Developing the Potential of the Life-time Health Plan LHP Managing population health, early warning systems, disease sur

1. Developing the Potential of the Life-time Health Plan (LHP)Managing population health, early warning systems, disease surveillance, etc�

2. Present healthcare systems: Organised around acute catastrophic illnesses Patients treated until they are well Episodic, fragmented Many countries: Health financing based on �casualty� approach of health insurance Based on fundamental unpredictability of disease & injuries Expensive health systems developed based on �acute care� model.

3. In coming decades: Increased predictability of risks of disease (Lots of research still to be done) Major advances in: Immunology Predictive genetics & human genome project ? enable to predict disease long before symptoms occur.

4. Concept of illness Not all are unpredictable or �Acts of God� Trauma, infections ? remain unpredictable ? smaller part of burden of illness Predictive genetics ? illnesses that can be predicted Implications: responsibility for dealing with avoidable or manageable illnesses. Paradigm Change for Healthcare

5. �Early warning systems�- individual & population health �Managed care� ? improving: ? health status ? health outcomes Community-based healthcare systems hospital- �back up� supports primary care ?�engine� of health service delivery Patient-centred healthcare system. (Note: 8 goals of health system in Telehealth blueprint changing roles of: hospitals, healthcare providers, patients) Paradigm Change for Healthcare

6. Move from: diagnosis & treat, salvage to predict & early management of: health risk factors illness Major implications: ?�Acute care� model of healthcare delivery ?�Casualty� model of health insurance. Paradigm Change for Healthcare

7. Focus on: Developing full potential in health- �wellness� Manage individual health while still in state of �wellness� Screen for health risk factors Early management of identified health risk factors Early management of illness. Paradigm Change for Healthcare

8. Technology enabler to realise the vision for health Emphasis on : Health promotion Disease prevention Health risk assessment in management of individual, community health Empowerment of individuals, families, communities.

9. Telehealth Blueprint Lifetime Health Plan To facilitate continuum of care for the lifetime health data in state of wellness & illness systematically captured and available to healthcare providers Ensures patient focused, continuous, coordinated, integrated care throughout life Lifetime Health Record to be created

10. Telehealth Blueprint  Promoting the Health Paradigm Essential health services : information and education for individuals to support the wellness paradigm consultations to maintain health or to provide early treatment of illness, all underpinned by a lifetime health plan and lifetime health record.

11. Telehealth Integration of information, communications, human-machine interface technologies with health and medical technologies to provide services to promote health and provide healthcare National enterprise-wide health information system, which includes person management and health information, and which facilitates the sharing of health information and knowledge in healthcare settings, and which facilitates the management of health from the beginning to the end of life.

12. National Health Information System Total Health Information System allows information sharing to facilitate the implementation of a National Health System to proactively manage wellness and illness with adequate and appropriate support for healthcare planning and financing system. Such an infostructure will be : goal focus, clinical outcomes, clinical eficiency, cost efficiency, episode and facility costs, condition specifics and risk related costs, total consumer-based costs National Health Information System : Strategic Approach.

13. National Enterprise-wide Health Information Network  Potential of IT to improve quality: automation of same types of clinical data Automated clinical data required in many promising IT applications: Computer-aided decision support system � linked to evidence based with patient-specific clinical data Diagnosis and treatment options treatment Clinical trials � collect, pool, analyse & disseminate data to all participants Health service research applications: assessment of clinical outcomes, identification of best practices, evaluation of methods for � financing, service delivery Etc�

14. Lifetime Health Plan (LHP)Summary of Features National Enterprise-wide Master Person Index (MPI) Integration to MyKAD TELEHEALTH Data Dictionary Lifetime Health Record Enterprise Wide Order Management Standard Documents (Visit Summary, Referral Form, Lab Test Request etc) 7. Lifetime Health Summary Browser 8. Customization of Dataset For Clinical Clerking 9. GDS For Hospital And Health Care Facility Management.

15. Some Issues to be Addressed Lifetime Health Record (LHR) Potential of LHR repository: Surveillance Registries Early Warning Systems Health Planning Risk Projections Population Health - management of health risk factors etc

16. Telehealth Platform � to deliver various services: Wellness, health promotion Disease prevention � individual, community early warning systems disease forecasting Healthcare services elearning Health financing, insurance, etc.

20. Potential for �early warning systems� Immunisation rates: countries, regions, districts Australia: - lack of knowledge of immunisation status of population, result in urgent steps to be taken when immunisation rate was estimated to be low.

21. Potential for �early warning systems� USA: estimated 46% of adult population (60 million) functionally illiterate in dealing with health ?health literacy: ?levels of: mortality, morbidity, inequality, cost Study (1997): poor literacy - x5 mistakes interpreting prescriptions x2 visits to doctors high literacy - ?mortality, morbidity, inequality, cost ?health, well-being.

22. Potential for �early warning systems� Health risk management: � proactive management of wellness � early detection of disease Health-testing ? identification of health risk factors Pooling of health risk of individuals in the community Health risks of the community Intervention strategies at community/district levels, implemented by targeting individuals identified at risk.

23. Potential for �early warning systems� Disease reporting systems Communicable disease reporting electronic maps New York City: SARS outbreak Syndromic approach Network of electronic health records Web-crawler identified 3 individuals with symptoms consistent with SARS in 48 hours.

24. Potential for �early warning systems� Clinical practice Monitoring of outcomes of clinical interventions (QOC, functional status, clinical outcome) Possible to identify trends of less than optimum results by districts, hospitals, teams In time, ability to project risk of particular intervention (e.g. treatment to improve visual acuity, icu care, cardiac surgery, etc).

25. Potential for �early warning systems� Disease Registries Disease electronic surveillance system Patient safety etc.

26. Challenge of Genomics & Health Information Systems

27. Challenge of Genomics & Health Information Systems

28. Health Information levels, systems, adaptation to genetic, genomic data