Microsoft NI Healthcare Executive Breakfast

1. Microsoft NI Healthcare Executive Breakfast 27 November 2007

2. Agenda • 0850hrs               Paul Mason  Ireland Enterprise Director • Introductions / Welcome  • 0900hrs                   John Coulthard    Health Director • Strategic direction of Microsoft in Health • Knowledge Driven Healthcare • Overview / examples of relevant case studies • 0925hrs               Ilia Fortunov  Global Healthcare Architect • Connected Health Framework • Frameworks for Health and Social Services

3. Agenda • 1000hrs                Nick Umney    Healthcare Platforms • Executive balanced scorecard for health • Information driven Leadership • Team working and x boundary collaboration • 1030hrs          Mark Fitzsimons NI BP Specialist • Live demo of multi-disciplinary team working • 1050hrs          Peter Russell         NI Regional Manager • Close/ Follow Up

4. Microsoft in Health John Coulthard dms MBA MIoD johncoul@microsoft.com Director, Health and Human Services Microsoft Corporation

5. To help people around the world live longer, healthier lives.

6. Key Issues in Health • Provider • Patient safety • Long term conditions • Disparity of access • Cost containment • Outcome-based funding • Global Health • Aging population • Chronic disease burden • Severe health worker shortages • Public Health risks: pandemics and bioterrorism • Increasing share of national income devoted to healthcare • Rapidly increasing, global population means great demand for healthcare HEALTH SYSTEM • Funder/Payer • Medical cost growth • Inconsistent quality • Uninsured and underinsured • Engaging consumers in their health • Consumer • Managing the family’s health • Dealing with the “sandwich generation” effect – caring for older parents and children at the same time • Navigating an increasingly complex healthcare system – managing issues of access, cost, and quality • Information overload from the Web

7. Access Affordability Quality

8. Watch out for the language • marketing provision of products or services: the business activity of presenting products or services in such a way as to make them desirable • communication the exchange of information between people, e.g. by means of speaking, writing, or using a common system of signs or behaviour • Customer Someone that is not ill

9. Healthcare is Becoming Consumer-centric Microsoft Corporation Confidential and Privileged

10. Some thoughts Professor Lee Hood

11. The Traditional Healthcare Universe Consumers (C1 to C5) are forced to interact with facilities – focused around the needs of the healthcare provider, employer, payer or supplier, not the consumer C4 FACILITY C1 C5 C2 C3 In 1543, Copernicus was the first to propose that the Earth rotated around the sun, while accepted scientific thought at the time believed that the Earth was the center of the universe. Copernicus effectively “changed the center of the universe”. 11

12. Healthcare’s “Copernican Shift” • Clinic • Convenience • Access Healthcare is undergoing a “Copernican Shift” – with the consumer now placed at the centre of the orbits of various healthcare strategies • Home Prevention • Knowledge • Fitness • Wellness CONSUMER • Home Outpatient • Visits • Access • Monitoring • Hospital • Hospital in/out-patients • Results • Access • Home Chronic Care • Knowledge • Senior Care • Family awareness

13. Microsoft Connected Health Framework

14. Wellness to Illness.... Too Late

15. What is Causing the Consumer-centric Shift? Microsoft Corporation Confidential and Privileged

16. The “total-system healthcare win” is in the home Lower cost (good for commissioners) Higher quality of life (good for consumers) The key focus for all competitors will be on home-based, consumer-centric healthcare solutions HOME CARE FOCUS: Prevention Knowledge Fitness Wellness Communications Chronic Care and Outpatient Medications Monitoring Community Medical Communications Increasing Consumer Involvement in HC HOME CARE Specialty Pharmacy 100% Healthy,Independent Living CommunityClinic SHIFT LEFT ChronicDisease Management GP Quality of Life COMMUNITY CARE Assisted Living ACUTE CARE Skilled Nursing Facility Specialty Clinic Community Hospital ICU 0% £1 £10 £100 £1,000 £5,000 Cost of Care per Day

17. Cost Matrix Wellness Non Medical Alternative Prevention Fitness Chiropractics Acute Healthcare Cosmetic Surgery Medical Elderly care Government Individual Who pays

18. Web is too rich to be reduced to a wodge of paper Microsoft Corporation Confidential and Privileged

19. Search is not the Answer Microsoft Corporation Confidential and Privileged

20. Healthcare is Complex for Consumers Purchasers Employers “the patient group” Providers Health Industry

21. Microsoft Corporation Confidential and Privileged

22. DISCOVERY DISCOVERY READ LEARN ACT STORAGE SHARE Microsoft Corporation Confidential and Privileged

23. Access will not be equal Digital Natives will have all the access Analogists will have a tough time Digital Immigrants will have to keep expecting change

24. A large partner ecosystem supported by more than 700 Microsoft employees Our Commitment 2007 Acquisition of Global Care Solutions 1995 MSHUG formation Growing Healthcare Presence Active X for Healthcare Windows NT SQL Server Partner ecosystem development 2005 Health Solutions Group Peter Neupert Re-joins Microsoft from Drugstore.com to incubate and lead HSG 2006 Acquisition of Azyxxi 1995 Microsoft Healthcare Team established 2007 Acquisition of Medstory 2007 US launch of HealthVault 1999 health & fitness 1995 1996 2000 2002 2003 2005 2006 2007 1998

25. Frameworks

26. Healthcare is Complex for Providers “Behind the scenes” “On the floor”

27. Knowledge Driven HealthConnecting people and systems, enabling improved collaboration for more informed decision making, improving patient safety, personal health and clinical outcomes. Business Solutions Health Information Care Management Health Back Office Public Health Delivery Transformation Solutions Shared Services Connected Health Platform Connect  Collaborate  Inform Business Productivity Architecture and Design Blueprint, Reference Implementations Infrastructure Application Platform Core Infrastructure Privacy Usability Accessibility Security Standards Interop Policy

28. Information Exploitation is the result of coherent interaction between people, process, information and technology - these are the strands of development Develop new & consistent Ways of Working, behaviours, skills & competences Ensure core activities are understood & managed Develop coherent, resilient and integrated networks/ systems

29. Knowledge Driven HealthConnecting people and systems, enabling improved collaboration for more informed decision making, improving patient safety, personal health and clinical outcomes. Business Solutions Health Information Care Management Health Back Office Public Health Delivery Transformation Solutions • Health Information • Electronic Health Records • Health Portals • Health Information Networks • Imaging Solutions Connect  Collaborate  Inform Architecture and Design Blueprint, Reference Implementations Infrastructure Privacy Usability Accessibility Security Standards Interop Policy

30. Microsoft Connected Health Framework Dr Ilia Fortunov Industry Technology Strategist - EMEA Microsoft Worldwide Health

31. Connected Health Framework Vision Define an overarching framework for Health Industry Architecture • Best practices for service oriented health information integration and collaboration architectures • Enterprise-, state-, province- and country-wide projects • Leverage available assets to deliver more value faster • Based on open standards and protocols – platform-agnostic • Develop ecosystem of CHF-enabled solutions • Deliver value for customers faster and at lower cost • Frame of reference for partners solutions • Easier integration across multiple solution areas Microsoft Connected Health Framework

32. Connected Health FrameworkBusiness Framework • The CHF Business Framework uses a service oriented approach to • Define business components and major subject areas • Offer a range of services that can be “orchestrated” to enable and support business processes • Leverage existing sources of functionality and information • It provides a Business Pattern for Health Microsoft Connected Health Framework

33. Business Framework Microsoft Connected Health Framework

34. Connected Health FrameworkTechnical Framework • The CHF Technical Framework addresses: • Multiplicity of services, sources of data and systems • Management of patient and clinician identity • Integration across multiple systems • Flexibility and agility • Security • Scalability, Performance and Availability • It provides a Reference Architecture for Health Microsoft Connected Health Framework

35. Technical Framework Communication Operations Management Security Collaboration, Presentation and Point of Access, Identity Management, Privacy and Security Services Service Publication and Location, Shared Services Connected Health Services Hub Integration Services Business Components Service Component Interface Data Services System Management Services Communication Services Microsoft Connected Health Framework

36. Connected Health Framework Architecture Communication Operations Management Security AGILE Collaboration Services Presentation and Point of Access Services User Processes Identity Management Services Privacy and Security Services Business Processes Service Publication and Location Shared Services STABLE Connected Health Services Hub Integration Services Business Components Service Component Interface Data Access Logic Components Data Services System Management Services Communication Services

37. Options For Storing Clinical Data Mostly a matter of ownership and policy • Centralizedmodel • Central repository holds replica of full health record • Clinical Data Exchange (CDX) Gateway publishes full health record and manages data synchronization • Federated model • Central repository holds no personal data • CDX Gateway publishes registration events and caches full record obtained from multiple sources • Hybrid model • Central repository holds record summary • CDX Gateway publishes record summary and caches full record • Could be multi-tier, with many data stores Microsoft Connected Health Framework

38. Flexibility in Deployment Microsoft Connected Health Framework

39. Connected Health Framework: Levels and Components • Connected Health Framework is Microsoft’s multi-year world-wide industry strategy, encompassing our industry solutions, partner strategy, platform offering and policy initiatives. • Connected Health Framework – Architecture and Design Blueprint represents a vendor agnostic set of best practices and approach based on Services Oriented Architecture (SOA) for architecting e-Health solutions for health information networks ranging from within healthcare regional, national and cross-agency systems • Microsoft Connected Health Platform is Microsoft technology offering and prescriptive architecture guidance for e-Health solutions built on the Microsoft platform. • Health Connection Engine(HCE) is a reference implementation part of Microsoft’s Connected Health Platform. HCE accelerates the deployment of solutions based on the guidance in the CHF – Architecture and Design Blueprint Microsoft Connected Health Framework

40. Microsoft Connected Health Platform Communication Operations Management Security Windows Mobile Office System, LiveMeeting, Exchange, Windows Server System Collaboration Services Presentation and Point of Access Services User Processes Office System Identity Management Services Privacy and Security Services Business Processes Service Publication and Location Shared Services Connected Health Services Hub BizTalk Server, .NET Framework Integration Services Business Components Visual Studio, .NET Framework Service Component Interface Data Access Logic Components Data Services SQL Server Operations Manager, System Center System Management Services Communication Services

41. Reference Implementations • Health Connection Engine (HCE) • Community project on http://www.CodePlex.com/hce • Accelerates the development and deployment of connected solutions • Adapters SDK • Standard set of Web Services • Based on BizTalk, SQL Server and the .NET Framework • Microsoft Common Health User Interface (MSCUI) • Available at http://www.mscui.net • Community project on http://www.CodePlex.com/mscui • Facilitates development of consistent and safe clinical user interfaces • Based on .NET Framework • IHE Cross-Enterprise Document Sharing-b (XDS.b) • Community project on http://www.CodePlex.com/ihe • Implements standard IHE Integration Profile to facilitate sharing of clinical and health documents • Based on .NET Framework and SQL Server Microsoft Connected Health Framework

42. Knowledge Driven Health> Solutions for Health and Social Services Dr Ilia Fortunov Industry Technology Strategist - EMEA Microsoft Worldwide Health

43. Integration of existing systems on different platforms, ensuring interoperability Creation of single client record, ensuring that identification of citizens is consistent and reliable, including services and outcomes Address major business problems without resorting to a risky “rip and replace” approach Key Issues Facing Health and Social Services Systems Increasing demand for services, constrained resources, and increasing client expectations Communication with remote and mobile employees, systems and/or locations Integrating information from disparate systems 43

44. Knowledge Driven Health Knowledge Driven Health connects people and systems, improving collaboration for more informed decision making. This allows organizations to empower employees to provide improved services to a broader population, help protect and promote good health, and enhance citizens’ health status and outcomes while also managing the cost of delivering care and services. Shared Services Disease Surveillance Knowledge Driven Health for Health and Social Services Case Management 44

45. Knowledge Driven Health - People and systems connect and collaborate to make informed decisions. Organizations can provide improved services to more people while protecting and promoting health, and managing the cost of delivering care and services while enhancing patient health outcomes. Case Management Business Solutions Health Information Care Management Health Back Office Public Health Delivery Transformation Solutions Shared Services Disease Surveillance Connected Health Platform Connect  Collaborate  Inform Business Productivity Architecture and Design Blueprint, Reference Implementations Infrastructure Application Platform Content Management, CRM, Common Client Index (CCI), Search Core Infrastructure Privacy Usability Accessibility Security Standards Interop-erability Policy 45

46. Knowledge Driven Health Benefits • Create electronic client records, providing a single unified view of the client • Pull records from multiple agencies into one client record via common client ID • Create interoperability within IT infrastructure, to tie into older systems, and to move data between old and new systems • Share and integrate data appropriately with security-enhanced technologies • Create service-oriented architecture. • Improved decision-making through increased real-time collaboration, using data from across agency silos • Improved content and data management reducing the time spent searching for info • Maximize Enterprise Search capabilities that help people find and share information • Integrated collaboration capabilities such as automated workflow • Collaborate seamlessly virtually anywhere on virtually any device. • Quick and easy access to data and information via enhanced analytical tools, dashboards and business intelligence • Share citizen records as appropriate to speed services and avoid duplication, using security-enhanced technologies • Improved access to information and services including Search • View data from multiple agencies in a single repository • More informed decision-making. Inform Connect Collaborate

47. Addressing the Challenges 1 Challenge Resolution • Connect seamlessly via interoperable technologies and shared services, to resources and information across the organization. • Unite systems and share appropriate citizen information from multiple geographic locations, 24/7, in real-time. • Improve business intelligence with increased access to dashboards, analytical tools, mapping tools and reports for more informed decision-making. • Siloed functions within an organization that potentially leads to duplication and non-optimal client care. • Deliver appropriate care and services to the appropriate individual, at the appropriate time, increasing time spent with citizens, and decreasing administration. • Compromised and outdated methods used to plan, budget, and resource. Make information more readily available to plan, evaluate, predict and model. 2 Resolution Challenge 3 Challenge Resolution

48. Overcoming the Ubiquitous Problem Resolution 1: Coordination Regional Health and Social Services Agency Case Coordination happens mainly through manual outreach Limited cross-agency reporting hinders ability to secure funding Caseworkers must duplicate data entry in separate systems Management Division of Public Health Services Divisions of Youth & Families, and Child Support Community Based Services: Mental Health, Elder Care, Developmental Disabilities Healthcare Department POLICY AND ANALYSIS. HEALTH PLANS, CALL CENTERS COMMUNITY HEALTH COMMUNITY MENTAL HEALTH CENTERS, HOME CARE ELIGIBILITY Clients in Multiple Programs Struggle to access services across programs; experience gaps and overlaps. 48

49. Resolution 2: • Common Client Index (or eID) provides a single unified view of the citizen or outbreak related data, across multiple agency databases (silos), reducing duplication and errors in client care and services • Increase amount and quality of time spent with citizens in their own surroundings, with deeper context and information for interaction, evaluation and delivery of care and/or services • Access information online using familiar Microsoft tools and technologies • Proven technology platform to support Health and Social Services needs • Increased mobility options providing greater flexibility, allowing agencies to be more proactive. Unite systems and share appropriate citizen information from multiple geographic locations, 24/7, in real-time.

50. CHF – Architecture & Design Blueprint Resolution 2: 50