SOA enabled next generatione EMR/EHR
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Transcript of SOA enabled next generatione EMR/EHR
SOA enabled next generation
EMR/EHR
Victor Chai
13-Nov-2013
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@Copyright 2012 Health InterConnect
Disclaimer
The information shared here does not
represent the official opinions of my
current employer (MOH Holdings).
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@Copyright 2012 Health InterConnect
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
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@Copyright 2012 Health InterConnect
Topics
• SOA reality check
• The challenges & complexities
• The solution
• Adoption strategy
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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
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
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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
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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
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Healthcare IT Overview
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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.
@Copyright 2012 Health InterConnect
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
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
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
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
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
Polyclinic/ Family Medicine
Clinic
Palliative
Care
Screening &
Prevention
Nursing
Homes
Communit
y Hospital
Restructur
ed
Hospital
Home
Medical
Centres
Healthcare Landscape of Future
Source: HIMSS 2012
@Copyright 2012 Health InterConnect
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
@Copyright 2012 Health InterConnect
A patient journey within a setting
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Patient arrives
at hospital Consultation Investigation
Patient
discharged
Claim & Billing
Treatment
@Copyright 2012 Health InterConnect
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
@Copyright 2012 Health InterConnect
Different information models
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Data Source1 Data Source2 Data Source3
Heterogeneity in naming, syntax, representation and structure
e.g., “Severe osteoarthritis of the left knee ”
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Lack of standardisation
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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
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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
@Copyright 2012 Health InterConnect
WHAT IS THE SOLUTION
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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
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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
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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
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Unified Info Access Layer
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• Provides consistent
API to access
diversified
information
• Transparent data
access control and
privacy
enforcement
@Copyright 2012 Health InterConnect
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 Presentation
Presentation Presentation
Presentation
Business
Service Business
Service Business
Service Business
Service Business
Service Business
Service
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Standards Based Reference Design
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Lightweight
Restful Service
Messaging and Document
based Integration
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SOA in Summary
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Source: Gartner Ross Altman
@Copyright 2012 Health InterConnect
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
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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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