Liris blue academy 2010 2011 - smarter healthcare - nicky hekster
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Smarter Healthcare - lecture at the Univ. of Leuven, March 10th 2011

Smarter Healthcare - lecture at the Univ. of Leuven, March 10th 2011

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Liris blue academy 2010 2011 - smarter healthcare - nicky hekster Liris blue academy 2010 2011 - smarter healthcare - nicky hekster Document Transcript

  • The LIRIS Blue Academy 2010-2011 Smarter Healthcare An initiative from L.I.R.I.S. and IBM Belgium Dr N.S. Hekster IBM Nederland B.V. © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 LIRIS Program 2010-2011 SMARTER cities are the Future in ‘Beleidsinformatiesystemen’ (HIR, HIRB) Jacques De Kegel, Business Development Executive, IBM 17-Nov-2010 (11:00 – 13:00) (VHI - 02.29) BPM & Case Management (**) in ‘Analyse en ontwerp van informatiesystemen’ Te bepalen spreker (SAP) (Wim Verhelst ?) 25-Nov-2010 (14:00 – 16:00) (DV1 - 02.54) From Enterprise Architecture to ICT Architecture (**) in ‘Architecture & Modeling of MIS’ Steven Laurent, Enterprise Architect, AE 6-Dec-2010 or 29-Nov-2010 (11:00 – 13:00) (ILT - 00.176) Enterprise Content Management (**) in ‘Geavanceerd DB Management en Content Management’ Eric Michiels, Executive IT Architect, IBM 02-Dec-2010 (14:00 – 16:00) (HOGC - 02.22) Juridical aspects of ICT Solutions (**) in ‘Analyse en ontwerp van informatiesystemen’ Johan Vandendriessche (Bird & Bird) 13-Dec-2010 (15:00 – 17:00) (Aud. Monnet) Smarter Healthcare (*) in ‘Beleidsinformatiesystemen’ (Kortrijk) Nicky Hekster, Technical Leader Healthcare, IBM 10-Mar-2011 (11:00 – 13:00) (Aula lokaal C611) Mobile Banking (*) in ‘Beleidsinformatiesystemen’ (lic) Anton Wilsens, Client Solutions Manager Financial Services xx-yyy-2011 (16:00 – 18:00) (VHI - 01.29) ICT Sourcing Strategies (**) in ‘ICT Service Management’ Marnix Gillis, Distinguished Engineer,IBM 31-Mar-2011 (18u – 20u) (VHI - 00.10) Software development productivity (*) in ‘ICT Service Management’ Antoon Goderis & Jo Vanackere, KBC uu-vvv-2011 (18:00 – 20:00) (VHI - 00.10)2 Smarter Healthcare © 2010-2011 IBM Corporation 1
  • LIRIS Blue Academy 2010-2011 Introduction speaker My name: Nicky Hekster Role: Industry Technical Leader Healthcare & LifeSciences IBM Benelux Active in ICT since 1987 Vendor-chair IHE Netherlands n.s.hekster@nl.ibm.com You can find me also on LinkedIn and Twitter3 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Agenda IBM in Healthcare Healthcare in State of Emergency Smarter World, Smarter Healthcare ======== B r e a k ======== Smarter Healthcare ICT Examples4 Smarter Healthcare © 2010-2011 IBM Corporation 2
  • LIRIS Blue Academy 2010-20115 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Team IBM – 400,000 people worldwide 15,000 15k 160,000 sales people salespeople 9k 9,000 salespeople sales people 58,000 5k 5,000 salespeople sales people 42,000 Defense 10k 10,000 Healthcare salespeople sales people 102,0006 Smarter Healthcare © 2010-2011 IBM Corporation 3
  • LIRIS Blue Academy 2010-2011 IBM Benelux IBM Benelux was formed in July 2005 Over 7000 employees in 3 countries7 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Heart-Lung machine (IBM and Dr J.H. Gibbon, 1957)8 Smarter Healthcare © 2010-2011 IBM Corporation 4
  • LIRIS Blue Academy 2010-2011 nanoMRI (2009) Magnetic Resonance Force Microscopy (MRFM)9 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 The Scripps Research Institute Project Checkmate10 Smarter Healthcare © 2010-2011 IBM Corporation 5
  • LIRIS Blue Academy 2010-2011 Eye lasering invented by IBM Excimer laserInvention Innovation Using invention to create value, leads to innovation Collaboration Close-up of an IBM logo inscribed on Close-up of an eye surgery a human hair. The Excimer laser with the Excimer laser where surgical procedure is so precise it can the eye is repaired for sharper cut a clean pattern into a human hair visibility without burning the strand.11 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Saving the chocolate industryThe cacoa genome project - a collaboration among MARS, USDA-ARS, IBM, NCGR,Clemson University, HudsonAlpha Institute for Biotechnology, Indiana University andWashington State University IBM and Mars, sequencing the Theobroma cocoa genome (done! Sept 2010) – http://www.youtube.com/watch?NR=1&gl=U S&hl=uk&v=ERu5TaqIvHs Sustainable crops, unraveling the cocoa genome – without engineering higher-yielding cacao trees, demand would outstrip supply within 50 years. Howard-Yana Shapiro of Mars Inc. was seeking IBMs help in analyzing the cacao genome to ensure the future of the plant, which is being wiped out.12 Smarter Healthcare © 2010-2011 IBM Corporation 6
  • LIRIS Blue Academy 2010-2011IBM Journal of Research & DevelopmentIBM Systems Journal Systems Biology Information-based Medicine Volume 50, Number 6, 2006 Volume 46, Number 1, 200713 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 www.ibm.com/genographic National IBM The Geographic + = Genographic Society Research Project IT Paleontology Infrastructure Phylogenetics Using DNA to Genetics unravel Computational the path followed Anthropology by our ancestors Biology14 Smarter Healthcare © 2010-2011 IBM Corporation 7
  • LIRIS Blue Academy 2010-2011IBM’s Commitment to Healthcare & Life Sciences Designated Life Sciences an IBM Emerging Business Opportunity Unit - Spring 2000 – $100M initial investment IBM Research – Computational Biology Center – Deep Computing Institute – Blue Gene Project IBM Business Consulting Services – PriceWaterhouseCoopers Consulting acquisition – Pharma 2010: The Threshold of Innovation – Healthcare 2015, Win-Win or Lose-Lose Strategic partnerships with industry leaders, e.g. Mayo Clinic Created IBM Healthcare & Life Sciences (1/04) – $250M Investment (2/04)15 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 IBM’s Commitment to Healthcare & Life Sciences Designated Information Based Medicine an IBM Emerging Business Oppty Unit (1/04) – Clinical Genomics and Biomedical Imaging (2004) – Expand to PGx, CDI and Pervasive in 2005 National Genographic Project – IBM and National Geographic jointly gathering one of the largest collections of DNA samples to map how humankind populated the planet. Setting new Health Record precedents – IBM offers U.S. Employees Electronic Records for Healthcare – IBM revises non-discrimination and equal opportunity policy – restricts genetic data Dedication to Standards – IBM allow royalty-free access to its patents for developers who wish to create new healthcare and education applications around open standards – IBMers from Research on the international boards of HL7 and IHE Acquisition of Acure (DK) Acquisition of HealthLink (5/05) Acquisition of Cognos (11/2007) Acquisition of Initiate Systems and SPSS (02/10)16 Smarter Healthcare © 2010-2011 IBM Corporation 8
  • LIRIS Blue Academy 2010-2011IBM Healthcare Knowledge Centers La GaudeGlobal Healthcare Center of Healthcare Barcelona Excellence Zürich Research Lab Center of Excellence MontpellierProducts & Solutions Support Center Beaverton Network Haifa Research Lab Transformation Center (NTC) Mayo Clinic Medical Imaging Mainz Technical Marketing Information Innovation Center Dallas Health Analytics (M3IC) Solution Center Competence Center (TMCC)17 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Fact-based thought leadership helps clients realize businessvalue18 Smarter Healthcare © 2010-2011 IBM Corporation 9
  • LIRIS Blue Academy 2010-2011 So what in the world is happening with healthcare?19 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Five drivers make healthcare fundamentally different from the past Globalization Consumerism Changing demographics and lifestyle Diseases that are more expensive to treat New medical technologies and treatments20 Smarter Healthcare © 2010-2011 IBM Corporation 10
  • LIRIS Blue Academy 2010-2011 Globalization Developed Countries Developing Countries Least Developed CountriesA majority of adults in ten of The increasing prevalence of There is a strong need tothe 30 OECD countries are and costs to treat chronic address basic public healthoverweight diseases, as well as the issues such as clean water, associated lost productivity, good sewage systems, andAs life expectancy has are impacting systems vaccinationsincreased (68.5 years in1960 to 77.8 years in 2003), – The loss of income to Countries are beginning tothere has been a China over the next ten experience the rise of chronicconcomitant rise in the years as a result of heart diseases but are lessincidence of chronic diseases disease, stroke, and capable to manage them diabetes is estimated atTotal healthcare – By 2015, chronic US$550 billionexpenditures are increasing diseases will be a leading2.0 times more rapidly than Countries are still fighting cause of death in Nigeriaeconomic growth infectious diseases – not only Population expansion is existing ones, but also new higher than in developed or diseases and new strains developing countries * Definitions of “developed,” “developing,” and “least developed” countries are presented in the Appendix.21 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Consumerism The patient becomes co-producer/co-director of his own care Patient emancipation and empowerment Wants to make better health and wellness choices Growing expectations for value from increasingly costly health systems Broad global awareness of quality and safety challenges New clinical pathways, retail clinics Life-style management Medical tourism22 Smarter Healthcare © 2010-2011 IBM Corporation 11
  • LIRIS Blue Academy 2010-2011 Medical tourism is beginning to subject healthcare delivery to global competitive pressures Procedure United States Mexico Costa Rica India Thailand Singapore Angioplasty $33,000 $13,125 $14,500 $7,800 $9,200 $12,500 Heart bypass $37,000 $14,400 $13,600 $6,650 $11,000 $13,500 Hip replacement $45,000 $9,400 $13,000 $6,500 $8,000 $9,000 Knee replacement $21,000 $10,500 $9,500 $6,500 $8,500 $10,000 Laparoscopic $19,000 $4,275 $6,500 $2,238 $4,500 $4,500 hysterectomy Laparoscopic $27,500 $16,800 $11,500 $5,900 $9,500 $16,000 prostatectomy23 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Medical tourism in practice24 Smarter Healthcare © 2010-2011 IBM Corporation 12
  • LIRIS Blue Academy 2010-2011 Changing demographics and lifestyle Graying baby boomers More chronic patients Overweight Population growth Mobility Pandemics Lack of resources25 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Diseases that are more expensive to treat Diseases are more expensive to treat Drug development costs go up26 Smarter Healthcare © 2010-2011 IBM Corporation 13
  • LIRIS Blue Academy 2010-2011 Emerging diseases 1937 – Q-fever, Coxiella burnetii 1973 – Rotavirus 1977 – Ebola virus 1981 – Toxic shock syndrome 1982 – Lyme disease 1983 – HIV/AIDS 1991 – Multidrug-resistant tuberculosis 1993 – Cholera caused by strain 0139 1994 – Cryptosporidium infection (large outbreak in Wisconsin, USA) 1998 – Avian flu 1999 – West Nile Virus (first appearance in USA) 2003 – SARS (severe acute respiratory syndrome) 2004 – Marburg virus (largest outbreak in Angola) 2009 – April Swine/Mexican Flu H1N1 strain27 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 New medical technologies and treatments Less invasive therapies Improved diagnostics Confluence of biotech and healthcare28 Smarter Healthcare © 2010-2011 IBM Corporation 14
  • LIRIS Blue Academy 2010-2011 Technology advances at enormous speeds Grid Computing29 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Transformation of Medicine accelerated by a combination of revolutionary technologies and evolutionary practices Automated Personalized Health CareRevolutionary Technology Systems Lifetime Treatment Throughput Analytics Pre-symptomatic Treatment CA Diagnosis Information Correlation Translational Molecular Medicine Medicine Genetic Predisposition Testing Clinical Genomics 1st Generation Health Care Diagnosis Today Digital Imaging Episodic Treatment Electronic Health Records Artificial Expert Systems Data and Systems Integration Non-specific Organized Personalized (Treat Symptoms) (Error Reduction) (Disease Prevention) Evolutionary Practices30 Smarter Healthcare © 2010-2011 IBM Corporation 15
  • LIRIS Blue Academy 2010-2011Confluence Research In silico modeling Drug discovery Bioinformatics Diagnostics Biomarkers Computational Proteomics, Chemistry Transcriptomics, MicroArrays and Information- Metabonomics based medicine Very large databases Medical Visualization Clinical and Regulatory Process Management Analytics31 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Counterbalancing the drivers for change are key inhibitors that threaten to maintain the healthcare status quo32 Smarter Healthcare © 2010-2011 IBM Corporation 16
  • LIRIS Blue Academy 2010-2011 Healthcare Systems in Europe Funding is very different - increasing cost sharing among public and private health insurers and individuals. Access to Healthcare Social Insurance National Health Service Reimbursement Benefits in kind Centralized Decentralized Belgium Netherlands Cyprus Greece France Italy Luxembourg Portugal Spain33 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Financial constraints Health expenditure as a share of GDP, 2004 16 15,4 14 12 11,5 10,6 10,5 10 9,7 9,2 8 8 % of GDP 6 4 2 0 USA CH D F B NL L34 Smarter Healthcare © 2010-2011 IBM Corporation 17
  • LIRIS Blue Academy 2010-2011 Inability to access and share information The Electronic Health Record (EHR) Different definitions – Electronic Medical Record (EMR) – Personal Health record (PHR) Unstructured efforts Semantic non-interoperability Retentions laws Regulatory compliance35 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Where is the relevant information?36 Smarter Healthcare © 2010-2011 IBM Corporation 18
  • LIRIS Blue Academy 2010-2011 Electronic Health Records37 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 EHR – potential inputs38 Smarter Healthcare © 2010-2011 IBM Corporation 19
  • LIRIS Blue Academy 2010-2011 Watson – a future physician’s assistant? Complex diagnoses Better medication Prevent medical errors YouTube, Perspectives on Watson: Healthcare39 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Healthcare systems must address major issues and questions in the search for an value-based, affordable, sustainable system Many healthcare systems are being pushed to a crisis stage because of unrelenting pressures related to cost, quality, and access/choice Concurrently, factors such as new treatments and increasing demand for services and value are converging to increase the pressures Without major changes, many countries will “hit the wall” (i.e., not be able to continue on the current path) in the next decade New levels of accountability, tough decisions, and collaborative hard work on the part of all stakeholders will be required to transform healthcare systems into a national asset Countries that successfully transform will focus on value, develop better consumers and create better options to promote health and provide care40 Smarter Healthcare © 2010-2011 IBM Corporation 20
  • LIRIS Blue Academy 2010-2011 EHR adoption around the world (January 2006)41 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Realizing the importance of information in healthcaretransformation, there has been a surge of investment worldwidedirected to Health IT Europe Europe UK– ₤20.4B UK– ₤20.4B Asia North America North America Asia US ARRA – $20.4B China – $4.2B China – $4.2B US ARRA – $20.4B Singapore – $1.1B SIN Canada –$3.1B CDN (InfoWay) Canada –$3.1B CDN (InfoWay) Singapore – $1.1B SIN Worldwide Worldwide Middle East EMR – $10B in 2010 Middle East EMR – $10B in 2010 $30B in 2019 ** $30B in 2019 Saudi Arabia – $14B**** Saudi Arabia – $14B**** EMR Adoption EMR Adoption US – 10% US – 10% AUS – 25% AUS – 25% UK – 59% UK – 59% CAN – 14% CAN – 14% NZ – 52% NZ – 52% Additional Opportunities Additional Opportunities Clinical Decision Intelligence: $75M (2010), $3.1B (2019)** Clinical Decision Intelligence: $75M (2010), $3.1B (2019)** Health Analytics: Health analytics: $2.3B, $3.29B (2014)** Health Analytics: Health analytics: $2.3B, $3.29B (2014)** Cloud Computing for HCLS: $1.04B (2010), $6.2B (2014)*** Cloud Computing for HCLS: $1.04B (2010), $6.2B (2014)*** * assuming current growth rates ** source – HCLS *** Medical Imaging and Collaborative Care Cloud sizing **** a large percentage of that spending is on eHealth Large spending and digitization will not improve outcomes without proper healthcare system Large spending and digitization will not improve outcomes without proper healthcare system design. We need to instrument the point of care and have consumable, knowledge enhanced EMRs design. We need to instrument the point of care and have consumable, knowledge enhanced EMRs42 Smarter Healthcare © 2010-2011 IBM Corporation Healthcare Transformation 21
  • LIRIS Blue Academy 2010-2011 The world-wide challenge Changing the cure and care stakeholder ecosystem – the Healthcare Information Exchange (HIE) Government General Practitioner Insurance Pharmacy Payors eHealth Primary Platform Portal Rehabilitation Social card Hospital Patient, citizen Secondary 43 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Example: eHealth Platform (Frank Robben, 6/2009) Patiënten, zorgverleners Patië nten, en zorginstellingen Software PortaHealth zorgverlener DTW DTW DTW DTW DTW DTW Software DTW DTW Site RIZIV zorginstelling DTW DTW Portal MyCareNet DTW DTW DTW DTW DTW DTW eHealth DTW DTW DTW DTWGebruikers Basisdiensten Netwerk eHealth-platform eHealth- GAB GAB GAB GAB GAB GABLeveranciers 44 Smarter Healthcare © 2010-2011 IBM Corporation 22
  • LIRIS Blue Academy 2010-2011From supply-based to demand-driven healthcarePower to the patient – the patient as co-producer of care Physiotherapist Water and air Laboratory Alzheimer Ambulances quality bracelet From Specialist treatment Hospital Pharmacy to prevention Beds Patient groups From acute Home to Food chronic Doctor delivery diseases citizen patient Medical devices From Social services passive to pro-active Radiology Nurse patients Coordination calendar Nurse center Insurance 45 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 The continuum of cure and care 46 Smarter Healthcare © 2010-2011 IBM Corporation 23
  • LIRIS Blue Academy 2010-2011Traditional healthcare delivery model t ien University Medical Centers pat he ft to en Top Clinical Hospitals Tertiary care em ov lm ica Regional Hospitals Secondary care ys Ph General Practitioners Primary care The patient community- bottom of the pile! Unchanged for 6000 years - circa 4000 BC!47 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Future health system transformationiPad The always connected and informed citizen community iPhone Web 2.0 Acute Trauma Home Care Maternity TV Retail Health Centers Health Kiosks Daycare Surgery Diagnostic Centers Allied health professionals Community HospitalsCommunity Hospitals non-acute care acute care Primary Healthcare The Super Primary Care Physician Primary teleradiology e-Health telepathology telemedicine telediagnostics Clusters of specialists, Patient/citizen-centric care globally spread and universal >Direct access to specialists< accessible48 Smarter Healthcare © 2010-2011 IBM Corporation 24
  • LIRIS Blue Academy 2010-2011 So what is happening in the world?49 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011The world isSMALLERThe world isFLATTERThe world is about to get increasinglySMARTER50 Smarter Healthcare © 2010-2011 IBM Corporation 25
  • LIRIS Blue Academy 2010-2011 ICT merging with our physical world51 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 INSTRUMENTED We now have the ability to measure, sense and see the exact condition of everything. Today, there are 1 billion transistors for each person on the planet. By 2010, 30 billion RFID tags will be embedded into our world and across entire ecosystems. Remote patient monitoring devices that track the vital signs of patients with chronic diseases could reduce U.S. healthcare spending up to $197 billion over 25 years. Typically, hospitals over-procure mobile assets by 20-30% while critical staff spend 10-30% of their time searching for them. Smarter health systems automatically capture and exchange information through diverse channels to proactively manage and deliver preventive and therapeutic care.52 Smarter Healthcare © 2010-2011 IBM Corporation 26
  • LIRIS Blue Academy 2010-2011 INTERCONNECTED People, systems and objects can communicate and interact with each other in entirely new ways. The Internet of people is 1 billion strong. Almost one third of the world’s population will be on the Web by 2011. There are more than 4 billion mobile phone subscribers worldwide. In 2007, 56% of American adults sought information about a personal health concern on the Internet—up from 38% in 2001. Smarter health systems remove information barriers and work as integrated teams with the individual to make smarter decisions.5353 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 INTELLIGENT We can respond to changes quickly and accurately, and get better results by predicting and optimizing for future events. Every day, 15 Petabytes (1015) of new information are being generated. This is 8x more than the information in all U.S. libraries. More than 3,600 statistical articles are published each year on the topic of coronary heart disease alone. Increasing digitization and medical imaging will lead to a 41% annual increase in storage requirements between 2008 and 2012. Smarter health systems continually analyze information to meet the changing needs of the organization, optimize performance, integrate predictive models, and deliver greater value to the individual.5454 Smarter Healthcare © 2010-2011 IBM Corporation 27
  • LIRIS Blue Academy 2010-2011 The mandate for change is a mandate for smart. A smarter health system forges collaborative partnerships to deliver better acute, chronic and preventive care, while activating individuals to make smarter choices. 55 55 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 To meet expectations for improved outcomes, increased value and more accountable, sustainable health systems, healthcare organizations are working to … IMPROVE OPERATIONAL DELIVER COLLABORATIVE EFFECTIVENESS CARE FOR PREVENTION ANDBuilding flexibility into operations WELLNESS to support cost reduction and Collaborating across care settings excellence in clinical and HEALTHCARE to deliver integrated, personalized business performance and care experiences, prevent practices. disease, promote wellness and manage care. ACHIEVE BETTER QUALITY AND OUTCOMES Applying insights to improve quality of care, clinical outcomes and services and deliver personalized healthcare value, while improving financial results. 56 56 Smarter Healthcare © 2010-2011 IBM Corporation 28
  • LIRIS Blue Academy 2010-2011 IBM’s strategy Patient-centric Networks Achieve better quality and – The availability of information at the outcomes. right time, at the right place, and in the right context Clinical and Business Optimization Improve operational effectiveness. – Increasing productivity and efficiency Health and Wellness Management Deliver collaborative care for prevention and wellness. – Lowering costs en improving quality in the long term + +57 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Smarter Healthcare ICT58 Smarter Healthcare © 2010-2011 IBM Corporation 29
  • LIRIS Blue Academy 2010-2011Clinician’s environmentToday Find record and acquire useful Diagnose Treat Document & process records patient information Anywhere, Anywhere, Any Time Any Time Any Device Any Device Automatic document generation Relevant Patient Information Increase Cognitive Window Impact Clinician’s use systems Clinician’s use systems Horizontal platform for knowledge workers Horizontal platform for knowledge workers59 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 The hospital tension triangle “De techniek interesseert me niet, ik ben alleen geinteresseerd in de Poor governance Board of cost/benefit van de business case en het No transparency Directors risicoprofiel” Low risk, no risk J.Th. Kedzierski, ex- Not business-like voorzitter raad van ICT as a cost bestuur MCA Old boys network ICT Forcing power Ultimate patient responsibility ICT as a tool No enforcing power Technology shifts the entire approach Ad hoc application that physicians have to medicine management and deployment dictated by Learning new technologies consumes too physicians much time Busy managing day-to-day Clinical New technologies changes existing procedures too much operations Practice60 Smarter Healthcare © 2010-2011 IBM Corporation 30
  • LIRIS Blue Academy 2010-2011 Change requires a strong governance model Resistance to change Changes in habits Skeptics of the system Becoming transparent Privacy Complexity of the issue Changes on legislation are often needed Lack of confidence in the system Funding Who is going to fund it? What is required to obtain it?61 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Transformation of healthcare Clinical process management Information management Changes of roles Collaboration Culture and attitude Education62 Smarter Healthcare © 2010-2011 IBM Corporation 31
  • LIRIS Blue Academy 2010-2011In the meantime at the datacenter …Crisis of infrastructure complexity Information growth 54% per year Maintenance costs 70 cent per €1 Utilization 85% runs idle63 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Today’s application complexity M a inframe apps - B lue Page 1 of 2 PC/NT apps - G reen Unix apps - Y ellow 3rd party interface - Orange Vendor Setup Application Diagram V4 Depository Banks Lines: Colors have no special meaning. Vendor They are to help make the diagram easier to Process Servers I17 Customer Perceived Budget Maintenance UAR - Universal Account read. (Imaging) NEW Sound scan Sterling VAN In-Stock For More Information: See the database Analysis Tool Mesa D ata NPD Group Roadshow Reconcilliation Printer AIG W arrant y Gu ard Mailbox (Value) containing information about each S20-Sales Maintenance Polling I13- Auto application: Application V4.mdb I15 Hand Scan I06 - Customer Replenishment Apps Printer PO Insertions S01 - Sales Order AIS Reports Orders AIS Calendar Corrections Due Dates I06 Warehouse Print Costing General Invoice App Management Stores & Mrkts Broadcast Maintenance E13 Filter E3 Interface Fringe PO Smart Plus Smart Plus M03 - Millennuim 3.0 Launcher S04 - Sales Posting S07 - Cell P16 - Tally Sheet Phones I03 Return to D01 Post Load Vendor M02 - Millennium S06 - Credit App Billing Equifax Stock Options I12 Entertainment S09 - Digital P15 EES Employee Software Satellite L02-Resource Change Notice A04 - Cust System Scheduling L01-Promo Refund Chks E01-EDI 1 Analysis (Campbell) P14 On-line New Hire Entry AAS V02-Price Resumix P01- Marketing Employee Washington, Support Masterfile RGIS, Ntl Bus Systems P09 - P17 Cobra Frick S11 - ISP Cyborg CTO2.Bestbuy. CTS Co I10 Cycle Physical Tracking com I04 Home Inventory ACH Deliveries V04-Sign Prodigy System U18 - CTO Banks - ACH and Pos to I02 - POS X92-X96 Pay Transfers Host to AS400 Plan Administrators Communication (401K, PCS, Life, Spec Source B01 - Stock Unicare, Solomon SKU Tracking Status I11 Price Smith Barney) I09 Cycle Counts Testing Supplier S08 - Vertex NPD, S02 - Compliance Intercept Sales E02-Employee SoundScan Layaways Tax Purchase Spec I01 PO Source SKU Scorecard - HR Receiving Performance V03- Mkt Reactions L60 MDF P09 Coop S03-Polling V01-Price Management I05 SKU Selection Bonus/HR System Inventory Info Tool I35 - CEI K02 ASIS Customer Repair Arthur Planning I35 Early Warning Tracking I18 System Rebate SKU Rep Transfer I55 SKU I07 Purchase Store Information Order Ad Expense Monitor ELT PowerSuite G02 - General Ledger Store Scorecard Texlon 3.5 Sign System NARM I14 Count Corrections Store Budget Reporting Valley Media U16-Texlon B02 Merchandise CopyWriters Analysis BMP - Bus Workspace performance Mngt EDI Coordinator Merch Mngr Approval Batch Forcasting AIMS Journal Entry Tool Kit Ad Measurement A05 - AP AIMS Admin Cellular INVENT ORY CON TROL APPS - PC INVENT ORY CON TROL APPS - PC ACCT S R EC A PPS - PC Code Alarm DPI/C PI 990C OR AIMS Rollover OTHER A PPS - PC Debit R eceivin gs IC Bat ching Bad D ebt Ad Reporting S05 - House AP - Collection s/Cr edit Devo Sales Inventor y Adj/Count Corr ect Ben efical F ees TM - Credit C ard D B Display Inventor y Inventor y Control Reports Ben eficial R econ cil Launcher Charges In Hom e Inventor y Lev els JEAXF Jun kout s Inventor y Roll JEBF A US Bank Recon Merch an dise W ithdrawl Merch an dise W ithdrawl Optika JEBK A PSP File Prom o Cr edits Open Receiving s JEDVA C02 - Capital RTV Accru al PI Co unt Result s JESOA Shrin k PI Tim e Results from Inv JEVSA Projects Connect 3 ICMS Credit AP R esear ch - Inv Cntrl Price Prot ectio n JEVSF AP R esear ch- Addl Rpts Sales Flash R eportin g SiteSeer NSF In-Home Book to Perp etual Inventor y Shrin k R epo rting TeleCr edit F ees Data Warehouse Repair Close Out R ep orting SKU Gro ss M argin Connect 3 Connect 3 Computer Intelligence D ata SKU Shrink Lev el D etail (Interfaces to and from the Cash Receipts/Credit PDF Transfe Reports Count Corr ections USM Data Warehouse are not F06 - Fixed Cross R ef for VCB Dn lds VCB Do wnload s displayed on this diagram) Warranty Assets Misc Accounting/Finance Apps - PC/NT Dam ag e W rite Off Billing COBA (Corp office Budget Assistant) Debit R eceivin gs Star Repair PCBS(Profit Center Budget System) System Cash Over/ DFI Vend or D atab ase Display Inventor y Recon cil Short Merchandising Budget Display Inventor y Reporting Pr epared b y Mich elle Mills64 Smarter Healthcare © 2010-2011 IBM Corporation 32
  • LIRIS Blue Academy 2010-2011 Healthcare information infrastructure A true system of systems Traditionally, healthcare institutions Hospital Information System have invested in siloed EHR applications and infrastructure Admin and planning PACS/RIS Collaboration, e-mail Claims and payment e-Learning Telecare Transmural communication Manuals, literature There is a need for an integrated environment for all healthcare GP Information System stakeholders Pharmacy Information System Laboratory Information System65 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Average dept.-hospital-region-country: point-to-point66 Smarter Healthcare © 2010-2011 IBM Corporation 33
  • LIRIS Blue Academy 2010-2011 The data explosion 67 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Challenges of smarter medical data managementStatic data! xIS 500 MB/4D Structured Shipped PBs image PACS Unstructured 1 MB/2D image 2005 2006 2007 2008 2009 2010 2004 2009 Around 85% of all Shipments of storage 30% of world-wide medical data is capacity grows with storage consists of reference data/fixed 54% per year medical images content (e-mail, video, images) “I am in the business of taking care of patients here. I am not in the business of specializing and managing data storage” 68 Smarter Healthcare © 2010-2011 IBM Corporation 34
  • LIRIS Blue Academy 2010-2011Healthcare infrastructure pain points Complexity Surge in criticality, value and volume of data Under-, over- and misutilization of servers and storage Security, role-based access to data (IAA) Reliability, availability and serviceability (RAS) Future investments Integration of new medical technology Resources MI is symptomatic of a non-human disorder which is characterized by Suffering from working inefficiently; storing multiple duplications of data in non-integrated Multiple data systems. Informatiose Theo van der Ven (Royal Haskoning in The Lancet)69 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Healthcare Integration Framework (HIF)SOA based blueprint for smarter integration and interoperability Business Innovation & Optimization Services Facilitates better decision-making with real-time business information Development Interaction Services Process Services Information Services Services Orchestrate and automate Enables collaboration between business processes Manages diverse data in a Management people, processes & information unified manner IT Service Enterprise Services Bus Integrated environment for design and Partner Services Business App Services Access Services Info Assets creation of Manage and Apps & solution Connect with trading partners Build on a robust, scaleable, Facilitates interactions with secure assets and secure services existing information and services, environment application assets applications & resources Infrastructure Services Optimizes throughput, availability and performance Strategic platform for healthcare and life sciences solutions, focused on helping clients to build, extend and transform existing infrastructures incrementally over time through re-use of an extensive set of business services, industry-specific extensions and built-in support for industry, business and technology standards.70 Smarter Healthcare © 2010-2011 IBM Corporation 35
  • LIRIS Blue Academy 2010-2011 Use (inter)national standards HL7 Integrating the Healthcare Enterprise Open Health Tools (OHT) Continua Health Alliance COCIR SNOMED ICD-9, ICD-10 LOINC KMEHR DICOM ISO 1360671 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 IHE – Integrating the Healthcare Enterprise IHE drives the adoption of standards to address specific clinical needs by creating a framework for passing vital health information seamlessly across the entire healthcare enterprise – From application to application, system to system and setting to setting IHE currently supports the following domains: – Cardiology – Eye Care – IT Infrastructure – Laboratory – Patient Care Coordination – Patient Care Devices – Quality, Research and Public Health – Radiation Oncology – Radiology http://www.ihe.net or http://www.ihe-nl.org72 Smarter Healthcare © 2010-2011 IBM Corporation 36
  • LIRIS Blue Academy 2010-2011 Telecare (Health 1.0) Deliver collaborative care for prevention and wellness. eConsult (e.g. e-mail, SMS, Twitter) – Rob Mol, www.internetdokter.nl – Prof dr George Henneman, www.mijnspecialist.nl – Erik Jansen, Nijmegen Remote Patient Monitoring (e.g. Health Buddies) Education On-line treatments Video conferencing e-Fitness e-Appointment (e.g. SMS, RememberTheMilk) e-Prescription Medication loyalty (e.g. SMS) Family care73 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Teledoctor (Cisco July 2008) Improve operational effectiveness.74 Smarter Healthcare © 2010-2011 IBM Corporation 37
  • LIRIS Blue Academy 2010-2011Telemonitoring Alert Data Data Data Server Calendar Athlete Nourish and exercise schemes Deliver collaborative care for prevention and wellness.75 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Telemedicine through satellite communication Tristan da Cunha Deliver collaborative care for prevention and wellness.76 Smarter Healthcare © 2010-2011 IBM Corporation 38
  • LIRIS Blue Academy 2010-2011 Patient Centered Medical Home Health and Welness Scenario - Obesitas + Diabetes Type 2 PHR Cloud Devices Device Healthcare Manager Management Wired Glucose Meter Wired Glucose Meter Telemedicine Service Wired Weighing Scale Data aggregation Deliver collaborative care for prevention and wellness. Independent Living Hub Medication Monitor77 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011Speed medical research while preserving patientprivacy in the Academic Medical Center – a biobank AMC had a vision to integrate Clinical and Research environments integrate clinical information of patients and DNA information for research and treatment of patients Achieve better quality and Inflammatory Bowel Diseases (IBD) outcomes. IBM implemented solution which makes integration of data from different sources possible federated data warehouse preserves patient privacy Benefits are significant time savings when gathering data from different databases minutes in stead of weeks or months This solution will enable better research and more accurate diagnoses and tailored treatment, improved patient outcomes. part of the Dutch UMC Research project Parelsnoer.78 Smarter Healthcare © 2010-2011 IBM Corporation 39
  • LIRIS Blue Academy 2010-2011 Achieve better quality and University Hospital of Heidelberg - outcomes. Transforming the treatment of dialysis patients In a groundbreaking pilot study, Benefits of innovation the University of Heidelberg – Increases quality of life for patients wanted to explore the value of – Allows state-of-the-art treatment for patients telemedicine for dialysis patients. regardless of patient or doctor location The German hospital undertakes – Reduces costs for patients who do not have a telemedicine pilot study that to travel to doctors’ offices – enables doctors to adjust dialysis – Ensures the most reliable, precise care possible, eliminating detrimental long-term settings and medication remotely side effects that can result from improper – based on weight and blood dialysis settings or medication amounts pressure measurements sent remotely to a healthcare portal via Bluetooth technology79 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Bedside terminals Improve operational effectiveness.80 Smarter Healthcare © 2010-2011 IBM Corporation 40
  • LIRIS Blue Academy 2010-2011Portals for patients, employees and specialists Univ. of Texas Mayo Clinic King Faisal Memorial Health Duke Medical Cancer Therapy & Cancer Center System Research Center Richardson Danish/Swedish Baby Kiek UZ Gent Regional eHealth Portal MST University Hospital System Medical Center81 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 DenmarkAchieve betterquality andoutcomes. Improve operational effectiveness.Deliver collaborative care forprevention and wellness.82 Smarter Healthcare © 2010-2011 IBM Corporation 41
  • LIRIS Blue Academy 2010-2011 Sweden Deliver collaborative care for prevention and wellness.83 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011eHealth Belgiumhttps://www.ehealth.fgov.be84 Smarter Healthcare © 2010-2011 IBM Corporation 42
  • LIRIS Blue Academy 2010-2011 1 out of 3 patients seek advice of non- medical professionals 14% writes about 6% of on-line disease and companion treatment patient information is wrong 52% goes >14.000 Hyves on-line, 4% 7 out of 10 dealing with asks the consults healthcare general dr. Google practitioner85 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Health 2.0 – patient and citizen a blog a day keeps the doctor away Search engines Self-management, self-care Virtual tours through the human body Medical encyclopedia Wikipedia Blogs for chronic diseases Social networks - The Wisdom of Crowds Life-style management, well-being86 Smarter Healthcare © 2010-2011 IBM Corporation 43
  • LIRIS Blue Academy 2010-2011 Health 2.0 – care provider Professional networks Chatting with patients e-Anamnesis, e-Triage Auctioning of care Serious gaming for surgeons; simulation On-line Q&A, wiki’s On-line treatment (e.g. psychiatry) On-line pharmacy (Health malls, health boulevards, retail-based health clinics) MediumZorg 87 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 MijnZorgNet - the virtual outpatient clinic St. Radboud Nijmegen, Prof. dr Jan Kremer and Prof. dr Bas Bloem“Do not underestimate the patient”“Specialists have lost focus on the patient”“From paternalism to collaboration on the basis of equivalence” 88 Smarter Healthcare © 2010-2011 IBM Corporation 44
  • LIRIS Blue Academy 2010-2011 Personal Health Records (PHRs)89 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 CS Anesthesia Training tool and guide in anestesia Top 1 Medical App in the Netherlands90 Smarter Healthcare © 2010-2011 IBM Corporation 45
  • LIRIS Blue Academy 2010-2011 NeuroMind Tool for medical students, neurology residents, and even neurosurgeons. Developed by Pieter Kubben, resident in neurosurgery (Maastricht University hospital)91 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 181692 Smarter Healthcare © 2010-2011 IBM Corporation 46
  • LIRIS Blue Academy 2010-2011 Sensors of band-aids – cardiovasuclair solutions from Corventis Why now? – 4 billion cell phone users – Broadband 3G – Pervasive connectivity – SmartPhones – Ingeneous Sensors – Nike shoe! Data-driven healthcare innovation93 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Health rabbit WiFi enabled Contact with family Improves/alleviates care experience Pilots at children’s hospitalsDeliver collaborative care forprevention and wellness.94 Smarter Healthcare © 2010-2011 IBM Corporation 47
  • LIRIS Blue Academy 2010-2011 3D Avatar – a visual patient health record Anatomic and Symbolic Mapper Engine New 3D graphical and intuitive way to request, annotate and exchange patient information “Google Earth” of the patiënt, in a relevant clinical context95 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Nationwide Health Information Network (NHIN) RHIO = Regional Health Information Organization Mid-Hudson Valley, NY, Mid-Hudson Valley, NY, Use case scenarios Use case scenarios THINC RHIO THINC RHIO Biosurveillance Biosurveillance 6 counties sharing 6 counties sharing Consumer Empowerment Consumer Empowerment information information Electronic Health Record Electronic Health Record Rockingham Co., NC Rockingham Co., NC NCHICA RHIO Research Triangle Park, NC Research Triangle Park, NC NCHICA RHIO Rural environment, small NCHICA RHIO NCHICA RHIO Rural environment, small practices and regional High-tech, competitive, city High-tech, competitive, city practices and regional hospitals environment environment hospitals96 Smarter Healthcare © 2010-2011 IBM Corporation 48
  • LIRIS Blue Academy 2010-2011 epSOS - Smart Open Services for European Patients Goal for the epSOS eHealth Project: – to develop a practical eHealth framework and ICT infrastructure that will enable secure access to patient health information, particularly with respect to a basic patient summary and ePrescription, between European healthcare systems Challenges to get there: – Legal Interoperability – Organizational Interoperability – Semantic Interoperability – Technical Interoperability Supported by 27 beneficiaries representing 12 EU-member states97 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Servicio Extremeño de Salud (SES) Population of 1 million citizens 8 care regions 104 primary care posts 10 hospitals > 5000 care providers SAP based Improve Achieve better operational quality and effectiveness. outcomes.Deliver collaborative care forprevention and wellness.98 Smarter Healthcare © 2010-2011 IBM Corporation 49
  • LIRIS Blue Academy 2010-2011 Building the hospital environment for the future at Medical Centre Alkmaar Smarter Healthcare starts with the hospital organization • For the Medical Centre in Alkmaar IBM is building the hospital environment for the future. • The integration of Medical Centre Alkmaar and Gemini Ziekenhuis in Den Helder are part of this project. • This is to gain a higher efficiency and open possibilities to build a new IT platform that makes these hospitals ready for the new ways of communication within healthcare. Improve operational effectiveness.99 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Improve the knowledge and diagnostic capability of rare diseases in the UZATHE RARE DISEASE DIAGNOSIS PLATFORM Allows for an earlier, quicker and more accurate diagnosis by integrating both medical expertise and data mining tools Creates direct and indirect value for different stakeholders Rules are generated much faster and accurate by a predictive model based on known patient data In comparison with a pure rule based system, a combination with data mining tools proofs both a higher sensitivity and specificityAchieve better quality and outcomes.100 Smarter Healthcare © 2010-2011 IBM Corporation 50
  • LIRIS Blue Academy 2010-2011 Healthcare Cloud – Storage as a Service Information lifecycle management Improve – Long-term digital preservation operational effectiveness. Exchange hub Applications – Computer Aided Detection – Grid computing Business Intelligence en Analytics – Clinical Decision Support – Datawarehouse – Data mining – Simulation Content Management – Images, ultrasound, film101 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 Cloud-based Medical Imaging and Data Services InSiteOne –Wallingford, Connecticut, V.S. Number of exams: ~43 million Number of images: ~3 billion Standards based –DICOM, HL7, XDS-I –CIFS102 Smarter Healthcare © 2010-2011 IBM Corporation 51
  • LIRIS Blue Academy 2010-2011Evidence services platforms (e.g. Cloud) enable data aggregation,evidence extraction, synthesis and dissemination to consumers, providers,payers, pharma’s, individuals, regulators… Trends Emergence of large scale consortia for data and EHR EHR evidence sharing PHR Evidence PHR Repositories Emergence of innovative & Registries companies for evidence generation & deliveryClaimsClaims HSM Evidence Synthesis Engine RCT RCT Analytics Achieve better quality and outcomes. Evidence Aggregators & providersDevicesDevices The industry is enhancing the traditional static, locally curate evidence with dynamic The industry is enhancing the traditional static, locally curate evidence with dynamic real-time evidence synthesis real-time evidence synthesis103 Smarter Healthcare © 2010-2011 IBM Corporation Healthcare Transformation LIRIS Blue Academy 2010-2011 World Community Grid www.worldcommunitygrid.org Launched in Nov ’04 Mobilize the community >2400 years of computing in first 50 days Technology solving problems Advisory Board of experts in health sciences, technology and philanthropy RFP for new projects d te p le C om FightAIDS@Home launched Nov 21, 2005 30,000 additional devices in first 10 days Art Olson, Scripps AutoDOCK for HIV Protease inhibitors Deliver collaborative care for prevention and wellness.104 Smarter Healthcare © 2010-2011 IBM Corporation 52
  • LIRIS Blue Academy 2010-2011 Achieve better IBM and the Scripps Research Institute quality and outcomes. The Scripps IBM Project Research + = Institute Research Checkmate Virology Bio-patterning Immunology Microfluidics Biochemical Super Anticipate, modeling computing Manage and Contain Pandemics Drug Computational Discovery Biology105 Smarter Healthcare © 2010-2011 IBM Corporation LIRIS Blue Academy 2010-2011 References http://www.ibm.com/ibm/ideasfromibm/us/smartplanet/topics/healthcare/20091006/index.shtml http://www.youtube.com/ibmhealthcare http://www-01.ibm.com/software/solutions/smartwork/healthcare.jsp http://blog.irvingwb.com/blog/2009/10/designing-a-smart-healthcare-system.html http://www.youtube.com/watch?v=hAKy_e5MVXk106 Smarter Healthcare © 2010-2011 IBM Corporation 53
  • LIRIS Blue Academy 2010-2011 Thank you for your attention!107 Smarter Healthcare © 2010-2011 IBM Corporation The LIRIS Blue Academy 2010-2011 Thank You for attending this Lecture on “Smarter Healthcare” An initiative from L.I.R.I.S. and IBM Belgium Dr N.S. Hekster Industry Technical Leader Healthcare & Lifesciences © 2010-2011 IBM Corporation 54