I was asked by the US Commerce department to attend and present at a roundtable that took place in Sofia, Bulgaria on February 27th. This roundtable included people from president's office, National Healthcare Fund, Patient Groups and key vendors. Bulgaria had many efforts to kickstart eHealth. This was an overview of US legislation and lessons learned as well as a look forward into healthcare innovation trendds

1. Wiring Healthcare
eHealth for Bulgaria
Eugene Borukhovich
Chief Executive Officer
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2. Agenda
•What is eHealth?
•Wiring Healthcare: A bit of history
•Wiring Healthcare: Lessons Learned (so far)
•Health Innovation Trends
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3. What is eHealth?
• Lack of clear and precise definition
• Set of disparate concepts, including health, technology and communication
•Meaning varies with context in which the term is used
•Meant to enhance the quality, improve access to health care services at
lower costs and strengthen healthcare systems as a whole
#digitizing #collaborating
#connecting
#personalizing
#empowering
#improving
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4. Wired Healthcare
Source: An Overview of eHealth Initiatives -Strategies and Lessons from Around the
World by GE Healthcare IT (2011)
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5. eHealth ecosystem
Source: An Overview of eHealth Initiatives -Strategies and Lessons from Around the
World by GE Healthcare IT (2011)
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6. Wiring Healthcare: US government initiatives
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7. Meaningful Use: Three stage implementation
Source: www.ehealthdc.org
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8. Meaningful Use: Impact
• As of 2012,Use Stage 1 Corephysicians adopted EHR technology capable of meeting twelve
Meaningful
half or more of
objectives
Source: “Physician Adoption of Electronic Health Record Technology to Meet Meaningful Use Objectives: 2009-
2012,” Health and Human Services Dept. Office of the National Coordinator for Health Information Technology,
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9. Open Health Data: United States
Health Data Initiative (HDI)
Launched in 2010 by the Institute of Medicine (IOM) and the U.S. Department of Health and
Human Services (HHS)
HDI is a public-private collaboration that encourages innovators and entrepreneurs to utilize
HHS data to help improve health and health care
A growing inventory of public health data resources easily available and accessible at a
central location: HealthData.gov
Includes clinical care provider quality information, nationwide health service provider
directories, databases of the latest medical and scientific knowledge, consumer product
data, community health performance information, government spending data and much
more
In addition to publishing and promoting the availability of health data, HDI is preparing the
data for use by developers while protecting privacy and confidentiality
HDI is seeking to identify, encourage and accelerate the meaningful uses of the published
data by organizing forums, public competitions or hackathons
Policy Developments Support Openness
The Affordable Care Act, signed by President Obama in 2010, authorized HHS to release
new data sources
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10. Beacon Community Cooperative Agreement Program
•$250 million over three years to 17 selected communitiesand Innovation
progress in Beacon Pursuits linking Health IT, Improvement,
that make
• In 2012,Michigan and Greater Cincinnati – launched an innovative mobile
Southeast
three Beacon communities - Crescent City (New Orleans),
health application for individuals at risk of developing Type 2 diabetes
•"txt4health" campaigns aim to support patients with:
• Assessing their diabetes risk levels
• Engaging in and managing their health
• Accessing resources on wellness and diabetes care
• Part of a broad effort to leverage mobile health technology to empower self-
management of chronic disease
•In Prevention, the Office of theDiabetes Association, the Health IT for Disease Control
and
cooperation with American
National Coordinator for
Centers
and Voxiva (a 10

11. Health IT: Progress mixed and savings elusive
•could save the U.S. more than in 2005 that rapid adoption of Health
IT
RAND Corporation estimated
$81 billion/year
• According tocost-saving promise of Health IT has not been
investments the
a 2013 RAND Corporation study, despite wide
reached
•According to the same study, empirical data on the Health IT’s
impact on health care efficiency and safety are mixed, and annual
health care expenditures in the U.S. have grown by $800 billion
• The study attributes poor HIT performance to:
• Sluggish adoption of Health IT systems
• Systems that are neither interoperable nor easy to use
• Failure of health care providers and institutions to reengineer
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12. Health IT: Lessons Learned
• Health IT adoption is critical but not adequate alone to improve healthcare
• Need for a broad-based use of EHRs and robust health information
exchange (HIE)
• Ensuring EHRs integration and interoperability identified as a key to maximizing their benefits
• Need for coordination and monitoring of the regional connectivity across providers
• Implementation of safety and privacy framework
• Building the necessary infrastructure is a first step, yet there are many social,
economic, and cultural barriers to overcome
• Workflow changes need effort and determination to succeed
• Incentives measures can encourage Health IT adoption among providers
• Timely implementation and achievement of full benefits require training and education
• Need for engagement, collaboration and clear communication across all levels
•Health IT is an investment in health and health care
• Need for commitment to transparency
• Quality metrics have shown to be challenging to meet, yet should not be discouraged
• Emphasis on accuracy of measuring and monitoring of outcomes
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13. Recommendations
•Do not make this initiative a health IT project
•Engage all stakeholders form the beginning, including patients!
•Focus on foundational components
•Focus on driving standard for information exchange (ex. HL7)
•Ensure security, integration and interoperability of the systems
•Encourage national and international cooperation
•Track, compensate and communicate efforts
•Health IT adoption is not a race it’s a marathon
•Start with OPEN first 13

14. Health Innovation Trends
eHealth for Bulgaria
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15. Health Innovation Trends
•Social discovery
•Self-diagnosis
•Telemedicine
•Personalized medicine
•Quantified Self
•Remote health monitoring
•Data analytics and clinical decision support (CDS)
•Appscriptions
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16. Health Innovation Trends
•Social discovery - to facilitate social learning, self-management
and improved decision making
• Online platforms such as CureTogether and PatientsLikeMe allow people to
compare their symptoms with each other and share advice about treatments
and medical providers
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17. Health Innovation Trends
•Self-diagnosishealth
patients in their
- to enable self-tracking and engagement of
• iTriage help people to evaluate their symptoms, learn about possible causes and
seek appropriate and close-by care
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18. Health Innovation Trends
•Telemedicine - to extend the reach and accessibility of health care
• American Well Online Care enables patients to conduct real-time video visits with
their care providers
• Hello Health provides the EHR Patient Management platform for primary care
professionals that allow them simplify their businesses and increase patients’
engagement and convenience
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19. Health Innovation Trends
•Personalized medicine – to transform and improve disease
prevention and treatment
• 23AndMe – provides genetic testing for over 100 traits and diseases as well as
DNA ancestry
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20. Health Innovation Trends
•Quantified self – to enable self-tracking and incorporate healthy
habits into life
• Fitbit offers wide range of sensors and devices to motivate users to stay active,
live better and reach their healthy goals
• Basis is a wirst-based health tracker and online personal dashboard that enable
users to capture heart rate patterns, motion, perspiration and skin temperature to
improve their sleep, diet and exercise
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21. Health Innovation Trends
•Remote health monitoring – to enable self-tracking and disease
management
• iBGStar is a blood glucose meter that connects to the Apple devices allowing
patients to view and analyze “real time” information
• Approved by FDA, AliveCor's Heart Monitor allows patients and care providers to
record, display, store, and transfer single-channel ECG rhythms
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22. Health Innovation Trends
•Data analytics and clinical decision support (CDS) - harnesses real-
time medical data to generate fact-based diagnostic and
therapeutic decisions
• “ Outcomes-based reimbursement is the future of the heath industry. To improve
patient outcomes, proactively identify chronic and high-risk patients in this new
environment, and effectively manage their financial performance, healthcare
organizations must be able to provide analytics at the point of service and rely
on historical and longitudinal data to manage patient populations.“ Health
Research Institute: PwC, February, 2012
• Archimedes IndiGO is a Clinical decision support system that offers individualized
guidelines and outcomes
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23. Health Innovation Trends: mHealth
•Appscriptions – to enable self-management, improve compliance
and allow remote monitoring
• Digital ‘medicines’ prescribed as part of a course of treatment
• Happtique is a mobile app store for healthcare professionals that offers an
electronic prescription app mRx which enables providers to prescribe, track and
remind use of apps assigned to their patients
• Approved by FDA, Proteus Digital Health offers an ingestible medicine
compliance tracking sensor
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24. Questions?
Eugene Borukhovich
Chief Executive Officer
@HealthEugene
http://icgbv.com
EugeneB@icgbv.com
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