February 23, 2013

Transforming business models in Health IT

eHealth Interoperability is an overused buzzword. But interoperability is still instrumental for us to access disparate health data and use it. And we need to meaningfully access and merge more and more data to drive innovation, develop new eHealth services and create new added value of Health IT (HIT).
In PARENT, we observe an increased desire from EU member states (i.e. regional and national patient registries) for the EU to increase interoperability efforts - even taking it as far as to providing interoperability frameworks and toolkits. I think this can be attributed to registry holders' interest to reduce the risk of vendor lock-in as well as to prepare for the implementation of the Cross-Border Healthcare Directive. Similarly, in epSOS (brief description in my previous post) Member States benefit from epSOS not just because of the future cross-border scenarios but also from applying the same principles on national/regional level and reducing the future national cost of interoperability.

The need for more interoperable data creates a marked effect on the HIT value stack and ultimately the HIT market. The need for interoperability is changing the relative importance of elements in the value stack.  The traditional HIT value stack in the market today is composed (starting at the bottom and moving up) of hardware, a (thin) interoperability layer, software and services. Typical HIT vendors usually provide at least the software and services components but often also the rest of whole stack.
The need for interoperability is increasing the relative added value of the 'interoperability' component. And this component is in nature quite different from the other components - it pushes vendors to open up content, to reduce the lock-in they create by storing data in vendor specific information models. Thus it pushes them to give away a valued competitive advantage - vendor locked health data. Applying Porter's Five forces diagram this reduces the entry barriers for new entrants as well as opens up opportunities for rivals, possibly even substitutes - all this because health care providers could now migrate their health data. And this eventually leads to de-fragmentation of the eHealth market.
For health care providers, national and EU decision makers this is a good and wanted effect as it enables us to access and merge previously locked islands of vendor specific health data, extracting further value from it for better policies and better care.
For existing IT vendors, this is a turning point – if they don’t change their business models and keep relying on the lock-in effect, not the quality and price of their services, they might be overtaken by those who will. A new line of companies focussing on data transformation is emerging, turning vendor-locked data into shareable data. And as a side effect many more companies are using new (XAAS, plug-and-play style) business models in areas where once deemed impossible (business intelligence, clinical decision support, business rules and process management). The ‘interoperability’ buzzword is live and kicking.

Do you agree? Please let me know of your views and comments - I will update the post accordingly.

This post is based on some of my thoughts at the 'Economics of Interoperability' round table at World of Health IT 2012 in Copenhagen (with Prof. Charles Jaffe as chair and Catherine Chronaki, Fredrik Linden, Rick Cnossen and myself as panelists). Figures 1 and 2 ©MaticMeglic

February 12, 2013

EU-US eHealth Scenarios

You may have come across the US EU Memorandum of Understanding on exchange of health care data. It is an approach to improve eHealth collaboration across the Atlantic and is run by the European Commission (responsible body being DG CNECT) and US Department of Health and Human Services 's (responsible body being the Office of the National Coordinator for Health Information Technology).

The most recent related publicized event was the 2012 Boston meetings aiming to define an actionable roadmap to support the Memorandum. Flying back to Europe I was trying to identify actionable scenarios to support actual exchange of patient related health data across the Atlantic. I aimed at somehow combining the two different (if not opposing) conceptual approaches – namely the pursuit for patient mediated exchange in the US and for provider mediated exchange in the EU. My starting point was to acknowledge in an equal fashion the different existing policies and work already performed on both sides, as well as to maximise the use of existing infrastructure, while maintaining the security-, identification-, data ownership- specificities of each region. The result are a couple of early stage brainstorming scenarios. It is very likely they might include show-stoppers (legal, organisational, though not semantic). And there are probably a number of other alternative scenarios.
When trying to identify existing services on both sides that could be used as proxies to feed data into these new cross-Atlantic scenarios we obviously look for a number of characteristics: significant content overlap, significant semantic overlap (or at least existing structured data on both sides that could be cross-mapped), and possibly being in production or late pilot stage with real patients. You don't have to be a Nobel laureate to think of Blue Button and epSOS.

The Blue Button initiative is a joint venture between the US Department of Veterans Affairs (VA), HHS, and US Department of Defense, in which these three agencies have collectively undertaken the simple but powerful action of allowing veterans, Medicare beneficiaries, and members of the military to freely and easily download electronic copies of their own personal health information or claims (by simply hitting a newly installed “Blue Button” on the VA, Medicare, and military’s patient/beneficiary websites).  Deployed in October 2010, it is now expanding into Blue Button +. Implementation example: Veterans Affairs

epSOS is a Large Scale Pilot co-funded by the European Commission and most EU Member States collaborate in it. It develops a practical eHealth framework and ICT infrastructure to enables secure access to patient health information among different European healthcare systems. The two scenarios being implemented within epSOS are ePrescription and Patient Summary.

Now, how could we put these two together at minimum cost and efforts? As source data are coming from two different systems, the scenarios would probably be different depending on the direction of transfer.Now let us look at the scenarios - 1 and 2 are US to EU, and 3 is EU to US.

Scenario 1 (for US citizens travelling to EU): while downloading Blue Button patient summary, US residents can also choose to upload this data into epSOS - possibly stored in 'US virtual NCP'. This would be an additional functionality of Blue Button. This data would be available for access by the EU physician at the time of contact.

Scenario 2 (for US citizens travelling to EU): Alternatively to Scenario 1, the data in epSOS can be generated at time of contact of US patient with the EU care provider - based on patient request and accessed by the epSOS capable care provider at the point of care in EU, using the 'US virtual National Contact Point' - NCP - at the moment of providing care (patient summary can be stored at 'US virtual NCP' for future use). This would be an additional functionality of Blue Button for the US patient (the epSOS country B portal would only need to add a new country of origin).
Both scenarios would likely require setting up some kind of a 'virtual NCP' for the US, into which Blue Button data can be imported.

Scenario 3 (for EU citizens travelling to US): EU residents travelling to the US can download epSOS patient summary into a Blue Button type format&medium. The download can take place either before the encounter or at the time of encounter. The data can then be imported to any US system supporting Blue Button import. Export from epSOS system would be an additional functionality within epSOS end-user portal aimed to EU citizens. No ‘virtual NCP’ for US would be required as compared to Scenarios 1 and 2.

Of course a number of issues (ownership, data recency/reliability, identification, data manipulation, reduced trust) arise with each of the scenarios and would need to be addressed. What's your take on them - do you find them feasible? I plan to update this post based on your feedback.

April 8, 2012

Yes, it's difficult to show ALL the foreseen benefits in a pilot.

The recently published 'National Evaluation of the Department of Health’s Integrated Care Pilots', performed by RAND Europe and Ernst and Young, is an interesting read. Besides pointing out several benefits in the business process and quality field, it also notes that several benefits (mainly in the consumer/patient domain) could not be demonstrated. This could easily lead to less scholarly interpretations, suggesting these pilots were a turn in the wrong direction. Given the experience (from our team back at the University of Primorska) with similar pilots I can confirm that it's very difficult to demonstrate all the foreseen benefits of a novel intervention in a pilot. Especially as  these interventions often do not replace the existing interventions or services but merely complement them (thus it's sometimes difficult to demonstrate reductions of patient visits or to show the cost efficiency).
I am happy to see that the majority of media publications and related forum posts were supportive of this.

And I hope we will soon be able to discard the following interpretation: '...the most likely improvements following integrated care activities are in healthcare processes. They are less likely to be apparent in patient experience or in reduced costs.' Obviously further improvements in the field of patient engagement and empowerment - likely including certain levels of gamification and possibly socially (family) driven motivation - will be needed.

What is your take on this?

Some further references:

March 2, 2012

Social Project Management

Projects need management. Projects also need the project team to collaborate - communicate, share and version documents, discuss issues, share information, mutually track assignments and their progress, identify optimal meeting times, hold online meetings etc.
Social project management brings the concept of social networks to project management. And as you would imagine there are online tools supporting this two concepts.
Perhaps you've already heard of or used online collaboration and project management tools - personally I've been implementing ProjectPlace and CoMindWork for collaboration in various different projects and in different organisational settings - either internal or with up to 70 partner organizations across Europe (EPAAC Joint Action, PARENT Joint Action). ProjectPlace has recently published an article in International Innovation on the topic of Social Project Management including some of my thoughts on importance of online collaboration and experience with their tool. International Innovation is a global dissemination resource for the wider scientific, technology and research communities. To read the whole article, see the issue - scroll to pages 96 and 97.
Our experts form part of several cross-European virtual teams, analysing data, preparing policies, strategies, etc. Reliable and cost efficient communication channels, collaborative work on documents, and transparent reporting are key for these teams to work in an efficient and effective manner, thus ensuring success of research projects. When preparing a Joint Action proposal in spring 2011, both NIPHRS as proposal coordinator and 17 partners from 16 member states faced a short time window to agree on the proposal content, timings, responsibilities and finance. Use of classic communication channels (e-mail and telephone) would hamper the timely preparation of the proposal. We were happy to have in place online solutions (Projectplace) to work collaboratively in a structured and transparent way that enabled us to catch the deadline while maximising the quality of proposal.

In our field of work (eHealth, Public Health), interdisciplinary collaboration as well as collaboration between stakeholders and organizations across Member States is of vital importance in pursuing our goals. I feel strongly that social media present an opportunity to enable faster and easier sharing of information and increase the ease and transparency of the collaboration process. However, as we still observe lack of adoption of social media in certain environments, we need to invest more time to educating and demonstrating value.

What is your opinion on social project management? Are you already using it in your organisation and in what scenarios? I would love to hear about your experience.

February 15, 2012

Tips&Tricks: CIP funded projects for Public Organizations

Today our Ministry of science and technology organized an information day to present the 6th Call of CIP ICT PSP programme by the EC. I had the pleasure to present some of the tips&tricks based on my experience gained from participating in two CIP projects. I structured the recommendations around the things to have in mind while:
  • creating the proposal (i.e. how to ensure remaining funding; to be careful about other direct cost where own participation cannot be contributed in kind)
  • formalising the project (i.e. keeping an eye on possible common fund pooling - reducing EC contribution on partner level)
  • doing the actual work (i.e. cash flow issues, partner exits as opportunities, avoidance of double staff reporting, application of local procurement legislation)
  • and not forgetting its sustainability and possible intellectual property rights issues.
I also did a short pro/contra of CIP to other programmes.The presentation is in Slovene language. We've also listened to the presentation on the upcoming CEF framework by Maruška Damjan. Kudos to Samo Zorc for organizing the event and to ZIT @ Chamberce of Commerce and Industry of Slovenia for hosting it.

Thanks for all the positive feedback!

November 23, 2011

Napovednik predavanja: Socialne igre na spletu kot orodje za boljše zdravje (12. 12. 2011)

Spletne socialne igre so v zadnjih dveh letih doživele razcvet in ustvarile milijardni trg. Razlogi za hitro rast so vedno večja uporaba spletnih socialnih omrežij, dostopanje do njih preko (pametnih) mobilnih naprav ter sama razpoložljivost iger. Poslovni modeli spletnih iger so zelo raznoliki - od zaračunavanja igranja do povezovanja brezplačnih iger v oglaševalske akcije, izobraževanje ali celo nova znanstvena odkritja. Predavanje bo skušalo odgovoriti na vprašanje, ali lahko (in kako) tovrstne igre, ki lahko v celoti  potekajo na spletu ali imajo tudi fizično komponento, uporabimo tudi za ohranjanje in spodbujanje zdravja posameznikov in skupin. S tem namreč korenito spreminjamo koncept dosedanjega javnega zdravja.

Če vas je pritegnilo, ste vabljeni na predavanje, ki ga bom imel  12. 12. ob 11:30 - 12:15 v mali predavalnici Dijaškega doma Koper ter bo služilo kot izvolitveno predavanje za naziv docent za področje eZdravje. Predavanje bo potekalo v slovenščini.

Če vas že srbijo ušesa, si lahko do takrat na temo zunanje motivacije in zdravja ogledate moj nedavni TEDx govor z naslovom We're motivated to stay healthy. Really?

September 17, 2011

Medicine 2.0 2011 Stanford University

This year's Medicine 2.0 is happening in Silicon Valley in California. The location adds an interesting (entrepreneurial?) touch to the event. Stanford Summit (a satellite event happening the day before Medicine 2.0) was what I'd call 'American Style', full of hype generation and US eHealth celebrities.
Today it was more down to earth:) and back to research. We've heard Gunther Eysenbach speaking on infodemiology, Jennifer Aaker on utilising social media to do good, and a lot of other highly renowned experts in the field (like Peter Murray, Kevin Clauson).
For those interested in following the event, it's simple - just follow the twitter #med2 hashtag or go to www.medicine20congress.com.
I also try to tweet what I find interesting @matic_meglic.
Next year's Medicine 2.0 will be in Boston. I'm already looking forward.