Canada's Global Viewpoint: Emerging Technologies and Healthcare Interoperability

Transcription

1 Canada's Global Viewpoint: Emerging Technologies and Healthcare Interoperability Ron G. Parker, Group Director Canada Health Infoway Inc. 1/31/

2 About The Speaker 2 28 years in IT/IM integration and consulting, in social services and health care Group Director with Emerging Technology Group in Canada Health Infoway Inc. (Infoway) Also responsible for the Infoway Blueprint for e-health solutions for Canada Vice-chair of the HL7 Architecture Board Chair of the Governance Board for HL7 Fast Healthcare Interoperability Resources

3 First: Some background for the perspectives offered today

4 About Infoway Created in 2001 $2.1 billion in federal funding Independent, not-for-profit corporation Accountable to 14 federal/provincial/territorial governments Mission: To foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-canadian basis with tangible benefits to Canadians. Infoway will build on existing initiatives and pursue collaborative relationships in pursuit of its mission. 4

5 Five Rs of e-health The right information About the right client Available to the right person In the right place At the right time 5

6 E-health Blueprint 6 A framework for coordinated & collaborative care designed to: Enable improved client-patient access and participation Enable inter-professional collaboration Facilitate integrated service delivery Enable information to facilitate decision support, utilization of health care services and quality improvement At a systemic level: Across software applications, care settings, and organizations With emphasis on serving clinician and patient solution needs

7 The Path Forward 7 7

8 About Infoway s Emerging Technology Group 8

9 ETG Vision & mission Vision Emerging technologies are appropriately and effectively used in promoting the health of Canadians and the sustainability of the health care system. Mission To identify, assess and promote viable emerging and disruptive information and communication technologies that can be used to support the health care system in Canada. We achieve this through evaluation, analysis and demonstration of emergent ICTs, and by communicating the results to our public and private stakeholders. 9

10 The future is already here it's just not evenly distributed. - William Gibson Source: The Economist, December 4, 2003

11 A popular technology platform ecommerce platform data, applications and services itunes end-user management end-user applications enduser devices 11

12 E-Health as a platform for innovation ehealth platform and EHR health data, applications & services Electronic Medical Record, Hospital Info. System, patient or provider portals; etc. end-user applications enduser devices 12

13 Electronic health records as a platform for innovation ehealth platform and EHR We need to move our thinking beyond the EHR. This platform is one that can and will support 13 health data, applications & services a broader set of innovations. What are those innovations? What exists today? end-user applications What are emerging? Which ones have value? What should we implement? Electronic Medical Record, Hospital Info. System, patient or provider portals; etc. enduser devices

14 The old world Provider-focused Illness Site-of-care Episode management Supply management Solitary decision making Efficiency De-centralized, generalized care Provider delivered/managed The world of health care is changing The new world Patient & family-focused Wellness Continuum of care Disease management Demand management Collaborative, evidence-based decisions Effectiveness Centralized, specialized care Consumer personalized, delivered and managed 14

15 Nexus of forces Research over the past several years has identified the independent evolution of four powerful forces: information, mobile, social and cloud. As a result of consumerization and the ubiquity of connected smart devices, people's behavior has caused a convergence of these forces. Information is the context for delivering enhanced social and mobile experiences. Mobile devices are a platform for effective social networking and new ways of work. Social links people to their work and each other in new and unexpected ways. Cloud enables delivery of information and functionality to users and systems. The forces of the Nexus are intertwined to create a user-driven ecosystem of modern computing. Source: Mobile and the Nexus of Forces: Creating the New Experience, Gartner Research, June 25,

16 Five Enablers Five Technology Enablers Impacting Health 16

17 Cloud Computing 90% of traditional computing infrastructure capacity is unused, yet it exists to be able to handle peak demands 80% of new commercial enterprise apps will be deployed on cloud platforms in 2012 (IDC) 55% of US based health care organizations had something in the cloud: clinical apps, storage; ; PACS; EHR. (KLAS) >50% of Global 1000 companies will have stored customersensitive data in the public cloud by 2016 (Gartner) 17 Agile deployment of infrastructure and software services Better utilization, lower costs Better enables shared services Facilitates data and services platforms

18 Cloud Computing Implications Data, information and services, regardless of: Where you are located Device. Devices for data capture, like home monitoring and devices to view, like a smart phone Care coordination and collaboration, e.g. e-referrals, chronic disease management and orders processed through the cloud Platform for mobile devices and apps Support of consumer enablement and social networking Shift in costs from corporate capital expenditure for IT to departmental operational expenses 18 18

19 Mobile Computing 62% of Primary Care physicians own a smart phone 82% use them for professional purposes 17% of physicians now own an ipad, with the majority (56%) using it for professional purposes $197 billion savings to US health care system over 25 years if remote patient monitoring is effectively put in place (Deloitte) 19 Devices are always on, always connected Devices are always with the individual Convenience, data input and output Smart phones and tablets with special purpose health apps Mobile monitoring and diagnostics

20 Mobile Computing 20 Implications A nexus of information sources, data sources, social interactions For personalized health information For personal health records Wellness Information at your finger tips, from the cloud Enhances communications among clinicians, and between clinicians and patients Remote patient monitoring, wherever you are Context Analytics End users provision their apps Monitoring and management challenges Challenges for supporting policies including legal, licensing, regulatory frameworks 20

21 Ubiquitous & Agile By 2015, networkconnected devices will number 15 billion, outpacing humans by two to one 13,000 medical apps are available in the AppStore & 1000s more in the Android Market & Blackberry App World. Pervasive networks Every health care device will be a networked device Decoupled Distributed Small, agile applications and services Interoperability explosion 21

22 Implications Ubiquitous & Agile Everything is connected, challenging clinical information interoperability Access to data and services platforms from anywhere, anytime Enterprise services, e.g. CPOE as a service rather than embedded in clinical systems Quicker and cheaper deployment Agile systems can be transformed quickly to support changes to the business Apps on the device of course Apps on the infostructure No more monolithic system deployments Requires robust strategic planning Requires more robust governance 22

23 Consumer Enablement 500 million people will be using health care mobile apps by million users per month Supports patients with of life changing conditions from 1 to more than 1,200+ in 6 years access 734 million page views on WebMD s website 23 Consumer-enabled for providers and patients Personalized Convenient, efficient, social In context Consumer-friendly medical devices User experience advancements Low cost

24 Implications Consumer Enablement User experience and usability enhancements create new opportunities and may advance adoption Support of care coordination and collaboration Support of home care and self care Consumers can be partners and participants in their health, wellness and care Allows for the shifting of some of the burden for wellness and health management from the health system to consumers/patients Changes to clinical process and scope of practice Changes to reimbursement models 24

25 Data & Analytics Global information created in exabytes (~ 6 million desktop computers) The equivalent of every U.S. citizen writing 3 tweets /minute for 26,976 years million: number of articles indexed in MEDLINE 1 million: annual rate at which articles are indexed in MEDLINE 13%: proportion of clinical practice articles, published in NEJM in 2009, that were reversals of previous findings 50%: estimated that half of clinical guidelines become outdated in < 6 yrs $300 billion: annual value that could be created if US health were to use big data creatively 65%: proportion of savings from reduced healthcare expenditures of about 8% (2005) (2011) 25 Data from many sources Data is big Volume, Velocity and Variety Data is free form and ambiguous Data structured and coded Clinically complex Analytics to drive business Predictive and real time Analytics on social networking data sources Artificial intelligence question and answer

26 Data & Analytics Implications: Leverage data for: Health knowledge Insights clinical, program, population, research Actions, Decisions Big Data requires IT to aid the human Analytics to aid and alert given the volume and complexity of data Intelligent linkage to knowledge bases for information and evidence Interoperability and semantic challenges Will require improved data quality Visualization challenges New tools and techniques Own your database! 26

27 Context is everything Convergence of the four trends Location, clinician role, patient need and status determine the appropriate device, app, supporting analytics and workflow The device and capabilities used may change as the context changes Many apps one user identity A separate login for every app is not going to work for long Device + biometric + EMPIs for user identity One user presumes consistent data across apps Regardless of what device I choose for a given context, I want it to access a consistent backplane of information Data goes in analytics come back I know what data I provide Now give it back to me as information to support my decision making, in a readily understandable way 27

28 28 Improving the patient and provider experience Ultimately we want the patient and provider to not particularly notice where ICT is being used Complexity must be hidden Updates just occur when they are ready My source of information is configured once, is attached to the applications that will use it on an ongoing basis, and then is always automatically used Interfaces must be intuitive Functionality is task and workflow oriented Access must be everywhere, anytime, and setting appropriate Don t just automate a process, bring real value to people who make decisions about health and health care every day

29 Moving Forward The ecosystem may evolve organically but a little engineering would go a long way The industry would be well served by having a framework for the foundations for interoperability A simple, overarching framework Top down strategy, bottom up execution We need to standardize on certain business patterns and the middleware and infrastructure necessary to support them Policy, people, process and then technology We need to introduce certification mechanisms that allow solution providers to sell to a stable market, and for end users to procure solutions they can be confident will deliver what they need 29

30 Nexus of forces in digital health Health information is the context for delivering enhanced collaborative and coordinated care experiences. Point of service systems and mobile devices are the platforms for effective social networking and new ways of work. The health IT eco-system links people to their work and each other in new and unexpected ways. e-health infostructure as Software-asa-Service in the cloud enables delivery of information and functionality to users and systems. The forces of the Nexus are intertwined to create a user-driven ecosystem of modern computing. 30

31 Thank you