1 What IHE Delivers

Business models - sustainability

IHE Australia Worhshop – July 2011Peter MacIsaac & Paul Clarke

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Blair Butterfield – eHealth Initiative

18/07/2011 3Blair Butterfield – eHealth Initiative

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Connecting standards to reality and care delivery

Care providers, authorities and IT professionals work with solutions developers to coordinate the implementation of standards to meet their needs Care providers identify the key interoperability problems

they face Drive industry to develop and make available standards-

based solutions Implementers follow common guidelines in purchasing

and integrating systems that deliver these solutions

More than 300 IHE members/stakeholders work togetherin an open and transparent way to advance practical interoperability

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Community orsub-network

Clinical Encounter

Clinical IT System

Sharing System

Clinic Record Specialist Record

Hospital Record

Sharing Records: simple but powerful: IHE-XDS

1-Referenceto records

Repository ofDocuments

Repository ofDocuments

Index of patients records

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Community orsub-network

Clinical Encounter

Clinical IT System

Aggregate Patient Info

4-Patient data presented to

Physician

Sharing System

Clinic Record Specialist Record

Hospital Record

2-Referenceto Records for Inquiry

Point-to-Point plus Search : IHE-XDS

3-RecordsReturned

1-Referenceto records

Repository ofDocuments

Repository ofDocuments

Index of patients records

What IHE Delivers

Information Sharing- Business Approach and Options (1)

• Adopt a collaborative partner model- Governance model- RHIO or other legal entity collaborative- Amortise operational costs across participant services- Capital funding / equity arrangements- Cooperative model to manage infrastructure and service

provision- Partners may include key vendor and/ or service provider

organisations ( eg. Hosted services providers)- Contractual framework and service level agreements

JamPac Health Informatics Consulting

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What IHE Delivers

Information Sharing - Business Approach and Options (2)

• Focus on achieving “regional” sustainability- Consider provider / user demography and geography

when defining the “region” to be serviced – need to consider ALL boundaries, constraints, critical mass of users required, existing services and provider / user needs

- Baseline modelling of uptake by users (providers / consumers) should be conservative over a 3-5 year period

- Incentive to increase / accelerate uptake / connectivity to services (beyond the baseline model) – decrease service provision costs and potentially subscription or transactional fee costs to providers

- Determine the critical number of users required to provide sufficient revenue generation to enable self-sustainable operations to be achieved in a short (but realistic) timeframe

JamPac Health Informatics Consulting

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What IHE Delivers

Information Sharing - Business Approach and Options (3A)

• Fully consider Business model requirements and constraints- Need to establish business case for investment by partners- Capital cost requirements – partner funding /equity

model, external funding sources- Partner equity considerations – benefits flow, contribution

to solution and services provision, capacity of business to make the investment

- Not-for-profit or commercial business model ?- Benefits flow to participant providers / users - quantum

and timing is important- Provider / user Subscription Vs transactional fee based

model – consider capacity to pay, business value and benefits flow

- Staged, incremental implementation of services / functionality Vs “big bang” approach – risks / benefitsJamPac

Health Informatics Consulting

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What IHE Delivers

Information Sharing - Business Approach and Options (3B)

• Fully consider Business model requirements and constraints - Incremental adoption curve – differential curves for specific user

types based on ability to access the services, impact on user workflows, benefits, capacity to pay (e.g. is there a need to discount subscription / transactional fees over an initial or longer term period to increase adoption rate) implementation roll-out timeframe

- Minimise changes required to user applications and ensure information sharing services support rather than require significant redesign of user business processes where possible

- ROI will require achieving a critical mass for adoption of services in as short (but realistic) as possible timeframe – short-term discounting of service fees may be an option but will require monitoring and review to assess impacts

- Some Partner organisations may conceivably be (or represent) providers or users – hence benefits / equity / cost considerations may become more complexJamPac

Health Informatics Consulting

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What IHE Delivers

Information Sharing - Business Approach and Options (4)

• Maximise opportunities to enhance stakeholder benefits and minimise costs- Look at opportunities to extend or enhance the scope of

services to achieve economy of scale- Can regional coverage be extended to increase the number of

connected users ?- Consult with users to determine the business and functional

requirements for the proposed services – identify the critical (must have), expected (baseline functionality) requirements and look at benefits of staging incremental service delivery functionality to meet differential user requirements (i.e. not all users require the same functions at the same time) – delivery of enhanced functional scope of services over time

- Information sharing must support business workflow and care delivery processes – adoption will be impacted if information sharing greatly impacts on existing processes – need to consult widely with all users / stakeholders

JamPac Health Informatics Consulting

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What IHE Delivers

Information Sharing - Business Approach and Options (5)

• Performance based hosted technology services model to minimise service delivery costs- Hosted services model avoids capital investment in

technology infrastructure (with a high obsolescence factor, significant maintenance requirements, and minimal asset value after 2 years)

- Adopt a performance based contractual agreement with a selected technology partner(s) over a fixed 3-5 period to underpin system performance and enable technology and support costs to be capped across the contractual period (and tied to performance guarantees)

JamPac Health Informatics Consulting

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What IHE Delivers

Information Sharing - Business Approach and Options (6)

• Standards based interoperability approach to reduce technology obsolescence and maximise information sharing capabilities- Adopt standards based IHE interoperability approach- Impact of standards adoptions on provider / user systems

(e.g. changes required to user systems) and workflows needs to be fully assessed and addressed

- Consider cross-community information sharing requirements (e.g. between RHIOs using IHE XDS or XCA protocols)

JamPac Health Informatics Consulting

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16 What IHE Delivers