Clinical Leadership in e-Health Era. Fernandez Aguado JE. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. "eHealth and
healthcare organizations
–
The chicken and the egg"

2. The great challenges of the
XXIth century
Ethic Genetics & Drinkable Autonomy &
challenges Engineering water Welfare
Information
Global warming Poverty Health
society
Alternative Terrorism & Population
Governability
energies Human Rights ageing
Multi- Demographic
Oil crisis Sex equality
culturalism growth
Source: Siemens elaboration from the report
“XXI Century: Tentative of Identification of Some Great Trends”
Jerôme Bindé, Manager of the Office of Analysis and Foresight, UNESCO

3. How to best improve
healthcare efficiency
Through:
• Innovation
• Process
optimization
Quality Cost
of healthcare delivery

4. Innovation helps to increase healthcare
efficiency and meet the public’s demands
Increases patient comfort
• Reduced invasiveness
• Shorter examination times
• Less radiation
• Selective therapy
In line with citizens’ Essential as
desire to stay as demographic trends
put more and more
healthy as possible
demands on health-
during their lifetime
Innovation care systems
in Healthcare
Improves quality of care Reduces cost of care
• Faster report turnaround
• More accurate, reliable diagnosis
• Faster acquisition times
• Fewer diagnostic and medication
errors • Higher patient throughput

5. Innovation
 One picture
shows a dynamic
process

6. eHealth and healthcare organizations
Process Optimization a challenge
Patient’s Home
Technology

7. eHealth and healthcare organizations
Process Optimization a challenge
Hospital
(from latin “hospitalis”) as an aid place, charity,
Handout for the most disadvantages when they
got sick: Poors, pilgers, elders, …
Great Royal Hospital of Santiago de Compostela
(It started to work in 1509)

8. eHealth and healthcare organizations
Process Optimization a challenge
1- Hospital was an alternative to the care at home, which was habitual,
when the social and economic circumstances did it possible.
In the XX century, technological advances “take out” the diagnostic and treatment
and they bring it at the hospital, with independence of the social situation of the
patients.
It becomes something universal and it concentrates all the medical knowledge.

9. eHealth and healthcare organizations
Process Optimization a challenge
How the Healthcare System will be ?

10. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Stay Prevention
Sick, healthy Born Acute disease Death
injured Rehabilitation Senior care
Care
Management
Trauma
Recovery Sick, cured
Stroke
injured
Cardio
Integrated Diagnostics Desease
Management
Patientflow X-Ray MR
CT
Treatment
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

11. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Technology
Medicine

12. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Technology
Medical
Interaction Places
Beds
Utilization
Patient Medicine Management

13. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Sick,
injured
Technology
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

14. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Sick,
injured
Examination
Care Therapy Diagnosis
Patientflow X-Ray MR
CT
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

15. eHealth and healthcare organizations
Process Optimization a challenge
1- Hospital was an alternative to the care at home, which was habitual,
when the social and economic circumstances did it possible.
In the XX century, technological advances “take out” the diagnostic and treatment
and they bring it at the hospital, with independence of the social situation of the
patients.
It becomes something universal and it concentrates all the medical knowledge.
2- The medical diagnosis and treatment are spot on. But the processes behind it
are broken

16. eHealth and healthcare organizations
What is workflow in healthcare?
Workflow w ə rk-fl ō n :
a series of activities to produce a
pre-determined result
Industrial workflows are: Healthcare workflows are:
 Linear  Non-linear
 Unidirectional  Multi-directional
 Continuous  Interrupt-driven
 Have limited complexity  Have unlimited complexity

17. eHealth and healthcare organizations
What is workflow in healthcare?
Today's Process inside
1 the clinic center
Improvement of actual clinical
2 workflow by use of latest modalities
and IT-Systems.
(solving the “low hanging fruits”)
Roadmap/Concept of a
3 totally integrated and IT-
supported, controlled
Controlled Workflow Workflow
Roadmap to an optimized workflow supported and guided by an integrated
“Workflow Engine” based on medical symptoms, guidelines and actual situation.
(e.g. automated scheduling, benchmarking, patient tracking)

18. eHealth and healthcare organizations
What is workflow in healthcare?
Scope
 Visualization
 Workflow-oriented
facility planning
Benefits
Deeper understanding
of complex workflow
interdependencies
 Faster identification of
bottlenecks
 Comprehensive
space utilization

19. eHealth and healthcare organizations
What is workflow in healthcare?
Example “Hip Replacement”
Ideal
Process
1 Day 1 Day 1 Day 3 Days 8 Days = 14 Days
Actual
Process
3 Days 2 Days 1 Day 1 Day 1 Day 4 Days 14 Days
= 26 Days

20. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Sick,
injured
Examination
Care Therapy Diagnosis
Patientflow X-Ray MR
CT
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

21. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Sick,
injured
Patientflow X-Ray MR
CT
Treatment
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

22. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Sick,
injured
Trauma
Sick, cured
Stroke
injured
Cardio
Integrated Diagnostics Desease
Management
Patientflow X-Ray MR
CT
Treatment
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

23. eHealth and healthcare organizations
Process Optimization a challenge

24. eHealth and healthcare organizations
Process Optimization a challenge
1- Hospital was an alternative to the care at home, which was habitual, when the
social and economic circumstances did it possible.
In the XX century, technological advances “take out” the diagnostic and treatment
and they bring it at the hospital, with independence of the social situation of the
patients.
2- The medical diagnosis and treatment are spot on. But the processes behind it
are broken
3- Integrated Diagnostics
The convergence of laboratory diagnostics, medical imaging and IT solutions helps to
advance the shift from a proactive to a more active care.
"Although still in its infancy, integrated diagnostics has the potential to dramatically
transform healthcare - and it will do it along the entire healthcare continuum, from
prevention to early diagnostics to more-targeted, personalized therapies.

25. Modern Flight Control
Controlled Workflow
Early Aviation Modern Flight Control
 Controls complete system
 Flight plans; flights centrally
 No flight plans  directed
 Each pilot had  Constant tracking and correction
complete control
 Manages air traffic
 No coordination - Safety
- Efficiency - Timeliness
- Coordinates resources

26. eHealth and healthcare organizations
Controlled Workflow
Past Future
Early detection of
diseases
Imaging biomarkers
Fast drug/medicines
development
Reactive medicine
Knowledge-based Molecular Medicine and
Medicine Knowledge Management
 Wait for symptoms or
clear evidence of illness  Predictive
Personalized Medicine
 Anatomical and functional  Preventive
image
 Personalized Medicine
 Standard Therapy Information flow
parallel to workflow

27. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Sick,
injured
Trauma
Recovery Sick, cured
Stroke
injured
Cardio
Integrated Diagnostics Desease
Management
Patientflow X-Ray MR
CT
Treatment
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

28. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Prevention
Sick, Born Acute disease Death
injured Rehabilitation Senior care
Care
Management
Trauma
Recovery Sick, cured
Stroke
injured
Cardio
Integrated Diagnostics Desease
Management
Patientflow X-Ray MR
CT
Treatment
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

29. … year 2020

30. … year 2020

31. eHealth and healthcare organizations
Process Optimization a challenge
1- Hospital was an alternative to the care at home, which was habitual, when the
social and economic circumstances did it possible.
In the XX century, technological advances “take out” the diagnostic and treatment
and they bring it at the hospital, with independence of the social situation of the
patients.
It becomes something universal and it concentrates all the medical knowledge.
In the XXI century, technological advances are going to take medicine at
home. The hospital is going to change his role.
2- The medical diagnosis and treatment are spot on. But the processes behind it
are broken
3- Integrated Diagnostics
The convergence of laboratory diagnostics, medical imaging and IT solutions helps to
advance the shift from a proactive to a more active care.
"Although still in its infancy, integrated diagnostics has the potential to
dramatically transform healthcare - and it will do it along the entire healthcare
continuum, from prevention to early diagnostics to more-targeted, personalized
therapies.

32. Healthcare System
a challenge of the XXIth century
Healthcare Economy
Stay Prevention
Sick, healthy Born Acute disease Death
injured Rehabilitation Senior care
Care
Management
Trauma
Recovery Sick, cured
Stroke
injured
Cardio
Integrated Diagnostics Desease
Management
Patientflow X-Ray MR
CT
Treatment
out OP
Bed
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Healed,
Medical
fit for work Interaction Places
Beds
Utilization
Patient Medicine Management

33. Healthcare System
a challenge of the XXIth century
IT Tools
Population Screening: OIS Prevention
Born Acute disease
MIS Death
Rehabilitation Senior care
Citizen Digital Health Records
Care
Management
Trauma
Knowledge-driven IT Sick, cured
Stroke
injured
Cardio
Integrated Diagnostics Desease
Management
Patientflow X-Ray MR
Hospital Information Systems CT
out OP
Bed
Health Records PACS
in
LEAN HOSPITALS Angio Intens.
Workflow
Management
Departmental Software:
RIS / LIS / Pharmacy
Beds
Pathologic Diagnosis / ICU
Utilization
Medicine Management

34. Healthcare System
a challenge of the XXIth century
The potential
remains very large
to improve the
Quality of care

35. eHealth and healthcare organizations
Disclaimer: The views developed in this presentation are those of the author and do not reflect
necessarily the Siemens position on the subject matter