2012-09-05
Healthcare
Casper Abraham
http://www.edgevalue.com
casper@edgevalue.com
JAN 2003
Business Models, Strategy, Ideas
Healthcare Business Model
Medical
Diagnostics
& Imaging
Lab.
Out-Patient
CARE
In-Patient
CARE
Doctor
Community
Hospital
& ...
Medical Cover ‘change’
aspects
1. Traditional Care & Medical Insurance.
1. Since 1900’s. Lifetime employment with 1 compan...
Healthcare Opportunities
SAS
* Statistics
* Clinical Research Solutions
* Enterprise Intelligence
Electronic Information
*...
Areas of Coverage
1. IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
2. IS 02 Biosurveillance
3. IS 03 C...
Coverage Details
• IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
• The Electronic Health Records Labor...
Coverage Details
• IS 05 Consumer Empowerment and Access to Clinical Information via Media
• The Consumer Empowerment and ...
Coverage Details
• IS 09 Consultations and Transfers of Care
• The Consultations and Transfers of Care Interoperability Sp...
Coverage Details
• IS 11 Public Health Case Reporting
• The Public Health Case Reporting Interoperability Specification su...
Mathematic Inc. USA perception
1. Improving Self-Care and Care Management
Interactive technology holds promise for helping...
Entry Points … sick.
Healthcare
MIS
DICOM
Medical
Transcription
HIPAA / HL7
Nurses / Manpower
Medical Equipment
Accessorie...
Entry Points … well.
Healthcare
Dental
Chinese
Routine
Checkup
You’re ok, Software
Health Foods
Gyms & Equipment
Accessori...
2012-09-05
Strategy
1. Positioning.
1. Charity.
2. IPO Public Profit.
3. Private Profit.
2. Model
1. Single. General, Spec...
Moral & Legal
1. Moral
1. Minority, Public Good or Profit.
2. Capacity. Spread. Reach. Modalities.
2. Legal
1. Statutory a...
Touch Point(s)
1. Doctor - Patient (usually 1 to 1)
2. Patient - Nursing Staff. (usually many to 1)
3. Patient - Attendant...
Numbers, Figures, Data
Facts of ‘doctor-time-data ..’
1. more time with your physician is spent in obtaining a past medical
history than attendin...
Issues in the USA
1. Big Pharma
1. Protecting R&D investments.
2. Generic & other competition.
3. Marketing costs of US $ ...
Where’s the money …
1. USA, 25% of Healthcare expenses/income from the last 6 months of
a patient …
2. 50% of Healthcare c...
Industry Types
1. Key-Large Industries
1. Medical Equipment
2. Pharmaceutical.
3. Bio-Pharmaceutical.
4. Bio-Technology
2....
Market activity ...
1. Clinical Research cycle of 15 years; $ 800 M
2. A lot of M&A activity; in the non-core areas.
3. Fr...
More USA numbers
1. Pharmaceutical industry figures
1. Big 5, R&D and others.
2. US affected
1. 20% (of 270 M population) ...
US Nursing needs
1. Year 2002.
1. Current capacity is 1,200,000.
2. Current shortage is 11%. ie. 125,000
2. Year 2010
1. N...
US Healthcare Industry
1. Current Health Insurance ‘focus’ on symptoms
disease rather than prevent/cure ..
2. Alternate .....
Counterfeit Problem
1. 8% of drugs entering the US is counterfeit.
2. In some countries as high as 65% is counterfeit.
3. ...
USA IRS & Tax deduction
1. Historical.
1. Single company, 25 years, single-doctor, Company supported.
2. Employer run, ins...
Clinical Research : CR
1. Treatment trials
2. Prevention trials
3. Early-detection/screening trials
4. Diagnostic trials
5...
India TPA’s
1. GIPSA & IRDA
1. National Insurance Company
2. New India Assurance
3. Oriental Insurance
4. United India Ass...
Healthcare Expenses
Source : Medical Expenditure Panel Household Component
Expenses Median
Source : Medical Expenditure Panel Household Component
Disease & Cure
Unfortunately ‘sick’ …
1. Problems & Issues
1. Genetic, Social or Biological : FEW CURES
2. Low diagnostics. Who needs it?...
List of diseases under control
1. Anthrax
2. Gonorrhea
3. Syphilis
4. Typhoid fever
5. Suppuration
6. Cholera
7. Diphtheri...
List of Diseases, little control
1. Single gene
1. Cystic fibrosis
2. Tobacco & Lung Cancer
3. Ageing
1. Rheumatoid Arthri...
Example : Mental illness
1. 26 drugs under research for of the depression. 19 million people,
costs the economy an estimat...
Diseases
1. Types
• Genetic
• Social
• Biological
2. Stages
• Pre-Conception
• Fetal
• 1st year
• Childhood
• Teens
• Midd...
Complexity
1. Of evolution & you ..
1. Several organs …
2. Several mechanisms …
3. Several modalities
4. Bacteria, Virus, ...
Mind … Brain
1. The effect of the neuro-endocrine immuno system
is NOT understood at all…
2. The emotional – physical inte...
Race against time
A non-
knowledge
Route
An informed
route
• Saves Time
• Saves Money
• Saves Lives
Information Technology
Modern Healthcare
Information
Technology
SuppliesPeople
Public / Society
Patients
Doctors
Nursing
Vendors
Hospitals & Clin...
Delivery : Fulfillment :
Transaction
1. Supplier Information.
2. Supplier Item or Service.
3. Buyer Information.
4. Buyer ...
Hospital Management Systems
I.T.
PR, eZines,
Communications etc.
Patient Care
Accessories &
Spares Sales
Doctor
Access
Equ...
Current utilisation of IT
1. Access to current medical records.
2. Access to medical history.
3. Access to patient flow sh...
Linen and Laundry Management
Processing
Reject
Central
Store
FRESH
Re-Wash
Used / Billed to
Customer
CASH
Fresh
Purchases
...
RFID Deployment
Clextra based Solutions
1. Stockflow.
2. RFID tagging
3. Consignment Inventory Handling. VMI or CMI.
4. Doctor Information...
Engineering HelpDesk
inetOrgPerson
inetOrgPerson
Organizational role
Organizational person
Organizational person
inetOrgPe...
Patient Care & Issues
Medical Practice
Listen to the Patient's story
One (or more) diagnoses
comes to mind.
Interact. Ask questions.
Gather more...
Doctor ‘Thinking’ ...
1. General, Specialty, Super Specialty.
2. Single-Modality; Multi-Modality.
3. Patient History. (Rec...
Diagnosis
1. Key to solutions. Key to a cure.
2. Any average competent can take over from there.
3. Pattern Recognition.
4...
Components
Patient
• Lifestyle
• Good Health
• Perception
• No risk
Insurance
• Patient
• Doctor
• Administration
• Resear...
Nursing Locations
1. In-Patient;
2. Out-Patient;
3. Home-Care.
4. Attendant Care; (at Clinic / Hospital)
5. Attendant Care...
Possible key-transaction(s)
1. Date (of treatment)
2. Doctor (may be called "provider")
3. Patient
4. Procedure
5. Primary...
Technology Advancements
1. Life Sustaining
1. Intensive Care
2. Ventilator
3. Dialysis
4. Pacemakers
2. Diagnostic
1. CT S...
Healthcare Categorization
1. Modality.
1. Cardiology, Dermatology, Nephrology, ENT,
Ophthalmology etc.
2. ICD
1. Internati...
Well Code
0 Human Being not alive. Brain & legally dead.
1 Very high risk, will die in the next 1 hour, if no medical
inte...
Sales Facts …
1. Health impairment (instead of Disease)
2. No cures, no promises, no expectations, no
answers, no solution...
Transaction Server Model
Based on ‘ALL’ but
Better suited to the
Internet than :-
* X Open Distributed
Transaction Process...
Key to Transaction(s)
1. Who ID.
1. National ID. Social Security Number. Voter ID.
2. Health ID.
1. In-patient number. Out...
Transaction include ...
1. In-Patient Stay. (Large & Long Transaction.)
2. Lab. Test or DI usage or Surgery/Medicine.
3. O...
Managed Care Transactions
BuyerSeller
1. Current scenario with Medical Insurance.
1. Risk evaluation models for health.
2....
DICOM
1. DICOM Hardware & Interfaces
1. Equipment Interface
2. Box
3. General purpose PC; TCP/IP; wireless etc.
2. DICOM S...
SNP Potential
1. Single nucleotide polymorphisms. SNP
identification is of major technological and
commercial significance...
Standards
Adoption of standards
1. HIPAA (for the US), Europe, Asia etc.
2. HL7 Version 2.4 and Version 3.0
3. 21 CFR Part 11 (Elect...
Certifications (USA)
1. Doctors
1. TOEFL
2. USMLE Step 1
3. USMLE Step 2
2. Nurses
1. TOEFL
2. CGFNS
3. IELTS
4. NCLEX-RN
...
Government & Social
Medi-rural
A franchising concept for getting mass
medical treatment going with State
Officials, worldwide.
Regulation
A curious by-product of
‘advanced’ vs less ‘value for
life’ is ‘Regulation’
Healthcare
Regulation
Value for Lif...
Suggested Packages
Super
Specialty Specialty General Basic
Class C CS CP CG CB
Class B BS BP BG BB
Class A AS AP AG AB
Inv...
Components for each
1. Infrastructure. Location. Guidelines.
2. Equipment List. Bill of Materials.
3. Finance Options.
4. ...
Targets (example, Karnataka in
India)
1. End-DEC 2003
1. Class A : 5 in Karnataka; 20 across India.
2. Class B : 10 in Kar...
edgevalue
Ideas; Thoughts; Plans.
(clextra Products support some of them)
Next Practice Healthcare
1. All Doctors Registry. IMA for India. Controls, checks
& balances. Registration. Public verific...
Healthcare Business Model
Medical
Diagnostics
& Imaging
Lab.
Out-Patient
CARE
In-Patient
CARE
Doctor
Community
Hospital
& ...
UHN (Unique Human Number)
1. YYYYMMDDSSSSSSSS
2. Up to 100,000,000 th person born on a particular day.
3. The 9th, 10th an...
Smaller Ideas
1. Front-end; GUI’s & Usage is IMPORTANT
1. Pattern Maps access.
2. Networked / Archived Digital Pen ‘data-e...
A Healthcare Hybrid BPO
1. Nursing
1. Staffing
1. Recruitment. Manning. Attrition & Replenishment.
2. IT
1. BPO related to...
clextra DILABS concept
1. DILABS Connect
1. Hardware Connectivity. DICOM and non-DICOM.
Intranet. API’s.
2. DILABS Xfer
1....
Your single-source partner
1. Establish information needs horizontally and vertically.
Feasibility studies & Budgets
2. RF...
http://www.edgevalue.com
http://clextra.in
casper@edgevalue.com © JAN 1999
62-B Modi Residency, Millers Road
Benson Town
B...
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Healthcare Whitepaper

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With all the focus on Healthcare. Lowering costs, Out-sourcing. Generic drugs. HL7 & HIPAA getting the bigger picture and ensuring SOCIAL and BUSINESS needs are merged is important. Corporate Social Responsibility, Ethics, Values, Transparency ALONG with Business, Revenue, Profit, Patents, Trade-secrets & IPR.

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Healthcare Whitepaper

  1. 1. 2012-09-05 Healthcare Casper Abraham http://www.edgevalue.com casper@edgevalue.com JAN 2003
  2. 2. Business Models, Strategy, Ideas
  3. 3. Healthcare Business Model Medical Diagnostics & Imaging Lab. Out-Patient CARE In-Patient CARE Doctor Community Hospital & Clinic Services Manufactures & Suppliers Multi-Modality DICOM IT & MIS Bio-Tech Know-how Information Data Problem to Solution Desire to Fulfillment Disease to Cure TeleMedicine Managed Care Traditional Care Match Financial Risk Layer Information Layer Service Layer Lifestyle Layer State or Private Freebie or Paid for Credit or Debit Real time or Delayed Availability / Sharing Quality / Integrity Security Home CARE MedicineSurgery
  4. 4. Medical Cover ‘change’ aspects 1. Traditional Care & Medical Insurance. 1. Since 1900’s. Lifetime employment with 1 company. Home & Family close to factory. Works dawn to dusk 6- days a week. Little leisure, minimum travel. Sleep 8 hours every night. 2. Today’s Reality 1. Works with over 10 companies in a career. Changes city. Works 40 hours out of 168. Lifestyle & increased leisure. Wider travel. Irregular and avoidance of sleep.
  5. 5. Healthcare Opportunities SAS * Statistics * Clinical Research Solutions * Enterprise Intelligence Electronic Information * HIPAA / HL7 / NHS etc. * CMM I * Integration opportunities Managed Care * Medical Insurance * Risk Intermediary * Medical Due-diligence * India TPA. Cash less. Life Sciences * Genetics * Proteomics * BioChemistry, Molecular Biology * Bio-Technology : Marine / Plant Manpower * Doctor interaction * Nursing shortage(s) * Home care * Finishing School Learning & Knowhow * Content Management * Syllabus, Courseware. * Administration / Commercial aspects Communications * Doctor interaction * Patient interaction / acceptance. * DICOM and alternate standards * Trade & Industry * Security, Privacy, Legality, Integrity Integration * Allopathic to all others. * Ayurveda. Homeopathy * Chinese Medicine. * Acupuncture * Africa …. CRO / PRO DILABS MT
  6. 6. Areas of Coverage 1. IS 01 Electronic Health Record (EHR) Laboratory Results Reporting 2. IS 02 Biosurveillance 3. IS 03 Consumer Empowerment 4. IS 04 Emergency Responder Electronic Health Record (ER-EHR) 5. IS 05 Consumer Empowerment and Access to Clinical Information via Media 6. IS 06 Quality 7. IS 07 Medication Management 8. IS 08 Personalized Healthcare 9. IS 09 Consultations and Transfers of Care 10. IS 10 Immunizations and Response Management 11. IS 11 Public Health Case Reporting 12. IS 12 Patient - Provider Secure Messaging 13. IS 77 Remote Monitoring
  7. 7. Coverage Details • IS 01 Electronic Health Record (EHR) Laboratory Results Reporting • The Electronic Health Records Laboratory Results Reporting Interoperability Specification defines specific standards to support the interoperability between electronic health records and laboratory systems and secure access to laboratory results and interpretations in a patient-centric manner. • IS 02 Biosurveillance • The Biosurveillance Interoperability Specification defines specific standards that promote the exchange of biosurveillance information among healthcare providers and public health authorities. • IS 03 Consumer Empowerment • The Consumer Empowerment and Access to Clinical Information via Networks Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). This Interoperability Specification defines specific standards needed to enable the exchange of such data between patients and their caregivers via networks. • IS 04 Emergency Responder Electronic Health Record (ER-EHR) • The Emergency Responder Electronic Health Record Interoperability Specification defines specific standards required to track and provide on-site emergency care professionals, medical examiner/fatality managers and public health practitioners with needed information regarding care, treatment or investigation of emergency incident victims.
  8. 8. Coverage Details • IS 05 Consumer Empowerment and Access to Clinical Information via Media • The Consumer Empowerment and Access to Clinical Information via Media Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). This Interoperability Specification defines specific standards needed to enable the exchange of such data between patients and their caregivers via physical media or secure email exchange. • IS 06 Quality • The Quality Interoperability Specification defines specific standards needed to benefit providers by providing a collection of data for inpatient and ambulatory care and to benefit clinicians by providing real-time or near-real-time feedback regarding quality indicators for specific patients. • IS 07 Medication Management • The Medication Management Interoperability Specification defines specific standards to facilitate access to necessary medication and allergy information for consumers, clinicians, pharmacists, health insurance agencies, inpatient and ambulatory care, etc. • IS 08 Personalized Healthcare • The Personalized Healthcare Interoperability Specification describes family history and genetic/genomic lab order and results which are used to provide personalized treatment specific to genetic makeup.
  9. 9. Coverage Details • IS 09 Consultations and Transfers of Care • The Consultations and Transfers of Care Interoperability Specification describes the information flows,ISsues and system capabilities that apply to: 1. a provider requesting and a patient receiving a consultation from another provider 2. a provider requesting a transfer of care for a patient and the receiving facility admitting the patient. ItIS intended to facilitate access to information necessary for consultations and transfers for consulting clinicians, referring clinicians, transferring facilities, receiving facilities and consumers. • IS 10 Immunizations and Response Management • The Immunizations and Response Management Interoperability Specification focuses on: 1) providing information about individuals who need to receive specific vaccines, drugs, or other interventions; 2) the ability to report, track, and manage administration of vaccines, drugs,ISolation, and quarantine; 3) the ability to identify and electronically exchange information describing the treatment or prophylaxis status of populations; 4) the ability to exchange specific resource and supply chain data from public and private sectors.
  10. 10. Coverage Details • IS 11 Public Health Case Reporting • The Public Health Case Reporting Interoperability Specification supports the bi- directional information exchanges of the Public Health Case Reporting process. It focuses on enabling more efficient data capture at the point of care while allowing for optimizing the information delivery format and content allowing for current SDO efforts to be finalized. In the absence of standards in structured content and associated Clinical Decision Support for alerts and information reporting criteria, this Interoperability Specification provides options for the secure communication of basic presentation preserving content to better automate the current paper-based information flows. • IS 12 Patient – Provider Secure Messaging • The Patient-Provider Secure Messaging Interoperability Specification describes the information flows, processes, and system capabilities that are required for patients to interact with their healthcare clinicians remotely using common computer technologies readily available in homes and other settings. • IS 77 Remote Monitoring • The Remote Monitoring Interoperability Specification addresses the information exchange requirements for the transfer of remote monitoring information from a device physically attached to or used by a patient in a location thatIS remote to the clinician to an Electronic Health Record (EHR) system and/or a Personal Health Record system.
  11. 11. Mathematic Inc. USA perception 1. Improving Self-Care and Care Management Interactive technology holds promise for helping people with chronic illnesses better manage their diseases and prevent costly complications. Through health care appliances—such as glucometers, scales, and stethoscopes capable of transmitting readings over the internet to a central repository—and other technologies for self-care management, patients can obtain diagnostic and monitoring information and play a more active role in their care. These tools can also help people overcome barriers to care, such as limited personal mobility or residence in medically underserved areas. For the Centers for Medicare & Medicaid Services, we are conducting a large-scale evaluation in New York State of home-based telemedicine services. These services for Medicare patients with diabetes use communications and information technology to transmit medical diagnostics and monitoring services between patients and health care providers. We are examining whether patients randomly assigned to receive these services experience improved clinical outcomes and greater satisfaction with care. This study is also looking at factors that facilitate patients' use of the technology. We are evaluating the effectiveness of several care coordination and disease management programs, some of which rely on telemedicine technologies. In addition, we are informing policy discussions about the future direction of personal health records—electronic records of an individual's health information that the individual owns and manages in a secure environment—in reducing disparities and empowering consumers living in medically underserved areas. 2. Changing Incentives to Improve Quality of Care Aligning health care payments with the quality of care provided is an important objective for policymakers and health plans alike. Yet, reaching this goal requires large investments in new technology as well as changes in existing systems and processes. Mathematica is evaluating whether incentives increase the number of physician practices that adopt electronic health records— technology that has the potential to improve care quality and coordination, patient safety and satisfaction, and reduce costs for employers, insurers, and, ultimately, providers. The incentives being studied include technical assistance and pay for performance. We are assessing whether adopting such technology improves outcomes for Medicare beneficiaries with certain chronic conditions. In another project, we are surveying a national sample of hospital medical directors to assess how they are using health information technologies to enhance quality of care and reduce administrative costs. 3. Tracking Real-Time Public Health Data The U.S. public health system plays a vital role in protecting the population against disease outbreaks and potential bioterrorism, in addition to its function in promoting the health of its citizens. Yet, the system is made up of a vast assortment of federal, state, and local agencies providing a multitude of services that affect the lives of millions of people. We have broad experience in assessing the functions and performance of public health systems, and in developing performance indicators and surveillance systems to monitor public health activities. We also have used vital health records for evaluating community-based health interventions in 15 large urban areas across the United States. As electronic health records become more widely available, we can provide technical assistance for linking and analyzing these records and producing real-time data for public health surveillance activities.
  12. 12. Entry Points … sick. Healthcare MIS DICOM Medical Transcription HIPAA / HL7 Nurses / Manpower Medical Equipment Accessories Consumables Integration Services Managed Care mCARD
  13. 13. Entry Points … well. Healthcare Dental Chinese Routine Checkup You’re ok, Software Health Foods Gyms & Equipment Accessories Ayurveda Lifestyle / SpasmCARD gFoods Hair Removal Health Insurance Sports
  14. 14. 2012-09-05 Strategy 1. Positioning. 1. Charity. 2. IPO Public Profit. 3. Private Profit. 2. Model 1. Single. General, Specialty, Super-Specialty. 2. Multi. Self-serving or Hub & Spoke. 3. Global, New Economy Model. 3. Operative 1. ROI Modality-wise, Segment-wise, etc. 2. Efficiency Metrics.
  15. 15. Moral & Legal 1. Moral 1. Minority, Public Good or Profit. 2. Capacity. Spread. Reach. Modalities. 2. Legal 1. Statutory adherence. State & Local laws. 2. Associations, Practice ethics etc. 3. Patient handling, records & legality. 4. Vendor NDA’s, MOU’s, Contracts etc.
  16. 16. Touch Point(s) 1. Doctor - Patient (usually 1 to 1) 2. Patient - Nursing Staff. (usually many to 1) 3. Patient - Attendant Care. 4. Patient - Equipment. 1. Automated. Semi-automated. Manual. Self. 5. Vendor - Hospital Administration. 1. Buyer. User. Decision Maker. Influencer(s). 6. Patient Lifetime Frequency of Touch Points.
  17. 17. Numbers, Figures, Data
  18. 18. Facts of ‘doctor-time-data ..’ 1. more time with your physician is spent in obtaining a past medical history than attending to your current problem. 2. if attending physicians can track long standing medical information they have a better chance of detecting early stages of disease. 3. many people refrain from travelling due to the fear of being separated from their medical record. 4. many individuals postpone medical treatment when travelling or away on business as the are afraid that a new physician will be unaware of their past history. 5. many individuals are inappropriately managed because of lack of past medical data. 6. each year many people die because of adverse medication interactions or drug allergies.
  19. 19. Issues in the USA 1. Big Pharma 1. Protecting R&D investments. 2. Generic & other competition. 3. Marketing costs of US $ 15 Bn in 2000 4. Limited Physician & related influencers. 2. Wall Street 1. Returns on ‘Blockbuster’ drugs. 2. More drug solutions from the US $ 50 Bn. Annual spent on Research. 3. Lower Drug introduction costs. US $ 900 M and 15 years. 3. Other Issues. 1. Doctor(s); Nurses(s); Pharma; Hospital Practice etc. Controls. 2. Economic size & consequent wider ‘business’ interest. 3. Range & Depth of Legal implications.
  20. 20. Where’s the money … 1. USA, 25% of Healthcare expenses/income from the last 6 months of a patient … 2. 50% of Healthcare costs from the last 60 days (2 months) …. 3. In India ‘Life Insurance’ is estimated at Rs. 40,000 billion from a population of 250 million possible … Medical a subset of that. 4. PR. Indirect brand. Identify the ill … 5. INFLOW – From Information only; quick, effective and reliable, during this period. To ALL parties concerned … 6. Consultancy. Diagnostics Leasing. Medication. Hired/leased equipment. Logistics/Travel. Delivery/Conveniences, Nursing & Caring.
  21. 21. Industry Types 1. Key-Large Industries 1. Medical Equipment 2. Pharmaceutical. 3. Bio-Pharmaceutical. 4. Bio-Technology 2. Other-Industries 1. Traditional Care. Medical Insurance. 2. Managed Care.
  22. 22. Market activity ... 1. Clinical Research cycle of 15 years; $ 800 M 2. A lot of M&A activity; in the non-core areas. 3. Fresh insights, developments, ideas … 1. Managed Care 2. Genetics. 3. Bio-Technology. 4. Animal Rights. Activism. Environment.
  23. 23. More USA numbers 1. Pharmaceutical industry figures 1. Big 5, R&D and others. 2. US affected 1. 20% (of 270 M population) Mental illness. 2. 1 in 6 physical impairment (Section 508) 3. Ageing Population. 4. Nursing. 125,000, 11% short. By 2010, 1 million. Figures in brackets is the number of US population affected.
  24. 24. US Nursing needs 1. Year 2002. 1. Current capacity is 1,200,000. 2. Current shortage is 11%. ie. 125,000 2. Year 2010 1. Need will increase by 1,000,000 2. Almost 100% shortage, cannot be met locally. 3. Why is there a shortage? 1. Baby boomers of the 60’s getting older. 2. People are living longer. 3. Divorce. Single-parents. Lower Household units. 4. Not ‘first-choice’ career for local Americans.
  25. 25. US Healthcare Industry 1. Current Health Insurance ‘focus’ on symptoms disease rather than prevent/cure .. 2. Alternate .. 1. US $ 24 bn Fitness Club Industry. 2. US $ 78 bn Vitamins. 3. TOTAL = US $ 200 Bn. In 2001
  26. 26. Counterfeit Problem 1. 8% of drugs entering the US is counterfeit. 2. In some countries as high as 65% is counterfeit. 3. Includes countries such as Spain, England, China, France, Germany, Bahamas, Mexico. 4. US. ‘Operation Safeguard’. 5. Counterfeit types :- 1. 1. Original. BUT expired, wrong dosage or re-labeled. 2. 2. Safe. Alternate ingredients, no benefit could even result in earlier un-timely death. 3. 3. Unsafe. Toxic and/or other spurious ingredients.
  27. 27. USA IRS & Tax deduction 1. Historical. 1. Single company, 25 years, single-doctor, Company supported. 2. Employer run, insurance company dictated, anti-employee AND symptom- oriented, NOT prevention nor cure oriented. 3. Drug company. R&D on $ 800/- cure OR $ 1/- each day for 365 days, rest-of- your-life? 2. From 2003, 100% individual tax deduction on medical insurance. 3. 50 million US citizens are self-employed.
  28. 28. Clinical Research : CR 1. Treatment trials 2. Prevention trials 3. Early-detection/screening trials 4. Diagnostic trials 5. Quality-of-life/supportive care trials Phase 1: Looking at Safety 1. To find a safe dosage 2. To decide how the agent should be given 3. To observe how the agent affects the human body Phase 2: How Well the New Treatment Works 1. To determine if the agent or intervention has an effect on a particular cancer 2. To see how the agent or intervention affects the human body Phase 3: Comparing a New Treatment to the Standard Treatment 1. To compare the new agent or intervention (or new use of a treatment) with the current standard Phase 4: Continuing Evaluation 1. To further evaluate the long-term safety and effectiveness of a new treatment
  29. 29. India TPA’s 1. GIPSA & IRDA 1. National Insurance Company 2. New India Assurance 3. Oriental Insurance 4. United India Assurance 2. Bajaj Allianz; IFCO Tokyo; Reliance General Insurance; ICICI Lombard; Tata AIG; Telos 3. TPA’s 1. 14 TPA’s licensed. Paid-up capital of Rs. 1 crore. (3 are ex-dotcom’s). 2. TPA increases premium by 7 to 10%; but necessary evil as Rs. 141/- was being paid on Rs. 100/- premium ‘killing the goose’. 3. TPA (Doctor vs Bill Settler arguments) 1. Paramount Health Services. 250 staff; 36 doctors. Bombay. Dr. Nayan Shah 2. Parekh Health, Bombay.
  30. 30. Healthcare Expenses Source : Medical Expenditure Panel Household Component
  31. 31. Expenses Median Source : Medical Expenditure Panel Household Component
  32. 32. Disease & Cure
  33. 33. Unfortunately ‘sick’ … 1. Problems & Issues 1. Genetic, Social or Biological : FEW CURES 2. Low diagnostics. Who needs it? Who’ll pay? 3. So what if I die … Heaven. Karma. Jihad. 4. Near & dear ones, influence, legal issues … 5. Inter-country movement, legal issues again …. 2. If & when it happens … 1. What is it …. Speed, Assurance & Cost of diagnostics. 2. Availability, Options, Choice of Treatment … 3. Location(s) of treatment …. Start, middle or End points. 4. Coverage, insurance, capacity to pay … 5. Period of likelihood.
  34. 34. List of diseases under control 1. Anthrax 2. Gonorrhea 3. Syphilis 4. Typhoid fever 5. Suppuration 6. Cholera 7. Diphtheria 8. Whooping cough 9. Dysentery 1. Tetanus 2. Pneumonia 3. Paratyphoid 4. Meningitis 5. Food poisoning 6. Gas gangrene 7. Botulism 8. Plague 9. ….. etc., etc. .. Most were brought under control in the 19th century.
  35. 35. List of Diseases, little control 1. Single gene 1. Cystic fibrosis 2. Tobacco & Lung Cancer 3. Ageing 1. Rheumatoid Arthritis 2. Cataracts 3. Major Cancers 4. Neurological disorders 1. Alzheimer's 2. Multiple Sclerosis 5. Dermatological disorders 1. Psoriasis 6. Gut disorder 1. Crohn’s disease 7. Circulatory disorders 8. AIDS 9. SARS 10. ADS (Autism Spectrum Diseases)
  36. 36. Example : Mental illness 1. 26 drugs under research for of the depression. 19 million people, costs the economy an estimated $44 billion a year, including $12 billion in lost work days. 2. Alzheimer's, 24 in development. 4 million, costs about $100 billion each year. Alzheimer's expected to triple in the next 20 years. 3. 16 in the pipeline for schizophrenia, 2 million Americans costs $30 billion. 4. Substance use disorders, which cost U.S. society nearly $400 billion a year, are the target of 21 new medicines.
  37. 37. Diseases 1. Types • Genetic • Social • Biological 2. Stages • Pre-Conception • Fetal • 1st year • Childhood • Teens • Middle Age • 40+ • 55+ • Old Age
  38. 38. Complexity 1. Of evolution & you .. 1. Several organs … 2. Several mechanisms … 3. Several modalities 4. Bacteria, Virus, Retro-virus or Prion … 5. Your Genetic Makeup … 6. Your Social circumstances …. 7. History, Track-record … 8. Doctors are human …just like you … 9. Doctors are specialists …. Just like you ….. 10. Infrastructure, facilities are an issue …. 11. Equipment & Technology is fallible ….. 1. Of humans & options … 1. Doctor modalities … 2. Clinic facilities 3. Clinical trials & Stats. 4. Side Effects. Friend or Foe. 5. Big Pharma interests 6. Drug – Drug interactions. 7. Alternate medicine 8. Materialism … quick, fast, easy … 9. Technical challenge, guinea pig, scapegoat …. 10. Hypocratic oath .. What oath?
  39. 39. Mind … Brain 1. The effect of the neuro-endocrine immuno system is NOT understood at all… 2. The emotional – physical interaction of hormones, steroids and glandular systems is NOT understood at all … 3. The real effect of chemicals and trace elements in food intake is not understood at all… 4. The power of mind and mental faculties in the generation OR suppression of these vis-à-vis automatic body responses … not understood ….
  40. 40. Race against time A non- knowledge Route An informed route • Saves Time • Saves Money • Saves Lives
  41. 41. Information Technology
  42. 42. Modern Healthcare Information Technology SuppliesPeople Public / Society Patients Doctors Nursing Vendors Hospitals & Clinics Transportation Infrastructure Equipment Consumables Pharma & Medicine Distribution & Logistics Infrastructure Equipment Consumables Investors / Risk Management Knowledge Process & Methods Skills (with Machines) Choice of Options Communications
  43. 43. Delivery : Fulfillment : Transaction 1. Supplier Information. 2. Supplier Item or Service. 3. Buyer Information. 4. Buyer Item or Service. 5. The Transaction. 6. Billing. 7. Payment & Collection. 8. Close. Receipts, paperwork, archive, MIS etc.
  44. 44. Hospital Management Systems I.T. PR, eZines, Communications etc. Patient Care Accessories & Spares Sales Doctor Access Equipment Scheduling Vendor Development Rostering Billing Industry Standards Patient Records Migrate Legacy Systems Inventory, Billing Accounting
  45. 45. Current utilisation of IT 1. Access to current medical records. 2. Access to medical history. 3. Access to patient flow sheets. 4. Access to patient demographics. 5. Order-entry of laboratory tests. 6. Results review for laboratory tests. 7. Order-entry of radiology procedures. 8. Results review for radiology images, including 9. Picture archiving and communications systems (PACS). 10. Results review of radiology reports. 11. Order-entry of medications. 12. Real-time drug interaction alerts. 13. Back-end drug interaction alerts. 14. Clinical guidelines and pathways. 15. Patient support through home monitoring, self-testing, and interactive patient education.
  46. 46. Linen and Laundry Management Processing Reject Central Store FRESH Re-Wash Used / Billed to Customer CASH Fresh Purchases Re-work Morph Reduce Stitch / Patch Central Store SOILED Local Store ISSUE
  47. 47. RFID Deployment
  48. 48. Clextra based Solutions 1. Stockflow. 2. RFID tagging 3. Consignment Inventory Handling. VMI or CMI. 4. Doctor Information System 5. Patient Information System. 6. Digital Tablet Based Ordering. 7. Pharmacy Logistics. (Nearest Pharmacy / Stockist) 8. Secondary Sales Solution(s) 9. Clinical Research (Phase 1 to 4 Documentation Management). Questionnaire Handling. 10. Hospital Bed optimisation. ROI on Equipment 11. ….more, much, much more … on request.
  49. 49. Engineering HelpDesk inetOrgPerson inetOrgPerson Organizational role Organizational person Organizational person inetOrgPerson inetOrgPersoninetOrgPerson Organizational role Response - Automated - eMail - with 24 hours Helpdesk coordinator(s) Remote Access Joint Decision Decision of 3 people Escalation User(s) Cloud Head of HR Control Sponsor Expert Access Organizational person Decision For larger complex (eg. 5000+ Staff), you should consider the clextra Docket Management Module.
  50. 50. Patient Care & Issues
  51. 51. Medical Practice Listen to the Patient's story One (or more) diagnoses comes to mind. Interact. Ask questions. Gather more information. Diagnoses List. Add, Subtract, Prioritise. Test. To support or eliminate diagnosis. Treat & Observe. Disease Space Diagnosis & Cure Space Source : Casper Abraham © 2002 Disease Treatment Cure
  52. 52. Doctor ‘Thinking’ ... 1. General, Specialty, Super Specialty. 2. Single-Modality; Multi-Modality. 3. Patient History. (Records & Memory). 4. Family/Genetic History. (Records & Memory). 5. Tools. Observation. Examination. DI. Lab. 6. Disciplines :- 1. Medicine. 1. Statistical data. Clinical Research. 2. Surgery. 1. Hand-eye co-ordination Skills. Expertise. Experience. 3. Contemporary. 1. Radiology. Simulation. Non-Invasive Techniques. 2. Information. Communications. Multimedia. Colour. 3. Alternate Medicine. 4. Human Mind - Brain-Body nexus. Neuro-Psychology. 7. Modern Commercial impact. 1. Patient as Customer, Consumer, Suer. 2. Doctor as Supplier. Human error. Challenge.
  53. 53. Diagnosis 1. Key to solutions. Key to a cure. 2. Any average competent can take over from there. 3. Pattern Recognition. 4. Expert. Expert System. Human Expert working. 5. Mind set. Prepared to ‘go-back’ even over assumptions.
  54. 54. Components Patient • Lifestyle • Good Health • Perception • No risk Insurance • Patient • Doctor • Administration • Research & Advisory • Big Pharma Emergency • Golden Hour Package • Proximity • Solution Competence Diagnostics • Routine / Preventive • Emergency • Out-patient Tests • In-patient Tests Treatment • Alternatives / Choice • Service Quality • Tracking • Centralized Data • WORKS / N)-GO Informatics • Demographics • History • Own Genome • Group Genetics • Current Problem
  55. 55. Nursing Locations 1. In-Patient; 2. Out-Patient; 3. Home-Care. 4. Attendant Care; (at Clinic / Hospital) 5. Attendant Care; (at Home or elsewhere)
  56. 56. Possible key-transaction(s) 1. Date (of treatment) 2. Doctor (may be called "provider") 3. Patient 4. Procedure 5. Primary Diagnosis 6. Location (presumably the doctor's office) 7. Billing Organization (an organization the doctor belongs to) 8. Responsible Party (either the patient or the patient's legal guardian) 9. Primary Payer (often an insurance plan) 10. Secondary Payer (maybe the responsible party's spouse's insurance plan).
  57. 57. Technology Advancements 1. Life Sustaining 1. Intensive Care 2. Ventilator 3. Dialysis 4. Pacemakers 2. Diagnostic 1. CT Scanner 2. MRI Scanner 3. PET Scanner 4. Ultrasound 5. Angiographies 6. Cardiac catheterization 3. Surgical 1. Joint Replacement 2. The pump 3. Intraocular lens 4. Operating microscope 5. Cochlear implant 6. Endoscopy
  58. 58. Healthcare Categorization 1. Modality. 1. Cardiology, Dermatology, Nephrology, ENT, Ophthalmology etc. 2. ICD 1. International Classification of Disease 3. Well Code Adaptation
  59. 59. Well Code 0 Human Being not alive. Brain & legally dead. 1 Very high risk, will die in the next 1 hour, if no medical intervention. 2 High risk, will die in the next 72 hours, if without medical intervention. 3 Requires unspecified time-frame of life-support system(s) to survive. 4 Requires life-support systems for survival for the next 30 days. 5 Requires a near life-time of hospitalization and treatment. 6 Requires a near life-time, on-going, periodic in-patient hospitalization and treatment. 7 Requires on-going, periodic out-patient treatment. 8 On controlled non-OTC, prescription medication. 9 On OTC type medication. 10. Near perfect good health. No medical help whatsoever. Prefix each with a HC, a well-person is HC10
  60. 60. Sales Facts … 1. Health impairment (instead of Disease) 2. No cures, no promises, no expectations, no answers, no solutions ….. Just data, extracted information, hopefully leading to knowledge. 3. Man proposes …. God disposes. Knowledge is power … Ignorance is bliss. 4. To the end-consumer, patient, one doctor, one nurse …. Reasonable quality of service/supply will be adequate.
  61. 61. Transaction Server Model Based on ‘ALL’ but Better suited to the Internet than :- * X Open Distributed Transaction Processing Standard * OMG Object Transaction Server * JTA and JTS * MS Transaction Server * EJB Transaction Model * WebLogic * WebSphere
  62. 62. Key to Transaction(s) 1. Who ID. 1. National ID. Social Security Number. Voter ID. 2. Health ID. 1. In-patient number. Out-patient or Casual number. 2. Illness Code. 3. Cover ID. Date_start. Date_stop. Amount. 4. Vendor ID. 1. Doctor. Hospital. Pharmacy. Other. Touch Point
  63. 63. Transaction include ... 1. In-Patient Stay. (Large & Long Transaction.) 2. Lab. Test or DI usage or Surgery/Medicine. 3. Out-patient Doctor Visit. 4. Drug Store Purchase. 5. Prescription usage.
  64. 64. Managed Care Transactions BuyerSeller 1. Current scenario with Medical Insurance. 1. Risk evaluation models for health. 2. Data Management for improved cost-efficiencies. 3. Lack of Technical competence; requiring TPA’s. 2. Why ‘Care Manager’ … 1. Doctor, DI & Lab nexus ‘inflates’ services. 2. Market reality of ‘commercialised’ practices. 3. Lack of ‘awareness’; and ‘ill’ state of consumer. 3. Issues … 1. ‘State’ cannot manage all issues. 2. Technical nature of ‘arbitration’ services. 3. Inherent pre-use & post-use ‘problems’. 4. Solution. 1. Use of IT, Internet & Software Technologies. 2. Larger Size & Scale of operations. 3. Speed of ‘service delivery’. 4. Lower & Upper limits of ‘automated’ approvals. 5. Constant Technical Learning of ‘Care Manager’. 6. Data gathering & Information availability. 7. Risk estimation improvement. 8. Lower costs. Improved Profitability. Quality Service. Care Manager BuyerSeller Source : Casper Abraham © 2002
  65. 65. DICOM 1. DICOM Hardware & Interfaces 1. Equipment Interface 2. Box 3. General purpose PC; TCP/IP; wireless etc. 2. DICOM Software & Standards 1. Print 2. Store. File Format. 3. Modality Work List 4. PPS. Data-Link. SCU-SPU SOP. 5. Storage Commitment. Host Control. 6. Cine. DVI. CA. CA+ 7. High-Line Rate 8. Color. 3. DICOM Media 1. MO. CD-R. DVD
  66. 66. SNP Potential 1. Single nucleotide polymorphisms. SNP identification is of major technological and commercial significance to the pharmaceutical industry for helping to determine an individual patient's susceptibility to disease or response to drugs 2. Incyte acquired Hexagen in 1988
  67. 67. Standards
  68. 68. Adoption of standards 1. HIPAA (for the US), Europe, Asia etc. 2. HL7 Version 2.4 and Version 3.0 3. 21 CFR Part 11 (Electronic data capture)
  69. 69. Certifications (USA) 1. Doctors 1. TOEFL 2. USMLE Step 1 3. USMLE Step 2 2. Nurses 1. TOEFL 2. CGFNS 3. IELTS 4. NCLEX-RN 3. IT 1. FDA requirements. 2. HIPAA / HL7 3. Market Leaders SAP / SAS
  70. 70. Government & Social
  71. 71. Medi-rural A franchising concept for getting mass medical treatment going with State Officials, worldwide.
  72. 72. Regulation A curious by-product of ‘advanced’ vs less ‘value for life’ is ‘Regulation’ Healthcare Regulation Value for Lifelow high low highICH/GCP USMLE CGFNS/NCLEX IPR & Patents India USA China Europe Lower Population More Affluent Patients More Money in the Business Infrastructure & Facilities Legal Involvement • Ignorance • Lack of resources • Malpractice • Experimentation • even ‘kill’ for money South America Source : Casper Abraham © 2002
  73. 73. Suggested Packages Super Specialty Specialty General Basic Class C CS CP CG CB Class B BS BP BG BB Class A AS AP AG AB Investment Cases Revenue Profit Class C 50 L 3650 20 L 10L Class B 600 L 7300 150 L 90 L Class A 2000 L 14600 200 L 100 L
  74. 74. Components for each 1. Infrastructure. Location. Guidelines. 2. Equipment List. Bill of Materials. 3. Finance Options. 4. Cases. Population, Statistics, Research. Planning. Potential & Projections. 5. Pricing. 6. Marketing. Communications. Advertising. Reach. 7. Manning. Training. 8. MRO. SCM. Supplies. Vendor Development. 9. Service Quality. Ethics. Values. Statutory. 10. Franchise Fee / Royalty Management.
  75. 75. Targets (example, Karnataka in India) 1. End-DEC 2003 1. Class A : 5 in Karnataka; 20 across India. 2. Class B : 10 in Karnataka; 50 across India. 3. Class C : 25 in Karnataka; 100 across India
  76. 76. edgevalue Ideas; Thoughts; Plans. (clextra Products support some of them)
  77. 77. Next Practice Healthcare 1. All Doctors Registry. IMA for India. Controls, checks & balances. Registration. Public verification. 2. Community Information. NGO’s. Social Support. 3. Closest Hospital. MAP. Query by mobile or wired. 4. REVENUE : Sponsored Social VC. Disease based. 5. Hub / Spoke Management. 6. Primary - Secondary - Tertiary Support. 7. Tie-in with SAP, SAS for CR etc. 8. RFID. PACS. DICOM etc. 9. Pharma Information. 10. Public awareness creation through a Web Portal concept. 11. Other vendors can also plug’n’play at a price. 12. Activate. Key-hospitals. Apollo. Mallya. Manipal Others.
  78. 78. Healthcare Business Model Medical Diagnostics & Imaging Lab. Out-Patient CARE In-Patient CARE Doctor Community Hospital & Clinic Services Manufactures & Suppliers Multi-Modality DICOM IT & MIS Bio-Tech Know-how Information Data Problem to Solution Desire to Fulfillment Disease to Cure TeleMedicine Managed Care Traditional Care Match Financial Risk Layer Information Layer Service Layer Lifestyle Layer State or Private Freebie or Paid for Credit or Debit Real time or Delayed Availability / Sharing Quality / Integrity Security Home CARE MedicineSurgery
  79. 79. UHN (Unique Human Number) 1. YYYYMMDDSSSSSSSS 2. Up to 100,000,000 th person born on a particular day. 3. The 9th, 10th and 11th can even be a country code to establish nationality & origin. 4. Examples; 1. 1957061809100009 Casper Abraham 2. 2001060700114232 Bonica Clinton 3. 2002110804400021 21st kid, unknown parents, UK 5. Accessible at www.uhn.net and www.uhn.org 6. Patient id, on Smart card, implants number, chip implant number, fingerprint, ECG, hospital id, Gene Bank, blood type, etc. etc. 7. Could be mapped to Voter no., National Id, Social Security Number etc., in each country.
  80. 80. Smaller Ideas 1. Front-end; GUI’s & Usage is IMPORTANT 1. Pattern Maps access. 2. Networked / Archived Digital Pen ‘data-entry’. 2. Product(s) 1. DI-LAB’s Tele-Radiology. PACS movement. 2. CEO Dashboard. Hospital Administrator. 3. SAS Training for CR Professional(s) / Development. 3. Concepts 1. Healthcare hybrid-BPO between Developed & Developing Countries. Eg. USA - India. 2. Tier II entry; to move to Tier I. Franchise products that emerge from this module generation. 4. Life Sciences 1. Genetic & DNA Testing. Sequence Database Management.
  81. 81. A Healthcare Hybrid BPO 1. Nursing 1. Staffing 1. Recruitment. Manning. Attrition & Replenishment. 2. IT 1. BPO related to ALL nursing management. 2. Payroll. Benefits. Rostering. Technical Inventory. 2. IT (Information Technology) 1. Website. 1. Communication. Patient-well wishers. 2. Modalities. Services. Price-lists. 3. Appointments. 2. Rostering 1. Doctors. Nurses. Aides. 3. MIS 3. Medical Transcription 1. Claims Processing. Insurance Documentation. 4. CR (Clinical Research) 1. ALL modalities and ALL patients, doctors, nurses related to THIS CLIENT(s). 5. Other 1. PACS DICOM etc.
  82. 82. clextra DILABS concept 1. DILABS Connect 1. Hardware Connectivity. DICOM and non-DICOM. Intranet. API’s. 2. DILABS Xfer 1. No storage. From. To. Cc. Security. Privacy. 3. DILABS Infobase 1. Storage. SAN. License. Reports. Publications. R&D. 4. DILABS Services 1. AMC. Per-call. Support. Transaction. Plan, prototype(s) being evolved.
  83. 83. Your single-source partner 1. Establish information needs horizontally and vertically. Feasibility studies & Budgets 2. RFP generation. Vendor identification. RFQ facilitation. 3. Supply Specifications Adherence. Quality controls & assurance. 4. Multi & Inter-vendor negotiations & closing. 5. INTEGRATION. 6. Uptime. Crises Support 7. Training. Support Services. Documentation. 8. SAS centric; CR Professional Development Business Plan. 9. clextra DILABS (for those interested). 10. clextra Dashboard for Efficiency / Control
  84. 84. http://www.edgevalue.com http://clextra.in casper@edgevalue.com © JAN 1999 62-B Modi Residency, Millers Road Benson Town Bangalore 560 046 INDIA Phone : 91 (india) 80 (bangalore) 2595 0059 Cellphone : 98450 61870

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