Time for health care to move to the next level

Medical systems globally are haemorrhaging money and buckling under the strain. Electronic streamlining is the answer.

A study showed that an e-health initiative in Australia could eliminate up to 7 million unnecessary laboratory tests.
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The healthcare industry worldwide needs a shot in the arm. Rising rates of chronic diseases require more complex healthcare services; ageing populations demand services for longer periods of time; medical technologies are becoming more sophisticated and more widely available, but also much more expensive.

As a result, healthcare systems must offer more complex care to more demanding and informed patients, at higher levels of quality, while also trying to control costs.

This is particularly true in the GCC, where many countries suffer from high rates of chronic lifestyle diseases, including obesity, diabetes and cardiovascular ailments. GCC residents still seek treatment abroad. In the UAE alone, this cost the Government US$2 billion (Dh7.34bn) in 2007. GCC countries are focused on improving the provision of health care and this was one of the highest areas of government spending last year.

To deliver better quality to more people at lower cost, while also improving healthcare infrastructure, many countries are turning to "e-health" initiatives. Though the concept has been defined in different ways, it essentially entails applying the latest information and communication technologies to the delivery of care. E-health services often include, but are not limited to, a national electronic health record, e-claims and e-prescriptions.

E-health programmes offer a range of potential benefits. Caregivers are freed from low-level administrative tasks, allowing them to devote more attention to patient care. They also have better access to patient information and a more holistic view of patients' medical history. Errors are reduced; preventative health programmes, outbreak surveillance and other public health programmes can be planned more effectively. Perhaps equally important, e-health programmes reduce costs, because they make the healthcare system more efficient.

A Booz & Company study recently quantified some of the projected benefits from a proposed e-health initiative in Australia: by 2020, the programme could eliminate up to 10,000 deaths caused by medication mistakes, along with up to 310,000 unnecessary hospital admissions, 2 million unnecessary outpatient visits, and 7 million laboratory tests. The patients who need these procedures still get them, of course, but other patients can avoid them. That means a more efficient healthcare system and lower costs for everyone.

Yet for all their promise, most e-health initiatives worldwide have yet to deliver results. These are massive programmes, with a range of interested parties - patients, hospitals, doctors, pharmaceutical companies, insurers, government agencies - that often have competing demands and incentives. All too often they have been implemented hastily, without a long-term road map for success, and many of them have fizzled out.

GCC countries have taken some early steps towards e-health, and, like the rest of the world, they will continue to explore the benefits of such a venture. However, to ensure any future initiative succeeds, a long-term strategy that addresses five core elements is essential. These are:

Stakeholders: it is critical to involve key stakeholders in the public and private sectors when designing an e-health programme, including governments, providers (public and private hospitals and clinics), payers (insurance), patient advocacy groups and professional associations. Without the early support of these entities, any programme is likely to flounder.

Services: e-health services can vary widely and should be tailored to local demands and technology infrastructure to ensure they meet stakeholder needs. Services may be as sophisticated as national electronic health records, or as simple as text-based alerts. For example, pivotal elements of sophisticated e-health programmes such as Singapore's national health records are the management of patient data records and the avoidance of counter-indicated drugs. Because stakeholders are likely to be wary early on, it is crucial to establish some early "wins" by choosing services that are relatively easy to implement and that all parties agree on.

Technology: the choice of a specific technology platform has wide ramifications, as it determines the applications, data and infrastructure needed to support specific services and reap the full benefits of an e-health initiative. More important, defining shared standards, such as technology and data, are crucial to make this platform ubiquitous. Some programmes, such as Canada Health Infoway and Denmark's national e-health portal sundhed.dk, have succeeded by implementing enterprise systems for shared infrastructure that can help existing technology platforms talk to each other.

Financing: governments must ensure that appropriate funding is in place for an e-health programme to be designed, developed, implemented, and sustained in the long term. Financing can come from different sources, such as governments or public-private partnerships. This will require governments to consider the reimbursement model in place, as well as incentives and disincentives for stakeholders to participate. For example, Singapore's Ministry of Health Holdings developed a financial model for national electronic health records to understand the projected benefits and costs for the programme over 10 years with the aim of developing a financially sustainable e-health programme.

Governance: national governments find the greatest efficiencies and effectiveness when they have established policies and regulations to oversee, regulate, and manage e-health programmes. Because of strong concerns over privacy, this oversight should include a legal framework, including confidentiality measures that can convince all stakeholders that information will be shared judiciously - and that they have legal recourse if it is not.

Finally, the sequence of these elements is key. No country can consider them all simultaneously - rather, success for the GCC will involve emphasising different elements at the right point in time, with the goal of creating a programme designed specifically for its stage of development and technology infrastructure. We do not claim that the process will be easy, but the benefits of an intelligent e-health programme, implemented with a long-term strategy in mind, will justify the effort.

Ramez Shehadi is a partner and Dr Walid Tohme and Jad Bitar principals at Booz & Company