Technologies for

E-Healthcare

HIMSS 2002
Kenneth Kleinberg
VP/Research Director
Gartner
Stamford, CT
www.gartner.com
 Conclusions
E-business/e-health applications and technologies will have a greater effect
on HCOs than any other IT development since the 1980s. The business risks
of not adopting them now exceeds the technology risk of implementation
failure. The dot.com implosion will not stop e-health from occurring.
Vendors and users that do not embrace the new wave of delivery and
integration technologies including Web integration servers, browsers,
integration brokers, SOAs, XML, ASPs and Web services will wither and die.
HCOs that do not take advantage of new communication technology
advances such as broadband and wireless computing, and that do not use
business process management technologies such as workflow and rule-
based processing, will only get a fraction of the value of e-health applications
and technologies.
Collaborative, application-focused technologies including supply chain
management, e-forms, e-procurement and customer self service will provide
near immediate ROI, but only if they are done well.
E-health applications must be supported by a comprehensive security
strategy that may include PKI, firewalls, biometrics, smart cards and intrusion
detection systems, but its all too easy to overspend and under-protect.
Fundamental Changes: Moving to
the Internet and Wireless Era
Old Limited Way New, More Open Way
Point-to-point interfaces Digital dial tone
Application-to-application B2B and B2C
Document-based Process-based
Few internal application users Millions of external users
Closed networks Open networks
Hard to update client software Browser-based computing
Location-locked computing Wireless computing
Low bandwidth High bandwidth
Few modes of contact Many modes of contact
 Application Hosting Technology:
Old and New Approaches
Open E-Services
SOA XML/XSL
HTML
Java Clients
N-Tier
Components (Network
Computing) WAP/PDA
Citrix/Metaframe ASP Support
Two-Tier Client/Server

Closed Monolithic Legacy

Old Paradigm New Paradigm

 Evolving to E-Forms
Pluses Minuses

Paper Forms Inflexible, error-prone,

Simple for users,
and expensive to store,
easy to mark up
process and access forms

C/S GUI-Based Forms Sophisticated client-based Difficult to roll out

edits, stateful interaction, client software
fast

First-Generation Web- Easy to deploy via browsers, Lack of state

Based E-Forms (HTML) can be ASP hosted

New Generation Web- Sophisticated Performance and

Based E-Forms (XML) edits, stateful interaction bandwidth
easy to deploy requirements
 Healthcare Standards

Emerging
EbXML
HL7 v.3

CORBAmed?
SNOMED-RT
HL7/CCOW

Mature HL7 v.2x

X12N
Cross-Industry Healthcare Focused
Healthcare Vertical Portals
All Things to All Stakeholders?
Capabilities: Stakeholders:
content, consumers,
transactions, physicians,
shopping, payers,
partner links, pharmaceutical,
interactive tools labs,
mass-media, office managers,
and more and more

Technical Challenges:
navigation
search,
performance,
state,
integration,
(re)branding,
personalization,
browser requirements
 PHRs Evolve to Patient-Centered
HVP/Repositories
Links to
Longitudinal Patient Record (LMR) Links to
Other PHRs
Patient Access
Structured and Unstructured
Health Data E-Mails/
Notifications
Consumer-to-Physician
Images Translator/CMV
Security Ad Hoc (e.g.,
Access
Scheduler Wellness CDSS Emergency)
(future) Tools (future) and Prepared
Faxes Requests
Documentation
Communication Links to
Health Security Access Payers
Appliances
Links to CPR Feeds Links to
Labs (ambulatory and acute) Pharma
 Physician-Patient Web-Based
Messaging Example: Healinx
Patient-Initiated Message
Patient Requests
E-mail to provider:
I am going on
Prescription Online
vacation and need Update to
a prescription refill. medical profile Patient to pharmacy:
Provider Reply Could you please
fill this?
1 5
Rule-based E-mail to patient
priority routing to Fine, here is 4
physician, nurse Special button
a prescription.
or admin. for fill request

Special button for

Patient Receives
Prescription Tool Prescription
prescriptions
Screens for 2 E-mail to patient:
interactions, comply Here is an
with formulary
3 electronic
prescription.
Business Process Management and
Process Efficiency
Analysis
Automation
Consistency
Process Definition
Coordination
Business Rules
Streamlining
Workflow
Monitoring
Context
Administration
Sharing
Integration
 Wireless Technologies:
Three Major Choices

PAN LAN WAN

Personal-Area Local-Area Wide-Area
Network Network Network

Bluetooth 802.11b GSM

802.11a GPRS
HyperLAN2 CDMA
2.5G to 3G

Low Data Rates Higher Data Rates Lower Data Rates

Short Distances Medium Distances Longer Distances
Notebook/PC to Devices/ Computer to Computer PDA Devices and
Printer/Keyboard/Phone and to Internet Handhelds to Internet

< 1 Mbps 2 Mbps to 54 Mbps+ 10 Kbps to 384 Kbps

 PDAs and Clinical Applications
Function 2001 to 2002 2003 to 2004 2005 to 2007
Connectivity Cradled/synchronized WLAN (02), WWAN(03) Broadband wireless

medical reference, lab report viewing, basic CDSS, benefits,

Applications Outpatient R writing, Order entry, alerts, referrals, clinical
x
(beyond PIM) charge capture eligibility & benefits trials
checks, dictation

Integration PM, pharmacy, PBM HIS, laboratory, payer CPR Level 3 and >

PDA form factor, PKI, processor speed, Speech/handwriting

Enabling data synchronization, HIS integration, PDA AD recognition,
Technologies bar-code technology tools, Bluetooth wearable, biometrics

200,000 physicians, 350,000 physicians, 500,000 physicians,

Adoption most pharmaceutical most all pharmaceutical many home care
representatives representatives professionals

Healthcare PDA Leading HIS/PM vendors Almost all

Available vendors(e.g. AllScripts, (e.g. Cerner, Eclipsys, CPR/HIS/PM
From ePhysician, ePocrates, Epic, IDX, McKesson, vendors
iScribe, Mdeverywhere) Meditech)
 TeleMedicine:
See Me, Feel Me, Operate on Me?
Robotic Surgery With
High Robotic Surgery Minimal Assistance
With Significant Assistance

Remote Drug Administration

Remote Examinations
Expense
Remote Consultations
Remote Patient Monitoring

Low Educational Videos

Now Time 20XX

 Home Health Internet Appliances

Sensatexs infant
monitoring system is
designed to detect
conditions such as sleep
apnea

VivoMetrics LifeShirt Alere Alerenet System

measures more than DayLink Monitor captures
30 physiological signs patient weight

Health Heros Health Buddy

home messaging device provides
reminders and asks questions
 Medication Management Using
Bar Coding, PDAs and Wireless
Pharmaceutical
ERP CPR/
System CDSS

Internet
SCM Wireless PDA
Supplier With Bar Code Patient
Manufacturer Reader With
Drug Dispensing Unit
Distributor Physician With Bar Coded
With Bar Coding
Bar-Coded Wristband
IT Badge

834X538

Drug With
Unit-Dosing Bar Code
 E-Procurement and E-Supply Chain
Management Challenges
How will e-marketplaces
Manufacturers The Web improve/upset the
GPOs relationship between
stakeholders?
What healthcare and
Distributors cross-industry standards
are adding value?
Warehousers How can manufacturers
Payers ensure that their products
CDOs are described in a
favorable light for multiple
comparison engines?
Consumers How will B2B
marketplaces be
integrated with ERP and
legacy systems?
How will e-procurement
 Contact Center Challenges:
Apologize or Address?
You saw it on our Web site Im sorry, I dont Web Call-Through, Web Hyped
have access to our Web site. Chat and Collaboration
Sorry, I havent checked my faxes yet this Universal Queue
morning.
You e-mailed us when? E-Mail Response Mgmt.
This is a recording Our East Coast Virtual Contact Center
office is closed.
Yes, I understand that you already keyed in Computer Telephony
your ID number on your phone, but could you Integration
please give it to me again?
Your lab results Im sorry but youll have to Interactive Voice
call your doctor on Monday. Response
Im sorry, Im not sure where this needs to go. Workflow
Oh, that far back, Im sorry but that information Integrated Document Mature
is now on microfiche and will take a few days to Archive and Retrieval
access.
 Security Technologies in Healthcare
Who You Are Where You Are What Device
Physician/Nurse Doctors Office Phone
Case Worker Shopping Mall PDA
Patient or Payer Home PC
Pharmacist Foreign Country Kiosk
What You Know What You Are What You Have
Uh, my password is Face Recognition ID Cards
and my mothers maiden Retinal/Iris Magnetic Strip Cards
name is Fingerprint/Hand Hardware Tokens
Voice/Handwriting Smart Cards

Intrusion Detection Systems, Firewalls, PKI

What Else Digital Certificates, Certificate Authorities,
Can be Used Digital Signatures, Anti-virus Software, SSL

What are you protecting? How obtrusive is the security?

What does it cost to deploy? What does it cost to maintain?
What happens if it fails? Who is your real security risk?
 E-Health Vendors (Representative)
Healthcare
Internet Appliances Healthcare Vertical Portals Workflow/Process
HealthHero WebMD PegaSystems
Vivometrics HealthVision
TenFold
Medscape
Healthcare
Web Development
E-Procurement PHRs
MedSeek
Neoforma WellMed
Doghouse
MediBuy Medscape/aboutmyhealth
Sequoia
Veranto WebMD
Wellogic
Ventro HealthCPR
Handheld Healthcare Omnicell Healthcare Security
ePhysician Integration Brokers Presideo
ePocrates VeriSign
Sybase/NEON
PatientKeeper bTrade.com
Mercator
AllScripts Silanis
Quovadx/Healthcare.com
iScribe
SeeBeyond
 Recommendations

Start now to develop and execute on an e-health strategy.

Press vendors to comply with leading healthcare standards bodies.
Aim for hybrid HVP approaches of bricks and clicks.
Aim for PHRs with structured data feeds from CPRs.
Look for opportunities to apply e-forms, workflow, rules and BPA.
Apply ASPs only where appropriate, with an eye on bandwidth.
View handheld healthcare devices as extensions of existing
applications.
Consider telehealth applications where touch is not needed.
Support or start deployment of home Internet appliances.
Participate in B2B marketplaces dont burn your bridges.
Upgrade call centers to contact centers.
Deploy security technologies commensurate with risks.