Hospital Information Systems “ Hospital” as a big complicated healthcare organisation

2. Danny Solomon Senior Architect, iSOFT danny.solomon@isoftplc.com www.isoftplc.com Hospital Information Systems“Hospital” as a big complicated healthcare organisation

3. Understand information requirements of hospitals and other health-care organisations Understand issues and challenges in the life-cycle of health-care information-systems Understand some of the history – and some future directions Introduce iSOFT Objectives challenge dispute interrupt

4. What is a health-care information system? What’s it for? Issues in their creation and deployment – why is it hard? Where they have come from – where they are going iSOFT Agenda

5. Requirements Context How it all relates to CfH What is a health-care information system? What’s it for?

6. Requirements of a health-care information system • Information-systems to run health-care organisations (HCOs)? • OR • Information-systems to manage the records of patients cared for in those organisations? BOTH

7. StHA PCTs GPs Acute Mental Health Community Sites Directory and desktop Infrastructure Population record Records Analysis HRI Out-of hours access Reference data Terminology Security Service user index Clinical governance Booking and scheduling Knowledge mgt Digital Imaging Prescribing Orders and results Diagnosis and care Pathology Any community service for tactical reasons Eg. PAS, Mental Health, Tertiary Non-federated data . . . What is an HCO? Guys & citizen Identity Clinical information . . . . . . National London

8. Multiple facilities (sites) Wards Clinics Diagnostic services Radiology, Pathology, etc Pharmacy Treatment Theatres, Modalities Medical Records Coding Links to other organisations Local: Primary care, Community National: DoH, CfH, national information systems Catering Portering Physio Phlebotomy Management HR, Finance, etc … Anatomy of a hospital

9. Information-systems to run health-care organisations • What’s going on? • What’s planned? • Where are my patients? • What reports do I need to generate? • Get my money • Am I about to run out of money? • Run my clinics • Run my waiting lists • Run my wards • Run my theatres

10. Administrative Where do they live Booked for a clinic? On a ward? GP Next of kin … Clinical What’s wrong with them What am I planning to do to them? Order a test See the result Refer them on Describe them … Information systems to manage patient records Division is not clear cut • Information Governance (IG) issues • Who can see what? • Is restricting to demographics safe? • Who can see clinical? • Is ward location clinical or demographic? • How much information is shared? To whom? • What does the patient expect?

11. Issues in the creation and deployment of health-care information systems • Why is it hard? • Total cost of ownership (TCO)

12. Why is it hard? • Well, is it hard? • Empirical evidence suggests it is • Beacon examples are generally not reproducible • Productising is an issue • Medicine is not a science • Out of the box, computers are good at numbers, not people • Organisational setting is complex • Different across different markets • Change control and management is always hard • Some specifics…

13. Why it is hard • Booking a clinic is like booking a flight? • Slots not constant • Different resources required for different slots/clinics • Recipient has to explicitly accept • Over-booking rules • Patients aren’t predictable … • Clinic booking is the easy bit!

14. Why it is hard • Lots of different kinds of users • Clinicians • Docs • Different grades, specialties, experiences, training, backround • Nurses • … • PAMS • … • Managers • Administrative staff • Patients • Well • Unwell • Worried well • Vulnerable • Young / old • Expert / non-expert

15. Why it is hard • Lots of different kinds of users • Doing different kinds of things • Seeing patients • Clinics, wards, A&E, telephone • Planning budgets • Organising resources • Human, equipment, consumable, locations • In many different settings • Organisational • Hospital (wards, clinics…), Community, Practice, Lab, • Specialty • Paed, Geri, Med, Surg, … • Everyone likes to do things their own way Don’t panic

16. Maintaining the balance

17. There is commonality we can exploit

18. Healthcare services Care settings Health economy One product, many solutions

19. Product vs solution • Product = software • Solution = software configured and deployed onto a managed technical architecture • Many areas to consider: TCO

20. Total cost of ownership (TCO) • Forget shelf prices • What will it cost my organisation to procure, contract, implement, run, update and ultimately retire an information system? • What if I do nothing? • A useful way of examining areas that make this whole process hard

21. Typical TCO model

22. Health-care information systems: where they have come from & where they are going History Drivers Direction of travel Past, present and Future

23. Where health-care information systems have been • Organisation often based on physical artefacts • Eg Hospitals • Lots of local autonomy • Need to maintain links with labs • Maintain own coding departments • Maintain own IT infrastructure • Information systems • Local procurement • PAS critical • Clinicals less so • Lots of local activity at a departmental level – nightmare to manage • Order-comms typically an early requirement/win • EPR / Prescribing not common in secondary care

24. Drivers • Health-care organisation is changing • Everywhere, quite frequently • From the centre • Reporting requirements • Spine compliance • PBR • Locally • (some) clinicians demanding better tools • Access to knowledge & best practice, decision support, lose the paper • Procurement model is changing • Local  Regional  National • Do once and share • Procurement, configuration

25. Drivers • Health-care organisation is changing • Procurement model is changing • Deployment model is changing • Critical data under a GP’s desk? • Critical data in a hospital server-room? • DR-capable data-centre • Information-sharing becoming critical • Support the patient journey • Empower the patient • Where that’s a good thing • Avoid unnecessary errors

26. SH SH SH SA SA SA SA Step 1 – Analyse landscape Qualify legacy systems Plan the transition Step 2 – Install products Legacy replacement commenced Service adapters for core services deployed Service hubs introduced Architecture being delivered Step 3 – Join Up More uniform landscape More information access Common services and accessible data Supports shared and coherent care across the community User experience: Mix of modern and legacy Organisation-focused: little information passed around the community User experience: Modern applications becoming pervasive Information becoming accessible across the community Legacy decreasing User experience: Modern applications across the community Information accessible across the community GP legacy Citizen Healthcare community Hospital legacy iSOFT customer Integrated healthcare community Direction of travel

27. Mission Market leadership Business strategy Global healthcare and social reform iSOFT

28. To be the global leader in the healthcare software applications market. iSOFT is working with patients, clinicians, other healthcare professionals, administrators and governments to help transform the delivery of healthcare. We focus on satisfying the needs of all individual stakeholders, whoever they are, and however they participate in the supply chain of healthcare provision. Our solutions not only meet the current need, they also describe the future of healthcare. Our inspiration and motivation is to improve the life experience of citizens worldwide Our mission • iSOFT: inspired by life.

29. Leading the healthcare software applications market Financials Scale of business • Customers • 1,700 hospitals • 6,000 family doctors • 18 countries in five continents • Employees • 2,700 healthcare IT specialists • 1,000 technology and development professionals • Two dedicated offshore development and solution design centres in India • Fourth largest software and computer services business on the LSE • Market capitalisation of over £900m (US$1,600 million) • Stock market listing in July 2000 • Revenues grown from £17m to £262m • Profits increased by over 2,000%

30. Expand partnership arrangements Target rapid market leadership Deliver growth in existing markets Develop and execute new market entry strategies Maintain software application leadership • Develop and grow existing market shares for LORENZO • Configure LORENZO to meet local market requirements • Provide world class references for international expansion • Conduct detailed market analysis and qualification • Establish strong foundation based on significant early wins • Build on initial success through effective promotion of LORENZO • Establish leading competitive position • Win majority of open market procurements • Accelerate market share through targeted acquisitions • Work with third party technology and service partners on large scale projects and new market entry • Develop existing partnership arrangements • Identify opportunities for new partnerships and collaborations • Offer strategic ‘universal’ application set • Continue to invest in development capability and capacity • Promote LORENZO as our new generation software solution Our business strategy

31. The needGlobal healthcare and social reform • Healthcare is undergoing rapid, unprecedented change • Forward referencing solutions required by citizens, clinicians, policy makers • Work to implement the necessary systems will take place over the next 10 years

32. Summary • Successful well managed healthcare applications business • Consistent and focused business strategy • Large and growing international market opportunity • Leader in the supply of advanced application solutions • Strong positive differentiation from small number of credible competitors • Well positioned in respect of future growth opportunity in both existing and new international markets

33. Understand information requirements of hospitals and other health-care organisations Understand issues and challenges in the life-cycle of health-care information-systems Understand some of the history – and some future directions Introduce iSOFT Re-cap Objectives