Oracle in the Healthcare &
Life Sciences Industry
Sofia, February the 1st, 2006
EMEA Healthcare and LifeSciences
Giancarlo Ruscitti, Business Development Director
Agenda
Healthcare IT market overview
Oracle’s vision and strategy
1
Outlook: Blueprint for the Healthcare
community
Security
access control
Supply chain
systems
Clinical/
Administrative
Systems
Medical
Systems
Electronic
Patient
Records
Integration
architecture
Wireless
systems
Database infrastructure
Systems with potential Oracle participation in red font
2
HC IT: A huge industry
Breakdown of EMEA HC IT market (2004)
$Bn
$7.8Bn
$1.6Bn
$0.93Bn
$0.93Bn
Payors
R&N(1)
Services
Maintenance
Primary
care
Clinical
& other(2)
Nonacute
Hardware
License
Acute
hospitals
ERP
D'base
tools
Software
D'base
Total IT
spend
SW
spend
Customers
Product
(1) Regional & National initiatives plus military (2) Hospital departmental systems, GP systems, desktop SW, payor back office solutions, etc.
Sources: National statistics bodies; OECD; WHO; Gartner; Dresdner KW; Silicon Bridge Research; IDC
3
Highest growth of all industries
Growth of IT spending in Western Europe (selected industries) 2003 - 2008
Growth
p.a.
9%
2004
8%
2005
2006
7%
2007
2008
6%
5%
4%
3%
2%
1%
0%
Manufacturing
Source: IDC
Retail/wholesale
Finance
Transport,
communications,
utilities
Central/local
government
Health
Total IT
4
Leading Business Trends
Why is the European market different?
The common healthcare challenges
• Increasing pressure to reduce costs
• Improving quality of care delivery
• Secure, self-service access to healthcare information and
services
The healthcare challenges in EMEA
• Medical Progress
• Ageing population
• Rising healthcare costs and social security deficits
• The move to citizen-centered care
5
Key Healthcare Concerns
Regarding healthcare systems
Excellence in clinical care
• Provider access to critical information at the point
of care
Financial management and tarification
• Increased financial and regulatory oversight
Managing human resources and retaining skills
• Proactive staff management to reduce workforce
turnover
6
Requirements for Healthcare IT
Information Technology Trends
• Adherence to global industry standards
• Consolidation and integration of healthcare
systems
• Management of the scale and complexity of the
healthcare infrastructure
• Robustness and security in healthcare systems
7
Basic Pain Points
•
•
•
•
•
•
•
Who is my patient ?
Where is he ?
Did he come to me before ?
Does he have a clinical history ?
Are his medications and lab tests results available ?
Can I access medications and lab tests results ?
Can I leave a message to my colleagues about my
patient ?
• Can I share informations about my patient and
exchange with my colleagues about him ?
8
IT driven by known challenges
Stakeholder
Provider
• Clinician
• Nurse
• Dentist
• Radiologist
• Lab
• Pharmacist
Management
Payer/regulator
Patient
Pain points
IT solutions
• Lack of comprehensive accessible clinical patient notes
both in and outside of normal office hours
• Inability to communicate easily with colleagues
• Increasing administrative workload
• Increasing litigation concerning medical/drug errors
• Need to fulfil continual educational requirements
Electronic Patient
Record (EPR)
• Increasing demand (leading to longer waiting lists)
• Increasing need to report performance metrics
• Lack of comprehensive organisation-wide information to
facilitate planning
• Staff shortages
• Lack of IT skills
Decision support
systems
•
•
•
•
Lack of transparency of provider information
Inability to integrate data from different providers
Lack of population level statistics
Difficult/expensive communication with individual
customers/providers eg individual eligibility checks
• Increasing cost of medical care
• Poor access to medical services eg long waiting times,
difficult to access services out of hours etc
• Lack of choice of care providers
• Insufficient information to make informed decisions
e-booking
e-prescribing
Clinical databases
AddressedManagement information
by IT
systems
solutions • Finance
• HR
• Payroll
• Procurement
e-learning
Web/telephone based
patient information
services
At the same time IT penetration (1.5 % – 2%) lowest among information intensive industries
9
HIS Level of Sophistication
100%
80%
Level 4
Level 3
Level 2
Level 1
<Level 1
60%
40%
20%
EU
FI
N
K
D
SW
O
N
H
C
U
A
L
N
E
B
ES
IT
FR
K/
EI
RE
U
D
E
0%
Infra in US > Europe!
Level 1 : PAS-Patient Administration System
Level 2 : Common MPI-Master Patient Index, integration around patient number
Level 3 : Clinical Order, results, advanced medical library
Level 4 : Decision Support, ePrescribing
10
Source : HINE 2005
HIS Level of Sophistication
Differences between countries
• Spain indicates rather sophisticated approach with
100% of hospitals – highest results after Sweden
• 531 workstations per hospital (mobile WS 3% in
Germany and Italy, 7% in UK/Eire)
• 3.52 staff per workstation
• 1.1 screen per bed
• Mobile technology (11% in Sweden, 17% in Norway)
11
Agenda
Healthcare IT market overview
Oracle’s vision and strategy
12
Healthcare and Life Sciences Strategy
REAL TIME !
Evaluate, Compare, Analyse and Pay
Payer
Ask for More
Medical Efficiency
Pay taxes and insurances
•Pharma Labs
•Research Centres
•Medical Societies
Define
Indications
Clinical Pathways
Best Practices
MEDICAL
PROGRESS
Budget
Life Sciences
Medical Activity
Safety
Personalize
Provider
Allocate Service Budget
Optimize Care Processes
Monitor Financial Performance
Patient
•Satisfaction
•Well-being
•Health
Deliver Care
WAITING LIST!
DEFICIT !
13
Oracle’s Vision in Healthcare
Providing a robust healthcare platform and enterprise
applications enabling organizations to:
 Reduce healthcare IT complexity
 Lower total cost of ownership
 Improve scalability, security and availability of IT
systems
14
Oracle has a strong position in the
HC market
• Oracle is the leading worldwide database provider for payors and
hospitals
• In Europe 50% - 80% (depending on country) of all healthcare
payors and providers use Oracle Technology
• More than 300 leading healthcare providers and more than 80
healthcare payors run Oracle applications
• Oracle is the leading provider of Clinical Trial Management Systems
• 15 of the top 20 Pharma companies use Oracle Clinical
• Oracle is the only company to offer a health data repository and
integration platform based on the open standard HL7 v3 Reference
Information Model (RIM)
15
4 product families for the HC market
Third Party / Partner Applications
• Clinical Suite
• Medication Management
• Chronic Disease Management
• Patient Safety alert
• Home care delivery
• HC transportation
• Health Insurance Front Office
• Public Health Reporting
Oracle
Pharmaceutical
Applications (OPA)
• Oracle Clinical
• Adverse Event
Reporting
• Thesaurus Management
• Trial Management
Oracle EBS
Applications:
• Financial
• Human Resources
• Procurement,
Order Mgt, SCM
• Sales
• Service
• Projects
• CRM
Oracle Health Transaction Base (HTB)
• Health Data Repository
• Application Development Platform
• Integration Platform
Base technology
• Database (incl. HC-specific options like DICOM support)
• Application Server
• Collaboration Suite
• Business Intelligence
16
Oracle products support future HC
trends
Trend
Oracle support
Convergence between
Healthcare and Life
Sciences (personalized
medicine)
HL7 standard now used in HC and LS industry;
HTB to be used with Pharma and Healthcare
customers eg for cohort identification and
selection
Reduction in costs and
improved efficiencies
Oracle E-Business Suite and Data Mining tools
increase administrative efficiency in healthcare
organizations and ministries
Patient empowerment
Oracle products with high data security standards
and Internet front-end
Regional / national
health care
infrastructure and card
projects
HTB, a genuine and unique product for highly
scalable projects that require complex clinical
data and a high degree of multi-application
semantic interoperability1
1 – Gartner Report Nov 2004
17
Four major Go-To-Market Initiatives
defined
Go-To-Market
Initiative
(GTMI)
Description
Involved
products
Shared
Services
Consolidates frequently duplicated and inconsistent functions
to reach economies of scale, standardisation, and single
technological base for maintenance and improvement work
Oracle EBusiness Suite
(EBS)
Integrated
Hospital
Combines applications and functions to integrate clinical,
administrative and business intelligence processes in
hospitals
EBS, HTB,
partner
applications
Medication
Management
Provides electronic prescription transfer, drug history, interaction and eligibility check, and decision support to improve
patient care, reduce costs and improve patient safety
EBS, HTB,
partner
applications
Chronic
Disease
Management
Supports coordinated healthcare interventions and
communication for patients with long-term conditions across
multiple organisations incl. patient self-care via HTB and
partner application
EBS, HTB,
partner
applications
18
Integrated Hospital Solution
• Solution
• Partners
• References
Integrated Hospital Solution
Revenues
Orders + Planning
CLINICAL
FINANCIAL
PATIENT
BILLING
43 M€
PATIENT
RECORD
BI
CDR
10 M€
HRMS
ERP
38 M€
ISVs with or
without HTB
as CDR
LIS87 M€
RIS
PHARMA
PACS
Results + Reports +
Drug Dispensing
20
Integrated Hospital Solution
Revenues
Orders + Planning
CLINICAL
FINANCIAL
PATIENT
BILLING
Performance
BI
10 M€
Reference
LIS87 M€
RIS
PHARMA
PACS
Persistence
CFDR
HTB
HRMS
Expenses
43 M€
PATIENT
RECORD
ERP
38 M€
•Organizations
•Persons
•Roles
•Terminologies
•Acts
•Participation
•Security
Results + Reports +
Drug Dispensing
21
Integrated Hospital Solution
Financial
Medical
Billing
Medical
DRG
Budget
Analysis
Repository
ERP
Payroll
Processes
ICD-10
SNOMED-CT
Labs
Radiology
Pharmacy
Blood
Optimization
22
Integrated Hospital Solution
Revenues
CLINICAL
FINANCIAL
PATIENT
BILLING
Performance
43 M€
PATIENT
RECORD
Core
CFDR
HTB
Applications
EBS
BI
Oracle
10 M€
HRMS
Expenses
Orders + Planning
ERP
38 M€
ISVs
LIS87 M€
RIS
PHARMA
PACS
Results + Reports +
Drug Dispensing
23
Oracle And Partner Core
Competencies
European and
Local SIs
Change
Management
Recruitment
Project
Management
Package
Enabled
Reengineering
Method
Core
Applications
Process
Design
Organisation
Design
Configuration
and
Architecture
Location/
Office
24
Infomentis process
Healthcare GTMi’s
12.
11.
Shared Service Centre
10.
Increase
Viability
of
Healthcare
Delivery
Integrated Hospital Solution
Medication Management
Improve
Throughput and
Outcomes
1.
Asset
Management
Litigation
Avoidance
2.
Improve
Use of Healthcare
Resources thru’
Better
Communication
3.
GTMi’s
Medication Management
Chronic Disease Management
E-Business Suite Shared-Service
Centre
Hospital Package
9.
Provider
Performance
Management
Segmented
Medicine
4.
Healthcare
Data
Standards
incl. HL7
8.
Supply Chain
Efficiency and
Collaboration
Chronic Disease Mgt
5.
7.
Patient
Empowerment
6.
Strategic
Healthcare
Planning and
Monitoring
Key Business
Requirements
Key Business
Drivers
Analyst Input
Human Resource
Management
Support for
KBR
evidence based
medicine
Ensure right act KBR
done to right
patient by
authorised staff
Process
KBR
control through
workflow
CD
CEO / CIO / CD / LC
CIO / CEO / CD
•…
Return
Identify Training Needs
Poor control
on quality of care
•KBR 1
•KBR 2
Enterprise Flows: HRMS: Learn to Develop
CP
No standard
for workflow
management
CIO / CD/ MP / LC
No control
of staff credentials
CP
Incomplete
and inconsistent
patient data
CIO / CD / LC
Poor data
security policies
CIO / CD
TP
CP
CIO / CD / MP
HRM system
not liked with
clinical apps
CIO /. CD
TP
TP
CP
CP
Inadequate
Validation of Clinical
Acts
CIO / CD / MP
TP
Difficult to capture
and manage
patient data
CIO / CD / MP
• From Competence
Management flow
(Re)Define Learning Structure
Analyse
Analyse
Training
Training
Requirements
Requirements
(re)Define
(re)Define
Learning
Learning
Strategy
Strategy
• Analyse skills required
• Identify learning needs
Define
Define
Competencies
Competencies
Delivered
Delivered by
by
Learning
Learning Content
Content
Build
Build
Learning
Learning
Content
Content
• Types of learning
• External v. internal
• Self paced, classroom blended
• in-house v. acquired
• Link back to skills gap
CIO / CD
CIO / CD / MP
Clincal Data not
available at point of
care
CIO /. CD
Insufficient
support for clinical
pathways
CP
Identify
Identify Skills
Skills
Gap
Gap
Patient data in
numerous
departmental
systems
CIO / CD / MP
Poor IT systems
integration
CP
TP
Clinical data
sources that are
not semantically
interoperable
Choose
Learning
Learn
Search
Search
for
for
Appropriate
Appropriate
Options
Options
CIO / CD
TP
• Location
•Timing
• Cost
• Prerequisites
• Competencies
• Learning Method
Select
Select
Most
Most Suitable
Suitable
Option
Option
Participate
Participate in
in
Learning
Learning
Activity
Activity
• Based on Search
• Attend training
• Self-paced
• Classroom
• Blended
Update
Competence
CIO / CD
Assess
Evaluate
Analyse
Analyse &&
Evaluate
Evaluate
Learning
Learning
Strategy
Strategy
Assess
Assess
Learning
Learning
Effectiveness
Effectiveness
• Feedback
• Measure
effectiveness
•Summarise
Feedback
Vision Corporation
HR Specialist
Update
Update
Competence
Competence
Profile
Profile
HR Director
HR Administrator
Employee
Line Manager
• Linked to Competence
Management Flow
Flow Value Statement
EBS HRMS Bruges 24-09-02
Solution 1
Slide 1
Solution 2
25
Business Flows for Administrative
Processes
•Procure to Pay (I-Procurement, Purchasing)
•Fulfilment (Order Management)
•Inventory management (Inventory)
•Accounting to Financial Reporting (Financials)
•Budget to Investment (Projects)
•People to Paycheck (Human Resources)
26
Analyze to Agreement: Process
Analyze to Agreement: Process
Analyze
Define Sourcing Requirements
PR0131
Analyze
Sourcing
Requirements
• Identify strategic
sourcing opportunities
• Establish Sourcing
Strategy – types of
sourcing, RFx Stages,
Evaluation Criteria
Publish Request
PR0135
PR0136
Determine Item
Requirements
Select
Suppliers
• Identify Item Attributes
(Quality) and Relative Scores
& weights for Bid Analysis
• Identify Supply Reqs (Delivery
Reqs, Packaging)
• Determine Sourcing Strategy
to be used for Item
Evaluate and Award Responses
• Review and Select
Incumbent Suppliers
• Assess local capabilities
• Identify external sources
PR0137
PR0152
Define Sourcing
Rules of
Engagement
Publish
Specification
and Sourcing Doc
• Set starting and ending
times
• Specify Bidding/Quoting
Rules
• The process of
providing
specifications and
requests for quotation
to a supplier.
Multi-Round Sourcing Process – e.g Rfi plus Reverse Auction
Finalise Legal Contract
Contract Maintenance
PR0139
PR0132
PD1096
PR0133
PR0134
Manage
Supplier
Responses
Evaluate
and Award
Negotiations
Develop Legal Terms
and Conditions
Maintain Negotiated
Supplier
Agreements
Evaluate Supplier
Contract
Performance
• Add, Modify or renew
negotiated agreements as necessary.
• Agreements can be
purchase orders,
blankets or contracts.
• This process covers
reviewing the
suppliers performance
against the negotiated
contract..
• Collect and evaluate
responses to award the
contract or agreements
• Qualify suppliers if Rfi
• Complete evaluation
• Create new round if
needed
• Make award decisions
based on item/supplier
strategy
• Create Procurement
Contract or Blanket
Agreement
• Submit Contract or Blanket
Agreement for approval
• Finalise incentives and
penalties
• Develop business agreement
between Provider and Supplier
• Approve/make Contract or
Blanket Agreement available for
use
Suppliers
Roles
Items
PD1096
Maintain
Products and
Items
• Add or modify items
• Maintain additional information
for inventory items, e.g. planning
parameters, default locators, etc.
• Integration req’d between Oracle
Inventory and ProCure for Items
PR1005
PR0148
PR0142
Maintain
Suppliers
Maintain
Approved
Supplier List
Maintain
Supplier
Catalogs
• Maintain supplier /
creditors information.
• Maintain bank
information for
electronic payment
• Maintain a list of
approved suppliers
per item.
• Prices are maintained on
purchase agreements,
Contracts, or loaded in
iProcurement directly.
• Items in Purchase
agreements or Contracts
are loaded in the
iProcurement catalog.
Manager Purchasing
Buyer
Pharmacist
Supplier
27
Business Flow for Clinical Processes like
Medication Management
There are four main business flows associated with Medication Management:
• Evaluation
- Reviewing all clinical information to ensure that the appropriate course of treatment is
selected
• Prescribing
- The act of selecting a medication from an approved formulary
- Fulfilment
- The method by which the drugs identified in the prescription are made available for
administration
• Dispensing (Pharmacy or Hospital)
- Delivery of drug to the point of care
• Administration
- The process by which the drug selected during the prescribing process is given to the
person
Associated with all four business processes is the management of compliance
28
Medication Management
Right Use of Drug in an Hospital
75% Staff
25% Supply
Budget
A bad use of drug
leads to an
increase of
pharmaceutical
expenses and a
bad use of medical
staff
25% Drugs
75% Others
Supply
29
Proof points
Dutch Hospitals – E-Business Suite with Business Flows
•
> 15 others (EBS only) including
- OLVG
- MC Haaglanden
France
•
•
•
•
Hospices Civils de Lyon
CHU Montpellier (started implementation) – E-Business Suite Only
Creteil and Montreuil (mid implementation) – E-Business Suite and HTB
Institut Claudius Regaud
Belgium
•
4 hospitals including
- ZNA Antwerp hospital group
UK shared services
•
>150 Hospitals in UK including
- Cardiff and Vale NHS Trust (2nd Largest in UK)
- University College London Hospital
- Sandwell and City Hospitals
30
Le Havre Hospital Group in France
Objectives
• Consolidation of clinical data
• Enable management reporting
Solution
• Healthcare Transaction Base at the core of the solution
– Aggregation of persons clinical data from disparate systems
– person, activity, orders, medications, results etc.
– Clinical viewer developed on HTB
Benefits
• Improve clinical processes and provide improved decision support
• Enable changes in French reimbursement model
Status
• Prototype complete
• Demonstrator available for reference visits
• Not in live use
31
Le Havre Hospital Group :
A full Oracle Fusion Hospital
Patient
GP/Referrer Point of Care Community
HR
ADT
Finance
ISVs
Supply
Chain
Others….
10g Portal, SSO, OID, Mobile Technology (GSM, GPRS, UMTS, Wifi), RFID
CollabSuite
CRM
ERP
(master)
HRMS
ilearning
BI
Admin
Financial
Clinical
Partner Apps Partner Apps Partner Apps
RAC
10g JDev
OC4J
BPEL
BC4J
Workflow
HTB Repository
+ EBS Repository
10g AS
10g DB
Enterprise Service Bus
Partner Interface Engine (Connectors, Apps & Biomedical Devices) – HL7 V3 messages
Labo
Apps
Radio
Apps
Pharmacy
Apps
HAD
Apps
Clinic
Apps
Biomed
Device
Biomed
Device
Biomed
Device
32
Azienda Ospedaliera Di Circolo Busto
Arsizio
Project Live
Business Objectives
• Improve care delivery process
• Replacement of legacy Healthcare Information Systems
Solution
• Healthcare Transaction Base
– Central repository for Clinical Documents
– Platform for deployment of Healthcare Information Systems
Additional Benefit
• The Healthcare Transaction Base becomes the central repository for all Clinical
Information
• Enabling more effective Clinical Decision support
Status
•
•
•
•
Partner has developed application
Training and deployment complete
Acceptance received by customer
Change Management issues delaying project
33
Azienda Ospedaliera Di Circolo
Busto Arsizio
Scope
Single Portal
Healthcare Transaction Base
•
•
•
•
Messaging Services
Person Services
Terminology Management
Security and Auditing
Clinical
Data
Repository
J2EE
Integration
Engine
Clinical
ADT
34
CSAM : Clinical System All Managed
Oslo – Rikshospitalet
“Advanced medicine in a safe environment”
Service layer:
The service layer offers
components which gives
access to integrated
information from the
different source systems.
New functionality
developed will also
belong to the service
layer (activity handling,
specialized views: previsit)
Integration layer:
The integration architecture
focuses on the
communication
between the applications and
the systems. This is solved
with Oracle 9
InterConnectHubarchitecture.
Portal-layer:
A user logs on from a single
sign-on-desktop. Single signon is portal function that
uses a catalogue service for
authorization control.
Depending on the user's
rights the portal presents a
tailored work interface,
which comprises different
portal items (portlets)
Security
architecture:
In the portal, the
authorization of users to
access individual data/views
are controlled by giving
unique access rights on a
portlet level to a group of
users. The groups and the
individual users are stored in
the OID. Each group contains
a list of those members
belonging to the group. A
group can be a member of
another applications.
group.
Source
35
CSAM: Establishing an integrated and
coherent view of patient data is essential
for improving processes
Information at your
fingertip:
Updated and complete
patient health information
when you need and
anywhere you need it!
Patient information
From the journal
From LAB
From PACS/RIS
Fra scheduling tool
36
National and Regional Healthcare
Information Infrastructure
• Architecture
• References
• Medication Management
National and Regional Healthcare
Information Infrastructure Architecture
National
Disease
Registries
HL7 V3 RIM
Prov Portal
Healthcare
Worker Portal
Portal
Pat+Mob
Portal
Patient Portal
+RFID
Core Id
Access
Control
Provider Registry
Pat Registry
Patient Registry
Appli
Server
Anonymous
Collab
ARR
Suite
Patient Info
NCR
National
or Regional
Framework
CFDR
HTB
Act Reference Registry
Public
Healthcare
Reporting
OLAP
Patient
Disco
Safety
Alerts
Common
Applications
/Services
Prov Registry
Adverse
Event
Report
eg E-bookings
E- prescribing
Patient consent
Terminology
Services …
National or Regional Care Record
Reference
•Organizations
•Persons
•Roles
•Terminologies
Inspired from Rene Spronk
BPEL
Persistence
Local Systems
Local Systems
•Acts
•Participation
•Confidentiality
GP, Hosp, Insurance
Company,REHA,
Homecare
GP, Hosp, Insurance
Company,REHA,
Homecare
Hospitals
Primary Care
Payors
TC251 card standard
38
Customer references
Diraya –deReceta
XXIde
- Andalucia
Sistemas
Información
Indra para Sanidad
C O N
TA
Tarjeta
sanitaria
n
ió
st na
e
r
G te
in
Ot ros
se rvic
ios
de
ía
er s
in to
M da
ici
ed
le m
na
C
O
s
R
E
S
BDU
Te
Call Center
Al
er
ta
At
sa e nc
ni ión
tar
ia
EN
TE
S
EI
Promoción
de la salud
a de
tor i
d
sa lu
I
NDICAD
ele R ec
c t e ta
ró
nic
a
H is
I
CM
T
Ge s
t ión
de m de la
o ra
Escenario Global
C
Internet
s
de
a
s
d
ci ra le
a
p o
ca p
In t em
R
Visión Integrada de los Sistemas de
Información de Indra para la Atención
Sanitaria
Presencial
39
Indra Healthcare Information System
Misión Global
1
Estrategias de Optimización
Desarrollos Tácticos y Operativos
Ciudadanos
Demanda de
Servicios
Actividad
Quirúrgica
Productividad y
Eficiencia
Actividad
Farmacia
Actividad Socio
Sanitaria
SISTEMAS ASISTENCIALES
 Historia de Salud Digital
 Cita Centralizada
 Contact Center de Salud
 Gestión Hospitalaria
 Gestión SocioSanitaria
 Segunda Opinión
 Gestión Imagen Médica
Infraestructuras y
Logística
SISTEMAS DE GARANTIA
2
• Centros Coordinadores de
Emergencias
• Redes de Alerta Sanitaria
• Sistemas de Control de
Enfermedades Infecciosas
• Sistemas de Control de
Drogodependencias
3
4
Base de Datos de
Recursos Sanitarios
Base de Datos de
Historia Clínica
Base de Datos
Cartográficas
Base de Datos de
Imágenes Médicas
Información para la
Actividad Sanitaria
Vigilancia de la Salud
y Gestión Operativa
•
•
•
•
HTB
Base de Datos de
Usuarios/Tarjetas
Información para la
Planificación y Toma
de Decisiones
• Estadísticas
• Reports
• Comparativas
EconómicoFinanciero
SISTEMAS DE SALUD PUBLICA
 Receta Electrónica
 Tarjeta Sanitaria
 Gestión Incapacidad Temporal
 Gestión de Listas de Espera
 Portal de Salud
 Central de Compras
 Mapa de Recursos Sanitarios
• Indicadores
• Inductores
• Evolución
Gestores
Vigilancia
Epidemiológica
Recursos
Humanos
Cuadro de Mando
Integral
Hojas de Consulta
Actos Clínicos
Pruebas diagnósticas
Recetas
Datos Básicos del
Sistema de Salud y
Población
• Hospitales
• Médicos
• Asegurados
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Stockholm County Council Sweden
Regional Healthcare Solution
• Strategic opportunity
• 4 Counties procuring similar solutions
Integration of 30+ solutions
Proof of Solution
• Medication management
• Acceptance testing December 2004
• Live April 2005
Breaking the HISA stronghold
Partner - WM Data
HQAPPs approval for: • Specific Pricing / HISA Compliance
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Customer references
Stockholm County – WMData
Laboratory
Pharmacy
Systems
Laboratory
System
Primary
Care
Systems
Pharmacy
Abstract Layer
Community
Care
Primary
Care
Systems
Primary
Care
Systems
Primary
Care
Social
Care
HTB
Acute
Care
Acute
Care
Systems
Central Standards Based
Healthcare Repository
Wireless
Emergency
Care
Pager
Emergency
Care
System
Citizen
Phone
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Distribute information processing
Sensium
- Sensor interfacing
- Wireless transceiver
- Local processing
filtering data
Lots of fuzzy and
uncoordinated data
Health database
Personal DA
- Wireless network
coordinator
- Personal information
- Local database
Moderate but somewhat
processed data
- Authorized (HL7)
- Combined
- Aggregated
- High qulaity
Data prepared and mined
For health personnel
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Customer references
Tennessee – TennCare - Cerner
Person
Financing &
Administration
Clinical & Care
Delivery
(Health Plans)
(Providers)
Personal
Health Record
Community
Health Record
Shared Services
Member
Health
Record
Shared Services
Unification Platform
Electronic
Medical
Record
Informatics
(Centers of Excellence)
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Regional or
National
EMPI
Hospital or
Payer
Pharmacy or
Payer
Labs
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Medication Management Service & Process
model
From Fulfillment to Compliance
National or Regional EHR
3 ) Medication Passport
All “active”/historic
Medications / allergies
1) Many Prescribers
a) GP’s
- your own
- weekend/night
- away from home
L
A
B
I
M
A
G
E
S
9) Statistical
Epidemiologic
Macro-data
6) Execution
4) Controls
b) Specialists
Med . Consultants
25+ Specialties
A) Insurance
Covered ?
Co-payments ?
c) Dentists etc
2) Proposed
Medication
d) Nursing
Cure / Care
first time
e) Self medication
alternatives ??
repeating
prescription
f) Discharge
Medication
B) Safety
Interactions ?
Allergies ?
5) Ordering
To Deliver
C) Effectiveness
Formulary
Dis. M Protocols
D) Economics
Alternatives
Generics
E) Promotion
Education
Instructions
7) Patient
Compliance
Post Mk
surveillance
Add to :
Medication
Passport
Ware
Logistics
house
Delivery
(Make) by
A Pharmacy
Payment
Via Insurer
Payer
Pat. Direct/co
payment
8) Refills
Inspired from Leo Volbregt
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Proposed Solution
Doctor
Pharmaco
Vigilance
Iatrogenic events
distributed database
Pharmacist,
Nurse
Patient
Services platform
Oriented towards reducing
the adverse drug risk
Prescription support
Prescriptions
management
Patient
information
Correspondence
between health
practitioners
Clinical
monitoring
Reporting
Risks/benefits
(Decision trees)
Prescriptions log
Drug files
Check-ups to
be performed
Letter(s)
Epidemiological
management charts
Contra-indications,
interactions
adverse drug reactions
(update +++)
Conflicts management
(interactions)
Observance
(reminders)
Warnings
Reports
(Consultation,
Hospitalization)
Good practices
Duplicata/
Replacement
Self-medication
(conflicts)
Drafting supports
(standard prescriptions)
Prevent ADE
to enhance quality
Multi-disciplinary
coordination
(+++ cancerology)
Diseases,
Intervention
Files
EHR
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Shared Services
• Positioning
• Different Models
• NHS reference
Shared Service Positioning
National or
Corporate
Governance



Shared Service
Centre
Strategy and Policy
Resource Allocation
(e.g. in UK)
IT leadership and
standards



Provider
Organisations
(Hospitals / Clinics)
Transaction processing
Specialised functional
expertise
Continuous Improvement



Organisation unit for
accountability
Provision of Care
P & L accountability
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Different Shared Service Centre
Models
Value
Transaction
Processing performed
in SSC
Charge for Services
Share Processes e.g
Purchasing Contracts,
External Catalogues
Single Instance of
Application
Aggregate Information
Central IT Team
Technology
Only
Technology
and Process
Technology. Process
and People
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Oracle Supported Shared Service Processes
•General Ledger
•Accounts Payable
•Treasury
•Accounts Receivable
•Fixed Assets
•Insurance
•Tax Compliance
•Cash Management
•Project Management
Human
Resources
• Payroll Processing
• Compensation
Administration
• Benefits
Administration
• Training & Education
•Relocation Services
•Expense Processing
Information
Services
• Standards
• Technology/
Development
• Applications
Development
• Application Maintenance
• Telecommunications
• Hardware &
Software Acquisition
• Litigation Support and
Co-ordination
• Environment, Health
and Safety
• Property Management
• Regulatory Compliance
• Communication Services
• Media Relations
• Purchasing
• Warehousing
• Transportation
• Returns Processing
• Credit & Collections
• Order Management
• Call Centres
Centres
Finance
Legal/
Corporate
Affairs
Logistics
Customer
Service
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NHS Shared Financial Services
South West
NHS SHARED SERVICES
Aim is to change the way
the NHS provides financial
services
West Yorkshire
2 Shared Service Centres live in April 2003 – now running 100
Healthcare Providers on Oracle E-Business Suite
Their Objectives in their words
• Enabling Finance Directors and other local staff to concentrate on the core services:
business cases, capacity planning, performance issues etc
• Reducing pressure on accommodation through having a small number of Centres
around the country, rather than every
organisation
Currently
tworequiring its own finance
‘department’
pilots
• Supporting new organisations, for example
Primary Care Trusts, with a ready-made
service that meets most of their financial needs
• A single organisation with the ability to provide common answers and solutions
• Ensuring sustained, appropriate levels of investment in systems
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