1. health and fitness

Madis Tiik
Turku 29.11.2012
Madis Tiik, MD
• Tartu University , Medical Doctor 1996
• Nordic School of Public Health – Diploma
in Public Health 2003
• Tallinn University of Technology, Institute
of Clinical Medicine , lecturer, Phd student
(defending on the 14th of December 2012)
• Chairman of The Estonian Society of
Family doctors 2001-2008.
• CEO of Estonian eHealth Foundation 20072011
Current work
• Vormsi island, family doctor
• Finnish Innovation fund Sitra, senior
adviser
The EU roadmap for eHealth
Towards full picture of the
individual’s health status
3
2
1
Connecting individuals
with Health Information Networks
Linking all the points of care
Time
1990s
ICT for Health – Gérard Comyn – MIE 2009, Sarajevo
Today
What is eHealth?
 Electronic Health Record
 Collects data from multiple healthcare organisations
 Patient summary: allergies, prescriptions, recent events
 Applications based at facilities

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Computer-based patient records for hospitals
Electronic medical records for primary-care physicians
PACS and other digital imaging systems
Business intelligence and financial management
 Telemedicine and telemonitoring
 Remote diagnosis: Teleradiology, teledermatology etc
 Remote consultation: Video visits, e-visits
 Remote monitoring: Home and mobile
All three areas are important!
Analysis
Follow-up
Policymaking
Treatment
Guidlines
Public
Services
Campaigns
PHR
EHR
Tele-advice
Self-help
Diagnostics
Appointment
Workflow
Notification
Prescription
Lifestyle
The future of healthcare will be shaped by
seven separate, but interconnected, trends.
 Healthcare spending will continue to rise, not only because of inflationary
drivers, but because of growing recognition by policymakers that improved
health is linked with greater national wealth.
 Keeping the universal healthcare model will require rationing of services and
consolidation of healthcare facilities, as public resources fall short of demand.
 General physicians will become more important as gatekeepers to the system
and as co-ordinators of treatment for patients with multiple health issues.
 More effective preventive measures and fundamental lifestyle changes will be
promoted to encourage healthy behavior.
 European governments will need to find a way to improve collection and
transparency of health data in order to prioritize investment decisions.
 Patients will need to take more responsibility for their own health, treatment
and care.
 Governments will have to tackle bureaucracy and liberalize rules that restrict
the roles of healthcare professionals and artificially raise the cost of medical
research.
© The Economist Intelligence Unit Limited 2011
5 extreme scenarios for European healthcare
in 2030:
 Technology triumphs and cures chronic disease, while ehealth takes a prominent role in the management of
healthcare;
 European nations join forces to create a single panEuropean healthcare system;
 Preventive medicine takes precedence over treating the
sick;
 European healthcare systems focus on vulnerable members
of society;
 European nations privatize all of healthcare, including its
funding.
© The Economist Intelligence Unit Limited 2011
Health Care Costs
Public
Health and
Preventive
Measures
5%
Curative
Medicine
95 %
McGinnis, et al., Health Affairs; 21(2), 2002
Factors Contributing to
Early Mortality
Behavior
40%
Medical Care
10%
Social
15%
Environment
5%
Genetics
30%
McGinnis, et al., Health Affairs; 21(2), 2002
Focus
Empowering Citizens
PHR
Preventive care
EHR systems
Health care
With the help of advanced eHealth services a
citizen can take control of his well-being
before ailment.
Healthcare professionals can use
the rich background data that is
stored in Taltioni.
The variety of eHealth services enable the
citizen to have a holistic view of his health.
Taltioni enables a smooth
information flow between
professionals and systems.
PHR
After care
Advanced eHealth services enable cost
effective and effective after treatment.
Quick responses to changes in healing
process and personal treatment foster
faster recovery from ailment.
TALTIONI
Finish population (5.4M), based of
the risk calculation
Very
high risk
60 000
High risk
200 000
Low risk
800 000
Self-care, prevention
4 340 000
Hospital care
High specialization
Patient
centric team
GP, outpatient
care
Supported
Self-care Motivated,
supported
Walk in clinics citizen
Home monitoring
Electronic medical records (EMRs)
and IT.
 By 2020,
health systems will move from predominantly paper
records controlled by the industry to predominantly
digital ones controlled by individuals.
Ninety percent of health leaders surveyed said making
EMRs available to clinicians and patients would make
their systems more efficient and effective. But effective
implementation will be difficult and expensive.
HealthCast 2020
eHealthTask Force Report
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Toomas Hendrik Ilves – President of Estonia (chairman)
Stefano Marzano- Electrolux, IT
Tero Ojanperä – Vision+, FI
Joan Guanyabens i Calvet- Catalan Agency for Health
Information, Assesment and Quality, ES
Maria Leonor Beleza- Champalimaud Foundation, PT
Anders Olauson- European Patients Forum, SE
Neil Bacon- iHAM Ltd, UK
Miklos Szocska- Minister of State, HU
Wendy Tankard- Harmoni, UK
Ineta Ziemele – European Court of Human Rights, LV
My data, my decisions
Individuals are the owners and controllers of their own health
data, with the right to make decisions over access to the data
and to be informed about how it will be used.
 The main preconditions
 trusted, accepted and interoperable data collection and
management;
 understanding of the benefits by all stakeholders.
 The main benefits
 for patients who are empowered to manage their own health –
if they wish – and get personalized treatment
Liberate the data
Large amounts of data currently sit in different silos within health and
social care systems. If this data is released in an appropriate manner
and used effectively it could transform the way that care is provided.
 The main precondition
 is that regulators and policymakers to require institutions to publish
their data;
 The main benefits
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accelerated innovation and increased scale (from standardization)
spread across all actors in the form of lower costs
integrated services
rich data flows for research and policy making
new services, more choice through more competition
better and more evidence.
Connect up everything
The digital environment is growing and evolving rapidly with an
increasing trend of interaction and sharing. The popularity of
online networking and social spaces has created a parallel digital
existence for millions of people.
 The main preconditions
 policymakers and regulators provide for open access to public
services and require minimum standardization and safety of
health apps that serve interest in citizens’ and patients’
generating information
 for clinicians, care professionals and service providers to
appreciate and incorporate such information into health
decision-making and treatment plans
 The main benefits
 citizens who will receive support for continuous health treatment
and healthy living rather than only interventions
Revolutionise health
Full transparency will unleash disruptive innovation across the
health sector
 The main preconditions
 Commitment of regulators and policy makers to radical
reconfiguration of health system as well as clinicians and care
professonals accepting and erosion of their primary leadership
of healthcare
 The main benefit
 Good, multidisciplinary care will be well recognised and
delivered
 Citizens and patients will be empowered to actively participate
in managing their own health
Include everyone
Those without the skills, capacity and opportunity to use eHealth risk
beaing further excluded
 The main preconditions
 political and regulatory commitment to reduction of health inequalities
 with professional, providers, and payers ensuring no discrimination in
provision of care
 equity of access and in using eHealth tools
 and citizens and patients having understanding health and having basic
IT literacy.
 The main benefit
 is improved health status. This includes availability of a greater range of
treatment options for complex health problems
 better resource allocation, better understanding of barriers to good
health,
 improved involvement of patients and citizens in self care and improved
health awareness.
Recommendations
 A new laegal basis for health data in Europe
 Create a“beacon group“ of Member States and
regions committed to open data and eHealth
 Support health literacy
 Use the power of data
 Re- orient EU fonding and policies
ICT and healthcare in Estonia
Patient empowerment
•Software's for hospital and for GP in 1994
•Digital claims since 1995
•Equipping GP-s with PC-s 1998
•Skipping paper claims 2002
•Legally allowed to use only digital patient record
since 2002
Local EMRs
Digital Claims & Reimbursement
1992
2010
Time
2015
2020
Current situation
Activiti indicators
 More than 75% citizens has digital documents in the
EHR (989 338 persons)
 555 Healthcare providers have send documents to the
EHR
 47 314 citizenz have viuwed his/her data
• 768 have made expressions of
will/preferences
Most popular documents
 Ambulatory consultation notes
2 311 506
 Hospital discharge letters
897 944
 Image address links
1 139 790
 Consultation notes/image reports
1 508 306
 Immunization notes
Altogheter 20 standardized medical documents
50 590
E-prescribtions
1 000 000
900 000
800 000
700 000
600 000
500 000
400 000
300 000
200 000
100 000
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
issued
sold
Paper prescriptions
16,0%
14,0%
12,0%
10,0%
8,0%
6,0%
4,0%
2,0%
0,0%
july
august
sept
oct
nov
dec
jan
feb
march
april
October 2012 – 4,6%
may
ICT and healthcare in Estonia
Patient empowerment
Value Added
services
Secundary use
of data
Information
Exchange
Personal Simulation
Integration with
-Environment data
-Behaviour data
-Genetic data
Health sertificate
Integration with social care
EbmDS decision support service
Integrated statictic
Clinical registries
2015?
2015?
2014?
2010-2013
2011-2012
2011-2013
2010-2013
2011-2013
Central EHR
2005-2008
Health Portal
2009
Registries Integration ( non clinical) 2008
Standardization
2007-2012
Integration of different user groups 2009-2013
Local EMRs
Digital Claims & Reimbursement
1992
2015
2010
Time
2015
2020
Thank you!
Madis Tiik
madis.tiik@eesti.ee
THANK YOU !