Prepared by Sabianet, Inc'

1

• A U.S. Perspective

• Prepared by Sabianet, Inc.
• September 17, 2005
• THIS INFORMATION IS PROPRIETARY AND CONFIDENTIAL
  TO SABIANET, INC.

2
The U.S. Healthcare System

• Private Insurance paid by employees and employers
  50 of the total healthcare cost.
• Federal 50 of the total healthcare cost in the
  U.S. 700B
• Medicaid provided to poor population Federal
  Government
• Medicare employees pay through Social Security
• Military Health Care 40B most sophisticated
  system in the world
• War Veterans 17B Largest Safety Net in the world

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Statistics and Challenges U.S.

• The world largest and most inefficient
  information enterprise in the world.
• Out of 1.7T it absorbs it has the highest level
  of infant mortality in OECD (organization of
  economic collaboration and development)
• Most medical records are stored on paper in the
  U.S.
• Only 30 of the Emergency Rooms have information
  technology systems
• Only 15-20 of U.S. physicians and 20-25 of
  hospitals have adopted an electronic health
  record.
• Elderly U.S. patients are prescribed improper
  medications in about one out of every 12
  physician visits.
• The U.S. to top industrialized countries (OECD)
  ranking for overall spending at 5,267 per
  capital in 2002. Total cost of Healthcare in the
  U.S 1.7T. 13 of GDP highest in the World. Yet
  43m are uninsured in the U.S.

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Statistics and Challenges U.S.

• Between 44,000 and 98,000 people die in hospitals
  each year as result of medical errors.
• Elderly U.S. patients are prescribed improper
  medications in about one out of every 12
  physician visits.
• 57,000 Americans die each die needlessly because
  they dont receive appropriate medication
• Inadequate availability of patient information is
  associated with 18 of adverse drug effects

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Statistics and Challenges U.S. cont.

• During 2003-2004 1.3m increased jobs, salary
  declined and poverty increased. Less people can
  afford health insurance. Employee sponsored
  programs declined by 4.6 and Medicare/Medicaid
  Federal Government coverage increased by 2.4
  points
• More than half of the uninsured population
  resides in the South of the U.S.
• U.S. population will increase by 120 million
  people over the next fifty years, 80 million will
  be the direct or indirect consequence of
  immigration. Latino are the largest minority in
  the U.S. today.
• Undocumented illegal immigrants are 50 of the
  uninsured population in the U.S. 98 are Latinos.
  In California they can apply for Medicaid
  government funded programs.
• Huge political divide between Republicans and
  Democrats on the Healthcare Reform in the U.S.
  Social Insurance, Single Payer as England and
  Canada or regulated multipayer programs like
  Germany, France or Japan.

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Mandates and Initiatives

• President Bush National Electronic
  Infrastructure for Electronic Health Record in 10
  years
• Office of the National Coordinator for Health IT
  Dave Brailer reporting to Secretary of Health and
  the President on Healthcare IT initiatives.
• HIPAA Health information portability and
  accountability act
• Legislative support Sen. Hillary Clinton (NY),
  Senator Christopher Dodd (CT) Rep. Nancy Johnson
  (CT), Sen. Ted Kennedy(MA) and Rep. Patrick
  Kennedy (RI). Strong advocates to accelerate
  clinical IT adoption in the U.S.
• Other Health Care Mandates - NHII/CHI
• Electronic Health Records interoperable
  information systems
• Connecting consumers with personal health records
• Improving population health base errors and
  omissions
• Communicating inter-intra and external Federal
  Health Architecture

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Health Reforms and Informatics

• RHIOS Regional Health Information Organizations
  across the U.S. consortium of private, public and
  community leaders. Over 200 formed in the U.S.
• Health Reform includes funding from the Federal
  Government for RHIOs, over 200M in the next two
  years.
• HIPAA compliance and new legislation
• Medicare Modernization Plan includes ePrescribing
• Patient Safety Initiative
• Certification for Electronic Health Record
  vendors
• Financial Incentives for providers

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Why focal point on Informatic?

• Productivity gains similar to Telecommunication
  Industry use of IT 4 - Healthcare 813B
• Cost savings for inpatient and outpatient care
  42b per year.
• Eliminate 2M adverse drug events and save about
  3.5B per year.
• Cost savings from implementing a full EMR based
  on standards over 15 year period 371B

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Biggest Challenges

• Acquisition and implementation costs (28B per
  year for 10 years and 16B per year thereafter)
• Adoption of the technology by Hospitals 6.5B per
  year for 15 year period.
• Adoption of the technology by providers 1.1B per
  year
• Changing the business processes
• Poor inter-operability and information networks
• Legislation
• Stds

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Technology Infrastructure

• Interoperability Platform must be designed with
  EMR, CPOE and Analytics for the Healthcare
  Industry from the get go. Proprietary generic
  platforms used in other industry required
  extensive amount of customization and interfaces
  to adopt to the Healthcare Industry.
• Industry Stds a must HL7, Web-based Services
  based on Stds, medical coding ICD10 and the likes
  must be part of the infrastructure
• Mobile devices, VoiP, and single sign on must be
  part of the infrastructure
• Security based on biometrics, pki infrastructure,
  electronic signatures for privacy, authentication
  and non-repudiation
• Architectures organized around individual
  patients with one aggregator or rule engine.

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Technology Infrastructure The challenge
Inter-Operability Platform
Electronic Health Record
CPOE
Analytics
Std
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What has failed?

• Centralized MPI
• Using a single HIS Client-Server technology
  with web enabled interfaces
• Expensive IT platforms not sustainable in the
  long run
• Generic Inter-Operability platforms that have not
  taken into consideration CPOE, Analytics as part
  of the design
• Inter-operability platforms and HIS not centered
  around the patient and encounter information
• Complex technology difficult user interfaces for
  providers to adopt as part of their regular
  practices
• Poor training and change management
• Lack of standards

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Some Success Stories
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Worldwide Health Care

• 9.2 million beneficiaries
• 70 military hospitals/medical centers
• 411 medical clinics
• 417 dental clinics
• 130,800 employees

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A Week in the Life

• 1.7 million outpatient encounters
• 19,200 inpatient admissions
• 400,000 dental procedures
• 1.9 million prescriptions
• 2,000 births

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Iraq Since March 2005

• 66,928 outpatient encounters
• 3,282 inpatient admissions
• 14,387 x-ray procedures
• 119,417 prescriptions
• 107,057 lab procedures

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Worldwide Electronic Health Records
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Implementation Progress 5 years 1B

• 74 of 140 facilities to date
• 99 of 140 historical data feeds to date
• 250,000 encounters/week
• 9.8 million encounters to date
• 7.1 million patients with records online

As of 21 October 2005
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DoD-VA Joint Plan for Electronic Health Records
The Path to Interoperability
Interoperable Electronic Health Records
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Federal Health Information Exchange

• 3.14 million unique patients
• 41 million lab results
• 6.5 million radiology reports
• 40.5 million pharmacy records
• 37.9 million standard ambulatory data records

BHIE
FHIE
CHDR

• 2-way
• Local exchange
• Text data
• Real-time

• 1-way
• Enterprise exchange
• Text data

• 2-way
• Enterprise exchange
• Computable data
• Real-time

Interoperable Electronic Health Records
As of 7 September 2005
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Bidirectional Health Information Exchange

• Leverages FHIE infrastructure
• Clinical data for shared patientsDemographics,
  allergies, laboratory, radiology, outpatient Rx
• Operational at five sites
• Seven additional sites planned

BHIE
CHDR
FHIE

• 2-way
• Local exchange
• Text data
• Real-time

• 2-way
• Enterprise exchange
• Computable data
• Real-time

• 1-way
• Enterprise exchange
• Text data

Interoperable Electronic Health Records
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Clinical Data Repository/Health Data Repository

• Establishes interoperability between DoD VA
• Computable dataDrug-drug drug-allergy
  interaction checking
• February 2006Planned implementation of
  demographics, outpatient Rx, and allergy data

CHDR
BHIE
FHIE

• 2-way
• Enterprise exchange
• Computable data
• Real-time

• 2-way
• Local exchange
• Text data
• Real-time

• 1-way
• Enterprise exchange
• Text data

Interoperable Electronic Health Records
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Vision
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Innovation, Collaboration, Transformation

• Enterprise architecture
• Advanced technology research development
• Federal collaboration
• Public-private collaboration
• Office of the National Coordinator for Health
  Information Technology (ONCHIT)
• American Health Information Community (AHIC)
• Joint Commission on Accreditation of Healthcare
  Organizations Healthcare IT Advisory Panel

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Puerto Rico

• Gobierno Estado Libre Asociado (Capital - San
  Juan)
• Población 3.8 Millones (78 Municipios, 33 SJ)
• Agencia Departamento de Salud
• Presupuesto DS US 2.5 Billones
• Modelo Público Privado
• Facilidades 63 Hospitales Privados
• 34 CDT (Primarios)
• 15 Centros Inmunológicos y/o Pediátricos
• 4 Facilidades de Salud Mental Regionales
• Centro Médico Supra Terciario / RCM
• Seguro de Salud Reforma del Gobierno (1.7
  Millones)
• Privado
• Condiciones Prevalecientes
• Asma, Hipertensión, Fallo Cardiáco, Diabetes

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Critical Success Factors

• Creating a Technical framework for connectivity
• Addressing Financial barriers
• Engaging the public and communities
• Evidence based medicine across the board

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The Road Less Traveled
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Start with the End in mind
In Developing Countries only
Access
ltlt0.001
Manage more with same headcount Provide Access to
remote locations economically Leverage the
Medical Resources in a region Promotes
Collaboration of all constituencies Can the
Military and Civilian into a single model
Have Access to Health Care In remote locations
locally and Internationally. Multi-lingual,
Multi-Cultural. In Rural America Access, quality
and costs are below the country average. Our
MOTTO No patient and Provider will stay behind
Collaboration INTEROPERABILITY
Decreases medical errors by 80 Proactive
Approach To Health Care, facilitates Prevention
Models for Education And Training.
Decreases Cost by 50 Reduces Fraud by
40 Decreases IT cost by 80 It is financially
feasible
Improves Health through Knowledge
Cost
Quality