Health Information Infrastructure: A Global Tour

1
Health Information Infrastructure A Global Tour

• Ticia Gerber, Vice President, International
  Programs and Public Policy
• eHealth Initiative and Foundation
• Physicians Electronic Health Record Coalition

2
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

3
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.

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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
• eHealth Initiative (eHI) is an independent,
  non-profit, multi-stakeholder consortium whose
  mission is to improve the quality, safety, and
  efficiency of healthcare through information and
  information technology

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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
  continents

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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
  monthly
• Initiated outreach to relevant policymakers to
  increase global HIT collaboration and funding in
  the long-term.

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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,
  consumer)
• US-European summit on health improvement and HIT
  discussed

8
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
  Worldwide

9
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

10
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

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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
  campaigns
• 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
  systems
• Appropriately addressing privacy and security
  concerns at every step in the process.

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Geneva LIGHT Summit Learnings

• Common Challenge of Participants
• Maintaining HIT as a top item on the national
  agenda in shifting political and budgetary
  environments
• 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
  owners
• Addressing cultural barriers and stigmas
• Adapting HIT to different care and practice
  environments
• 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

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Geneva LIGHT SummitAreas for Global
Collaboration

• The following were identified by summit
  participants as areas for global support and
  collaboration
• 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

14
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
  training.

15
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.

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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
  that 
• Contains a comprehensive life-long history of
  patients health, care and information,
  regardless of where, when and by whom they were
  treated
• 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
  resources
• Holds essential information at the local level
  where most care is delivered

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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
  England.

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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
  regions
• Only 10 of healthcare is private
• Finland viewed by some informaticists as the most
  advanced health information infrastructure in
  Europe

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Health Information Infrastructure Reform Examples

• FinnWell - Healthcare Technology Programme
  Objectives
• Improve the quality of healthcare
• Enhance the efficiency of healthcare
• Create new products of healthcaretechnology
• Promote business in healthcare
• Promote healthcare exports

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Health Information Infrastructure Reform Examples

• FinnWell - Healthcare Technology Programme
  Targets
• Technologies for diagnosticsand care
• Healthcare IT related productsand systems
• Operational processes ofhealthcare

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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

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Health Information Infrastructure Reform Examples

• Europe
• Netherlands Excellent progress toward an EHR
  for every resident. Medication record scheduled
  to be in place by Spring 2006. Uses HL7 V3 and
  CDA.
• Ascension Countries - Former Eastern bloc
  countries and Soviet republics, many of which
  were admitted to the EU in the May 2004 expansion
  from 15 to 25 EU member states are particularly
  innovative. Counties such as Hungary, Lithuania,
  Slovenia and the Czech Republic do not have as
  much of an existing informatics infrastructure
  and are attempting to leapfrog forward in their
  e-Health programs. For example, a Lithuanian
  informatics leader stated in October 2005 that
  almost all the health care institutions in that
  country are connected to the Internet and they
  plan to have continuity of care 100 supported by
  a national, interoperable health system by 2008.
• Asia
• Japan Regional EHR operational around
  Hamamatsu, Government supporting moving this
  system across Japan. Uses HL7 and sharing of data
  is by patient who carries data on CD or DVD.
  Probably least expensive of any country.
  Singapore, Korea and Taiwan are all moving
  towards national eHR.
• South America
• Brazil Excellent systems in major hospitals.
  Developing a plan for a national EHR based on
  standards, starting in 2006. Mexico also has some
  movement towards a national eHR.

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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
  2010.

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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
  Instiute 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. 

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Global Partnerships for Health Developing World

• Mosoriot Medical Record System
• EMR created to serve a particular need ?
  HIV/AIDS
• 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

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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

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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

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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

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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
  world
• 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
  information
• 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
  collaboration
• And a doubling of donor funding for
  infrastructure, which includes information and
  communications technology.

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Summary

• A myriad of countries are moving in a targeted,
  coordinated and expeditious way towards
  implementation of HIT and health information
  exchange
• Although embroyonic, critical point in global
  e-Health, interoperability and connectivity
  efforts
• 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

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

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• Ticia Gerber
• Vice President, International Programs and Public
  Policy
• eHealth Initiative and Foundation
• www.ehealthinitiative.org
• 1500 K Street, N.W., Suite 900
• Washington, D.C. 20005
• 202.624.3264
• ticia.gerber_at_ehealthinitiative.org