rajendra pratap gupta chairman member, board of directors global agenda council digital health (...
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Rajendra Pratap Gupta
Chairman Member,Board of Directors Global Agenda Council
Digital Health ( 2012-14)
CIS Conference – Doha, Qatar.20th April 2013
©Rajendra Pratap Gupta healthcarere4m
CIS & mHealthcare
©Rajendra Pratap Gupta
Qatar Health System
Universal Healthcare
Transition
Healthcare undergoing a Paradigm Change in Qatar
©Rajendra Pratap Gupta
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In Alberta, Canada’s wealthiest province, 50 % of out patients waited more than 41 days for an MRI scan in 2008
In Saskatchewan, 10 % of the patients awaiting knee replacement surgery waited 616 days or longer for care
In Nova Scotia , 50 % of hip-replacement patients waited 201 days or longer for surgery
The Situation is so dire, that some townships hold lotteries with winners gaining access to a family doc
Why Obama’s Government takeover of Healthcare will be a disaster by David Gratzer
Social Healthcare – Lessons learned
©Rajendra Pratap Gupta
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On 31st March 2001, 10,400 patients had been waiting more than 15 months for admission and about 80,000 patients waited more than 15 months during the year
In 2000 / 2001, the median waiting time for inpatient admission was 12.9 weeks …. ….. Significant number waiting up to the limit then of 78 weeks or 18 months
OPD appointment median waiting time was 4.8 weeks and a maximum of 52 weeks
24 : HOURS TO SAVE THE NHS, NIGEL CRISP Dept. of Health Waiting list statistics, Quoted n the National Audit Office (2010). Management of NHS Hospital Productivity , 17 Dec
Social Healthcare – Lessons learned
©Rajendra Pratap Gupta
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In Ireland , according to IMO ( Irish Medical Organization), one patient waited 32 months to see a specialist
Why Obama’s Government takeover of Healthcare will be a disaster by David Gratzer
Social Healthcare – Lessons learned
©Rajendra Pratap Gupta
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Universal Healthcare leads to increase in the ‘waitlist’ , ‘waiting times’, increasing
investment and the practice of defensive medicine.
Rajendra Pratap Gupta
©Rajendra Pratap Gupta
Social Healthcare – Initial Trends
Overuse / abuse
Increasing cost
Defensive
medicine
Universal Healthcare , if not carefully implemented , will lead to rewarding the ‘Unhealthy’ & ‘Irresponsible’ at the
cost of ‘Healthier’ and ‘Responsible’Rajendra Pratap Gupta
©Rajendra Pratap Gupta
Social Healthcare – Challenges
Reduce wait times / lists
Control the budget / cost
Making it sustainable
Accessibility
increases the use of
the system
Affordability to the patient calls for
more investment
Yet to find one e.g.
So far, social healthcare has not delivered a model that is sustainable
©Rajendra Pratap Gupta
mHealth , CIS & UHC
©Rajendra Pratap Gupta
( NHV 2030)
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1.Comprehensive world-class healthcare system whose services are accessible to the whole population
7. Preventive healthcare, taking into account the differing needs of men, women and children
NHS 2011-16 ( NHV 2030)
©Rajendra Pratap Gupta
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• Shifting the balance of care towards a preventive & community based model
• Enhancement of primary care is a focus area
• Vision and Goal of the Qatar’s healthcare system is to be centered on the patient
NHS 2011-16 ( NHV 2030)
©Rajendra Pratap Gupta
Healthcare is going crazy for mHealth
2004200620082010201220140
50000100000150000200000250000300000350000
314500
No. of Hits
No. of Hits
Years
No.
of
hit
s
mHealth search hits on Google. Source : * Emerging mHealth :
Path for growth. PwC & EIU report 2012 ©Rajendra Pratap Gupta
2750
15
“Mobile Healthcare is the biggest technology break-through of our time to address our greatest national
challenge”Kathleen Sebelius,
Health Secretary of the United States
Processing ePrescription through electronic ordering system can halve the likelihood of a drug error , and avert more than 17 million such incidents in US hospitals in one
year alone ( AMIA , March , 2012)
©Rajendra Pratap Gupta
©Rajendra Pratap Gupta
mHealth – in the next three years
Patients View
46 % Reduce
cost
52 % Convenien
ce
48 % Quality
* Emerging mHealth : Path for growth. PwC & EIU report
©Rajendra Pratap Gupta
What can mHealth do to UHC
Patient Engagement
Intervention
Interaction
Information
mHealth can drive patient engagement , which is a pre-requisite for successful UHC
Qatar has about 3 Mn Mobile phones , a density of about 170 %
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Internet not only fuels demand for healthcare but also can be used to address some part of it
Rajendra Pratap Gupta
©Rajendra Pratap Gupta
Have begun to offer
Would like to offer
Have no plans to offer
Offer but intend to stop
Total
Telephone based consultations 38 % 32 % 28 % 2 % 100 %
Administrative communication 38 % 45 % 16 % 1 % 100 %
Receiving data to monitor patient 21 % 51 % 26 % 1 % 100 %
Provide patients access to portions of their medical records
17 % 38 % 44 % 2 % 100 %
Drug adherence and other health related communication
17 % 51 % 31 % 1 % 100 %
Use of mobile device to explain / demonstrate during office visits
17 % 46 % 37 % 1 % 100 %
Text based consultations 16 % 31 % 52 % 1 % 100 %
Analysis of general health and wellness data gathered by mobile devices
13 % 48 % 37 % 1 % 100 %
Video consultations 8 % 44 % 47 % 1 % 100 %
Doctors see promise in offering mHealth Services
% of doctors who have begun to offer the following types of services via mobile devices , and which they would like to offer*
* Emerging mHealth : Path for growth. PwC & EIU report ©Rajendra Pratap Gupta
44 % use mobile phones to learn about / monitor wellness ( weight , diet , amount of exercise)
43 % contact between patient and healthcare provider by mobile phone or other device
42 % Accessing health telephone call centres / advice lines/ emergency services
29 % Automated contact with my healthcare provider ( e.g. reminders about appointments or to take medication )
25 % Healthcare providers monitoring a specific patient condition ( e.g. chronic disease )
Patients define mHealth in terms of access & Control
* Emerging mHealth : Path for growth. PwC & EIU report
How patients define mHealth
©Rajendra Pratap Gupta
18 % Community health promotion or information initiatives sending messages to mobile phone
18 % medical professionals having remote access to electronic patient records
14 % support for medical professionals making decisions remotely
5 % Collecting patient data for clinical trials
Patients define mHealth in terms of access & Control
* Emerging mHealth : Path for growth. PwC & EIU report
How patients define mHealth
©Rajendra Pratap Gupta
46 % Ability to access my healthcare providers more conveniently / effectively
43 % Ability to reduce my own healthcare costs
32 % Ability to take greater control over my own health
28 % Ability to obtain information that is difficult or impossible to obtain from other sources
25 % Ability to access better quality healthcare
Patients will adopt mHealth if it improves access , lowers cost and
increases control
* Emerging mHealth : Path for growth. PwC & EIU report
Top drivers for patients to consider beginning to use or increase use of mHealth applications / services
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©Rajendra Pratap Gupta
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Time magazine poll found that 84 percent of respondents worldwide could not go a day without
their mobile device
one in four people check their phones every 30 minutes
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©Rajendra Pratap Gupta
mHealth behind the Times Most powerful people - 2013
26
• 82% of HCDMs indicate they would be comfortable communicating with consumers using technology rather than in person
• Nearly 8 in 10 consumers indicating they would be likely to consult with their doctor by telephone instead of visiting their doctor’s office in person
• 3 in 10 HCDMs indicate mobile device and web based (through a site like Microsoft HealthVault) accessibility for medical records are available for their patients.
• 4 in 10 HCDMs indicate their consumers can access suggested preventive screening electronically
* Cisco Customer Experience Research conducted 11-12/2012 across 10 countries
CCER* - 2013
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Chronic diseases cause 47 % of all classified deaths in 2008* .
Prevalence of diabetes is 16.7 % . Fourth highest in the World*
71 % of all residents & 75 % Qataris are overweight. 32 % residents & 40 % Qataris are obese. 28 % of Qatari children are overweight*
Prevalence of TB is 4.5 %**
http://www.nhsq.info/strategy-goals-and-projects/preventive-healthcare/nutrition-and-physical-activity**( 2010) ( www.who.int/gho/countries /qat.pdf )
Health Maintenance & Wellness
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41.4 % of the Qatari adults are obese* .
32.9% of the women had higher BP than men ( 37.7 % vs 28 % )*
64.2 % of the respondents had a family history of Hypertension *
Overall prevalence of diabetes was 33.9 % among the age group 45-64 and 11.8% among the age group 18-44 years*
21.9 % of respondents have high cholesterol level*
Gulf Times , page 7, dated 18th April , 2013. National Stepwise survey report for chronic NCD & risk factor . Survey % represents the respondents of the survey
Health Maintenance & Wellness
©Rajendra Pratap Gupta
©Rajendra Pratap Gupta
Which areas of care can be impacted
Healthcare
Screenings
MCH
NCDHome care
TB
Emergency care
mHealth can significantly impact the delivery of healthcare services
http://www.who.int/goe/publications/goe_mhealth_web.pdf
Future of Health Maintenance & Wellness
Illness & doctor centric – Secondary prevention ( Curative care model )
Prevention focused – (Preventive care model )
Predictive care & wellness oriented – ( Pre-emptive care model )
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Future of illness lies in wellness and the future of wellness lies in using mobiles for health
Rajendra Pratap Gupta
©Rajendra Pratap Gupta
With an estimated $218 billion spent annually on diabetes in the US,* there
is hope that this solution could enable annual cost savings per patient of as
much as US$10,000 in reduced healthcare charges and increased worker
productivity*.In addition, this approach could allow patients to gain more
control over their condition and make better decisions on a daily basis,
which should enhance the lives of millions of patients who suffer from
diabetes. Remote- based coaching of this kind also has considerable
potential for other chronic diseases. Diabetes, obesity and hypertension
are seen as the three chronic diseases with the highest potential for
mobile management through the application of phones and web-based
solutions.
*Figures for the Centers for Disease Control and Prevention (2010) and the American Diabetes Association, 2009. *Milliman, 2011. *Medication adherence leads to lower health care use and costs despite increased drug spending, Roebuck MC, et al. Health Affairs (Mill- wood) (1):91-9, Jan 30 2011; Hospital Stays for Patients with Diabetes, Fraze T, et al. 2008; Statistical Brief #93. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); Aug 2006-2010. * Testa MA, et al. Health Economic Benefits and Quality of Life During Improved Glycaemic Control in Patients With Type 2 Diabetes Mel- litus. JAMA 280 (17):1490-6, Nov 1998.
mHealth & NCDs
* Emerging mHealth : Path for growth. PwC & EIU report ©Rajendra Pratap Gupta
11 % of the time, people don’t go anywhere
©Rajendra Pratap Gupta
Digital Health , POCD driven & home based –
Pre-emptive care model
@ Home / office desk
RNP / Health
Counselor
mHealth / eHealth
POCD / Non
invasive diagnosti
cs
©Rajendra Pratap Gupta
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Self care and self control are the biggest tool in the hands of patient to avoid pain and
suffering , and mHealth is the best ammunition to arm the patient with .
Rajendra Pratap Gupta
©Rajendra Pratap Gupta
CIS – A knowledge, decision & resource management tool
Quality , Patient Safety&
Mobility in care
Supply chain, Transparency & Accountability
tool
Personalized / predictive medicine
Epidemiology
CIS
CIS has to be viewed for VOI than just ROI
©Rajendra Pratap Gupta
21st Century Healthcare Ecosystem
Insurance / Payer
CIS – eHealth / mHealth
HCP - Hospitals / Clinic / Doctor
Etc.
Pharmaceuticals / Consumables
Patient / Family
CIS is a critical ‘virtual’ life support system for healthcare & logically, the
next priority after the payer Rajendra Pratap Gupta©Rajendra Pratap Gupta
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Patient Portal accessible via computers or mobile phones
Health Apps on all cell phones for health vitals , OTC based treatments & NCDs accessible only via EHR.
Enhanced participation and role of RNP /M & counselors
Payment for results & higher co-pay for people not taking to a healthier lifestyle
Suggestions
©Rajendra Pratap Gupta
CIS……
CIS will have to become universally interoperable in the years ahead, as today’s patient & healthcare travel with the speed of
‘dream-liners’ and try to seek the best of treatment possible , anywhere & anytime !
Rajendra Pratap Gupta
©Rajendra Pratap Gupta
Paradigm change without change management !
Use of CIS / mHealth or for that matter , any form of IT in healthcare is a paradigm change for the clinicians of the earlier millennium , &
so, this requires a ‘change management’ approach and is not just a ‘tool’ to be
incorporated and implemented in practice Rajendra Pratap Gupta
©Rajendra Pratap Gupta
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©Rajendra Pratap Gupta
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Disclosures & Acknowledgements
• Views presented are personal
• Presenter is associated with healthcare organizations across USA, Europe , U.K. India .
• The figures and studies are indicative & for representational purpose only
• Utmost care has been taken to quote the data. Any inadvertent error is regretted• • The presentation has used many resources and acknowledges the contributors with
appreciation and thanks . Some of the trade names / marks used may belong to third parties , and have been quoted just for the sake of information for the audience with or without the consent of the respective trademark owners .
• Please do not copy or reproduce in whole or part thereof, the contents of this presentation without the written permission from the presenter .
• Contact : president@dmai.org.in / Office.rajendra@gmail.com
©Rajendra Pratap Gupta
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