III Edició "The British Experience in Technologies for Health". Hospital de Sant Pau, Barcelona. 9 de novembre de 2011. Esdeveniment organitzat per la Fundació TICSalut i el Departament de Comerç i Inversions del Consolat General Britànic a Barcelona, UK Trade & Investment, per posar en contacte oportunitats i coneixements entre el Regne Unit i Catalunya.

5. Budget pressures everywhere ... CANADA: From 2012–13 to 2017–18, the Ontario government will attempt to hold health-care spending increases to just 3 per cent per year. Over the last five years, health-care spending has risen by an annual average of 6.5 per cent. (March 2010) German Health Care Spending Cut, Fees Raised (July 2010) DANISH healthcare spending cuts (June 2010) ITALY: EUR24bn Austerity Package Contains Healthcare Spending Cuts (June 2010) SPAIN’s budget for healthcare has been decreased by 2.8 billion euros through a 19 billion dollar austerity plan. (WHO, June 2010)

6. We know there is a great deal of variation 6 fold variance of your chances of surviving an aneurism across London 4 fold variance of your chances of surviving a stroke across London 10 fold variance of your chances of surviving a heart attack across London Despite 15 years of evidence based standardisation there is still wide variation in outcomes across the NHS Data 2005/06

7. Outcome against cost of intensive care No evidence that shows spending more creates better outcomes or spending less creates worse outcomes Data 2005/06

8. Relationship between quality of care and Medicare spending, by US State, 2004 Composite measurement of quality of care 100 = maximum Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality The evidence does not indicate that higher Medicare spending is associated with better care for Medicare beneficiaries. In fact, it suggests the opposite: After adjusting for other factors, areas with higher Medicare spending tend to score substantially worse on a composite indicator of the quality of care provided to Medicare beneficiaries

9. Cost Effectiveness of Evidence-Based Treatment Guidelines for the Treatment of Non–Small-Cell Lung Cancer in the Community Setting 12-month cumulative cost by Pathway status. Neubauer M A et al. JOP 2010;6:12-18 ©2010 by American Society of Clinical Oncology

10. Reducing cost through the use of evidence “ Finish medical school and residency knowing everything…read and retain 2 articles every single night…at the end of 1 year you’re only 1,225 years behind.” W Stead. JAMIA 2005;12:113-20 Alper BS, Hand JA, Elliott SG, et al. J Med Lib Assoc 2004;92:429-37

12. How to drive cost reduction Make the institutions more productive Make the system more productive

13. Driving cost reduction by being better

14. Integrating The UK Health System

15. Reducing costs system-wide (Spain)

16. Rural Hospital Clinic Local Hospital Satellite Campus Pharmacy Rehab Surgery Imaging Center Nursing Home Government Physician Office Laboratory Healthcare System/Hospital (main campus) HUB AND SPOKE CONNECTIVITY MODEL

17. eHealth Path

18. Reducing cost through process efficiency Managing discharge to reduce readmissions Managing nurse time effectively Automated infusion management Integrated information availability

19. Readmission Risk Algorithm: Daily assessment

21. Engaging the patient in managing their own health

23. Finally – Redesign to improve the service Computerisation of poor process solves nothing