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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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A Long and Proud History & Heritage
We focus on combining strategy, technology and innovation
Founded in 1886 as the world’s first management consulting firm
Today a premier global management consulting firm with 35 offices worldwide
Serving 75% of FTSE and Fortune 100
A member of the Altran Technology group
NASA and ADL
– Arthur D. Little was hired to assist in the planning and execution of the Apollo 11 mission
– The result: NASA kept their deadline of putting a man on the moon before the end of the decade
Arthur D. Little is the world’s first management consulting firm
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A Global Player: We have the global reach and local market experience to ensure our clients achieve their objectives
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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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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
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Kronoberg (Sweden)
Rhone–Alp. (France)
78
7
Diraya (Andalusia,
Spain)
HUG (Canton Geneva)
8
Lombardy (Italy)
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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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9
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15
1
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8
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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
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2
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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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Arthur D. Little is the oldest management consulting firm in the world and assists clients with complex assignments in a wide range of industries
Arthur D. Little, founded in 1886, is a global leader in management consultancy, linking strategy, innovation and technology with deep industry knowledge. We offer our clients sustainable solutions to their most complex business problems.
Arthur D. Little has a collaborative client engagement style, exceptional people and a firm-wide commitment to quality and integrity.
Visit us atwww.adlittle.cz
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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
Thank you for attention
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