Madis Tiik Turku 29.11.2012
Transcription
Madis Tiik Turku 29.11.2012
Madis Tiik Turku 29.11.2012 Madis Tiik, MD • Tartu University , Medical Doctor 1996 • Nordic School of Public Health – Diploma in Public Health 2003 • Tallinn University of Technology, Institute of Clinical Medicine , lecturer, Phd student (defending on the 14th of December 2012) • Chairman of The Estonian Society of Family doctors 2001-2008. • CEO of Estonian eHealth Foundation 20072011 Current work • Vormsi island, family doctor • Finnish Innovation fund Sitra, senior adviser The EU roadmap for eHealth Towards full picture of the individual’s health status 3 2 1 Connecting individuals with Health Information Networks Linking all the points of care Time 1990s ICT for Health – Gérard Comyn – MIE 2009, Sarajevo Today What is eHealth? Electronic Health Record Collects data from multiple healthcare organisations Patient summary: allergies, prescriptions, recent events Applications based at facilities Computer-based patient records for hospitals Electronic medical records for primary-care physicians PACS and other digital imaging systems Business intelligence and financial management Telemedicine and telemonitoring Remote diagnosis: Teleradiology, teledermatology etc Remote consultation: Video visits, e-visits Remote monitoring: Home and mobile All three areas are important! Analysis Follow-up Policymaking Treatment Guidlines Public Services Campaigns PHR EHR Tele-advice Self-help Diagnostics Appointment Workflow Notification Prescription Lifestyle The future of healthcare will be shaped by seven separate, but interconnected, trends. Healthcare spending will continue to rise, not only because of inflationary drivers, but because of growing recognition by policymakers that improved health is linked with greater national wealth. Keeping the universal healthcare model will require rationing of services and consolidation of healthcare facilities, as public resources fall short of demand. General physicians will become more important as gatekeepers to the system and as co-ordinators of treatment for patients with multiple health issues. More effective preventive measures and fundamental lifestyle changes will be promoted to encourage healthy behavior. European governments will need to find a way to improve collection and transparency of health data in order to prioritize investment decisions. Patients will need to take more responsibility for their own health, treatment and care. Governments will have to tackle bureaucracy and liberalize rules that restrict the roles of healthcare professionals and artificially raise the cost of medical research. © The Economist Intelligence Unit Limited 2011 5 extreme scenarios for European healthcare in 2030: Technology triumphs and cures chronic disease, while ehealth takes a prominent role in the management of healthcare; European nations join forces to create a single panEuropean healthcare system; Preventive medicine takes precedence over treating the sick; European healthcare systems focus on vulnerable members of society; European nations privatize all of healthcare, including its funding. © The Economist Intelligence Unit Limited 2011 Health Care Costs Public Health and Preventive Measures 5% Curative Medicine 95 % McGinnis, et al., Health Affairs; 21(2), 2002 Factors Contributing to Early Mortality Behavior 40% Medical Care 10% Social 15% Environment 5% Genetics 30% McGinnis, et al., Health Affairs; 21(2), 2002 Focus Empowering Citizens PHR Preventive care EHR systems Health care With the help of advanced eHealth services a citizen can take control of his well-being before ailment. Healthcare professionals can use the rich background data that is stored in Taltioni. The variety of eHealth services enable the citizen to have a holistic view of his health. Taltioni enables a smooth information flow between professionals and systems. PHR After care Advanced eHealth services enable cost effective and effective after treatment. Quick responses to changes in healing process and personal treatment foster faster recovery from ailment. TALTIONI Finish population (5.4M), based of the risk calculation Very high risk 60 000 High risk 200 000 Low risk 800 000 Self-care, prevention 4 340 000 Hospital care High specialization Patient centric team GP, outpatient care Supported Self-care Motivated, supported Walk in clinics citizen Home monitoring Electronic medical records (EMRs) and IT. By 2020, health systems will move from predominantly paper records controlled by the industry to predominantly digital ones controlled by individuals. Ninety percent of health leaders surveyed said making EMRs available to clinicians and patients would make their systems more efficient and effective. But effective implementation will be difficult and expensive. HealthCast 2020 eHealthTask Force Report Toomas Hendrik Ilves – President of Estonia (chairman) Stefano Marzano- Electrolux, IT Tero Ojanperä – Vision+, FI Joan Guanyabens i Calvet- Catalan Agency for Health Information, Assesment and Quality, ES Maria Leonor Beleza- Champalimaud Foundation, PT Anders Olauson- European Patients Forum, SE Neil Bacon- iHAM Ltd, UK Miklos Szocska- Minister of State, HU Wendy Tankard- Harmoni, UK Ineta Ziemele – European Court of Human Rights, LV My data, my decisions Individuals are the owners and controllers of their own health data, with the right to make decisions over access to the data and to be informed about how it will be used. The main preconditions trusted, accepted and interoperable data collection and management; understanding of the benefits by all stakeholders. The main benefits for patients who are empowered to manage their own health – if they wish – and get personalized treatment Liberate the data Large amounts of data currently sit in different silos within health and social care systems. If this data is released in an appropriate manner and used effectively it could transform the way that care is provided. The main precondition is that regulators and policymakers to require institutions to publish their data; The main benefits accelerated innovation and increased scale (from standardization) spread across all actors in the form of lower costs integrated services rich data flows for research and policy making new services, more choice through more competition better and more evidence. Connect up everything The digital environment is growing and evolving rapidly with an increasing trend of interaction and sharing. The popularity of online networking and social spaces has created a parallel digital existence for millions of people. The main preconditions policymakers and regulators provide for open access to public services and require minimum standardization and safety of health apps that serve interest in citizens’ and patients’ generating information for clinicians, care professionals and service providers to appreciate and incorporate such information into health decision-making and treatment plans The main benefits citizens who will receive support for continuous health treatment and healthy living rather than only interventions Revolutionise health Full transparency will unleash disruptive innovation across the health sector The main preconditions Commitment of regulators and policy makers to radical reconfiguration of health system as well as clinicians and care professonals accepting and erosion of their primary leadership of healthcare The main benefit Good, multidisciplinary care will be well recognised and delivered Citizens and patients will be empowered to actively participate in managing their own health Include everyone Those without the skills, capacity and opportunity to use eHealth risk beaing further excluded The main preconditions political and regulatory commitment to reduction of health inequalities with professional, providers, and payers ensuring no discrimination in provision of care equity of access and in using eHealth tools and citizens and patients having understanding health and having basic IT literacy. The main benefit is improved health status. This includes availability of a greater range of treatment options for complex health problems better resource allocation, better understanding of barriers to good health, improved involvement of patients and citizens in self care and improved health awareness. Recommendations A new laegal basis for health data in Europe Create a“beacon group“ of Member States and regions committed to open data and eHealth Support health literacy Use the power of data Re- orient EU fonding and policies ICT and healthcare in Estonia Patient empowerment •Software's for hospital and for GP in 1994 •Digital claims since 1995 •Equipping GP-s with PC-s 1998 •Skipping paper claims 2002 •Legally allowed to use only digital patient record since 2002 Local EMRs Digital Claims & Reimbursement 1992 2010 Time 2015 2020 Current situation Activiti indicators More than 75% citizens has digital documents in the EHR (989 338 persons) 555 Healthcare providers have send documents to the EHR 47 314 citizenz have viuwed his/her data • 768 have made expressions of will/preferences Most popular documents Ambulatory consultation notes 2 311 506 Hospital discharge letters 897 944 Image address links 1 139 790 Consultation notes/image reports 1 508 306 Immunization notes Altogheter 20 standardized medical documents 50 590 E-prescribtions 1 000 000 900 000 800 000 700 000 600 000 500 000 400 000 300 000 200 000 100 000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 issued sold Paper prescriptions 16,0% 14,0% 12,0% 10,0% 8,0% 6,0% 4,0% 2,0% 0,0% july august sept oct nov dec jan feb march april October 2012 – 4,6% may ICT and healthcare in Estonia Patient empowerment Value Added services Secundary use of data Information Exchange Personal Simulation Integration with -Environment data -Behaviour data -Genetic data Health sertificate Integration with social care EbmDS decision support service Integrated statictic Clinical registries 2015? 2015? 2014? 2010-2013 2011-2012 2011-2013 2010-2013 2011-2013 Central EHR 2005-2008 Health Portal 2009 Registries Integration ( non clinical) 2008 Standardization 2007-2012 Integration of different user groups 2009-2013 Local EMRs Digital Claims & Reimbursement 1992 2015 2010 Time 2015 2020 Thank you! Madis Tiik [email protected] THANK YOU !