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  1. The Shift to Digital Health and the Era of Healthcare 3.0 Office of the CTO Second Edition, 2016-2017
  2. SUMMARY Health systems in most countries clearly recognize the potential of digital health, yet e-health programs have delivered only modest returns in quality, efficiency or better patient outcomes. Ambitious e-health initiatives focus on providing actionable information to clinicians, but often struggle with the legacy systems that impede data integration. The solution is a digital services platform that holds healthcare data and optimizes data access, enabled with APIs and common IT services for identity, access and consent management. This digital health platform could serve as the basis for an ecosystem of digital-health services innovation by certified third parties and could be steered by the respective health systems. It could revolutionize health-service use and delivery, help health systems bend the cost curve, and usher in an era of contextualized information that could be called “Healthcare 3.0.” 2 | The Shift to Digital Health and the Era of Healthcare 3.0
  3. The services and structure that constitute the next phase of healthcare are beginning to take shape, and it looks considerably different from the past. Regulatory reform, advances in technology and changing demographics are just a few of the factors driving healthcare toward a better future. At the same time, the advent of wearables, smartphones, cloud computing and global connectivity has created a population of patients/consumers accustomed to mobile technology pervasive in other sectors of the economy, such as banking and retail. Increasingly, consumers wonder why health systems cannot provide similar service innovations. In that respect, digital health companies would appear to be well positioned, but so far they have been impeded by a lack of access to health data and uncertainty about how to distribute the economic benefits generated by e-health applications. Healthcare IT is shifting toward integrating and exploiting the diverse health IT ecosys- tem, focusing on patient-centric information integration and communication, rather than on building new centralized and proprietary systems. This shift will require open data approaches to allow the friction-free flow of data, and cognitive analytics to use that data to inform decisions at the patient, organization and population levels. Patients are finding their voices in the conversation about healthcare, and the result is a significant shift in the patient- demand curve. Three dominant trends illustrate the influence of patients: • Patient-centric care. “Partner with me to engage in and manage my health. My care team truly cares about my holistic health. I am not alone.” • Consumer engagement. “Enable me to engage in and take charge of my health. I feel engaged in my health and am empowered to make informed decisions.” • Science of prevention. “Empower me to direct my life plan. I understand my health and wellness profile and what I need to do to live long and well.” Meanwhile, market behaviors are changing. A record pace of organizational activity — including amalgamations and new busi- ness and reimbursement models — and changing clinical work patterns are fueling the need for value-based care, coordinated care and efficient innovation. Rapid advances and lower costs for technology are fueling innovation that was not previ- ously feasible, creating a distributed and loosely connected ecosystem of services. The shift to digital health creates new rules of data engagement and healthcare innovation, where interfaces are wearable, and where physical is merging with digital. It leads to new business models, new delivery models, and new levels of transparency and openness. This environment creates a sophisticated clinical pathway, powered by data insights, that enables healthcare organizations to deliver the right therapy, tailored to the right patient in the right place and at the right time — all dynamically orchestrated. New patient-centric care models make care more collaborative and focused on outcomes. New investments will need to focus on the power of combined informa- tion sources to derive greater context. This context is needed to more effectively and securely leverage patient data, recognize patterns faster, and manage the health of populations more effectively. Simply put, digital health is about using technology to enable the delivery of a 3 | The Shift to Digital Health and the Era of Healthcare 3.0 Surveyed healthcare organizations cite the primary goals for becoming more digital as increased efficiency (50%), keeping up with existing competitors (39%), and cutting costs (30%). Source: Global Digital Enterprise Survey 2016-2017, conducted by the Economist Intelligence Unit and sponsored by CSC.
  4. better patient experience, with improved results, at a lower cost. It is not a panacea; it will need to be accompanied by initiatives that go above and beyond IT, including business and clinical transformation. Digital Health Today By its very definition, digital health is built on a foundation of next-generation technologies. But it isn’t something in the far-off future. Several broad technology trends support the drive toward digital health, all of which are occurring today: • Digital health is becoming mainstream. Doctors and healthcare workers cur- rently use digital applications to be more efficient, provide better care and take on 4 | The Shift to Digital Health and the Era of Healthcare 3.0 Putting Data to Better Use The shift to digital infrastructure presents opportunities for healthcare providers and patients to collect and share new kinds of data, with the potential for more personalized healthcare. Personalized healthcare is more than merely using predictive analytics to generate tables and graphs. It requires advanced analytics capable of adding context to large varieties of data and distilling it down to something actionable. Take, for example, the task of reducing the amount of time a patient spends recovering from a procedure. Reducing patient recovery time lowers expenses for the hospital and improves the level of care for the patient. But thousands of factors could affect a patient’s recovery time. CSC used industrial-scale machine learning to tackle this issue, to find out which factors really matter for each patient and how to take action. We started by using digital platforms to access new sources of healthcare data. To produce a model to predict length of hospital stay, we used a data extract of routinely collected administrative data supplied by the healthcare purchasers for a specific geographic locality. We used machine-learning algorithms to extract new insights. We looked for features that were most important in predicting length of stay for patients undergoing hip or knee replacements. We found key leading indicators (such as the patient’s age, the patient’s core healthcare providers, and the secondary diagnosis) for predicting length of stay. We built a regression model using the leading indicators, which allowed us to predict a patient’s stay. Those predictions became the basis of operational dashboards that alert hospitals to future costs and help identify patients who may experience problems in recovery. We’re at the beginning of a new phase of big data — a phase that has less to do with massive data capture and storage and much more to do with producing impactful, scalable insights. In health- care, there is no shortage of data, but the shift to digital platforms and industrial machine learning puts that data to better use. — Jerry Overton, Data Scientist, CSC Distinguished Engineer Healthcare Insights aaS Sample: Hip and Knee Replacement Procedure LOS Predictions Industrial Machine Learning leads to insights that help improve patient care. We can predict future hospital costs and identify patients likely to experience problems during recovery.
  5. increasingly complex tasks. Clinicians are using multiple channels to access patient data. Many physicians use smartphones to research medications. In some coun- tries, physicians, ambulatory centers, hospitals and health systems have deployed enhanced electronic health record (EHR) systems. • Digital health is bridging the gap between the old economy and the new. The old economy measured success by patient volume; the new economy mea- sures success by outcomes. APIs and modern application development create bridges between legacy systems, off-the- shelf solutions and new applications. And much of this innovation is cloud-based. • The healthcare platform revolution has arrived. It’s now possible to define eco- systems of healthcare technologies and design healthcare IT platforms to capture data from disparate sources (e.g., wear- ables, phones, glucometers). All of these new data sources and systems provide patients and caregivers with a holistic and real-time view of patients’ health. • The era of the intelligent enterprise brings it all together. The data explosion — accompanied by advances in process- ing power, industrial-scale machine learning, health analytics and cognitive technology — is fueling software intelli- gence. Medical devices and wearables can now “think” with contextual and situational awareness, and respond accordingly. Huge amounts of data and smarter systems lead to better health- care and the development of capabilities such as population health management. These trends are driving several shifts in focus in the care-delivery approach: • Population Health: From the needs of an individual patient to a holistic view of the needs of the population • Care Coordination: From the support of an individual provider at the point of care to all providers across the spectrum of care 5 | The Shift to Digital Health and the Era of Healthcare 3.0 Early adopters will begin to consider 3rd Platform EHR replacements in 2016 and will begin replacement implementations in 2017. Source: IDC FutureScape: Worldwide Healthcare 2016 Predictions, November 2015
  6. • Continuity of Care: From the activities in a particular care setting or location to all activities in the entire spectrum of care • Preventive Care and Patient Engagement: From a discrete episode of illness and care to all the activities that promote wellness, prevent illness and recurrence • Care Anywhere: From multiple, uncoor- dinated, “siloed” records per patient to one patient, one record, one system — anywhere, anytime • Predictive Medicine, Personalized Medicine and Personalized Service: From reactive care to personalized, patient-centric care that closes the loop of care through better patient engage- ment and use of dynamic models to refine risk scores and care plans Considering the speed and scope of change that comes with increased adoption of digital health, it’s hardly surprising that many organizations are struggling to adapt. Some trends, such as the evolution of patient-centric care, have challenged norms that existed throughout the life of organized care systems. Once seen as the sole author- ities in matters of treatment and care, doctors and hospitals now share responsi- bility with patients. Business models that were built on the volume of patients and the number of treatments are now shifting to payments based on health outcomes. As patients become active participants in determining the kind of treatment they want, organizations will need to coordinate across the care continuum, recognizing that patients touch many different components of the wider health system. Providers and payers alike are putting a lot of effort into integrating new technologies and absorbing the growing volume of data generated by smart devices and wearables. The need for flexible and interoperable computing resources is growing, and the current IT status quo is not suited to that need. Elements of Transformation By design, digital health technologies are disruptive. Health systems need to thor- oughly evaluate how they will adopt and apply them. At an operational level, health systems must change their structure and workflows to derive maximum benefits. They must set clear goals, get active participation from leadership, assess their technology require- ments and create an effective rollout strategy. A winning strategy requires aligning key stakeholders — patients, physicians, care providers, payers, et al. — to a common set of outcome objectives and redesigning the interaction models between them. In many cases, this could be a significant change-management activity. 6 | The Shift to Digital Health and the Era of Healthcare 3.0 Isolated and disconnected data reposi- tories have been, and remain, among the biggest barriers to efficiency gains and improved services in the industry. Virtual care will become routine by 2018, and by 2020, 80% of consumer service interactions will make use of IoT and big data to improve quality, value, and timeliness. Source: IDC FutureScape: Worldwide Healthcare 2016 Predictions, November 2015
  7. The move to an advanced, standards-based health IT system (HIT) is essential to digital health, but it needs to be tailored to sup- port the characteristics of digitally enabled population health management, including: • An organized system of care • The use of multidisciplinary care teams • Coordination across care settings • Enhanced access to primary care • Centralized resource planning • Continuous care • Patient self-management and education • A focus on health behavior and life- style changes • The use of HIT for data access and reporting for communication among providers and payers and between providers, payers and patients The selection and implementation of HIT is among the most important compo- nents of planning for population health management. EHR adoption is only the first step toward creating the needed infrastructure. A wide range of other digital applications is required to automate digital health and to engage patients in their own care. Moreover, systems must be constantly re-evaluated because of rapid changes in technology, as well as new government regulations. Developing an Ecosystem of Services Commissioners, and potentially even indi- vidual patients, now need to be able to “assemble” healthcare services from multi- ple organizations to deliver optimum care. One of the potential steps, particularly in addressing care-transition challenges, is the creation of a digital health-enabled patient 7 | The Shift to Digital Health and the Era of Healthcare 3.0 The Cybersecurity Challenge A recent U.S. Department of Health and Human Services study reveals that healthcare providers are at risk of losing $305 billion in cumulative lifetime patient revenue over the next five years due to the mishandling, loss and theft of patient data. To avert these losses and the liability they create, providers must prioritize cybersecu- rity improvements for clinical and financial systems. Often healthcare IT security is based on binary security controls – i.e., “you can have all of my information or none of it.” The introduction of the Internet, consumer devices and many more outside elements complicates this approach, and the growing consumerization of IT in healthcare means this trend will continue. Providers that have confidence in the identities of their users will be able to more successfully manage the risk associated with the disclosure and sharing of sensitive patient data. Concurrently, they will boost trust among their patients while also improving the individualized patient experience, as individuals can decide what information to release to whom, when a certain situation arises. Active defense requires a risk-based approach to cybersecurity management, using threat intelligence and analytics to proactively detect potential events, as well as enabling a swift response to incidents. The reality is that security is an ongoing activity, not a single project. As such, healthcare companies that are able to automate their monitoring and response capabilities will be able to create the “fire doors” that stop data leakage during a breach, track the remediation, and re-scan the system to ensure the vulnerability has been corrected. Health systems must make security the foundation of every application they launch and every infrastructure they procure. Healthcare providers that successfully make this leap will limit the damage cyberattack- ers can cause. Active defense measures can safeguard future patient revenue that would otherwise be lost to competitors and also safeguard consumers who have entrusted providers with their medical and financial information. Patients with low engagement levels incur costs from 8-21% more than patients who are actively engaged in their own health decisions, according to a 2013 study published in Health Affairs. Source: IDC, Best Practices: Changing Payer and Provider Relationships — Processes and IT Tools in a Reformed, Collaborative Environment, Deanne Kasim, July 2015
  8. care coordination center (CCC). The CCC can determine the best entry point for a patient to receive the most appropriate and cost-effective care. Central to the success of this center are the digital health technolo- gies that support it. A care-coordination system must present a patient’s data to clinicians across the local health and social care system in a contextual manner. The key to improving population health management is building a deep understand- ing of patterns of health, disease and well-being. The power of data comes from analytics, and many providers need to liberate the large amounts of data already residing in enterprise systems, such as EHRs. Such patient data is of enormous value to individual patients and physicians, but the potential value to the healthcare system is much greater. Organizations need to identify and under- stand innovative uses of data that will help them reduce costs and identify new revenue streams. With aggregation, standardization and analysis, data can offer the insights healthcare providers need to close gaps, improve care and make distinctions in patient populations that can help stratify services, deliver care more efficiently and provide more appropriate, higher-quality care in a wider range of settings. Newer technologies also hold great promise for population health management. Home telehealth devices, for example, have become more sophisticated and less expen- sive, and telemonitoring data can be trans- mitted to care managers more easily than in the past. Interactive Web-based applica- tions and tailored educational programs can also be effective. These programs must, however, be coupled with other interven- tions to motivate patients to improve their health. The coordination center could also be leveraged to do telehealth monitoring, some telemedicine consultations, as well as telecoaching. While there is little data yet on how mobile health applications affect patient outcomes, healthcare organizations should watch this space carefully, because the number of mobile health applications and devices is exploding. 8 | The Shift to Digital Health and the Era of Healthcare 3.0 One out of three individuals will have their healthcare records compromised by cyberattacks in 2016. Source: IDC FutureScape: Worldwide Healthcare 2016 Predictions, November 2015
  9. The Big Challenge: Data Mobility Digital health technologies and new value- based care models such as accountable care organizations (ACOs), clinical network collab- oration and care management, hold great promise for optimizing care delivery. However, their ability to recoup the anticipated value is heavily discounted. In many cases, they are targeting only silos in the healthcare value chain. This means that the paucity of full-scope data access and availability in healthcare will continue to be a drag on realizing the promise of digital health. Addressing this data void — bridging the healthcare data chasm with key information flow pivots — will enable organizations to create next-generation digital health services that will coalesce the current fragmented landscape. Four key levers are essential: • A data ingestion/accessibility pipeline that supports real-time, potentially transactional, batch and streaming interfaces • The capability to semantically and structurally transform incoming data (and/or persist where necessary and preserve provenance) so that down- stream operations can operate on a more stable base • Federated query capabilities that range from non-time-sensitive queries against read-consistent information, to highly transactional, real-time continuous requests • The ability for upstream business processes and applications to exploit the integrated data These pivots create a connected network of information that enables a healthcare enter- prise to act with massive information bias and drive toward gaining more and more information that is current. This feedback loop applies that data throughout the orga- nization to enable better, faster and more meaningful decisions. This is Healthcare 3.0. Healthcare 3.0: The Target State Healthcare 3.0 delivers the next wave of productivity gains in healthcare delivery. It is not coming just from the delivery of information but also from the cross-linked aggregation of a more complete informa- tion corpus that understands the context of a transaction and therefore provides the critical information that is necessary to fulfill the obligation. At the heart of this productivity gain is just-in-time information delivery. This is why many health systems are moving to hybrid clouds and have chosen platforms that naturally have better information-access properties. Despite the disruption to their environments, firms are implementing these platforms because they can cut latency to end clients, minimizing the time it takes to get interaction and collaboration moving. They also offer an elastic capability to scale up and down with demand. And they bring rich information together cheaply and deliver it cheaply to an end user. These clouds are providing business advantages not only in their operating cost, but also in their operating model, very close to the 9 | The Shift to Digital Health and the Era of Healthcare 3.0 Payers Patients Providers Retailers CCG/ACOs Life Sciences Med Devices Provider Engagement Patient Contact Center Patient Engagement Directory of Services Disease Management AWS Azure Biz Cloud Soft Layer Care Transition Care Coordination Care Logistics Systems of Engagement Systems of Insight Systems of Record API Gateway/Open Data Cognitive Ploatform Virtual Lifetime Patient Record Cognitive Platform Cognitive Insight 3rd Party Services IOT/PHR Cognitive Insight 3rd Party Services AWS Azure Biz Cloud Soft Layer AWS Azure Biz Cloud Soft Layer CSC Agility Platform (Enterprise 1) CSC Agility Platform (Enterprise 3) CSC Agility Platform (Enterprise 2) Popluation Health Enablement
  10. end user. Networks and data centers are beginning this shift because it enables users to employ data inside and outside of an organization to derive maximum value from the information supply chain. From a technology perspective, the vision for digital health is made possible by a layered series of systems that collect, filter, analyze, link and present data in a growing degree of refinement and value. IT infra- structure is essential to creating a clinically integrated network to improve population health. Following years of investment in advanced EHR applications and related technologies, healthcare organizations now have the potential to capitalize on these assets and accelerate key business and clinical transformations. To achieve this, though, they need to optimize the e-health systems and services available to them: At the lowest level reside Systems of Record. These systems are responsible for integrat- ing structured and unstructured datasets from multiple sources. Feeds to upstream systems are augmented with an API market- place that can be semantically linked and can curate data for upstream value. Systems of Insight, fed with data from systems of record, provide a surveillance capability that recognizes patterns in popu- lation data and care management character- istics. These systems can identify impending high-risk clinical events, gaps in care coordi- nation or noncompliant patient situations. At the highest level lie Systems of Engagement. This layer describes a large portfolio of clinical and business process services that support patients, providers and care coordinators via integrated and collaborative services. The Digital Future Regulatory pressure, new technologies and patient expectations are pushing providers toward systems and models that provide convenience and improved care for less. Organizations need to respond to new rules of engagement with new healthcare IT paradigms. Digital health promises to improve health outcomes and reduce the overall cost of care. While the transition requires an invest- ment in new technologies and ways of doing business, the supporting technologies, systems and methods are rapidly maturing, growing in power and falling in cost. 10 | The Shift to Digital Health and the Era of Healthcare 3.0 Cybersecurity for Providers and Payers Here are the steps that providers and payers should take to protect patient data: • Assess current security capability and identify opportunities: Determine where the organization currently stands and the level of resources required to support mean- ingful transformation. • Manage complexity and integrate the enterprise: Establish an end-to-end enterprise security program and integrate it with current enterprise architecture processes to reduce complexity and produce outcomes valued by the business. • Become agile: Embrace the cloud and other emerging technologies to boost IT agility and reach customers faster, capitalize on efficiency and cost benefits, and do so within risk tolerances. • Accelerate toward security intelligence: Adapt to handle new threats to the enter- prise by developing threat-centered operations based on a deep understanding of adversaries, their goals and techniques. • Develop end-to-end delivery and sourcing: Plan a delivery and operational strat- egy for each of the security services you offer to make a clear-eyed assessment of internal competencies for designing, building and deploying elements of a cyber- security program. Healthcare organizations plan to focus much of their IT investments on digital technologies that support mobile devices. 60% will increase use of smartphones, with 33% increasing use of tablets. Source: Competitive Necessity: IT Strategy in Healthcare, based on a survey conducted by the Economist Intelligence Unit and sponsored by CSC. ©2016
  11. By applying relevant technology and auto- mation to every aspect of healthcare man- agement, provider and payer organizations will be able to deliver high-quality care to patients in an efficient and sustainable manner. As a result, the transition from volume to value will be smoother and have a much better chance of yielding the results all healthcare providers desire for their patients and their practices. 11 | The Shift to Digital Health and the Era of Healthcare 3.0 Healthcare Industry Disruption A Leading Edge Forum (LEF) Perspective In recent decades, the healthcare business has become increasingly industrialized and bureaucratic — vast medical facilities, highly specialized training and practices, complex information and management processes — all creaking under rising work- loads and relentless financial pressures. Modern medical technology can chip away at these problems. Hospitals expect they will need fewer beds as more treatments are consumerized and performed in homes, clinics, pharmacies and assisted-living facilities. New technologies will make many tests — blood tests, blood pressure, ECG, insulin, eye, fertility — inexpensive and increasingly self-administered. Pharmacies such as CVS, Walgreens and Boots will become ever-bigger parts of the overall healthcare ecosystem. Automated data collection — based on mobile phones and IoT devices — will be faster, more detailed and more accurate than self-reporting; 3D printing will be used to make everything from prosthetics to eyeglasses; advanced analytics will sift through enormous data volumes to develop new knowledge, and algorithms will nudge us all toward the “right” behavior. All of these innovations will help deinstitutionalize care, lower costs and increase the transparency of prices and efficacy. Additionally, many of today’s healthcare startups will sell directly to consumers, often bypassing national or private insur- ance. Over time, these new relationships could become increasingly disruptive, especially as service volumes rise, costs fall and innovation migrates to the cloud. For the foreseeable future, however, healthcare will remain a hybrid sector — part government responsibility, part institutional marketplace and part empowered customer experience. This will make the industry less susceptible to full-scale dis- ruption, but disruption around the edges will become increasingly common. Healthcare providers with agile digital infrastructures will be best positioned to embrace these changes. The Leading Edge Forum (LEF) is the independent research arm of CSC. Only 5.5% of hospitals reported maintenance costs for EHR have been higher than expected, while 26.5% of hospitals reported that the total cost of ownership for the EHR is lower than expected. Source: IDC, Business Strategy: Trends and Opportunities in the U.S. Healthcare Provider Market — A Discussion of the 2015–2016 Healthcare Provider Technology Spend Survey Results, Judy Hanover, January 2016
  12. 12 | The Shift to Digital Health and the Era of Healthcare 3.0 How CSC Can Help CSC believes that our Agile Health framework, coordinated care solutions and innova- tive technology platform can bring together major healthcare system stakeholders and create an environment for success. While taking into account possible constraints in existing organizations and systems, our Agile Health framework brings together all stages of the HIT evolution: CSC’s eHealth Optimization solutions enable organizations to maximize their financial investments in EHR systems and create greater clinical value through new integration, and open information and API gateways that support interoperability. CSC’s Population Health Enablement solutions expand the care model and the integra- tion of services to deliver better health and well-being population outcomes by enabling enhanced clinical function and collaboration, and data insights to optimize care and improved patient outcomes. CSC’s Agile IT approach promotes an “as-a-service” enterprise that automates IT opera- tions and ensures consistency of deployed solutions in a continuous delivery model that enables organizations to meet the aggressive cycle time frames. All of these components are delivered in a heterogeneous healthcare landscape that lets organizations derive value from a flexible IT environment that enables and responds to transformational change. It offers the richness of open clinical collabora- tion with a built-in situation awareness security framework, which ensures privacy and confidentiality. CSC’s Agile Health as a Service Framework
  13. 13 | The Shift to Digital Health and the Era of Healthcare 3.0 Authors Femi Ladega is chief technology officer for CSC’s Healthcare and Life Sciences global industry group. With experience of delivering major transformation engagements to private, public and international organizations in Europe, America, Middle East, Australia and the United Kingdom, Femi provides leadership for driving the solution strategy and technology direction for the industry group. oladega@csc.com Gurdip Singh is vice president and general manager, responsible for the development and delivery of software products and business services for CSC’s Healthcare and Life Sciences global industry group. His primary skills include program leadership, operational business management and business transformation. gsingh69@csc.com * CSC’s ResearchNetwork contributed to this paper. Join the conversation and share this position paper with your social network using #PowerForward.
  14. © 2016 Computer Sciences Corporation. All rights reserved. About CSC CSC leads clients on their digital transformation journeys. The company provides innovative next-generation technology services and solutions that leverage deep industry expertise, global scale, technology independence and an extensive partner community. CSC serves leading commercial and international public sector organizations throughout the world. CSC is a Fortune 500 company and ranked among the best corporate citizens. For more information, visit us at CSC.com. Regional CSC Headquarters The Americas 1775 Tysons Blvd. Tysons, Virginia 22102 United States +1.703.876.1000 Asia, Middle East, Africa Level 9, UE BizHub East 6 Changi Business Park Avenue 1 Singapore 468017 Republic of Singapore +65.6809.9000 Australia 26 Talavera Road Macquarie Park, NSW 2113 Australia +61(2)9034.3000 Central and Eastern Europe Abraham-Lincoln-Park 1 65189 Wiesbaden Germany +49.611.1420 Nordic and Baltic Region Retortvej 8 DK-2500 Valby Denmark +45.36.14.4000 South and West Europe Tour Carpe Diem 31 place des Corolles CS 40075 92098 Paris La Défense Cedex France +33.1.55.707070 UK, Ireland and Netherlands Floor 4 One Pancras Square London N1C 4AG United Kingdom +44.020.3696.3000
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