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

2 © 2005 Cisco Systems, Inc. All rights reserved. “Just make me better” From eHealth to Connected Health Kevin Dean Cisco Systems Internet Business Solutions Group

333 © 2004, Cisco Systems, Inc. All rights reserved. eHealth - an obvious investment? Historically low investment in Healthcare IT <1% ? Historically un-coordinated investment in IT & huge scale of organisations “Not Invented Here” 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

444 © 2004, Cisco Systems, Inc. All rights reserved. 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 Suicide ‘Mistake’ “A cancer patient killed himself last year after a letter saying he was clear of the disease apparently failed to reach him…. An inquest was told he had moved house and changed doctors. Verdict: suicide” The Times, January, 2005

555 © 2004, Cisco Systems, Inc. All rights reserved. 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 “The inability, and reluctance, of doctors and hospitals to use information technology more widely is killing thousands of people” Economist April 28, 2005

6 © 2005 Cisco Systems, Inc. All rights reserved. eHealth

7 © 2005 Cisco Systems, Inc. All rights reserved. Health

8 © 2005 Cisco Systems, Inc. All rights reserved. Outpatient clinic Consultant Pharmacist Radiologist Surgeon Tests GP Pathologist Nurse Dietician Houseman Patient Connected Health

999 © 2004, Cisco Systems, Inc. All rights reserved. Lessons from Health Innovators

10 © 2004, Cisco Systems, Inc. All rights reserved. Top of Mind Issues – Healthcare “CEOs” Improve Patient Care Quality, Consistency, Speed Increase Productivity Higher costs Limited budgets Be the Employer of Choice Workforce shortage

11 © 2004, Cisco Systems, Inc. All rights reserved. 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

12 © 2004, Cisco Systems, Inc. All rights reserved. Top of Mind Issues – “Worried Well” Privacy Protect my confidential data Rising costs Higher tax, premiums, medicines Treat my family well Quality, trust, transparency, access

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

14 © 2004, Cisco Systems, Inc. All rights reserved. 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

15 © 2004, Cisco Systems, Inc. All rights reserved. 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, Cost Quality, Cost Access, Cost Access, Quality, Cost Quality, Cost Access, Cost

16 © 2004, Cisco Systems, Inc. All rights reserved. Automating current Healthcare practices, organisations, patient experiences is not the answer Re-engineer delivering quality care quickly to the patient using information assets across organisational boundaries

17 © 2004, Cisco Systems, Inc. All rights reserved. Connected Health Business Architecture Medical Grade Architecture Connected Health Solutions Health Policy & Funding Strategy The Connected Health Model

18 © 2004, Cisco Systems, Inc. All rights reserved. Connected Health Business Architecture Connected Health Solutions The Connected Health Model – More Detail Target Funding, Strong Governance, Change Working Practices, Manage Sourcing, Implementation, Increase IT Competence, Work with Industry Health Policy & Funding Strategy Medical Grade Architecture

19 © 2004, Cisco Systems, Inc. All rights reserved. Connected Health Business Architecture Connected Health Solutions Health Policy & Funding Strategy The Connected Health Model – More Detail Performance Information Public Health Information Medical Grade Architecture

20 © 2004, Cisco Systems, Inc. All rights reserved. Connected Health Business Architecture Connected Health Solutions Health Policy & Funding Strategy The Connected Health Model – More Detail Performance Information Public Health Information Connected Hospital Connected Patient Connected Health Community Medical Grade Architecture

21 © 2004, Cisco Systems, Inc. All rights reserved. Connected Health Community - example 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

22 © 2004, Cisco Systems, Inc. All rights reserved. Connected Health Business Architecture Connected Health Solutions Health Policy & Funding Strategy The Connected Health Model – More Detail Medical Grade Architecture Consistent foundation for Communication, Authorities, Authentication: Responsive, Protected, Resilient, Interactive

23 © 2004, Cisco Systems, Inc. All rights reserved. Delivering Connected Health…. Portfolio Planning -VisionVision -PrioritiesPriorities Governance -StandardsStandards -ChoiceChoice -DeliveryDelivery Obtain & Manage Funding -LevelLevel -DistributionDistribution Developing Capacity Consent Authentication Authority Implementation -FootprintsFootprints -PriorityPriority National, Local Services -DesignDesign -InteractionInteraction Business Case & Measuring results Sourcing & Procurement Strategy Changing Working Practices Medical Grade Architecture design

24 © 2004, Cisco Systems, Inc. All rights reserved. All we have to do is solve…. Portfolio Planning -VisionVision -PrioritiesPriorities Governance -StandardsStandards -ChoiceChoice -DeliveryDelivery Obtain & Manage Funding -LevelLevel -DistributionDistribution Developing Capacity Consent Authentication Authority Implementation -FootprintsFootprints -PriorityPriority National, Local Services -DesignDesign -InteractionInteraction Business Case & Measuring results Sourcing & Procurement Strategy Changing Working Practices Infrastructure design Locally ? Regionally ? Nationally ? EU Wide ? Global ?

25 © 2004, Cisco Systems, Inc. All rights reserved. But what is really important? Business case Reduction in medical errors; shorter stays Shorter waits; Choice Reduction in costs Top priorities Reform cross organisation process Prescribing & prescriptions Imaging Tele-medicine Transferable medical record Clinician engagement Clinician engagement; Clinician engagement; Clinician engagement Create Trust Authentication & Authorities Model Standards, interoperability Recognise importance Simple steps Build on current assets Information architecture