© 2010 IBM Corporation

Building a Smarter Planet: Healthcare

2010, IBM Healthcare

© 2010 IBM Corporation2

Global Factors Driving an industry-wide transformation in healthcare

Changing Demographics and Lifestyles

Aging and overweight populations

Increased healthcare costs associated with aging

Estimated over 1.5 billion overweight by 2015

ConsumerismConsumers more engaged and demanding

more control over their own healthGrowing awareness of risks and adverse

events with higher expectations of care and service quality

The Changing Nature of DiseaseGrowing incidence and impact of chronic diseases, which account for 60% of the 58 million deaths each yearAs much as 75% of healthcare resources are consumed by the needs of those with chronic conditions

GlobalizationCompetition on a worldwide basis

Changing business models (e.g. rise of medical tourism, retail clinics, wellness centers)

Source: Healthcare 2015: Win-win or lose-lose?

© 2010 IBM Corporation3

Healthcare organizations must be agile and innovate

Clinical Quality and OutcomesApply insights to improve patient safety, quality of care, clinical outcomes, while improving financial resultsEngage and activate patients and consumers to promote health and deliver value-based care

Operational EfficiencyBuild flexibility into operations to support cost reduction and excellence in clinical and business performances and practicesEfficiently respond to increasing regulatory demands

.

InnovationBetter understand the molecular characteristics of disease, and discover new treatmentsEnable a flexible, responsive IT foundation to meet changing demands

© 2009 IBM Corporation

Accelerate Healthcare Solution Delivery

Healthcare realities: The need for progress

People worldwide pushed below the poverty line by personal healthcare expenditures each year.

100 million

In many parts of the world, healthcare costs are rising two times faster than economic growth.

1.5 millionErrors in the way medications are prescribed, delivered and taken harm 1.5 million U.S. citizens every year.

The number of developed countries where people with higher incomes have better access to physicians than those with lower incomes.

5O percent

2 timesThe estimated number of patients affected by healthcare-related infections in the EU.

1 in 10With poor urban governance, life expectancy within developing countries can be as low as 35 years.

35 years

5 © 2010 IBM Corporation

Building a smarter planet: Healthcare

Health Care expectations are greatly influenced by service levels they experience in other industries

e-Access to Healthcare DataHealth Benefits Employee Portal• PHR/HER/MHR• Advanced decision support tools• Wireless access

Simpler Provider Reimbursement Model

• Co-payments & co-insurance• IRS-approved services & goods

Online Patient Information• Contact data• Medical history, e.g., meds,

allergies• Secure, authorized access

Compliance with Evidence-BasedMedicine Guidelines• Measure impacts of targeted

interventions• Disease management support• Member Relationship Mgmt platform

Enables improved

quality of care and easier access to

information

Enables information access, e.g., emergency

medical record at point-of-care

Enables real-time benefits verification and updated personal medical history

Enables single swipe payment from Health Plan and employee (FSA/HSA) with extended credit

line – “One & Done”

“I have my own private health information that is comprehensive, up-to-date, and accessible when and where I need and authorize it’s use.”

6 © 2010 IBM Corporation

Building a smarter planet: Healthcare

6

Healthcare systems require a totally integrated approach

Your hospital

Physician’soffice

Outpatientcenter

Imaging centers

Long-termcare

Otherhospitals

Homecare

Consultingphysician

In-transit

Care givers

7 © 2010 IBM Corporation

Building a smarter planet: Healthcare 77The Business of Government … puts Healthcare also in a broader perspective IBM supported components

Central Government Regional Government Large Cities

Local Government Small Cities, Municipalities Other Organizations

Common Government

Public Safety and Security

State Financials

Defense

Education

Social Security

Traffic Management

E-GovernmentRegistries

IT ServicesCity Management

Physical Security and SurveillanceCrime Analysis, Threat and Fraud Intelligence

Emergency Response Planning and Organization

Criminal Justice

State TreasuryCustoms Management

Tax Management

Homeland Security Identity ManagementBorder Management

Network Centric Operations

Postal Services

NGO´s

Healthcare Providers

Infrastructure Providers

PPP´s

…

Education Organization ManagementCultural Heritage

Employment SecuritySocial Security

Payment & Benefit

…

Cross Sector Shared ServicesSmart Solutions

Government Sector

HealthcareeHealth (central information, transactional depending on the stakeholder)

eHealth strategy/roadmaplink to eGov, MoF, MoI

Optimization/Interoperability

8 © 2010 IBM Corporation

Building a smarter planet: Healthcare

1

IBM solutions support cost containment and value creation opportunities for healthcare organizations.

Achieving better qualityand outcomes

• Health Analytics

• Health Plan Member Analytics

• Performance Management

• Public Health, Disease Surveillance and Modeling

Delivering collaborative care for prevention and wellness

• Medical Home: Patient-centered Collaborative Care

• Health Information Exchanges

• National health portals

• Portals for care teams and patients

• Mobility and telehealth

• Converged communications

Improving operationaleffectiveness

• Clinical process optimization

• Program management

• EMR Integration

• SOA for flexible business processes

• Enterprise asset and service management

• Privacy, security and business resilience

• Application management and hosting

• Enterprise medical image archival solutions

• Server, storage and desktop virtualization

• Energy efficient technologies

• Data center automation and optimization solutions

Achieving better qualityand outcomes

• Health Analytics

• Health Plan Member Analytics

• Performance Management

• Public Health, Disease Surveillance and Modeling

Delivering collaborative care for prevention and wellness

• Medical Home: Patient-centered Collaborative Care

• Health Information Exchanges

• National health portals

• Portals for care teams and patients

• Mobility and telehealth

• Converged communications

Improving operationaleffectiveness

• Clinical process optimization

• Program management

• EMR Integration

• SOA for flexible business processes

• Enterprise asset and service management

• Privacy, security and business resilience

• Application management and hosting

• Enterprise medical image archival solutions

• Server, storage and desktop virtualization

• Energy efficient technologies

• Data center automation and optimization solutions

IBM IS DELIVERING …HEALTHCARE ORGANIZATIONSARE FOCUSED ON …

© 2010 IBM Corporation9

IBM Healthcare Research and Software Labs

Hursley, UKHealthcare Service Bus

- Devices, HL7 V3, CDA

Haifa, IsraelHIE Interoperability

- Images Management

Beijing, ChinaTraditional Chinese and Western Medicine EHRs

Zurich, Switzerland3D EHR modeling

Austin, USAHospital RoomOf the Future,

RFID - Real Time Location Services

La Gaude, FranceDrug RFID Tracking,

Health Analytics

Dallas, USAHealth Analytics

Center

10 © 2010 IBM Corporation

Building a smarter planet: Healthcare

e-referral

HomeMonitoring

HealthInformation

e-Vaccination

card

e-Reimbursement

DecissionSupportSystem

e-Appointment

e-PatientDiary

KnowledgeManagement

e-Learning

HCBusiness

Intelligence

e-Surveillance

e-Consultation

e-documentation

e-Ordering

e-Prescription

e-Medication

e-Lab

results

e-referrel

e-Health

Strategy

eHealthPortal

?

?

?

The potentiale-Health Applicationsand the Portal ...... exemplary.

11 © 2010 IBM Corporation

Building a smarter planet: Healthcare

Generically EPR is at the core of eHealth,which is the entire picture.

EMRECREPR

Knowledge- DB

Portal

BI / Analytics

eHealth core

Archive

Network / connection

TerminologyDe-Identification

Registers/Idexis

Health Card

eHealth Infrastructure

eHealth context / General conditions

Acceptance

Roles

ResponsibilitiesUsability

Standardization

Law

eHealth Applications

12. © Copyright IBM Corporation 2008For IBM Internal Use Only

IBM Global Business Services

12

Primary/Community Secondary and Tertiary Healthcare

Electronic Patient Records

(EPRs)

Primary Health Information

Systems

Electronic Patient Records

(EPRs)

Hospital Information Systems

An Electronic Health Record from cradle to grave ….

13

Healthcare Providers, Specialists & Hospitals• Patient Summary (allergies,

chronic diseases, …)• Prescriptions, dispensed

drugs & current medication• Referrals• Lab results• Hospital Episodes• …

eHealth portal

Government Agencies

Citizens• View information

Input for key performance indicators

Public Health Surveillance

13

Method of health information collection - Who, What, Where, When, Why, HoweHealth portal

Integration Healthcare Enterprise (IH

E)

Hospital/Clinic HIS/CIS

Primary care systems

Labs

Patient Summary Prescriptions Discharges summaries Lab Results

Radiology Images …

RadiologyPharmacies

Medical Emergency

Home Care

Research

Existing IT

systems

What is an EHR System?

14

Interoperability FrameworkNational Health Record Repository

Individual Master Health

Records

Consolidated Data Reporting

Records

•Patient•Provider•Location•Organisation

Master Registers

Patients

Transportable Health Record

Healthcare Provider(s)HIS / CIS

Content Viewers/ Portals

Existing Health Management Systems

External Reference Systems

Disease Registry

TB Registry

Access and Security Framework

National Population Register

Existing Health Management Systems

Cancer Registry DHIS

Terminologies

COHERE Facility Registry

Data consumer(s)

Reference data source(s)Health record source(s)

Patients visit multiple

healthcare provides

RIS

PACS

NHLS

Basic eHR.ZA Application

HIV/AIDS Registry

Health smartcard

What is eHR.ZA?

16

17.17. © Copyright IBM Corporation 2008For IBM Internal Use Only

IBM Global Business Services

Department of Health

+- 4700 facilities

+- 85% out of 50m population

+ R100 billion / per year(approx $14.3b)

+- 125,000 health workers

18.18. © Copyright IBM Corporation 2008For IBM Internal Use Only

IBM Global Business Services

18

Phase 1 Scope6 provinces have existing HIS Hub Deployments

GautengLimpopoNorthern CapeWestern CapeKwaZulu-NatalThe Free State

3 provinces do notNorth WestEastern CapeMpumalanga

Facilities per Province

●1 Tertiary hospital

●1 Regional (Seconda ry)

hospital

●1 District hospital

●2 Community Health Centres

●2 Clinics (1 provincial and 1

local, where at least 1 clinic is

completely paper based)

© 2010 IBM Corporation1919

IBM Health Integration Framework

Healthcare and Life Sciences Extensions

Key Software Group Products

Data and Process Models

Interfaces and Adapters

Tools

Portals and Portlets

Information Management Lotus Rational Tivoli WebSphere

IBM Services Assets and Delivery

IBM Solutions

Health Plans

HospitalsLife

Sciences

Business Partner Solutions

Health Plans

HospitalsLife

Sciences

Health Integration FrameworkIBM Health Integration FrameworkThe Health Integration Framework establishes a foundation for our solutions and is central to our partner and client collaborations

Reference Architectures

IBM Dynamic Infrastructure

ISV EcosystemPartners as an integral aspect of the framework – become a trusted

network of solution providers

IBM Product Foundation as shared, trusted

platform

Build and design faster with industry

accelerators

Solve client problems with a

common and extensible platform

20

SOA Industry Specific Framework

IBM & Business Partner Solution

Offerings

Integrated Solutions need Mapping Customers Business Architecture, Business Processes and IT - Infrastructure

Solution Offerings, Business servicesSolution Offerings, Business servicesSolution Offerings, Business services

Industry Thought LeadershipIndustry Thought LeadershipIndustry Thought Leadership

Partner ContentPartner ContentPartner Content

Integrated Solution Integrated Solution Solution ViewAn unified approach that leverages IBM Thought leadership, services & SOA/IA based solution offerings

Framework ViewSoftware platforms with industry specific extensions

21

Speed –accelerate delivery and integration

Flexibility – grow and add new capabilities incrementally

Choice – multiple solution on-ramps and business partners

Infrastructure and Governance

Healthcare Industry Framework

Business Partner Ecosystem

Government Industry Solutions

Rapid Development & Integration Process Flexibility Agility

Lowered Risk and Cost

Interoperability Scalability

Architectural blueprint for Government transformation

Pre-integrated software platform

Pre-built businessspecific accelerators

Smart SOATM foundation

Open standards

Well defined and described Interfaces to other Frameworks

Ecosystem of partner content

A robust base for Government Agency transformation and extending capability over time

IBM Healthcare Industry Framework Provides Speed, Flexibility and Choice

What it is: “Triton” is an asset from IBM providing an accelerated delivery of a a fully functional SOA Foundation

What it does: Enable delivery excellence in SOA infrastructure by leveraging implementation best practices, including delivery services, and utilizing harvested implementation assets

Provides Core Services

Focus on Foundations SOA Foundation aka “Triton”

Internal use only

SOA Foundation (aka “Triton”)SOA Foundation (aka SOA Foundation (aka ““TritonTriton””))

Why is this important: SOA infrastructure implementations can be complex

What it is composed of: Assets to support the full lifecycle of a SOA Infrastructure

Why use it: To accelerate implementations (calendar and overall person/year effort) and lower risk, and leverage SOA best practices from across IBM globally.

More Details : http://w3.tap.ibm.com/w3ki08/display/FWKS/Triton

IBM’s Service Oriented software infrastructure foundation that enables and supports wide variety of applications and functionality

© 2010 IBM Corporation

Building a smarter planet: Healthcare

24

Configurable & extensible BPM solution assets for enrollment, member & group, claims & provider collaboration; Based on HL7, ASC X12 EDI (HIPAA) standards & IBM’s best practices

BPM Solution Scenarios

Process ModelsCapability Models Service Models

Common Components Business Vocabulary Business Object Models

Based on HL7 & IBM’s Best Practices

Based on IBM’s Best Practices

Based on HL7, ASC X12 & IBM’s Best Practices

Based on HL7, ASC X12 & IBM’s Best Practices

Based on HL7, ASC X12 & IBM’s Best Practices

Based on HL7 RIM & IBM’s Best Practices

Capability Maps & Process Maps align business strategy with

process execution

Process Flows & Business Measures simulate human

workflows & automate processes

Service Interface & Schemas facilitate creation & assembly of

process implementations

Common Services & Utilities enable interoperability with the

application ecosystem

Repository of Business Concepts, Terms & Relationships

to ensure consistency

Conceptual Data Models to provide a foundation for information management

Benefits Eligibility, Real-Time Claims Adjudication – Includes UI Forms, Dashboards, Process Implementation

WebSphere Healthcare Content Pack Healthcare Solution Assets for WebSphere BPM

2525

IBM Health Integration Framework

Healthcare and Life Sciences Extensions

Key Software Group Products

Data and Process Models

Interfaces and Adapters

Tools

Portals and Portlets

Information Management Lotus Rational Tivoli WebSphere

IBM Services Assets and Delivery

IBM Solutions

Health Plans

HospitalsLife

Sciences

Business Partner Solutions

Health Plans

HospitalsLife

Sciences

Health Integration FrameworkIBM Health Integration FrameworkThe Health Integration Framework establishes a foundation for our solutions and is central to our partner and client collaborations

Reference Architectures

IBM Dynamic Infrastructure

ISV EcosystemPartners as an integral aspect of the framework – become a trusted

network of solution providers

IBM Product Foundation as shared, trusted

platform

Build and design faster with industry

accelerators

Solve client problems with a

common and extensible platform

© 2010 IBM Corporation26

Health Integration Framework: Domain and Project Taxonomy

26

Segment HIF Domain HIF Project

Healthcare Provider

Enterprise Health AnalyticsEnterprise Health Analytics

Medical Record Text Analytics

Operations Optimization

Service Management for Hospitals

Asset Management for Hospitals

Real Time Location Services

Clinical Business Integration

Device Integration to EMR Platform

Regulatory Compliant Clinical User Access

Enterprise, Patient & Clinical e-Views

Enterprise Service Bus for Healthcare

Healthcare InteroperabilityHealth Information Exchange, Patient Centered Collaborative Care, Medical

Home

Health Information Exchange -

EMR and EHR integration

Health Plans

Enterprise Health Plan AnalyticsEnterprise Health Plan Analytics

Medical Record Text Analytics

Health Plan Core Systems Modernization

Model Driven Architecture and BPM/BPR

EDI/Channel Modernization/HIPAA 5010-ICD10

Service Management for Health Plans

Customer Service Modernization Member 360, Provider 360, Portals

Life Sciences

Life Sciences Transformation

Life Sciences Stakeholder Communities and Collaboration

Medical Image Management (IBM SCORE MIMS)

Secure data sharing and data transfer

Regulatory Compliance

Regulatory Compliant Enterprise Content Management (SCORE)

Track and Trace

Life Sciences Asset Management

Life Sciences Performance Management

Business Analytics and Optimization for Life Sciences

© 2010 IBM Corporation27

Health Integration Framework Domain Healthcare Providers

Enterprise Health Analytics• The aggregation and analysis of information across a healthcare

enterprise, to improve clinical, financial or administrative outcomes and results.

Patient and Clinician e-Views (portals)• Using a portal-based user interface for the aggregation of

information across a healthcare and life sciences enterprise, to create custom views depending on role and providing new services.

Clinical Integration and Interoperability (HL7 ESB)• The integration, exchange, and sharing of information across a

healthcare organization. This can involve the integration of multiple systems within a single hospital, or within an integrated delivery network.

Health Information Exchange (HIE)• The exchange, sharing and usage of information across multiple

healthcare organizations, regions, or communities of interest.

27

Partner

© 2009 IBM Corporation

Accelerate Healthcare Solution Delivery

What is top of mind for decision makers in U.S. Health Plan organizations?

Source: Managed Care Executive Group, 2009

Client Challenges Focus1. Government regulation and intervention HIPAA, ICD-10 and HIPAA 5010

2. Containing administrative / medical costs Boost administrative efficiency

3. Impact of recession Declining membership as employers drop coverage

4. Collaboration with providers Health information exchanges, e-Rx (e- prescribing) and electronic medical records

5. Data analytics and informatics Underwriting and care management

6. Data transparency to improve quality Measuring provider performance

7. Fraud and abuse Detecting fraud faster and supporting utilization management

8. Consumers, the Web and Health 2.0 Personal health records and self-service portals

9. Adding value Disease management, health and wellness

10.Developing new products Individual plans and consumer-directed plans

© 2010 IBM Corporation29

Health Plan Core Systems Modernization• The transformation of core health insurance systems through

integration and process orchestration to improve overall efficiency and flexibility in creating and deploying new services e.g. claims process transformation, member enrollment.

Health Plan Analytics• The aggregation and analysis of information across a health plan,

to improve member wellness, financial and administrative outcomes and results.

Health Plan Member 360 (Single View)• The federation and consolidation of information from disparate

sources to build an understanding of all member-related activities from the perspective of a unique individual.

29

Partner

Health Integration Framework Domain Health Plans

© 2010 IBM Corporation30

Solution components:IBM Global Business Services - AIS Information Integration

“Under this public-private partnership, we hope to demonstrate how technology and Internet-based connectivity can significantly improve the quality of life for people in remote locations.”

— Ferial Saeed, Deputy U.S. Coordinator & Office Director for International Communications &

Information Policy

U.S. Department of State – Pakistan Telemedicine Initiative Telemedicine brings doctors to remote patients via the Internet

Business challenge: Pakistan has almost 179 million people, but more than 75 percent live in remote villages with limited access to healthcare. In the remote village of Attock, there are only 16 primary-care doctors and no specialists. If a villager needs specialized care, he or she often cannot afford the trip to the larger hospital in Rawalpindi. As a result, ailments that aren't emergencies are ignored, often for years.

Solution:IBM Global Business Services is working with the U.S. State Department on a telemedicine project that has enabled medical specialists to treat patients in remote areas of northern Pakistan. The project uses WiMAX wireless broadband technology, videoconferencing, and the Internet to connect a main hospital with a remote facility in Attock.

Benefits:Moving information instead of people, it gives people in remote areas access to care without traveling and incurring large costs

Without the telemedicine solution, many easily treatable diseases would continue to go untreated

Enables access to help from medical experts at some of the most elite medical institutions in Pakistan and around the world

© 2010 IBM Corporation31

Business challenge:Geisinger Health System sought to improve its electronic health record systems, allowing the healthcare group to organize information and integrate real-time clinical data with medical history information. An integrated solution providing increased clinical insight would help identify clinical trends, best practices and ultimately, improve patient care.

Solution:IBM Global Business Services implemented a Clinical Decision Intelligence System (CDIS) Solution. This first-of-its-kind system leverages the health system's wealth of clinical data derived from its decade-long use of one of the industry's most advanced electronic health record systems. The CDIS, which utilizes open standard based technology, will serve as the foundation for Geisinger's integrated clinical, financial, operational, claims, genomic and other medical data in a format that allows for rapid analysis and reporting of vital insights from millions of patient encounters.

“Building upon our electronic health record experience, our work with IBM now sets the stage for Geisinger to expand its role as a national model for patient engagement, research, and education, as well as leading to business and growth opportunities for the System.”

— Glenn Steele Jr., MD, PhD, president and chief executive

officer of Geisinger Health System

Geisinger Health System First-of-its-kind Clinical Decision Intelligence System

Benefits:Consolidates information to provide a comprehensive patient viewincluding complete medical history

Provides a massive storehouse of clinical information, procedure and research to quickly assist doctors in providing best practice care

Amount and diversity of medical information can be the basis forinnovative medical research, treatments and life-saving breakthroughs

Solution components:Clinical Decision Intelligence System (CDIS) solutionIBM InfoSphere Warehouse 9 platformIBM Global Business ServicesIBM Business Partner: Business Objects

© 2009 IBM Corporation

Accelerate Healthcare Solution Delivery

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