Leveraging “meHealth” to support better, more effective, more equitable healthcare How standards-based, person-centric mHealth + eHealth ("meHealth") architecture

Leveraging “meHealth” to support better, more effective, more equitable healthcareHow standards-based, person-centric mHealth + eHealth ("meHealth") architecture is leveraged to support better care, more effective health system management, and universal health coverage (UHC).

10 December, 2014

So… what is meHealth?

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mHealth + eHealth = meHealth

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Your facilitators today…

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Caren Althauser

Program Officer, Digital Health Solutions, PATH

Technical Facilitator, JLN Information Technology Initiative

Cees Hesp

Director Joint Learning,PharmAccess Foundation

Technical Facilitator, JLN Information Technology Initiative

Derek Ritz

Principal Consultant, ecGroup Inc.

Leveraging “meHealth” to support better, more effective, more equitable healthcare

Agenda:

1. Introducing the Joint Learning Network for Universal Health Coverage (JLN).

2. Understanding ‘meHealth’ and its role in supporting care delivery and financial payments; insights from country experiences.

3. Games!

4. Key messages and take-aways.

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The JOINT LEARNING NETWORK FOR UNIVERSAL HEALTH COVERAGE (JLN) is an innovative collaborative learning platform where practitioners and policymakers co-develop global knowledge that focuses on the practical “how to’s” of achieving Universal Health Coverage.

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The JLN is a global, innovative learning platform at the forefront of UHC reform, currently led by 9 member countries and recently expanded to a group of 13 associate countries from Latin America, Europe, Africa, and Asia.

Full Members• Ghana• Indonesia• India• Kenya• Philippines• Malaysia• Mali• Nigeria• Vietnam

Associate Members• Bangladesh• Colombia• Egypt• Ethiopia• Japan• Kosovo• Mexico• Moldova• Mongolia• Morocco• Namibia• Senegal• Sudan

The Joint Learning Approach: Using collaborative learning among practitioners to co-develop global knowledge on the practical “how-to’s” of achieving UHC

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1. Common Problem Identification 2. Collective

Problem Solving 3. Synthesis of New Knowledge 4. Knowledge

Adapted Within JLN Countries

5. Knowledge Disseminated to Other Countries

Key Benefits of the JLN Approach: Strong country ownership Relevance to country priorities Space to analyze root causes Builds trust, safe space, and community Results in practical tools/knowledge products that can be

used & shared Creates opportunities for responsive follow-up by partners

JLN Information Technology Initiative

PATH and PharmAccess Foundation have facilitated the Information Technology (IT) Initiative of the Joint Learning Network since December, 2010.

We work directly with ministries of health and national health insurers to foster peer-to-peer learning and to develop and share artifacts, knowledge, and tools that can be used by countries to develop and implement national health insurance information system plans.

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JLN developed eBook:

Outlines the value proposition behind national-scale, eHealth infrastructure in a way that policymakers and IT professionals alike can readily understand.

Sets context by describing the experiences of countries at various stages of UHC and eHealth implementation.

Introduces four key stakeholders—Patients, Providers, Payors and Policymakers (the 4 P’s)—and their differing perspectives on the care delivery value chain.

Describes a “storytelling approach” that may be employed to develop eHealth standards specifications appropriate to a country’s interoperability requirements.

Describes practical steps for moving forward.

Connecting Health Information Systems for Better Health

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Why an eBook on standards and interoperability?

JLN member countries expressed an interest in learning more about interoperability standards and how to select standards to support UHC insurance programmes.

The eBook is a companion piece to more broad-based reference material on the topic such as the WHO 2012 eHealth Strategy Toolkit and forthcoming WHO handbook on standards and interoperability.

The eBook uses an approachable writing style to break-down concepts and strategies into understandable actionable steps.

Country case studies describe various approaches and lessons learned.

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The Key Message…

“A common, standards-based, national-scale eHealth infrastructure should support both care delivery and financial payments workflows as well as produce the analytics necessary to monitor and manage these.”

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Leverage the computers that pervade at the edge of the network; especially mobile devices.


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Leverage robust, re-usable, shared computing power in the centre of the network.


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Improve the health of populations by improving our ability, system-wide, to deliver person-centric care to individuals.

How does meHealth improve health?

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How does meHealth improve health?Instrument of strategy

Instrument of execution

Instrument of payment

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Countries’ Experiences…

Dr. Rosemary Foster

Mr. Cees Hesp

Dr. Alvin Marcelo

Mr. Ramiro Guerrero

Dr. Boonchai Kijsanayotin

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Let’s get interactive!

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SMS 123 to+1 703 962 6112

Or connect via web at: http://tinyurl.com/kzlq8av

Let’s get interactive!

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Poll results…

Take-away #1…

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Standards-based data are

computable data!

Why do any of us care about standards?1. Successful health interventions rely on

continuity of care, over time and across different care sites

2. Continuity of care depends upon interoperability between systems

3. Interoperability is achieved through standardization

“We care about eHealth standards because they help achieve health impacts.”

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Computable data is essential to supporting system process control

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Ok… let’s play a GAME!

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This is a jelly bean production game… Gummy bears make jelly beans; jelly beans

are good… the more the better! Different colours of gummy bears have

different jelly bean production capacities. A smartie makes a gummy bear smarter

and a smarter gummy bear makes more jelly beans.

Each colour of gummy bear has a different price. Adding a smartie to your gummy bear costs a bit extra.

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Gummy bear teams…

Only yellow gummy bears can work alone Green gummy bears can team up with

yellow gummy bears; there can be up to 4 green gummy bears per yellow gummy bear

Red gummy bears can join teams of yellow & green gummy bears; you can add 1 red gummy bear per green gummy bear

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Price and production…

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$16(75) $3(14) $2(10)

$1(7)

$4(25)$1(11)

You have a $100 budget.Try to produce as many jelly beans as you can.

Choose your combination…

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$16 75

$3 14

$2 10

$20 100

$4 25

$3 17

CostJelly Bean

Production

4 allowed per

1 allowed per

Gummy Bear Teams

*you can mix regular and “smart” gummy bears on the same team

How many?

Let’s get started!

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SMS 999 to+1 703 962 6112

Or connect via web at: http://tinyurl.com/nlnys5y

Choose your combination…

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$16 75

$3 14

$2 10

$20 100

$4 25

$3 17

CostJelly Bean

Production

4 allowed per

1 allowed per

Gummy Bear Teams


How many?

Gummy bear game results…

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Game results

Take-away #2…

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It is worth the extra money to have a smarter Gummy Bear!

Revelation…

What if we were talking about smart investments in the production of health outcomes?

What if you are faced with resource constraints? All countries, rich & poor alike, have the same

problem...

In your context, go for the biggest “bang for the buck”

What if there is no “one size fits all”? Caution: don’t reinvent the wheel

Know your literature— evidence of success does exist

Gummy Bears, Smarties and Jelly Beans...

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Example: UHC or payment-led initiatives

If a country is moving forward with a UHC or payment-led initiative, take into consideration the care-delivery requirements alongside the health insurance/payment requirements

For example, if a capitation payments scheme is being rolled out, consider the re-usability of the IT pieces

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Capitation

Individual Providers (or sometimes, provider organizations) are funded, in advance, based on their size of their enrolled patient population

At the most basic level, a Provider Registry (PR) and a Client Registry (CR) provide sufficient information to support payment

At higher levels of sophistication, there may be adjustments to the capitated fee amount based on the demographic or health profile of the client population

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Share common eHealth information sources and databases to support payment transactions such as Capitation

Patient

Policymaker Payor

Provider

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CR

PR

Example: Care delivery-led initiative

If a country is moving forward with a care delivery-led initiative, take into consideration the insurance/payment requirements alongside the clinical requirements

For example, if an HIV care programme is being rolled out, consider the re-usability of the IT pieces

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HIV Care Programme

To support person-level care, on a long-term basis, it is necessary to know who receives the care (client registry) and what care was received (health record and terminology services)

If the provider registry and facility registry are also implemented, fee-for-service or DRG payment schemes may also be supported

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Ideally the same coding standards should be used to support both care delivery and insurance billing

Patient

Policymaker Payor

Provider

CR

PRTS

SHR

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Let’s play again!

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SMS 999 to+1 703 962 6112

Or connect via web at: http://tinyurl.com/nlnys5y

Let’s play again with $200…

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$16 75

$3 14

$2 10

$20 100

$4 25

$3 17

CostJelly Bean

Production

4 allowed per

1 allowed per

Gummy Bear Teams


How many?

Gummy bear game results (round 2)…

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Game results

Take-away #3…

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There is a natural maturity model for

meHealth investments.

An example of an eHealth infrastructure maturity model

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An example of a shared eHealth infrastructure

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Final thoughts…

Some countries have quite sophisticated health insurance infrastructure but nascent or weak care delivery eHealth systems (and some are the opposite).

A strong health insurance transaction processing capability can be leveraged as a first step towards person-centric electronic health records.

Opportunistically, financial incentives/disincentives may be employed to strengthen the coding of physician claims submissions so that, over time, the usefulness of this data as health records will grow.

Look for ways to leverage what you have and add capabilities as you go

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Key Messages

Standards make life easier Computable data, at lower cost, and better quality

Design for the future Anything you can reuse/repurpose later is a better

investment

Capability Maturity Model Crawl-Walk-Run

Think big, start small, act now

Take-aways for lunch

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www.jointlearningnetwork.org

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Get the eBook at

http://jointlearningnetwork.org/resource/connecting-health-information-systems-for-better-health

Documents

Leveraging “meHealth” to support better, more effective, more equitable healthcare How standards-based, person-centric mHealth + eHealth ("meHealth") architecture