Tatiana Abreu Personal Assignment Enterprise Resource Planning Systems L000CG09-3002

Helsinki Metropolia University of Applied Sciences Master’s Degree Master’s Degree Programme in Business Informatics Final Assignment – ERP Systems 01.12.2016

Abstract

Author(s) Title Number of Pages Date

Tatiana Abreu Personal Assignment 13 pages (included 2 pages of Figures) + 2 References 1st December 2016

Degree Master’s Degree

Degree Programme Master’s Degree in Business Informatics

Specialisation option ERP Systems, Final Assignment

Instructor(s) Sakari Lind, Principal Lecturer

The assignment tries to contextualize the Apotti Project and an alternative proposal based on multiple suppliers to provide social and healthcare ecosystem. A current state analysis on healthcare modus operandi is provided and the need of innova-tion has been put into the test for the past ten years. Artificial intelligence plays an important role in data gathering, a long-term issue to the healthcare business, thus analysis, diagnosis and preventive actions. Big players such as IBM and SAP are devoting their teams and system to drive a technology disruption in the sector thru integrations and cognitive capabil-ities. Numerous start-ups blossoming up to get their share on this trillionaire industry. Countries and municipalities work local projects to achieve little by little the challenging goal of healthcare ecosystem. Apotti Project is dedicated to Helsinki and some nearby munici-palities and relies on Infosys and Accenture to its implementation. S-Care Project is the alternative suggested ecosystem which is based on available technology and it tries to unify different solutions – from wearables to hospital management – to a better understanding of the big picture, increase trackability, reducing costs and delivering a more efficient service. Keywords ERP, Healthcare, Ecosystems, Technology, IoT, IoHT

Contents 1. Introduction 2 2. Current State Analysis 2 2.1 Current Modus Operandi in Healthcare 2 2.2 Digital Healthcare challenge: how to reduce costs and 3 be more effective? 2.3 The role of Internet of Things (IoT) in Healthcare 3 2.4 Healthcare Applications: big IT players’ main initiatives 5 2.4.1 IBM Watson 5 2.4.2 SAP Connected Care 7 3. Apotti x S-Care Proposal 9

3.1 Main objectives and coverage 9 3.2 Apotti Project 9 3.3 S-Care Proposal 11

4. Conclusions 15 4.1 Summary 15 4.2 Conclusions 15

References 17

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1 Introduction This personal assignment will address an alternative fictitious proposal in line with the scope of the social services and healthcare covered by project Apotti in Helsinki area. The idea is to suggest an ecosystem which does not rely in one single solution, not in one single system provider. The referred proposal will count on real initiatives already being tested and on available literature. A current state scenario – healthcare modus operandi and available technology - will help to understand the big picture and an anal-ysis on both projects with be provided. For the conclusions, a forecast scenario must be considered and some projections and figures will be revisited to create a possible vision of the future.

2 Current State Analysis 2.1 Current Modus Operandi in Healthcare Healthcare may be the one that maintains one of the oldest model in business. Technol-ogy intervention was classified as distance and with inaccurate results. Although busi-ness model was old/fashion it was yet very profitable. Reservation system, consultation by the hour and expensive machine images, videos and reports have been an effective formula to guarantee the return on the investment. But seems that the lack of patient’s background and untrack diagnosis became one of the main issues on productivity for the business. Medical facilities and practitioner’s shifts are becoming more and more ex-hausted by the large number of patients and the lack of information to coordinate actions and decision making in a short period. Rather than being profitable, businesses are demanded to be smart. The smart concept touches the combination of tools and strategies that can benefit from efficiency, low costs and better conditions to customers and service providers. Healthcare services in some countries already realized that digital transformation could be one of the main drivers to the change. Let’s explore a bit more on the main challenge and the initiatives from solu-tion big players.

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2.2 Digital Healthcare challenge: how to reduce costs and be more effective? A global structural change is taking place in healthcare: how care is financed, where and how it is delivered and the role of individuals (patients, practitioners, researches) are all changing (IBM 2016). The system or business is now focused on value, a moto that can be applied to any company willing to survive in any given nowadays market: better quality service with the most affordable cost. This change needs to fits also the criteria of transparency and data management. Specially towards data management, an average person generates more than 1 million gigabytes of health-related data in his lifetime and an estimated growth rate of doubling information every 73 days (IBM 2016). An unprecedented challenge considering its broad application and coverage. Thanks to IoT an ecosystem can be created to include all new features on monitoring, collecting and analysing data thus reducing costs on tracking and diagnosing diseases via face-to-face appointments and laboratory and equipment results, reducing facilities expenses and using human and artificial intelligence to better suggest treatments. 2.3 The role of Internet of Things (IoT) in Healthcare One main concern is towards data source, volume and variety: the modern age paradox of too much data, too little insight (IBM 2016). Although data is the main concern to the development of efficient modus operandi, a more holistic project orientation is expected to take place. A business perspective on IoT could be dividend in three broad groups: strategic asset management, costumer experience and product or service experience (SAP/IDC 2016). First group is about how increase performance, efficiency, safety and security of assets. Monitoring the status, location and movement of physical assets owned by the organi-zation. Second group is the key drive for industry transformation: how provide a contex-tualized and personalized customer experience benefiting from data collection whether is it a consumer or employee. Focus on the experience, as well as physical safety and security. The last one is related to the enhancement of a product or on the delivery of a service based on a IoT-enabled product. Collaboration, shared systems and extended on information chain, whether from machine-to-machine or machine-to-human. This last

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one can boost customer experience as well, although main goal is to improve the product or service. The consequence or result is more and more visible in high tech products due to the imperative user friendly concept. From another perspective (SAP 2016) the same holistic view is represented by a dis-rupting healthcare business models, i.e., the accommodation of digital technology, from wearables to large ecosystems of digital apps in the cloud and IT partners. A shift from reactive to preventive treatment and a health ownership generation, where their health responsibility is shared with caregivers. Besides that, ongoing treatment can be sup-ported by Remote Patient Monitoring (RPM) when sensors can remotely monitor pa-tient’s real time conditions and doctors can act often in an early stage, enough to prevent further damage. From executive and management board perspective, while conducting some empirical data gathering, it was shown that healthcare executives are aware of the challenge and the need of a drastic change. Big numbers represent the orientation towards IoT im-portance and impact, the intention of investing in the technology and operational model transportation:

- 84% of healthcare executives familiar with cognitive computing believe it will play a disruptive role in the industry (IBM 2016)

- 81% believe it will have a critical impact on the future of their business (IBM 2016)

- 58% of companies think IoT is strategic (SAP/IDC 2016) - 95% intend to invest in cognitive capabilities (IBM 2016) - 33% of all industry leaders disrupted by digitally enabled competitors by 2018

(SAP/IDC 2016) IDC Health Insights forecasts that by 2020, 80% of consumer service interactions will use IoT and big data and analytics to improve quality, value and timeliness of care (SAP/IDC 2016).

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2.4 Healthcare Applications: big IT players’ main initiatives Some big IT players such as IBM and SAP are heavily investing in healthcare ecosys-tems. Each system brings different approaches to be combined with ecosystems of part-ners from cognitive capabilities to digital enterprises.

2.4.1 IBM Watson At IBM Watch dedicated page, you can make a simulation on the best scenario and Watson solution for your healthcare business. For this assignment, I have recreated a possible scenario considering that would be the priorities based on literature and empir-ical data gathering. The result is the suggested solution to a generic healthcare business which has no digital transformation process ongoing. In self-assessment section, priorities were ranked as below:

1. Improving the customer experience at every point 2. Collecting all available data to make it more useful 3. Driving innovations for our applications and services

Besides that, I (strongly) agree with the statements below:

- I want to understand multiple streams of data to guide strategic planning for our company

- Ensuring that customers have a satisfying and productive experience each time they engage is imperative

- I actively pursue innovation through new development tools and get hands-on with the code to advance our mission

In my challenge section, I stated my business challenge as data gathering and insights, statement embedded in all reports about the healthcare. In my IT section, priorities were ranked as below:

- Innovation and process improvement - Intelligence search - Voice of the consumer

Moreover, some questions about my IT infrastructure:

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- Percentage of unstructured data you can act upon – 0% to 10% - How reliable is your customer service automation platform- does not apply since

we do not have a self-service platform - Adopting cognitive APIs would improve our offering – mostly agree

In my role challenge, I stated insights as the main challenge representing a practitioner or doctor role. In my business goals, I have strongly agreed with the statements below:

- Our organization is looking to quickly create and deploy apps in a hybrid cloud environment while cutting costs

- We plan to analyse contextual customer sentiment (i.e. joy, anger, frustration, etc.). to create personalized communications.

- To pursue high-value initiatives, we must automate intensive structured and un-structured data analysis.

- It is important that our technology platform unite data silos and enable advanced content analytics.

- Resolving customers’ issues quickly improves customer satisfaction while reduc-ing costs

- Accessing APIs that can reveal relationships and expose trends would allow my organization to be more responsive to the marketplace

IBM works with three different approaches with Watson:

- Watson Explorer - Watson Virtual Agent - Watson Developer Cloud

The key point of Watson Explorer is the need to enhance, accelerate and scale enter-prise search and discovery capabilities with smart automation to improve employee productivity (IBM Watson 2016). For Watson Virtual Agent the main issue is shifting demographics and mobile technolo-gies have rewritten the rules of engagement; customers expect to be able to interact with companies when they want, how they want and where they want (IBM Watson 2016).

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And finally, for the Watson Developer Cloud, within a disrupt-or-be-disrupted business climate, there is no substitute for deepening relationships with customers, knowing them better than competitors and acting swiftly and securely on game-changing ideas and innovations (IBM Watson 2016). Based on the survey above the suggested solution was Watson Virtual Agent which main goal is to help customers by implementing better self-service through an interactive vir-tual agent that understands and engages in natural language offering the best matches recommendations and insights. Watson has been implemented in 25 countries and 20 different industries. Healthcare projects dedicated to cancer and oncology treatments are experimenting that are the benefits that Watson can bring to them.

2.4.2 SAP Connected Care SAP has a broader concept to its business. Their solution cover from healthcare analytics and electronic medical records (EMR) to health information exchange (HIE). Their prom-ise is to deliver leading technologies to build effective information systems, practice evi-dence-based medicine – and improve overall patient experience (SAP Healthcare 2016). They rely on their accredited know how and expertise to offer dedicated healthcare eco-systems embedding the concepts of patient care, care collaboration, healthcare analytics and research, human resources, finance, sourcing and procurement and platform and technology. They state that the future of health care is simple as seen in Figure 1.

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Figure 1. Run Simple in Healthcare (modified) How do SAP solutions help with this new healthcare reality. Source: www.go.sap.com SAP works closely with their partners such as Lenovo, Accenture, Hewlett Packard En-terprise (HPE), Infosys – which involvement in Apotti project will be address in Chapter 3 – and TCS. These partners have conducted interesting research, findings and making them available through thoughtful and inspiring articles on the issues below (SAP 2016):

- Customer engagement - patients profile and their interests in monitoring tools, for example)

- Big data challenge - volume, source, diversity, unstructured content, and so one - New order in healthcare business model - lean innovators, value innovators,

around-the-patient innovators and new health digitals - New partnerships – medical devices and technology companies together with

pharmaceutical firms, healthcare providers managing risk with life sciences com-panies and much more

- Customer Experience in Digital Era – switch on healthcare providers due to better experience

- Healthcare Complexity – recognition of a very complex ecosystem by the IT pro-viders which and the need to for architectures and platforms where several tech-nologies can work together from both a technical and business perspective.

These findings will be the starting point for the suggested proposal in the Chapter 3, the main goal for this assignment. I am convinced that the findings on the issues above can lead to an alternative project where cooperation and integration are the main drivers to a successful implementation of an ecosystem for healthcare businesses. Rather than counting on a single provider, the strategy will be focused on several initia-tives that together can work in synergy to deliver a clear big picture based on diverse source of data, cognitive interpretation on unstructured data, data analysis (pattern and deviation) and suggested actions and insights.

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3 Apotti x S-CARE Proposal 3.1 Main objectives and coverage Apotti Project main objective is to implement a system that is cohesive enough to cover social services and healthcare, a new perspective for their process thus improving their quality. Practitioner’s and treatment backgrounds will be the starting point for blueprint. Main current issues are related to data gathering which is not structured in a way to support doctors’ decisions making processes. The project advocates not only a system implementation but also a change in social services and healthcare operations. Infosys and Accenture are the chosen partners to conduct the project (Apotti 2016). In the new information and operations management system will be applied to Helsinki, Vantaa, Kirkkonummi, Kauniainen and Hospital District of Helsinki and Uusimaa (HUS). The suggested alternative ecosystem described in Session 3.4 can be applied in a na-tional basis. 3.2 Apotti Project Back in 2013, the R&D director for Apotti, Heikki Onnela, during a conference in Dublin presented the main reasons to purchase and adopt a client and patient IT-system with high international standards and explain why one system:

- Unified solution available to all practitioners - Customer oriented processes - Cross regional treatments and plans protocols - Standardized clinical context and work flow - Reduced number of different IT systems - Centralized 24/7 support - Single interface (customer portal) and services

The following figures represents the systems integrations (Figure 2) and processes in-teractions (Figure 3).

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Figure 2. Apotti (Asiakas - ja PotilasTietojärjestelmä) (Client and Patient data system) Program, slide 9. Source: www.slideshare.net In Figure 3 we can notices that interactions are broad. Apotti suggests from specialities branches such as oral care, intensive care units, laboratories, births, anaesthesia as well as catastrophe emergency case management, decision support and order payments as well.

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Figure 3. Apotti (Asiakas - ja PotilasTietojärjestelmä) (Client and Patient data system) Program, slide 10. Source: www.slideshare.net From an ecosystem point of view some important interactions “out of consultation ap-pointment / visit” might not be covered. From my understanding, new technologies could be integrated such as wearables and monitoring apps as well as triggers in analytics tools so practitioners could act in a more preventive way since the main approach of the project is to put the patient in the centre of its operations. A cloud based server can collect all information from different sources and their analytics tools can combine data, come up with conclusions and suggest scenarios and decisions. The next section will introduce the aim of this assignment, an alternative proposal to the Apotti project finding out how similar social services and healthcare could be built with available technology being cost-effectively and without committing to one system sup-plier. 3.4 S-CARE Proposal This alternative proposal aims to collect information and act before hand utilizing top notch technology which has being already applied to many other sectors such as fitness and diet and tools that use cognitive computing to decode social media sentiment and interpret unstructured data. The main objective is to provide a comprehensive ecosystem which could mirror real life into a manageable system where data is transformed into

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patterns and deviations and help practitioners to take the best decisions based on a holistic analysis. An infographic is available for a better visual understanding. A step by step and a referral system to each step is provided as below as well as examples of ongoing technologies. The ecosystem embeds the following structure: Lifestyle management, monitoring and wearables – the main idea is to use remote mon-itoring tools to provide detailed patients information in a daily basis. Combined data from blood pressure, sugar levels, sleep data could be tracked as well as unstructured data provided or where the patient interacted or reacted such as in social media. Some com-panies such as Wellframe which works mainly in behavioural health and chronic care management, IBM Watson uses cognitive capabilities to interprets unstructured data and Ai cure confirms medication ingestion. Insights and risks management – analytics tools based on algorithms help identifying risk patients. Data gathered in step 1 are fundamental for this process. Low risks patients can be coordinated through text, email or phone call to assist him/her in a faster way. High risks patients are taken to the next level and/or analysis are studied by a specialist or dedicated doctor. Cloudmedx provide the features above as well as cost utilization which tracks organization’s spending in real time. Apixio and Health Fidelity are compa-nies providing similar services. Medical images, diagnostics and drug discovery – patients and practitioners need to count on machine expertise when it comes to images, laboratories, analysis on samples, and more. In addition, chemistry research and drug development to minimize or cure a specific illness or its side effects. The whole health supply chain is affected through dis-ruptive ecosystems. Technologies are known earlier and everybody can benefit from it. Pharma industry is aware of how artificial intelligence can play an import role in their business, cooperation instead of competition can be the word of order from now on. Big players in pharmaceutical industry such as Merck is working in Atomwise, an American start up, on the drug discovery replacing test tube with supercomputers (Atomwise 2016). Emergency room and Hospital Management – practitioners, based on analytics tools and insights, can decide whether patients should be hospitalized or even kept home under

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supervision. Depending on the risk, local health centres could be enough for assistance or directly sent to a specialist care. SAP as mentioned before, is a big player and working close to important hospital to provide insights and ERP solutions. To another extend, if the decision is extreme and surgery is involved some start-ups such as Gauss Surgical which measure blood loss during a procedure, for example. Risk management is applied to into a more realistic and hands on experience. Figure 4 shows how these processes are integrated. The concept is simple: more ac-countability from patients’ side and more predictability to support practitioners. Commu-nications is facilitated by alerts and pro-active workflow whenever needed. The feeling of accomplishment from practitioners’ side increases when they have time and data to analyse what could be the best medicine, treatment or even save more lives. Every pa-tient can finally have their own needs fulfilled (children care, elderly care, pregnant care, chronic diseases care, etc). Health finally demystified, consciousness and easy to track.

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Figure 4. Introducing S-Care: Shared Care Social and Healthcare Ecosystem. Source: www.magic.piktochart.com

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4 Conclusions 4.1 Summary

The assignment tries to contextualize the Apotti Project and an alternative proposal based on multiple suppliers to provide social and healthcare ecosystem. A current state analysis on healthcare modus operandi is provided and the need of inno-vation has been put into the test for the past ten years. Artificial intelligence plays an important role in data gathering, a long-term issue to the healthcare business, thus anal-ysis, diagnosis and preventive actions. Big players such as IBM and SAP are devoting their teams and system to drive a technology disruption in the sector thru integrations and cognitive capabilities. Numerous start-ups blossoming up to get their share on this trillionaire industry. Countries and municipalities work local projects to achieve little by little the challenging goal of healthcare ecosystem. Apotti Project is dedicated to Helsinki and some nearby municipalities and relies on Infosys and Accenture to its implementation. S-Care Project is the alternative suggested ecosystem which is based on available technology and it tries to unify different solutions – from wearables to hospital management – to a better understanding of the big picture, increase trackability, reducing costs and delivering a more efficient service. 4.2 Conclusions Artificial Intelligence is an irreversible trend which has a substantial impact in everyday lives. That would not be different towards our health and the way we manage it nowa-days. Robotics, deep learning, neural networks seems to call to awareness and account-ability when it comes to our own health: machines remembering us who limited we are and unlikely that technology does to us now (mainly thinking and acting in our behalf), this time, it is merely our virtual guardian angel, evaluating and advising our behaviour. Practitioners are thankful for 24/7 guidance since they are as well patients at some point and their duty is limited.

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A study conducted by the Standing Committee found no cause for concern that AI is an imminent threat to humankind. “Instead, increasingly useful applications of AI, with po-tentially profound positive impacts on our society and economy are likely to emerge be-tween now and 2030” (AI 100 Stanford 2016). This statement is part of The One Hundred Year Study by the Association for the Ad-vancement of Artificial Intelligence (AAAI) which aiming to provide a report on the matter every five years to assess the current state of AI. To conclude the adoption of AI is primarily a society adoption that can be faced with fear and suspicion which will slow down AI’s development or drive it underground thus some barriers on safety and reliability with be presented. On the other, an open-minded ap-proach beneficiating and profoundly transforming society, uniting and enhancing human experience. Are you ready for the future?

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References

1. SAP/IDC 2016, White Paper – IoT and Digital Transformation: A Tale of Four Industries. Available from: http://go.sap.com/documents/2016/05/0eea93b3-707c-0010-82c7-eda71af511fa.html [23 November 2016]

2. IBM 2016, The Future of health is cognitive. Available from: http://www-

01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=HLW03025USEN [23 No-vember 2016]

3. SAP 2016, Connected Care The Digital Pulse of Global Healthcare. Available

from: https://ebooks-sap.com/index.php?book=connected-care [23 Novem-ber 2016]

4. IBM Watson 2016, Watson Solution Guide. Available from: http://www.ibm.com/watson/whitepaper/solutions-guide/#/watson-developer-cloud-mandate-for-change [24 November 2016]

5. SAP Healthcare 2016, Solutions by Industry: Healthcare. Available from:

http://go.sap.com/solution/industry/healthcare.html [24 November 2016]

6. Apotti Aikaa Ihmisille 2016, What is Apotti?. Available from: http://www.apotti.fi/en/what-is-apotti/ [29 November 2016]

7. LinkedIn Slide Share, Apotti (Asiakas - ja PotilasTietojärjestelmä) (Client and

Patient data system) Program. Available from: http://www.slideshare.net/SitraHyvinvointi/renko-and-onnela-apotti-pro-gramme [29 November 2016]

8. Figure 1 Run Simple in Healthcare (modified) How do SAP solutions help with

this new healthcare reality, SAP 2016. Available from: http://go.sap.com/doc-uments/2015/02/c6e07dc3-187c-0010-82c7-eda71af511fa.html [24 Novem-ber 2016]

9. Figure 2 Apotti (Asiakas - ja PotilasTietojärjestelmä) (Client and Patient data

system) Program, slide 9. LinkedIn Slide Share. Available from:

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http://www.slideshare.net/SitraHyvinvointi/renko-and-onnela-apotti-pro-gramme [29 November 2016]

10. Figure 3 Apotti (Asiakas - ja PotilasTietojärjestelmä) (Client and Patient data

system) Program, slide 10. LinkedIn Slide Share. Available from: http://www.slideshare.net/SitraHyvinvointi/renko-and-onnela-apotti-pro-gramme [29 November 2016]

11. Figure 4 Introducing S-Care: Shared Care Social and Healthcare Ecosystem.

Created from: http://www.magic.piktochart.com [29 November 2016] 12. Wellframe Solution, Wellframe 2016. Available from:

https://www.wellframe.com/solution [29 November 2016] 13. Aicure 2016. Available from: https://aicure.com/ [29 November 2016] 14. Cloud Medx 2016. Available from: http://www.cloudmedxhealth.com/medxin-

sights [29 November 2016] 15. Atomwish 2016. Available from: https://www.atomwise.com/ [30 November

2016] 16. AI 100 Report, AI 100 Stanford 2016. Available from: https://ai100.stan-

ford.edu/sites/default/files/ai_100_report_0831fnl.pdf [01 December 2016]