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

2. 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 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

3. 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,
Patient Relationship Management
References: Andalucia Salud Responde

4. 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

5. 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

6. 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

7. 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

8. 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

9. A typical pattern in chronical treatment Adherence drops – patients are at risk
VISIT
VISIT
VITAL SIGNS
ADHERENCE
TIME
Source: Mengden et al. ISH 18th meeting, Chicago P21.02

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

11. 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

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

13. What about Oracle?

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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
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

21. 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

22. Q
& A

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