anthony staines
TRANSCRIPT
![Page 1: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/1.jpg)
Getting to visible – information, integrated care, and Ireland: Moving from fragmented to integrated care
Anthony StainesICT Strategy Unit, System Reform Group, HSESchool of Nursing and Human Sciences, DCU
![Page 2: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/2.jpg)
Summary
● Challenges● Some misconceptions about these
● Where are we● Where do we need to go● How are we going to get there
![Page 3: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/3.jpg)
Challenges
● We can overcome these, if we want to
![Page 4: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/4.jpg)
Ageing population
● Increasing life expectancy● Increasing healthy life expectancy● Both good
![Page 5: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/5.jpg)
Rising prevalence of chronic disease
● Series of Irish studies from the IPH and the NCRI
● All the chronic diseases studied, so far, will rise in prevalence from 2010 to 2020
● The rise is 20% to 60%● Partly due to ageing● More due to fixable lifestyle risks
![Page 6: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/6.jpg)
Rising prevalence of multi-morbidity
● Most of the money is spent on people, no all elderly, with more than one chronic disease
● This is multi-morbidity● It poses significant personal, clinical, and health
system challenges, all of which have to be met
![Page 7: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/7.jpg)
Mean no. of conditions by sex and age (TILDA)
![Page 8: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/8.jpg)
Distribution of US health expenditure http://www.nihcm.org/images/stories/Dat
aBrief3_Final.pdf
![Page 9: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/9.jpg)
Where we are
![Page 10: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/10.jpg)
Irish health system structures
● Complex fragmented system● Paper based system● Largely manual communications, except in
General Practice
![Page 11: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/11.jpg)
Complex system
● Roughly 8,000 health providers with contracts to the public service
● Two-tier hospital care system● High user charges for primary care services
● Perverse incentives
● Primary care poorly developed except general practice
● Weakening private insurance market
![Page 12: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/12.jpg)
Fragmented care
● Too much care delivered in a very busy acute hospital system
● Poor communications● Primary and community care underused,
unsupported, and underdeveloped
![Page 13: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/13.jpg)
Budget cuts
● Budget falling fast, and likely to continue to fall● Population rising, and ageing quickly● Business as usual will not do!
![Page 14: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/14.jpg)
Changes in expenditure (OECD)
![Page 15: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/15.jpg)
Strong political leadership – ex-GP
![Page 16: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/16.jpg)
Changes happening
● Strong political leadership● Integrated care● Care at the lowest level of complexity● Move to community and primary care● Free GP care, initially for children under 6● Generic prescribing● Hospital groups and Money follows the patient● Moving to Universal Health Insurance
![Page 17: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/17.jpg)
Information
● Astonishingly little● What there is, is well used● Poor information systems
● Little information on clinical activity● Poor information for staff and for managers at every
level
● Only GPs have access to good systems, albeit mostly confined to individual practices
![Page 18: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/18.jpg)
Where do we need to go?
![Page 19: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/19.jpg)
Integrated care
![Page 20: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/20.jpg)
Integrated care
● Patient centred care – the 'Medical Home'● Shared care following agreed clinical pathways
between primary and secondary care● Includes GPs, hospitals, and community staff● Tools to support the implementation of these
pathways do not (yet) exist in Ireland
![Page 21: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/21.jpg)
An example – Ran Balicer, Clalit, Israel
● ICT supported, data driven, patient centred integrated care in a health fund covering 4 million people
● 6% fall in hospital readmission rates for the elderly
● 60% reduction in inequalities in the quality of care between centres
● Very good RoI
![Page 22: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/22.jpg)
An example – Paul Grundy, IBM, Vermont
● Patient centred medical home with working ICT● Family practice based community coordinators● Agreed care pathways● 10% reduction in insurance costs● 60% reduction in the rate of complications of
Type II diabetes
![Page 23: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/23.jpg)
ICT principles
● The right data accessible to the right people at every clinical encounter● ICT is to support clinical work directly● Information for Health/Business Intelligence comes
out of clinical ICT systems● Audit, research, planning, accountability all driven
by clinical activity
![Page 24: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/24.jpg)
Steps
● There is no simple solution● We do not have a blank slate
● Learn from other peoples' failures, and successes
● No big bang!● Will be done, in stages, over 4 to 8 years
● Must achieve visible results on a relevant time scale● Keep the momentum up
● It will keep changing forever
![Page 25: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/25.jpg)
Process
● Patient centred process focussed on clinical care
● ICT development supports business needs● No ICT only projects● Technology is easy, and quite cheap● The hard bit, and most of the cost, is in changing
how people do things
![Page 26: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/26.jpg)
Infrastructure
● HSE spends under 1% of the budget on ICT● Ought to be at least twice this● There is past underinvestment to deal with
![Page 27: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/27.jpg)
Individual Health Identifier
● Legislation moving through the Seanad this week
● Critical building block for everything else● The challenge for the system will be getting the
IHI into all of the existing records● Data sharing will still be a problem● Legislation will be required to share data
effectively
![Page 28: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/28.jpg)
Supporting activity
● Clinicians● Patients● Managers
![Page 29: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/29.jpg)
Clinical support
● The right data accessible to the right people at every clinical encounter● Good EMR/EHR as a skin over the data for
clinicians● Good adaptable decision support tools
● Mobile access is required by many staff● Tools and data systems to support innovation in
ICT and health care delivery● Health information standards throughout the
system
![Page 30: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/30.jpg)
Patient support
● Full support for self-care● Access to appointments, basic data, test
results, prescriptions, and more for patients, and, as appropriate, families and carers
● Mutual support for patients e.g.● Expert patients● Support groups● Carer support
![Page 31: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/31.jpg)
Management support
● Flexible reporting systems● Configurable and open● Build on e.g. NQAIS work● Able to accommodate changes over time● Generate necessary canned analyses● Provide for more complex work
![Page 32: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/32.jpg)
Technology
● Several technology solutions can be envisaged● Final choice will come from engagement with
industry to find optimum solutions● Technology is not the real issue
![Page 33: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/33.jpg)
Models
● Build on the good existing systems - no 'rip and replace'
● No big bang● Build common infrastructure● Data accessible through agreed international
standards● Data accessible through open, documented,
APIs● Service oriented architecture
![Page 34: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/34.jpg)
Innovation
● Allow innovation, building tools for staff and patients to manage and use their data
● Rapid feedback of activity and outcomes at individual, unit, facility, region and organisation level
![Page 35: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/35.jpg)
Success or failure?
● Governance● Leadership● Buy-in
● Patients● Clinical● Managerial
● Trust● Resources
![Page 36: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/36.jpg)
Acknowledgements
● My colleagues in HSE, in the ICT Strategy unit, in the School of Nursing and Human Sciences in DCU, and many others for invaluable discussions
● Olga McDaid and the Tilda Study
![Page 37: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/37.jpg)
References
– Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, McKee M. Ageing in the European Union. Lancet. 2013 Apr 13;381(9874):1312-22. PubMed PMID: 23541057.
– Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009 Oct 3;374(9696):1196-208. PubMed PMID: 19801098.
– McDaid O, Hanly MJ, Richardson K, Kee F, Kenny RA, Savva GM. The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys. BMJ Open. 2013 Jun 21;3(6).PubMed PMID: 23794595
![Page 38: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/38.jpg)
References
– Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, Murphy AW. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011 Oct;28(5):516-23. PubMed PMID: 21436204.
– Erixon F, van der Marel E. What is Driving the Rise in Health Care Expenditures? An Inquiry into the Nature and Causes of the Cost Disease. [Internet]. Brussels: ECIPE; 2011 p. 27. Report No.: 05/2011. Available from: http://www.ecipe.org/publications/what-is-driving-the-rise-in-health-care-expenditures-an-inquiry-into-the-nature-and-causes-of-the-cost-disease/
![Page 39: Anthony staines](https://reader034.vdocuments.net/reader034/viewer/2022042618/589da5561a28ab21728b47c3/html5/thumbnails/39.jpg)
References
– CSO. Population and Labour Force Projections 2016 - 2046 [Internet]. Dublin, Ireland: Central Statistics Office; 2013. Available from: http://www.cso.ie/en/releasesandpublications/population/populationandlabourforceprojections2016-2046/
– Przywara B. Projecting future health care expenditure at European level: drivers, methodology and main results [Internet]. Brussels, Belgium: European Commission; 2011 p. 85. Report No.: 417. Available from: http://ec.europa.eu/economy_finance/publications/economic_paper/2010/ecp417_en.htm