1. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 1 Connected Health A Roadmap for Healthcare in the Future September 21, 2006 Michael Gibbs, RN, FNP, MSN, MBA Manager, Internet Business Solutions Group,

2. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 2 State of Healthcare Challenges Costs/limited budget Access/wait times Quality/patient safety Labor shortages Aging population New medical technology Costs/limited budget Access/wait times Quality/patient safety Labor shortages Aging population New medical technology Desired Results Safe Effective Patient centered Timely Efficient Equitable Safe Effective Patient centered Timely Efficient Equitable

3. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 3 Healthcare Costs Are Rising Source: Centers for Medicare & Medicaid Services (CMS), Office of the Actuary, National Health Statistics Group $3000 $2500 $2000 $1500 $1000 $500 $0 1980199520002001200220032004200520062007200820092010 ACTUAL PROJECTED ($B) 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% GDP Share U.S. Healthcare Costs as a Percentage of Gross Domestic Product (GDP)

4. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 4 Healthcare Costs Are Rising Source: CMS, Office of the Actuary, National Health Statistics Group, Annals of Internal Medicine, 2003 $3000 $2500 $2000 $1500 $1000 $500 $0 1980199520002001200220032004200520062007200820092010 ACTUAL PROJECTED ($B) 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% GDP Share Redundant testing Unnecessary hospital admissions Medical errors Manually handled paperwork 30% Average Annual Waste U.S. Healthcare Costs as a Percentage of Gross Domestic Product (GDP)

5. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 5 No Improvement in Quality and Access Preventable errors— sixth leading cause of death Patients receive currently recommended (evidence- based) care only half of the time 45M uninsured in the United States—28 percent of the U.S. workforce by 2013 Source: Institute of Medicine, RAND Corp., 2004; Henry J. Kaiser Family Foundation, U.S Census Bureau, 2004; Health Affairs, 2005

6. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 6 Total Estimated Savings = $280 Billion Projected Impact Is High for Health IT Ease of Technology Implementation HIGH LOW Disease Management, Remote Patient Monitoring $32B 3,5 Electronic Claims and Eligibility $62B 5 Sources: 1. Center for IT Leadership, 2003; 2. American Health Quality Association, March 2004; 3. New England Healthcare Institute; 4. National Center for Policy Analysis; 5. Cisco analysis, April 2005 Interoperable Ambulatory Electronic Health Records (EHR) $78B 1 Inpatient CPOE $44B 3,5 Barcoding $5B 2 E-ICU $8B 3,5 Standalone Ambulatory CPOE and EHR $44B 1 Electronic Prescribing $29B 4 Quality and Safety Impact Physician- Patient Messaging $8B 3,5

7. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 7 Connected Hospital: Looking Beyond the Digital Hospital

8. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 8 Production Transaction Applications automating workflow and back-office processes. Begins to integrate information systems to support the hospital’s role as a provider of well- managed business intelligence. Most Hospital Applications Are Optimized Within Functional Silos Value Impact Automation/Cost Reduction Safety, Quality, Efficiency

9. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 9 Production Transaction Supply chainSupply chain Asset managementAsset management Workforce optimizationWorkforce optimization E-learningE-learning AdmittingAdmitting FinanceFinance EHREHR CPOECPOE Asset TrackingAsset Tracking Electronic prescribingElectronic prescribing Electronic claims / eligibilityElectronic claims / eligibility PACSPACS Customer self-serviceCustomer self-service Value Impact Automation/Cost Reduction Safety, Quality, Efficiency Most Hospital Applications Are Optimized Within Functional Silos

10. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 10 “Digital Hospitals” Use IT Across the Enterprise Hospital industry recognizes the need to adopt IT across the enterprise—not just in functional silos—to impact patient experience “Digital Hospital” is the phrase most used to describe this recent phenomena Technology now exists—after years of waiting Use of clinical IT tools is now a medical school norm Hospital leaders intuitively know this will mitigate their risk, but don’t yet have the data to prove it ROI modeling is also still theoretical Sources: PWC, Reactive to Adaptive: Transforming Hospitals with Digital Technology, 2005; Cisco IBSG, 2005; Strategic Management of Information Systems in Healthcare, 2005

11. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 11 Digital Hospitals Integrate Information and Medical Technologies Source: PWC, 2005; Cisco IBSG, 2005; Crane and Raymond, 2003 Bioinformatics Ancillary Clinicals Infrastructure “Smart” Technology Point of Care Technology Digital Imaging Device Integration Physician Docu- mentation Electronic medical record Computerized physician order entry Evidence-based medicine Stretchers, beds Nurse call Patient cards Phones Bar coding/RFID/infrared Voice recognition Handheld devices Radiology PACS Cardiology PACS Multi-modality Advanced Imaging Medical equipment Medications Computer-aided diagnostics Computer-aided surgery Robotics Pharmacy Lab Dietary Radiology Transcription Voice over IP Security Wireless, integrated network Healthcare standards High-speed data networking Master patient index Patient management system Patient accounting General financials Core clinical applications Core Hospital Information Services In Digital Hospitals, the silos are integrated under one roof

12. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 12 And Deliver More Services at the Bedside Patient information available on flat-panel, high-density monitors along the walls Patient entertainment services Speech recognition for voice-activated controls and language translation Patient identification and tracking devices Internet access at bedside for patient communication and education Patient-controlled access to outdoor air—voice activation to open and close windows Electronic charting for nurses and medical technicians Wireless technology for Internet access and handheld medical- information devices for hospital staff Videoconferencing for patients to talk with family members outside the hospital and for consultations with medical staff located elsewhere; video can also be used for patient to talk with hospital staff

13. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 13 The hospital “owns” the information and controls its use and how it is shared. Digital HospitalConnected Hospital The patient may own his own or a family members’ information and control how it is used and shared. Being a Connected Hospital Offers More Benefit Than Just Being Digital Electronic information is collected and exchanged within the hospital or health system. Information is shared electronically—both received from and sent to those with permission to do so. Paper copies are primary form of record exchange between other facilities, out-of-system specialists, and patients. Paper copies, paper records, and file rooms no longer exist, saving real estate and acquisition costs. The physician and hospital staff are primary users (customers) of digital tools. Anyone along the continuum of care can use digital tools to review, update, and transfer information.

14. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 14 Opening Up New Ways To Interact—Beyond the Enterprise Bioinformatics Ancillary Clinicals Infrastructure “Smart” Technology Point of Care Technology Digital Imaging Device Integration Physician Docu- mentation Electronic medical record Computerized physician order entry Evidence-based medicine Stretchers, beds Nurse call Patient cards Phones Bar coding/RFID/infrared Voice recognition Handheld devices Radiology PACS Cardiology PACS Multi-modality Advanced Imaging Medical equipment Medications Computer-aided diagnostics Computer-aided surgery Robotics Pharmacy Lab Dietary Radiology Transcription Voice over IP Security Wireless, integrated network Healthcare standards High-speed data networking Physician and patient portals; peer to peer applications Self-diagnosis/care Physician collaboration/research Disease e-management Sensors; Smart Homes Personal Health Records eHealth Tele- medicine Data Exchange Real-time info sharing between enterprises Knowledge management Video conferencing Physician/patient education Remote patient monitoring Virtual visualization Master patient index Patient management system Patient accounting General financials Core clinical applications Core Hospital Information Services

15. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 15 CONNECTED HOSPITAL Employers Public Health Organizations Laboratories Pharmacies Connected Clinicians Social Services Clinics Emergency / First Responders Suppliers Government and Private Payers Home and Long Term Care Connected Hospitals Share Information Across a Healthcare Ecosystem

16. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 16 Continua Health Alliance

17. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 17 The Continua Health Alliance Objectives Objectives: Through the combined leadership and talents of the finest companies in the personal telehealth industry (including: consumer electronics, mobile, PC, healthcare devices, fitness devices & healthcare providers) we will create new opportunities by: Developing design guidelines that will provide vendors with the information needed to build interoperable sensors, home networks, telehealth platforms, and health & wellness services. Establishing a product certification program with a consumer recognizable logo signifying the promise of interoperability with other certified products. Collaborating with government regulatory agencies to provide methods for safely and effectively managing diverse vendor solutions. Working with leaders in the healthcare industries to develop new ways of addressing the costs of providing personal telehealth systems.

18. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 18 General Health & Wellness Generally healthy family Mobile Health Assistant (Cellular HH - data collection) Professional Caregivers Glucose Sensor Pedometer Blood- pressure Cuff Cholesterol Monitor Medication Tracking Mobile Health Assistant (cellular HH – data collection) Digital Home Home Health Appliance Fitness equipment Baby Monitor WWW Consumer Services: + Diet and fitness + Disease prevention + Secure data storage & sharing Health Use Cases Extension of healthcare system into the home Initial triage of conditions Biosensors Images Email / chat / video Knowledge base Appointment scheduling Personal Health Record Wellness Use Cases Weight loss Fitness Long term data collection for medical baseline Predictive alerts for high risk conditions

19. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 19 Disease Management Chronic disease patient, post trauma recovery Mobile Health Assistant (Cellular HH - data collection) Professional Caregivers Glucose Sensor Pedometer Blood- pressure Cuff Cholesterol Monitor Medication Tracking Mobile Health Assistant (cellular HH – data collection) Disease Management Appliance Digital Home Fitness equipment Baby Monitor WWW Health Use Cases Extension of healthcare system into the home…improve overall disease management care and reduce health care costs Monitoring of specific disease progress indicators Biosensors Activity Trend analysis and alerts Email, chat, video conferencing (remote consultation) Appointment scheduling

20. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 20 Elderly Monitoring Elderly living independently Digital Home Remote Loved One Mobile Health Assistant (Cellular HH - data collection) WWW Home Health Appliance Glucose Sensor Pedometer Blood- pressure Cuff Cholesterol Monitor Medication Tracking Professional Caregivers Mobile Health Assistant (cellular HH – data collection) Home Automation Security Network Lights Doors windows Motion / Activity Bed Drawers Kitchen Bathroom Sensor networks Use Case Elderly or independent living individual System, sensors and natural UI to assist in daily tasks Medication minders Activity prompts Typical tasks Bio-sensor data collection for monitoring and early warning Increasing social connectedness Overlap with CE devices Automated dietician Emergency response Real time alerts and communication Neurological (cognitive decline)

21. © 2005 Cisco Systems, Inc. All rights reserved. IBSG - 21 Continua: Personal Telehealth Eco-System CONNECTIVITY Ethernet SENSORS AGGREGATION COMPUTATION SERVICES Diet or Fitness Service MICS / MEDS Disease Management Service Personal Health Record Service Implant Monitoring Service Healthcare Provider Service PC Personal Health System Cell Phone Set Top Box Aggregator N E T W O R K (POTS, Cellular, BB) Glucose Meter Pedometer Blood- pressure Medication Tracking Fitness equipment Weight Scale Thermometer Pulse Oximeter Spirometer Cholesterol Monitor Home sensing & control Bed / Chair Sensors Implant Monitors Baby Monitors PERS Consumer Electronics