COCIR sessioneHealth Market?

Present and Prospects, A View from Industrial Players

What eHealth strategies work and do not work, and what

should be implemented to effectively meet these

healthcare ‘transformational’ imperatives?

John Crawford

COCIR HealthCare IT Committee Member

Cost

Cost rising at a rate higher than GDP; e.g., US costs projected to reach 20%

US GDP by 2017 (world highest)

Aging population; most of the cost is during the last 2 years

No quantitative and comparative value options

Quality

One size fits all treatments

Fee-for-service payment models; money does not buy quality

Lack of Comparative Effectiveness data

Disease centered versus wellness centered

Preventable errors; too many deaths caused by preventable mistakes

Productivity

Too little patient involvement

Slow and inefficient processes

Little best-of-breed methodologies and processes

Complexity

The pressing need for healthcare system transformation

Hospital Information Systems

Clinical Information Systems

Telemedicine

Electronic Health Records

Public Health Surveillance

Chronic Disease

Productivity for

Providers & Payers

Access for

Patients

Quality for

Citizens & Consumers

Basic Intermediate Advanced

Wellness & Welfare

eHealth supports the entire spectrum of benefits from productivity gains,

through improved patient access, to high quality care and health maintenance

eHealth can enable cost reduction, improve quality of care through systemic

evidence generation and use, and supports new payment and delivery models

Today

Tomorrow

„One-size-fits-all‟

Institution-based care

Fee for service

Intuitive medical practice

Molecular Diagnostics / “-omics”

Electronic Health Records

Electronic Patient Records

New Delivery Models

Improved Clinical Pathways

ICT Education

Personalized medicine

Patient-centered & collaborative

Outcome-based payment

Evidence-based practice

New Payment Models

eHealth Transformation Bridge

Lower costs, activated patients,

Improved outcomes

Recognising the importance of ICT in healthcare transformation, there has

been a recent surge of eHealth programmes and key investments worldwide,

based on a strong vision, political will, and sustained funding

North America

US (ARRA) – $20.4B

Canada (InfoWay) –$3.1B CDN

Asia

China – $4.2B

Singapore – $1.1B SIN

Europe

England (NPfIT) - ₤12B

Middle East

Saudi Arabia – $14B

Worldwide

EPR/EHR investments >$10B in 2010 rising to >$30B by 2019

• Successful approaches share the following attributes:

• A strong vision of the goal, political will and sustained funding

• Consistency of policy across all stakeholder organisations

• Willingness to change care processes to take advantage of ICT,

supported by new legislation, business and financing models

• A clear set of priorities for implementing eHealth projects, including

expected benefits, incentives and additional support where needed

• A steady step-by-step adoption of change, with realistic

expectations defined, and successes clearly communicated

• A robust governance model to set the agenda, establish technical

standards and architectures, and monitor implementation

What eHealth strategies work and do not work?

• Failing approaches share the following attributes:

• Constantly changing goals, weak consensus between political

factions, and lack of investment (healthcare as a political football)

• Lack of joined-up health policy, misaligned incentives

• Innovation held back because of medical conservatism, fears

about loss of revenue or status, and previous failed ICT projects

• Confusion and disagreement about how health information will be

exchanged, and how eHealth services will be funded

• Unrealistic timescales, limited public perception of improved

service, bad press about money being „wasted‟

• Fragmentation and duplication of effort, focus on technology-driven

projects rather than safety, efficiency or outcome improvements

What eHealth strategies work and do not work?

“By 2010, 50 per cent of Canadians and by 2016, 100 per cent of Canadians will have their electronic health record available to their authorized professionals…”

Widespread use of PACS has increased radiologist

productivity by 23 percent, saving an estimated $1B a year.

In 2009 the PharmaNet system in British Columbia avoided

2.5M potential cases of drug interactions.

In Alberta, WebSMR has reduced post-

surgical reporting from 1 month to 1 hour

Some examples of the transformative power of eHealth supported by a vision,

strong political will, and sustained investment

Universal EHR use; 98% GPs, majority of specialists, all 73 hospitals, all 331 pharmacies and about half the 98 local authorities

Incentives for standards-based EHR adoption, plus national eHealth portal (sundhed.dk) for patients

Cumulative present value cost of prior to YE2005 was €536M , benefit was €872M (Empirica)

Typical GP serving 1,300 patients, saves30 hour/week of secretarial work by usingeHealth standards (Empirica)

Denmark Healthcare Data NetworkCanada Health InfoWay

Success factors:

• Develop a strong vision for the way healthcare will be structured, organized, managed,

financed, delivered and monitored, and how ICT will support this.

• Share a collective vision of eHealth in order to assist users, health professionals, suppliers and

procurers in signing up to the benefits of eHealth.

• Integrate the policy process, as issues will cut across the remit of different government

departments and agencies.

Some examples of the transformative power of eHealth supported by a change

in business & financing models

Implemented EHR in 1995, Clinical Decision Support (CDIS) in 2009, to „hard wire‟ best practice into systems

ProvenCare care program provides 90 day warranty on outcomes

Re-admission within 30 days has fallen from 6.9% to 3.8% Average total length of stay (LOS) down from 6.2d to 5.7d

“We are quickly approaching a situation where working without an electronic infrastructure will be impossible…”

Dr Ronald A Paulus, CTIO, May 2009

Geisinger ProvenCare

Pre-paid plans and emphasis on preventive care; full deployment of EHR and CPOE in 2003

8% reduction in doctor visits and 14% reduction in phone calls among My Health Manager (patient portal) users.

Kaiser members in California have 30% less chance of dying of heart failure compared to the US population

Kaiser members have 12% improvement in survival rates for colon cancer compared to SEER Medicare averages

Kaiser Permanente

Success factors:

• Address the fragmented nature of care i.e. “continuum of care” versus “episodic care” (e.g.

introducing disease management, case management, participatory medicine etc)

• Align interests between the party making the investment and the beneficiary.

• Develop financial incentives, reward health outcomes (quality, safety, prevention), and nurture

the innovative business models that are made possible through the use of eHealth.