Patient Relationship Management Turkey V1

Patient Relationship Management David Hancock – Director, Oracle Healthcare and Life Sciences Industry Business Unit Oracle Proprietary & Confidential

Agenda • Healthcare Trends and Challenges for Healthcare Providers • PRM Proposition For Healthcare Providers • Case Study • Conclusion Oracle Proprietary & Confidential

Growing Healthcare Expenditure • Healthcare expenditure is growing due to: • Rapid advances in medical technology • Rising Public Expectations – especially around Quality of Life • Deliberate policy in some countries as previous cost containment had strained healthcare systems • Population Ageing • With Healthcare Expenditure growing up to 1.5 – 2.5 times faster than GDP this cannot continue. Oracle Proprietary & Confidential

Strategies for Controlling Costs that Affect Healthcare Providers 1. Payment per Case – DRG’s (Diagnosis Related Groups) • More financial risk moved down to the Provider • Provider has more to gain, especially if they can attract more Patients to maximise utilisation of their capacity and resources 2. Patient Choice • Patients can choose which Healthcare Provider they have to provide their treatment. • What factors would determine which Provider you would chose? Oracle Proprietary & Confidential

Strategies for Controlling Costs that Affect Healthcare Providers 3. Improving Quality of Treatment • Governments and Healthcare Insurance Companies are disallowing payments when Patients are re-admitted following discharge 4. Healthcare Organisations being measured on Patient Satisfaction • As part of a regulatory process, healthcare organisations are measured on satisfaction of patients who use their services 5. Improved Patient Empowerment to manage their own and their dependants conditions • Especially as healthcare moves from episodic to chronic care Oracle Proprietary & Confidential

Relationship between Cost and QoL 100% Home Care Healthy Community Independent Living Clinic Chronic Doctor’s Disease Mgt Office Quality Residential Care Acute Care of Life Assisted Specialty Living Clinic Skilled Nursing Community Facility Hospital ICU 0% $1 $10 $100 $1,000 $10,000 Cost of Care/Day Oracle Proprietary & Confidential Source: Intel Corp 2006

Managing and Supporting the Patient Flow Improving the Patient Experience and Quality of Life Pushing Consumer Monitoring to Waiting Room Attracting Patients BIG ISSUE BIG ISSUE BIG ISSUE “I should talk “Which Provider “I know when my condition is to my Dr.” should I Choose?” getting better/worse” Patient Patient Unaware Aware Get Patient is Patient is Visits HC Dis- patient patient Treatment Compliant Stable Profsnal charged “I may be at “I am prepared for “I am happy risk…” my appointment” “It is important I with my Quality take my of Life” medication and Consumer Wasted follow treatment Meeting ALL of Awareness Appointments the Patients’ plan” Needs BIG ISSUE BIG ISSUE Adherence BIG ISSUE BIG ISSUE Oracle Proprietary & Confidential

PRM Focus on Patient Flow Velocity Down the Flow Keep Patient Here Patient Patient Unaware Aware Get Patient is Patient is Visits HC Dis- patient patient Treatment Compliant Stable Profsnal charged • Identifying, Stratifying and Targeting Patients • Improving the Dischcarge • Attracting Patients Process • Improvement in Administrative Processes • Adherence • to improve utilisation of resources • Patient Monitoring • to help Patients get treatment • Supporting Patient Behaviour • to improve patient experience Modification • Making interventions Focus is on Access, Resource Focus is on Outcome, Utilisation and Attracting Patients Experience and Quality of Life Oracle Proprietary & Confidential

How does this Relate to Clinical Systems in a Provider? PRM Discharge and Post-Discharge PRM Pre-Admission and Admission CPOE Nursing/Ward ADT System ADT Pharmacy Surgery Oracle Proprietary & Confidential

Technology Roadmap Cholesterol Monitor Blood Pressure •Dashboards Monitor Agent (Telecarer) •Analytic Apps Interaction Channels Assisted Web/Portal Business WWW Pedometer Phone Intelligence Email • Patient Info • Results Captured Training • Case Info Glucose from Self Care Sensor • Determinations Web Conference Digital Plaster Web 2,0 Clinical WWW Systems Smart Phone Home Hub Appliance Access and Utilisation and Attracting Patients Medication Tracker Outcome Quality of Life Oracle Proprietary & Confidential

Siebel Healthcare in EMEA SALES/ACCOUNT MANAGEMENT BROKER/AGENT MANAGEMENT CALL CENTER PROVIDER/CARE DELIVERY CALL CENTERS PORTALS BUSINESS INTELLIGENCE Oracle Proprietary & Confidential

Andalusian Health System Public Andalusian Public Administration Health Sytem 7.975.672 inhabitants 38 370 80,629 8 Hospitals Primary Care Professionals Ambulancy & Health Centres Transp Centres Oracle Proprietary & Confidential

Main Services SMS Campaign 24 * 7 Booking services for 370 1. Expected Pollen Levels Primary Healthcare Centers 2. Flu Vaccination Campaign 3. Heat Wave advice Hospital waiting list management 4. Antibiotics information Hospital Discharge Follow-up 24 saludandalucía hrs Medical advice 1. Pediatric advice 2. Teenagers and sexuality Living Will Registry Mgt 3. Vaccination 4. Child nutrition Oracle Proprietary & Confidential

Northumbria Healthcare The Customer NHS Foundation Trust • Northumbria Healthcare is based in Northern England on the borders of Scotland • It is part of the National Health Service, within which hospitals compete for business and patients and referring agents (general practitioners, dentists, opticians) can exercise their choice • Northumbria Healthcare is entirely dependant upon the reimbursement that it receives from the commissioners (national insurer) as a result of the patients that it treats • Northumbria Healthcare NHS Foundation Trust is one of the largest healthcare employers in the North East, with over 6,000 staff. Oracle Proprietary & Confidential

ACUTE SERVICES Maternity / Children Services PATIENTS Outpatient Clinics EMERGENCY Therapy Services A&E diagnostics Primary Care GP’s Dentists Inpatient Services Opticians NHS Direct REFERRALS Walk in Surgical Services How do Patients Access their services? Oracle Proprietary & Confidential

ACUTE SERVICES Maternity / Children Services PATIENTS Outpatient Clinics A&E Therapy Services diagnostics Primary Care GP’s Dentists Inpatient Services Opticians NHS Direct Walk in Surgical Services What does their communication network look like? Oracle Proprietary & Confidential

ACUTE SERVICES Maternity / Children Services PATIENTS Outpatient Clinics •Frustrated & Stressed patients A&E •Missed messages and communications •High incidence of repeated communications Therapy Services •Contribution to high level of DNA’s •Difficulty in managing National waiting targets diagnostics •Danger of errors- sent to wrong clinics etc •With the “Choice” agenda, danger that patients go elsewhere for treatment Inpatient Services •Dangers of “miss-counting” episodes and therefore losing income Surgical Services What is the outcome? Oracle Proprietary & Confidential

ACUTE SERVICES Maternity / Children Services PATIENTS Outpatient Clinics A&E A Single Point of Contact! Therapy Services diagnostics Primary Care GP’s Dentists Inpatient Services Opticians NHS Direct Walk in Surgical Services Centres Contact Centre What did they require ? Oracle Proprietary & Confidential

What do they see as the role of the contact centre ? Role of the Contact Centre Proposal For Improving the Patient Experience Patient Operational Contact Services END TO END PROCESS Oracle Proprietary & Confidential

Where were they starting Northumbria Healthcare NHS Foundation Trust from? IN HOUSE DATABASE CURRENT SITUATION • Creaking In-House Access • Doesn’t Maintain history of previous Database contact • Doesn’t provide common scripts • Doesn’t provide access to Knowledge Base • Doesn’t Support advanced Messaging • Has limited process automation ie “Workflow” Patient Admin • Isn’t interfaced into or out of PAS System • Doesn’t Build relationships between patients PAS • Is not a contact tool Oracle Proprietary & Confidential

What Did They Need? PATIENT Standard Scripts Ability to fulfil service Common Message requests ORACLE CUSTOMER RELATIONSHIP Single Point of Contact MANAGER Record of Contacts Remove paper chase (CRM) “Single Experience” Through electronic notifications CONTACT CENTRE Knowledge of Patient Automate Process Relationships through workflow Access to Knowledge Follow up services Base for enquiries requests through workflow,email, SMS Oracle Proprietary & Confidential

What are their Data Sources? PATIENT Our main patient data source and record of clinical activity is the Patient Administration System (PAS) Oracle It is essential that our CRM system acts as a front end to CRM DATA this key clinical system CONTACT CENTRE H I S CLINICAL SERVICES Oracle Proprietary & Confidential

What was their Project Strategy We recognise the enormous opportunities to improve the experience of our patients and improve the efficiency of the services we provide. However, we are approaching the opportunities with caution and have divided the programme into stand alone phases, each independent and supported by a stand alone business case - Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Controlling the Extend Better Multi Chronic interaction interfaces resource Channel Disease between the with allocation Delivery- Management Trust and its clinical through Internet Patients systems demand TV Each high level stage will be completed before moving onto the next stage. This will allow us to build confidence and support amongst the clinical stakeholders by demonstrating increasing added value as each stage is completed. Oracle Proprietary & Confidential

PHASE 1 Objectives PATIENT Outpatient Clinics Therapy Services SMS / Email Reminders Book and amend service diagnostics CONTACT CENTRE appointments Inpatient Services Surgical Services Use Script data base for “Controlling the interaction patient between the Trust and its Maintain interaction queries Patients” history for all contacts Oracle Proprietary & Confidential

PHASE 2 Objectives CONTACT CENTRE RADIOLOGY PATHOLOGY Other Clinical Systems Oracle CRM TWO WAY NEW HIS INTERFACE Extend interfaces with clinical systems Oracle Proprietary & Confidential

PHASE 3 Objectives PATIENT Improved Resource management Improved Outpatient clinic SMS/ Email throughput Reminders Through Better elective demand Improved CONTACT CENTRE management Profitability Through less Improved Surgical DNA’s List management Improved Patient Satisfaction Better Patient Outcomes Better resource allocation through demand management Oracle Proprietary & Confidential

PHASE 4 Objectives PATIENT •Exploring the introduction •Expanding the of wireless symptom communication channels monitoring technology for patients. •Expanding the telecoms •Investigating email, SMS capability to include and interactive or complex tele-health community TV facilities CONTACT CENTRE Multi Channel Delivery- Internet – tv Oracle Proprietary & Confidential

PHASE 5 Objectives THE REAL PRIZE – Chronic Disease Management In the UK, it is estimated that seventeen and a half million people live with a chronic condition and around 80% of GP consultations relate to chronic disease. By 2015, almost five million people in the UK will die from a chronic disease, with a cost to the UK economy of £18.8 ($28) billion. .”Chronic disease places a huge burden on NHS resources. Those with chronic conditions are significantly more likely to see their GP, to be admitted as inpatients, and to use more inpatient days than those without such conditions. The burden of chronic illness falls principally on the elderly, so as our population ages the incidence and prevalence of chronic diseases will increase” Royal College of Physicians Oracle Proprietary & Confidential

PHASE 5 Objectives – Chronic Disease Management CHRONIC DISEASE MANAGEMENT INFORMATION CARE PLAN COMPLIANCE CONTACT POINT SELF CARE SUPPORT APPOINTMENT ARRANGEMENTS PATIENT WITH CHRONIC • Condition monitoring DISEASE • Improving patients quality TECHNOLOGY of life Cholesterol • Early interventions Monitor • Avoiding adverse clinical CONTACT CENTRE events • Earlier Patient Discharge ESTABLISHED INFRASTRUCTURE AND NETWORK Blood Pressure Monitor Glucose Sensor Oracle Proprietary & Confidential

Conclusion • 5 key drivers for Providers and Health Systems to improve the way they deal with and interact with Patients • Patient Choice, Payment Per Case, Disallowing payment if patient re-admitted, Measurement of Patient Satisfaction, Patient Empowerment • Needs to be a New Class of Solution that works either side of clinical applications PRM Discharge and Post-Discharge PRM Pre-Admission and Admission CPOE Nursing/Ward ADT System ADT ADT • Oracle is leading vendor in this area Pharmacy Surgery • Oracle has many references and a great vision of how this can be developed. Oracle Proprietary & Confidential

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Patient Relationship Management Turkey V1

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