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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

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

topics key insight only about each
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
context and cost can we afford e health
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
context and cost can we afford e health1
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!!

what do we focus on health informatics the electronic health record
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
what do we focus on health informatics the electronic health record1
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
what do we focus on other components of e health
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]

what do we focus on risk factors gbd 2010 study
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

what do we focus on the future gbd 2010 study
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

what do we focus on the now gbd 2010 study
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

where do we start frequently we learn from others good and bad idea
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
where do we start old news and more recent news
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

slide14

ORGANISATION

CONSTRUCTION

OPERATION

Conducive Setting

[Complex]

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Where

Working?

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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

where do we start2
Where Do We Start?

COMPLEXITY

LOW HIGH

where do we start what s available from the litereature
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
what is strategy what it is what it does
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.
what is strategy quite different from policy but often used interchangeably
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’
intended and realised strategy mintzberg and waters concept modified
Intended and Realised Strategy - Mintzberg and Waters Concept (Modified) -

Intended Strategy

Deliberate Strategy

Ultimate Strategy

Intended Strategy

Influential Factors

e health strategy development 8 steps
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.)
e health strategy development 8 steps1
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.)
a panacea the goose that lays golden eggs
A Panacea ?- The Goose That Lays Golden Eggs -
  • e-Health is a facilitator
  • e-Health is NOT always the answer
e health strategy development 8 steps2
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.)
strategy vs policy how do they relate
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

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

$

$$$$$$$$

how is this easy to do no but it s darned important
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.

slide31

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?

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