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Transcript of How eHealth Contributes to the Globalization of Health Care 2 - Susan Hyatt... · How eHealth...
How eHealth Contributes to the Globalization of Health Care
eHealth Summit 2008Mont Tremblant, Quebec
Susan J Hyatt
GlobalizationGlobalization……the Borderless Worldthe Borderless World
“…globalization is nothing but liberalization of the individual, consumers, corporations, and regions from the legacy of the nation-state…Whether the consumers buy the best and cheapest from anywhere in the world is also their choice…Ultimately it is a competitive world and one that will migrate across national borders.”
“…globalization is nothing but liberalization of the individual, consumers, corporations, and regions from the legacy of the nation-state…Whether the consumers buy the best and cheapest from anywhere in the world is also their choice…Ultimately it is a competitive world and one that will migrate across national borders.”
— Kenichi Ohmae, The Next Global Stage (2005)— Kenichi Ohmae, The Next Global Stage (2005)
“As the world starts to move from the primarily vertical –command and control – system for creating value to a more horizontal – connect and collaborate – value-creation model…societies are going to find themselves facing a lot of very profound changes all at once.
“As the world starts to move from the primarily vertical –command and control – system for creating value to a more horizontal – connect and collaborate – value-creation model…societies are going to find themselves facing a lot of very profound changes all at once.
— Thomas L. Friedman, The World is Flat (2006)— Thomas L. Friedman, The World is Flat (2006)
New Global Business PlatformsNew Global Business Platforms
Platforms provide common ground for companies or individuals to communicate, in a standardized way, to get things done more quickly or efficiently. They are easy to use and adaptable. - Kenichi Ohmae, The Next Global Stage, 2005
English Inc.Technological (e.g., the Internet)US DollarBrands (e.g., Coca Cola)Global business cultureATMs, Smart Cards, GPS etc.
…Technology is powering this new global economy and triggering industry transformations.
What is an Industry Transformation?What is an Industry Transformation?“Transformation alters the…culture by changing selected underlying assumptions and the ways in which those assumptions manifest themselves in…behaviors, processes, and products; is deep and pervasive and therefore affects the whole...and, is purposeful; and occurs over time.”
“Transformation alters the…culture by changing selected underlying assumptions and the ways in which those assumptions manifest themselves in…behaviors, processes, and products; is deep and pervasive and therefore affects the whole...and, is purposeful; and occurs over time.” — CHET; South Africa— CHET; South Africa
Attributes of System-wide Transformation:
Old StateOld StateOld State New StateNew StateNew State
Forced to die
Fundamental shift in mindset& organizing principles
Islands of information
Isolated skill sets& competencies
Emerges from visioning,trial and error
Designed with intent to support new business directions/models
Continuous process& reinvention
Innovation embraced
Success?...Critical mass of organizations must operate from new stateSuccess?...Critical mass of organizations must operate from new Success?...Critical mass of organizations must operate from new statestate
Health Care is GlobalizedHealth Care is GlobalizedThe evidence continues to build although there is minimal Canadian comment to date…
1. Global business platforms are evidentEnglish is the language of global HCBrands – HIMSS USA, Europe and AsiaPacGlobal HC Culture – Open Health Tools
2. eHealth enables the HC industry transformation “Ehealth is a global phenomenon.” – World Health Organization, Building Foundations for eHealth, 2006
ehealth systems are now essential infrastructure in countries around the world
3. The “global health care bazaar”
Global Global eHealtheHealth/EHR Activity/EHR Activity
Strong EHR/eHealth Activity
OpportunityStatus:
Data N/A
England: >12b GBP EHR initiative in processWales; Scotland. N.Irelandunderway
Spain: Regional initiatives underway
Singapore: National EHR strategy in development
Chile: National RFP for EHR project expected soon
Argentina: 1st
adoption of a digital radiography solution-2004
South Africa: EHR infrastructure tendered
Australia: Revising nat’lehealth strategy; NEHTA refocusing
USA – Federal NHIN contract underway. Multiple State initiatives for RHIOS.Still emergent
Canada – Infoway co-invests $1.6 B for nat’l/regional EHR investments
Germany: Smart Health Card. Future EHRs to be regional
New Zealand: National EHR system; ’08 RFP to refresh infrastructure
Hong Kong:HKHA has EHR
Brazil: National Health Card Project
Norway: Developinga National EHR
Malaysia: Lifetime Health Record (LRH) by 2010
Mexico: No EHR but aim for HL7 Integration
China: Plans todevelop a national EHR
Italy: EHR regional initiatives started
Ireland: Nat’l EHR strategy complete. Procurement 08
France: EHR mandated for 07
Denmark: Focuson EMRs
Sweden: Developinga National EHR
Finland: Have procured for nat’l architecture; EHR applications in ‘07
India: Plans to develop national EHR
Netherlands:Regional EHR projects (focused on GPs)
South Korea:National identifier initiative
Taiwan:National identifier initiative
regional
Qatar/UAENat’l EHRs in development
Israel: Hospital based EHRs
National Initiatives Trigger HC TransformationNational Initiatives Trigger HC TransformationAccurate patient & provider identification & matching is the fouAccurate patient & provider identification & matching is the foundationndation
Electronic Health Record (EHR)Electronic Health Record (EHR)
• Realize returnon investmentfor strategicIT initiatives
• Improve customer service with reduced risk
• Comply with regulations
ROI
• Enhance operational productivity& efficiency
• Improve patient care and reduce medical risks
ROI
National Initiatives National Initiatives –– Critical Success FactorsCritical Success FactorsCommon to all initiatives….
Clear and articulated vision promoted by critical massof political and health care leadershipCommon Architecture for country collaboratively developed with standards-driven approachTransparent governance structuresand accountability frameworks
Additional factors in Canada…Portfolio management with targeted investment programs in infrastructure and clinical applicationsPrivacy Commissioners engaged in early dialogueWell-defined gated co-investment strategy to manage risk
The Challenge for Canada and the USThe Challenge for Canada and the US
%
Primary Care Doctors Use of Electronic Patient Medical Records, 2006
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
eHealtheHealth Enables HC Industry TransformationEnables HC Industry Transformation
Vision, Strategy & Investments continuously integrating with…
Vision, Strategy & Investments continuously integrating with…
PeoplePeople
• Capability, culture, leadership
• Innovativeorganizations
• Capability, culture, leadership
• Innovativeorganizations
Processes Processes
• Workflow, benefits framework
• Risk management
• Workflow, benefits framework
• Risk management
Transformation sustained by knowledge transfer…best practices, virtual communities & thought leadership
Transformation sustained by kTransformation sustained by knowledgenowledge tratransfernsfer……best practices, virtual communities & thought leadershipbest practices, virtual communities & thought leadership
ICT ICT
• Architecture,standards & security
• Privacy solutions
• Architecture,standards & security
• Privacy solutions
Questions Countries AskQuestions Countries AskIn Starting Up National eHealth Initiatives....
1. Where do we draw the boundaries between national information utilities and local eHealth applications? Should national utilities include health and social services? ...e-citizen initiatives?
2. How do we exploit the power of ICT networks to develop and sustain networked Electronic Health Records?
3. What is the transformative eHealth vision for our country?
4. How will this impact on service design and provision across the health care ecosystem?
5. How do we progress the vision? How do we get continued investment?
6. How will this impact on citizen’s expectations of their health system?
““The Global Health Care BazaarThe Global Health Care Bazaar””Global business platforms provide common ground for individuals to communicate…to get things done more quickly or efficiently…easy to use and adaptable.
750,000 Americans sought offshore medical care in 2007Why Canadians seek alternatives?
waiting lists; treatment not available here; HR shortage; costs in US
Global business platforms in place English language, low cost of international travel, easy telecommunications, digitized patient records and eventually interoperable EHRs
Typical procedures? Diagnostic tests, cancer therapies, hip and knee replacements, cardiac surgery, etc.MRI $495USD in Amherstburg, NY; Coronary Artery Bypass Graft $55,000USD in California and $5-10,000USD in India at cardiac centre
Opportunities for Opportunities for eHealtheHealth in the Global Economyin the Global Economy
Registration Layer: Distributed, Centralized or Hybrid IdentifiRegistration Layer: Distributed, Centralized or Hybrid Identificationcation
GlobalGlobalEconomic Focus:• New economy emerges as
information goes digital• Information & communication
technologies drive change• Socio-economic impact
triggers globalization, outsourcing, privacy concerns, etc.
Use electronic business processes across the value chain to increase shareholder value
E-Business:Use electronic tools to transform government service, delivery & management
E-Government: E-Health:Applications running on National Health Information Infrastructure (NHII)
InfostructureInfostructure Layer: Security, Privacy, Standards, Connectivity, etc.Layer: Security, Privacy, Standards, Connectivity, etc.
Customers, Suppliers& Organizations
Client, Service Provider& Agency
Patient, HC Provider & Location
CountryCountryGovernment Focus:
Security
NationalEfforts
PublicHealth &Safety
Education
Environ-mental
Protection
Law & Order
PhysicalInfrastructure,
etc.
RegionRegionShared E-Health Focus:
(e.g., EHRs)
Discharge SummaryDrug ProfileDiagnostic ImagingLab Information
D. Becker-Smith
Sources: Tapscott, Hyatt, Kling