Etervise suunad

Madis Tiik

29.08.2014

• Tartu University , medical doctor 1996• Nordic School of Public Health (Sweden) -Diploma in

Public Health 2003 • Estonian Business School 2001-2003 ICT Management• Tallinn University of Technology , PhD (healthcare

engineering )14.12.2012

• Family doctor 1998-• Estonian Society of Family doctors, chairman 2001-2008. • Estonian eHealth Foundation , CEO, 2007-2011• EU eHealth Task Force group scientific adviser of the

President of the Estonia (2011-2012)• Tallinn University of Technology , project manager,

lecturer 2011-2014• Senior Adviser , Sitra (Finnish innovation fund) 2012-

2014• Scripps Translational Sciense Institute, San Diego, USA

2014 -

14.12.2012

Madis Tiik, MD, Phd

Tervishoiusüsteemi transformatsioon

Pro-aktiivne Reaktiivne

tegevus

Patsiendi keskne

Teenuse-osutaja keskne

PWC Health Research Institute raport “HealthCast “ March 2010

1000 adults during 1 month

800 health related symptoms

329 looking for professional help

217 Healthcare113 Family physician104 Specialized doctor

65 Alternative medicine (acupuncture, homeopathy etc.)

25 day clinic

13 emergency

8 hospital.

1 university

clinic

Green, LA. Fryer, GE Jr. Yawn, BP. Lanier, D. Dovey, SM (2001). ‘The ecology of medical care revisited.’ New England Journal of Medicine, 344(26): 2021–2025

Where patients seek information?406 self-care?

329 data from EHR- illness

data

7Sitra • Madis Tiik • 23.04.2014

Traditional service flowLaboratory/ Other tests

SpecialistGeneral

practitioner

329 will meet a medical

professional, e.g. nurse

Laboratory/ Other tests

1000 citizensDuring one month

800 of them have

somemedical

concerns

Green, LA. Fryer, GE Jr. Yawn, BP. Lanier, D. Dovey, SM (2001). ‘The ecology of medical care revisited.’ New England Journal of Medicine, 344(26): 2021–2025

EPR

Today’s healthcare is provider –centric, driven by fee –for-service payments and it’s a barrier to a better healthcare model

Georg Halvorson, Chairman and CEO, Kaiser Permanente

Health data

Time

Vo

lum

e

Child clinic

Healthcentre

Occupational healthHospital

McGinnis, et al., Health Affairs; 21(2), 2002

Wave 1:PATIENT-CENTERED CARE (2010-2016)

– Tervishoiusüsteemi raviplaanid keskenduvad patsientide vajadustele – vajadustepõhine raviplaan.

– Arstid loobuvad visiitide tootmisest ja standardiseeritud , mitte perrsonaalsete ravijuhiste kasutamisest

– Arstid liiguvad one size-fits to all mõtteviisist, rahvatervist edendavale mõtteviisile, kus resursse jagatakse erinevate segmentide vajadustest lähtuvalt(n. terved, kiireloomulist abi vajajad, kroonilist haigust põdevad või multimorbiidsed ).

– Patsientidele kellel on erilisi vajadusi tehakse individuaalsed raviplaanid ja neid ravivad multidistsiplinaarsed ravimeeskonnad

– Ravimeeskonna liikmeteks on erinevad spetsialistid (arstid,õed, case manager - juhtumikorraldaja, füsioterapeut, sotsiaaltöötaja, toitumisspetsialist jne)

Kanavamalli osana terveyden edistämispalveluja

Palveluohjauspiste

Nopea hoidonalku

Hoidon toteutus

Omahoito

Palvelu-tarpeen arviointi

Sovitustihoitoon

Hoito-vastaava

Hoito-suunnitelma

Oma-hoidon

tuki

Tyytyväinen

asiakas

Useita terveysriskejä

(Terveyshyötykanava)

Yksittäisiä

terveysongelmia

(Episodikanava)

Oman terveyden edistäminen ja ylläpito

Voimaantu-minen

Hämenlinnan Terveyspalvelut

Vir

tuaa

lklii

nik

WAVE 2: CONSUMER ENGAGEMENT (2014-2020)

• Luuakse uusi patient –centered teenuseid• Teenuse pakkujad võistlevad hinna, lisaväärtuse, ja

tulemustega. • Mõtle crowdsourcing teenuste peale, nagu Yelp

teenuspakkuja tulemuskaart• Mobiillahendused , mis toetavad klientide

tervisealaseid otsuseid. (My prevention plan)• Turule sisenevad tervishoiusektorist väljaspool

tegutsevad ettevõtted– retail clinics (tervisekioskid) – WalMart, Walgreens– ICT ja Media firmad - WedDOC, Symptom checker etc.

SupportedSelf-care

Walk in clinicsHome monitoring

GP, outpatientcare

Hospital careHigh specialization

Very high risk 19 500

High risk

58 500

Low risk

299 000

Self-care, prevention

923 000

Organization centric team

Motivated, supported

citizen

PROBLEEM Unequal distribution of healthcare services in Estonia

(population 1,3 mio)

ICT and healthcare in Estonia

Central EHR 2005-2008Health Portal 2009Registries Integration ( non clinical) 2008Standardization 2007-2012Integration of different user groups 2009-2013

Information Exchange

Local EMRsDigital Claims & Reimbursement

1992 2010 2015 2020

Time

Patient empowerment

Health sertificate 2010-2013Integration with social care 2011-2012EbmDS decision support service 2011-?Integrated statictic 2010-2013Clinical registries 2011-?

Secundary use of data

Personal Simulation 2015Integration with -Environment data 2015?-Behaviour data 2015?-Genetic data 2014?

Value Added services

WAVE 3: THE SCIENCE OF PREVENTION(2018-2025)

Kujuta, et kaubanduskeskuses saad tervisekioskist, milliseid on igas kaubanduskeskuses 50€ eest süljeproovist geenikaardi ja selle aluselt tehtud personaalse terviseplaani koos vastava APP-ga, mida toetab Avatari taoline abiline. Kes igapäevaselt aitab sul teha õigeid valikuid käitumises, toitumises , juhib sinu tähelepanu sinu tegevusest tulenevatele riskidele

OHIO STATE UNIVERSITY MEDICAL CENTRE

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Sitra • Madis Tiik • 23.04.2014 •

Online clinic and service flow

Online clinic

Laboratory

Specialist

General practitioner

Nurse

1000 citizens 800 of them havesome medical

concerns

Self-care

EPR

PHR

20%

80%

Online clinic (+ artificial intelligence)• Data integration and mining

20•

Research and reference database• Cohorts• Biobanks

• Research articles

Electronic health records

User interface, e.g. webpage/app

Online serviceportal & booking

toolVirtual health check

Mobile & walk-inservice channels

Personal health records• Health & wellness data

• Genetic data

Health information& Risk assesment

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http://www.forbes.com/sites/ciocentral/2014/04/03/virtual-health-care-visits-will-revolutionize-the-industry-if-we-let-it/

BASKIMAA Näiteid

Health and wellbeing ecosystem

Health portal

Internet

Integration engine

HIE

NurseBaddy

GP portalApp-store

PHRTerminology

service

BigData

An

on

ymis

atio

n

myPreventionplan

DiabetesAPP

Meedoc

Hospital

EPR

Online clinic

Madis.tiik@eesti,.ee

Tänan kuulamast !

ehealth,mhealth,phealth=

healthcare delivery of the 21st century

Health Forecasting

NHS Network

Medixine software

and server

Medixine

interactive voice

response system

Medixine

administrator

Monitoring

Health

Forecasts

Automated

telephone call

Patient

responses

Telephone

numbers

Patient name and

tel no, changes to

patient status

Call logs

Met Office Forecaster

Person with

COPD

GP practice Patient

responses

Significant savings

• According to the inquiry, in addition to the savings, self-nurturing increased and the patients were satisfied with the service.

* www.heli.fi/content/Liitteet/Hengitysliitto_jasentutkimus_keuhkoahtaumatautia_sairastaville_09112011.pdf

** Estimation based on savings in the UK and Finland

Population 200 000

Percentage of COPD patients in

population 4,0 % 8 000

Percentage of patients with

hospital admissions* 37 % 2 960

Cost of admissions 1500 € / admission 4 440 000

Reduction of admissions** 20 % 592

Savings 1500 € / admission 888 000

Cost of the service 30 € / patient 240 000

Net savings € 648 000

Automatic Coaching

• Easy to use web solution

• Informational messages, reminders and alerts through SMS, e-mail, automatic voice calls

• Customer definable message sets can be flexibly allocated to members/patients

• Escalation of alerts and reminders easily programmed

• In Delaware: HbA1c compliance from 48% to 75%

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