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Placing Countries In Charge of Their Own e-Health Destiny - The Need for Strategy -
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Dr. Richard E. Scott Director, NT Consulting – Global e-Health; Professor, University of KwaZulu Natal, Durban, South Africa; Director, Office of Global e-Health Strategy, and Adjunct Professor, Departments of Community Health Sciences and Family Medicine, University of Calgary. Dr. Maurice Mars Professor, University of KwaZulu Natal, Durban, South Africa AeHIN Hour Calgary, Canada 12 th – 13 th November 2013
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Placing Countries In Charge of Their Own e-Health Destiny - The Need for Strategy -. Dr. Richard E. Scott Director, NT Consulting – Global e-Health; Professor, University of KwaZulu Natal, Durban, South Africa; - PowerPoint PPT Presentation
Transcript of Placing Countries In Charge of Their Own e-Health Destiny - The Need for Strategy -
Dr. Richard E. ScottDirector, NT Consulting – Global e-Health;
Professor, University of KwaZulu Natal, Durban, South Africa;Director, Office of Global e-Health Strategy, and Adjunct Professor, Departments
of Community Health Sciences and Family Medicine, University of Calgary.
Dr. Maurice MarsProfessor, University of KwaZulu Natal, Durban, South Africa
AeHIN HourCalgary, Canada
12th – 13th November 2013
Topics- Key Insight Only About Each -
Context and CostWhat do we focus on?Where do we start?What is Strategy?The e-Health Strategy Development Framework
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Context and Cost?- Can We Afford e-Health? -
WHO’s Report of the Commission on Macroeconomics and Health [2001] - minimum $34 per capita to provide just a ‘basic health care package’.
2011 ExampleUS $8,650 per capita; Canada $5,800 per capitaCanada – Of $5,800 , ~ 72% ($4,176) from public purse. About 2.7% spent on ‘technology use in health’ or ~$113 per
capitaIf spend only $10-35 per capita, 2.7% = 27-67 cents per capita
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Context and Cost?- Can We Afford e-Health? -
e-Health is an ‘opportunity cost’
Money spent on e-health is money NOT spent on immunization, sanitation, clean water, rural clinics, health provider salaries, …..
Any decision to invest in e-Health MUST be sound, evidence-based, transparent, and defensible!!
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What Do We Focus On?- Health Informatics - The Electronic Health Record -
Core components of an EHR include:Client registry Provider registry Diagnostic imaging system Drug information system Laboratory information system Interoperable. Yet private and confidential
An EHR initiative is a complex, high-risk endeavour
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What Do We Focus On?- Health Informatics - The Electronic Health Record -
Is An EHR The Right Solution for Developing Countries?British Columbia - $222 million capital costs by March 31,
2013; ongoing annual operating costs – maybe $30M
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Generic problems:Expectations of “instant results” Lack of needed supportLack of knowledge and understanding by policy and decision makers.
What Do We Focus On?- Other Components of e-Health? -
Global Health
e-Health
Health Informatics
[Telemedicine]
[Telepaediatrics]
[Decision Support Systems]
[Teleradiology]
[Home e-Health] [EHRs]
[PHR]
[EPRs]
[Tele-Social Work;Tele-Pastoral care]
[Surveillance Systems]
[Websites;Personal Remote
Monitoring;Teleradiology]
(Source: Scott RE – 2004, 2006, 2009, 2011, 2013)
[e-Learning][e-Commerce]
[EMRs]
Global e-Health
[SMART Cards]
[Tele-Rehab]
[m-Health] [Social Media]
What Do We Focus On – Risk Factors?- GBD 2010 Study -
Risk factors that account for the most disease burden - Philippines
Dietary Risk
Tobacco Smoking
Hypertension
0-5 years:Childhood Underweight
15-49yearsDietary Risks
http://www.healthmetricsandevaluation.org/sites/default/files/country-profiles/GBD%20Country%20Report%20-%20Philippines.pdf
What Do We Focus On – The ‘Future’?- GBD 2010 Study -
DALYs - % Change 1990-2010 - Philippines
Diabetes
Chronic Kidney Disease
Hypertension
Cirrhosis
Interpersonal Injury
http://www.healthmetricsandevaluation.org/sites/default/files/country-profiles/GBD%20Country%20Report%20-%20Philippines.pdf
What Do We Focus On – The ‘Now’?- GBD 2010 Study -
Years lived with disability(YLDs = Philippines 2010)
‘Other NCD’
Musculo-skeletal
Mental and Behavioural Disorders
Other Respiratory Diseases
HIV/AIDS and TB
http://www.healthmetricsandevaluation.org/sites/default/files/country-profiles/GBD%20Country%20Report%20-%20Philippines.pdf
What Do We Focus On?- Country Specific Focus Needed -
Where Do We Start?- Frequently – We ‘Learn’ from Others - Good and Bad Idea -
Emulate vs Adapt vs Context Specific
Learn from ‘Bad’ experiences
Care with ‘Good’ experiences
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Where Do We Start?- Old News – and More Recent News …. -
“The most favourable approach to the implementation of e-health is to have a framework of strategic plans
and policies which lay the foundation for development” WHO, 2006
“Ontario has spent more than $1-billion, most of it apparently now lost, in part because the province
rushed into the program without a strategic plan.”National Post, 2010
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Where Working?
SustainableWhy
e-Health Options
e-Health SolutionHow
ORGANISATION
Health Needs
IdentifiedIdentified
Conducive Setting[Complex]
? Setting
? Setting ? Setting
Privacy Setting
Standards Setting
Policy Settin
g
Regulatory Setting
Legal Setting
Health Needs
AddressedAddressed
Architecture
STRATEGY
Implementatio n
Integration
Change
Management
Evaluation
Infrastructure
Infostructure
GGoo
//
NNoo
GGoo
CONSTRUCTION OPERATION
Where Do We Start?
LOW IMPACTHIGH
IMPACT
LOW COST NOABSOLUTELY
YES
HIGH COSTABSOLUTELY
NOMAYBE
Where Do We Start?
LOW IMPACT
MEDUIUM IMPACT
HIGH IMPACT
LOW COST NO PERHAPSABSOLUTEL
Y YES
HIGH COSTABSOLUTEL
Y NODOUBTFUL MAYBE
Where Do We Start?
LOW IMPACT
MEDUIUM IMPACT
HIGH IMPACT
LOW COST NO PERHAPSABSOLUTEL
Y YES
HIGH COSTABSOLUTEL
Y NODOUBTFUL MAYBE
COMPLEXITY
LOW
HIGH
Where Do We Start?- What’s Available from the Litereature? -
WHO/ITUNational eHealth Strategy
Toolkit
Commonwealth;Developing an E-Health
Strategy
KenyaKenyan National e-Health
Strategy 2011-2017
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What is ‘Strategy’- What it Is ~ What it Does -
Strategy:Clarity around where you are going and why
you are going there.e-Health strategy:
Documentation that describes and justifies the overall approach to be taken by a country (or organisation) for progressive implementation of e-health solutions.
Strategy is key:Foundation for sustainable e-health
implementation.
What is ‘Strategy’ ?- Quite Different from Policy, but often used Interchangeably !! -
Lot of misuse of the term ‘strategy’ / ‘strategic’
Lot of debate even in the business sector re ‘strategy’
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UNDERSTANDABILITY of ENVIRONMENT
LOW HIGH
HIGH LEVELS OF ENVIRONMENTAL
TURBULENCEIntra-
preneurshipStrategic
Intent
LOW LEVELS OF ENVIRONMENTAL
TURBULENCEEmergent strategy
Strategic Planning
Intended Strategy Deliberate Strategy Ultimate Strategy
Intended Strategy
Influential Factors
e-Health Strategy Development- 8 Steps -
Evidence Gathering and Situation Assessment (Step 1)Holistic Review (Step 2)Differential Diagnosis (Step 3)Preliminary Prioritization (Step 4)Identifying Solutions (Step 5)Considering eHealth Solutions (Step 6)Secondary Prioritization (Step 7)Strategy Formulation (Step 8)(next steps – policy, architecture, infra / infostructure, etc.)
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e-Health STRATEGY- Holistic Review -
Table 1. Categories for Consideration during a Differential Diagnosis for Development of an e-Health
Strategy
Sachs (2005):
Poverty TrapEconomic Policy FrameworkFiscal Framework and Fiscal
TrapGovernance Patterns and
FailuresCultural BarriersPhysical GeographyGeopoliticsInfrastructure - Current and
Planned (e.g., coverage – 3G/4G/GPRS-EDGE)
Additional:
Health - Status, Services, and Policy Framework - NEEDS
e-Health - Status, Services, Policy Framework, and Readiness
External Factors - Projected Impact on Health of Climate Change
Literacy - basic, health, e-healthInfostructure - Current and Planned
(e.g. HHR capacity (health, e-health, and IT))
Setting: Readiness; ‘Traditional’ Medicine
Change management - ? Which
e-Health Strategy Development- 8 Steps -
Evidence Gathering and Situation Assessment (Step 1)Holistic Review (Step 2)Differential Diagnosis (Step 3)Preliminary Prioritization (Step 4)Identifying Solutions (Step 5)Considering e-Health Solutions (Step 6)Secondary Prioritization (Step 7)Strategy Formulation (Step 8)(next steps – policy, architecture, infra / infostructure, etc.)
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A Panacea ?- The Goose That Lays Golden Eggs -
e-Health is a facilitator
e-Health is NOT always the answer
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e-Health Strategy Development- 8 Steps -
Evidence Gathering and Situation Assessment (Step 1)Holistic Review (Step 2)Differential Diagnosis (Step 3)Preliminary Prioritization (Step 4)Identifying Solutions (Step 5)Considering e-Health Solutions (Step 6)Secondary Prioritization (Step 7)Strategy Formulation (Step 8)(next steps – policy, architecture, infra / infostructure, etc.)
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Strategy vs Policy?- How do they relate? -
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e - e - H H e e a a l l t t hh
S t r a t e g yS t r a t e g y
P o l I c y
P o l I c y
Benefits of this Approach?
A Clear Understanding of Where and Why you need e-HealthEvidence-basedLocally needs-basedTransparentDefensible
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$ $$$$$$$$
Benefits of this Approach?
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How ?- Is This Easy To Do ….. ? No. But It’s Darned Important -
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What you do now is laying the foundation for what will happen in Pakistan for the next 10, 20, 30 years.
Take the time to do it.
And do it right – first time.
The train has already left the station – and is changing the ‘health’ forever.
You may be on board – But – are you headed in the right direction?
e-Health
