New information technologies for Human Health Whats new in e-Health? Jean-François Penciolelli...

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


Order test

Discharge Patient


Diagnosis

Submit claim

Treatment


Perform procedure

…

Write report



Support patient

Refer patient

Process claim


Order test

Discharge Patient


Diagnosis

Submit claim

Treatment


Perform procedure

…

Write report



Support patient

Refer patient

Process claim


Order test

Discharge Patient


Diagnosis

Submit claim

Treatment


Perform procedure

…

Write report



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


Application Server & Database

E-Health Applications

CRM

ClinicalPortal

MMAViewer




Connectivity

Orchestration

Transformation & Routing ETL





Datawarehouse


RISSystem

PACSSystem

EMRSystem

AccountingSystem


Security & Privacy


Oracle/partner footprint


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




Connectivity

Orchestration

Transformation & Routing ETL





Datawarehouse


RISSystem

PACSSystem

EMRSystem

AccountingSystem


Security & Privacy


Oracle/partner footprint


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

Email

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



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

New information technologies for Human HealthWhat’s new in e-Health?

Jean-François Penciolelli

Global Business Development Director

IBU Healthcare and Life Sciences

New information technologies for Human Health Whats new in e-Health? Jean-François Penciolelli...

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