Date post: | 14-Aug-2015 |
Category: |
Health & Medicine |
Upload: | caroline-rute |
View: | 184 times |
Download: | 6 times |
Etervise suunad
Madis Tiik
29.08.2014
• Tartu University , medical doctor 1996• Nordic School of Public Health (Sweden) -Diploma in
Public Health 2003 • Estonian Business School 2001-2003 ICT Management• Tallinn University of Technology , PhD (healthcare
engineering )14.12.2012
• Family doctor 1998-• Estonian Society of Family doctors, chairman 2001-2008. • Estonian eHealth Foundation , CEO, 2007-2011• EU eHealth Task Force group scientific adviser of the
President of the Estonia (2011-2012)• Tallinn University of Technology , project manager,
lecturer 2011-2014• Senior Adviser , Sitra (Finnish innovation fund) 2012-
2014• Scripps Translational Sciense Institute, San Diego, USA
2014 -
14.12.2012
Madis Tiik, MD, Phd
Tervishoiusüsteemi transformatsioon
Pro-aktiivne Reaktiivne
tegevus
Patsiendi keskne
Teenuse-osutaja keskne
PWC Health Research Institute raport “HealthCast “ March 2010
1000 adults during 1 month
800 health related symptoms
329 looking for professional help
217 Healthcare113 Family physician104 Specialized doctor
65 Alternative medicine (acupuncture, homeopathy etc.)
25 day clinic
13 emergency
8 hospital.
1 university
clinic
Green, LA. Fryer, GE Jr. Yawn, BP. Lanier, D. Dovey, SM (2001). ‘The ecology of medical care revisited.’ New England Journal of Medicine, 344(26): 2021–2025
Where patients seek information?406 self-care?
329 data from EHR- illness
data
7Sitra • Madis Tiik • 23.04.2014
Traditional service flowLaboratory/ Other tests
SpecialistGeneral
practitioner
329 will meet a medical
professional, e.g. nurse
Laboratory/ Other tests
1000 citizensDuring one month
800 of them have
somemedical
concerns
Green, LA. Fryer, GE Jr. Yawn, BP. Lanier, D. Dovey, SM (2001). ‘The ecology of medical care revisited.’ New England Journal of Medicine, 344(26): 2021–2025
EPR
Today’s healthcare is provider –centric, driven by fee –for-service payments and it’s a barrier to a better healthcare model
Georg Halvorson, Chairman and CEO, Kaiser Permanente
Health data
Time
Vo
lum
e
Child clinic
Healthcentre
Occupational healthHospital
McGinnis, et al., Health Affairs; 21(2), 2002
Wave 1:PATIENT-CENTERED CARE (2010-2016)
– Tervishoiusüsteemi raviplaanid keskenduvad patsientide vajadustele – vajadustepõhine raviplaan.
– Arstid loobuvad visiitide tootmisest ja standardiseeritud , mitte perrsonaalsete ravijuhiste kasutamisest
– Arstid liiguvad one size-fits to all mõtteviisist, rahvatervist edendavale mõtteviisile, kus resursse jagatakse erinevate segmentide vajadustest lähtuvalt(n. terved, kiireloomulist abi vajajad, kroonilist haigust põdevad või multimorbiidsed ).
– Patsientidele kellel on erilisi vajadusi tehakse individuaalsed raviplaanid ja neid ravivad multidistsiplinaarsed ravimeeskonnad
– Ravimeeskonna liikmeteks on erinevad spetsialistid (arstid,õed, case manager - juhtumikorraldaja, füsioterapeut, sotsiaaltöötaja, toitumisspetsialist jne)
Kanavamalli osana terveyden edistämispalveluja
Palveluohjauspiste
Nopea hoidonalku
Hoidon toteutus
Omahoito
Palvelu-tarpeen arviointi
Sovitustihoitoon
Hoito-vastaava
Hoito-suunnitelma
Oma-hoidon
tuki
Tyytyväinen
asiakas
Useita terveysriskejä
(Terveyshyötykanava)
Yksittäisiä
terveysongelmia
(Episodikanava)
Oman terveyden edistäminen ja ylläpito
Voimaantu-minen
Hämenlinnan Terveyspalvelut
Vir
tuaa
lklii
nik
WAVE 2: CONSUMER ENGAGEMENT (2014-2020)
• Luuakse uusi patient –centered teenuseid• Teenuse pakkujad võistlevad hinna, lisaväärtuse, ja
tulemustega. • Mõtle crowdsourcing teenuste peale, nagu Yelp
teenuspakkuja tulemuskaart• Mobiillahendused , mis toetavad klientide
tervisealaseid otsuseid. (My prevention plan)• Turule sisenevad tervishoiusektorist väljaspool
tegutsevad ettevõtted– retail clinics (tervisekioskid) – WalMart, Walgreens– ICT ja Media firmad - WedDOC, Symptom checker etc.
SupportedSelf-care
Walk in clinicsHome monitoring
GP, outpatientcare
Hospital careHigh specialization
Very high risk 19 500
High risk
58 500
Low risk
299 000
Self-care, prevention
923 000
Organization centric team
Motivated, supported
citizen
PROBLEEM Unequal distribution of healthcare services in Estonia
(population 1,3 mio)
ICT and healthcare in Estonia
Central EHR 2005-2008Health Portal 2009Registries Integration ( non clinical) 2008Standardization 2007-2012Integration of different user groups 2009-2013
Information Exchange
Local EMRsDigital Claims & Reimbursement
1992 2010 2015 2020
Time
Patient empowerment
Health sertificate 2010-2013Integration with social care 2011-2012EbmDS decision support service 2011-?Integrated statictic 2010-2013Clinical registries 2011-?
Secundary use of data
Personal Simulation 2015Integration with -Environment data 2015?-Behaviour data 2015?-Genetic data 2014?
Value Added services
WAVE 3: THE SCIENCE OF PREVENTION(2018-2025)
Kujuta, et kaubanduskeskuses saad tervisekioskist, milliseid on igas kaubanduskeskuses 50€ eest süljeproovist geenikaardi ja selle aluselt tehtud personaalse terviseplaani koos vastava APP-ga, mida toetab Avatari taoline abiline. Kes igapäevaselt aitab sul teha õigeid valikuid käitumises, toitumises , juhib sinu tähelepanu sinu tegevusest tulenevatele riskidele
OHIO STATE UNIVERSITY MEDICAL CENTRE
19
Sitra • Madis Tiik • 23.04.2014 •
Online clinic and service flow
Online clinic
Laboratory
Specialist
General practitioner
Nurse
1000 citizens 800 of them havesome medical
concerns
Self-care
EPR
PHR
20%
80%
Online clinic (+ artificial intelligence)• Data integration and mining
20•
Research and reference database• Cohorts• Biobanks
• Research articles
Electronic health records
User interface, e.g. webpage/app
Online serviceportal & booking
toolVirtual health check
Mobile & walk-inservice channels
Personal health records• Health & wellness data
• Genetic data
Health information& Risk assesment
21
22
http://www.forbes.com/sites/ciocentral/2014/04/03/virtual-health-care-visits-will-revolutionize-the-industry-if-we-let-it/
BASKIMAA Näiteid
Health and wellbeing ecosystem
Health portal
Internet
Integration engine
HIE
NurseBaddy
GP portalApp-store
PHRTerminology
service
BigData
An
on
ymis
atio
n
myPreventionplan
DiabetesAPP
Meedoc
Hospital
EPR
Online clinic
Madis.tiik@eesti,.ee
Tänan kuulamast !
ehealth,mhealth,phealth=
healthcare delivery of the 21st century
Health Forecasting
NHS Network
Medixine software
and server
Medixine
interactive voice
response system
Medixine
administrator
Monitoring
Health
Forecasts
Automated
telephone call
Patient
responses
Telephone
numbers
Patient name and
tel no, changes to
patient status
Call logs
Met Office Forecaster
Person with
COPD
GP practice Patient
responses
Significant savings
• According to the inquiry, in addition to the savings, self-nurturing increased and the patients were satisfied with the service.
* www.heli.fi/content/Liitteet/Hengitysliitto_jasentutkimus_keuhkoahtaumatautia_sairastaville_09112011.pdf
** Estimation based on savings in the UK and Finland
Population 200 000
Percentage of COPD patients in
population 4,0 % 8 000
Percentage of patients with
hospital admissions* 37 % 2 960
Cost of admissions 1500 € / admission 4 440 000
Reduction of admissions** 20 % 592
Savings 1500 € / admission 888 000
Cost of the service 30 € / patient 240 000
Net savings € 648 000
Automatic Coaching
• Easy to use web solution
• Informational messages, reminders and alerts through SMS, e-mail, automatic voice calls
• Customer definable message sets can be flexibly allocated to members/patients
• Escalation of alerts and reminders easily programmed
• In Delaware: HbA1c compliance from 48% to 75%
13