An eHealth Strategy for Ireland

Kevin Conlon ICT Unit Department of Health

‘Connected Health : Collaboration & innovation to engage patients and elevate care’ CCD 1 April 2014

eHealth : What does it mean?Different things in different places

• eHealth is European also known as

• Health IT is a US phrase

• Connected Health by both and the best

• mHealth ehealth without wires?

… not solely about computerisation

Definitions of eHealth exist• What is eHealth"The combined use of electronic communication and information technology in the health sector“

World Health Organisation

“eHealth means Information and Communication Technologies tools and services for health. Whether eHealth tools are used behind the scenes by healthcare professionals, or directly by patients, they play a significant role in improving the health of European citizens”

European Commission

Societal changes from technologyWhere is health care in the digital economy?

• Travel …think Ryanair.com, Trivago, AirBNB• Media … think RTE player, IrishTimes.com … Twitter ..

Facebook ..You Tube• Education … think digital school books.. Distance learning• Retail : think Amazon.com, ebay, pigsback, Brown Thomas• Registration for nurses doctors is on-line• Bills, Bookings … think Tolls, Bins, Parking fines, Banking, Theatre ,

Revenue, Property Tax car tax– All done over the Internet … still costs the same !!

Where is health care in all this?Healthcare is well behind the curve

– Why can’t we readily book appointments for GP’s, hospitals, clinics…..

– See our test results….– Keep track of immunisations for our kids….– Prescriptions…. See on line what we are taking.. what we took 6

months back … or did we take it?– When we were last at the GP, Specialist etc

What are the barriers to e-enablement?

• HealthCare transactions – Are complex– About vulnerable people– Services delivered by multiple professions, multiple providers over many

locations– Change processes to bring about change are not simple– Legal issues – Technology issues– Legacy issues such as PPARS– Privacy and confidentiality issues

Process Change• At its simplest eHealth is about

“Access to the right information, in the right place at the right time”

• “Information is the lifeblood of modern medicine, and health information is dedicated to be circulatory systems. “– David Blumenthal New England Journal of Medicine 362 2010

• It is fundamentally about process change and reconfiguration underpinned by ICT

(Hal Woolfe, Kaiser Permanente)

• If we are to benefit from technology we must be prepared for change.

Opportunities that eHealth provides• Impact of eHealth developments on the healthcare

delivery system

• Potential and opportunities to change and help re-configure healthcare delivery

• New information and systems environment

• Provides a enormous opportunities and significant challenges

eHealth offers new services• Personal Health Records

GoogleHealth, HealthVault, Have not got traction yet but are not ‘mainstream’• Health social networks,

Breast cancer.org, PatientsLikeMe, CureTogether, MedHelp very popular widely used • Consumer personalised medicine

23andMe (Genomics) DirectLabs (Blood & Bio Marker Tests) Genome Sequencing is now nearly a consumer product

• Quantified self-monitoringKeas, (Personalised Care Plans) Zumelife (Chronic Care)

• Healthcare Social MediaBlogs - DiabetesMine, HealthMatters, WedMDMicroblogs - Livestrong, Stupid CancerSocial Networking - Organised Wisdom, PatientsLikeMe, DailyStrengthPodcasts - John Hopkins Medical Podcasts, Mayo ClinicSocial Sharing - Flickr, You Tube, ICYouForums - Google Health Groups

• Clinician Social NetworksSermo, Medscape Physician Connect, Asklepios, MEDTING

For clinical resources

For patients …..

Health Information resourcesUse of Services

61% - American adults looked online for health information (2009)

84% - physicians engage online as part of their clinical workflow

71% - physicians are interested or already use physician social networks

Sources of information used by American adults for health or medical issues information or assistance:

86% - Ask a health professional - such as a doctor

68% - Ask a friend or family member

57% - Use the internet

54% - Use books or printed material

Impact of online Health Information

60% - Affected a decision about how to treat an illness or condition

56% - Changed their overall approach to maintaining their health or the health of someone they help take care of

53% - Led them to ask a doctor new questions, or to get a second opinion from another doctor

Potential from Advances in Technologies Location-aware technologies enables increased access

and quantity of information – provides greater safety

Home automation and sensor technologies support telehealth and mobile health applications

Virtual doctors/health professional visits

Easier user access to information and technologies through voice, touch screen, eReaders, biometrics, etc.

Focus and investment by large scale companies inmonitoring and telehealth technologies

Broadband and Internet use among seniors increases

Significant developments in portals and tools for caregivers

Increasing use and development in personal emergency response systems

How Smart can technology get?

Some views of the future….

eHealth is about Transformation

Person

Community

Primary

Secondary

Tertiary

Individual Self-care

Friends & Family

Community Networks

Professionals as Facilitators

Professionals as Partners

Professionals as Authorities

Transformation Through Cost-Effective Use of Information & Communication Technologies

Industrial Age Healthcare Information Age Healthcare

Source: Adapted from Malaysian Telemedicine Blueprint

Changing Role of Patients

…from passive to active patients ……

Health systems challenges we all know them…..• Increasing Demand due to:

• Ageing Populations• Rise of Chronic Diseases

• Already Stretched Services

• Planned Reform of Health Services• Universal Health Insurance• Money Follows the Patient• Formation of Hospital Groups

• Current ICT Issues• Current Ireland ICT budget 0.85% vs. EU

average 2-3%.• Lack of understanding of benefits

eHealth Strategy for Ireland

Ireland eHealth Strategy : Methodology• Extensive Research • 8 countries, EU and Non-EU

• Benefits/ROI and Lessons Learned

• eHealth week in Dublin in May

• Analysis of EU and WHO Policy• Re-designing Health for

Europe 2020

International ExperiencesSummary of Findings...

(Based on 8 countries analysed)1. Dedicated delivery entity with proper focus,

governance and authority2. Deploy in phases. Avoid ‘big bang’ approach.3. Use interoperability standards4. Strong stakeholder and clinical engagement

from the outset.5. National Health Identifier is crucial.6. Strong branding and pubic awareness 7. Skills shortages need to be addressed at all

educational levels

eHealth Benefits to Ireland • Population Wellbeing

• Healthier Citizens • Empowered and Mobile citizens Patient as Consumer• Focus on prevention Healthy Ireland• ‘Keep people out of hospital’ Supporting the clinical Programs and hospital groups

• Health Delivery Service Benefits• Deliver Higher Quality, Lower Cost models of care • Easier Access, Higher Transparency Supporting UHI , MFTP• Move to Patient-Centric system Chronic Disease Management / Tele health/care• Will enable Planned Reform Program : Supporting Money Follows the Patient

• Economic Development • Export-driven jobs creation : Some good examples of that in Ireland • eHealth start-ups : • Ireland Ideally placed for new ‘Services’ : industry leader in Pharma, ICT hardware and

software and Medical Devices

Implementation• Create ‘eHealth Ireland’ (initially within HSE ICT)• Fully focussed delivery entity• Made up of stakeholder organisations

• Health, DJEI, Agencies, Academia etc• Full Fiscal Oversight• 4 Key Functions…

• Project Delivery (ePrescribing, Telehealthcare etc)• Ecosystem • Patient Empowerment• Economic Impact Realisation

• Key ‘Enabling Functions’• Legal and regulatory• Technical interoperability• Health identifier• Branding and Public awareness

eHealth Innovation Ecosystem Build a World Class Innovation Ecosystem• Collaborative Environment

• Academia• Industry• Health Services• Cross Border • International Alliances (e.g. EU/US)

• Focus on Commercialisation• Open-up services to R&D

E.g. Horizon 2020 Funding • Promote Entrepreneurship

• Start-ups support• VC funds, incubators…

• Export-led Jobs Creation

eHealth Innovation Ecosystem Models in Catalonia, Northern Ireland, Manchester, New York….

Indicative Timelines

1. Create ‘eHealth Ireland’ and source requisite leadership.2. Develop full Business Plan

• Input (funding and resources) from Govt depts, agencies, academia and others• Set up governance structure including board.• Strongly branded entity eHealth Ireland• Resource internally where possible.

3. Begin Work on Priority Programs

• Identifier, ePrescribing, Online Referrals and Scheduling, Telehealthcare and others4. Begin work on ‘Enabling’ Functions

• Legal, Regulatory, Standards, Branding and others.

5. Coordinate with Govt agencies to drive Economic Benefits program.

6 . Health Identifiers Bill 2013 (now in Oireachtas) • Work with partners to ensure Identifier is deployed in a timely manner.

Key Actions

eHealth update• eHealth strategy finalised and published• eHealth Ireland entity to be set up• CIO approval • Health Identifiers Bill• APJ 2014• MoU with NI• Ecosystem / forum to be set up ……

Its only beginning……American Healthcare is one of the last great industries to remain largely undisturbed by information technology revolution of the past few decades

– Vijay Vaitheeswaran, The Economist, November 22, 2010

Medicine has built on a long history of innovation, from the stethoscope and roentgenogram, to the MRI. Doctors have embraced each new technology to advance patients care. But nothing has changed clinical practice more fundamentally than one recent innovation: the Internet.Pamela Hartzband and Jerome Groopman , New England Journal of Medicine.

Where will we go?

• Implementing eHealth in Ireland is about….

– Bringing improved population wellbeing, health service efficiencies and economic opportunity through the use of technology enabled solutions.

Thank you for your time…….