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The impact of eHealth on Healthcare Professionals and Organisations: e-health and Healthcare...
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Transcript of The impact of eHealth on Healthcare Professionals and Organisations: e-health and Healthcare...
e-health and Healthcare Organization
Josep M. Piqué, MD.Hospital Clínic, Barcelona
Healthcare deliveryHealthcare delivery
Payment systemsPayment systemsPayment systems
ICTICTICT
Patient & society demandsPatient & society demandsPatient & society demands
Social, demographic &epidemiologic evolutionSocial, demographic &
epidemiologic evolutionSocial, demographic &
epidemiologic evolutionTraslational research &technology innovation
P4 Medicine
Predictive, Preventive, Personalized, and Participatory
At present, the three major hindrance to achieve the above mentioned objectives are:
1. The lack of an integrative approach to diagnose, treat, and prevent the health problems from different departments in the same healthcare level organization.
2. The huge fragmentation of organizations among primary care, social care, and specialized care.
3. The lack of communication and standardization between different healthcare electronic medical records.
We need to increase the efficiency and outcomes of basic, clinical and epidemiological research and facilitate faster translation into clinical practice, particularly in the field of age-related chronic diseases and conditions.
It is also necessary to personalize care and to move from reactive to preventive and predictive medicine.
Fragmented healthcare systems
Conflict AreaConflict AreaArea of potentialdevelopment
Area of potentialdevelopment
Competition
Collaboration
vs
Hospital fragmentation
Fragmented healthcare systems
Behaviour and attitudes of health professionals.
Lack of education for professionals promoting coordinated efficient work.
Lack of citizen’s education on a rational use of healthcare systems.
The payment systems that in many cases do not encourage coordinated work.
Increasing the efficiency of hospital organization
Wards ICU Day Care
DiagnosticUnits
Proc
ess
Uni
ts
Refe
renc
eph
ysic
ian
Instituts, Departments, Services
Proc
ess
Uni
ts
HOSPITALCommunity
Care
FamilyPhysician
Nurse
SocialWorker
HomeCare
Transplant
Dementia
COPD
CHF
TerritorialHealthcareTerritorialTerritorialTerritorialHealthcareTerritorialHealthcare
Hospitals vs territorial healthcare
Adaptation of health services to chronic patients (shared care arrangements across the system)
Adaptation of health services to chronic patients (shared care arrangements across the system)
Patient
Consultant
Relatives & care givers
PrimaryCareTeam
Mobile teams
Emergencyteam Case
Manager
Home
Primary Care
Hospital
Permanent Comission
TechnicalManagement
Team
TechnicalManagement
Team
TechnicalManagement
Team
Process 1
Process 2
Process 3
Process 4
Em
erge
ncie
s
Soc
ial C
are
Hea
lthTr
ansp
ort
Hom
eC
are
Ped
iatri
cca
re
Pha
rmac
y
RedesignImplementation
& follow-up
Men
tal h
ealth
IT
Operational Committees
Territorial Health Care ComissionBarcelona Esquerra
Territorial Health Care ComissionBarcelona EsquerraBarcelona Esquerra
Territorial Health Care ComissionBarcelona Esquerra
Spe
cial
ized
Car
e
Institutionsrepresentative
Territorial Information SystemsTerritorialTerritorial Information SystemsSystems
PlatformPlatform
Primarycare
Primarycare
Primarycare
Hospital 2Hospital 2Hospital 2Hospital 1Hospital 1Hospital 1
Administrator
Homecare
Homecare
Homecare
Web
Firewall
Charging
IISWeb Server
IISWeb Server
SQLServer
Windows 2003File Server
NetworkSwitch
Socialcare
Socialcare
Socialcare
Process managementProcess management
PatientsProfessionals
- Commorbility personalized management - Multimedia access to suport center- Patient self-management of health- Remote follow-up- Multidisciplinary working team
What do we need?
Process-oriented multidisciplinary working teams
To share information based on health problems
To implement evidence based clinical pathways
Health outputs evaluation based on cost-benefit analysis
Pay-for-performance (P4P) taking into account patientneeds and new approaches to deliver healthcare
Working teams sharing information100%
75%
50%
25%
1-3 4-5 6-10 11-50 ≥50Size of practice (number of physicians)
N Engl J Med 2010:362;192-5
Adoption of EHR according to the practice size
Diverticulitis
Angina
Breast fibrosis
Breast cancer risk
Apendicitis
Penicillin allergy
3456907834569078 1975 1980 1985 1990 1995 2000 2005
IP OP OP OP OP
OP Eme IP OP OP OP OP
OP DC OP OP
OP OP OP
Eme IP OP
1975 1980 1985 1990 1995 2000 2005
IP OP OP OP OP
OP Eme IP OP OP OP OP
OP DC OP OP
OP OP OP
1975 1980 1985 1990 1995 2000 2005
IP OP OP OP OP
OP Eme IP OP OP OP OP
OP DC OP OP
Problem oriented information system
Decision-making support
Decision-making support
Decision-making support
Expert patient-self-care
Expert patient-self-care
Expert patient-self-care
Problem 1
Problem 2
Problem 3
MultidisciplinaryWorking team
MultidisciplinaryWorking team
MultidisciplinaryWorking team
Home care
Primaryphysician
Case-managementnurse
Day-carehospital
Social care
Problem oriented and evidence-based healthcare approach
Weinstein M and Skinner J. N Engl J Med 2010
Health outputs evaluation based on cost-benefit analysis
Gov
ernm
entC
ontr
ol
Patie
ntor
Com
mun
ityC
ontr
ol
Tendency
Protector
(homogeneousprotection for theoverall communitybased on governmentunderstanding)
Connecter
(services organizedaccording to thecommunity or individual needs decided by a participatory approach)
Who has the moneyMoney for what?EducationInformationIT systemsIT systems
Who has the moneyMoney for what?EducationInformationIT systems
DriversDriversDriversDrivers
Personalyzed and participatory care
P4PIT systems
Who has the moneyMoney for what?EducationInformationIT systems
PEducationPEducation4Education4Education PP4P
Investment forecast in health information technology
20
15
10
5
$ bn
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
CSC Healthcare. The Economist, April 18th 2009
Patient data-analysissupporting medical
practice and drugs research
Electronic health records
Health informationexchange