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Flow of the Presentation
HIE Definition HIE Stakeholders Stakeholder Interaction Value Proposition for HIE Stakeholders Contribution by Stakeholders Commercials for HIE
Definition of HIE
HIE is a platform through which an entity can provide data aggregated from its Telemedicine centers and also facilitate one-to-one or one-to-many exchange/s of healthcare related information among the following stakeholders commercially and non-commercially: Healthcare Seekers Healthcare providers Pharma / Surgical companies Pharmacies/ Chemists Wellness providers Insurers Government NGOs Institutes
Interactions among and with Government, NGOs and Institutes are critical but will remain mostly non-commercial on the HIE platform
HIE Stakeholders
Healthcare Providers
Pharma / Surgical
companies
Insurers
GovernmentNGOs
Institutes
Pharmacies/ Chemists
Healthcare Seeker
HIE
Stakeholders involved
Individuals (Rural, Urban healthcare seekers)
Corporate (through reimbursement model of healthcare delivery)
Integrated Delivery Networks
Hospitals
Nursing homes
Clinics
Diagnostic centers/ Pathology labs
108 services
Health Insurers
Agents
Wealth planners
Central government
State government
Regulatory bodies i.e. MCI
WHO
UNICEF
World Bank
ADB
Surgical instruments
Drug manufacturers
Device manufacturers
NGOs
Healthcare SeekerHealthcare Providers
Pharma / Surgical companies
Insurers Government
NGOs
Medical & dental colleges
Pharmacy colleges
R$D Institutes
Institutes
Pharmacies
Wholesalers
Individual
Chains
Hospital owned
Pharmacies/ Chemists
AYUSH
Fitness centers
Skincare & Dermatology
Wellness providers
Interaction Details – Healthcare Seeker
Individual: Demographic Segment • Urban• Semi-Urban• Rural
Income-Group Segments: • High Income Group• Middle Income Group• Low Income Group
Coverage Segment: • Covered with Insurance• No Insurance
Corporate Segment: • Reimbursed Healthcare• Company Provided healthcare
Healthcare Providers
• Tele-Medicine Clinics• Private Doctors• Specialist Doctors • Specialty Hospitals• Emergency Services
Pharmacy / Chemists
Insurance Companies
Government Agencies
NGOs
Commercial Interactions
Non-Commercial Interactions
Interaction Details - Others
Healthcare providers
Pharmacies/chemists
Insurance Companies
Government
Healthcare Seekers
Insurers
Pharma/ surgical companies
Pharmacies/Chemists
Government
Healthcare Seekers
Healthcare providers
Government
NGOs
Institutes
Healthcare Seekers
Healthcare providers
Pharma/ surgical companies
Pharmacies/ Chemists
Insurers
Healthcare providers
Pharmacies/ chemists
Government
Institutes
Healthcare Seekers
Healthcare providers
Pharma/ surgical companies
Government
Healthcare SeekerHealthcare Providers
Pharma / Surgical companies
Insurers Government
NGOs
Healthcare providers
Pharma/surgical companies
Government
Institutes
Healthcare Seekers
Healthcare providers
Pharma / Surgical companies
Government
NGOs
Pharmacies/ Chemists
Healthcare Seekers
Pharmacies
Wellness providers
HIE Value Proposition
Access to care
Reduce care/insurance cost
Improve services
Support health of family members
Improved healthcare awareness
Improve care quality
Access to EMR
Drug research & information
Knowledge sharing
Technological advancements
Increased visibility impacting top-line
Tie-ups with other stakeholders
Increase membership by targeted marketing
Direct sales
Easier claim settlement
Informed premium calculation
Better product design
Improve wellbeing- Social mandate
Better & transparent funding
Reduce care costs
Improve reach & access
Improve services
Reduce fraud & abuse
Increase volume
Improve service
Increase direct sales
Accelerate clinical trials at lower cost
Access to end-consumer and market intelligence
Access to competition focus areas
Greater access to the market
Government focus and budget allocation
Opportunity to tie-up with the best fit care providers or pharmacies
Attracting private/public funding/sponsorship
Healthcare SeekerHealthcare Providers
Pharma / Surgical companies
Insurers Government
NGOs
Clinical trials and studies
Research feed
Use data to refine the course material
Funding/sponsorship
Institutes
Greater access to the market
Product knowledge
Procurement/ inventory planning
Pharmacies/ Chemists
Access to a more organized platform to showcase their capabilities
Easier access to customer base
Wellness providers
HIE Value Proposition
Access to care
Reduce care/insurance cost
Improve services
Support health of family members
Improved healthcare awareness
Improve care quality
Access to EMR
Drug research & information
Knowledge sharing
Technological advancements
Increased visibility impacting top-line
Tie-ups with other stakeholders
Increase membership by targeted marketing
Direct sales
Easier claim settlement
Informed premium calculation
Better product design
Improve wellbeing- Social mandate
Better & transparent funding
Reduce care costs
Improve reach & access
Improve services
Reduce fraud & abuse
Increase volume
Improve service
Increase direct sales
Accelerate clinical trials at lower cost
Access to end-consumer and market intelligence
Access to competition focus areas
Greater access to the market
Government focus and budget allocation
Opportunity to tie-up with the best fit care providers or pharmacies
Attracting private/public funding/sponsorship
Healthcare SeekerHealthcare Providers
Pharma / Surgical companies
Insurers Government
NGOs
Clinical trials and studies
Research feed
Use data to refine the course material
Funding/sponsorship
Institutes
Greater access to the market
Product knowledge
Procurement/ inventory planning
Pharmacies/ Chemists
Access to a more organized platform to showcase their capabilities
Easier access to customer base
Wellness providers
Stakeholders Contribution to HIE
Generic personal information
Medical Records
Healthcare provider information
Healthcare spending behaviour
Payment for Services availed
Location
Service provided
Doctor information
Patient records
Diagnosis best practices/ knowledge
Drug efficacy
Healthcare spending behaviour
Insurance schemes
Insurance coverage
Medical history
Claims history
Client list
Demographic information (Census, UID)
Development Schemes
Funding
Consultation papers
List of products
Patent information
Research
Formulations
Technological advancements
Profiles- focus areas
Knowledge
Epidemics
Plans & funding
Healthcare SeekerHealthcare Providers
Pharma / Surgical companies
Insurers Government
NGOs
Clinical trials and studies
Research
Courses offered
Institutes
Location
Demographic profile of their region
Product sales information
Preferred healthcare provider
Pharmacies/ Chemists
Alternative & economic treatment
Care for lifestyle diseases
Wellness providers
HIE is projected to acquire critical mass by 2015
Type Stakeholders
Commercial
IndividualsHealthcare ProvidersPharmacies & ChemistsWellness care providersInsurersPharma & Surgical Companies
Non- commercial
Government
Institutes
NGOs
Stakeholder paying to HIE For transacting with
IndividualsHealthcare ProvidersPharmacies & ChemistsWellness care providers
Healthcare Providers IndividualsPharmacies & Chemists Individuals
Healthcare ProvidersWellness care providers Individuals
Insurers Individuals
Pharma & Surgical Companies Pharmacies & Chemists
Revenue in INR Crores 2012 2013 2014 2015
Individuals 5.2 12.3 30.1 95.6Healthcare Providers 2.9 7.1 18.1 61.4Pharmacies & Chemists 0.9 2.0 4.7 13.2Wellness care providers 0.3 0.6 1.6 4.8Insurers 0.3 0.9 2.3 7.0Pharma & Surgical Companies 0.6 3.3 13.2 55.0
Total Revenue Projection 9.7 26.3 70.0 237.0
HIE Revenue Model
Appendix
Learning from NoMoreClipboard …1/3
NoMoreClipboard Overview
The founders of NoMoreClipboard got their start in healthcare IT when they created one of the first commercially viable health information exchanges in the United States. The wires and pliers effort required to connect hospitals, physicians and other healthcare providers embedded the importance of practical and affordable interoperability into our organizational DNA. This same team developed a web-based electronic health record platform widely used by physicians, Fortune 500 companies operating on-site health clinics and safety net healthcare providers.
In 2003, NoMoreClipboard was formed as a separate legal entity to provide consumers with a portable, patient-managed personal health record platform designed to interoperate with virtually any other healthcare IT application. NoMoreClipboard is built on a robust electronic health record architecture developed for clinicians – with a consumer-friendly user interface. While much of the underlying clinical functionality is "turned off" for consumer use, it can be enabled for enterprise clients.
NoMoreClipboard is recognized as one of the top personal health records on the market, based largely on our ability to help consumers compile, manage and share personal health information with physicians and other care providers. NoMoreClipboard is able to deliver PHR data directly from the application in a format that integrates with existing provider workflow. PHR data can be delivered electronically using secure, interoperable data standards, or on the specific paper registration forms used by each individual provider. Physicians receive information that is more legible, accurate and complete – improving communication and coordination of care, and reducing medical errors and unnecessary costs.
Learning from NoMoreClipboard …2/3
NoMoreClipboard Milestones NoMoreClipboard.com is integrated on the Google Health platform, enabling Google Health users
to deliver their health information and medical records to physicians without electronic connectivity
NoMoreClipboard.com has a strategic relationship with Microsoft HealthVault, enabling consumers to compile, manage and share health records, delivering data from HealthVault to care providers
Howard University Hospital is providing diabetes screening and treatment on a mobile van that visits the Washington D.C. community – after the visit, the Howard EMR populates a NoMoreClipboard.com PHR account
NoMoreClipboard.com collaborated with NCHICA and IBM to demonstrate PHR interoperability as part of the Consumer Access to Clinical Information use case at the National Health Information Network (NHIN) demo sponsored by HHS
Medicare beneficiaries in Arizona and Utah can populate their NoMoreClipboard.com accounts with CMS claims data as part of a the Medicare PHR Choice Pilot program
Indiana University students can create an IU branded PHR and send their information to the campus student health center – information from NoMoreClipboard.com populates existing health center registration forms
NoMoreClipboard.com serves as the consumer gateway at the 2009 HIMSS Interoperability showcase in Chicago
Bon Secours Health System in Virginia is offering a branded version of the NoMoreClipboard.com PHR to its patient population as part of an online patient portal offering- Meridian Health in New Jersey is also offering a branded PHR to its patients – the PHR will include integration with innovative home monitoring devices including MDMouse
Learning from NoMoreClipboard …3/3
NoMoreClipboard Innovations The NoMoreClipboard FroozHIE tool is a user-friendly, interoperable application that
intelligently translates, compares and helps clinicians reconcile clinical patient data from disparate sources including PHRs, EMRs, HIEs and health care IT platforms such as Google Health and Microsoft HealthVault. Further, FroozHIE supports data between platforms utilizing different data standards including CCR, CCD, CDA and HL7.
NoMoreClipboard forms definition technology enables practice-specific patient registration forms to be scanned and defined – matching the fields on paper registration forms with the contents of the NoMoreClipboard PHR. Clinical information is SNOMED-CT coded so that information in the PHR corresponds to matching questions on practice forms (e.g. CHF entered in the patient PHR automatically indicates a history of heart disease on the practice form). With this technology, physicians receive a printed version of their own forms that is more legible, accurate and complete than the same form filled out in a practice waiting room.
NoMoreClipboard is able to create a branded patient portal experience that integrates the brand identity of the sponsoring organization with the benefits of the personal health record. Portals can incorporate additional functionality including secure messaging, appointment requests and prescription refill requests.
NoMoreClipboard functionality can be tailored for enterprise level clients to automate health risk assessments, integrate with other applications, and incorporate organization-specific modules
Lessons from Google’s failure
Google also proved that a consumer PHR service requires widespread, aggressive advertising. It will not spread virally, at least not at this nascent point in the PHR market. Google did not advertise the service widely, so hardly anyone realized Google Health existed. The few consumers who knew about it were not entranced, and did not recommend it to their friends. Google Health was too hard to use, too complicated.
Then the PHR must be explained and advertised to consumers so they crave it.
Given the lessons of Google’s failure, should we abandon visions of successful PHR systems for at least five years? The United States cannot afford that. There is little hope of controlling healthcare costs until we educate consumers about managing their health and dealing efficiently, as buyers, with physicians and hospitals. Consumers need their own health records on their own screens. They need help using those records with Internet tools and games, and on social networks
ONC’s experiment with NwHIN (Nationwide Health Information Network) Direct may be the way for consumers to get copies of their data easily, and sooner rather than later. If hospitals and physicians were required simply to write to, and read from, a standardized central communications backbone, there would be hope that commercial PHR systems could succeed.
The write-read backbone design relies on existing infrastructure and requires only the minimum standards necessary for the job. It is attractive because it is realistic using today’s technology, and because the “publish-subscribe” backbone can be made smarter and otherwise more capable over time. As a bonus, that architecture makes it easy for patients to get digital copies of their records for hassle-free input to their
PHRs.
None of this is as fancy as pie-in-the-sky dreams of universal structured data interchange, semantic interoperability, or comprehensive metadata tagging. But it is possible to do in the short-term, affordable, acceptable to physicians and the rest of the health industry, and very much worth doing.
Those are systemic lessons all of us can draw from Google Health’s demise.
http://www.himss.org/ASP/ContentRedirector.asp?type=HIMSSNewsItem&ContentId=78818
Lessons from Google’s failure
At the opening Google decided that they would support CCR (Continuity of Care Record) from ASTM and AFFP rather than the much more complex CDA/CCD from HL7. The CCR vs CCD debate has been one of the most controversial and long-standing arguments in Health IT. HealthVault, the Microsoft product which survives Google Health has always elected to support both standards. But Google insisted that the CCD standard was too complex, and not only insisted on CCR, but a smaller subset of that standard.
http://www.fredtrotter.com/category/hie/
A word or two of caution
"The HIE market is extremely volatile," states Lynne A. Dunbrack, program director, IDC Health Insights, "and will change dramatically in the next 12–18 months as HIE technologies become a commodity and dominant players acquire their way into a crowded market currently made up of many small, privately held vendors.“March, 2010, IDC Health
“The exchanges could help consumers and small businesses compare competing health plans” and “they also could increase price competition by requiring health insurers to offer more standardized plans and by providing consumers with better information about what they are buying.
HIEs are taking root across the country, despite technical, governance, institutional and funding challenges. Currently, there are more than 150 HIE projects in varying stages of maturity and employing several types of business models. Unfortunately, many of these HIEs may not exist long enough to realize their full potential because their business model is not financially sustainable. The key to sustainability is working with stakeholders to define and develop a business model that addresses the near term needs of individual stakeholders, yet is flexible enough to accommodate the diversity and evolution of these needs. Source: Deloitte Center for Health Solutions
Thank You
