Technology & innovation in health information systems - a lever for health system strengthening? Peter Stephens, MA, PhD

Financial Sustainability Technology enables the application of new research methodologies and reduces financial risk….efficiently Clinical Excellence Financial Sustainability Strong Health System Technology as a lever Study power Advanced methods Concurrent, varied studies Technology as a lever Depth of analysis Complexity of analysis Financial risk reduction

2,880 per hospital episodes over 3 years Clinical Excellence Technology as a lever Use of antipsychotics in dementia Finding undiagnosed patients with HCV (200 million records) Precision (% identified correctly) Sensitivity (% identified incorrectly) Logistic Regression Random Forest Gradient Boosting Trees Ensemble via GBT New techniques 49 times more effective at identification Audit 40 per hospital consecutive patients Technology 2,880 per hospital episodes over 3 years Sample is 72 times as large Stephens P (IQVIA) et al: European Geriatric Medicine, 2014 Doyle O (IQVIA) et al: Pharmaceutical Management Science Association, 2018

3 26 250 Provider Focus Payor Focus Provider & Payor Focus Technology as a lever Financial Sustainability Dubai Health Insurance (IQVIA) PLICS systems promote payor and provider co-operation 4.5 million members 2800+ providers 70+ payors 12280+ insurance products 27.4 million electronic claims 250 transactions per second 3 seconds to approve 26 million combination checks Fixed cost to fee ratio e.g. 10% + Provider Focus Relative Value Weights (e.g. Medicare) Payor Focus Activity Based Costing (Patient Level Based Costing Systems) Provider & Payor Focus Reduces payor and provider financial risk IQVIA is largest PLICS supplier to NHS in UK with installations across Middle East

Strong Health System Technology as a lever Needs human expertise At an Institutional level Incomplete recording Under-utilisation Cost allocation differences Under and over resourcing of centres At a design level Cost pooling design (failing to take account of case-mix) But NHS RCI varies by almost two-fold IQVIA cost analysis of HD centres, 2018

Questions Peter Stephens, MA, PhD