Upload
theresa-barton
View
215
Download
0
Embed Size (px)
Citation preview
The Real Deal on Enterprise Portals
Bob BretonSenior Director, Product StrategySybase Enterprise Solutions Division
Bob LaGaliaSVP, Strategy & Corp DevelopmentNIA|RadMD
Agenda
State of Healthcare in the United States Who is NIA and what is RadMD? The RadMD Enterprise Portal Enterprise Portal Market Requirements Key Success Factors
Rising Costs, Complex, & Highly Fragmented
The State of Healthcare in the U.S.
Single Largest Industry in the U.S. ->$1.2 trillion in spend
– As a % of GDP, national expenditures have risen from 5% in 1960 to fully 14% today.
– This is the largest percentage in the industrialized world
– Little evidence exists that aggregate outcomes are better in the U.S. than in countries that spend a smaller % of their GDP on health care.
Rising Costs, Complex, & Highly Fragmented
The State of Healthcare in the U.S.
HCFA predicts costs to grow at 7% CAGR; and reach $2.2 trillion by 2008
Alarmingly, only 1/2 represents “required care”:– 20% spent on administrative inefficiencies– 30% inappropriate, redundant, and unnecessary procedures
Huge service-based industry– Over 250 million patients/consumers (aging population)– Over 5,000 Hospitals, 40,000 Nursing Home and AL Facilities– 700,000 Physicians, 100,000 Dentists– Cumbersome 3d Party Payment System– Over 500 Managed Care Enterprises
Highly Transactional, Data Rich, Information Poor
The State of Healthcare in the U.S.
Billions of claims processed each year, representing multiple patient encounters(doctor visits), and multiple transactions (eligibility, referral, lab studies, radiology studies, etc.)
Clinical & Financial Data resting on antiquated technology; mainframe, old client-server. Industry contributes only 2-3% on information technology vs. 6-8% in other highly-information based business
Physicians need access and information flow across the continuum of care in order to manage patients and their businesses
Consumerism on the rise - accessing information enabling the comparison of quality, treatment options, and outcomes data of hospitals & physicians.
The Impact on Quality of Care?
The Institute of Medicine’s (IOM) Committee on Quality of Healthcare released results of a study that indicates that as many as 98,000 deaths occur each year due to medical errors - it was the 8th leading cause of death in the U.S; nearly as much as MV accidents, Breast Cancer, and AIDs combined.
“…when patients see multiple providers in different setting, none of whom have access to complete information, it is easier for something to go wrong than when care is better coordinated” - IOM Committee on Quality of Healthcare
The State of Healthcare in the U.S.
The Impact on Quality of Care?
As much as 40% of patient information is missing when needed by a medical professional, and this is compounded each time a patient moves, changes health plans, or visits a different specialist - Boston Consulting Group
The State of Healthcare in the U.S.
Diagnostic Radiology Market - a microcosm
The State of Healthcare in the U.S. - Radiology
Diagnostic Radiology Market Size– $70 to $80 Billion Spend, 10% of healthcare dollar
Rising Costs– Direct costs increasing at twice the rate of medical inflation (9% to
12%)
Quality– Unnecessary radiation exposure and false positives associated with
inappropriate use
MidwestRegion Util./1000/Yr.A 1092B 885C 914
Mid-AtlanticRegion Util./1000/Yr.A 587B 987
NortheastRegion Util./1000/Yr.A 775B 872C 824D 1176E 750F 1000G 980H 760
SoutheastRegion Util./1000/Yr.A 1073B 790C 780
SouthwestRegion Util./1000/Yr.A 664
West
Region Util./1000/Yr.A 801
Rising costs, inappropriate use, and lower quality contribute to the wide variation in utilization patterns for diagnostic radiology services
The State of Healthcare in the U.S. - Radiology
How?
Apply new technologies to enable better and more efficient transactions among all participants
Apply clinical domain expertise to appropriately manage cost growth
Productivity, Efficiency, & Quality of Patient Care
Reduce Spending on Unnecessary & Inappropriate Care
An imperative to:
The State of Healthcare in the U.S.Rising Costs + Quality Concerns = An impetus to change
Agenda
State of Healthcare in the United States Who is NIA and what is RadMD? The RadMD Enterprise Portal Enterprise Portal Market Requirements Key Success Factors
Who is NIA? (founded in 1995 at Corning Life Sciences, Inc.)
We are a medical management company providing payers and physicians with cost effective business solutions in diagnostic radiology
What is RadMD? (today)
RadMD represents NIA’s medical management portal, designed to promote the most appropriate and effective use of diagnostic radiology services. It connects physicians and information, providing access to knowledge–knowledge which helps to improve the efficiency of business transactions, while improving the quality of patient care.
National Imaging Associates & RadMD
NIA Call Center & Workflow (pre-EP)
Our Operations– Call Center/IT organization located in San Bruno, California with over 100 employees;
Customer Service Representatives, Registered Nurses, Board-Certified Physicians
– Provide Medical Management services to over 4.5 million enrollees through our client relationships
– Process over 80,000 clinical consultations per month involving multiple transactions each - eligibility, clinical decision support algorithms, provider selection and referral, authorization resolution
2000 - strategic move to an Enterprise Portal Computing Architecture
Requestsvia Telephone
Call Center
DB
MS SQL ServerPowerBuilder Appson WIN NT
Offline (batch)
Data Loaded intoProduction offline
Members
Providers
Claims/Clinical
TelephoneWorkstation
Workstation
Workstation
Data
Data
Data
NIA Client Server Architecture (1996-1999)
Agenda
State of Healthcare in the United States Who is NIA and what is RadMD? The RadMD Enterprise Portal Enterprise Portal Market Requirements Key Success Factors
For our Users:• An alternative, personalized experience, with access to same protocols• Improved clinical information sharing during the care delivery process• Self-service, empowerment, ownership• Access anytime, anywhere
For our Company:• “Free” capacity• Increased productivity - physician experts connected nationwide• Margin improvement - cost reduction (40% less via web)
For our Future:• Flexible business model - full outsource to ASP hosting• Leverageable platform for other “plug-in”devices; access expansion wireless• Direct integration with clients• Expansion into other medical management solutions
Why an Enterprise Portal?
Facilitating Information Transfer
RadMD
ReferringPhysicians
Patients RadiologyProviders
InsuranceCarrier
Facilitate Clinical Information Exchange
• Improve Admin Transac tions• Collect Outcomes for analysis• Identify patients early
• Lower administrative expenses• Improved medical cost management
• Access to expert consult• Education re: best practice• Improve Patient outcomes
Learning
4-Phase Approach Critical Learnings
1, Discovery:research, focus testing, ~ integrate within the current workflow
user requirements ~ must have incremental impact
understand existing workflow & tech. ~ no new tech investment
~ access, bandwith
2, Definition & Design:obtain key stakeholder input, ~ speed, reliability, availabilitytechnical & clinical consultation ~ privacy, security
~ integrated w/ call center
3, Development:vendor solutions ~ Sybase Enterprise Portal Early Adopterdetermine optimal approach ~ Sybase Professional Services Team
~ Port PB App and business logic~ Integrated Solution
4, Deployment:step-wise roll-out ~ select pilot sites
How did we Develop?
NIA Call Center & Workflow Today
Web Server
EP Applications
EP Application Services
EP Integration Services
Call CenterEnterprise Application Server
Browser Mobile PC Wireless B2B App
EP Common Services
Enterprise Information Systems
Content Apps Events Data
myRadMD
Tel
RadMD Portal (2001)
Telephone-based clients
Pen computerRadio tower
Wireless computingMobile WAP Tel
Mainframe
Member, ProviderData Transfer Using
XML & Mainframe Integration
Data
MS IIS on NT ~ load balancing ~ high availability ~ failover
Telephone
Call Center
Workstation
Workstation
Workstation
Offline (batch)
Members
Providers
Claims/Clinical
Data
Data
Data
Desktop
Desktop
Browser-based users
Internet
HTTP / HTTPS web server
web server
Web Server Cluster App Server Cluster
App Server
App Server
IIOP / IIOPS
Sybase EP on NT ~ load balancing ~ high availability ~ failover ~ security
HTTP / H
TTPS
Server
Content ManagementVignette StoryServer
DataContent DBSybase ASE
Telephone
Telephone
MS SQL
What have we learned?
Portal technologies provide a means to connect the participants in the healthcare delivery process to valuable clinical information necessary to improve the quality and efficiency of patient care
Look for technology partners and engage existing stakeholders
Fundamental Project Management Skills are paramount
Value proposition must be unique, tangible, and measurable
Agenda
State of Healthcare in the United States Who is NIA and what is RadMD? The RadMD Enterprise Portal Enterprise Portal Market Requirements Key Success Factors
e-Business Evolution
Static ContentStatic Content
TransactionsTransactions
Meaningful relationshipsMeaningful relationships
Dynamic ContentDynamic Content
Approval &Billing
Expanding Opportunities
Care Review
Healthcare Provider
Knowledge Access
HMO
Current e-Business SolutionsFragmented and Impersonal
Partner
Employee Customer Supplier
Partner Site Intranet Corporate Site Supplier
Sales MarketingCustomerService Shipping Manufacturing
Enterprise PortalsPersonalized Business Experience
Policy BillingCustomerService Provider
SystemsMedicalContent
PersonalizationPersonalization
IntegrationIntegration
Enterprise PortalEnterprise Portal
HMO HealthcareProvider
RadiologySpecialist
Management
What is an Enterprise Portal?
It’s NOT just a personalized URL directory – E.g. Internet Portals like MyYahoo
It’s NOT just a personalized employee webtop– Corporate Portal technologies
It’s about creating a unified e-business experience personalized to the needs of your diverse business audiences:– Deeply integrated into the business infrastructure– Broadly connecting disparate business infrastructure into a comprehensive e-business
experience– Focused on the unique needs of each e-business audience to build meaningful relationships– The Quality of Service to meet market expectations– Lowering the Total Cost of Ownership of e-Business
Evaluating Enterprise PortalsThe complete functional perspective
Content Content ManagementManagement
Staging, Workflow, MetricsStaging, Workflow, Metrics
PersonalizationPersonalization
IntegrationIntegrationData, Events, Applications, Exchanges,Data, Events, Applications, Exchanges,
Process WorkflowProcess Workflow
SecuritySecurityDesktop to BackendDesktop to Backend
Enterprise ClassEnterprise ClassPlatformPlatform
HA, Scalability, Load BalancingHA, Scalability, Load Balancing
GlobalizationGlobalization
Content Content OrganizationOrganizationContext, KeywordContext, Keyword
ManagementManagementCentral ManagementCentral Management
Enterprise PortalEnterprise Portal
Rep
osito
ryR
epo
sitory
Man
agem
ent
Man
agem
ent
Browser
DocumentsERP/CRM
DatabaseMainframe CustomFeeds
Mobile
PersonalizePersonalize SecuritySecurity PublishPublishSubscribeSubscribe
ContentContentOrganizatiOrganizati
onon
ProcessProcessManagemeManageme
ntnt
ContentContentManagemeManageme
ntnt
DataData ApplicatioApplicationsns
EventsEvents
Sybase Enterprise Portal
•Continuous availability platformContinuous availability platform•Portal Services in a Single ProductPortal Services in a Single Product•Wide range of Portal optionsWide range of Portal options
Sybase Enterprise PortalEnterprise Class Platform
ScalablePlatforms: Solaris, HP-UX, AIX, NTApplication server clustersDatabase server clustersDynamic load balancingMainframe integration
ReliableAutomatic client fail-overHigh availability serversRemote site fail-over
Open StandardsXML, EJB, CORBA, DCOM, LDAP
SecureSSL, X.509, Role-based security
SecureSecure
OpenOpen
Scalable, Reliable, High Scalable, Reliable, High PerformancePerformance
Man
agem
ent
Man
agem
ent
Rep
osito
ryR
epo
sitory
DocumentsERP CustomExchanges CRMEDI
Mobile
PersonalizePersonalize SecuritySecurity PublishPublishSubscribeSubscribe
ContentContentOrganizatiOrganizati
onon
ProcessProcessManagemeManageme
ntnt
ContentContentManagemeManageme
ntnt
DataData ApplicatioApplicationsns
EventsEvents
Sybase Enterprise Portal Extensions
Mobile Mobile ExtensionsExtensions
B2B B2B ExtensionsExtensions
Sybase EP Mobile ExtensionsExpanded services for the mobile community
DeviceDevice
IdentificatioIdentificationn
MobileMobileSecuritySecurity
MobileMobileMessaginMessagin
gg
GeometryGeometryTransformatTransformat
ionion
SessionSessionManagemeManageme
ntnt
DataDataSynchronizatSynchronizat
ionion
• Support for connected, wireless and Support for connected, wireless and synchronization focused small footprint devicessynchronization focused small footprint devices
• Extensive services for application designers and Extensive services for application designers and content managerscontent managers
• Full range of portal services for mobile Full range of portal services for mobile applications and contentapplications and content
Sybase EP B2B ExtensionsExpanded integration into B2B communities
CollaboratioCollaborationn
Message Message ProcessingProcessing
BroadcasBroadcastt
MessaginMessagingg
XMLXMLManagemenManagemen
tt
WorkflowWorkflow SchedulingScheduling
• Key Services to Support B2B ApplicationsKey Services to Support B2B Applications• Marketplace integrationMarketplace integration• B2B integrationB2B integration
• Collaborative Processing and Workflow Support Collaborative Processing and Workflow Support for B2B communitiesfor B2B communities
Agenda
State of Healthcare in the United States Who is NIA and what is RadMD? The RadMD Enterprise Portal Enterprise Portal Market Requirements Key Success Factors
The Sybase Solution
Methodology and Best PracticesEP specific expertise
Breadth of applicationsCertified for fast deployment
Partnerships
Unified product offeringEnterprise Class platform
Product
Services/Education
e-Portal Alliance Partners
Sybase Enterprise PortalSybase Enterprise Portal
BroadQuestYOUcentric
ExtensityKnowledge MechanicsNiku
BroadVision
EveryPathFatWireGauss
InterprisePowerize.c
omVignetteWorldWeb.
net
PlumtreeSageMakerViador
DocumentumEnterworks
CorVuCorVuSterling Sterling
Mgt Mgt ConsultiConsultingng
WebTrendWebTrendss
e-CorporateBusiness
Productivity
e-CorporateBusiness
Productivity e-Contente-Content
e-CRMe-CRM e-Informatione-Information
e-Workflowe-Workflow
e-Analysise-Analysis
e-CommerceB2B
Exchanges
e-CommerceB2B
Exchanges
Black PearlBlack PearlCoheraCoheraEzCommerceEzCommerceIntershop Comm.Intershop Comm.Oasis Tech.Oasis Tech.PowerCervPowerCervTibcoTibcoTUMI SoftwareTUMI SoftwareXML SolutionsXML Solutions Service Partners
Computer Technology AssociateseCALYXeLoyalty
Keys to successful Enterprise Portal Implementation
Establish executive ownership
Develop a vision and define a strategy to get there
Balance unit ownership with central leadership
Plan for fundamental business change – not just ‘webizing’ your company
Design upfront the integration of new e-Business applications with existing systems
Involve key business partners in your initiative
Invest in a vendor who provides a comprehensive solution
www.radmd.com
www.sybase.com