The Real Deal on Enterprise Portals

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The Real Deal on Enterprise Portals
Bob Breton Senior Director, Product
Strategy Sybase Enterprise Solutions Division
Bob LaGalia SVP, Strategy Corp
Development NIARadMD
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Agenda

• State of Healthcare in the United States
• Who is NIA and what is RadMD?
• The RadMD Enterprise Portal
• Enterprise Portal Market Requirements
• Key Success Factors

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The State of Healthcare in the U.S.
Rising Costs, Complex, Highly Fragmented

• Single Largest Industry in the U.S. -gt1.2
  trillion in spend
• As a of GDP, national expenditures have risen
  from 5 in 1960 to fully 14 today.
• This is the largest percentage in the
  industrialized world
• Little evidence exists that aggregate outcomes
  are better in the U.S. than in countries that
  spend a smaller of their GDP on health care.

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The State of Healthcare in the U.S.
Rising Costs, Complex, Highly Fragmented

• HCFA predicts costs to grow at 7 CAGR and reach
  2.2 trillion by 2008
• Alarmingly, only 1/2 represents required care
• 20 spent on administrative inefficiencies
• 30 inappropriate, redundant, and unnecessary
  procedures
• Huge service-based industry
• Over 250 million patients/consumers (aging
  population)
• Over 5,000 Hospitals, 40,000 Nursing Home and AL
  Facilities
• 700,000 Physicians, 100,000 Dentists
• Cumbersome 3d Party Payment System
• Over 500 Managed Care Enterprises

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The State of Healthcare in the U.S.
Highly Transactional, Data Rich, Information Poor

• Billions of claims processed each year,
  representing multiple patient encounters(doctor
  visits), and multiple transactions (eligibility,
  referral, lab studies, radiology studies, etc.)
• Clinical Financial Data resting on antiquated
  technology mainframe, old client-server.
  Industry contributes only 2-3 on information
  technology vs. 6-8 in other highly-information
  based business
• Physicians need access and information flow
  across the continuum of care in order to manage
  patients and their businesses
• Consumerism on the rise - accessing information
  enabling the comparison of quality, treatment
  options, and outcomes data of hospitals
  physicians.

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The State of Healthcare in the U.S.
The Impact on Quality of Care?
The Institute of Medicines (IOM) Committee on
Quality of Healthcare released results of a study
that indicates that as many as 98,000 deaths
occur each year due to medical errors - it was
the 8th leading cause of death in the U.S nearly
as much as MV accidents, Breast Cancer, and AIDs
combined.
when patients see multiple providers in
different setting, none of whom have access to
complete information, it is easier for something
to go wrong than when care is better coordinated
- IOM Committee on Quality of Healthcare
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The State of Healthcare in the U.S.
The Impact on Quality of Care?
As much as 40 of patient information is missing
when needed by a medical professional, and this
is compounded each time a patient moves, changes
health plans, or visits a different specialist -
Boston Consulting Group
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The State of Healthcare in the U.S. - Radiology
Diagnostic Radiology Market - a microcosm

• Diagnostic Radiology Market Size
• 70 to 80 Billion Spend, 10 of healthcare
  dollar
• Rising Costs
• Direct costs increasing at twice the rate of
  medical inflation (9 to 12)
• Quality
• Unnecessary radiation exposure and false
  positives associated with inappropriate use

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The State of Healthcare in the U.S. - Radiology
Rising costs, inappropriate use, and lower
quality contribute to the wide variation in
utilization patterns for diagnostic radiology
services
Northeast Region Util./1000/Yr. A
775 B 872 C 824 D 1176 E 750 F 1000 G 980 H 760
Midwest Region Util./1000/Yr. A
1092 B 885 C 914
West Region Util./1000/Yr. A
801
Southwest Region Util./1000/Yr. A
664
Mid-Atlantic Region Util./1000/Yr. A
587 B 987
Southeast Region Util./1000/Yr. A
1073 B 790 C 780
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The State of Healthcare in the U.S.
Rising Costs Quality Concerns An impetus to
change
An imperative to
Productivity, Efficiency, Quality of Patient
Care
Reduce Spending on Unnecessary Inappropriate
Care
How? Apply new technologies to enable better and
more efficient transactions among all
participants Apply clinical domain expertise to
appropriately manage cost growth
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Agenda

• State of Healthcare in the United States
• Who is NIA and what is RadMD?
• The RadMD Enterprise Portal
• Enterprise Portal Market Requirements
• Key Success Factors

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National Imaging Associates RadMD
Who is NIA? (founded in 1995 at Corning Life
Sciences, Inc.) We are a medical management
company providing payers and physicians with cost
effective business solutions in diagnostic
radiology
What is RadMD? (today) RadMD represents NIAs
medical management portal, designed to promote
the most appropriate and effective use of
diagnostic radiology services. It connects
physicians and information, providing access to
knowledgeknowledge which helps to improve the
efficiency of business transactions, while
improving the quality of patient care.
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NIA Call Center Workflow (pre-EP)

• Our Operations
• Call Center/IT organization located in San Bruno,
  California with over 100 employees Customer
  Service Representatives, Registered Nurses,
  Board-Certified Physicians
• Provide Medical Management services to over 4.5
  million enrollees through our client
  relationships
• Process over 80,000 clinical consultations per
  month involving multiple transactions each -
  eligibility, clinical decision support
  algorithms, provider selection and referral,
  authorization resolution
• 2000 - strategic move to an Enterprise
  Portal Computing Architecture

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NIA Client Server Architecture (1996-1999)

Call Center
Offline (batch)
Members
DB
Requests via Telephone
Providers
Claims/Clinical
MS SQL Server
PowerBuilder Apps on WIN NT
Data Loaded into Production offline
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Agenda

• State of Healthcare in the United States
• Who is NIA and what is RadMD?
• The RadMD Enterprise Portal
• Enterprise Portal Market Requirements
• Key Success Factors

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Why an Enterprise Portal?

• For our Users
• An alternative, personalized experience, with
  access to same protocols
• Improved clinical information sharing during the
  care delivery process
• Self-service, empowerment, ownership
• Access anytime, anywhere
• For our Company
• Free capacity
• Increased productivity - physician experts
  connected nationwide
• Margin improvement - cost reduction (40 less
  via web)
• For our Future
• Flexible business model - full outsource to ASP
  hosting
• Leverageable platform for other
  plug-indevices access expansion wireless
• Direct integration with clients
• Expansion into other medical management
  solutions

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Facilitating Information Transfer
Facilitate Clinical Information Exchange
Referring Physicians
Patients
Radiology Providers
Learning
RadMD

• Access to expert consult
• Education re best practice
• Improve Patient outcomes

• Improve Admin Transac tions
• Collect Outcomes for analysis
• Identify patients early

Insurance Carrier

• Lower administrative expenses
• Improved medical cost management

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How did we Develop?
4-Phase Approach Critical Learnings 1,
Discovery research, focus testing,
integrate within the current workflow user
requirements must have incremental
impact understand existing workflow tech.
no new tech investment access, bandwith 2,
Definition Design obtain key stakeholder
input, speed, reliability, availability techni
cal clinical consultation privacy,
security integrated w/ call center 3,
Development vendor solutions Sybase
Enterprise Portal Early Adopter determine
optimal approach Sybase Professional Services
Team Port PB App and business logic
Integrated Solution 4, Deployment step-wise
roll-out select pilot sites
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NIA Call Center Workflow Today
myRadMD
Browser
Mobile PC
Wireless
B2B App
Tel
Web Server
Call Center
Enterprise Application Server
EP Applications
EP Common Services
EP Application Services
EP Integration Services
Data
Content
Apps
Events
Enterprise Information Systems
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RadMD Portal (2001)
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What have we learned?

• Portal technologies provide a means to connect
  the participants in the healthcare delivery
  process to valuable clinical information
  necessary to improve the quality and efficiency
  of patient care
• Look for technology partners and engage existing
  stakeholders
• Fundamental Project Management Skills are
  paramount
• Value proposition must be unique, tangible, and
  measurable

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Agenda

• State of Healthcare in the United States
• Who is NIA and what is RadMD?
• The RadMD Enterprise Portal
• Enterprise Portal Market Requirements
• Key Success Factors

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e-Business Evolution
Meaningful relationships
Transactions
Dynamic Content
Static Content
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Expanding Opportunities
Approval Billing
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Current e-Business SolutionsFragmented and
Impersonal
Partner
Employee
Customer
Supplier
Partner Site
Intranet
Corporate Site
Supplier
Customer Service
Manufacturing
Sales
Shipping
Marketing
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Enterprise PortalsPersonalized Business
Experience
Personalization
HMO
Healthcare Provider
Radiology Specialist
Management
Enterprise Portal
Customer Service
Medical Content
Policy
Provider Systems
Billing
Integration
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What is an Enterprise Portal?

• Its NOT just a personalized URL directory
• E.g. Internet Portals like MyYahoo
• Its NOT just a personalized employee webtop
• Corporate Portal technologies
• Its about creating a unified e-business
  experience personalized to the needs of your
  diverse business audiences
• Deeply integrated into the business
  infrastructure
• Broadly connecting disparate business
  infrastructure into a comprehensive e-business
  experience
• Focused on the unique needs of each e-business
  audience to build meaningful relationships
• The Quality of Service to meet market
  expectations
• Lowering the Total Cost of Ownership of e-Business

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Evaluating Enterprise PortalsThe complete
functional perspective
Content Organization Context, Keyword
Content Management Staging, Workflow, Metrics
Globalization
Personalization
Enterprise Portal
Management Central Management
Enterprise Class Platform HA, Scalability, Load
Balancing
Security Desktop to Backend
Integration Data, Events, Applications,
Exchanges, Process Workflow
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Sybase Enterprise Portal
Mobile
Browser
Personalize
Security
Publish Subscribe
ContentManagement
ContentOrganization
Process Management
Management
Repository
Data
Applications
Events
Feeds
Documents
ERP/CRM
Database
Mainframe
Custom

• Continuous availability platform
• Portal Services in a Single Product
• Wide range of Portal options

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Sybase Enterprise PortalEnterprise Class Platform
Scalable Platforms Solaris, HP-UX, AIX,
NT Application server clusters Database server
clusters Dynamic load balancing Mainframe
integration Reliable Automatic client
fail-over High availability servers Remote site
fail-over Open Standards XML, EJB, CORBA, DCOM,
LDAP Secure SSL, X.509, Role-based security
Secure
Open
Scalable, Reliable, High Performance
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Sybase Enterprise Portal Extensions
Mobile
Mobile Extensions
B2B Extensions
Personalize
Security
Publish Subscribe
ContentManagement
ContentOrganization
Process Management
Repository
Management
Data
Applications
Events
EDI
Documents
ERP
Custom
Exchanges
CRM
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Sybase EP Mobile ExtensionsExpanded services for
the mobile community
Mobile Messaging
Device Identification
Mobile Security
Data Synchronization
Session Management
Geometry Transformation

• Support for connected, wireless and
  synchronization focused small footprint devices
• Extensive services for application designers and
  content managers
• Full range of portal services for mobile
  applications and content

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Sybase EP B2B ExtensionsExpanded integration
into B2B communities
Broadcast Messaging
Message Processing
Collaboration
Scheduling
Workflow
XML Management

• Key Services to Support B2B Applications
• Marketplace integration
• B2B integration
• Collaborative Processing and Workflow Support for
  B2B communities

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Agenda

• State of Healthcare in the United States
• Who is NIA and what is RadMD?
• The RadMD Enterprise Portal
• Enterprise Portal Market Requirements
• Key Success Factors

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The Sybase Solution
Methodology and Best Practices EP specific
expertise
Services/Education
Partnerships
Unified product offering Enterprise Class platform
Product
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e-Portal Alliance Partners
e-CorporateBusinessProductivity
e-Content
e-Analysis
Extensity Knowledge Mechanics Niku
e-CRM
e-Information
BroadVision EveryPath FatWire Gauss
Interprise Powerize.com Vignette WorldWeb.net
CorVu Sterling Mgt Consulting WebTrends
e-Commerce B2B Exchanges
e-Workflow
PlumtreeSageMaker Viador
BroadQuest YOUcentric
Documentum Enterworks
Black Pearl Cohera EzCommerce Intershop
Comm. Oasis Tech. PowerCerv Tibco TUMI
Software XML Solutions
Sybase Enterprise Portal
Service Partners Computer Technology
Associates eCALYX eLoyalty
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Keys to successful Enterprise Portal
Implementation

• Establish executive ownership
• Develop a vision and define a strategy to get
  there
• Balance unit ownership with central leadership
• Plan for fundamental business change not just
  webizing your company
• Design upfront the integration of new e-Business
  applications with existing systems
• Involve key business partners in your initiative
• Invest in a vendor who provides a comprehensive
  solution

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www.radmd.com
www.sybase.com