Les outils de mesure de la performance Jean-François Penciolelli Directeur Marché Santé Social

<Insert Picture Here> Agenda <Insert Picture Here> Oracle La Santé 2.0 Les solutions Oracle OBIEE et EPM Fonctionalités et Valeur Références Questions This VP

<Insert Picture Here> Agenda <Insert Picture Here> Oracle La Santé 2.0 Les solutions Oracle OBIEE et EPM Fonctionalités et Valeur Références Questions This VP

Une stratégie sectorielle & métier … TECHNOLOGIES Performance Management Identity Management Content Management Middleware Management Database Systems Management APPLICATIONS Enterprise Deals Manufacturing Industries Retail Industry Comms Industry Banking Industry Utilities Industry Others 4

… qui a étendu l’offre d’Oracle en 4 ans Operating System Database Middleware Suite Development Tools Applications Consulting Services Windows SQL Server .NET Visual Studio .NET Linux/Unix/Windows Database 10g, TimesTen IMDB, Berkeley DB Fusion Middleware Oracle Tools / J2EE DB2 WebSphere Rational / WebSphere IBM GlobalServices Oracle, DB2, MySQL, SQL Server NetWeaver NetWeaver / ABAP SAP Consulting Fusion Microsoft Business Solutions mySAP Oracle Consulting 3rd Party ISVs 3rd Party SIs Linux MySQL, PostgreSQL JBoss, Spring, Geronimo PHP, Eclipse SugarCRM, others Open Source So this is what we’ve been talking about all morning is this stack concept. I think every one of these vendors up here, IBM, SAP, Microsoft, and now to a small extent Open Source, in terms of trying to pull together a stack, is the way that the industry looks at a very macro level. And it’s important to take away that Oracle has the most complete software stack compared to the other vendors on here. IBM missing applications and focused on services, SAP focused on applications, missing the infrastructure, and Microsoft really focusing at the departmental level and non-standards based. And Open Source is just a conglomeration of a bunch of things that certainly are not well integrated and can’t meet the needs of most customers of the scale that we’re talking about here. 5

La cohérence technologique et applicative Oracle Cohérence globale applications (ERP, HCM, CRM) et technologique Baisse des coûts d’acquisition des licences (négociation globale) Augmenter les chances de réussite des projets applicatifs par une plateforme technologique unique Augmenter la sécurité de bout et bout et la disponibilité du système d’information Baisse des coûts d’intégration (30% du coût des projets) Baisse des coûts de production Baisse de la durée de déploiement (50% du coût des projets) Souplesse par rapport à l’évolution des applications Baisse des coûts de formation et d’assistance technique Consulting Services Oracle Consulting Applications Fusion Applications Development Tools Oracle Tools / J2EE Middleware Suite Fusion Middleware Database Database 10g, TimesTen IMDB, Berkeley DB So this is what we’ve been talking about all morning is this stack concept. I think every one of these vendors up here, IBM, SAP, Microsoft, and now to a small extent Open Source, in terms of trying to pull together a stack, is the way that the industry looks at a very macro level. And it’s important to take away that Oracle has the most complete software stack compared to the other vendors on here. IBM missing applications and focused on services, SAP focused on applications, missing the infrastructure, and Microsoft really focusing at the departmental level and non-standards based. And Open Source is just a conglomeration of a bunch of things that certainly are not well integrated and can’t meet the needs of most customers of the scale that we’re talking about here. Operating System Linux 6

<Insert Picture Here> Agenda <Insert Picture Here> Oracle La Santé 2.0 Les solutions Oracle OBIEE et EPM Fonctionalités et Valeur Références Questions This VP

Interoperabilité des processus La vision Application Médecine de Ville Dossier Médical Réferentiel Patients Référentiel Ressources Santé RRS RPat DM HL7v3 / ENV 13606 interface Télé Communication RNIS ADSL GPRS/UMTS Interoperabilité des processus Webservices, API ou message Médecin Interopérabilité sémantique Application Laboratoire Laboratoire Professionnels de Santé et Patients Pharmacie Application Pharmacie 8

Webservices, API ou message La santé aujourd’hui Référentiel Patients Référentiel Ressources Santé Dossier Médical RPPS Autorisation Exercice Webservices, API ou message CPS Médecin Généraliste Id 9

PIRES, Médecin Traitant + Filtrage portail La santé aujourd’hui Référentiel Patients Référentiel Ressources Santé Dossier Médical NIS CNAM Marine Feu Vert Assurance Maladie Retrouver les informations Identification du patient et données administratives Webservices, API or message Vitale Contrôle des droits Id Remboursement, PIRES, Médecin Traitant + Filtrage portail Patient Médecin Généraliste 10

Webservices, API ou message La santé aujourd’hui Référentiel Patients Référentiel Ressources Santé Dossier Médical Assurance Maladie Webservices, API ou message Recherche Historique Données médicales Matrice Habilitations Médecin Généraliste 11

Webservices, API ou message La santé aujourd’hui Référentiel Patients Référentiel Ressources Santé Dossier Médical Ordonnance CNAM Assurance Maladie Webservices, API ou message Mise à jour Dossier Médical FSE Facture Consultation … Envoi facture Institutions Santé Publique Médecin Généraliste Veille sanitaire Consultation … AFSSAPS INVS, Sentinelle… 12

Webservices, API ou message La santé demain Référentiel Patients Référentiel Ressources Santé Dossier Médical CNOP + DP Prescription dispensée Ordonnance Assurance Maladie UK + ETP Webservices, API ou message Prescription dispensée Indra + Recetta Médecin généraliste Prescription Pharmacie 13

Webservices, API ou message La santé demain Référentiel Patients Référentiel Ressources Santé Dossier Médical Bioserveur Résultats Labo Ordonnance Assurance Maladie Webservices, API ou message Résultats Labo Résultats Médecin Généraliste Institutions Santé Publique AFSSAPS INVS… Ordonnance Laboratoire Résultats 14

La santé d’après-demain Référentiel Patients Référentiel Ressources Santé Dossier Médical Ordonnance Lettre de Sortie Assurance Maladie Informations médicales Patient hospitalisé Webservices, API ou message Demande de données médicales Lettre de Sortie Lettre de sortie Médecin Généraliste Institutions Santé Publique Ordonnance SIH Données Médicales Patient Lettre de Sortie Hôpital 15

Professionnels de santé Agences gouvernementales La santé du futur Ecole de Santé Publique Ministère Santé Ordres Professionnels de santé Agences gouvernementales Gynecologue Pédiatre Specialiste RPat RRS DM Webservices, API ou message Assurance Maladie Médecin Généraliste Hôpital Institutions Santé Publique Laboratoire Pharmacie 16

<Insert Picture Here> Agenda <Insert Picture Here> Oracle La Santé 2.0 Les solutions Oracle OBIEE et EPM Fonctionalités et Valeur Références Questions This VP

Les solutions de mesure de la performance Oracle Enterprise Performance Management Workspace Performance Management Applications BI Applications BI Applications Business Intelligence Foundation Fusion Middleware The most visible aspect of the EPM System is the information delivery layer. This pervasive access layer allows information to be personalized and delivered based on the individuals needs and role in the organization – one size doesn’t fit all. The EPM Workspace supports executives through Web-based dashboards. It can meet the needs of the most advanced analysts through the industry’s best Microsoft Office Integration. Our Workspace allows information consumers to utilize Google Search or Oracle Secure Search to find just the reports or metrics their looking for. Alternatively alerts can be pushed to mobile devices to notify managers of emerging issues or growing variances. No matter how technical or what information your consumers are looking for, Oracle’s EPM System can meet their information access needs. OLTP & ODS Systems Data Warehouse Data Mart OLAP SAP, Oracle, Siebel, PeopleSoft, HIS CIS, McKesson, Medasys, Cerner, Agfa, Softway,… Excel XML Business Process

Une fondation hautement performante EPM Workspace Performance Management Applications BI Applications BUSINESS INTELLIGENCE FOUNDATION Common Enterprise Information Model Essbase BI Server Predictive Analytics FUSION MIDDLEWARE Data Quality Data Integration Identity Management Content Management Business Process Management SOA Name the benefits of our BI Foundation using a common enterprise information model - for example in conjunction with Essbase to do advanced or even predictive analytics. CONNETCS TO SOURCE DATA MODELLING PART (STAR SCHEME SORT OF IN MEMORY VS. ESSBASE?) TRANSFORMATION PRESENTATION LAYER (FOR DASHBOARDS) MDM OLTP & ODS Systems Data Warehouse Data Mart OLAP SAP, Oracle, Siebel, PeopleSoft, HIS CIS, McKesson, Medasys, Cerner, Agfa, Softway,… Excel XML Business Process

Des applications décisionnelles pré-construites EPM Workspace Performance Management Applications BI APPLICATIONS Contact Center Order Mgmt. Supply Chain Sales Svcs. Mktg. HR Finance Business Intelligence Foundation Fusion Middleware ….and the BI applications. OLTP & ODS Systems Data Warehouse Data Mart OLAP SAP, Oracle, Siebel, PeopleSoft, HIS CIS, McKesson, Medasys, Cerner, Agfa, Softway,… Excel XML Business Process

Les applications BI Oracle bonnes pratiques, rapidement mises en oeuvre Patient Contact Center Service Effectiveness Patient Satisfaction Resolution Rates Service Rep Efficiency Service Cost Churn & Service Trends Healthcare Marketing Campaign Effectiveness Customer Insight Product Propensity Loyalty & Attrition Market Basket Analysis Campaign ROI Procurement & Spend Direct / Indirect Spend Buyer Productivity Off Contract Purchases Supplier Performance Purchase Cycle Time Employee Expenses Supply Chain & Order Management Revenue and Backlog Inventory Fulfillment Status Customer Status Order Cycle Time BOM Analysis Financials Human Resources Employee Productivity Compensation Compliance Reporting Workforce Profile Retention Analysis Return on Human Capital General Ledger Accounts Receivable Payable Cash Flow Profitability Expense Management The BI applications enable more pervasive BI by providing role-based insight for each functional area, including sales, service, marketing, contact center, finance, supplier/supply chain, HR/workforce, and executive management. For example, Sales Analytics includes role-based applications for sales executives, sales management, as well as front-line sales reps, each of whom have different needs. The applications integrate and transform data from a range of enterprise sources—including Siebel, Oracle, PeopleSoft, SAP, and others—into actionable intelligence for each business function and user role. and Other Operational & Analytic Sources Source adapters: 21 21

Oracle BI Suite Enterprise Edition Unified Business Intelligence Infrastructure User  Decision Information Data Ad-hoc Analysis Proactive Detection and Alerts MS Office Plug-in Reporting & Publishing Interactive Dashboards Disconnected Analytics Web Services Oracle BI Server Multidimensional Calculation and Integration Engine Intelligent Caching Services Intelligent Request Generation and Optimized Data Access Services Common Enterprise Information Model The Oracle BI Suite is a comprehensive, integrated solution that enables organizations to have a single business intelligence architecture that meets the needs of all users, enabling more pervasive BI. The first requirement in delivering a BI platform is providing the full range of user access options so all users can get the information they need in a way they want it. For example, within our customer base we have users that are railroad workers at Union Pacific railroad. We have call center agents at DirecTV. These sorts of users are not trained BI experts, so they need the information presented in a way that is easily digestible. We also have BI experts, and they need to be able to access the same information but have the tools they need for more interactive, ad hoc analysis. With BI EE, insight is delivered in a personalized manner through various channels, like interactive dashboards, proactive detection and alerts, ad-hoc analytics, mobile disconnected analytics, published reports, as well as integrated into other applications such as MS Office, or through Web Services. While different types of users need to access and interact with information in different ways, organizations can’t support over the long term a different infrastructure for every type of user or every department. Organizations need a common infrastructure to enable users to get the information they need how they want to see it, yet present a consistent view of that information. This is what the Oracle BI server provides. With the BI Server, organizations can simultaneously access and derive insight from across multiple heterogeneous data sources, including: Historical data sources in data warehouses Real-time data stored in operational data sources and OLTP systems Data stored by various applications Data stored in Files, Excel, XML One of the key differentiators of the Oracle BI EE suite is this ability to access data from multiple heterogeneous data sources– this is what enables the delivery of real-time, pervasive insight. OLTP & ODS Systems Data Warehouse Data Mart SAP, Oracle PeopleSoft, Siebel, McKesson, Medasys, Cerner, Agfa, Softway,… Files Excel XML Business Process

<Insert Picture Here> Agenda <Insert Picture Here> Oracle La Santé 2.0 Les solutions Oracle OBIEE et EPM Fonctionalités et Valeur Références Questions This VP

Le PMSI 24

Tableaux de bord Source : Keyrus 25 25

Connexion au portail décisionnel Source : Keyrus 26

Analyse des séjours (1/3) Source : Keyrus 27

Analyse des séjours (2/3) Source : Keyrus 28

Analyse des séjours (3/3) Source : Keyrus 29

Structure de l’établissement DRILL DRILL Source : Keyrus 30

Données de synthèse Source : Keyrus 31

Tableaux e-PMSI LIEN Source : Keyrus 32

Case Mix en GHS (1/3) DRILL Source : Keyrus 33

Case Mix en GHS (2/3) DRILL Source : Keyrus 34

Case Mix en GHS (3/3) Source : Keyrus 35

Valorisation des séjours par unité médicale Source : Keyrus 36

Requêtes libres Source : Keyrus 37 37

Choix des indicateurs métiers Source : Keyrus 38

Affichage des résultats Source : Keyrus 39

Transformation du tableau Source : Keyrus 40

Enregistrement du tableau Source : Keyrus 41

La couche métier MCO Source : Keyrus 42 42

Couche sémantique métier MCO Source : Keyrus 43

Couche sémantique métier MCO CIM10 ENC CCAM RSS RUM TARIFS GHS Structures Couche Physique : Gestionnaire de requêtes intelligent Les sources de données sont renseignées dans le catalogue central à partir du datamart PMSI sous-jacent. Le SQL logique est converti en SQL physique natif et optimisé Source : Keyrus 44

Couche physique : le modèle de données Source : Keyrus 45

Couche sémantique métier MCO Couche logique : Moteur de Calcul La complexité physique est convertie en domaines fonctionnels La déclaration de hiérarchies permet la navigation intuituve dans l’ensembles des tableaux de bord De puissants calculs dérivés peuvent être implémentés Gestion du partitionnement (fragments) et des aggregations Source : Keyrus 46

Couche logique : le modèle en étoile Source : Keyrus 47

Couche de Présentation Couche sémantique métier MCO Couche de Présentation Basée sur les rôles, contextuelle, présentation personnalisée : Oracle Answers Source : Keyrus 48

La “prescription intelligente”

Datamining historique CHRU Lille CHRU Rouen Fichier Plats Outil d’Analyse CH Denain Fichiers CSV Region H

Datamining cible Couche services (SOA) Profil IHE XDS Contenu HL7v3 SIH Dossiers Médicaux Couche services (SOA) Profil IHE XDS Contenu HL7v3 Couche Integration RDBMS Biologie Data Mining results HL7v3 messages Modèle données PSIP Prescriptions Médicament Moteur Data Mining Lettres Accés direct aux systèmes *IHE: Integrating the Healthcare Enterprise *XDS: Cross-Enterprise Document Sharing ETL Extractions spécifiques à chaque hôpital Solution générique pour tous les hôpitaux

Oracle Datamining Résultats Data Mining HL7v3 messages SIH Dossiers Médicaux Biologie Résultats Data Mining Modèle données PSIP Prescriptions Médicament HL7v3 messages Lettres Extractions spécifiques à chaque hôpital Solution générique pour tous les hôpitaux

Knowledge Mining Ontology Engineering Modeling Process Information Extraction Categorization, Feature/term Extraction RDF/OWL OWL Ontologies Processed Document Collection Web Resources Domain Specific Knowledge Base Knowledge Mining & Analysis Text Indexing using Oracle Text Non-Obvious Relationship Discovery Pattern Discovery Text Mining Faceted Search News, Email, RSS SQL/SPARQL Query Objective of the knowledge mining workflow is to provide meaning and better intelligence on the large reams of data coming into the system from unstructured and possibly structured data sources Metadata stored in RDF format and OWL ontologies are used to provide a meaningful way to categorize the underlying RDF data TopQuadrant TopBraid is a market leading tool for to defining ontologies and add new artifacts to evolve the ontologies There are a range of tools for reporting and visualization of graph data and integrating with the geospatial and temporal data Content Mgmt. Systems Explore Analyst Browsing, Presentation, Reporting, Visualization, Query

Applications & Analysis Oracle Knowledge Management Analyser des profils, des tendances et des relations Edit & Transform Load, Query & Inference Applications & Analysis Transaction Systems Unstructured Content RDF/OWL Data Management SQL & SPARQL Query Inferencing Semantic Rules Scalability & Security Graph Visualization Link Analysis Statistical Analysis Faceted Search Pattern Discovery Text Mining Entity Extraction & Transform Ontology Engineering Categorization Custom Scripting RSS, email Other Data Formats This is a canonical semantics workflow Data coming from structured and unstructured sources. A common ontology is used in order to define patterns and relationships across them to relate concepts, terms and map across schemas ETL entities from unstructured & structured data sources OS, CMS, Web, databases Categorize using an ontology load into RDF as triples, infer new relationships using the ontology and query Apply search analytics and decision making tools Oracle Spatial provides the technology for the middle box and Oracle Partners provide the tools for 1st & 3rd boxes as well as UIs for 2nd box Data Sources Partners

Oracle 11g Statistiques et SQL analytiques Fonctions de classement Agrégation par fenêtre glissante (moving and cumulative) Fonctions LEAD/LAG Reporting Aggregate functions Agrégations statistiques Régression Linéaire Statistiques Descriptives Corrélations Matrices Tests d’hypothèses Test de distributions Analyse de Pareto-Levi Highlight new stats?

La santé électronique dans le monde Les initiatives nationales et régionales Sweden: Developing a National Patient Summary Denmark: New National IT-strategy to standardize EHR´s Canada – Infoway set up to design and procure National EHR - $1.2 billion of government backing for regional EHR projects Finland: National eHealht-Archives to be established Netherlands: National Switch Hub Ireland: Procurement contracting has started to drive national EHR effort Russia: 15 Diagnostic Centers project in progress. Plans being developed for national HER for 145 million people. China: Plans to develop a national EHR Germany: One regional deal underway. Future EHR efforts are expected to be regional England: EHR initiative in process, PACS project is imminent USA – Federal ONC NHIN contract underway. Multiple State initiatives for RHIOS. Still emergent – national EHR by 2014 Hong Kong: Territory wide Patient Master Index Spain: Regional initiatives are being considered Singapore: EMR system tender expected Q1 2005 France: EHR mandated by 2007. National RFP has been issued SEE: Bulgaria, Romania, Turkey and Serbia all developing national eHealth strategies. Opportunity Status Mexico: No EHR but aim for HL7 Integration Current Work Italy: EHR regional initiatives have begun Malaysia: Lifetime Health Record (LRH) by 2010 Australia: HealthConnect is developing a National Information Network Planning Chile: National RFP for EHR project is expected soon Brazil: National Health Card Project. Monitor Considering EHR Argentina: 1st adoption of a digital radiography solution- 2004 South Africa: No EHR – but infrastructure being developed Data N/A or No EHR Presence New Zealand: National EHR system in place (complete) * Target opportunities identified by text in red Source: Accenture + Oracle

Agencia Valenciana de Salut Strategic Management with Balanced Scorecard CUSTOMER PERSPECTIVE “Oracle’s Hyperion applications have enabled us to create scorecards at the agency and local level, allowing us to monitor compliance with objectives as well as take correct corrective action, when needed.” Gregorio Gómez, Assistant Director, Valencia Regional Health Agency, Valencia Regional Government The Valencia Regional Health Agency serves more than 5 million individuals through a network of 29 hospitals, 828 primary health care centres, 27 specialist centres, and more than 10,000 doctors. COMPANY OVERVIEW CHALLENGES/OPPORTUNITIES track & monitor compliance objectives of 22 local health departments Align strategy between agency central services, local health departments and their employees Standardize sets of KPIs for key process Facilitate improved employee performance - link performance to pay Single overview of the state of the agency RESULTS each department to manage its own objectives, as well as agency-wide objectives Developed 104 management indicators 87 balanced scorecards and dynamic reports - integrated with 15 agency’s information systems Track management agreement indicators to assess compliance with objectives. Facilitated decision-making and the adoption of corrective measures Improve workforce equality by alignment between departments and inter-department comparisons Enabled a management-by-objectives system Improved internal transparency & competition between departments, fostering performance improvement Slide Instructions: Create as many Customer Success Profile examples (1 slide each) as necessary; provide a minimum of three (3) Customer Success Profiles. SOLUTION Oracle’s Hyperion Performance Scorecard Oracle Hyperion Interactive Reporting Oracle Database Enterprise Edition Oracle Partner: Agensys Technology

Valencia case study

Valencia case study

Valencia case study Days 2005 2006 2007

UK Biobank Epidemiology Monitoring Monitoring 500 000 people in age range 40 -69 Dedicated assessment centers throughout UK Explicit broad consent Detailed lifestyle and health questionnaire Physical measurements Collection of blood and urine samples Follow-up participants health Time span of 20-30 years Information from multiple sources Medical records Biological samples Environmental information Using Oracle HTB and other products Not 100% epidemiological monitoring example

SISTEMAS ASISTENCIALES Andalucia Healthcare Information System Cuadro de Mando Integral POLÍTICAS Misión Global 1 Indicadores Inductores Evolución Estrategias de Optimización GESTIÓN Desarrollos Tácticos y Operativos Ciudadanos Gestores Información para la Planificación y Toma de Decisiones Demanda de Servicios Productividad y Eficiencia Infraestructuras y Logística Vigilancia Epidemiológica 2 Estadísticas Reports Comparativas Actividad Quirúrgica Actividad Farmacia Actividad Socio Sanitaria Recursos Humanos Económico-Financiero Información para la Actividad Sanitaria Vigilancia de la Salud y Gestión Operativa SISTEMAS ASISTENCIALES Historia de Salud Digital Cita Centralizada Contact Center de Salud Gestión Hospitalaria Gestión SocioSanitaria Segunda Opinión Gestión Imagen Médica SISTEMAS DE GARANTIA SISTEMAS DE SALUD PUBLICA 3 Receta Electrónica Tarjeta Sanitaria Gestión Incapacidad Temporal Gestión de Listas de Espera Portal de Salud Central de Compras Mapa de Recursos Sanitarios Centros Coordinadores de Emergencias Redes de Alerta Sanitaria Sistemas de Control de Enfermedades Infecciosas Sistemas de Control de Drogodependencias Hojas de Consulta Actos Clínicos Pruebas diagnósticas Recetas Datos Básicos del Sistema de Salud y Población 4 Hospitales Médicos Asegurados Base de Datos de Usuarios/Tarjetas Base de Datos de Recursos Sanitarios Base de Datos de Historia Clínica Base de Datos Cartográficas Base de Datos de Imágenes Médicas

London Imperial College - Toumaz Sensium Sensor interfacing Wireless transceiver Local processing filtering data Lots of fuzzy and uncoordinated data Personal DA Wireless network coordinator Personal information Local database Moderate but somewhat processed data Health database Authorized (HL7) Combined Aggregated High qulaity Data prepared and mined For health personnel Distribute information processing