVASVASVAS Healthcare institution software

VASVASVASVASMyCareNet

VASVASVASVAS

Care provider software

VASVASVASVASRIZIV-INAMI

siteVASVASVASVAS

ADSADSADS

Network

Users

Suppliers


The TEMPEST Model

84 Indicators across 7 TEMPEST categories, 3 sub-categories, 4 indicators per sub-category

Technology

Economic Market

Political Evaluation Social

Transformational

Technology: Enabling/Emerging Technologies Interoperability of eHealth eHealth Service Delivery Model (Cloud)

Technology: Enabling/Emerging Technologies Interoperability of eHealth eHealth Service Delivery Model (Cloud)

Economic: Healthcare Funding eHealth Expenditure Healthcare Infrastructure

Economic: Healthcare Funding eHealth Expenditure Healthcare Infrastructure

Market: Market-Driven Healthcare Consumer-Driven Healthcare IT Market Capabilities and Skills

Market: Market-Driven Healthcare Consumer-Driven Healthcare IT Market Capabilities and SkillsPolitical:

eHealth Policy Education and Training Institutional Infrastructure

Political: eHealth Policy Education and Training Institutional Infrastructure

Evaluation: Governance and

Regulation eHealth Adoption

and User Engagement

Performance Measurement

Evaluation: Governance and

Regulation eHealth Adoption

and User Engagement

Performance Measurement

Social: Social Inclusion/Access to IT Patient Centred Healthcare Patient Choice

Social: Social Inclusion/Access to IT Patient Centred Healthcare Patient Choice

Transformational: Integrated Healthcare Reform Agenda eHealth Strategy and

Implementation

Transformational: Integrated Healthcare Reform Agenda eHealth Strategy and

Implementation


TEMPEST eHealth Roadmap

© WL Currie and DJ Finnegan, (All rights reserved)

7

TECHNOLOGY

ThemesCross CuttingProgrammes / Initiatives

Focal Areas Goals/Targets

ECONOMIC

MARKET

POLITICAL

EVALUATION

SOCIAL

TRANSFORMATIONAL

• Technical/semantic Interoperability• Data Security and patient rights• Information Models, standards and

infrastructure

• Economic conditions of member states

• Health and eHealth Budgets and Expenditure

• Financial costs of chronic diseases, obesity, alcohol abuse

• Economic conditions of member states

• Health and eHealth Budgets and Expenditure

• Financial costs of chronic diseases, obesity, alcohol abuse• New business model development• Re-defining and re-engineering

business processes to improve customer service

• New business model development• Re-defining and re-engineering

business processes to improve customer service

• Political priorities for health and eHealth

• Funding for R&D, education and training

• Capacity building for health sector and citizens

• Health literacy

• Political priorities for health and eHealth

• Funding for R&D, education and training

• Capacity building for health sector and citizens

• Health literacy• Identify key indicators (metrics and

measures) for benchmarking eHealth

• Performance measurement and evaluation

• Identify opportunities and barriers to eHealth

• Identify key indicators (metrics and measures) for benchmarking eHealth

• Performance measurement and evaluation

• Identify opportunities and barriers to eHealth

• Access to healthcare and eHealth to reduce the ‘Digital Divide’

• Patient protection and safety• Patient rights

• Access to healthcare and eHealth to reduce the ‘Digital Divide’

• Patient protection and safety• Patient rights

• New models of health service delivery

• Cross-border healthcare and health tourism

• New models of health service delivery

• Cross-border healthcare and health tourism

• Align and harmonise EU, national and regional Healthcare Policies to promote a shared vision towards integrated , interoperable and a secure citizen centric healthcare

• Develop policies to enable self health awareness and healthy lifestyles

• Align and harmonise EU, national and regional Healthcare Policies to promote a shared vision towards integrated , interoperable and a secure citizen centric healthcare

• Develop policies to enable self health awareness and healthy lifestyles

• Use of TEMPEST to compare financial and non financial indicators to eliminate economic waste

• Rebalance target expenditures towards prevention and lifestyle change• A technology-pull (demand-led) rather than technology-push (supplier-

led approach

• Use of TEMPEST to compare financial and non financial indicators to eliminate economic waste

• Rebalance target expenditures towards prevention and lifestyle change• A technology-pull (demand-led) rather than technology-push (supplier-

led approach

• EU, national and regional policymakers to promote health literacy for patient choice and consumer-driven healthcare

• An EU wide stakeholder forum to develop recommendations for EU health policy

• Vertical (national/regional) and Horizontal (EU wide) integration through multi stakeholder partnerships

• EU, national and regional policymakers to promote health literacy for patient choice and consumer-driven healthcare

• An EU wide stakeholder forum to develop recommendations for EU health policy

• Vertical (national/regional) and Horizontal (EU wide) integration through multi stakeholder partnerships

• Alignment of eHealth approaches at national level with EU-wide efforts

• Set up an EU-wide multi disciplinary forum to discuss ehealth policy as a multi

• dimensional transformational change• Develop legislation to promote trust and data security• Set up health literacy programmes through Public- Private

Partnerships • (PPPs)

• Alignment of eHealth approaches at national level with EU-wide efforts

• Set up an EU-wide multi disciplinary forum to discuss ehealth policy as a multi

• dimensional transformational change• Develop legislation to promote trust and data security• Set up health literacy programmes through Public- Private

Partnerships • (PPPs)• Promote cross-border knowledge sharing and contextualising of 'best

practice' examples of eHealth using TEMPEST• Improved tracking and benchmarking of Health and eHealth indicators

across member states• Funding for multi disciplinary and country comparison studies to enable

lower IT maturity member states to leap frog

• Promote cross-border knowledge sharing and contextualising of 'best practice' examples of eHealth using TEMPEST

• Improved tracking and benchmarking of Health and eHealth indicators across member states

• Funding for multi disciplinary and country comparison studies to enable lower IT maturity member states to leap frog

• Adopt a bottom-up approach to implement enabling technologies in care homes, leisure/sports centres and schools/universities to engage citizens

• Promote an EU partnership to design and implement legislation on data protection across national boundaries

• Make technology accessible and affordable to all citizens

• Adopt a bottom-up approach to implement enabling technologies in care homes, leisure/sports centres and schools/universities to engage citizens

• Promote an EU partnership to design and implement legislation on data protection across national boundaries

• Make technology accessible and affordable to all citizens

• Design an EU policy to promote integration and interoperability with shared benefits

• A Healthier Europe

• Design an EU policy to promote integration and interoperability with shared benefits

• A Healthier Europe

Mu

ltid

iscip

lin

ary

Researc

h/K

now

led

ge S

hari

ng

Ed

ucati

on

an

d T

rain

ing

For

Key S

takeh

old

ers

Cit

izen

En

gag

em

en

t an

d A

ware

ness


TEMPEST model applied to 12 EU Member States Belgium Denmark France Germany Italy Malta Netherlands Poland Romania Spain Sweden UK Catalonia

(Regional Study)


Eight Priority Areas for a Healthier Europe


9

Informational eHealth

Transformational ET Health

Fragmented healthcare

Problems with access and mobility

High cost

Standardized solutions

IT centric

Poor Clinician and Patient Engagement

Perverse incentives

Re-engineer existing work practices

Integrated healthcare

Mobile and accessible

More affordable

Customized/Personalized

Patient centric

Clinical and Patient Buy-In

Clear Value Proposition

New Business Models for Health Care


Key ET Findings 5 Enabling Technologies for Transformational HealthCare

➜ Electronic Health Records (EHRs)➜ Telemedicine➜ Health Portals➜ Personal Health Records (PHRs)➜ Cloud Computing

EU and Member State policy to complement existing initiatives (i.e. EPSoS)

eHealth policy is highly fragmented across the EU Research, education and training in single disciplinary silos Health Technology Assessment (HTA) needs to go beyond evaluating

technical factors Poor stakeholder engagement continues to inhibit progress on eHealth Regional approach to eHealth more effective than top-down

implementations Citizen-centric health is a medium to long term target EU health budgets need to be rebalanced to target expenditure on

health and well-being (prevention and lifestyle - around 3% of Member States' total budgets for health) compared with diagnosis and treatment (around 97%)


Leapfrogging Opportunities

Telep

hone lines

per hundred

people

Mobile ce

llular

subscr

iption per hundred

people

Internet

subscr

ibers per

hundred peo

ple

Personal

Computers

Households w

ith TV

sets

020406080

100120

BelgiumDenmarkRomania


Total Expenditure on Health as a Percentage of Gross Domestic Product (GDP)

OECD 1997, 2009 • Poland - WHO 1995 and 1985 figures for government health as % GDP• ** Romania – WHO/EU 2005, 1995 and 1985


Health Spending and Medical Technology Spend France (1-3)

Germany (2-1)

Belgium (3-10)

Italy (6-5)Sweden (7-8)UK (8-9)

Spain (10-4)

Romania (12-12)

Malta (9-2)

Denmark (3-6)

Netherlands (5-7)

Poland (11-11)

Medium Medical Technology Spending (0.3-0.5%)

High Medical Technology Spending

(> 0.5%)

Low Medical TechnologySpending (<0.3%)

Medium Health Spend(7-8%)

High HealthSpend (>9%)

Low HealthSpend (< 7%)

Highest Health Spend

Highest Medical Tech. Spend

http://en.wikipedia.org/wiki/File:Flag_of_Italy.svg

http://en.wikipedia.org/wiki/File:Flag_of_Italy.svg

http://en.wikipedia.org/wiki/File:Flag_of_Sweden.svg

http://en.wikipedia.org/wiki/File:Flag_of_Sweden.svg

http://en.wikipedia.org/wiki/File:Flag_of_the_United_Kingdom.svg

http://en.wikipedia.org/wiki/File:Flag_of_the_United_Kingdom.svg

http://en.wikipedia.org/wiki/File:Flag_of_Spain.svg

http://en.wikipedia.org/wiki/File:Flag_of_Spain.svg


Indicator Belgium DenmarkFrance Germany Italy MaltaNetherlan

dsPoland Romania SpainSwede

n UK

Take-up of Internet services: looking for information about goods and services (% of population) 58 73 57 66 50 42 76 33 17 46 75 64

% population who have never used the internet 26 12 26 20 50 49 11 44 64 38 9 19

Internet Use in Member States

Belgium

Denmark

France

Germany

Italy

Malta

Netherlands

Poland

Romania

Spain

Sweden

UK

0 10 20 30 40 50 60 70 80 90 100

% Population with internet access% basic public services for citizens available online

Indicator Belgium DenmarkFrance Germany Italy MaltaNetherland

sPoland Romania SpainSwede

n UK

% basic public services for citizens available online 42 50 58 64 58 92 55 17 8 58 75 91

% Population with internet access 67 83 63 79 53 64 90 59 38 54 86 77

Population with Internet Access v Online Public Service Availability

Belgium

Denmark

France

Germany

Italy

Malta

Netherlands

Poland

Romania

Spain

Sweden

UK

0 10 20 30 40 50 60 70 80

% population who have never used the internetTake-up of Internet services: looking for information about goods and services (% of population)

Indicator Belgium Denmark France Germany Italy MaltaNetherland

s Poland Romania SpainSwede

n UK

Take-up of Internet services: looking for information about goods and services (% of population) 58 73 57 66 50 42 76 33 17 46 75 64

% population who have never used the internet 26 12 26 20 50 49 11 44 64 38 9 19

Lack of Internet Use v Take-up of Internet Services

Belgium

Denmark

France

Germany

Italy

Malta

Netherlands

Poland

Romania

Spain

Sweden

UK

0 20 40 60 80 100 120

% GPs with Internet Connection% GPs Using Computers



n UK

% GPs Using Computers 86.1 98.9 82.8 98.8 86.2 65.2 98.5 71.5 65.8 77.2 99.6 97.3

% GPs with Internet Connection 83.9 98.9 73.2 58.9 70.7 55.4 96.6 61.5 35.2 51.4 98.5 95.4

GPs with Internet Connection v Computer Usage

Belgium

Denmark

France

Germany

Italy

Malta

Netherlands

Poland

Romania

Spain

Sweden

UK

0 20 40 60 80 100 120

Transfer of medical patient data to other care providers or professionals

Electronic storage of individual medical patient data

%GPs Transferring data electronically



n UK

%GPs Transferring data electronically 75 98 48 66 16 17 91 29 11 37 89 91Electronic storage of individual medical patient data 4.3 4.8 4.1 3.2 3.4 2.5 4.9 2.7 2.2 4.1 4.1 4.3

Transfer of medical patient data to other care providers or professionals 0.6 3.7 0.2 0.2 0.4 0.3 1.3 0.1 0.1 0.6 0.7 1.3

GP Storage and Transfer of Electronic Patient Data


Indicator Belgium Denmark France Germany Italy MaltaNetherland


n UK

%GPs Transferring data electronically 75 98 48 66 16 17 91 29 11 37 89 91Electronic storage of individual medical patient data 4.3 4.8 4.1 3.2 3.4 2.5 4.9 2.7 2.2 4.1 4.1 4.3

Transfer of medical patient data to other care providers or professionals 0.6 3.7 0.2 0.2 0.4 0.3 1.3 0.1 0.1 0.6 0.7 1.3

EHRs – Progress in Member States

20 Future of eHealth

Improved regional and local integration of eHealth initiatives

Multi-level stakeholder engagement (HCPs, social workers, patient forums, etc)

Closer collaboration using PPPs (i.e. to develop eHealth solutions)

Different standard used within hub (Kmehr web-services/IHE)

Discussion on patient access to data (only beginning)

Policy Recommendations


21

Health TechnologyAssessmen

t (HTA)

Regional and Local

Implementation Centres

EU-Wide Stakehol

der Forum

EDUCATION, ENGAGEMENT and EVALUATION


Thank you

Any Questions?

Warwick Business School Professor Wendy CURRIE Director, IPTRU/WBS, UK Dr David FINNEGAN Director,...

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