the real deal on enterprise portals bob breton senior director, product strategy sybase enterprise...

The Real Deal on Enterprise Portals

Bob BretonSenior Director, Product StrategySybase Enterprise Solutions Division

Bob LaGaliaSVP, Strategy & Corp DevelopmentNIA|RadMD

Agenda

State of Healthcare in the United States Who is NIA and what is RadMD? The RadMD Enterprise Portal Enterprise Portal Market Requirements Key Success Factors

Rising Costs, Complex, & Highly Fragmented

The State of Healthcare in the U.S.

Single Largest Industry in the U.S. ->$1.2 trillion in spend

– As a % of GDP, national expenditures have risen from 5% in 1960 to fully 14% today.

– This is the largest percentage in the industrialized world

– Little evidence exists that aggregate outcomes are better in the U.S. than in countries that spend a smaller % of their GDP on health care.

Rising Costs, Complex, & Highly Fragmented


HCFA predicts costs to grow at 7% CAGR; and reach $2.2 trillion by 2008

Alarmingly, only 1/2 represents “required care”:– 20% spent on administrative inefficiencies– 30% inappropriate, redundant, and unnecessary procedures

Huge service-based industry– Over 250 million patients/consumers (aging population)– Over 5,000 Hospitals, 40,000 Nursing Home and AL Facilities– 700,000 Physicians, 100,000 Dentists– Cumbersome 3d Party Payment System– Over 500 Managed Care Enterprises

Highly Transactional, Data Rich, Information Poor


Billions of claims processed each year, representing multiple patient encounters(doctor visits), and multiple transactions (eligibility, referral, lab studies, radiology studies, etc.)

Clinical & Financial Data resting on antiquated technology; mainframe, old client-server. Industry contributes only 2-3% on information technology vs. 6-8% in other highly-information based business

Physicians need access and information flow across the continuum of care in order to manage patients and their businesses

Consumerism on the rise - accessing information enabling the comparison of quality, treatment options, and outcomes data of hospitals & physicians.

The Impact on Quality of Care?

The Institute of Medicine’s (IOM) Committee on Quality of Healthcare released results of a study that indicates that as many as 98,000 deaths occur each year due to medical errors - it was the 8th leading cause of death in the U.S; nearly as much as MV accidents, Breast Cancer, and AIDs combined.

“…when patients see multiple providers in different setting, none of whom have access to complete information, it is easier for something to go wrong than when care is better coordinated” - IOM Committee on Quality of Healthcare


The Impact on Quality of Care?

As much as 40% of patient information is missing when needed by a medical professional, and this is compounded each time a patient moves, changes health plans, or visits a different specialist - Boston Consulting Group


Diagnostic Radiology Market - a microcosm

The State of Healthcare in the U.S. - Radiology

Diagnostic Radiology Market Size– $70 to $80 Billion Spend, 10% of healthcare dollar

Rising Costs– Direct costs increasing at twice the rate of medical inflation (9% to

12%)

Quality– Unnecessary radiation exposure and false positives associated with

inappropriate use

MidwestRegion Util./1000/Yr.A 1092B 885C 914

Mid-AtlanticRegion Util./1000/Yr.A 587B 987

NortheastRegion Util./1000/Yr.A 775B 872C 824D 1176E 750F 1000G 980H 760

SoutheastRegion Util./1000/Yr.A 1073B 790C 780

SouthwestRegion Util./1000/Yr.A 664

West

Region Util./1000/Yr.A 801

Rising costs, inappropriate use, and lower quality contribute to the wide variation in utilization patterns for diagnostic radiology services

The State of Healthcare in the U.S. - Radiology

How?

Apply new technologies to enable better and more efficient transactions among all participants

Apply clinical domain expertise to appropriately manage cost growth

Productivity, Efficiency, & Quality of Patient Care

Reduce Spending on Unnecessary & Inappropriate Care

An imperative to:

The State of Healthcare in the U.S.Rising Costs + Quality Concerns = An impetus to change

Agenda


Who is NIA? (founded in 1995 at Corning Life Sciences, Inc.)

We are a medical management company providing payers and physicians with cost effective business solutions in diagnostic radiology

What is RadMD? (today)

RadMD represents NIA’s medical management portal, designed to promote the most appropriate and effective use of diagnostic radiology services. It connects physicians and information, providing access to knowledge–knowledge which helps to improve the efficiency of business transactions, while improving the quality of patient care.

National Imaging Associates & RadMD

NIA Call Center & Workflow (pre-EP)

Our Operations– Call Center/IT organization located in San Bruno, California with over 100 employees;

Customer Service Representatives, Registered Nurses, Board-Certified Physicians

– Provide Medical Management services to over 4.5 million enrollees through our client relationships

– Process over 80,000 clinical consultations per month involving multiple transactions each - eligibility, clinical decision support algorithms, provider selection and referral, authorization resolution

2000 - strategic move to an Enterprise Portal Computing Architecture

Requestsvia Telephone

Call Center

DB

MS SQL ServerPowerBuilder Appson WIN NT

Offline (batch)

Data Loaded intoProduction offline

Members

Providers

Claims/Clinical

TelephoneWorkstation

Workstation

Workstation

Data

Data

Data

NIA Client Server Architecture (1996-1999)

Agenda


For our Users:• An alternative, personalized experience, with access to same protocols• Improved clinical information sharing during the care delivery process• Self-service, empowerment, ownership• Access anytime, anywhere

For our Company:• “Free” capacity• Increased productivity - physician experts connected nationwide• Margin improvement - cost reduction (40% less via web)

For our Future:• Flexible business model - full outsource to ASP hosting• Leverageable platform for other “plug-in”devices; access expansion wireless• Direct integration with clients• Expansion into other medical management solutions

Why an Enterprise Portal?

Facilitating Information Transfer

RadMD

ReferringPhysicians

Patients RadiologyProviders

InsuranceCarrier

Facilitate Clinical Information Exchange

• Improve Admin Transac tions• Collect Outcomes for analysis• Identify patients early

• Lower administrative expenses• Improved medical cost management

• Access to expert consult• Education re: best practice• Improve Patient outcomes

Learning

4-Phase Approach Critical Learnings

1, Discovery:research, focus testing, ~ integrate within the current workflow

user requirements ~ must have incremental impact

understand existing workflow & tech. ~ no new tech investment

~ access, bandwith

2, Definition & Design:obtain key stakeholder input, ~ speed, reliability, availabilitytechnical & clinical consultation ~ privacy, security

~ integrated w/ call center

3, Development:vendor solutions ~ Sybase Enterprise Portal Early Adopterdetermine optimal approach ~ Sybase Professional Services Team

~ Port PB App and business logic~ Integrated Solution

4, Deployment:step-wise roll-out ~ select pilot sites

How did we Develop?

NIA Call Center & Workflow Today

Web Server

EP Applications

EP Application Services

EP Integration Services

Call CenterEnterprise Application Server

Browser Mobile PC Wireless B2B App

EP Common Services

Enterprise Information Systems

Content Apps Events Data

myRadMD

Tel

RadMD Portal (2001)

Telephone-based clients

Pen computerRadio tower

Wireless computingMobile WAP Tel

Mainframe

Member, ProviderData Transfer Using

XML & Mainframe Integration

Data

MS IIS on NT ~ load balancing ~ high availability ~ failover

Telephone

Call Center

Workstation

Workstation

Workstation

Offline (batch)

Members

Providers

Claims/Clinical

Data

Data

Data

Desktop

Desktop

Browser-based users

Internet

HTTP / HTTPS web server

web server

Web Server Cluster App Server Cluster

App Server

App Server

IIOP / IIOPS

Sybase EP on NT ~ load balancing ~ high availability ~ failover ~ security

HTTP / H

TTPS

Server

Content ManagementVignette StoryServer

DataContent DBSybase ASE

Telephone

Telephone

MS SQL

What have we learned?

Portal technologies provide a means to connect the participants in the healthcare delivery process to valuable clinical information necessary to improve the quality and efficiency of patient care

Look for technology partners and engage existing stakeholders

Fundamental Project Management Skills are paramount

Value proposition must be unique, tangible, and measurable

Agenda


e-Business Evolution

Static ContentStatic Content

TransactionsTransactions

Meaningful relationshipsMeaningful relationships

Dynamic ContentDynamic Content

Approval &Billing

Expanding Opportunities

Care Review

Healthcare Provider

Knowledge Access

HMO

Current e-Business SolutionsFragmented and Impersonal

Partner

Employee Customer Supplier

Partner Site Intranet Corporate Site Supplier

Sales MarketingCustomerService Shipping Manufacturing

Enterprise PortalsPersonalized Business Experience

Policy BillingCustomerService Provider

SystemsMedicalContent

PersonalizationPersonalization

IntegrationIntegration

Enterprise PortalEnterprise Portal

HMO HealthcareProvider

RadiologySpecialist

Management

What is an Enterprise Portal?

It’s NOT just a personalized URL directory – E.g. Internet Portals like MyYahoo

It’s NOT just a personalized employee webtop– Corporate Portal technologies

It’s about creating a unified e-business experience personalized to the needs of your diverse business audiences:– Deeply integrated into the business infrastructure– Broadly connecting disparate business infrastructure into a comprehensive e-business

experience– Focused on the unique needs of each e-business audience to build meaningful relationships– The Quality of Service to meet market expectations– Lowering the Total Cost of Ownership of e-Business

Evaluating Enterprise PortalsThe complete functional perspective

Content Content ManagementManagement

Staging, Workflow, MetricsStaging, Workflow, Metrics

PersonalizationPersonalization

IntegrationIntegrationData, Events, Applications, Exchanges,Data, Events, Applications, Exchanges,

Process WorkflowProcess Workflow

SecuritySecurityDesktop to BackendDesktop to Backend

Enterprise ClassEnterprise ClassPlatformPlatform

HA, Scalability, Load BalancingHA, Scalability, Load Balancing

GlobalizationGlobalization

Content Content OrganizationOrganizationContext, KeywordContext, Keyword

ManagementManagementCentral ManagementCentral Management

Enterprise PortalEnterprise Portal

Rep

osito

ryR

epo

sitory

Man

agem

ent

Man

agem

ent

Browser

DocumentsERP/CRM

DatabaseMainframe CustomFeeds

Mobile

PersonalizePersonalize SecuritySecurity PublishPublishSubscribeSubscribe

ContentContentOrganizatiOrganizati

onon

ProcessProcessManagemeManageme

ntnt

ContentContentManagemeManageme

ntnt

DataData ApplicatioApplicationsns

EventsEvents

Sybase Enterprise Portal

•Continuous availability platformContinuous availability platform•Portal Services in a Single ProductPortal Services in a Single Product•Wide range of Portal optionsWide range of Portal options

Sybase Enterprise PortalEnterprise Class Platform

ScalablePlatforms: Solaris, HP-UX, AIX, NTApplication server clustersDatabase server clustersDynamic load balancingMainframe integration

ReliableAutomatic client fail-overHigh availability serversRemote site fail-over

Open StandardsXML, EJB, CORBA, DCOM, LDAP

SecureSSL, X.509, Role-based security

SecureSecure

OpenOpen

Scalable, Reliable, High Scalable, Reliable, High PerformancePerformance

Man

agem

ent

Man

agem

ent

Rep

osito

ryR

epo

sitory

DocumentsERP CustomExchanges CRMEDI

Mobile

PersonalizePersonalize SecuritySecurity PublishPublishSubscribeSubscribe

ContentContentOrganizatiOrganizati

onon

ProcessProcessManagemeManageme

ntnt

ContentContentManagemeManageme

ntnt

DataData ApplicatioApplicationsns

EventsEvents

Sybase Enterprise Portal Extensions

Mobile Mobile ExtensionsExtensions

B2B B2B ExtensionsExtensions

Sybase EP Mobile ExtensionsExpanded services for the mobile community

DeviceDevice

IdentificatioIdentificationn

MobileMobileSecuritySecurity

MobileMobileMessaginMessagin

gg

GeometryGeometryTransformatTransformat

ionion

SessionSessionManagemeManageme

ntnt

DataDataSynchronizatSynchronizat

ionion

• Support for connected, wireless and Support for connected, wireless and synchronization focused small footprint devicessynchronization focused small footprint devices

• Extensive services for application designers and Extensive services for application designers and content managerscontent managers

• Full range of portal services for mobile Full range of portal services for mobile applications and contentapplications and content

Sybase EP B2B ExtensionsExpanded integration into B2B communities

CollaboratioCollaborationn

Message Message ProcessingProcessing

BroadcasBroadcastt

MessaginMessagingg

XMLXMLManagemenManagemen

tt

WorkflowWorkflow SchedulingScheduling

• Key Services to Support B2B ApplicationsKey Services to Support B2B Applications• Marketplace integrationMarketplace integration• B2B integrationB2B integration

• Collaborative Processing and Workflow Support Collaborative Processing and Workflow Support for B2B communitiesfor B2B communities

Agenda


The Sybase Solution

Methodology and Best PracticesEP specific expertise

Breadth of applicationsCertified for fast deployment

Partnerships

Unified product offeringEnterprise Class platform

Product

Services/Education

e-Portal Alliance Partners

Sybase Enterprise PortalSybase Enterprise Portal

BroadQuestYOUcentric

ExtensityKnowledge MechanicsNiku

BroadVision

EveryPathFatWireGauss

InterprisePowerize.c

omVignetteWorldWeb.

net

PlumtreeSageMakerViador

DocumentumEnterworks

CorVuCorVuSterling Sterling

Mgt Mgt ConsultiConsultingng

WebTrendWebTrendss

e-CorporateBusiness

Productivity

e-CorporateBusiness

Productivity e-Contente-Content

e-CRMe-CRM e-Informatione-Information

e-Workflowe-Workflow

e-Analysise-Analysis

e-CommerceB2B

Exchanges

e-CommerceB2B

Exchanges

Black PearlBlack PearlCoheraCoheraEzCommerceEzCommerceIntershop Comm.Intershop Comm.Oasis Tech.Oasis Tech.PowerCervPowerCervTibcoTibcoTUMI SoftwareTUMI SoftwareXML SolutionsXML Solutions Service Partners

Computer Technology AssociateseCALYXeLoyalty

Keys to successful Enterprise Portal Implementation

Establish executive ownership

Develop a vision and define a strategy to get there

Balance unit ownership with central leadership

Plan for fundamental business change – not just ‘webizing’ your company

Design upfront the integration of new e-Business applications with existing systems

Involve key business partners in your initiative

Invest in a vendor who provides a comprehensive solution

www.radmd.com

www.sybase.com