1. 1 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited.

2. 2 Hospital Information Systems “ Hospital” as a big complicated healthcare organisation Danny Solomon Senior Architect, iSOFT danny.solomon@isoftplc.com www.isoftplc.com

3. 3 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Objectives Understand information requirements of hospitals and other health-care organisations Understand issues and challenges in the life-cycle of health-care information-systems Understand some of the history – and some future directions Introduce iSOFT interrupt challenge dispute

4. 4 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Agenda What is a health-care information system? What’s it for? Issues in their creation and deployment – why is it hard? Where they have come from – where they are going iSOFT

5. 5 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. What is a health-care information system? What’s it for? Requirements Context How it all relates to CfH

6. 6 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Requirements of a health-care information system  Information-systems to run health-care organisations (HCOs)?  OR  Information-systems to manage the records of patients cared for in those organisations? BOTH

7. 7 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. What is an HCO? StHAPCTsGPsAcuteMental HealthCommunitySites............ LondonNational... Identity Clinical information Directory and desktop Infrastructure Population record Records Analysis HRI Out-of hours access Reference data Terminology Security Service user index Clinical governance Booking and scheduling Knowledge mgt Digital Imaging Prescribing Orders and results Diagnosis and care Pathology Any community service for tactical reasons Eg. PAS, Mental Health, Tertiary Non-federated data Guys &

8. 8 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Anatomy of a hospital  Multiple facilities (sites)  Wards  Clinics  Diagnostic services Radiology, Pathology, etc  Pharmacy  Treatment Theatres, Modalities  Medical Records  Coding  Links to other organisations Local: Primary care, Community National: DoH, CfH, national information systems  Catering  Portering  Physio  Phlebotomy  Management HR, Finance, etc  …

9. 9 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Information-systems to run health-care organisations  What’s going on?  What’s planned?  Where are my patients?  What reports do I need to generate?  Get my money  Am I about to run out of money?  Run my clinics  Run my waiting lists  Run my wards  Run my theatres

10. 10 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Information systems to manage patient records  Administrative Where do they live Booked for a clinic? On a ward? GP Next of kin …  Clinical What’s wrong with them What am I planning to do to them? Order a test See the result Refer them on Describe them … Division is not clear cut  Information Governance (IG) issues Who can see what? Is restricting to demographics safe? Who can see clinical? Is ward location clinical or demographic? How much information is shared? To whom? What does the patient expect?

11. 11 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Issues in the creation and deployment of health-care information systems Why is it hard? Total cost of ownership (TCO)

12. 12 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Why is it hard?  Well, is it hard? Empirical evidence suggests it is Beacon examples are generally not reproducible Productising is an issue  Medicine is not a science  Out of the box, computers are good at numbers, not people  Organisational setting is complex Different across different markets  Change control and management is always hard  Some specifics…

13. 13 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Why it is hard  Booking a clinic is like booking a flight? Slots not constant Different resources required for different slots/clinics Recipient has to explicitly accept Over-booking rules Patients aren’t predictable …  Clinic booking is the easy bit!

14. 14 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Why it is hard  Lots of different kinds of users Clinicians – Docs – Different grades, specialties, experiences, training, backround – Nurses –…–… – PAMS –…–… Managers Administrative staff Patients – Well – Unwell – Worried well – Vulnerable – Young / old – Expert / non-expert

15. 15 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Why it is hard  Lots of different kinds of users  Doing different kinds of things Seeing patients – Clinics, wards, A&E, telephone Planning budgets Organising resources – Human, equipment, consumable, locations  In many different settings Organisational – Hospital (wards, clinics…), Community, Practice, Lab, Specialty – Paed, Geri, Med, Surg, …  Everyone likes to do things their own way Don’t panic

16. 16 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Maintaining the balance

17. 17 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. There is commonality we can exploit

18. 18 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. One product, many solutions Health economy Care settings Healthcare services

19. 19 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Product vs solution  Product = software  Solution = software configured and deployed onto a managed technical architecture Many areas to consider: TCO

20. 20 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Total cost of ownership (TCO)  Forget shelf prices  What will it cost my organisation to procure, contract, implement, run, update and ultimately retire an information system?  What if I do nothing?  A useful way of examining areas that make this whole process hard

21. 21 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Typical TCO model

22. 22 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Past, present and Future Health-care information systems: where they have come from & where they are going History Drivers Direction of travel

23. 23 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Where health-care information systems have been  Organisation often based on physical artefacts Eg Hospitals Lots of local autonomy Need to maintain links with labs Maintain own coding departments Maintain own IT infrastructure  Information systems Local procurement PAS critical Clinicals less so – Lots of local activity at a departmental level – nightmare to manage Order-comms typically an early requirement/win EPR / Prescribing not common in secondary care

24. 24 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Drivers  Health-care organisation is changing Everywhere, quite frequently From the centre – Reporting requirements – Spine compliance – PBR Locally – (some) clinicians demanding better tools – Access to knowledge & best practice, decision support, lose the paper  Procurement model is changing Local  Regional  National Do once and share – Procurement, configuration

25. 25 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Drivers  Health-care organisation is changing  Procurement model is changing  Deployment model is changing Critical data under a GP’s desk? Critical data in a hospital server-room? DR-capable data-centre  Information-sharing becoming critical Support the patient journey Empower the patient – Where that’s a good thing Avoid unnecessary errors

26. 26 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Direction of travel Step 1 – Analyse landscape Qualify legacy systems Plan the transition User experience: Mix of modern and legacy Organisation-focused: little information passed around the community Step 2 – Install products Legacy replacement commenced Service adapters for core services deployed Service hubs introduced Architecture being delivered User experience: Modern applications becoming pervasive Information becoming accessible across the community Legacy decreasing Step 3 – Join Up More uniform landscape More information access Common services and accessible data Supports shared and coherent care across the community User experience: Modern applications across the community Information accessible across the community Healthcare community Integrated healthcare community GP legacy Hospital legacy iSOFT customer Citizen SH SA SH SA

27. 27 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. iSOFT Mission Market leadership Business strategy Global healthcare and social reform

28. 28 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Our mission To be the global leader in the healthcare software applications market. iSOFT is working with patients, clinicians, other healthcare professionals, administrators and governments to help transform the delivery of healthcare. We focus on satisfying the needs of all individual stakeholders, whoever they are, and however they participate in the supply chain of healthcare provision. Our solutions not only meet the current need, they also describe the future of healthcare. Our inspiration and motivation is to improve the life experience of citizens worldwide iSOFT: inspired by life.

29. 29 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Leading the healthcare software applications market  Customers 1,700 hospitals 6,000 family doctors 18 countries in five continents  Employees 2,700 healthcare IT specialists 1,000 technology and development professionals Two dedicated offshore development and solution design centres in India Scale of business  Fourth largest software and computer services business on the LSE  Market capitalisation of over £900m (US$1,600 million)  Stock market listing in July 2000 Revenues grown from £17m to £262m Profits increased by over 2,000% Financials

30. 30 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Our business strategy Deliver growth in existing markets  Develop and grow existing market shares for LORENZO  Configure LORENZO to meet local market requirements  Provide world class references for international expansion Develop and execute new market entry strategies  Conduct detailed market analysis and qualification  Establish strong foundation based on significant early wins  Build on initial success through effective promotion of LORENZO Expand partnership arrangements  Work with third party technology and service partners on large scale projects and new market entry  Develop existing partnership arrangements  Identify opportunities for new partnerships and collaborations Target rapid market leadership  Establish leading competitive position  Win majority of open market procurements  Accelerate market share through targeted acquisitions  Offer strategic ‘universal’ application set  Continue to invest in development capability and capacity  Promote LORENZO as our new generation software solution Maintain software application leadership

31. 31 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. The need Global healthcare and social reform  Healthcare is undergoing rapid, unprecedented change  Forward referencing solutions required by citizens, clinicians, policy makers  Work to implement the necessary systems will take place over the next 10 years

32. 32 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Summary  Successful well managed healthcare applications business  Consistent and focused business strategy  Large and growing international market opportunity  Leader in the supply of advanced application solutions  Strong positive differentiation from small number of credible competitors  Well positioned in respect of future growth opportunity in both existing and new international markets

33. 33 THIS DOCUMENT IS CONFIDENTIAL and intended solely for the use of the individual to whom it is addressed or any other recipient expressly authorised by iSOFT Group plc, in writing or otherwise, to receive the same. If you are not the addressee or authorised recipient of this document, any disclosure, reproduction, copying, distribution, or other dissemination or use of this communication is strictly prohibited. Re-cap Objectives Understand information requirements of hospitals and other health-care organisations Understand issues and challenges in the life-cycle of health-care information-systems Understand some of the history – and some future directions Introduce iSOFT