Ehealth Implementation

7/31/2019 Ehealth Implementation

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Accelerating

innovation: thepower of the

crowdGlobal lessons in eHealth

implementation

kpmg.com

KPMG INTERNATIONAL
http://www.kpmg.com/http://www.kpmg.com/


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About the research

This research is based on in-depth interviews and discussions with 39 healthleaders rom across 15 countries and three dierent regions Europe, ASPAC

and the Americas. The individuals interviewed or this report are those withnational and international reputations in the eld o health management, healthpolicy and eHealth across the world. Insights rom these interviews wereaugmented with existing published literature rom leading academics andpractical examples o eHealth around the world.

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2012 KPMG International Cooperative (KPMG International), a Swiss entity. Member rms o the KPMG network o i ndependent rms are aliated with KPMG International. KPMG International provides no client services. All rights reserved.

A word on our approach. eHealth covers an increasingly wide range o activitiesand approaches. It is commonly understood as encompassing electronichealth records, personalized or remotely delivered healthcare (includingdiagnostics, monitoring, advice, appointments and prescribing), mobile healthdevices, virtual teamwork, and electronically enabled disease and knowledgemanagement. We have used eHealth as a broad term to include all the

inormation and communication technologies, tools and services or health. Itincludes health inormation networks, electronic transmission o data, healthportals, telemedicine services and patient owned devices supporting selmanagement and disease prevention.


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Executive

summary

Mark BritnellChairman, Global Health PracticeKPMG in the UK

Jan de BoerGlobal Health IT leaderKPMG in the Netherlands

The case or eHealth has never been more compelling yet its perormance globallyhas never been more mixed. Our research, which covers many executives workingacross many dierent countries, points to successul examples o both theconceptualization and execution o value adding eHealth initiatives.

For too long, eHealth strategies have ocused on pushing people to accept, oten asan article o aith, promised high level benets which do not ully materialize. We mightrather, take inspiration rom successul pull movements which attract and harnessthe power o the crowd. The explosion o social networking is perhaps the greatestexample o how individuals are pulled together to rejoice in the power o the crowd.Todays crowd are tomorrows patients. Increasingly thereore, tech-savvy cliniciansneed to be seen not as a block to be won over but as a catalyst to be nurtured andsupported. This approach will deliver sustainable success and avoid costly ailures.

Beore we address the health industry specically, let us, or just a moment,pause and think about e-trends in our wider society because they oer valuableinsights or the possibilities in healthcare. While, as consumers, we may struggleto comprehend the gigabyte and terrabyte, we now have to be prepared or newbinary prexes peta, exa and zetta which respectively denote 1 million, 1 billionand 1 trillion gigabytes. The amount o digital data is exploding, up by 30 percent injust one year with an estimated 1.8 zettabytes in use in 2011. Technically there is nolimit in the amount o data that we can store in dierent systems and in the cloud.At the moment the T in Inormation Technology (IT) is pretty much solved. Thereal challenge or the uture o healthcare is how do we get a grip on the I. In otherwords, how do we extract reliable inormation out o all the data that will be available?

In 2012, we can expect the possible initial public oering (IPO) o Facebook with

its 800 million users while Twitter will host 500 million tweets per day. Thisawesome orce and the power o the crowd can be used to push eHealth into newareas o support and care. eHealth will no longer be seen as an IT solution in thesame way the Internet is no longer seen as an IT solution. eHealth will becomemainstream, part o our daily lives and ultimately synonymous with health.

Few would argue over the power technology will have to help solve the manychallenges now acing healthcare. Yet, around the world, there has been a largelyinconsistent approach to eHealth. Many jurisdictions are either developing orimplementing large scale change programs, the likes o which have not been seenin healthcare or the last hundred years.

While some projects have ultimately been successul, more oten they have

lost momentum ater the pilot phase, collapsed under their own complexity, orbecome irredeemable thanks to spiraling implementation costs. Recently both theNetherlands and the UK have scaled back their eHealth initiatives, refecting thesignicant challenges aced by some o the larger, government-led programs.

2 | Accelerating innovation: the power of the crowd



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Based on KPMGs global experienceand interviews with 39 eHealth leaders,planners, experts and implementersaround the world, we have developedthree concepts that in our experience can help eHealth participants todevelop and implement a holistic andintegrated approach.

This change can be acilitated with

three basic concepts:1. Crowd accelerated innovation

suggests that eHealth becomesmore sustainable based on thesize o the program and breadth ostakeholder adoption. Participantswill need to share a clear vision, striveor ull transparency in processesand objectives, and use the powero the crowd o bringing doctorsand patients together to create aneconomy o scale to cut costs and

bolster innovation.

2. Collaborative alignment recognizesthe importance each player has in thehealthcare continuum and places ahigh value on their active participationin the development and operation othe system. Aligning the interests andeorts o stakeholders is key to thesuccess o eHealth, and to enablingits lasting presence in healthcareorganizations.

3. Creative dislocation, thanks toeHealths transormative nature,is essential. The introduction onew methods will make manylegacy processes and approachesredundant. Stakeholders must beprepared to change the way theywork, rather than just seeing eHealthas an add-on. This is one the bestway to integrate eHealth into theabric o the healthcare environment.

How will eHealth programs move

beyond the pilot stage throughimplementation to a state osustainability? The truth is that there

is no single global path to eHealthtransormation. Each jurisdiction willneed to ace the specic challenges andcomplexities in their own markets tond a unique path to success.

A good example o these conceptscan be ound in the Hong Kong HealthAuthority. In this tech-savvy ChineseSpecial Administrative Region (SAR)

clinicians, acilitated by executives,have developed a high value, relativelylow cost eHealth tool which providespersonalized, preventative andpurposeul care or patients. The system,known as HARRPE (hospital admissionand risk reduction programme or theelderly) provides algorithm based dataextraction o 44 key sentinel social andmedical markers to analyze everynight patients that might be vulnerableto re-admission. Nurse-led outboundand inbound care, advice and support

reduced re-admissions by 25 percent.More remarkably, this system, which isgradually being extended across all7 million citizens in Hong Kong, takesan average o two, twelve minute callsrom a nurse practitioner: 24 minutes toreduce admissions by 25 percent!

This successul example also reinorcesthe three key basic requirements thatwere repeated time and time again byour respondents. While separately theserequirements are patently obvious, it isstill surprising to see that they are notalways managed together.

1. Create a strategic plan that providesclarity, vision and a consistentapproach to eHealth. Without ashared vision and consistent policyon eHealth, governments and systemmanagers will nd it increasinglydicult to achieve value or theirinvestment or better clinical outcomesor patients. This doesnt necessarily

mean mandating a system-wideapproach, but it does require everyoneto be heading in the same direction.

2. Focus on core elements that drivethe greatest benets or the largestnumber o people. eHealth initiativesare massive projects and simply cantbe done in one step. Some o themore successul systems are the onesthat start by ocusing on the mostcommon elements o the healthcareprocess (such as discharge letters,diagnostic tests and prescription

records) and then incrementally addcomponents once the core systemhas been developed and adopted.

3. Healthcare professionals and

patients in the lead. The level ochange around processes, eHealth andempowered patients can be dauntingto healthcare proessionals. But byensuring that clinical sta own anddrive eHealth program development,and then demonstrating the programsbenet through evidence based clinical

outcomes, health system managersare able to drive adoption and becomesignicant evangelists.

But across this spectrum o successesand ailures, there are a number okey lessons to be learned by eHealthpioneers which will help renestrategies throughout the industry andnarrow the ocus o eHealth programs.

Indeed, or eHealth to deliver onits promises it must not only be

implemented it must also besustained. This means evolvingeHealth rom a lab-bench innovationin healthcare into a ull scale andsustainable model that ultimatelyleverages the power o the crowd andtransorms the whole industry.

We would like to thank our healthcareclients, Manchester Business School(MBS) and all those who participatedin this work and hope that thereport makes a contribution to thedevelopment o eHealth.

Accelerating innovation: the power of the crowd | 3



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The case or

eHealthThere is little doubt among healthcare proessionals, governments

and system managers that eHealth has the potential to redenethe healthcare industry. Indeed, the combination o mobile

devices, cloud computing and networking capability presents a

great opportunity to promote eHealth.

The potential benets o eHealth are not disputed. Freed rom the burden opaper les, advocates envision a world where patients are empowered withaccess to their own records where healthcare acilities are interconnected,sharing everything rom patient records and diagnostic images to operating roombookings and accounting platorms.

The resulting system would not only be patient-centric in its approach. It wouldalso deliver a cost-eective way o building the capacity o health systems, bothin the developed and developing worlds. In some cases, this metamorphosiscould not come too soon.

Source: Accelerating Innovation KPMG International/Manchester Business School, 2011

Medical tourism

Absence of legacy systems

Global initiatives

Shortage of staff

Safety & quality

Availability of technology

Government mandate

Increase in demand

Demographics

Increase in efficiency

Patient expectation

Key drivers for eHealth

0

10

20

30

40

50

60

70

61%58%

37%34%

29%

18%

8%

26%29% 29%

5%




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Facing an era o greater nancial austerity and rising healthcare costs, manygovernments and health systems are now taking a closer look at eHealth as asustainable way to deliver cost savings, better patient outcomes and greateraccessibility o healthcare or all.

There is certainly anecdotal evidence that patients are ready or eHealthsbenets. Beyond the ultra-tech-savvy early adopters, many baby boomers are alsotechnologically adept and, as they retire and come into greater contact with thehealth and social care systems, they are increasingly taking a greater role in theirown healthcare decisions. These consumers already bank and book holidays online,and are starting to ask why they cant book a doctors appointments and reviewhealth inormation in the same way.

Already we are seeing patients take greater control o their medical inormation anddata. PatientsLikeMe.com, a patient-driven health site that leverages social mediaapproaches to connect patients suering rom similar conditions, already has morethan 120,000 members. But with greater patient empowerment in controllingtheir data will come additional responsibilities. Patients will need to support theaccessibility o their data and permit the transer o their personal health inormationthroughout the patient pathway i they are to enjoy the ull benets o eHealth.

Technology

Lack of clinical involvement

Concerns about safety

Lack of evidence base

Incentive structures

Lack of political involvement

Lack of patient buy in

Legislation

Lack of transparency

Poor change management

Professional attitudes

Money

Barriers to eHealth

0

10

20

30

40

34%

13%13% 13%

16%

11%

21%

13%

18%

8%

5%

29%




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There are a number o common bottlenecks to eHealth (see chart below) and romthe outset eHealth promoters and advocates will need to manage expectations,since long, complex change programs tend to lose momentum as time passes.Moreover, some eHealth objectives particularly a signicant improvement inpatient health may take years to achieve, making it all the more important thatunders, patients and healthcare proessionals share the same long-term vision.

And while demand rom healthcare proessionals may build slowly, the proessionis recognizing the potential clinical benets o having the whole patient record attheir ngertips. As a new generation o medical proessionals gains seniority inhealthcare practices, demand and acceptance will sharply increase.

Around the world, we have seen plenty o pilot programs, but oten there is a lacko clear vision on how to properly adopt eHealth in the clinical setting; an issue thaturgently needs addressing. Indeed, in our experience, healthcare proessionalsstart to become voracious users o eHealth systems as they begin to see theclinical and eciency benets that a well-designed system can deliver.

Common bottlenecks to eHealth

Lack o supportivelegislation and

regulation

Inconsistentstandardization and

interoperability

Cultural dierencesbetween

stakeholders

Lack o largescale medical

evidence

Insucient undingand nancemechanisms

Concerns overrisk and security

issues





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Three concepts or

sustainableeHealthImplementing eHealth programs and sustaining them are

very dierent ventures. Sustaining eHealth requires programs

to move beyond the pilot stage in such a way that promised

benets are consistently and universally delivered.

To become sustainable indeed, to become the new standard o healthcaredelivery radical change will be required in every aspect o the healthcaresystem.

eHealth must move rom being simply an innovation in healthcare through asustainable change process to ultimately transorm healthcare delivery. Thesimple truth is that, until eHealth becomes the status quo rather than the outlier,governments and unders will not see the ull value o the transormation.

Through this research and our extensive experience in the eld, we havedeveloped three concepts that, when used as lenses through which to viewplanning, may well help achieve sustainability.




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Crowd accelerated

innovationFor eHealth programs to become sustainable, they must reach

critical mass.



In part, this is because small initiatives will never achieve the benets that scalebrings to a project o this magnitude; also, the real value o eHealth is only unlockedonce the program permeates the system and patient population.

One o the most successul examples o this concept is the Human Genome Project. Byleveraging the power o thousands o researchers, all working towards a common goalwith a transparent approach, the project overcame massive challenges and has changedthe way we understand our species.

Crowd accelerated innovation relies on three basic principles to succeed.

The rst is that a clear goal must be identied and shared by participants; theremust be a desire or the benets o eHealth. All too oten, governments, hospitalsand health systems take a tempered approach to eHealth that cuts the program intosingle, short-term projects or ocuses on a single disease category. Sustainabilityrequires health leaders to be clear and committed to a larger change.


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Secondly, or crowd accelerated innovation to work, the program must be ullytransparent. Health leaders and governments must consistently and transparentlycommunicate the benets, progress, results, security, costs, and ultimate goals oeHealth across all stakeholder groups.

The nal principle or crowd accelerated innovation is the need or critical mass.eHealth planners must strive to expand the audience or eHealth as much aspossible to enhance adoption and gain value rom the system. While some pundits,

particularly in Europe and the Americas, continue to argue that eHealth is notscalable to entire national populations, other countries such as Singapore and Chinaclearly disagree. In particular, Chinas progress towards a national eHealth systemshould demonstrate that crowd accelerated innovation is not only possible, butcritical to achieving sustainability.

Kaiser Permanente and the Care Connectivity Consortium (CCC)Building critical mass to drive sustainable change

In April 2011, ve o the USs largest health systemscame together to announce a plan to securely sharepatient-specic data through a collaboration called theCare Connectivity Consortium. The companies KaiserPermanente, the Mayo Clinic, Geisinger, IntermountainHealthcare and Group Health share a mission to deliverpatient-centred, high-value health care to US citizens,and believe that achieving electronic health inormationinteroperability and connectivity will be critical to achievingthat mission.

The goal o the consortium is clear and is to provide better

and saer care through greater data availability, noted JamieFerguson, Vice President o Health IT Strategy and Policy atKaiser Permanente. Not only are we committed to sharingpatient records in a secure and transparent way within ourconsortium, but we are also ensuring that any standards wedevelop are open source and the inrastructure is available toall healthcare providers in the US.

Individually, each o the ve member organizations have beenelectronic health record pioneers in their own right and haveseen rst-hand the benets o greater access to patient data

on the care provided within the system. As a group, they havea clear goal to extend the same benets that exist in eacho the systems individually to all patients by connecting allcommunities and eventually the nation in order to improvehealth care or Americans.

And while the consortium is currently ocused on gainingcritical mass within the private healthcare system, they havenot lost sight o the need to build a ully interoperable andtransparent system.

All o the partners in this collaboration understand, agreeand believe that using standardized computable inormationor systematic integration o care delivery really improveshealth, noted Mr. Ferguson. And by ollowing the nationalcontent and exchange standards set out by the government,we know it will be scalable and interoperable withgovernment systems in the long-term.

By setting a clear goal, emphasizing transparency betweenparticipants and the healthcare system, and building criticalmass, the CCC is successully driving crowd acceleratedinnovation through the US health system.




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Collaborative

alignmentSustaining the eHealth transormation requires everyone in the

health system to work together to achieve results.



eHealth cannot ocus on physicians alone, but must involve the active participationo patients, medical IT rms, insurance providers, governments and healthcareproviders as well. This idea brings together long-held concepts in participatorymedicine and integrated healthcare to move the healthcare delivery paradigm

rom one where the system is the arbiter o care to one that revolves aroundpatient-centric personal healthcare.

Collaborative alignment has been crucial to sustainability in many other industries,such as the automotive industry, where suppliers and manuacturers align theiroperations and interests to produce better cars, but has yet to be widely adopted inthe health sector.


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For the health sector to embrace collaborative alignment, it must rst considerthe context rom which each stakeholder approaches the program. The driversor patients will dier greatly rom those o insurance companies or governments;each will aect the way they participate in the project.

There must also be alignment in the level o maturity o each party, as more evolvedgroups tend to take a broader view o collaborative participation.

eHealth planners will also need to understand that sustainable and successuleHealth programs and participatory medicine tend to shit the power to the patient.Few stakeholders in the system are participating or purely altruistic motives, andeach has a sel-interest to gain rom their participation. For patients and physicians,there is also the mutual benet o better clinical outcomes. For insurance providersand governments, it also involves cost savings.

Denmark: Sundhed.dkWorking across the patient pathway to drive success

Denmark currently enjoys one o the best eHealth

systems in the world. Launched in 2003, Sundhed.dk isa public web-based portal that collects and distributeskey healthcare inormation to citizens and healthcareproessionals, and empowers patients to access thehealthcare system more eectively. Developed as a jointregional and national eort, the portal was developed ona modest budget, but has delivered massive returns.

The system started to get its basics in place back in the1990s, said Claus Pedersen at OUH Odense Hospital.It started with an understanding that there are somebasic common denominators that are the oundations oany eHealth system such as reerral letters, discharge

letters, prescriptions and lab results.

By ocusing on these commonalities, the system wasable to standardize large volumes o daily transactions.This created a critical mass in avor o the electronicmanagement o key transactions and processes. Thestrategy was uniquely bottom up in nature: the 1990ssaw the emergence o a large number o small projects,which merged into a network o integrated projects.From there, and with government support, a nationalbody was ormed in 1999 as a co-operative venture

between government, local authorities, public and private

organizations ocused on eHealth.

Todays system brings together a user-riendly interacethat adapts its presentation to suit its users needs. Asa result, patients now enjoy a very dierent experiencewhen interacting with their healthcare system. EveryDanish citizen has their own personal web page, can viewtreatment/diagnoses rom their own hospital record,book appointments with general practitioners, sendsecure emails to health authorities, order medication rompharmacies, monitor sel-compliance with medication,and get access to local disease management systems.

The program has already resulted in signicant nancialsavings and enabled the government to merge15 counties into ve distinct regions without anyinterruption to health services.

According to our interviewees, much o the success is dueto a clear and strategic vision delivered by Danish healthauthorities, combined with strong management and theengagement o stakeholders. Denmarks experienceshows that it is possible to work across sectors andspecialist elds by leveraging collaborative alignment.




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Creative

dislocationThere is one certainty o eHealth: things are going to change.

eHealth planners must recognize that change is inevitable andbe willing to engage in creative dislocation to eliminate outdated

concepts and tools.



To help achieve real and lasting change, eHealth planners need to be bold and lead

the transormation o business and economic models to allow the adoption o newtechnology and innovations. Healthcare lags behind other industries, where structures,systems and incentives have made it ar easier to embrace creative dislocation.Consider, or example, changes in the music industry over the past ew decades: just20 years ago, consumers purchased music on either vinyl records or cassette tapes,allowing music producers to bundle dozens o songs together to increase the value otheir products. Today, however, digital technology has enabled consumers to purchaseindividual songs online, thereby changing the undamental business model o theindustry and orcing producers to explore new revenue streams.

O course, creative dislocation is ineasible unless the replacement systems areaordable and have critical mass in the marketplace. This will require investmentand innovation to reduce prices, and a certain level o standardization to enable


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new technologies to be successully integrated. At the core, this requireshealthcare operators to have the courage to identiy and eliminate processes andtechnologies that are no longer relevant to the system, rather than nding waysto append eHealth components to existing systems. Once again, respondentssuggest that eHealth planners ocus on developing the systems and processesthat underpin the program. The technology should come last, said Dr. SeherKorkmaz with the Stockholm County Council in Sweden. eHealth strategiesshouldnt be driven by technocrats; rather, it is health strategy that should be at

the heart o eHealth implementations.

Technology clearly represents one o the biggest and most expensive challengesin developing an eHealth system. But, as Dr. Seher Korkmaz points out, We haveall made the same mistakes in every country. We have tended to make things toocomplicated. The simpler the technical solution, the better.

UK Department of Health:Whole System Demonstrator (WSD) programChanging the model o care to enhance patient outcomes

Having undertaken a series o clinical trials, small pilotsand meta-data reviews, the UKs Department o Health(DoH) recognized that while the case or telehealth wasstrengthening the evidence lacked scale, statisticalsignicance and robust cost-savings data. As a result, theDoH launched the Whole System Demonstrator (WSD)program in May 2008. Preliminary ndings rom this, thelargest randomized control trial o its kind in the world,prove how eHealth delivers on its promise to be trulytransormational.

WSD sought to build the evidence or a new way oproviding patient care through integrated health and

social care provision, supported by advanced assistivetechnologies such as telehealth and telecare. It involvedmore than 6,000 participants across three locations.

The program selected ve main themes upon which toevaluate the system:

theimpactuponserviceutilizationandcostsacross

health and social care

theimpactuponthelivesofparticipantsandcarers

thecostandcost-effectivenessoftheservice

theviewsandexperiencesofusers,carersand

proessionals involved in the program

theimpactofchange,collaborativeworkingandlarge-scale programs on the organization and individual.

What we have seen in preliminary results is thattelehealth and telecare when applied to chronic diseaseareas such as diabetes, COPD and heart conditions canprovide a valuable alternative to the current model opatient care in the UK, noted Andrew Hine, a Partnerwith KPMG in the UK. And by treating patients outsideo the emergency or ambulatory wards, the program haseectively changed the model o care that is provided tosome o the most requent users o health services.

The project represents a strong example o all threeeHealth concepts: collaborative alignment (bringingtogether multiple stakeholders across the health care

continuum), crowd accelerated innovation (buildingthe mass required to generate change), and creativedislocation (changing the way chronic disease suerersinteract with the system).

The WSD Headline Findings December 2011 releasedby the Department o Health reveals the signicantbenets o telehealth: I used correctly telehealth candeliver a 15 percent reduction in A&E visits, a 20 percentreduction in emergency admissions, a 14 percentreduction in elective admissions, a 14 percent reduction inbed days and an 8 percent reduction in tari costs. More

strikingly they also demonstrate a 45 percent reduction inmortality rates.




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AcceleratingeHealth implementation:

get the

basics rightCreate a

strategic planeHealth systems do not develop in isolation. Rather, they demand

a long-term perspective and strategic approach; planners must

ensure that the right environment has been created to support the

transormation.

While our respondents all identied the basics (a strategic plan, ocus on core

elements, and the need to win over heath proessionals) it was surprising to seethat ew projects attended to all o these critical issues in a systematic way,said Mark Britnell, KPMG in the UK.

Adequate and sustained funding is critical

One o the primary considerations or strategic planners is unding. Participantsin our survey were clear that any eHealth system would depend on adequatelong-term unding to achieve its long-term goals. In part, this is because eHealthcarries high upront implementation costs or technology and systems. An industryso young lacks a variety o service providers and platorm developers, which areessential to building a large market a real catch-22.




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When money is lacking or tight, what can happen is that the overall scopeo a project can be sacriced in order to balance budgets, notes RogerGirard, CIO at Manitoba Health. But reducing expected unctionality

is the best way to start the spiral o disengagement with end-users.

A number o interviewees asserted that their countries hadsignicantly under invested in eHealth. Some blamed the lack ounding on the cyclical nature o government budgeting; otherssaw a need or clear metrics-based Return on Investment (ROI)models. It is clear that both eHealth leaders and the IT industryare actively seeking innovative unding alternatives such ascontracting to deliver more secure sources o investment(see sidebar).

Creating a sound governance and policy framework

Building the right environment to support an eHealthstructure also requires active participation rom policymakers. I am convinced that eHealth cannot bedeveloped at the national level i there is no politicalstrategy, and no change in health care organization,commented Dominique Acker, Gnral Inspector oSocial Aairs, with the French Ministry o Health.

A social impact bond (or pay for success bond)is a vehicle to encourage private investment

in social outcomes. Under a social impact bondmodel, a government contracts with a private sector

bond issuer intermediary organization to obtainsocial services. The bond issuer is paid based on the

achievement o certain targets (whether cost savingsor clinical outcomes) that are specied in the contract.

Oten, bond issuers obtain additional unds by raisingcapital through private investors who pay up-ront in

exchange or a share o the uture government payments.While the approach has yet to be ully tested in the

healthcare arena, the UKs Ministry o Justice is currentlytrying the approach in the prison system, with success

measured by changes in re-oending rates.

According to Andrew Donald, Chie Operating Ocer orBirmingham East and North NHS in the UK, To bridge the

gap between where we are now and where we need to be,we should investigate the use o social impact bonds to und

investment in eHealth.

Developing a strategic approach for eHealth

Developing a strategic approach

Establishing evidence base

Moving away from pilots

Ensuring data protection/security

Ensure funding/contingencies

Collaboration

0

10

20

30

40

50

16%

24%

45%

29% 29%

21%





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United Kingdom: National Programme for IT inthe National Health Service (NPFIT)Developing a common inrastructure to support collaboration

Launched in 2002, the NPFIT was a large-scale, ambitiousproject aimed at establishing comprehensive national

Electronic Health Records (EHR) or everyone in the UK. Withan estimated cost o more than 12.4 billion over ten years,it was planned to be the worlds largest IT project, covering330 acute hospitals and mental health trusts across England.

The service was centralized around its Data Spine,which integrated patient registers, electronic prescriptionservices, summary care records and a patient-acing portalor communicating with health proessionals and updatingmedical details called Health Space. The spine was alsoexpected to support radiology picture archiving, electronicprescription transer and NHS email.

As a result o NPFIT, the National Health Service (NHS)expected to deliver better, saer and more ecient care byimproving clinical decision making, reducing medicationerrors, speeding up the consultation process and reducing testduplication. By providing patients with easy access to boththeir personal health records and their medical proessionals,the system also aimed to increase patient satisaction.

However, the implementation o summary care recordsand Health Space was signicantly delayed and eventuallyscaled back in mid-2011. Many issues, including

insucient clinical engagement, gaps in stakeholderexpectations, and problems with technology, held the

program back. Doing things electronically takes timeinitially ... and adopting technology is hard, noted SimonEccles, Medical Director at NPFIT. Things will go wrongso the technology has to be fexible.

The NPFIT experience provides a number o key lessonsto those starting out on an eHealth initiative. For one, itsimplementation required collaboration between many dierentsectors: political, clinical, academic, technical, commercialand personal. Dierences in values, norms, priorities andmethodology or each o these stakeholders were among themost challenging aspects o implementing NPFIT.

It is also important to create a avorable environment beorepurchasing IT systems and services. The UK system,or example, procured large commercial contracts romIT companies, beore creating important structures ininormation governance, clinical coding and standards andinormation system architecture. Respondents to our surveyalso argued that the strategy or national electronic healthrecords should not be let to the IT departments, since thisscale o transormation requires undamental changes toprotocols, ways o working and organizational cultures thatgo ar beyond systems implementation.




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Governments and regulators will need to consider the broader implications oeHealth. They must go beyond creating a supportive policy environment ortransormative change they must also deal with more technical considerations oissues like data ownership and the role o third parties. Participants in this researchalso stressed the benets o eHealth in addressing access disparities, suggestingthe universal nature o a system will open doors. The Chinese government isactively engaged in a program to drive universal access to eHealth, said EgidioZarrella, a Partner with KPMG in China. By raising the standard o care througheHealth, the government is, in one ell swoop, extending access to more than1.3 billion people.

eHealth also creates a number o complex challenges in medical ethics. In thisregard, medical authorities and physicians colleges will need to careully considerthe broader implications o eHealth on key medical principles such as inormedconsent, privacy and patient condentiality. Sound governance models and clearpolicy in this area will be critical to acilitating the new provider-patient relationshipunder eHealth, as will the important concepts o crowd accelerated innovation,collaborative alignment and creative dislocation.

Good governance is critical to the enablement o eHealth, but it is oten toughto get right and slow to evolve, notes Dr. Sarah Muttitt with MOH Holdings inSingapore. It is important to remember that good governance is not static andrequires constant attention, support and creativity to get right.

Most o all, political leaders and top administrators will need to articulate a strongvision or eHealth that engages all stakeholders and ormalizes the integration ocare as the predominant objective.

The importance o this cannot be overstated. eHealth initiatives ocused primarilyon cost-cutting or back-oce consolidation will never add up to a whole system.Instead, eHealth must be championed as a method or delivering a saer, moreresponsive and more ecient orm o healthcare; only then will it win thesupport and active engagement o stakeholders. Indeed, the top-down approacho mandating a certain sotware or program will likely not succeed in eHealth,

particularly given that healthcare proessionals need to be convinced they aremaking the right investment decisions or their patients.




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Barriers to telemedicine globally

%o

frespondents

Cost

Legal

Culture

Infrastructure

Policy

Priorities

NoDemand

Standards

Knowledge

Expertise

Other

100

90

80

70

60

50

40

30

20

10

0

Source: Barriers to telemedicine (Global Observatory or eHealth, 2011)



Collaborate across the system

Taking a strategic approach to eHealth requires planners to work throughoutthe healthcare industry to ensure that eHealth solutions meet the needs oproessionals throughout the care continuum.

To achieve the breakthrough levels o care that are possible with eHealth, you needsystematic integration, notes Jamie Ferguson with Kaiser Permanente. Schemeslike the Care Connectivity Consortium are going to be absolutely critical to achievethose types o benets or all patients. (See page 9 or more on the CCC.)


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In part, this is because much o the value o eHealth is driven by a strong networkeect where the sum value o a system grows each time a new node joins thenetwork that underpins the system. To be widely adopted, eHealth needs tohave input rom patients, doctors, and other medical proessionals, said JeroldHowell, a Partner with KPMG in the US. You are much more likely to meet therequirements o the users i you have their input early on in the process.

Yet eHealth also demands a more holistic view o the way the patient interacts

with the health system, rom their rst contact with a general practitioner orhospital admission, through to the completion o treatment (otherwise known asthe patient pathway). This is critical to ensuring that everyone rom primary careproviders to payers understands the role they play in the system. According tosome interview respondents, this alignment o stakeholder interests can also beused to identiy and develop innovative ideas to make the system more valuable.

Focus on clinical outcomes, then technology

Participants in our research were overwhelmingly clear that any eHealth strategy whether on an institutional, regional or national level must have improving clinicaloutcomes as its overarching goal. Clinicians need to point to clinical outcomes theywant to see, like shorter patient wait times or reduced obesity, and then you can line up

an eHealth strategy to respond to that, added Tim Beasley, an eHealth Consultant withKPMG in Canada. Then it comes down to the IT guys developing a technology solutionaround that priority.

Too oten, eHealth is positioned more as a technology to implement than what itactually is: a clinical transormation. And while technology will certainly be a keyenabler o any eHealth strategy, planners must be careul to make sure that anyIT decisions are careully aligned to a specic clinical objective.

KEY TAKEAWAYS

eHealthrequiresstableandsecurefundingtoachievesystem-widegoals.

Supportivepolicyandpoliticalvisionarecriticaltolong-termsuccess.

End-users,suchasdoctors,nursesandpatients,mustbeinvolvedearlyin

the process to achieve participatory medicine.

Programfocusshouldalwaysbebasedonclinicaloutcomes,with technology as an enabler.




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Focus on coreelements

eHealth programs are massive and highly complex to implement.Let unchecked, the scope o eHealth can easily overwhelm the

project and stall momentum. Many participants in our research

cited the need or strict ocus in a number o key areas to reduce

overall complexity and achieve measurable results.

Start with core systems and services

Many successul eHealth programs have purposely narrowed their scope,prioritizing one or two key elements common to patients. A number ojurisdictions, such as Singapore (see case study on page 23), have ocused theirattention on consolidating all patient records into one electronic health record thatis accessible throughout the healthcare system, thereby creating a very obviousand patient-centric tool around which to rally the wider program. To realize ouraspiration o patients being cared or in the most appropriate setting, and at thelowest cost, the sharing o records between the various care settings becomescrucial, said Wah Yeow Tan, a Partner with KPMG in Singapore. In many cases itis quality o care and eciency that is driving the need or these programs.




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Australia: National E-Health Transition AuthorityAccelerating eHealth through national inrastructure and leadership

In order to achieve a consistent national vision o eHealth,the Australian State and Territory governments establishedthe National E-Health Transition Authority (NEHTA) todevelop enhanced ways o electronically collecting andsecurely exchanging health inormation.

In part, the program was intended to create greater equitybetween the ederal governments and the individual statesand territories. But it was also expected to tackle some o

the challenges in treating chronic diseases such as diabetesand asthma. According to its ve strategic priorities,NEHTA aims to deliver, establish and enhance the essentialoundations o eHealth; coordinate the progress o keyeHealth initiatives; and accelerate national adoption o theprogram.

One o the more immediate benets o NEHTA hasbeen the ability to provide leadership and a nationalocus on implementing eHealth. The organization hasalso accelerated the development o national eHealthinrastructure and, as a result, has eectively shited thenational ocus rom using a range o dierent products

across the system to ull end-to-end interoperability basedon national standards, according to Stephen Moo, CIO othe Northern Territory.

NEHTA and its partners have learned several lessonsalong the way. Echoing the basic premise o collaborativealignment, the program ound that engaging with allstakeholders was critical to ensuring that technology isadopted and ully utilized. In the Northern Territory, or

example, a consumer registration team worked closelywith the community to encourage user adoption, and hasresulted in a 70 percent coverage o the target population.At the same time, clinician commitment was encouragedthrough dedicated clinical engagement teams who ocus onmaking sure proessionals understand the benets o thesystem in terms o enhancing their clinical practice.

Where will NEHTA take the program rom here? Accordingto John Zelcer, Head o Strategy or NEHTA, the programhas signicant capacity to drive improvements in thedelivery o saer, quality healthcare or many years.


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In Denmark, the eHealth program started by automating reerral letters, dischargeletters, prescriptions and lab results (see case study on page 11), which led to theintegration o other key programs in later phases. This strategy has eectivelyallowed organizations to ocus all o their resources on achieving a set goal, learningkey lessons that can be adapted into the next phase, and building adoption througha step-by-step program.

In both cases, authorities ocused their attention on creating eective change

within a small number o common elements that would have the largest impact onboth the program and the patient experience.

Target chronic diseases

Respondents indicated that eHealth could have the biggest impact on patientsthat suer rom chronic diseases such as asthma, diabetes and COPD (chronicobstructive pulmonary disease). These patients are high-requency users o healthservices and tend to require ongoing monitoring and treatment. Indeed, thissegment should be o particular importance to eHealth planners or a number oreasons.

For one, they are the audience that is most likely to see immediate benets rom

an eHealth system. By leveraging technology, chronic disease suerers can beempowered to sel-manage their condition, reducing the need or on-site testing,and eliminating unnecessary hospital visits. eHealth really enables out-o-hospitalcare such as homecare and community care, added Tim Beasley. As a result,it could both reduce system costs and improve clinical outcomes or those withchronic diseases.




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This will not only improve the patients quality o lie, but also ree up valuablehealthcare acilities and proessionals to ocus on emerging cases. Accordingto Dorte Stigaard with the Region o North Denmark, I we can deal withchronic diseases in another way, with patient empowerment supported throughinormation and communication technologies, we can have a win-win all the wayround. For eHealth planners, this patient segment can also help to deliver strongevidence-based clinical results that demonstrate the programs value. Key metricssuch as number o hospital visits, disease progression and pharmaceuticalcompliance are all straightorward to measure and clearly relate to enhancedclinical outcomes.



Singapore: National EHR systemThe benefts o strong government support and accessible inrastructure

With one o the most advanced economies in the Asia Pacicregion, Singapore enjoys an established healthcare system,a robust national broadband inrastructure and an internet-

savvy culture. But with one o the astest-aging populationsin the world, more than a th o Singapores population isprojected to be over the age o 65 by 2030.

Singapore is a good example o where the pervasivenesso IT and connectivity has been a strong enabler orthe adoption o eHealth, noted Dr. Sarah Muttitt, withSingapores MOH Holdings.

For Singapore, eHealth is widely seen as a means o meetinguture healthcare challenges. The country has been makingsignicant progress: most individual healthcare operatorshave already implemented their own electronic medical

record system and, in April 2011, the government rolled outthe National Electronic Health Record system (NEHR).

The system is a signicant move toward achieving theOne Singaporean, One Health Record vision by enablingindividual EHR systems to interoperate. The NEHR acts as

a consolidator by extracting all clinically-relevant inormationrom the records o each encounter a patient has withthe healthcare system, orming an integrated healthcare

record centered on the individual. Data captured in theEHR system includes diagnoses, allergies, immunizations,current medication, investigations, procedures administered,reerrals and care plans.

Participants in our survey highlighted a number o keyenablers that have helped drive the system, including: aclear government push, patient demand, the desire or moretransparency between healthcare organizations and payers,and the desire or increased access.

Singaporean eHealth executives were quick to acknowledgethe catalyzing role o government and the pervasiveness o IT

as key ingredients to their success, as well as the importanceo strategic leadership, broad stakeholder engagement andbold innovation. But they also noted the need or appropriateand sucient unding mechanisms to encourage continuous,consistent and coordinated investment into the system.


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Put the basic technological infrastructure in place

The most obvious prerequisite or eHealth is a basic technical inrastructure,including crucial components like telecommunications networks, internet access,and high device penetration.

Respondents rom jurisdictions that enjoy advanced technology inrastructurereported ewer barriers to both eHealth implementation and adoption. For example,by implementing a national high-speed broadband network, eHealth authorities inChina are creating capacity to condently roll-out programs to both patients andproessionals over a very reliable system. China is working to virtualize the entirecountry, noted Egidio Zarrella, a Partner with KPMG in China. And by making sureevery member o the population is technology enabled, they are also driving themarket or eHealth.

From an enabling perspective, this oten means developing systems that housedata, compile records and control access to patient records. By developing ascalable platorm that can easily interoperate with a wide variety o systems,eHealth planners can build a level o fexibility into the system that enables theconsolidation o uture technology and programs. Dr. Siobhan OHalloran, Head oAcute Hospitals at the Health Service Executive (HSE) in the Republic o Ireland,

reminds us that, what we couldnt even dream o ten years ago is now possible.

Developing a core set o technology standards and processes will be crucial toaccelerating eHealth implementation. While on a regional or institutional levelindividual stakeholders must be encouraged to select the platorms and systemsthat best refect their unique clinical needs, it will be vitally important to providestandard guidelines to acilitate interoperability o systems. As Petra Wilson, asenior director at Cisco and Secretary-General o Continual Health Alliance inEurope notes, industry standardization is a big driver or adoption.

Byfocusingoncoreelements,eHealthmanagerscanscopetheireffortstoareas

that create the widest benets to the system as a whole.

ElectronicHealthRecords(EHR)areoftenthecatalysttowidespread

healthcare system transormation.

Thelargestimpactisoftenachievedinpatientsegmentsthatsufferfrom

chronic diseases.

WhiletechnologyinfrastructureisanecessaryenablerofeHealth,every

eort should be made to ensure it is simple, accessible and aordable.



KEY TAKEAWAYS


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Harness healthprofessionals

The implementation o a truly successul eHealth project requires

the support and engagement o a wide variety o stakeholders.While each has a role to play in driving the strategy, one group

has the potential to make or break the system entirely: healthcare

proessionals.

Involve clinicians in design

According to our respondents, involving end-users in the development o eHealthis critical to ensure the systems eventual adoption. Let the clinicians rule whatgoes into the system, not the researchers and technicians, advised Chris McLean,Senior VP and CFO o Methodist Health in the US.

Clinician-led design is important or a number o reasons. For one, it ensures thatthe program remains ocused on addressing clinical issues and outcomes. But italso allows planners to identiy both user-interace challenges and opportunities toenhance the system. I you design it poorly, you are going to alienate the nursingand clinical sta, added McLean.

By including clinical sta in the development process, eHealth planners can createa ready-made group o peer evangelists that can be harnessed to drive greaterclinical adoption. You need to get the opinion leaders in the healthcare networkinvolved in the project, notes Anssi Ylimaula, Chie Operating Ocer with Mawellin Finland. I you can convert them to like the solution, it is possible.




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However, it must be stressed that participation should include a wide cross-sectiono clinical sta, such as nurses, diagnostic technicians, specialists and pharmacists,in order to provide a holistic approach and ensure that strategies are mappedacross the patient pathway. It is critical to be constantly reinorcing the messageo collaboration and communication between all the stakeholders in the healthcontinuum, added Michael Beaty, a Partner with KPMG in the United States. Manyprogram leads have ound that, by ocusing their training eorts on rontline andnursing sta, they have accelerated the systems adoption while simultaneouslybuilding a critical mass o capacity within the clinical setting. Frontline sta have tosee the benet o the system, cautioned Simon Eccles, a consultant physician inEmergency Medicine and Medical Director or the National IT Programme in the UK.Frontline sta can be very quick to adopt technology i they see the benet.

Empower the patient

In the eHealth system, patients are ultimately the owners o their personal healthinormation and data. Rather than the traditional trust my doctor approach, thiswill result in patients taking a greater role in the management, treatment andmonitoring o their health inormation, which will ultimately redene thedoctor-patient relationship.

What is more, eHealth systems will need to clearly dene how patient inormationis accessed and shared across the healthcare spectrum, while maintaining theprivacy and security o the patient. In the US, we have rules that prohibit thegovernment rom creating a national patient identier system, noted JamieFerguson at Kaiser Permanente. And yet the ability to uniquely identiy individualpatients and providers is absolutely critical to health inormation sharing.




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United States: Veterans Health InformationSystems and Technology Architecture (VistA)Going open source to reduce cost and drive adoption

As one o the largest medical systems in the United States,the Veterans Health Administration (VHA) provides care to

over 4 million individuals. The organization is widely seen asan eHealth pioneer, having implemented automated clinicaland administration capabilities as ar back as 1985. Thesystem that evolved rom that innovative idea has becomethe Veterans Health Inormation Systems and TechnologyArchitecture (VistA).

As an enterprise-wide inormation system ocused onelectronic health records (EHR), VistA was built rom theground up, designed by clinicians with a primarily clinicalocus. Given the size and scope o the VHA (170 hospitals,800 community clinics and myriad other acilities), plannersquickly recognized that cost could become a major barrier.

In response, VistA was developed as an open source, publicdomain platorm that is available to download (ree o cost)rom the VHA website and highly adaptable to the needs othe local organizations.

VHA invested around US$3.6 billion to implement theprogram, but research shows that the organization hadalready yielded more than US$3 billion in savings ater

actoring in investment costs by 2007. This includedsavings resulting rom reduced workloads, reed-up

workspaces, the near-elimination o unnecessary lab testsand avoided hospital admissions.

The program has also improved patient saety. As a resulto VistA, the VHA has achieved pharmacy prescriptionaccuracy rates o 99.97 percent. The system also enablesauthorities to use the data to pinpoint problem areas such asmedication errors and track how closely proessionals areollowing evidence-based treatment standards.

For the VHA, the most challenging aspects oimplementation were organizational actors, changemanagement and the task o training the approximately

180,000 health proessionals it employs. The organizationalso ound that many o the commercial o-the-shelsystems were designed rom a nancial perspective anddid not adequately serve the clinically-driven needs o theorganization. Those involved in the program are also quickto note that setting up an EHR system is every bit as mucha clinical transormation as it is an IT implementation project.




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Focus on evidence-based outcomes

Real change is oten unsustainable without strong evidence to demonstrate itsvalue. While more than one-in-ve interview respondents stated that a lack orobust evidence is likely to threaten the widespread adoption o eHealth, a largernumber noted challenges in developing a consistent set o metrics to measure.But measurement and the communication o ndings are critical steps to drivingadoption by healthcare proessionals.

It is interesting that when a new medication with clear clinical benets passesrigorous research and testing, the entire health industry quickly adopts it, but whenit comes to eHealth, which has also passed rigorous testing and research, we donthave the same reactions, noted Iain Gravestock, a Partner with KPMG in the UK.

Do not underestimate the behavioral changes required

Even the best eHealth system will ail i the users do not have the right knowledgeand skills to use it eectively. Respondents were clear that proper skills trainingand education are key components to driving clinician adoption. For a lot o them,its scary, admits Lucien Engelen, eHealth Director with University Medical CentreRadboud Nijmegen in the Netherlands.

While many eHealth initiatives include technical training and manuals or thespecic platorm, ar ewer ocus on the behavioral changes that must accompanythe adoption o eHealth. These will be particularly important in engaging clinicianswho may be less tech-savvy and more resistant to changing their habits.

Some interview respondents suggest a need to redene the patient-physicianrelationship, to embrace the idea o an intelligent and inormed patient. Thiswill also require medical schools to revisit their training programs and rethinkmany o their approaches to education. As one respondent put it, Im not surethat the preparatory program will deliver the kind o proessionals that willbe needed in a system that is underpinned by technology and driven by theintelligent patient.




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Manage the change process

eHealth represents a undamental transormation or the healthcare system that,i poorly planned, has the potential to be highly disruptive. Change managementshould be as important as the technology or the idea itsel, notes Jerold Howell.From the start, eHealth leaders must apply a change management approach thatrecognizes barriers and works with stakeholders to enable transormation. Morethan a quarter o our respondents identied cultural change as one o the most

important aspects in this change process.

Once again, respondents warn against thinking o eHealth simply as atechnology implementation. Dont treat eHealth as an IT project, saysDr. Sarah Muttitt with MOH Holdings in Singapore. It is a businesstransormation project. eHealth planners must consider the implicationso eHealth on both people and processes.


Harness health professionals

0

10

20

30

40

50

60

70

80

Capacity building

Clever incentives

Culture change

Stakeholder engagement

Clinical acceptance

21%

68%

29%26%

8%




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Manitoba, Canada: Computerized Provider Order EntryGaining clinical support by communicating evidence-based results

For the Canadian province o Manitoba, eHealth is seenas a signicant opportunity to improve patient health andmake the existing system more transparent. In 2009, the

provinces second largest hospital launched a ComputerizedProvider Order Entry (CPOE) system as a way o movingdocumented patient treatment plans electronically. Thesystem allows an authorized provider to initiate individualorders and order sets, which are communicated over thenetwork to the appropriate medical sta or departments.

The CPOE system has already delivered signicant value.It enables the real-time tracking o critical saety inormationsuch as patient IDs, adverse drug reaction reviews,recommended dosages and cross-checks or allergies.Patient saety has also been enhanced by providing a strongmechanism or identiying prescribing errors.

CPOE also provides benets on the operational side. Thesystem delivers statistical reports online so that managerscan quickly analyze patient statistics and make appropriate

changes to stang and inventory. Audits can be conductedto ensure that patient privacy and condentiality areproperly protected, and to monitor utilization throughout

the organization.

Those close to the project identiy a number o keytakeaways. Having strong clinical leadership is the singlelargest actor to the success o an eHealth initiative,said Roger Girard, CIO o Manitoba eHealth. To achievethis, planners collected and communicated evidence oimproved care to clinician groups to gain their supportand engagement. Planners also engaged clinicians in thedevelopment o evidence based content.

Participants in our study noted the need to developcontingencies to help the project remain ocused and on

schedule, as well as the importance o secure undingcommitments. Maintaining momentum was highlighted askey, with experience showing that long lags between therst and second versions can oten deter clinical champions.


Interoperability

Use of norms

Flexibility/innovation

Technical development for eHealth

0

10

20

30

40

50

21%

50%

26%




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Align incentives in the system

Medical proessionals must be properly compensated or providing eHealthservices. However, many jurisdictions have not revisited their reimbursementpolicies to refect the very dierent needs o eHealth. The physician has tobe able to see the value and benets in the orm o eciency, outcomes andcompensation, added Michael Beaty.

A number o respondents also cited the need to incentivize institutions toimplement eHealth systems through government grants, loans or cost-reductionmeasures. The Meaningul Use provisions in the Obama Healthcare Reorms, orexample, oer signicant incentive payments or the implementation o ElectronicHealth Records (EHRs), but ties those payments to the providers ability to makesignicant improvements in patient care.

KEY TAKEAWAYS

Clinician-ledeHealthsystemswillenjoyhigheradoptionratesandgreater

clinician acceptance.

Clinicalvaluemustbedemonstratedtohealthcareprofessionals,particularlythrough evidence-based outcomes.

ThisrequiresthescalingupofeHealthprojectwhichwouldotherwisenot

deliver conclusive evidence.

Manyclinicianswillrequiresignicantcapacity-buildingintechnologyandthe

behavioural changes that accompany eHealth.

Healthprofessionalsandorganizationsmustseevalueandbenets

rom the system in the orm o eciency, clinical outcomes and nancialcompensation.




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ConclusionUltimately, there will be as many dierent models o eHealth as there are healthcaresystems, and each will take a unique approach to both implementation and long-termsustainability.

But, to move rom being simply an innovation in healthcare through to being asustainable change process to transorm healthcare delivery, we believe eHealthplanners will benet rom considering their initiatives against three undamentalconcepts: crowd accelerated innovation, collaborative alignment and creativedislocation.

Our research also shows that, almost regardless o the underlying marketcharacteristics, building a successul and ecient eHealth system comes down to thestrength o strategic planning, the communication o a clear vision and the ability toharness proessionals.

So while there is no single path to eHealth transormation, we rmly believe thateHealth is too important, and too expensive, or implementing organizations to repeatthe mistakes o their peers. Indeed, much value will come rom sharing lessons andbest practices between countries, systems, institutions and proessionals.

We hope that this report adds to the global dialogue on eHealth and helps healthcaresystems achieve sustainable and valuable benets or governments, systemmanagers, payers, healthcare proessionals and, most importantly, patients.




35/40

The eHealth

diagnostictestAround the world and in virtually every region, eHealth is rapidly

becoming a reality. Some providers are moving ahead with ull-scale

roll-outs that aim to transorm the health system with one huge leap

orward; others are taking an incremental approach that slowly but

surely evolves into an integrated eHealth network.

So how can eHealth participants use the inormation learned in this research tomove their own strategies and programs orward?

KPMGs Healthcare Practice has developed a quick and simple eHealth diagnostictest to help gauge their progress on the path towards building a sustainabletransormation in health. Executives may also want to check the potentialsustainability o their eHealth programs against our eHealth Barometer (seepage 35) to see how our three eHealth concepts might help drive their program

to sustainability.




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eHealth diagnostic testHow to get from pilot stage to a sustainable transformation in health

On a scale from 1 (No) 5 (Yes). No Yes

Questionnaire 1 2 3 4 5

Crowd accelerated innovation

Isastrategicplan,supportedbycleargoals,inplacetoachieveyoureHealthprogram?

Isthereopencommunicationandatransparentenvironmentinsharingknowledgeand

outcomes rom your eHealth program?

IsthereasustainablecrowdinvolvedindevelopingandembracingyoureHealthprogram?

Collaborative alignment

DowereallyunderstandtheperceptionsofallofthestakeholdersinvolvedintheeHealth

program (patients, physicians, medical irms, insurance providers, governments, healthcareproviders)?

Areallkeystakeholdergroupsatasufficientlevelofmaturity?

Canweclearlydescribehoweachstakeholdergroupwillbenefitfromtheprogram(focuson

core elements like improved quality, better access and/or lowering costs o healthcare)?

Creative dislocation

Arefinancialmechanismsinplacetogetbeyondthepilotstage(changeandruncost)?

Areweusingproventechnology,standardizedcomponentsandopensolutionsusedtoget

critical mass (ease to expand the program)?

Arewefocusingonhowthisinitiativecantransformthewaythathealthcareisdelivered(to substitute current way o working)?


Results in...

Score 9 to 20:

Your eHealth program is notsustainable enough to rise beyondthe pilot stage. There is notsucient innovation led by a crowd,collaboration between stakeholdersis an issue and there is a lack ocommitment to transorming theexisting way o working.

Score 21 to 32:

There is a medium risk that youreHealth program initiative is notsuciently sustainable to risebeyond the pilot stage. Additionaleort is required in getting morecrowd support, to align thestakeholders and substitute theexisting way o working.

Score 33 to 45:

Your eHealth program has importanteatures to rise beyond the pilotstage. Innovation is led by a crowd,collaboration between stakeholdersis in place and serious eort hasbeen put towards changing theexisting way o delivering healthcareto patients.





37/40

The eHealth sustainable barometer

eHealth program has

important features to rise

beyond the pilot stage

Clarity in goals of the eHealth program

Level of transparency enabled by eHealth program

Involvement of crowd in eHealth program

Insight in involved stakeholders in eHealth programs

Alignment of stakeholders around the eHealth

program

Level stakeholders benefit from eHealth program

Financial mechanisms settled in eHealth program

Easy to expand ehealth technology to achieve

critical mass

Clear how healthcare models will be substituted

by the eHealth program

Crowd accelerated innovation

Collaborative alignment

Creative dislocation

eHealth program has a

medium risk to be not

sufficiently sustainable and

rise beyond the pilot stage

eHealth program is not

sustainable enough to rise

beyond the pilot stage




KEY TAKEAWAYS

CrowdacceleratedinnovationsuggeststhateHealthbecomesmore

sustainable based on the size o the program and breadth o stakeholderadoption.

Collaborativealignmentrecognizestheimportanceeachplayerhasinthe

healthcare continuum and places a high value on their active participation inthe development and operation o the system.

DuetoeHealthstransformativenature,creativedislocationisessential.


38/40

2011 KPMG International Cooperative (KPMG International). KPMG International provides no client services and is a Swiss entity with which the independent member frms o the KPMG network are afliated.

The KPMG name, logo and cutting through complexity are registered trademarks or trademarks o KPMG.

A new vision forhealthcare

In healthcare, every patient is unique yet

many o the challenges acing

their healthcare systems are similar.

KPMG practitioners spanning150 countries in our global network

help clients see their biggest issues

clearly, delivering solutions that

help change the ace o health.

Take a closer look at

kpmg.com/healthcare



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Acknowledgments

This report is underpinned by research undertaken byManchester Business School (MBS) at the University oManchester, led by Proessor Naomi Chambers assisted byDr. Claire Moxham, Dr. Shruti Garg, Je Girling, and also aidedby Lizzie Jels and Jeni Bremner rom The European HealthManagement Association.

The case studies are derived rom research undertaken by ateam including Manchester Business School (MBS), Universityo Manchester, Mark Britnell, Chairman, Global Health Practice,

KPMG in the UK, Jan de Boer, Global Health IT Leader, KPMG inthe Netherlands with support rom Matt Roberts, COO, GlobalHealthcare, KPMG in the UK, Tim Beasley, eHealth consultantwith KPMG in Canada, Iain Gravestock, a Partner with KPMG inthe UK, Michael Beaty, a Partner with KPMG in the US, Egidio

Zarrella, a Partner with KPMG in China, Jerold Howell, a Partnerwith KPMG in the US, Andrew Hine, a Partner with KPMG inthe UK, Wah Yeow Tan, a Partner with KPMG in Singapore, theKPMG Global Resource Centre and Peter Schram.

We extend a special thank you to all o the participants in thesurvey and this report.

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