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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
Warwick Business School
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
Warwick Business School
Exchange of patient data: From IT....
Remote files unknown
Warwick Business School
......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
Warwick Business School
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
Warwick Business School
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
Warwick Business School
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
Warwick Business School
TEMPEST model applied to 12 EU Member States Belgium Denmark France Germany Italy Malta Netherlands Poland Romania Spain Sweden UK Catalonia
(Regional Study)
Warwick Business School
Eight Priority Areas for a Healthier Europe
© WL Currie and DJ Finnegan, (All rights reserved)
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
Warwick Business School
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%)
Warwick Business School
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
Warwick Business School
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
Warwick Business School
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
Warwick Business School
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
Indicator Belgium DenmarkFrance Germany Italy MaltaNetherland
sPoland Romania SpainSwede
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
Indicator Belgium DenmarkFrance Germany Italy MaltaNetherland
sPoland Romania SpainSwede
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
Warwick Business School
Indicator Belgium Denmark France Germany Italy MaltaNetherland
sPoland Romania SpainSwede
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
© WL Currie and DJ Finnegan, (All rights reserved)
21
Health TechnologyAssessmen
t (HTA)
Regional and Local
Implementation Centres
EU-Wide Stakehol
der Forum
EDUCATION, ENGAGEMENT and EVALUATION
Warwick Business School
Thank you
Any Questions?