Prof. Mukesh Haikerwal and Chris Bartlett

Using 21st Century Tools to overcome the ‘fear of

frying’ and build success

Mukesh Haikerwal

Melbourne, Australia

General Medical Practitioner

Chair of Council, World Medical Association

Professorial Fellow, Flinders University

19th President, Australian Medical Association

Chair beyondblue Doctors Mental Health

Ex-Commissioner, National Health & Hospitals

Reform Commission

Brain Injury Australia

CSIRO / Australian E-Health Research Centre:

Former Head Clinical Leadership, Engagement

& Clinical Safety: NeHTA

Chris Bartlett

Sydney, Australia

Professional management consultant

Advisor on Australian eHealth strategy to

National Health & Hospital Reform Commission

& Department of Defence

Former advisor on eHealth strategy to

Singapore’s Ministry of Health Holdings

Experience within the pharmaceutical and

telecommunications industry sectors

Health technology programs in Australia have

claimed success in some cases…

GOOD

NEWS…

Health & infrastructure programs have had

poor publicity – contributing to a ‘fear of frying’

BAD

NEWS…

Rising healthcare costs continue to challenge national

agendas globally

0

2

4

6

8

10

12

14

16

18

UK

Sin

gapore

New

Zeala

nd

% of GDP

US

A

Neth

erlands

Japan

Italy

Germ

any

Denm

ark

Canada

Austr

alia

2010 2009 2008 2007

Source: Economist Intelligence Unit, October 2013; WHO; Booz & Company analysis

Spend on Health is a high % of GDP in many

developed countries….

0

2

4

6

8

10

12

14

16

1810

8

6

4

2

0

3

New

Zeala

nd

3

Neth

erlands

5

Japan

3

Italy

3

Germ

any

4

Denm

ark

5

Canada

5

Austr

alia

4

% of GDP Health $ per Capita

(000s, 2010 PPP)

US

A

9

UK

3

Sin

gapore

…and has been growing over time

Developing economies spend much less/ capita

today…. …but should grow in line with GDP growth

Healthcare spend in developing markets is behind, but

also expected to grow with GDP/capita and aspirations

0 2,000 4,000 6,000 8,000 10,000

UK

Australia

Germany

Canada

Denmark

Netherlands

USA

India

Indonesia

Vietnam

Thailand

China

Malaysia

Russia

Singapore

New Zealand

Italy

Japan

30,000 35,000 40,000 45,000 50,000

3

6

4

5

2

7

9

8

Spend per Capita

($ ’000s)

GDP Per Capita

Italy

NZ Singapore Japan

UK Australia

Germany

Canada Denmark

Netherlands

USA

$/ Capita on

Healthcare

(2010 PPP adjusted)

Developed Economies Developing Economies

Health costs to increase with developing

countries aspirations for better quality of life

Source: Economist Intelligence Unit, October 2013; WHO; Booz & Company analysis

There is a need to better manage chronic diseases (NCDs)

Source: Booz & Company analysis ; Unleashing the Potential of Therapy Adherence, Booz & Company viewpoint, 2013

Non-Adherence Rates for Various Diseases

Chronic Disease Management - NCDs

Local National International

Perspectives

Global burden of Diseases:

Washington University

UN WHO: International Conference

on NCD

World Health Professionals Alliance

‘collateral’

eHealth as enabler for Chronic

Disease

Agencies involved: multiple

Evidence based interventions

Technological trends are beginning to change the

health ecosystem and impact all players

Virtual visit

Patient self-service

Personal medical records

Tele-diagnosis

Telemedicine

Clinician Long Term

Care

Patients

Disease

management

ePrescription

Mobility

Hospital

Medical content in emergency care

Surgical robotics

Retail e-clinic services

Home Monitoring

Telemedicine & Tele-health

Public Health

R&D

Healthcare robotics

Mobile medical

technology

Access & analysis of

laboratory and radiology

Discharge summaries

Tele-consultation

Innovative healthcare solutions require a high-quality communication

infrastructure

Personal Health Monitoring

Mobile Health

NON-EXHAUSTIVE

Source: Booz & Company analysis.

Existing Hospital Referral Workflow

Technology Enabled Hospital Referral Workflow

Regional Card Service in Lombardy

Carta Regionale dei Servizi - SISS Results

One of the largest e-health programs to date

Forecasted € 2B annual public sector benefits

(less bureaucracy and fraud)

Stimulated € 1B ICT investments

9M people integrated with a multi-function smart

card (contact and contact-less for transportation)

150,000 operators integrated in a secure broadband

extranet (100% pharmacies, doctors, hospitals)

Electronic Health Record in place for 9M citizens

Electronic access & payment via call centre, kiosks,

web, TV, pharmacies & doctors’ PC, ATM’s, …

Web Service net-centric architecture

No upfront investment by the State - funded by

private companies and managed as a service

(€ 10 per year per citizen)

Lombardia Italy is one of the more successful national

eHealth networks to date, with widespread adoption

Source: Booz & Company analysis.

The Australian healthcare system context

Majority of health services,

including 130 million in

2010-11 subsidised by MBS

In 2010-11, 39% of hospital

emergency visits for GP-

type consultations

No national coordination of

primary healthcare data

collection and analysis

>95% of GPs computerized,

<30% exchange information

Primary Healthcare

Of ~9m hospitalizations,

60% were in public hospitals

The number of private

hospitalizations increased

by 22% in 2010-11, more

than public hospitals (14%)

In 2009-10, indigenous

Australians were

hospitalized at 2.5x the rate

of other Australians

Admitted Hospital Care

From 2007-2010 emergency

hospital visits increased by

~4% p.a. to 6.2m in 2011

In 2010-11, about 70% of

emergency department

patients were seen within

their recommended times

In 2009-10, public hospitals

provided almost 17 million

specialized outpatient clinic

consultations

Non-Admitted Care

Source: AIHW 2011a ; Booz & Company analysis.

Direct benefits from digitizing the healthcare sector

can be measured – the challenge is realization

Australian Steady-State Annual Benefits by eHealth Application (AU$ M, Year 2020, assumes full eHealth scope and international benchmark adoption rates)

Source: Booz & Company National eHealth Benefits Model.

3.0

2.0

1.0

0.0

AU$ B

Patient Self-

Management

0.5

Decision Support

0.9

EMR

1.6

Quality and

Performance

Mgmt

2.7

Medication

Management

$0.4

1.5

Summary

Care Record

Total = AU$7.6 billion

Potential benefits of

PCEHR alone

assuming adoption

Health technology also contributes to significantly to a

better customer experience

Source: Booz & Company National eHealth Benefits Model.

Benefits are not evenly distributed across stakeholders

and their source is often from other care settings

5,000

4,500

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

0

211

1,527

Public

Hospitals

626

1,006

Private

GPs

144

4,850

180

2,603

1,171

2,562

0

Federal

Gov./Medicare

0

State Gov.

0

Patients

0

Long-

Term Care

146 151

Private

Hospitals

0 108

Public

Outpatients

AU$ M

Private

Insurance

Providers Payors

Australian eHealth Steady-State Annual Benefits (AU$ M, Year 2020, assumes full eHealth scope and international benchmark adoption rates)

Source: Booz & Company National eHealth Benefits Model.

By Beneficiary (Gross Benefits)

By Source of Benefits (Gross Benefits)

Total = AU$7.6 billion

Primary care is usually the largest source of benefits

given its fragmentation

Source: Booz & Company National eHealth Benefits Model.

Australian Annual Value Generation from Primary Care, per GP Clinic

Technology alone is not the problem: this is about

changes to ways of working and using new tools

Behaviour change

theory and evidence: a

presentation to

Government

Susan Michie a* and

Robert West b

a)Department of

Psychology,

b)Department of

Epidemiology and

Public Health

University College

London, London, UK

Note, no:

• Bribery

• Enforcement

• Entrapment** (MCH Comment)

Source: Health Psychology Review, 2013 Vol. 7, No. 1, 122

Leadership is required from the top, with governance

that facilitates (not complicates) the right decisions

Lessons Learned

• Strong Clinical leadership is essential

• Too many committees, councils, forums

reduces accountability and delays

decisions

• Where are Clinicians who are to use this?

• Clinical Governance framework

• Need government to be supportive and

leading the charge

• Need honesty

Ensure we know what we are doing &

why: “make my work easier and be sure

it makes a difference to patient care.”

Health technology needs to improve the clinicians’

workflow and the patient’s experience

Lessons Learned

• Blindly building to specifications does not

guarantee clinicians will be able to use

• The case for change for clinicians must

be compelling – service delivery and

process changes must improve the

working life of clinicians

• Clinical workflow assessment and rapid

prototyping can demonstrate benefits

• Avoid system and usability faults

Solution has to be easy to use for

clinicians and benefit patient care

Complexity impeding use of

technology

Design without reference to

end user / customer

A patient in Mt Isa could be cared for by a multitude of providers of many disciplines

Shortage of available clinical time and care provided with paucity of clinical information

Need for a pro-active, team based, collaborative methodology, particularly for CDM

PCEHR adoption was encouraged and enabled a "joined up clinical community" with better clinical information for consumers and clinicians who were all primed participate

Lessons

• The adage ‘build it and they will come’

does not apply in healthcare technology

• Main focus on consumer segments where

the need is greatest (e.g. older, CDM

needed) rather than other segments (e.g,

young, tech savvy) where long term

benefits could be greater

• Financial incentives can achieve rapid

adoption (e.g. Australian GPs)

• Quid pro quo…..

Mount Isa in NW Queensland

has a population of ~20,000

Small number of clinicians from

multiple organisations

Isolated mining community,

hence a need for transfers of

patients outside immediate area

National eHealth is not attractive to

everyone – high risk patient or provider

segments have the most to benefit

Coaching ‘informal leaders’ is a powerful way to

encourage adoption and stewardship

Informal networks need to be utilized – particularly to

manage potential set-backs during implementation

Lessons

• Successes out of adversity

– Victorian Heathsmart system maligned

– Use of local ICT talent to adopt & adapt

– Proof of Concept and deployment

– More widespread deployment of ICT

– Super-users on floor / training / support

– Problems noted and responded to

– Workarounds in place: high alert so safe

– Making good / responding to end user

Rollout of new hospital network system was far from ideal -

ICT underfunded, usability and safety issues, limited

functionality and extensive change requests

Locally identified issues and mitigations developed in spite

of the central directions and due to local knowledge

persistence flare and diligence rather than governance

Efforts and collaboration of clinicians and administrators

made it a successful, working system: work in progress

Benefits of a supportive CEO, local ICT

ingenuity and tenacity and forging ahead to

deliver a clinical programme with Clinicians

Health cultures are difficult to change – hence the need

to focus on changing behaviors

Lessons

• Outcomes from 4 Cornered roundtable

• Every e-health adoption must be treated

as a business change and planned and

led by local clinicians

• All clinicians have to be engaged for all of

the change journey

• Place for Consumer voice is vital

• Partner with ICT industry

• Support from government helps

Thank you…