What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?. Crawford J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. COCIR session
eHealth Market?
Present and Prospects, A View from Industrial Players
What eHealth strategies work and do not work, and what
should be implemented to effectively meet these
healthcare ‘transformational’ imperatives?
John Crawford
COCIR HealthCare IT Committee Member

2. The pressing need for healthcare system transformation
Cost Quality Productivity
Cost rising at a rate higher than GDP; One size fits all treatments Too little patient involvement
e.g., US costs projected to reach 20% Fee-for-service payment models; Slow and inefficient processes
US GDP by 2017 (world highest) money does not buy quality Little best-of-breed methodologies
Aging population; most of the cost is Lack of Comparative Effectiveness and processes
during the last 2 years data
No quantitative and comparative Disease centered versus wellness
value options centered
Preventable errors; too many deaths
caused by preventable mistakes
Complexity

3. eHealth supports the entire spectrum of benefits from productivity gains,
through improved patient access, to high quality care and health maintenance
Basic Intermediate Advanced
Productivity for Access for Quality for
Providers & Payers Patients Citizens & Consumers
Wellness & Welfare
Chronic Disease
Public Health Surveillance
Electronic Health Records
Telemedicine
Clinical Information Systems
Hospital Information Systems

4. eHealth can enable cost reduction, improve quality of care through systemic
evidence generation and use, and supports new payment and delivery models
Tomorrow
eHealth Transformation Bridge Molecular Diagnostics / “-omics”
Today
Evidence-based practice
ICT Education
Personalized medicine
Intuitive medical practice Improved Clinical Pathways
Patient-centered & collaborative
„One-size-fits-all‟ Electronic Patient Records
Outcome-based payment
Institution-based care Electronic Health Records
Fee for service New Payment Models
Lower costs, activated patients,
Improved outcomes
New Delivery Models

5. Recognising the importance of ICT in healthcare transformation, there has
been a recent surge of eHealth programmes and key investments worldwide,
based on a strong vision, political will, and sustained funding
Europe
England (NPfIT) - ₤12B
Asia North America
China – $4.2B US (ARRA) – $20.4B
Singapore – $1.1B SIN Canada (InfoWay) –$3.1B CDN
Middle East
Saudi Arabia – $14B
Worldwide
EPR/EHR investments >$10B in 2010 rising to >$30B by 2019

6. What eHealth strategies work and do not work?
• Successful approaches share the following attributes:
• A strong vision of the goal, political will and sustained funding
• Consistency of policy across all stakeholder organisations
• Willingness to change care processes to take advantage of ICT,
supported by new legislation, business and financing models
• A clear set of priorities for implementing eHealth projects, including
expected benefits, incentives and additional support where needed
• A steady step-by-step adoption of change, with realistic
expectations defined, and successes clearly communicated
• A robust governance model to set the agenda, establish technical
standards and architectures, and monitor implementation

7. What eHealth strategies work and do not work?
• Failing approaches share the following attributes:
• Constantly changing goals, weak consensus between political
factions, and lack of investment (healthcare as a political football)
• Lack of joined-up health policy, misaligned incentives
• Innovation held back because of medical conservatism, fears
about loss of revenue or status, and previous failed ICT projects
• Confusion and disagreement about how health information will be
exchanged, and how eHealth services will be funded
• Unrealistic timescales, limited public perception of improved
service, bad press about money being „wasted‟
• Fragmentation and duplication of effort, focus on technology-driven
projects rather than safety, efficiency or outcome improvements

8. Some examples of the transformative power of eHealth supported by a vision,
strong political will, and sustained investment
Canada Health InfoWay Denmark Healthcare Data Network
“By 2010, 50 per cent of Canadians and by 2016, 100 Universal EHR use; 98% GPs, majority of specialists,
per cent of Canadians will have their electronic health all 73 hospitals, all 331 pharmacies and about half the
record available to their authorized professionals…” 98 local authorities
Widespread use of PACS has increased radiologist Incentives for standards-based EHR adoption, plus
productivity by 23 percent, saving an estimated $1B a year. national eHealth portal (sundhed.dk) for patients
In 2009 the PharmaNet system in British Columbia avoided Cumulative present value cost of prior to YE2005 was
2.5M potential cases of drug interactions. €536M , benefit was €872M (Empirica)
Typical GP serving 1,300 patients, saves
In Alberta, WebSMR has reduced post- 30 hour/week of secretarial work by using
surgical reporting from 1 month to 1 hour eHealth standards (Empirica)
Success factors:
• Develop a strong vision for the way healthcare will be structured, organized, managed,
financed, delivered and monitored, and how ICT will support this.
• Share a collective vision of eHealth in order to assist users, health professionals, suppliers and
procurers in signing up to the benefits of eHealth.
• Integrate the policy process, as issues will cut across the remit of different government
departments and agencies.

9. Some examples of the transformative power of eHealth supported by a change
in business & financing models
Geisinger ProvenCare Kaiser Permanente
Implemented EHR in 1995, Clinical Decision Support Pre-paid plans and emphasis on preventive care; full
(CDIS) in 2009, to „hard wire‟ best practice into systems deployment of EHR and CPOE in 2003
ProvenCare care program provides 90 day warranty on 8% reduction in doctor visits and 14% reduction in phone
outcomes calls among My Health Manager (patient portal) users.
Re-admission within 30 days has fallen from 6.9% to 3.8% Kaiser members in California have 30% less chance of
Average total length of stay (LOS) down from 6.2d to 5.7d dying of heart failure compared to the US population
“We are quickly approaching a situation where working Kaiser members have 12% improvement in survival rates
without an electronic infrastructure will be impossible…” for colon cancer compared to SEER Medicare averages
Dr Ronald A Paulus, CTIO, May 2009
Success factors:
• Address the fragmented nature of care i.e. “continuum of care” versus “episodic care” (e.g.
introducing disease management, case management, participatory medicine etc)
• Align interests between the party making the investment and the beneficiary.
• Develop financial incentives, reward health outcomes (quality, safety, prevention), and nurture
the innovative business models that are made possible through the use of eHealth.