111 © 2004, Cisco Systems, Inc. All rights reserved

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

[email protected]


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


eHealth


Health


Connected Health


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


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


Top of Mind Issues – Healthcare “CEOs”

Improve Patient CareQuality, Consistency,

Speed

Increase ProductivityHigher costs

Limited budgets

Be the Employer of Choice

Workforce shortage


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


Top of Mind Issues – “Worried Well”

PrivacyProtect my confidential

data

Rising costsHigher tax, premiums, medicines

Treat my family well

Quality, trust, transparency,

access


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…


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


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


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


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


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


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


The full Connected Health Model







Increase IT Competence,Work with Industry

Portfolio 1 – Clinical tools,Health Records,

Prescriptions Service, Appointment Booking,

Patient Access, Images, Telemedicine……




E-HR,E-Finance

Portfolio 4–PatientServices


Perfo

rman

ce Measu

remen

t

Perfo

rman

ce Measu

remen

t


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


“Knowledge is the Enemy of disease”


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


Patient relationship

www.nhsdirect.nhs.uk


Bedside Services


Bedside Services

Softphone klient

IP/Video klient

Internet

Billing solution with Smartcard/creditcard

Standard touchscreen

Smart-card reader

Headphone or/and USB handset


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


Beyond immediate care

Infrastructure (Devices, Desktop, Servers, Security, Storage, LAN, WAN, Mobile / Wireless….)





E-HR,E-Finance

Portfolio 4–Patient

Services



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….


The Big Challenge – “How?”



Portfolio 1 – Clinical tools,PAS, PACS

Health Records, Workflow, Prescriptions Service, Appointment Booking,

Patient Access…..




E-HR,E-Finance

Portfolio 4–Patient

Services




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


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 ?


The Connected Health Model….






E-HR,E-Finance




Portfolio of Services for Patients Clinicians, and Management


Increase IT Competence, Work with Industry


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


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

Documents

111 © 2004, Cisco Systems, Inc. All rights reserved