New information technologies for Human Health What’s new in e-Health?

1. New information technologies for Human HealthWhat’s new in e-Health? Jean-François PenciolelliGlobal Business Development DirectorIBU Healthcare and Life Sciences

2. e-Health is all over the place!National and regional initiatives Sweden: Developing a National Patient Summary Denmark: New National IT-strategy to standardize EHR´s Canada – Infoway set up to design and procure National EHR - $2 billion of government backing for regional EHR projects Finland: National eHealht-Archives to be established Netherlands: National Switch Hub Russia: 15 Diagnostic Centers project in progress. Plans being developed for national HER for 145 million people. Ireland: Procurement contracting has started to drive national EHR effort China: Plans to develop a national EHR Germany: One regional deal underway. Future EHR efforts are expected to be regional England: EHR initiative in process, PACS project is running in north region USA – Federal ONC NHIN contract underway. Multiple State initiatives for RHIOS. Still emergent – national EHR by 2014 – Obama Stimulus Plan Hong Kong: Territory wide Patient Master Index Spain: Regional initiatives are being considered Singapore: EMR system tender expected Q1 2005 SEE: Bulgaria, Romania, Turkey and Serbia all developing national eHealth strategies. France: EHR mandated by 2007. National RFP has been issued Mexico: No EHR but aim for HL7 Integration – National Disease Surveillance going on Opportunity Status Current Work Italy: EHR regional initiatives have begun Australia: HealthConnect is developing a National Information Network Malaysia: Lifetime Health Record (LRH) by 2010 Planning Brazil: National Health Card Project. Chile: National RFP for EHR project is expected soon Monitor Considering EHR Argentina: 1st adoption of a digital radiography solution- 2004 South Africa: No EHR – but infrastructure being developed New Zealand: National EHR system in place (complete) Data N/A or No EHR Presence * Target opportunities identified by text in red Source: Accenture + Oracle

3. Many e-Health usage scenarios • Public Health Registries • References: STAKES, Italian Ministry of Health • Healthcare Interoperability Platform (Patient/Provider Collaboration, Provider/Provider Collaboration, Provider/Insurer Collaboration) • References: Lombardia, STAKES, Rikshopsitalet, Balearics, Andalucia DIRAYA • Electronic Health Record (incl. Document Management) • References: Andalucia,Rikshospitalet, Stockholm County, Lombardia Region • Electronic Prescribing / Medication Management • References: Andalucia RECETA XXI, Lombardia, Swedish APOTEKAT • Electronic Healthcare Card • References: Lombardia, Andalucia, Bundesknappschaft, Italian Army • Chronic Disease Management • References: Riskhospitalet (MyJournal), Friuili Venezia Guillia, CNAM-TS Sophia • Disease Surveillance • References: Washington D.C. • Telehealth (Sensor-based, Personal Health Mgt Tools, Homecare) • References: ACTION, Sweden, care@home • Patient Relationship Management • References: Andalucia Salud Responde

4. Relationship between Cost and Quality of Life 100% Home Care Healthy Independent Living Community Clinic Chronic Disease Mgt Doctor’s Office QoL Residential Care Acute Care Assisted Living Specialty Clinic Skilled Nursing Facility Community Hospital ICU 0% $1 $10 $100 $1,000 $10,000 Cost of Care/Day Source: Intel Corp 2006

5. Pushing Consumer to Waiting Room Monitoring Attracting Patients “I know when my condition is getting better/worse” “I should talk to my Dr.” “Which Provider should I Choose?” Patient Dis-charged Patient Visits HC Profsnal Patient is Stable Aware patient Get Treatment Patient is Compliant Unaware patient “I am happy with my Quality of Life” “It is important I take my medication” “I may be at risk…” “I am prepared for my appointment” ConsumerAwareness Adherence Meeting ALL of the Patients’ Needs Wasted Appointments Managing and Supporting the Patient FlowImproving the Patient Experience and Quality of Life

6. Increase Velocity Down the Flow Keep Patient Here Here Is Where We Focus Here is more Vision Patient Dis-charged Patient Visits HC Profsnal Patient is Stable Aware patient Get Treatment Patient is Compliant Unaware patient Focus is on Access, Resource Utilisation and Attracting Patients Focus is on Outcome, Experience and Quality of Life The need for a Service Delivery Platform • Identifying, Stratifying and Targeting Patients • Attracting Patients • Improving Administrative Processes • improve utilisation of resources • help Patients get treatment • improve patient experience • Support after Discharge • Adherence • Patient Monitoring • Supporting Patient Behaviour Modification • Making interventions

7. Why Focus on Chronic Conditions? 80% of US/Europe healthcare spending 81% of inpatient stays 91% of prescriptions 76% of physician visits 98% of home healthcare visits

8. Patient Relationship ManagementDefinition Patient Relationship Management is about personalising interactions and interventions based on patient preferences, behaviours and their disease states to improve outcomes, safety and quality of life

9. A typical pattern in chronical treatmentAdherence drops – patients are at risk VISIT VISIT VITAL SIGNS ADHERENCE TIME 0 1 2 Source: Mengden et al. ISH 18th meeting, Chicago 2000. P21.02

10.    PRM platform    sms sms sms Solution: continuous interaction to drive adherence Enabled by patient relationship management VISIT VISIT TIME 0 1 2 Source : Pierre Leurent, Voluntis

11. Sensium • Sensor interfacing • Wireless transceiver • Local processing • filtering data • Personal DA • Wireless network • coordinator • Personal information • Local database • Health database • Authorized (HL7) • Combined • Aggregated • High quality Data prepared and mined For health personnel Lots of fuzzy and uncoordinated data Moderate but somewhatprocessed data Continuous Monitoring: Sensium Distribute information processing

12. Source: EMBL-EBI Create the medical avatar: the new frontier!

13. What about Oracle?

14. Nursing System Payer System Radiology System CIS System HIS System GP System Schedule appointment Diagnosis Refer patient Treatment Order test Perform procedure … Write report Update medical record Receive report Send discharge letter Discharge Patient Start rehabilitation Submit claim Support patient Process claim Submit results Follow-up Healthcare Interoperability Clinical IT Reality Home Care Nurse Primary Care Physician Medical Office Staff Orthopedic Specialist Radiologist Payer

15. GP System HIS System CIS System Radiology System Payer System Nursing System Schedule appointment Schedule appointment Diagnosis Diagnosis Schedule appointment Refer patient Refer patient Diagnosis Refer patient Single Sign On Treatment Treatment Treatment Perform procedure Perform procedure Order test Order test Order test Perform procedure … … … Write report Write report Write report Update medical record Update medical record Update medical record Receive report Receive report Send discharge letter Send discharge letter Discharge Patient Discharge Patient Receive report Send discharge letter Discharge Patient Start rehabilitation Start rehabilitation Submit claim Submit claim Support patient Support patient Start rehabilitation Submit claim Support patient Process claim Process claim Process claim Submit results Submit results Follow-up Follow-up Submit results Follow-up SOA Orchestration Clinical Portal Healthcare Interoperability Clinical Integration Framework Home Care Nurse Primary Care Physician Medical Office Staff Orthopedic Specialist Radiologist Payer Clinical Context Management

16. Healthcare Interoperability Home nurse GP Collaborative Network Private Practice Hospital Pharmacy Enabling Collaborative Networks • Collaborative services • Teleradiology • E-referral • E-prescribing • Homecare Hospital • Improved quality • Information sharing • Better planning and monitoring • Reduced administration • Specialization, higher volumes • Reduced cost • Loadbalancing • Higher througput • Improved work / life balance SOA Platform Orchestration Portal

17. Healthcare Interoperability E-Health Applications Accounting System PACS System RIS System EMR System Application Server & Database Orchestration Transformation & Routing Management & Monitoring ETL Security & Privacy Connectivity ? Packaged Messaging Database Clinical Data Repository MultiMedia Medical Archive Datawarehouse EMPI Terminology EHR Index Existing Legacy Applications Blueprint Architecture Healthcare Infrastructure Services Clinical Portal MMA Viewer Business Intelligence Prescribing Homecare CRM Health Information Access Layer Clinical Data Repositories

18. Healthcare Interoperability E-Health Services MDM DB 11g DB 11g HTB – ECM - CDMS Siebel OBIEE RIS System PACS System Accounting System EMR System ESB BPEL AS&DB ESB Connectivity ODI BAM IAM Clinical Data Repository MultiMedia Medical Archive Datawarehouse EMPI Terminology Terminology EHR Index EHR Index Existing Legacy Applications Oracle/partner footprint Healthcare Infrastructure Services Clinical Portal MMA Viewer Business Intelligence Prescribing Homecare CRM Management & Monitoring Orchestration Health Information Access Layer Transformation & Routing ETL Security & Privacy Clinical Data Repositories

19. Healthcare Interoperability E-Health Services MDM OBIEE DB 11g DB 11g HTB – ECM Siebel cIndex Concerto Accounting System EMR System PACS System RIS System BPEL ESB AS&DB Connectivity IAM BAM ODI Rhapsody Rhapsody Clinical Data Repository MultiMedia Medical Archive Datawarehouse EMPI Terminology EHR Index Existing Legacy Applications Oracle/partner footprint Healthcare Infrastructure Services Clinical Portal MMA Viewer Business Intelligence Prescribing Homecare CRM Management & Monitoring Orchestration Health Information Access Layer Transformation & Routing ETL Security & Privacy Clinical Data Repositories

20. Cholesterol Monitor Blood Pressure Monitor • Dashboards • Analytic Apps Agent (Telecarer) Assisted Interaction Channels Web/Portal Business Intelligence Pedometer Phone Email • Patient Info • Case Info • Knowledge Base Clinical Data Repository Training Glucose Sensor WWW WWW Web Conference Digital Plaster External Systems Web 2,0 Smart Phone Home Hub Appliance Access and Utilisation (Cost) Medication Tracker Outcome (Care) Quality of Life Technology Roadmap

21. WWW WWW Access and Utilisation Oracle Lite Oracle Products Cholesterol Monitor Oracle Lite Blood Pressure Monitor • Dashboards • Analytic Apps Agent (Telecarer) Assisted Oracle Lite Interaction Channels “Edge Server” Oracle Business Intelligence Oracle Crystal Ball Portal Pedometer Phone Fusion Middleware Collaboration Suite Siebel Call Centre Fusion Middleware Oracle Lite Learning Mgt Glucose Sensor Oracle HTB Collaboration Suite Fusion Middleware Digital Plaster Fusion Middleware External Systems Web Center “Edge Server” Smart Phone Home Hub Appliance Oracle Lite Oracle AIA OracleAERS Oracle Lite Outcome Medication Tracker Quality of Life

22. Q & A

23. New information technologies for Human HealthWhat’s new in e-Health? Jean-François PenciolelliGlobal Business Development DirectorIBU Healthcare and Life Sciences