1. IBM involvement in adoption of EHR,
health data standards and epSOS
Matej Adam
Healthcare Leader EMEA
matej.adam@cz.ibm.com © 2012 IBM Corporation

2. Let’s build a smarter planet: Healthcare
Agenda
1.IBM in healthcare
2.Health data standards
3.epSOS
4.EHR adoption and value creation
1 © 2012 IBM Corporation

3. Let’s build a smarter planet: Healthcare
IBM Healthcare & Life Sciences Team
 4,000+ employees worldwide
– Services, Systems, Software,
Research, & Financing, Sales
– Large Clinical Consulting Staff
 Clients include:
– Hospitals: 14 of the top 14 hospitals
– Healthcare Insurance: 12 of top 13
companies
– Government: significant projects in
Canada, Singapore, Denmark,
Germany, Ireland, Spain, Italy, China,
India and US
– Pharmaceutical: 30 of the top 30
companies
– Biotech: 18 of top 20 companies
– Also, medical research in
Almaden/Watson, Haifa, Zurich, Japan
2 © 2012 IBM Corporation

4. Let’s build a smarter planet: Healthcare
IBM Involvement in European eHealth
 Large Scale EU Projects
– epSOS – engaged in 3 working groups
– Renewing Health – Supporting Smart Personal Health action (via Continua)
 European Trade Associations
– COCIR – 3 resources on HIT and Telemedicine Focus Groups
– Continua Health Alliance – 1 resource on Policy/Strategy Work Group
– EHTEL- ETSI- CEN/CENELEC- EuroRec
 Other European ‘Centres of Excellence’
– Norway – Tromso Telemedicine Centre
– N Ireland – European Centre for Connected Health
 Major European Conferences and Exhibitions
– eHealth Week - World of Health IT (7-9 May 2012, Copenhagen)
– HIMSS CIO Summit (18-20 November 2012, Mallorca)
– eHealth Week - World of Health IT (13-15 May 2013, Dublin)
3 © 2012 IBM Corporation

5. Let’s build a smarter planet: Healthcare
New Generation of Standards aim at ‘True’ Interoperability
 “To provide standards for the exchange,
e.g., HL7 mission:
management and integration of data that supports clinical
patient care and the management, delivery and evaluation
of healthcare services.”
 interoperability
: ability of two or more systems or components to
exchange information and to use the information that has
been exchanged.
Source: IEEE Standard Computer Dictionary: A Compilation of
IEEE Standard Computer Glossaries, IEEE, 1990]
Functional Semantic
interoperability interoperability
4 © 2012 IBM Corporation

6. Let’s build a smarter planet: Healthcare
Enabling interoperability: Metadata, Ontologies, Standards… ?
(Inter) nationally
Accredited
Standards
Public Reference
Ontology Inter- Database
Metadata operability? Interface
Registry Engine
Metadata Metadata Metadata Metadata
Enterprise Enterprise Enterprise Enterprise
Data Data Data Data
5 © 2012 IBM Corporation

7. Let’s build a smarter planet: Healthcare
IBM HCLS Standards Program
 An IBM “Standards Team” with experts on each key* SDO**
Examples of innovative standards development led by or with IBM:
• HL7 Clinical Genomics & Family History : lead
 Develop innovative standards • HL7 Clinical Document Architecture (CDA): co-editor
• HL7 Continuity of Care Document (CCD): co-editor
• IHE XCA, XCPD, XDS-SD, XD-Lab: lead
 Promote adoption of standards within IBM and outside
 Implement HCLS standards over open technology standards
 Foster a continuum/convergence of healthcare and life sciences standards
 Use model-driven approach, enabling customization through constraining
 Push industry to reduce overlaps where possible
 Show how standards fit together and support interoperable EHR
* key = accredited, appointed, dominant or emerging SDOs
6 © 2012 IBM Corporation
** SDOs = Standard Developing/Profiling Organizations

8. Let’s build a smarter planet: Healthcare
IBM Research Lab in Haifa - Activities with Standards Implementations
Clinical Genomics Medical Imaging Management
CG / BII / BioMIMS / Cli-G CMO, VNA Cross-facility intelligent archive
Data mining analysis
of massive amount of
operational clinical- Admin
HL7
Interface
DICOM
Interface
User specific
Interface
Server
genomic data yielding Agent Agent Agent
Management
decision support Consol
components RMI/IIOP
CM API
CM API CM API
SME
CM
CM API
Hypergenes – exploring TSM
the genetic background
of hypertension
EuResist – fine-tuning
the AIDS drug cocktail by
Tape Tape Tape
the viral genome Raid Drive (local cache)
Interoperability and PHREHR Health Standards Practice
HIE&Initiate / MECIDS / uHealth HL7 / IHE / CEN / DICOM / HIPAA
Offering Education & Services
• Regional and national • Medical home and
HL7 involvement:
EHR initiatives collaborative care
• Co-chair and facilitator of
• Public health Clinical Genomics Group
information exchange • Co-editor of the Pedigree spec
• Patient Empowerment • Co-editor of CDA Release Two
(clinical document) & CCD IG
through connecting EHR
and PHR systems • Co-chair of RIMBAA (RIM-based
Application Architecture)
CMO = Content management Offering HIE = Health Information Exchange
7 BioMIMS = Biomedical Imaging Management MECIDS = Middle East Consortium on Infectious Disease Surveillance © 2012 IBM Corporation
BII = Biomedical Information Infrastructure uHealth = Smart PHR and social-medical networks for the patient

9. Let’s build a smarter planet: Healthcare
epSOS - Goals & Challenges
 Goal for the epSOS eHealth Project:
– “to develop a practical eHealth framework and ICT infrastructure [based
on existing national infrastructures] that will enable secure access to
patient health information, particularly with respect to a basic patient
summary and ePrescription, between European health care systems”
 Challenges to get there (based on the EIF (European Interoperability Framework)):
– Legal Interoperability
– Organisational Interoperability
– Semantic Interoperability
– Technical Interoperability
8 © 2012 IBM Corporation

10. Let’s build a smarter planet: Healthcare
Why is epSOS important?
 eHealth Governance Initiative and the adoption of the
Directive 2011/24/EU on the application of patient's rights in
cross-border healthcare
 Deploy Telemedicine solutions for Chronic Disease
Management
 Identifies 5 political goals for this digital agenda:
– Patient Safety (evidence based healthcare, reduced risk of patient
harm)
– Quality of Care (patient satisfaction, effectiveness of care service
provision)
– Availability (equal access, reduced waiting times and better utilisation of
resources)
– Empowerment (patient-centricity and direct involvement in the patient’s
own care)
– Continuity of Care (coordination of activities & information sharing w/
caregivers)
9 © 2012 IBM Corporation

11. Let’s build a smarter planet: Healthcare
From Strategies to Services
Provide concrete cross border services that ensure safe, secure and
efficient medical treatment for citizens when travelling across Europe
 Focus on services close to the patient:
– Patient Summary for EU Citizens
Occasional Visit
Regular Visit
– ePrescribing for EU Citizens
Medication ePrescription
Medication eDispensation
 Build on existing National eHealth Projects and use experiences and
knowledge from all Member States
10 © 2012 IBM Corporation

12. Let’s build a smarter planet: Healthcare
epSOS – European Patients Smart Open Services
Country B Country A
POC epSOS POC
(Pharmacy) (Pharmacy)
Circle of Trust
NCP B NCP A
POC POC
(Hospital) (Hospital)
POC POC
(General Practioner) (General Practioner)
IHE & CDA are
key standards!
National Circle of Trust National Circle of Trust
Source: epSOS project documentation
11 © 2012 IBM Corporation

13. Let’s build a smarter planet: Healthcare
The epSOS participating nations
20 EU Member States
3 Non EU Member States
12 © 2012 IBM Corporation

14. Let’s build a smarter planet: Healthcare
The epSOS Industry Team
as per 15.05.2013
3M Agfa HealthCare Alert Life Sciences Apollo Information
Computing Technologies
Boston Life Labs CareCom Cisco Conet AG
dbMotion Dedalus Healthcare Engineering S.p.A GE Healthcare
Systems Group
Gnomon Informatics IBM IHE Europe* Indra
Insiel S.p.A. Intel Corporation Mawell MediCognos
Microsoft Netsmart Oracle Posam
RISE Steria Tiani-Spirit TrebleM
T-Systems UBM Medica X-tention
*Industry Team Coordinator,
Industry Team Steering Group members are underlined
no member of Industry Team
13 © 2012 IBM Corporation

15. Let’s build a smarter planet: Healthcare
IBM involvement in epSOS project
 IBM joined the project in January 2010
 We have one representative in the Steering Group of the
Industry Vendor team
 We've been active in a number of Work Packages during the
Analysis & Technical Specification phases, sharing our
experience and promoting eHealth standards that have
proven their value in some of IBM projects.
 We're in contact with several Member States to help them
build and run their epSOS pilot
 We're in contact with epSOS to provide additional
security/privacy services
14 © 2012 IBM Corporation

16. EHR Adoption – Risks and Opportunities
© 2012 IBM Corporation

17. Let’s build a smarter planet: Healthcare
EHR adoption improvements – why it is important
16 © 2012 IBM Corporation

18. Let’s build a smarter planet: Healthcare
It is NOT about Information Technology!
17 © 2012 IBM Corporation

19. Let’s build a smarter planet: Healthcare
Project Risks in Healthcare IT
80% 20%
18 © 2012 IBM Corporation

20. Let’s build a smarter planet: Healthcare
Change Management is key driver of Successful Healthcare implementations
The key success factors for transformation are
organizational rather than technical
Change Management is a key driver of success
Sponsoring of senior management 82%
Fairness with staff 82%
Involvement of staff in change programs 75%
Honest communications 70%
Good training programs 68%
Usage of performance management 65%
Usage of super users 60%
Availability of resources for program 48%
Software functionality 44%
System performance 35%
Realistic program planning 31%
Source: IBM Institute for Business Value
19 © 2012 IBM Corporation

21. Let’s build a smarter planet: Healthcare
Need Help? Being a Physician is Only Getting More Difficult. No
One Individual Can Do Everything that’s Needed or Expected.
20 © 2012 IBM Corporation

22. Let’s build a smarter planet: Healthcare
On the way for clinical value and meaningfulness
Importance of defining the Clinical Value of the EHR around:
 Improving Quality of Care
 Increasing Access to Services
 Increasing Patient Safety
 Managing Costs
 Providing Proactive rather than Reactive Health Care
 Chronic Disease Prevention Management
 Patient Self Management
21 © 2012 IBM Corporation

23. Let’s build a smarter planet: Healthcare
Generations of EHR capabilities
Functionality Generation 5
The Mentor
Predictive / Watson
Generation 4
The Colleague
Generation 3
The Helper
Generation 2
The Documentor DiaLog Shared Care
(Denmark)
Generation 1
The Collector Basic Health Portal
Shared
Repository
Time
22 © 2012 IBM Corporation
22

24. Let’s build a smarter planet: Healthcare
HIMSS Europe adoption model
23 © 2012 IBM Corporation

25. Let’s build a smarter planet: Healthcare
HIMSS adoption 2012 status - Poland
 Source: HIMSS Analytics Europe 2012
24 © 2012 IBM Corporation

26. Let’s build a smarter planet: Healthcare
Focus on a how to leverage datacollection base for more value add
clinical and operational functions on the way to patient centric
Deliver collaborative care Personalized
for prevention and wellness Healthcare Value
Retrospective to Prospective to
Achieve better quality and Predictive Care Management
outcomes
Collaboration and Automation
Integration / Information compliance,
Interoperability availability and security
Improve operational
effectiveness
EMRs, Images, Records, Forms
Lifecycle Management, Clinical Trials, Safety
IBM Health Integration Framework
25
25 © 2012 IBM Corporation

27. IBM aPatient Healthcare and Insights
Let’s build smarter planet: Care
Capture, Analyze, Activate
Raw Information IBM Content and
IBM Content Analytics IBM Similarity Analytics
(e.g. EMR and Claims) Predictive Analytics
Recommended DTIC
Patient Age: 65 Risk of 47% Add’l
Gender: Male metastasi Treatment
Race: White s
Diagnosi Melanoma
s Stage: 2
10’s of thousands of Social Marital status: single
patients One Patient
A 65-year old white male Labs AJCC: T2 100’s or 1000’s of
has been diagnosed with patients
stage 2 melanoma. He is
widowed and lives alone.
IBM Care Manager
AJCC: T2
Goals Avoid remission
Activities Avoid UV radiation
Regular screening
100’s or 1000’s of Transportation
patients assistance
26
26 © 2012 IBM Corporation

28. Casea smarter planet: Healthcare Really Caused Readmissions at Seton
Let’s build Study: What
The Data We Thought Would Be Useful … Wasn’t
• 113 candidate predictors from structured and unstructured data sources
• Structured data was less reliable then unstructured data – increased the reliance on unstructured data
New Insights Uncovered by Combining Content and Predictive Analytics
• LVEF and Smoking are significant indicators of CHF but not readmissions
• Assisted Living and Drug and Alcohol Abuse emerged as key predictors (only found in unstructured
data)
• Many predictors are found in “History” notations and observations
Top 18 Indicators
18. Jugular Venous Distention Indicator
17. Paid by Medicaid Indicator
Predictor Analysis % Encounters % Encounters
16. Immunity Disorder Disease Indicator
Structured Data Unstructured
15. Cardiac Rehab Admit Diagnosis with CHF Indicator
Data
14. Lack of Emotion Support Indicator Ejection Fraction (LVEF) 2% 74%
13. Self COPD Moderate Limit Health History Indicator
12. With Genitourinary System and Endocrine Disorders Smoking Indicator 35% 81%
11. Heart Failure History (65% Accurate) (95% Accurate)
10. High BNP Indicator
9. Low Hemoglobin Indicator Living Arrangements <1% 73%
8. Low Sodium Level Indicator (100% Accurate)
7. Assisted Living (from ICA Extract)
6. High Cholesterol History Drug and Alcohol 16% 81%
5. Presence of Blood Diseases in Diagnosis History Abuse
4. High Blood Pressure Health History
3. Self Alcohol / Drug Use Indicator (Cerner + ICA)
Assisted Living 0% 13%
27 Heart Attack History
2.
27 © 2012 IBM Corporation
1. Heart Disease History

29. Let’s build a smarter planet: Healthcare
How Similarity Analytics Work
 Create personalised profile based on longitudinal data, determine risk factors
 Find the most similar patients (or dynamic cohort) from entire population
 Analyze the attributes and outcomes for this cohort (across 30,000+ dimensions)
 Predict the probability of the desired outcome for patient in question
 Suggest a personalized care plan based on the unique needs of this patient
Historical Observation Window Prediction Window
This Patient’s Longitudinal Data Predicted Outcome For This Patient
Desired
Outcomes
Dynamic Cohort Longitudinal Data with Outcomes
28 © 2012 IBM Corporation

30. Let’s build a smarter planet: Healthcare
IBM Competency in Health IT
Structured and formalised method
Many years of experience
for benefits of our clients
IBM delivers e-health
in Denmark for 15 years E-health adoption framework
IBM delivers e-health ROI driven healthcare program
in Canada for 10 years management
IBM building Smart Healthcare ROI data from IBM own
in US, UK, Spain, Germany, projects and combined
Norway, Sweden, Ireland, Italy, industry expertise
CEE, Middle East, SA, Asia ...
Health Integration Framework
IBM Institue for Business Value and Smarter Health solutions
Healthcare Industry Practice
IBM expert team helping
clients to define national and
IBM Center for Applied Insights
regional e-health strategies
ROI for Healthcare
based on ROI
32 © 2012 IBM Corporation

31. Improving patient safety and care quality while improving the bottom line >> Achieving quality, safety, cost, and revenue improvements
Let’s build a smarter planet: Healthcare
IBM Center of Applied Insights Healthcare ROI Econometric Model
Business leader interviews Value of the
•27 interviews representing: Collaborative Care Econometric Model
•Titles: CMIO, CIO
•Sizes: range from 60 to  Holistic: Takes a holistic perspective
1000 beds unlike other studies
•Locations: 5 countries Econometric Model
 Financial impacts: Quantifies clinical
• Analyze business and business impacts as costs or
Subject matter expert model, sources of value, revenues
interviews economic impact,
 Research: Leverages academic and
• 35 healthcare analysts and competitive alternatives
thought leaders, including industry research and results of
• Identify value and ROI
notable authors and interviews with healthcare leaders
delivered to Healthcare
speakers Providers  Outlook: Accounts for transition path
and steady state benefits
Academic and industry  Flexible: Can accommodate alternative
studies meta analysis technology functionalities and
• >200 peer-reviewed articles implementation scenarios
• Journals include New
England Journal of Medicine,  Vendor neutral: Takes a functional,
Health Affairs, JAMA rather than vendor-driven approach
Source: IBM Market Insights
33 10 January 2013 © 2012 IBM Corporation

32. Let’s build a smarter planet: Healthcare
Summary - Ingredients for success in EHR adoption
 Learn from the past and other countries – best practices
 Design a rock solid Governance process
– Direction
– Project oversight
– Stakeholder buy-in
– Manage the Change
– Allocate 20 to 25% of project budgets on Change Management
– Build in motivation criteria
 Focus on clinical meaningfulness
– Improvements in quality, safety, costs of care
– Decisionmaking support
– Proactive rather than Reactive Health Care
 Use Standards and methods across the program
– Project management
– Common project phases & gates
– Alignment with a national E-Health Architecture using a Design Authority
 Value Measurement
– Define outcomes
– Establish Benefits Realization mechanism
– KPIs
37 © 2012 IBM Corporation

33. Let’s build a smarter planet: Healthcare
... and please don‘t forget
Technology is just a tool ...
... how much value we
create is up to us all!
38 © 2012 IBM Corporation

34. Thank you
matej.adam@cz.ibm.com
© 2012 IBM Corporation