Singapore National EHR -- Adaptive Architecture for Transformation and Innovation

Architecture World ‘11

Singapore National EHR – Adaptive Architecture for

Transformation and Innovation

Peter Tan, Lead Enterprise ArchitectWong Ming Fai, Senior Architect

MOH Holdings, Singapore

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First Up, Organization Context - Singapore …

Confidential to MOH Holdings Pte Ltd.

4.99 million people on 710.3 sq km (7,025/km2)

Ethnically diverse: Chinese: 75 per cent Malays: 14 per cent Indians: 9 per cent

It’s Characters: A city state Rich technology foundations Support of the government Will of the people Less legal constraints ‘It will be done’

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The Healthcare Services


Primary Care Long-Term CareAcute &Intermediate Care

Restructured Hospital

Rehab & Support Services

Community Hospital

Polyclinics

General Practitioners

Screening & Preventation

Nursing Home

Home Care

Palliative Care

Public sector Private sector People sector

35,000+ healthcare workers

11,580 hospital beds

429,744 hospital admissions (2007)

Public sector out-patient visits (2007)– Specialist Outpatient Clinics 3,687,910– A&E 752,122– Polyclinics 3,797,953

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Secondary Care

At The 30,000 Feet…


Tertiary Care

Primary & Intermediate Long Term Care

A pyramid model, Anchored by Regional

Hospitals

More autonomy in day-to-day operations

own networks of general practitioners

step-down care facility in respective zones.

Community Hospital

General Practitioners

NursingHome

Polyclinics


RH

CH

NHPolyclinics

FPs Home Care

Rehab & support services

Screening & Prevention

Palliative Care

RH

CH

NHPolyclinics

FPs Home Care



Palliative Care

RH

CH

NHPolyclinics

FPs Home Care



Palliative Care

RH

CH

NHPolyclinics

FPs Home Care



Palliative Care

RH

CH

NHPolyclinics

FPs Home Care



Palliative Care

RH

CH

NHPolyclinics

FPs Home Care



Palliative Care

04/09/2023 ©2011 Healthcare Information and Management Systems Society

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One Patient One Record Strategy

Enable integrated healthcare services

Enable integration between healthcare and advances in biomedical

science

Health Information

Exchange - e-Enable seamless

and secured information

exchange in the healthcare value

chain

Integrated Healthcare

Continuum - e-Enable

processes and linkages across the healthcare

value chain

Translating Biomedical Research to Healthcare Delivery -

integrate clinical and biomedical research data

Well-Integrated

Quality Healthcare

Cost-effective

Healthcare Services

Greater ability of public to manage

their health

Strong clinical and

health services

research

To accelerate sectoral transformation through an Infocomm-enabled personalised healthcare delivery system to achieve high quality clinical care, service

excellence, cost-effectiveness and strong clinical research

Strategic Thrusts

Outcomes

Goal

Strategies

iN2015 Strategic FrameworkFrom iN2015 Healthcare and Biomedical Sciences Report

• Visibility of supply, demand, costs and care pathways

• Well populated clinical database• Patients have visibility of their health

journey and available options

• Manage ‘cases’ across care settings using defined care pathways

• Enable interconnection of clinicians, carers and patients in support of integrated care

• Shared use of common services and effective right-siting

• Connection of core health systems to support electronic transactions initiated across settings

• For example - PHR / NEHR for access to an individuals common health record, eReferrals, or e-Prescriptions

• Adoption of Health Infocomm technologies across all care settings

• System adopted are core health systems such as EMR, NEHR, PAS, RADT, PHR

Integrated

Connected

Adopted

Optimized

… a journey summarised by …

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Polyclinics

Fun & Challenges For EA


Chain of 9 polyclinics

Chain of 9 polyclinics

Ancillary systems

EMR Systems

Unique “paperless”

system

http://www.google.com.sg/imgres?imgurl=http://www.nhgp.com.sg/uploadedImages/About_Us/NHGP%20Logo_1(1).jpg&imgrefurl=http://www.nhgp.com.sg/aboutus.aspx&usg=__b8eaJoHZx2Wu2fjoaqApzSIiRHg=&h=635&w=751&sz=84&hl=en&start=1&sig2=yANwb7SiHtc13AeAtnUjuw&zoom=1&um=1&itbs=1&tbnid=cO6Y3oN4Mr1Y9M:&tbnh=119&tbnw=141&prev=/images?q=national+health+polyclinic+logo&um=1&hl=en&tbs=isch:1&ei=U06cTOClEIfcvQPYyIiHDQ

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At MOHH, The Alternative paths for Architecture


(1) Top Down StrategyiN2015 Healthcare and Biomedical SciencesReport

?

Focus on Governance

& Control

Develop Artefact Library

Focus on Delivery

Future Planning &Innovation

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Reflecting back…


Gartner Research, 10 Feb, 2010Case Study: Understanding the Impact of Emergent Strategy on Enterprise Architecture

(1) Top Down StrategyiN2015 Healthcare and Biomedical Sciences Report

NEHR

Future Planning &Innovation

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Enterprise Architecture – Our Approach


Work Collaboratively

Add value early on

Pragmatic approach

Become part of natural process

It’s always about Delivery

Be supportive

Value breeds demand.

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Transformation Driven Approach


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To Enable Transformation and Innovation

Planned Capabilities

1.0 Support & Educate Patient

1.1 Educate

1.2 Enable Self Management

2.0 Deliver Health Services

2.1 Schedule / Register

2.2 Assess Patient 2.3 Deliver Care

2.4 Transfer of Care

3.0 Plan & Manage the Health System

4.0 Manage Population Health

4.2 Design Programme 4.3 Execute Programme 4.4 Evaluate Programme

1.2.1 Access Screening Data in PHR

2.5 Manage Patient Flow

4.3.1 Extract Data for Programme Evaluation

4.1 Define & Manage Performance Targets

4.1.1 Extract EHR Data for Clinical Audit

1.3 Relationship Management

2.1.1 Enable EHR Access

2.1.2 Manage Patient Demographics

2.1.3 Capture Care Team Details

2.2.1 Review Summary Record

2.2.3 Review Investigation Details

2.2.4 Review Procedure Details

2.2.5 Review Referral Details

2.2.6 Review Care Plans

2.2.2 Review Event Details

2.2.7 Review Notifications

2.3.1 Episode of Care Planning

2.3.2 Reconcile Medications

2.3.3 Reconcile Problem List

2.3.4 Update Allergy / ADR

2.4.1 Create / Manage Referral

2.4.2 Create Event Summary

2.4.3 Create Discharge Summary

Legend

1.4 Personal Health Record Management

1.2.5 Self-Assessment Support

1.2.2 Personal Health Risks Assessment, Care Plan and Monitoring

1.2.4 Health Peer Support

1.2.3 Health Advice

1.2.6 Personal Health Care Scheduling

1.2.7 Personal Medications Management

1.2.8 Personal Chronic Health Care Management

1.2.9 Home Monitoring and Therapy

1.2.10 Immunization Access and Management

1.2.11 Health Research Programs

1.3.1 Patient Relationship Coordination

1.1.1 Health Education Information

1.1.2 Health Promotion Programs

1.1.3 Health Management Tools

1.1.4 Outreach Programs

1.4.1 Personal Health History

1.4.2 Health Record Consent Management

1.4.3 NEHR Access and Update (Patient)

3.1 Manage Logistics

3.2 Manage Finances

3.3 Manage Legal & Commercial

3.4 Manage HR 3.5 Manage IT 3.7 Manage Quality

3.6 Manage Policy

3.1.1 Manage Facility Information

3.4.1 Manage Clinician Information

3.5.1 Manage EHR Operations

2.3.5 Care Results Sharing

2.4.4 Health System and Provider Capacity Identification

2.4.5 Care Transfer Planning

2.5.1 HealthCare Options Assessment

2.5.2 Case Management

2.5.3 Length of Stay Management

2.5.4 Resource Usage Monitoring and Management

2.5.6 Care Outcomes Evaluation

2.5.6 Health Finances Management

2.5.7 Demand Management

3.7.1 Care Quality Monitoring and Management

3.8 Manage Partners3.8.1 External Service Provider Management

3.8.2 Provider Relationship Coordination

3.8.3 Clinical Networking Support

4.2.1 Integrated Care Pathways Design

Not impacted by programsEHR functionality = post P1EHR and CIC functionalityEHR-related functionalityPHM-related functionalityCIC-related functionalityLevel Two business capabilityLevel One business capability

2.0.1 School Health Services

2.2.8 Care Requirement Assessment

2.5.8 NEHR Access and Update

Planned Components

Developed Reusable Components Services catalog Inter-operability &

Integration National Service Bus

Architecture Data & Data repository

Architecture National Health Identity

Service Capabilities Catalog

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Conceptual View of the NEHR


Event Summary, Referral & Screening Documents

EHR Summary Record

NameNRIC No.

Primary Care ProviderCare Coordinator

Allergies

DiagnosesCurrent Medications Procedures

Recent EventsRecent Referrals

Care Plan

Date of BirthGender

Detailed Reports / Images

Shared Services / Functionality

Business Intelligence

Data Warehouse

National Scorecard

Programme Scorecard

Link

Share Data

DA / ADR Module

Immunisation

Medications Reconciliation

Problem List Reconciliation

Shared Care Plan

Care Team Details

Personal Health Record (PHR)

Referral Processing

Laboratory Reports

Procedure Reports

Radiology Reports / Images

Drill DownDrill Down

School Screening

Fit for Instruction

SOC Referralto GP

AIC / ILTC Referral

Community Hosp Disch. Summ.

Referral to SOCSOC Event Summary

Inpatient Disch. Summ.

GP Event Summary

ED Event Summary

Investigations

Immunisations

Applications that are not a part of the EHR solution, but will be integrated with the EHR


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Source Data Characteristics

Service Catalogue: Organisation

5 Domains: EHR, Identify and Access Mgmt, Terminology, National Health Identification Service, Integration

x 461

x 82

x 24

x 5

A Peek into the Service Catalogue

Domain

Functional Area

Service Name

Service Name Description

Service Operation

Service Operation Description

Service Input

Service Output

EHR 1. Summary Care Record

PatientManages the services to register patients.

AddPatient

Registers a new patient with the EHR based on inputs from the source systems

Patient Particulars; e.g. Last Name, First Name, etc

Success or failure indicator

EHR 1. Summary Care Record DeletePatient

De Registers the patient from the EHR based on the source systems

PIDSuccess or failure indicator

Key Questions Answered:

Interoperability Specifications– How can EHR information be understood in

a consistent manner? Integration Services

– What capabilities does the EHR need to provide to support interoperability and integration?

Security Administration

– How does interoperability impact administration and operations of EHR and EMR systems?

Infrastructure

Interoperability Specifications

Infrastructure

Ad

min

istr

ati

on

Sec

urity

Integration Services

Interoperability and Integration Architecture

Information Exchange Requirements

Benefit: Establish Common Understanding

Linkage to Standards

S/N

Name Purpose Integration Standards

Semantic Standards

5 Doc – Request EMRX

Request source system for a specific document.

Leverages on EMRX’s GetDoc functionality.

Web Service EMRX XML

Linkage to Service Catalogue

Domain Functional Area Service Name Service OperationService Operation Description

EHR 1. Summary Care Record Medication UpdatePatientMedic

ation

Update medication(s) on the patient medication list.

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3Q ‘08

4Q ’08

1Q ’09

2Q ’09

3Q ’09

4Q ’09

1Q ’10

2Q ‘10

3Q ‘10

4Q ’10

1Q ’11

2Q ’11

3Q ’11

4Q ’11

NEHR

CIC & PHM

EA Ops & Gov

“Operationalise” the EA practice


CIC & PHMArchitecture

Extending to new Business Areas

Tooling: EA Repository

Gov & OperationContent

population

Implementing operation & governance only when

needed.

NHISA

NEHRA

ESB

Service Catalog

IIA

From Strategy to Program

focus From problem to innovation:Deep dive into a tricky problem space & take opportunity to innovate.

ValueValue

Value

Value

NEHR POC NEHR RFP

NHIS Scoping

NEHR detailed design

Repository

Data/Doc

Interop Specs

Design Assurance

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Collaborative EA Gov & Processes


Architecture & Solution Governace

EA –Project Engagement

(Interaction Points)

EA Repository & Content Mgmt System

Architecture Office

Implementation Projects

PrincipalEnterprise Architect

ArchitectureChange

Management

Architects (Enterprise & Domain)

Guidance

Architecture &Solutions BlocksProcesses IT RoadmapArchitecture

Decisions

Inception

Elaboration

Realization

ARB

SimplifiedInteraction

An Accessible Reference Library

Senior Management Stewardship

1

6

3

4

2

5

7

Current state of application

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EA Tool & Repository


1

23

4

23

EA Repository Meta Model


Data Architecture Technology ArchitectureBusiness Architecture Application Architecture

Alfabet Content Meta ModelD

Architecture Principles, Vision & Requirements

Other References

Adapted from TOGAF 9

Architecture Principles

D

Architecture Requirements RepositoryRequirements | Constraints | Assumptions | Gaps

D Architecture VisionBusiness strategy | Business Principles Objectives & Drivers | Stakeholders | Technology Strategy

D

Deliverable's PARCI

D

ProcessesD

Architecture Decision Log

D Staff Contact list

DToolkits

DSpecifications?

DArchitecture Position Statement

D

Enterprise’s Architecture landscape (Baseline and to-be)supported Business Domains/Organizations (Business Support) - which IT systems provides which Capabilities to which Organizations.

A

Program/Project’s Architecture landscape (Implementation Programs/projects )View of affected Architecture components and/or architecture Components dependencies/overlap

A

OrganizationA

CapabilityA

Process*(Attachment)

A

ApplicationA

ApplicationReleases

AServices

A

Information FlowA

Business Object (LIM)

A

Business Data (Physical)

A

Components / Standard

Components

A

A

Standard Platform

A

GlossaryA

ComponentModule

A

Managed in a Directory repository

DManaged in Alfabet repository

A

Overview of EA Repository’s Meta Model

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3Q ‘08

4Q ’08

1Q ’09

2Q ’09

3Q ’09

4Q ’09

1Q ’10

2Q ‘10

3Q ‘10

4Q ’10

1Q ’11

2Q ’11

3Q ’11

4Q ’11

NEHR

CIC & PHM

EA Ops & Gov

“Operationalise” the EA practice


CIC & PHMArchitecture

Extending to new Business Areas

Tooling: EA Repository

Gov & OperationContent

population

Implementing operation & governance only when

needed.

NHISA

NEHRA

ESB

Service Catalog

IIA

From Strategy to Program

focus From problem to innovation:Deep dive into a tricky problem space & take opportunity to innovate.

ValueValue

Value

Value

NEHR POC NEHR RFP

NHIS Scoping

NEHR detailed design

Repository

Data/Doc

Interop Specs

Design Assurance

NHRA next iteration

NEHR Architecture Refresh Approach

Gap analysis of current NEHR system

Gap analysis of current NEHR system

Items from current target architecture

Items from current target architecture

Integration analysis of current systems

Integration analysis of current systems

New business services and applications

New business services and applications

Goal state architectureGoal state architecture

Options analysis

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Solidifying EA Process


1

23

4


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What We’ve Learned

1.Focus on solving

problems, not just delivering

artefacts

2.Build

relationships / trust

3.Be a

servant first,

policeman later

5.Evolve from where you

are

4. Be

pragmatic, not

dogmatic

Revolutionaries make

Good Martyrs!

Health and MedicalPractice Insurance Pte Ltd

Thank you

Singapore National EHR -- Adaptive Architecture for Transformation and Innovation

Health & Medicine

Transcript of Singapore National EHR -- Adaptive Architecture for Transformation and Innovation