building a business collaboration infrastructure for health care · 2009. 5. 28. · ehealth...
TRANSCRIPT
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Dr. Peter Rohner
University of St. Gallen
Institute of Information Management
Competence Center Health Network Engineering (CC HNE)
Mueller-Friedberg-Strasse 8
CH-9000 St. Gallen, Switzerland
http://www.iwi.unisg.ch | http://ehealth.iwi.unisg.ch
Building a Business Collaboration Infrastructure for Health CareExperiences from Switzerland
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 2
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 3
Healthcare in SwitzerlandStructure
� 7.5 mio. inhabitants
� Federal / decentral structure:
� Federal government (definition, regulation and controlling of health issues)
� 26 provinces (execution with particular regulation, disctinctorganisations and infrastructures)
� Combination of public, subsidised private and fully private systems:
� Public (state-owned): university hospitals, provincial hospitals
� Subsidised private: (home) care services
� Fully private: hospitals, specialized clinics, health centers, general practitioners, insurance companies (health insurance is mandatory), service providers
� Distinct structures and payment systems for inpatient and outpatient services („SwissDRG“ coming soon, „TARMED“)
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 4
Healthcare in SwitzerlandCompetition in Service Delivery
cost
investment
„privatized“
„socialized“
public private
?
?
?
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 5
Healthcare in SwitzerlandCost Development
Source: Konjunktur Forschungsstelle ETH Zürich, Frühjahrsprognose der Entwicklung der schweizerischen Gesundheitsausgaben
2005–2007, Juni 2006
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 6
Healthcare in SwitzerlandInternational Comparison (Cost as part of GDP)
Source: OECD Directorate for Employment, Labour and Social Affairs [homepage on the Internet]. Change in health expenditure as a
share of GDP, OECD countries, 1990 and 2004 [cited 2007 July 08]. Available from: http://www.oecd.org/dataoecd/5/28/36992150.pdf
he
alth
exp
en
ditu
re a
s a
sh
are
of
GD
P
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 7
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 8
� Part of the Institute of Information Management at the University of St. Gallen
� Small, very specialized team
� Exchange of best practice
� Management education
� Design research (create new and innovative artefacts that address relevant problems; .. together with the relevant partners; … intensive evaluation phases)
� Our intention
– We do not intend to change the Swiss healthcare system (directly)
– we support our members in their own transformation (quality of outcome, efficiency of operation, cost control, competitiveness, …)
– therefore we do change the system (indirectly) ☺
CC HNEOrganization and Purpose
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 9
© 2007 IWI-HSG, CC HNE, Dr. Peter RohnerSeite 9
CC HNEServing the Swiss Hospitals
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 10
� Cooperation and Collaboration:
– Primary Care (Hospital) - Secondary Care
– Hospital - Hospital
– Hospital - Insurance
– Hospital - Supplier (SRM)
� Process Management (administrative and clinical):
– PBB: Process Building Blocks (services in the organization layer; an FP6-EU-research-project)
– Process-oriented patient identification (as a service and a centerpiece between the organization layer and IT layer)
� Business value of IT in healthcare (together with industry partners)
CC HNEResearch areas
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 11
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 12
ProblemsGoals
Effectiveness(Doing the right things)
Efficiency(Doing the things right)
Quality(Producing a steady outcome; safety)
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 13
ProblemsEffectiveness (of a Hospital)
� High degree of regulation:
– Law
– Politics
– Service Agreements
– …
� No incentives for a patient-centric behaviour (e.g. reduction of waiting times, conjoint treatment planning, swift information) orpatient experience
� …
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 14
ProblemsEfficiency and Cost
� The Whole System
– Ageing of the society; chronic/degenerative diseases
– Densitiy of supply
– Growing number of doctors
– Technological advancements
– Rising expectations
� Hospitals
– Many incentives for expansion
– Relationship between cost and price (in spite of DRG)
– …
Source: Institut für Sozial- und Präventivmedizin der Universität Zürich
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 15
ProblemsQuality of Outcome (incl. Patient Safety)
� Some Examples (…):
– Blood Transfusion Errors
– Wrong Side Surgeries
– Medication Errors
– …
� CIRS
� Opposition against transparency [in an industrialized and competitive environment, it‘s the customer who judges thequality, in healthcare it‘s the „supplier“…]
� …
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 16
Health Care� Outcome (Patient)
� Monolithic structureswith a low degree of (external) division of labour
� Limited competition(in the state-owned sector)
� Hierarchies, administrative agreements
� Costs (plans)
� Better/more outcome leadsto higher costs
� Output (Customer)
� Very high degree of divisionof labour between the actor(industrialization)
� Intensive competition
� "Coopetition" (networkingand standards)
� Prices (market)
� More output leads to diminishig costs
Machine Works (Ex.)
ProblemsHealth Care Compared to Competitive Industries
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 17
ProblemsTransformation Will Take Place
� The Rapidity … of Transformation [Greenwood, Hinnings1996]:
– „Highly regulated sectos withstand change …“,
– „If there is a disruption strong enough…, change will be radicaland happening fast“
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 18
ProblemsTransformation Path (Rather Internally)
� The Evolving World of Health Care Organizations [Scott et al 2003]: Reduction of government-owned hospitals,
– Competitiveness:
� Running a hospital as a business
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 19
ProblemsThe Swiss Hospital Agenda: Competitiveness
Source and © ROHNER BERATUNG AG
Physicians do typically not have any management education
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 20
ProblemsTransformation Path (Also Externally)
� The Evolving World of Health Care Organizations [Scott et al 2003]: Reduction of government-owned hospitals,
– Competitiveness:
� Running a hospital as a business [see you consultant]
– Interconnection of the actors [let‘s do serious research on this]:
� Higher level of Specialization
� Increase of cooperation between healthcare service providers
� Advance of collaboration between healthcare service providers and other actors
� Integration of different partners into delivery systems, „combined with insuranceand financial function …“
– …
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 21
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 22
NetworkabilityWhat is ist?
Networkability is the ability of every single actor to
team up with other players (in the health care sector)
� rapidly
�and with low setup costs
for the joint delivery of services
This aint no „technical“ task at all!
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 23
… leading to a higher IT-adoption rate
Strategy
Layer
SoftwareLayer
NetworkabilityA Complex Task: Some Business Engineering Needed…
Source: Based on [Winter2003]
Organi-
sation
Layer
Integration
Layer
Syste
m L
aye
r
Hie
rarc
hy, C
om
ma
nd
Lin
e
Re
po
rting
, Co
mp
en
sa
tion
Motiv
atio
n, C
om
mu
nic
atio
nA B C D
A
B
C
D
Re
gu
latio
n
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 24
NetworkabilityTeaming Up…
Strategy
Layer
Organi-sationLayer
IntegrationLayer
SoftwareLayer S
yste
m L
aye
r
CooperationStrategy
CollaborativeProcesses
CompatibleApplications
CommonInterfaces
Hospital Hospital
Strategy
Layer
Organi-sationLayer
IntegrationLayer
SoftwareLayer S
yste
m L
aye
r
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 25
NetworkabilityFactors (Objects) Influencing Networkability
ProcessManage-
Ment
ProcessGoals
(Perf. M.)
Struc-ture
Strategy
Layer
Organi-
sation
Layer
Integra-
tion
Layer
Re
gu
latio
n
Politics
Law
Public Admin.
Service
Agreements
Interest
Groups
Public Health
Research
National
E-Health-
Strategy
Adaptability
Team
Capabilities
Communication
Capability
Customer
Orientation
Economic
Orientation
Patient-
Centric
Behaviour
Hie
rarc
hy, C
om
mand
Lin
e, R
eportin
g,
Com
pensatio
n, M
otiv
atio
n, C
om
munic
atio
n
Software
Layer
ICTStrategy
Corp.-
Strategy
Incen-tives
ClearRole,
Position
Will toco-
operate
Corp.Dvlpmt.
ServiceAgr.
ProjectPortfolio
Mgmt
SLA
Boards/
Comm.
PortaleIT
Architec-ture
WFMS
„CRM“HIS,…
TechServices
DataEchange(EAI….)
Sys
tem
La
yer
ICT-Stan-
dards
SCM/SRM
Op.
AppsDWH/MIS
Portals DMS(incl.
PACS)
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 26
Spitäler Kooperationswille
Spitäler Kooperationsverienbarungen
Spitäler Klarheit der Rolle
Spitäler Anreizsystem
Spitäler IT-Strategie
Spitäler Integration der IT-Strategie in der U.strategie
Spitäler Definition von Marktleistungen
Spitäler Standardisierung von Marktleistungen
Spitäler Teilbarkeit von Marktleistungen
Spitäler Auslagerung von Marktleistungen
Spitäler Integration von Marktleistungen
Spitäler Projektportfolio-Management
Spitäler Funktionalorientierte Ablauforganisation
Spitäler Prozessorientierte Ablauforganisation
Spitäler Technikorientierte IT-Abteilung
Spitäler Prozessorientierte IT-Abteilung
Spitäler Service-Level-Agreement
Spitäler Mitwirken in internen Fachgremien
Spitäler Mitwirken in externen Fachgremien
Spitäler Mitwirken in internen IT-Gremien
Spitäler Mitwirken in externen IT-Gremien
Spitäler Mitwirken in internen interdisziplinären Gremien
Spitäler Mitwirken in externen interdisziplinären Gremien
Spitäler Organisationsinterne Prozessbeschreibungen
Spitäler Org.übergreifende Prozessbeschreibungen
Spitäler Qualität von Prozessen
Spitäler Transparenz von Prozessen
Spitäler Isolierbarkeit von Prozessen
Spitäler Steuerbarkeit von Prozessen
Spitäler IT-Architekturrahmen
Spitäler IT-Standards
Spitäler Technische Services
Spitäler Standardisierung des internen Datenaustauschs
Spitäler Standardisierung org.übergreifenden Datenaustauschs
Spitäler Elektronisch unterstützte interne Admin.prozesse
Spitäler Elektronisch unterstützte externe Admin.prozesse
Spitäler Elektronisch unterstützte interne Fachprozesse
Spitäler Elektronisch unterstützte externe Fachprozesse
Spitäler ERP
Spitäler CRM
Spitäler SCM
Spitäler Branchenlösungen
Spitäler W
orkflow-Management-System
Spitäler Kunden/Patienten-Portal
Spitäler Partner/Lieferanten-Portal
Spitäler Data Warehouse
Spitäler Anpassungsfähigkeit der Mitarbeitenden
Spitäler Team
fähigkeit der Mitarbeitenden
Spitäler Kommunikationsfähigkeit der Mitarbeitenden
Spitäler Kundenorientierung der Mitarbeitenden
Spitäler Ökonomische Orientierung der Mitarbeitenden
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Unternehmenstyp Daten
NetworkabilityEvaluation of the Factors (Objects)
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 27
NetworkabilityPriority of the Factors
Incentivemanagement
Cooperation management
Performance management
Project portfolio
management
Processmanagement
Committee w ork
ICT standards
ICT architectureICT strategy
Operational applications
ICT integration
Analytic applications
Portals
A
B
C
D
Influence on the Networkability of the Hospital
Influence o
n the N
etw
ork
abili
ty o
f th
e H
ealthcare
Secto
r
of little importance moderately importantunimportant important
of
little
im
po
rtan
ce
mo
de
rate
ly im
po
rtan
tun
imp
ort
an
tim
po
rtan
t
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 28
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 29
eHealth Collaboration InfrastructureTeaming Up …
Cooperation Strategy
Collaborative Processes
Compatible Applications
Common Interfaces
Coop. Culture
Co
op
era
tion
Stra
teg
y
Co
llab
ora
tive
Pro
cesses
Co
mp
atib
leA
pp
licatio
ns
Co
mm
on
Inte
rfaces
Co
op
. Cu
lture
Cooperatio
n Strategy
Collabora
tive Pro
cesses
Compatib
leApplic
ations
Comm
on Inte
rfaces
Coop. Cultu
re
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 30
Inte
gra
-ti
on
Syste
m
eHealth Collaboration InfrastructureTeaming Up: Hub and Spoke…
n x (n-1)/2
nIntegration System
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 31
eHealth CollaborationInfrastructure
(Standards and Services)
Hospital C
Service Provider B
Hospital A
Insurance D
eHealth Collaboration InfrastructureTeaming Up: Standards and Services
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 32
� Primary Care - Secondary Care (Hospital)
� Hospital - Hospital (e.g. Regionalization, Specialisation, SharedServices)
� Hospital (or Delivery System) - Insurance
� Hospital - Supplier or Service Provider (e.g. Ambulance, BloodDonation, Medical Equipment)
� Hospital - Government Agency
� … also over the border (Austria, France, Germany, Italy)
eHealth Collaboration InfrastructureTypes of Cooperation and Collaboration
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 33
� B2E (e.g. use of a HIS, PACS)
� B2B2E (e.g. resource and appointment management; typicallywith user interaction)
� B2B (e.g.logistics data, payment; typically without userinteraction)
� B2C (e.g. HMO portal)
� B2B2C (e.g. EHR portal)
� B2C2B (e.g. EBPP with „Tiers Garant“)
eHealth Collaboration InfrastructureDifferent Combinations of Partners (Business Models)
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 34
eHealth Collaboration InfrastructureServices (1/2)
� EHR (…)
� Patient Relationship Management
� „Kostengutsprache“ (insurance states that it will pay the cost)
� Billing
� Financial Clearing
� Prescription
� Doctors Letter
� Resource Planning
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 35
eHealth Collaboration InfrastructureServices (2/2)
� Treatment Planning
� Diagnostic Support
� Telemedicine Support
� Knowledge Sharing
� Shared Commercial Services (e.g. Logistics, SRM/SCM, Finance)
� Catalog Services (e.g. Pharmaceutical Master Data)
� Identity Management (Health Professionals)
� Patient Identification (MPI, …)
� …
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 36
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 37
Investment DilemmaComplexity
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 38
Investment DilemmaValue of an IT Solution for a Single Player
t
TC
OV
alu
e
NecessityInnovation Maturity Normality
StandardsEconomies of
Scale
� Differentiation
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 39
Investment DilemmaValue of an IT Solution for a Network of Players
t
TC
OV
alu
e
� Networking
NecessityInnovation Maturity Normality
Networking Gap
Economies of
ScaleStandards
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 40
?
Investment DilemmaWhat has to come first?
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 41
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 42
National/Regional eHCISwiss Landscape (of RHIOs): Specialization and …
� Centris (full service provider for insurance companies)
� H-Net (data exchange between insurances and hospitals(mainly administrative data) and between hospitals (mainlyradiology pictures))
� HIN (trusted mail between hospitals and general practitioners)
� Medidata (data exchange between insurances and hospitals(mainly administrative data))
� More then a dozen trust centers for general practitioners
� One service center for most independent Swiss pharmacies
� Some provincial pilots („eKOGU“, „MediSwiss“)
� …
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 43
National/Regional eHCISwiss Landscape (of RHIOs): … and Dependency
� Most of the service providers are owned by a large insurancecompany, an association or a group of specific actors etc. and are therefore not mutually trustworthy
� no service provider supports all business models orsupplies the full spectrum of services
� the service providers are not linked (the actors have to beconnected to multiple service providers [!])
� the roles (exclusive service provider or a shared serviceprovider or a service integrator) are continuously changing
� the services which are provided are concentrated on thesystem layer (for data exchange); the ability to manage processes and to foster certain business models is lacking
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 44
National/Regional eHCILooking for a Shared Service Provider (“Intermediate”)
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 45
National/Regional eHCIQuestions (1/2)
� Who defines the role of an intermediate?– The federal government („Bund“)?
– The conference of the regional health secretaries („GDK“)?
– Actors‘ associations?
– The „market“?
� Who should act as the intermediate?– One of the exsiting Swiss RHIOs by extending ist services?
– Some of the existing Swiss RHIOs by integrating one another?
– A new Service Provider (from the healthcare industry, from the IT industry, from the „Service Public“, from abroad)?
� How can this intermediate be financed?– Through a „Public Private Partnership“?
– By transaction fees?
– By a tertiary use of clinical data?
– …?
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 46
National/Regional eHCIQuestions (2/2)
� Who should/can/wants/will be forced to take the lead?– The federal government („Bund“)?
– The conference of the regional health secretaries („GDK“)?
– Actors‘ associations?
– The „market“?
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 47
National/Regional eHCI„Good Governance and Regulation“
cost
investment
„privatized“
„socialized“
public private
?
?
?
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 48
National/Regional eHCI„Good Governance and Regulation“
StrategyLayer
Organi-sationLayer
IntegrationLayer
SoftwareLayer
Syste
m L
aye
r
StrategyLayer
Organi-sationLayer
IntegrationLayer
SoftwareLayer
Syste
m L
aye
r
CooperationStrategy
CollaborativeProcesses
CompatibleApplications
CommonInterfaces
NO
Government
Interference
Federal
Definition
Standards
Body
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 49
National/Regional eHCI„Good Governance and Regulation“
StrategyLayer
Organi-sationLayer
IntegrationLayer
SoftwareLayer
Syste
m L
aye
r
StrategyLayer
Organi-sationLayer
IntegrationLayer
SoftwareLayer
Syste
m L
aye
r
CooperationStrategy
CollaborativeProcesses
CompatibleApplications
CommonInterfaces
NO
Government
Interference
Federal
Definition
Standards
Body
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 50
� Healthcare in Switzerland
� Competence Center Health Network Engineering(CC HNE)
� Problems
� Networkability
� eHealth Collaboration Infrastructure (eHCI)
� Investment Dilemma
� National/Regional eHCI
� Summary and Outlook
Agenda
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 51
� To overcome the problems (mainly quality and cost) a shift towards “privatization” and consumer-driven healthcare is needed
� Hospitals have to become competitive (DGRs are only a forerunner)
� Networkability is the key to the “industrialization” of healthcare
� The development of competitiveness (internally) and networkability (externally) go hand in hand
� An eHealth Collaboration Infrastrure (eHCI) is needed
� Government regulation and private initiatives should be combined to solve the investment dilemma
Summary
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 52
� CC HNE Trip to the U.S. & Canada in early 2009
� Let’s get in touch!
� Please e-mail or call
Outlook
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© 2008 IWI-HSG, CC HNE, Dr. Peter RohnerSlide 53
Thank you for your attentionSee you in the U.S. or Canada in early 2009
Dr. Peter [email protected]@rohner.chehealth.iwi.unisg.ch+41 71 224 38 60