How eHealth Contributes to the Globalization of Health Care

eHealth Summit 2008Mont Tremblant, Quebec

Susan J Hyatt

GlobalizationGlobalization……the Borderless Worldthe Borderless World

“…globalization is nothing but liberalization of the individual, consumers, corporations, and regions from the legacy of the nation-state…Whether the consumers buy the best and cheapest from anywhere in the world is also their choice…Ultimately it is a competitive world and one that will migrate across national borders.”

“…globalization is nothing but liberalization of the individual, consumers, corporations, and regions from the legacy of the nation-state…Whether the consumers buy the best and cheapest from anywhere in the world is also their choice…Ultimately it is a competitive world and one that will migrate across national borders.”

— Kenichi Ohmae, The Next Global Stage (2005)— Kenichi Ohmae, The Next Global Stage (2005)

“As the world starts to move from the primarily vertical –command and control – system for creating value to a more horizontal – connect and collaborate – value-creation model…societies are going to find themselves facing a lot of very profound changes all at once.

“As the world starts to move from the primarily vertical –command and control – system for creating value to a more horizontal – connect and collaborate – value-creation model…societies are going to find themselves facing a lot of very profound changes all at once.

— Thomas L. Friedman, The World is Flat (2006)— Thomas L. Friedman, The World is Flat (2006)

New Global Business PlatformsNew Global Business Platforms

Platforms provide common ground for companies or individuals to communicate, in a standardized way, to get things done more quickly or efficiently. They are easy to use and adaptable. - Kenichi Ohmae, The Next Global Stage, 2005

English Inc.Technological (e.g., the Internet)US DollarBrands (e.g., Coca Cola)Global business cultureATMs, Smart Cards, GPS etc.

…Technology is powering this new global economy and triggering industry transformations.

What is an Industry Transformation?What is an Industry Transformation?“Transformation alters the…culture by changing selected underlying assumptions and the ways in which those assumptions manifest themselves in…behaviors, processes, and products; is deep and pervasive and therefore affects the whole...and, is purposeful; and occurs over time.”

“Transformation alters the…culture by changing selected underlying assumptions and the ways in which those assumptions manifest themselves in…behaviors, processes, and products; is deep and pervasive and therefore affects the whole...and, is purposeful; and occurs over time.” — CHET; South Africa— CHET; South Africa

Attributes of System-wide Transformation:

Old StateOld StateOld State New StateNew StateNew State

Forced to die

Fundamental shift in mindset& organizing principles

Islands of information

Isolated skill sets& competencies

Emerges from visioning,trial and error

Designed with intent to support new business directions/models

Continuous process& reinvention

Innovation embraced

Success?...Critical mass of organizations must operate from new stateSuccess?...Critical mass of organizations must operate from new Success?...Critical mass of organizations must operate from new statestate

Health Care is GlobalizedHealth Care is GlobalizedThe evidence continues to build although there is minimal Canadian comment to date…

1. Global business platforms are evidentEnglish is the language of global HCBrands – HIMSS USA, Europe and AsiaPacGlobal HC Culture – Open Health Tools

2. eHealth enables the HC industry transformation “Ehealth is a global phenomenon.” – World Health Organization, Building Foundations for eHealth, 2006

ehealth systems are now essential infrastructure in countries around the world

3. The “global health care bazaar”

Global Global eHealtheHealth/EHR Activity/EHR Activity

Strong EHR/eHealth Activity

OpportunityStatus:

Data N/A

England: >12b GBP EHR initiative in processWales; Scotland. N.Irelandunderway

Spain: Regional initiatives underway

Singapore: National EHR strategy in development

Chile: National RFP for EHR project expected soon

Argentina: 1st

adoption of a digital radiography solution-2004

South Africa: EHR infrastructure tendered

Australia: Revising nat’lehealth strategy; NEHTA refocusing

USA – Federal NHIN contract underway. Multiple State initiatives for RHIOS.Still emergent

Canada – Infoway co-invests $1.6 B for nat’l/regional EHR investments

Germany: Smart Health Card. Future EHRs to be regional

New Zealand: National EHR system; ’08 RFP to refresh infrastructure

Hong Kong:HKHA has EHR

Brazil: National Health Card Project

Norway: Developinga National EHR

Malaysia: Lifetime Health Record (LRH) by 2010

Mexico: No EHR but aim for HL7 Integration

China: Plans todevelop a national EHR

Italy: EHR regional initiatives started

Ireland: Nat’l EHR strategy complete. Procurement 08

France: EHR mandated for 07

Denmark: Focuson EMRs

Sweden: Developinga National EHR

Finland: Have procured for nat’l architecture; EHR applications in ‘07

India: Plans to develop national EHR

Netherlands:Regional EHR projects (focused on GPs)

South Korea:National identifier initiative

Taiwan:National identifier initiative

regional

Qatar/UAENat’l EHRs in development

Israel: Hospital based EHRs

National Initiatives Trigger HC TransformationNational Initiatives Trigger HC TransformationAccurate patient & provider identification & matching is the fouAccurate patient & provider identification & matching is the foundationndation

Electronic Health Record (EHR)Electronic Health Record (EHR)

• Realize returnon investmentfor strategicIT initiatives

• Improve customer service with reduced risk

• Comply with regulations

ROI

• Enhance operational productivity& efficiency

• Improve patient care and reduce medical risks

ROI

National Initiatives National Initiatives –– Critical Success FactorsCritical Success FactorsCommon to all initiatives….

Clear and articulated vision promoted by critical massof political and health care leadershipCommon Architecture for country collaboratively developed with standards-driven approachTransparent governance structuresand accountability frameworks

Additional factors in Canada…Portfolio management with targeted investment programs in infrastructure and clinical applicationsPrivacy Commissioners engaged in early dialogueWell-defined gated co-investment strategy to manage risk

The Challenge for Canada and the USThe Challenge for Canada and the US

%

Primary Care Doctors Use of Electronic Patient Medical Records, 2006

Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians

eHealtheHealth Enables HC Industry TransformationEnables HC Industry Transformation

Vision, Strategy & Investments continuously integrating with…

Vision, Strategy & Investments continuously integrating with…

PeoplePeople

• Capability, culture, leadership

• Innovativeorganizations

• Capability, culture, leadership

• Innovativeorganizations

Processes Processes

• Workflow, benefits framework

• Risk management

• Workflow, benefits framework

• Risk management

Transformation sustained by knowledge transfer…best practices, virtual communities & thought leadership

Transformation sustained by kTransformation sustained by knowledgenowledge tratransfernsfer……best practices, virtual communities & thought leadershipbest practices, virtual communities & thought leadership

ICT ICT

• Architecture,standards & security

• Privacy solutions

• Architecture,standards & security

• Privacy solutions

Questions Countries AskQuestions Countries AskIn Starting Up National eHealth Initiatives....

1. Where do we draw the boundaries between national information utilities and local eHealth applications? Should national utilities include health and social services? ...e-citizen initiatives?

2. How do we exploit the power of ICT networks to develop and sustain networked Electronic Health Records?

3. What is the transformative eHealth vision for our country?

4. How will this impact on service design and provision across the health care ecosystem?

5. How do we progress the vision? How do we get continued investment?

6. How will this impact on citizen’s expectations of their health system?

““The Global Health Care BazaarThe Global Health Care Bazaar””Global business platforms provide common ground for individuals to communicate…to get things done more quickly or efficiently…easy to use and adaptable.

750,000 Americans sought offshore medical care in 2007Why Canadians seek alternatives?

waiting lists; treatment not available here; HR shortage; costs in US

Global business platforms in place English language, low cost of international travel, easy telecommunications, digitized patient records and eventually interoperable EHRs

Typical procedures? Diagnostic tests, cancer therapies, hip and knee replacements, cardiac surgery, etc.MRI $495USD in Amherstburg, NY; Coronary Artery Bypass Graft $55,000USD in California and $5-10,000USD in India at cardiac centre

Opportunities for Opportunities for eHealtheHealth in the Global Economyin the Global Economy

Registration Layer: Distributed, Centralized or Hybrid IdentifiRegistration Layer: Distributed, Centralized or Hybrid Identificationcation

GlobalGlobalEconomic Focus:• New economy emerges as

information goes digital• Information & communication

technologies drive change• Socio-economic impact

triggers globalization, outsourcing, privacy concerns, etc.

Use electronic business processes across the value chain to increase shareholder value

E-Business:Use electronic tools to transform government service, delivery & management

E-Government: E-Health:Applications running on National Health Information Infrastructure (NHII)

InfostructureInfostructure Layer: Security, Privacy, Standards, Connectivity, etc.Layer: Security, Privacy, Standards, Connectivity, etc.

Customers, Suppliers& Organizations

Client, Service Provider& Agency

Patient, HC Provider & Location

CountryCountryGovernment Focus:

Security

NationalEfforts

PublicHealth &Safety

Education

Environ-mental

Protection

Law & Order

PhysicalInfrastructure,

etc.

RegionRegionShared E-Health Focus:

(e.g., EHRs)

Discharge SummaryDrug ProfileDiagnostic ImagingLab Information

D. Becker-Smith

Sources: Tapscott, Hyatt, Kling

Global Insight.

shyatt@hyattdio.com