Www.healthsysconsult.co.uk Health System Transformation : eHealth in Europe 5 th ASEM Conference - Jiaxing - China 5 th ASEM Conference - Jiaxing - China

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Health System TransformationHealth System Transformation : : eHealth in EuropeeHealth in Europe

55thth ASEM Conference - Jiaxing - China ASEM Conference - Jiaxing - China 22ndnd November 2006 November 2006

Professor Ricky J RichardsonProfessor Ricky J RichardsonChair (Europe) ASEM eHealth Working GroupChair (Europe) ASEM eHealth Working Group

Life President UK eHealth AssociationUK eHealth AssociationChairmanChairman eHealth Working Group – EHTELeHealth Working Group – EHTEL

European Commission - 1999 – 2003European Commission - 1999 – 2003Vice PresidentVice President International Society for Telemedicine International Society for Telemedicine

& eHealth& eHealthFounding DirectorFounding Director European eHealth ForumEuropean eHealth ForumGroup Clinical Director Group Clinical Director HealthSystems Group of companiesHealthSystems Group of companiesVisiting Professor – eHealthVisiting Professor – eHealth Imperial College, LondonImperial College, London

Consultant PaediatricianConsultant Paediatrician – practicing at:- – practicing at:-Great Ormond Street Hospital for Children, LondonGreat Ormond Street Hospital for Children, London

The Portland Hospital for Women & Children, LondonThe Portland Hospital for Women & Children, LondonLondon Child and Family Consultation Practice, Harley StreetLondon Child and Family Consultation Practice, Harley Street

Princess Margaret Hospital (BMI), WindsorPrincess Margaret Hospital (BMI), Windsor


Ageing PopulationCost of Chronic Disease – consumes 70% of national health budgets

New Accession Countries – different levels of care and health outcomesPresent Healthcare Models are unsustainable:

– Kerr Report (Scotland)- Wanless Report (England)

Pan European problemsRequire increasingly PanEuropean solutions:- Trans border transactions- Migration of Patients- Migration of Healthcare

ProfessionalsRef: 7FP Doubling Budget (Health ICT)

€100 Million per annum

European CommunityEuropean Community550 Million People (?870 550 Million People (?870 Million?)Million?)


Health Transition - THE TIME Health Transition - THE TIME BOMB !!BOMB !!

FertilitydeclinesFertilitydeclines

Infectious DiseaseMortalitydeclines

Infectious DiseaseMortalitydeclines

Population ages

Population ages

Chronic and nonCommunicable

Diseasesemerge

Chronic and nonCommunicable

Diseasesemerge

Demographic transition Epidemiological transition

Copyright Dr Rifat Atun – Imperial College


Population ageing and healthPopulation ageing and healthThe next 50 years ! 1995 to 2045The next 50 years ! 1995 to 2045

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160

1995 2005 2015 2025 2035 2045

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mb

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(mill

ion

s)

More developed countries

0

200

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500

600

100

1995 2005 2015 2025 2035 2045

Less developed countries

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1995 2005 2015 2025 2035 2045

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Least developed countries

Under 65s65s and over

Estimated future numbersof dependent people by age


Ageing and cost of careAgeing and cost of care

0

500

1000

1500

2000

2500

Copyright: Dr Rifat Atun

Birth 0-4 5-15 16-44 45-64 65-74 75-84 85+

Co

st p

er h

ead


DemographicsAgeing population - Implications

Increased Dependency ratioIncreased cost of long term care

Who will support the health andWho will support the health and welfare system in the Future?welfare system in the Future?


But… improved health can be But… improved health can be an economic benefitan economic benefit

• ‘‘if life expectancy (in low-income countries) were to if life expectancy (in low-income countries) were to grow from 59 to 68 years, the increase in annual grow from 59 to 68 years, the increase in annual economic growth would increase 0.5 percent, economic growth would increase 0.5 percent, roughly 10 percent over twenty years.’ roughly 10 percent over twenty years.’

J Sach, WHO, 2002: Macroeconomics and Health: J Sach, WHO, 2002: Macroeconomics and Health: Investing in Health for Economic DevelopmentInvesting in Health for Economic Development


The nine Drivers Forcing Change• Obligatory search for cost containment

• Changing demographics

• Peripheralisation of health care delivery

• Changing disease patterns

• Impact of information technology including IT

support for clinical decisions

• More informed and expectant patients

• The well-being factor – responsibility shift into patients hands - The Wellness Paradigm

• Moving Information and Knowledge – Not People

• Creation of Managed Clinical Networks

for patients with Chronic Disease

The Paradigm ShiftThe Paradigm Shift


Implications Implications

- - Health systems are strugglingHealth systems are struggling

– The way we are providing care is The way we are providing care is changingchanging

– Patients are better informedPatients are better informed

– ICT must be seen as a key enabler for ICT must be seen as a key enabler for patient : clinician relationshippatient : clinician relationship


Public Health Improvement - Epidemiology

Patient Learning – use of media channels

Care Provider eLearning

Clinical ApplicationsHealth Informatics - Medical Devices

eHea

lth

Healthsystems TransformationHealthsystems Transformation


eeHealthHealth• Clinical Applications

Electronic Health RecordsTeleConsultations including Videoconferencing (Telemedicine)Clinical Decision Making Support SoftwareVital Signs Monitoring ServicesTeleHomeCare Ambulatory eHealth - smart clothing - eWear - eClothingNational ePrescribing & eBooking ServiceseNursingPicture Archiving and Communication Systems - PACS

• eDissemination of – personalised - Healthcare Professional Continuing Education – www and eLearning tools

• Public Health education & Information – better use of all media channels to inform citizens to increase self help and thus change healthcare demand• LifeTime Health Records – aggregation of individual electronic health records

capturing longitudinal healthcare events – Population based tracking of health trends leading to prediction and anticipation of hostile disease trends and thus PreventionPrevention


Inte

gra

tion

Inte

gra

tion o

f IT

of

IT

IT as a gadgetTrojan horse: networks, …Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system

19801980 19901990 20002000 Jean-Claude HealyJean-Claude HealyMay 2000May 2000

ManufacturingManufacturingFinancial ServicesFinancial Services Public ServicesPublic Serviceseg: Health eg: Health

Integration of IT intoIntegration of IT intoBusiness SectorsBusiness Sectors


Technology driven Disappointment

Healthcare Professionals: HELP!!!!!Sit on the fence or Resist “I told you so !” Accept the inevitable and want controlcontrol

GlobalisationGlobalisationHealthcare Economists Healthcare Economists Patient PowerPatient PowerThe Medical ProfessionThe Medical ProfessionThe World Wide WebThe World Wide WebNew TechnologiesNew Technologiese.g. Mobile Videophonese.g. Mobile VideophonesG3 mobile networksG3 mobile networks

19801980 19901990 20062006

Uptake of IT Solutions inUptake of IT Solutions in Healthcare delivery Healthcare delivery


Selected facts and figures – Selected facts and figures – Drivers for ICT Investment by Drivers for ICT Investment by

European hospitalsEuropean hospitals20042004 2005/72005/7

• Meet legal requirementMeet legal requirement • Meet legal requirementMeet legal requirement

• Reduce avoidable medical Reduce avoidable medical errorserrors

• Reduce avoidable medical Reduce avoidable medical errorserrors

• Facilitate sharing of patient Facilitate sharing of patient informationinformation

• Facilitate sharing of patient Facilitate sharing of patient informationinformation

• Comply with government Comply with government funded policyfunded policy

• Increase clinical capacity Increase clinical capacity and productivityand productivity

• Improve security and privacyImprove security and privacy • Comply with government Comply with government funded policyfunded policy

• Improve security and privacyImprove security and privacy


Selected facts and Selected facts and figuresfigures

• HINE study of large European Hospitals HINE study of large European Hospitals foundfound– 99% have PAS99% have PAS– 87% have integration around a patient 87% have integration around a patient

number - common MPInumber - common MPI– 19% have clinical orders and results, 19% have clinical orders and results,

advanced medical libraryadvanced medical library– 2% have decision support , e-prescribing2% have decision support , e-prescribing

• HINE also found > 50% of hospitals IT HINE also found > 50% of hospitals IT budget was < 2% total hospital budgetbudget was < 2% total hospital budget


Selected facts and Selected facts and figuresfigures

E-Business W@tch 2006 of European E-Business W@tch 2006 of European HospitalsHospitals : :– 34% provide remote access to network34% provide remote access to network– Hospitals better provided with ICT Hospitals better provided with ICT

infrastructure than 10 other economic sectorsinfrastructure than 10 other economic sectors– 34% intend to increase ICT spending, but the 34% intend to increase ICT spending, but the

investments and difficulties are larger than in investments and difficulties are larger than in 10 other economic sectors10 other economic sectors

– Concerns about security and cost of Concerns about security and cost of technology are inhibitors to investmenttechnology are inhibitors to investment

– Strength in eg online procurement, weak in Strength in eg online procurement, weak in patient facing ICTpatient facing ICT


• eHealth Impact (cost benefit study eHealth Impact (cost benefit study for European Commission on impact for European Commission on impact of ICT in healthcare) found:of ICT in healthcare) found:

– On average that Year 4 was the first On average that Year 4 was the first year in which annual benefits exceed year in which annual benefits exceed costscosts

– Year 5 – first year that cumulative Year 5 – first year that cumulative investments exceed cumulative costsinvestments exceed cumulative costs

www.healthsysconsult.co.ukSelected National eHealth Selected National eHealth InitiativesInitiativesin Europein Europe

• Complementary to local hospital investments, the following Complementary to local hospital investments, the following top down eHealth initiatives are underwaytop down eHealth initiatives are underway

– England – NHS Connecting for HealthEngland – NHS Connecting for Health– UK – NHS 24 and NHS DirectUK – NHS 24 and NHS Direct– France - Patient and Professional Cards/DMPFrance - Patient and Professional Cards/DMP– Wales – Informing Healthcare Wales – Informing Healthcare – Germany – Cards – Prescribing and InsuranceGermany – Cards – Prescribing and Insurance– Lombardy, Italy – CSS-SISS Lombardy, Italy – CSS-SISS – Denmark – MedComDenmark – MedCom– The Baltic eHealth ExchangeThe Baltic eHealth Exchange – Malaysia – The Telemedicine BlueprintMalaysia – The Telemedicine Blueprint

All Infrastructure Building BlocksAll Infrastructure Building Blocks


The idea…

Introduction of eHealth in Rural areas

Better access to specialized healthcare

Less out migration from rural areas

Healthcare and migration?


PartnersFacts:• Ten partners

• Five countries

• Start: 2004

• End: 2007

• Budget: 2 M€


NHS Connecting for Health – England NHS Connecting for Health – England

The largest civilian IT project on the planet EarthThe largest civilian IT project on the planet Earth

Total estimated Cost : Total estimated Cost :

???? £60 Billion over ten years???? £60 Billion over ten years

Procurement alone cost Procurement alone cost £6.4 Billion £6.4 Billion

All paid for by taxpayers money!!!!All paid for by taxpayers money!!!!


This is what This is what we have we have now!!now!!

Historical focus of Historical focus of ICT has been on ICT has been on automation not automation not transformation transformation


What is NHS Connecting for Health?What is NHS Connecting for Health?

N3, the NationalNetwork

N3, the NationalNetwork

Picture Archiving and Communications Systems

Picture Archiving and Communications Systems

Electronic Transmission of Prescriptions

Electronic Transmission of Prescriptions

NHS Care Records Service

NHS Care Records Service Choose & BookChoose & Book


LSP

Patient info

Broken Leg

Patient visits A&E

Patient info

LSP

Back Pain

Patient visits GP

LSP

Patient info

Chest infection

Patient visits hospital

Spine

The information flow is repeated over time

Spine Build-Up


EU / WHO / Commonwealth initiatives :-EU / WHO / Commonwealth initiatives :-

World Health Organisation – Global eHealth World Health Organisation – Global eHealth StrategyStrategy

• European Community (25 countries – 27 in Jan 2007)European Community (25 countries – 27 in Jan 2007)• ASEM eHealth Working Group (39 countries)ASEM eHealth Working Group (39 countries)• Commonwealth eHealth Secretariat (53 countries)Commonwealth eHealth Secretariat (53 countries)

eHealth has become a core pre-occupation of eHealth has become a core pre-occupation of governments worldwidegovernments worldwide

Countries are forming groups to share scarce Countries are forming groups to share scarce health resources, skills and knowledgehealth resources, skills and knowledge

Public Private Partnerships are essential to achieve Public Private Partnerships are essential to achieve eHealth goalseHealth goals


The Dilemma:The Dilemma:

Wait until infrastructure is in placeWait until infrastructure is in place

NPfIT approach (England)NPfIT approach (England)

oror

Start implementing useful Start implementing useful transformationtransformation

projectsprojects


Traditional Healthcare Delivery Traditional Healthcare Delivery ModelModel

The Patient Community - Bottom of the pile!!

PhysicalMovement

ofPatients

3° HealthCare

2° HealthCare

1° HealthCare

Teaching Hospitals

Regional Hospitals

District General Hospitals

General Practitioners

Unchanged for 6000 years - circa 3000 BC!


The wellness paradigm

PRIMARY TELERADIOLOGYPRIMARY TELERADIOLOGYAND TELEPATHOLOGYAND TELEPATHOLOGY

eHealth &eHealth &TelemedicineTelemedicine

Clusters of SpecialistsClusters of Specialistsglobal spread &global spread &universal accessuniversal access

Allied HealthCare Professionals

Primary HealthCarePrimary HealthCareThe ‘Super’ Primary Care PhysicianThe ‘Super’ Primary Care Physician

CommunityHospitals

(Acute)

CommunityHospitals(Non-acute)

Freestanding Diagnostic

Centres

HomeCare

HealthKiosks

DayCareSurgery

MaternityAcute

Trauma

??

Direct Access to specialistsDirect Access to specialistsWWWWWW IDTVIDTV IDTVIDTV WWWWWW

The Informed Wired upInformed Wired up Citizen Community

CC--HealthHealth

Future Health System TransformationFuture Health System Transformation


We are at the We are at the dawn of the age dawn of the age of citizen centric of citizen centric

Healthcare Healthcare SystemsSystems



Where are the challenges?? Where are the challenges?? Not the technology ------------------- The PeopleNot the technology ------------------- The People


HealthSystem TransformationHealthSystem Transformation

The reasonable man adapts himself to the world;The reasonable man adapts himself to the world;

The unreasonable one persists in trying to adapt the The unreasonable one persists in trying to adapt the

world to himself.world to himself.

Therefore, all progress depends on the unreasonable Therefore, all progress depends on the unreasonable

man !!!man !!!

George Bernard ShawGeorge Bernard Shaw

(1856– 1950)(1856– 1950)

Via Prof Jean Claude HealyVia Prof Jean Claude Healy

World Health OrganizationWorld Health Organization

September 2005September 2005


eeHealthHealthUK eHealth AssociationUK eHealth Association

www.ukeha.org.uk

International Society for Telemedicine and International Society for Telemedicine and

eHealtheHealthwww.ISfT.net

THANK YOU!!!!THANK YOU!!!!Professor Ricky J RichardsonProfessor Ricky J Richardson

[email protected] +44 7785 231 762Mobile +44 7785 231 762

www.healthsysconsult.co.ukwww.healthsysconsult.co.uk

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Www.healthsysconsult.co.uk Health System Transformation : eHealth in Europe 5 th ASEM Conference - Jiaxing - China 5 th ASEM Conference - Jiaxing - China