The Real Deal on Enterprise Portals
Bob Breton
Senior Director, Product Strategy
Sybase Enterprise Solutions Division
Bob LaGalia
SVP, Strategy & Corp Development
NIA|RadMD
Agenda
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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 State of Healthcare in the U.S.
Rising Costs, Complex, & Highly Fragmented

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.
The State of Healthcare in the U.S.
Rising Costs, Complex, & Highly Fragmented

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
The State of Healthcare in the U.S.
Highly Transactional, Data Rich, Information Poor

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 State of Healthcare in the U.S.
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. - Radiology
Diagnostic Radiology Market - a microcosm

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
The State of Healthcare in the U.S. Radiology
Rising costs, inappropriate use, and lower quality contribute to the wide
variation in utilization patterns for diagnostic radiology services
Northeast
Region
A
B
C
D
E
F
G
H
Midwest
West
Region
A
Util./1000/Yr.
801
Region
A
B
C
Util./1000/Yr.
1092
885
914
Southwest
Region
A
Util./1000/Yr.
664
Southeast
Region
A
B
C
Util./1000/Yr.
1073
790
780
Util./1000/Yr.
775
872
824
1176
750
1000
980
760
Mid-Atlantic
Region
A
B
Util./1000/Yr.
587
987
The State of Healthcare in the U.S.
Rising Costs + Quality Concerns = An impetus to change
An imperative to:
Productivity, Efficiency, & Quality of Patient Care
Reduce Spending on Unnecessary & Inappropriate Care
How?
Apply new technologies to enable better and more efficient
transactions among all participants
Apply clinical domain expertise to appropriately manage cost growth
Agenda
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



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
National Imaging Associates & RadMD
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.
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
NIA Client Server Architecture
(1996-1999)
Call Center
Offline (batch)
Telephone
Requests
via Telephone
Data
Members
Data
Providers
Workstation
DB
Workstation
Data
Claims/Clinical
Workstation
PowerBuilder Apps
on WIN NT
MS SQL Server
Data Loaded into
Production offline
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
Why an Enterprise Portal?
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
Facilitating Information Transfer
Facilitate Clinical Information Exchange
Patients
Referring
Physicians
Learning
• Access to expert consult
• Education re: best practice
• Improve Patient outcomes
Radiology
Providers
RadMD
• Improve Admin Transac tions
• Collect Outcomes for analysis
• Identify patients early
Insurance
Carrier
• Lower administrative expenses
• Improved medical cost management
How did we Develop?
4-Phase Approach
1, Discovery:
research, focus testing,
user requirements
understand existing workflow & tech.
Critical Learnings
~ integrate within the current workflow
~ must have incremental impact
~ no new tech investment
~ access, bandwith
2, Definition & Design:
obtain key stakeholder input,
technical & clinical consultation
~ speed, reliability, availability
~ privacy, security
~ integrated w/ call center
3, Development:
vendor solutions
determine optimal approach
~ Sybase Enterprise Portal Early Adopter
~ Sybase Professional Services Team
~ Port PB App and business logic
~ Integrated Solution
4, Deployment:
step-wise roll-out
~ select pilot sites
NIA Call Center & Workflow Today
myRadMD
Browser
Mobile PC
Wireless
B2B App
Tel
Web Server
Enterprise Application Server
EP Applications
EP Application Services
Call Center
EP
Common
Services
EP Integration Services
Content
Apps
Events
Enterprise Information Systems
Data
RadMD Portal (2001)
Web Server Cluster
App Server Cluster
Offline (batch)
Data
Browser-based users
Members
HTTP / HTTPS
Desktop
w eb server
IIOP / IIOPS
A pp Server
Internet
Data
MS SQL
w eb server
Data
Data
Providers
Claims/Clinical
A pp Server
Desktop
Telephone
MS IIS on NT
~ load balancing
~ high availability
~ failover
Pen computer
Radio tow er
Wireless computing
Mobile WAP Tel
Content DB
Sybase ASE
Sybase EP on NT
~ load balancing
~ high availability
~ failover
~ security
Data
Mainf rame
Server
Content Management
Vignette StoryServer
Telephone-based clients
Call Center
Works tation
Telephone
Works tation
Telephone
Works tation
Member, Provider
Data Transfer Using
XML & Mainframe Integration
What have we learned?
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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
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Look for technology partners and engage existing stakeholders
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Fundamental Project Management Skills are paramount
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Value proposition must be unique, tangible, and measurable
Agenda
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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
Meaningful relationships
Transactions
Dynamic Content
Static Content
Expanding Opportunities
HMO
Healthcare Provider
Care Review
Approval &
Billing
Knowledge Access
Current e-Business Solutions
Fragmented and Impersonal
Partner
Employee
Partner Site
Intranet
Sales
Marketing
Customer
Corporate Site
Customer
Service
Shipping
Supplier
Supplier
Manufacturing
Enterprise Portals
Personalized Business Experience
Personalization
HMO
Healthcare
Provider
Radiology
Specialist
Management
Enterprise Portal
Policy
Billing
Customer
Service
Integration
Provider
Systems
Medical
Content
What is an Enterprise Portal?
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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 Portals
The complete functional perspective
Content
Organization
Context, Keyword
Content
Management
Staging, Workflow, Metrics
Globalization
Personalization
Enterprise Portal
Management
Central Management
Security
Enterprise Class
Platform
HA, Scalability, Load Balancing
Desktop to Backend
Integration
Data, Events, Applications, Exchanges,
Process Workflow
Sybase Enterprise Portal
Mobile
Browser
Publish
Subscribe
Security
Content
Process
Content
Organization Management Management
Data
Mainframe
Applications
ERP/
CRM
Events
Repository
Management
Feeds
Personalize
Custom Database Documents
•Continuous availability platform
•Portal Services in a Single Product
•Wide range of Portal options
Sybase Enterprise Portal
Enterprise Class Platform
Scalable
Secure
Open
Scalable, Reliable, High Performance
Platforms: Solaris, HP-UX, AIX, NT
Application server clusters
Database server clusters
Dynamic load balancing
Mainframe integration
Reliable
Automatic client fail-over
High availability servers
Remote site fail-over
Open Standards
XML, EJB, CORBA, DCOM, LDAP
Secure
SSL, X.509, Role-based security
Sybase Enterprise Portal Extensions
Mobile
Mobile
Extensions
B2B
Extensions
Personalize
Exchanges
Applications
ERP
Events
CRM
Custom
Management
Repository
Content
Process
Content
Organization Management Management
Data
EDI
Publish
Subscribe
Security
Documents
Sybase EP Mobile Extensions
Expanded services for the mobile community
Device
Identification
Mobile
Security
Mobile
Messaging
Geometry
Transformation
Session
Management
Data
Synchronization
• Support for connected, wireless and
synchronization focused small footprint devices
• Extensive services for application designers and
content managers
• Full range of portal services for mobile
applications and content
Sybase EP B2B Extensions
Expanded integration into B2B communities
Collaboration
Message
Processing
Broadcast
Messaging
XML
Management
Workflow
Scheduling
• Key Services to Support B2B Applications
• Marketplace integration
• B2B integration
• Collaborative Processing and Workflow Support
for B2B communities
Agenda

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
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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
Services/Education
Partnerships
Product
Methodology and Best Practices
EP specific expertise
Breadth of applications
Certified for fast deployment
Unified product offering
Enterprise Class platform
e-Portal Alliance Partners
e-Analysis
e-CRM
e-Commerce
B2B
Exchanges
BroadQuest
YOUcentric
Black Pearl
Cohera
EzCommerce
Intershop Comm.
Oasis Tech.
PowerCerv
Tibco
TUMI Software
XML Solutions
e-Corporate
Business
Productivity
Extensity
Knowledge
CorVu
Sterling Mgt Mechanics
Consulting Niku
WebTrends
e-Content
BroadVision
EveryPath
FatWire
Gauss
Interprise
e-Information
e-Workflow
Plumtree
SageMaker
Powerize.com Viador
Vignette
Documentum
WorldWeb.net
Enterworks
Sybase Enterprise Portal
Service Partners
Computer Technology Associates
eCALYX
eLoyalty
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