*

Group 2:

Adil Umer (504512)

Anastasiya Koveshnikova (506447)

Anna Yureva (506709) Asim Ali Imtiaz (506625) Muhammad Adnan Waheed (506502) Saikat Asaduzzaman (506681)

*
22.6 mln population 81 years life expectancy 1326 hospitals

Primary care
GP Nurse Family doctors 96%

Secondary care
Specialist doctors

Acute care
Advanced diagnoses Complex treatment Acute conditions

National E-Health and Information Principal Committee. National E-Health Strategy. Deloitte, 2008

*
Strengths Defined planning horizons of 3, 6, 10 years Development of data standards (PCEHR, UHI, NASH), infrastructure and medical accreditation programs Awareness campaigns and incentive programs Weaknesses Lack of engagement of key stakeholders Lack of pressure for action from consumers Lack of efforts to engage care providers Shortage of IT health skills Complexity of the workplace Need for training and education programs Security issues not resolved Harm to the system (availability; data corruption) Harm to the people (personal data; prescription fraud) Privacy risks System security (preventing unauthorized access) Patient confidentiality (levels of data access; not revealing personal data used for research purposes)

Quality not guaranteed. Risks of: Not meeting the requirements Poor engineering (full or partial use of functions)
P.R. Croll, J. Croll, Investigating risk exposure in e-health systems, Int. J. Med. Inform. (2006)

*
Opportunities Threats

Stronger consumer push due to increasing consumer technologies sophistication

Improved quality, safety and efficiency of medical practice, especially in rural and remote locations Ageing population

Fragmentation of healthcare system Disjointed service delivery processes Autonomous service providers Coordination difficulties
Justifying spending 5-10 year ROI vs. 1-3 year for traditional funding Funding E-Health vs. getting benefits Poor state of health IT systems and infrastructure Historic underinvestment in IT Poor broadband coverage Small market for IT vendors Limited on-demand availability of world class health IT solutions Usability (low acceptance by users clinicians, patients, administrators)

Niche, mobile and app-oriented markets

National E-Health and Information Principal Committee. National E-Health Strategy. Deloitte, 2008 P.R. Croll, J. Croll, Investigating risk exposure in e-health systems, Int. J. Med. Inform. (2006)

*

Governance Concerns over proposed governance structure: adequate transparency and accountability mechanisms not provided Safety concerns Unreliable performance of the National E-Health Transition Authority (NEHTA): Accusations of ineffective oversight and failure of administrators to acknowledge design flaws" and "warnings that the system will not succeed because its implementation has been ill-considered and rushed.* Human error in registering data and reading data; loss of device. Irreparable consequences (effect on human health) Machine error in transmitting and processing data. Consequences and effect on human health. Security concerns PCEHR will be vulnerable to hacking via the endpoint computers participants use to access the central system (Security response team AusCERT ) Increasing reliance on system information (user number growth; more complex data; wider circle of health practitioners)
* A call for national e-health clinical safety governance, Medical Journal of Australia, August 2012

*Patient summary and electronic health record (EHR)

*ePrescription

*
* eView and citizens eHealth services * Complement the eArchiving and ePrescription * eView is a service for citizens wishing to view their own eHealth information * An integral part of the national eHealth services, and is already functional for
the ePrescription data included in the ongoing pilot.

* The eView service is seen as a key tool for empowerment of citizens in the
maintenance of their own health and in their participation in their care plan.

Strengths Compehensive basic IT infrastructure in health care Widely adopted uniform set of procedures for data processing Strong political support for the introduction of IT in the health care The social welfare sector has extensive experience in the use of IT in insurance
Opportunities Structured information: easier to find and easier to reuse data Centralized services make planning, monitoring and management much easier-> new opportunities for research Uniformity ->IT infrastructure can be more cost-effective and ensure a high level of data security Possibilities in international cooperation

Weaknesses Decentralized healthcare system The viewpoint of the individual citizen has been of secondary importance in development efforts Existing information systems do not support quality management Project funding is available from several sources which are not mutually coordinated

Threats Difficulty of anticipating the costs of the system, the technical executability of the design, the timetabling of implementation and the acceptability of the system among the various interest groups Challenges of efficiently processing the retrieval of information from the patient registers of various organizations and stored in a central archive The acceptability of the entire architecture from the users point of view

Epworth was established in 1920 by the Methodist Church as a community hospital.

Through development and acquisition Epworth has grown to encompass seven hospitals in the Melbourne Metropolitan area and is now Victorias largest notfor-profit private health care group.
Renowned for excellence in diagnosis, treatment, care and rehabilitation. It is the first healthcare organization to adopt surgical robotics and cardiac surgery in Australia. To maintains its leadership position and to meet the increasing healthcare requirements and treatment standards the Board has adopted a strategy of expansion and redevelopment.

Using e-health strategy to facilitate the design & development of effective healthcare processes by Raphael de francesco and Nilmini wickramasinghe

*
Potential Entrants

Suppliers

Industry Competitors

Customers

Substitutes

Porters Five Forces PPTS

SWOT

TOWS

*
Maxi-Maxi Strengths and Opportunities Mini-Maxi Weaknesses and Opportunities Maxi-Mini Strengths and Threats Mini-Mini Weakness and Threats

Mapping with objectives & critical success factors

*
Use Use
the already established ICT foundations and the hospital expansion and redevelopment program as an opportunity to implement e-health solutions. the already established ICT infrastructure to facilitate the centralization of

information and the information sharing between hospitals to improve care

planning, coordination and decision making at the point of care.

Use the existing intranet and internet infrastructure as delivery tools to provide
secure access to hospitals e-health services anytime anywhere. Use the existing infrastructure, health information knowledge bases to build knowledge sources for care providers and patients.

Use

the good change management practices to facilitate the implementation

and adoption of e-health solutions.

Use the well established ICT foundation, the great technical IT skills, the project
delivery capabilities and the good governance practices to implement leading ehealth solutions aligned with the NEHTA PCEHR initiative.

 People:
User resistance. Process:

Management:

Time
Budget Resources Top Management support Change management Continuity of existing level of service quality.

Optimized reorganization of business

processes.

Technology:

Compliance with existing ICT

infrastructure.

Whole strategy based on

assumptions.

Interoperability to external systems.

Security:
Secure information sharing. Compliance with security policies and
guidelines

Source: empirica, Pilot on eHealth Indicators, 2007

*
* First drawn up in 1996 by the Ministry of Social Affairs and Health. * Principle of citizen-centered, seamless service structures * Horizontal integration of services (Social, Primary and Secondary care) * Updated in 1998, Placing emphasis on Interoperability between legacy
systems, supported by a high level of security and privacy protection

* Personal Data Act (523/1999) and (811/2000)

Source: Electronic Patient Record in Finland. Report 1/2009 National Institute of Health and Welfare

*
* In those hospital districts which had entered the clinical phase of regional
data exchange systems, five different types could be identified:

* The master patient index model, or "Fiale/Navitas system" used in 8 hospital

districts

* The Web distribution model or "Municipal ESKO" used in 4 hospital districts * Regional sharing of electronic patient data or "Regional Effica system" used
in eight hospital districts

* Mixed model of patient data sharing or "Kainuu Model" was used in one
hospital districts

* Regional sharing of data from different patient record systems or "KeskiSuomi Model" used in one districts
Source: Electronic Patient Record in Finland. Report 1/2009 National Institute of Health and Welfare

*
* 3 main services, ePrescription, eArchive and eAccess (for patients) * ePrescription provides medication summary and enables a fully electronic
process

* eArchive
Centralised active and real-time datastore (+ legal archive) Allows sharing of data between healthcare providers securely and with patient consent

* Focus on standards based solutions and interoperability (HL7 CDA R2) * Original data in national services, trusted source of information * eAccess, citizen can view their own prescriptions and electronic records * National services are accessed through existing systems -> implement
standards in local systems

Source: Seen as, Jari Porrasmaa, Senior advisor, Ministry of Social Affairs and Health, Finland 2010

Source: National Health Archive, Finland www.kanta.fi

Source: Electronic Patient Record in Finland. Report 1/2009 National Institute of Health and Welfare

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* National guidelines for safeguarding of data * Informed consent-secure archiving * e-signature- identification of patients, documents * Professionals and organizations by ISO/OID-standard * PKI architecture-Legislation on the eArchive (Act 159/2007) and the
ePrescription system (Act 61/2007)

*
Management of informed consent

e-signature Used in EpSOS Smart Card (First the technology was used similar to Bank cards, later it was changed) User name and password
Source: Electronic Patient Record in Finland. Report 1/2009 National Institute of Health and Welfare

Electronic identification of health care professionals

*
* In terms of communication and security, Finland has chosen to adopt
international standards, such as:

* HL7: Base communication standard that uses XML as a basis for transfer of
patient information between health care organizations.

* and DICOM: For digital imaging standard

* In Information Security Management they have used ISO 17799 (based on
the BS7799)

*
* Professional education and training

* Computer skills of health care personnel

* Need for ICT training

*
Strengths Cost savings Independent from distances Weaknesses Seems not to be a tool for specialized health care because of the role in care chain Doesnt fit well for multi-problematic patients More intensive and longer therapies Equality of achieving services Opportunities
Widening the service to outlying sites

Shortage of resources for speech therapy Information can be lost because of lacking tactile contact Threats
Failure of technology Danger of hacking Quality of picture and voice transmission Risk that the service supplants f2f contacts

*
epSOS is the next step towards an integrated european healthcare information system
Seamless healthcare services in Europe

Vision

Problem

Separated national healthcare infrastructures No information exchange between countries

epSOS connects national infrastructures Solution epSOS enables information exchange between national information systems

*
Patient summary

Access to important medical data for the further treatment of patients

ePrescription

* Cross-border use of electronic

prescription services

The epSOS system relies on a service oriented architecture

NCP: the main component

epSOS Services connect NCPs with each other

Individual national services connect NCPs with national infrastructures

Subcomponents of NCPs handle:

Security
Data transformation Data discovery Auditing

epSOS succeded in laying the foundations for seamless european healthcare services by enabling cross-border information exchange
Achievements
Data security using different OS and protocols Information exchange Patient Summaries ePrescriptions

Semantic transformation Concept for the integration of heterogenous systems

Future Challenges

Dissemination of epSOS
Legal issues Lack of national infrastructures

*
* Better to take small steps instead of giant leaps * Changing existing systems is slow, long term planning and together with
clear vision is necessary

* Enterprise Architecture and measuring must be used to guide development * Security measures need to be taken along with the advancement of the
technology.
Technology and eHealth are only tools, real changes can be obtained by effcient users.