InterSystems Symposium 2009 Hluboka nad Vltavou, Czech Republic 8 thd – 9 th of June 2009

1. Healthcare Sector Global Capabilities InterSystems Symposium 2009 Hluboka nad Vltavou, Czech Republic 8thd – 9th of June 2009

2. Healthcare Sector Overview Healthcare Sector Highlights • 60% of the English population will use healthcare systems installed and operated by CSC • 70% of the hospital beds in Denmark are supported by systems designed, built and operated by CSC • CSC has built two of the largest healthcare claims data warehouses in the United States • CSC’s proprietary DirectConnect software supports one of few financially viable health information exchanges in the United States • In 2007, CSC served 14 of the top 20 global pharmaceutical companies and more than 300 hospitals globally Healthcare sector is a principle CSC operating unit

3. Healthcare Sector Overview We have a global presence and relevant services • $1.4 billion in world wide healthcare revenue • 6000 people serve our healthcare clients world wide • Services include consulting, systems integration, information technology outsourcing and business process outsourcing • Engagements range in size from 10’s of thousands to billions of dollars • Contract durations extend up to 10 years • Our customers receive the highest quality of services at the lowest possible cost Denmark Netherlands Slovakia UK Austria U.S. Belgium Hong Kong France Switzerland India

4. Healthcare Sector Overview Our clients span the health services continuum

5. Healthcare Sector Overview Healthcare Sector has experienced a 13.5% CAGR since 2005 RevenueBillions of Dollars 13.5% CAGR

6. Capabilities Significant healthcare engagements in Europe England Netherlands Scandinavia Belgium 2003 - Awarded a $1.7BN share of NHS National Programme for IT. CSC led alliance also wins $347.5M diagnostic imaging contract with the NHS. 2006 – Extended relationship by adding the North East and Eastern clusters - $3.73BN over 9 years CSC now responsible for 60% of UK population within the Connecting for Health programme • Creation of National Information Infrastructure (called Aorta) for patient information to hospitals, pharmacies and general practitioners. • Built “LSP” system selected on the basis of: Rapid development timescales (using CSC C-Rup process and Rational Requisite Pro); Scalability through use of Inter Systems ensemble products and virtualisation; and, • Data management strategy with need for 10 year traceability • Contract award November, 8th 2005 – 1st system delivery31 January 2006. • Largest healthcare company in Scandinavia employing over 300 people • Services include: application development; systems integration; systems operations and consulting • Products include: • Hospital Information Systems • Clinical Systems • Laboratory Systems • Home Care Records • Health Insurance Systems • 70% of hospital beds in Scandinavia are supported by CSC products • Consulting on platform of common services (“Portalhealth”) • Design/build of key data warehouses: • clinical records (200 hospitals) • Hospital cost/funding analysis • psychiatric records • Medega Project - a nationwide application which helps organising the ‘Doctors on Duty’ activities • Maintain Carenet – A Communication platform trough gateways for invoicing of medical care between Hospitals and Insurers • Developing conceptual design for an entitlement card to enable reimbursement of healthcare services IT Outsourcing

7. Capabilities CSC’s services in the United States public sector Provider & Public Health Life Sciences Payers Integrity Health System Solutions AdvanceMed Health Research and IT Support Vaccine Program Management NEDSS Program Development Mission Support Data Center Operation Medicare A/B Claims Processing Medicare Part D Insurance and Claims processing Clinical data Abstraction Software Development Medicare Fraud Medicare – Medicaid fraud Provider Education Data Quality Review Eclipsys CIS Implementation Mission Support Biotechnology Integration Science Solutions management Black Lung Claims Processing NHIN Prototype Development Occupational Medicine State and Local Government Medicaid Fraud Health Information Exchange Medicaid Claims Processing

8. Capabilities Services to United States healthcare providers Patient Access andRevenue Cycle Management Supply Chain Management Planning and Operations Improvement Healthcare Technologies Cerner Implementation Payer / Provider Connectivity Eclipsys Implementation Supply Chain Savings program Health information Exchanges Epic Implementation Strategic Planning Lawson ERP Implementation Master Distributor Agreement Clinical Data Exchange Economic Performance Improvement Clinical Data Management

9. Capabilities Services to United States based commercial health insurance companies Legacy System Modernization Systems Integration Business Intelligence Business Process Outsourcing Claims System Implementation Blue Health Intelligence design development, implementation and operation Medicare Part D enrollment and claims processing Care Focused Purchasing Enterprise Billing System Implementation Data warehouse design development , implementation and operation CRM Planning and Implementation Website design development and deployment

10. Capabilities Services to the life sciences industry Clinical Information Warehouse Contracts and Pricing CRM Strategy and Implementation Enterprise Content Management Reg. Affairs, Technical Process Support, Implementation LIMS Support Customer Master CRM Strategy & Implementation Health Care Compliance

11. Capabilities CSC licenses, installs and maintains its own proprietary healthcare software

12. Healthcare Sector Vision Healthcare Sector Objective To establish CSC Healthcare Sector vertical as a world wide leader in the effective use of information to transform the healthcare industry through improved care delivery, decision making, and operating performance.

13. Agenda Healthcare activities in Europe • The Netherlands – National Healthcare Switchboard • The UK NHS Program • CSC ScandihealthClinical Suite • Medical Record • Clinical Overview • ePrescription • Clinical Portal Accounting / Health Insurance

14. The concept The Netherlands – National Healthcare Switchboard Pharmacist General Practitioner Pharmacist Hospital General Practitioner Hospital LSP

15. The Netherlands – National Healthcare Switchboard Principles • Patients’ information stays at the source • The Dutch National Switchpoint is a pointer index • The Switch Point alsoretrieves the information from the QHIS-ses and transfers the information to the requesting QHIS. • Importance of authentication and autorization • privacy aspects • reliability of information (responsibility) • Citizen Service Number for patients identification • Unique Healthcare provider identification for doctors etc. • Importance of logging • The patient in the driving seat • final autorization of healthcare professionals by the patient • right to see logging information by law

16. The Netherlands – National Healthcare Switchboard IT-related principles • HL7v3 messages • between QHIS-ses and the National Switch Point • At the start: SSL handshake to exchange authentication information • Currently: also using Digital Signing as means to exchange authentication information • Certification/Qualification of Healthcare systems before connecting (Qualified Healthcare Information System) • Certification/Qualification of network-service-providers before connecting • Service Oriented Architecture aka Composite Application • at first focussing on information exchange

17. UK NHS Program The NHS National Program (NPfIT) • Aims to give healthcare professionals access to patient information safely, securely and easily, whenever and wherever it is needed. • Started in 2003 by the NHS Information Authority. Transferred in 2005 to Connecting for Health, an agency of the Department of Health • Links systems via broadband network delivering: • Care Records • Electronic Appointment Booking • Electronic Prescriptions • Picture Archiving and Comms Systems (PACS) • Supporting Systems

18. UK NHS Program Program Background • The National Programme For IT • Run by NHS Connecting for Health – now moving to local ownership (NLOP) • £12.4 billion investment • IT focus is on transforming the way patient information is accessed, used and shared • Service improvement focus is on improving access, increasing choice, reducing waiting times, reducing lengths of stay and increasing clinical safety across the patient journey • Standard IT solutions are being developed • Consistent ways of working are required • CSC responsible for delivering the programme to 60% of the UK NPfIT is the largest civil IT programme in Europe and a key enabler for transformation of health services

19. UK NHS Program CSC Alliance: Scope of Services • NWWM Cluster signed 23.12.03 • Delivery of Electronic Patient Record • 10 year deal • Contract Value $1.9bn • No staff transition • PACs signed mid 2004 • 10 year deal • Contract Value $383m • Renegotiated April 2006 • New Contract Value $400m • NE & EEM Clusters agreed 29.9.06 • Ex Accenture TUPE circa 350 staff • Transition complete 8th Jan 2007 • Increased TCV by $3.9bn • Contract extended by 1 year CSC Alliance CSC Alliance CSC Alliance BT Fujitsu East Midlands / East of England North East / Yorkshire & Humberside London North West / West Midlands South West / South East

20. UK NHS Program Mental Health A&E i.PM and i.CM i.PM / EDIS Theatre ORMIS Maternity Integration Bus Evolution SeeBeyond e*Gate 4.5 Ambulance Medusa CSC Alliance Reference Solution GP Systems Electronic Patient Record Community Care TPP SystmOne Lorenzo GP iSOFT i.EPR including: i.PM - i.CM - i.IE - Lorenzo TPP SystmOne in Primary Care i.PM HSW and S1 (for child health) Core Pharmacy PACS/ RIS ASCribe / JAC GE ,HSS Additional Laboratory Dental = Superseded by PACS contract iSOFT iLab SoE

21. CSC Scandihealth CSC Scandihealth A/S Company Facts Perspective • Largest healthcare IT company in Scandinavia. • Revenue FY08: $ 73 M. Profit margin: 15%. • 350 employees – with combination of clinical and IT education. • Specialised in development of clinical and administrative Healthcare IT product (IPR) – and associated services (consulting, systems integration, outsourcing). • Serving national, regional and local (municipality) clients. Vision: Create the coherent healthcare society

22. CSC Scandihealth International Product Suites Company Facts Perspective • Clinical Suite • Patient Administrative System • Laboratory System • Home Care and Nursing Home Record • Healthcare Portal

23. CSC Scandihealth - Medical Record The Roles of CSC Clinical Suite • Shared Patient Record • Monitoring tool for clinicians • Shared coordination tool for patient treatment and care • Documentation tool for clinical units • Clinical IT-workstation • Clinical knowledge base • Patient Administrative management tool • Patient administrative workstation • Production Management tool

24. CSC Scandihealth - Medical Record Business Architecture Basic Business Principles • Interdisciplinary and team-oriented work processes at hospitals and other healthcare institutions • Planning, reporting and evaluation directly in connection with the clinical work. • Implementation of evidence based medicine • Accreditation processes within healthcare institutions • Quality measurement and improvement of clinical work • Support both highly specialized university hospitals and generalized institutions • Support the specific clinical settings and the specific professional

25. CSC Scandihealth - Medical Record Clinical overview

26. CSC Scandihealth - ePrescription The ePerscription Module • The purpose is to support all of the clinicians activities regarding medication in one system. • The goal is to enhance quality, security and efficiency in the treatment from initial referral to discharge including a print or electronic transfer of all prescribed medication. • We call it a 'one-string' medication system, where both the prescription and the receipt for giving the medicationby the nurse, is documented in the same system. • The system is interdisciplinary for doctors and nurses.

27. CSC Scandihealth - ePrescription Prescribe medicine Assess medicine Dispense medicine Give medicine Discontinue medicine Deviations Information to the patient Clinical Guidelines Recommended drugs Regimes Standard prescriptions

28. CSC Scandihealth - ePrescription Quality • Drugs recommended by the local Medical board • Standard assortment of drugs provided by the pharmacy • Standard prescriptions (templates) • Standard prescription sets (regimes) • Documentation of allergic reaction to drug treatment • Dose calculator

29. CSC Scandihealth - ePrescription Drugs recommended by the local Medical board Standard assortment of drugs provided by the pharmacy

30. CSC Scandihealth - ePrescription Overview of current prescribed medicine

31. CSC Scandihealth – Finance Management Economic and Finance Management • Notus Healthcare: Health Insurance Solution • Accounting of private providers in Denmark • Activity based accounting • Domus Healthcare • Inter-regional accounting • Accounting of activity based funding of hospitals – 85% fixed / 15% activity financed

32. CSC Scandihealth – Clinical Portal Clinical PortalOpen Clinical Workspace (OCW) Patient in context Main menu OPUS Arbejdsplads Module menu Module area Patient list

33. CSC Scandihealth Open Clinical Workspace (OCW) • ”Open” • Framework with open interface. • Interfaces are documented and publicly available. • ”Clinical” • Portal build around a central coordinated context sharing module. (Based on HL7.org’s CCOW) • ”Workspace” • Common Workspace that support the users various applications and thereby cross-application tasks. • Can be customized per individual user. • Ensures Single Sign-on to all applications.

34. CSC Scandihealth ”Great Things In Small Packages” OCWMobile • Same portal concept as on the desktop

35. Thank You