The Infrastructure Behind eHealth

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Tony Cooke …

Tony Cooke
Hutt Valley DHB
www.huttvalleydhb.org.nz
(1/10/09, Forum, 3.20)

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  • 1. The Infrastructure Behind eHealth
    • HINZ Conference & Exhibition
    • 1 st Oct 2009
    • Presentation by
    • Tony Cooke
    • CIO, Hutt Valley DHB
  • 2. RAID HL7 Change Control Directory services Two factor Authentication EMR UPS Interoperability SAN PHR Virtual Server HTTPS Proxy server Layer 3 Network VPN Host Bus Adaptor CDA CCOW Dicom SNOMED ISO 17799
  • 3. Functional Interoperability Technical Interoperability Communications Interoperability Human/Computer Interface Interoperability Semantic Interoperability eHealth Systemic Interoperability Security/ Privacy Interoperability Legal, ethical And societal Interoperability Environmental Interoperability Business Interoperability Stakeholder Interoperability
  • 4. Back to the Past
    • 50 years ago we had person centred health care!
  • 5. Pharmacy Laboratory Radiology Hospital Community based e.g. NGO’s, Maternity, Homecare Aged Care General Practice Emergency Services Specialist Clinic Specialisation leads to Silos Consumers / Populations
  • 6. Paper is simple
    • Everyone has the skills to capture information on paper
    • Paper and pens are cheap and readily available
    • Paper is flexible – always room in the margin
    • HOWEVER
      • Can only be in one place at one time
      • Largely unstructured and often bits missing
      • Takes up lots of space
      • Hard to retrieve the information
  • 7. Technology – Opportunity & Risk
    • Technology infrastructure overcomes some limitations of paper based systems
      • Info in many places at once (distance no barrier)
      • Data quality controls
      • Easy to search and report on
      • Stores lots of data and can make many copies
    • Risks
      • Failures are big
      • Specialist skills required to develop and support
      • Large investments
      • Rapid changes and turnover in infrastructure
  • 8. Technology is here to stay
    • Increased use of computers
    • Increased dependence – always on
    • Increased use in different settings – off-site, at other DHBs, at conferences, at home
    • Only source of patient information
    • Crossover between computers and medical equipment
    • High volumes of data
  • 9. Trends in IT Services
  • 10. I want to have...
    • Access to relevant patient information
    • Easy and user friendly access
    • No downtime
    • No loss of information
    • Fast response times
    • Flexibility
    • Accurate and trusted information
    • Reduced administration
    • Support for professional and legal obligations
    • Access at home
  • 11. And IS needs...
    • More storage space
    • More servers
    • Leading to more data centres…
    • More automation
    • More security
    • Low cost infrastructure
    • Low maintenance infrastructure
    • Greater standardisation
    • Stable and reliable staff
    • Range of skills and 24 x 7 coverage
  • 12. Consumer as co-producer of their healthcare
    • Internet knowledge
    • Communicate with their health professional
    • Participate in their own care plan (or wellness plan)
    • Monitor treatment from home (vital signs, medications)
    • Medical alerts
    • Recalls; screening
    • Information at their fingertips
  • 13. Consumer infrastructure
    • Authentication – who are you?
    • Secure access to the Internet
    • Secure communication with your care provider
    • Access to your electronic health record
      • Update your vitals data
      • Alerts for screening or medication
      • Add to your care plan
    • Integrates with existing data sources
  • 14. What is infrastructure?
    • Anything which keeps the lights on
    Applications Network Operating System Hardware Information
  • 15. Components of Infrastructure
    • Hardware
    • Network and directories
    • Applications
    • Training and support
    • Security and authentication
    • Identifiers
    • Standards – content and messaging
  • 16. Backend Resilience SAN 1 SAN 2 Servers Servers CR 1 CR 2
  • 17. High Level Information Framework Population Health/Funding (Health Needs Assessment, Public Health, Pricing) Primary Care (GP, Clinic, NGO, Rest Home) Secondary Care (Patient Management, Electronic Medical Record) National Systems (NHI, HPI, NIR Reporting, Surveillance, Payments) Clinical Support (Laboratory, Radiology, Pharmacy, On-line Knowledge) Corp Support (HR, Payroll, Finance, Business Reporting, Service Contracts, Identity Mgmt)
  • 18. External Aotea Lab NIR NHI Surveillance GP PMS Breast Screening Payments (HealthPAC) National Extracts Cervical School Based Vaccination System Public Health Regional Health Surveillance System Data Exchange (Rhapsody) Helpdesk File & Print Email Document Mgmt Small Apps (MS Access) Internet Apps Directory Services/Identity Management Login, Office Applications, Email, Calendar Intranet, Contact List Blood Bank Clinical Support Corporate Support Systems Radiology PACS Laboratory Pharmacy Radiology Internet Clinical Knowledge Bases Poisons Concerto MAP/CDV/Searches Clinical Data Repository Discharge Summaries Clinical Audit (SWE) Referrals (SCD) Medical Documents (Meddocs) Clinical Information Systems Event & Incident Reporting Orderlies jobs Paging Doctors Messaging Service Contracts (HIN) HR Payroll Timesheets Rostering Self-service HR/Payroll Public Health Contract Reporting (ARS) Patient Events, Caseweight Budgets, NNPAC, Business/ Activity Reporting, ESPIs Reporting Nurse Rostering Ward Acuity Rostering Supply Finance Equipment Tracking CSSD (Traybax) Asset Mgmt (BEIMS) Snapshot Ward Imprest Finance & Supply Concur Hutt Valley DHB Systems Map – 16 April 2009 Endoscopy School & Hospital Dental Digital Dictation NASC Head & Neck Audit OSH Ear-van Patient Management System Patient Master Index Outpatients Inpatients Waiting List Medical Records Tracking Medical Records Coding/ 3M Encoder Theatre ED NMDS NBRS Referral Mgmt (Allied Health) PRIMHD NHI Interface ADT Messaging
  • 19. NZ Health Sector Information Model
  • 20. Tests/ Results Labs NZ Health Sector Information Model
  • 21. Tests/ Results Tests/ Images Labs Diagnostic Imaging NZ Health Sector Information Model
  • 22. Health Applications Local Users Doers NZ Health Sector Information Model Tests/ Results Tests/ Images Pharm Data PAS Data Bookings Practice Data Transactors Labs Diagnostic Imaging Pharmacy Patient Administration System Appointment Booking Practice Management
  • 23. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management NZ Health Sector Information Model
  • 24. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model
  • 25. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model
  • 26. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting NMDS NHI NIR HealthPAC ACC Accumulators Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model
  • 27. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model
  • 28. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Surveillance Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Health Data Repositories Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model
  • 29. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Surveillance Patient VITALS MyHealth Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Health Data Repositories Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model
  • 30. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Surveillance Patient VITALS MyHealth Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Health Data Repositories Connectivity Viewers Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model Policy Maker/ Researcher Health Practitioner Patient/ Individual Provider Organisation Funder
  • 31. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Surveillance Patient VITALS MyHealth Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Health Data Repositories Role & Patient Context Connectivity Index(s) NHI HPI Apps Viewers Security Mgmt Authentication Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model Policy Maker/ Researcher Health Practitioner Patient/ Individual Provider Organisation Funder
  • 32. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Surveillance Patient VITALS MyHealth Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Health Data Repositories Health Portal Viewer Search Engine | Identifiable | Individual Anonymised | Aggregated | Role & Patient Context Connectivity Index(s) NHI HPI Apps Viewers Security Mgmt Authentication Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model Policy Maker/ Researcher Health Practitioner Patient/ Individual Provider Organisation Funder
  • 33. Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Surveillance Patient VITALS MyHealth Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Health Data Repositories Health Portal Viewer Search Engine | Identifiable | Individual Anonymised | Aggregated | Role & Patient Context Connectivity Index(s) NHI HPI Apps Governors & Monitors Viewers Auditing & Compliance Security Mgmt Authentication Labs Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management NZ Health Sector Information Model Policy Maker/ Researcher Health Practitioner Patient/ Individual Provider Organisation Funder
  • 34. Labs Tests/ Results Tests/ Images Pharm Data Clinical Data Repository PAS Data Bookings Practice Data Health Applications Local Users Doers Transactors Messaging / Routing / Reporting Surveillance Patient VITALS MyHealth Regional CDR/PACS Regional Data WH NMDS NHI NIR HealthPAC ACC Accumulators Health Data Repositories Health Portal Viewer Search Engine | Identifiable | Individual Anonymised | Aggregated | Role & Patient Context Connectivity Index(s) NHI HPI Apps Governors & Monitors Viewers Auditing & Compliance Policy Maker/ Researcher Health Practitioner Patient/ Individual Provider Organisation Funder Security Mgmt Authentication Diagnostic Imaging Pharmacy Local EMR Patient Administration System Appointment Booking Practice Management Clinical Knowledge Databases Labs Labs Diagnostic Imaging Diagnostic Imaging Pharmacy Pharmacy Local EMR Local EMR Patient Administration System Patient Administration System Appointment Booking Appointment Booking Practice Management Practice Management . health.nz NZ Health Sector Information Model
  • 35. And yet technology is the easy bit…
    • People
      • A young industry – not mature
      • Skills development – especially health
      • Partnership between Clinicians and IT
      • Cultural change
      • Acceptance of technology
      • Investment and mandate
  • 36. And …
    • Process
      • Change control
      • Capacity planning
      • Efficiency and accountability
      • Audit checking
      • Anti-malware
      • Project and Change Management
  • 37. Conclusion
    • Infrastructure is not trivial
    • Scale is important
    • Skills and investment needed
    • Standardisation creates sustainability
    • Interoperability requires an architecture
    • Questions and Answers?