Healthcare Global - September 2014

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S e p t e m b e r 2 0 14

CDCChanging Warns Hospitals

The Face Of the TheHarnessing Health power of Big Data Insurance Industry to improve emr system

Top 10 Healthcare stocks to watch

Changing the face of the Health Insurance Industry

edi t o r ’ s c o mme n t

Predicting the future through formulation T h e U n i t e d S tat e s h a s

seen a plethora of changes

within the health insurance industry throughout the years, but most recently it has undergone some extensive innovations due to the inauguration of the Patient Protection and Affordable Care Act. We go in depth on these drastic measures and how they’re affecting health insurance companies in today’s market in our feature The Changing Face of the Health Insurance Industry.

In this issue we also examine the current methods hospitals are employing when it comes to their EMR systems.

According to the Centers for Disease Control, they’re falling short when it comes to deployment.

We then take a look at Robert Szczerba’s ideology on how healthcare should employ certain practices from the aviation and gaming industries and report on how big data can leverage medical professionals’ insight into current health trends. We wrap up the September issue with the top 10 healthcare stocks that remain well positioned to deliver market-topping returns.

We hope you enjoy this issue and wish you the best of health!

Stephanie C. Ocano Editor stephanie.ocano@wdmgroup.com 3

C o n t e n ts

Features

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8 Hospitals

Technology Harnessing the Power of Big Data for Healthier Cities

Top 10

Healthcare Stocks To Watch

CDC Warns Hospitals to Improve EMR System

14 22 Finance

Supply Chain

The Changing Face of the Health Insurance Industry

Re-Engineering Healthcare with Aviation, Gaming Industries in Mind

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h o s p i ta ls

Electronic medical record (EMR) systems enable hospitals to store and retrieve detailed patient information to be used by healthcare providers across care settings. Embedded clinical decision support and other tools have the potential to help clinicians provide safer, more effective care than by relying on memory and paper-based 8

September 2014

systems.

EMRs allow clinicians to track data over time, easily identify which patients are due for preventive screenings or checkups, check how patients are doing on certain parameters and monitor and improve the overall quality of care within a practice.

As the percentage of providers

CDC Warns Hospitals to Improve EMR System The Centers for Disease Control does not routinely tell hospitals how to run their operations, but with increasing reports of EHR deployment problems, it now sees the need to act Written by: Ste phan i e C. Ocano

using EHR systems has significantly increased over the last decade, there is concern that EHR system-related patient safety events may also be on the rise. Recently, reports of deployment issues have come to the attention of the Centers for Disease Control (CDC).

“Some hospital laboratories have legacy information systems that

do not even have the ability to use current coding,” Megan Sawchuk, lead health scientist for CDC’s office of public health scientific services, told Healthcare IT News.

Outdated software is only one of the problems that the CDC notes. There are also issues involving staff time and expertise. The fact that different medical facilities use different codes 9

h o s p i ta ls for the same tests is particularly problematic for physicians who work in multiple practices and hospitals.

“We have to develop a simpler coding system that balances the clinician’s need to consistently order the right test with the laboratory’s need to show unique aspects of testing when necessary,” added Sawchuk. “There are pros and cons on each side, but ultimately we want to make it easy for clinicians to order and interpret the right test for the patient.”

Creating consistent codes, however, would require multiple changes by staff.

Staff would first need to have the time to learn code, and then additional time to implement it, stated Sawchuk.

This would require additional personnel, which small settings, especially rural hospitals, are highly unlikely to have.

In a recent report, the CDC found that many of the EMR issues could be attributed to system design.

Specifically, the lack of IT participation in design details prior to rollout.

“End users are not yet sufficiently involved in the early stages of [EHR] design, including innovation in display design and workflow analysis, and 10

September 2014

‘As the percentage of providers using EHR systems has significantly increased over the last decade, there is concern that EHR systemrelated patient safety events may also be on the rise’ that creates problems with their ability to effectively understand and use the information,” Sawchuk said.

One example she noted tied display preference with a patient not being treated for a life-threatening disease.

Laboratory data is typically displayed in reverse chronological order, with the newest results on top. One EHR had the default setting as chronologic. A young woman’s abnormal pap smear results went undetected for four years due to a usability issue with her physician’s EHR system. Due to a default setting, the system presented the physician

C D C W ar n s H o spi t als T o I mpr o v e E mr S y s t em

Outdated software is one of the major components to deployment issues with the patient’s previously normal laboratory result and the most recent abnormal result went unnoticed. The young woman’s advanced cervical cancer was only detected when she sought treatment for other symptoms that had developed. As a result of the delay in diagnosis and treatment, the young woman had a hysterectomy.

“Had a clinician provided input during development of the system, or even during implementation, this patient safety event could have been avoided,” said Sawchuk.

Additional examples the CDC reported of EHR interoperability and

display issues included: • Hard-coding of data elements in the EMR system, such as reference ranges and unites of measure, which can cause errors when the reporting laboratory does not use the same values • Truncation of text and long number strings causing incompleteness of data when the laboratory and EMR system have different maximum character limits for fields • Allowable special characters causing unusual system behaviors, such as displaying gibberish or stopping interface communications 11

h o s p i ta ls • Inconsistencies in design of alerts, flags, and color-coding between systems causing user confusion • Inconsistencies between the printed version of laboratory reports and the user-screen display causing user confusion Patient Safety Organizations (PSOs) are also identifying patterns of safety concerns associated with the adoption

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September 2014

of health IT. Recognizing that such errors can occur without health IT systems, there is cause for concern as an occasional error in a health IT system can be replicated very quickly across a large number of patients.

Combining documented patient safety events with the anecdotal evidence shared by individual laboratory professionals across the U.S. presents enough concern to warrant further

C D C W ar n s H o spi t als T o I mpr o v e E mr S y s t em

investigation and mitigation.

Currently, there is no single place for health IT issues to be reported, pointing to the best option being the Health IT Safety Center proposed through FDASIA, according to Sawchuk.

Data centralization is vital because it is the only way to retrieve the data that is needed to fix the system, argues Sawchuk.

EMR systems provide significant advantages for managing laboratory information as structured data compared to paper records or electronic versions of paper records. The use of structured data substantially improves accessibility

and portability of health information, local and national surveillance programs, and clinical decision support tools. Thus, it is important for laboratory and other healthcare professionals to invest their time and effort now in the development of consensus-based information exchange standards.

While the problem looks deceptively easy to resolve given the widespread agreement that naming and preference standardization is needed, the answer lies in getting hospitals to agree on the consistent format and funding short-staffed hospital administrators who have limited resources to make such changes.

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finance

The Changing Face of the Health Insurance Industry The Affordable Care Act is helping Americans access the care and coverage they need. At the same time, states and the Obama Administration are moving forward to continue holding insurance companies accountable, working with health care providers to improve care for patients, and creating new health insurance marketplaces Written by: Ste phan i e C. Ocano

The health insurance industry has seen a number of changes throughout time, and with it, some challenges. Federal state legislative and regulatory reforms, demands of more price- and serviceconscious customers, shift of customer mix and uncertain economic conditions are just a few to be named.

Despite these challenges, however, the industry continues to thrive.

Major players such as Cigna, Wellpoint, Humana, Health Net, UnitedHealth Group and Molina Healthcare have reported unfaltering growth in premium as well as fees and other income over the years.

According to a report by the American

Association of Orthopedic Surgeons, a 14 percent increase in revenues came from these insurers on a combined basis in the first quarter of 2014.

The health and medical insurance industry is integral to the United States economy, with health expenditures accounting for approximately 18 percent of the country’s annual gross domestic product, according to the Centers for Medicare and Medicaid Services. The World Health Organization has also stated that healthcare expenditure per person in the United States is the highest in the world.

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finance But despite the large amount of money spent on health care, the quality of care was inferior and millions of Americans lacked health insurance coverage or were underinsured.

To expand coverage, President Obama introduced drastic healthcare reforms in March 2010. The Patient Protection and Affordable Care Act required that all individuals have health insurance come 2014 and that those with low and middle incomes who do not have access to affordable coverage through their jobs will be able to buy coverage with federal subsidies.

The reform was aimed at offering coverage to the 32 million uninsured

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‘The health and medical insurance industry is integral to the United States economy, with health expenditures accounting for approximately 18 percent of the country’s annual gross domestic product’ Americans, expanding coverage for customers with pre-existing health conditions and a check on health insurers. Significant provisions of the legislation mandated coverage requirements, greater investment in health IT, rebates to policyholders based on minimum benefit ratios, and reduction in federal assistance on Medicare Advantage.

The reform had a rough start, with opponents challenging its individual mandate and Medicaid expansion clause and taking it to court. Insurers lobbied against the provisions but the law survived the challenges with

Protesters march to the Oklahoma capitol building to demonstrate their support for President Obama’s health care plan on September 13, 2009 in Oklahoma City, OK the Supreme Court upholding the constitutionality of individual mandate.

Price Discrimination The Affordable Care Act places restrictions on an insurer’s ability to discriminate prices. The act allows insurers to only charge limited differential prices on certain factors.

Although insurance companies can rate on age, the oldest adult in the risk pool cannot be charged more than three times as much as the youngest adult. Similarly, smokers

can be charged no more than 1.5 times as much as non-smokers. The end of price discrimination will lead to healthy competition between players.

Insurer Profit Caps Medical Loss Ratio (MLR) is a measure of the share of premiums that an insurer actually spends on delivering care to policyholders, rather than on administrative costs, marketing, and profits. The minimum MLR mandate established by the Affordable Care Act aims to control the portion of premium 17

finance that goes toward non-medical expenses such as administration, marketing, overheads and profits.

The MLR is set at 85 percent for the large group market and at 80 percent for the small group market.

This provision will lead to limited bottom-line growth as carriers

will be forced to spend a minimum amount on the insured, with failure to abide leading to carriers rebating the excess money back to the insured or lowering the premium.

Pre-Existing Conditions Before, it was common among insurers to deny coverage to applicants with a pre-existing disease. In doing so, claim payments were kept at bay.

With the Affordable Care Act in place, insurers must cover individuals regardless of any pre-existing conditions. This will lead to lower profit per policy as previously, individuals with pre-existing conditions were charged two to five times higher than those with average health.

With the Affordable Care Act in place, insurers must cover individuals regardless of any pre-existing conditions.

The C ha n gi n g F ace o f t he H eal t h I n sura n ce I n dus t r y

‘Over the next few years, growth opportunities for insurance players will be driven by greater reliance on managed care’ In the fourth year of its implementation, uncertainty relating to the Affordable Care Act reform seems to be cleared up. Insurers, however, are seeking new ways to prosper in the changing industry, with various players looking to international markets.

Lesser regulations, higher margins, greater demand and lower competition are key foreign attractions.

Companies such as Cigna and Aetna already have a wide overseas presence, and view their international business as a positive differentiator amongst peers. Both companies intend to penetrate deeper into the emerging economies of Asia and the Middle East.

In April, Aetna bought U.K.-based InterGlobal, which offers private medical insurance to groups and individuals in the Middle East, Asia, Africa and Europe. Similarly,

UnitedHealth has also expanded its reach to Brazil with the purchase of AmilParticipacoes. It shouldn’t come as a surprise if more international deals begin to surface.

Over the next few years, growth opportunities for insurance players will be driven by greater reliance on managed care. According to estimates from the Office of the Actuary at the Centers for Medicare and Medicaid Services, aggregate health care spending in the United States will grow at an average annual rate of 5.8 percent, or 1 percent faster than the expected GDP growth. Moreover, managed care penetration is expected to grow to about 50 percent of the total national health care spending, up from approximately 33 percent at present on increase reliance on insurers for Medicare and Medicaid products.

Starting in 2014, Affordable Insurance Exchanges will make it easy for individuals and small businesses to compare qualified health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs.

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U.S. Healthcare Reform through the Years 1900s – Organized Medicine Takes Shape The American Medical Association gains powerful influence as the national organization of state and local associations. Unlike European countries, U.S. policymakers find little value in health insurance.

1912 – Concept of Health Insurance Promoted Social insurance, including health insurance, gains public attention when Teddy Roosevelt and his Progressive Party campaign focus on the issue.

The American Association for Labor Legislation also publishes and promotes a draft bill for compulsory health insurance, but the effort is derailed when the U.S. enters WWI.

unemployment insurance and “old age” benefit. President Franklin Roosevelt creates the Committee on Economic Security to address these issues as well as medical care and insurance but when the Social Security Act is passed, health insurance is omitted. The American Medical Association strongly opposes a national health insurance program.

1944 – FDR Proposes “Economic Bill of Rights” In his State of the Union Address, President Franklin Roosevelt outlines an “economic bill of rights” that includes the right to adequate medical care and the opportunity to achieve and enjoy good health. During WWII, businesses begin to offer health benefits as they compete for workers.

Health Insurance Baylor Hospital in Dallas, Texas, starts a prepaid hospital insurance program with a local teachers’ union and creates what is thought to be the nation’s first example of modern health insurance.

1945 – National Health Insurance Condemned Shortly after becoming president, Harry Truman proposes a broad health care restructuring that includes mandatory coverage, more hospitals, and double the number of nurses and doctors. Denounced by the American Medical Association and other critics as “socialized medicine,” his plan goes nowhere in Congress.

1934 – New Focus with Hard Economic Times The Depression shifts attention to

1946 – Discrimination Barred in Hospital Care The Hill-Burton Act pays for the

1929 – A Model for

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The C ha n gi n g F ace o f t he H eal t h I n sura n ce I n dus t r y

construction of hospitals, especially in rural areas, to close the gap in medical care. It also prohibits discrimination on the basis of race, religion, or national origin in the provision of hospital services.

1965 – Medicare and Medicaid Become Law President Lyndon Johnson signs into law the most significant health reform of the century: Medicare, which provides comprehensive health care coverage for people 65 and older, and Medicaid, which helps states cover long-term care for the poor and disabled.

1970s – Health Care in Crisis Medical costs rapidly escalate now that millions more are insured after the passage of Medicare and Medicaid. In 1972, President Richard Nixon signs the Health Maintenance Organization Act as part of his national health strategy to reduce costs. For the next several decades, presidents and lawmakers try, and fail, to overhaul the health care system.

1980s – Corporations Take Greater Control There is a shift toward privatization of health care as corporations begin to integrate the hospital system and enter many other healthcarerelated businesses and consolidate

control. In 1987, the Census Bureau’s annual estimate of health insurance coverage in the United States finds 31 million Americans uninsured (13 percent of the population).

2006 – States Enact Reform Laws Massachusetts implements laws to provide health care coverage to nearly all state residents and calls for shared responsibility among individuals, employers and the government in financing the expanded coverage.

Within two years, the state’s uninsured rate is cut in half. Vermont also passes comprehensive healthcare reform aiming for near-universal coverage. The law creates a health plan for uninsured residents and focuses on improving overall quality of care.

2010 – Major Health Care Reform Signed President Barack Obama signs landmark health care legislation. The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in 2014.

Health plans cannot deny coverage for any reason, including a person’s health status, nor can they charge more because of a person’s health or sex.

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S U PP LY C HAIN

Re-Engineering Healthcare with Aviation, Gaming Industries in Mind

Robert Szczerba, CEO of X Tech Ventures, shares his ideology on how healthcare can learn from industries such as aviation and gaming to improve upon its current practices Written by: Ste phan i e C. Ocano 23

S U PP LY C HAIN “We seek answers to some of today’s most challenging issues by looking at how individuals, cultures, and companies from other industries may have already addressed similar issues,” states the front page of X Tech Ventures’ website.

Founded just last year, the company is led by CEO Robert Szczerba, a global executive exploring the intersection of technology, innovation and healthcare. Previously, Szczerba was the corporate director of healthcare and life science and a senior fellow emeritus for Lockheed Martin Corporation.

Driven by the inefficiencies he saw in the healthcare system, Szczerba began X Tech Ventures in an effort to solve some of the most challenging

problems in healthcare by using a simulation platform that can be adapted for several various needs.

As the healthcare industry shifts from a fee for service to a fee for outcome model, technology has the capability to reduce medical errors and improve outcomes once tailored.

Szczerba finds that while technology has positively impacted the healthcare sector through higher-end diagnostic abilities, very little improvement has been made in the larger range of basic healthcare needs.

Szczerba said he sees opportunities for technology to help hospitals improve their design, workflows and patient experience and X Tech Ventures’ platform can be used to help hospitals troubleshoot these problematic areas.

Improving patient experience In ‘Plane’ Sight Aviation, specifically the pilot’s checklist, is a practice healthcare systems should adopt more widely, says Szczerba. Similarly, the way the banking industry is able to give its customers secure access to their accounts is something hospitals should take note of.

“It’s so frustrating that you can 24

September 2014

R e - E n gi n eeri n g H eal t hcare

Technology helps hospitals improve their design, workflows and patient experience

‘As the healthcare industry shifts from a fee for service to a fee for outcome model, technology has the capability to reduce medical errors and improve outcomes’

go into your bank account online and see your transactions for the past three hours but it’s so difficult to get immediate access to a child’s medical records,” Szczerba told MedCity News.

In a report co-authored by Szczerba on clinical environments and virtual system-of-systems engineering for healthcare, the argument for aviation influence in the healthcare industry was made.

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S U PP LY C HAIN “Just as the use of flight simulators and system integration concepts revolutionized the aircraft industry decades earlier, similar concepts can be applied to improve the effectiveness and efficiency of the health care industry today,” the report noted. “As with comparable tools in aviation, our goal is for simulationbased tools for health care to make analysis and training fast, safe, measurable and reproducible.”

While inherent differences between the aviation and healthcare industries are a constant challenge

“Just as the use of flight simulators and system integration concepts revolutionized the aircraft industry decades earlier, similar concepts can be applied to improve the effectiveness and efficiency of the health care industry today”

Similar to the flight simulation tools of the aviation industry, healthcare can adopt a like-for-like approach in their own industry

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September 2014

R e - E n gi n eeri n g H eal t hcare

to overcome, checklists, structured communication techniques, preoperative briefings, error reporting and simulator training are a few of the aviation safety methods that can be implemented in medicine.

Checklists • Brief lists of evidence-based protocols designed to make it easier for physicians and health professionals to rigorously follow safety steps.

Teamwork Training • Adapted from “crew resource management,” this technique focuses on improving communication among physicians and nurses to spot mistakes prior to taking place.

Briefings and Debriefings • These techniques are aimed at putting all members of the care team on the same page with regard to the medical situation and what is expected.

Incident Reporting • Systems that allow physicians, nurses and other medical staff

About Robert Szczerba Dr. Szczerba is currently the CEO of X Tech Ventures, a new type of company focused on solving some of today’s most challenging problems through the integration of technologies from multiple, diverse domains.

Previously, he was the Corporate Director of Healthcare and Life Science and a Senior Fellow Emeritus for Lockheed Martin Corporation.

For further information, visit the X Tech Ventures’ website: www.xtechventures.com

to anonymously report adverse events, near mistakes and unsafe conditions to hospital officials and regulatory authorities.

Simulator Training • A technique that uses sophisticated mannequins to help physicians and nurses in training gain technical competence in various scenarios while practicing communication skills.

Standardization • Every 747 has the same instrument panel, lessening the likelihood that pilots will make preventable mistakes. By standardizing 27

S U PP LY C HAIN the layout of areas such as nursing stations, patient and operating rooms, hospitals can achieve a similar success.

Entertainment Integration Leads to Knowledge Gaming is a growing interest in healthcare because it can be a more effective way to improve training and the way people learn; which can serve especially helpful for medical and nursing students.

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September 2014

Maryland-based Breakaway has been building a catalog of medical training simulator programs where the user interacts with the “patient,� diagnoses and treats them.

The training platform can collect every keystroke and look at what decisions were made and the amount of time it took to make such decisions, evaluating their diagnostic skills and critical thinking.

In healthcare, some of the roadblocks include the sheer variety

R e - E n gi n eeri n g H eal t hcare

of products and technologies in the patient care system.

Through interoperability, the process of care can be vastly improved while reducing costs.

In a recent interview with Szczerba, Joe Kiani, founder and CEO of Masimo Corporation, shared his thoughts on an integrated clinical system and its importance in the medical world.

“An integrated clinical system is one that accomplishes sets of tasks together, and provides decision

“The evolving expectations of patients, driven by advances in technology, will change how hospitals are designed, built, and operated”

support to all stakeholders. In a healthcare setting, medical devices would report to each other so that the central electronic health record and relevant data would be available to clinicians for the benefit of patients,” said Kiani.

“Technology-driven changes to the way we experience healthcare are coming and the impacts will be far-reaching,” wrote Szczerba in an entry on his blog Rocket Science Meets Brain Surgery. “The evolving expectations of patients, driven by advances in technology, will change how hospitals are designed, built, and operated.”

X Tech Ventures closes its introductory statement on its site with a note on how they would like to improve the healthcare industry.

“By bridging the gap between different domains we leverage the best of what has already been accomplished to solve problems that some have deemed unsolvable … in essence, ‘redistributing the future.’”

By incorporating successful practices from industries such as aviation, gaming and even banking, the light of day for a more successful healthcare industry is on the horizon.

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Technology

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Harnessing the Power of Big Data for Healthier Cities While managing the health and wellness of entire populations is a complex puzzle, due largely in part to vast amounts of information, technology is on the rise to harness big data and give medical professionals insight into current health trends W r i t t e n b y: N e i l J o r d a n

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Technology For the first time in history, more than 50 percent of the world’s population lives in urban areas. By 2050, nearly 70 percent of the global population, or more than 6 billion people, will live in cities. This urban renaissance offers the opportunity to rethink our urban landscapes to plan and build the social and physical networks and infrastructure needed to create healthier, safer and more sustainable places to live.

Urbanization will also challenge government agencies, healthcare organizations and social services to cost-effectively meet the health needs of a widely diverse citizen population with limited or declining resources.

Aging populations and the related rise in chronic conditions will also drive up costs and complexity. With global rates of chronic cardiovascular and lung disease, cancer and diabetes continuing to increase, health systems in industrialized and developing countries alike will be strained.

At the same time, the complexity of data will only continue to grow as health organizations and the patients they serve become more hyper connected across devices and environments. Health organizations 32

September 2014

of all sizes and types collect and store enormous amounts of sensitive clinical, operational and financial data which is still commonly funneled into disparate technology systems, making it difficult for organizations and health professionals to mine for insight and intelligence. Just consider the explosion of structured and unstructured health data generated every second from sources ranging from patients’ devices, mobile apps and social networks and hospitals’ clinical, enterprise and operational systems.

The generic term for these large data sets is “big data.” But a broader way to look at it is how new tools like Microsoft Power BI is unlocking the strategic value of health data that we weren’t able to track or analyze before because, well, it was too big. If the devil is in the details of EMRs, diagnostic images, supply chain, claims, revenue and resource management systems, then so too is the solution if we are just able to identify patterns.

While managing the health and wellness of entire populations is a complex puzzle, technology is how we can capture the promise data holds

H ar n essi n g t he P o wer o f B ig D a t a

‘The complexity of data will only continue to grow as health organizations and the patients they serve become more hyper connected across devices and environments’

by first making sense of vast amounts of information so that we can find solutions. Business intelligence has the potential to improve the health of entire populations by giving providers, local governments, universities and NGOs insight from disparate data sources to better predict, prevent or react to health trends. In fact, a recent study conducted by IDC found that the health industry worldwide stands to gain $109 billion in value from data over the next four years.

By applying analytics that combine

disparate sources of data from electronic health records, hospital operations and other community, economic, social, geographic and environmental sources, we can gain new insight to solve problems.

For example, one health system in the upper Midwest mined its patient records for rates of obesity and diabetes and compared the data with GIS maps showing parks and green-spaces as well as fast food restaurants overlaying the information as a heat map.

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Technology It came as little surprise to the researchers that the map showed clusters of obese and diabetic patients in areas that had more fast food restaurants and fewer parks.

With this insight, the health system could design a targeted patient education campaign about healthy eating, provide incentives to join local gyms to encourage fitness or partner with local farms to establish farmer’s markets to increase access to fresh fruits and vegetables.

How business intelligence is applied to big data and is only limited by the creativity of the researchers using the tools and the problems that they are seeking to solve.

This could range from understanding utilization of drugs or medical devices across a region’s hospitals to reduce variation and costs; developing social programs to educate at-risk citizens; or using predictive analytics to model public health threats from infection rates, social networks, location and environmental data to plan disaster response. It can also overlay which supplies and processes lead to better outcomes, optimal staffing levels and management of energy resources.

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September 2014

‘By applying analytics that combine disparate sources of data from electronic health records… we can gain new insight to solve problems’ In the United Kingdom, Leeds Teaching Hospitals has been testing a syndrome-surveillance proof of concept as an early outbreak predictor to support emergency preparedness and service planning. Leeds generates up to half a million records

H ar n essi n g t he P o wer o f B ig D a t a

each year and approximately one million unstructured case files each month, but using Microsoft business intelligence is able to see patterns in the data to identify potential outbreaks of infectious disease, effectiveness of vaccination programs and other public health threats.

Just as government agencies have the opportunity to become more coordinated, integrated and streamlined, hospitals can also apply technology to break down silos of information across systems to visualize a common picture, share intelligence and increase collaboration. Within hospitals or regional health systems, business

intelligence can be applied to patient and operational data to identify best practices for clinical care that can be broadly replicated to improve outcomes and reduce costs.

This is exactly what Oslo University Hospital in Oslo, Norway is doing.

Established in 2010 following the merger of four smaller hospitals, Oslo University Hospital sought to mine data from those separate databases for enterprise-wide analysis comparing utilization and rationale for different types of imaging used by radiology departments (e.g., x-rays, CAT scans, vs. MRIs). With the cloud-based self-service business intelligence tool, they can analyze 35

Technology data in hours rather than months and collaborate with colleagues around the country to identify trends. Researchers are now using Power Map to better understand how the frequency of different types of endovascular surgery varies across geographic regions.

Similarly, Department of Health Pomorskie Region, Poland is using business intelligence to monitor healthcare provision in the region and support public health providers.

Implemented in late 2013, the system covers 14 large hospitals with a total

of 6,000 beds and 340,000 patients treated each year. In time, the system will collect data on structure, workflow, economy, medical treatment and outcomes from 20 hospitals serving 2.3 million citizens in the region. By being able to analyze more than 200 key performance indicators for each hospital down to specialties, individual treatments and providers, the Pomorskie Department of Health can better identify population health, costs and utilization trends.

By leveraging on-premises, cloud, or hybrid Microsoft solutions,

Oslo University Hospital in Oslo, Norway

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H ar n essi n g t he P o wer o f B ig D a t a

At OUH data can be analyzed in hours rather than months

14

large hospitals

6,000

beds

340,000 patients

organizations can use business intelligence to optimize the value and utility of EMR systems, improve the quality of care and patient outcomes, and make informed decisions that lead to better operational performance. These solutions can unify disparate departments within a health organization or cities’ ecosystem and empower clinicians with real-time health analytics to identify health trends and solve problems more quickly.

Ultimately, the value of big data is that it helps more people get better care which benefits everyone.

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T OP 1 0

Top10

HEALTHCARE Stocks to Watch

Healthcare has been a top sector for investors in 2014. Leading the S&P 500 so far this year, the healthcare market remains well positioned to deliver further market-topping returns. These are the top healthcare stocks to watch (and buy) right now Written by: Ste phan i e C. Ocano

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top 10

10

Medassets Inc.

Listing:Â (NASDAQ: MDAS) Medassets Inc. is a financial and performance improvement company.

The company provides technology-enabled products and services for hospitals, health systems and other ancillary healthcare providers in the United States. The stock closed on Aug. 15 at $21.19. www.medassets.com

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H eal t hcare S t o cks t o W a t ch

09

Simulations Plus Inc.

Listing:Â (NASDAQ: SLP) Simulations Plus Inc. designs and develops pharmaceutical simulations software to promote cost-effective solutions to a number of problems in pharmaceutical research and in the education of pharmacy and medical students. Shares closed on Aug. 15 at $6.74. www.simulations-plus.com 41

top 10

08

Cerner Corp.

Listing:Â (NASDAQ: CERN) Cerner Corp. is a supplier of health care information technology and offers a range of software, professional services, medical device integration, remote hosting and employer health and wellness services. Cerner is the largest publically traded company focusing soley on health care information technology. The stock closed on Aug. 15 at $55.49. www.cerner.com 42

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H eal t hcare S t o cks t o W a t ch

07

Eli Lilly & Co.

Listing:Â (NYSE: LLY) Eli Lilly & Co. is a top drug stock to buy. Investors are paid a solid 3.3 percent dividend and many analysts see a number of strong catalysts for the stock for the rest of 2014. Firms like Merrill Lynch see increased share buybacks as a strong support for the stock. Shares closed on Aug. 15 at $60.84. www.lilly.com

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06

Stryker Corp.

Listing:Â (NYSE: SYK) Stryker Corp. is a top medical technology name to buy. With the acquisition of Trauson about a year ago, Stryker has shown the commitment to expand its business in the lower-priced segment and emerging markets. Sales in these regions have grown from 6 percent of total in 2012 to 7 percent in 2013, and are expected to grow further to 8 percent in 2014, according to 24/7 Wall Street. Additionally, the company has committed $700 million for the repurchase of its stock. Stryker closed on Aug. 15 at $80.47. www.stryker.com

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05

Biogen Idec Inc.

Listing: (NASDAQ: BIIB) Biogen Idec Inc. is an industry powerhouse. The global biotechnology company is expected to beat this year’s earnings expectations. With an incredible portfolio and pipeline, Biogen Idec is a top portfolio holding for many mutual funds and hedge funds. Shares closed on Aug. 15 at $342.47. www.biogenidec.com 45

top 10

04

Gilead Sciences

Listing: (NASDAQ: GILD) Gilead Sciences is at the top of the “Buy” lists at most Wall Street firms. Following a successful hepatitis C drug (Sovaldi) launch in January, the company continues to build a strong and impressive oncology pipeline. The company also continues to innovate in the HIV arena. The stock closed on Aug. 15 at $99.49. www.gilead.com 46

September 2014

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03

AbbVie Inc.

Listing:Â (NYSE: ABBV) AbbVie Inc. is a top pharmaceutical name. The company has entered the race for oral interferon-free combination therapies for hepatitis C and recently finished its phase three clinical-trial program for its all-oral hepatitis C drug. AbbVie closed on Aug. 15 at $53.90. www.abbvie.com

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H eal t hcare S t o cks t o W a t ch

02

Pfizer Inc.

Listing:Â (NYSE: PFE) Pfizer develops and produces medicines and vaccines for a wide range of medical disciplines, including immunology, oncology, cardiology, diabetology/endocrinology, and neurology. Pfizer Inc. is expected to deliver strong results in all metrics in 2014. According to 24/7 Wall Street, it is widely expected that Pfizer will soon separate its branded and generic divisions internally, with the latter prone to a spin-off or sale. Pfizer closed on Aug. 15 at $28.64. www.pfizer.com 49

top 10

01

Allergan Inc.

Listing: (NYSE: AGN) Allergan is a global, technology-driven multi-specialty health care company pursuing therapeutic advances to help patients live life to their fullest potential. The company’s flagship franchises are in eye care, neurosciences, medical dermatology and urologics. With the acquisition of Inamed Corporation in 2006, Allergan added breast aesthetics and dermal fillers to its business portfolio to create a world-leading medical aesthetics franchise.

With specialty product lines focused on high-growth markets, Allergan represents a new multi-specialty health care model for the future, where diversification and focus live together to offer physicians and patients best-in-class treatments and a robust pipeline for continuous innovation. Allergen Inc. is ranked on the Merrill Lynch US 1 list in the health care sector. Reporting solid earnings, the company benefits from a strong balance sheet and a stable revenue base from established drugs.

According to Merrill Lynch, investors should see a double-digit annual growth through 2018 from Botox injections and the eye treatment Restasis. The stock closed on Aug. 15 at $158.26. www.allergan.com 50

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Medtech Ethiopia Pioneers Domestic Industry Growth through EPHARM Acquisition Written by: Matthew Staff Produced by: Kiron Chavda

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Medtech Ethiopia

For the past 16 years, Ethiopia’s pharmaceutical industry has developed alongside Medtech Ethiopia and EPHARM, ensuring that this latest acquisition will optimise the international influence of both

Internal Operations

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M

edtech Ethiopia has signaled its intentions in recent years through various acquisitions and diversifications, and is well on its way to benefiting from its most significant investment to date.

The Ethiopian pharmaceutical company’s recent acquisition of EPHARM (Ethiopian Pharmaceuticals Manufacturing Factory) signals a full circle in the business’s 16-year development, which initially saw it operate as a distributor for the latter to fill the demand gap in Ethiopia.

Founder and Chief Executive Officer (CEO), Dr. Mohammed Nuri , was the innovator who noticed the concerning trend and has not looked back since deciding to form the country’s first pharmaceutical supplier.

“I am a doctor by background, and was really frustrated by the shortage of availability of pharmaceutical products in the country,” he said.

“This is what pushed me to go into this field and with the Ethiopian market untested at the time, we grew exponentially.

“From five staff members in a three-room office, with capital of $50,000, we have now registered more than 300 pharmaceutical products from more than 20 global suppliers. We are ISO certified and one of the top pharmaceutical companies in Ethiopia.”

EPHARM acquisition EPHARM has been a government-owned organisation for the past 50 years, establishing an

sec t o r

unrivalled reputation in the country and industry, making the acquisition a vital feather in the cap of Medtech Ethiopia.

With a total of 63,000 square meters of land to expand the EPHARM facilities, Dr. Nuri has taken the opportunity to make sure that the potential of this venture is optimised.

“EPHARM has eight manufacturing lines for various products and we will be renovating each one in turn over the next five years to make sure they meet GMP (Good Manufacturing Practice) guidelines before making them fully operational,” the CEO explained. “Any machinery that needs changing we will change, and any that needs upgrading, we will upgrade; all the while maintaining the existing employees and giving them the relevant upgrades in training.”

Medtech now has extensive warehouse facilities to distribute its products

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Medtech Ethiopia

A frica

Alongside the physical assets of the renovations and inherited product lines, the retention of the 500 staff members and identity that EPHARM has within the country is seen as pivotal to the success Dr. Nuri expects from the acquisition, while the operational improvements that have begun are already receiving international input and recognition via the likes of Bosch, in regards to the installation and training involved with new machinery.

The end result will see EPHARM’s facilities globally competitive, and will subsequently continue to carry the flag for the industry in Ethiopia.

Joint venture Collaborations, acquisitions and partnerships – both domestic and international – have been key features of Medtech Ethiopia’s vast expansion

Key Personnel

Dr. Mohammed Nuri Founder and Chief Executive Officer (CEO)

Customer operations

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Medtech Ethiopia

Medtech specialises in more than just pharmaceuicals

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over the past 16 years.

The company now consists of four business units; pharmaceuticals, medical supplies, lifecare and general trading. The first comprised a large portion of the company’s early successes, relying on key partnerships in India and the Middle East to provide as many market-leading products as possible to Ethiopia.

The aim now, however, is to capitalise on Ethiopia’s general economic growth and to become the hub for manufacturing and distribution locally.

To aid this slow, but concerted transition away from imports, Medtech Ethiopia has recently embarked on a joint venture with one of the UAE’s giant pharmaceutical companies, Julphar, as Dr. Nuri explained: “We signed an exclusive agreement with Julphar 12 years back, registering certain products from this company, and in 2012 we signed a joint venture agreement with them on a state-of-the-art pharmaceutical manufacturing factory here in Ethiopia called Julphar Ethiopia PLC. “This factory was inaugurated by our Prime Minister and has received big public approval.”

With three production lines and 100 employees introduced as a result of the venture, the immediate success of the partnership has subsequently led to a further proposal which will see Julphar Ethiopia open up the country’s first insulin factory.

Work will begin on the factory by 2015 which,

“From five staff members in a three room office, with capital of $50,000, we have now registered more than 300 products from more than 20 global suppliers.

We are ISO certified and one of the top pharmaceutical companies in Ethiopia” - Dr Mohammed Nuri, Chief Executive Officer, Medtech Ethiopia

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Medtech Ethiopia

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once completed, will not only become a massive benchmark for availability of insulin in Ethiopia, but will ultimately become a hub for the entire continent.

Corporate Social Responsibility Being a pioneer from a business sense is very important to Medtech Ethiopia, but being a positive influence in the country outside of its profit-making activities is every bit, if not more significant.

For the past 10 years the company has donated three percent of its net income to be distributed around the country to worthy causes, as part of its widespread Corporate Social Responsibility (CSR) programme.

“This money goes to the poor and needy and we currently have 10 non-governmental organisations and charities that we regularly support, including work with the blind, providing spring water for 30,000 people in 13 rural areas and supporting rural elementary & secondary schools and two autistic centres,” Dr. Nuri said.

“We also work in association with the local university to provide scholarships for young students and are also very much involved in making sure that our manufacturing practices preserve the environment as best as possible.”

Once the EPHARM renovation has been completed, the business even has plans to open its own charity foundation, providing further aid to people unable to provide for themselves.

3% Percentage of the company’s income donated to worthy causes over the past 10 years

Spring water development donation project

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Medtech Ethiopia

“Medtech Ethiopia is an ethical and highly professional company, proud of itself here and abroad as a reliable and admired business partner” - Dr Mohammed Nuri

Vision 2020 As a result of the company’s recent acquisitions and subsequently successful expansion plans, Medtech Ethiopia has had to revise its initial 2020 vision, with the target now to become one of the top businesses in the country.

This refers not just to the pharmaceutical sector, but across all businesses, leading to even further efforts to diversify and expand its offering at present.

Dr. Nuri explained: “We currently import and distribute products in baby nutrition like DanoneBebelac, as well as being an agent for companies like Procter & Gamble.

“We have also just begun running a big ceramic factory in a joint venture with a world class ceramic manufacturer. This factory in Ethiopia

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Company Information Industry

Healthcare headquarters

Addis Ababa, Ethiopia founded

1998 Ceramics factory em p l o y ee s

will be upgraded over the next nine months to become the biggest for ceramics in the country.”

Adding to this repertoire exists the company’s animal exporting business from its tailor-made export house, which led the company to be named as best cattle exporter in the country five years ago; all of which, Dr. Nuri believes, will conspire to make sure Medtech Ethiopia becomes one of the top three business groups in Ethiopia by 2020.

“Medtech Ethiopia is an ethical and highly professional company, proud of itself here and abroad as a reliable and admired business partner,” he concluded.

“We have set a new vision of being a top three business group by 2020 while strengthening our CSR programme by truly supporting the needy across the country.”

1,500 revenue

Not Disclosed products/ services

Pharmaceutical

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Hospital Metropolitano Vivian Pellas: Nicaraguan medical excellen

Changing the development of medicine in Central America Written by: Rebecca Castrejon Produced by: Carmenza David Interviewee: Dr. William Abdalah, medical director

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nce

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H o s p i ta l M e t r o p o l i ta n o V i v i a n Pe l l a s

Vivian Pellas culture

F

or years, the institutional values held by Hospital Metropolitano Vivian Pellas have been the foundations supporting the medical center’s status as one of Nicaragua’s best. The growing bonds between the hospital management and medical staff continuously improve service quality.

Dr. William Abdalah, Medical Director of

“We are eager to perform at our best, revolutionizing the way medical services are being provided in our country,” says Dr. William Abdalah, chief physician at Vivian Pellas.

Hospital Metropolitano Vivian Pellas

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Medical management Dr. Abdalah, current chief physician at Hospital Metropolitano Vivian Pellas, has been a part of the hospital’s history since the facility’s inception and design, being consulted about the acquisition of medical equipment and surgical instruments.

Afterwards, he became involved as head of the surgery department until 2013, when he was appointed as chief physician.

Abdalah is a general surgeon and he also earned an MBA; these academic achievements and experience have been key factors for a proper balance by keeping the medical staff aligned with the hospital’s enterprise vision. His 11-year experience managing private practice hospitals provided him the necessary leadership at his current position as chief physician.

A merica L a t i n a

Entrepreneuring medical staff Vivian Pellas has established cooperation agreements with institutions in the United States and Central America with the purpose of increasing their staff’s medical knowledge.

Some of these institutions are the Baptist Health Systems and Jackson Memorial Hospital (both in Miami, Fla.), as well as St. Luke’s Episcopal hospital (Houston, Texas).

Exchange programs with other medical centers in Central America and the Dominican Republic are held through Asociacion de Hospitales Privados’ (private hospitals association) connections, these programs have brought benefits in nursing practices.

Health professionals go through constant training to be prepared for the necessary endeavors demanded by the opening of new service units. In order to accomplish medical excellence, the staff undergoes

“We are eager to perform at our best, revolutionizing the way medical services are being provided in our country” - Dr. William Abdalah, Medical Director of Hospital Metropolitano Vivian Pellas

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Hospital Metropolitano Vivian Pellas

training abroad in the fields of new diagnostic areas, acquiring scientific knowledge regarding these and other subjects. To set some examples, the medical staff heads to Miami and Mexico to receive training by experienced doctors for the proper reading of images produced by a 128-slice tomography; and also to take courses updating them in specialties such as cardiology and neuroscience. “We are constantly raising our entire staff’s knowledge level for advanced technology operation, providing the most exact evaluations to our patients,� says Abdalah.

Staff

Hospital innovation There are three important projects under development among the planned excellence centers: 68

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Hospital Metropolitano Vivian Pellas

1. The opening of a diabetes clinic in a new five-story facility under construction, including a multidisciplinary care unit.

2. Upgrades and innovations in the cardiology unit, which will include catheterization for pacemaker implantation, and cardiac e lectrophysiology, afterwards.

3. The opening of the neuroscience unit. This department is currently formed by a multidisciplinary team, properly trained to manage CVA with the most advanced technology, prehospital, and rehab services.

“We want to thrive into a regional reference for medical centers, with the support of what we’ve already achieved, along with the stem cell therapy clinic, taking ourselves into a level which will allow us to provide medical services to a larger population�

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http://www.pdelaire.com/ | Informacion@pdelaire.com.ni http://www.facebook.com/Productos-del-Aire-de-Nicaragua-SA

nicaragua@scientific-centroamerica.com

www.scientific-centroamerica.com

www.cobas.com

www.crilamyt.com | mproanio@crilamyt.com

H o s p i ta l M e t r o p o l i ta n o V i v i a n Pe l l a s Currently, the Stem Cell Therapy area is also part of the ongoing extension, working along with local colleges whose research protocols are based on stem cells obtained from abdominal fat for tissue regeneration. Stem cell therapy at Vivian Pellas is used mainly for osteoarthritis treatment, to be applied to burn victims, for patients suffering peripheral circulatory collapse, for development of kidney tissue, and for inflammatory diseases such as asthma.

“We want to thrive into a regional reference for medical centers, with the support of what we’ve already achieved, along with the stem cell therapy clinic, taking ourselves into a level which will allow us to provide medical services to a larger population,” says Abdalah.

Growth and expansion Business development plans consist of doubling the hospital’s capacity in its actual location. The diagnosis and outpatient surgery branches program will be running by 2015, mainly focused on patients suffering from diabetes. Branches will be located in different areas in the country. North and southeast Nicaragua are being evaluated as possible locations for this expansion.

Nurse attending patient

Nurses

The future for Hospital Metropolitano Vivian Pellas The goal is to become Central America’s best hospital by 2017. For this purpose, a strategic plan has been developed to make Vivian Pellas the w w w. m e t ro p o l i t a n o . c o m . n i

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Under this extension, the hemodyalisis units will expand, and the available seats for patients with terminal kidney disease will increase to 30.

Outpatient surgery services will increase as well, with the construction of two new operating rooms.

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Medical technology Vivian Pellas hospital owns the country’s fastest MRI scanner, which has constant upgrades including updated training for the medical staff in charge of the device’s operation, particularly for those in the neuroscience unit.

A merica L a t i n a

region’s top reference for medical centers with the highest standards, also to sustain leadership as the country’s best nursing facilities, to increase brand presence in other markets; and to hire radiotherapy, transplant and molecular biology services, due to the high rate of patients with terminal illnesses.

“At Hospital Metropolitano Vivian Pellas we want to change the way medical services are provided in the country. That’s the reason to install multidisciplinary practice among the medical community,” says Abdalah

Company Information Industry

Health services He a d q u a r t e r s

Managua, Nicaragua Founded

May, 2004 E m p l o y ee s

600 K e y Pe o p l e

Dr. William Abdalah (chief physician), Gilberto Guzman (CEO), Sandra Picado (supply manager), Arlen Pérez (medical tourism manager), MBA Carolina Castro (marketing and sales manager) Products / Se r v i c e s

Hospital, maternity ward, neonatology, intensive care, emergencies, pharmacy, medical imaging, laboratory, specialties, etc.

Re v e n u e

USD $200 millon www.facebook.com/HospitalMetropolitanoVivianPellas

https://twitter.com/HMetropolitano www.linkedin.com/company/hospital-metropolitano-vivian-pellas w w w. m e t ro p o l i t a n o . c o m . n i

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Healthcare Facilities Symposium & Expo HFSE

BUILDING CONNECTIONS HEALTHCARE DESIGN

Healthcare Facilities Symposium & Expo Fosters Collabora Chicago Conference Author name: Liz Miller , Marketing Director

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IN

ation & Innovation in Annual

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The Healthcare Facilities Symposium & Expo is the original event that examines the trends in healthcare and the trends in healthcare design as one single movement. Industry leaders from design firms to healthcare owners come together for three days of education and collaboration. The Healthcare Facilities Symposium & Expo will take place September 30 - October 2, 2014 in Chicago with pre-conference events on September 29, 2014.

Resonating through the event is the theme of Building Connections.

The Healthcare Facilities 76

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Symposium & Expo is known as a collaborative environment where connections are formed through networking opportunities, sparked by creative ideas, and answering the challenges of attendees by connecting them with solution providers or expert speakers.

A hallmark of the event is the willingness of attendees to look past competition and share ideas to further the mission of turning brilliant design into improved healthcare delivery.

Building Connections is also echoed by keynote presenter John S. Milne, MD, MBA, FACEP, Founder

USA

and CEO, Avnew Health. Milne will explore the rapid transformation of healthcare delivery and discuss trends including ACO structures, mobile apps, and big data. “I am incredibly excited to be addressing healthcare planners and facility designers at this year’s Healthcare Facilities Symposium & Expo” says Milne. “I hope that through my presentation, they will see the connections between care delivery trends and the built environment and be inspired to transform the way patients experience healthcare” The conference program will feature sessions presented

by leading healthcare facilities and design firms. Case-studies and instructional sessions will tackle issues challenging design teams today including integrating technology, influence of the Affordable Care Act, sustainability, renovation projects, and the task of doing more with less.

Returning for the second year is the Student Charette sponsored by CannonDesign and in partnership with AIA Chicago, the AIA Chicago Healthcare Knowledge Community and The Caritas Project. Promoting interaction and idea exchange between university students and w w w. h c a re f a c i l i t i e s . c o m

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attendees, this year’s design challenge will be Completely Reimagining Outpatient Health and Wellness Environments.

A Technology Pavilion featured in the Exhibit Hall will bring big data alive in an enticing visual display where attendees will interact and explore how technologies are helping us view, investigate, 78

September 2014

analyze data and understand how technology can make a difference for a health system seeking to know their patients and proactively manage their health. “Two years ago the advisory board of the Healthcare Facilities Symposium & Expo saw a need to bring technology to the exhibit floor” said Gary Collins, Principal, PFB

sec t o r

Architects. “Something that would capture the interest and imagination of the younger tech generation yet offer real solutions for today’s Healthcare leaders. I was fortunate that Jenabeth Ferguson, VP, Symposium Director, and her staff believed in my Technology Pavilion idea and now we are preparing to launch an immersion experience

like no other.” The project is led

by Sensory Technologies, Blue Cottage, Power Construction, PFB Architects, KaziaLi Design Collaborative, Koroseal Interior Products, and Interface.

Details: The 2014 Healthcare Facilities Symposium & Expo includes: w w w. h c a re f a c i l i t i e s . c o m

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John Milne

• Educational sessions featuring case-studies and instructional sessions presented by the upper echelon of thought leaders and industry authorities.

• Exclusive networking opportunities on the show floor and 80

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off-site, including The Symposium Party with activities, music and the Annual Raffle which will benefit The Cure It Foundation.

• An Exhibit Hall with the latest products and solutions critical to designing cutting-edge facilities.

USA

Company Information Industry

Events Company headquarters

: 5520 Park Avenue, Suite 305 Trumbull, CT 06611

• Facility tours of the Northwestern Medicine’s 259 East Erie Facility and the Erie Family Health Center (Waukegan).

For more information on the Healthcare Facilities Symposium & Expo please visit www. hcarefacilities.com .

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BridgeCrest

Medical, Inc. Better Health and Safety in Construction

83

B r i d g eC r e s t M e d i c a l , I n c .

Employee health and safety are crucial concerns for any construction company. Employers can often be surprised by potential dangers to employee health such as heart failure, hearing loss, and lung damage.

In the 21st century, we now have to power to proactively monitor and address employee health concerns before they become more serious.

BridgeCrest is a digital platform that closely monitors and runs diagnostics from two water bottle sized moÂŹbile health devices which connect to a smartphone or tablet via Bluetooth. Simple to set up and use, this application stores crucial information in the cloud, where safety professionals

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and doctors can carefully analyze and give immediate medical reports. Additionally, the system automatically provides employers with alerts and suggestions to improve their employee productivity.

This easy turnkey solution provides state of the art surveillance that can significantly reduce accidents and liability costs.

What are the credentials of this company?

BridgeCrest partners with the industry’s leading medical doctors. In developing its product, BridgeCrest works with Dr. Steven Steinhubl, Director of Digital Medicine at the Scripps Translational Science Institute.

Together, Dr. Steinhubl works with the BridgeCrest Medical team to identify devices that can positively impact your employee surveillance program and bottom line.

Their system is currently in operation in the USA, Africa and South America. Besides typical use cases such as cardiac health, lung health and hearing loss the system provides rapid diagnostics to closely

A us t ralia

track the spread of drug use and infectious diseases such as malaria or dengue fever. With a global distribution network and the ability to work without cell connection, the BridgeCrest platform can operate anywhere.

Co-Founders of BridgeCrest Medical, believe that the system has broad applications for the industry as a whole. “Our low cost occupational health technology platform benefits both employers and employees – it’s a win-win”.

How effective is this program?

Innovation at Hand

Some clients have been able to save thousands of dollars in work related costs. “BridgeCrest has helped me to identify pending health problems to save on insurance costs, protecting my bottom line.” Alex Dolginov, Dolan Realty San Diego, CA. Nathan Klarer and AJ Cawood,

The BridgeCrest service differentiates itself from other devices by incorporating realtime telemedicine assistance.

Suppose that an employee fractures an arm or requires immediate CPR instructions in the field. Using BridgeCrest you can receive immediate video and

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cr oim n yr e nsatme B d pa g eC Medical, Inc. audio medical attention through a partnered telemedicine system that operates through the same tablet or phone used to collect diagnostic data. The company believes that as a custodian of your data they

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have the utmost responsibility for its integrity. The system ensures the highest standard of security and HIPAA compliant integrity.

The technology revolution for medical devices can be extended

A us t ralia

to many fields: transportation, natural resource production, and humanitarian efforts; the possibilities are endless. BridgeCrest is a true bridge for health data and actionable results to reduce work related accidents and insurer liability.

This system can and should be rapidly utilized.

Company Information Industry

Construction headquarters

12255 EL Camino Real, San Diego CA, 92130 founded

2013 em p l o y ee s

Nathan Klarer, AJ Cawood, Dr. Steven Steinhubl, Michael Holland

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Cremer focuses on positioning as a strategic partner Leader in disposable healthcare products invests in innovation, product development, acquisitions and partnerships.

Written by: Tania Franco Produced by: Taybele Piven

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trong and solid brand reputation, ability to direct distribution at the national level, and structure development through partners as well as internal products lines. Besides adding all these requirements in its operations for disposable healthcare products for the Brazilian market, and export to over 10 countries, Cremer – a company based in Blumenau, Santa Catarina - focuses on new challenge. “We seek to become the best provider in disposable healthcare products and have a complete portfolio, understand the business of our clients and help them improving their business. We also seek a position not only as a company that sells products, but as a strategic partner,� explains the CEO, Leonardo Almeida Byrro. According to the executive, to achieve this goal the company is working hard on new acquisitions, internal development of new products, investments in factories, opening new distribution centers and investment in qualified staff.

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c r eme r The sector of disposable healthcare products includes textiles and adhesives, syringes and needles, surgical gloves, disinfectants and electronics, among others. In this market, Cremer’s performance covers three major divisions. The largest - that corresponds for 60 per cent of the company’s revenue - is to supply disposable products to hospitals, clinics and laboratories nationwide. The second division, which amounted to 25 per cent of its revenue, is called Retail or Consumer where the products are sold to the final consumer in pharmacies and supermarkets throughout Brazil. The third business segment, responsible for 13 per cent of company’s revenue, focuses to distribute products and dental care. Through its distribution network, Cremer provides for approximately 40,000 customers and professionals nationwide. In order to cover it all, Cremer has six factories concentrated in Santa Catarina, São Paulo and Minas Gerais, as well as distribution centers ranging from Fortaleza to Blumenau.

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Cremer First Aid Line

www.businessfriend.com

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In mid-2008 the company changed its ownership and Cremer transitioned to a new management role. At that time, the company already had high market share and leadership position in the industry.

According to the CEO, the company saw the need to grow through innovation, implement ways to differentiate their products, adding new product categories to its portfolio and become more efficient and marketoriented. “Five years ago, we promoted this transformation aiming to become an organization focused on the market, where sales, marketing, innovation and product development are the flagship of the company.”

Innovation has been strongly applied in Cremer’s operations. “By bringing innovation within your operations, somehow you end up degrading the processes a little bit which generates some kind of discomfort.” Our challenge is to figure out how to bring innovation to our products and the market, but maintaining the efficiency and productivity

Zig-Zag Cotton

Cremer Advanced Bandage

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Complete Line of Cremer and Topz Products

levels required by the company. “Besides the robust structure of operations, Cremer constantly invests in modernization of machines, systems and processes. The last five years alone, the company invested around US$ 100 million in improvements.

As part of the growth strategy, three new companies were acquired between 2011 and 2013, that produce items not manufactured by Cremer.

“This acquisition is a way to grow our products portfolio and to develop partnerships with companies overseas,” highlights Leonardo de Almeida Byrro. Through the partnership, Cremer uses its distribution system, and its national presence, to introduce these products in Brazil.

One of the positive results after these acquisitions is that the company entered in a totally new segment that it never served before - disposable plastic products for healthcare - through partnerships with Embramed 96

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and Psimon. “We have made these acquisitions in 2011 and 2012. Due to our structure, we are managing a much bigger rate of growth than what those companies product line were having alone,” he says. Currently, the plastic products is the fastest growing platform in the company. In 2013, sales in this segment grew 25%.

Another innovative step was some new international partnerships. The American company Deroyal, partner since 2013, manufactures plastic products with technology solutions that do not exist in Brazil and Cremer sells these items nationwide. Another partner, Ansell, is a manufacturer of specialty surgical gloves. “We signed the partnership in 2014 and we will bring the product line of this global company to the Brazilian market,” adds Byrro.

All the innovations implemented at Cremer is in addition to the greatest attribute of the brand the quality and value of its products recognized by consumers is: “We have very strict control in our industrial processes and operations, strong quality control, certifications and good manufacturing practices that often go beyond what is required by public agencies, bids or private hospitals.”

Company Information n a me

Cremer S.A. Industry

Healthcare headquarters

Blumenau, Santa Catarina - Brazil e s ta b l i s h e d

1935 Products

Products for first aid areas, surgery, treatment, hygiene and welfare. Leaders in the market of gauze pads, surgical pads, plaster bandages, plasters, cotton wool, cloth diaper and other healthcare products.

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