Future Health: eHealth challenges

Brussels 17th June 2009

Octavian Purcarea ocpurca@microsoft.comGlobal Solution Manager WW HealthMicrosoft Corporation

ChallengesAging populationIncreasing costs and burden of chronic diseases (affordability and sustainability)Economic growthAccess, quality and safety of healthcare (including consumer protection)Free movement of citizens and servicesEmpowerment (health and wellness issues)Change management

HealthCast 2020 – (Price Waterhouse Coopers)

High increase in Health expenditures

eHealth adoption challenges

UsabilityTrustSustainability (economic model)Implication of different actors (empowerment)

USE OF DATA FROM THE PRIMARY CARE EPR ‐ RESISTANCES AND SOLUTIONS Prof Dr Marc VANMEERBEEK DUMG  2004

Analysis of the database records of the EPR in 8 Medical Homes, 3 years, 133.0000 contacts

Belgian Study

Why we need a new generation HIT ?EPR EPR UsabilityUsability in the in the dailydaily practice practice of the of the GPsGPs

« 6, 7%  of the contacts were recorded in the database  »

« exasperation of the user  »

« It seems illusory to continue an IT program 

without a rapid response to the numerous improvement demands »

« 6, 7%  of the contacts were recorded in the database  »

« exasperation of the user  »

« It seems illusory to continue an IT program 

without a rapid response to the numerous improvement demands »

QUALITY IMPROVEMENT IN THE PRIMARY CARE BASED ON DATA COLLECTION OF DIABETES AND HYPERTENSION RELATED CONSULTATIONS  Vandenberghe H., Bastiaens H., Jonckheer P., Orban T., Declercq E.,Lafontaine M.‐F.,Van Casteren V.Service d’Epidémiologie Institut Scientifique de la Santé Publique, 2003, Bruxelles

Exploration of the feasibility of data collection for quality improvement interventions .Two groups: paper based data collection and EPR based data collection 

Conclusion 

“40% of the physicians from the EPR based group  finally didn’t send the data”

« The quality indicators are strongly divergent for the 2 methods”

Conclusion 

“40% of the physicians from the EPR based group  finally didn’t send the data”

« The quality indicators are strongly divergent for the 2 methods”

EPR EPR UsabilityUsability in in public public healthhealth and and qualityquality managementmanagement

Belgian Study

Why we need a new generation HIT ?

Conclusions

‐ only 20% of care networks have electronically data exchange

‐ only 9% have enough structured data

‐ only 3% can document  the care processes  electronically 

Conclusions

‐ only 20% of care networks have electronically data exchange

‐ only 9% have enough structured data

‐ only 3% can document  the care processes  electronically 

German Study

PRAXISNETZ STUDIE 2006  MANAGEMENT ‐PROZESSE –INFORMATIONSTECHNOLOGIEGünter Schicker und Oliver Kohlbauer , Wirtschaftsinformatik II Universität Erlangen‐Nürnberg

Analysis of the practice mangement and IT situation of  GP Associations  in Germany and Switzerland ; ( 72 deutsche Praxisnetze und 18 Schweizer)

EPR Usability in daily practice & quality management

Why we need a new generation HIT ?

Tesler's Law of Conservation of Complexity:

“Every application has an inherent amount of irreducible complexity. 

The only question is who will have to deal with it ‐ the user, the application developer, or the platform developer?”

Larry Tesler,  the inventor of the graphical user interface 

USABILITYUSABILITY

Clinical Software for USABILITY

1. Software  behavior should reflect the work process of  the user  (workflow )

2. Software  objects  should reflect the mental model (concepts) of the user (terminology )

1. Software  behavior should reflect the work process of  the user  (workflow )

2. Software  objects  should reflect the mental model (concepts) of the user (terminology )

Usability threshold

Terminology+ ---------------------------------------------------->

Clinical Process Models

Usability threshold

Terminology+ ---------------------------------------------------->

Clinical Process Models

The Technological Convergence for USABILTY & FUNCTIONALITY

The Technological Convergence for USABILTY & FUNCTIONALITY

How clinicians spend time

Direct patient care

Otheractivities

Seekingdata

Time value of information1/8 second:

"instant"

1/4 second: "snappy"

1 second:cognitive drift

10 seconds:capture by other task

Clinical User Interfacewww.mscui.net

Why Communication is important

Caregivers preference their peers over textCommunication errors are the most common cause of preventable medical errorsBlind calls and paging

Source: J. Westbrook et al, MJA, 5 May 2008

Helping The Healthcare Workforce

Helping The Healthcare Workforce

Helping The Healthcare Workforce

Helping The Healthcare Workforce

Mobility

Data Input

Surface Computing

We See, We Feel, We Change

People change what they do less because they are given analysis that shifts their thinking than because they are shown a truth that influences their feelings. This is especially so in large-scale organizational change, where you are dealing with new technologies, new strategies, cultural transformation

The Heart of ChangeJohn P. Kotter H A R V A R D B U S I N E S S S C H O O L P R E S S 2006

The change management problem The change management problem

The magnitude of cultural change that is needed for the deployment of systematic Quality Management in Healthcare is so important that it will work only by “revelation”.

with a low number ( 5-20) but highly motivated physicians ( the micro-system model*)

train them correctly on the methodology and the information system

coach them intensively

show the new model in action and show data of improving process and outcomes .

Build an experimental “Healthcare Management & Integration Network”

The solution The solution

Trust and Change ManagementTrust and Change Management

“In the software industry it is the business, not the technology that determines success or failure.”

M.Cusumano, professor at MIT's Sloan School of Management

How can we make Health care sustainable?

Source: Intel.com Cost of Care per Day

$1 $10 $100 $1,000 $10,000

0%

Qua

lity

of L

ife

COMMUNITY CARE

Healthy,Independent Living

ChronicDisease Management

CommunityClinic

Doctor’sOffice

100%

Assisted Living

Skilled Nursing Facility

Specialty Clinic

Community Hospital

ICU

HOME CARE

ACUTE CARE

Specialty Pharmacy

‘SHIFTLEFT’

Disease Management - What is worth for the local administration (Belgium example) ?

Health care model concept Instrument Operative means Data-processing tools

Expectable Economies

/year*Individual health

care providerIsolated GP Electronic Patient Record 1. Local EPR ?

Level 1

Patient centered health care

GP networkShared health record filePatients portal for healthShared secretary

1. Secure web server2. Semantic interoperability:

Reference Information model (RIM) : Architecture Templates, Data structures, Data types,

Terminologies3. Shared platform for Secretariat

Documents management (Scan/OCR/Indexation)

Online Agenda

5%

Belgium+ 1 billion3,4

Level 2Integrated Chronic

Care ModelOptimizing the

health care systemwith Quality

management and cost containment

Providers Network

Quality Indicators Benchmarking

Drug therapy management

Guidelines Adherence

Care plansCare teamsTask delegation and managementDrugs alerts, reminders

Indications and contraind.Adverse effects

Guideline AlertsAgreed guidelines

1. Clinical process information modelActors, contexts, actions/tasks, events, rules

2. Process editor3. Web application for Orchestration of the

processes

4. Pharmacotherapy knowledge database5. Care plans editor and rules editor

10%

Belgium+2 billion,5,6

Level 3Integrated system for care management

Prevention and Chronic DiseaseManagement Quality and Safety

Management

Quality indicatorsClinical BPM -BIMining Process Re-engineering Process

15%

Belgium3 billion 7

L’Informatique dans le contexte de santé publique et d’économie de la santé (Belgique : buget soins santé 20 milliards) 1.Implmentation du projet RIPAM (Ardeche) : une « 13éme heure » de travail de plus par jour pour tenir le DMP2.La prime INAMI pour « DMI homologué »3.Bilan 2004 de la Mutuelle Knappschaft en Allemagne après introduction d’un dossier informatique partagé « Web » pour tous les médecins 4.Bilan 2006  Suisse : 10 ans des systèmes de Managed Care ; Observatoire Suisse de la Santé 20065.Infoway Canada 2005 ‐ Coût évitable des effets indésirables des médicaments par prescription informatisée avec support décisionnel6.Etude prospective , randomisé à grande echelle «Improve Compliance With Clinical Guidelines.. » Jonathan C. Javittet all ; AJMC 2005 7.Bilans Kaiser Permanente vs moyenne nationale et californienne 

Consumer Empowerment

HealthVault = Health Application Platform

Application & Device ProvidersSigned and Live as of 10/29/08

Walk Me

For More Information about Microsoft Health

Health Web site: www.microsoft.com/healthcare Health Blog: www.blogs/msdn.com/healthblogEMEA Health Blog: http://blogs.msdn.com/ms_emea_health_blog/default.aspxInformation on Amalga and Health Vault can be found at: http://www.microsoft.com/hsg/You can find information on the Common User Interface and the design guides at: www.mscui.comHere is the link to the CHF (Connected Health Framework) material: http://msdn2.microsoft.com/en-us/architecture/bb525069.aspxFor MedStory (now called Live Search – Health) go to https://ssl.search.live.com/health/default.aspx or www.medstory.com.

E-mail: ocpurca@microsoft.com

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