Opportunities for e-Improving Healthcare Delivery with Network Convergence and IP Telephony

1. Opportunities for e-Improving Healthcare Delivery with Network Convergence and IP Telephony Terri Wimms Healthcare Industry Marketing Manager Cisco Systems, Inc. twimms@cisco.com

2. Food for Thought Amazon.com can show me every transaction I’ve ever had with them Why doesn’t my hospital’s ambulatory care clinic know about the mammogram I had in radiology last week? Any ATM in the world can verify my identity and determine the funds available in my checking account. Why does my physician’s office have to photocopy my insurance card and call for authorization to care for me? Is it not possible to improve the way we communicate with one another?

4. Key Issues Facing Businesses Today

5. Key Issues Facing Healthcare Today These imperatives are inter-related and require good information sharing. That means quick collection of good quality data, near real-time data sharing and access data for multiple purposes. Wireless solution helps with all of these—earlier data collection, better quality data collection, faster data sharing and easier access to data. Improve patient safety – reduce medical errors Improve care quality – w/ comprehensive current info. And decision support data at the point of care Improve clinician efficiency – deliver more care to more people despite shortages of staff Manage infectious diseases – quickly detect, track and manage disease outbreaks Manage population health – prevent and manage chronic conditions such as diabetes, asthma and congestive heart failure. Work effectively across the continuum – share information quickly between all health partners to improve access, quality and population health. These imperatives are inter-related and require good information sharing. That means quick collection of good quality data, near real-time data sharing and access data for multiple purposes. Wireless solution helps with all of these—earlier data collection, better quality data collection, faster data sharing and easier access to data. Improve patient safety – reduce medical errors Improve care quality – w/ comprehensive current info. And decision support data at the point of care Improve clinician efficiency – deliver more care to more people despite shortages of staff Manage infectious diseases – quickly detect, track and manage disease outbreaks Manage population health – prevent and manage chronic conditions such as diabetes, asthma and congestive heart failure. Work effectively across the continuum – share information quickly between all health partners to improve access, quality and population health.

6. The Integrated Healthcare Enterprise The web of information sharing in healthcare has become more interwoven, with new reporting partners. Today, with outbreaks like SARS, information from retail pharmacies can help identify problems earlier, rather than waiting for sick people to visit and emergency room or their physician. And, healthcare professionals are mobile, practicing in hospitals and clinics, participating in research studies from an office or home. They need anywhere, anytime information access.The web of information sharing in healthcare has become more interwoven, with new reporting partners. Today, with outbreaks like SARS, information from retail pharmacies can help identify problems earlier, rather than waiting for sick people to visit and emergency room or their physician. And, healthcare professionals are mobile, practicing in hospitals and clinics, participating in research studies from an office or home. They need anywhere, anytime information access.

7. Waves of Innovation:Healthcare IT Adoption

9. The Evolution of Networking

10. Intelligent Networking for Healthcare The Nervous System of Your Organization: The Medical Grade Network Uses intelligence to triage information Built to integrate ecosystem partners Optimized to reduce information errors Provides a seamless connectivity regardless of device or location Improves productivity in a 24x7 world.

11. 21st Century Care …. Enhancing Care with Technology Resilient Infrastructure Converged – voice, video, data Bandwidth and Speed - 10Ge core; 1Ge DT Available and Resilient – 24/7 Standards-based Secure & Protected Imbedded in Network SSO Authentication Biometrics-enhanced Responsive at Point of Care Intelligence, Flexibility, Speed and Access Ubiquitous Wireless – Campus, Office, Home Greater Speed and Bandwidth Storage Enhanced Interactive and Collaborative Multimedia Enhanced - Portal, VC, Cellular, Pager, VOD

12. A Case for Streamlined Communications 900 million voice mails a day! 7.2 billion e-mails a day! 30% of long distance is FAX! 200M voice/100M e-mail/150M fax users Mobile workforce/cell phones Internet access All of these communication forms are separate islands

13. 1969: Transformation of Public Communications Networks

14. 1990: Transformation of Business Computing Centralized control Inflexible Vendor-driven services

15. The Vision: Any Time, Anywhere Communications

16. 1990: Transformation of Business Computing Centralized control Inflexible Vendor-driven services

17. The Vision: Any Time, Anywhere Communications

18. Where Are We Today? In the last 12 months, all major communication suppliers have announced that their next-generation products will be based on IP For many businesses, it is no longer a question of If, but When The business case for IP telephony is increasingly driven by measurable gains in end-user productivity

19. Which Technologies Will Drive Employee Productivity?

20. The Hard Data on IP Telephony Productivity Gains

21. IP SoftPhone—Fingertip Features Dual Purpose IP Telephony client Easy Feature Access One-click conference and transfer Drag-and-drop phone numbers to place calls Keyboard shortcuts Directory Integration Dial by name/e-mail address Meeting Collaboration NetMeeting Share PowerPoint/WhiteBoard Double click SoftPhone Picture for avi movie showing real drop and drag call by directory using Cisco’s LDAP v3 directory SoftPhone can either control a desktop physical IP Phone allows for even easier access of advanced features like multiple conference. Or it can be used as a stand alone SoftPhone on a PC. SoftPhone ships with CM 3.0 and replaces virtual phone Directories use your own personal directory and drag and drop a call into that directory to avoid retyping Use an LDAP vs directory to find and voice connect other users. Use control K for LDAP v3 directory look up short cutDouble click SoftPhone Picture for avi movie showing real drop and drag call by directory using Cisco’s LDAP v3 directory SoftPhone can either control a desktop physical IP Phone allows for even easier access of advanced features like multiple conference. Or it can be used as a stand alone SoftPhone on a PC. SoftPhone ships with CM 3.0 and replaces virtual phone Directories use your own personal directory and drag and drop a call into that directory to avoid retyping Use an LDAP vs directory to find and voice connect other users. Use control K for LDAP v3 directory look up short cut

22. Are Legacy PBXs Really More Secure?

23. The IP Communications Network:A Platform for Converged Applications

24. Many “Killer Apps” for IP Communications

25. VoIP Applications for Healthcare The Business Side of Healthcare Enterprise-wide 4/5 digit dialing Directories online Unified Messaging Voice, Email, Fax Follow-me Roaming extensions Call and Message Center Personal Assistant Time and Attendance Video Conferencing Video-on-Demand Education Also apply to healthcare …..Also apply to healthcare …..

26. VoIP Applications for Healthcare The Clinical Side of Healthcare Emergency Broadcasting Extension of Clinical Apps Room scheduling Bed Management Billing and Coding Physician/patient queue Dictation VR Technology Advances Nurse call & Messaging Telemedicine Consultation Robotics Surgery

27. VoIP Applications for Healthcare: Clinical

28. VoIP Applications for Healthcare

29. VoIP Applications for Healthcare IRCAD, NYC Lap-Cholesystectomy France 155ms time delay 54 minute surgery St. Joseph’s Healthcare, Hamilton, Ontario Surgery performed on patient 250 miles away 1st in Canada Voice video convergenceVoice video convergence

30. “Telemedicine is breaking down barriers and improving the quality of life” - Jon Phillips, Director, Telemedicine Program Texas Tech University Health Sciences

31. Voice over IP Case Studies for Healthcare

32. Springhill Medical Center Case Study Profile: Part of Southern Medical Systems, Inc.; general acute care center in Mobile, AL Number of beds: 206 Admissions: 11,531; Inpatient surgeries: 3,634; Outpatient visits: 121,973; Outpatient surgeries: 4,862Emergency room visits: 32,196; Births: 1,441 First hospital worldwide to go live with a Cisco phone system based completely on Voice over IP. Since then, they have seen an 18% reduction in operating costs compared with the previous traditional phone network, along with a quantum leap in functionality. The new network enables the telephone to behave more like a computer, both for dispensing info to the user (on the phone’s LED display) and for entering data into an application. New capabilities are almost unlimited. For example: a photo of a patient or worker can be displayed on the phone’s LED screen as an aid in confidentiality and security. when a housekeeper cleans a room, he or she can pick up the phone and enter a short code to tell the admissions department that the room is clean and ready for the next patient. patients can listen to choices on the day’s menu and then transmit selections to the dietary department using the telephone keypad. enterprise enjoys more flexibility when relocating people and groups. They can unplug phones and move them between offices and buildings, and phone operates with the same properties as before. They avoid the need to call the phone company and wait days for service. Currently (11/03) deploying patient tracking application through the phone that is expected to improve staff efficiency, reduce incidence of redundant testing, and improve productivity. Along with reducing operating costs, the VoIP system established interesting scenarios for recovering the cost to purchase and install the network. They had 50 physician practices on campus, each with their own traditional phone system. Now they have the option to tie into the hospital’s VoIP system, often at lower cost than running their own phone system. By charging a reasonable amount, Springhill can recover some of its capital improvement costs, while providing physicians with much more advanced phone service. According to a hospital exec: “It’s a beautiful arrangement: our costs go down, the physician’s costs go down, and the capabilities available to them improve drastically. 11/03 the system was extended to the Alabama Orthopedic Clinic’s 350 phones. The hospital is hosting the services which are conencted through a central call manager. Although the roll-out is in its infancy, the hospital says it has already realized the ability to recoup 80% of the costs. It expects to cover the costs and begin to generate revenue for the hospital within the first year. Sources: Account Manager – Hank Williams hawillia@cisco.com Journal of Healthcare Information Management, Vol. 17, No. 2Profile: Part of Southern Medical Systems, Inc.; general acute care center in Mobile, AL Number of beds: 206 Admissions: 11,531; Inpatient surgeries: 3,634; Outpatient visits: 121,973; Outpatient surgeries: 4,862Emergency room visits: 32,196; Births: 1,441 First hospital worldwide to go live with a Cisco phone system based completely on Voice over IP. Since then, they have seen an 18% reduction in operating costs compared with the previous traditional phone network, along with a quantum leap in functionality. The new network enables the telephone to behave more like a computer, both for dispensing info to the user (on the phone’s LED display) and for entering data into an application. New capabilities are almost unlimited. For example: a photo of a patient or worker can be displayed on the phone’s LED screen as an aid in confidentiality and security. when a housekeeper cleans a room, he or she can pick up the phone and enter a short code to tell the admissions department that the room is clean and ready for the next patient. patients can listen to choices on the day’s menu and then transmit selections to the dietary department using the telephone keypad. enterprise enjoys more flexibility when relocating people and groups. They can unplug phones and move them between offices and buildings, and phone operates with the same properties as before. They avoid the need to call the phone company and wait days for service. Currently (11/03) deploying patient tracking application through the phone that is expected to improve staff efficiency, reduce incidence of redundant testing, and improve productivity. Along with reducing operating costs, the VoIP system established interesting scenarios for recovering the cost to purchase and install the network. They had 50 physician practices on campus, each with their own traditional phone system. Now they have the option to tie into the hospital’s VoIP system, often at lower cost than running their own phone system. By charging a reasonable amount, Springhill can recover some of its capital improvement costs, while providing physicians with much more advanced phone service. According to a hospital exec: “It’s a beautiful arrangement: our costs go down, the physician’s costs go down, and the capabilities available to them improve drastically. 11/03 the system was extended to the Alabama Orthopedic Clinic’s 350 phones. The hospital is hosting the services which are conencted through a central call manager. Although the roll-out is in its infancy, the hospital says it has already realized the ability to recoup 80% of the costs. It expects to cover the costs and begin to generate revenue for the hospital within the first year. Sources: Account Manager – Hank Williams hawillia@cisco.com Journal of Healthcare Information Management, Vol. 17, No. 2

33. The Present or the Future?: Medical Monitoring with Phones Goal: Monitor status of high-risk patients without hospital confinement Solution: Heart function information fed from electrodes into electronic circuit, converted to infrared signal sent to mobile phone. Phone beams data across network to MD computer Impact: Patient can be hundreds of miles from nearest hospital and still be given routine check; saves both physician and patient time Here’s an emerging example from the UK of virtual cardiac care. No matter where the patient is, their personal cardiac physician can monitor their status (vs. having to visit an unknown cardiologist if a problem arises while travelling) and patients can receive care from specialists in distant cities, an important benefit for rural residents that improves access to the best possible care. UK Example—Research funded by Swindon-based Engineering and Physical Sciences Research Council Currently a research project. Lead researcher is Professor Bryan Woodward of Loughborough University, UK. “The system can be used for anything that can be monitored electronically, such as heart rate, blood pressure or temperature.” “Fortunately, we have been able to reproduce signals very accurately indeed. The only limitations appear to be those inherent in the mobile phone network—losing the signal if you are going through a tunnel, for example.” Professor Woodward Electrodes on patient’s chest capture data. Feed into electronic circuit on patient belt holster. Holster also holds mobile phone. Infrared signal from holster to phone. Phone beams data across mobile network to MD pc.Here’s an emerging example from the UK of virtual cardiac care. No matter where the patient is, their personal cardiac physician can monitor their status (vs. having to visit an unknown cardiologist if a problem arises while travelling) and patients can receive care from specialists in distant cities, an important benefit for rural residents that improves access to the best possible care. UK Example—Research funded by Swindon-based Engineering and Physical Sciences Research Council Currently a research project. Lead researcher is Professor Bryan Woodward of Loughborough University, UK. “The system can be used for anything that can be monitored electronically, such as heart rate, blood pressure or temperature.” “Fortunately, we have been able to reproduce signals very accurately indeed. The only limitations appear to be those inherent in the mobile phone network—losing the signal if you are going through a tunnel, for example.” Professor Woodward Electrodes on patient’s chest capture data. Feed into electronic circuit on patient belt holster. Holster also holds mobile phone. Infrared signal from holster to phone. Phone beams data across mobile network to MD pc.

34. Chronic Disease Management with Phones Goal: More frequent monitoring of asthmatics so that immediate attention can be given at the first sign of worsening condition Solution: Asthma patients use combined phone/PDA linked with peak flow meter. Lung capacity recorded and submitted to physician via the mobile phone. MD messages to patients via mobile device. Impact: Reduce hospitalizations and associated cost of care; saves physician and patient time Worldwide, asthma is on of the moist common health problems (along with diabetes and obesity). Today, most patients monitor and record their lung capacity each day, but visit their doctor only 3 or 4 times per year. Information is often inaccurate. Some patients aren’t consistent about testing and recording their status. And a problem can progress for sometime before corrective steps are taken. With this type of solution, physicians are immediately aware when a patient’s condition deteriorates. And, the MD can quickly and easily send a message to the patient, saving both parties time. UK Example from firm e-SAN 100 asthma patients in Slough area of UK. Device is 02’s XDA (combined phone and pda) 3.5 million asthmatics in UKWorldwide, asthma is on of the moist common health problems (along with diabetes and obesity). Today, most patients monitor and record their lung capacity each day, but visit their doctor only 3 or 4 times per year. Information is often inaccurate. Some patients aren’t consistent about testing and recording their status. And a problem can progress for sometime before corrective steps are taken. With this type of solution, physicians are immediately aware when a patient’s condition deteriorates. And, the MD can quickly and easily send a message to the patient, saving both parties time. UK Example from firm e-SAN 100 asthma patients in Slough area of UK. Device is 02’s XDA (combined phone and pda) 3.5 million asthmatics in UK

35. The Future Patient Communication Portal

36. What’s New? What’s Next? Why not color ….video …. IP to cellular,,,, Push to Talk features?Why not color ….video …. IP to cellular,,,, Push to Talk features?