Notes for the Presenter: This deck sets out: the vision for Country Transformation, why investment in a broadband infrastructure is needed and how this involves the interconnection of infrastructure needed to support a number of e-Services, one of which is Health Global health trends show that developing countries have to deal with significant levels of both communicable and non-communicable diseases. Measures of the burden of illhealth show that many of the risk factors are associated with poverty. Poverty exacerbates illhealth and vice versa. In addition, health manpower is not where the burden is greatest Cisco’s point of view on Connected Health is that in focusing on connected health communities ICT can play a key role in meeting goals for both health and development. The path to Connected Health begins with understanding that health systems as a whole can be strengthened by investment in ICT, and then starting by improving public health systems and health knowledge, and then delivering telehealth, working towards Connected Hospitals and then creating a Connected Health Provider Community with Connected Health Consumer Communities seen as an increasingly important part of the Health System. The evolution of a Connected Health community involves addressing what functionality can be afforded. Working towards transformation, therefore, involves assessing the makeup of the socio-economic and health systems at country level and below, and then considering (and using appropriate case studies) what opportunities there are for making progress for connecting health organisations, health workers, citizens and communities.
First and foremost, healthcare for all is a fundamental responsibility of government. It’s an essential economic function; after all, a healthy nation is a productive and competitive one. Healthcare has not only to be accessible and affordable, but it must also be responsive – to the specific, constantly-changing medical and clinical needs of patients, and to the broader demographic, social and cultural shifts which typify the modern world, and are more clearly defined in emerging economies than anywhere else.
New technology is crucial to the successful delivery of modern healthcare services. Information and communications technology, or ICT, has proven to be a massive influence on growth, efficiency and innovation worldwide. ICT integration, in which once-disparate areas of infrastructure are unified and consolidated, is especially important. It is common for healthcare to be viewed as an expensive function, scattered inefficiently across different, discrete areas – general practice surgeries, local clinics, specialist consultancies and other points of delivery. And since today's advanced hospital networks typically run more than 300 applications, it can be costly to share data between healthcare professionals across a fragmented ICT infrastructure. The promise of healthcare integration concentrates the minds of governments, prompting them to focus on healthcare as a worthwhile and wide-ranging social and economic benefit. It is Cisco’s goal to make it easy and practical for healthcare professionals in emerging markets to share vital medical, clinical and patient information, in turn fostering a culture that perpetuates the idea of an integrated service, with the patient at its heart.
The Solution Data available when patient comes to clinic Automation of electronic data collection & electronic health educational content for family visits Potential roll out to 60k Mobile Rural Health Workers Results Reduced time between data capture and analysis
The key challenges for radiologists in current imaging workflows are the wasted time in tracking and locating referring physicians to communicate results, the inability to maintain a record of the results notification and acknowledgement interactions with referring physicians for regulatory compliance purposes, and the lack of collaboration tools and screen-sharing capabilities that limit the effectiveness of current interactions with referring physicians. Leading healthcare organizations have made large investments in Picture Archiving and Communication Systems (PACS) to enhance clinician productivity and to increase the effectiveness of using digital imaging to provide accurate and timely diagnosis of various conditions. PACS investments have been focused on optimizing the presentation, distribution, storage, and retrieval of patient images, but have not addressed the integration of physician-to-physician communication and collaboration into imaging workflows. Radiologists still largely rely on manual processes to communicate and collaborate with referring physicians. This not only affects radiologist productivity, but impacts patient safety and patient care. There is a growing need to simplify, streamline and enhance the timeliness of communications and collaboration between clinicians. The University of Wisconsin solution gives Radiologists the flexibility to communicate patient results to referring physicians using the most appropriate mode of communications, based on acuity of care, and criticality of the results and the patient. When radiologists need to communicate unexpected results to referring physicians, they no longer have to waste time making multiple calls or waiting for responses to pages to find the right clinician to communicate results. The Cisco Unified Presence Server presents the radiologist with a filtered list of clinicians that is relevant for that patient study, along with their presence, availability, and preferred mode of contact. One of the key sources of value from the solution is the ability to capture and store an auditable record of results communication and acknowledgements between radiologists and referring physicians. The ability to collaborate and share the same screen will also enhance radiologist and referring physician productivity. The solution will streamline the workflow by enabling radiologists to push specific images to referring physicians and share the same screen while they highlight the areas of interest. In addition, no patient images are transferred, which eliminates privacy and latency concerns.
Cisco is committed to healthcare from our highest executive: &quot; The prime drivers in health care are very similar to what drives other businesses - first, improving service to customers, second, cost reduction. Medical costs are growing almost out of control. Those organizations that can find a way to contain medical costs and provide a higher level of service are going to have a huge advantage. Cisco hopes to supply that advantage to its customers by consolidating health-care voice, video, and data on a single network.&quot; John Chambers, CEO, Cisco
Ontario's northern sector, on the other hand, is often referred to as a province within a province. The area is roughly the size of Texas and California combined, yet it is home to fewer than 1.5 million residents. In such a sparsely populated land, healthcare providers constantly battle shortages of health professionals, distance barriers, isolation, escalating health care costs, and the demands of serving the diverse needs of distinct populations. Of course, serving an isolated population is a challenge for medical professionals. It is impractical for every specialty to represent itself in such a region, yet medical challenges in which time is a critical factor arise regularly. The Clinical Collaboration solution is a cost-effective, audio and videoconferencing system. As easy to use as dialing a telephone, it fosters improved communication among geographically dispersed users leading to improved productivity. Geographically dispersed isolated clinical experts can be called in on a case without having to travel, saving time, money and often lives. One of the mission critical services that OTN delivers over the Cisco Medical-Grade Network is Telestroke. Telestroke brings together videoconferencing and CAT scan Diagnostic Image Sharing over the network. Using this equipment, specialists around the province are on 24-hour call to assist hospitals in rural and remote areas. In the early hours of a stroke, doctors can use a drug to break down the blood clot and reverse the attack, but the same drug can also make a patient bleed to death. So doctors use OTN to reach experts quickly so that they can receive direction on how to properly administer the drug in the few hours that it can make a difference. OTN’s use of telemedicine saves the province of Ontario about Canadian $8 million each year in travel costs alone. OTN may also contribute to patients in Northern Ontario avoiding hospital visits entirely. Studies show that decreased access to medical care results in increased hospitalization rates. Such is the case for Northern Ontario, where hospitalization rates are 25 percent higher than the provincial average. Surveys show that more than 90 percent of patients who received telemedicine services were “satisfied” or “very satisfied” with the experience.
The technology foundation for Connected Health is what we call a “Medical-Grade Network.” The Medical-Grade Network is designed to meet the key technology requirements for healthcare customers: to reduce the complexity of their ever-growing networks, and to lower the total cost of ownership of their network investments. Principles of MGN: No info are created/managed/transported manually – electronic devices + nw Info are stored as they are created: nw + storage systems Info are coherent, not redudant/duplicated (created once): centralized DC + normalization of Info (metadata) Info are available everywhere – anytime (any device?) (used anytime): nw (knows device) + DC An optimized network architecture for the healthcare industry based on best practices for real-time collaboration, resiliency, security, responsiveness and interactivity The MGN architecture : Industry-specific framework for defining network strategies and policies Maps clinical and business needs to technology solutions Optimizes interactions between processes, applications, and technical architecture components Facilitates business and clinical communications throughout the continuum Enhances collaboration across the technology partner ecosystem Criteria and checklists for network efficacy and assessments The MGN architecture is not: A static end state One size fits all A detailed network design A bill of materials A capital and operating budget An implementation guide Specific metrics for performance and availability The Medical Grade Network supports: Communication needs for clinicians, patients, administrators and partners Healthcare requirements for availability, security, and fault tolerance Healthcare’s unique information, technology, bandwidth, and integration challenges Anytime, anywhere information capture and access for wired and wireless applications and devices Converged data, voice, and video networks enhancing patient care collaboration Application, medical device, and workflow messaging supporting clinical and business processes Identity and policy-based privacy and security from inside the network to beyond organizational walls Transfer and storage of large data amounts (for example, MRI images) created by healthcare applications Adaptive and intelligent network management operations
To continue to thrive in the competitive healthcare industry, Florida Health Care Plans wanted to empower its employees to communicate more effectively, using voice, video, and Web collaboration. The ability to reach the right person the first time would strengthen the company’s appeal to members and employers, plus increase employee productivity. Another part of their strategic plan was to migrate from paper charts to electronic health records (EHRs) that clinicians and administrators can securely access from a Web browser. Employees now use Cisco Unified IP phones or Cisco Unified Personal Communicator software, a desktop application that integrates all communications applications and services, including instant messaging, an employee directory, call lists, unified messaging, and presence information, which shows if an employee is currently available and the preferred contact method. Employees can quickly initiate a call from within Microsoft Outlook with the click of a button. Cisco Unity Unified Messaging is integrated with Microsoft Exchange, which makes it just as easy to forward a voicemail message as an e-mail message. Savings projections include: $10,000 monthly savings for prescription refill calls: Members who call a toll-free number for prescription refills and need to be transferred to the pharmacy are now transferred over the IP network at no cost instead of over the public switched telephone network. This eliminates the previous T1 lease costs and long-distance charges. $11,000 monthly savings on long distance. Previously, FHCP pre-committed to $200 monthly in long distance for each of its 13 primary care facilities. Now the company aggregates all long-distance calls at its two data centers to eliminate this surcharge and receive a lower long-distance rate. “Our $16,000 monthly long-distance bill has been reduced to $5000,” says Fielder. $10,000 annual savings on maintenance compared to when FHCP had 13 PBX systems. Employees can reach each other more quickly with Cisco Clinical Collaboration features such as online employee directory, four-digit dialing, and presence. Approximately 150 employees use Cisco Unified Personal Communicator on their laptops, giving them access to voice, video, instant messaging, Web conferencing, voicemail, and presence information—all from one easy-to-use interface. Practice managers can meet virtually, using Cisco Unified MeetingPlace Express for voice, video, and Web collaboration, including sharing documents. They join the sessions from their office or home using a Cisco Unified IP Phone 7971G with built-in video or Cisco Unified Video Advantage.
The University of Miami is using Cisco Unified IP Phones with video screens to provide counseling, education, and resources. Today, family members usually do not receive training to care for people with illnesses such as Alzheimer’s disease and can become overwhelmed by behavioral problems and memory loss as well as basic caregiving activities such as bathing and feeding. Part of the problem is that many caregivers cannot leave home to obtain resources or attend support groups. Therefore, a need has emerged to provide training to everyone, everywhere —including their own or a relative’s home. In response, the Center on Aging and other organizations developed a program called Resources for Enhancing Alzheimer’s Caregiver Health (REACH), funded by the National Institute on Aging and National Institute of Nursing Research which are part of the National Institutes of Health. In the first phase of the project at the University of Miami site, family caregivers were given phones with built-in screens that could display text-based instructions on topics that the caregivers selected from menus. Caregivers also participated in telephone support groups with other caregivers. The initial project was successful, and the Center on Aging decided to expand the intervention by adding video. The Center on Aging selected the Cisco Unified IP Phone 7985G for the program because of its large display area, buttons that caregivers could press to select different options, and the ease of programming to display text-based information based on caregivers’ menu selections—and also because telephones are a more familiar technology to this population than computers. Giving family members the resources and support that they need has a significant economic impact. Currently, there are 22 million family caregivers in the United States alone, a population expected to increase to 37 million by 2050. The estimated economic value of family-provided care is US$257 billion annually.
Connected health venfinal
Salud Conectada Debra Sloane Healthcare Business Development Manager Public Sector – Emerging Markets February 18, 2009
The Cisco Vision: Connected Health <ul><li>"The prime drivers in health care are very similar to what drives other businesses - first, improving service to customers, second, cost reduction. Medical costs are growing almost out of control. Those organizations that can find a way to contain medical costs and provide a higher level of service are going to have a huge advantage. Cisco intends to supply that advantage to its customers by consolidating health-care voice, video, and data on a single network." </li></ul>John Chambers CEO, Cisco
Agenda <ul><li>The Opportunity for Transformation </li></ul><ul><li>Connecting Healthcare Around the Globe </li></ul><ul><li>?Preguntas? Gracias </li></ul>
Conectado Salud <ul><li>The Opportunity for Transformation </li></ul>ICT is crucial to sustainability because it makes a country’s economy more efficient and globally competitive, improves health and education services, and creates new sources of income and employment for all people. Information and Communications for Development, The World Bank, 2006
The Opportunity for Transformation <ul><li>Healthcare: a primary responsibility of government </li></ul><ul><ul><li>Essential to nation’s future </li></ul></ul><ul><ul><li>Must be accessible and affordable for all citizens </li></ul></ul><ul><ul><li>Transformation goals must align with demographic, social and cultural issues </li></ul></ul>
<ul><li>Worldwide, healthcare is one of the largest economic sectors Sample share of Gross Domestic Product (GDP) spending for healthcare: </li></ul><ul><li>Venezuela: 4.7% </li></ul><ul><li>Chile: 6.1% </li></ul><ul><li>Brazil: 8.8% </li></ul><ul><li>United Kingdom: 8.1% </li></ul><ul><li>Mexico: 6.5% </li></ul><ul><li>Healthcare costs are sky-rocketing worldwide due to demographic change, growth of chronic diseases, inefficient workflows </li></ul>Healthcare Worldwide Challenge: Improve ROI of each dollar spent in healthcare by creating an infrastructure able to create by technical and clinical efficiencies for improved present and future outcomes.
<ul><li>Continuum of Care: Kaiser Permanente (largest non-profit healthcare provider in U.S.) reports a 22% greater cost efficiency through use of an integrated system to provide bi-directional communication between patient and clinician.* </li></ul><ul><li>Patient access: 15% reduction in number of patients required to travel to a specialist in Nigeria due to a government-sponsored village practitioner education initiative. </li></ul><ul><li>Patient access: 30-month ROI pay-back on installation of UC Call Center in Florida to connect patients-at-home to out-patient Call Center. </li></ul><ul><li>Patient access: 8Mil saved in clinician travel due to province-wide telemedicine network for video-based telemedicine appointments. </li></ul><ul><li>Connected patient data: In Slovakia, doctors saved 2.5 hours per day with patient data available at point-of-care. </li></ul><ul><li>Connected patient data: In Australia, clinicians can spend 10% more time with patient during daily rounds with of patient data made available at point-of-care. </li></ul><ul><li>* New York Times, Feb 1, 2009 </li></ul>The Opportunity for Transformation: ROI Data
The Opportunity for Transformation: Improving Patient Outcomes <ul><ul><li>Improve patient access to care provider </li></ul></ul><ul><ul><li>Increase secondary care capacity </li></ul></ul><ul><ul><li>Improve resource planning </li></ul></ul><ul><ul><li>Improve point-of-care info availability </li></ul></ul><ul><ul><li>Manage infectious and chronic disease </li></ul></ul><ul><ul><li>Create more efficient clinical workflow and process </li></ul></ul><ul><ul><li>Make healthcare worker education available and up-to-date </li></ul></ul>
Conectado Salud Connected Healthcare Around the Globe
Sichuan Province Earthquake Rebuilding Foundation for regional health information network for Disease Monitoring and Telehealth Services Connectivity across the province County Health Network Newly built, smaller Tier 2 hospital with Medical Grade Network, acting as a “Spoke” and connected to the Hub Sichuan Province Health Network 1 2 3 Other Tier 2 / 1 Hospital Tier 3 Connected Hospital Other Tier 2 / 1 Hospital Other Tier 2 / 1 Hospital Pilot Tier 2 Connected Hospital Major upgrade to Medical Grade Network to an existing, Top Tier facility, to act as a “Hub”
VA Caribbean Hospital, Puerto Rico <ul><li>Challenges </li></ul><ul><li>Equipment due for preventive maintenance cannot be located on time and valuable staff time is spent searching for equipment </li></ul><ul><li>Staff perform manual temperature monitoring and logging of lab refrigeration units and clean utility rooms. Logging mechanisms are unreliable and labor is utilized inefficiently </li></ul><ul><li>Safety issues due to elderly patients wandering unattended out of nursing homes </li></ul><ul><li>Loss and theft of laptops </li></ul><ul><li>Solution </li></ul><ul><li>Deployment of a Cisco Unified Wireless Network. </li></ul><ul><li>Asset tracking of infusion pumps, defibrillators, ventilators and beds with AeroScout T2 Tags over the Wireless Network. </li></ul><ul><li>Chokepoint Exciters at exits of nursing homes instantly detect wandering patients </li></ul><ul><li>Alerts are sent to hospital staff via Cisco VOIP 7920 & 7921 phones </li></ul><ul><li>Automated temperature monitoring of utility rooms and lab refrigerators with AeroScout temperature sensor tags </li></ul><ul><li>Benefits </li></ul><ul><li>Increased patient safety </li></ul><ul><li>Improved search times and utilization of equipment </li></ul><ul><li>Increase efficiency of staff </li></ul><ul><li>Improved regulatory compliance </li></ul><ul><li>Minimize loss and theft of equipment </li></ul>
Mexico: Mobile Health Workers for Community Outreach <ul><li>Challenge: </li></ul><ul><ul><li>Increase worker productivity and family interaction </li></ul></ul><ul><ul><li>Improve data collection accuracy </li></ul></ul><ul><ul><li>Decrease delay between collection and analysis </li></ul></ul><ul><li>Solution: </li></ul><ul><ul><li>eForms auto-complete with information in database. Vaccination tracking for people </li></ul></ul><ul><ul><li>Data sync @ clinic & stored on local server </li></ul></ul><ul><ul><li>Educational content to share with the families visited </li></ul></ul><ul><li>Results so far: </li></ul><ul><ul><li>Deployed 40,000 Class Mate PCs (CMPC) in 90 days </li></ul></ul><ul><ul><li>Improved worker efficiency- data accuracy & analysis – and ability to efficiently download data for transmission to Govt Agency. </li></ul></ul>Healthcare Govt Agency Data Collection CMPC eForms from ISV PC Basics, Intel Teach, BKMs Next Phase WiMAX, 3G Rural Healthcare Delivery Policy Usages Platforms Content Content Scaling
University of Wisconsin Hospital <ul><li>Integration of Unified Communications tools with PACS </li></ul>Business Results <ul><li>Streamline communication between radiologists and referring physicians </li></ul><ul><li>Reduce down-time of scarce radiologist resources </li></ul><ul><li>Capture and store an auditable record of results communication and acknowledgment </li></ul><ul><li>Improve efficiency in communicating imaging results between radiologists and referring physicians </li></ul><ul><li>Maintain a record of results notification and acknowledgment </li></ul><ul><li>Meet stringent regulatory and audit requirements </li></ul>Business Need Cisco Solution
Children’s Cancer Hospital Egypt 57357 <ul><li>Establish Unified Communications throughout the facility to: </li></ul><ul><li>Improve access to critical patient data in all hospital units </li></ul><ul><li>Capture and identify trends for epidemiological study </li></ul><ul><li>Reduce costs by using single network across multiple applications </li></ul><ul><li>Results help to sustain this charity-funded hospital </li></ul>
Ontario Telemedicine Network <ul><li>Cisco Clinical Collaboration </li></ul><ul><li>Cisco videoconferencing stations with audio, video, and data capabilities for remote evaluation and diagnosis </li></ul>Business Results <ul><li>Saved $8 million in provincial medical travel </li></ul><ul><li>Network hosts more than 32,000 clinical consultations a year </li></ul><ul><li>To deliver expert, cost-effective healthcare to citizens in remote locations </li></ul><ul><li>Overcome shortage of healthcare professionals and medical facilities </li></ul><ul><li>Serve the diverse needs of distinct populations </li></ul>Business Need Cisco Solution
Connected Health Vision Cable DSL Dial Patients / MDs at home Pharmacies State Agencies Suppliers IVSS Laboratories Hospitals Clinics Universities Barrio Adentro Long Term Care Diagnostic Centers Connected Health Core WiMAX/3G Remote Areas (( ))
Connected Health <ul><li>Reliable & Available </li></ul><ul><li>Secure </li></ul><ul><li>Communications and Mobility </li></ul><ul><li>Any Service, Anywhere </li></ul><ul><li>Clinical Applications </li></ul>Medical Grade Network Architecture Places in Health Sector <ul><li>Central Hospital </li></ul><ul><li>Barrio Adentro </li></ul><ul><li>WAN </li></ul><ul><li>Diagnostic Clinic </li></ul><ul><li>Laboratory </li></ul><ul><li>Pharmacy </li></ul>Connected Health Experience Connect Communicate Collaborate <ul><li>Patients </li></ul><ul><li>Clinicians </li></ul><ul><li>Nurses </li></ul><ul><li>Ancillary Care </li></ul><ul><li>Administration </li></ul><ul><li>Organisations </li></ul><ul><li>Research Ctr </li></ul><ul><li>Patient Home </li></ul><ul><li>LAN </li></ul>Convergence Reduced Cost, Efficiency, Functionality <ul><li>Patient Safety </li></ul><ul><li>Quality of Care </li></ul>Business Drivers <ul><li>Patient Satisfaction </li></ul><ul><li>Cost Efficiencies </li></ul><ul><li>Staff Retention </li></ul><ul><li>Regulatory Compliance </li></ul>Data Voice Video Mobility
Florida Health Care Plans Agency <ul><li>Deploy Unified Communications tools for voice, video, and web collaboration </li></ul><ul><li>Disaster recovery site for electronic health records </li></ul>Business Results <ul><li>Payback on investment in 30 months </li></ul><ul><li>Patient and Staff Satisfaction: Easier for members and employers to connect the first time </li></ul><ul><li>Improve member service </li></ul><ul><li>Reduce contact center costs </li></ul><ul><li>Ensure reliable access to electronic health records </li></ul>Business Need Cisco Solution
University of Miami Center on Aging <ul><li>Provide video-based counseling and skills training and educational seminars to the home via Unified Communications </li></ul><ul><li>Text-based tips and resource lists to the IP phone. </li></ul>Business Results <ul><li>Enable informal network of caregivers to access formal support and resources without leaving the home and family member </li></ul><ul><li>Provide cost-effective training and information </li></ul><ul><li>User-friendly technology footprint </li></ul><ul><li>Help reduce elderly patient-reports of isolation, loneliness, burden, and distress </li></ul><ul><li>Help family members to serve as an extension of the medical community. </li></ul>Business Need IT Solution