© 2010 IBM Corporation Building a Smarter Planet: Healthcare 2010, IBM Healthcare
© 2010 IBM Corporation2
Global Factors Driving an industry-wide transformation in healthcare
Changing Demographics and Lifestyles
Aging and overweight populations
Increased healthcare costs associated with aging
Estimated over 1.5 billion overweight by 2015
ConsumerismConsumers more engaged and demanding
more control over their own healthGrowing awareness of risks and adverse
events with higher expectations of care and service quality
The Changing Nature of DiseaseGrowing incidence and impact of chronic diseases, which account for 60% of the 58 million deaths each yearAs much as 75% of healthcare resources are consumed by the needs of those with chronic conditions
GlobalizationCompetition on a worldwide basis
Changing business models (e.g. rise of medical tourism, retail clinics, wellness centers)
Source: Healthcare 2015: Win-win or lose-lose?
© 2010 IBM Corporation3
Healthcare organizations must be agile and innovate
Clinical Quality and OutcomesApply insights to improve patient safety, quality of care, clinical outcomes, while improving financial resultsEngage and activate patients and consumers to promote health and deliver value-based care
Operational EfficiencyBuild flexibility into operations to support cost reduction and excellence in clinical and business performances and practicesEfficiently respond to increasing regulatory demands
.
InnovationBetter understand the molecular characteristics of disease, and discover new treatmentsEnable a flexible, responsive IT foundation to meet changing demands
© 2009 IBM Corporation
Accelerate Healthcare Solution Delivery
Healthcare realities: The need for progress
People worldwide pushed below the poverty line by personal healthcare expenditures each year.
100 million
In many parts of the world, healthcare costs are rising two times faster than economic growth.
1.5 millionErrors in the way medications are prescribed, delivered and taken harm 1.5 million U.S. citizens every year.
The number of developed countries where people with higher incomes have better access to physicians than those with lower incomes.
5O percent
2 timesThe estimated number of patients affected by healthcare-related infections in the EU.
1 in 10With poor urban governance, life expectancy within developing countries can be as low as 35 years.
35 years
5 © 2010 IBM Corporation
Building a smarter planet: Healthcare
Health Care expectations are greatly influenced by service levels they experience in other industries
e-Access to Healthcare DataHealth Benefits Employee Portal• PHR/HER/MHR• Advanced decision support tools• Wireless access
Simpler Provider Reimbursement Model
• Co-payments & co-insurance• IRS-approved services & goods
Online Patient Information• Contact data• Medical history, e.g., meds,
allergies• Secure, authorized access
Compliance with Evidence-BasedMedicine Guidelines• Measure impacts of targeted
interventions• Disease management support• Member Relationship Mgmt platform
Enables improved
quality of care and easier access to
information
Enables information access, e.g., emergency
medical record at point-of-care
Enables real-time benefits verification and updated personal medical history
Enables single swipe payment from Health Plan and employee (FSA/HSA) with extended credit
line – “One & Done”
“I have my own private health information that is comprehensive, up-to-date, and accessible when and where I need and authorize it’s use.”
6 © 2010 IBM Corporation
Building a smarter planet: Healthcare
6
Healthcare systems require a totally integrated approach
Your hospital
Physician’soffice
Outpatientcenter
Imaging centers
Long-termcare
Otherhospitals
Homecare
Consultingphysician
In-transit
Care givers
7 © 2010 IBM Corporation
Building a smarter planet: Healthcare 77The Business of Government … puts Healthcare also in a broader perspective IBM supported components
Central Government Regional Government Large Cities
Local Government Small Cities, Municipalities Other Organizations
Common Government
Public Safety and Security
State Financials
Defense
Education
Social Security
Traffic Management
E-GovernmentRegistries
IT ServicesCity Management
Physical Security and SurveillanceCrime Analysis, Threat and Fraud Intelligence
Emergency Response Planning and Organization
Criminal Justice
State TreasuryCustoms Management
Tax Management
Homeland Security Identity ManagementBorder Management
Network Centric Operations
Postal Services
NGO´s
Healthcare Providers
Infrastructure Providers
PPP´s
…
Education Organization ManagementCultural Heritage
Employment SecuritySocial Security
Payment & Benefit
…
Cross Sector Shared ServicesSmart Solutions
Government Sector
HealthcareeHealth (central information, transactional depending on the stakeholder)
eHealth strategy/roadmaplink to eGov, MoF, MoI
Optimization/Interoperability
8 © 2010 IBM Corporation
Building a smarter planet: Healthcare
1
IBM solutions support cost containment and value creation opportunities for healthcare organizations.
Achieving better qualityand outcomes
• Health Analytics
• Health Plan Member Analytics
• Performance Management
• Public Health, Disease Surveillance and Modeling
Delivering collaborative care for prevention and wellness
• Medical Home: Patient-centered Collaborative Care
• Health Information Exchanges
• National health portals
• Portals for care teams and patients
• Mobility and telehealth
• Converged communications
Improving operationaleffectiveness
• Clinical process optimization
• Program management
• EMR Integration
• SOA for flexible business processes
• Enterprise asset and service management
• Privacy, security and business resilience
• Application management and hosting
• Enterprise medical image archival solutions
• Server, storage and desktop virtualization
• Energy efficient technologies
• Data center automation and optimization solutions
Achieving better qualityand outcomes
• Health Analytics
• Health Plan Member Analytics
• Performance Management
• Public Health, Disease Surveillance and Modeling
Delivering collaborative care for prevention and wellness
• Medical Home: Patient-centered Collaborative Care
• Health Information Exchanges
• National health portals
• Portals for care teams and patients
• Mobility and telehealth
• Converged communications
Improving operationaleffectiveness
• Clinical process optimization
• Program management
• EMR Integration
• SOA for flexible business processes
• Enterprise asset and service management
• Privacy, security and business resilience
• Application management and hosting
• Enterprise medical image archival solutions
• Server, storage and desktop virtualization
• Energy efficient technologies
• Data center automation and optimization solutions
IBM IS DELIVERING …HEALTHCARE ORGANIZATIONSARE FOCUSED ON …
© 2010 IBM Corporation9
IBM Healthcare Research and Software Labs
Hursley, UKHealthcare Service Bus
- Devices, HL7 V3, CDA
Haifa, IsraelHIE Interoperability
- Images Management
Beijing, ChinaTraditional Chinese and Western Medicine EHRs
Zurich, Switzerland3D EHR modeling
Austin, USAHospital RoomOf the Future,
RFID - Real Time Location Services
La Gaude, FranceDrug RFID Tracking,
Health Analytics
Dallas, USAHealth Analytics
Center
10 © 2010 IBM Corporation
Building a smarter planet: Healthcare
e-referral
HomeMonitoring
HealthInformation
e-Vaccination
card
e-Reimbursement
DecissionSupportSystem
e-Appointment
e-PatientDiary
KnowledgeManagement
e-Learning
HCBusiness
Intelligence
e-Surveillance
e-Consultation
e-documentation
e-Ordering
e-Prescription
e-Medication
e-Lab
results
e-referrel
e-Health
Strategy
eHealthPortal
?
?
?
The potentiale-Health Applicationsand the Portal ...... exemplary.
11 © 2010 IBM Corporation
Building a smarter planet: Healthcare
Generically EPR is at the core of eHealth,which is the entire picture.
EMRECREPR
Knowledge- DB
Portal
BI / Analytics
eHealth core
Archive
Network / connection
TerminologyDe-Identification
Registers/Idexis
Health Card
eHealth Infrastructure
eHealth context / General conditions
Acceptance
Roles
ResponsibilitiesUsability
Standardization
Law
eHealth Applications
12. © Copyright IBM Corporation 2008For IBM Internal Use Only
IBM Global Business Services
12
Primary/Community Secondary and Tertiary Healthcare
Electronic Patient Records
(EPRs)
Primary Health Information
Systems
Electronic Patient Records
(EPRs)
Hospital Information Systems
An Electronic Health Record from cradle to grave ….
13
Healthcare Providers, Specialists & Hospitals• Patient Summary (allergies,
chronic diseases, …)• Prescriptions, dispensed
drugs & current medication• Referrals• Lab results• Hospital Episodes• …
eHealth portal
Government Agencies
Citizens• View information
Input for key performance indicators
Public Health Surveillance
13
Method of health information collection - Who, What, Where, When, Why, HoweHealth portal
Integration Healthcare Enterprise (IH
E)
Hospital/Clinic HIS/CIS
Primary care systems
Labs
Patient Summary Prescriptions Discharges summaries Lab Results
Radiology Images …
RadiologyPharmacies
Medical Emergency
Home Care
Research
Existing IT
systems
What is an EHR System?
14
Interoperability FrameworkNational Health Record Repository
Individual Master Health
Records
Consolidated Data Reporting
Records
•Patient•Provider•Location•Organisation
Master Registers
Patients
Transportable Health Record
Healthcare Provider(s)HIS / CIS
Content Viewers/ Portals
Existing Health Management Systems
External Reference Systems
Disease Registry
TB Registry
Access and Security Framework
National Population Register
Existing Health Management Systems
Cancer Registry DHIS
Terminologies
COHERE Facility Registry
Data consumer(s)
Reference data source(s)Health record source(s)
Patients visit multiple
healthcare provides
RIS
PACS
NHLS
Basic eHR.ZA Application
HIV/AIDS Registry
Health smartcard
What is eHR.ZA?
17.17. © Copyright IBM Corporation 2008For IBM Internal Use Only
IBM Global Business Services
Department of Health
+- 4700 facilities
+- 85% out of 50m population
+ R100 billion / per year(approx $14.3b)
+- 125,000 health workers
18.18. © Copyright IBM Corporation 2008For IBM Internal Use Only
IBM Global Business Services
18
Phase 1 Scope6 provinces have existing HIS Hub Deployments
GautengLimpopoNorthern CapeWestern CapeKwaZulu-NatalThe Free State
3 provinces do notNorth WestEastern CapeMpumalanga
Facilities per Province
●1 Tertiary hospital
●1 Regional (Seconda ry)
hospital
●1 District hospital
●2 Community Health Centres
●2 Clinics (1 provincial and 1
local, where at least 1 clinic is
completely paper based)
© 2010 IBM Corporation1919
IBM Health Integration Framework
Healthcare and Life Sciences Extensions
Key Software Group Products
Data and Process Models
Interfaces and Adapters
Tools
Portals and Portlets
Information Management Lotus Rational Tivoli WebSphere
IBM Services Assets and Delivery
IBM Solutions
Health Plans
HospitalsLife
Sciences
Business Partner Solutions
Health Plans
HospitalsLife
Sciences
Health Integration FrameworkIBM Health Integration FrameworkThe Health Integration Framework establishes a foundation for our solutions and is central to our partner and client collaborations
Reference Architectures
IBM Dynamic Infrastructure
ISV EcosystemPartners as an integral aspect of the framework – become a trusted
network of solution providers
IBM Product Foundation as shared, trusted
platform
Build and design faster with industry
accelerators
Solve client problems with a
common and extensible platform
20
SOA Industry Specific Framework
IBM & Business Partner Solution
Offerings
Integrated Solutions need Mapping Customers Business Architecture, Business Processes and IT - Infrastructure
Solution Offerings, Business servicesSolution Offerings, Business servicesSolution Offerings, Business services
Industry Thought LeadershipIndustry Thought LeadershipIndustry Thought Leadership
Partner ContentPartner ContentPartner Content
Integrated Solution Integrated Solution Solution ViewAn unified approach that leverages IBM Thought leadership, services & SOA/IA based solution offerings
Framework ViewSoftware platforms with industry specific extensions
21
Speed –accelerate delivery and integration
Flexibility – grow and add new capabilities incrementally
Choice – multiple solution on-ramps and business partners
Infrastructure and Governance
Healthcare Industry Framework
Business Partner Ecosystem
Government Industry Solutions
Rapid Development & Integration Process Flexibility Agility
Lowered Risk and Cost
Interoperability Scalability
Architectural blueprint for Government transformation
Pre-integrated software platform
Pre-built businessspecific accelerators
Smart SOATM foundation
Open standards
Well defined and described Interfaces to other Frameworks
Ecosystem of partner content
A robust base for Government Agency transformation and extending capability over time
IBM Healthcare Industry Framework Provides Speed, Flexibility and Choice
What it is: “Triton” is an asset from IBM providing an accelerated delivery of a a fully functional SOA Foundation
What it does: Enable delivery excellence in SOA infrastructure by leveraging implementation best practices, including delivery services, and utilizing harvested implementation assets
Provides Core Services
Focus on Foundations SOA Foundation aka “Triton”
Internal use only
SOA Foundation (aka “Triton”)SOA Foundation (aka SOA Foundation (aka ““TritonTriton””))
Why is this important: SOA infrastructure implementations can be complex
What it is composed of: Assets to support the full lifecycle of a SOA Infrastructure
Why use it: To accelerate implementations (calendar and overall person/year effort) and lower risk, and leverage SOA best practices from across IBM globally.
More Details : http://w3.tap.ibm.com/w3ki08/display/FWKS/Triton
IBM’s Service Oriented software infrastructure foundation that enables and supports wide variety of applications and functionality
© 2010 IBM Corporation
Building a smarter planet: Healthcare
24
Configurable & extensible BPM solution assets for enrollment, member & group, claims & provider collaboration; Based on HL7, ASC X12 EDI (HIPAA) standards & IBM’s best practices
BPM Solution Scenarios
Process ModelsCapability Models Service Models
Common Components Business Vocabulary Business Object Models
Based on HL7 & IBM’s Best Practices
Based on IBM’s Best Practices
Based on HL7, ASC X12 & IBM’s Best Practices
Based on HL7, ASC X12 & IBM’s Best Practices
Based on HL7, ASC X12 & IBM’s Best Practices
Based on HL7 RIM & IBM’s Best Practices
Capability Maps & Process Maps align business strategy with
process execution
Process Flows & Business Measures simulate human
workflows & automate processes
Service Interface & Schemas facilitate creation & assembly of
process implementations
Common Services & Utilities enable interoperability with the
application ecosystem
Repository of Business Concepts, Terms & Relationships
to ensure consistency
Conceptual Data Models to provide a foundation for information management
Benefits Eligibility, Real-Time Claims Adjudication – Includes UI Forms, Dashboards, Process Implementation
WebSphere Healthcare Content Pack Healthcare Solution Assets for WebSphere BPM
2525
IBM Health Integration Framework
Healthcare and Life Sciences Extensions
Key Software Group Products
Data and Process Models
Interfaces and Adapters
Tools
Portals and Portlets
Information Management Lotus Rational Tivoli WebSphere
IBM Services Assets and Delivery
IBM Solutions
Health Plans
HospitalsLife
Sciences
Business Partner Solutions
Health Plans
HospitalsLife
Sciences
Health Integration FrameworkIBM Health Integration FrameworkThe Health Integration Framework establishes a foundation for our solutions and is central to our partner and client collaborations
Reference Architectures
IBM Dynamic Infrastructure
ISV EcosystemPartners as an integral aspect of the framework – become a trusted
network of solution providers
IBM Product Foundation as shared, trusted
platform
Build and design faster with industry
accelerators
Solve client problems with a
common and extensible platform
© 2010 IBM Corporation26
Health Integration Framework: Domain and Project Taxonomy
26
Segment HIF Domain HIF Project
Healthcare Provider
Enterprise Health AnalyticsEnterprise Health Analytics
Medical Record Text Analytics
Operations Optimization
Service Management for Hospitals
Asset Management for Hospitals
Real Time Location Services
Clinical Business Integration
Device Integration to EMR Platform
Regulatory Compliant Clinical User Access
Enterprise, Patient & Clinical e-Views
Enterprise Service Bus for Healthcare
Healthcare InteroperabilityHealth Information Exchange, Patient Centered Collaborative Care, Medical
Home
Health Information Exchange -
EMR and EHR integration
Health Plans
Enterprise Health Plan AnalyticsEnterprise Health Plan Analytics
Medical Record Text Analytics
Health Plan Core Systems Modernization
Model Driven Architecture and BPM/BPR
EDI/Channel Modernization/HIPAA 5010-ICD10
Service Management for Health Plans
Customer Service Modernization Member 360, Provider 360, Portals
Life Sciences
Life Sciences Transformation
Life Sciences Stakeholder Communities and Collaboration
Medical Image Management (IBM SCORE MIMS)
Secure data sharing and data transfer
Regulatory Compliance
Regulatory Compliant Enterprise Content Management (SCORE)
Track and Trace
Life Sciences Asset Management
Life Sciences Performance Management
Business Analytics and Optimization for Life Sciences
© 2010 IBM Corporation27
Health Integration Framework Domain Healthcare Providers
Enterprise Health Analytics• The aggregation and analysis of information across a healthcare
enterprise, to improve clinical, financial or administrative outcomes and results.
Patient and Clinician e-Views (portals)• Using a portal-based user interface for the aggregation of
information across a healthcare and life sciences enterprise, to create custom views depending on role and providing new services.
Clinical Integration and Interoperability (HL7 ESB)• The integration, exchange, and sharing of information across a
healthcare organization. This can involve the integration of multiple systems within a single hospital, or within an integrated delivery network.
Health Information Exchange (HIE)• The exchange, sharing and usage of information across multiple
healthcare organizations, regions, or communities of interest.
27
Partner
© 2009 IBM Corporation
Accelerate Healthcare Solution Delivery
What is top of mind for decision makers in U.S. Health Plan organizations?
Source: Managed Care Executive Group, 2009
Client Challenges Focus1. Government regulation and intervention HIPAA, ICD-10 and HIPAA 5010
2. Containing administrative / medical costs Boost administrative efficiency
3. Impact of recession Declining membership as employers drop coverage
4. Collaboration with providers Health information exchanges, e-Rx (e- prescribing) and electronic medical records
5. Data analytics and informatics Underwriting and care management
6. Data transparency to improve quality Measuring provider performance
7. Fraud and abuse Detecting fraud faster and supporting utilization management
8. Consumers, the Web and Health 2.0 Personal health records and self-service portals
9. Adding value Disease management, health and wellness
10.Developing new products Individual plans and consumer-directed plans
© 2010 IBM Corporation29
Health Plan Core Systems Modernization• The transformation of core health insurance systems through
integration and process orchestration to improve overall efficiency and flexibility in creating and deploying new services e.g. claims process transformation, member enrollment.
Health Plan Analytics• The aggregation and analysis of information across a health plan,
to improve member wellness, financial and administrative outcomes and results.
Health Plan Member 360 (Single View)• The federation and consolidation of information from disparate
sources to build an understanding of all member-related activities from the perspective of a unique individual.
29
Partner
Health Integration Framework Domain Health Plans
© 2010 IBM Corporation30
Solution components:IBM Global Business Services - AIS Information Integration
“Under this public-private partnership, we hope to demonstrate how technology and Internet-based connectivity can significantly improve the quality of life for people in remote locations.”
— Ferial Saeed, Deputy U.S. Coordinator & Office Director for International Communications &
Information Policy
U.S. Department of State – Pakistan Telemedicine Initiative Telemedicine brings doctors to remote patients via the Internet
Business challenge: Pakistan has almost 179 million people, but more than 75 percent live in remote villages with limited access to healthcare. In the remote village of Attock, there are only 16 primary-care doctors and no specialists. If a villager needs specialized care, he or she often cannot afford the trip to the larger hospital in Rawalpindi. As a result, ailments that aren't emergencies are ignored, often for years.
Solution:IBM Global Business Services is working with the U.S. State Department on a telemedicine project that has enabled medical specialists to treat patients in remote areas of northern Pakistan. The project uses WiMAX wireless broadband technology, videoconferencing, and the Internet to connect a main hospital with a remote facility in Attock.
Benefits:Moving information instead of people, it gives people in remote areas access to care without traveling and incurring large costs
Without the telemedicine solution, many easily treatable diseases would continue to go untreated
Enables access to help from medical experts at some of the most elite medical institutions in Pakistan and around the world
© 2010 IBM Corporation31
Business challenge:Geisinger Health System sought to improve its electronic health record systems, allowing the healthcare group to organize information and integrate real-time clinical data with medical history information. An integrated solution providing increased clinical insight would help identify clinical trends, best practices and ultimately, improve patient care.
Solution:IBM Global Business Services implemented a Clinical Decision Intelligence System (CDIS) Solution. This first-of-its-kind system leverages the health system's wealth of clinical data derived from its decade-long use of one of the industry's most advanced electronic health record systems. The CDIS, which utilizes open standard based technology, will serve as the foundation for Geisinger's integrated clinical, financial, operational, claims, genomic and other medical data in a format that allows for rapid analysis and reporting of vital insights from millions of patient encounters.
“Building upon our electronic health record experience, our work with IBM now sets the stage for Geisinger to expand its role as a national model for patient engagement, research, and education, as well as leading to business and growth opportunities for the System.”
— Glenn Steele Jr., MD, PhD, president and chief executive
officer of Geisinger Health System
Geisinger Health System First-of-its-kind Clinical Decision Intelligence System
Benefits:Consolidates information to provide a comprehensive patient viewincluding complete medical history
Provides a massive storehouse of clinical information, procedure and research to quickly assist doctors in providing best practice care
Amount and diversity of medical information can be the basis forinnovative medical research, treatments and life-saving breakthroughs
Solution components:Clinical Decision Intelligence System (CDIS) solutionIBM InfoSphere Warehouse 9 platformIBM Global Business ServicesIBM Business Partner: Business Objects
© 2009 IBM Corporation
Accelerate Healthcare Solution Delivery
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