rajendra pratap gupta chairman member, board of directors global agenda council digital health (...

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


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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


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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



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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



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Universal Healthcare leads to increase in the ‘waitlist’ , ‘waiting times’, increasing

investment and the practice of defensive medicine.



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


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


mHealth , CIS & UHC


( 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)


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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)


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

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“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)



mHealth – in the next three years

Patients View

46 % Reduce

cost

52 % Convenien

ce

48 % Quality

* Emerging mHealth : Path for growth. PwC & EIU report


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



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


How patients define mHealth


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


How patients define mHealth


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


Top drivers for patients to consider beginning to use or increase use of mHealth applications / services


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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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mHealth behind the Times Most powerful people - 2013

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• 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


http://www.nhsq.info/strategy-goals-and-projects/preventive-healthcare/nutrition-and-physical-activity

http://www.nhsq.info/strategy-goals-and-projects/preventive-healthcare/nutrition-and-physical-activity

http://www.who.int/gho/countries%20/qat.pdf

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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



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



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


Digital Health , POCD driven & home based –

Pre-emptive care model

@ Home / office desk

RNP / Health

Counselor

mHealth / eHealth

POCD / Non

invasive diagnosti

cs


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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 .



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


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


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 !



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


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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 : [email protected] / [email protected]


mailto:[email protected]

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