ITU Workshop on
“E-health services in low-resource settings:
Requirements and ITU role”
(Tokyo, Japan, 4-5 February 2013)
Abu Dhabi Weqaya Programme Tackling NCDs:
Application to Low and Middle Income Health Markets
Reehan Sheikh
Technology Strategist
Platform Health
reehan.sheikh@opensecurehealth.com
Tokyo, Japan, 4-5 February 2013
Abu Dhabi has been ideal market for innovation in
health data
2.1m lives: “Big enough to matter,
small enough to manage…”
Highly strategic government with
broad-based popular trust
Extreme pace and depth of socioeconomic development – very
high burden of NCDs
Plural and diverse payers and
providers
Relatively well-resourced health
system enabling innovation
Tokyo, Japan, 4-5 February 2013
2
Abu Dhabi’s greatest health challenge
Implementing the Dubai declaration
GCC Council of Ministers
#
Objective
1 Na tiona l pol i ci es , prevention a nd trea tment
Yes , di rect
2 Hea l th a wa renes s
Yes , di rect
3 Promoting a hea l thy l i fes tyl e
Yes , di rect
4 Women, pregna nt women a nd chi l dren
Pendi ng
5
UAE: World’s 2nd
highest prevalence
of diabetes
Relevance
Empoweri ng pa tients a nd promoting di a l ogue
wi th ca re provi ders
Yes , di rect
6 Stoppi ng di s cri mi na tion
Indi rect
7 Res ea rch a nd s tudi es
Yes , di rect
8
Moni tori ng s ys tems a nd moni tori ng hea l th a nd
Yes , di rect
economi c burden
Addresses at least six of the eight
objectives
Tokyo, Japan, 4-5 February 2013
3
Modeling suggests rapid cost increase
Direct healthcare cost
Predicted costs of UAE National
diabetes treatment, AED
Societal cost
Tokyo, Japan, 4-5 February 2013
4
Delivering model at scale: Overview of Weqaya
Approach
1
PLAN
SCREEN
ACT
Screen
Screen individuals iteratively
97% adult Emiratis screened (>190,000)
Plan
Clinical Standards, website/call centre
Act
Clinical care, targeted lifestyle
behaviour change (diet, physical
exercise, tobacco)
Interventions
2
Population
Group
Individual
Population
•Standard clinical care
•Nutrition (trans-fats, food labeling)
•Physical activity (gyms, AD UPC)
•Tobacco control
Group
•Workplaces and schools
•Local communities, families
•Segments: Disease groups e.g. diabetics
Individual
•Clinical care
•Encourage: Weqaya reports
•Enable: Website/call centre
Tokyo, Japan, 4-5 February 2013
5
An individual score and customized call to action
Principles of data feedback
Patients should have access to
their own health data:
- Personal Health Record (secure
paper mail-out)
- Electronic Health Record
(www.weqaya.ae)
- Smart Portable Health Record
(Weqaya Data Architecture)
Tokyo, Japan, 4-5 February 2013
6
Pay for Quality and Pay for Health
Pay for
Quality
Pay for
Health
• Based on compliance with evidence-based care pathways and
clinical quality indicators
• Mechanism set-out in Standard Contract (between Healthcare
Facilities and Health Insurers)
• Expectation it will affect base payment by <10%
• “Compliance with high quality care receives a bonus”
• Based on individual health status
• Health initially defined as 10-year risk of cardiovascular event (heart
attack or stroke)
• Contract between individual and Disease Management Programme
• AED1,000 per 1% reduction in risk to maximum of AED5,000 (5%)
• “No health improvement – no money”
7
In AD eHealth systems are a platform for health
Everyone can know their numbers…
… and the numbers can change health outcomes
% engaged with
care*
% with HbA1c
<7.5%
% with LDL:HDL
ratio <3.5
MAM J J A S OND J F MAM J J A S OND J F
2008
2009
Tokyo, Japan, 4-5 February 2013
2010
8
Two domains of Weqaya action
Healthcare Sector
•
•
•
•
Clinical care standards
Patient empowerment
Customer-centred services
Research and Innovation
Health Guardians
•
•
•
•
•
•
Nutrition
Physical activity
Tobacco control
Alcohol control
Employers and schools
Urban Planning
9
We set clear targets based on global evidence
Annual
Weqaya
targets
Type
Objective
Baseline
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2030
Input
Screening
94%
50%
90%
100%
50%
90%
100%
50%
90%
100%
100%
100%
Programme engagement*
6%
30%
50%
60%
75%
75%
75%
75%
75%
75%
75%
75%
% obesity
35%
35%
36%
36%
35%
34%
33%
33%
32%
31%
28%
26%
% Weqaya population with pre-diabetes 26%
26%
26%
26%
26%
26%
25%
25%
25%
24%
24%
23%
% Weqaya population with diabetes
18%
19%
20%
20%
21%
21%
20%
19%
19%
18%
18%
15%
% diabetes with HbA1c <7%
15%
25%
40%
50%
60%
70%
75%
75%
75%
75%
75%
75%
% smoking
11%
12%
12%
11%
11%
10%
10%
9%
9%
9%
8%
6%
0%
1%
2%
5%
8%
12%
15%
18%
20%
24%
30%
80%
Process
Reduction in predicted incident
Output
cardiovascular mortality
* Weqaya account activation and/or % eligible population engaged with DMP
Target risk
reduction
Tokyo, Japan, 4-5 February 2013
10
Screening: Adaptations for medium and low income
countries
Per person cost
Data variable
Memberid
Gender
Age
LDL cholesterol
HDL cholesterol
Random glucose
HbA1c
Systolic BP
Diastolic BP
Height
weight
Waist circumference
Hip circumference
History of diabetes
History of high blood
History of high cholesterol
History of heart attack or
History of stroke or other
circulatory disorder
On medical treatment for
On medical treatment for
high blood pressure
On medical treatment for
high cholesterol
Family history of premature
heart attack or stroke
Smoking
Smoking per day
Smoking duration
Facility of screening
Comment
Daman member id
Male / female
dd/mm/yyyy format
mmol/l
mmol/l
mmol/l
%
mmHg
mmHg
cm
cm
cm
cm
Yes / no
Yes / no
Yes / no
Yes / no
Yes / no
Adaptation
$1
• Non-clinical staff
• Train the trainer
• SMS-based reporting
$2
• Clinical/para-clinical staff
• Train the trainer
• SMS-based reporting
Yes / no
Yes / no
Yes / no
Yes / no
$15
• Personal Health Record
Yes / no
Number
years
Name and code
Tokyo, Japan, 4-5 February 2013
11
Data Exchange in low and medium income
countries
A
B
C
Data capture (mobile device)
Standardised data
Data store
•Unique identifier (patient,
clinician, etc.)
•(Simplified) diagnosis,
treatment provided,
outcome, etc.
•Kilobyte range
(works with 2G
mobile phone)
•Donors
•Clinicians
•Programme
managers
•Academia
•WHO
•UN – Development
Goals (MDGs)
Option to create “central health
philanthropy bank” to administrate
12
Range of data systems enable secure ubiquity
Measuring
health
Taking health
promoting
action
• Opt-out screening
• Opt-in data sharing
• Ubiquitous Weqaya
Programme
• Point of decision
prompts (e.g.
Weqaya label on
healthy food)
• At home monitoring
• Secure data
sharing
Standardized and Centralized Health Data
1
2
4
14
Health & Wellness data can
be capture in the field using
basic mobile technologies
All Health & Wellness
information is saved centrally
for population and individual
level analysis
Personal health/wellness tracking and
intervention can be tied to clinical
information allowing a view into
effectiveness of intervention and
patient behaviour change
3
5
Healthcare workers can
immediately access data
captured in the field and
begin a two-way dialog
In healthcare facilities, providers
can get a full view of the patient
Thank You
Questions?
Reehan Sheikh
Platform Health
reehan.sheikh@opensecurehealth.com
www.opensecurehealth.com