delivering smart healthcare with ict innovations
TRANSCRIPT
Delivering Smart Healthcare with ICT Innovations
Disruptive Technologies and Healthcare Transformation
Pawel Suwinski2010 HIMSS APAC Congress and Leadership SummitDaegu, Korea
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“The most profound technologies are those that disappear.
They weave themselves into the fabric of everyday life until they are indistinguishable
from it”Mark Weiser
M.Weiser, The Computer for the Twenty-First Century, Scientific American, 265 (3), (1991).
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Introduction
• Despite Healthcare Delivery Industry having much to gain from Information and CommunicationTechnologies, it is the slowest from all industries in the adoption. There are many reasons for ITfailures in healthcare environment, but the single most important cause is the HIT capabilitymismatch to address work processes within healthcare service organisation.
• Until today, for more than 20 years ICT and healthcare service organisations have been lockedin a Love-&-Hate affair with neither being able the break the stalemate. It could be down to thatwe spent too much time on design and implementation and not on how end user react toalready implemented HIT solutions.
• HIT investment will only be successful if the fit between IT and clinical processes will be close tomatching, which will be reflected by the acceptance or rejection of end users.
• In the short history of HIT the emergence of new, disruptive technologies play a crucial role inclosing the capability gap and gaining more acceptance from the main users.
• The latest innovations are changing not only how the medical care is organised, practiced anddelivered but are also redefining host of other qualities including changing patient-physicianmodel and facilitating the emergence of new industry players within the value chain.
• Will these Innovations be successful in delivering better, smarter care?
Evolution of Healthcare Information Technologies
PMI EMR eHealth SmarteHealth
80’ 90’ 00’ 2010 2015
Health Informatics
Stand Alone Applications
Limited Functionality
Focused on Back-office Flow: Financial,Inventory & Patient Master Index
No interoperability
Stand Alone Applications
Extended Functionality
Focused on Administrative Flow :ADT, SchedulingPharmacy
Limited interoperabilityFirst Healthcare Standards
Hospital Information System – Single EMR
Full Functionality
Focused on integration of Administrative and ClinicalFlows
Full interoperability withinThe same location
E-Health – Lifetime Health record
Full Functionality, POC
Focused on advanced Clinical Flow and Business Intelligence Systems
Country and regionalinteroperability
Personalised E-HealthPersonalised Health Record
Full Functionality, HomeMonitoring
Focused on KnowledgeManagement/ Complex BI and AI Systems
Full Interoperability
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Complex Environment of HIT
Financial
GLARAPBillingPOThird Party PayerInsurance
Resource Management
Clinical Patient related
Life Sciences
Bio-InformaticsGene-SequencingGene-AnalyticsLibrary ISCollege ISResearch IS
ADTPMIEMRHERPHRHealth Portal
CISHospital Departmental Systems LISRISPACSPharmacyDecision Support System
InventoryHRSchedulingFacility ManagementReportingBusiness Intelligence
HEALTH INFORMATION SYSTEMS
Healthcare Information Technologies can be defined as any computer based products and services that are specifically designed anddeveloped for Healthcare Industry. This broad classification includes infrastructure, software, devices, and services that are used by all theparticipants within the healthcare value chain. As we later will see, the major consumer of HIT are the healthcare services organisation – thecare givers, and their will be our main focus when discussing the HIT.
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Capability Gap
Capability Gap
Industry Practice Characteristics
Unmet Needs
Large quantity ofdata/information
Met Needs
Partial Capture/Store/Retrieval Full capture. POC Capture/ RetrievalNon-disruptive to work processes/ RelevantRetrieval
Sensitive Data/ InformationPartial Security/ Confidentiality/Privacy (PKI, Biometrics, SSL) Full Security/ Confidentiality/ Privacy
MobilityMobile Devices/ WirelessConnectivity
Non-disruptive to work processes andlifestyle. Remote sensors and automatedcapture/ retrieval/ alerts
Complexity
Collaboration
Mission Critical
Follow work processes : improve on but donot disrupt. Easy to implement andcustomize by the user.
One lifelong health record collating allwellness and illness parameters.
Analytics that deliver accurate and relevantinformation at the POC. Non-disruptive towork processes.
Limited integration – not all processesautomated. Long implementation timesand high failure ratio. Limitedcustomisability.
Limited Interoperability mostly atlocal level – EHR/PHR
Partial analytics (mostly non-clinical)
HIT Development/Adoption Cycle
Excitement
Disappointment Threshold
Requirements fully Implemented
Requirements not Implemented
Customer Satisfied
Customer Dissatisfied
Source: Frost & Sullivan.
1980 1990 2000 2010 2020
The ICT has entered intoHealthcare DeliveryIndustry with “big bang”of excitement .
Decade later, the moods wererunning low as thetechnologies failed to meetthe expectations. The ride hasbeen continuouslydownwards.
With new innovations on thehorizon, the credibility credithas been rebuilt. We might belooking upwards and finallyclimbing the slope.
Despite HIT Shortcomings Sustained and Long Term Demand for Healthcare Services will support HIT Growth
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• Increase in population•Population Ageing
Changing Demographics
•Increase in life style diseases• Increase in chronic diseases
Changing Disease Patterns
•Consumer expectations toward s governments•Politicization of stakeholder groups
Political Importance
• Change in value system: health is valued more• Healthcare consumerism: consumers are making decisions about their own care needs
• Medical Tourism
Changing Consumer Behaviour
•Cheaper drugs•Cheaper diagnostics
Technological Advances
•New treatments are becoming very expensive•Practice insurance drives cost of services highCost Pressures
Increased Demand for Healthcare Services
Demand Drivers
Increased Supply of Healthcare Services
Increased Supply of HIT
Global Trends on Expenditure on HIT
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• The delivery of care depends on information madeavailable to both: the caregivers and executives.The more accurate and timely data the betterdecision-making processes, and therefore betteroperational strategies and clinical outcomes can beattained.
• The adoption of Information and CommunicationTechnologies (ICT) is essential for modernhealthcare delivery systems to gain greaterefficiency, reduce overall healthcare costs andimprove patient safety.
• In recent years, the acquisition of computertechnologies by healthcare organizations hasincreased substantially with the spending showingupward tendency placing the industry as one of themajor consumer of ICT products and services.
• In 2009, the Global expenditure on HealthcareLicensed Applications by healthcare providersstood at USD 3Billion for North America, USD 1.9Billion for Western Europe, and USD 0.8 Billion forAsia Pacific. All three regions will experience highgrowth rate (on average CAGR ~10%) due toincreased demand for healthcare services.
License Software Spent by Healthcare Providers in 2010 in USD Billion
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Note: All figures are rounded; the base year is 2009. Source: Frost and Sullivan
*Healthcare IT includes: Software, Hardware, IT services and Lifesciences IT
Asia Pacific Life sciences and Health IT Market*Interoperability challenges hinder adoption
7.1 7.9 8.8 9.8
43.5 46.7 49.6 52.7
0
10
20
30
40
50
60
70
80
2009 2010 2011 2012
Rest of the World
APAC
14.5% 15.7%
Market Drivers
Market Restraints
Strong and sustained demand for healthcare services
Demand for higher quality of healthcare and access to information
Interoperability of discrete medical equipment
Bandwidth
Lack of skilled resources for implementation
Lifesciences & Healthcare IT, US$ Bn, 2009-2012
CAGR7%
CAGR11.3%
APAC Share
50.654.6
58.4 62.5
APAC License Software Market (TMP) By CountryUS $ (MM) and 4 Year CAGR (%)
Lice
nsed
Sof
twar
e Sp
end
in U
S $
(MM
)
4 Ye
ar C
AG
R (%
)
Japan, Australia and China are the biggest markets while China, Malaysia and Thailand presents the most significant market growth in APJ 2010 – 13.
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Extending Care Beyond Hospitals - Connected Healthcare
• Connected Healthcare is a care delivery model that uses technology enabled solutions toexpand the care capabilities beyond healthcare institutions to natural human habitats.
• The main aim of Connected Healthcare is to maximize healthcare resources, increasepreventive and predictive component of care with the expectation of keeping individualsas healthy as possible and less dependent on curative care.
• It works through deploying sensor – monitoring devices, data storage and analytics, andcommunication channels to healthcare providers for decision making process, careplanning and delivery. It empowers the individuals to self manage medical needs, andprovide cannels for more interactive communications with healthcare professionals.
• At present, It is directed at chronic diseases, aged population, and dependency. Thescope, however, is rapidly expanding to include entire population to mange health ratherthan to monitor illness. Smart homes, the mush up of real estate and healthcare is anatural expansion of Connected Healthcare.
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Connected Healthcare – Uses and Benefits
Products/Services
Practical Applications
• Telehealth• Wired/wireless sensors• Nursing Alarms/Alerts• Enterprise Mobility Solutions• GSM/Wimax healthcare
applications• Voice Communication• Pagers
• Outreach Programmes for underserved locations: Telehealth and Telemedicine• In-building Communication – providing common infrastructure for all voice and data communication• Preventive and predictive measures against Hospital Acquired Infections• Patient monitoring within hospital and outside (home monitoring)• Remote consultation and supervision. • Emergency medicine – alerts/alarms
Growth Potential
Growth Potential
0
1
2 3
4
5
4.0
Maturity/Adoption Level
Maturity/Adoption Level
0
1
2 3
4
5
2.0
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Empowering Patients/Individuals - Interactive Healthcare
• With the adoption of Web 2.0, collaborative technologies were introduced allowingunprecedented level of social interactivity. The use of Web 2.0 applications and resourcesfor health related purposes is called Health 2.0
• Health 2.0 has become very popular and important platform for patients and consumers tofind health information, interact with each other in virtual communities, and communicatewith care givers. It empowers individual to manage own health according to personalpreferences.
• Health 2.0 provides communication platform to healthcare organisations to reach out totheir existing and potential clients. Hospital Portals and presence in the SocialNetworking Medias (e. g. Facebook, Twitter) has redefined marketing and salesstrategies.
• According to the Pew Internet & American Life Project, 83 percent of Internet users havelooked online for health information. New data released by Pew this week show manypeople are now using cell phones to search for health information - 29 percent of cellphone owners age 18 to 29, and 17 percent of cell owners overall. It's the first time Pewhas surveyed health searches on cell phones.
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Interactive Healthcare – Uses and Benefits
Products/Services Maturity/Adoption Level
Practical Applications
• Email• Instant Messenger• Blog• PHR• Analytics Applications (Health
3.0)• Web – Mobile Devices interfaces• Wikis
• Provider – Consumer Relationship: influence on Consumer by providing relevant information• Provider: Promotion and Marketing Activities • Medical Tourism : enabling decision making about the desired destination• Consumer: source of information on healthcare related topics• Consumer: Support groups• Provider/Researcher: analytical tools
Maturity/Adoption Level
0
1
2 3
4
5
1.5
Growth Potential
Growth Potential
0
1
2 3
4
5
3.5
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Making Care More Efficient - Cloud Healthcare
• Cloud Computing is an IT architecture model that virtualises computing resources todeliver them on demand and in required quantities. These resources are highly scalable(almost infinite) and highly available (24/7).
• The main characteristics of cloud computing are:– User does not own hardware, network, and application resources– Computing resources are provided through remote data centres on a subscription basis (on
demand).– The infrastructure and services are delivered, accessed by user, via web browser (cloud).
• In cloud computing architecture, user is running services not on the local terminal butremotely. It means that instead of transferring data from remote host to be processed onthe local terminal all transactions take place outside the local terminal.
• Healthcare industry is just exploring the capabilities and benefits of cloud computing. Themain concern is over security of medical information as all is residing off-site in remotedatacenter. However, the economic advantages to healthcare providers are making someto venture into the virtual realm of cloud computing.
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Cloud Healthcare – Uses and Benefits
Products/Services
Practical Applications/Benefits
• Software as a service (SaaS)• Infrastructure as a service (IaaS)• Platform as a service (PaaS)
• Back office applications (Resource Management) , Office Automation and Productivity Tools can be easily accessed already without costly investments.
• Providers do not need to maintain infrastructure• Clinical Applications and Patient Management can be delivered using Private Cloud where all data is protected. Such
network can be created with data-centre within organisation.• Payment Model is based on subscription or pay-as-you-go.
Maturity/Adoption Level
Maturity/Adoption Level
0
1
2 3
4
5
0.5
Growth Potential
Growth Potential
0
1
2 3
4
5
1.5
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Knowledge care - Business Intelligence in Healthcare
• Business Intelligence (BI) is a broad concept describing the process of transforming data intoactionable knowledge. In recent years the term has became a label for information technologies:software and infrastructure that facilitate the BI process. Such applications capture, collate, store,transfer, retrieve, and analyse data to generate best choices for strategic decisions in the form of “what-if” analysis, predictive analytics, and multi dimensional data mining that in a blink of an eye deliver,insightful advises for managerial and clinical use.
• BI applications act as integration platform across the entire organisation. They connect togetherdisparate systems to collect and exchange needed data. They glue the “silo” environment together toprovide a seamless framework for information exchange and processing.
• Can be used as Health 2.0 and 3.0 applications linking data sources with analytical capabilities.
• By linking applications that otherwise were not communicating freely the BI is able to reduce themanual process effort used to facilitate exchange of information. The automation significantly canreduce access to data as well the occurrence of unintentional human errors while handling the data.
• BI solutions provide dedicated informational path linking the source of request/query with timely andrelevant information.
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Intelligence in Healthcare - Impact and Uses
Products/Services
Practical Uses/Benefits
• Reporting• Analytics• Predictive information modelling• Integration• Visualisation - Dashboards
• Administrators: timely and accurately information on organizational economic performance and resource utilisation. • Care Givers: timely and relevant information delivered at the point of care• Patients: Improved quality of care• Organisation: creating platform for virtual organisation.• Public/scientists: utilisation of Health 2.0 analytical capability to conduct custom research
Maturity/Adoption Level
Maturity/Adoption Level
0
1
2 3
4
5
2.0
Growth Potential
Growth Potential
0
1
2 3
4
5
4.5
21
Moving Beyond Reality - Virtual Healthcare
• Virtual Reality is the ability to create artificial environment with the ability to act as it wasreal. It used advanced technologies to generate space and physical fabric and appliesartificial intelligence to add interactive component. It is experienced by two senses(presently): sight and sound.
• Lighter version of Virtual Reality – Simulation has been well adopted by most industriesincluding healthcare.
• The major users of these technology are gaming and military industries. It has also beensuccessfully adopted by healthcare for simulations, 3D Image modelling for laparoscopicprocedures, treatments, rehabilitation, and assessment.
• Virtual reality can be divided into:– The simulation of a real environment for workflow processes analysis and design,
training, education, therapies.– The development of an imagined environment for health assessment, capability
assessment, and therapies.
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Virtual Healthcare – Uses and Benefits
Products/Services
Practical Uses/Benefits
• Simulators• Virtual Reality• Augmented Reality• 3D Modelling• Games
• Training for healthcare professionals• Simulation for work processes and facility design• Disease Control: spread of contagious diseases• 3D preoperative and perioperative modelling• Treatment (phobias, rehabilitation, compliance to medication)
Maturity/Adoption Level
Maturity/Adoption Level
0
1
2 3
4
5
1.5
Growth Potential
Growth Potential
0
1
2 3
4
5
3.0
OutcomesProvider Consumer
Technology Impact on Stakeholders and Care Quality
Source: Frost & Sullivan.
Low HighKey :
Intelligent Healthcare
Low High1 52 3 4
Low High
1 52 3 4
Low High 12.0
Cloud Healthcare Low High
1 52 3 4
Low High
1 52 3 4
Low High 8.0
Connected Healthcare Low High
1 52 3 4
Low High
1 52 3 4
Low High 10.0
Virtual Healthcare Low High
1 52 3 4
Low High
1 52 3 4
Low High 8.0
Interactive Healthcare Low High
1 52 3 4
Low High
1 52 3 4
Low High 12.0
Total 15 Points
1 52 3 4
1 52 3 4
1 52 3 4
1 52 3 4
1 52 3 4
Connected Healthcare
Cloud Healthcare
Interactive Healthcare
Intelligent Healthcare
Virtual Healthcare
0
1
2
3
4
5
6
0 1 2 3 4 5 6
Technology Strategic Roadmap
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Out
com
es Im
pact
Providers Impact
High
HighLow
Low
Bubble size shows Impact on ConsumerLarge Size = HighSmall Size = Low
25
Smart Healthcare: Communication Trends
HOME CARE
INSTITUTIONAL CARE
Specialty Clinic
Hospitals
Current Model: Curative & Provider Focused
Telehealth
Connectivity
Communication/Voice
Source: Frost & Sullivan, Motorola
Tracking/ResourceManagement
Nursing HomesCommunication/Data
Home Monitoring
Aged Care
Smart Homes
Assisted LivingCritical Alarms
Smart Model: Continuum of Care & Patient Focused.