Health Information Exchange and e-Health—Creating Sustainable Healthcare SystemsNorth America Region 2010

A Frost & Sullivan White Paperin Partnership with HP Enterprise Services

2 Frost & Sullivan

TABLE OF CONTENTS

Executive Summary......................................................................................... 3

Sustainability ................................................................................................... 4

We Are All Stakeholders ................................................................................... 4

Health Information Exchange ......................................................................... 5

Underlying Challenge ...................................................................................... 5

Transforming Health Data into Knowledge-Driven Solutions ......................... 6

Key Issues and Sustainability of Healthcare Systems in North America ........ 6

Maintaining a Sustainable Health System ....................................................... 6

Juggling Healthcare Initiatives......................................................................... 7

Health Information Exchange and e-Health .................................................... 7

e-Health as an Enterprise System ................................................................... 7

Issues ............................................................................................................... 8

Convergence of e-Health and Health IT Priorities .......................................... 8

Leveraging Health Data................................................................................... 9

Access to Health Data..................................................................................... 9

Health Data Exchange .................................................................................... 9

Near-Term Opportunities ................................................................................ 10

Enabling Public Health Initiatives ................................................................... 10

Consumer Empowerment................................................................................ 10

Stakeholder Roles ............................................................................................ 10

Barriers to Consumer Empowerment ............................................................. 11

Associated Benefits.......................................................................................... 11

Health Information Exchange in North America ............................................ 11

Overview ......................................................................................................... 12

Transforming Health Data into Knowledge-Driven Solutions .......................... 12

Future Directions ............................................................................................ 14

Paradigm Shift ................................................................................................. 14

Sustainability................................................................................................... 15

New Business Models ...................................................................................... 15

Principal Drivers .............................................................................................. 16

Access and Security ......................................................................................... 16

Consumer Empowerment ................................................................................. 17

Acknowledgement of Collaborating Organizations......................................... 17

Advances in information and communication technologies have progressed enough toenable the electronic exchange of health data between service providers, consumers, and community stakeholders. The exchange of health information facilitates prevention,wellness, and chronic disease management. Health information exchange (HIE) is madepossible through e-health, the electronic exchange of patient data via health information networks.

A sustainable health system relies on our ability to transform health data into knowledgeand knowledge into actions to achieve cost-effective health outcomes on individual andpopulation levels. A sustainable healthcare system is one that meets current consumerdemands without reducing its capacity to provide for future generations.

EXECUTIVE SUMMARY

A country’s economic growth is interminably intertwined with the health of its population.A critical point is reached, however, when healthcare spending becomes an economicburden to individuals, communities, governments, and society at large. At that juncture, the sustainability of a country’s healthcare system is threatened and its economic growth endangered.

The underlying challenge is to offer the right healthcare product/service to the right person at the right place and time at the right price to achieve optimal health outcomes. HIE and e-health can meet this challenge as advancements in information, communication, andmedical technologies have dovetailed to afford the tools. The missing element is a definitiveprocess, a process HP describes as a 360-Degree Healthcare Continuum.

In 2010, Frost & Sullivan and HP sponsored a global exercise to lay the foundation for anopen dialogue on e-health, HIE, and sustainability. In focus groups and surveys, C-levelexecutives, representing a cross-section of stakeholders, shared their insights on key issues,priorities, and processes, leveraging health data and consumer empowerment in theirindividual countries.

In North America, findings reflected the unique stakeholder environment in whichexecutives contend in Canada, Mexico, and the United States. Although these decision-makers cited healthcare financing, access to care, and consumer demands and expectationsas predominant issues, providing quality healthcare trumped cost management inimportance to achieving sustainability.

E-health was viewed as an enterprise-wide capability, with adoption, utilization, andintegration of technology applications critical to establishing the intrinsic role of HIE inachieving better health outcomes. Stakeholder collaboration in planning and implementationwas recognized as crucial to maximizing return on investment.

HIE is an intermediate endpoint leading to sustainable health systems.

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SUSTAINABILITY

The concept of healthcare’s tremendous impact on economies recognizes the relationshipbetween population health and economic growth and development. A healthy populationmay be considered a prerequisite for economic productivity, prosperity, and sustainability.

Health spurs community economic development directly and indirectly. Direct economicdevelopment results from healthcare services delivered by medical and nonmedicalproviders. Those services would be paid for by consumers and private and governmentthird-party payers, with the latter bringing new dollars into the community. Indirecteconomic growth results from productivity levels driven by a healthy population.

We Are All Stakeholders

A critical point is reached when spending on health and health-related conditions becomesa significant economic burden for individuals, families, businesses, and society at large. Theoperative words are “significant economic burden.” Spending is driven by a complex mazeof consumer demographics, expectations, and care-seeking behaviors on one hand; providersettings, practice protocols, and use of technologies for screening, diagnosis, treatment, andhealth maintenance are on the other. Economic burden relates to value—ability to pay,willingness to pay, and expected outcomes. Expected outcomes are measured in terms ofsafer care and healthier, more productive lives.

As stakeholders, we all share in the responsibility for maintaining a sustainable healthsystem and a productive economy. Contributions to maintaining a sustainable health systemtake different forms. For example, individuals are responsible for living healthy lifestyles andadopting healthy behaviors to maintain and/or improve health. Employers are responsiblefor providing a safe and healthy work environment and may offer benefits such as healthand/or disability plans, prevention and wellness programs, and paid leaves.

Government policymakers and agencies are responsible for regulating and monitoringpublic health safety, funding entitlement programs, approving new medical/drugtechnologies, and so on. Government and private third-party health insurers, as payers,focus on risk, actuaries, reimbursement, costs, and cost-efficiencies. In varying degrees, eachstakeholder is concerned with health and healthcare spending related to prevention andwellness, access to care, quality of care, and the inherent value in maintaining a betterquality of life.

Stakeholder collaboration now has the potential to positively ease the complex maze ofhealthcare spending. Advances in information and communication technologies have mergedwith medical device innovations to capture real-time health data across physical boundaries.These technologies, with the essential infrastructure (broadband and/or private networks),provide the mechanisms to achieve sustainable health systems. Stakeholder utilization andcollaboration will provide the means via health information exchange.

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Health Information Exchange

HP describes the health information exchange process as a critical part of the 360-DegreeHealthcare Continuum—“moving pieces” centered on the following core priorities:knowledge distribution, consumer empowerment, performance improvement, streamlinedbusiness practices, and leveraged infrastructure and applications (see Figure 1). TheContinuum accommodates diversity in healthcare financing (government versus private),access to care (multiple entry points), electronic practices (automated processes to manageworkflow, communications, and recordkeeping), and provision of care (in-person and real-time virtualization). It is solution-based to build and reinforce stakeholder trust; providemeasurable, cost-effective results; and demonstrate value.

The Continuum, however, does not infer linear functions. It involves a dynamic flow of health data that needs to be transformed into knowledge to devise solutions—solutions to achieve cost-effective health outcomes on individual and population levels tofoster sustainability.

Figure 1: The 360-Degree Healthcare Continuum

Source: HP

Underlying Challenge

The challenge is not technology-oriented or technology-driven. The underlying challenge isin restructuring stakeholder relationships to support health information exchange thatgenerates health solutions. The challenge is to provide health solutions that offer the rightproduct/service to the right person at the right place and time at the right price.

To this end, HP and Frost & Sullivan partnered to explore and lay the foundation for aninternational dialogue on health system sustainability, e-health and health information

PopulationHealth

Analysis Communityand Family

SupportSystems

CustomerContact

Systems andServices

PaymentSystems and

Incentives

HealthInformation

and ElectronicHealth

Records

PharmacyManagement

CareManagement

BenefitDesign andConsulting

Services

Quality andBenchmarking

Public HealthSystems

Eligibilityand

EnrollmentServices

360-DegreeHealthcareContinuum

ConsumerEmpowerment

Streamlined

BusinessProcesses

Knowledge

Distribution

Performance

Improvem

ent

Leve

rage

dApplic

atio

ns

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exchange in North America, the EMEA countries (Europe, Middle East, and Africa), and theAsia Pacific countries.

TRANSFORMING HEALTH DATA INTO KNOWLEDGE-DRIVEN SOLUTIONS

In 2010, C-level executive stakeholders—representing government and privateorganizations, healthcare providers (hospitals and physicians), third-party payers, andassociations (physician and consumer)—were invited to share their perspectives, insights,and plans by participating in an online survey. Questions focused on the five elements inHP’s 360-Degree Healthcare Continuum.

One-hundred twelve organizations completed the survey. Findings were analyzedindependently and then compared to similar questions posed to chief information officers(CIOs) during a series of focus groups and interviews Frost & Sullivan industry analystsconducted in its North America, EMEA, and Asia Pacific offices in late 2009 and early 2010.

This paper will focus on the insights and perceptions shared by 68 C-level executives fromNorth America (Canada, Mexico, and the United States) who participated in the onlinesurvey and 43 CIOs from the region who participated in focus groups and interviews. Ofthe survey respondents, 52 percent were hospital/physician providers, 26 percent werethird-party payers or government agencies, and 20 percent represented physician orconsumer associations. The majority described themselves as “C-level decision-makers” (68 percent) and “C-level information technology executives” (22 percent).

Of note, the predominance of universal healthcare coverage in Canada and Mexico versusthe more fragmented coverage in the United States did not appear to unduly influence theinsights and responses received.

KEY ISSUES AND SUSTAINABILITY OF HEALTHCARE SYSTEMS IN NORTH AMERICA

C-level executives were asked their opinions on issues affecting sustainability of thehealthcare system in their individual countries and what issues their organization wasspecifically addressing. Several themes emerged: healthcare finance, consumer behavior anddemands, access to care, human manpower, medical model focus, policy/planning, andimproved health outcomes. Health information technology (HIT) was cited in terms ofpolicy/planning and integration of services.

Of interest, healthcare finance was the predominant issue related to sustainability byparticipants in all three countries (36 percent), followed by access to care (13 percent), andconsumer behavior and expectations (12 percent). These three issues were also thepredominant action items currently being addressed by organizations, along with humanmanpower limitations.

Maintaining a Sustainable Health System

Recent Frost & Sullivan interviews of key healthcare thought leaders support publishedfindings that access to care, prevention and wellness activities, quality of healthcare, and

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KEY ISSUES

“… rising costs,health humanresources, public and providerexpectations,inadequateinfrastructure …”

Canada

“…access tohealthcare services,adequate number of primary carephysicians, adequatereimbursement …”

United States

“… economic, moneyto buildinfrastructure andprovide services …”

Mexico

cost management are the four principal ingredients to maintaining a sustainable healthsystem—whether or not universal health coverage has been implemented.

Survey participants were asked to rank these four factors on a four-point scale ofimportance, with “4” being most important. Quality of healthcare received the highestaverage ranking (3.5), followed by access to care (3.17), and prevention and wellnessactivities (3.04).

Although participants believed healthcare finance was the key issue, they ranked costmanagement as least important in maintaining a sustainable health system. Frost & Sullivanbelieves these findings reflect the perception that quality healthcare leads to better healthoutcomes that, in turn, lead to less utilization of scarce health resources.

Juggling Healthcare Initiatives

C-level executives were asked what advice they would give to those struggling to balance healthcare initiatives to improve access to care and patient outcomes (qualityhealthcare) with cost-management directives. The advice naturally clustered into measurereturn on investment (39 percent), plan/change policy (23 percent), adopt best practices (23 percent), take incremental steps (12 percent), and collaborate and integrate systemsand services (9 percent). The majority of participants gave lengthy responses that centeredon measuring return on investment in terms of total costs and total value through planningand policy processes.

HEALTH INFORMATION EXCHANGE AND E-HEALTH

e-Health as an Enterprise System

Eighty-six percent of North American survey respondents believed that e-health was bestdescribed as an enterprise system, with data silos developed and adopted followingnonlinear pathways. Of note, 100 percent of participants believed that electronic medicalrecords and electronic health records were basic minimum requirements for a sustainablehealth system (see Figure 2). Less than half (46 percent) believed administrative functionssuch as eligibility, claims, and processing were essential.

Frost & Sullivan thinks the latter finding is curious; it suggests that almost 50 percent ofthese C-level executives view electronic operational capabilities related to billing forservices as an adjunct function with a neutral impact on sustainability.

Figure 2: Minimum e-health components for health system sustainability

Electronic Medical RecordsElectronic Health Records100%

Clinical Workflow70%

Personal Health Records59%

Online Medical Information54%

Physician Education & Training

Clinical Decision Support

Comparison of Patient Outcomes

Public Health Monitoring

Prevention & Wellness Activities

Eligibility Claims & Processing49%

79%

67%

56%

51%

46%

Unanimously, EMRsand EHRS were

considered essentiale-Health components

for a sustainablehealth system.

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COMPETINGPRIORITIES

“… consider thathigh investment nowwill lead to bettercost-management inthe long term foraccess and improvedquality …”

Canada

“… Start out with amodest benefitpackage. Grow at arate you can supportfinancially and froman access standpoint,with a focus onrewarding healthbehaviors and high-quality providers …”

United States

Issues

C-level executives were explicit in describing issues related to e-health and healthinformation technology in their survey responses and focus group discussions. Adoption andutilization and integration of technology applications were the issues cited most often,closely linked to data integrity and confidentiality.

Financial considerations were related to funding sources and eligibility for governmentincentives and subsidies in all three countries. Less than 14 percent had concerns withpolicy and planning issues or the ability to demonstrate outcome measures. This finding isconsistent with other Frost & Sullivan surveys showing that policy and planning andoutcome demonstrations are becoming embedded principles in healthcare spendingdecision-making.

Figure 3: Most important issues related to e-health and health IT

Convergence of e-Health and Health IT Priorities

Survey participants did not distinguish between e-health and health information technologypriorities over the next 12 to 18 months. The need for leadership was the pervading theme.Core priorities centered on technology integration and stakeholder collaboration.

Figure 4: e-Health priorities

IT

ITIT e-Health

e-Health

e-Health

IT

IT APPs Expansion

EMR/EHR Implementation

Policy and Planning

Integration and Collaboration

Adoption and Utilization

Adoption and Utilization

Infrastructure Expansion

0% 10%

Adoption &Utilization

Technology AppIntegration

Data Integrity& Confidentiality

FinancialConsiderations

Policy &Planning

DemonstratedOutcomes

20% 30% 40% 50% 60% 70% 80% 90% 100%

48%

47%

40%

35%

13%

12%

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LEVERAGING HEALTH DATA

Access to Health Data

The debate over who should have access to health data continues. Concerns center onHIPAA compliance, data security and confidentiality, and the place of “raw” health data in apersonal health record. Survey respondents were asked to select from nine groups thosewho should have open access to health data.

Figure 5: Access to health data results

Clear lines were drawn. More than 70 percent of participants believed patients andhealthcare providers (physicians and hospitals) should have access to health data. Less than10 percent believed private insurance companies or nonmedical health providers shouldhave access.

Health Data Exchange

In a similar vein, there are countless debates on who should be responsible for sharing,storing, and maintaining health data, and then “control” after health information is shared.Should there be industry standards for health data exchange? Should exchange of data beshared in real time? How does one accommodate integration demands?

Using a seven-point scale to gauge level of responsibility, survey respondents believedproviders (hospitals and patient physicians) should have a more responsible role in sharing,storing, and maintaining health data than private companies and Internet providers.Government agencies were viewed as having some, but not major, responsibility.

0% 10%

Non-medical Healthcare Providers

20% 30% 40% 50% 60% 70% 80% 90% 100%

7%

Private Insurance Companies 9%

Government Agencies 22%

Healthy Consumers 25%

Caregivers 42%

Public Health Agencies 43%

Hospitals 71%

Medical Specialists 73%

Patients 73%

Primary Care Doctors 79%

Thumbs Down

Thumbs Up

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Figure 6: Health data exchange results

Near-Term Opportunities

Focus group discussions conducted by Frost & Sullivan support published research findingsshowing multiple ways health data can be leveraged to improve and facilitate access to care,quality of care, and cost-management activities in the near term. These include chronicdisease management, clinical decision support, consumer empowerment, consumer healthpromotion, healthcare policy development, patient safety, public health programs, andoperational efficiencies.

Survey respondents suggested that health data utilization could have the greatest impact onchronic disease management, clinical decision support, and patient safety. They believed theability to leverage health data was more dependent on planning and policy directives thanstakeholder collaboration, improving systems, or funding.

Enabling Public Health Initiatives

In terms of public health initiatives, respondents felt that health data could be leveraged tosupport evidence-based medicine and serve to target health policy priorities more than tosupport the design and development of behavioral health and wellness programs.

Frost & Sullivan believes the responses may reflect the provider orientation of theparticipants more than perceptions of the breadth of health data collected.

CONSUMER EMPOWERMENT

On one level, healthcare economists have suggested that the absence of consumerinvolvement has contributed to rising healthcare costs and led individuals to ignore theirhealth. On another level, “consumer connectivity” has been aligned with higher treatmentplan compliance and less risky health behaviors.

Stakeholder Roles

Organizations have engaged in four main activities to encourage individuals to take controlof their health: developing health education programs, developing consumer health literacy

1 2

Internet Provider

3 4 5 6 7

2.0

Private Company 3.1

National Government Agency 3.7

Each Patient 4.2

Local/Regional Govt. Agency 4.3

Health Info. Network of Hospitals 5.2

Each Patient’s Healthcare Provider 5.7

Thumbs Down

Thumbs Up

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programs, sponsoring wellness activities (for example, weight control and nutritionprograms), and sponsoring online blogs and health portals.

Survey respondents believed sponsoring wellness programs would be given the highestpriority in their organization, while establishing an online blog or health portal would havethe lowest priority. This choice supports previous findings that stakeholders place a highervalue on activities where outcomes may be directly measured than less expensive activitieswith unknown outcomes.

Individuals who participate in a company-sponsored exercise or weight-reduction programhave better health outcomes than those accessing company health portals or blogsproviding diet and exercise information. The former is an ongoing activity (higher employercost) versus a transaction activity (lower employer cost), but the benefits—such as usingfewer sick days—are higher.

BARRIERS TO CONSUMER EMPOWERMENT

Healthcare providers have suggested that there are a number of barriers to consumerempowerment, including: computer literacy, Internet access, health literacy, mobile phoneaccess, and the movement of consumers between health organizations.

When asked to rank these four barriers, survey participants were most concerned withhealth literacy and the movement of consumers between health organizations thanlimitations associated with physical access to information. This finding supports otherresearch highlighting the significance of the consumer’s understanding of “data” versushaving an abundance of data.

Associated Benefits

Survey respondents were somewhat vague in describing the potential benefits associatedwith consumer empowerment, qualifying their comments with phases like “reasonable toassume.” Perceptions included: improved quality of care, increased awareness, financialsavings, improved health management, and “not sure.”

The majority of participants felt that improved health management would be the principalbenefit of consumer empowerment and explained under what conditions this might occur.The underlying assumptions were that a more knowledgeable consumer would makehealthier lifestyle choices and be more compliant with treatment protocols.

HEALTH INFORMATION EXCHANGE IN NORTH AMERICA

Our principal research objective was to explore and lay the foundation for an internationaldialogue on health system sustainability, e-health, and health information exchange,recognizing two important factors. First, advances in information, communication, andmedical device technologies that have progressed to enable the electronic exchange ofhealth data between service providers, consumers, and community stakeholders are arelatively new phenomenon.

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Second, the intrinsic value of the findings would be found in how the information was usedto support HIE and the transformation of health data into solutions to create and maintainsustainable healthcare systems. In North America, the process of transforming health datainto knowledge to achieve tangible cost-effective health outcomes is a work in progress.

Overview

Envision “Lego Lands” (ecosystems) of health and healthcare activities and practicessupported by electronic processes and communication across three countries. The Legomodules are suspended, anchored by diverse HIT silos linked to various healthcare settings.

Although the ecosystems in Canada, Mexico, and the United States have three distinctivepopulations, cultures, political and economic dynamics, and divergent healthcare systems,there are some similarities.

• In each country, the government initially funded and laid the foundation for thenecessary infrastructure, giving rural populations access to healthcare.

• Infrastructure development continues to be a work in progress, with ongoinggovernment financing often augmented by transindustry matching funds.

• A diverse array of health information technologies (hardware and software) that offeropen, vendor-agnostic architecture configurations are in play to achieveinterconnectivity.

• Some industry standards exist and are being refined.

• Adoption and utilization of electronic processes by providers (hospitals, hospitalsystems, medical and nonmedical practitioners, and ancillary services) have been slowin all three countries.

• Planning and decision-making considerations are tempered by return on investmentexpectations.

• Government subsidies may have covered all or some of the initial costs of healthinformation network (HIN) and HIT pilot/demonstration projects. Funding, however,may not have been immediately available for ongoing system operations andmaintenance. To sustain these projects, some regions were successful in formingcommunity collaborative partnerships at the onset of funding to ensure post-fundingcontinuation of the programs.

Misalignment of benefits derived from HIT and HIN investment activities has been cited asa principal deterrent to adoption. In the past, providers assumed the investment risks andcosts, while payers who control reimbursements reaped the financial benefits.

Transforming Health Data into Knowledge-Driven Solutions

Frost & Sullivan believes a more collaborative adoption approach has been initiated withpilot HIT/HIN programs directly funded through in-kind financial support from government

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agencies, nonprofits, health providers, payers, and industry. In these programs, adoption andutilization of health information technologies and networks are intermediate objectives. Thelong-term objective is real-time health information exchange that improves access to care,quality of care, and value in terms of cost-efficiencies and better health outcomes.

• Canada—In 2001, the 14 ministers of health formed Canada Health Infoway, anindependent, nonprofit organization to fund electronic health record implementationand spur adoption of health information exchange. Infoway has established a nationalEHR blueprint of requirements and core components for a national system. It will fundup to 75 percent of the costs of an area’s project that ties monies to achieving certainproject milestones.

As of December 2009, the organization approved $1.6 billion funding for 294 projectsspanning initial planning through implementing regional health networks. By the end of2010, the goal is that authorized healthcare professionals will have access to the EHRsof 50 percent of Canadians and 100 percent of Canadians by 2016.

Individual provincial HIE advancements continue. For example, in June 2010, Televisitwas introduced. Televisit integrates telehealth services into the National Program forHome Ventilatory Assistance. Healthcare providers are able to conduct “virtual visits”to patients through live video communications. The system enables the transmission ofphysiological data in real time to assist in the assessment of a patient’s health.

• Mexico—IMSS (Mexican Social Security Institute) is the public health system in Mexicoand the largest healthcare provider, offering coverage to 44 million individuals—nearlyhalf the population. In 2003, IMSS obtained a copy of VistA, the clinical informationsystem of 100 integrated software modules developed by the U.S. Veterans HealthAdministration. VistA has been translated into Spanish and modified to meet IMSS needsof hospitals and clinics. Installation has expanded from an initial 12 hospitals in 2005 tomore than 56 hospitals and 1,000 clinics to date. A medical staff of more than 278,100now has access to the system, which houses more than 36 million individual records.

There are also a number of independent efforts to establish EHRs in private healthcarefacilities (for example, Clinica Lomas Altas, Clinica Londre, Hospital Ingles, and HospitalABC) and telemedicine services.

The government’s principal goal is to establish universal healthcare for its citizenry by 2011.

• United States—Federal and state governments and healthcare providers (hospitals,academic medical centers, government providers, and clinicians in private practice) havemade independent investments in EMRs/EHRs and e-health over the past 30 years.Levels of investments have varied. Since 2009, more than $2.7 billion has been awardedto 260 projects to establish broadband connections alone, and most funding awardswere attached to matching fund agreements by states and private businesses. Industryanalysts believe that 68 percent of hospitals and 35 percent of office-based physicianshave full or partial EMRs.

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Federal legislation in 2009 and 2010 was enacted to fund and provide incentives forinfrastructure development/improvements, regional health information organizations,and HIT systems for physician office use. In addition, a number ofgovernment/payer/private industry collaborative partnerships have been formed topilot virtual care programs using exchange of real-time health data during online visits.

On another level, health advocacy companies have emerged to help consumers navigatethrough the healthcare system and its third-party reimbursement maze.

In all three countries, agencies, providers, and payers are engaging consumers and patientsin health and wellness information exchange activities. Personal health record software(Google Health and Microsoft’s HealthVault) are linked to many of the health informationnetworks. Health information silos are slowly dissolving.

FUTURE DIRECTIONS

Paradigm Shift

The health system of the future demands a paradigm shift as stakeholders move fromfragmented health information systems to an integrated and automated exchange of healthinformation in real time and as silos of HIT resources dissolve.

Frost & Sullivan envisions connectivity across North America, whether or not universalhealth coverage is embraced in the United States or diluted in Canada and Mexico with thegrowth in private insurance carriers to attract medical tourism.

Connectivity will be fostered by stakeholder partnerships forged to deliver health, wellness,and healthcare services across Canada, Mexico, and the United States. Telehealth andtelemedicine programs will become a mainstay of health systems, and medical tourism willbe more fully embraced by payers, employers, and consumers.

Connectivity also will be fuelled by real-time exchange of health information, withconsumers taking a proactive, responsible role in improving or maintaining their health.Personalized medicine will weave its root in chronic disease management as monitoringmoves into the community and home. Electronic personal health records (E-PHRs) willassume equal prominence with EMRs.

Figure 7: Health system of the future

Invasive

Provider Centric

Centralized—Hospital

One Size Fits All

Therapeutics/Diagnostics/Devices

Treating Sickness

Fragmented

Diagnosis & Treatment

Focus

Monitor

Approach

Objective

Health Information

Less Invasive, Preventative,Image Based

Patient Centric

De-Centralized-Shift to Community

Personalized Medicine

“Theranostics’Tools

Preventing Sickness—”Wellness”

Integrated & Automated

From... To...

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Sustainability

A sustainable health system is dependent upon whether the demands placed on it can bemet without reducing its capacity to meet the demands of future generations. Sustainablehealth systems will be achieved as “cost management” policies replace “cost-savings”directives, with return on investment measured in terms of total costs versus total value. Asustainable health system is one that provides the right service (prevention, screening,diagnosis, or treatment) to the right person at the right time in the right venue at the rightcost—based on health data exchanged between integrated national, regional, and localhealth information networks.

In turn, integrated health information networks achieve sustainability through collaborationand stakeholder partnerships in which the benefits derived justify the investment. Althoughthere are relatively few network providers, there are hundreds of hardware and softwarevendors that offer a variety of legacy-compatible systems and application modules thatcontribute to an integrated network of EMRs, EHRs, and PHRs. Most of these offerings are“customized” to meet individual provider needs and preferences.

As healthcare providers across segments move to establish or expand their HITapplications and data integration activities, decision-makers will be looking for HITsolutions to meet their needs, not transactional purchases. Frost & Sullivan believes thesesolutions will be derived from cross-industry strategic partnerships that resolve limitationsand roadblocks from HIT silos in an organization.

For example, the HP Care Network Solution (CNS) helps close the healthcare informationgap associated with spiraling costs and risks inherent in paper-based, information-intensiveapproaches. It is a flexible, standards-based set of services that combines relevantinformation about an individual’s health, treatment, medications, and demographics frommultiple data sources to promote collaborative care. Concurrently, CNS offers metricsessential to modeling wellness outcomes and public health initiatives, such as assistance forrapid disaster response and bio-surveillance.

New Business Models

Frost & Sullivan North American industry analysts have reported an increase in cross-industry mergers and acquisitions as vendors move from offering fragmented products tointegrated solutions. Traditional communication and telecommunication providers believethe health industry offers new opportunities, while traditional health providers are lookingto share investment risk and increase market share.

One example is the HP acquisition of EDS. This created an entity that serves organizationsacross the health and life sciences value chain to improve business and health outcomesthrough the capture, management, and integration of information. By providing an extensive,integrated portfolio of products, solutions, services, and partnerships, HP has enabledhealth and life sciences organizations to lower costs, speed innovation, function moreefficiently, and improve the quality of care. As a result, HP is positioned as a trustedtechnology leader, providing the healthcare marketplace with innovative solutions thatimprove operational efficiencies while delivering a higher quality of care.

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On another level, the HP Digital Hospital solution uses a holistic approach to integrate andmanage information, medical, communication, and building technologies to improveprocesses, enhance safety, improve quality of care, and enable customized healthcare. HP’sDigital Hospital was born out of a groundbreaking project delivered by HP, Cisco, andIMATIS at St. Olavs Hospital (Trondheim, Norway).

Principal Drivers

Government subsidies and incentive programs in Canada, Mexico, and the United States willremain the mainstay and principal drivers of e-health and health information exchange. InJuly 2010, for example, 66 stimulus-funded grants from the U.S. Departments of Commerceand Agriculture will install broadband Internet connectivity to underserved communities.This includes 900 healthcare facilities, 685,000 businesses, and 2,400 schools throughoutthe United States. Initial award and continuing funding, however, will be linked to expectedimpact in achieving specific HIE milestones.

Fueled by government financial incentives, individual medical offices of all sizes willincreasingly turn to their affiliated hospitals for guidance on adopting the “right” EHR solution for their practices. HP and Intel have partnered to meet this need. The HP EHReady program is a full-service electronic medical records package designed tofacilitate adoption and utilization of electronic records storage, including providinghardware (such as desktops, notebooks, tablet PCs, and scanners) to facilities needing atechnological revamp.

Access and Security

Health systems of the future will require health information networks that have real-time,intuitive automated processes to distinguish access permit levels among users, identifysecurity breaches, and implement immediate corrective actions. Recent governmentdirectives in Canada, Mexico, and the United States have increased individual and provideraccess to health data, but new security measures like patient identification encryption arestill under advisement. Likewise, policies on security breaches, corrective actions, andenforcement are slowly being implemented.

The HIE module of the HP Care Network Solution uses standard security protocols thatsupport user authorization, authentication, non-repudiation, encryption, and administration.Privacy management measures support opt-in/opt-out and provider-specific privacy models,hold patient privacy preferences, and hold business rules for restricting databases onsensitive data classes.

Identity management measures validate providers’ credentials to access data; providedelegated administration to link the same clinician to multiple organizations; provide role-based access to give different capabilities to users within a clinical setting; validatemembers’ access to clinical records; and serve as an extension of the existingprovider/citizen portal security.

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Consumer Empowerment

At an accelerated rate, individuals will assume more ownership of their health data to beable to navigate through the dynamic maze of modern healthcare and choose the “right”product. Medical providers will continue to adopt more patient-centric approaches indiagnosis, treatment, and care management. Government and private payers will focus onmore consumer-oriented benefit plans and health promotion activities, including support ofemployer-sponsored wellness programs.

Consumers will need simple ways to process and assimilate this information, and this needwill be viewed as a “white space” opportunity for non-provider stakeholders. One exampleis the July 2010 acquisition of Hummingbird Coaching Services (HCS) by LifeSynch,Humana’s health and wellbeing subsidiary. Three winning scenarios resulted. A large groupof consumers became aware of health information provided by MyHealthCoach.com andAboutMykids.com, LifeSynch broadened its benefit plan portfolio and Humana gained theopportunity to further its position as a health planner versus a third-party payer.

Established in 1997, HCS is a telephone- and Web-based health and wellness organizationwith two principal offerings: MyHealthCoach.com and AboutMyKids.com. The acquisitionbroadened LifeSynch’s benefit plan portfolio and afforded Humana the opportunity tofurther its stakeholder position as a health planner promoting consumer empowermentversus a third-party payer.

The need for information and transparency, however, is greatest when an individual or family member has been hospitalized. The HP Digital Hospital has an innovative solution.Each patient bed is equipped with a Patient Portal that provides interactive entertainmentand education, along with bedside computing and communication. Healthcare self-servicekiosks are also available. The HP Care Network Solution provides consumer portals that can serve as a personal health record to facilitate collaboration between patients andtheir caregivers.

SUMMARY

A new age in health information exchange has emerged that enables stakeholders in North America to collaborate and create sustainable health care systems. Information,communication and medical technologies have converged to provide the tools. Thechallenge is to devise the process. As an initial step, C-level stakeholders from Canada,Mexico and the United States have shared their insights and perspectives to build afoundation that will bring the right product/service to the right person at the right place andtime at the right price to achieve optimal health outcomes.

Frost & Sullivan 17

ACKNOWLEDGEMENT OF COLLABORATING ORGANIZATIONS

Frost & Sullivan 18

NORTH AMERICACANADA Alberta Health and Wellness

Alzheimer Society B.C.

Brain Injury Association of NS

Cancer Care Nova Scotia

Central East Local Health Integration Network

Eastern Health

Covenant Health (Edmonton)

Headwaters Health Care Centre

Interior Health Authority

Local Health Integration Network

London Health Sciences Centre

Manitoba Blue Cross

National Indian & Inuit CHR Organization

UNITED STATESAcute Care, Inc.

Arizona Association of Community Health Centers

Baptist Health System

Barnes-Kasson Hospital

Baylor UT Houston Center AIDS Research

Bowdle Health Care

Broadstone Memorial Hospital

Cass Regional Medical Center

DCH Health System

Florida Agency for Health Care Administration

Good Samaritan Hospital

Hawaii Primary Care Assn.

Healthcare Care Access San Antonio

North Simcoe Muskoka Local Health Integration Network

Regina-Qu’Appelle Health Region

SAHO

Saskatoon Health Region

South East Local Health Integration Network

Spina Bifida & Hydrocephalus Canada

Stanton Territorial Health Authority

Sunrise Health Region

Trillium Health Centre

Western Health

MEXICOMedicina a Distancia

UMAE HTO 21 IMISS

EMEAAIMAR (Italy)

EACCI (Europe)

European Fundraising Assn. (Belgium)

Herzog Hospital (Israel)

Institute of Social Medicine (Macedonia)

Ministry of Health (Cyprus)

Ministry of Health (Romania)

NHS 24 (UK)

NHS Yorkshire and the Humber (UK)

Nuffield Hospital (UK)

Obafemi Awolowo University (Nigeria)

Técnicas de Salud (Spain)

University of KwaZulu-Natal (South Africa)

Humana, Inc.

Indian Health Service

Iowa Medicaid Enterprise

Kaiser Permanente (2)

Maine Primary Care Assn.

Martin Memorial Mayo Clinic

McLaren Regional Medical Center

National Center for Health Care Informatics

Oklahoma Healthcare Authority

Palo Alto Medical Assn.

Permian Regional Medical Assn.

Regence BlueCross BlueShield

Rhode Island Health Center Assn.

Riverwood Healthcare Center

Signature Hospital Corporation

Society of Hospital Medicine

State of Colorado

St. Joseph–Martin

Saint Luke’s Health System

St. Mary’s of Michigan

St. Vincent’s Health Services

TennCare

Texas Benefit

VA Puget Sound HealthCare System

WakeMed

Welch Community Hospital

Frost & Sullivan 19

ASIA/PACIFICAIIMS (India)

Apollo Hospitals Enterprise, Ltd. (India)

Asia Gateway China

Center for Health Systems and Policy Research and Development (Indonesia)

CICH, University of Melbourne (Australia)DHHS (Australia)

Ministry o Health (Cambodia)

Ministry of Health (India)

Sichuan Provincial Hospital for Women and Children (China)

South Australia Health (Australia)

Zhongshan Hospital (China)

20

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