How To Measure Health Care In Nordic Health Care

Transcription

1 Nordic ehealth Indicators Nordic collaboration for developing, testing and assessing a common set of indicators for monitoring ehealth in the Nordic countries and Greenland, Faroe Islands and Åland for use by national and international policy makers and scientific communities to support development of Nordic welfare. 1

2 ehealth indicator methodology used in the Nordic work 1. Defining the context (human and environmental) for measurement identifying key stakeholders and defining the area(s) or system(s) that are relevant to be studied. 2. Defining the goals Top-down: analysis of (ehealth) strategies and interviews of policy makers Bottom-up: review of existing indicator work, peer-reviewed literature and stakeholder priorities 3. Indicator selection and categorization. Generating longlist of Grouping preliminary indicators rating on scientific soundness and feasibility Rating of importance: Policy makers, practitioners, researchers 4. Defining the data Policy analysis, content analysis of existing surveys ehealth evaluation Literature, existing surveys Interviews for importance Selecting measures and sources, testing and collection of feedback rating from different user groups. Source: Hyppönen H, Ammenwerth E, de Keizer N.Exploring a methodology for ehealth indicator development. Stud Health Technol Inform. 2012;180: Modified from Reed Mark S., Fraser Evan D.G., Dougill Andrew J. An adaptive learning process for developing and applying sustainability indicators with local communities. ECOLOGICAL ECONOMICS 59 (2006) Hannele Hyppönen, Arild Faxvaag, Heidi Gilstad, Gudrun Audur Hardardottir, Lars Jerlvall, Maarit Kangas, Sabine Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 2

3 Framework for indicator categorization GROUP 1: IT-related Health care input GROUP 2: IT-related Health care process GROUP 3: IT-related Health care outcome SYSTEM AVAILABILITY CONTEXT OF IMPLEMENTAT ION Hannele Hyppönen, Arild Faxvaag, Heidi Gilstad, Gudrun Audur Hardardottir, Lars Jerlvall, Maarit Kangas, Sabine Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 3

4 What should we be using as measures within EHRs in the Nordic countries: Policy analysis results GROUP 1: IT-related Health care input GROUP 2: IT-related Health care process GROUP 3: IT-related Health care outcome 1. Context to be focused in a. Common Key stakeholder groups: Patients, Clinicians, HC Managers, Policy makers b. Key areas or systems to be focused in: 1. Common IT-services, IT-architecture; Information security tools and rules; Standardization, regulatory framework 2. The goals => indicators Improve access to relevant health information through IT-services for Clinicians, Patients/Citizens, secondary users Improve interoperability of health information systems Improve information security and privacy Improve process support in the Health Care system Improve usability of health information systems Improve quality, effectiveness of health care Empower and activate citizens Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 4

5 Review of existing indicator work: Analysis of national ehealth surveys in the Nordic countries and the OECD model survey OECD Norway Denmark Sweden Finland Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 5

6 What is currently being measured in the Nordic surveys/ in the OECD Indicator / measure Fi No DK SW OECD IT costs (investment/ maintenance budget) x x x Access to EHR Systems (proportion of organisations/clinicians/ patients having) x x x x Access to key Information generated within own org/ outside own org x x (x) x x Health care input (GROUP 1) HC process (GROUP 2) Health care outcome (GROUP 3) Access to info sharing functionalities (HIE) - proxy for System integration/ interoperability/ x x x x x Access to PHR functionalities x x (x) x x Access to telemedicine services x x IT support quality (UX = proportion of clinicians experiencing) x x IT system quality (e.g. reliability, down-time) (UX) x x Most challenging/ successful aspects of information systems (UX) x x x Information quality (UX) x x Intensity of use of EHR system/ information types / HIE/ PHR x x x x x Usability (UX) x x x Benefits (general) (UX) x x Productivity/ efficiency gains (e.g. avoidance of duplicate tests) x x x Professional development support (UX) x x x Support for collaboration/ care continuity (UX) x x x Patient safety (several ) x x Patient centredness (UX) x x x Hannele Hyppönen, Arild Faxvaag, Heidi Gilstad, Gudrun Audur Hardardottir, Lars Jerlvall, Maarit Kangas, Sabine Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 6

7 What is covered, what is missing in Group 1 - HC input? CON- TEXT Policy goals/ survey indicators Improve information security and privacy Existing Measures 1) Proportion of organisations with an information security plan (F) 2) Proportion of organisations conducting log monitoring regularly (S) CON- TEXT IT costs 1) IT investment/ maintenance budget 2) Proportion of IT costs in organisation s cost budget SYST AVAILA BILITY SYST Q Improve access to relevant health information through IT-services for Clinicians, Patients/Citizens, sec.users Improve interoperability of health information systems 1) Proportion of organisations/ clinicians/ patients with access to systems/ functionalities/ information 2) Product brands 1) Proportion of organisations/ clinicians with access to key information generated outside own organisation, HIE functionalities 2) Proportion of organisations with defined codes and classifications implemented in EHR systems (F) 3) Varying other System integration in different Nordic countries SYST Q Standardization activities 1) Proportion of organisations that comply to specific HIE standards (F) SYST Q HELP Q Technical quality of system IT support quality 1) Proportion of clinicians experiencing the system technically stable (little or no down-time) (F, S) 2) Proportion of clinicians getting sufficient help with IT systems (F, S) INFO Q Information quality 1) Proportion of clinicians experiencing information offered by system is consistent, complete, timely (F) Hannele Hyppönen, Arild Faxvaag, Heidi Gilstad, Gudrun Audur Hardardottir, Lars Jerlvall, Maarit Kangas, Sabine Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian 7

8 What is covered, what is missing in group 2 HC process? Policy goals/ survey indicators Existing Measures Intensity of use 1) Usage rate (proportion of actions performed electronically) 2) Proportion or organisations Using EHR data for defined secondary purposes (N) Improve usability of health information systems Improve process support 1) Proportion of clinicians experiencing system Easy to use (F, S) 2) Prop. of clinicians experiencing syst. Efficient to use (F, S) 3) Prop. of clinicians satisfied with the system (F) 1) Prop. Of clinicians experiencing system helping avoid unnecessary repetition of tasks (double documentation, duplicate examinations etc.) (F) 2) Prop. Of clinicians experiencing system saving time (S) 3) Prop. Of organisations with access to DSS functionalities 4) Proportion of clinicians experiencing that IT facilitates collaboration (B2B and B2C) (F, S, N) The focus is on intensity of use, some in some countries monitor usability. Should we also monitor e.g. compliance to documenting guidelines, experience in improvement of adherence to clinical guidelines or clinical decisions? Hannele Hyppönen, Arild Faxvaag, Heidi Gilstad, Gudrun Audur Hardardottir, Lars Jerlvall, Maarit Kangas, Sabine Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian 8

9 What is covered, what is missing in Group 3 (Outcome )? Policy goal/ survey indicators Improve quality, effectiveness of health care Empower and activate citizens Professional development support Existing Measures 1) Proportion of clinicians experiencing IT enhancing care quality (generic) (F, S) 2) Different measuring clinicians experience of impacts on patient safety (F, S) 1) Proportion of clinicians experiencing IT enhancing patient centredness/ empowerment (D, F, S) 1) Proportion of clinicians experiencing IT supporting assistance of own work performance (S, N, F) Focus on health outcomes (effectiveness) and savings is lacking at present Current measures are mainly generic, health benefits are functionality/condition-specific, e.g. Defined PHR functionalities e.g. Diabetes risk test+self care instructions +care path -> empowerment of patients with increased risk -> impact on service demand for patients with these conditions (may increase visits, since up to 50% of diabetics are undiagnosed) ->Diabetes-related morbidity (e.g. cardiovascular disease, chronic renal failure, diabetic retinopathy) Comprehensive active medication list > medication safety (e.g. adverse drug events; drug misuse) => need to agree on definitions of key functionalities (including maturity level), define their intended health impacts prior to monitoring health benefits measuring health outcomes requires combining info from several sources e.g. surveys (or logs) on availability and use rate of a specific functionality, register data on service use and population health data. Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 9

10 What additional measures are in early adoption or planning stages in the Nordic countries? At present, we are in the process of: 1. defining the common functionalities and common measures for ehealth-related input, process (and outcome), mapping these measures against defined by the OECD (availability and use) 2. updating the existing ehealth surveys to allow comparison between the Nordic countries 3. looking for alternative sources for the input, process (and outcome) data 4. discussing ehealth outcome (benefit) Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 10

11 Where are we regarding current, planned or anticipated steps for evaluating effectiveness of these indicators in achieving outcomes linked to stated national healthcare goals? The current ehealth policies have been analyzed and indicators mapped against the policy goals Comprehensiveness of indicators under scrutiny Challenges: Health outcome goals generic, measurements need to be systemand condition specific systems that are targeted in the ehealth policies are changing National eprescription system => National patient data archive =>National PHR services => We need to define some key functionalities, for which anticipated health outcomes can be defined (may be disease-specific) => We need to specify varying sources of the needed data, and explore availability of it (especially health data not necessarily easily available for monitoring purposes) =>We need to collaborate with HC quality indicator specialists Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 11

12 Next steps and future work in indicator development and evaluation within these contexts to meet national health goals The Nordic group work plan for the next two years: Deliverable I: A stakeholder-rated list of priority (groups (3)), with common Nordic Variables identified. Indicators constructed from the Common Nordic Variables to be included in the Nordic surveys in Deliverable II: pilot data collection on comparable from national surveys: comparison of results. The deliverable contains examples of results of the data collection on comparable Nordic ehealth indicators. (Data will not be available from all the Nordic countries) Deliverable III: Results of the data collection from log/register data on comparable Nordic ehealth indicators (for frequent monitoring) Deliverable IV: final report: lessons learned and recommendations to achieve an efficient and easy-to-use benchmarking information results. The deliverable condenses DI-III results, with conclusions on the first and second mandate period and a suggestion on a reporting system. Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 12

13 Thank you! Christian Nøhr Guðrún Auður Harðardóttir Interested in more information about the Nordic ehealth indicator work? 1. Read the report 2. Google Nordic ehealth Research Network OR go directly to arch_network 3. Follow scientific publications: Exploring a methodology for ehealth indicator development. Hyppönen H, Ammenwerth E, de Keizer N. Stud Health Technol Inform. 2012;180: ehealth indicators: results of an expert workshop. Hyppönen H, Ammenwerth E, Nohr C, Faxvaag A, Walldius A. Stud Health Technol Inform. 2012;180: Nordic ehealth Indicators: Organisation of research, first results and plan for the future. Hannele Hyppönen, Arild Faxvaag, Heidi Gilstad, Gudrun Audur Hardardottir, Lars Jerlvall, Maarit Kangas, Sabine Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund. Stud Health Technol Inform. 2013;192: Koch, Christian Nøhr, Thomas Pehrsson, Jarmo Reponen, Åke Walldius, Vivian Vimarlund 13