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111© 2004, Cisco Systems, Inc. All rights reserved.
2© 2004 Cisco Systems, Inc. All rights reserved.
“Just make me better”
From eHealth to Connected Health
How we can use connected information to improve the quality, access and costs of healthcare
Kevin Dean, Cisco Systems IBSG
333© 2004, Cisco Systems, Inc. All rights reserved.
eHealth - an obvious investment?
• Historically low investment in IT – 1% ?
• Historically un-coordinated investment in IT & huge scale of organisations
• Oversold, under-delivered past health and public sector IT
• Complex “global” issues to solve – privacy, connectivity, standards
• Melange of legacy systems & data…. & paper
• Investment now vs benefits in 10, 20, 30 years time
4© 2004 Cisco Systems, Inc. All rights reserved.
eHealth
5© 2004 Cisco Systems, Inc. All rights reserved.
Health
6© 2004 Cisco Systems, Inc. All rights reserved.
Connected Health
777© 2004, Cisco Systems, Inc. All rights reserved.
Connected Health
• Citizens should be helped to avoid being ill
• Citizens and patients should be able to trust the “system”
• The patient makes a journey through care, often a unique journeySimple
Complex
Chronic
…and should be agnostic to the organisation structures giving care
• Clinicians should be, virtually, as good as each other
• Managers should operate the healthcare business on lowest possible overhead and highest possible productivity
888© 2004, Cisco Systems, Inc. All rights reserved.
Our Connected Health initiatives
• Connected Health book
• IBSG Advisors
• The Hospital of the Future
• The Business Case for eHealth
• HealthGrid
Available from www.cisco.com
Available from www.healthgrid.org
999© 2004, Cisco Systems, Inc. All rights reserved.
Top of Mind Issues – Healthcare “CEOs”
Improve Patient CareQuality, Consistency,
Speed
Increase ProductivityHigher costs
Limited budgets
Be the Employer of Choice
Workforce shortage
101010© 2004, Cisco Systems, Inc. All rights reserved.
Top of Mind Issues – Clinician
What did “they” do to you last?Quality,
Avoid errors
What did I do to you last?
Quality, Avoid errors
What should I / we / they do next?
Quality, speed, Avoid errors
111111© 2004, Cisco Systems, Inc. All rights reserved.
Top of Mind Issues – “Worried Well”
PrivacyProtect my confidential
data
Rising costsHigher tax, premiums, medicines
Treat my family well
Quality, trust, transparency,
access
121212© 2004, Cisco Systems, Inc. All rights reserved.
Top of Mind Issues – Patient
Just make me better
…don’t make me worse
..and be quick about it
…wherever I am, or need to
be…
131313© 2004, Cisco Systems, Inc. All rights reserved.
Benefits come from….
• Shorter route through treatment, fewer steps
• Avoiding malpractice, misdiagnosis, misprescribing, misdispensing….
• Shorter hospital stays
• Fewer tests and retests
• Reduced drug budgets – cheaper prescribing, lower waste, less inventory
• Scaling expensive resources
• Prevention of disease
• Lower whole-life treatment costs
• Lower overheads in finance, human resources, transactions, efficient procurement
• New streams of revenue
141414© 2004, Cisco Systems, Inc. All rights reserved.
Benefits come from….
• Shorter route through treatment, fewer steps
• Shorter hospital stays
• Fewer tests and retests
• Avoiding malpractice, misdiagnosis, mis-prescribing, mis-dispensing….
• Reduced drug budgets – cheaper prescribing, lower waste, less inventory
• Scaling expensive resources
• Prevention of disease
• Lower whole-life treatment costs
• Lower overheads in finance, human resources, transactions, efficient procurement
• New streams of revenue
Quality, Cost
Access, CostAccess, Cost
Quality, Cost
Access, Cost
Access, CostAccess, Quality, Cost
Quality, Cost
Quality, Cost
Access, Cost
151515© 2004, Cisco Systems, Inc. All rights reserved.
Reality – un-Connected Health hurts.
• 44,000 Americans die each year because of medical errors – more than from breast cancer, AIDS or car accidents
• Each year the NHS has a bill for £2 billion to cover prolonged stays in hospital because of errors
• The USA and England are not alone…..
France
Germany
Italy
Canada
161616© 2004, Cisco Systems, Inc. All rights reserved.
Can’t we train away these “errors” ?
“These quality problems occur
typically not because of a failure
of goodwill, knowledge, effort, or
resources devoted to health care,
but because of fundamental
shortcomings in the ways care is
organized.”Crossing the quality chasm: A new health system for the 21st century, Institute of Medicine, USA,
2001
171717© 2004, Cisco Systems, Inc. All rights reserved.
Automating current Healthcare practices, organisations, patient experiences is not the answer
Re-engineer delivering quality care quickly to the patient connecting information assets
across organisational boundaries
181818© 2004, Cisco Systems, Inc. All rights reserved.
The Connected Health Model….
Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless)
Web foundations – Directory, eMail, Consent/Authentication…
Portfolio 2 –Knowledge
Management & eLearning
Portfolio 3 –E-EnablementeProcurement
E-HR,E-Finance
Implementation planning – Capacity & capability, Industry & Services,Roll-out, Sourcing & Procurement
Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases
Secure, Intelligent, High Speed Infrastructure
Portfolio of Services for Citizens, Patients Clinicians, and Management
Target Funding, Strong Governance, Manage Implementation and Change Working Practices,
Increase IT Competence, Work with Industry
191919© 2004, Cisco Systems, Inc. All rights reserved.
The full Connected Health Model
Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless)
Web foundations – Directory, eMail, Consent/Authentication…
Implementation planning – Capacity & capability, Industry & Services,Roll-out, Sourcing & Procurement
Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases
Secure, Intelligent, High Speed Infrastructure
Target Funding, Strong Governance, Manage Implementation and Change Working Practices,
Increase IT Competence,Work with Industry
Portfolio 1 – Clinical tools,Health Records,
Prescriptions Service, Appointment Booking,
Patient Access, Images, Telemedicine……
Portfolio 2 –Knowledge
Management & eLearning
Portfolio 3 –E-EnablementeProcurement
E-HR,E-Finance
Portfolio 4–PatientServices
Web foundations – Directory, eMail, Consent/Authentication…
Perfo
rman
ce Measu
remen
t
Perfo
rman
ce Measu
remen
t
202020© 2004, Cisco Systems, Inc. All rights reserved.
Re-shaping cross-organisation processes
• Map of Medicine by Medic to Medic (UCL)
• Access – easily understood; share with patient; speed process
• Quality – applies guidelines; ensures communication; should eradicate some process steps
• Cost – radically change outpatients process
Medic to Medic’s Map of Medicine
Click for demonstration
212121© 2004, Cisco Systems, Inc. All rights reserved.
“Knowledge is the Enemy of disease”
222222© 2004, Cisco Systems, Inc. All rights reserved.
My life is on the web….
CorporateCorporateProcurementProcurement
End-to-End StaffingEnd-to-End StaffingTechnical SupportTechnical Support
DirectoryDirectory
BenefitsBenefitsEnrollmentEnrollment
Travel & ExpenseTravel & ExpenseFAST StartFAST Start
EmployeeEmployeeConnectionConnection
Executive Information Executive Information SystemSystem
IP TVIP TV
VoDVoDTrainingTraining
CiscoCastCiscoCast
VirtualVirtualClassroomClassroom
232323© 2004, Cisco Systems, Inc. All rights reserved.
Patient relationship
www.nhsdirect.nhs.uk
242424© 2004, Cisco Systems, Inc. All rights reserved.
Bedside Services
252525© 2004, Cisco Systems, Inc. All rights reserved.
Bedside Services
Softphone klient
IP/Video klient
Internet
Billing solution with Smartcard/creditcard
Standard touchscreen
Smart-card reader
Headphone or/and USB handset
262626© 2004, Cisco Systems, Inc. All rights reserved.
Healthcare – infrastructure dependencies
Hospital, Surgery
Health Community
Region
Nation
EpisodeHealth Record
Tele-medicine
Emergency Response
Tele-case conference
PACS Patient Administration
Systems
eTheatre
Home MonitoringAppointment booking
Security / VideoSurveillance
Paperless Hospital
Prescribingsupport
Prescriptions Service
Patient bedside services
Knowledge Management
Call centres
Training, Learning
Finance, Purchasingservices
Performance ManagementLife-long
Health Records
Ordering / reporting tests
272727© 2004, Cisco Systems, Inc. All rights reserved.
Beyond immediate care
Infrastructure (Devices, Desktop, Servers, Security, Storage, LAN, WAN, Mobile / Wireless….)
Web foundations – Directory, eMail, Consent/Authentication…
Portfolio 2 –Knowledge
Management & eLearning
Portfolio 3 –E-EnablementeProcurement
E-HR,E-Finance
Portfolio 4–Patient
Services
Implementation planning – Capacity & capability, Industry & Services,Roll-out, Sourcing & Procurement
Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases
Portfolio 1 – Clinical tools,Health Records,
Prescriptions Service, Appointment Booking,
Patient Access, Images, Telemedicine……
Performance Measurement-Waiting times
-Outcomes- Financial
-Disease patterns (Epidemiology)-Capacity
-Feedback….
282828© 2004, Cisco Systems, Inc. All rights reserved.
The Big Challenge – “How?”
Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless)
Web foundations – Directory, eMail, Consent/Authentication…
Portfolio 1 – Clinical tools,PAS, PACS
Health Records, Workflow, Prescriptions Service, Appointment Booking,
Patient Access…..
Portfolio 2 –Knowledge
Management & eLearning
Portfolio 3 –E-EnablementeProcurement
E-HR,E-Finance
Portfolio 4–Patient
Services
Implementation planning – Capacity & capability, Industry & Services,Roll-out, Sourcing & Procurement
Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases
292929© 2004, Cisco Systems, Inc. All rights reserved.
Key Topics
PortfolioPlanning-Vision
-Priorities
Governance-Standards
-Choice-Delivery
Obtain &Manage Funding
-Level-Distribution
Developing Capacity
ConsentAuthentication
Authority
Implementation-Footprints
-Priority
National, Local Services-Design
-Interaction
BusinessCase &
Measuringresults
Sourcing &Procurement
Strategy
Changing WorkingPractices
Infrastructuredesign
303030© 2004, Cisco Systems, Inc. All rights reserved.
All we have to do is solve….
PortfolioPlanning-Vision
-Priorities
Governance-Standards
-Choice-Delivery
Obtain &Manage Funding
-Level-Distribution
Developing Capacity
ConsentAuthentication
Authority
Implementation-Footprints
-Priority
National, Local Services-Design
-Interaction
BusinessCase &
Measuringresults
Sourcing &Procurement
Strategy
Changing WorkingPractices
Infrastructuredesign
Locally ?Regionally ?Nationally ?EU Wide ?Global ?
313131© 2004, Cisco Systems, Inc. All rights reserved.
The Connected Health Model….
Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless)
Web foundations – Directory, eMail, Consent/Authentication…
Portfolio 2 –Knowledge
Management & eLearning
Portfolio 3 –E-EnablementeProcurement
E-HR,E-Finance
Implementation planning – Capacity & capability, Industry & Services,Roll-out, Sourcing & Procurement
Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases
Secure, Intelligent, High Speed Infrastructure
Portfolio of Services for Patients Clinicians, and Management
Target Funding, Strong Governance, Manage Implementation and Change Working Practices,
Increase IT Competence, Work with Industry
323232© 2004, Cisco Systems, Inc. All rights reserved.
But what is really important?
• Business caseReduction in medical errors; shorter stays
Shorter waits; Choice
Reduction in costs
• Top prioritiesTransferable medical record
Reform cross organisation process
Prescribing & prescriptions
Imaging
Tele-medicine
• Clinician engagementClinician engagement; Clinician engagement; Clinician engagement
• Standards, interoperability
Recognise importance
• Simple stepsBuild on current assets
Information architecture
333333© 2004, Cisco Systems, Inc. All rights reserved.
The momentum is building…..
• NHS
England
Wales
Scotland
• France
Arras
MdS Paris
• Italy
• USA
• Poland
• Norway
• Finland
• Spain
• Iceland
• Saudi Arabia
• Bahrain
• Dubai Health City
• Germany
BIT4IT
• Denmark
MedCom
• European Commission
• WHO
• Australia
• Ireland