SOA enabled next generation EMR/EHR
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Industry sharing for NUS ISS SOA lecture on Nov 13, 2013
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SOA enabled next generation EMR/EHR
- 1. SOA enabled next generation EMR/EHR Victor Chai 13-Nov-2013 1
- 2. Disclaimer The information shared here does not represent the official opinions of my current employer (MOH Holdings). 2 @Copyright 2012 Health InterConnect
- 3. 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 eProcurement development HL7 Singapore TC member HL7 Interoperability Standards such as HL7v2, HL7 CDA, HL7 FHIR etc 3 @Copyright 2012 Health InterConnect
- 4. Topics • SOA reality check • The challenges & complexities • The solution • Adoption strategy @Copyright 2012 Health InterConnect 4
- 5. Is SOA still relevant today? Source: Gartner Ross Altman A fundamental shift from monolithic application centric design to service centric design @Copyright 2012 Health InterConnect 5
- 6. SOA has become increasingly relevant and important • Information • Mobile Internet of Things Contextualized Information Seamless user experience Multi-access channels App becomes more specialized Social interactions and Collaboration Infrastructure Platform Software • Social • Cloud @Copyright 2012 Health InterConnect 6
- 7. 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 @Copyright 2012 Health InterConnect 7
- 8. 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 @Copyright 2012 Health InterConnect 8
- 9. Healthcare IT Overview 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. Health Information Exchange (HIE): The mobilization of healthcare information electronically across organizations within a region, community or hospital system. 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. 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 @Copyright 2012 Health InterConnect 9
- 10. Healthcare Landscape of Future Strategic vision of patients moving seamlessly across the healthcare system, receiving coordinated patientcentric care at the most appropriate settings. Communit y Hospital Polyclinic/ Family Medicine Clinic Home Screening & Prevention Family Physician supported by CHCs Medical Centres Restructur ed Hospital Communit y Hospital Polyclinic/ Family Medicine Clinic Home Screening & Prevention Family Physician supported by CHCs Medical Centres Restructur ed Hospital Nursing Homes Palliative Care Rehab Centres Communit y Hospital Nursing Homes Polyclinic/ Family Medicine Clinic Palliative Care Home Screening & Prevention Family Physician supported by CHCs Rehab Centres Medical Centres Restructur ed Hospital Communit y Hospital Nursing Homes Home Screening & Prevention Family Physician supported by CHCs Medical Centres Source: HIMSS 2012 Restructur ed Hospital Home Screening & Prevention Rehab Centres Family Physician supported by CHCs Medical Centres Communit y Hospital Polyclinic/ Family Medicine Clinic Polyclinic/ Family Medicine Clinic Palliative Care Communit y Hospital Nursing Homes Polyclinic/ Family Medicine Clinic Palliative Care Rehab Centres Home Screening & Prevention Family Physician supported by CHCs Medical Centres Restructur ed Hospital Nursing Homes Palliative Care Rehab Centres @Copyright 2012 Health InterConnect Restructur ed Hospital Nursing Homes Palliative Care Rehab Centres
- 11. Vision of Future Healthcare Landscape - enabled by the Regional Health Systems (RHS) Screening & Prevention Polyclinic/ Family Medicine Clinic Community Hospital Nursing Homes Home Palliative Care Family Physician supported by CHCs Rehab Centres Restructured Hospital 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 personcentric care integrated with the rest of the care spectrum for both physical and mental healthcare Source: HIMSS 2012 @Copyright 2012 Health InterConnect
- 12. A patient journey within a setting Patient arrives at hospital Consultation Investigation Treatment Patient discharged Claim & Billing @Copyright 2012 Health InterConnect 12
- 13. Different IT systems along the patient journey Lab Order Patient Arrives at Hospital Patient Admission Rad Order Consultation Lab Result Rad Result Investigation Clinical Documentation Medical Procedure Surgical Procedure Patient Discharged Treatment Discharge Summary Medication Prescription Medication Dispense Billing & Claim Mgmt Medication Administration Insurance & MediClaim @Copyright 2012 Health InterConnect Casemix & Subvention 13
- 14. Different information models Heterogeneity in naming, syntax, representation and structure Data Source1 Data Source2 Data Source3 e.g., “Severe osteoarthritis of the left knee ” @Copyright 2012 Health InterConnect 14
- 15. Lack of standardisation Code Y N Code X Value Code 1 0 Resident Non Resident Code R N P Value Resident Non-resident PR/Residential Status Code A C P U Value Resident Non-Resident Value RESIDENT NON-RESIDENT PERMANENT RESIDENT Description Alien Citizen PR Unknown @Copyright 2012 Health InterConnect 15
- 16. Fragmented Information Input - Output Process Clinical Desicions Information Medical operational Society objective subjective Assesment Planning Workflow Action Community Isolated information Complex desicions Fragmented information Lack of training Not accessable information Changing knowledge Diference in structure and clinical meaning Medical errors Too much information Inefficient workflow Bad information presentation Understaffing Only clinical data is kept (no knowledge) No operational information Some information is not computer usable (free text, image features, (genome in the future)) No infrastructure information No common language No feed back to medical community and society @Copyright 2012 Health InterConnect 16
- 17. WHAT IS THE SOLUTION @Copyright 2012 Health InterConnect 17
- 18. Multichannel enabled architecture • From ‘PC first’ to “Mobile first’ • Embrace ‘multi-channel enabled architecture’ – It drives the underlying shared service design principle @Copyright 2012 Health InterConnect 18
- 19. 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 @Copyright 2012 Health InterConnect 19
- 20. 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 @Copyright 2012 Health InterConnect 20
- 21. 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 @Copyright 2012 Health InterConnect 21
- 22. 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 @Copyright 2012 Health InterConnect 22
- 23. Unified Info Access Layer • Provides consistent API to access diversified information • Transparent data access control and privacy enforcement @Copyright 2012 Health InterConnect 23
- 24. A unified information layer provides the foundation for RAD • Information consumers – Higher level business services – Presentation layer components – External partners information consumers Presentation External Business Presentation External partner Business Service Presentation External partner Business Service Presentation External partner Business Service Presentation External partner Business Service Presentation External partner Business Service Presentation External partner Service partner • Minimize the potential changes to information consumers @Copyright 2012 Health InterConnect Information Layer 24
- 25. Standards Based Reference Design Messaging and Document based Integration Lightweight Restful Service @Copyright 2012 Health InterConnect 25
- 26. SOA in Summary Source: Gartner Ross Altman @Copyright 2012 Health InterConnect 26
- 27. 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 @Copyright 2012 Health InterConnect 27
- 28. 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 @Copyright 2012 Health InterConnect 28