The eHealth Development Framework - eHDF -

1. The eHealth Development Framework- eHDF - Zlatan Šabić, Ph.D.The World Bank Astana Economic Forum, May 22, 2014

2. Information technology (IT) for health • Information technology is essential tool for supporting daily work of health care providers • Source of data generated for evidence based policy making • It is the backbone of health systems reforms “The opportunity is truly unprecedented. Like no time in history, we have today both the knowledge and the technology necessary to transform the medical practice. And that transformation is underway. Many barriers remain and the challenges are substantial, but he pace of change over the past five years has been remarkable.” Leavitt and Kilo, “Medical Practice Transformation with Information Technology”

3. Key Strategic Considerations* The process of getting there needs to be clear - approach, tasks to be done, resources/efforts and timeline for the solution(s) implementation. We are not implementing the IT based systems just to be “modern” and “computerized”. As that requires efforts and time, we must understand the value that will be gained. What capacity (capabilities and resources) will be needed to move through the process, to implement and to use the designed solution in order to gain value? To get value, specific products need to be deployed. Just a good idea does not necessarily produces value. Wrong design can reduce the gained value; sometimes make even more damage than improvements. * The VDPC framework was developed with support of the Fulbright Program and The World Bank, see: Sabic, and Zaimovic, “Doing IT Right! - A Guideline for Better Utilization of the IT in Human Development Projects”, The World Bank, 2012.

4. …but, sometimes over-simplified We can do it before next elections! Buy IT! No problem – we have few good IT persons in the ministry. We will implement the “health information system”.

5. It’s not that simple. Why?Answer is trivial – because it’s complicated. Millions of Lines Of Code (MLOC)* • Space Shuttle – 0.4 MLOC • Photoshop CS6 – 5 MLOC • Boeing 787 – 14 MLOC • healthcare.gov – 500 MLOC Chrysler Building – 3.8 millions of bricks** * REF: http://www.informationisbeautiful.net/visualizations/million-lines-of-code/ ** REF: http://en.wikipedia.org/wiki/Chrysler_Building

6. Do we have the same expectations when it comes to “(health) skyscraper development”? For years, it’s underground, we see nothing, and then skyrockets We cannot wait several years to see results?* * REF: "Concept for E-health Development for 2013–2020" , Government of Kazakhstan

7. We need to manage our expectations and set up good foundation for eHealth development Out of many important aspects of the VDPC framework, we would like to emphasize only one here: On national level, the progress is slow, non-coordinated and non-efficient without an eHealth Development Framework that provides regulated and stimulating environment for development of eHealth, and which is agreed on national level. Sounds simple, but many countries still do not have it

8. eHealth Development Framework (eHDF)- separation of governance, implementation and operations - Policy making eHealth Regulation and Standardization Governance & Regulation Information Analytics & Management • Main implementation body: • - Information Analytics & Mgmt. • - Coordination of Implementation • - Data Quality Mgmt. • Support to implementation • Support to operations Health Facility/Institution Implementation Management & Quality Mgmt. Health Facility/Institution Regulatory Framework Implementation Support Business processes IT Industry - Solutions

9. eHealth Development Framework (eHDF)- separation of governance, implementation and operations - Policy making eHealth Regulation and Standardization Governance & Regulation Information Analytics & Management • Main implementation body: • - Information Analytics & Mgmt. • - Coordination of Implementation • - Data Quality Mgmt. • Support to implementation • Support to operations Health Facility/Institution Implementation Management & Quality Mgmt. Health Facility/Institution Regulatory Framework Implementation Support Business processes IT Industry - Solutions

10. eHealth Development Framework (eHDF)- separation of governance, implementation and operations - Policy making eHealth Regulation and Standardization Governance & Regulation Information Analytics & Management • Main implementation body: • - Information Analytics & Mgmt. • - Coordination of Implementation • - Data Quality Mgmt. • Support to implementation • Support to operations Health Facility/Institution Implementation Management & Quality Mgmt. Health Facility/Institution Regulatory Framework Implementation Support Business processes IT Industry - Solutions

11. eHealth Development Framework (eHDF)- separation of governance, implementation and operations - Policy making eHealth Regulation and Standardization Governance & Regulation Information Analytics & Management • Main implementation body: • - Information Analytics & Mgmt. • - Coordination of Implementation • - Data Quality Mgmt. • Support to implementation • Support to operations Health Facility/Institution Implementation Management & Quality Mgmt. Health Facility/Institution Regulatory Framework Implementation Support Business processes IT Industry - Solutions

12. eHealth Development Framework (eHDF)- separation of governance, implementation and operations - Policy making eHealth Regulation and Standardization Governance & Regulation Information Analytics & Management • Main implementation body: • - Information Analytics & Mgmt. • - Coordination of Implementation • - Data Quality Mgmt. • Support to implementation • Support to operations Health Facility/Institution Implementation Management & Quality Mgmt. Health Facility/Institution Regulatory Framework Implementation Support Business processes IT Industry - Solutions

13. eHDF – “let’s agree who does what and how”Sounds simple and reasonable, but many countries do not have it Few examples from region • Serbia – a lot of work done (more than 80% primary health care, more than 20 hospitals, …), but development stalled because there is no agreed and sustainable eHDF • Ukraine – huge potential in last 10 years, very little done because there was no agreed eHDF (now - ???) • Bosnia and Herzegovina – not much done – there is no agreed eHDF • Croatia, Montenegro – successful, there is a clear eHDF • Kazakhstan – there is clear eHDF, the progress is already visible

14. Kazakhstan eHDF • Policy making – The eHealthDepartment in the Ministry of Health • Standards – Technical Committee for eHealth Standardization • Data Analytics - Department for Statistics and Department for Medical Data Analyses, within the Republican Center for eHealth • Implementation Management – Department for Health informatics, within the Republican Center for eHealth • Implementation model – IT governance monopoly to be gradually transformed to liberalized market • Financing models – central with gradual transformation to distributed • …

15. eHealth Development Frameworkthe goal is not to find “silver bullet”, but to create regulated and stimulating environment for the organized and regulated eHealth development. • There are many critical success factors for the eHealthimplementation and utilization in Kazakhstan • The agreed eHealth Development Framework may prove to be the most important one – it’s already visible (one floor above ground level)

16. The eHealth Development Framework- eHDF - Zlatan Šabić, Ph.D.The World Bank Astana Economic Forum, May 22, 2014