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Tools for Health TeUsing WHO's integ

Technology PackageHealthcare Qua

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TomWHO Health Tec

National Project Director KaiseNational Project Director, KaiseAtlanta, G

8º Congreso Colombiano de Hospitales y Clínicas, Abril 20

echnology Planning: grated Healthcare

echnology Planning: grated Healthcare ge (iHTP) To Improve lity and Delivery

ge (iHTP) To Improve lity and Deliverylity and Deliveryhtp.infolity and Deliveryhtp.info

m Juddchnology Consultanter Permanente Clinical Technologyer Permanente Clinical TechnologyGeorgia USA

008

AgendaAgendagg

Why iHTP Why iHTP

iHTP Concept and Methodop

iHTP System Overview

Country Implementations witHealthcare Quality and DelivHealthcare Quality and Deliv

iHTP Tool Support


logygy

th Impacts on veryvery

008

Wh iHTPWh iHTPWhy iHTP Why iHTP


……

008

Process ImprovementProcess Improvement

If you cannot measure something,

t ityou cannot manage it.

If you cannot manage it,

you cannot improve it !


C t SiC t SiCurrent SiCurrent Si


t tit tituation …tuation …

008

Given challengesg

Within WHO technical programsgare known, but rarely linked to te

Program and implementation str Program and implementation strwithout looking at resource plan

Resources are planned and imp

Implementation, training, monito Implementation, training, monitoisolation

Th t t i d ti l di The strategic and operational di

Currently, too many resource pla8º Congreso Colombiano de Hospitales y Clínicas, Abril 20

y, y p

s health needs and priorities (often) ( )echnology planning

rategies have been developedrategies have been developed ning implications

plemented vertically

oring and evaluation often done inoring and evaluation often done in

id i id tvide is evident;

an assumptions008

p

iHTP Concept and MeiHTP Concept and Me

D t i th t t l

pp

Determines the total resources neeservices based on:

P l ti d hi di Population demographics, diseaof pregnancies, number of birthsdiabetes, low birth weight, etc.); , g , );

Health care service targets and pcoverage by 2015; first level carecoverage by 2015; first level care

WHO clinical standards and guidWHO/PAHO set of tools and guiWHO/PAHO set of tools and gui


ethodologyethodology

d d t d li d fi d t f

gygy

eded to deliver a defined set of

d h lth fil ( bse and health profile (e.g. number s, prevalence of hypertension,

policy decisions (e.g. universal e to be provided by midwives; etc.);e to be provided by midwives; etc.);

delines (according to the delines)delines).

008

ConceptConcept

Medical

What ? How

Medical Equipment Guidelin

Drugs

HumanResources


w ?

HealthP k

How much ?

nes Package

Inter-ventions

Procedure

Facilities

008

Typical Healthcare DelivTypical Healthcare Deliv

Human Resources

c L

evel Facilities

Stra

tegi

cev

eltio

nal L

eO

pera


very Scenariovery Scenario

Medical EquipmentPharmaceuticals

008

Gaps analysis in iHTPGaps analysis in iHTPp yp y

Based on the estimated needs upiHTP provides a detail gaps an

d d i d tresources needed in order to starget and quality level.

Focus is on resource planning anp gprescription of clinical practice


PP

p against the current situation nalysis of the additional

l i t d i dscale up service to a desired

nd costing and not necessarily on g yes

008

Cost ImplicationsCost Implications

Incorrect specifications and donation provision leads to increased life-cycle costs;increased life-cycle costs;

Risk transferred to recipient;

Cost-benefit often very lowType Impact of

donationAdditional cost (%)

(CAPEX)

Incorrect Specifications High 10-30

Excessive sophistication Medium 20-30

Sub-optimal utilization High 30-80

Lack of spares High 30-50

Excessive downtime High 25-30


Planning ChallengesPlanning Challengesg gg g

FinancialHP

es

FinancialH

ealth ackageW

hat

reso

urc e

How to deliver


ss

008

System OverviewSystem Overview

iHTP Simulation Tool

Sharing of resources

iHTP Simulation Tool

Patient Profiles

iHTP Databases

Country Database

Reference Database


Clinical Guidelines

HCT Constraints

Simulations

Simulations and Planning

008

Medical EquipmentMedical Equipment

Comprehensive medical equipment datT h l i t d ti d Technology, maintenance and costing d

usability and technical criticality indicat Separated scenario and reference data


tabase (UMDNS based)d tdatatorsbase for improved country implementation

008

PharmaceuticalsPharmaceuticals

Comprehensive pharmaceutical p pdatabase

Based on WHO pharmaceutical databaseS h d li d d i t ti Scheduling and drug interaction capability

Country specific costs can be linked to any pharmaceuticalto any pharmaceutical


Clinical guidelinesClinical guidelinesgg

iHTP reference iHTP reference database contains 4500 pre-linked proceduralsprocedurals

Over 600 clinical guidelines (iHTP terminology: scenarios)terminology: scenarios) have been completed and are available on the web

Scenarios can be adapted to any country situationsituation


Epidemiological profileEpidemiological profileEpidemiological profileEpidemiological profile

Population indicatorsp Coverage rate and

hospital admissions Target indicators (i.e. g (

Caesarean rates) can be model to over specific years

Allows scaling up Allows scaling up


eseseses

008

Health package modelHealth package modelgg


linglinggg

008

Reports - StaticReports - Static

St ti h lth t h l Static healthcare technology reports (for pharmaceuticals; medical equipment; human resources and facilities)

Can be used for static equipment lists i.e. pedicure equipment procurement; technology scope evaluationgy p

Does not indicate quantity


Reports - DynamicReports - Dynamicyy

Dynamic healthcare technology ry gycalculation is based on workload

Provides operational costs; dynaiopportunity cost

Takes into consideration healthca

Reports provided “drill down techdrivers


reports includes quantities –p qand schedule

mic quantities; recurrent and

are technology availability

hnology” – ideal in evaluating cost

008

Drill-down CapabilityDrill-down Capabilityyy


Making Pregnancy SafMaking Pregnancy SafMaking Pregnancy SafMaking Pregnancy Saf Routine antenatal care (1st visit) - Prima Routine antenatal care (2nd visit)-Prima Routine antenatal care (3rd visit)-Primar Routine antenatal care (4th visit)-Primar Routine antenatal care (4th visit) Primar Severe anemia in pregnancy - Primary/S STIs and RTIs in pregnancy - Primary/S

Mild l i P i /S d Mild pre-eclampsia - Primary/Secondary Malaria in pregnancy - Primary/Seconda HIV in pregnancy - Primary/Secondaryp g y y y Antenatal infection - Primary/Secondary Routine labor and delivery - Primary/Sec Obstructed labor Primary/Secondary Obstructed labor - Primary/Secondary Antepartum hemorrhage - Primary/Seco Postpartum hemorrhage - Primary/Secon


fer (MPS) CPGsfer (MPS) CPGsfer (MPS) CPGsfer (MPS) CPGsary/Secondary ary/Secondary ry/Secondary ry/Secondaryry/SecondarySecondary

Secondaryyary

condary

ndaryndary

008

55 MPS CPGs continued55 MPS CPGs continued55 MPS CPGs, continued55 MPS CPGs, continued

Sepsis in pregnancy - Primary/Secondar Pre-labor rupture of membranes - Prima Eclampsia - Primary/Secondary Fetal distress - Primary/Secondary Fetal distress Primary/Secondary Caesarean section - Primary/Secondary Routine postpartum care - Primary/Seco

P t t f il l i P i /S Postpartum family planning - Primary/Se Postpartum infection - Primary/Secondar Routine newborn care - Primary/Secondy Low birth weight - Primary/Secondary Birth asphyxia - Primary/Secondary Newborn infection Primary/Secondary Newborn infection - Primary/Secondary Newborn malformation - Primary/Second


dddd

ryry/Secondary

ondarydecondary

ryaryy

dary

008

Integrated Manageme( C )

Integrated Manageme( C )Illnesses (IMCI)Illnesses (IMCI)

118 WHO Ideal CPGs mapped in 200● Pneumonia, cold, bronchiolitis, croup● Diphtheria, Pertussis (whooping coug● Diarrhea, Dehydration, Dysentery, Ma● Meningitis, Measles, Typhoid Fever, MMeningitis, Measles, Typhoid Fever, M● Otitis Media, UTI, Heart Failure, Hypo● HIV/AIDS in Child, Pneumocystis Car

B F t H d I j i● Burns, Fractures, Head Injuries


nt of Childhood nt of Childhood

05, at primary/secondary care levels:pgh), TBalnutrition, Typhoid FeverMalaria , Dengue FeverMalaria , Dengue Fever

othermiarinii Pneumonia (PCP)

008

iHTP VenuesiHTP VenuesiHTP VenuesiHTP Venues Kyrgyzstan and Mozambiqu Namibia, China (PRC), and Ukraine WHO internal programs

● MPS ● IMCI● Surgery, HIV, TB

S l Senegal Mexico, Malawi, and Sri Lan

DRC DRC USA (KP), Lux Developmen


ue 2001South Africa 2002

2003

200320052006

20042004nka 2005

20062006nt (several countries) 2007

008

iHTP Impact on HealtiHTP Impact on HealtiHTP Impact on HealtiHTP Impact on Healt Quality: Accelerate health re

infrastructure

Planning: Optimize resource Planning: Optimize resourcehealth providers

C ti C t k i t ti Costing: Cost key interventitechnology investment

HTM: Calculate recurrent coother key health technology

EBM: Use health technologyevidence-based clinical prac


p

th Quality & Deliveryth Quality & Deliveryth Quality & Deliveryth Quality & Deliveryeform and developing quality

e planning and utilization bye planning and utilization by

i t d t i b tions to determine best

osts (device maintenance), and management indicators

y performance data to drive ctice and improved quality008

p q y

Kyrgyzstan iHTP ImpaKyrgyzstan iHTP ImpaKyrgyzstan iHTP ImpaKyrgyzstan iHTP Impa

Key objectivesKey objectives

Quality

Costing

Results Databases

● National health resource four databas● National health resource four databas Evidence Based Medicine (EBM)

● Facilitated use of EBM improving qua Clinical Practice Guidelines

● Over 120 CPGs approved by MOH at ● Mapped in iHTP, validated by experts

Anemia/pregnancy, TB, ARI children, Bru


actsactsactsacts

ses standardizedses standardized

ality performance

three levels of care s, increased compliance: early focus Hypertensiocellosis

008

Kyrgyzstan Impacts, cKyrgyzstan Impacts, cKyrgyzstan Impacts, cKyrgyzstan Impacts, c

Human Resources Human Resources● More family practice staff identified● Set standards and clarified physicia

D Drugs ● Removed VAT fees for externally p● Developed MoH rules allowing med

h i t il blpharmacies not available● Improved handling of donated drug

Facilities● Improved coordination with local go

and secondary facility renovations Medical Equipment Technology

● National MoH policy for rational use● National policy for purchase of high


continuedcontinuedcontinuedcontinued

and trainedan/nurse responsibilities

purchased drugsdical drugs sold at sites where local

gs

overnments assuring funding for primary

y Managemente of medical devices h technology devices

008

Kyrgyzstan iHTP AppKyrgyzstan iHTP AppKyrgyzstan iHTP AppKyrgyzstan iHTP App

EBM CPGs EBM CPGs● Ideal (6): Finnish Lung Health Prog● Actual (6): Acute Bronchitis, Bronc

Acute Respiratory Viral Infection

Gaps Analysis● 5 sites in urban and rural areas, pr● Cost analysis compared for Ideal vy p

• Pre-post provider training sho• Providers began to reduce un• Facilities begin to ensure/sha

Results● MoH began to use ideag

reimbursement throug


plicationplicationplicationplication

gram for Adultschial Asthma, TB, COPD, Pneumonia, and

rimary and secondaryversus Actual CPGsowed cost-effectiveness of EBMnnecessary tests, staff, and drugsre vital medical devices for testing

al CPG costs for national gh the Health Insurance Fund

008

Mozambique iHTP ImpMozambique iHTP ImpMozambique iHTP ImpMozambique iHTP ImpKey objective Planning

ImplementationImplementation iHTP Team: Established in MoH Plan Levels/Venues: Primary & secondaryy y CPGs: Focus on MPS, Malaria, TB,

Key FindingKey Finding Demonstrated cost HIV Volunta

USD/encounter, not $11 used Incomplete resource planning (r

access for an important segm


pactspactspactspacts

nning Groupy, urban & ruraly,and STD including HIV

ary counseling & testing (VCT) $24 to build 35 rural clinics

re staffing and facilities) delayed ment of this population

008

Namibia iHTP ImpactsNamibia iHTP ImpactsNamibia iHTP ImpactsNamibia iHTP Impacts

Key objectivesy j

Planning

CostingImplementation iHTP Team: Established in MoH Quality Group Levels/Venues: 3 key Rural District Hospitals - p CPGs: Mapped 13 from MPS IMCI Malaria and CPGs: Mapped 13 from MPS, IMCI, Malaria and

Key FindingsDi t i t H it l G A l i District Hospital Gaps Analysisversus Actual CPGs demonstrate


ssss

primary/secondaryTBTB

Id l CPG b d ti l: Ideal CPGs based on national normd significant resource efficiencies

008

China iHTP ImpactsChina iHTP ImpactsChina iHTP ImpactsChina iHTP ImpactsImplementation: Fudan University Health Tec Levels/Venues – Tertiary Hospital focus

● 9 tertiary hospitals in 3 large cities in Zhejiang CPGs

● Tertiary level: Gallstones, Stroke● Secondary level: Orthopedics: (1) Fracture lon

protrusion, (3) Open injury of finger, (4) Fractu● Local “Actual” CPGs compared to national “Ide● Local Actual CPGs compared to national Ide

HT Management (HTM)● Conducted Health Technology Audit fo

C t Utili ti F ti lit C• Costs, Utilization, Functionality, Con● Outcomes

• Strengthened HTM system in provinceG l i O th di CPG• Gaps analysis re Orthopedics CPGs a

• Noted links between quality of HTM an• Gave clear direction on how to extend


chnology Assessment & Research Center, Shangh

Province ; provincial district hospital

g bone of 4 limbs, (2) Lumbar inter-vertebral disc re of lumbar vertebra

eal” CPGs from Shanghaieal CPGs from Shanghai

or medical devices re:bl HTM t t i t hi tsumables, HTM structure, maintenance history

e, including subsystem for device maintenanced ti lnd national norms

nd health quality and efficiency of care deliveryd the benefits of the project to other provinces

008

South Africa iHTP ImpSouth Africa iHTP ImpSouth Africa iHTP ImpSouth Africa iHTP Imp

Key objectivesy j Planning Costing Calculate recurrent costs and o

Levels/Venues Levels/Venues● Various at district level (prim● Focus on Mother and Child H

Results Wide number of CPGs developed Wide number of CPGs developed Several studies conducted: gaps

technology audit; national health


pactspactspactspacts

other key HTM indicators

mary/secondary healthcare)Health (MPS, IMCI), HIV, TB

ddanalysis (MPS); national health technology scoping study

008

Ukraine iHTP ImpactsUkraine iHTP ImpactsUkraine iHTP ImpactsUkraine iHTP Impacts

Mapping of Mother and Child healthMapping of Mother and Child health package

Approximately 30 guidelines – based on observations and recommended clinical practice

Primar and secondar le el of care Primary and secondary level of care

Resource requirements, including operational and recurrent costsoperational and recurrent costs


Operational Costs per Year (HR)

Nurse, Professional

8%

Specialist, family doctor71%

Laboratory assistant

21%

Primary Level: Maternal Services (Ukraine)Operational Costs Physical

Infrastructure73.53%

Human Resources

26.29%

Pharmaceutical0.18%

008

Ukraine iHTP ImpactsUkraine iHTP ImpactsUkraine iHTP Impacts Ukraine iHTP Impacts

• Identification of cost drivers• Minimum quantities of resources• Critical path identification

O ti i ti th h id

FURNITURE GENERAL G T

• Optimization through evidence

FURNITURE GENERAL Group TypeBench, {Not Specified} Furniture General Reusable

Desk, {Not Specified} Furniture General Reusable

Racks, Test Tube, {Not Specified} Furniture General Reusable

Cabinets, Laboratory, {Not Specified} Furniture Medical Reusable

Chairs, Office Furniture Medical Reusable

F t t l T /Th St {N t S ifi d} F it M di l R blFootstools, Two/Three-Step, {Not Specified} Furniture Medical Reusable

Tables, Examination/Treatment, Adjustable, Obstetrical, {Not Furniture Medical Reusable

Tables, Instrument, {Not Specified} Furniture Medical Reusable

8


- continued- continued- continued- continued

Simulated Total i d

Unit Cost ( i )

Unit Cost ( )

FIXED REPLACE

Qty Required (min) (max) OPER COST COST

0.7 1.0 300.00 394.00 260.71 394.00

2.8 3.0 300.00 320.00 895.37 960.00

0.9 1.0 30.00 35.00 30.66 35.00

0.3 1.0 140.00 160.00 47.05 160.00

4.9 5.0 70.00 90.00 443.97 450.00

0 1 1 0 80 00 120 00 10 79 120 000.1 1.0 80.00 120.00 10.79 120.00

0.1 1.0 5,400.00 12,000.00 1,089.86 12,000.00

0.1 1.0 500.00 600.00 55.59 600.00

9.8 14.0 2,834.02 14,719.00

Ukraine, UAH

008

Mexico iHTP Impacts 2Mexico iHTP Impacts 2Mexico iHTP Impacts 2Mexico iHTP Impacts 2 Mexican Ministry of Health (MoHy (

value in rapid prototyping and cprocess maps of clinical proced

In 2006, CENETEC (The Center fled by biomedical engineer Adriwith a team of 40 engineers phwith a team of 40 engineers, phPAHO had a small team with prpartner, et al.- lead pilot use of ito evaluate care in 2 Mexico CitInsurance Catalog (90 different of charge to Mexico’s significanof charge to Mexico s significan

A CENETEC consultant also be


2006200620062006H) deployment demonstrates iHTP ) p y

cost modeling based on using dures and resource databases.

for Excellence in Technology in Healthcare)iana Velazquez, #3 level in MoH,

hysicians etc ) in partnership withhysicians, etc.) in partnership with roject manager and physician iHTP for the perinatal care CPGs (4) ty clinics - as part of the Popular procedures) provided by MoH free t percentage of poor people.t percentage of poor people.

egan Spanish translation of iHTP.

008

Mexico iHTP Impacts 2Mexico iHTP Impacts 2Mexico iHTP Impacts 2Mexico iHTP Impacts 2 In early 2007, the MoH on beh

a national health initiative: “Cacare / outreach clinic allowing - to several of Mexico’s remote- to several of Mexico s remotewere sent throughout all states

C C CENETEC using iHTP assistefor Caravan in this implementadeliver caredeliver care.

Later in 2007, CENETEC alsod l i ll Cli i l P tideveloping all Clinical Practicewith various national experts.


2007200720072007half of President Calderon beganaravan” – a traveling primary timely referrals to hospital care

e rural areas 50 Caravanse rural areas. 50 Caravans s of Mexico.

ed the MoH planning departmentation, studying optimal ways to

o gained responsibility for G id li (CPG ) f M He Guidelines (CPGs) for MoH

008

Mexico MoH CaravanMexico MoH CaravanMexico MoH CaravanMexico MoH Caravan Project team: CENETEC Prj

leaders; WHO consultant

Various national physician l Various national physician ldevelopment of 20 evidence● Diabetes Screening

B t C S i● Breast Cancer Screening● 18 from Perinatal Care:

• Prenatal Care visits (4)Pre Eclampsia (4)• Pre-Eclampsia (4)

• Eclampsia (3)• Hemorrhage (4)• Newborn Care (3)• Newborn Care (3)

Completing cost and resource anresults to all MoH primary care (f


results to all MoH primary care (f

Project 2007Project 2007 Project - 2007 Project - 2007roject Leader and 2 physician j p y

eaders, assisting witheaders, assisting with e-based CPGs including:

nalysis currently; expected to apply fixed clinics) as well008

fixed clinics) as well

iHTP Tool SupportiHTP Tool SupportiHTP Tool SupportiHTP Tool Support iHTP Help Files (2006) and Tep ( )

iHTP website – www.iHTP.infcapabilities (2007)capabilities (2007)

MPS Resource Kit (individual potential users (2007)potential users (2007)

Ongoing Development of iHTPfor Q&A (2006-present)

Email response guiding user ta espo se gu d g use

Monthly Web Meetings for iHT


echnical Manual resource (2007(

fo for New Releases of iHTP

training guide) to train other

P Support Center (South Africa)

to “Knowledge Base” of FAQo o edge ase o Q

TP Users (begun 2007)

008

ThThThanThan

TomTom.juddj


kkk youk you

m [email protected]@ p g

008

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