Agenda

1. Oracle in the Healthcare & Life Sciences IndustrySofia, February the 1st, 2006EMEA Healthcare and LifeSciencesGiancarlo Ruscitti, Business Development Director

2. Agenda • Healthcare IT market overview • Oracle’s vision and strategy

3. Clinical/ Administrative Systems Wireless systems Outlook: Blueprint for the Healthcare community Security access control Supply chain systems Medical Systems ElectronicPatient Records Integration architecture Database infrastructure Systems with potential Oracle participation in red font

4. HC IT: A huge industry Breakdown of EMEA HC IT market (2004) $Bn $1.6Bn $7.8Bn $0.93Bn $0.93Bn Payors R&N(1) Maintenance Services Primary care Clinical & other(2) Non- acute Acute hospitals Hardware License ERP D'base tools Software D'base Total IT spend SW spend Customers Product (1) Regional & National initiatives plus military (2) Hospital departmental systems, GP systems, desktop SW, payor back office solutions, etc. Sources: National statistics bodies; OECD; WHO; Gartner; Dresdner KW; Silicon Bridge Research; IDC

5. Highest growth of all industries Growth of IT spending in Western Europe (selected industries) 2003 - 2008 Growth p.a. Source: IDC

6. Leading Business Trends Why is the European market different? • The common healthcare challenges • Increasing pressure to reduce costs • Improving quality of care delivery • Secure, self-service access to healthcare information and services • The healthcare challenges in EMEA • Medical Progress • Ageing population • Rising healthcare costs and social security deficits • The move to citizen-centered care

7. Key Healthcare ConcernsRegarding healthcare systems • Excellence in clinical care • Provider access to critical information at the point of care • Financial management and tarification • Increased financial and regulatory oversight • Managing human resources and retaining skills • Proactive staff management to reduce workforce turnover

8. Requirements for Healthcare ITInformation Technology Trends • Adherence to global industry standards • Consolidation and integration of healthcare systems • Management of the scale and complexity of the healthcare infrastructure • Robustness and security in healthcare systems

9. Basic Pain Points • Who is my patient ? • Where is he ? • Did he come to me before ? • Does he have a clinical history ? • Are his medications and lab tests results available ? • Can I access medications and lab tests results ? • Can I leave a message to my colleagues about my patient ? • Can I share informations about my patient and exchange with my colleagues about him ?

10. IT driven by known challenges Stakeholder Pain points IT solutions • Provider • Clinician • Nurse • Dentist • Radiologist • Lab • Pharmacist • Management • Payer/regulator • Patient • Lack of comprehensive accessible clinical patient notes both in and outside of normal office hours • Inability to communicate easily with colleagues • Increasing administrative workload • Increasing litigation concerning medical/drug errors • Need to fulfil continual educational requirements • Increasing demand (leading to longer waiting lists) • Increasing need to report performance metrics • Lack of comprehensive organisation-wide information to facilitate planning • Staff shortages • Lack of IT skills • Lack of transparency of provider information • Inability to integrate data from different providers • Lack of population level statistics • Difficult/expensive communication with individual customers/providers eg individual eligibility checks • Increasing cost of medical care • Poor access to medical services eg long waiting times, difficult to access services out of hours etc • Lack of choice of care providers • Insufficient information to make informed decisions • Electronic Patient Record (EPR) • e-booking • e-prescribing • Decision support systems • Clinical databases • Management information systems • Finance • HR • Payroll • Procurement • e-learning • Web/telephone based patient information services Addressedby ITsolutions At the same time IT penetration (1.5 % – 2%) lowest among information intensive industries

11. HIS Level of Sophistication Infra in US > Europe! Level 1 : PAS-Patient Administration System Level 2 : Common MPI-Master Patient Index, integration around patient number Level 3 : Clinical Order, results, advanced medical library Level 4 : Decision Support, ePrescribing Source : HINE 2005

12. HIS Level of Sophistication Differences between countries • Spain indicates rather sophisticated approach with 100% of hospitals – highest results after Sweden • 531 workstations per hospital (mobile WS 3% in Germany and Italy, 7% in UK/Eire) • 3.52 staff per workstation • 1.1 screen per bed • Mobile technology (11% in Sweden, 17% in Norway)

13. Agenda • Healthcare IT market overview • Oracle’s vision and strategy

14. Healthcare and Life Sciences Strategy Evaluate, Compare, Analyse and Pay REAL TIME ! Payer Ask for More Medical Efficiency Pay taxes and insurances Safety EXPENSES GROWTH ! • Life Sciences • Pharma Labs • Research Centres • Medical Societies • Patient • Satisfaction • Well-being • Health MEDICAL PROGRESS Medical Activity Budget Personalize Define Indications Clinical Pathways Best Practices Deliver Care Provider WAITING LIST! DEFICIT ! Allocate Service Budget Optimize Care Processes Monitor Financial Performance

15. Oracle’s Vision in Healthcare Providing a robust healthcare platform and enterprise applications enabling organizations to: • Reduce healthcare IT complexity • Lower total cost of ownership • Improve scalability, security and availability of IT systems

16. Oracle has a strong position in the HC market • Oracle is the leading worldwide database provider for payors and hospitals • In Europe 50% - 80% (depending on country) of all healthcare payors and providers use Oracle Technology • More than 300 leading healthcare providers and more than 80 healthcare payors run Oracle applications • Oracle is the leading provider of Clinical Trial Management Systems • 15 of the top 20 Pharma companies use Oracle Clinical • Oracle is the only company to offer a health data repository and integration platform based on the open standard HL7 v3 Reference Information Model (RIM)

17. 4 product families for the HC market • Third Party / Partner Applications • Clinical Suite • Medication Management • Chronic Disease Management • Patient Safety alert • Home care delivery • HC transportation • Health Insurance Front Office • Public Health Reporting • Oracle Pharmaceutical Applications (OPA) • Oracle Clinical • Adverse Event Reporting • Thesaurus Mana- gement • Trial Management • Oracle EBS Applications: • Financial • Human Resources • Procurement, Order Mgt, SCM • Sales • Service • Projects • CRM • Oracle Health Transaction Base (HTB) • Health Data Repository • Application Development Platform • Integration Platform • Base technology • Database (incl. HC-specific options like DICOM support) • Application Server • Collaboration Suite • Business Intelligence

18. Oracle products support future HC trends 1 – Gartner Report Nov 2004

19. Four major Go-To-Market Initiatives defined

20. Integrated Hospital Solution Solution Partners References

21. Integrated Hospital Solution Revenues Orders + Planning CLINICAL FINANCIAL PATIENT BILLING 43 M€ PATIENTRECORD ISVs with or without HTB as CDR BI CDR 10 M€ HRMS 87 M€ LIS RIS PHARMAPACS ERP 38 M€ Results + Reports + Drug Dispensing

22. Integrated Hospital Solution Revenues Orders + Planning CLINICAL FINANCIAL PATIENT BILLING Performance 43 M€ • Reference • Organizations • Persons • Roles • Terminologies PATIENTRECORD BI CFDR HTB 10 M€ HRMS • Persistence • Acts • Participation • Security 87 M€ LIS RIS PHARMAPACS Expenses ERP 38 M€ Results + Reports + Drug Dispensing

23. Integrated Hospital Solution Financial Medical Billing Medical Labs ICD-10 SNOMED-CT Processes Radiology Repository Pharmacy Blood DRG ERP Payroll Budget Analysis Optimization

24. Core Applications Oracle CFDR ISVs HTB EBS Integrated Hospital Solution Revenues Orders + Planning CLINICAL FINANCIAL PATIENT BILLING Performance 43 M€ PATIENTRECORD BI CFDR HTB 10 M€ HRMS 87 M€ LIS RIS PHARMAPACS Expenses ERP 38 M€ Results + Reports + Drug Dispensing

25. Project Management Change Management Recruitment Location/ Office Organisation Design Oracle And Partner CoreCompetencies Package Enabled Reengineering Method European and Local SIs Core Applications Configuration and Architecture Process Design

26. Analyst Input Healthcare GTMi’s Shared Service Centre Integrated Hospital Solution Medication Management Chronic Disease Mgt • Key Business Requirements • KBR 1 • KBR 2 • … Key Business Drivers Solution 2 Solution 1 Infomentis process

27. Business Flows for Administrative Processes • Procure to Pay (I-Procurement, Purchasing) • Fulfilment (Order Management) • Inventory management (Inventory) • Accounting to Financial Reporting (Financials) • Budget to Investment (Projects) • People to Paycheck (Human Resources)

28. Analyze to Agreement: Process PR0131 Analyze Sourcing Requirements PR0134 Evaluate Supplier Contract Performance PR0133 Maintain Negotiated Supplier Agreements PR0152 Publish Specification and Sourcing Doc • This process covers reviewing the suppliers performance against the negotiated contract.. • Identify strategic sourcing opportunities • Establish Sourcing Strategy – types of sourcing, RFx Stages, Evaluation Criteria • Add, Modify or renew negotiated agree-ments as necessary. • Agreements can be purchase orders, blankets or contracts. • The process of providing specifications and requests for quotation to a supplier. PR0148 Maintain Approved Supplier List PR1005 Maintain Suppliers • Maintain a list of approved suppliers per item. • Maintain supplier / creditors information. • Maintain bank information for electronic payment Analyze to Agreement: Process Analyze Define Sourcing Requirements Publish Request PR0137 Define Sourcing Rules of Engagement PR0135 Determine Item Requirements PR0136 Select Suppliers • Set starting and ending times • Specify Bidding/Quoting Rules • Identify Item Attributes (Quality) and Relative Scores & weights for Bid Analysis • Identify Supply Reqs (Delivery Reqs, Packaging) • Determine Sourcing Strategy to be used for Item • Review and Select Incumbent Suppliers • Assess local capabilities • Identify external sources Multi-Round Sourcing Process – e.g Rfi plus Reverse Auction Evaluate and Award Responses Finalise Legal Contract Contract Maintenance PR0139 Manage Supplier Responses PR0132 Evaluate and Award Negotiations PD1096 Develop Legal Terms and Conditions • Collect and evaluate responses to award the contract or agreements • Qualify suppliers if Rfi • Complete evaluation • Create new round if needed • Make award decisions based on item/supplier strategy • Create Procurement Contract or Blanket Agreement • Submit Contract or Blanket Agreement for approval • Finalise incentives and penalties • Develop business agreement between Provider and Supplier • Approve/make Contract or Blanket Agreement available for use Suppliers Roles Items PR0142 Maintain Supplier Catalogs Manager Purchasing PD1096 Maintain Products and Items Buyer Pharmacist • Prices are maintained on purchase agreements, Contracts, or loaded in iProcurement directly. • Items in Purchase agreements or Contracts are loaded in the iProcurement catalog. • Add or modify items • Maintain additional information for inventory items, e.g. planning parameters, default locators, etc. • Integration req’d between Oracle Inventory and ProCure for Items Supplier

29. Business Flow for Clinical Processes like Medication Management • There are four main business flows associated with Medication Management: • Evaluation • Reviewing all clinical information to ensure that the appropriate course of treatment is selected • Prescribing • The act of selecting amedication from an approved formulary • Fulfilment • The method by which the drugs identified in the prescription are made available for administration • Dispensing(Pharmacy or Hospital) • Delivery of drug to the point of care • Administration • The process by which the drug selected during the prescribing process is given to the person Associated with all four business processes is the management of compliance

30. 25% Drugs 75% Others Supply Medication ManagementRight Use of Drug in an Hospital 75% Staff 25% Supply Budget A bad use of drug leads to an increase of pharmaceutical expenses and a bad use of medical staff

31. Proof points • Dutch Hospitals – E-Business Suite with Business Flows • > 15 others (EBS only) including • OLVG • MC Haaglanden • France • Hospices Civils de Lyon • CHU Montpellier (started implementation) – E-Business Suite Only • Creteil and Montreuil (mid implementation) – E-Business Suite and HTB • Institut Claudius Regaud • Belgium • 4 hospitals including • ZNA Antwerp hospital group • UK shared services • >150 Hospitals in UK including • Cardiff and Vale NHS Trust (2nd Largest in UK) • University College London Hospital • Sandwell and City Hospitals

32. Le Havre Hospital Group in France • Objectives • Consolidation of clinical data • Enable management reporting • Solution • Healthcare Transaction Base at the core of the solution • Aggregation of persons clinical data from disparate systems • person, activity, orders, medications, results etc. • Clinical viewer developed on HTB • Benefits • Improve clinical processes and provide improved decision support • Enable changes in French reimbursement model • Status • Prototype complete • Demonstrator available for reference visits • Not in live use

33. Le Havre Hospital Group : A full Oracle Fusion Hospital ISVs Patient GP/Referrer Point of Care Community HR ADT Finance Supply Chain Others…. 10g Portal, SSO, OID, Mobile Technology (GSM, GPRS, UMTS, Wifi), RFID CollabSuite CRM ERP (master) HRMS ilearning BI Admin Partner Apps Financial Partner Apps Clinical Partner Apps RAC HTB Repository + EBS Repository 10g JDev OC4J BPEL 10g AS BC4J Workflow 10g DB Enterprise Service Bus Partner Interface Engine (Connectors, Apps & Biomedical Devices) – HL7 V3 messages Labo Apps Radio Apps Pharmacy Apps HAD Apps Clinic Apps Biomed Device Biomed Device Biomed Device

34. Azienda Ospedaliera Di Circolo Busto ArsizioProject Live • Business Objectives • Improve care delivery process • Replacement of legacy Healthcare Information Systems • Solution • Healthcare Transaction Base • Central repository for Clinical Documents • Platform for deployment of Healthcare Information Systems • Additional Benefit • The Healthcare Transaction Base becomes the central repository for all Clinical Information • Enabling more effective Clinical Decision support • Status • Partner has developed application • Training and deployment complete • Acceptance received by customer • Change Management issues delaying project

35. Integration Engine Healthcare Transaction Base J2EE ClinicalDataRepository • Messaging Services • Person Services • Terminology Management • Security and Auditing Clinical ADT Azienda Ospedaliera Di Circolo Busto Arsizio Scope Single Portal

36. CSAM : Clinical System All ManagedOslo – Rikshospitalet“Advanced medicine in a safe environment” Portal-layer: A user logs on from a single sign-on-desktop. Single sign-on is portal function that uses a catalogue service for authorization control. Depending on the user's rights the portal presents a tailored work interface, which comprises different portal items (portlets) Service layer: The service layer offers components which gives access to integrated information from the different source systems. New functionality developed will also belong to the service layer (activity handling, specialized views: pre-visit) Security architecture: In the portal, the authorization of users to access individual data/views are controlled by giving unique access rights on a portlet level to a group of users. The groups and the individual users are stored in the OID. Each group contains a list of those members belonging to the group. A group can be a member of another group. Integration layer: The integration architecture focuses on the communication between the applications and the systems. This is solved with Oracle 9 InterConnectHub-architecture. Source applications.

37. CSAM: Establishing an integrated and coherent view of patient data is essential for improving processes Information at your fingertip: Updated and complete patient health information when you need and anywhere you need it! Patient information From the journal From LAB From PACS/RIS Fra scheduling tool

38. National and Regional Healthcare Information Infrastructure Architecture References Medication Management

39. HL7 V3 RIM Portal +Mob +RFID Core Id Collab Suite HTB OLAP Disco Adverse Event Report BPEL • Persistence • Acts • Participation • Confidentiality • Reference • Organizations • Persons • Roles • Terminologies Hospitals Primary Care Payors National and Regional Healthcare Information Infrastructure Architecture National Disease Registries Prov Portal Healthcare Worker Portal Common Applications /Services eg E-bookings E- prescribing Patient consent Terminology Services … Appli Server Access Control Prov Registry Provider Registry Pat Registry Patient Registry Pat Portal Patient Portal National or Regional Framework ARR Act Reference Registry CFDR Public Healthcare Reporting Anonymous Patient Info NCR National or Regional Care Record Patient Safety Alerts Local Systems GP, Hosp, Insurance Company,REHA, Homecare Local Systems GP, Hosp, Insurance Company,REHA, Homecare TC251 card standard Inspired from Rene Spronk

40. Customer references Diraya – Receta XXI - Andalucia Sistemas de Información de Indra para Sanidad Escenario Global Visión Integrada de los Sistemas de Información de Indra para la Atención Sanitaria

41. SISTEMAS ASISTENCIALES • Historia de Salud Digital • Cita Centralizada • Contact Center de Salud • Gestión Hospitalaria • Gestión SocioSanitaria • Segunda Opinión • Gestión Imagen Médica HTB Indra Healthcare Information System Cuadro de Mando Integral Misión Global 1 POLÍTICAS • Indicadores • Inductores • Evolución Estrategias de Optimización GESTIÓN Desarrollos Tácticos y Operativos Ciudadanos Gestores Información para la Planificación y Toma de Decisiones Vigilancia Epidemiológica 2 Demanda de Servicios Productividad y Eficiencia Infraestructuras y Logística • Estadísticas • Reports • Comparativas Actividad Quirúrgica Actividad Farmacia Actividad Socio Sanitaria Recursos Humanos Económico-Financiero Información para la Actividad Sanitaria Vigilancia de la Salud y Gestión Operativa SISTEMAS DE GARANTIA SISTEMAS DE SALUD PUBLICA 3 • Receta Electrónica • Tarjeta Sanitaria • Gestión Incapacidad Temporal • Gestión de Listas de Espera • Portal de Salud • Central de Compras • Mapa de Recursos Sanitarios • Centros Coordinadores de Emergencias • Redes de Alerta Sanitaria • Sistemas de Control de Enfermedades Infecciosas • Sistemas de Control de Drogodependencias • Hojas de Consulta • Actos Clínicos • Pruebas diagnósticas • Recetas Datos Básicos del Sistema de Salud y Población 4 • Hospitales • Médicos • Asegurados Base de Datos de Usuarios/Tarjetas Base de Datos de Recursos Sanitarios Base de Datos de Historia Clínica Base de Datos Cartográficas Base de Datos de Imágenes Médicas

42. Stockholm County Council Sweden • Regional Healthcare Solution • Strategic opportunity • 4 Counties procuring similar solutions • Integration of 30+ solutions • Proof of Solution • Medication management • Acceptance testing December 2004 • Live April 2005 • Breaking the HISA stronghold • Partner - WM Data • HQAPPs approval for: - • Specific Pricing / HISA Compliance

43. Laboratory Laboratory System Abstract Layer Emergency Care System Community Care Primary Care Social Care Emergency Care Primary Care Systems Primary Care Systems Primary Care Systems HTB Phone Pharmacy Systems Pharmacy Citizen Acute Care Systems Acute Care Wireless Pager Customer references Stockholm County – WMData Central Standards Based Healthcare Repository

44. Sensium • Sensor interfacing • Wireless transceiver • Local processing • filtering data • Personal DA • Wireless network • coordinator • Personal information • Local database • Health database • Authorized (HL7) • Combined • Aggregated • High qulaity Data prepared and mined For health personnel Lots of fuzzy and uncoordinated data Moderate but somewhatprocessed data Distribute information processing

45. Clinical & Care Delivery (Providers) Financing & Administration (Health Plans) Member Health Record Electronic Medical Record Unification Platform Personal Health Record Shared Services Shared Services Community Health Record Informatics (Centers of Excellence) Customer references Tennessee – TennCare - Cerner Person

46. Hospital or Payer Regional or National EMPI Pharmacy or Payer Labs

47. National or Regional EHR 3 ) Medication Passport All “active”/historic Medications / allergies 9) Statistical Epidemiologic Macro-data • 1) Many Prescribers • a) GP’s • - your own • - weekend/night • - away from home • b) Specialists • Med . Consultants • 25+ Specialties • c) Dentists etc • d) Nursing • Cure / Care • e) Self medication • alternatives ?? • f) Discharge Medication 6) Execution Add to : Medication Passport Logistics Delivery (Make) by A Pharmacy Payment Via Insurer Pat. Direct/co payment 4) Controls A) Insurance Covered ? Co-payments ? B) Safety Interactions ? Allergies ? C) Effectiveness Formulary Dis. M Protocols D) Economics Alternatives Generics E) Promotion Education Instructions 2) Proposed Medication first time repeating prescription Ware house 5) Ordering To Deliver Payer 7) Patient Compliance Post Mk surveillance 8) Refills Medication Management Service & Process modelFrom Fulfillment to Compliance L A B I M A G E S Inspired from Leo Volbregt

48. Doctor Patient Pharmacist, Nurse Pharmaco Vigilance Prevent ADE to enhance quality Proposed Solution EHR

49. Shared Services Positioning Different Models NHS reference

50. Shared Service Positioning National or Corporate Governance Shared Service Centre • Strategy and Policy • Resource Allocation (e.g. in UK) • IT leadership and standards • Transaction processing • Specialised functional expertise • Continuous Improvement Provider Organisations (Hospitals / Clinics) • Organisation unit for accountability • Provision of Care • P & L accountability