Liris blue academy 2010 2011 - smarter healthcare - nicky hekster

The LIRIS Blue Academy 2010-2011

Smarter Healthcare

An initiative from L.I.R.I.S. and IBM Belgium
Dr N.S. Hekster
IBM Nederland B.V.

© 2010-2011 IBM Corporation

LIRIS Blue Academy 2010-2011

LIRIS Program 2010-2011
SMARTER cities are the Future in ‘Beleidsinformatiesystemen’ (HIR, HIRB)
Jacques De Kegel, Business Development Executive, IBM 17-Nov-2010 (11:00 – 13:00) (VHI - 02.29)

BPM & Case Management (**) in ‘Analyse en ontwerp van informatiesystemen’
Te bepalen spreker (SAP) (Wim Verhelst ?) 25-Nov-2010 (14:00 – 16:00) (DV1 - 02.54)

From Enterprise Architecture to ICT Architecture (**) in ‘Architecture & Modeling of MIS’
Steven Laurent, Enterprise Architect, AE 6-Dec-2010 or 29-Nov-2010 (11:00 – 13:00) (ILT - 00.176)

Enterprise Content Management (**) in ‘Geavanceerd DB Management en Content Management’
Eric Michiels, Executive IT Architect, IBM 02-Dec-2010 (14:00 – 16:00) (HOGC - 02.22)

Juridical aspects of ICT Solutions (**) in ‘Analyse en ontwerp van informatiesystemen’
Johan Vandendriessche (Bird & Bird) 13-Dec-2010 (15:00 – 17:00) (Aud. Monnet)

Smarter Healthcare (*) in ‘Beleidsinformatiesystemen’ (Kortrijk)
Nicky Hekster, Technical Leader Healthcare, IBM 10-Mar-2011 (11:00 – 13:00) (Aula lokaal C611)

Mobile Banking (*) in ‘Beleidsinformatiesystemen’ (lic)
Anton Wilsens, Client Solutions Manager Financial Services xx-yyy-2011 (16:00 – 18:00) (VHI - 01.29)

ICT Sourcing Strategies (**) in ‘ICT Service Management’
Marnix Gillis, Distinguished Engineer,IBM 31-Mar-2011 (18u – 20u) (VHI - 00.10)

Software development productivity (*) in ‘ICT Service Management’
Antoon Goderis & Jo Vanackere, KBC uu-vvv-2011 (18:00 – 20:00) (VHI - 00.10)

2 Smarter Healthcare © 2010-2011 IBM Corporation

1


Introduction speaker

My name: Nicky Hekster

Role: Industry Technical Leader Healthcare &
LifeSciences IBM Benelux

Active in ICT since 1987

Vendor-chair IHE Netherlands

n.s.hekster@nl.ibm.com

You can find me also on LinkedIn and Twitter



Agenda IBM in Healthcare

Healthcare in State of Emergency

Smarter World, Smarter Healthcare

======== B r e a k ========

Smarter Healthcare ICT

Examples


2




Team IBM – 400,000 people worldwide

15,000
15k
160,000 sales people
salespeople

9k
9,000
salespeople
sales people
58,000

5k
5,000
salespeople
sales people
42,000
Defense

10k
10,000
Healthcare salespeople
sales people
102,000


3


IBM Benelux

IBM Benelux was formed in July
2005

Over 7000 employees in 3
countries



Heart-Lung machine (IBM and Dr J.H. Gibbon, 1957)


4


nanoMRI (2009)
Magnetic Resonance Force Microscopy (MRFM)



The Scripps Research Institute
Project Checkmate


5


Eye lasering invented by IBM
Excimer laser
Invention

Innovation
Using invention to create
value, leads to innovation

Collaboration

Close-up of an IBM logo inscribed on Close-up of an eye surgery
a human hair. The Excimer laser with the Excimer laser where
surgical procedure is so precise it can the eye is repaired for sharper
cut a clean pattern into a human hair visibility
without burning the strand.



Saving the chocolate industry
The cacoa genome project - a collaboration among MARS, USDA-ARS, IBM, NCGR,
Clemson University, HudsonAlpha Institute for Biotechnology, Indiana University and
Washington State University

IBM and Mars, sequencing the Theobroma cocoa
genome (done! Sept 2010)
– http://www.youtube.com/watch?NR=1&gl=U
S&hl=uk&v=ERu5TaqIvHs
Sustainable crops, unraveling the cocoa genome
– without engineering higher-yielding cacao
trees, demand would outstrip supply within
50 years.
Howard-Yana Shapiro of Mars Inc. was seeking
IBM's help in analyzing the cacao genome to
ensure the future of the plant, which is being
wiped out.

6


IBM Journal of Research & Development
IBM Systems Journal

Systems Biology Information-based Medicine
Volume 50, Number 6, 2006 Volume 46, Number 1, 2007



www.ibm.com/genographic
National IBM The
Geographic + = Genographic
Society Research Project

IT
Paleontology Infrastructure
Phylogenetics Using DNA to
Genetics unravel
Computational the path followed
Anthropology by our ancestors
Biology


7


IBM’s Commitment to Healthcare & Life Sciences
Designated Life Sciences an IBM Emerging Business Opportunity Unit - Spring 2000
– $100M initial investment
IBM Research
– Computational Biology Center
– Deep Computing Institute
– Blue Gene Project
IBM Business Consulting Services
– PriceWaterhouseCoopers Consulting acquisition
– Pharma 2010: The Threshold of Innovation
– Healthcare 2015, Win-Win or Lose-Lose
Strategic partnerships with industry leaders, e.g. Mayo Clinic
Created IBM Healthcare & Life Sciences (1/04)
– $250M Investment (2/04)



IBM’s Commitment to Healthcare & Life Sciences
Designated Information Based Medicine an IBM Emerging Business
Oppty Unit (1/04)
– Clinical Genomics and Biomedical Imaging (2004)
– Expand to PGx, CDI and Pervasive in 2005
National Genographic Project
– IBM and National Geographic jointly gathering one of the largest
collections of DNA samples to map how humankind populated the
planet.
Setting new Health Record precedents
– IBM offers U.S. Employees Electronic Records for Healthcare
– IBM revises non-discrimination and equal opportunity policy –
restricts genetic data
Dedication to Standards
– IBM allow royalty-free access to its patents for developers who
wish to create new healthcare and education applications around
open standards
– IBMers from Research on the international boards of HL7 and IHE
Acquisition of Acure (DK)
Acquisition of HealthLink (5/05)
Acquisition of Cognos (11/2007)
Acquisition of Initiate Systems and SPSS (02/10)


8


IBM Healthcare Knowledge Centers

La Gaude
Global Healthcare Center of Healthcare Barcelona
Excellence Zürich Research Lab Center of Excellence

Montpellier
Products & Solutions
Support Center Beaverton Network Haifa Research Lab
Transformation Center (NTC)

Mayo Clinic Medical Imaging Mainz Technical Marketing
Information Innovation Center Dallas Health Analytics
(M3IC) Solution Center Competence Center (TMCC)



Fact-based thought leadership helps clients realize business
value


9


So what in the world is happening with healthcare?



Five drivers make healthcare fundamentally different
from the past
Globalization

Consumerism

Changing demographics and
lifestyle

Diseases that are more expensive
to treat

New medical technologies and
treatments


10


Globalization

Developed Countries Developing Countries Least Developed Countries

A majority of adults in ten of The increasing prevalence of There is a strong need to
the 30 OECD countries are and costs to treat chronic address basic public health
overweight diseases, as well as the issues such as clean water,
associated lost productivity, good sewage systems, and
As life expectancy has
are impacting systems vaccinations
increased (68.5 years in
1960 to 77.8 years in 2003), – The loss of income to Countries are beginning to
there has been a China over the next ten experience the rise of chronic
concomitant rise in the years as a result of heart diseases but are less
incidence of chronic diseases disease, stroke, and capable to manage them
diabetes is estimated at
Total healthcare – By 2015, chronic
US$550 billion
expenditures are increasing diseases will be a leading
2.0 times more rapidly than Countries are still fighting cause of death in Nigeria
economic growth infectious diseases – not only
Population expansion is
existing ones, but also new
higher than in developed or
diseases and new strains
developing countries
* Definitions of “developed,” “developing,” and “least developed” countries are presented in the Appendix.


Consumerism
The patient becomes co-producer/co-director of his own care
Patient emancipation and
empowerment
Wants to make better health and
wellness choices
Growing expectations for value
from increasingly costly health
systems
Broad global awareness of quality
and safety challenges
New clinical pathways, retail clinics
Life-style management
Medical tourism


11


Medical tourism is beginning to subject healthcare
delivery to global competitive pressures

Procedure United States Mexico Costa Rica India Thailand Singapore
Angioplasty $33,000 $13,125 $14,500 $7,800 $9,200 $12,500
Heart bypass $37,000 $14,400 $13,600 $6,650 $11,000 $13,500
Hip replacement $45,000 $9,400 $13,000 $6,500 $8,000 $9,000
Knee replacement $21,000 $10,500 $9,500 $6,500 $8,500 $10,000
Laparoscopic
$19,000 $4,275 $6,500 $2,238 $4,500 $4,500
hysterectomy
Laparoscopic
$27,500 $16,800 $11,500 $5,900 $9,500 $16,000
prostatectomy



Medical tourism in practice


12


Changing demographics and lifestyle

Graying baby boomers
More chronic patients
Overweight
Population growth
Mobility
Pandemics
Lack of resources



Diseases that are more expensive to treat

Diseases are more expensive to treat
Drug development costs go up


13


Emerging diseases
1937 – Q-fever, Coxiella burnetii
1973 – Rotavirus
1977 – Ebola virus
1981 – Toxic shock syndrome
1982 – Lyme disease
1983 – HIV/AIDS
1991 – Multidrug-resistant tuberculosis
1993 – Cholera caused by strain 0139
1994 – Cryptosporidium infection (large outbreak in Wisconsin, USA)
1998 – Avian flu
1999 – West Nile Virus (first appearance in USA)
2003 – SARS (severe acute respiratory syndrome)
2004 – Marburg virus (largest outbreak in Angola)
2009 – April Swine/Mexican Flu H1N1 strain



New medical technologies and treatments

Less invasive therapies
Improved diagnostics
Confluence of biotech and
healthcare


14


Technology advances at enormous speeds

Grid Computing



Transformation of Medicine accelerated by a combination of
revolutionary technologies and evolutionary practices

Automated Personalized Health Care
Revolutionary Technology

Systems
Lifetime Treatment
Throughput Analytics

Pre-symptomatic Treatment

CA Diagnosis
Information
Correlation Translational Molecular Medicine
Medicine
Genetic Predisposition Testing

Clinical Genomics
1st Generation
Health Care
Diagnosis
Today Digital Imaging
Episodic Treatment Electronic Health Records Artificial Expert Systems

Data and Systems Integration
Non-specific Organized Personalized
(Treat Symptoms) (Error Reduction) (Disease Prevention)

Evolutionary Practices


15


Confluence
Research In silico modeling
Drug discovery Bioinformatics
Diagnostics Biomarkers
Computational Proteomics,
Chemistry Transcriptomics,
MicroArrays and
Information- Metabonomics
based medicine
Very large databases
Medical
Visualization Clinical and Regulatory
Process Management
Analytics



Counterbalancing the drivers for change are key
inhibitors that threaten to maintain the healthcare
status quo


16


Healthcare Systems in Europe
Funding is very different - increasing cost sharing among public
and private health insurers and individuals.

Access to Healthcare

Social Insurance National Health Service

Reimbursement Benefits in kind Centralized Decentralized

Belgium Netherlands Cyprus Greece

France Italy

Luxembourg Portugal

Spain



Financial constraints
Health expenditure as a share of GDP, 2004
16 15,4

14

12 11,5
10,6 10,5
10 9,7
9,2
8 8
% of GDP
6

4

2

0
USA CH D F B NL L

17


Inability to access and share information

The Electronic Health Record (EHR)
Different definitions
– Electronic Medical Record (EMR)
– Personal Health record (PHR)
Unstructured efforts
Semantic non-interoperability
Retentions laws
Regulatory compliance



Where is the relevant information?


18


Electronic Health Records



EHR – potential inputs


19


Watson – a future physician’s assistant?
Complex diagnoses
Better medication
Prevent medical errors

YouTube, Perspectives on Watson: Healthcare


Healthcare systems must address major issues and
questions in the search for an value-based, affordable,
sustainable system
Many healthcare systems are being pushed to a crisis stage because
of unrelenting pressures related to cost, quality, and
access/choice

Concurrently, factors such as new treatments and increasing
demand for services and value are converging to increase the
pressures

Without major changes, many countries will “hit the wall” (i.e., not
be able to continue on the current path) in the next decade

New levels of accountability, tough decisions, and collaborative
hard work on the part of all stakeholders will be required to transform
healthcare systems into a national asset
Countries that successfully transform will focus on value,
develop better consumers and create better options to
promote health and provide care

20


EHR adoption around the world (January 2006)



Realizing the importance of information in healthcare
transformation, there has been a surge of investment worldwide
directed to Health IT

Europe
Europe
UK– ₤20.4B
UK– ₤20.4B
Asia North America
North America
Asia US ARRA – $20.4B
China – $4.2B
China – $4.2B US ARRA – $20.4B
Singapore – $1.1B SIN Canada –$3.1B CDN (InfoWay)
Canada –$3.1B CDN (InfoWay)
Singapore – $1.1B SIN

Worldwide
Worldwide
Middle East EMR – $10B in 2010
Middle East EMR – $10B in 2010 $30B in 2019 **
$30B in 2019
Saudi Arabia – $14B****
Saudi Arabia – $14B****
EMR Adoption
EMR Adoption
US – 10%
US – 10% AUS – 25%
AUS – 25% UK – 59%
UK – 59%
CAN – 14%
CAN – 14% NZ – 52%
NZ – 52%

Additional Opportunities
Additional Opportunities
Clinical Decision Intelligence: $75M (2010), $3.1B (2019)**
Clinical Decision Intelligence: $75M (2010), $3.1B (2019)**
Health Analytics: Health analytics: $2.3B, $3.29B (2014)**
Health Analytics: Health analytics: $2.3B, $3.29B (2014)**
Cloud Computing for HCLS: $1.04B (2010), $6.2B (2014)***
Cloud Computing for HCLS: $1.04B (2010), $6.2B (2014)***
* assuming current growth rates
** source – HCLS
*** Medical Imaging and Collaborative Care Cloud sizing
**** a large percentage of that spending is on eHealth

Large spending and digitization will not improve outcomes without proper healthcare system
Large spending and digitization will not improve outcomes without proper healthcare system
design. We need to instrument the point of care and have consumable, knowledge enhanced EMRs
design. We need to instrument the point of care and have consumable, knowledge enhanced EMRs
Healthcare Transformation

21


The world-wide challenge
Changing the cure and care stakeholder ecosystem – the
Healthcare Information Exchange (HIE)

Government General
Practitioner

Insurance Pharmacy

Payors eHealth Primary
Platform

Portal Rehabilitation

Social card Hospital

Patient, citizen Secondary


Example: eHealth Platform (Frank Robben, 6/2009)
Patiënten, zorgverleners
Patië nten,
en zorginstellingen Software
PortaHealth zorgverlener
DTW
DTW DTW
DTW
DTW
DTW Software DTW
DTW
Site RIZIV zorginstelling
DTW
DTW Portal MyCareNet DTW
DTW
DTW
DTW DTW
DTW
eHealth DTW
DTW
DTW
DTW

Gebruikers

Basisdiensten
Netwerk
eHealth-platform
eHealth-

GAB GAB GAB GAB GAB GAB
Leveranciers

22


From supply-based to demand-driven healthcare
Power to the patient – the patient as co-producer of care

Physiotherapist
Water and air Laboratory
Alzheimer
Ambulances quality
bracelet

From Specialist

treatment
Hospital Pharmacy
to
prevention
Beds Patient
groups
From acute Home

to Food
chronic Doctor
delivery
diseases citizen
patient

Medical devices

From Social
services
passive to
pro-active Radiology
Nurse
patients
Coordination calendar Nurse
center
Insurance



The continuum of cure and care


23


Traditional healthcare delivery model

t
ien
University Medical Centers

pat
he
ft
to
en
Top Clinical Hospitals
Tertiary care
em
ov
lm
ica

Regional Hospitals
Secondary care
ys
Ph

General Practitioners
Primary care

The patient community- bottom of the pile!
Unchanged for 6000 years - circa 4000 BC!


Future health system transformation
iPad The always connected and informed citizen community iPhone

Web 2.0 Acute Trauma
Home Care Maternity TV
Retail Health Centers Health Kiosks Daycare Surgery
Diagnostic Centers
Allied health professionals Community Hospitals
Community Hospitals non-acute care
acute care
Primary Healthcare
The Super Primary Care Physician

Primary teleradiology e-Health
telepathology telemedicine
telediagnostics

Clusters of
specialists,
Patient/citizen-centric care
globally spread
and universal
>Direct access to specialists<
accessible


24


So what is happening in the world?



The world is
SMALLER

The world is
FLATTER

The world is about to get increasingly
SMARTER


25


ICT merging with
our physical world



INSTRUMENTED
We now have the ability to measure, sense and see the
exact condition of everything.
Today, there are 1 billion transistors for each person on the
planet.
By 2010, 30 billion RFID tags will be embedded into our
world and across entire ecosystems.
Remote patient monitoring devices that track the vital signs
of patients with chronic diseases could reduce U.S.
healthcare spending up to $197 billion over 25 years.
Typically, hospitals over-procure mobile assets by
20-30% while critical staff spend 10-30% of their time
searching for them.

Smarter health systems automatically capture and exchange
information through diverse channels to proactively manage and
deliver preventive and therapeutic care.


26


INTERCONNECTED
People, systems and objects can communicate and
interact with each other in entirely new ways.

The Internet of people is 1 billion strong. Almost one third of
the world’s population will be on the Web by 2011.
There are more than 4 billion mobile phone subscribers
worldwide.
In 2007, 56% of American adults sought information about a
personal health concern on the Internet—up from 38% in
2001.

Smarter health systems remove information barriers
and work as integrated teams with the individual to
make smarter decisions.

53


INTELLIGENT
We can respond to changes quickly and accurately, and
get better results by predicting and optimizing for future
events.

Every day, 15 Petabytes (1015) of new information are
being generated. This is 8x more than the information in all
U.S. libraries.
More than 3,600 statistical articles are published each year
on the topic of coronary heart disease alone.
Increasing digitization and medical imaging will lead
to a 41% annual increase in storage requirements between
2008 and 2012.

Smarter health systems continually analyze information to meet
the changing needs of the organization, optimize performance,
integrate predictive models, and deliver greater value to the
individual.
54

27


The mandate for change is a mandate for smart.

A smarter health system
forges collaborative partnerships
to deliver better acute, chronic and preventive care,
while activating individuals to make smarter choices.

55


To meet expectations for improved outcomes,
increased value and more accountable, sustainable
health systems, healthcare organizations are
working to …

IMPROVE OPERATIONAL DELIVER COLLABORATIVE
EFFECTIVENESS CARE FOR PREVENTION AND
Building flexibility into operations WELLNESS
to support cost reduction and Collaborating across care settings
excellence in clinical and HEALTHCARE to deliver integrated, personalized
business performance and care experiences, prevent
practices. disease, promote wellness and
manage care.

ACHIEVE BETTER QUALITY
AND OUTCOMES
Applying insights to improve quality
of care, clinical outcomes and services
and deliver personalized healthcare value,
while improving financial results.
56

28


IBM’s strategy
Patient-centric Networks Achieve better quality and
– The availability of information at the outcomes.
right time, at the right place, and in
the right context

Clinical and Business Optimization Improve operational
effectiveness.
– Increasing productivity and
efficiency

Health and Wellness Management Deliver collaborative care for
prevention and wellness.
– Lowering costs en improving quality
in the long term

+ +


Smarter Healthcare ICT


29


Clinician’s environment
Today
Find record and acquire useful
Diagnose Treat Document & process records
patient information

Anywhere,
Anywhere,
Any Time
Any Time
Any Device
Any Device

Automatic document
generation
Relevant Patient
Information
Increase Cognitive Window

Impact Clinician’s use systems
Clinician’s use systems
Horizontal platform for knowledge workers
Horizontal platform for knowledge workers



The hospital tension triangle
“De techniek interesseert
me niet, ik ben alleen
geinteresseerd in de
Poor governance Board of cost/benefit van de
business case en het
No transparency Directors risicoprofiel”
Low risk, no risk
J.Th. Kedzierski, ex-
Not business-like voorzitter raad van
ICT as a cost bestuur MCA
Old boys network

ICT

Forcing power
Ultimate patient responsibility
ICT as a tool
No enforcing power
Technology shifts the entire approach
Ad hoc application that physicians have to medicine
management and
deployment dictated by Learning new technologies consumes too
physicians much time
Busy managing day-to-day Clinical New technologies changes existing
procedures too much
operations Practice


30


Change requires a strong governance model
Resistance to change
Changes in habits
Skeptics of the system
Becoming transparent

Privacy
Complexity of the issue
Changes on legislation are often needed
Lack of confidence in the system

Funding
Who is going to fund it?
What is required to obtain it?



Transformation of healthcare

Clinical process management
Information management
Changes of roles
Collaboration
Culture and attitude
Education


31

Liris blue academy 2010 2011 - smarter healthcare - nicky hekster

Liris blue academy 2010 2011 - smarter healthcare - nicky hekster

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