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Placing Countries In Charge of Their Own e-Health Destiny - The Need for Strategy -

Placing Countries In Charge of Their Own e-Health Destiny - The Need for Strategy -. Dr. Richard E. Scott Director, NT Consulting – Global e-Health; Professor, University of KwaZulu Natal, Durban, South Africa;

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Placing Countries In Charge of Their Own e-Health Destiny - The Need for Strategy -

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  1. Placing Countries In Charge of Their Own e-Health Destiny- The Need for Strategy - Dr. Richard E. Scott Director, NT Consulting – Global e-Health; Professor, University of KwaZulu Natal, Durban, South Africa; Director, Office of Global e-Health Strategy, and Adjunct Professor, Departments of Community Health Sciences and Family Medicine, University of Calgary. Dr. Maurice Mars Professor, University of KwaZulu Natal, Durban, South Africa AeHINHour Calgary, Canada 12th – 13th November 2013

  2. Topics- Key Insight Only About Each - • Context and Cost • What do we focus on? • Where do we start? • What is Strategy? • The e-Health Strategy Development Framework

  3. Context and Cost?- Can We Afford e-Health? - • WHO’s Report of the Commission on Macroeconomics and Health [2001] - minimum $34 per capita to provide just a ‘basic health care package’. • 2011 Example • US $8,650 per capita; Canada $5,800 per capita • Canada – Of $5,800 , ~ 72% ($4,176) from public purse. • About 2.7% spent on ‘technology use in health’ or ~$113 per capita • If spend only $10-35 per capita, 2.7% = 27-67 cents per capita

  4. Context and Cost?- Can We Afford e-Health? - • e-Health is an ‘opportunity cost’ • Money spent on e-health is money NOT spent on immunization, sanitation, clean water, rural clinics, health provider salaries, ….. Any decision to invest in e-Health MUST be sound, evidence-based, transparent, and defensible!!

  5. What Do We Focus On?- Health Informatics - The Electronic Health Record - Core components of an EHR include: • Client registry • Provider registry • Diagnostic imaging system • Drug information system • Laboratory information system • Interoperable. Yet private and confidential • An EHR initiative is a complex, high-risk endeavour

  6. What Do We Focus On?- Health Informatics - The Electronic Health Record - Generic problems: • Expectations of “instant results” • Lack of needed support • Lack of knowledge and understanding by policy and decision makers. Is An EHR The Right Solution for Developing Countries? • British Columbia - $222 million capital costs by March 31, 2013; ongoing annual operating costs – maybe $30M

  7. What Do We Focus On?- Other Components of e-Health? - (Source: Scott RE – 2004, 2006, 2009, 2011, 2013) Global Health Global e-Health [e-Commerce] [e-Learning] e-Health [m-Health] [Social Media] Telehealth [Videoconferencing] Health Informatics [SMART Cards] [Decision Support Systems] [Electronic Records] [Telemedicine] [Home e-Health] [Websites; Personal Remote Monitoring; Teleradiology] [EHRs] [EPRs] [Surveillance Systems] [Tele-Rehab] [PHR] [EMRs] [Telepaediatrics] [Teleradiology] [Tele-Social Work; Tele-Pastoral care]

  8. What Do We Focus On – Risk Factors?- GBD 2010 Study - Dietary Risk Tobacco Smoking Hypertension 0-5 years: Childhood Underweight 15-49years Dietary Risks Risk factors that account for the most disease burden - Philippines http://www.healthmetricsandevaluation.org/sites/default/files/country-profiles/GBD%20Country%20Report%20-%20Philippines.pdf

  9. What Do We Focus On – The ‘Future’?- GBD 2010 Study - Diabetes Chronic Kidney Disease Hypertension Cirrhosis Interpersonal Injury DALYs - % Change 1990-2010 - Philippines http://www.healthmetricsandevaluation.org/sites/default/files/country-profiles/GBD%20Country%20Report%20-%20Philippines.pdf

  10. What Do We Focus On – The ‘Now’?- GBD 2010 Study - ‘Other NCD’ Musculo-skeletal Mental and Behavioural Disorders Other Respiratory Diseases HIV/AIDS and TB Years lived with disability (YLDs = Philippines 2010) http://www.healthmetricsandevaluation.org/sites/default/files/country-profiles/GBD%20Country%20Report%20-%20Philippines.pdf

  11. What Do We Focus On?- Country Specific Focus Needed -

  12. Where Do We Start?- Frequently – We ‘Learn’ from Others - Good and Bad Idea - • Emulate vs Adapt vs Context Specific • Learn from ‘Bad’ experiences • Care with ‘Good’ experiences

  13. Where Do We Start?- Old News – and More Recent News …. - “The most favourable approach to the implementation of e-health is to have a framework of strategic plans and policies which lay the foundation for development” WHO, 2006 “Ontario has spent more than $1-billion, most of it apparently now lost, in part because the province rushed into the program without a strategic plan.” National Post, 2010

  14. ORGANISATION CONSTRUCTION OPERATION Conducive Setting [Complex] C h a n g e M a n a g e m e n t ? Setting Where Working? I m p l e m e n t a t i o n I n f r a s t r u c t u r e I n t e g r a t i on I n f o s t r u c t u r e E v a l u a t i o n G o / N o G o A r ch i te c t u r e Privacy Setting Regulatory Setting S T R A T E G Y Health Needs Identified e-Health Options How e-Health Solution Health Needs Addressed Sustainable Policy Setting Why Legal Setting ? Setting ? Setting Standards Setting

  15. Where Do We Start?

  16. Where Do We Start?

  17. Where Do We Start? COMPLEXITY LOW HIGH

  18. Where Do We Start?- What’s Available from the Litereature? - • WHO/ITU • National eHealth Strategy Toolkit • Commonwealth; • Developing an E-Health Strategy • Kenya • Kenyan National e-Health Strategy 2011-2017

  19. What is ‘Strategy’- What it Is ~ What it Does - • Strategy: • Clarity around where you are going and why you are going there. • e-Health strategy: • Documentation that describes and justifies the overall approach to be taken by a country (or organisation) for progressive implementation of e-health solutions. • Strategy is key: • Foundation for sustainable e-health implementation.

  20. What is ‘Strategy’ ?- Quite Different from Policy, but often used Interchangeably !! - • Lot of misuse of the term ‘strategy’ / ‘strategic’ • Lot of debate even in the business sector re ‘strategy’

  21. Intended and Realised Strategy - Mintzberg and Waters Concept (Modified) - Intended Strategy Deliberate Strategy Ultimate Strategy Intended Strategy Influential Factors

  22. e-Health Strategy Development- 8 Steps - • Evidence Gathering and Situation Assessment (Step 1) • Holistic Review (Step 2) • Differential Diagnosis (Step 3) • Preliminary Prioritization (Step 4) • Identifying Solutions (Step 5) • Considering eHealth Solutions (Step 6) • Secondary Prioritization (Step 7) • Strategy Formulation (Step 8) • (next steps – policy, architecture, infra / infostructure, etc.)

  23. e-Health STRATEGY- Holistic Review -

  24. e-Health Strategy Development- 8 Steps - • Evidence Gathering and Situation Assessment (Step 1) • Holistic Review (Step 2) • Differential Diagnosis (Step 3) • Preliminary Prioritization (Step 4) • Identifying Solutions (Step 5) • Considering e-Health Solutions (Step 6) • Secondary Prioritization (Step 7) • Strategy Formulation (Step 8) • (next steps – policy, architecture, infra / infostructure, etc.)

  25. A Panacea ?- The Goose That Lays Golden Eggs - • e-Health is a facilitator • e-Health is NOT always the answer

  26. e-Health Strategy Development- 8 Steps - • Evidence Gathering and Situation Assessment (Step 1) • Holistic Review (Step 2) • Differential Diagnosis (Step 3) • Preliminary Prioritization (Step 4) • Identifying Solutions (Step 5) • Considering e-Health Solutions (Step 6) • Secondary Prioritization (Step 7) • Strategy Formulation (Step 8) • (next steps – policy, architecture, infra / infostructure, etc.)

  27. Strategy vs Policy?- How do they relate? - e - H e a l t h P o l I c y S t r a t e g y

  28. Benefits of this Approach? • A Clear Understanding of Where and Why you need e-Health • Evidence-based • Locally needs-based • Transparent • Defensible $ $$$$$$$$

  29. Benefits of this Approach?

  30. How ?- Is This Easy To Do ….. ? No. But It’s Darned Important - What you do now is laying the foundation for what will happen in Pakistan for the next 10, 20, 30 years. Take the time to do it. And do it right – first time.

  31. e-Health The train has already left the station – and is changing the ‘health’ forever. You may be on board – But – are you headed in the right direction?

  32. Richard Scott ntc.ehealthconsulting@gmail.com Maurice Mars mars@ukzn.ac.za Thank You

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