With all the focus on Healthcare. Lowering costs, Out-sourcing. Generic drugs. HL7 & HIPAA getting the bigger picture and ensuring SOCIAL and BUSINESS needs are merged is important. Corporate Social Responsibility, Ethics, Values, Transparency ALONG with Business, Revenue, Profit, Patents, Trade-secrets & IPR.

1. 2012-09-05
Healthcare
Casper Abraham
http://www.edgevalue.com
casper@edgevalue.com
JAN 2003

2. Business Models, Strategy, Ideas

3. Healthcare Business Model
Medical
Diagnostics
& Imaging
Lab.
Out-Patient
CARE
In-Patient
CARE
Doctor
Community
Hospital
& Clinic
Services
Manufactures
& Suppliers
Multi-Modality
DICOM
IT &
MIS
Bio-Tech
Know-how
Information
Data
Problem to Solution
Desire to Fulfillment
Disease to Cure
TeleMedicine
Managed
Care
Traditional
Care
Match
Financial Risk
Layer
Information
Layer
Service
Layer
Lifestyle
Layer
State or Private
Freebie or Paid for
Credit or Debit
Real time or Delayed
Availability / Sharing
Quality / Integrity
Security
Home CARE MedicineSurgery

4. Medical Cover ‘change’
aspects
1. Traditional Care & Medical Insurance.
1. Since 1900’s. Lifetime employment with 1 company.
Home & Family close to factory. Works dawn to dusk 6-
days a week. Little leisure, minimum travel. Sleep 8
hours every night.
2. Today’s Reality
1. Works with over 10 companies in a career. Changes
city. Works 40 hours out of 168. Lifestyle & increased
leisure. Wider travel. Irregular and avoidance of sleep.

5. Healthcare Opportunities
SAS
* Statistics
* Clinical Research Solutions
* Enterprise Intelligence
Electronic Information
* HIPAA / HL7 / NHS etc.
* CMM I
* Integration opportunities
Managed Care
* Medical Insurance
* Risk Intermediary
* Medical Due-diligence
* India TPA. Cash less.
Life Sciences
* Genetics
* Proteomics
* BioChemistry, Molecular Biology
* Bio-Technology : Marine / Plant
Manpower
* Doctor interaction
* Nursing shortage(s)
* Home care
* Finishing School
Learning & Knowhow
* Content Management
* Syllabus, Courseware.
* Administration / Commercial aspects
Communications
* Doctor interaction
* Patient interaction / acceptance.
* DICOM and alternate standards
* Trade & Industry
* Security, Privacy, Legality, Integrity
Integration
* Allopathic to all others.
* Ayurveda. Homeopathy
* Chinese Medicine.
* Acupuncture
* Africa ….
CRO / PRO
DILABS
MT

6. Areas of Coverage
1. IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
2. IS 02 Biosurveillance
3. IS 03 Consumer Empowerment
4. IS 04 Emergency Responder Electronic Health Record (ER-EHR)
5. IS 05 Consumer Empowerment and Access to Clinical Information
via Media
6. IS 06 Quality
7. IS 07 Medication Management
8. IS 08 Personalized Healthcare
9. IS 09 Consultations and Transfers of Care
10. IS 10 Immunizations and Response Management
11. IS 11 Public Health Case Reporting
12. IS 12 Patient - Provider Secure Messaging
13. IS 77 Remote Monitoring

7. Coverage Details
• IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
• The Electronic Health Records Laboratory Results Reporting Interoperability
Specification defines specific standards to support the interoperability between
electronic health records and laboratory systems and secure access to laboratory
results and interpretations in a patient-centric manner.
• IS 02 Biosurveillance
• The Biosurveillance Interoperability Specification defines specific standards that
promote the exchange of biosurveillance information among healthcare providers
and public health authorities.
• IS 03 Consumer Empowerment
• The Consumer Empowerment and Access to Clinical Information via Networks
Interoperability Specification defines specific standards needed to assist patients in
making decisions regarding care and healthy lifestyles (i.e., registration
information, medication history, lab results, current and previous health
conditions, allergies, summaries of healthcare encounters and diagnoses). This
Interoperability Specification defines specific standards needed to enable the
exchange of such data between patients and their caregivers via networks.
• IS 04 Emergency Responder Electronic Health Record (ER-EHR)
• The Emergency Responder Electronic Health Record Interoperability
Specification defines specific standards required to track and provide on-site
emergency care professionals, medical examiner/fatality managers and public
health practitioners with needed information regarding care, treatment or
investigation of emergency incident victims.

8. Coverage Details
• IS 05 Consumer Empowerment and Access to Clinical Information via Media
• The Consumer Empowerment and Access to Clinical Information via Media Interoperability
Specification defines specific standards needed to assist patients in making decisions
regarding care and healthy lifestyles (i.e., registration information, medication history, lab
results, current and previous health conditions, allergies, summaries of healthcare encounters
and diagnoses). This Interoperability Specification defines specific standards needed to
enable the exchange of such data between patients and their caregivers via physical media or
secure email exchange.
• IS 06 Quality
• The Quality Interoperability Specification defines specific standards needed to benefit
providers by providing a collection of data for inpatient and ambulatory care and to benefit
clinicians by providing real-time or near-real-time feedback regarding quality indicators for
specific patients.
• IS 07 Medication Management
• The Medication Management Interoperability Specification defines specific standards to
facilitate access to necessary medication and allergy information for consumers, clinicians,
pharmacists, health insurance agencies, inpatient and ambulatory care, etc.
• IS 08 Personalized Healthcare
• The Personalized Healthcare Interoperability Specification describes family history and
genetic/genomic lab order and results which are used to provide personalized treatment
specific to genetic makeup.

9. Coverage Details
• IS 09 Consultations and Transfers of Care
• The Consultations and Transfers of Care Interoperability Specification describes
the information flows,ISsues and system capabilities that apply to: 1. a provider
requesting and a patient receiving a consultation from another provider 2. a
provider requesting a transfer of care for a patient and the receiving facility
admitting the patient. ItIS intended to facilitate access to information necessary for
consultations and transfers for consulting clinicians, referring clinicians,
transferring facilities, receiving facilities and consumers.
• IS 10 Immunizations and Response Management
• The Immunizations and Response Management Interoperability Specification
focuses on: 1) providing information about individuals who need to receive specific
vaccines, drugs, or other interventions; 2) the ability to report, track, and manage
administration of vaccines, drugs,ISolation, and quarantine; 3) the ability to
identify and electronically exchange information describing the treatment or
prophylaxis status of populations; 4) the ability to exchange specific resource and
supply chain data from public and private sectors.

10. Coverage Details
• IS 11 Public Health Case Reporting
• The Public Health Case Reporting Interoperability Specification supports the bi-
directional information exchanges of the Public Health Case Reporting process. It
focuses on enabling more efficient data capture at the point of care while allowing
for optimizing the information delivery format and content allowing for current
SDO efforts to be finalized. In the absence of standards in structured content and
associated Clinical Decision Support for alerts and information reporting criteria,
this Interoperability Specification provides options for the secure communication
of basic presentation preserving content to better automate the current paper-based
information flows.
• IS 12 Patient – Provider Secure Messaging
• The Patient-Provider Secure Messaging Interoperability Specification describes the
information flows, processes, and system capabilities that are required for patients
to interact with their healthcare clinicians remotely using common computer
technologies readily available in homes and other settings.
• IS 77 Remote Monitoring
• The Remote Monitoring Interoperability Specification addresses the information
exchange requirements for the transfer of remote monitoring information from a
device physically attached to or used by a patient in a location thatIS remote to the
clinician to an Electronic Health Record (EHR) system and/or a Personal Health
Record system.

11. Mathematic Inc. USA perception
1. Improving Self-Care and Care Management
Interactive technology holds promise for helping people with chronic illnesses better manage their diseases and prevent costly
complications. Through health care appliances—such as glucometers, scales, and stethoscopes capable of transmitting readings
over the internet to a central repository—and other technologies for self-care management, patients can obtain diagnostic and
monitoring information and play a more active role in their care. These tools can also help people overcome barriers to care,
such as limited personal mobility or residence in medically underserved areas. For the Centers for Medicare & Medicaid
Services, we are conducting a large-scale evaluation in New York State of home-based telemedicine services. These services for
Medicare patients with diabetes use communications and information technology to transmit medical diagnostics and monitoring
services between patients and health care providers. We are examining whether patients randomly assigned to receive these
services experience improved clinical outcomes and greater satisfaction with care. This study is also looking at factors that
facilitate patients' use of the technology. We are evaluating the effectiveness of several care coordination and disease
management programs, some of which rely on telemedicine technologies. In addition, we are informing policy discussions about
the future direction of personal health records—electronic records of an individual's health information that the individual owns
and manages in a secure environment—in reducing disparities and empowering consumers living in medically underserved
areas.
2. Changing Incentives to Improve Quality of Care
Aligning health care payments with the quality of care provided is an important objective for policymakers and health plans alike. Yet,
reaching this goal requires large investments in new technology as well as changes in existing systems and processes.
Mathematica is evaluating whether incentives increase the number of physician practices that adopt electronic health records—
technology that has the potential to improve care quality and coordination, patient safety and satisfaction, and reduce costs for
employers, insurers, and, ultimately, providers. The incentives being studied include technical assistance and pay for
performance. We are assessing whether adopting such technology improves outcomes for Medicare beneficiaries with certain
chronic conditions. In another project, we are surveying a national sample of hospital medical directors to assess how they are
using health information technologies to enhance quality of care and reduce administrative costs.
3. Tracking Real-Time Public Health Data
The U.S. public health system plays a vital role in protecting the population against disease outbreaks and potential bioterrorism, in
addition to its function in promoting the health of its citizens. Yet, the system is made up of a vast assortment of federal, state,
and local agencies providing a multitude of services that affect the lives of millions of people. We have broad experience in
assessing the functions and performance of public health systems, and in developing performance indicators and surveillance
systems to monitor public health activities. We also have used vital health records for evaluating community-based health
interventions in 15 large urban areas across the United States. As electronic health records become more widely available, we
can provide technical assistance for linking and analyzing these records and producing real-time data for public health
surveillance activities.

12. Entry Points … sick.
Healthcare
MIS
DICOM
Medical
Transcription
HIPAA / HL7
Nurses / Manpower
Medical Equipment
Accessories
Consumables
Integration
Services
Managed
Care
mCARD

13. Entry Points … well.
Healthcare
Dental
Chinese
Routine
Checkup
You’re ok, Software
Health Foods
Gyms & Equipment
Accessories
Ayurveda
Lifestyle / SpasmCARD
gFoods
Hair Removal
Health
Insurance
Sports

14. 2012-09-05
Strategy
1. Positioning.
1. Charity.
2. IPO Public Profit.
3. Private Profit.
2. Model
1. Single. General, Specialty, Super-Specialty.
2. Multi. Self-serving or Hub & Spoke.
3. Global, New Economy Model.
3. Operative
1. ROI Modality-wise, Segment-wise, etc.
2. Efficiency Metrics.

15. Moral & Legal
1. Moral
1. Minority, Public Good or Profit.
2. Capacity. Spread. Reach. Modalities.
2. Legal
1. Statutory adherence. State & Local laws.
2. Associations, Practice ethics etc.
3. Patient handling, records & legality.
4. Vendor NDA’s, MOU’s, Contracts etc.

16. Touch Point(s)
1. Doctor - Patient (usually 1 to 1)
2. Patient - Nursing Staff. (usually many to 1)
3. Patient - Attendant Care.
4. Patient - Equipment.
1. Automated. Semi-automated. Manual. Self.
5. Vendor - Hospital Administration.
1. Buyer. User. Decision Maker. Influencer(s).
6. Patient Lifetime Frequency of Touch Points.

17. Numbers, Figures, Data

18. Facts of ‘doctor-time-data ..’
1. more time with your physician is spent in obtaining a past medical
history than attending to your current problem.
2. if attending physicians can track long standing medical information
they have a better chance of detecting early stages of disease.
3. many people refrain from travelling due to the fear of being separated
from their medical record.
4. many individuals postpone medical treatment when travelling or
away on business as the are afraid that a new physician will be
unaware of their past history.
5. many individuals are inappropriately managed because of lack of
past medical data.
6. each year many people die because of adverse medication
interactions or drug allergies.

19. Issues in the USA
1. Big Pharma
1. Protecting R&D investments.
2. Generic & other competition.
3. Marketing costs of US $ 15 Bn in 2000
4. Limited Physician & related influencers.
2. Wall Street
1. Returns on ‘Blockbuster’ drugs.
2. More drug solutions from the US $ 50 Bn. Annual spent on
Research.
3. Lower Drug introduction costs. US $ 900 M and 15 years.
3. Other Issues.
1. Doctor(s); Nurses(s); Pharma; Hospital Practice etc.
Controls.
2. Economic size & consequent wider ‘business’ interest.
3. Range & Depth of Legal implications.

20. Where’s the money …
1. USA, 25% of Healthcare expenses/income from the last 6 months of
a patient …
2. 50% of Healthcare costs from the last 60 days (2 months) ….
3. In India ‘Life Insurance’ is estimated at Rs. 40,000 billion from a
population of 250 million possible … Medical a subset of that.
4. PR. Indirect brand. Identify the ill …
5. INFLOW – From Information only; quick, effective and reliable,
during this period. To ALL parties concerned …
6. Consultancy. Diagnostics Leasing. Medication. Hired/leased
equipment. Logistics/Travel. Delivery/Conveniences, Nursing &
Caring.

21. Industry Types
1. Key-Large Industries
1. Medical Equipment
2. Pharmaceutical.
3. Bio-Pharmaceutical.
4. Bio-Technology
2. Other-Industries
1. Traditional Care. Medical Insurance.
2. Managed Care.

22. Market activity ...
1. Clinical Research cycle of 15 years; $ 800 M
2. A lot of M&A activity; in the non-core areas.
3. Fresh insights, developments, ideas …
1. Managed Care
2. Genetics.
3. Bio-Technology.
4. Animal Rights. Activism. Environment.

23. More USA numbers
1. Pharmaceutical industry figures
1. Big 5, R&D and others.
2. US affected
1. 20% (of 270 M population) Mental illness.
2. 1 in 6 physical impairment (Section 508)
3. Ageing Population.
4. Nursing. 125,000, 11% short. By 2010, 1 million.
Figures in brackets is the number of US population affected.

24. US Nursing needs
1. Year 2002.
1. Current capacity is 1,200,000.
2. Current shortage is 11%. ie. 125,000
2. Year 2010
1. Need will increase by 1,000,000
2. Almost 100% shortage, cannot be met locally.
3. Why is there a shortage?
1. Baby boomers of the 60’s getting older.
2. People are living longer.
3. Divorce. Single-parents. Lower Household units.
4. Not ‘first-choice’ career for local Americans.

25. US Healthcare Industry
1. Current Health Insurance ‘focus’ on symptoms
disease rather than prevent/cure ..
2. Alternate ..
1. US $ 24 bn Fitness Club Industry.
2. US $ 78 bn Vitamins.
3. TOTAL = US $ 200 Bn. In 2001

26. Counterfeit Problem
1. 8% of drugs entering the US is counterfeit.
2. In some countries as high as 65% is counterfeit.
3. Includes countries such as Spain, England, China,
France, Germany, Bahamas, Mexico.
4. US. ‘Operation Safeguard’.
5. Counterfeit types :-
1. 1. Original. BUT expired, wrong dosage or re-labeled.
2. 2. Safe. Alternate ingredients, no benefit could even result in
earlier un-timely death.
3. 3. Unsafe. Toxic and/or other spurious ingredients.

27. USA IRS & Tax deduction
1. Historical.
1. Single company, 25 years, single-doctor, Company supported.
2. Employer run, insurance company dictated, anti-employee AND symptom-
oriented, NOT prevention nor cure oriented.
3. Drug company. R&D on $ 800/- cure OR $ 1/- each day for 365 days, rest-of-
your-life?
2. From 2003, 100% individual tax deduction on medical insurance.
3. 50 million US citizens are self-employed.

28. Clinical Research : CR
1. Treatment trials
2. Prevention trials
3. Early-detection/screening trials
4. Diagnostic trials
5. Quality-of-life/supportive care trials
Phase 1: Looking at Safety
1. To find a safe dosage
2. To decide how the agent should be given
3. To observe how the agent affects the human body
Phase 2: How Well the New Treatment Works
1. To determine if the agent or intervention has an effect on a particular cancer
2. To see how the agent or intervention affects the human body
Phase 3: Comparing a New Treatment to the Standard Treatment
1. To compare the new agent or intervention (or new use of a treatment) with the
current standard
Phase 4: Continuing Evaluation
1. To further evaluate the long-term safety and effectiveness of a new treatment

29. India TPA’s
1. GIPSA & IRDA
1. National Insurance Company
2. New India Assurance
3. Oriental Insurance
4. United India Assurance
2. Bajaj Allianz; IFCO Tokyo; Reliance General Insurance; ICICI
Lombard; Tata AIG; Telos
3. TPA’s
1. 14 TPA’s licensed. Paid-up capital of Rs. 1 crore. (3 are ex-dotcom’s).
2. TPA increases premium by 7 to 10%; but necessary evil as Rs. 141/- was
being paid on Rs. 100/- premium ‘killing the goose’.
3. TPA (Doctor vs Bill Settler arguments)
1. Paramount Health Services. 250 staff; 36 doctors. Bombay. Dr. Nayan Shah
2. Parekh Health, Bombay.

30. Healthcare Expenses
Source : Medical Expenditure Panel Household Component

31. Expenses Median
Source : Medical Expenditure Panel Household Component

32. Disease & Cure

33. Unfortunately ‘sick’ …
1. Problems & Issues
1. Genetic, Social or Biological : FEW CURES
2. Low diagnostics. Who needs it? Who’ll pay?
3. So what if I die … Heaven. Karma. Jihad.
4. Near & dear ones, influence, legal issues …
5. Inter-country movement, legal issues again ….
2. If & when it happens …
1. What is it …. Speed, Assurance & Cost of diagnostics.
2. Availability, Options, Choice of Treatment …
3. Location(s) of treatment …. Start, middle or End points.
4. Coverage, insurance, capacity to pay …
5. Period of likelihood.

34. List of diseases under control
1. Anthrax
2. Gonorrhea
3. Syphilis
4. Typhoid fever
5. Suppuration
6. Cholera
7. Diphtheria
8. Whooping cough
9. Dysentery
1. Tetanus
2. Pneumonia
3. Paratyphoid
4. Meningitis
5. Food poisoning
6. Gas gangrene
7. Botulism
8. Plague
9. ….. etc., etc. ..
Most were brought under control in the 19th century.

35. List of Diseases, little control
1. Single gene
1. Cystic fibrosis
2. Tobacco & Lung Cancer
3. Ageing
1. Rheumatoid Arthritis
2. Cataracts
3. Major Cancers
4. Neurological disorders
1. Alzheimer's
2. Multiple Sclerosis
5. Dermatological disorders
1. Psoriasis
6. Gut disorder
1. Crohn’s disease
7. Circulatory disorders
8. AIDS
9. SARS
10. ADS (Autism Spectrum Diseases)

36. Example : Mental illness
1. 26 drugs under research for of the depression. 19 million people,
costs the economy an estimated $44 billion a year, including $12
billion in lost work days.
2. Alzheimer's, 24 in development. 4 million, costs about $100 billion
each year. Alzheimer's expected to triple in the next 20 years.
3. 16 in the pipeline for schizophrenia, 2 million Americans costs $30
billion.
4. Substance use disorders, which cost U.S. society nearly $400 billion
a year, are the target of 21 new medicines.

37. Diseases
1. Types
• Genetic
• Social
• Biological
2. Stages
• Pre-Conception
• Fetal
• 1st year
• Childhood
• Teens
• Middle Age
• 40+
• 55+
• Old Age

38. Complexity
1. Of evolution & you ..
1. Several organs …
2. Several mechanisms …
3. Several modalities
4. Bacteria, Virus, Retro-virus or
Prion …
5. Your Genetic Makeup …
6. Your Social circumstances ….
7. History, Track-record …
8. Doctors are human …just like
you …
9. Doctors are specialists …. Just
like you …..
10. Infrastructure, facilities are an
issue ….
11. Equipment & Technology is
fallible …..
1. Of humans & options …
1. Doctor modalities …
2. Clinic facilities
3. Clinical trials & Stats.
4. Side Effects. Friend or Foe.
5. Big Pharma interests
6. Drug – Drug interactions.
7. Alternate medicine
8. Materialism … quick, fast, easy …
9. Technical challenge, guinea pig,
scapegoat ….
10. Hypocratic oath .. What oath?

39. Mind … Brain
1. The effect of the neuro-endocrine immuno system
is NOT understood at all…
2. The emotional – physical interaction of hormones,
steroids and glandular systems is NOT understood
at all …
3. The real effect of chemicals and trace elements in
food intake is not understood at all…
4. The power of mind and mental faculties in the
generation OR suppression of these vis-à-vis
automatic body responses … not understood ….

40. Race against time
A non-
knowledge
Route
An informed
route
• Saves Time
• Saves Money
• Saves Lives

41. Information Technology

42. Modern Healthcare
Information
Technology
SuppliesPeople
Public / Society
Patients
Doctors
Nursing
Vendors
Hospitals & Clinics
Transportation
Infrastructure
Equipment
Consumables
Pharma & Medicine
Distribution & Logistics
Infrastructure
Equipment
Consumables
Investors / Risk Management
Knowledge
Process & Methods
Skills (with Machines)
Choice of Options
Communications

43. Delivery : Fulfillment :
Transaction
1. Supplier Information.
2. Supplier Item or Service.
3. Buyer Information.
4. Buyer Item or Service.
5. The Transaction.
6. Billing.
7. Payment & Collection.
8. Close. Receipts, paperwork, archive, MIS etc.

44. Hospital Management Systems
I.T.
PR, eZines,
Communications etc.
Patient Care
Accessories &
Spares Sales
Doctor
Access
Equipment Scheduling
Vendor Development
Rostering
Billing
Industry
Standards
Patient Records
Migrate
Legacy
Systems
Inventory, Billing
Accounting

45. Current utilisation of IT
1. Access to current medical records.
2. Access to medical history.
3. Access to patient flow sheets.
4. Access to patient demographics.
5. Order-entry of laboratory tests.
6. Results review for laboratory tests.
7. Order-entry of radiology procedures.
8. Results review for radiology images, including
9. Picture archiving and communications systems (PACS).
10. Results review of radiology reports.
11. Order-entry of medications.
12. Real-time drug interaction alerts.
13. Back-end drug interaction alerts.
14. Clinical guidelines and pathways.
15. Patient support through home monitoring, self-testing, and interactive
patient education.

46. Linen and Laundry Management
Processing
Reject
Central
Store
FRESH
Re-Wash
Used / Billed to
Customer
CASH
Fresh
Purchases
Re-work
Morph Reduce
Stitch / Patch
Central
Store
SOILED
Local Store
ISSUE

47. RFID Deployment

48. Clextra based Solutions
1. Stockflow.
2. RFID tagging
3. Consignment Inventory Handling. VMI or CMI.
4. Doctor Information System
5. Patient Information System.
6. Digital Tablet Based Ordering.
7. Pharmacy Logistics. (Nearest Pharmacy / Stockist)
8. Secondary Sales Solution(s)
9. Clinical Research (Phase 1 to 4 Documentation
Management). Questionnaire Handling.
10. Hospital Bed optimisation. ROI on Equipment
11. ….more, much, much more … on request.

49. Engineering HelpDesk
inetOrgPerson
inetOrgPerson
Organizational role
Organizational person
Organizational person
inetOrgPerson
inetOrgPersoninetOrgPerson
Organizational role
Response
- Automated
- eMail
- with 24 hours
Helpdesk
coordinator(s)
Remote
Access
Joint
Decision
Decision of 3 people
Escalation
User(s)
Cloud
Head of HR
Control
Sponsor
Expert
Access
Organizational person
Decision
For larger complex (eg.
5000+ Staff), you should
consider the clextra Docket
Management Module.

50. Patient Care & Issues

51. Medical Practice
Listen to the Patient's story
One (or more) diagnoses
comes to mind.
Interact. Ask questions.
Gather more
information.
Diagnoses List. Add,
Subtract, Prioritise.
Test. To support or
eliminate diagnosis.
Treat & Observe.
Disease
Space
Diagnosis & Cure
Space
Source : Casper Abraham © 2002
Disease Treatment Cure

52. Doctor ‘Thinking’ ...
1. General, Specialty, Super Specialty.
2. Single-Modality; Multi-Modality.
3. Patient History. (Records & Memory).
4. Family/Genetic History. (Records & Memory).
5. Tools. Observation. Examination. DI. Lab.
6. Disciplines :-
1. Medicine.
1. Statistical data. Clinical Research.
2. Surgery.
1. Hand-eye co-ordination Skills. Expertise. Experience.
3. Contemporary.
1. Radiology. Simulation. Non-Invasive Techniques.
2. Information. Communications. Multimedia. Colour.
3. Alternate Medicine.
4. Human Mind - Brain-Body nexus. Neuro-Psychology.
7. Modern Commercial impact.
1. Patient as Customer, Consumer, Suer.
2. Doctor as Supplier. Human error. Challenge.

53. Diagnosis
1. Key to solutions. Key to a cure.
2. Any average competent can take over from there.
3. Pattern Recognition.
4. Expert. Expert System. Human Expert working.
5. Mind set. Prepared to ‘go-back’ even over
assumptions.

54. Components
Patient
• Lifestyle
• Good Health
• Perception
• No risk
Insurance
• Patient
• Doctor
• Administration
• Research & Advisory
• Big Pharma
Emergency
• Golden Hour Package
• Proximity
• Solution Competence
Diagnostics
• Routine / Preventive
• Emergency
• Out-patient Tests
• In-patient Tests
Treatment
• Alternatives / Choice
• Service Quality
• Tracking
• Centralized Data
• WORKS / N)-GO
Informatics
• Demographics
• History
• Own Genome
• Group Genetics
• Current Problem

55. Nursing Locations
1. In-Patient;
2. Out-Patient;
3. Home-Care.
4. Attendant Care; (at Clinic / Hospital)
5. Attendant Care; (at Home or elsewhere)

56. Possible key-transaction(s)
1. Date (of treatment)
2. Doctor (may be called "provider")
3. Patient
4. Procedure
5. Primary Diagnosis
6. Location (presumably the doctor's office)
7. Billing Organization (an organization the doctor belongs
to)
8. Responsible Party (either the patient or the patient's legal
guardian)
9. Primary Payer (often an insurance plan)
10. Secondary Payer (maybe the responsible party's spouse's
insurance plan).

57. Technology Advancements
1. Life Sustaining
1. Intensive Care
2. Ventilator
3. Dialysis
4. Pacemakers
2. Diagnostic
1. CT Scanner
2. MRI Scanner
3. PET Scanner
4. Ultrasound
5. Angiographies
6. Cardiac catheterization
3. Surgical
1. Joint Replacement
2. The pump
3. Intraocular lens
4. Operating microscope
5. Cochlear implant
6. Endoscopy

58. Healthcare Categorization
1. Modality.
1. Cardiology, Dermatology, Nephrology, ENT,
Ophthalmology etc.
2. ICD
1. International Classification of Disease
3. Well Code Adaptation

59. Well Code
0 Human Being not alive. Brain & legally dead.
1 Very high risk, will die in the next 1 hour, if no medical
intervention.
2 High risk, will die in the next 72 hours, if without medical
intervention.
3 Requires unspecified time-frame of life-support system(s) to
survive.
4 Requires life-support systems for survival for the next 30 days.
5 Requires a near life-time of hospitalization and treatment.
6 Requires a near life-time, on-going, periodic in-patient
hospitalization and treatment.
7 Requires on-going, periodic out-patient treatment.
8 On controlled non-OTC, prescription medication.
9 On OTC type medication.
10. Near perfect good health. No medical help whatsoever.
Prefix each with a HC, a well-person is HC10

60. Sales Facts …
1. Health impairment (instead of Disease)
2. No cures, no promises, no expectations, no
answers, no solutions ….. Just data, extracted
information, hopefully leading to knowledge.
3. Man proposes …. God disposes. Knowledge is
power … Ignorance is bliss.
4. To the end-consumer, patient, one doctor, one nurse
…. Reasonable quality of service/supply will be
adequate.

61. Transaction Server Model
Based on ‘ALL’ but
Better suited to the
Internet than :-
* X Open Distributed
Transaction Processing
Standard
* OMG Object Transaction
Server
* JTA and JTS
* MS Transaction Server
* EJB Transaction Model
* WebLogic
* WebSphere

62. Key to Transaction(s)
1. Who ID.
1. National ID. Social Security Number. Voter ID.
2. Health ID.
1. In-patient number. Out-patient or Casual number.
2. Illness Code.
3. Cover ID. Date_start. Date_stop. Amount.
4. Vendor ID.
1. Doctor. Hospital. Pharmacy. Other.
Touch Point

63. Transaction include ...
1. In-Patient Stay. (Large & Long Transaction.)
2. Lab. Test or DI usage or Surgery/Medicine.
3. Out-patient Doctor Visit.
4. Drug Store Purchase.
5. Prescription usage.

64. Managed Care Transactions
BuyerSeller
1. Current scenario with Medical Insurance.
1. Risk evaluation models for health.
2. Data Management for improved cost-efficiencies.
3. Lack of Technical competence; requiring TPA’s.
2. Why ‘Care Manager’ …
1. Doctor, DI & Lab nexus ‘inflates’ services.
2. Market reality of ‘commercialised’ practices.
3. Lack of ‘awareness’; and ‘ill’ state of consumer.
3. Issues …
1. ‘State’ cannot manage all issues.
2. Technical nature of ‘arbitration’ services.
3. Inherent pre-use & post-use ‘problems’.
4. Solution.
1. Use of IT, Internet & Software Technologies.
2. Larger Size & Scale of operations.
3. Speed of ‘service delivery’.
4. Lower & Upper limits of ‘automated’ approvals.
5. Constant Technical Learning of ‘Care Manager’.
6. Data gathering & Information availability.
7. Risk estimation improvement.
8. Lower costs. Improved Profitability. Quality Service.
Care Manager
BuyerSeller
Source : Casper Abraham © 2002

65. DICOM
1. DICOM Hardware & Interfaces
1. Equipment Interface
2. Box
3. General purpose PC; TCP/IP; wireless etc.
2. DICOM Software & Standards
1. Print
2. Store. File Format.
3. Modality Work List
4. PPS. Data-Link. SCU-SPU SOP.
5. Storage Commitment. Host Control.
6. Cine. DVI. CA. CA+
7. High-Line Rate
8. Color.
3. DICOM Media
1. MO. CD-R. DVD

66. SNP Potential
1. Single nucleotide polymorphisms. SNP
identification is of major technological and
commercial significance to the pharmaceutical
industry for helping to determine an individual
patient's susceptibility to disease or response to
drugs
2. Incyte acquired Hexagen in 1988

67. Standards

68. Adoption of standards
1. HIPAA (for the US), Europe, Asia etc.
2. HL7 Version 2.4 and Version 3.0
3. 21 CFR Part 11 (Electronic data capture)

69. Certifications (USA)
1. Doctors
1. TOEFL
2. USMLE Step 1
3. USMLE Step 2
2. Nurses
1. TOEFL
2. CGFNS
3. IELTS
4. NCLEX-RN
3. IT
1. FDA requirements.
2. HIPAA / HL7
3. Market Leaders SAP / SAS

70. Government & Social

71. Medi-rural
A franchising concept for getting mass
medical treatment going with State
Officials, worldwide.

72. Regulation
A curious by-product of
‘advanced’ vs less ‘value for
life’ is ‘Regulation’
Healthcare
Regulation
Value for Lifelow high
low
highICH/GCP
USMLE
CGFNS/NCLEX
IPR & Patents
India
USA
China
Europe
Lower Population
More Affluent Patients
More Money in the Business
Infrastructure & Facilities
Legal Involvement
• Ignorance
• Lack of resources
• Malpractice
• Experimentation
• even ‘kill’ for money
South
America
Source : Casper Abraham © 2002

73. Suggested Packages
Super
Specialty Specialty General Basic
Class C CS CP CG CB
Class B BS BP BG BB
Class A AS AP AG AB
Investment Cases Revenue Profit
Class C 50 L 3650 20 L 10L
Class B 600 L 7300 150 L 90 L
Class A 2000 L 14600 200 L 100 L

74. Components for each
1. Infrastructure. Location. Guidelines.
2. Equipment List. Bill of Materials.
3. Finance Options.
4. Cases. Population, Statistics, Research. Planning.
Potential & Projections.
5. Pricing.
6. Marketing. Communications. Advertising. Reach.
7. Manning. Training.
8. MRO. SCM. Supplies. Vendor Development.
9. Service Quality. Ethics. Values. Statutory.
10. Franchise Fee / Royalty Management.

75. Targets (example, Karnataka in
India)
1. End-DEC 2003
1. Class A : 5 in Karnataka; 20 across India.
2. Class B : 10 in Karnataka; 50 across India.
3. Class C : 25 in Karnataka; 100 across India

76. edgevalue
Ideas; Thoughts; Plans.
(clextra Products support some of them)

77. Next Practice Healthcare
1. All Doctors Registry. IMA for India. Controls, checks
& balances. Registration. Public verification.
2. Community Information. NGO’s. Social Support.
3. Closest Hospital. MAP. Query by mobile or wired.
4. REVENUE : Sponsored Social VC. Disease based.
5. Hub / Spoke Management.
6. Primary - Secondary - Tertiary Support.
7. Tie-in with SAP, SAS for CR etc.
8. RFID. PACS. DICOM etc.
9. Pharma Information.
10. Public awareness creation through a Web Portal
concept.
11. Other vendors can also plug’n’play at a price.
12. Activate. Key-hospitals. Apollo. Mallya. Manipal
Others.

78. Healthcare Business Model
Medical
Diagnostics
& Imaging
Lab.
Out-Patient
CARE
In-Patient
CARE
Doctor
Community
Hospital
& Clinic
Services
Manufactures
& Suppliers
Multi-Modality
DICOM
IT &
MIS
Bio-Tech
Know-how
Information
Data
Problem to Solution
Desire to Fulfillment
Disease to Cure
TeleMedicine
Managed
Care
Traditional
Care
Match
Financial Risk
Layer
Information
Layer
Service
Layer
Lifestyle
Layer
State or Private
Freebie or Paid for
Credit or Debit
Real time or Delayed
Availability / Sharing
Quality / Integrity
Security
Home CARE MedicineSurgery

79. UHN (Unique Human Number)
1. YYYYMMDDSSSSSSSS
2. Up to 100,000,000 th person born on a particular day.
3. The 9th, 10th and 11th can even be a country code to
establish nationality & origin.
4. Examples;
1. 1957061809100009 Casper Abraham
2. 2001060700114232 Bonica Clinton
3. 2002110804400021 21st kid, unknown parents, UK
5. Accessible at www.uhn.net and www.uhn.org
6. Patient id, on Smart card, implants number, chip implant
number, fingerprint, ECG, hospital id, Gene Bank, blood
type, etc. etc.
7. Could be mapped to Voter no., National Id, Social
Security Number etc., in each country.

80. Smaller Ideas
1. Front-end; GUI’s & Usage is IMPORTANT
1. Pattern Maps access.
2. Networked / Archived Digital Pen ‘data-entry’.
2. Product(s)
1. DI-LAB’s Tele-Radiology. PACS movement.
2. CEO Dashboard. Hospital Administrator.
3. SAS Training for CR Professional(s) / Development.
3. Concepts
1. Healthcare hybrid-BPO between Developed & Developing
Countries. Eg. USA - India.
2. Tier II entry; to move to Tier I. Franchise products that
emerge from this module generation.
4. Life Sciences
1. Genetic & DNA Testing. Sequence Database
Management.

81. A Healthcare Hybrid BPO
1. Nursing
1. Staffing
1. Recruitment. Manning. Attrition & Replenishment.
2. IT
1. BPO related to ALL nursing management.
2. Payroll. Benefits. Rostering. Technical Inventory.
2. IT (Information Technology)
1. Website.
1. Communication. Patient-well wishers.
2. Modalities. Services. Price-lists.
3. Appointments.
2. Rostering
1. Doctors. Nurses. Aides.
3. MIS
3. Medical Transcription
1. Claims Processing. Insurance Documentation.
4. CR (Clinical Research)
1. ALL modalities and ALL patients, doctors, nurses related to THIS
CLIENT(s).
5. Other
1. PACS DICOM etc.

82. clextra DILABS concept
1. DILABS Connect
1. Hardware Connectivity. DICOM and non-DICOM.
Intranet. API’s.
2. DILABS Xfer
1. No storage. From. To. Cc. Security. Privacy.
3. DILABS Infobase
1. Storage. SAN. License. Reports. Publications. R&D.
4. DILABS Services
1. AMC. Per-call. Support. Transaction.
Plan, prototype(s) being evolved.

83. Your single-source partner
1. Establish information needs horizontally and vertically.
Feasibility studies & Budgets
2. RFP generation. Vendor identification. RFQ facilitation.
3. Supply Specifications Adherence. Quality controls & assurance.
4. Multi & Inter-vendor negotiations & closing.
5. INTEGRATION.
6. Uptime. Crises Support
7. Training. Support Services. Documentation.
8. SAS centric; CR Professional Development Business Plan.
9. clextra DILABS (for those interested).
10. clextra Dashboard for Efficiency / Control

84. http://www.edgevalue.com
http://clextra.in
casper@edgevalue.com © JAN 1999
62-B Modi Residency, Millers Road
Benson Town
Bangalore 560 046 INDIA
Phone : 91 (india) 80 (bangalore) 2595 0059
Cellphone : 98450 61870