Secure Healthcare Data Management

Secure Communication: Delivering Secure Connectivity for Healthcare Presented by: Jonathan Gatrell 11.20.2008

Automation Spending Out of Alignment 18X More spent on Internal automation than External B2B Automation $55B Internal Automation $3B External B2B Automation But… “Non-linear revenue growth for companies is not going to come from within but from their extended ecosystem…” Harvard Business Review

Unrealized Value in Healthcare Healthcare has huge inefficiencies vs. other industries McKinsey

Connections are EVERYWHERE! Who owns data and process governance?

How to monitor orphaned processes? Who has what data?

Opportunity is beyond the 4 walls.

Risk is also beyond the 4 walls.

Risk Doesn’t Go Away

Gartner Predicts in Healthcare By 2011, 50% of CEOs will demand a 10% reduction in the cost and time to collect payment, because reimbursement will be squeezed by federal deficit reduction imperatives. Through 2015, CDOs [Care Delivery Organizations] characterized as having a "low" probability of success are 80 percent more likely to seriously evaluate full IT operations outsourcing than are CDOs characterized as a "high" probability of CIO success. Outsourcing Real-time Automation

Access and Controls The right systems, the right platforms, the people and the right partners

Technology Dynamics Inflection Point

Complexity

Varied Technology

Outsourcing

Multiple Standards

Increasing demand on data exchange

More “end points”

Need to manage diverse B2B and B2C communities

Multiple Models

Consumer Driven

“ Traditional”

Mixed Technology Legacy SOA

Changing Content

Payments

ePrescriptions

Rich eligibility/claims

Lab Results

Data is everywhere New processes and capabilities

Some of it just might be PHI Security inside and outside required

Technical Realities and Opportunities

Production Technology

Core transactional model and capabilities are EDI-centric

HIPAA compliance

Online portal access key

Limited Adoption

Emerging Technology

SOA Investments

Digital health records

New Transaction models

RTA

New Opportunities

XML

Web Services

Increased Relevance of Security Source: “2007 Security Budgets Increase: The Transition To Information Risk Management Begins” “ What percentage of your company’s IT spending will go to Security?” 2007 2007 7.5% 6.9%

B2B content exchange and transaction management

EDI

Provider Claims

Employee Enrollments

Eligibility Requests

Batch Adjudication

XML

Real-Time Adjudication

Prescriptions

Point-of-Service Payment validation

Claims, enrollments and eligibility

Payments

Providers

Employers

Banks

Understanding Secure Healthcare Transactions

Limited Adoption & Automation Key Healthcare Value Chains Payers Consumers Employers Providers Banks

Multi-Enterprise processes offer:

Expertise

Efficiency

Scale and reach

Cost reduction

… but create unique challenges:

More complex data

Always changing

Real-time requirements

You don’t own the data

Data Exchange Landscape Latency Data capture Batch Real-Time Bulk Transactional Documents Messages

>80% of data movement today is by file exchange

80% of the data movement remains unmanaged

The primary method of multi-enterprise integration will continue to be file exchange

Only about one-seventh of all healthcare transactions are processed electronically today.

Meta Group / Gartner

Complex Systems and Content MFT/ Batch B2B Messaging Records Mgt Payment Applications HRIS Pharmacy Consumer Applications Patient Care Apps LIS/ HIS

Fragmented Healthcare B2B Payments Benefits Banking RTA The Enterprise FTP Client HTTP Solution AS2 SW Translator Firewall Healthcare Revenue Healthcare Supply

Simplifying & Securing B2B Exchange in Healthcare VAN P2P – Direct Connect Managed File Transfer BizManager Suppliers Payers Banks Providers Clearing Houses

A B2B Gateway: Strategic Consolidation