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EMC IIG Solutions for Transforming Healthcare A Strategy Paper & Solutions Showcase

Date: 1st March 2013

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CONTENTS

1. EMC AT A GLANCE ................................................................................................................. 2

2. UNDERSTANDING YOUR EHEALTH STRATEGY ...................................................................... 3

3. LARGE EMC HEALTHCARE PROJECTS IN ACTION .................................................................. 5

4. EMC SOLUTIONS FOR COLLABORATIVE HEALTHCARE ......................................................... 7

4.1 Healthcare Integration Portfolio – Clinical Challenges ................................................. 7

4.2 Healthcare Integration Portfolio – Solution Description ............................................... 8

4.3 Healthcare Integration Portfolio – Solution Components ............................................. 8

4.4 Healthcare Integration Portfolio – Solution Benefits .................................................... 10

5. EMC IIG HEALTHCARE INTEGRATION PORTFOLIO (HIP) CAPABILITIES ................................. 11

5.1 Medical Image Management ........................................................................................ 11

5.2 Driving Efficiencies in Healthcare Business Processes ................................................. 12

5.2.1 Capturing Paper to Digital Records .................................................................... 12

5.2.2 Providing National Applications to Drive Process Efficiencies ........................... 12

5.3 Cloud Provisioned HIS Environment ............................................................................. 13

5.4 Enabling Services to Mobile Citizens ........................................................................... 15

5.5 Introducing Telehealth & Home Care Capabilities ........................................................ 15

5.6 Introducing Clinical Applications managed nationally ................................................. 16

5.6.1 An Example Application – Stroke Management .................................................. 16

5.6.2 An Example Application – HIV Management ...................................................... 16

5.6.3 An Example Application – Chronic Disease Management .................................. 16

5.7 Enabling National Healthcare Analytics ....................................................................... 16

5.7.1 Potentially Preventable Events ........................................................................... 17

5.7.2 Decision Support Systems for Doctors .............................................................. 17

6. SUMMARY ............................................................................................................................ 18

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1. EMC AT A GLANCE

EMC is a global leader in enabling businesses and service providers to transform their operations and deliver Information Technology as a service. Fundamental to this transformation is cloud computing. Through innovative products and services, EMC accelerates the journey to cloud computing, helping IT departments to store, manage, protect and analyse their most valuable asset — information — in a more agile, trusted and cost-efficient way.

EMC works with organisations around the world, in every industry, in the public and private sectors, and of every size, from start-ups to the Fortune Global 500. Our customers include banks and other financial services firms, manufacturers, healthcare and life sciences organisations, Internet service and telecommunications providers, airlines and transportation companies, educational institutions, and public-sector agencies. EMC also provides technology, products, and services to consumers in more than 100 countries. Our differentiated value stems from our sustained and substantial investment in research and development, a cumulative investment of approximately $10.5 billion from 2003-2010. To strengthen our core business and extend our market to new areas, EMC has invested $14 billion in acquisitions over the same period and has integrated 36 technology companies since 2006 alone.

EMC is supported by thousands of technical R&D employees around the globe, the industry’s broadest portfolio of systems, software, and services, our ability to create total integrated solutions, and our commitment to delivering the best Total Customer Experience in this or any industry. EMC ranks 152 in the Fortune 500 based on total consolidated revenue of $20 billion in 2012, the largest revenue year in EMC’s 30+ year history.

EMC employs approximately 48,500 people worldwide. We are represented by approximately 400 sales offices and scores of partners in more than 80 countries around the world. We have the world’s largest sales and service force focused on information infrastructure, and we work closely with a global network of technology, outsourcing, systems integration, service, and distribution partners.

EMC has over 5000 healthcare provider customers globally including 1600 healthcare customers who also utilise the EMC Healthcare software solutions globally. EMC is the number 1 U.S. healthcare storage vendor with a 52% market penetration rate (Source: HIMSS Analytics). EMC was recognized by Healthcare Informatics as 14th in 2011’s Top 100 Healthcare Information Technology (HIT) Vendors. (A rise from 21st position in 2010).

EMC’s Healthcare division holds membership of the HL7 organisation and participation at Connectathon in 2010, 2011, 2012 for our EMC Healthcare Integration Portfolio (EMC HIP) solution for Healthcare.Our Healthcare customers include government agencies, healthcare providers and healthcare insurance companies. Examples of these across Europe include in the UK the NHS; in Finland, Kela& Tampere Region; in France the University Hospital of Nancy and the CNAM National HealthInsurance Company; and in Belgium the University Hospital of Saint-Pierre and the Regional Hospital of Jan Yperman.

EMC at a Glance• Revenues (2012): $20B• Fortune 500 Rank: 166• Employees: ≈ 49,000• Countries with EMC operations: >80• R&D investment (2010): ≈ $2B• Total cash and investments (2010): $9.5B• Market capitalisation: ~$57B (3/31/11)• Founded: 1979

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2. UNDERSTANDING YOUR EHEALTH STRATEGY

We are keen to understand what the key objectives and main priorities are for enhancing healthcare services at a national level.

Matching EMC’s solutions for healthcare around your Healthcare strategy is the first step towards creating an effective partnership. We can assist in building this strategy in collaboration with you. We have experience in this area at a national, regional and hospital level.

In our experience from working with other nations key objectives in an ehealth strategy are tightly linked to the national development programmes at a political level. Improvements in the quality of healthcare and the consis-tency of the delivery of healthcare programmes have a direct effect on the contribution of the population to GDP, and therefore the economic success of the country. Education and Healthcare are the 2 pillars from which economic development of a country can be improved.

One of the strategic aims of the government could be, “to improve population health through a reduction of disease burden and mortality by 2015.” Expected results following the implementation of this strategy would be;

• Increase of the average life expectancy of the population – by reducing mortality resulting from averted premature death, primarily among children, as well as other age groups

• Improvement of the quality of life of the population of the country – by reducing general morbidity and associated disabilities

KEY PRINCIPLES OF THIS STRATEGY WOULD INCLUDE;1. Reduction of inequalities in access to medical care2. Creating a Patient focused health care system3. Creating an Affordable and efficient health care system4. Improvement of the quality of medical services5. Protection of the patient’s rights6. Prevention of diseases, readiness for response to health threats7. Refinement of the health care system management and increase of the sector efficiency

INITIATIVES WHICH SUPPORT EACH OF THESE KEY PRINCIPLES WOULD INCLUDE;• Hospital Sector development plan (Urban & Regional)• Development of the primary healthcare (Centralized Medical Records)• Increase of number of citizens with health insurance• Increase of access to medicines (Urban & Regional)• Increase of access to medical services for persons with special needs• New permit conditions for medical institutions (Controlling Quality)• Motivated and qualified medical staff (Controlling Quality)• Accreditation of programmes and clinical placements• Promotion of the evidence- based clinical practice• Creation and development of telehealth capabilities (Enhancing Access)• Electronic portal for citizens (Internet Based, Mobile Device Based)• Electronic portal for doctors (Internet Based, Mobile Device Based)• Enhancement of public health system• Enhancement of maternal and child health services• Prevention and control of tuberculosis and HIV/AIDS (Disease Registers)• Prevention and screening of non- communicable diseases

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• Facilitation of health and healthy life- style (Citizen Education)• Emergency and Disaster preparedness (National Registers, Response Systems)• Support health science, predictive medicine and national research programmes

The above are some examples of what has been seen with previous national customers in the healthcare domain. A number of these initiatives may be precisely what you are looking into, whilst others might not be relevant, and of course further programmes may be in place, or suitable for the future. We look forward to discovering more about the regional/national strategy and feedback from this paper.

SOME FURTHER QUESTIONS INCLUDE;

1. Is the strategy for healthcare provision on a city / regional basis or national?

2. Do healthcare provider organisations (hospitals) have individual autonomy, act in groups or follow closely to national guidelines?

3. Is it desirable to adapt your processes to suit a proposed system which has been developed for another country’s healthcare system or is the desire to create a new system to automate existing healthcare processes?

4. Have you thought about creating a nation- wide repository for information that can be accessed via cloud computing from any source?

5. Would it be helpful to provide the IT infrastructure to an international secure standard, vendor neutral, from which organisations can develop their own systems dependent upon local need?

6. Based on the main public health issues facing your population, would it be sensible to think about what national systems should be developed that make the most difference, and how to do this at scale? Specifically, are you likely to concentrate on population identification, immunisation programmes, and/or disease management programmes?

7. Have you considered an approach which includes a world- wide recognised IT Infrastructure Company in your thinking, and could we provide that consulting expertise?

8. What are likely to be your priorities based on current political thinking?

9. Should you be taking those areas of successful implementation from other countries, such as telehealth and telemedicine, to create some quick wins which are demonstrable?

10. Has there been implemented, or decided to be implemented, medical vocabularies as in many other countries across the world regarding classification and terminology? For example, ICD- 10, CPT, Snomed, ICPC, LOINC, etc..

This diagram might help in illustrating the various vocabularies and their disciplinary relevance.

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3. LARGE EMC HEALTHCARE PROJECTS IN ACTION

This section outlines some of the success stories across Europe where EMC technology and services have provided significant enhancements to healthcare service delivery.

In some cases we start with a large hospital in the major city of a country, deploy to a controlled ecosystem representing multiple actors that participate in the landscape, and then expand to a wider population. In other cases we start with a key functionality area (for example national immunization programme) and deploy this nationally, then expand to add other services.

Central to all our solutions is the concept of creating what we call a Citizen Electronic Health Record. Many countries call this an Electronic Health Record (EHR), Electronic Medical Record (EMR), National Medical Record (NMR), Central Medical Record (CMR) or whatever the local language defines the acronym. The EHR is the combination of the following;

EMC’s solutions provide the architecture, products, storage, security, cloud infrastructure and services to realise this vision. The national electronic medical record is the heart of the system. All healthcare providers and consumers have access points into this shared infrastructure which enables greater control of medical information, and enables at a national level the ability to perform analytics on the data to provide insight into the level of care provided as well as predictive analysis and the targeting of national campaigns.

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An interconnected system can initially be deployed in a controlled environment representing many different collaborators; the diagram below represents how thiscan be achieved;

An alternative approach is to provide the system from a case based perspective introducing a key management capability; the diagram below represents the management of insurance claims at a national level.

In both cases the electronic medical record is central to the solution. This may include medical imaging, allowing image creation, diagnosis and referral to be shared regionally, stored centrally. This enables telemedicine services and removes the need for major healthcare physical infrastructure to be deployed consistently across a population.

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4. EMC SOLUTIONS FOR COLLABORATIVE HEALTHCARE

The picture above represents the full breadth of the products available from EMC for healthcare at a high level. For each customer the best fit of hardware and software are selected based on their requirements.

EMC has a broad range of capabilities and through discussion with you we hope to target our Solutions forCollaborative Healthcare stack with the priority areas most relevant.

As presented in the previous section, our Healthcare Integration Platform is central to building up the national EMR. This could start from collecting patient demographic information to build up a national patient registry and/or take a medical image management approach, consolidating hospital imaging information and sharing this medical content.

The rest of this section goes into greater details of the EMC Healthcare Integration Portfolio. This is one of the solutions within what we call Collaborative Healthcare.

4.1 HEALTHCARE INTEGRATION PORTFOLIO – CLINICAL CHALLENGES

Global healthcare organizations are increasingly being pressured to share information to improve the delivery of patient care, coordinate patient financial services, and enable the adoption of the electronic health record. An interoperable healthcare environment allows siloed patient health information to be shared securely in order to gain a holistic view of the patient, improve the quality and efficiency of care, and control HealthIT costs. HealthIT interoperability is not only “a must” for collaborative healthcare, but it also greatly increases the value of technology investments made in healthcare organizations.

The EMC® Healthcare Integration Portfolio delivers healthcare standards-based integration, and enables the interaction between any healthcare information application or system for the secure sharing and exchange of information. Its massively scalable software architecture is based on open standards such as XML, HL7, and XDS. When this solution is deployed, your HealthIT infrastructure will be durable and able to handle your future needs as the volume of digital content created by your clinical applications grows. Utilizing EMC’s registry and repository also provides your organization with just the breadth of technology needed to meet changing requirements, for example, incorporating mainstream content management capabilities such as digital imaging or compliance management to augment the patient record prior to sharing it.

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4.2 HEALTHCARE INTEGRATION PORTFOLIO – SOLUTION DESCRIPTION

The EMC Healthcare Integration Portfolio is one of EMC’s Solutions for Collaborative Healthcare, providing patient-centric infrastructure to “content enable” PACS, HIS, and EMR applications for access to all relevant clinical, financial, and operational data. It allows healthcare providers to improve clinical workflow and productivity for safer, collaborative care decisions. This offering is based on open standards in accordance with the “Integrating the Healthcare Enterprise” (IHE) initiative which promotes the coordinated use of established standards such as DICOM, HL7, and XDS. The solution leverages the EMC Documentum® Content Server to manage the storing, retrieval, updating, and archiving of patient information and its metadata in an open, non-proprietary format. Documentum also provides the appropriate retention policies, security policies, and services-oriented management policies to ensure the compliance and availability of medical information during its lifecycle.

This solution helps improve clinical workflow and time to treatment by delivering integrated, unstructured data at the point of care. The solution enhances operational agility and reduces costs through the abstraction of applications and infrastructure, improves financial performance by managing physical and virtual assets with highly automated tools, and secures access to and prevents loss of protected health information (PHI) and personally identifiable information (PII).

As one of EMC’s Solutions for Collaborative Healthcare, the EMC Healthcare Integration Portfolio is a core solution that can be enhanced with additional capability as new components are added.

4.3 HEALTHCARE INTEGRATION PORTFOLIO – SOLUTION COMPONENTS

The EMC Healthcare Integration Portfolio consists of the following components:

• J4Care enhanced IHE protocol support enables the coexistence of multiple implementations of DICOM and HL7 standards, communication, and visualization and the J4Care Healthcare Connector (HCC) software establishes an IHE compliant Image Archive and Report Repository integrated with the EMC Documentum platform.

• EMC Documentum provides complementary capabilities to traditional RIS/PACS integrations— allowing documents, patient records, prescriptions, invoices, and other unstructured content to be easily accessed via a secure, virtual, and federated repository, while leveraging open standard message formats to reduce the expensive point- point integrations that are typically required.

• Documentum Content Server governs the Documentum content repository containing the data and metadata and can manage HTML and XML, graphics, multimedia, other types of rich media, and traditional documents created with desktop applications.

• Documentum Retention Policy Services (RPS) enables compliance with regulations for the retention and disposal of patient information. RPS attaches the appropriate lifecycle policies to the different types of medical information (i.e., DICOM, HL7, SAP, and scanned documents) stored in the Documentum repository. Static and dynamic policies can be configured to support real- life events based on any metadata on the objects or through referenced objects such as the patient or the facility.

• Documentum Content Storage Services (CSS) stores each medical document in a file store when it reaches the repository. CSS provides de- duplication and compression without changing the original

file and both automated and policy- based storage and migration of data across tiered storage layers of the corporate network.

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• Trusted Content Services (TCS) provides an additional security layer for controlling how content is protected, accessed, and authorized under complex, dynamic conditions.

• EMC Archiving Solutions creates an accessible online medical image archive and lowers operational costs, achieves regulatory and litigation requirements, and facilitates retrieval of patient information. EMC offers a range of backup solutions, including purpose- built cloud storage platforms that can manage millions of objects per day and efficiently store and protect data at petabyte scale throughout your healthcare organization.

• VMware vSphere dramatically reduces capital and operating costs and maximizes IT efficiency while giving healthcare organizations the agility through automation and the freedom to choose applications, operating systems, and hardware.

The healthcare integration portfolio is comprised of building block components, including:

• EMC Documentum XDS Registry is the directory or “white pages” for medical and administrative content and allows applications within the enterprise to discover and then access information. It provides a central catalog for documents that may reside in a federated system or repositories, either heterogeneous or geographically distributed.

• EMC Documentum XDS Repository stores structured and unstructured healthcare information where all patient- centric documents, images, and media are available via the XDS- specification for applications to consume—even when the clinical, financial, and operational content was not created via an XDS specification.

• EMC Documentum XCA Gateway is an interface that enables multiple healthcare organizations to federate and share information based on the IHE’s Cross- Community- Access (XCA) specification. The XCA gateway facilitates the secure access of information by participants from various user domains, e.g., regions within a country.

• EMC Identity Mapping is a solution that meets one of the key requirements in patient centric healthcare—the reconciliation of patient identity.

• Connectors provides a library of connectors for on- boarding information to be shared in addition to the standards- based integration through XDS messaging. An example is an XDS- I Connector, where DICOM images are processed for storage or retention and the XDS- I objects are provided to the repository.

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4.4 HEALTHCARE INTEGRATION PORTFOLIO – SOLUTION BENEFITS

The EMC Healthcare Integration Portfolio simplifies internal healthcare IT processes by providing an integrated, virtualized, and services-oriented IT environment for the management of all the information in the healthcare organization. Clinicians gain a 360-degree view of the patient that is secure, easy to access, and compliant-ready. In addition, this solution provides:

• Rapid access to patient health data at the point of care and across the healthcare exchange for collaborative healthcare.

• A modular approach to provide the breadth of technology needed to meet your requirements now and in the future.

• Scalable software architecture based on open standards allows easy data exchange.

• Supports for healthcare standards such as HL7 and XDS for ease of compliance.

This solution accelerates clinical workflow and time to treatment through the delivery of integrated, unstructured data to the point of care. It also enhances operational agility through the abstraction of applications and infrastructure; improves financial performance by managing physical and virtual assets with highly automated tools; and secures access to and prevents loss of protected health information.

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5. EMC IIG HEALTHCARE INTEGRATION PORTFOLIO (HIP) CAPABILITIES

There are 3 fundamental drivers for improving eHealth capabilities at a regional/national level.

Improving the access to quality healthcare for all citizens• Enabling mobile and home based applications• To improve processes and ultimately their experience of care when visiting clinics and hospitals• To feel empowered with information and be more participative in their own care

Improving the tools for medical professionals in your region/country• Providing up to date and modern systems for Doctors• Enable sharing of medical data and images at a regional and national level• Improving the continuity of care through access of the wider electronic health record• Enable more informed decision making from better access to trusted information

Improving the healthcare service for citizens whilst controlling the cost• Optimising processes to avoid duplicated costs and wasted effort• Enabling sharing of medical records and images to avoid duplicated procedures• Reducing errors, mistakes and fraud by moving from paper to digital records• Enabling healthcare analytics with greater governance, control and understanding of the healthcare

network, providing new insight into healthcare transformation

5.1 MEDICAL IMAGE MANAGEMENT

One of the core functions of the HIP platform is to enable the storage of medical images through the support of DICOM standards. Also part of the landscape is a medical image viewer which can retrieve studies and provide a clinical view for diagnostics and referrals. A common challenge for all hospitals is the management of medical images. PACS systems are used within hospitals to manage medical images, quickly these environments become costly to manage and constantly upgrade to store more images. The challenge for most PACS solutions is that they are primarily concerned with serving and storing studies. They are not designed for hierarchical storage management, they do not allow for sophisticated retention rules and they are not designed for enabling XDSi/XCA sharing.

The EMC HIP solution can be used as a central image archive, to reduce the reliance on specific vendors for PACS systems and storage at the hospital level, and to also allow for access to medical image studies at a shared regional/national level. This promotes not only patient mobility, but also enables tele-radiology and tele-referalls such that clinicians can remotely diagnose. For a large hospital, this also enables PACS systems to be smaller, and they can realised cost savings through the use of a Vendor Neutral Archive (VNA), which is what the EMC HIP provides.

Our medical image viewer also provides a view to non DICOM image documents within the same viewer. Therefore in this way, the physician can view the medical study images as well as associated documents, for example clinician notes, that make up the patient health record.

Also key to the sharing of medical image studies is cost avoidance. Through sharing, studies and exams can be reused and reviewed by many practitioners through a patient’s diagnosis. This approach helps to avoid the duplication of exams when a patient seeks a similar procedure for the same condition in a short time frame.

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5.2 DRIVING EFFICIENCIES IN HEALTHCARE BUSINESS PROCESSES

5.2.1 CAPTURING PAPER TO DIGITAL RECORDSAnother core function of the HIP platform is to enable the capture of paper records and store them digitally. We have a number of customers worldwide who use the capabilities of EMC Captiva attached to EMC Documentum to automate the scanning of medical records which have traditionally been stored in large paper archives either in a hospital, clinic or held at remote paper warehouses. These records are scanned, automatically detected to capture structured data and filed into Documentum against the proper patient folder.

This paper to digital journey enables the “paperless” experience for current patients, and also is a method for removing large paper warehouses to reclaim space and reduce manual errors by scanning in existing paper, validating it has been captured successfully, and then destroying the paper.

When to scan is quite important in this drive for efficiency. If physical storage costs are prohibitive, then batch scanning an archive makes sense. More recently is the concept of Scan On Demand. This approach only scans paper records when a patient is planning to visit a healthcare provider. The full paper history of that patient is scanned into the HIP and then that patient’s health record is fully digital going forward. Scanning linked to business processes, linked to providing healthcare service ensures paper to digital transformation is optimised for the current citizens of your region.

Reducing paper flow has a significant impact to enhancing clinical & administrative processes, reduces errors and lost time for administration to convert paper notes to digital records. The solutions available include the use of dedicated multi-function devices which can scan directly to the HIP, web based tools to allow already scanned documents to be analysed and imported into the HIP, and email inboxes so documents can be sent to a general email account for automatic import into the HIP.

5.2.2 PROVIDING NATIONAL APPLICATIONS TO DRIVE PROCESS EFFICIENCIESUtilising the HIP platform but extending it through our healthcare case management capabilities we can also drive efficiencies in sharing information. Examples of this are the 6PM partner solution named, HRVision. This application tracks the human resource requirements of healthcare practitioners, doctors, nurses – not only managing their HR factors like entitlements, leave, remuneration, but also manages their career appraisals, certification and registration. Taken at a national level this ensures all medical professionals are certified and registered, have demonstrated current experience and credentials, but also ensure doctors who have been identified as not able to practice due to certain medical failings of performance to highlight this at a national level.

Another solution using this environment could be enhanced collaborative scheduling. Through the integration of doctor clinics and hospitals, a citizen could log into their portal and only be offered appointments which correlate the availability of all healthcare delivery actors, for example an operation is only offered based on matching the service required with hospital bed availability, clinician availability and anaesthetist availability. This typically involves many systems and is paper based, so bringing this all together empowers the patient, allows for better healthcare service & optimisation, and reduces errors.

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5.3 CLOUD PROVISIONED HIS ENVIRONMENT

Another priority for many providers is to be able to provide a cloud provisioned HIS environment for those regional hospitals which would benefit from utilising national ehealth services as an alternative in procuring their own localised system. This would have considerable benefits – not only for the regional hospital, but also as a potential revenue stream for providers as well as enhancing governance and control from a regional/national standpoint.

An example HIS integrated with the HIP is wHospital from our partner Laserbiomed. wHospital is able to deliver HIS applications “in the cloud” to all healthcare providers consuming the service. The clinical features which can be provided through this cloud HIS can be selected based on appropriateness. The standard HIS features would include; patient case management, reservations, bed management, multi disciplinary views & order management.

Additional modules of the cloud HIS, called Clinical Application (cApp), which could be provided by wHospital include the following;

cApp Nurse Care Needs• “Nurse Care Needs” module gives the opportunity to nurses to indicate for each patient all the

activities performed during the shift to complete the clinical log for deliveries.• The purpose of the plan of assistance is to give vision of patients’ needs of care – that can be

opportunely set up – and of activities performed by nurses in each shift of each day of hospitalization in response to those needs: it was therefore created as a table in which are summarized the three daily shifts within nurses mark their interventions.

• This module has also usefulness for statistical purposes aiming to evaluate the workload spent over each single patient: in fact, thanks to the reporting tools integrated in wHospital®, data collected by nursing staff can be exported in a structured format data collected and carry them into tools of Business Intelligence and analysis able to support later nursing care plans.

• The “cross-running activities” horizontal module gives the list of all the patients currently present in ward allowing the rapid completion of all the activities performed.

cApp Chemotherapy• The modules of the Chemotherapy Suite support the complete management of outpatient / day

hospital and ward processes, from the prescription to the administration of oncological drugs.• This Suite has an intuitive module for the definition of chemotherapy cycles that allows authorized

personnel to implement specific protocols, defining various drugs, time of perfusion, methods of calculation of chemotherapy compared to the more modern standards of care.

• The Chemotherapy Suite is perfectly integrated dedicated to the management of hospitalized patients, and with the management of outpatient and day hospital patients.

• Prescription module: it lets define therapeutic programs , prescribe single cycles, customizing doses and infusion rates.

• Workflow management module of healthcare process: it allows the planning of appointment schedule and days of administration keeping an eye on the entire organization of the prescribed treatment. By means of this module it is possible to administer the healthcare process involving the carrying out of a visit for each day of administration or for each cycle and a first level of eligibility for the patient, foreseeing a following level of eligibility, very often taken from blood tests, and the final approval to the administration of various drugs, with its customization to the patient. The workflow management module also coordinates the final evaluation of the treatment, which may be managed both for each cycle and for each day of treatment.

• Administration module: according to the cycle defined and personalization received, it shows to the nursing staff the daily schedule of administration using specific alerts that signal the timing of administration both on the individual patient and in an “horizontal” vision of the entire department.

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cApp Vital Signs• The “Vital signs” suite is very large and composed of several health record modules (“signs setting”,

“shift monitoring” – typically morning, afternoon and night monitoring, “Values display” and “HL7 parameters validation”), of one module “horizontal” to the entire ward (“parameters detection”) and configuration modules (“wHospital® configuration parameters”, “parameters configuration in OU”, “HL7 parameters configuration in wH” and “HL7 parameters configuration in OU”).

cApp Lab Exams• Among the most common processes managed by wHospital® there is the one for the request and

automatic receive of the results of laboratory tests (blood chemistry and microbiology): these requests need to be done inside the system because they have to be digitally signed to ensure they are a suitable substitute to paper.

• Clinicians can select from a tree of requests, pre-configured in a special module (“configuration of the lab exams tree”) a set of types of examinations.

• All associated parameters, necessary for the proper completion of the request, are inserted automatically by the system and submitted to the user for the affixing of digital signature.

cApp Drug Therapy• The section of drug-prescribing holds great importance for its clinical implications in the perspective of

automation and risk management process.• Given the complexity of this process there are different application modules suited to supply effective

and efficient as possible the entire process from the prescription to the therapy administration: the suite is very wide and is composed of several health record modules

• treatment plan • therapies to be administered • delivered therapies• and several configuration modules: • types of therapies • types of therapies in OU • routes of administration • routes of administration in OU • association types of therapy – routes of administration• The most important module from an operational point of view is the one able to show the whole plan of

therapy (where instructions are given on monitor with a wizard-type procedure), day by day, highlighting parameters monitored and prescribed, deleted or confirmed drugs.

A healthcare cloud provider could enable any or all features in the cloud HIS, and then a healthcare institution will decide which feature to enable for their use and contract service with you as a provider in a “service per user” model (for example).

New features provided by the wHospital Cloud HIS extend the Central EMR and guarantee native integration between hospitals and clinics taking up the service and the Central EMR.

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5.4 ENABLING SERVICES TO MOBILE CITIZENS

As personal consumer technology continues to evolve, the rise of smartphones demands that service delivery must be made available to citizens. The empowered patient expects services to be made available to them at their demand, including when they are mobile, and they should have secured access to their personal data. The EMC HIP platform recognises this trend and a mobile service add on is available from EMC and its partners.

For one of our national customers, the EMC HIP also exposes a mobile device application infrastructure for EMR connectivity. The application provides access to a citizens’ personal medical record, and also includes a location aware feature to expose healthcare institutions and providers within proximity of the citizen. The mobile application, developed for iPhone and Android, acts as an XDS consumer application that pulls relevant patient data from the HIP. This mobile platform also includes contactless payment technology which enables the delivery of enhanced eHealth applications and service.

Connecting the HIP to ePrescriptions and extending the mobile Mokipay application to provide this service, together with contactless payment is an example of a service to be offered to citizens.

This would enable a “paperless” prescription, where the citizen is alerted on their mobile phone that they have a prescription available from their doctor. This would connect to the HIP to provide a remote view of the prescription; the application would provide them a contact number of the doctor if they would like to ask questions, it would also offer them a map to show where the drugs can be dispensed. The phone could be handed to the chemist and the prescription could be scanned. Also on the phone is the contactless payment technology, which the citizen would use for payment.

These systems would all be integrated. Live drug dispensary information stored in the HIP. Payments made securely and without cash, and drug fraud/errors reduced significantly.

5.5 INTRODUCING TELEHEALTH & HOME CARE CAPABILITIES

The availability of at home health monitoring and the explosion of telecare devices have enabled the point of care to move from the hospital bed and into the home, whilst continuing to delivery health services. Our partners at 6PM are deploying “emCare” across the whole country of Malta. These devices are issued by emCare at request from the citizen, but soon to be extended for issuing by hospitals, elderly care homes, with metrics being collected at regular intervals defined by the doctor. These metrics are collected centrally, stored in the HIP, and events outside threshold triggers events to contact the patient, the secondary contact, the doctors and the emergency services. The at home hub device or software application also has a loudspeaker functionality so the Tele Health call centre worker can attempt to provide first line of contact with the patient to check they are conscious and able to provide information.

The delivery of telehealth services is the future in managing citizens with chronic conditions and an aging population and also freeing up bed space in hospitals and appointments at clinics. This reduces costs to provide healthcare services whilst prioritising care for patients with complicated conditions.

With improvements in mobile network technology, exploiting this connectivity to improve overall delivery of care is critical. Connected then to the HIP enhances the central EMR and also enables all healthcare providers that are connected to understand the recent history of a patient more closely monitored and evidenced by real data than ever in the past.

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5.6 INTRODUCING CLINICAL APPLICATIONS MANAGED NATIONALLY

The HIP embraces healthcare standards in IHE. Profiles for connectivity of XDS, HL7 & DICOM enables clinical applications which also utilise these standards can therefore interconnect with the HIP and share data.

5.6.1 AN EXAMPLE APPLICATION – STROKE MANAGEMENTCare Solutions StrokePad is a clinical application developed by 6PM which meets all the Stroke assessments needs, developed by clinicians for clinicians. It removes the need for paper in a stroke unit inside a hospital, which is a high pressurised time sensitive environment. Managing Stroke within the first hours of arriving to the hospital can make the difference between up front thrombilising in time which has a high rate of success, and will save long term costs associated with stroke rehabilitation.

StrokePad manages the entire point of care clinical process from admission to discharge using a tablet device for use bed-side in the Stoke Unit. It removes the need for paper records, eliminates duplicate data creation, enforces correct coding and optimises time and recovery process.

Connecting this application to the HIS and to the HIP is an example where we can have a transformational impact to healthcare delivery at the point of care, whilst also allowing for monitoring, reporting and managing Stoke at a national level.

5.6.2 AN EXAMPLE APPLICATION – HIV MANAGEMENTCare Solutions CLIMATE – HIV is a clinical application development by 6PM which manages the long term HIV patient condition and tracks their treatment in a consolidated HIV care record. The application concept is to provide all the patient information in one screen or patient dashboard – their CD4, viral load, treatment, diagnosis, allergies, resistance as well as consulting physician notes. The physician can analyse the effectives of drug combination treatment against the viral load impact and determine resistances and responsiveness within a very simple to use single interface. In this way CLIMATE-HIV combines everything a physician needs so that their primary focus is the patient.

Connecting this application to the HIP allows for the potential of HIV management to be offered at a national level. 5.6.3 AN EXAMPLE APPLICATION – CHRONIC DISEASE MANAGEMENTwHospital CDN (Chronic Disease Network) is an advanced data sharing environment developed to enable sharing and continuity of care for all chronic disease patients. Enabling this function will allow to record and monitor population’s diseases using focused web form of Central EMR and/or HL7 integration engine to connect all clinical activity in Georgia.

The CDN will be a regional/national provisioned service, collecting data relating to diseases for example, diabetes, cardiovascular disease, chronic respiratory disease, cancer.

5.7 ENABLING NATIONAL HEALTHCARE ANALYTICS

As data collected in the HIP grows the importance of realising the greatest value of the data being held is leveraged. Its not just about collecting the data for a historic view of “what happened”. The next step is to start to look at “what is going to happen”, and how do I improve and optimise the service delivery.

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5.7.1 POTENTIALLY PREVENTABLE EVENTSLeveraging the Big Data capabilities of EMC Greenplum Unified Analytics Platform connected to the HIP one can analyse greater amounts of diverse data. Bringing everything together, not just the individuals personal medical history, but also their drug interactions, their geographical factors of locations and services, regional historical data, their citizen records within all governmental departments, aggregating social and economic factors within the region/country, as well as international factors produced by OECD, the EU and WHO. Leveraging all these data sources increases the overall quality of care and delivery of care significantly.

Potentially Preventable Events include• Predictive Readmission Management • Predicting readmission at the point of original admission• Predictive Days in Hospital • Length of Stay estimations• Predictive (Elective) Surgeries • Identify patients who will likely choose elective surgeries • Identify patients who will likely not benefit from surgery• Predictive Complications • Identify patients at risk for medical complications• Predictive Hospital Acquired Infection (HAI) • Risk score of likelihood to suffer from sepsis, MRSA, C. difficile• Predictive Illness / Disease Progression • Identify patients at risk for advancement in disease states • Identify causal factors of illness / disease progression • Identification of possible co-morbid conditions 5.7.2 DECISION SUPPORT SYSTEMS FOR DOCTORSCapturing the full medical history of citizens within the HIP is only the beginning. To then aggregate and anonymise these captured care pathways allows for the success and failure of treatments at all stages of care delivery. This data can become highly valuable to act as an entry point into Decision Support Systems for clinicians. The ability to provide point of care with a patient, and then to correlate and compare their current state to a very large sample of all similar patients at similar stages of their condition to quantify the, “what if?” when deciding on the next treatment plan.

This not only acts as a major benefit to trainee doctors, but also acts at a nationwide referral/second opinion engine – where next stage diagnosis is built into the system. For example in a university hospital scenario during off peak hours new doctors are in place as they build their experience. It can be seen that these new learning doctors send more people to exams during these times due to lack of experience and confidence. With a DSS style solution in place exposing a consolidated view of what was the next decision for a patient whose conditions are very similar, these learning doctors can obtain more confidence in their diagnosis, and there is a cost benefit connected to a reduction in exams, tests, studies only for verification purposes.

EMC does not propose it make recommendations in medicine, the concept here is to present what has been the next step for patients of the past and current, to deliver a broader view to the clinician of the options available, which have been exercised by their peers at a national level.

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6. SUMMARY

EMC look forward to working with you discover your healthcare IT strategy, understand your current challenges, and work together in articulating how we can partner to improve your healthcare service delivery.

All comments are welcome, further questions are encouraged. Thank you for the opportunity to present you with this paper.