2004 Cisco Systems Inc All rights reserved 1

© 2004, Cisco Systems, Inc. All rights reserved. 1

“Just make me better” From e. Health to Connected Health How we can use connected information to improve the quality, access and costs of healthcare Kevin Dean, Cisco Systems IBSG kevdean@cisco. com © 2004 Cisco Systems, Inc. All rights reserved. 2

e. Health - 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 © 2004, Cisco Systems, Inc. All rights reserved. 3

e. Health © 2004 Cisco Systems, Inc. All rights reserved. 4

Health © 2004 Cisco Systems, Inc. All rights reserved. 5

Connected Health © 2004 Cisco Systems, Inc. All rights reserved. 6

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 journey Simple 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 © 2004, Cisco Systems, Inc. All rights reserved. 7

Our Connected Health initiatives • Connected Health book • IBSG Advisors • The Hospital of the Future • The Business Case for e. Health Available from www. cisco. com • Health. Grid © 2004, Cisco Systems, Inc. All rights reserved. Available from www. healthgrid. org 8

Top of Mind Issues – Healthcare “CEOs” Increase Productivity Higher costs Limited budgets Improve Patient Care Quality, Consistency, Speed Be the Employer of Choice Workforce shortage © 2004, Cisco Systems, Inc. All rights reserved. 9

Top of Mind Issues – Clinician What did I do to you last? What did “they” do to you last? Quality, Avoid errors What should I / we / they do next? Quality, speed, Avoid errors © 2004, Cisco Systems, Inc. All rights reserved. 10

Top of Mind Issues – “Worried Well” Rising costs Privacy Higher tax, premiums, medicines Protect my confidential data Treat my family well Quality, trust, transparency, access © 2004, Cisco Systems, Inc. All rights reserved. 11

Top of Mind Issues – Patient …wherever I am, or need to be… Just make me better …don’t make me worse . . and be quick about it © 2004, Cisco Systems, Inc. All rights reserved. 12

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 © 2004, Cisco Systems, Inc. All rights reserved. 13

Benefits come from…. • • • Quality, Cost fewer steps Shorter route through treatment, Shorter hospital. Access, stays Cost Fewer tests and. Access, retests Cost Avoiding malpractice, misdiagnosis, mis. Quality, Cost prescribing, mis-dispensing…. Reduced drug budgets cheaper prescribing, Access, – Cost lower waste, less inventory Scaling expensive resources Access, Cost Prevention of disease Access, Quality, Cost Lower whole-life. Quality, treatment costs Cost Lower overheads in finance, Quality, Costhuman resources, transactions, efficient procurement New streams of Access, revenue Cost © 2004, Cisco Systems, Inc. All rights reserved. 14

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 © 2004, Cisco Systems, Inc. All rights reserved. Italy Germany Canada 15

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 21 st century, Institute of Medicine, USA, 2001 © 2004, Cisco Systems, Inc. All rights reserved. 16

Re-engineer delivering quality care quickly to the patient connecting information assets across organisational boundaries Automating current Healthcare practices, organisations, patient experiences is not the answer © 2004, Cisco Systems, Inc. All rights reserved. 17

The Connected Health Model…. Governance – National/Regional/Local processes, Target Strong Governance, Funding, Metrics, IT Management, Business Cases Manage Implementation and Practices, Implementation. Change planning – Working Capacity & capability, Industry & Services, Sourcing & Procurement Increase ITRoll-out, Competence, Work with Industry Portfolio 3 – E-Enablement e. Procurement E-HR, E-Finance Portfolio of Services for Citizens, Patients Clinicians, and Management Portfolio 2 – Knowledge Management & e. Learning Web foundations – Directory, e. Mail, Consent/Authentication… Secure, Infrastructure Intelligent, High Speed Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) © 2004, Cisco Systems, Inc. All rights reserved. 18

The full Connected Health Model Portfolio 1 – Clinical tools, Health Records, Prescriptions Service, Appointment Booking, Patient Access, Images, Telemedicine…… Portfolio 2 – Knowledge Management & e. Learning Portfolio 3 – E-Enablement e. Procurement E-HR, E-Finance Portfolio 4– Patient Services Web foundations – Directory, e. Mail, Consent/Authentication… Infrastructure (Devices, Desktop, Servers, Storage, Secure, Intelligent, High Speed Infrastructure © 2004, Cisco Systems, Inc. All rights reserved. LAN, WAN, Mobile / Wireless) Performance Measurement Governance – National/Regional/Local processes, Target Funding, Strong Governance, Funding, Metrics, IT Management, Business Cases Manage Implementation and Practices, Implementation. Change planning –Working Capacity & capability, Industry & Services, Sourcing & Procurement Increase ITRoll-out, Competence, Work with Industry 19

Re-shaping cross-organisation processes • Map of Medicine by Medic to Medic (UCL) Click for demonstration • Access – easily understood; share with patient; speed process • Quality – applies guidelines; ensures communication; should eradicate some process steps • Cost – radically change outpatients process © 2004, Cisco Systems, Inc. All rights reserved. Medic to Medic’s Map of Medicine 20

“Knowledge is the Enemy of disease” © 2004, Cisco Systems, Inc. All rights reserved. 21

My life is on the web…. Directory IP TV Cisco. Cast Executive Information System Employee Connection FAST Start Vo. D Training Technical Support © 2004, Cisco Systems, Inc. All rights reserved. Benefits Enrollment Virtual Classroom End-to-End Staffing Travel & Expense Corporate Procurement 22

Patient relationship www. nhsdirect. nhs. uk © 2004, Cisco Systems, Inc. All rights reserved. 23

Bedside Services © 2004, Cisco Systems, Inc. All rights reserved. 24

Bedside Services Softphone klient IP/Video klient Internet Billing solution with Smartcard/creditcard Standard touchscreen Smart-card reader Headphone or/and USB handset © 2004, Cisco Systems, Inc. All rights reserved. 25

Healthcare – infrastructure dependencies © 2004, Cisco Systems, Inc. All rights reserved. 26

Beyond immediate care Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases Implementation planning – Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Performance Measurement Portfolio 1 – Clinical tools, -Waiting times Portfolio 3 – Health Records, Portfolio 2 – -Outcomes E-Enablement Prescriptions Service, Knowledge e. Procurement - Financial Appointment Booking, Management & E-HR, -Diseasee. Learning patterns (Epidemiology) Patient Access, E-Finance -Capacity Images, Telemedicine…… Portfolio 4– Patient Services -Feedback…. Web foundations – Directory, e. Mail, Consent/Authentication… Infrastructure (Devices, Desktop, Servers, Security, Storage, LAN, WAN, Mobile / Wireless…. ) © 2004, Cisco Systems, Inc. All rights reserved. 27

The Big Challenge – “How? ” Governance – National/Regional/Local processes, Funding, Metrics, IT Management, Business Cases Implementation planning – Capacity & capability, Industry & Services, Roll-out, Sourcing & Procurement Portfolio 1 – Clinical tools, PAS, PACS Health Records, Workflow, Prescriptions Service, Appointment Booking, Patient Access…. . Portfolio 2 – Knowledge Management & e. Learning Portfolio 3 – E-Enablement e. Procurement E-HR, E-Finance Portfolio 4– Patient Services Web foundations – Directory, e. Mail, Consent/Authentication… Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) © 2004, Cisco Systems, Inc. All rights reserved. 28

Key Topics Portfolio Planning -Vision -Priorities Obtain & Manage Funding -Level -Distribution National, Local Services -Design -Interaction Consent Authentication Authority © 2004, Cisco Systems, Inc. All rights reserved. Business Case & Measuring results Infrastructure design Implementation -Footprints -Priority Changing Working Practices Governance -Standards -Choice -Delivery Developing Capacity Sourcing & Procurement Strategy 29

All we have to do is solve…. Portfolio Planning -Vision -Priorities Obtain & Manage Funding -Level -Distribution National, Local Services -Design -Interaction Consent Authentication Authority © 2004, Cisco Systems, Inc. All rights reserved. Business Case & Measuring results Locally ? Regionally ? Nationally ? EU Wide ? Global ? Infrastructure design Implementation -Footprints -Priority Changing Working Practices Governance -Standards -Choice -Delivery Developing Capacity Sourcing & Procurement Strategy 30

The Connected Health Model…. Governance – National/Regional/Local processes, Target Strong Governance, Funding, Metrics, IT Management, Business Cases Manage Implementation and Practices, Implementation. Change planning – Working Capacity & capability, Industry & Services, Sourcing & Procurement Increase ITRoll-out, Competence, Work with Industry Portfolio 3 – E-Enablement e. Procurement E-HR, E-Finance Portfolio of Services for Patients Clinicians, and Management Portfolio 2 – Knowledge Management & e. Learning Web foundations – Directory, e. Mail, Consent/Authentication… Secure, Infrastructure Intelligent, High Speed Infrastructure (Devices, Desktop, Servers, Storage, LAN, WAN, Mobile / Wireless) © 2004, Cisco Systems, Inc. All rights reserved. 31

But what is really important? • Business case Reduction in medical errors; shorter stays Shorter waits; Choice Reduction in costs • Top priorities Transferable medical record Reform cross organisation process Prescribing & prescriptions Imaging Tele-medicine © 2004, Cisco Systems, Inc. All rights reserved. • Clinician engagement; Clinician engagement • Standards, interoperability Recognise importance • Simple steps Build on current assets Information architecture 32

The momentum is building…. . • NHS England • Germany BIT 4 IT Wales Scotland • Denmark • • • Poland Norway Finland Spain Iceland Med. Com • France Arras • European Commission • Saudi Arabia • WHO • Bahrain Md. S Paris • Italy • Australia • Dubai Health City • USA • Ireland © 2004, Cisco Systems, Inc. All rights reserved. 33