Strategy

Report
eHealth Strategy
review
CEO conference
4 May 2011
Agenda
• Introduction
• McKinsey eHealth maturity diagnostic
• HAAD’s perspective
• General Discussion
• Moving forward
1
Objective for today
Review and recommit to
strategic direction + road map
for eHealth in Abu Dhabi
2
What is eHealth?
eHealth is anything electronic
that we find useful in healthcare
3
What is (relatively) easy to achieve?
•Technology
already
implemented
•Minimal
investment needed
Use existing assets and
processes differently
KEH
•Minimal clinician
Post Office
change required
Emirates ID card
4
Use existing assets+processes differently
You
• Exchange coded data
• Streamline internal
KEH
Eligibility
processes
Post Office
HAAD
• Collects data
• Uses data
• Shares data
Registration Emirates ID card
eRecord
Enrolment
EIDA
• Creates identity card
• Authenticates securely
• Shares person information
5
What Abu Dhabi’s CEOs voted for in 2009
6
What has HAAD regulated in terms of priorities
Achievements
Next steps
• Transactions defined by DSP • Healthcare entities to start…
eAuthorisation • HAAD infrastructure ready
• Users propose business rules
• Standard Contract requires it
ePrescription
eRecord
eLicensing
• Transactions defined by DSP
• PBM standard released
• Users propose business rules
• Payers to begin enforcing…
• Data available in KEH
• EIDA web service missing
• Access clarified by Access Panel • Providers submit claims late
• EIDCard MoU signed with EIDA
• Process automation under way • Based on feedback still a long
• PQR under review
way to go
• Privileging framework released
7
Detail PriorRequest  PriorAuthorization
Facility Request
Is Member active?
Is Facility in network?
Does network cover [elective]?
Is condition covered?
Authorization
Prescription
Facility submits
PriorRequest
MemberID+PayerID
FacilityID
EncounterType
Diagnosis
Activity
Observation
Payer submits
PriorAuth`n
Response
[Comment]
8
Technical Detail ePrescribing
Doctor*
Post
PriorRequest
Office
Prescription
Payer
PriorAuthorization
Prescription
Pharmacy
ClaimSubmission
RemittanceAdvice
*Can also be the Pharmacy, if the Doctor did not him/herself e-Prescribe
9
Technical Detail: Authentication with EmiratesIDCard
Device
/
driver
Authenticate
ADSIC
Authentication
Log
Submit claim
Providers
Payers
HAAD
Audit
authentication
event
Remit claim
10
What Abu Dhabi’s CEOs voted for in 2009
Significant regulatory
progress
Public Cube + free HAAD software
www.weqaya.ae
Mandatory observations (e.g., HbA1c)
Provider rating system
www.haad.ae
www.haad.ae
CPT codes activated
11
Remaining regulatory road map
•EmiratesID card authentication
•Turnaround time
•Reconciliation
•Devices
•Explore interoperability of health record
12
Provocative thoughts
• Regulation “done”
(except EID card)
• Execution is key
• Capturing Benefits is
• Do you agree?
• Why?
• How can
HAAD help?
[too] slow*
* Providers: Who is still photocopying insurance cards?
Payers: Who auto-adjudicates <80% of claims?
13
I am comfortable with the strategic direction as set out in 2009
Voting in workshop
Disagree, 3%
Disagree completely, 3%
Neither Agree nor
Disagree, 3%
Agree completely, 10%
Agree strongly, 13%
Agree partially, 17%
Agree, 50%
Voting on 4 May by stakeholders – Payers, Providers, HAAD and Vendors
14
My biggest challenge in capturing value from eHealth is
0%
20% 40% 60% 80% 100%
Hospital >50 beds
Hospital <50 beds
Insurer >20’000 lives
Insurer <20’000 lives
Vendor
EmiratesID
Authentication/Technology
Internal operations
Complying with new HAAD
regulation
Waiting for others to
mature
Absence of HAAD
regulation
HAAD
Voting on 4 May by stakeholders – Payers, Providers, HAAD and Vendors
15
Next steps
•Focus regulatory efforts on ensuring the EmiratesIDCard can be used
HAAD
for healthcare as a top priority
•Limit brand-new regulations for a while, until the bulk of the changes
started have been digested
•Invest in further strengthening governance for making operational
tweaks to existing regulations
–Increase lead times, and pre-decision discussion (in general)
–Develop an orientation roadmap with indicative timelines for changes
–Apply any changes to all healthcare entities concurrently, to ensure a
level playing field (whenever possible)
•Review eHealth Strategy at least annually to maintain alignment
Stake- •Actively suggest and shape the detail of new eHealth regulations –
specific rules for the PriorRequest/PriorAuthorisation transaction set,
holders
and electronic prescribing in particular. (On the basis of strong content
suggestions from stakeholders, Andrey Timoshkin, Chair of the Data
Standards Panel, will invite for a workshop to develop the relevant
business rules)
16

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