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MIE 2005

MIE 2005. eHealth Impact A context-adaptive method of evaluating the economic impact of eHealth methodological approach and work in progress. Empirica Gesellschaft für Technologieforschung, Bonn, Germany Tanjent Consultancy, Hereford, UK EUMEDES Agency, München, Germany.

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MIE 2005

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  1. MIE 2005 eHealth Impact A context-adaptive method of evaluating the economic impact of eHealth methodological approach and work in progress

  2. Empirica Gesellschaft für Technologieforschung, Bonn, Germany Tanjent Consultancy, Hereford, UK EUMEDES Agency, München, Germany Dr. Karl Stroetmann Dr. Veli Stroetmann Tom Jones, FRSA Dr. Wendelin Schramm E.C. Project: eHealth Impact

  3. eHealth Impact Workshop • Background • Earlier research • Methods and tools • Two case studies • Discussion – please interrupt

  4. MIE 2005 e-Health Impact [e-hi] Quality Access Cost-effective = Economic and productivity

  5. e-Health ImpactGoals • eHI promotes proven e-Health • eHI identifies e-Health • benefits • costs • productivity • Publicly available tool & knowledge for evaluation & future investment http://www.ehealth-impact.org

  6. e-Health Measurements • Who • Why • What • How • Where • When • Who benefits

  7. e-Health Communicate, Store, Aggregate, Compare, Report, Remind, Warn Prevention Diagnosis Therapy Monitoring Rehabilitation Follow-up Integrate, Interprete, Decide, Act Professional The Ideal Situation

  8. The Real Situation e-Health Communicate, Store, Aggregate, Compare, Report, Remind, Warn Prevention Therapy Monitoring Rehabilitation Follow-up Diagnosis Integrate, Interprete, Decide, Act Professional Social insurance fragmentation

  9. Numerous and Diverging Stakeholder Demands • Patients • Handicapped and Elderly Persons • Physicians • Hospitals • Pharmaceutical industry • Care management service providers • Health insurance • Healthcare politics and decision making • Publishers • Suppliers • New players

  10. e-Health payer patient provider Community Decision Making HealthPolitics Products & Services Health Portals And many more… Health Standards Science Demand Management Digital Imaging Electronic Health Record Triage System Hospital Information System Interfaces Mobile Computing Health Financing System Development

  11. Other Specialist Peer Consultation Pharmacy Referral / Feedback Hospital Specialist Request & Result Request & Result Referral / Feedback Services (imaging, ultrasound, laboratory etc.) Request & Result Outpatient Dept. Referral / Feedback Request & Result Referral / Discharge claims / payments GP practice / public primary care centre Re-imburser / insurance Patient Continuing Medical Education Other GP Prescription Home Nursing Peer Consultation Prescription Pharmacy Home Care Activity Reports Notifiable Diseases Home Administration Disease Surveillance etc. Educational Centres

  12. About Evidence From a complex system… …seeking evidence represents a complex process … so, no simple solutions

  13. Origins of Evidence - Clinical trials / intervention studies - Epidemiological studies - Metaanalyses / systematic review and many more … Clinical researchProductions of evidence Registration … Evidence based Clinical Guidelines Health TechnologyMedicine Assessment Evidence in practice Clinical Pathways Disease Management Programme Is eHI here?

  14. e-Health Communicate, Store, Aggregate, Compare, Report, Remind, Warn Prevention Diagnosis Therapy Monitoring Rehabilitation Follow-up Integrate, Interprete, Decide, Act Professional The Ideal Situation

  15. Why Models? • Stucture Evidence • Standardised Comparisons • Identify variables and levers • Simulate the future • Supports decision making

  16. An Example • Diabetes Care pilot contracts in several German countries: • Target: integrated care, improving quality of diabetes care AND being economical • Introduction of a type-2.2 diabetes: „not likely to reach diabetes related complications“ • Saxonia-Anhalt: „completing the age of 65“ • The consequence: Later referral to diabetologists, less tight metabolic control, less education, (less expenditure for elderly, discrimination of women ?)

  17. CE of Diabetes Care for the Elderly CLYG [€]

  18. CE of Diabetes Care for the Elderly CLYG [€]

  19. Why Models? • Stucture Evidence • Standardised Comparisons • Identify variables and levers • Simulate the future • Supports decision making „Imagination is more important than knowledge“ (Albert Einstein)

  20. Stop 1 • Questions and comments on this section • Room for Discussion

  21. Earlier research

  22. Earlier research

  23. Earlier research

  24. Earlier research

  25. Earlier research

  26. Earlier research Two previous case studies Patient costs and benefits Providers costs and benefits E-health utilisation Development implementation operation

  27. Earlier research Two previous case studies Net economic return - 5 to 6 years First impact - two years from live Provider investment cost Patients benefit Need sustained resources Utilisation drives benefits

  28. Earlier research Two previous case studies e-health findings Quality and effectiveness Improved work setting Better resource utilisation Balance financial focus

  29. Earlier research E-health investment should be approached as a clinical development

  30. e-hi methods and tools Three steps Evaluation Forecasting Initial business case model

  31. Methods and tools Cost benefit analysis (CBA) Cost effectiveness analysis (CEA) ? Breakeven Productivity Affordability Business cases

  32. Methods and tools CBA Impact on all actors in communities Future marginal benefits Future marginal costs Monetary value attached to benefits over time

  33. CBA Evaluation Benefits Accept Evaluate Evaluate Refuse Cost • is not concerned with cost saving

  34. Methods and tools CEA Aims to find the minimum cost of meeting a given target Benefits not estimated Not used by e-hi so far X

  35. Limitations of eHI • Practice data rarely available • CBA based on patient cohorts from different countries • Subgroup analysis is not available • Transfer between different healthcare systems? • Precision of findings (π) ? • Should be updated when new evidence available

  36. Methods and tools Development of costs and benefits

  37. Methods and tools Productivity Unit costs Throughput per person Resource utilisation

  38. Methods and tools Marginal change in productivity

  39. Methods and tools Affordability Not part of e-hi evaluations X … but, e-health needs long term financing to change and restructure resources

  40. Methods and tools Business cases Economic case - quality, access, cost effective Financial case – affordability, sustainable finance Select the right e-health application

  41. Costs Benefits Healthcare providers’ resources Patients and carers Clinical and working practices Point of care and e-health use Disease, diagnosis or treatment group Workload Data needed for healthcare e-health application Quality standards Access goals Healthcare service range Methods and tools Data

  42. Methods and tools Sensitivity analysis Tests and underpins all analysis

  43. 3 time periods Planning & development stage Implementation stage Running stage for routine operation 3 settings: service without eHealth service with eHealth estimate for a service without eHealth that has been replaced by eHealth Development costs Investments Change management Project management Running cost of health services Benefit for patients, professionals and payers information is needed on the numbers of: - patients serviced - items processed, such as x-rays, drugs, analyses and messages - colleagues serviced, such as second opinion, expert consultancies - prices and costs before and after attached to these services for each unit of workload Benefits for patients These include: • Faster service • Time saved • Better information • Longer life • Faster recovery • Less pain and stress Benefits for professionals, nurses, other staff, administration These include: • More reliable data • Improved access to data • Better communications • Improved effectiveness • Improved efficiency. Data / Information collected

  44. Stop 2 • Questions and comments on this section • Room for Discussion

  45. Two case studies Flanders Vaccination Database NHS Direct Online

  46. Kind & Gezin Flanders vaccination database Vaccination goals Data for plans and strategies Productivity solution In-house development

  47. Kind & Gezin Long term trends Sustainable economic benefit from productivity gains

  48. Kind & Gezin

  49. Kind & Gezin Patient benefits Significant impact on the economic case Quality Access Cost-effective

  50. Kind & Gezin

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