@SinisaVarga
Health Information and eHealth Landscapes: Bridging the Gap
Sinisa Varga, Vice-President Health and Social Policy Committee, Croatian Parliament
Better public health through strategic purchasing as a catalyst for eHealth design and development
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@SinisaVarga PLEASE ALLOW ME TO INTRODUCE MYSELF...
• External consultant for governments, EC, WHO and WB 2016-present
• Member of Croatian Parliament 2016-present
• Minister of Health 2014-2016
• Director Croatian Health Insurance Fund 2012-2014
• President Managerial Board Vrapće Psychiatric Teaching Hospital 2010-2012
• World Bank Project Bosnia & Herzegovina 2006-2008
• Deputy Minister of Health 2002-2004
• Deputy Director Dubrava University Hospital 2000-2002
• World Bank Project Croatia 1999-2002
• Head of Maxillofacial Rehabilitation Unit DUH 1992-present
DMD, Prosthodontist, QSM/QSA, Health Resources Manager, Diplomacy
"...it takes roughly ten thousand hours of practice to achieve
mastery in a field..." Malcolm Gladwell
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@SinisaVarga
World population:
> 7,5 billion • Chronic diseases account for up to 80% of total
healthcare expenditures
• Increasing number of chronic and long term patients
• Low birth rate, unhealthy lifestyle..
• 1.6 billion adults overweight
• 300 million people (4.3%) suffer from asthma
• 214,4 million people (3.1%) suffer from COPD
• 382 million adults (8.3%) have diabetes (2013)
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@SinisaVarga Projected healthcare spend is alarming
OECD countries 2005 2030 2050 2070
United States 15.3 24.9 36.7 65.0
Switzerland 11.6 18.8 27.8 49.8
France 11.1 18.0 26.6 47.6
Germany 10.7 17.4 25.6 45.9
Greece 10.1 16.4 24.2 43.3
Canada 9.8 15.9 23.5 42.0
Netherlands 9.2 14.9 22.0 39.5
Denmark 9.1 14.8 21.8 39.0
Italy 8.9 14.5 21.3 38.2
UK 8.3 13.5 19.9 35.8
Turkey 7.6 12.3 18.2 32.6
Mexico 6.4 10.4 15.3 27.5
– If healthcare expenditure continued simply following demographics, cost would reach 30% of total GDP
HEALTHCARE NEEDS TO REACT
STAKEHOLDERS NEED TO ADAPT
SYSTEMATIC CHANGE IS REQUIRED
Source: Extrapolation of current growth relative to OECD GDP growth
Development of health expenditures as % of total GDP
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@SinisaVarga
Strategic
decisions
Data collection &
processing
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@SinisaVarga National Health Care Strategy 2012-2020
• Basis for World Bank project: “Health System Quality and Efficiency Improvement”
• Project ID: P144871
• Payment for Results method
• Numerous DLI's tied to National HC Strategy
MoH website http://zdravlje.gov.hr (search: National Health Care Strategy 2012-2020)
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@SinisaVarga National Health Care Strategy 2012-2020
Priority 1: Health informatics and eHealth
Priority 2: Strengthening and better use of human resources
Priority 3: Strengthening management capacities
Priority 4: Reorganization of health institutions
Priority 5: Encouraging quality initiatives and accreditation
Priority 6: Strengthening preventive activities
Priority 7: Preserving financial stability
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@SinisaVarga eHealth landscape › 2,300+ GP offices
(8 different vendors)
› 192 pediatrician offices (7 different vendors)
› 180 gynecologist offices (8 different vendors)
› > 2,000 dentist offices (5 vendors)
› > 1,100+ pharmacies (7 vendors)
› 100+ biochemistry laboratory (5 vendors)
› 12 hospitals / 1000+ specialist care offices
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@SinisaVarga eHealth Ecosystem
Payors
Policy-
Makers
Policy-
Makers
Policy-
Makers
Policy-
Makers
Payors
Policy-
Makers
Payors
Policy-
Makers
Payors
Policy-
Makers
Payors
Policy-
Makers
Patients
Medicines &
Equipement
Producers
Other GO's
and NGO's
Patients Patients Patients Patients Patients Patients
Other GO's
and NGO's
Providers
Academic &
Scientific
Community
eHealth
Technology
Developers
Providers
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@SinisaVarga
Best available research evidence
Population characteristics, needs, values
and preferences
Resources, including
practitioner expertise
Environment and
organizational context
Decision making
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@SinisaVarga Implementation of Croatia's e-health plan 2002-2013
• ePrescriptions – fully implemented and operative since beginning of 2011
• eReferrals – biochemistry labs, specialists from 2011 onwards
• eWaiting Lists and eScheduling – fully implemented and operative since beginning of 2013; eHealth Records – ready for piloting in mid-2014
• By the end of 2017, all patient-related communication will be paperless available to all stakeholders within the health system (eScheduling, eReferrals, eFindings, eDischargeLetters) and result in improved efficiency and increased savings
• The introduction of “A5 referral pads” for consultations without patient presence should result in less primary care referrals to specialists and hospitals
• All hospital financial applications will be interconnected for permanent access in real time to financial, procurement, and payroll data
Key objective: Paperless care and cross-linking of stakeholders
Result: BIG DATA
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@SinisaVarga Resource efficiency
The 2010 World Health Report on financing for universal coverage noted that: “Raising sufficient money for health is imperative, but just having the money will not ensure universal coverage. Nor will removing financial barriers to access through prepayment and pooling. The final requirement is to ensure resources are used efficiently.”
WHO World Health Report, 2010
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@SinisaVarga Strategic purchasing requires the purchaser to engage actively in 3 main relationships between stakeholders
“Passive purchasing implies following a predetermined budget or simply paying bills when presented. Strategic purchasing involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, how, and from whom.”
WHO World Health Report, 2000
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@SinisaVarga Return on investment of eHealth
• Payors through pooling of funds become bulk purchasers of goods (medicines, orthopedic and other appliances, sometimes capital equipment, etc) and services (medical and other out) in multi-million/billion dollar amounts
• Investments in software and other eHealth tools that increase efficiency and efficacy of the purchased goods and services have an extremely short return on investment (ROI).
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@SinisaVarga eHealth benefit for public health
• National screening programs (early detection of breast, cervical and colon cancer) have dedicated SW for recruiting patients, data collection and data analysis
• Data from primary care is automatically collected and transferred to the Croatian Public Health Institute
• Data from hospitals and other providers collected through billing by the Croatian Health Insurance Fund is transferred to the Croatian Public Health Institute
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@SinisaVarga
Diabetes
eHealth & Chronic Disease Management
Hypertension
COPD
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@SinisaVarga
12.5.2017. 17
Electronic Health Record
Medical
information
is collected
and
displayed
in a
consistent
and
ergonomic
way in one
place to a
variety of
authorized
users
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@SinisaVarga PATIENT PORTAL
• Managing dashboard for different activities
• Administrative information
• Communication platform with different healthcare professionals
• mHealth apps results
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@SinisaVarga EVOLUTION: Integrated care – example
Applications need to be part of care processes through platform Application adjustments needed according to cultural needs
DIA
BET
ES
CA
RD
IO
RES
PIR
ATO
RY
GA
STR
O
ON
CO
LOG
Y
MEN
TAL
CHILD
30+
50+
70+
...
MANY DIFF APPS IN EACH AREA
eHealth
system
apps
input
mHeath platform
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@SinisaVarga BD4BO - Data is gold of the 21st century: Systematic approach to healthcare outcomes us necessary in order to increase health services efficiency, efficacy and sustainability.
Better outcome
Less variation
Lower overhead costs
Healthcare system
improvement (outcomes/choices/rewards)
... result in system sustainability
Clinical records / registries Cl. studies /HTA/RWE/ comorbidity IT/software/telephon …
From services towards outcomes Big data for better outcomes / more possibilities! Creating value in every faze of the process
Big Data – possibilities of healthcare improvement...
Information
feedback
and
earning
Transparent treatment outcomes data
(big and deep data sources) Variation
analysis
Identification
"best practices"
Behaviour
change Better
outcomes
identifify, gather, connect and analyze
Value = outcome/cost
Better outcome
Less variation
Lower overhead costs
Healthcare system
improvement (outcomes/choices/rewards)
... result in system sustainability
Clinical records / registries Cl. studies /HTA/RWE/ comorbidity IT/software/telephone …
From services towards outcomes Big data for better outcomes / more possibilities! Creating value in every faze of the process
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@SinisaVarga
Drive
continuous
improvement
Health data is a key enabler of health system efficiency
• Transparent outcomes data increases provider competition on meaningful metrics, generating incentives for high quality care
• This is likely to lead to increasing specialisation, given the positive impact of caseload on provider performance
• Tracking patients over time reveals how follow-on complications can be avoided
• Patients at risk can be identified and intervention organised, reducing costly complications
• Root-cause analysis of outcomes variation can identify ineffective practices • Stopping ineffective practices eliminates spending that is not delivering
outcomes Eliminating
waste
Reducing
complications
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@SinisaVarga
"Out of clutter, find simplicity" Albert Einstein
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@SinisaVarga
"Out of clutter, find simplicity" Albert Einstein
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@SinisaVarga
WHY: We believe that every citizen of the world has an equal opportunity for achieving health, happiness and well-being
HOW: By protecting the health of individuals, families, communities and the nation as a whole, in order to better the productivity of the workforce which results in a higher GDP, thus increasing living standards (better roads, houses, schools, hospitals, police, government, etc)
WHAT: To improve the health system by bettering the system of data collection, to use and analyze this data for public health interventions, better efficacy and efficiency of providers and financial sustainability of payors without reducing access to healthcare.
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@SinisaVarga Who do you work for?
Government Industry
@SinisaVarga
Thank you!
Sinisa Varga, Vice-President Health and Social Policy Committee, Croatian Parliament
Visit Croatia, you're invited!