Experiences from national eHealth Roll-out in Slovakia

June 09, 2011

Arthur D. Little GmbHDanube House

Karolinská 650/1186 00 Prague 8Czech Republic

Tel.: +420 224 941 303Fax: +420 224 941 302

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Content

1 ADL Introduction

2 Experiences from national eHealth roll-out in Slovakia

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Content

1 ADL Introduction

2 Experiences from national eHealth roll-out in Slovakia

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Majority of projections on healthcare cost development in the coming decades expect substantial increase in healthcare costs across the globe

Expected development of healthcare costs as a share of GDP

Source: Arthur D. Little research

5% 20%15%10%

Western Europe

North America

0%

Central and Eastern Europe

Asia

Latin America

Middle East

Predicted development

Comments

Until 2020, we can expect significant growth of healthcare costs in US as well as in countries of Western and Eastern Europe

Some of the reports project increase of US healthcare costs to the level of 22% of GDP The costs of healthcare in Western Europe should reach by 2020 level of 13% to 14% of GDP Conservative prognosis of healthcare costs in Slovakia in 2025 reaches level of 9.1% to 11% Analysis of ADL predicts the healthcare cost development in SR, if no measures are taken to stabilize

growing costs, to reach level of 11.5%-12% by 2020

Healthcare trends

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The roll-out of Slovak national eHealth system is mostly financed from EU structural funds under Operational Program – Informatization of Society

The combined costs, state budget and EU structural funds, for Slovak national roll-out is estimated at 138 mil. EUR

Management structure of Slovak national eHealth roll-out

Implementation structure of national eHealth roll-out in Slovakia

Ministry of Finance SR

Management authority for Operational Program – Informatization of Society

Project objectives fulfilment monitoring

Ministry of Healthcare SR

eHealth strategic direction

eHealth implementation fund recipient

Tendering and contractual body for 3rd parties

National Center for Health information

National eHealth implementation authority

PMO of eHealth roll-out

National eHealth operator

Ministry of Healthcare SR

EU Funding

EU Funding

HC budget

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After parliamentary election in July 2010, the new political leadership in Slovakia have initiated a thorough audit of national eHealth rollout

Shift in priorities with change of political leadership on Slovakia

Shift in national eHealth priorities

2008 2009 – 06 /2010 07 / 2010 2014

Focus on decrease of national DALY* and increase of citizen’s health

Building robust and centralized national eHealth solution

Increase healthcare efficiency

Governmental eHealth strategy formulated

Feasibility studies and technical architecture and

implementation kick-off

03 / 2011

Parliamentary election resulting in opposition

forming new government-

Implementation Audit

Revised Governmental eHealth strategy

developed

Expected deadline for national eHealth

implementationMilestones in eHealth deployment

Key priorities for national eHealth system

Preparation of technology strategy for eHealth system

Preparation of two feasibility studies evaluating eHealth deployment and defining scope of service offered

Arthur D. Little involvement

Project objectives primarily focused on: Cost savings Increase of efficiency Increase of citizen’s satisfaction

Building less centralized and gradually deployed eHealth solution

Revising feasibility study for the second phase of eHealth rollout in order to include shift in changed priorities as well

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3

1

*Disability-Adjusted Life Years

2

1

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The costs of eHealth implementation in selected European countries varies and is often influenced by the scope and duration of the implementation

Costs of eHealth implementation

Source:EC report* estimate

Costs of eHealth implementation in selected countries and regions of Europe

eHealth system Region / Country PopulationImplementation costs (mil. EUR)

Costs per capita (EUR)

Implementation years

Computerised patient record system

Canton Geneva, Switzerland

453 tis. 59.4 mil. 131 10

Regional EHR and ePrescribing system

Andalusia,Spain

8.3 mil. 170 mil. 20 7

Regional integrated EHR and ePrescribing

Kronoberg, Sweden 177 tis. 85 mil. 480 8

Dossier Patient Partagé Réparti (DPPR)

Rhone-Alpes, France 6 mil. 44 mil. 7 7

The health information platform SISS

Lombardy, Italy 9.9 mil. 595 mil. 60 7

National eHealth SystemNational roll-out,Slovakia

5.4 mil. 138 mil.* 26 7*

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The expected return on investment from Slovak eHealth rollout in terms of years to positive return is similar to other European eHealth implementations

Overview of return on investment of selected eHealth systems in Europe Key impacts

Calculation of socio-economic return is methodology used by European Commission for calculation of overall return from eHealth system implementations

Return on investment from eHealth deployment

Citizens

– Reduction of errors in care

– Better informed diagnostic and medication decisions

– Decrease of duplicities in diagnosis, tests and therapy

Healthcare providers

– More effective care

– Reduced costs of drugs

– More informed diagnostic procedures

Insurance companies

– Decreased costs

Source: EC Report in socio-economic returns of eHealth implementations

9.399

11

98

10

 2

 4

 6

 8

 10

 12

9

Kronoberg (Sweden)

Rhone–Alp. (France)

78

7

Diraya (Andalusia,

Spain)

HUG (Canton Geneva)

8

Lombardy (Italy)

8

Average

Years to positive cumulative SER*

Year to positive SER*

Yea

rs

Slovakia

7.8

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The main goal of eHealthEfficiency in providing healthcare

Health of citizens

Security measures used StandardHigher than in other e-services

Number of eHealth operators One operator Several

Ownership of the eHealth operators

State owned Private

Access to eHealth services One access point More access points

Database - registers Centralised Distributed

Compatibility with other eGovernment services

Basic Enhanced

Number of authentication methods

One mechanism More mechanisms

Client data exchange standard used

HL7 v3 EN 13606 (STN EN 13606)

Personal Health Record conceptPHR as a presentation component

PHR as an integration component

Clinical terminology Snomed CT Own terminology

Integration architecture of eHealth domains

Integration hub in SOA architecture

Direct communication

Database – clinical data Distributed Combined

Electronic Health Record data model

Based on OpenEHR Own design

Data model of the database – registers

Demographical data based on archetypes

Fixed data model

Architectural Framework Key eHealth Attributes

In the separate project, Arthur D. Little helped to define the overall eHealth strategy with focus on decisions

Inte

gra

tion Se

curit

yPresentation

eHealth services and domains

Application components

Database

Database functions

Data standards

Operations Organization

Infrastructure

I&A

mg

mt.

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2

3

4

5

6

7

8

9

10

11

12

13

14

15

1

2

8

3

1

31 43 4

7

9

1211 14

156 13

11

10

1 5

eHealth strategy project

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Strong PMO / National operator

Integration

Implementation of national eHealth system is a demanding initiative which requires fulfilment of several success factors

eHealth strategy Managing of buy-in of Healthcare providers1

3

2

4

Key success factors

Key lessons learned and key success factors

Evaluation and agreement on critical technological, organizational and operational aspects of eHealth solution

Agreement on key objectives, focus and scope of the eHealth system

Agreement on initial architecture of eHealth system

Establish and manage forum of recognized representatives of healthcare sector

Focus buy-in on explaining eHealth features that make “life easier” for medical community

Establish strong PMO organization with the managerial and technological capability of managing the implementation

Formal PMO structure

Division of work into workstreams

Establish communication with vendors of HIS/AIS IS – i.e. include representatives in the “eHealth forum”

Develop standardized interfaces and pre-discuss with software vendors

Consider providing a scheme of subsidies for integration of HIS

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Contact: Marcel HomindaPrincipal

Arthur D. Little GmbHOrganizacni slozkaDanube HouseKarolinska 650/1186 00 Praha 8

Tel.: +420 224 941 303Fax: +420 224 941 302E-mail: hominda.marcel@adlittle.com

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