Socio-economic benefits of interoperable electronic health record by broverya78

VIEWS: 7 PAGES: 47

									    Socio-economic benefits of
  interoperable electronic health
     record systems in Europe
         – the evidence -
__________________________________________

         Karl A. Stroetmann FRSM PhD MBA
      with Alexander Dobrev, Tom Jones, Yvonne Vatter

       empirica Communication & Technology Research
                     BONN - BRUSSELS




     Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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“Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
                                        Contents



1. The EHR Impact methodology
2. The Computerised Patient Record (CPR)
   system at the University Hospitals of Geneva
3. The Scottish Emergency Care Summary
   (ECS) Programme
4. Conclusions and lessons learned

            Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
   The EHR Impact methodology




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“Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
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                               Study context
               EC-commissioned study on the
         Socio-economic impact
of interoperable electronic health record
    and ePrescription systems in Europe
                                  www.ehr-impact.eu
Ø Identification, analysis and evidence on 10 good practice
  cases
Ø Policy recommendations to foster their diffusion in Europe
Ø Follow-up to eHealth IMPACT study (www.ehealth-
  impact.org)

              Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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         “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
     Focus of the EHRI methodology

§ Net socio-economic gains and eHealth
  utilisation (= the usage of services enabled by
  EHR and ePrescribing systems)
§ Underlying economic concept: benefit cost
  analysis (BCA)
  – Value added from eHealth = value of health services
    with eHealth less value of health services without eHealth
  – Total value added/net benefit = sum of positive and
    negative ‘value added’ for each stakeholder group
  – Overall socio-economic impact of interoperable EHR
    and ePrescribing systems = net benefits over time for the
    “system”
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         “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
                       Stakeholder analysis


§ Patients, carers, and other citizens
§ Healthcare staff – professionals, teams
§ Health service provider organisations
§ Third parties
  – Insurance companies
  – Other payers
  – Governments
  – Public authorities
§ Not: secondary/tertiary impacts
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     “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
Assigning monetary values to benefits and costs




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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
                                                             Data summary sheet

EHRI generic data summary                          2002           2003           2004            2005           2006           2007           2008           2009           2010           total
                                                     ₤              ₤              ₤               ₤              ₤              ₤              ₤              ₤              ₤              ₤


Estimated COSTS
Citizens                                                     0              0               0              0              0              0              0              0              0
HPOs
Doctors, nurses, other staff                          327.228       1.580.810      3.054.706      2.508.696      2.138.701      1.377.585        665.500        257.198        248.501
Organisation                                                0         287.420      1.278.054      1.456.266      1.647.159      1.168.186      1.573.382      1.491.935      1.124.750
3rd parties                                                 0               0              0              0              0              0              0              0              0
Present value of total annual costs                   327.228       1.868.231      5.001.766      4.574.757      4.846.373      2.944.246      2.480.882      2.011.114      1.624.832       25.679.427
Present value of cumulative costs                     327.228       2.195.458      7.197.224     11.771.981     16.618.354     19.562.600     22.043.482     24.054.596     25.679.427
Estimated BENEFITS
Citizens                                                     0              0           49.522      139.721        235.032        954.462      1.881.438      2.253.439      2.403.204
HPOs
Doctors, nurses, other staff                                 0              0        22.610         693.547        786.336        978.257        989.644        963.139        935.856
Organisation                                                 0              0        50.246         146.426        248.257      1.016.342      2.003.123      2.374.555      2.513.962
3rd parties                                                  0              0             0               0              0              0              0              0              0
Present value of annual benefits                             0              0       122.378         979.694      1.269.625      2.949.061      4.874.205      5.591.132      5.853.022       21.639.117
Present value of cumulative benefits                         0              0       122.378       1.102.072      2.371.697      5.320.758     10.194.963     15.786.095     21.639.117


Net benefits
Present value of annual net benefits                 -327.228      -1.868.231     -4.879.388      -3.595.063     -3.576.747          4.814      2.393.323     3.580.018      4.228.191       -4.040.310
Present value of cumulative net benefits             -327.228      -2.195.458     -7.074.846     -10.669.909    -14.246.657    -14.241.842    -11.848.519    -8.268.501     -4.040.310

Net benefits over cost ratio - annual                     -1,00          -1,00           -0,98          -0,79          -0,74           0,00           0,96           1,78           2,60            -0,16
Net benefits over cost ratio - cumulative                 -1,00          -1,00           -0,98          -0,91          -0,86          -0,73          -0,54          -0,34          -0,16

Number of records                                   4.800.000       4.900.000      5.000.000      5.100.000      5.200.000      5.450.914      5.450.914      5.450.914      5.450.914
Number of times records are accessed                        0               0         12.600         37.260         72.720        792.120      1.455.996      1.740.240      1.920.240


Distribution of benefits
Citizens                                                                                40,47%      14,26%         18,51%         32,36%          38,60%        40,30%         41,06%              36,59%
HPOs
Doctors, nurses, other staff                                                            16,10%      63,85%         57,82%         32,05%          20,30%        17,83%         17,13%              24,81%
Health provider organisation                                                            35,78%      13,48%         18,25%         33,30%          41,10%        43,96%         46,01%              38,60%
3rd parties                                                                              0,00%       0,00%          0,00%          0,00%           0,00%         0,00%          0,00%               0,00%

Base year: 2008; Discount rate:
                                            3,5%




                                           Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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                                      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
The Computerised Patient Record (CPR) at the
    University Hospitals of Geneva (HUG)


                        With support from
                   Prof. Dr. Christian Lovis
                 Head, Unit of Clinical Informatics,
                  University Hospitals of Geneva


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About the University Hospitals of Geneva (HUG)

§ Consortium of public and teaching state
  hospitals
§ 9 major facilities at four campuses
§ > 30 ambulatory facilities
§ Community, primary, secondary and tertiary
  care
§ > 48’000 inpatients and > 800’000 outpatients
  yearly
§ > 2’000 beds
§ > 5’000 care professionals,
§ Annual budget of nearly 1.4bn CHF
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About the Computerised Patient Record (CPR)




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      Benefits from the CPR system at HUG

§ Citizens
  – Patient safety
  – Time saving and avoided admissions
  – Better care because of better informed carers
§ Doctors & nurses
  – Do not have to waste time looking for records
  – Lower exposure to risk – carers feel safer, less vulnerable
  – Nurses do not have to chase doctors
  – Doctors do not have to guess while waiting for
    data
  – Life made easier through integrated presentation of
    different reports

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      Benefits from the CPR system at HUG


§ Benefits to HUG
  – Time savings – redeployment of resources:
     •   Looking for records
     •   Looking for colleagues
     •   Ward rounds
     •   Discharge letters

  – Reduction in exposure to risk due to better clinical governance
     • Critical information is always available where needed
     • Lower risk of errors when transferring patients across HUG sites

  – Avoided admissions – also for insurances
  – Reductions in number of tests
  – Extra income from better billing processes


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       HUG – cumulative economic performance
      140.000.000


      120.000.000


      100.000.000


       80.000.000
CHF
       60.000.000


       40.000.000


       20.000.000


               0
                       1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010


                         Present value of cumulative costs                             Present value of cumulative benefits
                                                                                                                  Preliminary data

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                    “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
The Scottish Emergency Care Summary (ECS)
                Programme


           With support from
         Jonathan Cameron
  Programme Manager for Emergency
             Care Summary,
    National Health Service Scotland

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      Emergency Care Summary (ECS)



§ NHS in Scotland
  – Primary and Secondary Care
     • 14 Local Health Boards
  – 1030 GP Practices (Family
    Practitioners)
     • 4 suppliers of GPs’ EHR
  – 1 National Ambulance Board
§ 5.3 million population

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                                      Background

§ A new GP contract meant changes to Out
  of Hours (OOH) care for Patients
§ A “useful summary” was needed for
  Emergency and Out of Hours services
  – A&E, Ambulance, NHS24 (National OOH Call
    Centre)
§ Previously localised, paper based, patchy
  system of information between
  contributors to patient care

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                          Policy and Strategy


§ Incremental and pragmatic approach to
  Electronic Patient Records
§ Focus on business challenges, not
  technology
§ Clinical leadership
§ Aim to deliver benefits, not IT systems
§ Integration across patient journeys


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                                Agreed Dataset


§ Patient demographics (address,
  telephone, CHI number)
§ Allergies and adverse reactions to
  medications
§ Medication history
   - Repeat prescriptions in past 12 months
   - Acute prescriptions in past 30 days
§ Consent flag
  – Patient opt out status

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       Engagement with Stakeholders

§ From the start….
§ GP and senior clinical leadership
§ Patient groups
  – Focus groups
§ National Patient Leaflet
  – Written by independent patient group
§ Variety of media used in different areas
§ Continued engagement throughout

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                         Progress and Usage

§ Over 5.3 million records extracted from
  GPs’ EHRs
§ 1400 citizens have ‘opted out’
  – Represents 0.026% of all patients
§ Over 1.6 million accesses to date and
  increasing trend in use – more than
  100,000 accesses p.m.
§ Expected increase in use as new
  developments are available

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                                            Progress and Usage

                                               ECS Accesses - Cumulative Total

               1600000

               1400000

               1200000
ECS Accesses




               1000000

               800000                                                                                                ECS Accesses

               600000

               400000

               200000

                    0
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              Costs and financing of ECS

§ Investment
  – redeployed resources
    • GPs engaged in ECS development from start
  – Extra expenditure
    • NHS Scotland project budget
§ Operations and maintenance
  – Time spent on ECS by GP / GP Admin
  – Technical and organisational
§ ICT cost: £3.3m = 13%
§ Total investment = £25.3m
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                         Benefits from the ECS

§ Citizens
  – Patient safety - reduced risk of ADE harm
  – Some avoided admissions & referrals
  – Time saving for patients
     • fewer repeat questions at OOH, NHS24 and A&E
  – More efficient consultation at NHS 24 – time & satisfaction
§ Doctors & nurses
  – Comfort to GPs
     • patients are taken care of efficiently out of hours
  – No manual preparation of medication records at NHS24
    and OOH
  – Doctors’ and nurses’ life made easier

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                           Benefits from the ECS

§ Benefits to NHS Scotland
   – Reduction in exposure to risk due to better clinical governance
      • Assurance that drugs are recorded correctly and fully
      • Assurance that advice is based on better information
   – Time savings – redeployment of resources:
      • Fewer repeat questioning about medications by doctors and
        nurses at OOH and A&E
      • More bed-side time by A&E pharmacists as fewer calls to GPs
      • Faster completion of current medication list at NHS24
      • No manual input of medication lists at NHS24
          – 1 min per call
   – Avoided admissions & visits
      • Avoided referrals by NHS24 to OOH and A&E
      • Faster treatment and some avoided admission at A&E
          – no overnight waiting for clarification with GP

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                       ECS – annual economic performance
       7.000.000


       6.000.000


       5.000.000


       4.000.000
   ₤
       3.000.000


       2.000.000


       1.000.000


                   0
                        2002         2003          2004           2005          2006           2007          2008   2009   2010

Preliminary data           Present value of total annual costs                                   Present value of annual benefits
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                        “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria
  Conclusions and lessons learnt




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           Conclusions and lessons learnt I


§ Engagement with all stakeholders before design is
  complete and implementation begins
   – The largest single estimated cost, over 50%, was the time of doctors
     needed for engagement, compared to the 13% for ICT (in Scotland)
§ Patient safety, the original goal, was about one-third of
  estimated benefits
§ The consent of patients and citizens can be achieved
  effectively and efficiently
§ Step by step progress is effective in realising a net
  benefit and managing risk
§ Interoperability can be achieved, enabling integrated care


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         Conclusions and lessons learnt II

§   Business cases for all stakeholders!
§   You need deep pockets & lots of patience !
    Ø up to ten years of sustained investment requires
     also sustained financing

§   You need to know what you will get !
    Ø quality, risk reduction, and efficiency; not cash

§   You need to know what can go wrong !
    Ø realistic risk management


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                    Acknowledgements
  We thank the European Commission for their financial and non-financial
                              support!

       This presentation is part of research supported by the European
 Commission, Directorate General Information Society and Media, Brussels.
  It reflects solely the views of its presenters. The European Community is
    not liable for any use that may be made of the information contained
                                      therein.

Further information:
European Commission
http://europa.eu.int/information_society/activities/health/index_en.htm
empirica
http://www.empirica.biz/themen/telemedizin/projekte_en.php
    Socio-economic benefits of
  interoperable electronic health
     record systems in Europe
         – the evidence -
__________________________________________

                  Karl A. Stroetmann FRSM PhD MBA
            with Alexander Dobrev, Tom Jones, Yvonne Vatter

             empirica Communication & Technology Research




                         BONN - BRUSSELS




        Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
                                                                                               2
   “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                   1
                                        Contents



1. The EHR Impact methodology
2. The Computerised Patient Record (CPR)
   system at the University Hospitals of Geneva
3. The Scottish Emergency Care Summary
   (ECS) Programme
4. Conclusions and lessons learned

            Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




          The EHR Impact methodology




            Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                       2
                                                                                                     5


                               Study context
               EC-commissioned study on the
          Socio-economic impact
 of interoperable electronic health record
    and ePrescription systems in Europe
                                 www.ehr-impact.eu
Ø Identification, analysis and evidence on 10 good practice
  cases
Ø Policy recommendations to foster their diffusion in Europe
Ø Follow-up to eHealth IMPACT study (www.ehealth-
  impact.org)

              Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
                                                                                                     5
         “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




     Focus of the EHRI methodology

§ Net socio-economic gains and eHealth
  utilisation (= the usage of services enabled by
  EHR and ePrescribing systems)
§ Underlying economic concept: benefit cost
  analysis (BCA)
  – Value added from eHealth = value of health services
    with eHealth less value of health services without eHealth
  – Total value added/net benefit = sum of positive and
    negative ‘value added’ for each stakeholder group
  – Overall socio-economic impact of interoperable EHR
    and ePrescribing systems = net benefits over time for the
    “system”
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         “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                         3
                         Stakeholder analysis


  § Patients, carers, and other citizens
  § Healthcare staff – professionals, teams
  § Health service provider organisations
  § Third parties
    – Insurance companies
    – Other payers
    – Governments
    – Public authorities
  § Not: secondary/tertiary impacts

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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




Assigning monetary values to benefits and costs




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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                       4
                                                             Data summary sheet

EHRI generic data summary                          2002           2003           2004            2005           2006           2007           2008           2009           2010           total
                                                     ₤              ₤              ₤               ₤              ₤              ₤              ₤              ₤              ₤              ₤


Estimated COSTS
Citizens                                                     0              0               0              0              0              0              0              0              0
HPOs
Doctors, nurses, other staff                          327.228       1.580.810      3.054.706      2.508.696      2.138.701      1.377.585        665.500        257.198        248.501
Organisation                                                0         287.420      1.278.054      1.456.266      1.647.159      1.168.186      1.573.382      1.491.935      1.124.750
3rd parties                                                 0               0              0              0              0              0              0              0              0
Present value of total annual costs                   327.228       1.868.231      5.001.766      4.574.757      4.846.373      2.944.246      2.480.882      2.011.114      1.624.832       25.679.427
Present value of cumulative costs                     327.228       2.195.458      7.197.224     11.771.981     16.618.354     19.562.600     22.043.482     24.054.596     25.679.427
Estimated BENEFITS
Citizens                                                     0              0           49.522      139.721        235.032        954.462      1.881.438      2.253.439      2.403.204
HPOs
Doctors, nurses, other staff                                 0              0        22.610         693.547        786.336        978.257        989.644        963.139        935.856
Organisation                                                 0              0        50.246         146.426        248.257      1.016.342      2.003.123      2.374.555      2.513.962
3rd parties                                                  0              0             0               0              0              0              0              0              0
Present value of annual benefits                             0              0       122.378         979.694      1.269.625      2.949.061      4.874.205      5.591.132      5.853.022       21.639.117
Present value of cumulative benefits                         0              0       122.378       1.102.072      2.371.697      5.320.758     10.194.963     15.786.095     21.639.117


Net benefits
Present value of annual net benefits                 -327.228      -1.868.231     -4.879.388      -3.595.063     -3.576.747          4.814      2.393.323     3.580.018      4.228.191        -4.040.310
Present value of cumulative net benefits             -327.228      -2.195.458     -7.074.846     -10.669.909    -14.246.657    -14.241.842    -11.848.519    -8.268.501     -4.040.310

Net benefits over cost ratio - annual                     -1,00          -1,00           -0,98          -0,79          -0,74           0,00           0,96           1,78           2,60            -0,16
Net benefits over cost ratio - cumulative                 -1,00          -1,00           -0,98          -0,91          -0,86          -0,73          -0,54          -0,34          -0,16

Number of records                                   4.800.000       4.900.000      5.000.000      5.100.000      5.200.000      5.450.914      5.450.914      5.450.914      5.450.914
Number of times records are accessed                        0               0         12.600         37.260         72.720        792.120      1.455.996      1.740.240      1.920.240


Distribution of benefits
Citizens                                                                                40,47%      14,26%          18,51%        32,36%          38,60%        40,30%         41,06%              36,59%
HPOs
Doctors, nurses, other staff                                                            16,10%      63,85%          57,82%        32,05%          20,30%        17,83%         17,13%              24,81%
Health provider organisation                                                            35,78%      13,48%          18,25%        33,30%          41,10%        43,96%         46,01%              38,60%
3rd parties                                                                              0,00%       0,00%           0,00%         0,00%           0,00%         0,00%          0,00%               0,00%

Base year: 2008; Discount rate:
                                            3,5%




                                           Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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                                      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




The Computerised Patient Record (CPR) at the
    University Hospitals of Geneva (HUG)


                                                          With support from
                                                     Prof. Dr. Christian Lovis
                                                   Head, Unit of Clinical Informatics,
                                                    University Hospitals of Geneva


                                           Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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                                      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                                                                                                                                 5
                                                                                                   11

About the University Hospitals of Geneva (HUG)

§ Consortium of public and teaching state
  hospitals
§ 9 major facilities at four campuses
§ > 30 ambulatory facilities
§ Community, primary, secondary and tertiary
  care
§ > 48’000 inpatients and > 800’000 outpatients
  yearly
§ > 2’000 beds
§ > 5’000 care professionals,
§ Annual budget of nearly 1.4bn CHF
            Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                   12

About the Computerised Patient Record (CPR)




            Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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       “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                        6
                                                                                                        13

      Benefits from the CPR system at HUG

§ Citizens
  – Patient safety
  – Time saving and avoided admissions
  – Better care because of better informed carers
§ Doctors & nurses
  – Do not have to waste time looking for records
  – Lower exposure to risk – carers feel safer, less vulnerable
  – Nurses do not have to chase doctors
  – Doctors do not have to guess while waiting for
    data
  – Life made easier through integrated presentation of
    different reports

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            “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                        14

      Benefits from the CPR system at HUG


§ Benefits to HUG
  – Time savings – redeployment of resources:
      •   Looking for records
      •   Looking for colleagues
      •   Ward rounds
      •   Discharge letters

  – Reduction in exposure to risk due to better clinical governance
      • Critical information is always available where needed
      • Lower risk of errors when transferring patients across HUG sites

  – Avoided admissions – also for insurances
  – Reductions in number of tests
  – Extra income from better billing processes


                 Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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            “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                             7
                                                                                                                              15

       HUG – cumulative economic performance
      140.000.000


      120.000.000


      100.000.000


       80.000.000
CHF
       60.000.000


       40.000.000


       20.000.000


               0
                       1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010


                         Present value of cumulative costs                             Present value of cumulative benefits
                                                                                                                  Preliminary data

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                    “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




The Scottish Emergency Care Summary (ECS)
                Programme


                  With support from
                Jonathan Cameron
         Programme Manager for Emergency
                   Care Summary,
           National Health Service Scotland

                         Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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                    “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                                                     8
                                                                                                  17

      Emergency Care Summary (ECS)



§ NHS in Scotland
  – Primary and Secondary Care
     • 14 Local Health Boards
  – 1030 GP Practices (Family
    Practitioners)
     • 4 suppliers of GPs’ EHR
  – 1 National Ambulance Board
§ 5.3 million population

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      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                  18

                                      Background

§ A new GP contract meant changes to Out
  of Hours (OOH) care for Patients
§ A “useful summary” was needed for
  Emergency and Out of Hours services
  – A&E, Ambulance, NHS24 (National OOH Call
    Centre)
§ Previously localised, paper based, patchy
  system of information between
  contributors to patient care

           Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                       9
                                                                                                  19

                          Policy and Strategy


§ Incremental and pragmatic approach to
  Electronic Patient Records
§ Focus on business challenges, not
  technology
§ Clinical leadership
§ Aim to deliver benefits, not IT systems
§ Integration across patient journeys


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      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                  20

                                Agreed Dataset


§ Patient demographics (address,
  telephone, CHI number)
§ Allergies and adverse reactions to
  medications
§ Medication history
   - Repeat prescriptions in past 12 months
   - Acute prescriptions in past 30 days
§ Consent flag
  – Patient opt out status

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      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                       10
                                                                                                  21

       Engagement with Stakeholders

§ From the start….
§ GP and senior clinical leadership
§ Patient groups
  – Focus groups
§ National Patient Leaflet
  – Written by independent patient group
§ Variety of media used in different areas
§ Continued engagement throughout

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      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                  22

                         Progress and Usage

§ Over 5.3 million records extracted from
  GPs’ EHRs
§ 1400 citizens have ‘opted out’
  – Represents 0.026% of all patients
§ Over 1.6 million accesses to date and
  increasing trend in use – more than
  100,000 accesses p.m.
§ Expected increase in use as new
  developments are available

           Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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      “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                       11
                                                                                                                               23

                                             Progress and Usage

                                                 ECS Accesses - Cumulative Total

               1600000

               1400000

               1200000
ECS Accesses




               1000000

                800000                                                                                                ECS Accesses

                600000

                400000

                200000

                    0




                          08
                          08
                   S 7
                          07




                   N 7

                   D 7
                   A 7




                           8
                   Fe 8
                   Ju 7




                   Ju 8
                           7




                   Ja 7


                         08

                           8
                        -0



                         -0

                        -0
                       l-0




                       l-0
                          0
                        -0




                        -0
                        -0




                        -0




                        -0




                      n-
                       r-
                      n-




                      n-

                      b-
                     ug



                      ct



                     ec
                     ep



                     ov
                     ay




                     ay
                     ar
                    Ju




                    Ju
                   Ap
                   O




                   M
                   M




                   M
                                                                   Month


                               Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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                          “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                                               24

                                  Costs and financing of ECS

               § Investment
                   – redeployed resources
                         • GPs engaged in ECS development from start
                   – Extra expenditure
                         • NHS Scotland project budget
               § Operations and maintenance
                   – Time spent on ECS by GP / GP Admin
                   – Technical and organisational
               § ICT cost: £3.3m = 13%
               § Total investment = £25.3m
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                          “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                                                     12
                                                                                                       25

                           Benefits from the ECS

§ Citizens
   – Patient safety - reduced risk of ADE harm
   – Some avoided admissions & referrals
   – Time saving for patients
      • fewer repeat questions at OOH, NHS24 and A&E
   – More efficient consultation at NHS 24 – time & satisfaction
§ Doctors & nurses
   – Comfort to GPs
      • patients are taken care of efficiently out of hours
   – No manual preparation of medication records at NHS24
     and OOH
   – Doctors’ and nurses’ life made easier

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           “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                       26

                           Benefits from the ECS

§ Benefits to NHS Scotland
   – Reduction in exposure to risk due to better clinical governance
      • Assurance that drugs are recorded correctly and fully
      • Assurance that advice is based on better information
   – Time savings – redeployment of resources:
      • Fewer repeat questioning about medications by doctors and
        nurses at OOH and A&E
      • More bed-side time by A&E pharmacists as fewer calls to GPs
      • Faster completion of current medication list at NHS24
      • No manual input of medication lists at NHS24
          – 1 min per call
   – Avoided admissions & visits
      • Avoided referrals by NHS24 to OOH and A&E
      • Faster treatment and some avoided admission at A&E
          – no overnight waiting for clarification with GP

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           “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                            13
                                                                                                                                  27

                       ECS – annual economic performance
       7.000.000


       6.000.000


       5.000.000


       4.000.000
   ₤
       3.000.000


       2.000.000


       1.000.000


                   0
                        2002        2003           2004           2005          2006           2007          2008   2009   2010

Preliminary data           Present value of total annual costs                                   Present value of annual benefits
                             Forum 5 “Innovations in coordinated care”, 11th European Health Forum Gastein
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                        “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                          Conclusions and lessons learnt




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                        “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




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                                                                                                        29

            Conclusions and lessons learnt I


§ Engagement with all stakeholders before design is
  complete and implementation begins
    – The largest single estimated cost, over 50%, was the time of doctors
      needed for engagement, compared to the 13% for ICT (in Scotland)
§ Patient safety, the original goal, was about one-third of
  estimated benefits
§ The consent of patients and citizens can be achieved
  effectively and efficiently
§ Step by step progress is effective in realising a net
  benefit and managing risk
§ Interoperability can be achieved, enabling integrated care


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            “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                        30

           Conclusions and lessons learnt II

§    Business cases for all stakeholders!
§    You need deep pockets & lots of patience !
     Ø up to ten years of sustained investment requires
      also sustained financing

§    You need to know what you will get !
     Ø quality, risk reduction, and efficiency; not cash

§    You need to know what can go wrong !
     Ø realistic risk management


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            “Values in Health – From Visions to Reality”, Oct. 02 - 03, 2008, Bad Hofgastein, Austria




                                                                                                             15
                    Acknowledgements
  We thank the European Commission for their financial and non-financial
                             support!

       This presentation is part of research supported by the European
 Commission, Directorate General Information Society and Media, Brussels.
  It reflects solely the views of its presenters. The European Community is
    not liable for any use that may be made of the information contained
                                      therein.

Further information:
European Commission
http://europa.eu.int/information_society/activities/health/index_en.htm
empirica
http://www.empirica.biz/themen/telemedizin/projekte_en.php




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