The impact of eHealth on Healthcare Professionals and Organisations: e-health and Healthcare Organization. Piqué J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. e-health and Healthcare Organization
Josep M. Piqué, MD.
Hospital Clínic, Barcelona

2. Payment systems
Payment systems
Traslational research & Social, demographic &
Social, demographic &
technology innovation epidemiologic evolution
epidemiologic evolution
Healthcare delivery
Healthcare delivery
Patient & society demands
Patient & society demands
ICT
ICT

3. P4 Medicine
Predictive, Preventive, Personalized, and Participatory

4. Fragmented healthcare systems
We need to increase the efficiency and outcomes of basic, clinical and epidemiological
research and facilitate faster translation into clinical practice, particularly in the field of
age-related chronic diseases and conditions.
It is also necessary to personalize care and to move from reactive to preventive and
predictive medicine.
At present, the three major hindrance to achieve the above mentioned objectives are:
1. The lack of an integrative approach to diagnose, treat, and prevent the health problems
from different departments in the same healthcare level organization.
2. The huge fragmentation of organizations among primary care, social care, and specialized
care.
3. The lack of communication and standardization between different healthcare electronic
medical records.

5. Hospital fragmentation
Competition
vs
Collaboration
Area of potential
Conflict Area
Area of potential
Conflict Area
development
development

6. Fragmented healthcare systems
Behaviour and attitudes of health professionals.
Lack of education for professionals promoting coordinated
efficient work.
Lack of citizen’s education on a rational use of healthcare
systems.
The payment systems that in many cases do not encourage
coordinated work.

7. Increasing the efficiency of hospital organization
Instituts, Departments, Services
Reference physician
Process Units
Diagnostic
Units
Wards ICU Day Care

8. Hospitals vs territorial healthcare
Community
HOSPITAL Care
Family
Process Units
Transplant Physician
Nurse
Dementia
Social
COPD
Territorial
Territorial Worker
Healthcare
Healthcare
Home
CHF Care

9. Adaptation of health services to chronic patients
(shared care arrangements across the system)
Hospital
Consultant
Emergency
Case
team
Manager
Primary Care
Mobile teams
Home
Primary
Patient Care
Team
Relatives & care givers

10. Territorial Health Care Comission
Territorial Health Care Comission
Barcelona Esquerra
Barcelona Esquerra
Institutions Permanent Comission
representative
Technical
Technical
Implementation Management
Management
Redesign & follow-up Team
Team
Process 1
Specialized Care
Mental health
Pediatric care
Health Transport
Pharmacy
Home Care
Emergencies
Process 2
Social Care
IT
Process 3
Process 4
Operational Committees

11. Territorial Information Systems
Territorial Information Systems
Hospital 2
Hospital 2
Hospital 1
Hospital 1
Primary
Primary
care Home
Home
care
care
care
Platform
Platform
Social
Social
care
care
Windows 2003
IIS File Server
Web Server
Web
Network
Charging Switch
Firewall
SQL
Server
IIS
Administrator Web Server

12. Process management
- Commorbility personalized management
- Multimedia access to suport center
- Patient self-management of health
- Remote follow-up
- Multidisciplinary working team
Professionals Patients

13. What do we need?
Process-oriented multidisciplinary working teams
To share information based on health problems
To implement evidence based clinical pathways
Health outputs evaluation based on cost-benefit analysis
Pay-for-performance (P4P) taking into account patient
needs and new approaches to deliver healthcare

14. Working teams sharing information
100%
Adoption of EHR according to the practice size
75%
50%
25%
1-3 4-5 6-10 11-50 ≥50
Size of practice (number of physicians)
N Engl J Med 2010:362;192-5

15. Problem oriented information system
34569078
34569078
1975 1980 1985 1990 1995 2000 2005
IP OP OP OP OP
Diverticulitis
OP Eme IP OP OP OP OP
Angina
OP DC OP OP
Breast fibrosis
OP OP OP
Breast cancer risk
Eme IP OP
Apendicitis
Penicillin allergy

16. Problem oriented and evidence-based healthcare approach
Problem 1 Primary
physician
Decision-making support
Expert patient-self-care
Home care
Problem 2 Case-management Multidisciplinary
Multidisciplinary
nurse Working team
Decision-making support Working team
Expert patient-self-care Day-care
hospital
Problem 3 Social care
Decision-making support
Expert patient-self-care

17. Health outputs evaluation based on cost-benefit analysis
Weinstein M and Skinner J. N Engl J Med 2010

18. Government Control Personalyzed and participatory care
Patient or Community Control
Tendency
Protector Connecter
(homogeneous (services organized
protection for the Drivers
Drivers according to the
overall community community or individual
based on government needs decided by a
understanding) participatory approach)
Who has the money
Who has the money
Money for what?
Money for what?
P P
P P
Education4
4
Education
Information
Information
IT systems
IT systems

19. Investment forecast in health information technology
$ bn
20
Electronic health records
15
10
Health information Patient data-analysis
supporting medical
exchange
practice and drugs research
5
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
CSC Healthcare. The Economist, April 18th 2009