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

2 © 2004 Cisco Systems, Inc. All rights reserved. “Just make me better” From eHealth to Connected Health How we can use connected information to improve the quality, access and costs of healthcare Kevin Dean, Cisco Systems IBSG

333 © 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

4 © 2004 Cisco Systems, Inc. All rights reserved. eHealth

5 © 2004 Cisco Systems, Inc. All rights reserved. Health

6 © 2004 Cisco Systems, Inc. All rights reserved. Connected Health

777 © 2004, Cisco Systems, Inc. All rights reserved. Connected Health Citizens should be helped to avoid being ill Citizens and patients should be able to trust the “system” The patient makes a journey through care, often a unique journey Simple Complex Chronic …and should be agnostic to the organisation structures giving care Clinicians should be, virtually, as good as each other Managers should operate the healthcare business on lowest possible overhead and highest possible productivity

888 © 2004, Cisco Systems, Inc. All rights reserved. Our Connected Health initiatives Connected Health book IBSG Advisors The Hospital of the Future The Business Case for eHealth HealthGrid Available from Available from

999 © 2004, Cisco Systems, Inc. All rights reserved. Top of Mind Issues – Healthcare “CEOs” Improve Patient Care Quality, Consistency, Speed Increase Productivity Higher costs Limited budgets Be the Employer of Choice Workforce shortage

10 © 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

11 © 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

12 © 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…

13 © 2004, Cisco Systems, Inc. All rights reserved. Benefits come from…. Shorter route through treatment, fewer steps Avoiding malpractice, misdiagnosis, misprescribing, misdispensing…. Shorter hospital stays Fewer tests and retests 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 © 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 © 2004, Cisco Systems, Inc. All rights reserved. Reality – un-Connected Health hurts. 44,000 Americans die each year because of medical errors – more than from breast cancer, AIDS or car accidents Each year the NHS has a bill for £2 billion to cover prolonged stays in hospital because of errors The USA and England are not alone….. France Germany Italy Canada

16 © 2004, Cisco Systems, Inc. All rights reserved. Can’t we train away these “errors” ? “These quality problems occur typically not because of a failure of goodwill, knowledge, effort, or resources devoted to health care, but because of fundamental shortcomings in the ways care is organized.” Crossing the quality chasm: A new health system for the 21st century, Institute of Medicine, USA, 2001

17 © 2004, Cisco Systems, Inc. All rights reserved. Automating current Healthcare practices, organisations, patient experiences is not the answer Re-engineer delivering quality care quickly to the patient connecting information assets across organisational boundaries

18 © 2004, Cisco Systems, Inc. All rights reserved. The Connected Health Model…. Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, , Consent/Authentication… 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 Secure, Intelligent, High Speed Infrastructure Portfolio of Services for Citizens, Patients Clinicians, and Management Target Funding, Strong Governance, Manage Implementation and Change Working Practices, Increase IT Competence, Work with Industry

19 © 2004, Cisco Systems, Inc. All rights reserved. The full Connected Health Model Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations–Directory, , 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, , Consent/Authentication… Performance Measurement

20 © 2004, Cisco Systems, Inc. All rights reserved. Re-shaping cross-organisation processes Map of Medicine by Medic to Medic (UCL) Access – easily understood; share with patient; speed process Quality – applies guidelines; ensures communication; should eradicate some process steps Cost – radically change outpatients process Medic to Medic’s Map of Medicine Click for demonstration

21 © 2004, Cisco Systems, Inc. All rights reserved. “Knowledge is the Enemy of disease”

22 © 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

23 © 2004, Cisco Systems, Inc. All rights reserved. Patient relationship

24 © 2004, Cisco Systems, Inc. All rights reserved. Bedside Services

25 © 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

26 © 2004, Cisco Systems, Inc. All rights reserved. Healthcare – infrastructure dependencies

27 © 2004, Cisco Systems, Inc. All rights reserved. Beyond immediate care Infrastructure (Devices, Desktop, Servers, Security, Storage, LAN, WAN, Mobile / Wireless….) Web foundations – Directory, , Consent/Authentication… 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 Portfolio 1 – Clinical tools, Health Records, Prescriptions Service, Appointment Booking, Patient Access, Images, Telemedicine…… Performance Measurement -Waiting times -Outcomes - Financial -Disease patterns (Epidemiology) -Capacity -Feedback….

28 © 2004, Cisco Systems, Inc. All rights reserved. The Big Challenge – “How?” Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, , 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

29 © 2004, Cisco Systems, Inc. All rights reserved. Key Topics Portfolio Planning -VisionVision -PrioritiesPriorities Governance -StandardsStandards -ChoiceChoice -DeliveryDelivery Obtain & Manage Funding -LevelLevel -DistributionDistribution Developing Capacity Consent Authentication Authority Implementation -FootprintsFootprints -PriorityPriority National, Local Services -DesignDesign -InteractionInteraction Business Case & Measuring results Sourcing & Procurement Strategy Changing Working Practices Infrastructure design

30 © 2004, Cisco Systems, Inc. All rights reserved. All we have to do is solve…. Portfolio Planning -VisionVision -PrioritiesPriorities Governance -StandardsStandards -ChoiceChoice -DeliveryDelivery Obtain & Manage Funding -LevelLevel -DistributionDistribution Developing Capacity Consent Authentication Authority Implementation -FootprintsFootprints -PriorityPriority National, Local Services -DesignDesign -InteractionInteraction Business Case & Measuring results Sourcing & Procurement Strategy Changing Working Practices Infrastructure design Locally ? Regionally ? Nationally ? EU Wide ? Global ?

31 © 2004, Cisco Systems, Inc. All rights reserved. The Connected Health Model…. Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) Web foundations – Directory, , Consent/Authentication… 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 Secure, Intelligent, High Speed Infrastructure Portfolio of Services for Patients Clinicians, and Management Target Funding, Strong Governance, Manage Implementation and Change Working Practices, Increase IT Competence, Work with Industry

32 © 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

33 © 2004, Cisco Systems, Inc. All rights reserved. The momentum is building….. NHS England Wales Scotland France Arras MdS Paris Italy USA Poland Norway Finland Spain Iceland Saudi Arabia Bahrain Dubai Health City Germany BIT4IT Denmark MedCom European Commission WHO Australia Ireland