Global&challenges&[1&of&3]&Increasing*healthcare*cost*and*leveling*of*health*impact*

1"

Healthcare)costs)spiral…)

…as)health)outcomes)plateau)

“Without"precise"measurement"innova3on"is"doomed"to"be"rare"and"erra3c…""With"it,"inven3on"becomes"commonplace”")2013"Annual"Le?er"from"Bill"Gates"(quo3ng"The$Most$Powerful$Idea$in$the$World,"by"William"Rosen)"

Global&challenges&[2&of&3]&There’s*huge*value*left*on*the*table…*

2"

Cost)of)NCDs)US$47)trillion)Cumula3ve"lost"output"in"all"developing"countries"due"to"NCD"2011L2025"

NCDs"were"the"second"ever"health"issue"addressed"at"a"special"mee3ng"of"the"United"Na3ons"General"Assembly

Cost)to)fix)it)US$170)billion)Overall"cost"for"all"developing"countries"to"implement"WHO""best"buy""interven3ons"for"NCD"2011L2025"

Global&challenges&[3&of&3]&Data*innovation*today*is*very*siloed*

3"

Siloed&data&systems&cannot&talk&to&each&other…&!

1.  Huge!complexity!for!buyers!

2. Market!cannot!put!a!price!to!a!

product!

3. Reinventing!the!wheel!

4. Increased!development!costs!!

5. Limited!market!size!

6. Limited!data!aggregation!

Results'

Uptake'•  >650,000&unique&patient&IDs&issued&in&Malawi&•  >6,000&patients&with&diabetes&•  Enthusiastic&clinicians&response&&Health'outcomes'•  Lower&patient&drop=out&and&death&rates&•  Reduction&of&drug&errors&

Scalability'•  Fully&open=source&system&

Additional'benefits'•  Automated&diabetes&registry,&enabling&

–  More&accurate&government&drug&forecasting&&

–  Better&referral&and&planning&of&surgically&necessary&treatments&(amputations,&foot&ulcers&etc.)&

•  Low=cost&power&backup&systems&&•  Hardware&for&information&storage&and&

transfer&

Background'&•  Data&critical&for&high&quality&patient&care,&

programme&monitoring&and&evaluation,&preventing&drug&stock=outs,&etc.&

•  Manual&paper=based&aggregation&of&data&and&compilation&of&reports&now&unfeasible&

Approach'

&•  User=friendly,&graphics=based&touchscreen&

incorporating&(in&one&shot):&1.  Basic&patient&medical&history&&2. Clinician&alerts&and&decision&support&3. Fully=automated&reports&for&M&E&4. Data&collection&for&secondary&uses&

Examples'we’ve'explored:'Baobab&A'Harries'

11"

Source' &Douglas&GP,&Gadabu&OJ,&Joukes&S,&Mumba&S,&McKay&MV,&Ben=&Smith&A,&Jahn&A,&Schouten&EJ,&Lewis&ZL,&van&Oosterhout&JJ,&Allain&TJ,&Zachariah&R,&Berger&SD,&Harries&AD,&Chimbwandira&F&(2010=.&&Using'Touchscreen'Electronic'Medical'Record'Systems'to'Support'and'Monitor'National'Scale?Up'of'Antiretroviral'Therapy'in'Malawi.'PLoS&One&Medicine,&August&2010,&Volume&7,&Issue&8&&Allain&TJ,&van&Oosterhout&JJ,&Douglas&GP,&Joukes&S,&Gadabu&OJ,&Darts&C,&Kapur&A,&Harries&AD&(2011).&&Applying'lessons'learnt'from'the'‘DOTS’'Tuberculosis'Model'to'monitoring'and'evaluating'persons'with'diabetes'mellitus'in'Blantyre,'Malawi.&&Tropical&Medicine&and&International&Health,&volume&16&no&9&pp&1077–1084&

Results'

Uptake'•  13#centres#already#use#eHealth#•  System#consolidation#underway#for#others##Health'outcomes'•  XX#

Scalability'•  XX#

Additional'benefits'•  XX#

Background'

•  24#centres#for#MCH/Diabetes#with#>200,000#patients/year#attend#them#

##

Approach'

•  Possibility#of#using#eHealth#to#monitor#mother#and#child#care#and#take#more#detailed#medical#records,#and#also#the#organisation’s#desire#to#expand#the#services#surrounding#diabetes#and#hypertension#

•  Mobile#health#initiative##

Examples'we’ve'explored:'Jordan'A'Harries'

12#Source' #XX#

Results'

Uptake'•  94%$eligible$population$within$<18$months$•  >190,000$$Health'outcomes'•  Discovered$‘silent$killer’$risk$factors$

–  1/3$diabetes$=$11,000$–  1/2$high$blood$pressure$=$27,000$–  2/3$high$cholesterol$=$$

•  24%$increase$in$patient$engagement$with$care$•  18%$increase$in$good$control$of$diabetes$•  20%$increase$in$good$control$of$cholesterol$

Scalability'•  Fully$openKsource$system$

Additional'benefits'•  Secure$patient$access$web$portal$•  CloudKbased$•  Multimedia$(web,$call$centre,$mobile,$smartphone$

apps,$etc.)$•  Rockefeller$implementation$OpenHDD$•  Platform$Health$ITU$standard$(H.MEDX)$

Background'$•  UAE$second$highest$prevalence$of$type$2$

diabetes$in$the$World$•  Comprehensive$health$reform$with$universal$

health$insurance$

Approach'•  Innovative,$lowKcost,$secure$eHealth$system$

(Shafafiya)$•  Pioneering$eHealthKenabled$population$NCD$

programme$(Weqaya)$

•  Weqaya$logo$on$healthy$products$•  Open,$secure$mobile$Cloud$•  API$creates$market$for$Weqaya$apps$•  Disease$Management$Programme$market$

Examples'we’ve'explored:'Abu'Dhabi'O'Harrison'

13#

Source' 'Podolak$I,$Vetter$P,$and$Harrison$O$(2012).$$Measuring'Health'Data'Management'Maturity'in'Abu'Dhabi'Health'Policy'and'Technology.$$Health$Policy$and$Technology$$Hajat$C,$Harrison$O,$Al$Siksek$Z$(2011).$Weqaya:'A'Whole'Population'Cardiovascular'Screening'Programme'in'Abu'Dhabi.$$AJPH$2011,$22$September$$Hajat$C,$Harrison$O$(2010).$The'Abu'Dhabi'Cardiovascular'Program:'The'Continuation'of'Framingham.$$Prog.$Cardiovasc.$Dis.,$Vol$53,$Issue$1,$JulyKAugust$2010,$pp28K38$$See$http://www.jointlearningnetwork.org/content/openhdd$and$http://www.jointlearningnetwork.org/content/dayKoneKsiteKvisitKabuKdhabi$$Weqaya$materials$available$online$at$URL$www.weqaya.ae$$

Source!!Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pp759T760!

Abu&Dhabi&was&an&ideal&market&for&innovation&in&tackling&chronic&disease&

4"

2.6m"lives:"“Big"enough"to"ma?er,"small"enough"to"manage…”"

Highly"strategic"government"with"broadLbased"popular"trust"

Extreme"pace"and"depth"of"socioLeconomic"development"–"very"high"burden"of"NCDs"

Plural"and"diverse"payers"and"providers"

Rela3vely"wellLresourced"health"system"enabling"innova3on"

Source )Weqaya,"Abu"Dhabi;"presented"in"public"at"the"IDF"World"Diabetes"Congress,"Dubai"2011"

“Closing&the&health&loop”&within&a&plural&healthcare&market,&at&population&scale&

Baseline)assessment)•  Secure"ID"(NHS"number)"•  CVD"risk"(e.g.,"NHS"Health"Check)"

Clinical)care)+)

SelfBcare)

Monitoring)+)

evaluaFon)Amendment)to)treatment)

plan)

Reassess!Shared)data)

5"

ClosedFloop&public&health&works&Abu*Dhabi*case*example*

6"Source&&Weqaya,!Abu!Dhabi;!Presented!at!the!IDF!World!Diabetes!Congress,!Dubai!2011!

Everyone&can&know&their&numbers…&

M A M J J A S O N D J F M A M J J A S O N D J F

2008! 2009! 2010!

…&and&the&numbers&can&change&health&outcomes&

%&engaged&with&care*&

%&with&HbA1c&<7.5%& %&with&LDL:HDL&ratio&<3.5&

100%*=*±220,000* 94%$$uptake$

Sustainable&business&models&distribute&risk&of&future&health&costs&and&align&incentives&for&health&

7"

Range&of&Disease&Management&Providers&

&!

!

!

Consent&for&data&

Pay&for&health&Tariff*set*as*a*

proportion*of*the*avoidable*cost*of*

complications*

Range&of&Apps&and&services&

Significant&Health&IT&innovation&in&a&wide&range&of&countries&

8"

•  UNRWA,!

Jordan!

•  Baobab,!Malawi!

•  Text!for!Change,!

Uganda!

Low* Medium*

Low*

Income&

Previous&eHealth&

capability&

High*

•  Arogya,!india!Medium*

•  Weqaya,!Abu!

Dhabi!

•  Text!to!Quit,!

New!Zealand!

High*

•  SHINTNY,!New!

York!

•  FoodSwitch,!

Australia!

•  Text4Baby,!USA!

Data&innovation&remains&siloed&

9"

Siloed&data&systems&cannot&talk&to&each&other…&!

1.  Huge!complexity!for!buyers!

2. Market!cannot!put!a!price!to!a!

product!

3. Reinventing!the!wheel!

4. Increased!development!costs!!

5. Limited!market!size!

6. Limited!data!aggregation!

Results'

Uptake'•  >650,000&unique&patient&IDs&issued&in&Malawi&•  >6,000&patients&with&diabetes&•  Enthusiastic&clinicians&response&&Health'outcomes'•  Lower&patient&drop=out&and&death&rates&•  Reduction&of&drug&errors&

Scalability'•  Fully&open=source&system&

Additional'benefits'•  Automated&diabetes&registry,&enabling&

–  More&accurate&government&drug&forecasting&&

–  Better&referral&and&planning&of&surgically&necessary&treatments&(amputations,&foot&ulcers&etc.)&

•  Low=cost&power&backup&systems&&•  Hardware&for&information&storage&and&

transfer&

Background'&•  Data&critical&for&high&quality&patient&care,&

programme&monitoring&and&evaluation,&preventing&drug&stock=outs,&etc.&

•  Manual&paper=based&aggregation&of&data&and&compilation&of&reports&now&unfeasible&

Approach'

&•  User=friendly,&graphics=based&touchscreen&

incorporating&(in&one&shot):&1.  Basic&patient&medical&history&&2. Clinician&alerts&and&decision&support&3. Fully=automated&reports&for&M&E&4. Data&collection&for&secondary&uses&

Examples'we’ve'explored:'Baobab&A'Harries'

11"

Source' &Douglas&GP,&Gadabu&OJ,&Joukes&S,&Mumba&S,&McKay&MV,&Ben=&Smith&A,&Jahn&A,&Schouten&EJ,&Lewis&ZL,&van&Oosterhout&JJ,&Allain&TJ,&Zachariah&R,&Berger&SD,&Harries&AD,&Chimbwandira&F&(2010=.&&Using'Touchscreen'Electronic'Medical'Record'Systems'to'Support'and'Monitor'National'Scale?Up'of'Antiretroviral'Therapy'in'Malawi.'PLoS&One&Medicine,&August&2010,&Volume&7,&Issue&8&&Allain&TJ,&van&Oosterhout&JJ,&Douglas&GP,&Joukes&S,&Gadabu&OJ,&Darts&C,&Kapur&A,&Harries&AD&(2011).&&Applying'lessons'learnt'from'the'‘DOTS’'Tuberculosis'Model'to'monitoring'and'evaluating'persons'with'diabetes'mellitus'in'Blantyre,'Malawi.&&Tropical&Medicine&and&International&Health,&volume&16&no&9&pp&1077–1084&

Results'

Uptake'•  13#centres#already#use#eHealth#•  System#consolidation#underway#for#others##Health'outcomes'•  XX#

Scalability'•  XX#

Additional'benefits'•  XX#

Background'

•  24#centres#for#MCH/Diabetes#with#>200,000#patients/year#attend#them#

##

Approach'

•  Possibility#of#using#eHealth#to#monitor#mother#and#child#care#and#take#more#detailed#medical#records,#and#also#the#organisation’s#desire#to#expand#the#services#surrounding#diabetes#and#hypertension#

•  Mobile#health#initiative##

Examples'we’ve'explored:'Jordan'A'Harries'

12#Source' #XX#

Results'

Uptake'•  94%$eligible$population$within$<18$months$•  >190,000$$Health'outcomes'•  Discovered$‘silent$killer’$risk$factors$

–  1/3$diabetes$=$11,000$–  1/2$high$blood$pressure$=$27,000$–  2/3$high$cholesterol$=$$

•  24%$increase$in$patient$engagement$with$care$•  18%$increase$in$good$control$of$diabetes$•  20%$increase$in$good$control$of$cholesterol$

Scalability'•  Fully$openKsource$system$

Additional'benefits'•  Secure$patient$access$web$portal$•  CloudKbased$•  Multimedia$(web,$call$centre,$mobile,$smartphone$

apps,$etc.)$•  Rockefeller$implementation$OpenHDD$•  Platform$Health$ITU$standard$(H.MEDX)$

Background'$•  UAE$second$highest$prevalence$of$type$2$

diabetes$in$the$World$•  Comprehensive$health$reform$with$universal$

health$insurance$

Approach'•  Innovative,$lowKcost,$secure$eHealth$system$

(Shafafiya)$•  Pioneering$eHealthKenabled$population$NCD$

programme$(Weqaya)$

•  Weqaya$logo$on$healthy$products$•  Open,$secure$mobile$Cloud$•  API$creates$market$for$Weqaya$apps$•  Disease$Management$Programme$market$

Examples'we’ve'explored:'Abu'Dhabi'O'Harrison'

13#

Source' 'Podolak$I,$Vetter$P,$and$Harrison$O$(2012).$$Measuring'Health'Data'Management'Maturity'in'Abu'Dhabi'Health'Policy'and'Technology.$$Health$Policy$and$Technology$$Hajat$C,$Harrison$O,$Al$Siksek$Z$(2011).$Weqaya:'A'Whole'Population'Cardiovascular'Screening'Programme'in'Abu'Dhabi.$$AJPH$2011,$22$September$$Hajat$C,$Harrison$O$(2010).$The'Abu'Dhabi'Cardiovascular'Program:'The'Continuation'of'Framingham.$$Prog.$Cardiovasc.$Dis.,$Vol$53,$Issue$1,$JulyKAugust$2010,$pp28K38$$See$http://www.jointlearningnetwork.org/content/openhdd$and$http://www.jointlearningnetwork.org/content/dayKoneKsiteKvisitKabuKdhabi$$Weqaya$materials$available$online$at$URL$www.weqaya.ae$$

Source!!Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pp759T760!

WHOBITU)Joint)IniFaFve)in)mHealth)Developing!the!technology,!delivering!the!promise!

10"

Brings!eight!countries!that!

may!implement!Open!

Health!Platforms!to!help!

refine!the!approach!and!

technology!

Open&Health&Platforms&joinsFup&silos&whilst&maintaining&security&and&commercial&boundaries&

11"

Transformative&change!1.  Unification!of!effort!

2.  Clarity!for!buyers!!

3.  Open!market!for!

devices,!Apps!and!

services!

4.  Scalability!(national!and!transnational)!

5.  (A)!scalable!business!model(s)!

Source&&Estrin!D,!Sim!I!(2010).!!Open!mHealth!Architecture:!An!Engine!for!Health!Care!Innovation.!!Science,!Vol!330,!pages!759T760!

Taking&the&first&steps&

1.  Interoperability!standards:!

-  How*to*exchange*data:!HL7,!ITUTT!H.810!(Continua!Health!Alliance)!-  Which*data*to*exchange:!ITUTT!H.MEDX!(Platform!Health)!

2.  PopulationTscale!demonstrators!(“early!adopters”)!

3.  Dissemination!of!best!practice!

-  Implementation!toolkits!

-  WriteTups!

-  Informed!commissioners!

-  Private!Sector!incentives!for!growth!

12"

Transforming&healthcare&delivery:&Success&stories&&&Abu*Dhabi*and*WHOKITU*mHealth*Joint*Initiative*

Wednesday,!26!February!2014!