Harnessing the Power of Technology to Improve

Chronic Care Management

A Whitepaper

Harnessing the Power of Technology to Improve Chronic Care Management

Contents

Executive Summary ...... 3 The Cost of Care ...... 4 Self-Management Scenario ...... 6 Care Coordination Scenario...... 8 Caregiver/Patient Collaboration Scenario ...... 11 Improved Decision Support Scenario ...... 13 Future of Healthcare ...... 15 Start Building a Better Future Today ...... 17 Appendix: Technologies Supporting Chronic Care Management ...... 18 Why Microsoft? ...... 19 Appendix: Microsoft Solutions at Work Today ...... 20

2 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Executive Summary

The prevalence of chronic conditions is increasing in Canada, and the financial impact on system is mounting. In the current environment, technology can be harnessed to support new approaches of coordinating and managing chronic conditions benefiting providers, patients and all Canadians.

The Canadian healthcare system is perceived to be a successful model by international comparison. However, governments and providers of healthcare services will need to develop new approaches in order to address key trends and challenges such as long wait times, growing consumer demand for access to higher quality healthcare, rising costs, rise in chronic illnesses, and an aging population. Overcoming these challenges will require a combination of initiatives such as coordinated disease management, patient self-care programs, and timely interventions to identify early warning signs of potential problems that could result in costly acute situations.

In particular, Canadian healthcare can benefit from both existing information technologies, as well as adaptation of newer information technologies and services that facilitate:

 Improved on-line patient interaction: Web based technologies that enable patients to self-manage conditions, access and share critical information about their health, and connect to biometric devices such as blood pressure monitors, glucometers and more.  Improved coordination of care: Empowering health professionals to have access to critical patient information as patients move across the continuum of care.  Remote monitoring and virtual communication: Tools that enable telehealth scenarios where consultations and collaboration take place via low cost and pervasive web conferencing tools and commodity devices, rather than face-to-face.  Population health intelligence: Making data readily available to provide a clear view of patient populations, helping drive better treatment for both the individual and the broader population health initiatives.

This thought paper illustrates the financial impact of chronic disease in Canada, and how a move towards the use of technology has the potential for improving the delivery of services, while helping to keep costs down. Many healthcare organizations in Canada as well as across the globe are realizing the benefits of taking advantage of existing infrastructure and information technologies.

Advances in web and mobile technologies, and telehealth services are helping improve efficiencies in care team collaboration, patient-doctor consultation, and patient education. Gaming technologies are gaining recognition for their potential in supporting health and wellness, physical activity and even rehabilitation scenarios. Cloud technology gives healthcare providers an opportunity to rapidly build and deploy scalable and interoperable systems without a large capital investment in infrastructure.

Microsoft has made significant investments to develop technologies that connect the health community, enable healthcare providers to unlock the power of data to help improve care, and to provide consumers the tools they

3 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management need to better manage their own health and specific conditions. In this paper, you will learn how technology can help improve chronic care management in the areas of:

 Patient Self-management  Care coordination across the health continuum  Caregiver/patient collaboration  Improved decision support and analytics

The Cost of Care

The Canadian healthcare system is perceived to be a successful model by international comparison. Spending on healthcare was expected to reach 11.6 percent of gross domestic product (GDP) in 2011,1 which compares favorably to the United States’ expenditure of around 17 percent of GDP.2 The future of Canadian healthcare, however, is facing serious risks. The current system is grappling with long wait times, growing consumer demand for access to high quality care, rising costs, and an aging population. Canada needs to find affordable ways to meet the increasing demands on their healthcare system.

The cost of healthcare is perhaps the most pressing issue. It’s rising rapidly in Canada – from $39.7 billion in 1975 to $200.5 billion in 20111 – an increase that more than doubled per-capita spending. Costs are being driven by a number of factors – data show that hospitals make up the largest component of healthcare spending, accounting for 29.1% of total health expenditures in 2009. Drugs represent the second-largest share at 16.2%, while physicians make up the third-largest share at 13.6%. While hospitals, drugs and physicians account for almost 60% of the total healthcare spending, many experts believe that one important way to reduce healthcare spending is to shift care delivery from costly acute settings to more cost effective community and home based settings. There are a number of critical factors required to make this shift, including policy enablers (such as payment models), information and communication technologies, and consumer empowerment – to help individuals take a more active role in managing health.

The largest single driver of healthcare costs in Canada is chronic disease. In 2010, the direct cost of care for chronic disease in Canada reached $68 billion, more than half of all health care spending3. Take diabetes, for example. The number of people diagnosed with diabetes in Canada [was] expected to double between 2000 and 2010, from 1.3 million to about 2.5 million. By 2020, another 1.2 million people are expected to be diagnosed with diabetes, bringing the total to about 3.7 million. As that number grows, diabetes will consume a growing share of healthcare budgets. By 2020, diabetes is expected to cost Canada more than $16 billion. It now accounts for about 3.5 percent of public healthcare spending in Canada, a share that is expected to rise significantly. Other chronic disease costs driven by obesity, cardiovascular conditions, and other illnesses, are expected to increase in a similar

1 Canadian Institute for Health Information, CIHI, (2011), National Health Expenditure Trends, 1975 to 2011, http://secure.cihi.ca/cihiweb/products/nhex_trends_report_2011_en.pdf 2 Centers for Medicare & Medicaid Services, National Health Expenditures 2009 Highlights, National Health Expenditure Data, Historical, https://www.cms.gov/NationalHealthExpendData/downloads/highlights.pdf 3 Public Health Agency of Canada, Chronic Diseases – Most Significant Cause of Death Globally (2011), http://www.phac-aspc.gc.ca/media/nr- rp/2011/2011_0919-bg-di-eng.php

4 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management fashion.4

The Canadian healthcare sector can make strides toward managing these costs and improving chronic disease management through the use of existing information technologies, and leveraging new innovative technologies and services. Many healthcare organizations in Canada and worldwide are already realizing the benefits of the technologies. These technologies enable greater patient self-management, improve care coordination through better access to patient information, provide ways to support caregiver/patient collaboration using remote monitoring and virtual communication, and allow healthcare providers better access to population health intelligence data and improved decision support.

Improving the healthcare system and keeping costs down is important to the Canadian public as well. According to a press release published by the Canadian Medical Association entitled, Canadians see "Moral Imperative" to Fix Health Care System Ottawa, August 10, 2011; the Canadian public is ready for a change in the healthcare system. In reference to the Voices into Action: Report on the National Dialogue on Health Care Transformation, the Canadian Medical Association states, “The report shows clearly that, while the public recognizes that our system does not work as well as it should, there remains a strong national commitment to transform our system so that it can deliver timely, compassionate and efficient care in the appropriate setting.” 5

4 Canadian Diabetes Association (December 2009), New Canadian Diabetes Cost Model Paints a Sobering View of Diabetes in Canada http://www.diabetes.ca/get-involved/news/new-canadian-diabetes-cost-model-paints-a-sobering-view-of-diabetes-in-cana/ 5 Canadian Medical Association, CMA, (August 2011), Canadians See "Moral Imperative" to Fix Health Care System, http://www.cma.ca/advocacy/canadians-see-moral-imperative

5 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Self-Management Scenario

For the Vancouver-based family of Sara, helping her husband, Bob, manage his diabetes is an everyday task. He sometimes struggles to keep his blood-sugar in balance which puts him at risk for further complications.

Sara lacked an easy way to keep track of Bob’s diabetes treatment. Records from visits to specialists, prescriptions, lab results, plus personal records of diet and glucose levels were kept in various locations, and not readily available. Having a centralized location to store and access all this information could help them a great deal to successfully manage his condition. Sara also needed to keep track of her own health records as well as those of her two teenage sons. One place for everything was the ideal solution.

Recently, Sara read an article about a new, web-based tool to manage personal health information, and she gave it a try. Using her computer and her mobile device, Sara was able to collect, store and manage health records for her entire family – even for her parents, who live in Toronto. She could also store copies of records from doctors’ appointments and prescriptions, and share that information with other healthcare providers, saving time and ensuring that relevant records are available and usable.

Bob, meanwhile, could now send data from his blood glucose meter directly to his online health record and diabetes management application. That way, both he and his doctor see blood sugar patterns over weeks or even months, and better understand how to help Bob keep control of his health. Similarly, Sara can add personal information about family conditions, upload data from a variety of medical devices and tools such as blood-pressure monitors, and share all of this important information with doctors and health professionals.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

While online solutions are offering a way for people to manage their health information, their functionality can be extended to meet the specific needs of a healthcare providers and patients, creating an inter-connected hub to allow provider, patients and care teams work together and share critical information more efficiently.

By harnessing the power of technology, providers can access useful and comprehensive data in order to gain continuous insight into the patients’ status. Timely interventions can help prevent the need for spur-of-the- moment appointments and preventable acute episodes. For patients, being able to track health-related information into one easily accessible view and share that information with doctors and specialists enables them to be more informed and proactive in partnering with their care teams. The more patients are engaged, the more likely they will become active participants in managing their health and wellness. Recent studies demonstrate that Canadians are ready.

6 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Over 65 per cent of Canadians said they would favor having a government-provided that could be used by themselves and their health providers;

a similar number support medical devices that enable them to check their health 6 condition and send information electronically to their doctor.

In December 2008, Cleveland Clinic and Microsoft collaborated on a pilot project that pairs the hospital’s electronic medical records system with the software company’s online HealthVault service to monitor patients’ health conditions. The participants of the program used a set of information technology tools and portable,

digital medical devices to upload health data to HealthVault – a security-enhanced, web-based data storage platform for patients – which then connected the data to their electronic medical record system used by the patient’s healthcare providers at A project that paired Cleveland Clinic. the patients of the Cleveland Clinic with The project found a significant change in the average number of days between Microsoft HealthVault physician office visits for patients. Diabetic and hypertensive patients were able to offers a promising make doctor’s office visits less often, increasing the number of days between model of how appointments by 71 percent and 26 percent respectively, indicating that patients had 7 technology can help better control of their conditions. improve patient self- The project demonstrated how technology can help link patients with caregivers, management. and it offers a promising model for improving patient self-management and physician oversight of patients with chronic diseases.

Technology innovation, however, is not only prevalent in US-based examples – these technologies and tools are quickly gaining momentum in Canada. In May 2010, TELUS® Health Solutions announced the launch of TELUS health space, powered by Microsoft HealthVault – Canada’s first Canada Health Infoway certified online platform for personal health. This cloud-based solution will give Canadians greater control on the organizing and managing of their personal and family health information in one place, and with a powerful ecosystem of health tools and applications on the platform.8 TELUS health space will allow patients to play a more active role in their health and manage their chronic conditions in a number of ways including tracking medications, lab results, and readings from devices (such as blood pressure cuffs and blood glucose meters), and sharing that information with their physicians and other allied health professionals.

6 Marketwire (August 2011), A Majority of Canadians Report They Are in Good Physical and Emotional Health, but Challenges With Wellness, Healthy Living and Chronic Disease Are on the Rise: Deloitte 7 Cleveland Clinic (2010, March 1). Cleveland Clinic/Microsoft Pilot Promising; Home Health Services May Benefit Chronic Disease Management. Retrieved from myclevelandclinic.org March 2012. 8 TELUS Personal Health Record introduced at eHealth 2011 Conference (May 2011). Retrieved August, 2011. http://telushealth.com/en/newsroom/news/2011/may30-a.aspx

7 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Care Coordination Scenario

Dr. Jones – Sara and Bob’s family physician – has her own challenges. When treating Bob, she needs to know what medications Bob is taking and what other kinds of treatment he may be receiving. Dr. Jones has an electronic medical record for Bob and her roster of patients, but other health professionals and clinicians with whom she works (such as dietitians, endocrinologists, or ophthalmologists) have their own systems, which don’t “talk” to one another. This makes it difficult for Dr. Jones and her peers to get consolidated access to Bob’s data, monitor his care plans, make patient medical performance visible to other clinicians, and see complete records of specialist referrals, hospitalization history, and more.

A connected system that enables information sharing between providers could allow Dr. Jones to practice more “team-based” medicine, and take a coordinated-care approach toward Bob’s needs.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

Patients’ health data is frequently confined to individual providers’ information systems (whether electronic or paper-based); consequently, physicians must often make treatment and prescription decisions without all available clinical data, or else spend valuable time and resources attempting to aggregate data.

Improving care coordination would enable better chronic condition management, as described by the Chronic Care Model, a framework developed in the 1990s by E.H. Wagner and his team. At the core of the Chronic Care Model is a fundamental premise that the best quality chronic care is accomplished by having collaborative, productive interactions between patients and their clinical care teams. The model focuses on strengthening these through self-management support, improved therapeutic decision-making, care team collaboration and managed follow-up. The Chronic Care Model is specifically designed to address the increasing problem of chronic disease, and the disparity of approaches for the management and care of chronic illnesses.9

While in some sectors, today’s consumers are accustomed to dealing with organizations that understand and even anticipate their needs – in the healthcare sector – patients go from the hospital, to their doctor and other specialists without a sense that their care providers understand their complete history or needs – which can negatively impact consumer confidence. Tools that have long been a staple of the business world, such as customer relationship management (CRM) systems, can help bring a similar ‘customer orientation’ to healthcare by leveraging case management, care coordination and patient outreach programs.

Through the use of CRM technology, providers can streamline administrative tasks, automate communications and manage patient outreach – often referred to as patient relationship management. CRM technology provides a central hub to process and integrate the patients' data collected by clinicians, care teams and staff, and manage

9 E.H. Wagner, “Chronic Disease Management: What Will It Take to Improve Care for Chronic Illness?” Effective Clinical Practice 1, no. 1 (1998), Retrieved May 2012 .

8 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management complex workflows. CRM technology also supports shared access to patient information to monitor critical procedures and track patient symptoms. As a result, physicians can spend time more efficiently with patients, spend less time accessing hard-to-find or paper-based information, and effectively change the care paradigm, from treating episodes of illness to enabling proactive care by establishing productive, ’shared decision making’ relationships with patients.

Maccabi Healthcare Services,10 a healthcare provider serving one of every four people in Israel with full range of facilities - hospitals, clinics, dental offices, and pharmacies - needed a means for bringing the data from these disparate systems together. Implementation of CRM technology helped Maccabi improve service levels and open up information from multiple systems to their care teams

In order to garner a 360-degree view of member data, information from multiple systems would be integrated into a single service application. The team integrated CRM solution with Maccabi’s core system. Every transaction that is performed in the older legacy system is populated into the CRM platform using automated processes to move tasks and work-flows from person to person through to completion.

As a result, customer service representatives have a full, real-time view of member data. Each interaction picks up where the previous one ends, boosting productivity and efficiently routing issues and tasks appropriately. Members no longer have to repeat their history because representatives have access to comprehensive member data at their fingertips.

Implementing portal platforms to both present and capture data in real time can improve operational efficiencies and patient services. In Australia,11 the Improvement Foundation produced a portal platform to connect more than 1,000 general practices to their patients. Using Microsoft SQL Server to house a wide range of data and Microsoft SharePoint portal to present the data, general practice physicians and staff were better able to collect and report data themselves, and share information across systems. Quick access to this data led to improvements in chronic care.

10 Microsoft Case Study Portal (July 2009.) Maccabi Healthcare Services, Healthcare Provider Improves Customer Service with Real-Time Patient Data Visibility. Retrieved August 2011. (see Appendix) 11 Microsoft Case Study Portal (June 2010) Improvement Foundation Australia, How Sharepoint helped IFA connect with healthcare professionals. Retrieved August 2011 (see Appendix)

9 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Often, disconnected data systems that don’t talk to each other provide a huge challenge for coordinated care. The freiburger spital,12 a consortium of six public

hospitals in Fribourg, Switzerland, joined together to integrate their various

applications into one IT system using Microsoft BizTalk Server. As a result, a large number of point-to-point connections were replaced by a central hub, through which data from a wide variety of systems is consolidated, synchronized, and forwarded. “Thanks to this integration solution, we have increased our flexibility,

reduced costs, and connected all hospital locations to a common IT infrastructure. This, in turn, enables us to provide our patients with a better level of care and support,” said Marc Devaud, Head of Projects and Development of the freiburger spital.

“The new integration Healthcare providers managing chronic diseases could also benefit from technology solution enables us to that simplifies research, identifies drugs and side effects, and provides evidence provide our patients based recommendations for how to manage patients with multiple chronic diseases. with a better level of In the United Kingdom, for instance, business tools such as Microsoft SharePoint care and support.” Server and FAST Search technology in combination with Microsoft ASP.NET were used to build a web-based search portal called NHS Evidence.13 Developed by the - Marc Devaud, Head National Institute for Health and Clinical Excellence (NICE), part of the United of Projects and Kingdom’s National Health Service (NHS), NHS Evidence is a single-source location Development, where healthcare providers can find the latest and most authoritative clinical and freiburger spital. nonclinical evidence, and use that information to better treat their patients.

NHS Evidence had 12,000 visits on its first day (in April 2009), and, as of November 2010, traffic averaged about 1 million visits a month. NHS Evidence users love the new service. The doctors can now find information in a fraction of the time it used to take. Also, because NHS Evidence is built with Microsoft products, it integrates well with other Microsoft products already in use by the NHS.

12 Microsoft Case Study Portal (June 2010) freiburger spital Hospital Network Reduces Costs and Improves Care by Consolidating Disparate IT Systems. Retrieved August 2011 (see Appendix) 13 Microsoft Case Study Portal (January 2011), National Institute for Health and Clinical Excellence Health Agency Simplifies Information Access for Health Professionals with Web Portal, Retrieved August 2011

10 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Caregiver/Patient Collaboration Scenario

Dr. Jones is responsible for scores of patients. Some live nearby, some in remote areas. Indeed, geography is a constant problem for Canadian healthcare providers, many of whom are responsible for patients in thinly populated areas where it’s not feasible to locate permanent healthcare facilities. She found that many of her patients were going too long between appointments making it difficult to catch changes in symptoms which put them at risk for medical complications, emergency care or hospitalization.

One patient in particular who lived over two hours away, relied on virtual on-line visits from a nurse to report changes in symptoms rather than having to travel to Dr. Jones’s office. During a recent on-line visit, the nurse suspected the patient may have been experiencing negative side- effects from a medication. The nurse was able to arrange a virtual consultation with Dr. Jones about this patient’s symptoms and seek guidance on the appropriate protocols. It turned out the nurse’s evaluation was very timely and a short video conference with Dr. Jones prevented complications and a costly trip to the nearest emergency room.

Dr. Jones found that her patients who kept themselves educated about their conditions and overall health, and those able to keep up with regular consultations did much better overall, requiring fewer interventions. This was true for both her long-distance patients, as well as those living nearby. Oftentimes a quick consultation (on-line or face-to-face) with another member of a patient’s care team was all she needed in order to make effective intervention decisions.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

Patients with chronic diseases – and the physicians who treat them – can benefit from harnessing technology solutions that allow more efficient collaboration, patient-doctor consultations, and patient education.

In January 2009, the Hawaii Medical Service Association (HMSA)14 became the first health plan in the U.S. to offer every Hawaiian resident and HMSA member medical care online, providing patients with the opportunity to speak to a physician or specialist via web-based video conferencing, telephone, or secure on-line chat. Patients can immediately speak to a local physician anytime and virtually anywhere and get answers to medical questions without waiting weeks for a scheduled appointment.

14 HMSA (January 2009) First in the nation, HMSA’s Online Care goes live, http://www.hmsa.com/mediacenter/press/2009/090115_onlinecare_launch.aspx

11 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Built in a partnership with American Well™, the HMSA system solves several problems relevant to Canada’s needs:

 Time — Illnesses and accidents rarely happen at the best times. And some patients must be seen immediately, unable to wait for weeks for a scheduled appointment. Online Care is an on-demand service that provides almost immediate access to doctors.

 Distance — Hawaii is a rural state with a scattered population and a limited number of doctors. Online Care connects patients with doctors statewide.

 Mobility/disability — Patients with impaired ability to get around may find it difficult to leave their homes for doctor visits. Online Care allows patients to speak with doctors without having to leave their own home.

Canada also is realizing some of the benefits of telehealth. The Ontario Telemedicine Network, for instance, uses video capabilities to deliver healthcare in remote locations. It employs some 1,200 video conferencing endpoints in locations across Ontario, and currently is rolling out capabilities that will allow doctors and nurses to access the network from personal computers. More than 3,000 healthcare providers in Ontario use the network, and manage remotely about 135,000 patient visits each year.15

According to a recent study commissioned by Canada Health Infoway,16 Telehealth Benefits and Adoption – Connecting People and Providers across Canada, telehealth services grew more than 35 percent in the past five years. This is resulting in improvements in care such as better chronic disease management and improved care coordination. Expanding telehealth offerings in Canada could help drive more efficient use of provider resources, delivering healthcare to remote areas, and give patients everywhere better access to health information and advice.

Unified communication technologies, such as Microsoft Lync and , offer solutions that bring the many ways healthcare professionals communicate into one familiar user interface. With the click of a mouse or a simple voice command, a caregiver can initiate an email, an instant message, a phone call, a web conference or book a meeting. By using an audio or video conference, caregivers can quickly find colleagues by department or role and connect with them using the presence information integrated within clinical and administrative portals. Distributed care teams can share test results, X-rays, and other clinical information with each other on a variety of systems and devices.

Such an approach can help resolve issues faster. Microsoft Lync also makes it easy to schedule patient appointments, plan follow-ups and set up alerts. Patients and caregivers can communicate more efficiently before, after and between office visits. That may include remote delivery of patient education, post-treatment counseling and virtual group sessions.

15 Ontario Telemedicine Network, Copyright © 2008 OTN. All rights reserved. http://otn.ca/en/otn/about-otn, http://otn.ca/index.php?uri=/en/services/video-conferencing 16 Canada Health Infoway, Telehealth Benefits and Adoption – Connecting People and Providers across Canada Source: https://www.infoway- inforoute.ca/about-infoway/news/news-releases/740

12 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Cancer Care Ontario (CCO) replaced their private branch exchange (PBX) systems17 with Communications Server to make their conferencing and communications systems more robust and agile, thus reducing the infrastructure costs required for a new employee. By implementing the Microsoft Unified Communications system, CCO was able to reduce or avoid additional equipment costs, improve employee efficiency and communication as well as provide employee’s location information that was so critical for 911 services.

Improved Decision Support Scenario

Over time, Dr. Carey noticed that a number of her patients were showing increased risks of developing diabetes, heart disease and other chronic conditions. While some patients were exhibiting negative trends in the progression of their conditions, she didn’t have access to comprehensive data that would support her observations or offer insights as to cause. She felt that having this insight could help her better identify “at risk” patients and improve care coordination across her extended care team. Access to comparative outcomes and analysis of different treatments and procedures could help her better manage patient care, and create efficiencies in clinic services.

Dr. Carey knows from reading peer review journals and attending conferences that healthcare providers and health systems around the world are putting new business intelligence technologies to work in healthcare environments. The data from these technologies is helping doctors understand which patients are at greater risk for hospital readmissions and how changes in treatment options can help with transitional care.

Scenarios described here are for illustration purposes only, and people described in the scenarios are fictional.

Commercial enterprises and advanced medical systems worldwide use advanced business intelligence tools to better understand their customers and optimize their business performance. Yet today, many healthcare organizations and governments lack the ability to effectively collect and use valuable information to gain insights, improve patient care, manage patient populations, improve operational performance, and speed up research cycles.

University of Washington Medicine’s Institute of Translational Health Sciences (ITHS)18 utilized – a health intelligence platform that integrates vast amounts of data from disparate information systems and turns that information into critical knowledge – in an effort to accelerate and improve translational research. This type of research involves applying knowledge gained from sciences and research to real-world clinical and

17 Microsoft Case Study Portal (July 2010) Cancer Care Ontario - Government Healthcare Agency Implements Unified Communications Solution to Reduce Costs. Retrieved August 2011 (see Appendix) 18 University of Washington to Use Microsoft Amalga to Support Clinical and Translational Research, September 2008 http://www.microsoft.com/presspass/press/2008/sep08/09-30UWAmalgaPR.mspx

13 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management community settings. University of Washington Medicine (UW Medicine) now is expanding its use of Amalga to support a range of clinical and research projects across the health organization.

In one study, UW Medicine is using the Amalga platform to launch a study of children and adolescents who have diabetes. Over the course of five years, a massive database of diabetic patients will be compiled and analyzed to better understand the potential number of new diabetes cases apt to appear among U.S. children, as well as describe the complications and quality-of-life issues of those with the disease. The system makes it possible to collect and analyze the large amounts of data that will be collected during the study.

Business intelligence tools can make it possible for organizations to better understand clinical and operational performance - for example - identifying which patients are at risk for being re-admitted to a hospital after discharge and the overall impact of preventable readmissions on cost and outcomes. Those tools help clinicians gain valuable insights into an acute care population by helping proactively manage at-risk patients throughout their stay and at discharge, effectively monitor patient cohorts across the organization, and reduce data collection time. As well, root causes of readmissions can be analyzed, with patient readmit probability reports based on predictive models.

At Providence Alaska Medical Center, professionals are using the Modified Early Warning System (MEWS) – powered by Microsoft Amalga – to help proactively monitor early clinical signals among all inpatients to help prevent infections, escalations to intensive care and fatalities.19 Manual tracking processes weren’t sufficient and missed early warning signs unnecessarily. With this platform, Providence has been able to immediately engage the appropriate clinician as soon as an early warning signal was flagged. In the first two months of use, the technology has increased the desired interventions by 40 percent, and Providence estimates that it could save as much as $450,000 annually from unreimbursed expenses that are associated with preventable intensive care admissions.

Computing power in support of laboratory and clinical research is an increasingly important factor in delivering appropriate care – systems that can handle quick analysis of genetic samples, for example, can help researchers deliver actionable results to clinicians. The Melbourne-Parkville branch of the Ludwig Institute for Cancer Research Ltd., which conducts clinical-related laboratory research, found that by converting to an all-Windows-based platform, deploying Microsoft HPC (high Performance Computing) Server, they gained needed computing power, reduced costs and improved their analysis.20 Cloud computing environments – such as - can also provide clinicians and the research community with efficient and scalable HPC compute and storage services – helping to speed up research cycles and unlocking computing resources and storage in cost effective ways. Leveraging cloud computing models allow organizations to utilize or ‘rent’ processing power and storage using on-demand models. On-demand service is more cost effective as it avoids costly up-front capital costs and permits organizations to pay for what they use.

19 Microsoft Users Group 2011 Innovation Awards Honors Forward-thinking Health Companies Powering Patient-Centered Medical Homes, Chronic Condition Management and Mobile Consumer Health, April 2008 http://blogs.msdn.com/b/microsoft_in_health/archive/2011/04/27/microsoft-users-group-2011-innovation-awards-honors-forward-thinking- health-companies-powering-patient-centered-medical-homes-chronic-condition-management-and-mobile-consumer-health.aspx 20 Microsoft Case Study Portal (January 2011) Ludwig Institute of Cancer Research Windows Supercomputer Speeds Quest to Identify Cancer Proteins. Retrieved August 2011

14 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Another aspect of managing chronic disease includes making sure patients get regular checkups, appropriate referrals or tests – and that the information is accurately recorded. Without accurate patient records and data, healthcare providers will find managing patients more labor intensive and a strain on their valuable time. Djerriwarrh Health Services (DjHS) of Australia was struggling with a patient management system consisting of inaccurate patient records and poor data quality, while also combating patient absenteeism.21 Because DjHS must provide accurate information to government about patient volumes, the health service was being underfunded according to the levels of care it was providing. Implementation of Microsoft SharePoint technologies led to a 20 percent increase in funding, early warning of data entry issues, less patient absenteeism, better resource management, and better visibility into activities.

Future of Healthcare

There’s no argument – technology holds the promise of transforming healthcare for health providers and patients.

A major emerging innovation comes from the cloud. Cloud technology gives healthcare organizations the opportunity to build and deploy leading-edge technology quickly and relatively inexpensively. The cloud offers opportunities to help reduce costs, move information outside the four walls of a healthcare institution, and engage with patients in new ways. From a cost savings perspective, a study conducted by Microsoft for the European Union concluded that Cloud computing brings the benefit of unprecedented economies of scale to IT operations, and the combined impact of economies of scale can result in long-term savings of up to 80%. Cloud services will enable IT groups to focus more on innovation while leaving non-differentiating activities to reliable and cost-effective providers.22

Using technology such as Azure, for example, a healthcare organization can deploy a large- scale chronic disease study within weeks, and without a large investment in infrastructure. This is achievable because applications can be built, hosted, and scaled on Microsoft datacenters with limited IT local resources required. Developers can use familiar tools such as , so applications can be built quickly, and then deployed to the cloud.

Microsoft teamed up with experts from Emory University to create the H1N1 Response Center,23 a Web site where people can receive information about flu and guidance based on a self-assessment. Visitors fill out a self- assessment form and Emory's algorithms determine the severity of the situation and offer guidance that individuals can use as input to make decisions about next steps.

The web site needed to be able to handle big spikes in traffic. When the media broke a story about the virus, it caused dramatic increases in site visits.

21 Microsoft Case Study Portal (February 2011) Djerriwarrh Health Services Reporting and analysis technology improves resource management, reduces patient absenteeism and secures additional funding. Retrieved August 2011 (see Appendix) 22 Microsoft (November 2010), The Economics of Cloud Computing for the EU Public Sector, http://www.microsoft.eu/Portals/0/Document/EU_Public_Sector_Cloud_Economics_A4.pdf; summary- http://www.microsoft.eu/Cloudeconomics.aspx 23 https://h1n1.cloudapp.net/

15 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

The solution was Windows Azure. The site saw peak traffic on November 9, 2009 with 123,746 page views-an unexpected 365% increase over the previous day. In

addition, by using Windows Azure we were able to go from idea to deployment in

just three weeks.

The H1N1 Response Center is a great showcase of how organizations can use Windows Azure to help people who are facing potentially dangerous situations, like H1N1. And by The H1N1 solution built on Windows Azure helps people have the information they need to make good decisions, we can help reduce the burden on

the public health system and help keep healthy individuals from being exposed to serious risks unnecessarily.

The H1N1 Response Using the cloud, Canadian healthcare providers also can engage patients more Center is a great effectively. TELUS health space, powered by Microsoft HealthVault is a Canadian- example of how based private cloud platform that is designed to empower patients. TELUS health organizations can use space helps people be more actively involved in their health and wellness by Microsoft Windows enabling them to collect, store and share health information with family members Azure to guide people and participating healthcare providers, and access to a variety user-friendly third- help people facing a party applications and devices to help them manage their fitness, diet, and health. scary and potentially The increasing power of mobile devices also will play a big role. Smartphones such dangerous situation, as Windows Phone 7 open rich new possibilities for improved productivity because like H1N1, thereby they work seamlessly across a myriad of technologies. With familiar Microsoft helping to reduce the productivity tools, like Microsoft Office and Microsoft Exchange, Windows Phone 7 burden on the public enables professionals to wirelessly connect to information and resources from health system. virtually any environment. For physicians – it’s an opportunity to get real-time, relevant information when and where they need it – viewing and interacting with personal healthcare records “on the go”, viewing schedules and lab results, receiving notifications, connecting with peers, and more.

Interactive gaming technologies will play an ever-increasing role in a variety of health scenarios. Microsoft knows the power gaming technology can play when it comes to supporting health, wellness and physical activity. Imagine in pediatric centers where children can connect virtually with family and friends to play games, or in elderly homes with supervised exercise programs, or capturing a person’s biometric health data and connecting that data to Microsoft HealthVault so family members and their care providers can monitor and manage their health in new, collaborative ways.

16 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Start Building a Better Future Today

Today’s technology offers healthcare organizations affordability, ease of use, and power on a scale that could not have been imagined 10 years ago. That means there is no reason to wait for the “next big thing” in technology – it is around us now, and ready to go to work.

Microsoft has the technology, the partnerships, and the know-how to help Canadian healthcare organizations reach their goals of improving care. As chronic diseases become more prevalent and consume a larger portion of each healthcare dollar, it is important for healthcare providers to find new, innovative ways to manage those conditions proactively and collaboratively within a connected network of care providers and patients. Whether through powerful data management tools such as Microsoft SQL Server, Windows Azure and Microsoft Amalga; Caregiver Collaboration tools such as Lync; personal health platforms such as Microsoft HealthVault; or consumer technology such as Kinect and Windows Phone 7, Microsoft can help Canadian healthcare providers build a better future for themselves and their patients. Start now.

17 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Appendix: Microsoft Technologies Supporting Chronic Care Management

Self-Management Coordinated Care Caregiver/Patient Decision Support Collaboration Technology that provides Technology that enables Technology that makes it easy Computer-based decision access to health information multidisciplinary care teams to for care teams to collaborate support tools that enable and resources for supported integrate information sources and communicate effectively. patients, clinicians and policy- self-management with chronic and coordinate care around makers to make informed conditions. the needs of patients. evidence-based decisions.

• Microsoft® HealthVault™ is a • Office 365™ provides virtually • Office 365™ provides virtually • Windows Azure and SQL privacy- and security-enhanced anywhere access to email, web anywhere access to email, web Azure enable you to build, host online service that puts patients conferencing, documents, and conferencing, documents, and and scale applications in in control of their health calendars. calendars. Microsoft datacenters, requiring information with self- • Microsoft® BizTalk® Server • Microsoft Unified no up-front expenses, no long management health tools and connects clinical information Communications powered by term commitment, and enabling devices and supports systems. Microsoft® Lync bring together payment only for the resources connectivity between clinical • Microsoft SharePoint Server voice, video, email, text used. systems. enables effective information messaging and fax. • Microsoft Amalga aggregates • Microsoft® SharePoint® sharing amongst providers and a • Microsoft SharePoint Server disparate data together and Server‑based patient portals mechanism to expose data from clinical portals provide fast easy makes it easy to identify and act provide a way to deliver existing systems. ways to share patient on insights into clinical, financial, personalized information and • Microsoft Dynamics® CRM information, clinical documents, or operational performance. resources to patients. provides an out-of-the-box test results medication reviews, • Microsoft SQL Server® • Windows Phone provides solution for case management images and care plans. aggregates data from diverse opportunities to create anytime and care coordination. • Clinical documents such as healthcare systems to provide and virtually anywhere access to • Microsoft SQL Server® referrals, discharge summaries health analytics. These can be critical health information for aggregates data from diverse and care plans can be created linked to patient data, financial providers and patients alike. healthcare systems to provide and exchanged using and operational data, decision health analytics. These can be Microsoft® Office and the support tools and geographic linked to patient data, financial Microsoft Clinical Document information to be displayed in and operational data, decision Solution Accelerator. relevant, role-based dashboards. support tools and geographic •Windows Phone - creates new •Microsoft SharePoint Server ‑ information to be displayed in opportunities for health based patient portals provide a relevant, role-based dashboards. professionals to share way to deliver personalized • Microsoft Amalga provides a information and to consult with information and resources platform to coordinate care and colleagues in real time. • /System engage patients by identifying, •Windows Server/System Center enables IT professionals tracking & managing chronic Center enables IT professionals to increase the reliability and populations and promoting self- to increase the reliability and flexibility of their server care. flexibility of their server infrastructures to support •Forefront helps deliver end-to- infrastructures to support applications, clinicians and end security and access to applications, clinicians and Policy-makers. information via an integrated line care teams. •Forefront - helps deliver end- of protection, access, and •Forefront - helps deliver end- to-end security and access to identity management products. to-end security and access to information through an •Windows Server/System information through an integrated line of protection, Center enables IT professionals integrated line of protection, access, and identity management to increase the reliability and access, and identity management products. flexibility of their server products. infrastructures to support applications, clinicians and Care-teams.

18 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Why Microsoft?

Microsoft has been committed to healthcare for the long term. Together with technology partners, Microsoft is creating powerful solutions that will help providers collaborate with people to connect processes and information and make insightful decisions.

Microsoft has a strong track record in developing user-friendly interoperable technology to be able to deliver cost-efficient technology solutions that work. Microsoft also provides unique comprehensive solutions for organizations and individuals that give direct integrated access to information using safety, security, and privacy technology/features. Microsoft also understands that clinics and hospitals are increasingly being asked to do more with less. That is why Microsoft is dedicated to offering easy-to-implement, off-the-shelf commodity technology to healthcare providers, so that they quickly and directly help benefit patients.

And because Microsoft makes some of the world’s most widely used and supported software, most people in an organization are familiar with Microsoft products - and healthcare enterprises can build on existing investments and leverage current infrastructure to do more. And because Microsoft technologies are interoperable, they can be combined with existing systems and prepared to integrate them with future technologies, and remain flexible and scalable.

Lastly, Microsoft knows that people make decisions based on knowledge, not just data, and they often don’t need more information, they need better information. That is why Microsoft solutions don’t just bring data together, they turn it into information that people can use to take knowledge-driven action. People can use Microsoft- based technologies to accomplish more throughout their day because they are familiar, intuitive, and user- friendly.

19 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Appendix: Microsoft Solutions at Work Today

20 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

United States Chronic Condition Management – American Heart Association (AHA) Heart36026 Wellness: Mayo Clinic24 This online wellness center from the AHA helps people The Mayo Clinic Health Manager helps people track track and manage risk factors for heart attack, heart progress towards recommended and personal goals, disease and stroke. People can receive information assess risk, monitor vital health stats like blood from HealthVault-enabled devices and applications, pressure, weight, and cholesterol, and offers and share that data with the caregiver. According to personalized condition and wellness guidance research by Kaiser Permanente, patients who used developed by the experts at Mayo Clinic. home monitoring and web-based reporting tools Technologies: were 50 percent more likely to have their blood

 Microsoft HealthVault pressure in control than those who were monitored in the doctor’s office. Technologies: Chronic Condition Management - American Cancer Society  Microsoft HealthVault  Home-based digital BP monitor Circle of Sharing allows people to share personalized Caregiver/Patient Collaboration - Mason General cancer information with loved ones and caretakers, Hospital & Family of Clinics (MGH&FC)27 and access a vast array of personalized cancer resources. Connected to the health ecosystem, it MGH&FC wanted to give patients easier access to enables data sharing between other applications on their visit summaries and medical histories and to the platform. Technologies: engage patients, families, and referring physicians in more-coordinated ongoing care. MGH&FC built a web  Microsoft HealthVault portal through which patients can view their Personal & Family Health Management: New York information and, soon, share it with other caregivers. Presbyterian Hospital25 The result was improved patient experience and coordination of care, increased organizational MyNYP.org wanted to reduce delays in getting patient efficiency and support of future enhancements. health information to the appropriate healthcare Technologies: provider, in order to avoid redundant tests and procedures. NYP was able to consolidate their clinical  Microsoft Amalga data and make it accessible to both providers and  Microsoft HealthVault patients. Technologies:  Microsoft SharePoint Server

 Microsoft Amalga  Microsoft HealthVault

26 Home Health Monitoring May Significantly Improve Blood Pressure Control, Kaiser Permanente Study Finds 24 http://www.prnewswire.com/news-releases/home-health- Microsoft Case Study Portal (January 2010): Cleveland Clinic monitoring-may-significantly-improve-blood-pressure-control- Prestigious online wellness resource launches with help of kaiser-permanente-study-finds-94576164.html Commerce Server 2009. Retrieved October 2011. 27 Microsoft Case Study Portal (June 2011) Mason General Hospital 25 Microsoft Case Study Portal (March 2011): New York-Presbyterian Hospital Pioneers New Personal Health Record—myNYP.org. & Family of Clinics Hospital Offers Advanced Online Patient Services Retrieved August 2011 Through Healthcare Portal. Retrieved August 2011

21 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

Business Intelligence - First Choice Home Health The National Institute for Health and Clinical and Hospice28 Excellence (NICE) provides clinical guidance and helps establish healthcare quality standards in the United First Choice, facing the same challenges as healthcare Kingdom. To help professionals to easily access up-to- providers throughout the United States, needed to date information, NICE launched an Internet portal. increase efficiency to offset rising costs and reduced There is now a single access point to more than 250 Medicare reimbursements. The company gave its core information sources. clinical workers Windows Phones running Allscripts software to file the patient reports used to generate  Microsoft SharePoint Server invoices resulting in savings of U.S.$500,000 annually  Microsoft FAST Search Server in rent, labor, travel and a 4% reduction in  Microsoft ASP.NET hospitalization rates. Technologies: Canada  Windows Phone Caregiver Collaboration - Cancer Care Ontario  Bing Maps (CCO)31 Coordinated Care - Dallas Neurosurgical & Spine CCO deployed a Microsoft Unified Communications (DNS)29 solution, which enabled it to provide robust Dallas Neurosurgical & Spine (DNS) needed a conferencing, scalable VoIP telephony, and integrated telemedicine solution that would enable remote messaging and desktop-sharing capabilities. patients to conduct follow-up visits at their local Technologies: physician’s office. US Medical IT, DNS’s project  Microsoft Office Communications Server management and IT service provider implemented a  Microsoft Office Outlook telemedicine solution that enables DNS to use audio  Microsoft Exchange Server Enterprise Edition conferencing, videoconferencing, and desktop sharing capabilities. The benefits to DNS include: ability to Switzerland provide more immediate care, reduction in patient costs, while providing cutting-edge technology Care Coordination – Public hospital consortium - 32 without the need for technology expertise. freiburger spital Technologies: To control rising healthcare costs, standardize  Microsoft Office 365 infrastructure, and streamline IT operations, the  Microsoft LYNC Online freiburger spital, a consortium of the six public hospitals in the territorial subdivision of Fribourg, United Kingdom Switzerland, deployed a systems integration solution

Decision Support - National Institute for Health 30 30 Microsoft Case Study Portal (January 2011) National Institute for and Clinical Excellence (NICE) Health and Clinical Excellence Health Agency Simplifies Information Access for Health Professionals with Web Portal 28 Microsoft Case Study Portal (July 2011) First Choice Home Health 31 Microsoft Case Study Portal (July 2010) Cancer Care Ontario - and Hospice of Utah Home Health Provider Saves $500,000 Government Healthcare Agency Implements Unified Communications Annually, Doubles Cash Flow, with Mobile Solution. Retrieved Solution to Reduce Costs. Retrieved August 2011 August 2011 32 Microsoft Case Study Portal (June 2010) freiburger spital Hospital 29 Microsoft Case Study Portal (June 2011) US Medical IT, Medical IT Network Reduces Costs and Improves Care by Consolidating Company Helps Physicians Provide Immediate Care through Online Disparate IT Systems. Retrieved August 2011 Solution. Retrieved August 2011

22 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management based on Microsoft BizTalk Server 2009. Now the poor data quality, while also combating patient hospital network has access to consolidated, absenteeism. Because DjHS must provide accurate synchronized, and automated systems, enabling better information to government about patient volumes, patient care and reduced support costs. Technologies the health service was being underfunded according used: to the levels of care it was providing. Implementation of Microsoft technologies led to a 20% increase in  Microsoft BizTalk Server funding, early warning of data entry issues, less  Microsoft SQL Server patient absenteeism, better resource management,  Windows Server and better visibility into activities. Technologies used:  Microsoft BizTalk Accelerator for HL7  Microsoft SharePoint Server Israel  Microsoft SharePoint Designer Decision Support - Maccabi Health Care Services33 Care Coordination – Improvement Foundation 35 Maccabi Healthcare Services is a leading healthcare Australia provider in Israel. The company provides lifelong Through the Australian Primary Care Collaborative medical and dental services to members. [They] Program, Improvement Foundation Australia and OBS created a plan to help improve the level of service to use Microsoft SharePoint to produce a portal platform their members. In order to garner a 360-degree view that connect over 1000 General Practices to their of member data, information from multiple systems patients to assist in the management of chronic care. would be integrated into a single service application. Technologies used: Technologies:  Microsoft Office  Microsoft Dynamics CRM  Microsoft SharePoint Administration Toolkit  Microsoft Office SharePoint Portal Server  Microsoft Office SharePoint Server  Microsoft Windows XP Service Pack Technologies  Microsoft Exchange Server  Microsoft Office Standard Business Intelligence & Research – Ludwig 36  Microsoft SQL Server Institute  Microsoft Windows Server The branch needs to analyze patient protein samples Australia very rapidly. However, genetic analysis demands vast quantities of computing power, and the Institute’s Business Intelligence - Djerriwarrh Health Services budget limits expensive IT purchases. Technologies 34 (DjHS) used:

DjHS was struggling with a patient management  Windows HPC Server system consisting of inaccurate patient records and  Windows Server

33 Microsoft Case Study Portal (July 2009.) Maccabi Healthcare Services, Healthcare Provider Improves Customer Service with Real- 35 Microsoft Case Study Portal (June 2010) Improvement Foundation Time Patient Data Visibility. Retrieved August 2011 Australia How Sharepoint helped IFA connect with healthcare 34 Microsoft Case Study Portal (February 2011) Djerriwarrh professionals. Retrieved August 2011 36 Health Services Reporting and analysis technology improves Microsoft Case Study Portal (January 2011) Ludwig Institute of resource management, reduces patient absenteeism and Cancer Research Windows Supercomputer Speeds Quest to Identify secures additional funding. Retrieved August 2011 Cancer Proteins. Retrieved August 2011

23 | P a g e J a n u a r y 2 0 1 2 Harnessing the Power of Technology to Improve Chronic Care Management

 Microsoft High Performance File System  Windows Server 2008 Technologies  Microsoft Windows Server Data Objects

(c) 2012 Microsoft Corporation. All rights reserved. This document is provided "as-is." Information and views expressed in this document, including URL and other Internet Web site references, may change without notice. You bear the risk of using it. Some examples are for illustration only and are fictitious. No real association is intended or inferred.

24 | P a g e J a n u a r y 2 0 1 2