soa enabled next generatione emr/ehr

SOA enabled next generation

EMR/EHR

Victor Chai

13-Nov-2013

1

@Copyright 2012 Health InterConnect

Disclaimer

The information shared here does not

represent the official opinions of my

current employer (MOH Holdings).

2


Brief Introduction of myself

Organisation Key Role Key Responsibilities

MOH Holdings Pte Ltd Senior Enterprise Architect National Architecture Office

Healthe Solutions Chief Software Architect Oversee, manage and lead EHR

product development and solution

implementation

Savi Technology System Architect Lead architecture design and

development of real-time supply

chain tracking and optimization

product

IBM Singapore Software Development

Lead

Lead IBM Production e-

Procurement development

HL7 Singapore TC member HL7 Interoperability Standards such

as HL7v2, HL7 CDA, HL7 FHIR etc

3


Topics

• SOA reality check

• The challenges & complexities

• The solution

• Adoption strategy

4

@Copyright 2012 Health InterConnect 5

Is SOA still relevant today?

Source: Gartner Ross Altman

A fundamental shift from monolithic application centric

design to service centric design


SOA has become increasingly

relevant and important

• Cloud • Social

• Mobile • Information

Internet of Things

Contextualized Information

Seamless user experience

Multi-access channels

App becomes more

specialized

Infrastructure

Platform

Software

Social interactions and

Collaboration

6


Design for the unknown

• Design for the known is in the past – Design the application to manage the known &

limited information

– Design the application for the specific access

channel, information storage

• Embrace for the unknown – Aggregation of external information to deliver

contextualized information

– Application is no longer tied to the fixed UI, must

be service-ready to enable the consumption &

collaboration with different kinds of external

applications

7


Challenges & Complexities in

Healthcare IT

• Many diversified IT systems within and across

healthcare settings

• Different information models across different

IT systems

• Lack of standardization

• Fragmented and inaccessible information

8


Healthcare IT Overview

9

Electronic Health Record

(EHR): A systematic

collection of electronic

health information about

individual patients or

populations in digital format

and capable of being

shared across different

healthcare settings.

Electronic Medical Record

(EMR): A computerized

medical record created in

an organization that

delivers care, such as a

hospital or physician’s

office, usually part of a local

health information system

that allows storage, retrieval

and modification of records.

Healthcare IT: The umbrella framework to describe the

comprehensive management of health information

across computerized systems and its secure exchange

between consumers, providers, government and quality

entities, and insurers

Health Information

Exchange (HIE): The

mobilization of

healthcare information

electronically across

organizations within a

region, community or

hospital system.


Strategic vision of patients moving seamlessly across

the healthcare system, receiving coordinated patient-

centric care at the most appropriate settings.

Rehab

Centres

Family Physician

supported by CHCs

Polyclinic/ Family Medicine

Clinic

Palliative

Care

Screening &

Prevention

Nursing

Homes

Communit

y Hospital

Restructur

ed

Hospital

Home

Medical

Centres

Rehab

Centres

Family Physician

supported by CHCs


Clinic

Palliative

Care

Screening &

Prevention

Nursing

Homes

Communit

y Hospital

Restructur

ed

Hospital

Home

Medical

Centres

Rehab

Centres

Family Physician

supported by CHCs


Clinic

Palliative

Care

Screening &

Prevention

Nursing

Homes

Communit

y Hospital

Restructur

ed

Hospital

Home

Medical

Centres

Rehab

Centres

Family Physician

supported by CHCs


Clinic

Palliative

Care

Screening &

Prevention

Nursing

Homes

Communit

y Hospital

Restructur

ed

Hospital

Home

Medical

Centres

Rehab

Centres

Family Physician

supported by CHCs


Clinic

Palliative

Care

Screening &

Prevention

Nursing

Homes

Communit

y Hospital

Restructur

ed

Hospital

Home

Medical

Centres

Rehab

Centres

Family Physician

supported by CHCs


Clinic

Palliative

Care

Screening &

Prevention

Nursing

Homes

Communit

y Hospital

Restructur

ed

Hospital

Home

Medical

Centres

Healthcare Landscape of Future

Source: HIMSS 2012


Vision of Future Healthcare Landscape - enabled by the Regional Health Systems (RHS)

Rehab

Centres

Family Physician supported by CHCs

Polyclinic/ Family

Medicine Clinic

Palliative

Care

Screening

&

Prevention

Nursing

Homes

Community

Hospital

Restructured

Hospital

Home

Medical

Centres

Strategic vision

of patients

moving

seamlessly

across the

healthcare

system, receiving

coordinated

patient-centric

care at the most

appropriate

settings.

Organisation of the RHS, where Home is the central location for care, with primary care delivering person-

centric care integrated with the rest of the care spectrum for both physical and mental healthcare

Source: HIMSS 2012


A patient journey within a setting

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Patient arrives

at hospital Consultation Investigation

Patient

discharged

Claim & Billing

Treatment


Different IT systems along the patient

journey

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Patient Arrives at Hospital

Consultation Investigation

Treatment Patient

Discharged

Billing & Claim Mgmt

Lab Order

Rad Order

Surgical

Procedure

Discharge

Summary

Lab Result

Rad Result

Medication Prescription

Medication Dispense

Medication Administration

Insurance &

MediClaim

Casemix &

Subvention

Clinical

Documentation

Patient

Admission Medical Procedure


Different information models

14

Data Source1 Data Source2 Data Source3

Heterogeneity in naming, syntax, representation and structure

e.g., “Severe osteoarthritis of the left knee ”


Lack of standardisation

15

Code Value

Y Resident

N Non Resident

Code Value

1 Resident

0 Non-Resident

Code Value

R RESIDENT

N NON-RESIDENT

P PERMANENT RESIDENT

Code Value

Resident

X Non-resident

PR/Residential Status Code

Description

A Alien

C Citizen

P PR

U Unknown


Fragmented Information

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Isolated information

Fragmented information

Not accessable information

Diference in structure and clinical meaning

Too much information

Bad information presentation

Only clinical data is kept (no knowledge)

Some information is not computer usable (free

text, image features, (genome in the future))

No feed back to medical community and society

Complex desicions

Lack of training

Changing knowledge

Medical errors

Inefficient workflow

Understaffing

No operational information

No infrastructure information

No common language

Input - Output

Information

Process

Clinical Desicions Workflow

Action Medical

Community

operational Society objective subjective Assesment Planning


WHAT IS THE SOLUTION

17


Multichannel enabled architecture

• From ‘PC first’ to “Mobile first’

• Embrace ‘multi-channel enabled

architecture’

– It drives the underlying shared service

design principle

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Data driven service enablement

• Do we understand why ‘SOA != Web Services’?

• Adopt SOA to enable data sharing & re-use

instead of moving data across

• What’s the fundamental benefits of SOA

service enablement?

– A paradigm shift from ‘move’ data across towards

‘share & reuse’ data across

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An analogy on ‘share’ instead of ‘move’

• Do we copy and paste the external content into our

site page, or we simply use URL link to reference the

external content when we build a web site?

• Why it is important?

– Prevent information proliferation, and avoid obsolete

information

– Promote self-discovery, requester can ‘follow’ the path to

navigate to the needed information

– Promote decoupling between requester and provider

– Each app can focus on managing its own information, and

relies on reference to build up network of information -

aggregation

20


Master Data Management

• Adopt SOA to share instead of duplicate

Master Data

• Data Entities

– Patient

– Care Provider

– Healthcare Organisation/Services

– Terminologies such as medication and

procedure

21


Standard-based Info Exchange

• Leverage on international standards –

HL7

– Reduce long time integration cost

– Support of wider development community

• Provides unified info access layer to

hide the underlying diversity and

complexity

22


Unified Info Access Layer

23

• Provides consistent

API to access

diversified

information

• Transparent data

access control and

privacy

enforcement


A unified information layer provides

the foundation for RAD

• Information consumers – Higher level business

services

– Presentation layer

components

– External partners information

consumers

• Minimize the potential

changes to information

consumers

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External

partner External

partner External

partner External

partner External

partner External

partner External

partner

Information Layer

Presentation Presentation



Presentation

Business

Service Business

Service Business

Service Business

Service Business

Service Business

Service


Standards Based Reference Design

25

Lightweight

Restful Service

Messaging and Document

based Integration


SOA in Summary

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Source: Gartner Ross Altman


SOA Adoption Strategy 1/2

• Start from infrastructure IT-driven

service

– E.g. Common authentication service

• Share and reuse existing IT assets

• Consolidate redundant business

functionality into fewer moving parts

27


SOA Adoption Strategy 2/2

• Establish common standards and

integration patterns

• Publish services to encourage reuse

• Remember, SOA is a journey of

business & IT transformation

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Thank you!

[email protected]

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soa enabled next generatione emr/ehr

Technology

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inaccessible information

healthcare system