1. 111 © 2004, Cisco Systems, Inc. All rights reserved.

2. 2 © 2004 Cisco Systems, Inc. All rights reserved. Connecting Health for Patient Care Internet Business Solutions Group (IBSG)

3. 333 © 2004, Cisco Systems, Inc. All rights reserved. Our Connected Health initiatives IBSG Advisors Connected Health book The Hospital of the Future The Business Case for eHealth eHealth Think Tank

4. 444 © 2004, Cisco Systems, Inc. All rights reserved. The crucial questions for life-long individual health records are not technical…. Why is improving the business case for Health Records & eHealth so important ? How can we create resonance with management and political agendas ? What actions are needed across Europe to drive improvements at the individual level ?

5. 555 © 2004, Cisco Systems, Inc. All rights reserved. Top of Mind Issues – Healthcare “CEOs” Improve Patient Care Quality, Consistency, Access, Speed Increase Productivity Higher costs Limited budgets Be the Employer of Choice Workforce shortage

6. 666 © 2004, Cisco Systems, Inc. All rights reserved. Top of Mind Issues – Clinician What did “they” do to you last? Quality, Avoid errors What did I do to you last? Quality, Avoid errors What should I / we / they do next? Quality, speed, Avoid errors

7. 777 © 2004, Cisco Systems, Inc. All rights reserved. Top of Mind Issues – “Worried Well” Privacy Protect my confidential data Rising costs Higher tax, premiums, medicines Treat my family well Quality, trust, transparency, access

8. 888 © 2004, Cisco Systems, Inc. All rights reserved. Top of Mind Issues – Patient Just make me better …don’t make me worse..and be quick about it …wherever I am, or need to be…

9. 999 © 2004, Cisco Systems, Inc. All rights reserved. Healthcare Challenges & Solutions OrganisationChallenges / initiativesKey “Solutions” 1Pan-EuropeanAccession, standards, new technologies, seed innovation Policy initiatives & governance, industry development projects, smart cards 2NationalCost effectiveness, quality of care, capacity management, political survival Lifelong transportable health records; National architecture; Privacy; ePrescribing; Performance Management; eProcurement; eLearning & KM…. 3RegionalCapacity management; cost effectiveness & quality of care …Telemedicine; eLab; Shared Services Finance, HR 4CommunityProductivity; cost effectiveness & quality of care Mobility; Telemedicine; GP – Hospital Integration; Integrated Care Services; Privacy; Citizen access 5LocalProductivity; cost effectiveness & quality of care Integrated Care Services; Imaging; Bedside Services; Paperless Hospital 6PayerMarket share; cost effectivenessPerformance Management; Customer Care 7PrivateMarket share, profit & margins; quality of care; interface to public sector Integrated Care Services; Imaging; Bedside Services; Performance Management

10. 10 © 2004, Cisco Systems, Inc. All rights reserved. Healthcare Challenges & Solutions OrganisationChallenges / initiativesKey “Solutions” 1Pan-EuropeanAccession, standards, new technologies, seed innovation Policy initiatives & governance, industry development projects, smart cards 2NationalCost effectiveness, quality of care, capacity management, political survival Lifelong transportable health records; National architecture; Privacy; ePrescribing; Performance Management; eProcurement; eLearning & KM…. 3RegionalCapacity management; cost effectiveness & quality of care …Telemedicine; eLab; Shared Services Finance, HR 4CommunityProductivity; cost effectiveness & quality of care Mobility; Telemedicine; GP – Hospital Integration; Integrated Care Services; Privacy; Citizen access 5LocalProductivity; cost effectiveness & quality of care Integrated Care Services; Imaging; Bedside Services; Paperless Hospital 6PayerMarket share; cost effectivenessPerformance Management; Customer Care 7PrivateMarket share, profit & margins; quality of care; interface to public sector Integrated Care Services; Imaging; Bedside Services; Performance Management Transportable, secure confidential, standard individual health records

11. 11 © 2004, Cisco Systems, Inc. All rights reserved. eHealth - an obvious investment? Historically low investment in IT – 1% ? Historically un-coordinated investment in IT & huge scale of organisations Oversold, under-delivered past health and public sector IT Complex “global” issues to solve – privacy, connectivity, standards Melange of legacy systems & data…. & paper Investment now vs benefits in 10, 20, 30 years time

12. 12 © 2004, Cisco Systems, Inc. All rights reserved. A more scientific view….. Access Quality Cost After Jean-Claude Healy, EU eHealth Directorate

13. 13 © 2004, Cisco Systems, Inc. All rights reserved. Benefits come from…. Shorter route through treatment, fewer steps Shorter hospital stays Fewer tests and retests Avoiding malpractice, misdiagnosis, mis- prescribing, mis-dispensing…. Reduced drug budgets – cheaper prescribing, lower waste, less inventory Scaling expensive resources Prevention of disease Lower whole-life treatment costs Lower overheads in finance, human resources, transactions, efficient procurement New streams of revenue

14. 14 © 2004, Cisco Systems, Inc. All rights reserved. Benefits come from…. Shorter route through treatment, fewer steps Shorter hospital stays Fewer tests and retests Avoiding malpractice, misdiagnosis, mis- prescribing, mis-dispensing…. Reduced drug budgets – cheaper prescribing, lower waste, less inventory Scaling expensive resources Prevention of disease Lower whole-life treatment costs Lower overheads in finance, human resources, transactions, efficient procurement New streams of revenue Quality, Cost Access, Cost Quality, Cost Access, Cost Access, Quality, Cost Quality, Cost Access, Cost

15. 15 © 2004, Cisco Systems, Inc. All rights reserved. The true scale of eHealth…. Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, eMail, Consent/Authentication… Implementation planning – Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases Secure, Intelligent, High Speed Infrastructure Target Funding, Strong Governance, Manage Implementation and Change Working Practices, Increase IT Competence,Work with Industry Portfolio 1 – Clinical tools, Health Records, Prescriptions Service, Appointment Booking, Patient Access, Images, Telemedicine…… Portfolio 2 – Knowledge Management & eLearning Portfolio 3 – E-Enablement eProcurement E-HR, E-Finance Portfolio 4– Patient Services Web foundations – Directory, eMail, Consent/Authentication…

16. 16 © 2004, Cisco Systems, Inc. All rights reserved. The Clinicians’ portfolio Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, eMail, Consent/Authentication… Portfolio 1 – Clinical tools, PAS, PACS Health Records, Workflow, Prescriptions Service, Appointment Booking, Patient Access….. Portfolio 2 – Knowledge Management & eLearning Portfolio 3 – E-Enablement eProcurement E-HR, E-Finance Portfolio 4– Patient Services Implementation planning – Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases

17. 17 © 2004, Cisco Systems, Inc. All rights reserved. Driving Front-line Productivity in Healthcare Alerts – New Treatments, Epidemics…. eMail Oncology News Training Announcements Performance Reports Referrals Access Patient Records Knowledge Transfer Diary sharing

18. 18 © 2004, Cisco Systems, Inc. All rights reserved. Post-operative Notes Automation Objective Increase efficiency of capture and transfer of operation notes and discharge summary Solution IP telephone application for Clinician, Nurses and Admin Potential Impact Up to 1-2 days reduced time for note transmission 10 minute saving per procedure for Clinician Objective Increase efficiency of capture and transfer of operation notes and discharge summary Solution IP telephone application for Clinician, Nurses and Admin Potential Impact Up to 1-2 days reduced time for note transmission 10 minute saving per procedure for Clinician

19. 19 © 2004, Cisco Systems, Inc. All rights reserved. Appointment Booking Online, telephone booking of secondary appointments Step 1 – discover & publish waiting times, capacity Step 2 – Match appointments to patients

20. 20 © 2004, Cisco Systems, Inc. All rights reserved. E-Prescriptions Prescriptions Service – covers creation, issue, dispensing Real benefits – prescriptions control, repeats Relay model vs direct delivery

21. 21 © 2004, Cisco Systems, Inc. All rights reserved. e-Virtual Hospital Objective Improve quality of care Empower consumers and engage them in health management Provide patients with access to specialists Solution On-line consultations for second opinions Impact Consumer access to world-class experts without travel costs and inconvenience Objective Improve quality of care Empower consumers and engage them in health management Provide patients with access to specialists Solution On-line consultations for second opinions Impact Consumer access to world-class experts without travel costs and inconvenience

22. 22 © 2004, Cisco Systems, Inc. All rights reserved. Paperless Hospital – the future ?

23. 23 © 2004, Cisco Systems, Inc. All rights reserved. Leveraging Knowledge….. Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, eMail, Consent/Authentication… Portfolio 1 – Clinical tools, PAS, PACS Health Records, Workflow, Prescriptions Service, Appointment Booking, Patient Access….. Portfolio 3 – E-Enablement eProcurement E-HR, E-Finance Portfolio 4– Patient Services Implementation planning – Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases Portfolio 2 – Knowledge Management & eLearning

24. 24 © 2004, Cisco Systems, Inc. All rights reserved. “Knowledge is the Enemy of disease” http://www.nks.nhs.uk

25. 25 © 2004, Cisco Systems, Inc. All rights reserved. Physician eLearning in the U.S. Objective Provide physicians just-in- time access to medical information Solution On-line clinical library with specialty-specific continuing education courses Impact 70% of physicians reported on-line system led to adjustments in treatment approach 90% of physicians plan to take an on-line CME course in next year Objective Provide physicians just-in- time access to medical information Solution On-line clinical library with specialty-specific continuing education courses Impact 70% of physicians reported on-line system led to adjustments in treatment approach 90% of physicians plan to take an on-line CME course in next year

26. 26 © 2004, Cisco Systems, Inc. All rights reserved. Operating efficiently….. Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, eMail, Consent/Authentication… Portfolio 1 – Clinical tools, PAS, PACS Health Records, Workflow, Prescriptions Service, Appointment Booking, Patient Access….. Portfolio 2 – Knowledge Management & eLearning Portfolio 4– Patient Services Implementation planning – Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases Portfolio 3 – E-Enablement eProcurement E-HR, E-Finance

27. 27 © 2004, Cisco Systems, Inc. All rights reserved. My life is on the web…. CorporateProcurement End-to-End Staffing Technical Support Directory BenefitsEnrollment Travel & Expense FAST Start EmployeeConnection Executive Information System IP TV VoDTraining CiscoCast VirtualClassroom

28. 28 © 2004, Cisco Systems, Inc. All rights reserved. Health Administration – hot topics Financial Management Procurement E HR Information for performance management

29. 29 © 2004, Cisco Systems, Inc. All rights reserved. Patients and Citizens….. Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, eMail, Consent/Authentication… Portfolio 1 – Clinical tools, PAS, PACS Health Records, Workflow, Prescriptions Service, Appointment Booking, Patient Access….. Portfolio 2 – Knowledge Management & eLearning Portfolio 3 – E-Enablement eProcurement E-HR, E-Finance Implementation planning – Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases Portfolio 4– Patient Services

30. 30 © 2004, Cisco Systems, Inc. All rights reserved. Bedside Services Softphone klient IP/Video klient Internet Billing solution with Smartcard/creditcard Standard touchscreen Smart-card reader Headphone or/and USB handset

31. 31 © 2004, Cisco Systems, Inc. All rights reserved. Patient access

32. 32 © 2004, Cisco Systems, Inc. All rights reserved. Citizen access

33. 33 © 2004, Cisco Systems, Inc. All rights reserved. In more detail…. Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations–Directory,eMail, Consent/Authentication… Implementation planning–Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Governance–National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases Secure, Intelligent, High Speed Infrastructure Target Funding, Strong Governance, Manage Implementation and Change Working Practices, Increase ITCompetence,Workwith Industry Portfolio 1–Clinical tools, Health Records, Prescriptions Service, Appointment Booking, Patient Access, Images, Telemedicine…… Portfolio 2– Knowledge Management & eLearning Portfolio 3– E-Enablement eProcurement E-HR, E-Finance Portfolio 4– Patient Services Web foundations–Directory,eMail, Consent/Authentication… Performance Measurement

34. 34 © 2004, Cisco Systems, Inc. All rights reserved. But what is really important? Business case Reduction in medical errors; shorter stays Shorter waits; Choice Reduction in costs Top priorities Transferable medical record Reform cross organisation process Prescribing & prescriptions Imaging Tele-medicine Clinician engagement Clinician engagement; Clinician engagement; Clinician engagement Standards, interoperability Recognise importance Simple steps Build on current assets Information architecture

35. 35 © 2004, Cisco Systems, Inc. All rights reserved.

36. 36 © 2004, Cisco Systems, Inc. All rights reserved. European e-Health Agenda The actions outlined below should allow the European Union to achieve the full potential of e-Health systems and services within a European e-Health Area. There are three target areas: how to address common challenges and create the right framework to support e-Health, pilot actions to jump start the delivery of e-Health, and sharing best practices and measuring progress.

37. 37 © 2004 Cisco Systems, Inc. All rights reserved. An example – the National Programme for IT in England Backup Note: Slides’ content taken from presentation to Forum PA, Rome, June 2003 – K Dean on behalf of Prof Sir John Pattison, DH

38. 38 © 2004, Cisco Systems, Inc. All rights reserved. NHS – a virtual organisation 1.2 Million “employees”, >55 million potential patients 28 Regions (5 in London cover ~8 million citizens) ~600 legal entities (Trusts – primary care, acute care, hospitals) ~35,000 General Practitioners self employed through contracts in 10,000 locations Budget >£60Bn ~660 million prescriptions per year….. Central policy, guidance – regional direction, local management Note: Slides’ content taken from presentation to Forum PA, Rome, June 2003 – K Dean on behalf of Prof Sir John Pattison, DH QualityAccessCost

39. 39 © 2004, Cisco Systems, Inc. All rights reserved. What - fundamental components of the NHS plans 1.Create Trust in citizens and Patients for information use 2.A backbone infrastructure with ubiquitous connectivity Data Video / Multimedia Voice 3.A single, life-long Electronic Health Record service “Thin” record with pointers to locally held detailed records 4.A standard design for an end-end National Care Record Service, delivered “locally” Generate; Order; Workflow; Share; Record; Results; Direct; Provide Knowledge; 5.Manage prescriptions; Handle hospital appointments

40. 40 © 2004, Cisco Systems, Inc. All rights reserved. Summary NHS has 1.Recognised the importance of IT in improving quality of care, increasing capacity, reducing waiting times, informing patients and clinicians 2.Focused resources and funding IT priorities Share experience & expertise Standards for data and systems 3.Addressed Governance issues 4.Created a Sourcing & Procurement strategy to maximise speed, value and industry contribution of IT to the organisation Note: Slides’ content taken from presentation to Forum PA, Rome, June 2003 – K Dean on behalf of Prof Sir John Pattison, DH