Changing Paradigm in Healthcare Information Technology

1. SAP Thought Leadership
Healthcare
Changing the Paradigm in
Healthcare Information Technology
Becoming Proactive and Moving
into the Home

2. In a program integrating disease management and wellness or prevention management,
patients learn how to improve the quality of their health, manage their chronic disease,
take responsibility for their health, and avert preventable complications.

3. CONTENT
4 Executive Summary
5 Taking Healthcare to the Next Level
6 Focusing on Prevention and Proactive
Integration of Care
6 Integrate Wellness and Disease Management
in the Home
7 Proactively Manage Episodes of Care
7 Integrate Telecommunication and Home Devices
9 Improving Patient Safety and Operational Efficiency
9 Use Analytics
0 Aggregate, Standardize, and Centralize Quality Data
1
0 Identify and Act on Problem and Risk Areas
1
0 Enhance Treatment Quality
1
1 Comply with Government Reporting Mandates
1
2 Extending Medication Safety
1
2 Extension of Medication Safety
1
3 Benefitting from an Event-Based Solution
1
3 For More Information
1
About the Authors
The following authors are from SAP:
• ohn Papandrea, senior vice president and global
J
healthcare sector head
• Andy De, senior marketing director, healthcare global
industry marketing
• Chris Christy, healthcare industry principal,
North America
• ohn Murray, solution manager, healthcare industry
J
business unit

4. Executive Summary
THE PARADIGM SHIFT
Healthcare systems are going through a difficult transition.
As populations age and require more from the healthcare
system, traditional payers (insurers) are trying to identify
innovative ways of coping with funding this increasing
demand. In many cases, individuals and families are left
without coverage or are required to make choices about
pursuing treatments not covered by their insurers. Chronic
diseases are increasingly common, and their management
requires more active participation by consumers than ever
before. Individuals must take more responsibility for their
own care whether they are willing to or not.
A paradigm shift must occur across the healthcare eco-
system to support a sustainable approach to improving
and integrating high-quality patient care across multiple
stakeholders. It is incumbent on providers to lead these
initiatives by being proactive, reaching out to their patient
base, and facilitating care in the home. Information tech-
nology can enable this paradigm shift.
4 SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology

5. Taking Healthcare to the
Next Level
Using Technology to Improve
Patient Care
Under the concept of a “medical home,” a patient has Ongoing efforts to integrate PHRs
with HIEs have allowed patient-entered
a personal physician and is part of a physician-directed data to be shared by healthcare provid-
medical practice that is responsible for the coordination ers (see Figure 1). However, the fre-
quency and accuracy of data entered
and integration of care. Medical homes are expected to by patients raises concerns about the
reduce costs directly by avoiding redundant or unneeded integrity of patient clinical data. To take
healthcare delivery to the next level,
tests, imaging, procedures, and medications; these re­ you need an IT solution that facilitates
ductions are expected to be large enough to offset any the following:
• Increased focus on prevention
increased spending on medical home services. and preventive integration
• Improved patient safety, quality,
Over the past 15 years, there have to provide physician office electronic and operational efficiency
been numerous efforts to improve the medical records (POEMRs) for the indi- • Enhanced medication safety
use of information technology to aid vidual use of physicians in their offices.
healthcare workers in the identification
Inpatient clinical
Inpatient clinical
and treatment of acute disease. The Personal health records (PHRs), some systems clinical
Inpatient
systems
systems
major focus worldwide has been within of which are provided free to patients
the walls of the hospital, where exten- by some vendors, enable patients
sive, year-long-plus implementations to gather their own healthcare data,
of complex and expensive software which can then be used to better treat
Inpatient clinical
systems Health
programs have been and are still under illnesses. PHRs in isolation, however, Ambulatory
systems information
way. Despite significant investments, create another island of patient infor- electronic exchanges
few hospitals see the originally prom- mation that may not be shared with medical records
ised benefits of financial and operation- healthcare providers.
al efficiency.
Inpatient clinical
Inpatient clinical
The challenge with these multiple systems office
Physician
systems
electronic
Additionally, there has been a focus systems is that they are often neither
medical records
on implementation of ambulatory integrated nor interoperable, resulting
electronic medical records (AEMRs) in in isolated patient data in a variety of
clinics associated with hospitals or hos- systems. Health information exchanges Personal health
pital groups. In some instances, these (HIEs) are designed to address this record
AEMRs have been integrated with the lack of continuity of data, facilitating
existing inpatient solutions. Moreover, sharing across the variety of touch Figure 1: The Basic HIE Foundation for
the relaxation of the physician self- points where the patient may come into Proactive and Interactive Care of Patients
referral “Stark” regulations has also contact with the healthcare system.
allowed some healthcare organizations
SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 5

6. Focusing on Prevention and
Proactive Integration of Care
Integrating Healthcare in the
Community
In many communities, physician practic- care. Only when this is realized can consolidate outreach, communication,
es, hospitals, and other providers are you achieve proactive integration of intervention, transitions, reporting,
poorly integrated with respect to cul- care into the community and execute a and assessment across a wide portion
ture, organization, and financing. While focus on prevention with the needed of the continuum of care.
these independent arrangements may impact.
offer some benefits, such as broad- In a program integrating disease man-
ened patient choice, the flip side of Integrate Wellness and Disease agement and wellness or prevention
independence is fragmentation – Management in the Home management, patients learn how to
across care sites, among providers, improve the quality of their health, man-
and in the clinical decision-making pro- According to Continua Health Alliance, age their chronic disease, take respon-
cess. The HIE initiative promotes stan- 860 million people worldwide have at sibility for their health, and avert pre-
dards for a connected and interopera- least one chronic condition, and this ventable complications. To realize this
ble healthcare infrastructure – one of number continues to grow. To illustrate, vision of participatory healthcare, the
the most significant efforts within the by 2020, the prevalence of diabetes is next generation of applications needs
last several years to foster data integra- expected to double, and heart disease to bring together the following aspects
tion. It provides a way to identify and stroke will account for more than of healthcare:
patients and share documents among 20 million deaths a year. Nearly 75% • Traditional disease management
disparate healthcare organizations. of all deaths worldwide will eventually processes
result from chronic conditions.1 • A personal health record
While the HIE initiative provides an • The ability for a patient to track his
infrastructure for the sharing of infor- Traditionally, disease management, or her healthcare progress with other
mation, it does not facilitate actionable wellness, or prevention programs were healthcare professionals
and orchestrated information so that promoted by individual stakeholders
each member in the continuum under- within the healthcare continuum. Pre- SAP® applications let you leverage HIE
stands and has insight into the appro- vention and proactive integration of networks and your integrated clinical
priate next steps for managing patient care requires integrated programs that systems implementations to integrate
and share disease and wellness pro-
cesses, patient portals, and patient
Focus on Prevention and Proactive • Enables seamless connectivity self-tracking with multiple stakeholders.
Integration of Care: to in-home devices for the auto- The patient portal in the SAP Collabor-
• Integrates wellness, disease man- mated capture of patient clinical ative E-Care Management application
agement, and postacute care in the information provides self-service by enabling a sin-
home, as a natural component of • Supports integration of telecom- gle point of entry into the healthcare
healthcare munication functionalities for system. Population identification and
• Creates an approach that proac- notification of parties interested stratification processing allow your
tively manages episodes of care as in a patient’s healthcare status or healthcare organization to target
the patient interacts with multiple changes in status (for example, groups or individuals for which addition-
providers across the healthcare text messages, e-mail, work list, al intervention may be required. Sup-
continuum; provides “events” to telephone, and video) port for evidence-based practice guide-
inform providers about the status lines and care plans provide a vehicle
of a patient at any given time, no for dialogue and collaboration between
matter where the patient is located the patient and the appropriate
(hospital, doctor’s office, home, caregivers.
and so on)
1. Information from Continua Health Alliance,
Keeping Fit to Stay Healthy
(http://continua-alliance.com/static/binary
/cms_workspace/5.04-CH1-CC-401
-Continua_flyers.pdf), page 3.

7. Proactively Manage Episodes The potential of medical homes to improve the timeliness and accuracy
of Care improve quality and reduce costs is lim- of data that is sourced from patients
ited without effective mechanisms for managing their own health.
The patient experience begins long exchanging clinical information that is Tele-health applications have proved
before a patient walks through the hos- actionable by patients and providers that you can monitor many health
pital door and continues long after the regardless of where a healthcare event conditions remotely. These systems
patient returns home. The traditional occurs. SAP BusinessObjects™ Event have demonstrated that regular moni-
focus in the industry is on what hap- Insight software enables you to collect, toring, and prompt intervention when
pens in the hospital. The payer commu- filter, manage, aggregate, propagate, necessary, helps maintain patient
nity has implemented transaction sets and publish healthcare events in a health and prevent the exacerbation
from the health insurance portability consistent, contextual way in an open of chronic conditions while averting
and accountability act, or HIPAA, for and comprehensive framework, across costly hospital stays and ER visits.
authorizations, referral, eligibility, and servers, locations, and healthcare orga-
service reviews. These allow payers nizations. It allows you to proactively Many of the earlier tele-health integra-
and providers to interact before and and automatically manage healthcare tion attempts were limited by the
during a hospital stay. Providers have events regardless of the source, technology available, which was very
reengineered hospital workflows to whether you are a payer or primary or expensive, highly confining to the
improve patient safety and reinforce acute provider (see Figure 2). patient, and restricted to a limited
productive steps while the patient is subset of patients in a reactive mode.
in the hospital. Both of these attempts Integrate Telecommunication However, new applications can facili-
do not move care beyond the walls of and Home Devices tate direct capture of blood pressure,
the hospital. Even using HIE profiles glucose, vital signs, or other measures
for anatomic pathology, cardiology, lab- Patient data entry into either PHRs from the patient location anywhere in
oratory, patient care coordination, or or electronic medical records is a the world via Bluetooth devices that
patient care devices to exchange spe- concern. Direct capture of clinical are connected to the cellular telephone
cific data within provider communities information from medical devices can network.
does not enable you to proactively
manage episodes of care.
To solve these problems, the industry
has now focused on the concept of a
“medical home.” Under this concept,
Portal
a patient has a personal physician and Telephone Video
is part of a patient-centered. physician-
directed medical practice that is Live Enterprise
SAP® BusinessObjects™ Event Insight
responsible for the coordination and
integration of care. Medical homes are Customer relationship management
expected to reduce costs directly by
avoiding redundant or unneeded tests, Healthcare information exchange
imaging, procedures, and medications;
these reductions are expected to be Patient health
Physician office Inpatient clinical
Ambulatory electronic
large enough to offset any increased electronic information
record medical record
medical record system
spending on medical home services.
Figure 2: Integrated Solution for Proactive Patient Management
SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 7

8. With the advent of the Continua Health
Alliance, software and hardware com-
panies are committed to establishing
interoperability guidelines that allow
systems and sensory devices to work
together, facilitating a more efficient
exchange of information. SAP
BusinessObjects Event Insight allows
actionable and orchestrated heath
event management at any time. It does
not matter where the patient is located
(hospital, doctor’s office, or home) or
what type of device is required (smart
phones; weight, glucose level, and
blood pressure devices; or security
systems).
As a care provider, interaction with
medical devices that can alert you of a
change in a patient’s status is likely to
improve speed to care and facilitate
Solutions from the SAP BusinessObjects portfolio healthier maintenance of patients with
chronic illnesses. This can result in
help you transform fragmented data-collection activi- reduction of acute episodes associated
ties into a streamlined, automated business flow that with chronic diseases, improve quality
of care and quality of life, and reduce
supports useful insight. The tools automatically pull the cost of providing care to the
data from existing systems, standardize it, and use it community.
to populate a multidimensional database that enables
rapid, flexible data analysis.
8 SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology

9. Improving Patient Safety
and Operational Efficiency
Using Enterprise Business
Intelligence
In an effort to improve patient safety typically a time-consuming, people- ity, safety, and efficiency under which
and reduce healthcare costs, govern- intensive process fraught with potential you currently operate. Additionally, you
ment bodies worldwide are mandating errors and likely to cause reporting need to maximize clinical transparency
that hospitals track and report on core delays or inaccurate data. In addition, and derive timely business insights
measures of quality and use them to hospitals tend to discover medical care from clinical and administrative data.
improve processes and patient out- and patient safety issues many months Finally, to maintain your investment in
comes. For example, since 2009 the after services have been rendered – far existing transactional systems, you
Centers for Medicare and Medicaid too late to take proactive, swift, impact- must source patient and clinical data
Services (CMS) in the United States ful action. from back-end legacy systems, aggre-
has required that hospitals track an gate it, summarize it, and present it
increasing number of quality measures. Use Analytics in custom real-time, on-demand dash-
This is a massive undertaking, given boards to meet diverse needs. This
the complexities associated with care Although HIEs can help improve the gives your hospital a consolidated
delivery for U.S. citizens. quality of patient care, unless you put view of patient care across the entire
analytics in place within the HIE, the organization. Armed with the ability to
As governments increase the number specific value of the HIE is difficult to identify and address quality or business
of quality measurement requirements, measure. HIEs, community collabora- process issues, your organization can
hospitals are finding it even harder to tion, and the deployment of POEMRs improve outcomes, reduce risks to
comply. Most quality improvement and AEMRs must incorporate analytics patient safety, and understand opera-
departments are small teams with out- in order to demonstrate value. Patients tional effectiveness. You can also
dated legacy systems and spread- require information regarding the quali- report core metrics to government
sheets, which are useful for tracking ty of care they receive, not only from bodies with greater accuracy and
and analysis but cannot support predic- hospitals, but also from physicians timeliness.
tive modeling or what-if analysis. Data who treat patients outside the hospital
collection processes used on the front setting. Applications such as those from
lines of patient care may be paper- the SAP BusinessObjects portfolio
based or fragmented across depart- To address any patient safety or quality intelligently aggregate and summarize
ments and locations. As a result, matters, your healthcare organization core measures. This enables your
aggregating and standardizing data is must first understand the levels of qual- hospital or healthcare organization to
Improved Patient Safety, Quality, Leveraging Business Intelligence • Problem and risk identification –
and Operational Efficiency: to Improve Quality: Proactively identify risks and drill
• Encourages implementation of • Data aggregation and quality down to understand root causes in
enterprise business intelligence management – Aggregate and order to improve patient care
within each hospital or healthcare standardize data from back-end outcomes
system systems and populate a prebuilt • Enhanced treatment quality –
• Turns islands of data, or data in a data model designed for health- Track and trend changes in quality
health information exchange, into care facilities and quickly bring about any needed
information that can be leveraged interventions
for actionable insights to improve • Compliance – Automatically pull
quality of care relevant data for various reporting
needs

10. understand and swiftly address the Because each system stores data in Identify and Act on Problem and
root causes of problems – and ultimate- different formats, your staffers need Risk Areas
ly improve patient care and safety. SAP to manually gather, interpret, and input
has compiled a series of interactive data into a spreadsheet or database Quality and management solutions
dashboards supported by an integrated for each core measure. This is a time- from SAP help your organization keep
and predefined data model to assist consuming, error-prone process that track of the most important key perfor-
healthcare organizations in leveraging makes it impossible to have real-time mance indicators (KPIs) by supporting
business intelligence (BI) to improve (or even near-real-time) insight into personalized dashboards that make the
quality of care. This software helps patient care. KPIs clearly visible to the right people.
your organization achieve your quality Leveraging prebuilt data models, you
goals in a standard, interactive, and Solutions from the SAP can instantly view data at the facility or
real-time manner. The preconfigured BusinessObjects portfolio help you department level as well as horizontally
software enables you to proactively transform fragmented data-collection across functional areas such as
manage patient data. activities into a streamlined, automated finance, quality, and operations. For
business flow that supports useful example, your hospital can automatical-
Aggregate, Standardize, and insight. The tools automatically pull ly track performance of staff; identify
Centralize Quality Data data from existing systems, standardize trends and potential problems; and
it, and use it to populate a multidimen- implement standards, policies, and
For many management and quality sional database that enables rapid, procedures that can help boost perfor-
departments, pulling together the mas- flexible data analysis. The database mance. The solutions also track com-
sive amounts of patient information uses a prebuilt data model specifically mon risk management issues found in
required to compile quality measures designed to support the unique way in hospitals, such as patient falls, medica-
is a monumental task. Your team needs which hospitals operate. Multiple drill- tion errors, hospital-acquired infections,
to mine a wide variety of systems for down functions built into the solutions and hospital-acquired conditions that
meaningful data – such as financial, enable user insight at the level of detail not only threaten patient well-being but
admission, and lab – as well as patient required (see Figure 3). also lead to medical and financial
information in various departments. liabilities.
Enhance Treatment Quality
In most cases, by the time the medical
professionals involved in the problem
are pinpointed, it is difficult to recall
specifics about why a quality measure
was not followed. By identifying these
variances early, you can implement
changes that optimize the patient care
process. You can instantly access up-
to-date information and insights and
detect problems earlier, investigate
root causes quicker, and proactively
address issues to minimize their
impact.
Figure 3: Using SAP® BusinessObjects™ Solutions to Drill Down into Patient Data
10 SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology

11. To change the paradigm of healthcare IT, you need a
community-wide implementation of an event-based
solution that facilitates proactive care and engages
with patients as well as the care providers involved
with treating a given patient. Coordination of care in
the community and use of smart medical devices
and status monitoring for the chronically ill is a must
in order to improve quality while decreasing the cost
of healthcare.
To do this effectively, you need access Comply with Government reporting requirements can lead to pen-
to better and more understandable Reporting Mandates alties. SAP BusinessObjects solutions
information to make informed choices. enable you to facilitate better compli-
Patients today are looking to their pro- With recent changes in legislation, ance by automatically pulling the rele-
viders for data about the outcomes of hospitals are increasingly obligated vant data required for various reporting
procedures. Forward-thinking hospitals to provide more and more data to the needs. Visibility into the source of the
that proactively provide this information CMS about outcomes and cost. In data gives you confidence that it is
as a basis for differentiation will be the turn, you then publish this data and complete and accurate.
winners going forward. To have these make it available to prospective
publicized KPIs benefit your hospital, patients so they can make informed
you need to ensure that the perfor- decisions about the quality and cost of
mance numbers reflect a consistent, their planned care. Failure to comply
high-quality patient experience, as well with this and other governmental
as operational excellence from the
provider.
SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 11

12. Extending Medication Safety
Avoiding Risk
Following the “five rights” of medica- Counterfeits risk harming human life by Just as serialization can be applied to
tion administration (right drug, right containing incorrect active ingredients pharmaceuticals, it can also be used to
dose, right route, right patient, and or even no active ingredients at all. If track medical devices, including
right time), bedside medication admin- allowed to flourish in the healthcare implantable medical devices. Once a
istration is supported by inpatient clini- supply chain, these substandard prod- device is implanted in a patient, you
cal processes and clinical information ucts can damage the brand and reputa- can use the same technologies to track
systems. One major assumption, tion of the authentic manufacturer. The the functioning of the device, as well as
however, is that the medication being issue of diversions can be equally dam- the health of the patient. Should there
administered is actually what it says it aging as certain markets are denied be any failures of the device, SAP
is – and not a fraud. their medications, while middlemen and BusinessObjects Event Insight would
traders enjoy profit by selling them. It instantly send a notification (as appro-
Counterfeit medications, medical devices, is impossible to do more than provide priate) – for example, to the manufac-
and medical disposables are increasing rough estimates of the full impact of turer, physician, hospital, and patient’s
problems across the globe. Currently counterfeits and diversions, but they relatives – of a change in the patient’s
implemented inpatient clinical informa- run into billions of dollars each year and health status. This would facilitate
tion systems do not protect patients impact thousands of lives. prompt action to treat the patient.
against counterfeit or fraudulent medi-
cations that frequently are difficult to It is critical to ensure the integrity of
distinguish from the original. Systems the entire supply chain – from plant to
implemented in a typical retail pharma- patient – to maximize patient care. By
cy also lack this important safety implementing serialization and track
mechanism. It is a major challenge and trace for pharmaceutical products,
to account for the movement of all which extend beyond the retail pharma-
products from the time of manufacture cy into the hospital pharmacy, manufac-
to the patient – and to prevent diver- turers can reinforce their brands. They
sions and counterfeits. can build a stronger relationship with
physicians and can assure patients and
health workers of the authenticity of
Extension of Medication Safety their medication. When used through-
out the hospital (from the pharmacy to
The healthcare community must the patient bedside), serialization and
extend medication safety outside the track and trace technologies can signif-
walls of the hospital to address any icantly lower errors with medication.
potential risks associated with coun- They can also help reduce associated
terfeits and authenticate the medica- adverse drug events, improve levels of
tion as genuine in the hospital or patient safety, and reinforce medication
retail pharmacy. compliance.

13. Benefitting from an
Event-Based Solution
Leveraging New Technologies
It is critical to ensure the integrity of the entire supply
chain – from plant to patient – to maximize patient care.
By implementing serialization and track and trace for
pharmaceutical products, which extend beyond the retail
pharmacy into the hospital pharmacy, manufacturers can
reinforce their brands. They can build a stronger relation-
ship with physicians and can assure patients and health
workers of the authenticity of their medication.
The healthcare industry has been a To change the paradigm of healthcare reducing reimbursement, is forcing
relatively slow adopter of information IT, you need a community-wide imple- providers to augment their traditional
systems. Complex processes, regula- mentation of an event-based solution business models.
tions, change management, and other that facilitates proactive care and
issues have contributed to this slower engages with patients as well as the For More Information
adoption. Over the past several years, care providers involved with treating a
hospitals and healthcare systems have given patient. Coordination of care in To learn more, call your SAP represen-
started implementing third-generation the community and use of smart medi- tative today or visit us on the Web at
inpatient clinical systems, as well as cal devices and status monitoring for www.sap.com/industries/healthcare
AEMRs. In addition, physicians have the chronically ill is a must in order to /index.epx.
been strongly encouraged to imple- improve quality while decreasing the
ment POEMRs, and there has been cost of healthcare.
minor adoption of PHRs. Starting in
2009, the U.S. federal government, as To understand the current quality of
well as various governments in the EU, care and improvements that you can
Latin America, and Asia Pacific, has achieve by implementing HIEs and oth-
provided funding for the implementation er technologies, you must use BI not
and adoption of information technology only to monitor community-wide care
in healthcare. HIEs have emerged as a processes but also to continuously
way to share patient and clinical data improve quality of care. You can do this
across various stakeholders in the all while increasing efficiency, transpar-
healthcare provider industry. While the ency, and effectiveness of care provid-
ability exists to produce increasing ed to patients. It is incumbent for
quantities of clinical data, the ability to healthcare providers to leverage new
translate this into actionable informa- technologies to maintain viability and
tion to improve patient care is critical. become active participants in the con-
The impact of an HIE is limited to the sumerism of healthcare. The reduction
extent that it provides reactive data to of Medicare and Medicaid reimburse-
care providers. ments, along with traditional insurers
SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 13

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