Reaching a Vision for eHealth Through Collaboration July 28, 2008.

Reaching a Vision for eHealth Through Collaboration

July 28, 2008

2bellagio intro deck v10 PVG 07.28.ppt

To the moon?

Ideas that stick are:

Simple

Unexpected

Concrete

Credible

Emotional

Stories

“… I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth. No single space project in this period will be more impressive to mankind, or more important for the long-range exploration of space; and none will be so difficult or expensive to accomplish… But in a very real sense, it will not be one man going to the moon--if we make this judgment affirmatively, it will be an entire nation. For all of us must work to put him there.” - John F. Kennedy, 1961

A telecom vision: We should be able to contact anyone, anywhere, at anytime, from anywhere.

“Committed to connecting the world: By connecting the world and fulfilling everyone’s fundamental right to communicate, we strive to make the world a better and safer place.” - ITU


A draft vision for eHealthOverall goal to improve health and quality of health-related information

Integrated eHealth systems for everyone, everywhere to improve access to quality health services, and allow for better health and well being of all citizens and better health systems management.

We believe eHealth should support: • Personal, family, community, public health services and preventative interventions,

particularly in resource-poor environments

• The most relevant health research, information and education, for health providers, researchers, policy makers and citizens

• Appropriate, complete, consistent and interoperable health information systems, that integrate public health and clinical requirements for overall health systems management and stewardship.

Still an early draft; need your assistance defining effortPlease comment at: www.ehealth-connection.org/wiki/

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“eHealth” a broad and diverse realm of efforts

eHealth:

the use of information and communication technologies (ICT) to improve health

Different types of eHealth initiatives include, but not limited to:Different types of eHealth initiatives include, but not limited to:

Health information systems• Public health informatics:

• Support for disease prevention• Disease and intervention surveillance (e.g. PDAs to community health workers for disease

surveillance)• National health info systems to detect/track global threats to public health

• Health and clinical informatics:• Electronic health records (EHR), electronic medical records (EMR), patient health records

(PHR)• Decision support for healthcare professionals

• Health system administration and operations• Pharmacy and supply chain management systems• Laboratory systems (e.g. electronic ordering, transmission processing)• Clinical administration software (e.g. billing)

Healthcare and expertise• Telemedicine / telehealth

Health research, advisories and education• eLearning for physician, nurse, healthcare personnel training• Access to research for healthcare personnel• Patient support and information (SMS reminders for drug compliance, online health

information, etc.)• Decision support for healthcare professionals


Variety of challenges to reaching visionBellagio a forum for vetting ideas

Barriers and impediments to

eHealth advancement

Little capacity for developing and managing health information technology

Prohibitive policy environment

Optimal eHealth development path unclear

System is fragmented – donors and other stakeholders push for narrow, specific solutions without interoperability considerations

• Leads to inefficient use of funds• Creates program stovepipes

Lack of private sector providers due to low market incentives threatens sustainability, independence

Immaturity and youth of

eHealth effort in developing countries

Lack of awareness about value of eHealth and breadth of possible solutions

Lack global forums with all relevant stakeholders in which to discuss progress, issues and learnings


Bellagio organized around solution areas grounded in domains of eHealth applications

“Path to Interoperability” and “Unlocking the eHealth Market” support developing countries in finding optimal development path to maximize eHealth potential

“eHealth Policies” and “Capacity Building” address the enabling environment to lower the barriers and impediments to eHealth diffusion and advancement

“Electronic Health Records”, “mHealth”, “Public Health Informatics” and “Access to Information” provide grounding in applications that strengthen health systems

EHR mHealth PHI A2K

Interop. Markets

Optimal development path

eHealth applications

PoliciesCapacity building

Enablers


Connected health information network will require interoperability across several dimensions

Across programs Across geographies

Across points of care Across technologies

Census

TB

Malaria

HIV/ AIDS

Hospital

Health clinic

Community health worker

Metcalfe’s LawMetcalfe’s Law Examples of dimensions to be addressedExamples of dimensions to be addressed

The value of a network (e.g. Telecomm) is proportional to the square of the number of users of the system (n²)

Early stage of eHealth in much of developing countries is an advantage – possible to take action now


Hypothesis: Collaborative action necessary for success

Collaboration can achieve synergy through united action• Branding: uniting all eHealth-related efforts to increase awareness• Funding coordination: drives alignment on key issues, reduces redundant activities• Mitigate HR constraint: limited group of experts in this field

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• Technology companies• Biopharmaceutical companies• Entrepreneurs• Research and academia• Others?

Fostering spread of eHealth requires multiple, interconnected efforts• HCIT capacity building required to support many eHealth efforts• National policies needed to support all types of programs• Emerging platform technologies, e.g. mobile health, span multiple areas of focus public health, clinical and patient-centered

informatics

Multi-player, multi-sectoral initiative needed

• Ministries of health and other representatives of target countries

• Private donors/foundations• Non-governmental organizations• Multilateral donor/aid organizations


Goal at Bellagio: engage stakeholders on collaborative action to address challenges facing eHealth efforts

Capacity building

• help countries build and sustain HR capacity to manage, maintain and develop eHealth solutions

Policy advocacy• develop enabling policy guidelines• advocate to and/or advise countries on policy development

Standards support

• identify/advocate/implement critical data standards to ensure data quality and interoperability

Funding coordination

• raise funds for eHealth, reduce redundant activities and increase pool of funding

• align funders on key issues (e.g. interop. standards), channel funding as needed

Market-making

• connect “buyers” and “sellers” of eHealth solutions– educate consumers on portfolio of available applications– aggregate demand for eHealth solutions– potentially provide base level of freeware / starter kits

Key collaborative actionsKey collaborative actions

Enablers

Policy

Cap. build.

Optimaldevelopment

path

Interop

Market


Many experts and decision-makers participating - sampleWho do you need to talk to and work with to push eHealth forward? Who’s missing?

Academic

Corporate

Donor

Other

NGO

Gov’t

Multilateral

Bill & Melinda Gates FoundationCarso Health InstituteCGAPGlobal FundIBMIDRC/ICT4D, Executive DirectorUNFUnited Nations FoundationsUS OGAC

Cell LifeCIDRZ, ZambiaDataDyneEarth InstituteGrameen Phone/MITIMIAMedical Research CouncilPartners In HealthRegenstrief InstituteSatellife

KarachiKerralaVital Wave ConsultingAmerican Public Health Association

D-tree International; DimagiHISPUCSFUniv.of New South Wales/ChileUniversity of ZimbabweUW

GoogleVodafoneVoxivaMicrosoftNokiaQualcommCisco/Nethope HIMSS AnalyticsKeiser PermanenteGSM AssociationMisysTSI

Health Policy Unit, MoH of VietnamZA Government

WHO


One mission of Bellagio is to gain a deeper understanding of the global eHealth landscape

Much of the value of these sessions is informal

However, the collective intelligence on these issues and the possibility for partnership(s) is an important benefit

Three ways of obtaining your thoughts throughout this conference:• Online survey• Wiki• Working session on Thursday


Bellagio participants

Feedback will be analyzed throughout Bellagio and synthesized results presented at subsequent sessions

Monday Tuesday Wednesday Thursday Friday

Participants have three days to fill out survey• Target 30 minutes• Two methods: online (preferred) and paper• Due at 9 pm on Wednesday (Italy time)

Collaboration workshop led by

Karl & TiciaRockefeller and BCG

Welcome, recap of previous

sessions (RF)

Surveys analyzed and synthesized

Introductory presentation on

collaborative effort and survey

(BCG)

Distribute surveys

Synthesize findings from survey, wiki and workshop for next week’s intro

session

Wiki to collect input from both Bellagio participants and webcast viewers throughout the week


Survey questions focused on the potential for eHealth

Value of eHealth

Share your thoughts on the broad vision for eHealth.

In the context of the larger global health effort how important (1 – 5) is investing in eHealth to improve health in developing countries? Please explain your response.

What are the fundamental eHealth applications for strengthening developing countries' health systems?

Advancing eHealth

What are the challenges facing the widespread adoption and use of eHealth in the developing world?

What factors would enable eHealth to be implemented in these areas?

Offer your ideas for specific solutions.

Key players

It is likely that many stakeholders will be necessary for these solutions. Please suggest your ideas for leaders in this area (both individuals and organizations). What resources would they contribute (e.g. funding, IP, expertise, time, staff)? What would be the nature of their engagement (e.g. consulting, leadership, donations in kind)?

Many have suggested that some form of collaborative action is needed to most effectively address the need for eHealth in the developing world. Do you agree?

What can be done to establish a successful collaboration?


Thank you for your engagement and hard work!

Capacity

IO

PH

Access

EHR

PolicyMarket

Mobile

Capacity

IO

PHI

Access

EHR

Policy

Market

Mobile

Unused slides


Co

mm

un

icat

ion

stan

dar

ds

Info

rmat

ion

stan

dar

ds

Example: hierarchy of eHealth standards supported by communication standards

SNOMED

TCP

XML

HL7 v2.51

IP

HTTP

TermTerm

Systematized Nomenclature of Medicine

Health Level Seven

eXtensible Markup Language

Hypertext Transfer Protocol

Transmission Control Protocol

Internet Protocol

DescriptionDescription

Systematically organized collection of medical terminology covering most areas of clinical information

Enables the exchange, management and integration of healthcare information

Facilitates sharing of structured data across different information systems

Used to transfer or convey information on the World Wide Web

Provides reliable, in-order delivery of a stream of bytes

Data-oriented protocol used for communicating data across the internet

Standard Standard First useFirst use

1987

2003

1997

1996

1974

1977

1. HL7 version 3 has not yet been widely adopted

Reaching a Vision for eHealth Through Collaboration July 28, 2008.

Documents

quality of health

health providers

online health information

public health services

relevant health research

quality health services

community health workers

electronic health records