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