The application of new technologies and IT in Health: standards as infrastructure for innovation

Trillium Bridge: Reinforcing the Bridges and Scaling up EU/US Cooperation on Patient Summary
28 Mar 2018
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
The application of new technologies and IT in Health: standards as infrastructure for innovation
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The application of new technologies and IT in Health: standards as infrastructure for innovation

Notes de l'éditeur

  1. The portion of healthcare spending devoted to classic insurable medical risk is decreasing (28%) Governments might impose regulations that eliminate core aspects of the insurance market e.g. flexibility in underwriting and pricing or replance insurance with public programs so that private insurance offers only supplementary products Need for new business models: e.g. risk impaired annuity from chronic disease Risk category, Consumer discretion, Consumer ability to absorb risk/expense, Potential financial approach, Potential reimbursement Routine, H, H, Saving, credit/prepaid cards, fee for services Preventive, H, H, Free, Fee for services Chronic Care, H, M (Catastrophic H, L) Insurance with incentives for proper management and risk impaired annuity, nested episodes with population health models Discretionary, H, M, Savings and credit cards, Episodes Purely elective, H, M, Savings and credit cards, Episodes Catastrophic non chronic, L, L, Insurance, Episodes End of Life, L, M, Savings, viatical, reverse mortage, Episodes
  2. The transparency into care dlivery performance makes possible very different payment and risk intermediation models: expansion of episode and bundled payment modesl, incentives baded on population health, complete capitated risk, transfer levels of financial risk to providers. Potential for transparency in the care delivery performance can test bundled payment modes, incentives based on population health, eliminate 30 day -readmission costs Wearable trackers quantify personal activity generating valuable data for private payors: measures collected, fully automated visualization and longitudinal evaluation, comparison with family, friends, and the online community. AXA partner with Samsung to provide discounts for healthy behavior John Hancock uses fitbit for life insurance offering 15% discound Generali uses discovery health, and offers vouchers and gifts for activity and prevention exams
  3. Figure 4.1 maps how the business models of physician practices will evolve disruptively. It suggests that the typical primary care physician's business consists of four different categories of healthcare delivery, enumerated in the figure as follows: 1 The straightforward diagnosis and treatment of disorders (generally acute ones) that are in the realm of precision medicine. Examples: ear ache, pink eye, sore throat. 2 Ongoing oversight of patients with chronic diseases. Examples: diabetes, high cholesterol, lupus, tobacco addiction, obesity. 3 Ongoing wellness examinations and disease prevention, which lead to: 4 Preliminary identification of disorders that are in the realm of intuitive medicine—some that might be handled by the primary care physician, but many of which are referred to specialists. Examples: osteoporosis, asthma, appendicitis, cancer, restless leg syndrome. Christensen, Clayton M.; Grossman M.D., Jerome H.; Hwang M.D., Jason (2008-12-25). The Innovator's Prescription: A Disruptive Solution for Health Care (p. 113). McGraw-Hill Education. Kindle Edition. Herodotus, the Greek historian who wrote The History of the Persian Wars in the fifth century BC (ca. 484 BC to 425 BC), observed what appears to have been a precursor to these sorts of networks during his travels through Babylonia: The following custom seems to me the wisest of their institutions . . . They have no physicians, but when a man is ill they lay him in the public square, and the passersby come up to him, and if they have ever had his disease themselves or have known anyone who has suffered from it, they give him advice, recommending him to do whatever they found good in their own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is.23
  4. In case of Emergency, the patient summary is there in our mobile phone and can be understood anywhere in the world Emergency response teams can use the patient summaries to capture accurately the aggregate and individual needs of a community hampered by disaster.
  5. Systems of record – SQL / CDA/CCD / Systems of differentiation – IHE Profiles / PCHA/Continua Profiles Systems of innovation – FHIR / OpenEHR Archetypes Data drive a wave of automation aspiring to improve care forge connections of health & wellness, medical research, and clinical decision support. Healthcare systems can rely on digital technologies to sustain costs, improve access, provide quality care facing dwindling resources and increasing demand offer mobile patient- and provider-facing apps mix patient-generated data with provider medical notes use data to shape personalized care pathways provide just-in time access to health services in person or online Health information technology standards are at the core of the compass, to tap the potential of shared aggregate data and sustain trust.
  6. At a rapid face of just-in-time disruption, Standards Developing Organizations need to cooperate to deliver quality, interoperability, and knowledge timely at an affordable cost. to look outside to listen to the users to rethink standards and tools that support their full lifecycle To deliver live eStandards a digital health compass can support safety, prevent harmful events, and assist in managing efficient, connected services of high quality and relevance in the digital health ecosystem. Health data standards, open interfaces, and a culture of sharing increase trust. Complementary initiatives to health information technology standards are the Dublin Core Metadata Initiative (DCMI) headings, the HONCode labelling online health resources, and W3C guidelines for usability and accessibility building confidence in navigation. Health information technology standards are required to provide common metadata about digital health products and assemble fragmented information scaling up and sustaining digital health literacy [5, 9]. Standards developing organizations work together on standards to meet the health information needs of people within and across health facilities. The value of data and the increasing focus on patient experience, dictates global cooperation on open standards emphasizing mobile use. Health System – government and regulators Rules to abide by for sustaining and innovating the health system Public health reporting and analysis Communication and coordination across health systems Workforce Communication and coordination of care Dissemination and availability of knowledge (CDSS) Citizens Active involvement in health maintenance and decisions Navigating the health system (or systems) they are involved in eHealth Market Creating opportunities for new health and IT services
  7. To develop, deliver, test and deploy standards sets which are properly adapted to a dynamic healthcare system, we need a constant flow of interaction between three types of activities: Co-creation between all relevant stakeholders to make it real using standards A supportive and appropriate governance system to make it scale toward large-scale deployment The flexibility to adapt and align as needs and requirements change to make it stay in a sustainable way =============== Alignment of eHealth standards accelerate knowledge-sharing, and promote wide adoption of standards. Evidence-based Roadmap Convergence, iterative consolidation, broad acceptance of eStandards Quality Management System interoperability testing & certification of eHealth systems. Coexistence of standards in large-scale eHealth deployment Go global: EU/US MoU roadmap Influence global standards Boost competiveness Fuel innovation Socio-economic aspects of interoperability language for user/vendor co-making’ in trust
  8. To develop, deliver, test and deploy standards sets which are properly adapted to a dynamic healthcare system, we need a constant flow of interaction between three types of activities: Co-creation between all relevant stakeholders to make it real using standards A supportive and appropriate governance system to make it scale toward large-scale deployment The flexibility to adapt and align as needs and requirements change to make it stay in a sustainable way Goal: identify the required clinical data, vocabulary and value sets for an international patient summary. Scope: “The IPS specification shall focus on a minimal and non-exhaustive Patient Summary, which is specialty-agnostic and condition-independent, but still clinically relevant.” The primary use case is to provide support for cross-border or cross-juridictional emergency and unplanned care: Cross-jurisdictional patient summaries (through adaptation/extension for multi-language and realm scenarios, including translation). Emergency and unplanned care in any country, regardless of language. Value sets based on international vocabularies that are usable and understandable in any country. Data and metadata for document-level provenance.