1. 1 Karl-Jürgen Schmitt Siemens Medical Solutions February 07, 2006 Processes and Applications in eHealth

2. 2 Healthcare is one of the most important infrastructure components just as... Power... Transportation... Communication...

3. 3 Healthcare as an Economical Factor Healthcare could support the goals of the Lisbon Strategy Europe: Expenses for health: 8.6 % of GDP in EU-15 Employment: around 10 % of European workforce 10% increase in average life expectancy means 0.35% increase of GDP per year* Germany: New Jobs in 2003: 25 000 Start-ups in 1995 – 2002 9 500 (Medical Technology) *Source: Macro-Economics and Health, J. D. Sachs, WHO, 2001

4. 4 Need for more quality and transparency in healthcare Less than 1 dead person on 100 000 adverse events Nuclear industry European roads Scheduled flights 1 dead person on 1 000 to 100 000 adverse events Road traffic at large Chemical industry More than 1 dead person on 1 000 adverse events Bungee jumping Mountain climbing Healthcare Quelle: Chirurgen Magazin 2005, *BMGS 2003 5 000 to 25 000 deaths in the German healthcare system due to wrong medication*

5. 5 Cost Quality of Care Therefore our common goal should be … By:  Innovation  Process optimisation

6. 6 Sick, injured Healed, fit for work Patient Information Medical Knowledge Examination DiagnosisTherapyCare Improving efficiency with the patient in focus

7. 7 Health Management Med meets IT Therapy Diagnosis Home Care Ambulatory Care Stationary Care Prevention / Early Detection IT is key in integrating and optimising work-flows throughout the healthcare continuum

8. 8 Chart copy sent to pharmacy Medication Errors in the USA Ordering 50% - 55% Transcription 6% - 12% Dispensing 5% - 14% Administration 33% - 38% Physician Order Review by Nurse Transcription Order Entry (Rx System) Administration Documented Verification by Pharmacist Medication Dispensed Nurse confirms drug, dose, route, time, and patient Medication Administered Optimising healthcare processes with IT Source: Agency for Healthcare Research and Quality, 2001 Example: Conventional medication process

9. 9 Chart copy sent to pharmacy Medication Errors in the USA Ordering 50% - 55% Transcription 6% - 12% Dispensing 5% - 14% Administration 33% - 38% Physician Order Review by Nurse Transcription Order Entry (Rx System) Administration Documented Verification by Pharmacist Medication Dispensed Nurse confirms drug, dose, route, time, and patient Medication Administered Source: Agency for Healthcare Research and Quality, 2001 Deaths7.000 (1999) Savings Potential$1.6... 5.6 billion * in US hospitals Effects on Healthcare System * Optimising healthcare processes with IT Example: Conventional medication process

10. 10 Verification by Pharmacist Administration Documented Nurse confirms drug, dose, route, time, and patient Medication Dispensed Physician Order Results Process simplification to reduce medication errors Includes software, barcodes, and an automated dispenser system All data available for later evaluation Optimising healthcare processes with IT Example: IT-supported medication process

11. 11 73% decrease in erroneous and unclear prescription Stockholm, Schweden „Proven Outcomes“ in medication: Real results with IT-supported processes Quality Costs Preventing 118 potential medication errors monthly. Estimated annual savings: $944 k Virginia, USA 96% decrease in medication turnaround time New York, USA 52% reduction of medication turnaround time, 35% reduction of medication errors Ohio, USA Quality Costs Quality Costs Quality Costs

12. 12 The applications drive eHealth infrastructure Consulting Integration and technical consultation Customizing and Installation Project management and turn key Support incl. Help Desks and Service Hotlines Operator Solutions incl. ASP Product Solutions Business Services Professional Services Client & Server Hardware Smartcard Solutions incl. HPC & HC Network and Security Solutions incl. VPN, Directories, Mobile Solutions Clinicial and administrative applications eScheduling eDisease Management eHomecare ePrescription eReporting ePatient Record incl. Siemens offers comprehensive solutions

13. 13 Improving workflow is our strength Proven outcomes: ASP ASP: Scale Effect for 24 x 7 Operations 1 7,200 people 75 people Individual Data Centers ASP (Centralised Data Center) In the U.S.  1,200+ Customers  200,000+ Physicians  137+ M Transactions/Day In Europe  20 customers, 60 potential customers in Germany  Roll-out in other countries ASP (Application Service Providing)  Centralized data center 1 Pure scale effect from human resources point of view; cost for network transmission has to be added  Significantly reduces healthcare systems’ investments in IT  Healthcare systems “pay per use” (3 shifts x 2 people x 1,200 sites)

14. 14 Archiving and Image Distribution throughout Institutions and Hospitals in Austria CT MR Laserprinter Lasercamera DLR Short Term Archiv Web Virtual Private Network Virtual Private Network Workstation Router Long Term Archive Referal Referal Hospital Specialist Report Images Institute LIC +

15. 15 Norway is a leader in utilizing eHealth The only country-wide use of an Electronic Patient Record (EPR) A broad application spectrum more quickly increases the quality of care and reduces costs North Mid East South West Example: Siemens’ DocuLive EPR in Mid 650,000 EPR 13,000 users, up to 1,100 concurrently (35,000 users in total in Norway) 10 Million documents, + 25,000 documents per week 30,000 discharge summaries sent electronically per mo. EPR in Norway includes … Orders Referrals Results Nursing treatment plans Multimedia module Digital dictation Scanning Safe e-mail communication Multi-entity / cross- enterprise applications ePrescribing (planned for Q1 2006)

16. 16 A promising project for disease management with IT in Scotland Disease Management Diabetes, Diabetic Retinopathy (DR) Up to 10% of Europeans diabetic 60% of diabetics develop DR DR is leading cause of blindness for individuals > 65 years of age Blindness can be avoided in 90% of DR cases if detected early Huge Potential Quality Compliance Processes Use of Resources Outcomes Improved... Implementation of an integrated, IT-supported Disease Management NHS Scotland and Siemens Medical Mobile Examination Inform Patient Central Evaluation by Experts Registration, Invitation 300.000 exam- inations / year planned 73 locations 5 regional evaluation centers

17. 17 Improvement of chronic conditions is key for more efficient healthcare  WHO concluded: 60% of health expenditures are due to chronic conditions  Studies indicate that 50% of hospital admissions of chronic heart failure patents can be avoided due to sophisticated DM programs containing: patient education, care coordination, care plans and compliance monitoring  The average Medicare beneficiary sees 7 physicians and receives more than 20 prescriptions p.a.  18% of people with chronic conditions undergo duplicate tests or procedures and 17% receive conflicting information from providers

18. 18 Standardize CHF Disease Management CHF Disease Management Simultaneous implementation of a CHF DM system at 3 provider sites and subsequent,joint study executed by a professional organization Goal: To prove care quality improvement and demonstrate financial impact on providers in three different scenarios on a unified workflow, data and reporting model Method: Application of  Unified workflow engine  Remotely accessible, shared data repository  Integrated quality-management tools  Fully automated telephony based patient monitoring system CHF Disease Management Simultaneous implementation of a CHF DM system at 3 provider sites and subsequent,joint study executed by a professional organization Goal: To prove care quality improvement and demonstrate financial impact on providers in three different scenarios on a unified workflow, data and reporting model Method: Application of  Unified workflow engine  Remotely accessible, shared data repository  Integrated quality-management tools  Fully automated telephony based patient monitoring system

19. 19 Streamline Workflow, Optimize Reporting LVA Donaustauf Asthma/COPD Disease Management Goal: Optimized Asthma/COPD care in an integrated (Payer-Provider) setting Method: Application of a unified workflow engine in a clinical-ambulatory scenario Integration of sophisticated reporting tools allowing the payer arm to efficiently steer patient care Participants: PCP‘S and clinical Competence Centers, Call-Centers and patients LVA Donaustauf Asthma/COPD Disease Management Goal: Optimized Asthma/COPD care in an integrated (Payer-Provider) setting Method: Application of a unified workflow engine in a clinical-ambulatory scenario Integration of sophisticated reporting tools allowing the payer arm to efficiently steer patient care Participants: PCP‘S and clinical Competence Centers, Call-Centers and patients

20. 20 Are high expenditures for health good or bad? Health: The Highest Asset?!

21. 21 medical services 33% commodities 30% nursing and therapeutic services 25% others 9% repairs / maintenance 26% Expenditures for Cars petrol & engine oil 21% vehicles 39% Source: Statistisches Bundesamt, 2004 (data for 2002) prevention / health protection 3% car rental, inspection, parking 12% vehicle tax 2% € 133 bn* € 174 bn * incl. employers’ share: € 66,5 bn Expenditures of Compulsory Health Insurance People are willing to pay for quality (Example: Germany)

22. 22 Healthcare … our largest economic factor ! Healthcare … our largest economic factor !... it’s a fascinating area!