Hospital of the future Irmtraut Gürkan Kaufmännische Direktorin German-Finnish Business and Research Forum 2013 Health Care und E-Health 12-16 June 2013 in Oulu Finland
AGENDA Heidelberg University Hospital a short overview Hospital volumes Data from different countries The German health care system - fundamental changes in the last years Strategies for more quality and efficiency in the future Examples from the Heidelberg University Hospital Closing remarks @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 2
Heidelberg University Hospital short overview 15 Clinics (45 divisions) 8 Institutes (13 divisions) organized in 8 departments 9.000 FTE (about 11.000 employees) 2.000 Beds for inpatients and daycare 65.000 Inpatients 53.000 Daycare patients 1.000.000 Outpatient visits 900 Mio Revenue @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 3
@ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 4
Ranking Medical Faculty At the list of the top 50 universities* of the world (2012) the Medical Faculty of Heidelberg is placed at position 1 in Germany 8 in Europe 36 worldwide we are working on the last two positions *QS World University Rankings by subject @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 5
Scope of the University Hospital High-end medical care for the Rhein-Neckar region Innovative and effective diagnosis and therapy for all complex diseases Modern buildings with state-of-the-art equipment and service for the patients Development of new forms of therapy and their quick implementation for the benefit of the patients Centers of competence in research and treatment on international level (selected areas of medical expertise) Oncology National Center of Tumor Diseases Heidelberg Cardio-vascular diseases Neurology and basic neuroscience (incl. psychiatry) Transplantation / immunology Infectious diseases @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 6
Managing Hospitals Volumes, OECD Germany 2011: 2,045 hospitals 502,000 beds Source: DKG Eckdaten I, 23.01.2013 @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 7
International comparison of health care expenses 2010 Total expenditure on health, % gross domestic product Public expenditure Private expenditure @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 8
Main problems in the health sector in Germany Access for everybody but without the right incentive for effective and patient oriented care One of the most expensive healthcare systems in the world Increasing expenses demographic development / an aging population new medical innovations and pharmaceutical drugs Over capacity (especially hospitals and beds) Less integration between the different health care service providers @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 9
Consequences for the whole health care system The need to change the system is recognised (by patients, politicians, providers) There is an increasing pressure to identify solutions that can enhance the health care delivery process A new generation of systems which are based on a network of social, health and welfare services, including prevention, treatment and care, use of e- services and technologies can generate added value @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 10
Fundamental changes in the Hospital reimbursement system since 2004 Implementation of the DRG-System In-patient and semi-inpatient hospital services are being reimbursed per case, no longer per day Each patient gets only one DRG per stay but there are additional regulations for medical innovations, specific and extremely expensive drugs and medical procedures @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 11
Consequences for the hospital sector The incentive to reduce the length of stay will result in a reduction of the number of beds and hospitals (30% according to expert opinion) There is a big competition between the providers and there will be winners and losers among big and small, general and specialized hospitals Hospitals that are focused on cooperating with other providers (hospitals on different levels, primary care) and implementing the use of new tools like IT for fostering the patient treatment process as well as medical innovations will survive. @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 12
Strategic domains for a future hospital Research and innovations (especially for the university hospitals) personalized medicine evaluation of new technological devices and procedures Patient safety and Quality of care Continuity of care / to be the driver for integrated care Require and involve various elements and technologies @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 13
Examples from the Heidelberg University Hospital - focused on high end medicine - conducted and projected activities @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 14
National Center for Tumor Diseases (NCT) Comprehensive Cancer Center in cooperation with DKFZ, Thoraxklinik, Deutsche Krebshilfe Financing of the building by Deutsche Krebshilfe Established in 2004 @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 15
National Center for Tumor Diseases (NCT) Aims Establishing a centralized contact point for all new regional, national and international cancer patients translate new findings of research into innovative methods for diagnosis, treatment and prevention of cancer and to offer these in clinical trials Provide patients, in the shortest way possible, with a diagnosis, a treatment plan as well as treatment according to the latest and most innovative standards, through to follow-up care and psychosocial care @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 16
Personalised Medicine @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 17
Example for outstanding innovations Heavy Ion Therapy (HIT) a financial volume of 119 Mio. replace surgery very good results in general outpatient treatment (10-20 irradiation units) costs: 30.000 /therapy world-wide unique innovation but high entrepreneurial risk! opening 2009 @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 18
Accelerator Heavy Ion Therapy Synchrotron 0,7 times speed of light Gantry 600 t Source Gas (H, C) Copyright: stern GESUND LEBEN, Heft 6, 29.11.2006, Ein Gigant gegen Krebs, Martin Freiling (Illustration) @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 19
Heavy Ion Therapy Radiation unit with robots @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 Radiation by heavy ions 20
Patient safety and quality of care 2 core projects in the field of surgery OR.net Objectives: Safe infrastructure, interoperability and manmachine interaction BMBF: 18 Mio., 3 years, 60 partners SFB/Transregio: Cognition-Guided Surgery Objectives: safe operating, image guided procedures, knowledge-based support DFG: 8 Mio., 4 years www.ornet.org; www.cognitionguidedsurgery.de @ Prof. Dr. Björn Bergh, IT Director, Heidelberg University Hospital 21
Safety and quality - Surgery @ Prof. Dr. Björn Bergh, IT Director, Heidelberg University Hospital / Storz 22
Integrated Care Concept Patient Decides - who sees what - sees all accesses - chooses provider Int. Standards Open Source Care providers Communicate only via the PEHR with each other Only reading Awards: TELEMED Award 2008, 2010, 2012, Influencer of the Year 2010 @ Prof. Dr. Björn Bergh, IT Director, Heidelberg University Hospital 23
Various core projects Integrated Care INFOPAT - IT for patient centric care BMBF Health Region of the Future: 15 Mio., 4 years, 27 partners Current proposal: Telemedicine call BW Ministries Baden-Württemberg 4 Mio., 5 years www.infopat.eu www.infopat.eu @ Prof. Dr. Björn Bergh, IT Director, Heidelberg University Hospital 24
INFOPAT Health region of the future Patients/Citizens Cluster 1 PEHR HC Professionals Patient empowerment Optimised diagnois and therapy Cluster 2 Medication Support + safety Knowledge + safety Cluster 3 Case Management Best care Optimised planning Cluster 4 Warehouse Individualisd Data Analysis @ Prof. Dr. Björn Bergh, IT Director, Heidelberg University Hospital Health services research 25
Regional Cooperation 220 Teaching institutions primary care, general practitioners Breast Cancer Center - Patient referrals/assignments - Providing physicians - Sale of services Schmieder- Kliniken Teleradiology und -communication KRH Sinsheim KRH Schwetzingen Neckar Odenwald Kliniken KRH Frankfurt / Höchst KRH KRH Eberbach Weinheim SRH- Kurpfalzkranken haus KRH Bethanien NCT Klinikum Heidelberg Thorax- Klinik KRH Salem DKFZ KRH Heppenheim St. Vincentius Krankenhaus KRH Eberbach St. Josef KRH KfH Nierenzentrum Cooperations for ambulatory care, contracts for preadmission treatments contracts with oncological specialists for joint patient treatments, close cooperation with the NCT 29 Cooperation agreements 38 Agreements with GP and specialists for ambulatory services Chief physician = Head of the Department of Heidelberg University Hospital Cooperation agreement Chief physician = Professor of the Medical Faculty Irmtraut Gürkan, Universitätsklinikum Heidelberg, 11.06.2013 26
Closing remarks Healthcare on a high quality level and with a good effectiveness needs legal und regulatory framework for collaboration between the players / providers in the system as well as process improvement in the hospitals without increasing costs We need cross-linked IT-systems that support the process within the hospital and between the different providers To act as a standalone entity as it happened in the past (and in Germany often until nowadays) will be no longer successful The role of the university-hospitals is to evaluate new, innovative products and pharmaceuticals as well as medical devices and systems and to coordinate their implementation for the whole healthcare sector @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 27
Heidelberg University Hospital @ Irmtraut Gürkan, Heidelberg University Hospital, 13 June 2013 28