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Karl-Jürgen SchmittSiemens Medical SolutionsFebruary 07, 2006

Processes and Applications in eHealth

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Healthcare is one of the most important

infrastructure components

just as ... Power ... Transportation

... Communication ...

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Healthcare as an Economical FactorHealthcare could support the goals of the Lisbon Strategy

Europe:

Expenses for health: 8.6 % of GDP in EU-15

Employment: around 10 % of European workforce

10% increase in average life expectancy means 0.35% increase of GDP per

year*

Germany:

New Jobs in 2003: 25 000 Start-ups in 1995 – 2002 9 500

(Medical Technology)

*Source: Macro-Economics and Health, J. D. Sachs, WHO, 2001

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Need for more quality and transparency in healthcare

Less than 1 dead person on 100 000 adverse events Nuclear industry European roads Scheduled flights

1 dead person on 1 000 to 100 000 adverse events Road traffic at large Chemical industry

More than 1 dead person on 1 000 adverse events Bungee jumping Mountain climbing Healthcare

Quelle: Chirurgen Magazin 2005, *BMGS 2003

5 000 to 25 000 deaths in the German healthcare system due to wrong medication*

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CostQualityof Care

Therefore our common goal should be …

By: Innovation Process optimisation

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Sick,injured

Healed,fit for work

Patient InformationMedical Knowledge

Examination

DiagnosisTherapyCare

Improving efficiency with the patient in focus

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HealthManagement

Medmeets IT

Therapy

Diagnosis

HomeCare

AmbulatoryCare

StationaryCare

Care

Prevention /Early Detection

IT is key in integrating and optimising work-flows throughout the healthcare continuum

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Chart copy sent to pharmacy

Medication Errors in the USA

Ordering 50% - 55%

Transcription 6% - 12%

Dispensing 5% - 14%

Administration 33% - 38%

PhysicianOrder

Reviewby NurseTranscription

Order Entry(Rx System)

AdministrationDocumented

Verification byPharmacist

MedicationDispensed

Nurse confirms drug,dose, route, time,

and patient

MedicationAdministered

Optimising healthcare processes with IT

Source: Agency for Healthcare Research and Quality, 2001

Example: Conventional medication process

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Chart copy sent to pharmacy

Medication Errors in the USA

Ordering 50% - 55%

Transcription 6% - 12%

Dispensing 5% - 14%

Administration 33% - 38%

PhysicianOrder

Reviewby NurseTranscription

Order Entry(Rx System)

AdministrationDocumented

Verification byPharmacist

MedicationDispensed

Nurse confirms drug,dose, route, time,

and patient

MedicationAdministered

Source: Agency for Healthcare Research and Quality, 2001

Deaths 7.000 (1999)

Savings Potential $1.6 ... 5.6 billion

* in US hospitals

Effects on Healthcare System *

Optimising healthcare processes with ITExample: Conventional medication process

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Verification byPharmacist

AdministrationDocumented

Nurse confirms drug,dose, route, time,

and patient

MedicationDispensed

PhysicianOrder

Results• Process simplification to

reduce medication errors

• Includes software, barcodes, and

an automated dispenser system

• All data available for later evaluation

Optimising healthcare processes with ITExample: IT-supported medication process

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73% decrease in erroneous and unclear prescription

Stockholm, Schweden

„Proven Outcomes“ in medication:Real results with IT-supported processes

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Preventing 118 potential medication errors monthly.Estimated annual savings: $944 k Virginia, USA

96% decrease in medication turnaround time

New York, USA

52% reduction of medication turnaround time, 35% reduction of medication errors Ohio, USA

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The applications drive eHealth infrastructure

ConsultingIntegration and

technical consultation

Customizingand

Installation

Project management andturn key

Supportincl. Help Desks and Service Hotlines

Operator Solutions incl. ASP

ProductSolutions

BusinessServices

ProfessionalServices

Client & Server Hardware

Smartcard Solutionsincl. HPC & HC

Network and Security Solutionsincl. VPN, Directories, Mobile Solutions

Clinicial and administrative applications

eScheduling

eDisease Management

eHomecare

ePrescription

eReporting

ePatient Record

incl.

Siemens offers comprehensive solutions

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Improving workflow is our strengthProven outcomes: ASP

ASP: Scale Effectfor 24 x 7 Operations

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7,200people

75people

IndividualData

Centers

ASP (Centralised

Data Center)

In the U.S. 1,200+ Customers 200,000+ Physicians 137+ M Transactions/Day

In Europe 20 customers, 60 potential

customers in Germany Roll-out in other countries

ASP (Application Service Providing)

Centralized data center

1 Pure scale effect from human resources point of view; cost for network transmission has to be added

Significantly reduces healthcare systems’ investments in IT

Healthcare systems “pay per use”

(3 shiftsx

2 peoplex

1,200sites)

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Archiving and Image Distribution throughout Institutions and Hospitals in Austria

CT

MRLaserprinter

Lasercamera

DLR

Short Term Archiv

Web

Virtual PrivateNetwork

Virtual PrivateNetworkWorkstation

Router

Router

Router

Long Term Archive

ReferalReferal ReferalReferal

HospitalHospital

SpecialistSpecialist

Report

Images

InstituteInstitute

LICLIC++

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Norway is a leader in utilizing eHealthThe only country-wide use of an Electronic Patient Record (EPR)

A broad application spectrum more quickly increases the quality of care and reduces costs

North

Mid

East

South

West

Example: Siemens’ DocuLive EPR in Mid

• 650,000 EPR

• 13,000 users, up to 1,100 concurrently(35,000 users in total in Norway)

• 10 Million documents, + 25,000 documents per week

• 30,000 discharge summaries sent electronically per mo.

EPR in Norway includes … Orders Referrals Results Nursing treatment

plans Multimedia module Digital dictation

Scanning Safe e-mail

communication Multi-entity / cross-

enterprise applications ePrescribing

(planned for Q1 2006)

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A promising project for disease management with IT in ScotlandDisease Management Diabetes, Diabetic Retinopathy (DR)

• Up to 10% of Europeans diabetic

• 60% of diabetics develop DR

• DR is leading cause of blindness

for individuals > 65 years of age

• Blindness can be avoided in 90%

of DR cases if detected early

Huge Potential

Quality

Compliance

Processes

Use of Resources

Outcomes

Improved ...

Implementationof an integrated,

IT-supportedDisease Management

NHS Scotland andSiemens Medical

MobileExamination

Inform Patient

Central Evaluation by Experts

Registration,Invitation

• 300.000 exam-inations / year planned

• 73 locations• 5 regional

evaluation centers

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Improvement of chronic conditions is key for more efficient healthcare

WHO concluded: 60% of health expenditures are

due to chronic conditions Studies indicate that 50% of hospital admissions of chronic

heart failure patents can be avoided due to sophisticated

DM programs containing: patient education, care

coordination, care plans and compliance monitoring The average Medicare beneficiary sees 7 physicians and

receives more than 20 prescriptions p.a. 18% of people with chronic conditions undergo

duplicate tests or procedures and 17% receive conflicting

information from providers

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Standardize CHF Disease Management

CHF Disease ManagementSimultaneous implementation of a CHF DM system at 3 provider sites and subsequent ,joint study executed by a professional organizationGoal: To prove care quality improvement and demonstrate financial impact on providers in three different scenarios on a unified workflow, data and reporting modelMethod: Application of

Unified workflow engine Remotely accessible, shared data

repository Integrated quality-management tools Fully automated telephony based patient

monitoring system

CHF Disease ManagementSimultaneous implementation of a CHF DM system at 3 provider sites and subsequent ,joint study executed by a professional organizationGoal: To prove care quality improvement and demonstrate financial impact on providers in three different scenarios on a unified workflow, data and reporting modelMethod: Application of

Unified workflow engine Remotely accessible, shared data

repository Integrated quality-management tools Fully automated telephony based patient

monitoring system

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Streamline Workflow, Optimize Reporting

LVA Donaustauf Asthma/COPD Disease Management

Goal:

Optimized Asthma/COPD care in an integrated (Payer-Provider) setting

Method:

• Application of a unified workflow engine in a clinical-ambulatory scenario

• Integration of sophisticated reporting tools allowing the payer arm to efficiently steer patient care

Participants:

PCP‘S and clinical Competence Centers, Call-Centers and patients

LVA Donaustauf Asthma/COPD Disease Management

Goal:

Optimized Asthma/COPD care in an integrated (Payer-Provider) setting

Method:

• Application of a unified workflow engine in a clinical-ambulatory scenario

• Integration of sophisticated reporting tools allowing the payer arm to efficiently steer patient care

Participants:

PCP‘S and clinical Competence Centers, Call-Centers and patients

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Are high expenditures for health good or bad?

Health: The Highest Asset?!

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medical services

33%

commodities30%

nursing and therapeuticservices

25%

others 9%

repairs / maintenance

26%

Expenditures for Cars

petrol & engine oil

21%

vehicles 39%

Source: Statistisches Bundesamt, 2004 (data for 2002)

prevention / health

protection 3%

car rental, inspection,

parking 12%

vehicletax2%

€ 133 bn* € 174 bn

* incl. employers’ share: € 66,5 bn

Expenditures ofCompulsory Health Insurance

People are willing to pay for quality (Example: Germany)

22Healthcare … our largest economic factor!

... it’s a fascinating area!