Health Information and eHealth Landscapes: Bridging the Gap … · @SinisaVarga Health Information...

@SinisaVarga

Health Information and eHealth Landscapes: Bridging the Gap

Sinisa Varga, Vice-President Health and Social Policy Committee, Croatian Parliament

Better public health through strategic purchasing as a catalyst for eHealth design and development

© HIMSS Europe GmbH 2

@SinisaVarga PLEASE ALLOW ME TO INTRODUCE MYSELF...

• External consultant for governments, EC, WHO and WB 2016-present

• Member of Croatian Parliament 2016-present

• Minister of Health 2014-2016

• Director Croatian Health Insurance Fund 2012-2014

• President Managerial Board Vrapće Psychiatric Teaching Hospital 2010-2012

• World Bank Project Bosnia & Herzegovina 2006-2008

• Deputy Minister of Health 2002-2004

• Deputy Director Dubrava University Hospital 2000-2002

• World Bank Project Croatia 1999-2002

• Head of Maxillofacial Rehabilitation Unit DUH 1992-present

DMD, Prosthodontist, QSM/QSA, Health Resources Manager, Diplomacy

"...it takes roughly ten thousand hours of practice to achieve

mastery in a field..." Malcolm Gladwell


@SinisaVarga

World population:

> 7,5 billion • Chronic diseases account for up to 80% of total

healthcare expenditures

• Increasing number of chronic and long term patients

• Low birth rate, unhealthy lifestyle..

• 1.6 billion adults overweight

• 300 million people (4.3%) suffer from asthma

• 214,4 million people (3.1%) suffer from COPD

• 382 million adults (8.3%) have diabetes (2013)


@SinisaVarga Projected healthcare spend is alarming

OECD countries 2005 2030 2050 2070

United States 15.3 24.9 36.7 65.0

Switzerland 11.6 18.8 27.8 49.8

France 11.1 18.0 26.6 47.6

Germany 10.7 17.4 25.6 45.9

Greece 10.1 16.4 24.2 43.3

Canada 9.8 15.9 23.5 42.0

Netherlands 9.2 14.9 22.0 39.5

Denmark 9.1 14.8 21.8 39.0

Italy 8.9 14.5 21.3 38.2

UK 8.3 13.5 19.9 35.8

Turkey 7.6 12.3 18.2 32.6

Mexico 6.4 10.4 15.3 27.5

– If healthcare expenditure continued simply following demographics, cost would reach 30% of total GDP

HEALTHCARE NEEDS TO REACT

STAKEHOLDERS NEED TO ADAPT

SYSTEMATIC CHANGE IS REQUIRED

Source: Extrapolation of current growth relative to OECD GDP growth

Development of health expenditures as % of total GDP


@SinisaVarga

Strategic

decisions

Data collection &

processing


@SinisaVarga National Health Care Strategy 2012-2020

• Basis for World Bank project: “Health System Quality and Efficiency Improvement”

• Project ID: P144871

• Payment for Results method

• Numerous DLI's tied to National HC Strategy

MoH website http://zdravlje.gov.hr (search: National Health Care Strategy 2012-2020)


@SinisaVarga National Health Care Strategy 2012-2020

Priority 1: Health informatics and eHealth

Priority 2: Strengthening and better use of human resources

Priority 3: Strengthening management capacities

Priority 4: Reorganization of health institutions

Priority 5: Encouraging quality initiatives and accreditation

Priority 6: Strengthening preventive activities

Priority 7: Preserving financial stability


@SinisaVarga eHealth landscape › 2,300+ GP offices

(8 different vendors)

› 192 pediatrician offices (7 different vendors)

› 180 gynecologist offices (8 different vendors)

› > 2,000 dentist offices (5 vendors)

› > 1,100+ pharmacies (7 vendors)

› 100+ biochemistry laboratory (5 vendors)

› 12 hospitals / 1000+ specialist care offices


@SinisaVarga eHealth Ecosystem

Payors

Policy-

Makers

Policy-

Makers

Policy-

Makers

Policy-

Makers

Payors

Policy-

Makers

Payors

Policy-

Makers

Payors

Policy-

Makers

Payors

Policy-

Makers

Patients

Medicines &

Equipement

Producers

Other GO's

and NGO's

Patients Patients Patients Patients Patients Patients

Other GO's

and NGO's

Providers

Academic &

Scientific

Community

eHealth

Technology

Developers

Providers


@SinisaVarga

Best available research evidence

Population characteristics, needs, values

and preferences

Resources, including

practitioner expertise

Environment and

organizational context

Decision making


@SinisaVarga Implementation of Croatia's e-health plan 2002-2013

• ePrescriptions – fully implemented and operative since beginning of 2011

• eReferrals – biochemistry labs, specialists from 2011 onwards

• eWaiting Lists and eScheduling – fully implemented and operative since beginning of 2013; eHealth Records – ready for piloting in mid-2014

• By the end of 2017, all patient-related communication will be paperless available to all stakeholders within the health system (eScheduling, eReferrals, eFindings, eDischargeLetters) and result in improved efficiency and increased savings

• The introduction of “A5 referral pads” for consultations without patient presence should result in less primary care referrals to specialists and hospitals

• All hospital financial applications will be interconnected for permanent access in real time to financial, procurement, and payroll data

Key objective: Paperless care and cross-linking of stakeholders

Result: BIG DATA


@SinisaVarga Resource efficiency

The 2010 World Health Report on financing for universal coverage noted that: “Raising sufficient money for health is imperative, but just having the money will not ensure universal coverage. Nor will removing financial barriers to access through prepayment and pooling. The final requirement is to ensure resources are used efficiently.”

WHO World Health Report, 2010


@SinisaVarga Strategic purchasing requires the purchaser to engage actively in 3 main relationships between stakeholders

“Passive purchasing implies following a predetermined budget or simply paying bills when presented. Strategic purchasing involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, how, and from whom.”

WHO World Health Report, 2000


@SinisaVarga Return on investment of eHealth

• Payors through pooling of funds become bulk purchasers of goods (medicines, orthopedic and other appliances, sometimes capital equipment, etc) and services (medical and other out) in multi-million/billion dollar amounts

• Investments in software and other eHealth tools that increase efficiency and efficacy of the purchased goods and services have an extremely short return on investment (ROI).


@SinisaVarga eHealth benefit for public health

• National screening programs (early detection of breast, cervical and colon cancer) have dedicated SW for recruiting patients, data collection and data analysis

• Data from primary care is automatically collected and transferred to the Croatian Public Health Institute

• Data from hospitals and other providers collected through billing by the Croatian Health Insurance Fund is transferred to the Croatian Public Health Institute


@SinisaVarga

Diabetes

eHealth & Chronic Disease Management

Hypertension

COPD


@SinisaVarga

12.5.2017. 17

Electronic Health Record

Medical

information

is collected

and

displayed

in a

consistent

and

ergonomic

way in one

place to a

variety of

authorized

users


@SinisaVarga PATIENT PORTAL

• Managing dashboard for different activities

• Administrative information

• Communication platform with different healthcare professionals

• mHealth apps results


@SinisaVarga EVOLUTION: Integrated care – example

Applications need to be part of care processes through platform Application adjustments needed according to cultural needs

DIA

BET

ES

CA

RD

IO

RES

PIR

ATO

RY

GA

STR

O

ON

CO

LOG

Y

MEN

TAL

CHILD

30+

50+

70+

...

MANY DIFF APPS IN EACH AREA

eHealth

system

apps

input

mHeath platform


@SinisaVarga BD4BO - Data is gold of the 21st century: Systematic approach to healthcare outcomes us necessary in order to increase health services efficiency, efficacy and sustainability.

Better outcome

Less variation

Lower overhead costs

Healthcare system

improvement (outcomes/choices/rewards)

... result in system sustainability

Clinical records / registries Cl. studies /HTA/RWE/ comorbidity IT/software/telephon …

From services towards outcomes Big data for better outcomes / more possibilities! Creating value in every faze of the process

Big Data – possibilities of healthcare improvement...

Information

feedback

and

earning

Transparent treatment outcomes data

(big and deep data sources) Variation

analysis

Identification

"best practices"

Behaviour

change Better

outcomes

identifify, gather, connect and analyze

Value = outcome/cost

Better outcome

Less variation

Lower overhead costs

Healthcare system

improvement (outcomes/choices/rewards)

... result in system sustainability

Clinical records / registries Cl. studies /HTA/RWE/ comorbidity IT/software/telephone …

From services towards outcomes Big data for better outcomes / more possibilities! Creating value in every faze of the process


@SinisaVarga

Drive

continuous

improvement

Health data is a key enabler of health system efficiency

• Transparent outcomes data increases provider competition on meaningful metrics, generating incentives for high quality care

• This is likely to lead to increasing specialisation, given the positive impact of caseload on provider performance

• Tracking patients over time reveals how follow-on complications can be avoided

• Patients at risk can be identified and intervention organised, reducing costly complications

• Root-cause analysis of outcomes variation can identify ineffective practices • Stopping ineffective practices eliminates spending that is not delivering

outcomes Eliminating

waste

Reducing

complications


@SinisaVarga

"Out of clutter, find simplicity" Albert Einstein


@SinisaVarga

WHY: We believe that every citizen of the world has an equal opportunity for achieving health, happiness and well-being

HOW: By protecting the health of individuals, families, communities and the nation as a whole, in order to better the productivity of the workforce which results in a higher GDP, thus increasing living standards (better roads, houses, schools, hospitals, police, government, etc)

WHAT: To improve the health system by bettering the system of data collection, to use and analyze this data for public health interventions, better efficacy and efficiency of providers and financial sustainability of payors without reducing access to healthcare.


@SinisaVarga Who do you work for?

Government Industry

@SinisaVarga

Thank you!

Sinisa Varga, Vice-President Health and Social Policy Committee, Croatian Parliament

Visit Croatia, you're invited!

Health Information and eHealth Landscapes: Bridging the Gap … · @SinisaVarga Health Information...

Documents

Transcript of Health Information and eHealth Landscapes: Bridging the Gap … · @SinisaVarga Health Information...