Smarter planet: Healthcare


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To prepare for the more dynamic world ahead, healthcare organizations are working to: (1) Improve operational effectiveness, (2) Collaborate for prevention and wellness, (3) Achieve better quality and outcomes.

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Smarter planet: Healthcare

  1. 1. George Mattathil -4/15/2011Let’s Build A Smarter Planet:Healthcare © 2010 IBM Corporation
  2. 2. Let’s build a smarter planet: HealthcareForces at work across healthcare systems are impacting us all. Growing expectations for value from increasingly costly health systems. Broad global awareness of quality and patient safety challenges. Increasing need for citizens to make better health and wellness choices. Emerging approaches to promoting health and delivering care such as e-health and medical tourism. Expanding resource challenges. Increasing cost sharing among public and private health insurers and individuals.The world is connected:economically, socially and technically.Source: “Healthcare 2015 Series,” IBM Global Business Services and IBM Institute for Business Value © 2010 IBM Corporation
  3. 3. Let’s build a smarter planet: HealthcareThe need for progress is clear.100 million 15% 50%People worldwide pushed Percent of diagnoses that The proportion ofbelow the poverty line by are inaccurate or developed countriespersonal healthcare incomplete.3 where people with higherexpenditures each year.1 incomes have better access to physicians than those with lower incomes.59% 1 in 10 35 yearsThe average ratio of total The estimated number With poor urbanhealthcare spending to of patients affected by governance, lifeGDP growth in all OECD healthcare-related expectancy withincountries, growing from infections in the EU.4 developing countries7.8% in 2000 to 9.0% can be as low asin 2008.2 35 years.6 © 2010 IBM Corporation
  4. 4. Let’s build a smarter planet: HealthcareThe opportunity for progress is clear.$104 million 10 years 1 millionin cost savings experience individualsSmarter healthcare: Smarter healthcare: Smarter healthcare:UPMC Geisinger Health System Extremadura Regional Government of SpainThis renowned academic This leading, fully-integrated Deployed an electronicmedical center projects a provider in Pennsylvania prescription system in moreUS$104 million reduction leveraged its ten years’ than 400 primary carein capital and operating experience with advanced centers and 680 pharmacies,costs and more than a EHR systems to build a providing the ability to220% increase in comprehensive repository prescribe and dispenseprocessing capacity, of clinical information, assist prescription medicationsto meet an ambitious doctors in providing best electronically.clinical agenda. practices patient care and support medical research. © 2010 IBM Corporation
  5. 5. Let’s build a smarter planet: HealthcareHealthcare leaders see change coming—and are challenged to usecomplexity to their advantage.Full sampleCEOs expect high/very high levelof complexity over 5 years. 79% 49%Feel prepared for expected complexity.HealthcareCEOs expect high/very high levelof complexity over 5 years. 88% 59%Feel prepared for expected complexity.Source: 2010 IBM CEO Study: Capitalizing on Complexity © 2010 IBM Corporation
  6. 6. Let’s build a smarter planet: HealthcareFor healthcare organizations, this means finding a way to leadin a new environment shaped by four key factors.SUSTAINABILITY CONCERNSHealthcare’s share of country budgets continues to increase, threatening competitiveness and financialstability. At the same time, stakeholders expect greater value, better outcomes and dramaticimprovements in efficiency.PATIENT AND CONSUMER EXPECTATIONSMore informed consumers are demanding greater value for their healthcare dollars—and governmentsare demanding accountability for healthcare expenditures. Hospitals will be increasingly measured byclinical performance and the cost of care.NEW HEALTH AND CARE MODELSIncreased use of technology is accelerating changes in how care is delivered and funded, how quality isdetermined and how patients experience care. New health and care models aligned with personal valuesand well-being are signaling a fundamental shift in how healthcare organizations will compete andoperate in the next decade.RESOURCE SHORTAGESHealthcare organizations will experience shortages in care professionals in areas such as prevention,prediction, early detection and treatment, evidence-based medicine and care coordination.Source: “Healthcare 2015 Series,” IBM Global Business Services and IBM Institute for Business Value © 2010 IBM Corporation
  7. 7. Let’s build a smarter planet: HealthcareTo prepare for the more dynamic world ahead, healthcareorganizations are working to: IMPROVE OPERATIONAL ACHIEVE BETTER EFFECTIVENESS QUALITY AND OUTCOMES Building flexibility into Applying integrated insights operations to support cost to deliver high-quality, safe reduction and excellence in HEALTHCARE care and services while clinical and business achieving better clinical performance and practices. outcomes, proactively managing chronic disease and improving the cost- effectiveness of care. COLLABORATE FOR PREVENTION AND WELLNESS Partnering to deliver comprehensive, coordinated, integrated and personalized care for better healthcare value. © 2010 IBM Corporation
  8. 8. Let’s build a smarter planet: Healthcare + + = An opportunity for health systems to think and act in new ways. Improve Achieve better Collaborate for operational quality and prevention and effectiveness. outcomes. wellness. © 2010 IBM Corporation
  9. 9. Let’s build a smarter planet: HealthcareSmart healthcare:Improve operational effectiveness.SMART ISUsing integrated asset management tokeep equipment in healthy condition. BG Trauma Hospital Hamburg (BUKH):Implemented an integrated asset management solution that provides a holistic view of all technical, medical and facility assets and automatically generates inspection or repair orders according to defined schedules.SMART ISTracking equipment to improve patientcare and reduce costs, without slowingdown busy healthcare professionals. Saint Michael’s Medical Center:Used ultrasound sensor tags on critical mobile assets to track equipment location, generating automatic alerts when devices move to an unauthorized area or inventories in a supply closet are low, improving patient care, reducing costs and increasing staff productivity and compliance with regulatory requirements. © 2010 IBM Corporation
  10. 10. Let’s build a smarter planet: HealthcareSmart healthcare:Improve operational effectiveness. (continued)SMART ISLeveraging predictive analytics to helphospitals optimize the efficiency ofpayment collections. MedeAnalytics:Developed a solution that analyzes massive volumes of patient data and identifies patients more likely to pay, helping hospitals to reduce write-offs, increase collections and reduce collections staff.SMART ISAutomatically discovering anomaliesin the process of analyzing claims andinvoices to catch fraudulent activity. Zorg en Zekerheid:Deployed a predictive analytics software solution that catches potential anomalies in claims and accelerating the analysis process from weeks to days, doubling financial results each year. © 2010 IBM Corporation
  11. 11. Let’s build a smarter planet: HealthcareSmart healthcare:Improve operational effectiveness. (continued)SMART ISDesigning safety into the processof handling dangerous medicines,anticipating potential threats to Masarykuv Onkologicky Ustav (MMCI):Built a first-of-its-patients and staff. kind solution that integrates MMCI’s pharmacy system with hospital information systems and deploys an innovative RFID solution to significantly improve the accuracy and efficiency with which it traces drug agents, enhancing patient and staff safety as well as reducing administrative time and costs.SMART ISProtecting your patients and staffthrough immediate connection andvisibility to their physical location. Toronto East General Hospital:In response to a growing number of security incidents, implemented a wireless communications system that allows immediate communication throughout the one-million-sq-foot facility. Two taps to a wireless communication badge opens a connection to the hospital’s entire security force. Security response times were reduced by an estimated 61 percent. © 2010 IBM Corporation
  12. 12. Let’s build a smarter planet: HealthcareSmart healthcare:Improve operational effectiveness. (continued)SMART ISCreating a more effective IT foundationfor transformational clinical initiatives. Swedish Medical Center:Designed and brought a world-class data center online in less than 12 months to support its transition to a major clinical information system, enhancing quality and speed of medical services and providing noticeable financial savings 24x7.SMART ISAutomating and streamlining how benefitplans are created to accelerate the abilityto respond to government mandates NASCO:Worked with IBM Research to build a tool thatanalyzes benefit rules and codes in a more automated way, easing benefits personalization, improving accuracy and lowering the cost of benefit plan customization. © 2010 IBM Corporation
  13. 13. Let’s build a smarter planet: HealthcareSmart healthcare:Improve operational effectiveness. (continued)SMART ISBuilding more flexibility into back officeprocesses to more quickly launch newproducts and services. Groupe Mutuel:Built an SOA-based infrastructure across all units that reduced operational costs, the time and cost of integrating new acquisitions and the time to market for new insurance products.SMART ISModernizing legacy processes andapplications to gain the flexibility neededto compete in a consumer-driven health Highmark:Established initiatives to realize more valueinsurance market. from SOA investments by fostering new ideas to accelerate adoption, improving ability to differentiate based on personalized insurance offerings and enabling faster, lower-cost integration of acquired companies. © 2010 IBM Corporation
  14. 14. Let’s build a smarter planet: HealthcareSmart healthcare:Improve operational effectiveness. (continued)SMART ISAutomatically tracking and recording theposition of each patient or device toimprove patient care and optimize Hannover Medical School (Medizinische Hochschuleasset utilization. Hannover, MHH):Created a comprehensive patient and asset tracking solution to improve patient experience and optimize treatment processes, increase patient security and reduce costs. The scalable, adaptable solution enables the hospital to add other tracking capabilities.SMART ISStreamlining insurance andmedical processes with accessible,real-time data. Health Insurance Institute of Slovenia:IBM joined with the Institute to deploy an electronic health insurance card system that creates a centralized store for medical insurance data. Medical facilities, patients and insurers can now access and update patient records in real-time. And patient insurance cards now only bear a digital certificate to support authentication. © 2010 IBM Corporation
  15. 15. Let’s build a smarter planet: HealthcareSmart healthcare:Achieve better quality and outcomes.SMART ISImproving patient care with unified treatmentplans and more accessible records. Trillium Health Centre:Teamed with IBM to launch a centralized health information system offering real-time insight into hospital operations and patient status. Advanced analytics tools help to better direct multi-department patient treatment efforts. Patients have increased visibility into their medical information through a public information portal.SMART ISEstablishing a strategic governancestructure and health analytics environmentto speed the development of disease University of North Carolina:Defined a governancetreatments. structure and developed a health analytics environment that enables researchers to analyze vast amounts of patient data, providing clearer insights leading to faster diagnoses and treatment decisions © 2010 IBM Corporation
  16. 16. Let’s build a smarter planet: HealthcareSmart healthcare:Achieve better quality and outcomes. (continued)SMART ISAccurately simulating interactions of HIVtreatment drugs within a human body EuResist Network GEIE:Partnered with IBM Research to develop the world’s largest database and prediction engine focused on HIV resistance and treatment response. The prediction tool and repository are accessible to medical staff across Europe, helping to improve treatment for HIV patients across Europe.SMART ISDriving improvements in patient careby opening up access to research data BioGrid Australia:Melbourne Health created a research initiative and virtual repository of roughly 25 million medical records for users from various hospital systems. The cross- organization initiative has yielded greater insight from research studies by expanding average sample size and equipping physicians with complex analysis tools that help them choose more effective treatment plans for patients. © 2010 IBM Corporation
  17. 17. Let’s build a smarter planet: HealthcareSmart healthcare:Achieve better quality and outcomes. (continued)SMART ISUsing powerful algorithms topinpoint potential problem areaswithin medical images and flag Mayo Clinic:Worked with IBM to deploy an advanced imagethem based on the probability of processing capability and created new analytic algorithms, integrating them seamlessly into its radiology workflow. Theabnormality. automated system gives radiologists a powerful new diagnostic tool and source of insight that helps them improve patient care through better, earlier detection. A 50 time reduction in motion correction processing enables radiologists to provide results in minutes, not hours.SMART ISHaving access to a person’s fullmedical and familial history andcoaching them on care provider Geisinger Health System:Integrates real-time clinical,selection and health. financial, operational, claims and other medical information in a massive clinical decision intelligence system, assisting doctors to provide best practice care and supporting innovative medical research and treatments. © 2010 IBM Corporation
  18. 18. Let’s build a smarter planet: HealthcareSmart healthcare:Achieve better quality and outcomes. (continued)SMART ISSpeeding the discovery of compounds tocombat disease outbreaks throughapplying the power of grid technology. University of Texas Medical Branch:Accelerated research to discover cures for deadly, untreatable disease by performing the equivalent of thousands of years of comprehensive calculations in less than one year, using the World Community Grid.SMART ISEngaging computational resources toreduce a complex AIDS research workproject from five years to six months. The Scripps Research Institute:With the aid of World Community Grid, researchers on the FightAIDS@Home project, virtually screened 2,000 drug candidates against 270 wild type and mutant HIV proteases, discovering potential leads to new medications. © 2010 IBM Corporation
  19. 19. Let’s build a smarter planet: HealthcareSmart healthcare:Achieve better quality and outcomes. (continued)SMART ISRemoving inhibitors that are slowingprogress on cancer research. The Cancer Institute of New Jersey, Rutgers University and UMDNJ-Robert Wood Johnson Medical School:Using World Community Grid, created a Web- based, robotics prototype for automatically imaging, analyzing, archiving and sharing digitized tissue microarrays. New levels of speed and sophistication can enable advances in cancer biology, drug discovery and therapy planning.SMART ISAnalyzing large-scale population data toidentify trends and member values. A major health insurance company:Created a first-of- its-kind aggregation of healthcare data that yields trends and insights to users nationwide, delivering information on how people receive medical treatments that is protected by exceptional security features. © 2010 IBM Corporation
  20. 20. Let’s build a smarter planet: HealthcareSmart healthcare:Achieve better quality and outcomes. (continued)SMART ISTaking a holistic approach to healthcaremanagement with IBM and SAP. Institut Català de la Salut (ICS):With IBM, implemented a suite of SAP ERP applications. The combination of SAP ERP for general business management and SAP for Healthcare provides a comprehensive range of integrated systems for ICS, where it is possible to control all operational processes from within a single environment.SMART ISUsing business intelligence to boostnonprofit hospital efficiency. Federação das Santas Casas e Hospitais Beneficentes do Estado de São Paulo (Fehosp):Implemented a business intelligence solution that evaluates key performance indicators of 22 member hospitals. Organizations can now analyze and monitor key hospital performance indicators covering operational, medical and human resources metrics, helping to improve decision-making processes. © 2010 IBM Corporation
  21. 21. Let’s build a smarter planet: HealthcareSmart healthcare:Achieve better quality and outcomes. (continued)SMART ISAccelerating genomic research by tappinginto a computing environment that canaccurately compare genes from multiple Oswaldo Cruz Foundation (Fiocruz):By teaming with Worldgenomes. Community Grid (Fiocruz Genome Comparison Project), performed a complete pair-wise comparison between all predicted protein sequences, creating a reference repository for biologists and a head start on understanding how to develop drugs to combat a disease tied to a particular protein.SMART ISSpeeding the discovery of treatment ofchildhood cancer with the WorldCommunity Grid. Chiba Cancer Center Research Institute (CCRI):Worked with World Community Grid to perform experiments to test the fit between cancer proteins and each of three million drug candidates. Nine million experiments can be run in parallel, reducing the project time to just over two years. © 2010 IBM Corporation
  22. 22. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness.SMART ISDeveloping a care management systemto effectively manage treatment ofpatients with chronic disease. Precedence Health Care:Worked with IBM to develop the Chronic Disease Management Network, allowing all care givers to track and share information, ensuring the effective delivery of collaborative treatment plans, and more importantly a better quality of life for the patient.SMART ISProactively engaging with patients topersonalize care, enabled by powerfulhealthcare analytics. Duke University Health System:Teamed with IBM to create the HealthView Portal, a one-stop source of healthcare information and services for its patients. Predictive analytics help identify high-risk scenarios and create new insight, improving caregiver training and patient safety, increasing patient engagement and satisfaction and improving outcomes. © 2010 IBM Corporation
  23. 23. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness.(continued)SMART ISSharing information across locations anddirectly with patients to better coordinatetreatment efforts and deliver a higher Institute for Applied Telemedicine at the Heart andquality of service. Diabetes Center NRW:With IBM Business Partner SVA Competence Center Health Care, deployed an integrated telemedicine portal that captures patient health data from in-home monitoring equipment and publishes this data to the Web. The solution integrates with existing medical systems, providing users with a unified, roles-based view of a patient’s complete medical history. It ensures correct and proven treatments according to established insurance guidelines with defined telemedical pathways. © 2010 IBM Corporation
  24. 24. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness. (continued)SMART ISOperating and better managinghealthcare services for a fast-growingpopulation and cutting cost at the same Chinese Provincial Health Bureau:Worked with IBM totime. establish an integrated healthcare platform to standardize public health data, create electronic health records for citizens, and serve as a database of medical experts and emergency resources, improving disease prevention, emergency response and utilization of medical resources.SMART ISCreating a shared electronic healthrecord system among communityhospitals and healthcare centers to Peking University People’s Hospital:Teamed with IBMprovide more responsive, proactive care Research to implement a community-wide electronic healthcareto patients with chronic conditions. record system based on SOA and international medical information standards. In addition, PKUPH is building into the platform telemedicine functionality that leverages mobile telecommunications and real-time messaging alert services. © 2010 IBM Corporation
  25. 25. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness. (continued)SMART ISEnabling electronic prescriptionmanagement, making it easier for patientsand doctors to monitor and control Extremadura Regional Government oftreatment and to improve quality of care. Spain:Deployed an electronic prescription system in more than 400 primary care centers and 680 pharmacies, providing the ability to prescribe and dispense prescription medications electronically. Rizzoli OrthopaedicSMART IS Institute:Engaged IBM Research to develop a first-of-a-kind pedigreeDeveloping a first-of-a-kind pedigree analytics platform that integratesanalytics platform to gain new insights clinical and genomic data, medicalinto how we can treat hereditary images and family history into adiseases. SOA-based medical imaging repository to which new analytical services, content sources and research partners can be easily and cost-effectively connected. © 2010 IBM Corporation
  26. 26. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness. (continued)SMART ISStandardizing clinical practices acrosshealth systems, informed by integratedinformation. Servicio Extremeño de Salud:Implemented a regionally integrated system that enables patients to go to any health center in the region knowing the doctor will be able to view their complete, up-to-date records for faster clinical decision-making.SMART ISSpeeding diagnoses and treatments bymaking it easier for doctors to navigatecomplex patient information. Thy-Mors Hospital:Developed a first-of-a-kind patient records system that uses a three-dimensional model of human anatomy to easily navigate patient records, simplifying access to electronic health information and helping to deliver and explain treatments to patients easier and faster by focusing solely on medical data relevant to current diagnostic efforts. © 2010 IBM Corporation
  27. 27. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness. (continued)SMART ISBeing able to access an individual’s fullmedical history with a single trusted view. Shanghai First People’s Hospital:Developed a reliable, large-scale identity repository that aggregates a patient’s historical care information while eliminating duplicate and erroneous data, improving care through the sharing of trusted patient information and reducing costs through efficiency improvements.SMART ISProactively driving the integration oftechnology, process and people changesback into the organization. American Hospital Dubai:Deployed an integrated healthcare information system for the community of Dubai and surrounding Gulf States, providing secure, real time access to patient information and changing the way medical, nursing and healthcare staffs perform their jobs when utilizing technology. © 2010 IBM Corporation
  28. 28. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness. (continued)SMART ISUpgrading its paper-based medicalrecords system to provide faster, moresecure patient care to thousands of Genesys Health System:Implemented an electronic health record system from BlueWare and IBM, using apatients. SOA strategy, making digitized information for all of its outpatient services available to over 1,000 physicians across six counties.SMART ISDelivering a unified healthcaremanagement system using a single,comprehensive electronic medical record Xicheng District Health Bureau:Leveraged a SOAto share information and resources strategy to create a flexible infrastructure for exchanging patient information, enabling users to access symptomamong over 500 medical institutions. descriptions, search for local medical resources and refer patients to doctors or specialists for treatment. Requests for prescriptions are sent automatically to the patients local pharmacy for pick-up. © 2010 IBM Corporation
  29. 29. Let’s build a smarter planet: HealthcareSmart healthcare:Collaborate for prevention and wellness. (continued)SMART ISEngaging patients in new product designand manufacturing processes to build theright products. Implanet:This supplier of hospital surgical implants leveraged RFID technology and a customer portal to gain visibility to customer demand and automated warehousing and inventory operations, growing customer satisfaction through richer pre-purchase support.SMART ISGaining real-time line of sight andresponses to individualized healthinformation. Western North Carolina Health Network:Implemented an electronic health record exchange that enables patient data to be securely shared across hospitals, improving patient care through reduced medical errors and unnecessary treatments, lowering overall costs and speeding patient records retrieval. © 2010 IBM Corporation
  30. 30. Let’s build a smarter planet: HealthcareAt the center of smarter healthcare is an increasingly morepersonalized experience, focused on the wellness of the individual. IMPROVING your long-term health and everyday experience ENROLLING in healthcare programs MEASURING your progress SHARING and plan individual health information COMPLYING UNDERSTANDING fulfilling your part of health risks the patient-doctor covenant BENEFITING ACTIVATING from an interconnected preventive and value-conscious care-giving team behavior ENGAGING in a self-directed system of care One result is higher satisfaction for consumers and service providers. © 2010 IBM Corporation
  31. 31. Let’s build a smarter planet: Healthcare Individuals will be served by collaborative, coordinated health systems. GOVERNMENTS CARE DELIVERY ORGANIZATIONSAddress the current lack of sustainability Expand the current focus on episodic, acute by providing leadership and political care to encompass the enhanced willpower, removing obstacles, management of chronic diseases and the encouraging innovation and guiding life-long prediction and prevention of illness. countries to sustainable solutions. DOCTORS, NURSES AND OTHER CAREGIVERS COMMUNITIES Develop partnerships with Make realistic, rational decisions individuals, payers/health plans and regarding lifestyle expectations, other stakeholders, collaborating to acceptable behaviors, and promote and deliver more evidence-healthcare rights and economies. based and more personalized healthcare. PHARMACEUTICALS AND DEVICE MANUFACTURERS PAYERS AND HEALTH PLANS Work collaboratively with care delivery Help individuals remain healthy and get more organizations, clinicians and individuals value from the healthcare system while to create products that improve assisting care delivery organizations and outcomes and lower costs. clinicians in delivering higher-value care. Source: “Healthcare 2015 Series,” IBM Global Business Services and IBM Institute for Business Value © 2010 IBM Corporation
  32. 32. Let’s build a smarter planet: HealthcareIBM’s solution strategy is aligned with the needs of thehealthcare industry FOR A FOCUS ON… EXAMPLE IBM INVESTMENT AREAS Collaborating for prevention and  Business transformation  Performance management  Health data integration  Portals for care teams, patients, wellness to deliver comprehensive,  Health information providers, members and coordinated, integrated and exchanges citizens/consumers personalized care for better  Communications and  IBM solution for collaborative healthcare value. collaboration care Achieving better quality and outcomes  Clinical performance  Business intelligence and  Chronic disease performance management to deliver high-quality, safe care and management  Patient / member analytics services while achieving better clinical  Data governance, data  Disease surveillance and outcomes, proactively managing integration and data quality modeling chronic disease and improving the  Medical records text analytics cost-effectiveness of care. Improving operational effectiveness  Business process  Business transformation transformation  Performance management to build flexibility and resilience into  Enterprise mobility  Core systems modernization operations to support cost reduction  Patient and equipment  ICD-10 compliance and excellence in clinical and tracking  Fraud & abuse analytics business performance and practices.  Enterprise asset  Data center optimization management  Smart hospitals  Revenue cycle  Integrated service management management  Virtualization  Privacy, security and  Cloud delivery models resilience © 2010 IBM Corporation
  33. 33. Let’s build a smarter planet: Healthcare The world will continue to become smaller, flatter and smarter. We are moving into the age of the globally integrated and intelligent economy, society and planet. There’s no better time to start building a smarter healthcare system—for greater individual healthcare value and sustainability. © 2010 IBM Corporation
  34. 34. Let’s build a smarter planet: HealthcareTrademarks and notes IBM Corporation 2011  IBM, the IBM logo and are registered trademarks, and other company, product or service names may be trademarks or service marks of International Business Machines Corporation in the United States, other countries, or both. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at  Adobe, the Adobe logo, PostScript, the PostScript logo, Cell Broadband Engine, Intel, the Intel logo, Intel Inside, the Intel Inside logo, Intel Centrino, the Intel Centrino logo, Celeron, Intel Xeon, Intel SpeedStep, Itanium, IT Infrastructure Library, ITIL, Java and all Java-based trademarks, Linux, Microsoft, Windows, Windows NT, the Windows logo, and UNIX are trademarks or service marks of others as described under “Special attributions” at:  Other company, product and service names may be trademarks or service marks of others.  References in this publication to IBM products or services do not imply that IBM intends to make them available in all countries in which IBM operates. © 2010 IBM Corporation