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Strategies for IT and Better Health: A Global Tour


'The last 12 months could be dubbed the international year of electronic health ... Richard Alvarez, Bulletin of the World Health Organization, May 2005 ... – PowerPoint PPT presentation

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Title: Strategies for IT and Better Health: A Global Tour

Strategies for IT and Better Health A Global
  • Ticia Gerber, Vice President, International
    Programs and Public Policy
  • eHealth Initiative and Foundation
  • George Washington University
  • February 9, 2006

Global Partnerships for Health
  • The last 12 months could be dubbed the
    international year of electronic health records,
    as electronic health information systems have
    been identified as a critical ingredient for
    reinvigorating health care in country after
  • Richard Alvarez, Bulletin of the World Health
    Organization, May 2005

eHealth Initiative and Foundation Mission and
  • Mission Improve the quality, safety, and
    efficiency of healthcare through information and
    information technology
  • Areas of Focus
  • Focus on states, regions and communities as the
    center of implementation aligning national
    standards with local solutions
  • Develop and drive adoption of sustainable model
    for healthcare transformation through
    quality-based incentives
  • Advocate for continued favorable national

eHI is the Go-to Organization For Health
Information Exchange Efforts
eHealth Initiative and Foundation
Hands-on Help
Global Partnerships for Health
  • International public health evolution framework
  • (1800-1950) Tropical medicine Colonialism and
  • (1950 1990) International health Cold War
  • (1990 Current) Global health Rapid advance of
    the global economy
  • (Elizabeth Fee, Ph.D, Examining a Framework The
    Three Phases of International Health, November
  • HIT part of growing global health movement
  • What is global health?
  • IOM defines global health as health problems,
    issues, and concerns that transcend national
    boundaries, may be influenced by circumstances or
    experiences in other countries, and are best
    addressed by cooperative actions and solutions."

Global Partnerships for Health
  • Global Health Challenges
  • Re-emergence of old threats
  • Avian Flu of 1918 which killed 20-100 m
  • Emergence of new threats
  • SARS
  • Treatment Resistance
  • Tuberculosis, Pneumococcus, HIV
  • Intentional Attacks/Engineered Virulence
  • Terrorism
  • Increased Mixing
  • International Travel - Two million people cross
    national borders as tourists, business travelers,
    immigrants, or refugees every day
  • Food Supply (Increased portability and import
    practices) - US agricultural imports (56
    billion) equal to exports for first time in 2004,
    and increased
  • Economic Goods and Service (Increased global
    trade and East-West bridge) Chinas merchandise
    exports grew 35 in 2005 to 593 billion and
    US-Chinese trade deficit increased to 200

Global Partnerships for Health
  • The great obstacle to serious progress towards
    global health goals remains the woeful state of
    the worlds public health infrastructure.
  • Health information systems remain inadequate,
    making it impossible to monitor the delivery and
    coverage of interventions in a timely and
    effective way.
  • Global Governance Initiative - Third Annual
    Report, Davos World Economic Forum, January 2006

Global Partnerships for Health
Global Partnerships for Health
  • Medical diplomacy' should be used in
    conjunction with our existing foreign and defense
    policies to achieve progress and win the hearts
    and minds of people worldwide.  Good medicine
    makes better neighbors.
  • Former U.S. Secretary of Health and Human
    Services Tommy Thompson, October 20, 2005
  • Medical diplomacy is defined as exporting
    medical care, knowledge and personnel to help
    those most in need in Africa, Asia, the Middle
    East and elsewhere.

Global Partnerships for Health
  • US Medical Diplomacy Examples
  • US provides 33 of annual donations to Global
    Fund to Fight AIDS, Tuberculosis and Malaria
  • Global Fund created to finance a dramatic
    turn-around in the fight against AIDs,
    tuberculosis and malaria, as a partnership
    between governments, civil society, the private
    sector and affected communities
  • Global Fund committed 4.4 billion in 128
    countries to support aggressive interventions.
  • New global health category added to US budget
    Presidents FY-07 request is 381 million

Global Health Partnerships - eHI Role
  • eHealth Initiative has been critical driver in
    creating and cultivating e-Health policy change
    in U.S. (community, state, federal activities)
  • We are extending our reach to collaborate with
    and learn from key healthcare stakeholders around
    the globe through the Leadership in Global Health
    Technology (LIGHT) Initiative
  • LIGHT Initiative established in May 2004

Home is Where the IT Is Growing National Agenda
around Health Information Exchange
  • Enormous momentum around improving quality,
    safety and efficiency through clinical exchange
    within Administration, Congress, and the private
  • Key themes
  • National standards for interoperability
  • Alignment of value based purchasing with HIT
    infrastructure required to get there
  • Government as catalyst
  • Public-private sector collaboration

Signs of Momentum for HIT and Health Info
Exchange Activities in Congress
  • 12 bills introduced in 2005
  • Most bi-partisan
  • Unprecedented collaboration between the
    Republicans and Democrats on the importance of
    leveraging HIT and the mobilization of
    information to address healthcare challenges

Signs of Momentum for HIT and Health Info
Exchange Activities in Congress
  • Active legislation includes
  • HIT bills
  • Senate
  • S 1416 Wired for Health Care Quality Act
  • House
  • Health Information Technology Promotion Act
  • Medicare Pay for Performance
  • Senate
  • S 1356 - Medicare Value Purchasing Act
  • House
  • HR 3617 Medicare Value-based Purchasing for
    Physician Services Act

Signs of Momentum for HIT and Health Info
Exchange Activities in Congress
  • Action on HIT legislation this year possible
  • Important characteristics of bill negotiation
  • Bi-partisan HIT issue support
  • 108th Congress spans both 2005 and 2006
  • Multi-committee discussions and drafting
  • House and Senate have very different solutions
    that must be worked out in conference
  • Budget deficit environment (challenge of adequate
    funding, meaningful incentives)
  • Lack critical mass of economic research on impact
    of HIT
  • Federal priority-shifting in wake of Hurricane
  • Congressional efforts must integrate with current
    Administration initiatives

Signs of Momentum for HIT and Health Info
Exchange Activities in Administration
  • Leadership on all Sides
  • Office of Secretary of DHHS
  • Office of the National Coordinator for HIT
  • Agency for Healthcare Research and Quality
  • Centers for Disease Control and Prevention
  • Centers for Medicare and Medicaid Services
  • Department of Defense
  • Department of Veterans Affairs
  • Office of Personnel Management
  • Executive and cabinet-level leadership critical
    in advancing the issue

Signs of Momentum for HIT and Health Information
Exchange Activities in Administration
  • AHIC public-private community formed to provide
    input to Sec. Leavitt re how to make health
    records digital and interoperable and assure that
    privacy and security are protected
  • Overseeing work in four break-through areas
    that will create realizable benefits to consumers
    in two to three years
  • Biosurveillance
  • Chronic care
  • Consumer empowerment
  • Electronic health records

Signs of Momentum for HIT and Health Information
Exchange Four DHHS Contracts
  • Standards Harmonization. 3.3 million contract to
    ANSI for convening Health Information Technology
    Standards Panel (HITSP) to review standards under
    development and develop a roadmap for single set
    of standards
  • Compliance Certification. 2.7 million contract
    to Certification Commission for HIT to develop
    process and criteria for inspecting EHRs and
    other HIT
  • Privacy and Security. 11.5 million contract to
    Health Information Security and Privacy
    Collaboration overseen by RTI International who
    will work with states to assess and develop plans
    to address variations in organization-level
    business policies and state laws that affect
    privacy and security practices that may serve as
    barriers to health information exchange
  • Nationwide Health Information Network. Four
    contracts totaling 18.6 million to four
    consortia led by Accenture, CSC, IBM and Northrop
    Grumman to develop a blueprint for how a
    generalized network would share information
    across the U.S.

Global Partnerships for Health eHI Role
  • Leadership in Global Health Technology (LIGHT)
    Initiative Background
  • eHI and its Foundation founded LIGHT Initiative
    in 2004
  • eHI LIGHTs purpose is to facilitate learning and
    information sharing among HIT innovators and
    other nations, in both the developed and
    developing world
  • Focus of these activities is to identify the key
    barriers, workable strategies and imperatives for
    implementing an interconnected, electronic health
    information infrastructure to support better
    health and healthcare 
  • Participants include high-level healthcare
    officers and executives from the public and
    private sectors around the globe
  • eHI LIGHTs project work and interests span six

Global Partnerships for Health - eHI Role
  • eHI LIGHT has
  • Hosted two global HIT conferences involving over
    17 nations (Geneva, Washington DC)
  • Begun discussions about mutual lessons learned
    and other issues with government health, science
    and technology representatives (England, Finland)
  • Sponsored regional health improvement discussions
    and HIT summits for different epicenters around
    the globe (Example Finland, Japan)
  • Developed an inventory of HIT-related efforts
    from different countries across the world
  • Launched an on-line Resource Center with global
    HIT information
  • Arranged site visits for global partners who
    are interested in learning from the U.S. HIT
  • Convened eHI Working Group on LIGHT meets
  • Initiated outreach to relevant policymakers to
    increase global HIT collaboration and funding in
    the long-term.

Global Partnerships for Health
  • Highlights of First Report of the Leadership in
    Global Health Technology InitiativeGlobal
    Connections Requirements, Enablers and
    Roadblocks to Implementing HIT and Electronic
    Connectivity for Better Health and Healthcare

Geneva LIGHT Summit Participants
  • Australia
  • Malaysia
  • Mexico
  • Peru
  • Saudi Arabia
  • South Africa
  • United Kingdom
  • United States
  • Bangladesh
  • Brazil
  • Canada
  • Colombia
  • Cuba
  • European Union
  • Kenya
  • Korea

Geneva LIGHT Summit Participants
  • Geneva Summit participants provided high-level
    overview of national strategy (if applicable) in
    each of the following areas
  • National leadership and governance strategies
  • Upfront funding and ongoing financing vehicles to
    assure sustainability
  • Technical issues such as architecture,
    applications, standards, security, and accurately
    and responsibly linking patient data
  • Methods to facilitate clinician adoption,
    clinical process change, and application of
    clinical knowledge at the point of care
  • Engaging patients and citizens

Geneva LIGHT Summit Learnings
  • Despite the diversity of participant experiences,
    many shared common views regarding factors
    critical to
  • Focusing on the local role and participation in
    system change
  • Tool-kits to capture and disseminate learnings,
    best practices and software
  • Accompanying consumer education and awareness
  • Knowledge transfer both from those nations who
    have gone before and between regions and
    provinces engaged in the system
    transformation.prototype legal agreements,
    governance models, and insight on requirements
    and specifications are key
  • Importance of data standards and interoperability
  • Availability of computer literate graduates,
    especially in every rural areas, where medical
    centers are located
  • Innovative use of low-cost technologies such as
    Palm Pilots, cell phones and simple computer
  • Appropriately addressing privacy and security
    concerns at every step in the process.

Geneva LIGHT Summit Learnings
  • Common Challenge of Participants
  • Maintaining HIT as a top item on the national
    agenda in shifting political and budgetary
  • Antiquated laws and regulations
  • Reducing deployment costs
  • Jumpstarting system reform projects in nations
    where HIT systems are largely disparate and
    unintegrated and in which HIT strategic planning,
    standardized infrastructure and health
    information networks are severely lacking
  • Monopolized telecommunications operations or an
    absence of integration among different network
  • Addressing cultural barriers and stigmas
  • Adapting HIT to different care and practice
  • Changing skill mix, structures and care processes
    to support patient-centred HIT services
  • Creating a truly integrative EHR
  • Change management challenges
  • HIT procurement cycles longer than desired system
    reform pace
  • Matching high patient volume with smaller HIT
    supplier capacity

Geneva LIGHT SummitAreas for Global
  • The following were identified by summit
    participants as areas for global support and
  • Developing a multi-national approach based on
    geographic location and cultural similarity
  • Developing an aggressive, formal agenda for
    funding HIT initiatives in different countries
  • Facilitating alignment between public and private
    sector activities
  • Encouraging a more active role from organizations
    like WHO, USAID, the World Bank and UN bodies in
    developing countries
  • Encouraging national EMR systems that are
    developed to incorporate globally accepted data
    standards and interoperability protocols

Global Partnerships for Health
  • WHO
  • World Health Assembly reviewed and
    adopted resolution
  • WHA58.28, in May 2005 urging Member States to
  • Consider developing long term strategic plans for
    developing and implementing eHealth services
  • Develop intrastructure for information and
    communication technologies
  • Requested WHO provide technical support to Member
    States, and facilitate integration of eHealth in
    health systems and services, including in

Global Partnerships for Health - Europe
  • EU e-Health Action Plan
  • EU Nations not bound by plans recommendations,
    but they do provide a useful basis for coalescing
    around certain objectives.
  • Blueprint officially launched in 2004 and
    provides a framework for addressing common
    eHealth and ICT challenges.
  • Plans overarching goal is to achieve a
    borderless Trans-European health information
    space by 2010 that recognizes the particular
    importance of interoperability and patient
    mobility, as well as strengthening disease
    prevention, health care personalization and
    patient involvement.

Health Information Infrastructure Reform Examples
  • Europe
  • United Kingdoms National Programme for IT
    (Connecting for Health)
  • NPfIT is composed of four key elements
  • NHS care records service (national patient record
    spine, local service providers)
  • Electronic appointment booking
  • Electronic transmission of prescriptions
  • Underpinning IT infrastructure.
  • A central goal of the National Programme for IT
    is the creation of a single electronic healthcare
    record for every individual in the United Kingdom
  • Contains a comprehensive life-long history of
    patients health, care and information,
    regardless of where, when and by whom they were
  • Provides healthcare professionals with immediate
    access to summary of care encounters and clinical
    events held on a national data repository
  • Supports the NHS in collecting and analysing
    information, monitoring health trends and to
    making the best use of clinical and other
  • Holds essential information at the local level
    where most care is delivered

Health Information Infrastructure Reform Examples
  • United Kingdoms National Programme for IT
    (Connecting for Health)
  • The electronic booking service, Choose and Book
    was introduced in Summer 2004 and eventually will
    be available across England.
  • From 1 January 2006, patient able to choose date
    and time of specialist appointment and book.
  • The first live electronic transfer of a patients
    medical record from one GP surgery to another has
    been successfully completed in trials.
  • Within two years, Summary Care Record available
    containing key diagnoses and problems, current
    and recent prescriptions, and important
    information such as allergies, drug reactions,
    discharge and out-patient care summaries will be
    available to patients and health professionals in

Health Information Infrastructure Reform Examples
  • FinnWell - Healthcare Technology Programme
  • Programme duration 2004-2009
  • Programme volume approx. 150 million euro
  • Finlands population 5 million
  • Healthcare responsibility lies largely with 450
    municipalities, organized into 20 provinces or
  • Only 10 of healthcare is private
  • Finland viewed by some informaticists as the most
    advanced health information infrastructure in

Health Information Infrastructure Reform Examples
  • FinnWell - Healthcare Technology Programme
  • Improve the quality of healthcare
  • Enhance the efficiency of healthcare
  • Create new products of healthcaretechnology
  • Promote business in healthcare
  • Promote healthcare exports

Health Information Infrastructure Reform Examples
  • FinnWell - Healthcare Technology Programme
  • Technologies for diagnosticsand care
  • Healthcare IT related productsand systems
  • Operational processes ofhealthcare

FinnWell - Healthcare Technology Programme
  • FinnWell - Healthcare Technology Programme
  • 90 of primary GPs have and use EMRs
  • Speciality hospital care 60 have EMR but usage
    varies widely from 10-90
  • Hear from Finns that EMRs not comprehensive
    enough and although used regionally, not hooked
    into any cohesive national infrastructure
  • Once implemented, Finns estimate that a National
    eHR could save 200 million euros per year

Global Partnerships for Health
  • In Europe specifically, we desire to
  • Engage with European health and technology
    leaders (EU, EHTEL, individual nations) to share
    current HIT policy and market developments and
    lessons learned
  • Fill knowledge gaps, facilitate targeted and
    helpful collaboration
  • Crosswalk progress on EU eHealth Action Plan and
    EU eHealth I2 project with US HIT agenda
  • Note Growing interest in US about how domestic
    HIT policy aligns/compares with EU policy
  • Share information gained from US community HIE
    projects (legal, technical, financial, clinical,
  • US-European summit on health improvement and HIT

Health Information Infrastructure Reform Examples
  • Australia - National HealthConnect program goal
    is eHR for every resident. Initial focus is on
    medication record.
  • Long-term goals of the Australian HIT initiative
    include widespread eHR use, e-enabling clinical
    and patient support and the creation of a
    national health information network. Regional HIE
    efforts are also cropping up.
  • North America
  • Canada - Canada Health Infoway is a
    not-for-profit agency formed to foster and
    accelerate the development and adoption of
    electronic health information systems with
    compatible standards and communications
    technologies on a pan-Canadian basis. 
  • Infoways six-year goal is to have the basic
    elements of interoperable electronic health
    records in place across 50 percent of Canada by

Global Partnerships for Health Developing World
  • Regenstrief Medical Record System
  • Mosoriot, Kenya
  • Rural health center
  • Serves mainly subsistence farmers
  • Current medical records
  • minimal data recorded
  • data recorded multiple times
  • counting by hand
  • Solution Mosoriot Medical Record System
    Project executed by Kenyan Ministry of Health and
    Moi University Faculty for the Health Sciences,
    in principal collaboration with the Indiana
    University School of Medicine, the Regenstreif
    Institute for Health Care and the Veterans
    Affairs Medical Center in Indianapolis.
  • (Dr. Bill Tierney)
  • First electronic medical record system used for
    ambulatory care in sub-Saharan Africa. 

Global Partnerships for Health Developing World
  • Mosoriot Medical Record System
  • EMR created to serve a particular need ?
  • run on a single microcomputer
  • multiple power sources
  • solar (85 available sunlight)
  • backup UPS
  • backup gas generator
  • create system components
  • registration system
  • electronic version of encounter form
  • data dictionary
  • formats for standard Min. of Health reports
  • Encounter forms to collect intensive initial and
    follow-up data
  • Print a summary flowsheet of patient data to
    place in clinic chart

Global Partnerships for Health Developing World
  • Mosoriot Medical Record System
  • Electronic data can be obtained without
    sophisticated, complex computer infrastructure
  • Clinical information systems are possible in even
    the most resource-constrained places

Global Partnerships for Health Developing World
  • Mosoriot Medical Record System
  • In the first 3 years, gt5000 patients were
    enrolled and made gt35,000 visits
  • 2/3 to Moi Hospital clinics
  • largest public HIV program in Kenya
  • 50 on anti-retroviral drugs

Global Partnerships for Health Developing World
  • Next steps
  • Migrate to a Web-based EMR
  • Add 3 district hospitals
  • Enter data in HIV clinics using wireless tablet
    computers ? flowsheets, care prompts
  • Extend the AMRS to HIV clinics in other
    sub-Saharan Africa countries
  • software downloaded by clinics in Ethiopia,
    Kenya, Mozambique, Namibia, Nigeria, Rwanda,
    South Africa, Tanzania, Uganda, Zimbabwe

Global Partnerships for Health Developing World
  • Foundations, NGOs and major international aid
    organizations such as World Bank stepping into
    global e-Health (ICT) arena
  • Examples infoDevs knowledge map project
    charting role and use of ICT in the developing
  • ICT in the Commission for Africa report
  • In addition to calling for increased
    international aid of 25 billion a year until
    2010 and a further 25 billion by 2015 and
    addressing issues of peace, security, trade and
    debt elimination, the Commission for Africa
    Report features many recommendations specific to
    health and global HIT such as calling for
  • An emphasis on capacity-building and better
  • Rebuilding African healthcare and public health
    systems, which it concludes requires not only new
    funding but better use of existing dollars with a
    focus on optimal delivery and results
  • A climate of increased public and private
  • And a doubling of donor funding for
    infrastructure, which includes information and
    communications technology.

  • A myriad of countries are moving in a targeted,
    coordinated and expeditious way towards
    implementation of HIT and health information
  • Although embroyonic, critical point in global
    e-Health, interoperability and connectivity
  • eHI and its LIGHT Initiative enthusiastically
    seek out collaborative endeavors and partnerships
    and will contribute to global progress
  • Look forward to the opportunity for mutual
    learning between the US and other nations

  • A small group of thoughtful people could change
    the world. Indeed, it's the only thing that ever
  • Margaret Mead

  • Ticia Gerber
  • Vice President, International Programs and Public
  • eHealth Initiative and Foundation
  • 818 Connecticut Avenue NW, Suite 500
  • Washington, D.C. 20006
  • 202.624.3264
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