On-demand e-health from IBM

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On-demand e-health from IBM
Janko Cicin-Sain
Healthcare Consultant Life Sciences CEMA
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Golden rules for the 21st- Century Health Care
System(defined by Institute of Medicine, USA
2001)
Current Approach New Rule Care is based
primarily on visits Care is based on continuous
healing relationships Professional autonomy
drives variability Care is customized according
to patient needs and values Professionals
control care The patient is the source of
control Information is a record Knowledge is
shared and information flows freely Decision
making is based on training Decision making is
evidence-based and experience Do no harm is an
individual responsibility Safety is system
property Secrecy is necessary Transparency is
necessary The system reacts to needs Needs are
anticipated Cost reduction is sought Waste is
continuously decreased
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Problems common in Health Care industry in whole
Europe but more accute in the countries in
transition

• how to cope with rapid increases in costs of
  healthcare services
• how to rationalize and balance limited budgets
  with, yet to define, expected quantity and
  quality of services
• how to move health care organizations (primarily
  hospitals) from public sector to business
  mentality while respecting high ethical standards
• how to stop borrowing from the future
• how to devise effective compensation schemes
  with objective to reduce the waste and stimulate
  effective medical procedures
• how to establish national (or accepting
  international where plausible) standards for
  medical procedures, clinical guidelines, coding
  of diagnosis and procedures and standards related
  to management of information
• what to learn from those who have been
  intensively dealing with above listed topics for
  last thirty years and leap-frog where posible

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Major challenges for countries in transition

• management of medical documentation (indexing,
  coding, storage,..) does not meet modern quality
  standards
• quality control in health care delivery system
  de facto non existent
• frequent lack of structured management of
  technologies used in medical procedures (quality
  control, preventive maintenance, standard
  maintenance contracts,..)
• most health care organizations (hospitals) not
  in position to become self-sufficient in handling
  Management of Information topics and IT solutions
• Quality Control and Management of Information
  over 25 years behind North America and 15 years
  behind Western Europe
• Ministry of Health usualy lacks experience in
  definition and execution of Projects and has very
  limited (or non existent) IT expertise

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Specific challenges related to the projects
funded by World Bank

• Health Care reform issues and related
  implementation projects always broken in many
  individual components
• for each component lengthy execution process due
  to formalities related to procurement,
  negotiaition and execution stages
• due to the fact that each component is
  separately negotiated, each provider of services
  has very limited liability leading to high risk
  final outcomes
• lack of major prime contractor, due to
  existing practice and issue of conflict of
  interest, leaving the buyer (usualy MOH or
  National Health Insurance) to bear the overall
  responsibility for final outcome...
  responsibility for which national agencies do not
  have internal human resources to effectively
  manage complex re-engineering and implementation
  projects

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Some important characteristics of Information
Solutions for organizations involved in health
care delivery and compensation processes
Hospitals IS solutions available on (primarily)
international and national levels Primary Care
and Specialists IS solutions available on
international levels and can be developed in
limited time Laboratories similar to
hospitals Health Insurance for Core Business
usually country specific, leading to custom
development while taking advantage of solutions
available in countries with similar compensation
schemes (capitation, service, DRG / Case
Mix) National Health Information Infrastructure
and Warehousing few solutions on international
market (Canada, UK, Australia, Germany) and
complementary custom development
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IBM strengths

• global player
• world wide leader in consulting services,
  project management, development methodologies,
  business process re-engineering, change
  management, technology provider
• leading consulting company in healthcare based
  on former Price Waterhouse healthcare practice
  with over 1.600 healthcare consultants worldwide
• effective partnership with all leading providers
  of IT solutions to healthcare organizations
• unique offerings for national / regional
  integrated information systems, linking all
  providers with each other, with MOH, Health
  Insurance or Public Health agency
• strong and continuous committment to national
  market

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Where IBM can provide help

• TOPIC National (regional) Health Care reform
  activities
• CONTENT
• BCS (former Price Waterhouse practice) and
  national consulting resources to manage the
  content of reform topics like
• Business models,
• Strategic Planning,
• Compensation strategies,
• National and international standards in
  healthcare, and methodically execute the projects
  and programs
• Delivarables,
• Business process re-engineering,
• Change Management

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Where IBM can provide help
METHODOLOGIES IBM BCS and BIS consulting
resources to train Ministry Of Health or Health
Insurance profesionals how to effectivly and
efficiently define and executed any type of
projects Organize for Ministry of Health or
Health Insurance organizations Virtual Project
and Program Office a structured and efficient
approach to how to manage and administrate all
project activities (reform is sequence of
projects) Implement Workflow Management and
Document Management solutions to improve the
execution and control of any programs or
activities in national organizations Lead initial
Projects and provide skill transfer to internal
resources VALUE of METHODOLOGIES Substantial
reduction of time and resources (human,
financial) needed to execute any component of
Health Reform while increasing the quality of
deliverables documentation, completion criteria
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Overview - Our Understanding of Your Requirements
Assessment of Hospital Plans and Policies
Socio-Demographic
Economic, financial and cost-benefit analysis
Development of Hospital Masterplan
Sector Structure
Public Expectations
Health Care Financing and Provider Payment Options
PREPARATION OF HEALTH SYSTEM OPTIMIZATION
PROJECT
Development of Hospital Plans
Hospital Management Training Plan
Review Hospital Management Capacity
Review economic and financial benefits of
project
Technology
Recommendations for Hospital Management
Training and Curricula
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Organization

• IBM Business Consulting Services Healthcare
  Industry Group
• Our Healthcare Industry Group is one of the
  largest healthcare consultancies in the world.
  We have over 500 professionals around the world
  dedicated to working in the healthcare sector. We
  serve a wide variety of clients, including acute
  care hospitals, academic medical centres, health
  insurance companies, and Ministries of Health.
  Our healthcare consulting activities are
  comprehensive and focused on solving complex
  issues in partnership with our clients in the
  areas of
• Strategic Change
• Performance Improvement
• Human Resources
• Organisational Change and Development
• Quality in Health Care
• Business Process Reengineering
• Business Process Outsourcing
• Management Planning
• Financial Management
• Information Technology for Health Care
• E-health
• ERP implementation

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Organization

• As example, our Canada-based Healthcare Industry
  Group employs professionals dedicated to
  healthcare consulting, with expertise in the
  following areas
• Healthcare Management
• Healthcare Planning and Policy Development
• Operational Management
• Public Health
• E-Health/Information Systems
• Health Economics
• Health Financing
• HIV/AIDS
• Primary Health Care and Health Promotion
• Project Management

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Organization

• IBMs Business Consulting Services international
  focus is on large-scale capacity building and
  institutional strengthening projects in the
  following key areas
• Health Sector Reform and Restructuring
• Strategic Planning
• Health Information Systems/Information
  Technology
• Healthcare Financing/Health Insurance/Economics
• Human Resources/Management Development/Change
  Management, and
• Institutional Strengthening

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Where IBM can provide help
TOPIC National Information Solution
Infrastructure, Warehousing IBM solutions and
services, based on experience and track record in
Canada, USA, UK IBM Health Network Solution or
Health Communication Solution as backbone of any
national or regional healthcare information
infrastructure Manage the development and
deployment of national standards or
implementation of international standards
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From a provider perspective, Torontos eCHN has
implemented an e-Health electronic health record
connecting hospitals, home care and
paediatricians to manage referrals, protocols and
urgent care.

• Improve health, quality of life for children
• Forge alliances and partnerships among providers
• Provide consistent standard of care
• Coordinate services across the continuum of care
• Share research and education information

• 17B Health Budget
• 212 Hospitals
• 21000 GP's specialists

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Alberta We//net has partnered with IBM to
implement a province-wide electronic health
record. IGS has developed the Pharmacy
Information Network, based on the eCHN EHR
architecture.

• Accessible and effective health services
• Alignment accountability among stakeholders
• Ensure the privacy, confidentiality and security
• Focus on promoting and protecting the health of
  the population.
• Appropriate education and research
• Engage Albertans to exercise personal
  responsibility gathering protocols

• 4B Health Budget
• 12 Health Regions
• 900 Pharmacies
• 5000 Doctors

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Vision Better information for better health

• alberta wellnet enables multi-stakeholder,
  information technology initiatives to improve
• the quality of health services
• the management and sustainability of the health
  system
• alberta wellnet is the health information network
  that will enable health professionals to share
  information by
• Connecting information islands at the point of
  decision to reduce costs, increase capacity and
  improve clinical outcomes
• Implementing secure information exchange,
  infrastructure, and the information tools

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Health reform project in Slovakia
Under World Bank loan, as component of health
care reform IBM manages Health Information
Standards project Closely linked to Data Center
project (future E-health infrastructure) Focus on
complemeting Quality Improvement project Focus on
legislative and procedural requirements for
future E-health environment
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Health insurance in Slovakia
Joint IBM-SAP project (modules) Insured Persons
Central Records (Registry) Other Central Records
related to Insurance Core Business Insurance
Collection Insurance Disbursement Medical
Inspection Activities All Above Modules
Functionality Extension Transactions via
Internet Data Migration and Data Fund
Transformation Internet Portal Migration Archive
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Where IBM can provide help Project bIT4health
Status (1)The Consortium and its Responsibilities

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Project bIT4health Current Status

bIT4health Better IT for better Health

• Planning and development of frame architecture
• Reaching acceptance of all involved parties
• Quality security and risk minimisation
• Scientific monitoring of test phases

Requirements
Architecture
IT-System
Legislation
Frame architecture
Solution architecture
Trans-formation
Current standards
Requirements partners
bIT4health Focus
Status Open
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Health Networks or e-Health is mandatory to cut
across organisational boundaries, integrate data,
create the health system without walls and
focus on patient-centric care.
Telemedicine removal of distance Knowledge
doctors, nurses, health professionals Access to
patients medical history life-time patient
record Access to citizens health
profile Collaboration between health
providers Management of health treatments related
to patients with chronical diseases Information
and education of citizens / patients Same
source of information for clinical and financial
/ managerial purposes
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Health Networks or e-Health is mandatory to cut
across organisational boundaries, integrate data,
create the health system without walls and
focus on patient-centric care.
Prerequisites National standards for Core data
set, Demographic Data, Health profile National
standards for Authorization, Authentication,
Privacy National standards for minimal
functional and data requirements of IT solutions
for providers (hospitals, primary care
doctors,...) Synchronized activities between all
health care sector organizations and agencies
(Master Project)
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Where IBM can provide help

• TOPIC Health Insurance
• Lead development projects, organize on-going
  support, user training and help desks
• implement proven IBM Application Development
  methodology required to achieve an optimal
  solution
• quality functional flow, quality control,
  solution documentation, user training
• provide ASP type services for managing IT assets
  and resources, and national help desk structure
• capitalize on broad experience from Health
  Insurance projects in several European Union and
  North American countries
• manage the implementation of Smart Card
  solutions for insurers and health care providers
• As component of National Health Information
  Infrastructure, manage deployment of Warehousing
  / Data Mining solution
• References Hungary, Lithuania, Estonia, Poland,
  Germany, Slovakia

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Where IBM can provide help

• TOPIC Hospitals
• Lead JCIA accreditation preparation, including
  QA and MOI components
• Complement leading IT solution providers with
  local support, project management and change
  management services
• Provide complete solutions for Document Imaging
  and Management and intergated PACS
• Deploy regional or national ASP type services
  for human resources, use of IT technologies and
  financial engineering
• TOPIC Primary Care and Specialists
• Lead either adaptation of international
  solutions or manage development of home grown
  solutions while linking it to national Health
  Infrastructure
• For any health care provider, define national
  standards for minimal data sets for
• Patient Demographic Data who is the person,
  address, insurance, relatives,..
• Patient Pertinent Medical Data health profile
  of each individual
• Patient Core Data Set clinical data from
  completed treatment and sufficient to next health
  care provider to determine any treatment history