New information technologies for Human HealthWhat’s new in e-Health?
Jean-François Penciolelli
Global Business Development Director
IBU Healthcare and Life Sciences
* Target opportunities identified by text in red
Source: Accenture + Oracle
Monitor
Planning
CurrentWork
OpportunityStatus
Data N/A or No EHR Presence
Considering EHR
England: EHR initiative in process, PACS project is running in north region
France: EHR mandated by 2007. National RFP has been issued
Singapore: EMR system tender expected Q1 2005
Chile: National RFP for EHR project is expected soon
Argentina: 1st adoption of a digital radiography solution- 2004
South Africa: No EHR – but infrastructure being developed
Australia: HealthConnect is developing a National Information Network
USA – Federal ONC NHIN contract underway. Multiple State initiatives for RHIOS. Still emergent – national EHR by 2014 – Obama Stimulus Plan
Canada – Infoway set up to design and procure National EHR - $2 billion of government backing for regional EHR projects
Germany: One regional deal underway. Future EHR efforts are expected to be regional
New Zealand: National EHR system in place (complete)
Hong Kong: Territory wide Patient Master Index
Brazil: National Health Card Project.
Finland: National eHealht-Archives to be established
Netherlands:National Switch Hub
Malaysia: Lifetime Health Record (LRH) by 2010
Mexico: No EHR but aim for HL7 Integration – National Disease Surveillance going on
China: Plans to develop a national EHR
Italy: EHR regional initiatives have begun
Ireland: Procurement contracting has started to drive national EHR effort
Spain: Regional initiatives are being considered
e-Health is all over the place!National and regional initiatives
Russia: 15 Diagnostic Centers project in progress. Plans being developed for national HER for 145 million people.
SEE: Bulgaria, Romania, Turkey and Serbia all developing national eHealth strategies.
Sweden: Developing a National Patient Summary
Denmark: New National IT-strategy to standardize EHR´s
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, care@home
• Patient Relationship Management– References: Andalucia Salud Responde
Relationship between Cost and Quality of Life
Cost of Care/Day
0%
100%
$1 $10 $100 $1,000 $10,000
Source: Intel Corp 2006
Acute CareResidential Care
Home Care
ICU
Community Hospital
Specialty Clinic
Assisted Living
Skilled Nursing Facility
Doctor’s Office
Community Clinic
Chronic Disease Mgt
Healthy Independent Living
QoL
Managing and Supporting the Patient FlowImproving the Patient Experience and Quality of Life
Aware patient
Patient Visits HC Profsnal
Get Treatment
Patient is Compliant
Patient is Stable
Unaware patient
Patient Dis-charged
“I may be at risk…”
ConsumerAwareness
“I should talk to my Dr.”
Pushing Consumer to Waiting Room
“It is important I take my medication”
Adherence
“I know when my condition is getting better/worse”
Monitoring
“I am happy with my Quality of Life”
Meeting ALL of the Patients’ Needs
“I am prepared for my appointment”
Wasted Appointments
“Which Provider should I Choose?”
Attracting Patients
The need for a Service Delivery Platform
– Identifying, Stratifying and Targeting Patients– Attracting Patients– Improving Administrative Processes
• improve utilisation of resources• help Patients get treatment• improve patient experience
– Support after Discharge– Adherence– Patient Monitoring– Supporting Patient Behaviour Modification– Making interventions
Focus is on Access, Resource Utilisation and Attracting Patients
Focus is on Outcome, Experience and Quality of
Life
Aware patient
Patient Visits HC Profsnal
Get Treatment
Patient is Compliant
Patient is Stable
Unaware patient
Patient Dis-charged
Increase Velocity Down the Flow Keep Patient Here
Here Is Where We Focus Here is more Vision
Why Focus on Chronic Conditions?
81% of inpatient stays
80% of US/Europe healthcare spending
91% of prescriptions
76% of physician visits
98% of home healthcare visits
Patient Relationship ManagementDefinition
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
A typical pattern in chronical treatmentAdherence drops – patients are at risk
TIME
ADHERENCE
VISITVISIT
0 1 2
VITAL SIGNS
Source: Mengden et al. ISH 18th meeting, Chicago 2000. P21.02
PR
M p
latf
orm
Solution: continuous interaction to drive adherence Enabled by patient relationship management
TIME
VISITVISIT
0 1 2
sms sms sms
Source : Pierre Leurent, Voluntis
Distribute information processing
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 somewhatprocessed data
Health database- Authorized (HL7)- Combined- Aggregated- High quality
Data prepared and minedFor health personnel
Continuous Monitoring: Sensium
Source: EMBL-EBI
Create the medical avatar: the new frontier!
What about Oracle?
Home CareNurse
Primary Care Physician
Medical Office Staff
Orthopedic Specialist
Radiologist Payer
Healthcare InteroperabilityClinical IT Reality
GPSystem
HISSystem
CISSystem
RadiologySystem
PayerSystem
NursingSystem
Process claim
Schedule appointment
Order test
Discharge Patient
Update medical record
Diagnosis
Submit claim
Treatment
Send discharge letterReceive report
Perform procedure
…
Write report
Start rehabilitation
Submit results Follow-up
Support patient
Refer patient
Home CareNurse
Primary Care Physician
Medical Office Staff
Orthopedic Specialist
Radiologist Payer
Healthcare InteroperabilityClinical Integration Framework
GPSystem
HISSystem
CISSystem
RadiologySystem
PayerSystem
NursingSystem
Process claim
Schedule appointment
Order test
Discharge Patient
Update medical record
Diagnosis
Submit claim
Treatment
Send discharge letterReceive 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 letterReceive 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 letterReceive report
Perform procedure
…
Write report
Start rehabilitation
Submit results Follow-up
Support patient
Refer patient
SOA Orchestration
Clinical Portal Clinical
Context Management
Single Sign On
• Improved quality– Information sharing
– Better planning and monitoring
– Reduced administration
– Specialization, higher volumes
• Reduced cost– Loadbalancing
– Higher througput
– Improved work / life balance
Healthcare Interoperability
SOA Platform
Collaborative Network
Hospital
PortalOrchestration
GP Home nurse
Hospital Private Practice
Enabling Collaborative Networks
• Collaborative services– Teleradiology
– E-referral
– E-prescribing
– Homecare
Pharmacy
ClinicalPortal
MMAViewer
BusinessIntelligence
Prescribing Homecare
Health Information Access Layer
Connectivity Packaged Database Messaging
Orchestration
Transformation & Routing
? ETL
TerminologyEMPI EHR Index
Healthcare Infrastructure Services
MultiMedia Medical Archive
Clinical Data Repository
Datawarehouse
Clinical Data Repositories
RISSystem
PACSSystem
EMRSystem
AccountingSystem
Existing Legacy Applications
Security & Privacy
Management & Monitoring
Blueprint Architecture
Healthcare Interoperability
Application Server & Database
E-Health Applications
CRM
ClinicalPortal
MMAViewer
BusinessIntelligence
Prescribing Homecare
Health Information Access Layer
Connectivity
Orchestration
Transformation & Routing ETL
TerminologyEMPI EHR Index
Healthcare Infrastructure Services
MultiMedia Medical Archive
Clinical Data Repository
Datawarehouse
Clinical Data Repositories
RISSystem
PACSSystem
EMRSystem
AccountingSystem
Existing Legacy Applications
Security & Privacy
Management & Monitoring
Oracle/partner footprint
Healthcare Interoperability
E-Health Services
CRMOBIEE Siebel
AS&DB
BPEL
ODI
HTB – ECM - CDMS DB 11g DB 11g
IAM
BAM
ESB
MDM
Terminology EHR Index
ESB
ClinicalPortal
MMAViewer
BusinessIntelligence
Prescribing Homecare
Health Information Access Layer
Connectivity
Orchestration
Transformation & Routing ETL
TerminologyEMPI EHR Index
Healthcare Infrastructure Services
MultiMedia Medical Archive
Clinical Data Repository
Datawarehouse
Clinical Data Repositories
RISSystem
PACSSystem
EMRSystem
AccountingSystem
Existing Legacy Applications
Security & Privacy
Management & Monitoring
Oracle/partner footprint
Healthcare Interoperability
E-Health Services
CRMConcerto OBIEE Siebel
AS&DBcIndex
BPEL
Rhapsody
ODIRhapsody
HTB – ECM DB 11g DB 11g
IAM
BAM
ESB
MDM
Technology Roadmap
Access and Utilisation (Cost) Outcome (Care)
Quality of Life
Interaction ChannelsAgent (Telecarer)
Assisted
Web/Portal
Phone
WebConference
Web 2,0
• Patient Info
• Case Info
• Knowledge Base
• Patient Info
• Case Info
• Knowledge Base
Training
Smart Phone
External
Systems
External
Systems
•Dashboards
•Analytic Apps
Medication Tracker
Clinical Data Repository
Clinical Data Repository
Business IntelligenceBusiness
Intelligence
WWW
Home HubAppliance
Cholesterol Monitor
Blood Pressure Monitor
Pedometer
Glucose Sensor
WWW
Digital Plaster
Oracle Products
Access and Utilisation Outcome
Interaction ChannelsAgent (Telecarer)
Assisted
Portal
CollaborationSuite
Phone
CollaborationSuite
Web Center
Siebel Call Centre
Siebel Call Centre
Learning Mgt Oracle HTB Oracle HTB
Smart Phone
Oracle Business
Intelligence
Oracle Crystal Ball
Oracle Business
Intelligence
Oracle Crystal Ball
WWW
Home HubAppliance
Cholesterol Monitor
Blood Pressure Monitor
Pedometer
Glucose Sensor
Medication Tracker
WWW
•Dashboards
•Analytic Apps
Quality of Life
Oracle Lite
Oracle Lite
Oracle Lite
Oracle Lite
Oracle Lite
Oracle Lite
“Edge Server”
External
Systems
External
Systems
Fusion Middleware
Fusion Middleware
Fusion Middleware
Fusion Middleware
“Edge Server”
Digital Plaster
OracleAERS
OracleAERS
Oracle AIA
AQ&
New information technologies for Human HealthWhat’s new in e-Health?
Jean-François Penciolelli
Global Business Development Director
IBU Healthcare and Life Sciences