1. Building eHealth Solutions on Oracle – Best
practice from Europe and Beyond
Miroslav Koncar, PhD
Healthcare Business Development Director, Oracle
Bucharest, 9th of June 2011

2. Contents
• The value of IT in healthcare – what is eHealth all
about?
• Oracle in eHealth – Learning by Examples
• Conclusions and Final Remarks

3. Healthcare expenditure across Europe
Total HC expenditure as % of GDP
12,0
• Healthcare Expenditure (HE) 10,0
% GDP
• EU - Reaching 9% of GDP and $3000+ 8,0
6,0
PPP in most developed economies 4,0
• Romania HE growth on per capita 2,0
0,0 2000
spending by 98% (2000-2007)
2007
• BMI forecasted Romania’s total HE growth
from RON23.47bn (US$7.75bn) in 2009 to
RON24.77bn (US$7.81bn) in 2010.
• Reasons for High Costs?
• Misbalance on supply and demand
• Impact of the ageing population and chronic
Per capita total expenditure on HC (USD,
diseases - hospital centric system does not
PPP)
support continuity of care
4 000
• Missing performance incentives for
USD, PPP
3 000
providers network
2 000
• Duplication and overhead (administration, 1 000
diagnostic procedures) 2000
0
• Drugs adverse events and information 2007
underuse
• Resources utilization
*source: McKinsey, WHO, OECD, Emprica, Business Monitor International

4. eHealth in Healthcare
Brothers in Arms
• Some of the Key Messages from Analysts
• eHealth is part of health strategy – usage of IT needs to span across all segments
structural reforms and care provisioning
• Interoperability as the key criteria – it enables you to leverage e from best practice
economies of scale
• Overall Key Benefits from eHealth*
• Improve prevention of illness and delivery of treatments
• Reduce the cost of errors, fraud and duplication in process
• Support a shift from hospital care to prevention and primary care
• Help in providing better citizen-centered care
• Support interoperability across national boundaries
• eHealth Market Size
• Estimated at 15b€ in Europe, and
• CEE is the 2nd largest growth market in EMEA (CAGR 11%)
• 6% of total EMEA IT market size (~950m USD)
* “Together for Health: A Strategic Approach for the EU 2008-2013”, European Commission WhitePaper, 2008

5. Contents
• The value of IT in healthcare – what is eHealth all
about?
• Oracle in eHealth – Learning by Examples
• Conclusions and Final Remarks

7. Romania - Spending on Pharmaceuticals
800
700
600
PS Spending on pharmaceuticals 1999–2005*
500
Million USD
400
300
200
100
0
1999 2000 2001 2002 2003 2004 2005
• Combined sales of prescription drugs and OTC medicines sold through pharmacies and
hospitals achieved growth of 17.5% to RON11.93bn (US$3.76bn)**
• Reasons for costs increase (or methods how to maintain it)?
• Regulatory mechanisms – reference pricing, out of pocket payments, payment policy
• Decision support and Incentive models – pharmaceutical budgets per physician’s office, generics
vs. branded drugs
• Clinical evaluation and compliance - finding the best treatment for the individual patient
• PharmacoEconomics
• Fraud detection
*Source: National Health Insurance Fund, 2006
**Source: Business Monitor International

8. Professional Community on
ePrescribing
• Functionality and Features
• Prescribing Decision Support (Dosage,
contra-indications, financials)
• Fraud detection
• Improved patient safety, by connecting
medical records with medication
treatments
• Increased compliance
• Policy and reimbursement process
automatization
• Business Benefits
• First year of positive annual net
benefits on ePrescribing and EHR - 4 to
9 years!
• ROI – socio-economic impact of EHR
and ePrescribing proven across 400+
benefit and 300+ cost functions
“ If you can not measure it, you can not improve it.”
Lord Kelvin

9. New and Enhanced Offering Health Information Exchange
Oracle
Health Management
OHIB
E-Health Applications Platform Healthcare Infrastructure Services
Oracle
Enterprise Healthcare Home Care Master Patient Terminology EHR Index
Clinical MMA Business Clinical
Portal Viewer
Analytics Prescribing
Intelligence Disease CRM
Trials Index
Mgmt.
Oracle Oracle
Healthcare Health Record
Application Server & Database
Master Locator
Person Index
Health Information Access Layer
Orchestration Management
& Monitoring
Transformation
? ETL
& Routing
Security
Connectivity & Privacy
Packaged Oracle
Database Messaging
Healthcare FastPath Oracle
Security Governor
for Healthcare
Clinical Data Multimedia Data Warehouse
Repository Medical Archive
RIS PACS EMR Accounting
System System System System Oracle Oracle Database 11g
Health Data Multimedia DICOM
Repository
Existing Legacy Applications Clinical Data Repositories
9

10. Oracle Applied in Practice
Regione Lombardia ePrescribing Case Study
CRS-SISS Project
(Carta Regionale dei Servizi della Lombardia-Sistema Informativo Socio Sanitario)
• Lombardy Basic Data • ePrescribing
• 9.2 Million citizens • 80 million prescriptions processed in
• 8500 GPs, 2500 Pharmacies, 140k health 2007, 150m in 2010
professionals in total
• National Health Insurance Card – basis
• SISS Project Objectives (2000 – ongoing)
for patient consent and authorization
• Improve healthcare and social services for
citizens by simplifying procedures and
mgmt
reducing waiting time; • Standards of choice – digitally signed
• Improve the quality of prescriptions, diagnosis, HL7 CDA format, IHE profiles
and care by sharing clinical data among
healthcare professionals
• Improve the administration of social and
healthcare system costs by enhancing
planning and controlling instruments
• Improve the efficiency of HPO’s internal
processes through the deployment of new
technologies such as digital signature,
electronic filing, and electronic prescriptions.
• SISS today interconnects entire public
sector plus 70% of private sector
10

11. Socio-economic impact
EHR/ePrescribing in Regione Lombardia*
180.000.000
160.000.000
140.000.000
120.000.000
100.000.000
Euro
80.000.000
60.000.000
40.000.000
20.000.000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Present value of total annual costs Present value of annual benefits
*Source: EHRImpact Analysis, Empirica 2010

12. Contents
• The value of IT in healthcare – what is eHealth all
about?
• Oracle in eHealth – Learning by Examples
• Conclusions and Final Remarks
12

13. Conclusions
• eHealth is part of healthcare strategy – two arms of the
same body
• eHealth can help in...
• Better understanding the needs of population – decision support,
segmentation
• Optimization of current processes (both care and administrative
processes)
• Faster deployment of new processes
• Detection of errors and fraud management
• For a successful eHealth project, you should always (try to):
• Involve all necessary stakeholders, and secure
political support
• Consult and align your strategy with best practices,
standards and interoperability guidelines
• Benchmark the progress with quality indicators

14. What do you get with Oracle?
• Clear market
leader with 50-
80% market share
in Technology
across EMEA
• Involved in and
providing
important
components of
eHealth projects Stockholms läns landsting
• Strong supporter
and contributor to
international
eHealth best
practice and
standards
development CURIA BETICA
*IDC Worldwide SW Market (2009-10)

15. Thank You for Your Attention!
Email: miroslav.koncar@oracle.com