New information technologies for Human Health What’s new in e-Health? Jean-François Penciolelli Global Business Development Director IBU Healthcare and Life Sciences

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 Ireland: Procurement contracting has started to drive national EHR effort Russia: 15 Diagnostic Centers project in progress. Plans being developed for national HER for 145 million people. 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 Opportunity Status Mexico: No EHR but aim for HL7 Integration – National Disease Surveillance going on Current Work Italy: EHR regional initiatives have begun Malaysia: Lifetime Health Record (LRH) by 2010 Australia: HealthConnect is developing a National Information Network Planning Chile: National RFP for EHR project is expected soon Brazil: National Health Card Project. Monitor Considering EHR Argentina: 1st adoption of a digital radiography solution- 2004 South Africa: No EHR – but infrastructure being developed Data N/A or No EHR Presence New Zealand: National EHR system in place (complete) * Target opportunities identified by text in red Source: Accenture + Oracle

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

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

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

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

Why Focus on Chronic Conditions? 80% of US/Europe healthcare spending 81% of inpatient stays 91% of prescriptions 76% of physician visits So, where should we focus to reduce cost or try to meet the demands of our growing health needs. My bet is on chronic illness management.. 98% of home healthcare visits

Patient Relationship Management Definition 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

A typical pattern in chronical treatment Adherence 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

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

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

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

What about Oracle?

Healthcare Interoperability Clinical IT Reality Home Care Nurse Primary Care Physician Medical Office Staff Orthopedic Specialist Radiologist Payer Process claim Schedule appointment Order test Discharge Patient Update medical record Diagnosis Submit claim Treatment Send discharge letter Receive report Perform procedure … Write report Start rehabilitation Submit results Follow-up Support patient Refer patient Multi-Media Medical Archiving (MMA) Clinician Workflow Management Homecare/Telemonitoring/Disease Managment/Payer Administration/CRM Business Intelligence GP System HIS CIS Radiology Payer Nursing

Healthcare Interoperability Clinical Integration Framework Home Care Nurse Primary Care Physician Medical Office Staff Orthopedic Specialist Radiologist Payer Single Sign On Process claim Schedule appointment Order test Discharge Patient Update medical record Diagnosis Submit claim Treatment Send discharge letter Receive report Perform procedure … Write report Start rehabilitation Submit results Follow-up Support patient Refer patient Process claim Schedule appointment Order test Discharge Patient Update medical record Diagnosis Submit claim Treatment Send discharge letter Receive report Perform procedure … Write report Start rehabilitation Submit results Follow-up Support patient Refer patient Process claim Schedule appointment Order test Discharge Patient Update medical record Diagnosis Submit claim Treatment Send discharge letter Receive report Perform procedure … Write report Start rehabilitation Submit results Follow-up Support patient Refer patient Clinical Portal Clinical Context Management SOA Orchestration Multi-Media Medical Archiving (MMA) Clinician Workflow Management Homecare/Telemonitoring/Disease Managment/Payer Administration/CRM Business Intelligence GP System HIS CIS Radiology Payer Nursing

Healthcare Interoperability Enabling Collaborative Networks Collaborative Network Collaborative services Teleradiology E-referral E-prescribing Homecare Home nurse GP 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 Pharmacy Hospital Private Practice 16

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

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

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

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

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

Q & A

New information technologies for Human Health What’s new in e-Health? Jean-François Penciolelli Global Business Development Director IBU Healthcare and Life Sciences