Seminar Medical Informatics 2015

Transcription

1 Seminar Medical Informatics 2015 Meeting 2 Ronald Batenburg UU/NIVEL February 6,

2 Agenda for today About health care and health care systems What is health care? Benefits and performances of health care Costs of health care The added value of m-health / medical apps for health care Issues/questions in the EU Green Paper on m-health Food for further thought 2

3 What is health care? 3

4 Some definitions What is health? What is health care? Health care is defined as activities aimed at alleviating, reducing, compensating and/or preventing deficiencies in the health status or autonomy of individuals Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. 4

5 Health care domains clustered by life cycle Public health Primary care Secondary Care Tertiary care Prevention, maternity and child care Surveillance, disaster, infection disease management first point of consultation outpatient specialized outpatient and inpatient specialized consultative health care inpatient Home and community care self care, long-term care, assisted living, substance use disorders, rehabilitation Residential, community and palliative 5

6 Health care domains clustered by treatment Cure Care Preventive Care Primary Care Dental Care Specialized Care Mental health Care Pharmaceutical Care Non-elective, emergency care Long-term Care Palliative Care Informal Care Complementary and alternative treatments 6

7 Some facts about the Dutch health care sector Headcount: 1.2 million are working in the health care sector Financial: 90 billion Euro yearly spending Largest sectors: long-term care, home care and social work Largest professions: nurses and nursing assistants, 13% doctors Nurses to population density is above EU-average Doctor to population density is on EU-average Strong primary care Social security health care system ( Bismarkian system )

8 NL = the best in Europe? Prevention Waiting lists Check the report! ouse.com/ehci2014- indicators/

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11 Benefits and performance indicators of health care 11

12 The OECD framework

13 Health care benefits or performance broken down Quality of care Effectiveness, Safety, Co-ordination, Responsiveness Accessibility of care Financial access, Geographical access, Timeliness, Access according to needs, Availability of personnel, Freedom of choice Efficiency of care Cost-effective use of resources, customized/care, cost awareness, financial position of care providers and health insurers 13

14 Quality of care The Institute of Medicine (IOM) defines quality as doing the right thing, at the right time, in the right way, for the right person, and having the best possible results Government Safeguard the public interest of a good-quality health care Health Care Inspectorate (IGZ) Quality of Care Institutions Act (Kwaliteitswet zorginstellingen (Kzi)) HealthCare Professions Act (Wet beroepen individuele gezondheidszorg (BIG) Health care providers / professionals Provide appropriate care, i.e. organise their work, provide personnel and equipment, and allocate responsibilities Systematically monitor, control and improve quality of care Account for their actions 14

15 Quality as safety 15

16 Accessibility of care Accessible care implies that people, who need care, can access care in a timely manner and without great barriers (Smits et al., 2002). Government Committed to equal access to health care for all people irrespective of their lifestyle Health Insurance Act (Zorgverzekeringswet (Zvw)) Access involves: Financial access Geographical access Timeliness Access according to needs Availability of personnel Freedom of choice. 16

17 Access as geographical proximity 17

18 Access as in waiting times 18

19 Efficiency of care Government Responsible expenditure growth; ensures that health care remains affordable for society and does not heap pressure on public resources Improved efficiency; can help to control expenditure, but is mainly about the relationship between the costs and revenues of the care provided Health Care Market Regulation Act (Wet marktordening gezondheidszorg (Wmg)) The insured and insurers Choose care with the most favourable price-quality ratio Health care expenditures and efficiency involve: Efficiency in health care processes Financial position of health care providers 19

20 NL health expenditure, by year, by other countries 20

21 Health expenditures on: 21

22 Health expenditure increase by: 22

23 What can be the added value of IT or m-health to improve health care? 23

24 How can m-health improve health care benefits or performances? Quality of care Effectiveness, Safety, Co-ordination, Responsiveness Accessibility of care Financial access, Geographical access, Timeliness, Access according to needs, Availability of personnel, Freedom of choice Efficiency of care Cost-effective use of resources, customized/care, cost awareness, financial position of care providers and health insurers 24

25 How can m-health improve health care taking actors/stakeholders into account? 25

26 Added values of m-health for health care actors/stakeholders Patients Self-management Medical knowledge Adherence Prevention programs Self efficacy Providers Medical knowledge and skills Patient-provider communication Multidisciplinary collaboration Managerial knowledge and skills Insurers Measuring health care quality Measuring health care costs Negotiating with providers Marketing patients Government Balancing benefits and costs Ensuring safety Monitoring the health care system Evaluating policy decisions 26

27 In sum: IT, e-health or m- health can add value but: It should fit the specific health care sector E.g., an app to support patients after hip surgery will have different benefits for specialized than primary care, as the financing of these sectors are different, the disease/treatment type are different It should fit the specific type of health care benefits/performances E.g., an app to improve the quality of life for COPD patients might increase costs in primary care, harming the accessibility of GP practices It should fit the specific health care actor/stakeholder E.g., an app to support people with sleeping problems will provide the user with different data then the health insurer or health provider 27

28 The EU Green Paper 28

29 Related to the EU Green Paper on m-health (1) The Potential of m-health for healthcare is: Increased prevention and quality of life More efficient and sustainable healthcare More empowered patients (Question: relation with the standard healthcare performance indicators?) Accessibility of care Quality of care Costs of care 29

30 Related to the EU Green Paper on m-health (2) 11 challenges of m-health for healthcare: 1. Data protection, including security of health data 2. Big data 3. State of play on the applicable EU legal framework 4. Patient safety and transparency of information 5. mhealth role in healthcare systems and equal access 6. Interoperability 7. Reimbursement models 8. Liability 9. Research and innovation in mhealth 10.International cooperation 11.Access of web entrepreneurs to the mhealth market 30

31 Related to the EU Green Paper on m-health (3) (2) Big data: What measures are needed to fully realise the potential of mhealth generated "Big Data in the EU whilst complying with legal and ethical requirements? 31

32 Related to the EU Green Paper on m-health (4) (4) Patient safety and transparency of information: What good practices exist to better inform endusers about the quality and safety of mhealth solutions (e.g. certification schemes)? Which policy action should be taken, if any, to ensure/verify the efficacy of mhealth solutions? How to ensure the safe use of mhealth solutions for citizens assessing their health and wellbeing? 32

33 Related to the EU Green Paper (6) Interoperability: on m-health (5) What, if anything, do you think should be done, in addition to the proposed actions of the ehealth Action Plan , in order to increase interoperability of mhealth solutions? Do you think there is a need to work on ensuring interoperability of mhealth applications with Electronic Health Records? And if yes by whom and how? Check: tient_summary_en.pdf 33

34 And finally 34

35 Food for further thought: 6Ulr9TCsc 1. Write down the argumentation lines of Wouter Bos 2. How can you argue in opposite of his argumentation? What would you need for that? 3. What do you learn from his argumentation? How can we as m-health researchers take his argumentation into account? 35