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Enterprise Architecture and RHIS Presentation Transcript

  • 1. 4th International RHINO Workshop Measuring and Improving Routine Health Information System Performance Enterprise Architecture & eHealth Guanajuato, Mexico March 11, 2010
  • 2. Survey Please, raise your hand those who live in developing countries and: Use SMS (mobile phone messages) daily Have an email account Access email daily as part of your professional activity Do Internet banking Use MSN or Skype for live communication Other uses?
  • 3. Questions: What is(are) the purpose(s) of a HIS? Consider either electronic or paper-based HIS What is eHealth?
  • 4. WHO’s Definition eHealth is the combined use of electronic communication and information technology in the health sector. For clarity, in this presentation: eHealth is the broadest concept An electronic HIS is a system that uses eHealth concepts.
  • 5. Why the sudden concern with eHealth? The vast majority of resource-impoverished countries: Do not have national eHealth policies; Have vertical health information systems for diseases such as AIDS, Malaria and TB, often donor-funded; Lack proper HR on Health Informatics; Do not have access to standards; Do not appreciate the complexity of national eHealth infrastructure. From: eHealth Enterprise Architecture for Emerging and Developing Countries, PPT presentation as part of NWIP for ISO
  • 6. Why it is Urgent There are duplicative activities from stakeholders defining sets of data to be collected and reported, e.g. Millennium Development Goals. Global South countries urgently need an architectural framework from which to conceive eHealth systems, plan implementations, make build-or-buy decisions, decide on acquisitions and undertake related activities. Low resource countries that are starting to use IT in health must make the right decisions now in order to be able to support interoperability and scalability of applications. From: eHealth Enterprise Architecture for Emerging and Developing Countries, PPT presentation as part of NWIP for ISO
  • 7. Multitude of Guidelines Documents Adapted from: WHO Indicator and Metadata Registry (IMR) DMX-HD Aggregate Data Exchange, Patrick Whitaker, IER/HSI/HCI
  • 8. Fragmented Indicators Indicator Source HIV prevalence among population aged 15-24 years www.mdgmonitor.org/goal6.cfm Percentage of young women and men aged 15–24 who data.unaids.org/pub/Manual/2007/20070411_ungass_core_in are HIV infected dicators_manual_en.pdf Proportion of population aged 15-24 years with www.mdgmonitor.org/goal6.cfm comprehensive correct knowledge of HIV/AIDS Percentage of population aged 15-24 years with www.unmillenniumproject.org/goals/gti.htm comprehensive correct knowledge of HIV/AIDS Percentage of young people who both correctly identify ways of preventing the sexual transmission of HIV and www.theglobalfund.org/documents/me/M_E_Toolkit.pdf who reject major misconceptions about HIV Percentage of young women and men aged 15–24 who both correctly identify ways of preventing the sexual data.unaids.org/pub/Manual/2007/20070411_ungass_core_in transmission of HIV and who reject major dicators_manual_en.pdf misconceptions about HIV transmission Ratio of orphaned children compared to non-orphaned www.theglobalfund.org/documents/me/M_E_Toolkit.pdf children aged 10-14 who are currently attending school Ratio of school attendance of orphans to school www.unmillenniumproject.org/goals/gti.htm attendance of non-orphans aged 10-14 years Current school attendance among orphans and among data.unaids.org/pub/Manual/2007/20070411_ungass_core_in non-orphans aged 10–14 dicators_manual_en.pdf Percentage of people with advanced HIV infection www.theglobalfund.org/documents/me/M_E_Toolkit.pdf receiving antiretroviral combination therapy Proportion of population with advanced HIV infection www.mdgmonitor.org/goal6.cfm with access to antiretroviral drugs Adapted from: WHO Indicator and Metadata Registry (IMR) DMX-HD Aggregate Data Exchange, Patrick Whitaker, IER/HSI/HCI
  • 9. Fragmented Indicators Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS Percentage of young people who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV Percentage of young women and men aged 15–24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission Adapted from: WHO Indicator and Metadata Registry (IMR) DMX-HD Aggregate Data Exchange, Patrick Whitaker, IER/HSI/HCI
  • 10. Strong Conviction It is impossible to deliver services to thousands and millions of people using craft production methods; Industrial production processes must be used if we are to provide millions of people with good health services; eHealth can: improve quality, reduce costs, optimize the use of resources, and extend the reach of health services
  • 11. eHealth: 5 Main Axes The Electronic Health Record Follow up treatment – notifiable diseases Provide help to health workers at point-of-care Health System Organization Deploy the reference – counter-reference model Management of Health Care Facilities Hospital and HC units management Connected Health Integrate persons within the community Management of the Overall Services Network Operate the health system
  • 12. A Model for eHealth Diag Centers Clinics Suppliers Hospitals Internet Technology Inidividuals (Patients) HMOs Doctors Datacenter Strategic Management Community
  • 13. A Model for eHealth Community Architecture!
  • 14. What is an Architecture? An Architecture is the fundamental organization of something, embodied in: Its components; Their relationships to each other and the environment, And the principles governing its design and evolution Adapted from “Manhattan II Architecture Overview, Geneva, Switzerland, 22 June 2007”
  • 15. What is an Enterprise? A collection of entities that share a common set of goals Government agency or ministry An entire organization Part of an organization A district (and its facilities) A facility (and its departments or clinics) Adapted from “Manhattan II Architecture Overview, Geneva, Switzerland, 22 June 2007”
  • 16. So what is “Enterprise Architecture”? The description of a current or future structure for an organization's processes, information systems, personnel and organizational subunits so that they align with the organization's core goals and strategic direction. This is achieved by applying a comprehensive and rigorous methodology. Although often associated strictly with information technology, EA relates more broadly to the practice of business optimization in that it addresses business architecture, performance management and process architecture as well. Adapted from “Manhattan II Architecture Overview, Geneva, Switzerland, 22 June 2007”
  • 17. Architecture and Engineering Simple Problem: • Simple Solution! My Dog’s House: • Can be built by a single person; • Simple modeling; • Simple tools; • Little consequences; • Little impact; • Can be undone. Adapted from
  • 18. A House • Is built by a team • Needs modeling • Takes well defined processes • Uses robust tools • Becomes part of the environment • Must abide by regulations • Not easily undone. Adapted from
  • 19. The Project of a House: Architecture Adapted from
  • 20. Questions: Which one is the “House”? The HIS, the Health Enterprise or both? Which of them deserve(s) an Architecture? The HIS, the Health Enterprise or both?
  • 21. Health and eHealth Architecture The Health Enterprise deserves a formal good- quality Architecture that describes processes, information systems, personnel and organizational subunits so that they align with the organization's core goals and strategic direction. eHealth deserves an Architecture that will ensure it “sticks” to the Health Enterprise’s needs. The link between the two Architectures is so strong it is difficult to separate them, and a good Enterprise Architecture encompasses an HIS Architecture.
  • 22. The Open Group Architecture Framework http://www.opengroup.org/architecture/togaf9-doc/arch/
  • 23. Essential Purpose of a HIS To support the Health Enterprise to achieve its goals by: Collecting, storing, processing, & analysing data; Ensuring data quality and privacy; Automating processes; Auditing; Supporting clinical & administrative decision making; ..... Implementing policies; Being the “engine” of the Health Enterprise.
  • 24. Published Enterprise Architectures NIH Enterprise Architecture Framework Australian Government Architecture Reference Models v1.0 launched by the Australian Government Information Management Office 2007-06-18, with the US Federal Enterprise Architecture (FEA) reference models, from Office of Management and Budget eGov area. These reference models, which include XML formats for EA reference model data transfer. A single-volume consolidated model is available (June 2006 version and will be updated annually). US DOI US Department of the Interior architecture, with mappings between US FEA reference models US DoD BEA - September 2006 Version of the US DoD Business Enterprise Architecture, with associated browseable dictionary, and printable diagrams. Source “Manhattan II Architecture Overview, Geneva, Switzerland, 22 June 2007”
  • 25. The Health Enterprise Architecture Developing an Architecture for a Health Enterprise is highly desirable but is far from being common place; The concept is becoming more widespread and pieces of it are being used in Health; Also, organizations as the Health Metrics Network are looking for ways to speed up the adoption of the concept by countries to describe their Health Systems.
  • 26. Fragmentation The absence of a proper Health Enterprise Architecture or a Health System for a country tends do lead to siloed, vertical Health Programs, and vertical HIS that fragment not only the information but also the delivery of care itself. Question: Can you give an example of a vertical systems and the associated fragmentation of information and/or care?
  • 27. Health (Enterprise) Architecture Four Layers Representative Questions Addressed Business 1. Who are the key decision makers, what are their roles and behaviors insofar as decision making is concerned? Architecture 2. What are the essential questions & requirements of users? 3. What are the business domains and processes (functions) 4. Who will be responsible for managing the HIS? Data 1. What are the essential core and common data necessary to support the organization’s business architecture? Architecture 2. How will the sources of these data be extracted linked and transformed for use from existing operational systems? Applications 1. What are the priority applications that a core HIS must deliver? Architecture 2. What applications are best included within a single platform design versus those applications that are best maintained as separate operational systems? 3. How should the user interface work? Technical 1. What are the requirements for information to be captured, data entered, tagged, communicated and managed? Architecture 2. What is the minimum information and communication technology capacity needed across the country to support access to the applications and dissemination of information?
  • 28. Strong Conviction Although we usually lack a Health Enterprise Architecture, there are eHealth practices and architectures that can be used to deploy flexible, useful, adaptable, reliable, robust and lasting HIS; We also believe that some general health enterprise requirements can only be conceived if eHealth is present: Nation-wide identification of individuals; Operating the reference and counter-reference model; Real-time notification o diseases; Support to HC workers at the point of care; Data collected once and used many times.
  • 29. eHealth Architecture Initiative ISO, the International Organization for Standardization, is developing a project of an “eHealth Enterprise Architecture for Emerging and Developing Countries”; This initiative somehow places the eHealth Architecture pushing forward the Enterprise Architecture. That’s the tail wagging the dog!
  • 30. eHealth Enterprise Architecture for Emerging and Developing Countries Beatriz de Faria Leao Patrick Whitaker Jan Talmon 1| Health Care Informatics|March 9, 2010
  • 31. Motivation The vast majority of resource-impoverished countries: Do not have national eHealth policies; Have vertical health information systems for diseases such as AIDS, Malaria and TB, often donor-funded; Lack proper HR on Health Informatics; Do not have access to standards; Do not appreciate the complexity of national eHealth infrastructure. 2| Health Care Informatics|March 9, 2010
  • 32. Why it is urgent There are duplicative activities from stakeholders defining sets of data to be collected and reported, e.g. Millennium Development Goals. Global South countries urgently need an architectural framework from which to conceive eHealth systems, plan implementations, make build-or-buy decisions, decide on acquisitions and undertake related activities. Low resource countries that are starting to use IT in health must make the right decisions now in order to be able to support interoperability and scalability of applications. 3| Health Care Informatics|March 9, 2010
  • 33. SKMT and Glossary Standards Knowledge Management Tool (SKMT) - developed as a tool to support classification of health informatics standards. Complimentary to NWIP for Knowledge Management of Health Information Standards– replaced former preliminary work item on EHRS Standards Classification Framework. Glossary work – is progressing well with all ISO terms and definitions entered into the SKMT soon. 4| Health Care Informatics|March 9, 2010
  • 34. Registry of Open Access Data Standards (ROADS) Data needed for patient care, Monitoring and Evaluation (M&E), policy development, and international reporting. Awareness of standards, cost, and access remain obstacles to their widespread adoption and implementation in economically- disadvantaged countries. Involvement in the standards process by these countries has been limited, introducing a bias towards creating standards appropriate for high-income countries. WHO is supporting both ROADS and SKMT with funding from the Rockefeller Foundation. Development of tools to facilitate standards adoption in low-income countries would expand the standards development process and promote standards use. 5| Health Care Informatics|March 9, 2010
  • 35. eHealth Enterprise Architecture for Emerging and Developing Countries: TR Structure Part 1: Environmental Scan Current international initiatives in the area of eHealth systems. Part 2: Business Requirements Framework for identifying business requirements that define an eHealth enterprise architecture in economically-constrained countries. 6| Health Care Informatics|March 9, 2010
  • 36. eHealth Enterprise Architecture for Emerging and Developing Countries: TR Structure Part 1: Environmental Scan Current international initiatives in the area of eHealth systems. Part 2: Business Requirements Framework for identifying business requirements that define an eHealth enterprise architecture in economically-constrained countries. 6| Health Care Informatics|March 9, 2010
  • 37. 14639-2 - eHealth Enterprise Architecture for Emerging and Developing Countries Part 2: Business Requirements Part 2 represents the core contribution of this TR. It provides a framework for identifying business requirements that define an eHealth enterprise architecture for economically-constrained countries taking into account different levels of capacity and maturity. Underlying Principles – The eHealth architecture should support and facilitate access to health research, information and educational materials for managers, providers, researchers, and the general population. – It should facilitate the construction of eHealth systems to support the wellness of the individual, family, and community. – Furthermore, It should be an essential resource to system designers, developers and implementers. 7| Health Care Informatics|March 9, 2010
  • 38. eHealth Enterprise Architecture for Emerging and Developing Countries: Scope and Audiences 8| Health Care Informatics|March 9, 2010
  • 39. Experts Australia: – Ken Tallis, Anthony Maeder, Richard Dixon Hughes Brazil: – Beatriz de Faria Leão, Rigoleta Dutra Canada: – Derek Ritz Kenya – Samuel Cheburet Netherlands: – J.L.Talmon New Zealand: – Mike Mair US: – Robert Owens 9| Health Care Informatics|March 9, 2010
  • 40. Basic Ideas for eHealth Architecture Build and use conceptual models Comply with standards Demand Interoperability Build Unique Identifiers Ask for web-based design Consider SOA Architecture Use Software Engineering tools Build capacity Say “no” to siloed systems
  • 41. The Electronic Health Record Operational Evidences Evidences Support Delivery Support Delivery Management of Care Clinical Knowledge Knowledge Management Quality EHRS Assessement Pseudo-anonymized Data (datawarehousing) Strategic Management Information at the Point of Care Billing & Others Best Practices Operational Knowledge & True Automation Support Decision Support Management
  • 42. Which standards are essential? Information content Capture, describe, edit, store and retrieve Vocabularies to express the content Terminologies Communications File formats, protocols Security Protect data, role-based access.
  • 43. Essential Identification within the Country Identify People Uniquely Individuals, patients, health workers Identify Health Workers Uniquely All types of workers and their profiles Identify Health Organizations Uniquely Who they are and what they do What they have (equipment) Identify Relationships Among Them Who works where and when and in which role Can organize the Reference and Counter-Reference Model Answers to who attended whom and where
  • 44. A Conceptual Model for Health Information National Domain Tables Registries and Vocabularies R o Hospitals and l Healthcare Units e Health Workers Users (Patients) - b a Electronic Health s Record e Exams d Emergency A Primary c Care Specialties Inpatients c e s s HC Services Flow Control Management Assessment C o n Beds Emergency Billing t Health r Consultations Exams Authorization Surveillance o Auditing l
  • 45. Interoperability of HIS No single HIS can encompass all the requirements of an enterprise; Something will always happen outside the reach of the Health Enterprise and its HIS; Therefore, HISes need to “Interoperate”; “Interoperability is the ability of two or more systems to exchange information and to use the information that has been exchanged” (IEEE); The only way to interoperate is by sticking to standards.
  • 46. Real World HIS Systems Interoperability Health Enterprise External Players Data Repository XML HL7 LOINC Standards
  • 47. Conclusion eHealth can change Health No single system can sort out all problems Need standards for Interoperability Say No to “Siloed Systems” Enterprise-wide unique IDs are essential Need for ICT infrastructure HR capacity building An eHealth Architecture is a must Think big, act step by step Give ourselves time to learn Build upon existing initiatives
  • 48. References eHealth Connection www.ehealth-connection ISO TC-215 eHeath Enterprise Architecture for Developing Countries www.iso.org/iso/pressrelease.htm?refid=Ref1275 TOGAF – The Open Group Architecture Framework www.togaf.org Health Metrics Network www.healthmetricsnetwork.INFO Vital Wave Consulting. Health Information Systems in Developing Countries. A Landscape Analysis, May 2009, www.vitalwaveconsulting.com
  • 49. São Paulo City Health Information System The largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area. Basic Figures (2009): 700 Heath Care Units SIGA Saúde is São Paulo City’s System 15 M Users for Managing the Public Health System. 1 M PC Cons/month It belongs to São Paulo City. 35% Reduction/wait time SIGA Saúde has been developed using 2M prescriptions/month open-source, free-software concepts.
  • 50. Ensuring Equity and Integrality of Care Patient Flow Management High Complexity - Hospitals Private University Public Hospital Hospital Hospital Electronic Health Record Medium Complexity Counter-reference reference Diagnostic Diagnostic Polyclinic Specialties Center Center Physician Primary Physician Physician Primary Primary Office Care Unit Office Office Care Unit Care Unit Entry Level Primary Care
  • 51. SIGA Saúde Building Blocks Nation-wide patient ID Captures encounter data set Nation-wide Identifiers Health workers, units & equipment Concepts, Policies & Norms Family health program National immunization program Municipalization of care on a capitation basis Automatic disease notification
  • 52. Schematic Representation Heath Care SMS-SP Management (Surveillance, Audit and Billing) Dept of Health Internet Patient Flow Control (Consultations, Procedures, Beds) Ambulatory Electronic Health Record (Primary, Specialties, High Complexity) SP City Datacenter Secure Access
  • 53. Encounter Data Set Type of Attendance Special Programs Anamnesis, Physical Exam, History Diagnosis Work-Related Disease Communication Disabilities Procedures carried-out Notifiable Disease Communication Requested procedures Medications High-Complexity Procedure Order Form Course of Action
  • 54. Notifiable Disease Report
  • 55. Primary Care Units in São Paulo City
  • 56. ERROR: undefined OFFENDING COMMAND: YJPgZ4rq STACK: