Iot, cloud and healthcare - Challenges and Opportunities
xenos_caa
1. Data Integration in the
Community
Chrystelle Ayerhart
Interface Systems Analyst
Peggy Millar
Corporate Manager Computer Applications
Grey Bruce Health Services
2. Making DI/Lab Results and
Transcribed Documents Available
Electronically to
Community
Physicians
3. Grey Bruce Information Network
(GBIN)
• Approximately 9000 sq.
km (3,475 sq. miles)
• 3 corporations
• 11 hospital sites
• 1 outpatient clinic site
4. Strategic Goals (Technology)
• Grey Bruce Health Services will utilize
technology as it becomes available if it
improves efficiency and safety, and
enhances our service
• We will create mechanisms to share
information to support a seamless care
experience for the patient and to
improve system efficiency
5. Operational Goals
• Reduction of paper
• Enter data once, reduce the effort
• Reduce labour
• Sharable data
• User friendly applications
• Efficiencies
• Less steps for clinical staff
6. Provider Benefits
• Reduced turn-around time for results
• Faster diagnosis and treatment
• Results requiring follow up are flagged
• Time and labour savings – decreased manual
handling of result
• Decreased paper, decreased physician
storage required
• Vendor neutral
• Ease of connection
8. Previous Process
• Lab, DI and Medical Transcription
documents produced in hard copy
• Results are sorted, mailed or faxed to
physician offices
• Document handling:
– Must be printed
– Filed in the patient’s physical chart
– Possibly scanned into electronic format
9. Project Specific Objectives
• Improve the method of sending results
to local physician clinics
• Produce standard method of
communication
• Have a flexible, scalable solution –
recognized the need to send to multiple
locations
10. Design Approach
• Potential to apply technology to many
locations is apparent
• Opted for single interface working with
a 3rd party gateway
• Burden of processing and maintenance
occur at gateway
11. Design Approach Continued
• Standardized message structure makes
system vendor-neutral
• Gateway alerts of errored messages or
dropped connections
• Interface maintenance handled
completely in-house
12. Build Steps
• Resources
– Technical Coordinator
– Interface Systems Analyst
– Representative from 3rd party vendor
• Physical Resources
– Servers (production and test)
• We were the driving force behind 3rd
party vendor’s functionality
13. Testing, Testing, Testing
• Phase 1
– Between Cerner and gateway only
– Simulated receiving clinics
– Set up scenarios to test gateway alerts
• Phase 2
– Contacted alpha clinic software vendor
– Set up testing environment with them
– Tested modality by modality
14. Implementation
• One modality, one message at a time
• Daily status calls
• Vendor/Customer gave approval to send next
modality messages
• 3rd party gateway vendor remote support
• Initially needed to work closely with
gateway system’s vendor
– Now only require very basic maintenance
support
15. Timeline
• Initial timeline 2 months
• Chose alpha site and went live in 2004
• Present state, new clinic go-live can be
done in three days:
1. Clinic contacts HIS with list of physicians
(dependent on their hardware/software setup)
– HIS sets up VPN and builds physicians on gateway
2. Send test messages to check connectivity
3. Go-live
16. Current Process
• Verified result or posted transcribed
note triggers result message that is
routed to interface
• Interface sends all messages to gateway
• Gateway prunes messages and routes
only to participating physician offices
• No paper, scanning or filing is required
at either the hospitals or clinic
• Multi site : multi clinic
20. Particulars
• System send 4800+ messages daily to
gateway
• After pruning, gateway distributes
2000+ messages to clinics
• 90 physicians practicing at 12 clinics
receive electronic reports
• Many have opted out of paper reporting
21. Particulars Continued
• Each clinic is free to choose whatever
office management package is suitable
• 4 different vendors are connected,
representing approximately 80% of
available vendors
• Physician account builds and
maintenance are very easy, nothing
changes at interface level
22. Legend
- included in Data
Integration initiative
- complete
- future
EPR Pyramid Now
General
Lab
Notes
Dictation
&
Transcription
Peri-Operative
Care
Patient
Scheduling
Chart
Tracking
Chart
Coding &
Abstracting
Chart
Deficiency
Chart
Viewer
Radiology
&
Nuclear
Med.
Patient
Registration
Blood
Bank
Chronic
Disease
Mgt
PACS
Management
Reporting
Electronic
Signature
Pathology
Orders
AutomationPharmacy
ED
Patient
Tracking
Document
Imaging
Cardiac
Care
Mgt
Critical
Care
System
Problem
List
Bedside
Care
Rules &
Alerts
Clinical
Documentation
Clinical
Pathways
Common
Charting
Practices
Community
Services
Home
Care
Regional
Hospitals
LTC Facilities
Adverse
Drug
Events
Clinical
Decision
Support
Physician
Order
Entry
Family
Physician
23. Lessons Learned
• We started before the wave of office
management vendors hit clinics
• Control of hardware/software set up and
configuration at the clinics is not in our
hands
• The time spent creating standard
specifications is key to success
24. Lessons Learned Continued
• Maintaining constant connectivity
through VPN problematic
• Distributed data model by far most
robust
• Consistent change control from vendors
is required
25. Lessons Learned - Clinics
• Vendor support
• Type of connection required
– Centralized server is most stable at this point
• Talk to other clinics that are live with Cerner
feeds
• Talk to hospitals that are sending Cerner
results
26. Next Steps
• Expect to perform routine hardware
and software upgrades
• Seeing more inquiries from more
clinics
• Can envision same model to send
messages to other corporations,
hospitals, LHINs
• No limit on message types
