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A nation-wide Architecture
Blueprint for Healthcare in
Emerging Countries
      Stefano SOLIANI
      Vertical Solution Architect



© 2010 Cisco and/or its affiliates. All rights reserved.   Cisco Confidential   1
Business Requirements
               National HC today in EM (where are we coming from)
               Stakeholders Requirements
               National HC of the future – how to tackle the issues
       Establishing Business and Technology linkage (how technology can provide business benefits)
               Why architectures
               Collaboration support
               Quality information - Info coherence and completeness (HIE)
               Flexible IT support – Cloud and Managed Services
       HC solutions taxonomy – what’s the impact on national networks
               EHR/HIS/RIS/LIS/PACS and Imaging
               Collaboration & Telemedicine
               HC Middleware
       Technology Architecture
                                    Data Center/Cloud and Imaging
                                    Transport (WAN and optimization)
                                    Collaboration (audio, video, web, social sw)
                                    Security (for transport of info across ecosystem, universal access to resources)
               Hierarchical view
                                    National, regional, local - Private vs Public HC

© 2010 Cisco and/or its affiliates. All rights reserved.                                                       Cisco Confidential   2
Access to care                  Quality and Care
          Rising Care Costs                                                                        Delivery
 • Staffing shortages                                      • Specialists and GPs           • Lack of National Visibility for
 • Ecosystem interoperability                                distribution                    disease Control and Planning
 • Lack of proper IT support                               • Underserved areas and         • Lack of standard tools and
                                                             uneven distribution of          single patient view at PoC
 • Explosive storage                                         specialists
   requirements                                                                            • Capacity Building for remote
                                                           • Lack of Interoperability to     Health workers
 • Ineffective use of economy of                             bring medical record to PoC
   scale                                                                                   • Extended and on-time
                                                           • Home care & mobile care         collaboration needed




© 2010 Cisco and/or its affiliates. All rights reserved.                                                       Cisco Confidential   4
Executive Messaging
   The vision of the Ministry of Health is to realize health in its comprehensive concept at all individual, family and community
   levels, maintaining health in both quantity and quality, and help the elderly and those of special needs by enabling them to
   accommodate with their health situations in coordination with different health care providers at both private and public
   sectors.



     Business Issues
 Health delivery Issues:                                     Planning and regulatory issues:
 • Shortage of specialized resources                          • Lightly Automated islands.
 • High cost of basic operational functions                   • No automated mechanism for data warehousing and reporting.
 • Inconsistent health delivery quality.                      • Lack of coordination with local and International medical entities.
 • Inefficient Trauma services.                               • Inefficient disease control and chronic disease planning.
 • No unified HIS.

    Customer Strategy and Vision
 Attain the best possible quality of health care provision at the levels of equality, efficiency, and ability to afford the financial
 burden. MOH carries out its mission in a way that satisfies the needs of the citizen by providing him with the best quality
 special and general health services that cover all the population.
 Create one basic body for formulating health policies, including health insurance services.
 To adopt a general national health strategy that concentrates on the main burdens of diseases, including transmissible
 diseases, nutrition, smoking, AIDS, accidents, and injuries.
 The system must have an adequate and fair methodology for estimating risks and advantages.
 To diversify the sources of revenues for effectively financing the system, whether general revenues, insurance premiums,
 and equal division of allotted costs and taxes.

© 2010 Cisco and/or its affiliates. All rights reserved.                                                                  Cisco Confidential   5
Provide quality HC           Create Managed
                                                           services regardless          Services model for
                                                           of the city / location       WAN Connectivity.

                                                                    Build complete infrastructure
                                                                    in HC Delivery locations to run
                                                                    core business applications.

                                                           National Electronic           Achieve national
                                                           Medical Record                business operational
                                                           (EMR)                         visibility.




© 2010 Cisco and/or its affiliates. All rights reserved.                                                        Cisco Confidential   6
How to support the HC of the future
                                                                                                      Support on-demand and
                         Private or Public Clouds
                                                                                                      always-on collaboration
                         offering HIS and Collaboration
                                                                                                      between caregivers at local,
                         aaS to promote standardization
                                                                                                      regional or national level.

                                                           Provide quality HC           Create Managed
                                                           services regardless          Services model for
                                                           of the city / location       WAN Connectivity.
     Adopt Clouds and
     Managed Services                                                                                           Leverage Telemedicine
     for scalability,                                               Build complete infrastructure               to provide universal
     cost-effectiveness                                             in HC Delivery locations to run             access to high-quality
                                                                    core business applications.                 care

Hybrid Image Storage                                       National Electronic           Achieve national
strategy to combine                                        Medical Record                business operational
local and centralized                                      (EMR)                         visibility.
storage resources
                                                                                                National network to provide full
                                                                                                support to medical info transport,
                                           Provide citizen access to their                      to audio and video based
                                           medical records, and on-line                         collaboration, to promote
                                           interaction with HC providers.                       nationwide interoperability through
                                                                                                a Health Information Exchange

© 2010 Cisco and/or its affiliates. All rights reserved.                                                                    Cisco Confidential   7
• The Cisco Medical-Grade Network is an optimized architecture for
           the healthcare industry based on Cisco’s best practices for security,
           campus, data center, remote office, and wireless networks
    • The Cisco MGN 2.0
                  Industry-specific framework following
                  a set of proven best practices
                  Provides a mapping of clinical
                  and business needs to
                  technology solutions
                  Optimizes interactions between
                  processes, applications, and
                  technical architecture components
                  Facilitates business and clinical
                  communications throughout the
                  continuum of care
                  Enhances collaboration across
                  the technology partner ecosystem

© 2010 Cisco and/or its affiliates. All rights reserved.                           Cisco Confidential   8
To enable real-time and always-
       on collaboration across the entire
       country, standards must be set to
       create solutions capable of
       interoperate across
       organizations, to share video,
       audio and any other information.
                                                                                                                    Solutions



       Standard Presence services                          Communication
                                                           & Collaboration
                                                                                                     Conferencing

                                                                                          Enterprise Social Software
                                                                                                                                Customer Care

                                                                                                                                  IP Communications

       enable the discovery of available                   Applications
                                                                                      Messaging              Mobile Applications                TeleMedicine


       personnel to collaborate.                                                          Presence              Session Mgmt                Content Mgmt
                                                           Collaboration
                                                           Services                       Location            Client Frameworks                   Tagging

                                                                                                       Policy and Security Management
       TeleMedicine becomes possible
       even across Health                                  Infrastructure         Virtual Machines                  Network                      Storage

       Organizations
                                                                             ON-PREMISE                                HYBRID                                  CLOUD




© 2010 Cisco and/or its affiliates. All rights reserved.                                                                                        Cisco Confidential     9
HIS systems must interoperate to:

       •Create single patient view across
       the country, delivered at PoC to
       get the highest level of quality of
       care
       •Give patients/citizens full view of
       their medical history to promote
       awareness and sustain health                                          Health Information Exchange Data Center

       campaign                                                        Analytics       Application
                                                                                       Services
                                                                                                         Billing     Collaboration       eRX


       •Not duplicate analysis and scans                               Routers         Switches         Security      Storage         Servers

       for patients, reducing costs to                                                      Interoperability Services
       insurance and social services                       Patient
                                                           Indexing
                                                                             Document
                                                                             Exchange
                                                                                                  Secure info flow
                                                                                                                      Access/
                                                                                                                      Auditing
                                                                                                                                            Format
                                                                                                                                            conversion

       •Define new models to optimize
       costs and payments
       •Achieve national HC visibility to
       control disease and support                          Hospital      Hospital 2              PCP          Radiology     Cardiology           Pharmacy

       national planning                                    1



© 2010 Cisco and/or its affiliates. All rights reserved.                                                                             Cisco Confidential   10
Classic                                       Managed         Managed and Cloud Services
               Resale                                        Services
           Customer                                          CPE-based    Hosted
            Premise                                           Services   Solutions        IaaS         SaaS
           Equipment




Delivery                                Customer Hosts -                         SP Hosts -
Platform                                                                 Next-Generation Data Center
                                             CPE

Consumption
Model       Dedicated
             On Premise                                                                            On-Demand
                                                                                                   On Demand


  © 2010 Cisco and/or its affiliates. All rights reserved.                                             Cisco Confidential   11
• SaaS is the largest opportunity area
    for HC in the long-term: hospitals
    can use HIS/EHR/PACS +
    collaboration tools out of the VSP
    cloud.
• PaaS supports cases when some
    sw development is necessary in the
    hospital for very customized
    applications, until is commoditized
    and offered aaS.
• IaaS is also possible in HC, as
    specific sw not available from the
    VSP is necessary, control of OS is
    required, and confidence on maturity
    is not there. Especially required in
    the short-term, as we transition into
    Cloud concept, and VSP gather
    maturity.
 © 2010 Cisco and/or its affiliates. All rights reserved.   Cisco Confidential   12
CLINICAL SYSTEMS
                                                                                   EMR
                                                                                   Patient registration
                                                                                   Physician Order system
                 Providing proper network support                                  Patient Tracking and Monitoring
                                                                                   Emergency e-monitoring
                                                                                   Caregiver search
                                                                                   RIS
                                                                                   PACS
                                                                                   Telemedicine/ Tele Care
                                                                                   Robotic Surgery
                                                                                   Online operating room
                                                                                   Lab management system
                                                                                   Pharmacy Management system
                                                                                   Excellence center
                                                                                   Ambulance management
                                                                                   IHE middleware
                                                                                            STAFF EFFICIENCY
                                                                                   Hospital Portals & Learning Systems
                                                                                   Communication & Collaboration
                                                                        (( ))
                                                                                   Video Conference and Telephony
                                                                                   Workflow Management
                                                                                           INTELLIGENT BUILDING
                                                                                   Video Surveillance
                                                                                   Intelligent System
                                                                                   Access management
                                                           UNIVERSITY
                                                                                       BACK OFFICE & HOSPITAL
                                                                        HC Cloud               EFFICIENCY
     Most Hospital Systems can be provided off a Cloud                             Device Tracking.
                                                                                   Paying system
     Some of those transport audio/video/medical info across                       E-procurement
     the community (local/regional/national)                                       Contact Center
                                                                                   External portal
                                                                                            BEDSIDE SERVICES
                                                                                   Patient portal
© 2010 Cisco and/or its affiliates. All rights reserved.                           Internet access  Cisco Confidential   13
                                                                                   Digital Signage
Event                       What happens                                                               Benefits                                Tech Infrastructure

National visibility         MoH or other national HC organization create visibility                    Information are easily collected as     HC CLOUD
required                    on national HC (statistics, costs, quality level, main                     standard tools are in use. Corrective   MDES(IHE middleware)
                            issues, …..).                                                              measures can be easily identified.

Recurrent/ad-               MoH looks for signs of epidemic or outbreak monitoring                     Detect early signs and be capable       HC CLOUD
hoc investigation           statistics on patients, treatments, and the like. Health                   of reacting in time, organizing         MDES
for outbreak is             records are collected at regional/national level, and                      resources, driving treatment
                            submitted to data mining.                                                  processing, alerting and teaching
performed                                                                                              population.

Efficiency, Costs           MoH looks for sign of fraud, or investigate to detect high                 Discover abnormal activities, or        HC CLOUD
and Fraud                   costs of healthcare service or suboptimal efficiency.                      potential areas of cost                 MDES
investigation               Health records are collected at regional/national level,                   improvements,.
                            and submitted to data mining.

Patient health              Patient journey involves different organizations, to                       Highest quality of care supported.      MDES
services                    perform consultations, lab analysis, scans, operations,                    Optimal efficiency and minimal care     VPN
delivered over              etc. Medical information is always collected as single                     cycle is offered, reducing healing      ISR G2
                            patient view at Point of Care, regardless of location.                     times, optimizing resources and         UCS [Express]
many                                                                                                   reducing costs.                         DC
public/private                                                                                                                                 ACS
different                                                                                                                                      WAAS
organizations                                                                                                                                  DICOM routing
                                                                                                                                               LOAD BALANCER

Expertise and                             Specialist in private hospital needs a synch up with local   Collaboration has no frontiers, as      HC CLOUD
learning sharing                          hospital one. A Video Conferencing Session is                private and public organization can     Audio/Video Bridge
                                          scheduled.                                                   be bridged to raise national            Webex
                                          University requires access to operating room for             healthcare quality. Skills and          TP
                                          learning purposes. Operation is broadcast live to            expertise are easily made available     Medianet
                                          university students, and the footage is then available on    also to learners, to accelerate the
                                          demand as best practice for future review.                   learning journey.
                                          Remote Health workers need upgrade on medical
                                          content/procedures/etc. They can go into a eSkills
                                          center, and attend scheduled or on-demand sessions.
 © 2010 Cisco and/or its affiliates. All rights reserved.                                                                                            Cisco Confidential   14
© 2010 Cisco and/or its affiliates. All rights reserved.   Cisco Confidential   15
•Host clinical and
     administrative systems on
     single platform
     •Virtualization helps on
     scalability, cost-effectiveness,
     complexity, energy reduction

© 2010 Cisco and/or its affiliates. All rights reserved.   Cisco Confidential   16
Presentation (user access)
    Application
        &                                                  App Middleware servers
   Management
                                                           Management & DB servers



                                                                 Virtualization

                                                           Unified Computing
                                                                       Network

                                                                        Storage




© 2010 Cisco and/or its affiliates. All rights reserved.                                Cisco Confidential   17
PACS
                                PACS
                                                                                             PACS




                                                                  Cisco UCSE/SRE Cisco ISR
                                                                  Network Module  Router




© 2010 Cisco and/or its affiliates. All rights reserved.                                        Cisco Confidential   18
National



                                             Regional                                                                 Regional


                         Public                                           Private      Public                                  Private


                                                                                                                                       Hospitals and
   Local
                      Hospital             Clinic Physician’   Clinic   Hospital    Hospital   Clinic   Physician’   Clinic Hospital
                                                                                                                                       clinics in country
                                                   s Office                                              s Office




     Retains data locally but accessable with appropriate access & security
     Start with a single HC entity and scale up to large projects
     Unique solution with an IHE based hierarchical Patient Index (PIX)
© 2010 Cisco and/or its affiliates. All rights reserved.                                                                                     Cisco Confidential   19
VIEWING STATION


                                                                VIEWING STATION
                         Digital
                         Modality Diagnostic
                                                                                                                WAN Optimization
                                         Workstation(s)                                                         MDES
 Computed
                                                                                  WAN Optimization
 Radiography
                                                                                  MDES

                                                                                                                                              Local eMR

                                                                                                                                          SMALL CLINIC/
                                                 Local PACS                                                                               DOCTOR OFFICE
                     Local PACS                                    Local PACS
                     Server                      Storage           Web Server
                                                 (Short-Term)                                        MPLS WAN
       HOSPITAL SITE with Local PACS


                                                                                                                           WAN        Load
                                                                                                                        Optimization Balancer
                                                                                                                                                      Call Manager
                                                                                                                                         MDES         Cluster
                                                               VIEWING STATION
                       Digital                                                                                    DICOM
                       Modality Diagnostic                                                                         layer
                                                                                   WAN Optimization
                                       Workstation(s)                              MDES                                                      PACS BACKUP
Computed
                                                                                                                                         & ARCHIVE (Long-Term)
Radiography




                                                Local PACS
                                                Storage
                                                (Short-Term)                                                               HIS            Central PACS
                                                                                                                                   RIS
                                                                                                                                          Web Server
    HOSPITAL SITE – NO PACS
© 2010 Cisco and/or its affiliates. All rights reserved.                                                                                    Cisco Confidential   20
                                                                                                                   SP-hosted HIS-RIS-PACS Cloud
Solutions


                                                                           Conferencing             Customer Care
Communication
& Collaboration                                                 Enterprise Social Software            IP Communications
Applications
                                                              Messaging             Mobile Applications         TelePresence


                                                               Presence                Session Mgmt             Content Mgmt
Collaboration
Services                                                       Location              Client Frameworks              Tagging
                                                                               Policy and Security Management




Infrastructure                                              Virtual Machines              Network                   Storage




                                                       ON-PREMISE                          HYBRID                             CLOUD


 © 2010 Cisco and/or its affiliates. All rights reserved.                                                                     Cisco Confidential   21
SIP
                                                                          Cisco Unified CM
                                                           SIP               Call Control              SIP




      Telepresence Application Servers

        H.323 Gatekeeper                                           Advanced
         H.323-to-SIP GW                                                                  Firewall
                                                                 Conferencing
            SIP Grooming                                                                 Traversal
                                                                     Services




          3rd party SIP and H.323                                   Distributed Conferencing                 B2B and Remote Workers
               video devices                                                  Services
© 2010 Cisco and/or its affiliates. All rights reserved.                                                                 Cisco Confidential   22
Applications
                                                          Corporate
 Scheduling                                                Email /               Messaging/           Recording
                                                         Calendaring              Presence            Streaming                  Can go into
                                                                                                                                 CLOUD
TelePresence                         Multipoint
                                      Meeting
                                                                 Call Control       Session     TelePresence Infrastructure
 and Video                                                                          Border
 Endpoints                            Servers                                      Controller
                                                                                                                   Session             TP / Video
                                                                                                                   Border              Endpoints
                                                                                                                  Controller
                                                                                                 Internet



                                                                                                 Global B2B
                                                                                                Inter-Network
                                                   Si



                                                                                                Enterprise
                                                                                                  WAN
                                                   Si                                                             Branch                       Access
                                                                                                                   WAN         Firewall
                                                                                                                                               Switch
   Campus                               Campus                     Firewall     Campus WAN
   Access                              Distribution                             Aggregation
                                                                                                                                                    Clinic
                                                                                                        Network Infrastructure
Hospital Campus
  © 2010 Cisco and/or its affiliates. All rights reserved.                                                                            Cisco Confidential   23
© 2010 Cisco and/or its affiliates. All rights reserved.   Cisco Confidential   24
Simplifying access to HC services



                                                                       Cisco
                                                                       Wired IP
                                                                       phones
                                                   Cisco Access
                                                   Point
Cisco Wireless                                ISR G2 with
IP phone                                      VPN
                                              FW
                                              WLC
                                              CME
                                                                                  UCS Express
                                              WAAS
                                                                                  hosting
                                                                  3G/DSL/         Tiani-Spirit
                                                                  T1/E1




 © 2010 Cisco and/or its affiliates. All rights reserved.                                        Cisco Confidential   25
Creating skills in rural areas                                                                 KNOWLEDGE CLOUD
                                                                                                                 (shared by GOVT entities)

                                                                                                                                    Call Control

                                                                Cisco
                                                                Wired IP                                       CONFERENCING
                                                                phones
Cisco CIUS                                                                                   HEALTHCARE
                                 Cisco Access
                                                                                             SOCIAL SOFTWARE
                                 Point


                                                                               3G/4G/VSAT/
                                                                               DSL/T1/E1
                                                            ISR G2 with
                                                            VPN                              DIGITAL MEDIA
Workstation                                                                                  MANAGER                              WAAS MANAGER
                                                            FW
                                                            WLC
                                                            CME                                                E-SKILLS CONTENT
                                                            WAAS                                               FOR HEALTHCARE
                                                                           Digital Media
                                                                           Player




                  Cisco TP


 © 2010 Cisco and/or its affiliates. All rights reserved.             Cisco LCD Screen                                            Cisco Confidential   26
Providing primary care to rural areas
                                                                                             MoH Cloud


                                                               3G                                    Call Control



                                                                                HEALTHCARE
                                                                                SOCIAL SOFTWARE

Remote Health Worker
                                                             GSM
                                                             PSTN



                                                                    Wide Area
                                                                    Network      E-HEALTH RECORD
                                                                                 SYSTEM
                                Citizen


  Hospital or Caregivers site




  © 2010 Cisco and/or its affiliates. All rights reserved.                                               Cisco Confidential   27
VPN-based
                                                                                                                                           connectivity
                                                                                                                    Cisco Security
Hospital                                                                                                             Intelligence          protects Health
                                                                                                                                         Remote Clinician
                                                                                                                     Operations
                                                                                                                                           Information
                                                                                                                                           while in motion
              Wireless
              Devices


                                                                         MGN 2.0                                        Internet
                                                                         Campus                       ISR w/VPN                          ISR w/VPN

                                                                                                                                         Remote Clinic
              Wired
             Devices                                                                                                      WAN




            •Single Sign-on access to HIS
                                                           Cisco NAC
                             Server

            •Smart Card or Token -based                                                     Cisco NAC
                                                                                                                                      ISR w/VPN

                                                                                            Mgr/Profiler          Partner
Data Center
                     PACS                                                                                             ISR w/VPN
                                                                                                  Cisco
                                                                                                  CS-MARS
             EHR
                                                                        MGN 2.0                                       Partner/Payer
                                                                       Data Center
               HIS                                                                           Cisco                  Centralized policy-
                                                                                             ACS
          Email and
                                                                                                                    based management
        Web Servers                                             ACE/XML
                                                                                     Cisco Security
                                                                                                                    provide universal
                                                                  GW
                                                                      Web App FW
                                                                                     Manager                        access to HIS and
                                                                                                                    HC resources
© 2010 Cisco and/or its affiliates. All rights reserved.                                                                                             Cisco Confidential   28
Vision for a Connected Healthcare Ecosystem
            Local Public Community
                                               Hospitals     Clinics      Patients /                                                     Rural
                                                                          MDs at home                     Retail                         Areas
                                                                                                          Pharmacies
                                                                                                                           WiMAX/3G/VSAT
Urgent                     Universities                                Cable    DSL   Dial
Care                                                                                                                       Reference labs



   Long Term Care

                                                                VPLS - MPLS or
                                                                 DMVPN core                                                             Suppliers
                                                                                SONET/SDH                          (( ))




                                                                                                                                     Employers
Outpatient
Centers
                                                                                             UNIVERSITY
                                                                                                                   Local Health
                                                                                                                    (Private or
                                           Health Insurers         PBMs        State / Fed Agencies                Community)
                                                                                                                      Cloud
© 2010 Cisco and/or its affiliates. All rights reserved.                                                                       Cisco Confidential   29
Vision for a Connected Healthcare Ecosystem
            Regional Public Community




                                                            VPLS-MPLS or
                                                             DMVPN core



                                                           SONET/SDH




© 2010 Cisco and/or its affiliates. All rights reserved.                   Cisco Confidential   30
Vision for a Connected Healthcare Ecosystem
            National Public Community




                                                              VPLS-MPLS or
                                                               DMVPN core



                                                           SONET/SDH




© 2010 Cisco and/or its affiliates. All rights reserved.                     Cisco Confidential   31
Vision for a Connected Healthcare Ecosystem
            Private Community




                                                           VPLS-MPLS or
                                                            DMVPN core



                                                            SONET/SDH




© 2010 Cisco and/or its affiliates. All rights reserved.                  Cisco Confidential   32
Vision for a Connected Healthcare Ecosystem
            Private-Public Integration




                                                             VPLS-MPLS
                                                                core


                                                           SONET/SDH




© 2010 Cisco and/or its affiliates. All rights reserved.                 Cisco Confidential   33
•      MGN Campus whitepaper: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MGN_Campus.html

•      MGN Wireless Whitepaper: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MGN_wireless_adg.pdf

•      MGN Security Whitepaper: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MGN_2.0.pdf

•      BioMed NAC Deployment Guide: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/bnac_adg.html

•      MDES Technical Overview: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MDE-Technical-Overview.html

•      Nurse Connect DIG: http://www.cisco.com/en/US/docs/solutions/Verticals/mobile_care_NurseConnect/mobcare_nurse.html

•      Context-Aware Tech Considerations: http://www.cisco.com/univercd/cc/td/doc/solution/wifidesi.pdf

•      WiFi and Tablets Whitepaper: http://www.cisco.com/en/US/solutions/collateral/ns340/ns394/ns348/ns767/white_paper_c11-
       634584_ps11156_Products_White_Paper.html

•      DesignZone for Healthcare: http://www.cisco.com/en/US/netsol/ns823/networking_solutions_program_home.html

•      Medianet Campus QoS design:
       http://www.cisco.com/en/US/docs/solutions/Enterprise/WAN_and_MAN/QoS_SRND_40/QoSCampus_40.html




© 2010 Cisco and/or its affiliates. All rights reserved.                                                      Cisco Confidential   34
www.cisco.com/go/healthcare




Stefano SOLIANI
Healthcare Solution Architect
ssoliani@cisco.com

  © 2010 Cisco and/or its affiliates. All rights reserved.   Cisco Confidential   35

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Nationwide Healthcare Blueprint

  • 1. A nation-wide Architecture Blueprint for Healthcare in Emerging Countries Stefano SOLIANI Vertical Solution Architect © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 1
  • 2. Business Requirements National HC today in EM (where are we coming from) Stakeholders Requirements National HC of the future – how to tackle the issues Establishing Business and Technology linkage (how technology can provide business benefits) Why architectures Collaboration support Quality information - Info coherence and completeness (HIE) Flexible IT support – Cloud and Managed Services HC solutions taxonomy – what’s the impact on national networks EHR/HIS/RIS/LIS/PACS and Imaging Collaboration & Telemedicine HC Middleware Technology Architecture Data Center/Cloud and Imaging Transport (WAN and optimization) Collaboration (audio, video, web, social sw) Security (for transport of info across ecosystem, universal access to resources) Hierarchical view National, regional, local - Private vs Public HC © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 2
  • 3. Access to care Quality and Care Rising Care Costs Delivery • Staffing shortages • Specialists and GPs • Lack of National Visibility for • Ecosystem interoperability distribution disease Control and Planning • Lack of proper IT support • Underserved areas and • Lack of standard tools and uneven distribution of single patient view at PoC • Explosive storage specialists requirements • Capacity Building for remote • Lack of Interoperability to Health workers • Ineffective use of economy of bring medical record to PoC scale • Extended and on-time • Home care & mobile care collaboration needed © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 4
  • 4. Executive Messaging The vision of the Ministry of Health is to realize health in its comprehensive concept at all individual, family and community levels, maintaining health in both quantity and quality, and help the elderly and those of special needs by enabling them to accommodate with their health situations in coordination with different health care providers at both private and public sectors. Business Issues Health delivery Issues: Planning and regulatory issues: • Shortage of specialized resources • Lightly Automated islands. • High cost of basic operational functions • No automated mechanism for data warehousing and reporting. • Inconsistent health delivery quality. • Lack of coordination with local and International medical entities. • Inefficient Trauma services. • Inefficient disease control and chronic disease planning. • No unified HIS. Customer Strategy and Vision Attain the best possible quality of health care provision at the levels of equality, efficiency, and ability to afford the financial burden. MOH carries out its mission in a way that satisfies the needs of the citizen by providing him with the best quality special and general health services that cover all the population. Create one basic body for formulating health policies, including health insurance services. To adopt a general national health strategy that concentrates on the main burdens of diseases, including transmissible diseases, nutrition, smoking, AIDS, accidents, and injuries. The system must have an adequate and fair methodology for estimating risks and advantages. To diversify the sources of revenues for effectively financing the system, whether general revenues, insurance premiums, and equal division of allotted costs and taxes. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 5
  • 5. Provide quality HC Create Managed services regardless Services model for of the city / location WAN Connectivity. Build complete infrastructure in HC Delivery locations to run core business applications. National Electronic Achieve national Medical Record business operational (EMR) visibility. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 6
  • 6. How to support the HC of the future Support on-demand and Private or Public Clouds always-on collaboration offering HIS and Collaboration between caregivers at local, aaS to promote standardization regional or national level. Provide quality HC Create Managed services regardless Services model for of the city / location WAN Connectivity. Adopt Clouds and Managed Services Leverage Telemedicine for scalability, Build complete infrastructure to provide universal cost-effectiveness in HC Delivery locations to run access to high-quality core business applications. care Hybrid Image Storage National Electronic Achieve national strategy to combine Medical Record business operational local and centralized (EMR) visibility. storage resources National network to provide full support to medical info transport, Provide citizen access to their to audio and video based medical records, and on-line collaboration, to promote interaction with HC providers. nationwide interoperability through a Health Information Exchange © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 7
  • 7. • The Cisco Medical-Grade Network is an optimized architecture for the healthcare industry based on Cisco’s best practices for security, campus, data center, remote office, and wireless networks • The Cisco MGN 2.0 Industry-specific framework following a set of proven best practices Provides a mapping of clinical and business needs to technology solutions Optimizes interactions between processes, applications, and technical architecture components Facilitates business and clinical communications throughout the continuum of care Enhances collaboration across the technology partner ecosystem © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 8
  • 8. To enable real-time and always- on collaboration across the entire country, standards must be set to create solutions capable of interoperate across organizations, to share video, audio and any other information. Solutions Standard Presence services Communication & Collaboration Conferencing Enterprise Social Software Customer Care IP Communications enable the discovery of available Applications Messaging Mobile Applications TeleMedicine personnel to collaborate. Presence Session Mgmt Content Mgmt Collaboration Services Location Client Frameworks Tagging Policy and Security Management TeleMedicine becomes possible even across Health Infrastructure Virtual Machines Network Storage Organizations ON-PREMISE HYBRID CLOUD © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 9
  • 9. HIS systems must interoperate to: •Create single patient view across the country, delivered at PoC to get the highest level of quality of care •Give patients/citizens full view of their medical history to promote awareness and sustain health Health Information Exchange Data Center campaign Analytics Application Services Billing Collaboration eRX •Not duplicate analysis and scans Routers Switches Security Storage Servers for patients, reducing costs to Interoperability Services insurance and social services Patient Indexing Document Exchange Secure info flow Access/ Auditing Format conversion •Define new models to optimize costs and payments •Achieve national HC visibility to control disease and support Hospital Hospital 2 PCP Radiology Cardiology Pharmacy national planning 1 © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 10
  • 10. Classic Managed Managed and Cloud Services Resale Services Customer CPE-based Hosted Premise Services Solutions IaaS SaaS Equipment Delivery Customer Hosts - SP Hosts - Platform Next-Generation Data Center CPE Consumption Model Dedicated On Premise On-Demand On Demand © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 11
  • 11. • SaaS is the largest opportunity area for HC in the long-term: hospitals can use HIS/EHR/PACS + collaboration tools out of the VSP cloud. • PaaS supports cases when some sw development is necessary in the hospital for very customized applications, until is commoditized and offered aaS. • IaaS is also possible in HC, as specific sw not available from the VSP is necessary, control of OS is required, and confidence on maturity is not there. Especially required in the short-term, as we transition into Cloud concept, and VSP gather maturity. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 12
  • 12. CLINICAL SYSTEMS EMR Patient registration Physician Order system Providing proper network support Patient Tracking and Monitoring Emergency e-monitoring Caregiver search RIS PACS Telemedicine/ Tele Care Robotic Surgery Online operating room Lab management system Pharmacy Management system Excellence center Ambulance management IHE middleware STAFF EFFICIENCY Hospital Portals & Learning Systems Communication & Collaboration (( )) Video Conference and Telephony Workflow Management INTELLIGENT BUILDING Video Surveillance Intelligent System Access management UNIVERSITY BACK OFFICE & HOSPITAL HC Cloud EFFICIENCY Most Hospital Systems can be provided off a Cloud Device Tracking. Paying system Some of those transport audio/video/medical info across E-procurement the community (local/regional/national) Contact Center External portal BEDSIDE SERVICES Patient portal © 2010 Cisco and/or its affiliates. All rights reserved. Internet access Cisco Confidential 13 Digital Signage
  • 13. Event What happens Benefits Tech Infrastructure National visibility MoH or other national HC organization create visibility Information are easily collected as HC CLOUD required on national HC (statistics, costs, quality level, main standard tools are in use. Corrective MDES(IHE middleware) issues, …..). measures can be easily identified. Recurrent/ad- MoH looks for signs of epidemic or outbreak monitoring Detect early signs and be capable HC CLOUD hoc investigation statistics on patients, treatments, and the like. Health of reacting in time, organizing MDES for outbreak is records are collected at regional/national level, and resources, driving treatment submitted to data mining. processing, alerting and teaching performed population. Efficiency, Costs MoH looks for sign of fraud, or investigate to detect high Discover abnormal activities, or HC CLOUD and Fraud costs of healthcare service or suboptimal efficiency. potential areas of cost MDES investigation Health records are collected at regional/national level, improvements,. and submitted to data mining. Patient health Patient journey involves different organizations, to Highest quality of care supported. MDES services perform consultations, lab analysis, scans, operations, Optimal efficiency and minimal care VPN delivered over etc. Medical information is always collected as single cycle is offered, reducing healing ISR G2 patient view at Point of Care, regardless of location. times, optimizing resources and UCS [Express] many reducing costs. DC public/private ACS different WAAS organizations DICOM routing LOAD BALANCER Expertise and Specialist in private hospital needs a synch up with local Collaboration has no frontiers, as HC CLOUD learning sharing hospital one. A Video Conferencing Session is private and public organization can Audio/Video Bridge scheduled. be bridged to raise national Webex University requires access to operating room for healthcare quality. Skills and TP learning purposes. Operation is broadcast live to expertise are easily made available Medianet university students, and the footage is then available on also to learners, to accelerate the demand as best practice for future review. learning journey. Remote Health workers need upgrade on medical content/procedures/etc. They can go into a eSkills center, and attend scheduled or on-demand sessions. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 14
  • 14. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 15
  • 15. •Host clinical and administrative systems on single platform •Virtualization helps on scalability, cost-effectiveness, complexity, energy reduction © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 16
  • 16. Presentation (user access) Application & App Middleware servers Management Management & DB servers Virtualization Unified Computing Network Storage © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 17
  • 17. PACS PACS PACS Cisco UCSE/SRE Cisco ISR Network Module Router © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 18
  • 18. National Regional Regional Public Private Public Private Hospitals and Local Hospital Clinic Physician’ Clinic Hospital Hospital Clinic Physician’ Clinic Hospital clinics in country s Office s Office  Retains data locally but accessable with appropriate access & security  Start with a single HC entity and scale up to large projects  Unique solution with an IHE based hierarchical Patient Index (PIX) © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 19
  • 19. VIEWING STATION VIEWING STATION Digital Modality Diagnostic WAN Optimization Workstation(s) MDES Computed WAN Optimization Radiography MDES Local eMR SMALL CLINIC/ Local PACS DOCTOR OFFICE Local PACS Local PACS Server Storage Web Server (Short-Term) MPLS WAN HOSPITAL SITE with Local PACS WAN Load Optimization Balancer Call Manager MDES Cluster VIEWING STATION Digital DICOM Modality Diagnostic layer WAN Optimization Workstation(s) MDES PACS BACKUP Computed & ARCHIVE (Long-Term) Radiography Local PACS Storage (Short-Term) HIS Central PACS RIS Web Server HOSPITAL SITE – NO PACS © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 20 SP-hosted HIS-RIS-PACS Cloud
  • 20. Solutions Conferencing Customer Care Communication & Collaboration Enterprise Social Software IP Communications Applications Messaging Mobile Applications TelePresence Presence Session Mgmt Content Mgmt Collaboration Services Location Client Frameworks Tagging Policy and Security Management Infrastructure Virtual Machines Network Storage ON-PREMISE HYBRID CLOUD © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 21
  • 21. SIP Cisco Unified CM SIP Call Control SIP Telepresence Application Servers H.323 Gatekeeper Advanced H.323-to-SIP GW Firewall Conferencing SIP Grooming Traversal Services 3rd party SIP and H.323 Distributed Conferencing B2B and Remote Workers video devices Services © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 22
  • 22. Applications Corporate Scheduling Email / Messaging/ Recording Calendaring Presence Streaming Can go into CLOUD TelePresence Multipoint Meeting Call Control Session TelePresence Infrastructure and Video Border Endpoints Servers Controller Session TP / Video Border Endpoints Controller Internet Global B2B Inter-Network Si Enterprise WAN Si Branch Access WAN Firewall Switch Campus Campus Firewall Campus WAN Access Distribution Aggregation Clinic Network Infrastructure Hospital Campus © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 23
  • 23. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 24
  • 24. Simplifying access to HC services Cisco Wired IP phones Cisco Access Point Cisco Wireless ISR G2 with IP phone VPN FW WLC CME UCS Express WAAS hosting 3G/DSL/ Tiani-Spirit T1/E1 © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 25
  • 25. Creating skills in rural areas KNOWLEDGE CLOUD (shared by GOVT entities) Call Control Cisco Wired IP CONFERENCING phones Cisco CIUS HEALTHCARE Cisco Access SOCIAL SOFTWARE Point 3G/4G/VSAT/ DSL/T1/E1 ISR G2 with VPN DIGITAL MEDIA Workstation MANAGER WAAS MANAGER FW WLC CME E-SKILLS CONTENT WAAS FOR HEALTHCARE Digital Media Player Cisco TP © 2010 Cisco and/or its affiliates. All rights reserved. Cisco LCD Screen Cisco Confidential 26
  • 26. Providing primary care to rural areas MoH Cloud 3G Call Control HEALTHCARE SOCIAL SOFTWARE Remote Health Worker GSM PSTN Wide Area Network E-HEALTH RECORD SYSTEM Citizen Hospital or Caregivers site © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 27
  • 27. VPN-based connectivity Cisco Security Hospital Intelligence protects Health Remote Clinician Operations Information while in motion Wireless Devices MGN 2.0 Internet Campus ISR w/VPN ISR w/VPN Remote Clinic Wired Devices WAN •Single Sign-on access to HIS Cisco NAC Server •Smart Card or Token -based Cisco NAC ISR w/VPN Mgr/Profiler Partner Data Center PACS ISR w/VPN Cisco CS-MARS EHR MGN 2.0 Partner/Payer Data Center HIS Cisco Centralized policy- ACS Email and based management Web Servers ACE/XML Cisco Security provide universal GW Web App FW Manager access to HIS and HC resources © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 28
  • 28. Vision for a Connected Healthcare Ecosystem Local Public Community Hospitals Clinics Patients / Rural MDs at home Retail Areas Pharmacies WiMAX/3G/VSAT Urgent Universities Cable DSL Dial Care Reference labs Long Term Care VPLS - MPLS or DMVPN core Suppliers SONET/SDH (( )) Employers Outpatient Centers UNIVERSITY Local Health (Private or Health Insurers PBMs State / Fed Agencies Community) Cloud © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 29
  • 29. Vision for a Connected Healthcare Ecosystem Regional Public Community VPLS-MPLS or DMVPN core SONET/SDH © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 30
  • 30. Vision for a Connected Healthcare Ecosystem National Public Community VPLS-MPLS or DMVPN core SONET/SDH © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 31
  • 31. Vision for a Connected Healthcare Ecosystem Private Community VPLS-MPLS or DMVPN core SONET/SDH © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 32
  • 32. Vision for a Connected Healthcare Ecosystem Private-Public Integration VPLS-MPLS core SONET/SDH © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 33
  • 33. MGN Campus whitepaper: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MGN_Campus.html • MGN Wireless Whitepaper: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MGN_wireless_adg.pdf • MGN Security Whitepaper: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MGN_2.0.pdf • BioMed NAC Deployment Guide: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/bnac_adg.html • MDES Technical Overview: http://www.cisco.com/en/US/docs/solutions/Verticals/Healthcare/MDE-Technical-Overview.html • Nurse Connect DIG: http://www.cisco.com/en/US/docs/solutions/Verticals/mobile_care_NurseConnect/mobcare_nurse.html • Context-Aware Tech Considerations: http://www.cisco.com/univercd/cc/td/doc/solution/wifidesi.pdf • WiFi and Tablets Whitepaper: http://www.cisco.com/en/US/solutions/collateral/ns340/ns394/ns348/ns767/white_paper_c11- 634584_ps11156_Products_White_Paper.html • DesignZone for Healthcare: http://www.cisco.com/en/US/netsol/ns823/networking_solutions_program_home.html • Medianet Campus QoS design: http://www.cisco.com/en/US/docs/solutions/Enterprise/WAN_and_MAN/QoS_SRND_40/QoSCampus_40.html © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 34
  • 34. www.cisco.com/go/healthcare Stefano SOLIANI Healthcare Solution Architect ssoliani@cisco.com © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 35

Hinweis der Redaktion

  1. Methodology:Technical Architecture must be derived from Business Requirements, as of today, and moving into the future.Content is first delivered with a deck to promote concept, discuss rationales, and fine-tune. Full text document will follow.First release will be adapted to Saudi HC status, to be then generalized.A sanitized version is required, easily customizable to various countries
  2. Make it Cisco independent to show the benefits of a collaboration architecture.Real-time and always-on collaboration across the entire country.Cisco’s collaboration architecture not only powers our product portfolio, it is also our most important differentiator. From the ground up, it is constructed to enable boundary less collaboration – breaking down silos between content formats, between individual tools and devices, between companies, and ultimately between people working towards a common goal.At Cisco, we recognize that it requires a combination of both great software and purpose-built hardware to deliver the experiences that most effectively bring people together. Yet at the same time, we recognize that heterogeneity is a fact of life and that interoperability, openness and customer choice are paramount. These principles are actively embraced throughout our architecture.We also realize that it’s neither all about the desktop nor all about the cloud – it’s about recommending the right option to empower individuals, teams and communities to get their work done. But whether it’s an on-premise in-room solution, a hosted PC-based solution, or a combination of the two – it’s an intelligent network that’s the foundation that makes it all possible.It is the converged network that binds together today’s infrastructure domains of virtualized computing, network resources and persistent storage to enable unmatched agility, resiliency, scalability and quality of experience – and that allows an organization to securely span beyond its corporate firewall in order to collaborate with customers, partners and suppliers.With MediaNet, the network will be able to dynamically route rich media traffic along the path of least resistance to deliver the fastest and highest quality voice, video and data experiences to end users.With the Service Advertisement Framework we’re building into MediaNet, devices will automatically be able to advertise what services are available to them so that things like the configuration of dial plans can be automated… changing the experience for those working in IT behind the scenes as well.And there’s much more - so when you hear competitors talk about the network as “just plumbing”, you can respond with confidence that it’s actually an intelligent platform for rich and effective inter-company collaboration.Our collaboration architecture is our most important differentiator. From the ground up it is constructed to enable boundary less collaboration—breaking down silos between content formats, individual tools and devices, companies, and between people working towards a common goal. 9a. The bottom layer of the network binds together today’s infrastructure domains of virtualized computing, network resources, and persistent storage. It provides unmatched agility, resilience, scalability and quality of experience. It allows an organization to securely expand beyond the firewall to collaborate with partners, customers, and suppliers. 9b. On top of this foundation lies a comprehensive set of network-based services that enrich collaborative applications. These services can: Turn data into information by providing associated context Construct social graphs of who you know—and need to know—to build a product, close deals faster, or spot market opportunities. Let you know who’s available. This is presence beyond the boundaries of instant messaging. It goes across different tools and devices and individual application silos by using standards-based protocols Locate people for you, whether in the office or on the road, and can manage collaborative sessions for you. These services operate consistently and reliably, with both Cisco and non-Cisco collaboration applications and they are consistently secured and managed via network-based policy.9C. On top of this layer are communication and collaboration applications. Applications on this layer leverage these services to help companies deliver against the top line business imperatives they are facing today—such as saving on travel costs, improving employee productivity, increasing customer intimacy, and facilitating innovation.9D. Lastly, aforementioned layers of the collaboration architecture enable the development of industry-specific solutions, such as Cisco HealthPresence==========================================================Our collaboration architecture is our most important differentiator. From the ground up it is constructed to enable boundary less collaboration—breaking down silos between content formats, individual tools and devices, companies, and between people working towards a common goal. The bottom layer of the network binds together today’s infrastructure domains of virtualized computing, network resources, and persistent storage. It provides unmatched agility, resilience, scalability and quality of experience. It allows an organization to securely expand beyond the firewall to collaborate with partners, customers, and suppliers. On top of this foundation lies a comprehensive set of network-based services that enrich collaborative applications. These services can: Turn data into information by providing associated context Construct social graphs of who you know—and need to know—to build a product, close deals faster, or spot market opportunities. Let you know who’s available. This is presence beyond the boundaries of instant messaging. It goes across different tools and devices and individual application silos by using standards-based protocols Locate people for you, whether in the office or on the road, and can manage collaborative sessions for you. These services operate consistently and reliably, with both Cisco and non-Cisco collaboration applications and they are consistently secured and managed via network-based policy.On top of this layer are communication and collaboration applications. Applications on this layer leverage these services to help companies deliver against the top line business imperatives they are facing today—such as saving on travel costs, improving employee productivity, increasing customer intimacy, and facilitating innovation.
  3. HIE are critical to optimal efficiency of the entire HC ecosystem:Single patient view across the country to get the highest level of quality of careReduction of analysis and scans for patients, reducing costs to insurance and social servicesPossibility to define new models to optimize costs and payments.
  4. These be characterized by their ‘profile’ on the network, so as to prepare for proper nw support.These applications have proper sense in a hospital environment. When we take it from a national perspective what becomes interesting is:The aaS potential nature of these, so as to optimize costs, increase flexibility, promote standards.The potential exchange of information at national levelThe storage strategy at national levelThe collaboration potential, therefore leveraging standard communications means.The ‘profile’ of the application on the network (application awareness).CLINICAL SYSTEMS – Hospital Information SystemsElectronic Medical RecordPatient database with entire patient history, clinical diary, radiographies, analysis, diagnosis, medicines, ..Patient registrationPaperless and mobile system to register new patient. Includes bed and room allocation.Physician Order systemPhysician can place order online any time. Total mobility and secure remote access required.Patient Tracking and MonitoringAll patients are tracked and monitored via RFID in-house or remotely (through Internet). All vital parameters are made available.Emergency e-monitoringDisplay status and facilitate patient flowCaregiver searchAutomatic system to search for caregiver on the base of proximity and skills. Integrated with telephony system.Radiology Information SystemA RIS is a computerized database used by radiology departments to store, manipulate and distribute patient radiological data and imagery. The system generally consists of patient tracking and scheduling, result reporting and image tracking capabilities. RIS complements HIS (Hospital Information Systems) and is critical to efficient workflow to radiology practices. Picture Archiving $ Communication SystemStore and manage all type of medical images (x-ray, scans, …). Secure access is allowed over Internet.Telemedicine/ Tele CareCollaborating system to support remote consultancy, in a synchronous (video capability is key) or asynchronous way (ex: store and forward).Robotic SurgeryRemote robot control for surgeryOnline operating roomRemote access to operating room to attend an operation with learning purposes.Lab management systemSystem to securely place lab orders from anywhere. Secure access to lab results on Internet. Integration with EMRPharmacy Management systemSolution to remotely place orders to pharmacy from anywhere. Includes a pharmaceutical handbook. Product is delivered by robot or automated delivery and is tracked via RFID or similar. System is integrated with procurement system.Excellence centerBest practice and knowledge management. Content can be offered externally.Ambulance managementCoordinate ambulance operations in real-time. Ambulances are connected to the hospital for exchange of first emergency information.IHE middlewareMiddleware to set up interoperability between HC systems, using standards and scenarios.BEDSIDE SERVICESPatient portalPatients have online access to: 1) Hospital General information, 2) Schedule an appointment with a Physician, 3) schedule a hospital procedure, such as Radiology or Lab work, 4) view their full Medical Record via secure Internet access; 5) Health calculator (Body Mass Index, diet calculator, life expectancy); 6) directions (end-to-end interactive map), facility navigation, and ability to pre-purchase parking; 7) Personal Health Organizer (support for the whole illness experience, including remainder for visits, medicine assumption, tracking results)Internet accessFor employees, patients, and guests.Digital SignageHospital IP based network is used to deliver TV, Education, Entertainment, generic information. STAFF EFFICIENCYHospital PortalsRole-centric portals for Physicians, Employees, Nurses, Executives. Information delivery is based on multimedia capabilities. Integrated with e-learning system. Physicians can also access their decision making support system. An online agenda is available .Communication and CollaborationBaseline tools: E-mail, vmail, IM, calendar, meeting organizer, remote presentation tool, Video Conferencing, Audio conferencing, web seminar, etcVideo Conference and TelephonyIP-based Video and audio systemsWorkflow ManagementEnables the definition of workflows and procedures in the hospital, including the automation of messages to staff when any critical events happens.BACK OFFICE & HOSPITAL EFFICIENCYDevice TrackingAll hospital devices, staff and patients are tracked via RFID.Paying systemSystem to pay for any services delivered in the hospital (not only clinical), securely accessible from anywhere.E-procurementAutomated system for hospital procurementContact CenterHospital Contact Centers, leveraging integration between all different channels (phone, e-mail, fax, web, ..)External portalCitizens (potential patients) have online access to: 1) Hospital General information, 2) Directory hospitals locations with interactive map 3) Directory of Physician profiles, 4) Interactive site with online operator and Internet call me feature 5) job posting 6) Health campaign and support materialINTELLIGENT BUILDINGVideo SurveillanceIP-based Video surveillance systems.Intelligent SystemCentrally manages all hospital systems: machinery sensors, heating/cooling systems, lighting, …Access managementManages all info from badge readers to provide access right to various hospital areas. Key to track all employees’ movements in the hospital.
  5. The next few slides we highlight the Vblock and its core components. Highlight the key components of the solution – application & management, VMware virtualization, Cisco Unified Computing, Cisco networking, and EMC storage
  6. Components:PACS serverPACS storage (LTS, STS)PACS backupPACS viewing station (Diagnostic wkst)PACS web serverPACS web viewing stationRIS serverRIS dbHIS serverHIS dbModalitiesNW:SITAMPLS WANSITA hosting sitesMDESWAAS
  7. Cisco’s collaboration architecture not only powers our product portfolio, it is also our most important differentiator. From the ground up, it is constructed to enable boundary less collaboration – breaking down silos between content formats, between individual tools and devices, between companies, and ultimately between people working towards a common goal.At Cisco, we recognize that it requires a combination of both great software and purpose-built hardware to deliver the experiences that most effectively bring people together. Yet at the same time, we recognize that heterogeneity is a fact of life and that interoperability, openness and customer choice are paramount. These principles are actively embraced throughout our architecture.We also realize that it’s neither all about the desktop nor all about the cloud – it’s about recommending the right option to empower individuals, teams and communities to get their work done. But whether it’s an on-premise in-room solution, a hosted PC-based solution, or a combination of the two – it’s an intelligent network that’s the foundation that makes it all possible.It is the converged network that binds together today’s infrastructure domains of virtualized computing, network resources and persistent storage to enable unmatched agility, resiliency, scalability and quality of experience – and that allows an organization to securely span beyond its corporate firewall in order to collaborate with customers, partners and suppliers.With MediaNet, the network will be able to dynamically route rich media traffic along the path of least resistance to deliver the fastest and highest quality voice, video and data experiences to end users.With the Service Advertisement Framework we’re building into MediaNet, devices will automatically be able to advertise what services are available to them so that things like the configuration of dial plans can be automated… changing the experience for those working in IT behind the scenes as well.And there’s much more - so when you hear competitors talk about the network as “just plumbing”, you can respond with confidence that it’s actually an intelligent platform for rich and effective inter-company collaboration.Our collaboration architecture is our most important differentiator. From the ground up it is constructed to enable boundary less collaboration—breaking down silos between content formats, individual tools and devices, companies, and between people working towards a common goal. 9a. The bottom layer of the network binds together today’s infrastructure domains of virtualized computing, network resources, and persistent storage. It provides unmatched agility, resilience, scalability and quality of experience. It allows an organization to securely expand beyond the firewall to collaborate with partners, customers, and suppliers. 9b. On top of this foundation lies a comprehensive set of network-based services that enrich collaborative applications. These services can: Turn data into information by providing associated context Construct social graphs of who you know—and need to know—to build a product, close deals faster, or spot market opportunities. Let you know who’s available. This is presence beyond the boundaries of instant messaging. It goes across different tools and devices and individual application silos by using standards-based protocols Locate people for you, whether in the office or on the road, and can manage collaborative sessions for you. These services operate consistently and reliably, with both Cisco and non-Cisco collaboration applications and they are consistently secured and managed via network-based policy.9C. On top of this layer are communication and collaboration applications. Applications on this layer leverage these services to help companies deliver against the top line business imperatives they are facing today—such as saving on travel costs, improving employee productivity, increasing customer intimacy, and facilitating innovation.9D. Lastly, aforementioned layers of the collaboration architecture enable the development of industry-specific solutions, such as Cisco HealthPresence==========================================================Our collaboration architecture is our most important differentiator. From the ground up it is constructed to enable boundary less collaboration—breaking down silos between content formats, individual tools and devices, companies, and between people working towards a common goal. The bottom layer of the network binds together today’s infrastructure domains of virtualized computing, network resources, and persistent storage. It provides unmatched agility, resilience, scalability and quality of experience. It allows an organization to securely expand beyond the firewall to collaborate with partners, customers, and suppliers. On top of this foundation lies a comprehensive set of network-based services that enrich collaborative applications. These services can: Turn data into information by providing associated context Construct social graphs of who you know—and need to know—to build a product, close deals faster, or spot market opportunities. Let you know who’s available. This is presence beyond the boundaries of instant messaging. It goes across different tools and devices and individual application silos by using standards-based protocols Locate people for you, whether in the office or on the road, and can manage collaborative sessions for you. These services operate consistently and reliably, with both Cisco and non-Cisco collaboration applications and they are consistently secured and managed via network-based policy.On top of this layer are communication and collaboration applications. Applications on this layer leverage these services to help companies deliver against the top line business imperatives they are facing today—such as saving on travel costs, improving employee productivity, increasing customer intimacy, and facilitating innovation.
  8. MoH can leverage e-Centers created by Government programs to produce and distribute content for training and educational purposes to remote/rural workers in various industries. Health workers can go into e-Centers on the scheduled days for HC, and get training over different types of media, either on-Demand or attending scheduled live training sessions.The content is hosted in a government-orchestrated Knowledge Cloud, where every minister can pay its contribution for the hosted content and the number of sessions hold.Connectivity is based on existing coverage as provided by local/national SPs. Knowledge Cloud need to have large bandwidth available to sustain a large number of connections.
  9. MoH can create HC Cloud to provide support to rural areas. Remote Health workers can collect vital signs from patients in rural areas with no access to primary care and send those to the centralized eHR over 3G using a smartphone to access eHR. Doctors and specialist can then interpret signs and provide with specific directions to patients over phone, SMS or email. eHR is also investigated for early signs of medical outbreaks or epidemics.Citizens in rural areas with no access to primary care can get support over the phone. The contact center can intelligently route the call to the specialist according to symptoms, and early screening can be provided over the phone. Citizens with Internet access can also browse the National HC social site, for investigations, Q&A, or to look for latest newsletter from MoH.