On-demand e-health fr o m IBM

1. On-demand e-health from IBM Janko Cicin-Sain Healthcare Consultant Life Sciences CEMA

2. Golden rules for the 21st- Century Health Care System(defined by Institute of Medicine, USA 2001) Current ApproachNew Rule Care is based primarily on visits Care is based on continuous healing relationships Professional autonomy drives variability Care is customized according to patient needs and values Professionals control care The patient is the source of control Information is a record Knowledgeis shared and information flows freely Decision making is based on training Decision making is evidence-based and experience Do no harm is an individual responsibility Safety is system property Secrecy is necessary Transparency is necessary The system reacts to needs Needs are anticipated Cost reduction is sought Waste is continuously decreased

3. Problems common in Health Care industry in whole Europe but more accute in the countries in transition • how to cope with rapid increases in costs of healthcare services • how to rationalize and balance limited budgets with, yet to define, expected quantity and quality of services • how to move health care organizations (primarily hospitals) from «public sector» to «business» mentality while respecting high ethical standards • how to stop borrowing from the future • how to devise effective compensation schemes with objective to reduce the waste and stimulate effective medical procedures • how to establish national (or accepting international where plausible) standards for medical procedures, clinical guidelines, coding of diagnosis and procedures and standards related to management of information • what to learn from those who have been intensively dealing with above listed topics for last thirty years and «leap-frog» where posible

4. Major challenges for countries in transition • management of medical documentation (indexing, coding, storage,..) does not meet modern quality standards • quality control in health care delivery system de facto non existent • frequent lack of structured management of technologies used in medical procedures (quality control, preventive maintenance, standard maintenance contracts,..) • most health care organizations (hospitals) not in position to become self-sufficient in handling Management of Information topics and IT solutions • Quality Control and Management of Information over 25 years behind North America and 15 years behind Western Europe • Ministry of Health usualy lacks experience in definition and execution of Projects and has very limited (or non existent) IT expertise

5. Specific challenges related to the projects funded by World Bank • Health Care reform issues and related implementation projects always broken in many individual components • for each component lengthy execution process due to formalities related to procurement, negotiaition and execution stages • due to the fact that each component is separately negotiated, each provider of services has very limited liability leading to high risk final outcomes • lack of major «prime contractor», due to existing practice and issue of «conflict of interest», leaving the buyer (usualy MOH or National Health Insurance) to bear the overall responsibility for final outcome... responsibility for which national agencies do not have internal human resources to effectively manage complex re-engineering and implementation projects

6. Some important characteristics of Information Solutions for organizations involved in health care delivery and compensation processes Hospitals: IS solutions available on (primarily) international and national levels Primary Care and Specialists: IS solutions available on international levels and can be developed in limited time Laboratories: similar to hospitals Health Insurance: for Core Business usually country specific, leading to custom development while taking advantage of solutions available in countries with similar compensation schemes (capitation, service, DRG / Case Mix) National Health Information Infrastructure and Warehousing: few solutions on international market (Canada, UK, Australia, Germany) and complementary custom development

7. IBM strengths • global player • world wide leader in consulting services, project management, development methodologies, business process re-engineering, change management, technology provider • leading consulting company in healthcare – based on former Price Waterhouse healthcare practice with over 1.600 healthcare consultants worldwide • effective partnership with all leading providers of IT solutions to healthcare organizations • unique offerings for national / regional integrated information systems, linking all providers with each other, with MOH, Health Insurance or Public Health agency • strong and continuous committment to national market

8. Where IBM can provide help • TOPIC: National (regional) Health Care reform activities • CONTENT • BCS (former Price Waterhouse practice) and national consulting resources to manage the content of reform topics like: • Business models, • Strategic Planning, • Compensation strategies, • National and international standards in healthcare, and methodically execute the projects and programs: • Delivarables, • Business process re-engineering, • Change Management

9. Where IBM can provide help METHODOLOGIES IBM BCS and BIS consulting resources to train Ministry Of Health or Health Insurance profesionals how to effectivly and efficiently define and executed any type of projects Organize for Ministry of Health or Health Insurance organizations Virtual Project and Program Office – a structured and efficient approach to how to manage and administrate all project activities (reform is sequence ofprojects) Implement Workflow Management and Document Management solutions to improve the execution and control of any programs or activities in national organizations Lead initial Projects and provide skill transfer to internal resources VALUE of METHODOLOGIES Substantial reduction of time and resources (human, financial) needed to execute any component of Health Reform while increasing the quality of deliverables – documentation, completion criteria

10. Overview - Our Understanding of Your Requirements Assessment of Hospital Plans and Policies Socio-Demographic Economic, financial and cost-benefit analysis Development of Hospital Masterplan Sector Structure Public Expectations Health Care Financing and Provider Payment Options “PREPARATION OF HEALTH SYSTEM OPTIMIZATION PROJECT” Development of Hospital Plans Hospital Management Training Plan Review economic and financial benefits of project Review Hospital Management Capacity Technology Recommendations for Hospital Management Training and Curricula

11. Organization IBM Business Consulting Services Healthcare Industry Group • Our Healthcare Industry Group is one of the largest healthcare consultancies in the world. We have over 500 professionals around the world dedicated to working in the healthcare sector. We serve a wide variety of clients, including acute care hospitals, academic medical centres, health insurance companies, and Ministries of Health. Our healthcare consulting activities are comprehensive and focused on solving complex issues in partnership with our clients in the areas of: • Strategic Change • Performance Improvement • Human Resources • Organisational Change and Development • Quality in Health Care • Business Process Reengineering • Business Process Outsourcing • Management Planning • Financial Management • Information Technology for Health Care • E-health • ERP implementation

12. Organization • As example, our Canada-based Healthcare Industry Group employs professionals dedicated to healthcare consulting, with expertise in the following areas: • Healthcare Management • Healthcare Planning and Policy Development • Operational Management • Public Health • E-Health/Information Systems • Health Economics • Health Financing • HIV/AIDS • Primary Health Care and Health Promotion • Project Management

13. Organization • IBM’s Business Consulting Service’s international focus is on large-scale capacity building and institutionalstrengthening projects in the following key areas: • Health Sector Reform and Restructuring • Strategic Planning • Health Information Systems/Information Technology • Healthcare Financing/Health Insurance/Economics • Human Resources/Management Development/Change Management, and • Institutional Strengthening

14. Where IBM can provide help TOPIC: National Information Solution Infrastructure, Warehousing IBM solutions and services, based on experience and track record in Canada, USA, UK IBM Health Network Solution or Health Communication Solution as backbone of any national or regional healthcare information infrastructure Manage the development and deployment of national standards or implementation of international standards

15. From a provider perspective, Toronto’seCHN has implemented an e-Health electronic health record connectinghospitals, home care and paediatricians to manage referrals, protocols and urgent care. • Improve health, quality of life for children • Forge alliances and partnerships among providers • Provide consistent standard of care • Coordinate services across the continuum of care • Share research and education information • $17B Health Budget • 212 Hospitals • 21000 GP's & specialists

16. Alberta We//net has partnered with IBMto implement a province-wide electronic health record. IGS hasdeveloped the Pharmacy Information Network, based on the eCHN EHR architecture. • Accessible and effective health services • Alignment & accountability among stakeholders • Ensure the privacy, confidentiality and security • Focus on promoting and protecting the health of the population. • Appropriate education and research • Engage Albertans to exercise personal responsibility gathering & protocols • $4B Health Budget • 12 Health Regions • 900 Pharmacies • 5000 Doctors

17. Vision: “Better information for better health” • alberta wellnet enables multi-stakeholder, information technology initiatives to improve: • the quality of health services • the management and sustainability of the health system • alberta wellnet is the health information network that will enable health professionals to share information by • Connecting ‘information islands’ at the point of decision to reduce costs, increase capacity and improve clinical outcomes • Implementing secure information exchange, infrastructure, and theinformation tools

18. Health reform project in Slovakia Under World Bank loan, as component of health care reform: IBM manages Health Information Standards project Closely linked to Data Center project (future E-health infrastructure) Focus on complemeting Quality Improvement project Focus on legislative and procedural requirements for future E-health environment

19. Health insurance in Slovakia Joint IBM-SAP project (modules): Insured Persons Central Records (Registry) Other Central Records related to Insurance Core Business Insurance Collection Insurance Disbursement Medical Inspection Activities All Above Modules Functionality Extension Transactions via Internet Data Migration and Data Fund Transformation Internet Portal Migration Archive

20. Consortium Manager Project management, methods, frame architecture, reference models, security aspects Exestierende Systeme, Referenzmodelle Existing systems, reference models Process definition, frame architecture, security aspects Card related aspects, reference models for card usage Scientific monitoring, acceptance management, quality assurance, standards, evaluation of test phase Where IBM can provide helpProject bIT4health – Status (1)The Consortium and its Responsibilities

21. Project bIT4health –Current Status »bIT4health« Better IT for better Health • Planning and development of frame architecture • Reaching acceptance of all involved parties • Quality security and risk minimisation • Scientific monitoring of test phases Requirements Architecture IT-System Legislation Frame architecture Solution architecture Trans-formation Current standards Requirements partners bIT4health – Focus Status: „Open“

22. Health Networks or e-Health is mandatory to cut across organisational boundaries, integrate data, create the ‘health system without walls’ and focus on patient-centric care. Telemedicine – removal of distance Knowledge – doctors, nurses, health professionals Access to patient’s medical history – life-time patient record Access to citizen’s health profile Collaboration between health providers Management of health treatments related to patients with chronical diseases Information and education of citizens / patients Same source of information for clinical and financial / managerial purposes

23. Health Networks or e-Health is mandatory to cut across organisational boundaries, integrate data, create the ‘health system without walls’ and focus on patient-centric care. Prerequisites: National standards for: Core data set, Demographic Data, Health profile National standards for: Authorization, Authentication, Privacy National standards for: minimal functional and data requirements of IT solutions for providers (hospitals, primary care doctors,...) Synchronized activities between all health care sector organizations and agencies (Master Project)

24. Where IBM can provide help • TOPIC: Health Insurance • Lead development projects, organize on-going support, user training and help desks • implement proven IBM Application Development methodology required to achieve an optimal solution • quality – functional flow, quality control, solution documentation, user training • provide ASP type services for managing IT assets and resources, and national help desk structure • capitalize on broad experience from Health Insurance projects in several European Union and North American countries • manage the implementation of Smart Card solutions for insurers and health care providers • As component of National Health Information Infrastructure, manage deployment of Warehousing / Data Mining solution • References: Hungary, Lithuania, Estonia, Poland, Germany, Slovakia

25. Where IBM can provide help • TOPIC: Hospitals • Lead JCIA accreditation preparation, including QA and MOI components • Complement leading IT solution providers with local support, project management and change management services • Provide complete solutions for Document Imaging and Management and intergated PACS • Deploy regional or national ASP type services for human resources, use of IT technologies and financial engineering • TOPIC: Primary Care and Specialists • Lead either adaptation of international solutions or manage development of home grown solutions while linking it to national Health Infrastructure • For any health care provider, define national standards for minimal data sets for: • Patient Demographic Data – who is the person, address, insurance, relatives,.. • Patient Pertinent Medical Data – health profile of each individual • Patient Core Data Set – clinical data from completed treatment and sufficient to next health care provider to determine any treatment history