20131125 e health_introductie

Transform to the power of digital

eHealth, changing the value proposition

in Healthcare

Copyright © 2011 Capgemini Consulting. All rights reserved.

Personal introduction

� Henk E. Bakker <[email protected]>

– Principal consultant for IT in Healthcare

• Capgemini Consulting Services NL

– Background

• Information Manager in several hospitals

• National Project leader of ICT program of the DBC project

• Project leader of National Electronic Medication Record project

• 25 years of industry experience

http://www.linkedin.com/pub/henk-bakker/4/280/95a

@henkebakker


Agenda

Why eHealth?

Definition of eHealth and telemedicine

eHealth from a patient perspective

eHealth business models

Acceleration of eHealth implementations

3

Why is eHealth necessary?

4


5

Healthcare systems are under pressure

Chronic conditions increasingly pressurize health systems…


In particular the accessibility, affordability and quality of care are challenged due to….

Future of Healthcare

Budget cuts

Privacy, Security and

Patient Consent

Increasing service

expectations

Shrinking and changing professional

workforce

Ageing population /

growing demand

Innovation in medication technology

Private competitors

Improved ‘diagnostic’ technologies


The prevalence of chronic diseases is increasing rapidly: Some figures for the

Netherlands

Now in 10-20 years

� Diabetic 450.000 1.100.000

� Alzheimer’s 120.000 500.000

� Total Hip 24.000 55.000

� Knee 18.000 75.000It will become a

gigantic challenge !!!


In order to remain viable or to regain viability, hospitals must realise

efficiency gains of 15-20% over the next years and sustain themselves through growth

2000 2010 2020 2030 Year

Care

Demand

Supply

AgeingDemanding care consumerNew diseasesMore demand caused by better supply

Characteristics of Supply

Decreasing workforceNo increase of care capacityCost containment

How can we close the gap?

Characteristics of Demand

Challenge for the Hospitals

Government

Response


The challenge: a paradigm shift from cure to care (quality of life)

From Cure

� Restore to health

� Restore to health

� Passive patient

� Expert

� Intramural

� Institute

� Fragmentation

� Monodisciplinary

� trade

To Care

� Ability to do things independently

� Prevention

� Active patient

� Counsellor

� Extramural

� Process

� Integration

� Multidisciplinary

� Evidence based

Reactive

Proactive

eHealth and telemedicine


eHealth is no other care, but it is designed differently

Self Service

Patiënt

Telemonitoring

Tele Treatment

eConsult

Professional and Patiënt

Alerts and Signalling

eConsult

Professional and Professional

Electronic Health Record and

Personal Health Record

Self diagnosis

and Prevention


eHealth is…..

– Applications for the healthcare professional itself

– Applications for the management of care continuity (information exchange of one

provider to another)

– Applications for the governance of care

Applications for the patient

Applications that support the interaction between patient and healthcare provider (telemedicine)

eHealth is often seen as "the application of ICT in Healthcare”;

However eBusiness or eCommerce in Healthcare is more applicable


The potential of eHealth is enormous

� eHealth contributes to:

� Health benefits (quality and gained lifetime)

� Social well being (longer in their own living environment, contact with peer

groups)

� Efficiency of care and of processes (productivity)

� Reducing labour issues

� eHealth promotes :

� Empowerment of clients (they take their own responsibility)

� Opportunities for providers to meet customer needs

Increases efficiency

Increases

self-reliance

Supports early

warning Can be

anonymous

Health benefits (quality and gained

lifetime)

Increases the

accessibility

Contributes to the

quality of careIs 24/7 available

Is economically

interesting

eHealth is about substitution of care provisioning, not about more healthcare

eHealth from a patient perspective

Realisation of the paradigm shift by eHealth


The Healthcare Provider - Patient Relationship shifts Fundamentally ....…

Maturity/time

Healthcare

delivery costs

and efforts

Provider

Driven

Patient

Awareness

Patient

Engagement

Patient Centric

Care

Patient – Value

determines

choices

Developing Emerging Near Maturity

Efficiency, patient

satisfaction, and

quality are key

indicators for

success

Care Providers

embrace Patient-

Value and

stimulate Patient

Centric Care

Patients are

involved in

healthcare services

development and

take responsibility

for sustainable

solutions

Innovative

Patient

manages

Personal

Health

…towards a service orientated model, developed for the patient, influenced by the patient and in

which the patient is actively engaged


Adoption of digital technologies has become mainstream and the pace is drastically

increasing …

� 5 billion mobile phone subscribers in 2010

� Mobile Internet access globally outperforming

desktop access in 2014(3)

� Mobile already being the main device to access

the Internet in developing countries

� People reading 10MB and hearing 400MB

worth of material a day(4)

� User-generated content exceeding the amount

contributed by professional organizations(5)

� 2 billion people connected to the Internet

� Broadband penetration is exceeding 85% from

2012 in developed countries(1)

� Access shifting from the wide-open web to

semi-closed platforms: apps, social media…(2)

Sources: (1) In-stat, June 10, 2008(2) The Web Is Dead. Long Live the Internet, Wired, 2010(3) Morgan Stanley, 2010(4) The Economist, November, 2006(5) Data Center of China Internet, 2010

CONNECTIVITY

MOBILITY

DATA ABUNDANCE

Accelerated pace of

adoption

Plane 68 y.

Phone 50 y.

Radio 38 y.

TV 22 y.

PC 14 y.

Internet 7 y.

iPod 3 y.

Facebook 2 y.

Time needed for “mass adoption”

(50 million users)


… which leads to customers becoming more involved in the organization and getting

more influence on clientservices

17

Inspiration Orientation Demand Service

Customer involvement

Increased business influence

Business scopeDomain of “customers”

‘Once upon a time’ In the digital world

Inspiration Orientation Demand Service


Interaction with the healthcare professional: the Digital Outpatient Clinic


Patient Empowerment

• Personal health record

• Doctor visit sheet (summary)

• Self-diagnosis/triage based on decision trees

• Provide comparative Health information

• Prevention and lifestyle

• Mutual contact (Forum)

• Monitoring (engage your own care team)

• Information on research programs


Personal Health Information is not safety-critical

� The information is owned and managed by the patient and

can be made available for use in a professional healthcare

setting

� Healthcare professionals have strict guidelines in the usage

of patient-originated data

� A conscious process of incorporation of personal health

information in the formal safety-critical systems and medical

decision support is the responsibility of all professional

healthcare provider organisations

HealthVault Personal Health Record (PHR) platform

An EHR supports the medical doctor, the PHR empowers the citizen

HealthVault

Personal health data from the citizen and

their health care providers

Personal wellness data from the

citizens and their wellness providers

Privately stored public information on

health, care and wellness

PreventionConvenience

Services

Social Networks

Entertainment Pleasure Services

Patient Empowerment

Self management


Bloodsugar monitor

Lifestyle Disease management

Professional Care

Personal Health

Blood pressure

monitor

ECG monitor

Fitness monitor

Heartrate monitor

Green is a deviceRed is a tool

Weight scales

Step counter

Personal record

Donor register

Electronic

prescriptions

Information sharing

Healthcare spending

Epilepsy diary

Medical record

Education and screening

Creating a Healthcare Information Ecosystem

eHealth business models

What is the value proposition?


Patient

Healthcare Provider

Payer(Insurance)

eHealth is patient centered, but the patients don’t pay us ….


From eHealth proposition to a sustainable business model

(Financiële) PrestatiesBron: Vrij naar Alexander Osterwalder, Business Model Generation

Resources

Value Configuration

PROFIT

Distribution Channels

CostStructure

RevenueStreams

CustomerOffer

Financial Performance

CustomerRelationship

Value Proposition

CustomerSegment

CoreCapabilities

PartnerNetwork

Co-creation

With a business model an organization describes, what value they create for their clients, how these services reach and support their customers, which resources should be used, with which third party

should be partnered and finally, how they will make money

Acceleration of eHealth implementations


Introduction of eHealth is going (too) slow

� Health insurers (the payers) have so far ehealth approached competitively and achieved

some successes

� But the Health insurers encounter barriers to further upscaling:

– Termination of a project when the grant money runs out

– The lack of a clear business case

– Uncertainty about the effectiveness and efficiency of eHealth applications

– Insufficient standardization and interoperability of eHealth applications

– Lack of funding and a structural wide purchasing

Embedding eHealth in organizational processes and changing the daily practice of healthcare professionals appear to be the most important critical success factors


Two dimensions spell out four different types of digital maturity

Transformation Management Intensity

Dig

ita

l In

ten

sity

BEGINNERS

• Beginners do very little with advanced digital capabilities,

although they may be mature with more traditional

applications such as ERP or electronic commerce. Although

companies may be Beginners by choice, more often than not

they are in this quadrant by accident.FASHIONISTAS

• Fashionista have implemented or experimented with many

sexy digital applications. Some of these initiatives may create

value, but many do not. While they may look good together,

they are not implemented with the vision of gaining synergies

among the items.CONSERVATIVES

• Conservatives favor prudence over innovation. They

understand the need for a strong unifying vision as well as for

governance and corporate culture to ensure investments are

managed well. However, they are typically skeptical of the

value of new digital trends, sometimes to their detriment.

DIGIRATI

• Digirati truly understand how to drive value with digital

transformation. They combine a transformative vision, careful

governance and engagement, with sufficient investment in

new opportunities.


Digital Leaders show common patterns: the Digital DNA

Focus

Investments on

where they

choose to Excel

Digitally

Combine Digital

Capabilities to

Exploit Synergies

Use Digital

Technologies to

Transform their

Business Models

Invest 100% in

transformation

management

Digital

Leaders


Our two-year research program with MIT provides some useful pointers for successfully

executing a digital transformation

Conducting a digital (eHealth) transformation requires taking action in four key areas:

framing, investing, engaging, and sustaining.

Frame

Frame the Digital Challenge

• Understand the impact

• Assess Digital Maturity

• Develop & Align around a

Vision

Focus

Focus Investments

• Invest in Digitally-Enabled

Initiatives

• Adapt your Business Model

Sustain

Sustain the Transformation

• Build Capabilities

• Measure & Monitor

Engage

Engage the Organization

• Signal and Mobilize

• Govern across silos

• Evolve Culture/ adapt Work

Practices


We discovered that many common perceptions about digital transformation were

actually myths, which can lead executives to make unfortunate and costly decisions

Digital is primarily about the customer

experience

Digital primarily matters only to

technology or B2C companies

Let 1000 flowers bloom; bottom-up

activity is the right way to change

If we do enough digital initiatives, we will

get there

Digital transformation will happen despite

our IT

Digital transformation approach is

different for every industry and company

In our industry we can wait and see how

digital develops

Huge opportunities exist also in efficiency,

productivity & employee leverage

Opportunities exist in all industries with

no exceptions

Digital transformation must be led form

the top

The how of transformation is more

important for driving overall performance

Business/IT relationships are key, and in

many companies they must be improved

Digital Leaders exhibit a common DNA

There are digital leaders outperforming

their peers in every industry today

Myth Reality“Many common

perceptions about digital

transformation are

actually myths

Fortunately, our global

survey of nearly 400 large

firms, supplemented by

157 in-depth interviews

with senior executives in

more than 50 large

companies, provides fact-

based answers”


Critical Success Factors for eHealth up scaling

� eHealth is an issue for board members:

It is about organizational strategy, not IT.

� The perception of the professionals:

eHealth should be given a place in the “hearts” and “minds” of healthcare professionals

� Funding:

From projectfunding, subsidies to structurally embedded in the healthcare funding system

� Business as Usual:

Application of eHealth should be part of the (development of) regular daily care

� Future proof:

“Is Cloud technology a Game Change? Business says Yes; IT says No!” (Andy Mulholland, Capgemini CTO)

The acceptance of digital services in the private sector in most EU countries makes it likely that many other basic conditions for up scaling of eHealth are properly fulfilled

Health & Medicine

20131125 e health_introductie