FORUM P.A.
Disease Management: l’importanza
della prevenzione attiva e il
coinvolgimento degli “attori” del
sistema
Maggio 2005
Leopoldo Frati
Healthcare & Life Sciences South Region Leader
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Healthcare scenario
Demographics
Major Biological
Advances
New approaches
enabled by advanced
technologies and better
understanding
Heightened Consumer
Expectations
“Educated” consumers
more likely to demand full
range of diagnostic and
therapeutic technologies
Graying Population
Aging of populace,
particularly baby
boomers, increases
population segment
most likely to utilize
health care services
Economics
Increasing
Consumer
Expectations
Providers are not able invest in
resources, infrastructure or
technology to respond to the
increasing demands due to:
Technology
Pervasive
increase in
internet and
technology
use
 Poor balance sheets and
inability to access external
capital
 Reimbursement rates dropping
 Infectious diseases and bioterrorism pose new threats
 Continuing nursing shortage
New
Technologies
1
Improved Diagnostics
New technologies
enable detection of
disease at earlier stage,
increasing number of
patient requiring
treatment
FORUM P.A. 2005
Less Invasive Therapies
Advances in procedural
techniques minimize risk
and recovery time,
expanding the potential
patient base
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
IBM Vision
Pharma 2010:
Healthcare 2010:
Move to Targeted Treatment Solutions
Integrate Discovery and Development
Increase usage of Biologics
Reduce cost/time for new drugs
-
-
Improve Quality (meet care standards)
Broaden Access (uninsured; poor)
Reduce/Maintain Cost (rising 10%+/yr)
Increase Productivity (now flat YTY)
Providers:
Government:
-
-
Pay for Performance
Care Management
Automation
Standards Adoption
-
Clinical and administrative effectiveness
and efficiency
Financial viability
Evolution to Information Based
Medicine
Payer:
-
Drive Efficiency
Cost / Risk
New Products
Care and Disease Management
IBM Point of View:
-
-
2
Healthcare and Life Sciences is an increasingly interdependent ecosystem
Stakeholders need to integrate their internal systems to enable more effective collaboration
across the ecosystem
IBM has the subject matter expertise, skills, and scale to help accomplish these bold goals
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Unprecedented Need for Integration, Analytics, and Management
…“When did my patient first visit a clinician
and have radiological scans and laboratory
tests performed to diagnose her condition?
What were the results of the treatments she
received? What future action is suggested to
improve her condition given her allergies,
current research findings, her family’s
medical history, her treatment regimen, and
her insurance coverage?”
1. Living Will
2. Resume
3. Qualifications
Hospital transaction events
Access to Diverse
Heterogeneous
Distributed Data
CAT, MRI,
X-Rays, etc.
Expression Arrays
Personal genomics,
SNPs
EKG, EEG, etc.
Clinical Record
3
FORUM P.A. 2005
Analysis,
lab notes
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
HCN
Today
Healthcare Collaborative Network enables Improved
Operating Efficiency between Healthcare players
Health
Agencies,
Health Plans
and others
who need
clinical data
Hospitals and
Other
Providers of
Care
Future
Hospitals and
Other
Providers of
Care
Open standards two way message flow
4
FORUM P.A. 2005
Health
Agencies,
Health Plans
and others
who need
clinical data
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
HCN’s Origin: The Foundation for eHealth Initiative
Federal healthcare agencies and industry leaders participated in demonstrations of
open standards technology through September 2003, to prove concept
Current planned participants
Create & Refine Acceptable Data Sharing Protocols
NY Presbyterian
Hospitals
Vanderbilt University
Medical Center
Wishard Memorial
CDC
CMS
IBM
FDA
Medstar
Test & Refine Feasible Models for Building Data Brokers
5
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Healthcare Collaborative Network (HCN)
Initial requirements driven from
eHealth Initiative members:
Federal
Agencies
(DOD, CDC, CMS,
FDA)
Healthcare
Providers
(Hospitals, Nursing
Homes, others)
• Enables rapid detection and response
to adverse healthcare events including
bio-surveillance
• Creates lower cost capabilities for
collecting, aggregating, analyzing and
reporting clinical information at near
real time
• Establishes a common electronic
healthcare information highway that
supports government, non-profit, and
private industry needs
Health Plans
6
FORUM P.A. 2005
HC Policy
Advocates
(AMA, AAFP)
Healthcare
Vendors
(Cerner, IBM,
McKesson,
Siemens,)
Industry
Consortia
(eHealth Initiative,
Connecting for
Health)
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
The HCN architecture is designed to leverage open
standards, be flexible and scalable, and facilitate easy
adoption at participant sites
DataSource
Source
Data
Data
Source
Organizations
Organizations
Organizations
Internet
Portal
Integration
Broker
HCN HUB
Internet
Internet
Legacy
HCN
Legacy
Legacy
Systems
Systems
Gateway
Systems
•Diagnosis
•Diagnosis
•Diagnosis
•Lab
•Lab
•Lab
•Pharmacy
•Pharmacy
•Pharmacy
•Other?
•Other?
•Other
Data
Review
Data
Source
Data
Source
Organizations
Organizations
Organizations
Agencies
HCN
Legacy Providers
Legacy
Gateway
and
Systems
Systems
others
•Diagnosis
•Diagnosis
who
•Lab
•Lab
analyze
•Pharmacy
•Pharmacy
•Other? clinical
•Other?
data
Key Design Elements
 Leverages open standards for secure two message flow (ICD, CPT, LOINC, drug names via HL7)
 Meets highest security standards for authentication and encryption
 As soon as a health topic is satisfied all information available on the related patient event can be shared
7
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
HCN within the Canadian CRTI (Chemical, Biological, Radiological and
Nuclear) Research Technology Initiatives) Biosurveillance Project
Business Challenge
 2 year demonstration of real-time
biosurveillance and response
readiness using an interconnected
electronic information infrastructure
 Foundation for a potential national
biosurveillance network
 Provide hospital quality of care
monitoring capability as well
Solution
 IBM Health Canada, Winnipeg
Regional Health Authority (WRHA)
partnership
 Use Healthcare Collaborative
Network solution components to
collect pertinent HL7 data and route
to Health Canada and WRHA
systems for analysis and action
8
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Two distinct solution models for the Healthcare industry
Government Model
Providers
2
1
Network
Monitoring
Activities
3
Feds
4
HCN
5
n
6
• Medical
Event detection and
alerting across hospitals in a network
using HCN technology
• Clinical performance/quality monitoring
9
FORUM P.A. 2005
State
2
1
Providers
3
4
HCN
5
Local
n
6
HCN Solution for disease
monitoring, clinical
performance monitoring,
bio-terrorism, and adverse
drug reactions
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
HCN is ready today to maximize the capabilities for collaboration
among various stakeholders in support of improved quality and
reduced medical errors
Summary of HCN solution benefits:
Enables monitoring groups (e.g. Local health jurisdictions, FDA, CMS,
CDC) to improve detection and response time for bio-surveillance,
adverse drug reactions, quality of care, and disease outbreaks
Enables rapid ability to aggregate and share data
Enhances ability to judge quality of care
Facilitates and improves efficiency of mandatory reporting and
collaboration with business partners
Provides a secure environment for clinical data transmission
using SSL and the highest level of encryption
Leverages existing applications minimizing barriers to
implementation
10
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Middleware IBM di
Integrazione
11
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Integrazione: tre approcci complementari
presentazione
Applicazioni verticali
• integrazione scarsa
o non esistente
• “information silos”
logica applicativa
accesso ai dati
Portali, workplaces,
applicazioni di tipo
collaborativo
Integrazione
orizzontale
• integrazione visuale
• portlets
EII: Enterprise Information
Integration
• integrazione a livello dati
• “virtual database”
• servizi sui dati
EAI: Enterprise Application Integration
• connettività tra applicazioni
• integrazione tra processi
• enterprise bus, workflow, event-driven
WPS
WII
WBI
12
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
IBM WebSphere Business Integration
Punto a Punto
Centralizzata
Interface
Hub
13
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
WBI connectors
Application Connectors
Technology Connectors



















Broadvision (5.0,5.5)
Clarify (8,8.1,8.5,9,10)
i2 Active Data Warehouse (4.x,5.x)
Metasolv TBS (4.x,5.x)
Oracle Applications (10.7,11,11i)
Peoplesoft (7.x,8.x)
Portal Internet (6.1)
SAP R/3 (3.x,4.x)
Siebel (2000)
Trilogy (3.0)
Vantive/Peoplesoft CRM (7.0,8.x)
OS/390 Connectors






IMS Transaction Manager
IMS Database
CICS
VSAM
DB2
ADABAS
14
FORUM P.A. 2005
JMS
Email
MQSI v2
XML
MQSeries
Jtext
JDBC
MQ Work Flow
Industry standard Connectors
 HL7
 “Packages”
SWIFT
CIDX
RosettaNet
 “Elements”
EDI
XML
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Progetto Estremadura
8 ospedali
22 unità dentistiche
394 cliniche locali
Websphere
Business
Integration
25 consultori familiari
Integration Architecture between SAP and the other Information Systems througout
HL7 standard, IHE Framework and WebSphere Business Integration Technology:
•Centralized Laboratory results Repository
•PIX, Patient Identifier Cross Reference
•PACS/RIS, based on Medora and Centricity (General Electric Medical Systems)
•Payroll Application, based on M3 (spanish services company)
•Departamental Applications: Pharmacy, Anatomo-Pathology,..
15
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
WebSphere Information Integrator (WII)
Federation, Replication, Event Publishing in ambienti distribuiti
applications
&end user tools
Linux,
Unix,
Windows
Integrated
SQL view
WS II
DB2
Family
relational engine
wrappers & functions
local db
cache
ODBC
SQL, SQL/XML, Search
metadata
Devel
envir
ODBC
Informix
Oracle
SQLSrv
Sybase
Teradata
Web Srvc
MQ msgs
16
FORUM P.A. 2005
XML
Excel
Flat files
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Il Change Management ha l’obiettivo di supportare la transizione dal
modello di business attuale al modello desiderato
Current
State
Transition State
Target
State
Comunicazione
Formazione
Organizzazione
17
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Le attività di Change Management aiutano le organizzazioni a
progredire verso lo “stato desiderato”, minimizzando il calo di
produttività che si verifica durante la transizione
Realizzazione dei
benefici
CHANGE MANAGEMENT
minimizza la profondità e la lunghezza
del calo di prestazioni e produttività
indotto da un cambiamneto
Mancanza di conoscenza
“Stato
attuale”
Paura
dell’ignoto
Valle della
disperazione
tempo
La “curva del cambiamento” mostra I tipici stadi attraverso i quali una organizzazione
progredisce allorquando individua, capisce ed implementa un cambiamento
18
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
La metodologia di Change Management è costituito da diverse
iniziative che sono tra loro collegate e distribuite sull’intero arco
temporale di un progetto di cambiamento
CHANGE MANAGEMENT PROGRAM
CRA
SPONSORSHIP
LEADERSHIP
COMMUNICATION
ALLINEAMENTO ORGANIZZATIVO
EDUCATION & TRAINING
Kick-Off
19
Go-Live
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Back-up
20
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Una comunicazione efficace ha il fine di creare consapevolezza e
coinvolgimento sul progetto di trasformazione, in sincornia con
l’avanzamento del progetto stesso
Analisi dei requisiti
Sintesi delle modalità di comunicazione
FORMALE E PIANIFICATA
One-Way
Obiettivo
Contenuto
Media
Target
Audience
Mittente
Messaggio
Timing
Feedback
Creatore
Memo
Newsletter
House Organ
Videotape
Brochure
Posters
Two-Ways
Meetings e tavole rotonde
Focus groups
Cassetta dei suggerimenti
E-mail
Colloqui face-to-face
Riunioni di reparto
 Interagire con gli
interlocutori al fine di
ottenere maggiore
partecipazione e
coinvolgimento, e
imparare dalle
esperienze passate
Realizzazione ed erogazione delle iniziative
Bacheca
aziendale
Sito internet
Macchinetta del caffè
Passaparola
Forum di discussione
(Intranet)
Mentoring & Coaching
Sviluppo del piano
Newsletter
PIANO DI COMUNICAZIONE
Intranet
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FORUM P.A. 2005
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© Copyright IBM Corporation 2005
Healthcare & Life Sciences
L’Education & Training copre i fabbisogni formativi delle nuove
modalità operative indirizzando la crescita professionale delle
persone
Metodologia
Definizione della Formazione
Definizione strategie
(sessioni, utenti, docenti)
Sviluppo del piano
di Education & Training
 Training via computer
 Training in classe
 Letture & Documenti
 Formazione a distanza
 Training on-the-job
 Tempo
 Risorse
Gestione dei feedback
Appl.
maintenance
Knowledge and
Ownership in
Business
 Training su skill tecnologici
 Training di processo
Erogazione
Prep
Blueprint Realisation Final Preparation Go Live
Information Transfer
Skills and Ownership Transfer
 Raccolta ed elaborazione
 questionari
 Monitoraggio continuo
Appl.
maintenance
Knowledge and
Ownership in
Project Team
Appl.
maintenance
SuperUsers
Trainers
Trainers
Sponsor
Bus Change
Leadership T
Bus Change
Leadership T
Bus Change
Leadership T
Change Mngt
Change Mngt
Change Mngt
Change Mngt
Core Pjct
Team
Core Project
Team
Core
Project
Core Pjct
Team
End
Users
Team
Sviluppo del Piano
Realizzazione ed erogazione
PIANO DI EDUCATION & TRAINING
4
Lezioni in aula
Supporti fisici
e online
Gruppi di
discussione
5
Azioni
6
11
12
13
14
15
18
19
20
2da sett. NOV
PP3_IE
PP2_MC
(FC) 4+2
OC3_LD
(MS) 3
PP3_DH
(MB, GS) 1+1
PP3_IE
(AP,PO) 8+2
FORUM P.A. 2005
8
PP3 _GDO
(FR) 10
PP3_DH
(MB, GS) 2+1
22
7
1ma sett. NOV
PP3 _GDO
(FR) 10
3za sett. NOV
(AP,PO) 9+1
OC2 _GDO
OC2 _GDO
(MU) 9
1FILIALE_D
(MB) 6
PP3 _GDO
OC1_IH
(AP,GS) 3+1
OC1_IH
(AP,GS) 4+1
2FILIALE_D
(MB) 6
OC3_LD
(MS) 3
(FR) 11
(MU) 9
PP4_P
(MD) 7
OC4_LD
(MS) 10
2FILIALE_D
(MB) 6
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
L'allineamento organizzativo rende coerente l’innovazione
introdotta, con la strategia aziendale e l’operatività gestionale
Metodologia
Assess
Current
Organization
Description
Current
Organization
Assessment
Plan
Analisi
Design
Implement
Job Roles,
Responsibilities
& Competencies
1
Future
Organization
Scope &
Requirement 3
Future
Organization
Design
4
Human
Capability
Assessment
Run
Vision
Valori
Mission
FCS/Strategie
6
Performance
Management System
and Rewards
2
Risultati
del
business
5
STADI
7
Processi
Organization Design
Organization
Transition Plan
FASI
Trasmettere la vision
aziendale alle unità
organizzative
8
Job Design
Education &
Training
Strategy
Organization Performance
Requirement
Sviluppare misure di performance
• Funzionali
• Di processo
Dimensionare i carichi di lavoro ed
allocare risorse




Nuova struttura organizzativa
Disegno attività e ruoli
Assegnazione responsabilità
Adeguamento procedure
9
Strumenti
MACRO ORGANIZZAZIONE
MICRO ORGANIZZAZIONE
FABBISOGNI FORMATIVI
RACI
Output
Competenze legacy/SAP
PDM
PVCS Tracker
Finance/FI
4
3
Hyperion
2
Controlling/CO
Material Management/MM
Sales and Distribution/SD
Cecolini
Mariani
Fichera
Perotta
Inaz/Paghe e DB personale
1
Production Planning/PP
Pancotti
Uguzzoni
0
MIS
Project System/PS
Pesce
Cevolani
Gestione profili/autorizzazioni SAP
Quality Management/QM
Savino
Target
MFG-PRO
Service Maintenanace/SM
Reporting/BW/SEM
Human Resources/HR
23
FORUM P.A. 2005
Asset Accounting/AA
Investment Management/IM
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Our strategic platform for healthcare interoperability, the Healthcare
Collaborative Network, is defined by three key components to create a
“Publisher – Subscriber” system
Internet Portal
for participant management
Integration Broker
data routed quickly, reliably and securely
The Broker transfers messages between
Publishers to authorized Subscribers, Content
Based Routing
The Gateway connects the participants’ IT
systems to the HCN De-identify patient
information, map codes, normalize local data,
parse HL7 and XML data types
Gateway
24
The Portal enables participants to identify
and configure the types of clinical
information they wish to receive or are willing
to provide
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Do you have information on which to base coverage & P4P models that drive quality outcomes?
25
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Across the healthcare ecosystems HCN has benefits that support
the needs of many stakeholder relationships

Hospitals/Physicians - Internal collaboration for:
Research/ Outcomes Analysis/ Quality Improvement Studies
Adverse Event Detections

Providers and Payers
Improved coordination for case management
Improved identification of disease management candidates
Support for quality incentive programs

Hospitals and Pharmaceutical Researchers
Identification of candidates for clinical trials
Post market population analysis
Compliance observation for outcomes analysis

Federal, Province and Local - Public Health Reporting
Biosurveillance/ Situational awareness
Health/disease management program candidate evaluation, outcomes analysis and
resource planning
Population monitoring
26
FORUM P.A. 2005
© Copyright IBM Corporation 2005
Healthcare & Life Sciences
Today’s situation
Informationsharing is
difficult:
• Higher costs due to reliance on paper, fax, mail, EDI
• Information is inaccessible, trapped in silos of legacy
systems sometimes linked by point-to-point connections
• Limited capabilities for real-time information sharing and
data synchronization
Those who need clinical data
(Peer Hospitals, Staff,
Administrators, government)
Hospitals,
Clinics, Staff
27
FORUM P.A. 2005
© Copyright IBM Corporation 2005