Eugene Igras

1
eHealth Business OpportunitiesExploratory Study
of eHealth Applications and Markets
E-Health Industry Project e-Health Market
Awareness Forum Health Telematics Unit, Faculty
of Medicine, University of Calgary February 20,
2007
Eugene Igras IRIS Systems, Inc. Calgary ?
Alberta ? Canada ? www.irisinc.ca Tel (403)
275-4549 ? Fax [phone] Email
eigras_at_irisinc.ca
2
Agenda

• eHealth Background
• Definitions
• Health systems is selected countries
• Driving factors behind eHealth in Canada and
  internationally
• Challenges and needs
• Strategies and priorities
• eHealth initiatives
• Supply of eHealth solutions
• Future considerations
• Trends in health service delivery and eHealth
  technology
• Value propositions of eHealth in the continuum of
  care
• Evolution of the eHealth market
• Conditions for success
• Discussion

3
eHealth Definitions (1)

• Published in JMIR in 2001
• eHealth is an emerging field in the intersection
  of medical informatics, public health and
  business, referring to health services and
  information delivered or enhanced through the
  Internet and related technologies.
• In a broader sense, the term characterizes not
  only a technical development, but also a
  state-of-mind, a way of thinking, an attitude,
  and a commitment for networked, global thinking,
  to improve health care locally, regionally, and
  worldwide by using information and communication
  technology.
• The e in eHealth stands not only for
  electronic, but implies other es

Source Eysenbach, G. (2001) Journal of Medical
Internet Research 3(2) e20 http//www.jmir.org/
2001/2/e20
4
eHealth Definitions (2)

• Multiple definitions of eHealth - 51 definitions
  of eHealth published 2005
• Source Oh, H. et al (2005) Journal of Medical
  Internet Research 2005 Volume 7 Issue 1
• Published by the eHealth Industry Project
• E-health is the application of information and
  communications technologies across the range of
  functions that affect the health care and
  wellness sectors.
• Going beyond Internet use, e-health solutions
  include tools for health regions, professionals
  and practitioners as well as personalized health
  systems for individuals. 
• Examples include health information networks,
  electronic health medical records, telemedicine
  services, personal wearable and portable
  communicable systems, health portals and many
  other information and communication
  technology-based tools.  This array of e-health
  solutions can assist prevention, diagnosis,
  treatment, health monitoring and lifestyle
  management.
• Source eHealth Industry Project,
  http//www.infoport.ca/ehealth/bins/index.asp

5
Health Systems Indicators

• Canada
• Population 2007 (Million) 32.4
• Life Exp at Birth (M / F) 78 / 83
• of Population 60 1994-2004 16.0?17.5
• Health Expenditure/Capita 2003 Intl 2,989
• HC Expenditure (B) 2000-2005 97.9?142
• of GDP 2000-2005 9.1?10.2
• Projected ?HC Exp (B) 2006-2015 148?NA

• EU (27 Member States)
• Population 2007 (Million) 492.8
• Life Exp at Birth (M / F) 75 / 81
• of Population 60 1994-2004 20.9?24.8
• Health Expenditure/Capita 2003 Intl 2,144
• HC Expenditure (T)
• of GDP (Ireland-Switzerland) 2004 7.1-11.6
• Projected ?HC Exp (B) 2006-2015

• USA
• Population 2007 (Million) 302
• Life Exp at Birth (M / F) 75 / 80
• of Population 60 1994-2004 16.3?16.5
• Health Expenditure/Capita 2003 Intl 5,711
• HC Expenditure (T) 2000-2005 1.34?2.02
• of GDP 2000-2005 13.8?16.2
• Projected ?HC Exp (T) 2006-2015 2.2?4.05
• Projected ? of GDP 16.5?20.0

• Australia
• Population 2007 (Million) 20.7
• Life Exp at Birth (M / F) 78 / 83
• of Population 60 1994-2004 15.4?17.0
• Health Expenditure/Capita 2003 Intl 2,874
• HC Expenditure (B) 2003 A70.0
• of GDP 2003 over 10
• Projected ?HC Exp (B) 2006-2015

Source The World Health Report 2006. Annex
Table 1. Basic indicators for all Member
States http//www.who.int/whr/2006/annex/06_annex1
_en.pdf
6
Health System in Canada
7
Health Challenges in Canada (1)
8
Health Challenges in Canada (2)

• Aging population
• Increasing prevalence of chronic disease
• Increasing use and cost of diagnostic tests
  procedures
• Escalating pharmaceutical costs
• Climbing healthcare expenditures
• Shortages of healthcare personnel
• Poor access to the health care system
• Increasing wait lists
• Adverse events
• Public health risk

9
Healthcare in Canada The Priorities

• Improving access
• Wait time reduction
• Health human resources
• Home care
• Primary care reform
• National pharmaceuticals strategy
• Public health
• Health innovation
• Aboriginal health
• Accountability

10
Common Challenges

• Demographic changes, including ageing population
• Increasing mobility of the public
• Rising expectations regarding equal access and
  quality of services
• Epidemiological changes - increasing prevalence
  of public health threats e.g., chronic,
  infectious, and mental diseases
• Shortages or unequal distribution of healthcare
  resources, including health professionals
• Rising costs
• Fiscal constraints and fragmented funding

11
Common Strategies (1)

• Improving health service delivery
• Equitable and timely access to health services
• Appropriate and effective care
• Improved workflow
• Ensuring health safety for patients health
  professionals
• Absence of accidents or occupational illnesses
• Physical, moral and social well-being
• Reduction of adverse events (AE) e.g., due to
  errors

12
Common Strategies (2)

• Enhancing responsiveness to health threats
• Building capacity
• Improving coordination
• Fostering health maintenance disease prevention
• Promotion of healthy lifestyle
• Early disease detection
• Moving care closer to home and community
• Self-care management
• Improving health outcomes
• Fostering research and innovation
• Improving efficiency and reducing costs
• Improving health information and knowledge

13
Common Strategies (3)

• Establishing organizations responsible for health
  information systems
• Canada Infoway
• US - Department of Health Human Services
• EU - Commission of the European Communities
• Australia - Department of Health and Aged Care
• Developing ITC strategies, plans and
  architectures
• Fostering the development and adoption of health
  and technology standards
• Fostering the development and adoption of health
  ITC solutions at the national level

14
eHealth Strategies

• eHealth is considered a key enabler in
  transforming health systems
• Development of eHealth solutions follows best
  practices
• Extensive use of proven methodologies
• Active engagement of all health stakeholders,
  including the public, service delivery
  organizations, research institutions, technology
  vendors, and governments
• Scope of eHealth goes beyond use of technology
  solutions and includes
• Innovative service delivery models to assist in
  prevention, diagnosis, treatment, health
  monitoring lifestyle management
• Proactive management of healthcare resources
• Commitment for global thinking and collaborative
  work environment to achieve common goals

15
Canada Health Infoway Programs
Source Canada Health Infoway. Corporate Business
Plan 2006-2007 http//www.infoway-inforoute.ca/Adm
in/Upload/Dev/Document/Business20Plan2006-0720E
N.pdf
16
ICT Spending in Canada Comparison
of Budget/Revenue
17
Program Activity Summary (Sep 2006)
183 projects (134 active and 49 completed) valued
at 736 million in all 9 investment programs. The
111 projects jointly developed with provinces and
territories are shown. In addition, there are 72
active or completed pan-Canadian projects.

• Legend
• ? Registries
• ? Diagnostic Imaging
• ? Drug Info Systems
• ? Lab Info Systems
• ? Telehealth
• ? Interoperable EHR
• ? Public Health Surv.
• ? Innovation Adoption?Number of Projects

18
Infoways Investment By Program
For 2006-07 Infoway has an investment target
range of 285 -385 million in project approvals.
On a cumulative basis this will result in
approvals of over 1.0 billion, which represents
approximately 85 of the 1.2 billion that
Infoway has committed to its nine investment
programs. This will result in major increases in
project approvals to the drug information
systems, laboratory information systems and iEHR
investment programs.
Source Canada Health Infoway. Corporate Business
Plan 2006-2007 http//www.infoway-inforoute.ca/Adm
in/Upload/Dev/Document/Business20Plan2006-0720E
N.pdf
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Infoways Investment Progress
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Implications for eHealth Vendors

• Growing recognition of vendors role in
  developing a national solutions
• Vendors are actively involved in shaping their
  products to meet the jurisdictional needs and
  comply with pan-Canadian standards
• eHealth Collaboratory has been established to
  test products
• Emphasis on integration of ITC solutions with
  care delivery
• Emergence of joint (inter-jurisdictional)
  technology procurement

21
Health Initiatives in the US

• Department of Health and Human Services
  established numerous health and eHealth programs
  (2007 FYB 698B)
• Specific goals include
• Transform the US health care system
• Provide health services to underserved
  populations
• Strengthen and modernize the Medicare and
  Medicaid systems
• Advance medical research
• Secure the Homeland against the major threats to
  the health and well-being of Americans
• Protect life, family, and human dignity
• Achieve excellence in management practices
• Health technology plays a key role in achieving
  these goals
• Source Fiscal Year 2007 Budget
  http//www.hhs.gov/budget/07plan/

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ITC Initiatives in the US Highlights (1)

• 2005 initiated several health IT programs
• Health Information Technology Standards
• Certification Commission for Healthcare
  Information Technology
• Privacy and Security
• Nationwide Health Information Network
• Adoption of Electronic Health Records
• Clinical Decision Support
• Health Information Exchange
• Hurricane Katrina Digital Health Information
  Recovery Project
• Source Health Information Technology Initiative
  Major Accomplishments 2004-2006.
  http//www.hhs.gov/healthit/news/Accomplishments20
  06.pdf

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US Health IT Initiatives Highlights (2)

• May 2006 AHIC (American Health Information
  Community) formed in 2005, delivered
  recommendations on interoperable electronic
  health IT
• Consumer Empowerment to create a
  consumer-directed and secure electronic health
  care registration info and medication history for
  patients
• Chronic Care to use secure messaging for
  communication between patients and care providers
• Electronic Health Records to create
  standardized, secure records of past and current
  health data accessible by health professionals
• Bio-surveillance to enable the transfer of
  standardized and anonymized health data to
  authorized public health agencies
• 2006 - AHIC recommended 3 sets of
  Interoperability Specifications approved by the
  Health Information Technology Standards Panel to
  be integrated into PoS systems by Dec 2007
• Source HITSP http//www.ansi.org/standards_activ
  ities/standards_boards_panels/hisb/hitsp.aspx?menu
  id3

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US ITC Initiatives Highlights (3)

• Aug 2006 - the Presidents Executive Order issued
  committing federal departments and agencies that
  purchase and deliver health care to require the
  use of health IT that is based on
  interoperability standards
• 2006 37 ambulatory and EHR products were
  certified for functionality, security and
  interoperability
• Jan 2007 completion of 4 prototype
  architectures for a Nationwide Health Information
  Network (NHIN) to connect the state and regional
  health information exchange networks that will
  make up the NHIN.
• Future projects include
• Addressing confidentiality, privacy and security
  issues
• Development of health care quality measures,
  their automation and use in PoS systems
• Plan for standardized integration of genomic test
  information into EHR
• Source Health Information Technology Initiative
  Major Accomplishments 2004-2006.
  http//www.hhs.gov/healthit/news/Accomplishments20
  06.pdf

25
eHealth Initiatives in EU (1)

• 2005 i2010 - a European Information Society
  initiative by the European Commission. Programs
  include
• Single European Information Space
  market-oriented regulatory framework for the
  digital economy (e.g., broadband, privacy and
  security, standardization and interoperability)
• Investment and Innovation in ITC Research a
  1.2B RD effort in cooperation with the private
  sector
• Inclusion, Better Public Services and Quality of
  Life primary focus is to bring the benefits of
  the Information Society into all segments of
  population and public services (e.g.,
  e-Accessibility, eHealth, digital libraries,
  independent living, sustainable development)
• Source i2010 http//ec.europa.eu/information_soc
  iety/eeurope/i2010/index_en.htm

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eHealth Initiatives in EU (2)

• Health Information Network Europe (HINE) the
  source for health care IT market information in
  EU member states. Highlights include
• Research reports
• Country Market Profile Reports assessment of
  the current status on both the demand and supply
  sides, including the policies, funding
  mechanisms, procurement process, installed base,
  market share and forecasts for areas of growth
• eHospital Census Reports - readiness assessment
  of acute hospitals to implement ITC solutions
• Health Information System market growth
• 6.3 Billion by 2010
• Over 12 billion by 2015
• Source HINE http//www.hineurope.com

27
eHealth Initiatives in Australia

• HealthConnect strategy a partnership between
  the federal, state and territory governments
• Purpose - Improve safety and quality in health
  care by establishing and maintaining a range of
  standardized electronic health information
  products and services for health care providers
  and consumers
• The Department of Health and Ageing responsible
  for investment in HealthConnect and coordination
  of various projects
• ITC spending was 2.2 B in 2004 (4 of total HC
  expenditure) growing at a rate of 15 / year
• 70 of sales to the public system 30 to the
  private sector
• Source http//www.health.gov.au/internet/hconnect
  /publishing.nsf/Content/home

28
Supply of eHealth Solutions
Canada
Source Branham Group. (2006). eHealth in Canada
Crossing the Chasm. Branham Group Inc., Ottawa,
Ontario. Canada
29
eHealth Challenges

• Overcoming traditional jurisdictional boundaries
• Up-front and ongoing investment
• High competition in well-established markets
• Diverse business and quality of service
  requirements
• Data stored in desperate systems - incompatible
  data content, syntax and semantics
• Privacy and confidentiality
• eHealth Standards a moving target
• Monolithic and closed architectures of legacy
  systems
• Use of non-interoperable technology platforms

30
Trends in Health Care

• The Old World
• Provider-focused
• Illness
• Site-of-care
• Episode Management
• Supply Management
• Solitary decision making
• Efficiency focused
• De-centralized, generalized care

Source Canada Health Infoway EHRS Blueprint
http//www.infoway-inforoute.ca
31
Tends in eHealth

• Comprehensive business, functional, information
  technology requirements
• Conformance to standards
• Data, information knowledge sharing
• Protection of privacy and confidentiality
• Focus on quality attributes
• Availability / reliability
• Performance
• Information security
• Usability / portability
• Scalability (expandability)
• Flexibility / modifiability
• Interoperability
• Sustainability

32
eHealth Value Proposition (1)

• Providing a platform for information sharing
  among health stakeholders across
• Organizational silos
• Jurisdictional / geographical boundaries
• Disciplines and domains
• Improving assess to and timeliness of health
  service delivery through
• Providing information regarding availability of
  services
• Enabling rapid access to the services e.g.,
  advise, remote monitoring, interpretation,
  diagnosis and treatment
• Enabling client active participation and
  education

33
eHealth Value Proposition (2)

• Improving quality of services through
• Facilitating collaboration among care givers
  e.g., second opinion, and care givers and
  patients e.g., compliance with care plan
• Reduced adverse events e.g., adverse drug effects
• Increased accuracy in detecting health problems
  or monitoring the effects of treatment
• Increased speed and accuracy in detecting
  infectious disease outbreaks
• Improving efficiency through
• Increased access to integrated patient
  information
• Improved care coordination
• Reduced duplicate tests and prescriptions
• Reducing patient / provider travel costs
• Improved information management resulting in
  reduced costs

34
Potential Markets Competition-Attractiveness
35
Potential Markets Risk-Attractiveness
Market Attractiveness (expenditure, market
potential, ITC sophistication, macroeconomic
env.)
Risk (market maturity and saturation, ease of
entry, acceptability, political social
stability)
Source Frost Sullivan, Identifying
International Healthcare IT Business
Opportunities for Small Medium-Sized British
Companies http//www.intellectuk.org/presentation
s/general/healthcare-phase1.html
36
Potential Markets Suggested Shortlist
Source Frost Sullivan, Identifying
International Healthcare IT Business
Opportunities for Small Medium-Sized British
Companies http//www.intellectuk.org/presentation
s/general/healthcare-phase1.html
37
Suggested Shortlist of eHealth Markets
Source Frost Sullivan, Identifying
International Healthcare IT Business
Opportunities for Small Medium-Sized British
Companies http//www.intellectuk.org/presentation
s/general/healthcare-phase1.html
38
Potential eHealth Applications
39
Canada Potential Target Markets
Source Frost Sullivan. (2004). Identifying
International Healthcare IT Business
Opportunities for Small Medium-Sized British
Companies. Phase 2. In depth Analysis of the
Canadian Healthcare IT Market. Final Report. May
2004. http//www.intellectuk.org/publications/repo
rts/default.asphealthcare
40
US Potential Target Markets
Source Frost Sullivan, Identifying
International Healthcare IT Business
Opportunities for Small Medium-Sized British
Companies http//www.intellectuk.org/presentation
s/general/healthcare-phase1.html
41
Australia Potential Target Markets
Source Frost Sullivan. (2004). Identifying
International Healthcare IT Business
Opportunities for Small Medium-Sized British
Companies. Phase 2. In depth Analysis of the
Australian Healthcare IT Market. Final Report.
May 2004. http//www.intellectuk.org/publications/
reports/default.asphealthcare
42
Conditions for Success in eHealth

• Alignment with the national health and eHealth
  initiatives
• Ability to demonstrate tangible value to the
  health sector
• Innovative, affordable and standard-based eHealth
  solutions that meet the business and quality of
  service requirements
• Ability to form and sustain some business
  relationship with the clients in the health care
  sector
• Ability to minimize costs and maximize efficiency
  in development and evolution eHealth products and
  provision of appropriate services
• Investing in research, creativity and innovation
  to be at the forefront of advances in science and
  technology

43
Evolution of the eHealth Market (1)
44
Evolution of the eHealth Market (2)
45
Evolution of the eHealth Market (2)
46

• Acknowledgments
• Health and Technology Experts
• Alberta Innovation and Science
• The e-Health Industry Project
• Health Telematics Unit, Faculty of Medicine,
  University of Calgary