Liris blue academy 2010 2011 - smarter healthcare - nicky hekster

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© 2010-2011 IBM Corporation

The LIRIS Blue Academy 2010-2011

An initiative from L.I.R.I.S. and IBM Belgium

Smarter Healthcare

Dr N.S. HeksterIBM Nederland B.V.

Smarter Healthcare2 © 2010-2011 IBM Corporation

LIRIS Blue Academy 2010-2011

LIRIS Program 2010-2011� SMARTER cities are the Future

� Jacques De Kegel, Business Development Executive, IBM

� BPM & Case Management (**)

� Te bepalen spreker (SAP) (Wim Verhelst ?)

� From Enterprise Architecture to ICT Architecture (**)� Steven Laurent, Enterprise Architect, AE

� Enterprise Content Management (**)

� Eric Michiels, Executive IT Architect, IBM

� Juridical aspects of ICT Solutions (**)

� Johan Vandendriessche (Bird & Bird)

� Smarter Healthcare (*)

� Nicky Hekster, Technical Leader Healthcare, IBM

� Mobile Banking (*)

� Anton Wilsens, Client Solutions Manager Financial Services

� ICT Sourcing Strategies (**)� Marnix Gillis, Distinguished Engineer,IBM

� Software development productivity (*)

� Antoon Goderis & Jo Vanackere, KBC

� in ‘Beleidsinformatiesystemen’ (HIR, HIRB)� 17-Nov-2010 (11:00 – 13:00) (VHI - 02.29)

� in ‘Analyse en ontwerp van informatiesystemen’� 25-Nov-2010 (14:00 – 16:00) (DV1 - 02.54)

� in ‘Architecture & Modeling of MIS’� 6-Dec-2010 or 29-Nov-2010 (11:00 – 13:00) (ILT - 00.176)

� in ‘Geavanceerd DB Management en Content Management’� 02-Dec-2010 (14:00 – 16:00) (HOGC - 02.22)

� in ‘Analyse en ontwerp van informatiesystemen’� 13-Dec-2010 (15:00 – 17:00) (Aud. Monnet)

� in ‘Beleidsinformatiesystemen’ (Kortrijk)� 10-Mar-2011 (11:00 – 13:00) (Aula lokaal C611)

� in ‘Beleidsinformatiesystemen’ (lic)� xx-yyy-2011 (16:00 – 18:00) (VHI - 01.29)

� in ‘ICT Service Management’� 31-Mar-2011 (18u – 20u) (VHI - 00.10)

� in ‘ICT Service Management’� uu-vvv-2011 (18:00 – 20:00) (VHI - 00.10)

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Introduction speaker

� My name: Nicky Hekster

� Role: Industry Technical Leader Healthcare & LifeSciences IBM Benelux

� Active in ICT since 1987

� Vendor-chair IHE Netherlands

� [email protected]

� You can find me also on LinkedIn and Twitter



Agenda � IBM in Healthcare

� Healthcare in State of Emergency

� Smarter World, Smarter Healthcare

� ======== B r e a k ========

� Smarter Healthcare ICT

� Examples

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Team IBM – 400,000 people worldwide

15k salespeople

15k salespeople

9k salespeople

9k salespeople

5k salespeople

5k salespeople

10k salespeople

10k salespeople

160,000

102,000

58,000

42,000

15,000sales people

9,000sales people

5,000sales people

10,000sales peopleHealthcare

Defense

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IBM Benelux

� IBM Benelux was formed in July 2005

� Over 7000 employees in 3 countries



Heart-Lung machine (IBM and Dr J.H. Gibbon, 1957)

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nanoMRI (2009)Magnetic Resonance Force Microscopy (MRFM)



The Scripps Research InstituteProject Checkmate

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Eye lasering invented by IBM

Close-up of an IBM logo inscribed on a human hair. The Excimer laser surgical procedure is so precise it can cut a clean pattern into a human hair without burning the strand.

Excimer laser

Inve

ntio

n

Inn

ovatio

nUsing invention to create value, leads to innovation

Collaboration

Close-up of an eye surgery with the Excimer laser where the eye is repaired for sharper visibility



Saving the chocolate industryThe cacoa genome project - a collaboration among MARS, USDA-ARS, IBM, NCGR, Clemson University, HudsonAlpha Institute for Biotechnology, Indiana University and Washington State University

� IBM and Mars, sequencing the Theobroma cocoa genome (done! Sept 2010)

– http://www.youtube.com/watch?NR=1&gl=US&hl=uk&v=ERu5TaqIvHs

� Sustainable crops, unraveling the cocoa genome

– without engineering higher-yielding cacao trees, demand would outstrip supply within 50 years.

� Howard-Yana Shapiro of Mars Inc. was seeking IBM's help in analyzing the cacao genome to ensure the future of the plant, which is being wiped out.

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IBM Journal of Research & DevelopmentIBM Systems Journal

Information-based MedicineVolume 46, Number 1, 2007

Systems BiologyVolume 50, Number 6, 2006



National IBM TheGeographic + = Genographic

Society Research Project

Paleontology

Genetics

Anthropology

IT Infrastructure

Phylogenetics

ComputationalBiology

Using DNA to unravel

the path followed by our ancestors

www.ibm.com/genographic

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IBM’s Commitment to Healthcare & Life Sciences

� Designated Life Sciences an IBM Emerging Business Opportunity Unit - Spring 2000

– $100M initial investment

� IBM Research

– Computational Biology Center

– Deep Computing Institute

– Blue Gene Project

� IBM Business Consulting Services

– PriceWaterhouseCoopers Consulting acquisition

– Pharma 2010: The Threshold of Innovation

– Healthcare 2015, Win-Win or Lose-Lose

� Strategic partnerships with industry leaders, e.g. Mayo Clinic

� Created IBM Healthcare & Life Sciences (1/04)

– $250M Investment (2/04)



IBM’s Commitment to Healthcare & Life Sciences� Designated Information Based Medicine an IBM Emerging Business

Oppty Unit (1/04)

– Clinical Genomics and Biomedical Imaging (2004)

– Expand to PGx, CDI and Pervasive in 2005

� National Genographic Project

– IBM and National Geographic jointly gathering one of the largestcollections of DNA samples to map how humankind populated the planet.

� Setting new Health Record precedents

– IBM offers U.S. Employees Electronic Records for Healthcare

– IBM revises non-discrimination and equal opportunity policy –restricts genetic data

� Dedication to Standards

– IBM allow royalty-free access to its patents for developers who wish to create new healthcare and education applications around open standards

– IBMers from Research on the international boards of HL7 and IHE

� Acquisition of Acure (DK)

� Acquisition of HealthLink (5/05)

� Acquisition of Cognos (11/2007)

� Acquisition of Initiate Systems and SPSS (02/10)

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La Gaude

Global Healthcare Center of Excellence

IBM Healthcare Knowledge Centers

Montpellier

Products & Solutions

Support Center

Healthcare Barcelona

Center of Excellence

Haifa Research Lab

Mayo Clinic Medical ImagingInformation Innovation Center

(M3IC)

Zürich Research Lab

Mainz Technical Marketing Competence Center (TMCC)

Beaverton Network Transformation Center (NTC)

Dallas Health AnalyticsSolution Center



Fact-based thought leadership helps clients realize business value

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So what in the world is happening with healthcare?



Five drivers make healthcare fundamentally different from the past

� Globalization

� Consumerism

� Changing demographics and lifestyle

� Diseases that are more expensive to treat

� New medical technologies and treatments

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Globalization

Developed Countries

�A majority of adults in ten of the 30 OECD countries are overweight

�As life expectancy has increased (68.5 years in 1960 to 77.8 years in 2003), there has been a concomitant rise in the incidence of chronic diseases

�Total healthcare expenditures are increasing2.0 times more rapidly than economic growth

Least Developed Countries

�There is a strong need to address basic public health issues such as clean water, good sewage systems, and vaccinations

�Countries are beginning to experience the rise of chronic diseases but are less capable to manage them

– By 2015, chronic diseases will be a leading cause of death in Nigeria

�Population expansion is higher than in developed or developing countries

Developing Countries

�The increasing prevalence of and costs to treat chronic diseases, as well as the associated lost productivity, are impacting systems

– The loss of income to China over the next ten years as a result of heart disease, stroke, and diabetes is estimated at US$550 billion

�Countries are still fighting infectious diseases – not only existing ones, but also new diseases and new strains

* Definitions of “developed,” “developing,” and “least developed” countries are presented in the Appendix.



ConsumerismThe patient becomes co-producer/co-director of his own care

� Patient emancipation and empowerment

� Wants to make better health and wellness choices

� Growing expectations for value from increasingly costly health systems

� Broad global awareness of quality and safety challenges

� New clinical pathways, retail clinics

� Life-style management

� Medical tourism

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Medical tourism is beginning to subject healthcare delivery to global competitive pressures

$16,000$9,500$5,900$11,500$16,800$27,500Laparoscopic

prostatectomy

$4,500$4,500$2,238$6,500$4,275$19,000Laparoscopic hysterectomy

$10,000$8,500$6,500$9,500$10,500$21,000Knee replacement

$9,000$8,000$6,500$13,000$9,400$45,000Hip replacement

$13,500$11,000$6,650$13,600$14,400$37,000Heart bypass

$12,500$9,200$7,800$14,500$13,125$33,000Angioplasty

SingaporeThailandIndiaCosta RicaMexicoUnited StatesProcedure



Medical tourism in practice

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Changing demographics and lifestyle

� Graying baby boomers

� More chronic patients

� Overweight

� Population growth

� Mobility

� Pandemics

� Lack of resources



Diseases that are more expensive to treat

� Diseases are more expensive to treat

� Drug development costs go up

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Emerging diseases

� 1937 – Q-fever, Coxiella burnetii

� 1973 – Rotavirus

� 1977 – Ebola virus

� 1981 – Toxic shock syndrome

� 1982 – Lyme disease

� 1983 – HIV/AIDS

� 1991 – Multidrug-resistant tuberculosis

� 1993 – Cholera caused by strain 0139

� 1994 – Cryptosporidium infection (large outbreak in Wisconsin, USA)

� 1998 – Avian flu

� 1999 – West Nile Virus (first appearance in USA)

� 2003 – SARS (severe acute respiratory syndrome)

� 2004 – Marburg virus (largest outbreak in Angola)

� 2009 – April Swine/Mexican Flu H1N1 strain



New medical technologies and treatments

� Less invasive therapies

� Improved diagnostics

� Confluence of biotech and healthcare

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Technology advances at enormous speeds

Grid Computing



Personalized Health Care

Translational Medicine

Health Care Today Digital Imaging

Episodic Treatment Electronic Health Records Artificial Expert Systems

Clinical Genomics

Genetic Predisposition Testing

Molecular Medicine

CA Diagnosis

Pre-symptomatic Treatment

Lifetime Treatment

Evolutionary Practices

Revolutionary Technology Automated

Systems

Non-specific (Treat Symptoms)

Information Correlation

1st Generation Diagnosis

Organized(Error Reduction)

Personalized(Disease Prevention)

Throughput Analytics

Data and Systems Integration

Transformation of Medicine accelerated by a combination of revolutionary technologies and evolutionary practices

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Confluence

� Research

� Drug discovery

� Diagnostics

� Computational Chemistry

� Information-based medicine

� Medical Visualization

� Analytics

� In silico modeling

� Bioinformatics

� Biomarkers

� Proteomics, Transcriptomics, MicroArrays and Metabonomics

� Very large databases

� Clinical and Regulatory Process Management



Counterbalancing the drivers for change are key inhibitors that threaten to maintain the healthcare status quo

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Healthcare Systems in EuropeFunding is very different - increasing cost sharing among publicand private health insurers and individuals.

Spain

Belgium Netherlands Cyprus

Luxembourg

Greece

Italy

Portugal

France

Benefits in kind DecentralizedCentralizedReimbursement

Access to Healthcare

Social Insurance National Health Service



Financial constraintsHealth expenditure as a share of GDP, 2004

15,4

11,510,6 10,5

9,79,2

8

0

2

4

6

8

10

12

14

16

USA CH D F B NL L

% of GDP

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Inability to access and share information

� The Electronic Health Record (EHR)

� Different definitions

– Electronic Medical Record (EMR)

– Personal Health record (PHR)

� Unstructured efforts

� Semantic non-interoperability

� Retentions laws

� Regulatory compliance



Where is the relevant information?

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Electronic Health Records



EHR – potential inputs

20



Watson – a future physician’s assistant?

� Complex diagnoses

� Better medication

� Prevent medical errors

YouTube, Perspectives on Watson: Healthcare



Healthcare systems must address major issues and questions in the search for an value-based, affordable, sustainable system� Many healthcare systems are being pushed to a crisis stage because

of unrelenting pressures related to cost, quality, andaccess/choice

� Concurrently, factors such as new treatments and increasing

demand for services and value are converging to increase the pressures

� Without major changes, many countries will “hit the wall” (i.e., not be able to continue on the current path) in the next decade

� New levels of accountability, tough decisions, and collaborative

hard work on the part of all stakeholders will be required to transform healthcare systems into a national asset

Countries that successfully transform will focus on value, develop better consumers and create better options to promote health and provide care

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EHR adoption around the world (January 2006)



* assuming current growth rates

** source – HCLS

*** Medical Imaging and Collaborative Care Cloud sizing

**** a large percentage of that spending is on eHealth

Realizing the importance of information in healthcare transformation, there has been a surge of investment worldwide directed to Health IT

North AmericaUS ARRA – $20.4BCanada –$3.1B CDN (InfoWay)

North AmericaUS ARRA – $20.4BCanada –$3.1B CDN (InfoWay)

AsiaChina – $4.2BSingapore – $1.1B SIN

AsiaChina – $4.2BSingapore – $1.1B SIN

EuropeUK– ₤20.4B

EuropeUK– ₤20.4B

Middle EastSaudi Arabia – $14B****

Middle EastSaudi Arabia – $14B****

WorldwideEMR – $10B in 2010 � $30B in 2019 *

WorldwideEMR – $10B in 2010 � $30B in 2019 *

EMR AdoptionUS – 10% AUS – 25% UK – 59%CAN – 14% NZ – 52%

EMR AdoptionUS – 10% AUS – 25% UK – 59%CAN – 14% NZ – 52%

Healthcare Transformation

Additional OpportunitiesClinical Decision Intelligence: $75M (2010), $3.1B (2019)**Health Analytics: Health analytics: $2.3B, $3.29B (2014)**Cloud Computing for HCLS: $1.04B (2010), $6.2B (2014)***

Additional OpportunitiesClinical Decision Intelligence: $75M (2010), $3.1B (2019)**Health Analytics: Health analytics: $2.3B, $3.29B (2014)**Cloud Computing for HCLS: $1.04B (2010), $6.2B (2014)***

Large spending and digitization will not improve outcomes without proper healthcare system

design. We need to instrument the point of care and have consumable, knowledge enhanced EMRs

Large spending and digitization will not improve outcomes without proper healthcare system

design. We need to instrument the point of care and have consumable, knowledge enhanced EMRs

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The world-wide challengeChanging the cure and care stakeholder ecosystem – the Healthcare Information Exchange (HIE)

Patient, citizen Secondary

Payors Primary

Social card

Portal

Hospital

Rehabilitation

Pharmacy

General Practitioner

Insurance

Government

eHealthPlatform



BasisdienstenBasisdiensten

eHealtheHealth--platformplatformNetwerk

Example: eHealth Platform (Frank Robben, 6/2009)

PatiPatiëëntennten, , zorgverlenerszorgverleners

en en zorginstellingenzorginstellingen

GABGAB GABGABGABGAB

Leveranciers

Gebruikers

PortalPortaleHealtheHealth

PortaHealthPortaHealth

DTWDTWDTWDTWDTWDTWDTWDTW Software Software zorginstellingzorginstelling

DTWDTWDTWDTWDTWDTWDTWDTWMyCareNetMyCareNet

DTWDTWDTWDTWDTWDTWDTWDTW

Software Software zorgverlenerzorgverlener

DTWDTWDTWDTWDTWDTWDTWDTWSite RIZIVSite RIZIV

DTWDTWDTWDTWDTWDTWDTWDTW

GABGABGABGABGABGAB

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citizenpatient

Home

Hospital Pharmacy

Specialist

Laboratory

Physiotherapist

Radiology

Beds

Doctor

Nurse

Patientgroups

Socialservices

Medical devices

NursecalendarCoordination

center

Ambulances

Insurance

Water and airquality

Alzheimerbracelet

Fooddelivery

From supply-based to demand-driven healthcarePower to the patient – the patient as co-producer of care

� Fromtreatment toprevention

� From acute to chronic diseases

� Frompassive topro-active patients



The continuum of cure and care

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Traditional healthcare delivery model

Tertiary care

Primary care

Secondary care

University Medical Centers

General Practitioners

Regional Hospitals

Top Clinical Hospitals

The patient community- bottom of the pile!Unchanged for 6000 years - circa 4000 BC!

Physical movement of the patient



Future health system transformation

Allied health professionals

Maternity

Diagnostic Centers

Retail Health Centers

Home Care

Health Kiosks Daycare Surgery

Community Hospitals

acute care

Community Hospitals

non-acute care

Acute Trauma

The always connected and informed citizen community iPhone

Web 2.0

iPad

TV

Primary Healthcare

The Super Primary Care Physician

Clusters of specialists,

globally spread and universal accessible

e-Health

telemedicine

Primary teleradiology

telepathology

telediagnostics

Patient/citizen-centric care

>Direct access to specialists<

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So what is happening in the world?



The world is

SMALLER

The world is

FLATTER

The world is about to get increasingly

SMARTER

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ICT merging with our physical world



INSTRUMENTED We now have the ability to measure, sense and see the exact condition of everything.

� Today, there are 1 billion transistors for each person on the planet.

� By 2010, 30 billion RFID tags will be embedded into our world and across entire ecosystems.

� Remote patient monitoring devices that track the vital signs of patients with chronic diseases could reduce U.S. healthcare spending up to $197 billion over 25 years.

� Typically, hospitals over-procure mobile assets by 20-30% while critical staff spend 10-30% of their time searching for them.

Smarter health systems automatically capture and exchange information through diverse channels to proactively manage and deliver preventive and therapeutic care.

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INTERCONNECTED

People, systems and objects can communicate and interact with each other in entirely new ways.

� The Internet of people is 1 billion strong. Almost one third of the world’s population will be on the Web by 2011.

� There are more than 4 billion mobile phone subscribersworldwide.

� In 2007, 56% of American adults sought information about a personal health concern on the Internet—up from 38% in 2001.

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Smarter health systems remove information barriersand work as integrated teams with the individual to make smarter decisions.



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INTELLIGENTWe can respond to changes quickly and accurately, and

get better results by predicting and optimizing for future events.

� Every day, 15 Petabytes (1015) of new information are being generated. This is 8x more than the information in all U.S. libraries.

� More than 3,600 statistical articles are published each year on the topic of coronary heart disease alone.

� Increasing digitization and medical imaging will lead to a 41% annual increase in storage requirements between 2008 and 2012.

Smarter health systems continually analyze information to meet the changing needs of the organization, optimize performance, integrate predictive models, and deliver greater value to the individual.

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55

A smarter health systemforges collaborative partnerships

to deliver better acute, chronic and preventive care, while activating individuals to make smarter choices.

The mandate for change is a mandate for smart.



To meet expectations for improved outcomes, increased value and more accountable, sustainable health systems, healthcare organizations are working to …

HEALTHCARE

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IMPROVE OPERATIONAL

EFFECTIVENESS

Building flexibility into operations to support cost reduction and

excellence in clinical and business performance and

practices.

DELIVER COLLABORATIVE CARE FOR PREVENTION AND

WELLNESS

Collaborating across care settings to deliver integrated, personalized care experiences, prevent disease, promote wellness and manage care.

ACHIEVE BETTER QUALITYAND OUTCOMES

Applying insights to improve qualityof care, clinical outcomes and services

and deliver personalized healthcare value, while improving financial results.

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IBM’s strategy

� Patient-centric Networks

– The availability of information at the right time, at the right place, and in the right context

� Clinical and Business Optimization

– Increasing productivity andefficiency

� Health and Wellness Management

– Lowering costs en improving quality in the long term

Improve operational effectiveness.

Deliver collaborative care for

prevention and wellness.

Achieve better quality and outcomes.

+ +



Smarter Healthcare ICT

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Find record and acquire usefulpatient information

Diagnose Treat Document & process records

Increase Cognitive WindowIncrease Cognitive Window

RelevantRelevant PatientPatientInformationInformation

Anywhere,Any Time

Any Device

Anywhere,Any Time

Any Device

Automatic documentgeneration

Automatic documentgeneration

� Clinician’s use systems� Horizontal platform for knowledge workers

� Clinician’s use systems� Horizontal platform for knowledge workers

Clinician’s environment

Impact

Today



The hospital tension triangle

Clinical Practice

Board of Directors

ICT

�No enforcing power

�Ad hoc application management and deployment dictated by physicians

�Busy managing day-to-day operations

�Forcing power

�Ultimate patient responsibility

� ICT as a tool

�Technology shifts the entire approach that physicians have to medicine

�Learning new technologies consumes too much time

�New technologies changes existing procedures too much

�Poor governance

�No transparency

�Low risk, no risk

�Not business-like

� ICT as a cost

�Old boys network

“De techniek interesseert me niet, ik ben alleen geinteresseerd in de cost/benefit van de business case en het

risicoprofiel”

J.Th. Kedzierski, ex-voorzitter raad van

bestuur MCA

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Change requires a strong governance model

Resistance to change

� Changes in habits

� Skeptics of the system

� Becoming transparent

Privacy

� Complexity of the issue

� Changes on legislation are often needed

� Lack of confidence in the system

Funding

� Who is going to fund it?

� What is required to obtain it?



Transformation of healthcare

�Clinical process management

� Information management

�Changes of roles

�Collaboration

�Culture and attitude

�Education

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In the meantime at the datacenter …Crisis of infrastructure complexity

Utilization85% runs idle

Information growth54% per year

Maintenance costs70 cent per €1



Today’s application complexity

E01-EDI

Data Warehouse

(Interfaces to and from theData Warehouse are not

displayed on this diagram)

Application Diagram V4

G02 - General

Ledger

A05 - AP

S01 - Sales

Corrections

I01 PO

Receiving

I03 Return to

Vendor

I06 Warehouse

Management

M a inframe apps - B lue

PC/NT apps - G reen

Unix apps - Y ellow

3rd party interface - Orange

Lines: Colors have no special meaning.

They are to help make the diagram easier toread.

For More Information: See the databasecontaining information about each

application: Application V4.mdb

S06 - Credit App

P15 EES Employee

Change Notice

OTHER A PPS - PC

AP - Collections/Credit

TM - Credit C ard D B

ACCTS R EC A PPS - PC

990C OR

Bad D ebt

Benefical Fees

Beneficial R econcil

JEAXF

JEBFA

JEBK A

JEDVA

JESOA

JEVSA

JEVSF

NSF

TeleCredit Fees

INVENTORY CON TROL APPS - PC

Code Alarm

Debit R eceivings

Devo Sales

Display Inventory

In Home

Junkout s

Merchandise W ithdrawl

Promo Credits

RTV Accrual

Shrink

AP R esearch - Inv Cntrl

AP R esearch- Addl Rpts

Book to Perpetual Inventory

Close Out R eporting

Computer Intell igence D ata

Count Corrections

Cross R ef for VCB Dn lds

Damage W rite Off

Debit R eceivings

DFI Vendor D atabase

Display Inventory Reconcil

Display Inventory Reporting

INVENTORY CON TROL APPS - PC

DPI/C PI

IC Bat ching

Inventory Adj/Count Correct

Inventory Control Reports

Inventory Lev els

Inventory Roll

Merchandise W ithdrawl

Open Receivings

PI Count Result s

PI Time Results from Inv

Price Prot ection

Sales Flash R eporting

Shrink R eporting

SKU Gross M argin

SKU Shrink Lev el D etail

USM

VCB Downloads

Journal Entry Tool Kit

Scorecard - HR

L02-Resource

Scheduling

(Campbell)

P09 - P17

Cyborg

M02 - Millennium

M03 - Millennuim 3.0

Banks - ACH and Pos to

Pay

Cobra

B01 - Stock

Status

S03-Polling

P14 On-line New

Hire Entry

CTS

Plan Administrators

(401K, PCS, Life,

Unicare, Solomon

Smith Barney)

D01 Post Load

Billing

I04 Home

Deliveries

I02 -

Transfers

Arthur Planning

I07 Purchase

Order

I12 Entertainment

Software

I05

Inventory Info

E13

E3 Interface

S04 - Sales Posting

V01-Price Management

System

I10 Cycle Physical

Inventory

I55 SKU

Information

K02

Customer Repair

TrackingI35 Early Warning

System

B02 Merchandise

Analysis

I13- Auto

Replenishment

U18 - CTO

Intercept

I09 Cycle Counts

E02-Employee

Purchase

Texlon 3.5

ACH

Stock Options

I17 Customer Perceived

In-Stock

U16-Texlon

SiteSeer

C02 - Capital

Projects

F06 - Fixed

Assets

US Bank Recon

File

Star Repair

EDI

Coordinator

Mesa D ata

NEW Soundscan

NPD Group

AIG W arrant y Guard

Resumix

Optika

Store Budget

Reporting

P16 - Tally Sheet

Cash Receipts/Credit

S05 - House

Charges

Ad Expense

L01-Promo

Analysis

V02-Price

Marketing

Support

BMP - Bus

performance Mngt

Store

Scorecard

I11 Price

Testing

Valley Media

P09

Bonus/HR

I15 Hand Scan

Apps

Roadshow

POS

S08 - Vertex

Sales

Tax

A04 - Cust

Refund Chks

Equifax

ICMS Credit

Cellular

Rollover

S09 - Digital

Satellite

System

NPD,

SoundScan

Sterling VAN

Mailbox (Value)

I18

SKU Rep

X92-X96

Host to AS400

Communication

S02 -

Layaways

Washington,

RGIS,

Ntl Bus Systems

V04-Sign

System

I14 Count CorrectionsNARM

P01-

Employee

Masterfile

I06 - Customer

Order

Frick

Co

UAR - Universal Account

Reconcilliation

Depository

Banks

S07 - Cell

Phones

S11 - ISP

Tracking

AAS

Fringe PO

Cash Over/

Short

L60 MDF

CoopSKU Selection

Tool

SKU

Performance

Supplier

Compliance

1

I35 - CEI

ASIS

Misc Accounting/Finance Apps - PC/NT

COBA (Corp office Budget Assistant)

PCBS(Profit Center Budget System)

Merchandising Budget

AIMS

Merch Mngr Approval

Batch Forcasting

Ad Measurement

AIMS Admin

AIMS

ReportingAd

Launcher

V03- Mkt

Reactions

Spec

Source

CTO2.Bestbuy.

com

Rebate

Transfer

Sign

System

CopyWriter's

Workspace

ELT

PowerSuite

Store

Monitor

AIS Calendar

Stores & Mrkts

Due Dates

Smart Plus

Insertions

Orders

Budget

Analysis Tool

Print Costing

Invoice App

AIS Reports

Broadcast

Filter

Smart Plus

Launcher

General

Maintenance

Printer PO

Printer

Maintenance

Vendor

Maintenance

Vendor Setup

Connect 3

Connect 3

ReportsConnect 3

PDF Transfe

Spec Source

SKU Tracking

S20-Sales

Polling

Prodigy

PSP

In-Home

Repair

Warranty

Billing

System

Process Servers

(Imaging)

Prepared by Michelle Mills

Page 1 of 2

33



Healthcare information infrastructureA true system of systems

EHR

PACS/RIS

Hospital Information System

Admin and planning

Collaboration, e-mail

e-Learning

Telecare

Laboratory Information System

Claims and payment

Transmural communication

Traditionally, healthcare institutions have invested in siloedapplications and infrastructure

There is a need for an integrated environment for all healthcare stakeholders

Manuals, literature

GP Information System

Pharmacy Information System



Average dept.-hospital-region-country: point-to-point

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The data explosion



Structured

Unstructured

Around 85% of all medical data is

reference data/fixed content (e-mail, video,

images)

Shipments of storage capacity grows with

54% per year

30% of world-wide storage consists of

medical images

1 MB/2Dimage

500 MB/4Dimage

2004 20092005 2006 2007 2008 2009 2010

PACS

Challenges of smarter medical data management Static data!

Shipped PBs

xIS

“I am in the business of taking care of patients here. I am not in the business of

specializing and managing data storage”

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Healthcare infrastructure pain points

� Complexity

� Surge in criticality, value and volume of data

� Under-, over- and misutilization of servers and storage

� Security, role-based access to data (IAA)

� Reliability, availability and serviceability (RAS)

� Future investments

� Integration of new medical technology

� Resources

Suffering fromMultiple

Informatiose

MI is symptomatic of a non-human disorder which is characterized by

working inefficiently; storing multiple duplications of data in non-integrated

data systems.

Theo van der Ven (Royal Haskoning in The Lancet)



Healthcare Integration Framework (HIF)SOA based blueprint for smarter integration and interoperability

Ap

ps

&

Info

As

sets

De

ve

lop

me

nt

Se

rvic

es

Interaction Services Process Services Information Services

Partner Services Business App Services Access Services

Enterprise Services Bus

IT S

erv

ice

Ma

na

ge

me

nt

Infrastructure Services

Enables collaboration between

people, processes & information

Orchestrate and automate

business processes Manages diverse data in a

unified manner

Connect with trading partners Build on a robust, scaleable,

and secure services

environment

Facilitates interactions with

existing information and

application assets

Optimizes throughput, availability and

performance

Integrated

environment

for design and

creation of

solution

assets

Facilitates better decision-making with real-time

business information

Manage and

secure

services,

applications &

resources

Business Innovation & Optimization Services

Strategic platform for healthcare and life sciences solutions, focused on helping clients to build, extend and transform existing infrastructures incrementally over time through re-use of an extensive set of business services, industry-specific extensions and built-in support for industry, business and technology standards.

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Use (inter)national standards

� HL7

� Integrating the Healthcare Enterprise

� Open Health Tools (OHT)

� Continua Health Alliance

� COCIR

� SNOMED

� ICD-9, ICD-10

� LOINC

� KMEHR

� DICOM

� ISO 13606



IHE – Integrating the Healthcare Enterprise� IHE drives the adoption of standards to address specific clinical needs

by creating a framework for passing vital health information seamlessly across the entire healthcare enterprise

– From application to application, system to system and setting tosetting

� IHE currently supports the following domains:

– Cardiology

– Eye Care

– IT Infrastructure

– Laboratory

– Patient Care Coordination

– Patient Care Devices

– Quality, Research and Public Health

– Radiation Oncology

– Radiology

� http://www.ihe.net or http://www.ihe-nl.org

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Telecare (Health 1.0)

� eConsult (e.g. e-mail, SMS, Twitter)

– Rob Mol, www.internetdokter.nl

– Prof dr George Henneman, www.mijnspecialist.nl

– Erik Jansen, Nijmegen

� Remote Patient Monitoring (e.g. Health Buddies)

� Education

� On-line treatments

� Video conferencing

� e-Fitness

� e-Appointment (e.g. SMS, RememberTheMilk)

� e-Prescription

� Medication loyalty (e.g. SMS)

� Family care

Deliver collaborative care for prevention and wellness.



Teledoctor (Cisco July 2008)


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Server

Telemonitoring

Nourish and exercise schemesCalendar Athlete

DataData

Alert

Data




Telemedicine through satellite communicationTristan da Cunha


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PHR Cloud

Devices Device Manager

TelemedicineService

Wired Weighing Scale

Independent Living Hub Medication Monitor

Wired Glucose Meter

Wired Glucose Meter

Healthcare Management

Data aggregation

Patient Centered Medical HomeHealth and Welness Scenario - Obesitas + Diabetes Type 2




Speed medical research while preserving patient privacy in the Academic Medical Center – a biobank

� AMC had a vision to integrate Clinical and Research environments� integrate clinical information of patients and DNA information for

research and treatment of patients� Inflammatory Bowel Diseases (IBD)

� IBM implemented solution which makes integration of data from different sources possible

� federated data warehouse� preserves patient privacy

� Benefits are significant time savings when gathering data from different databases

� minutes in stead of weeks or months

� This solution will enable better research and more accurate diagnoses and tailored treatment,

� improved patient outcomes. � part of the Dutch UMC Research project Parelsnoer.


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University Hospital of Heidelberg -Transforming the treatment of dialysis patients

� In a groundbreaking pilot study, the University of Heidelberg

wanted to explore the value of telemedicine for dialysis patients.

� The German hospital undertakes a telemedicine pilot study that

– enables doctors to adjust dialysis settings and medication remotely

– based on weight and blood pressure measurements sent remotely to a healthcare portal via Bluetooth technology

� Benefits of innovation

– Increases quality of life for patients

– Allows state-of-the-art treatment for patients regardless of patient or doctor location

– Reduces costs for patients who do not have to travel to doctors’ offices

– Ensures the most reliable, precise carepossible, eliminating detrimental long-term side effects that can result from improper dialysis settings or medication amounts




Bedside terminals Improve operational effectiveness.

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Portals for patients, employees and specialists

King FaisalCancer Center

Memorial HealthSystem

Duke MedicalUniv. of TexasCancer Therapy &Research Center

Mayo Clinic

Richardson RegionalMedical Center

Baby KiekMST

UZ Gent University Hospital System

Danish/SwedisheHealth Portal



Denmark




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Sweden




eHealth Belgiumhttps://www.ehealth.fgov.be

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1 out of 3 patients seek advice of non-medical professionals

7 out of 10 consultsdr. Google

14% writes about disease and treatment

6% of on-line companion patient

information is wrong

>14.000 Hyvesdealing with healthcare

52% goeson-line, 4% asks the general

practitioner



� Search engines

� Self-management, self-care

� Virtual tours through the human body

� Medical encyclopedia

� Wikipedia

� Blogs for chronic diseases

� Social networks - The Wisdom of Crowds

� Life-style management, well-being

Health 2.0 – patient and citizena blog a day keeps the doctor away

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� Professional networks

� Chatting with patients

� e-Anamnesis, e-Triage

� Auctioning of care

� Serious gaming for surgeons; simulation

� On-line Q&A, wiki’s

� On-line treatment (e.g. psychiatry)

� On-line pharmacy

� (Health malls, health boulevards, retail-based health clinics)

Health 2.0 – care provider

MediumZorg



MijnZorgNet - the virtual outpatient clinicSt. Radboud Nijmegen, Prof. dr Jan Kremer and Prof. dr Bas Bloem

“Do not underestimate the patient”

“Specialists have lost focus on the patient”

“From paternalism to collaboration on the basis of equivalence”

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Personal Health Records (PHRs)



CS Anesthesia

� Training tool and guide in anestesia

� Top 1 Medical App in the Netherlands

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NeuroMind

� Tool for medical students, neurology residents, and even neurosurgeons.

� Developed by Pieter Kubben, resident in neurosurgery (Maastricht University hospital)



1816

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Sensors of band-aids – cardiovasuclair solutions from Corventis

Why now?

– 4 billion cell phone users

– Broadband 3G

– Pervasive connectivity

– SmartPhones

– Ingeneous Sensors

– Nike shoe!

� Data-driven healthcare innovation



Health rabbit

� WiFi enabled

� Contact with family

� Improves/alleviates care experience

� Pilots at children’s hospitals


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3D Avatar – a visual patient health recordAnatomic and Symbolic Mapper Engine

� New 3D graphical and intuitive way to request, annotate and exchange patient information

� “Google Earth” of the patiënt, in a relevant clinical context



Rockingham Co., NCNCHICA RHIORural environment, small practices and regional hospitals

Rockingham Co., NCNCHICA RHIORural environment, small practices and regional hospitals

Research Triangle Park, NCNCHICA RHIOHigh-tech, competitive, city environment

Research Triangle Park, NCNCHICA RHIOHigh-tech, competitive, city environment

Mid-Hudson Valley, NY, THINC RHIO6 counties sharing information

Mid-Hudson Valley, NY, THINC RHIO6 counties sharing information

Use case scenarios� Biosurveillance� Consumer Empowerment� Electronic Health Record

Use case scenarios� Biosurveillance� Consumer Empowerment� Electronic Health Record

Nationwide Health Information Network (NHIN)

RHIO = Regional Health Information Organization

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epSOS - Smart Open Services for European Patients

� Goal for the epSOS eHealth Project:

– to develop a practical eHealth framework and ICT infrastructure that will

enable secure access to patient health information, particularly with

respect to a basic patient summary and ePrescription, between

European healthcare systems

� Challenges to get there:

– Legal Interoperability

– Organizational Interoperability

– Semantic Interoperability

– Technical Interoperability

� Supported by 27 beneficiaries representing 12 EU-member states



Servicio Extremeño de Salud (SES)

� Population of 1 million citizens

� 8 care regions

� 104 primary care posts

� 10 hospitals

� > 5000 care providers

� SAP based




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Building the hospital environment for the future at Medical Centre Alkmaar

Smarter Healthcare starts with the hospital organization

• For the Medical Centre in Alkmaar IBM is building the hospital environment for the future.

• The integration of Medical Centre Alkmaar and Gemini Ziekenhuis in Den Helder are part of this project.

• This is to gain a higher efficiency and open possibilities to build a new IT platform that makes these hospitals ready for the new ways of communication within healthcare.




Improve the knowledge and diagnostic capability of rare diseases in the UZA

THE RARE DISEASE DIAGNOSIS PLATFORM

� Allows for an earlier, quicker and more accurate diagnosis by integrating both medical expertise and data mining tools

� Creates direct and indirect value for different stakeholders

� Rules are generated much faster and accurate by a predictive model based on known patient data

� In comparison with a pure rule based system, a combination with data mining tools proofs both a higher sensitivity and specificity


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Healthcare Cloud – Storage as a Service� Information lifecycle management

– Long-term digital preservation

� Exchange hub

� Applications

– Computer Aided Detection

– Grid computing

� Business Intelligence en Analytics

– Clinical Decision Support

– Datawarehouse

– Data mining

– Simulation

� Content Management

– Images, ultrasound, film




Cloud-based Medical Imaging and Data Services

� InSiteOne

–Wallingford, Connecticut, V.S.

�Number of exams: ~43 million

�Number of images: ~3 billion

�Standards based

–DICOM, HL7, XDS-I

–CIFS

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EHRPHR

EHRPHR

RCTRCT

ClaimsClaims

DevicesDevices

HSM

Analytics

Evidence Synthesis Engine

Evidence Repositories & Registries

Evidence Aggregators & providers

Evidence services platforms (e.g. Cloud) enable data aggregation, evidence extraction, synthesis and dissemination to consumers, providers, payers, pharma’s, individuals, regulators…

Healthcare Transformation

TrendsEmergence of large scale consortia for data and evidence sharing

Emergence of innovative companies for evidence generation & delivery

The industry is enhancing the traditional static, locally curate evidence with dynamic

real-time evidence synthesis

The industry is enhancing the traditional static, locally curate evidence with dynamic

real-time evidence synthesis




World Community Grid� www.worldcommunitygrid.org

� Launched in Nov ’04

� Mobilize the community

� >2400 years of computing in first 50 days

� Technology solving problems

� Advisory Board of experts in health sciences, technology and philanthropy

� RFP for new projects

� FightAIDS@Home launched Nov 21, 2005

� 30,000 additional devices in first 10 days

� Art Olson, Scripps

� AutoDOCK for HIV Protease inhibitors

Completed


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IBM and the Scripps Research Institute

Virology Immunology

Biochemicalmodeling

DrugDiscovery

Bio-patterningMicrofluidics

Supercomputing

ComputationalBiology

Anticipate,Manage and Contain

Pandemics

The Scripps IBM ProjectResearch + = Institute Research Checkmate




References

� http://www.ibm.com/ibm/ideasfromibm/us/smartplanet/topics/healthcare/20091006/index.shtml

� http://www.youtube.com/ibmhealthcare

� http://www-01.ibm.com/software/solutions/smartwork/healthcare.jsp

� http://blog.irvingwb.com/blog/2009/10/designing-a-smart-healthcare-system.html

� http://www.youtube.com/watch?v=hAKy_e5MVXk

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Thank you for your attention!

© 2010-2011 IBM Corporation

The LIRIS Blue Academy 2010-2011

An initiative from L.I.R.I.S. and IBM Belgium

Thank You for attending this Lecture on“Smarter Healthcare”

Dr N.S. HeksterIndustry Technical Leader Healthcare & Lifesciences

Liris blue academy 2010 2011 - smarter healthcare - nicky hekster

Health & Medicine

Transcript of Liris blue academy 2010 2011 - smarter healthcare - nicky hekster