0
The state of play in NHS IT Chris Munt Cherylin Fletcher Royal Marsden NHS Trust
Agenda:  Part I <ul><li>Healthcare IT </li></ul><ul><li>A local view </li></ul><ul><ul><li>IT at the RMH </li></ul></ul><u...
Cherylin Fletcher Deputy Director of ICT The Royal Marsden Hospital Information System The State of Play in NHS IT
Electronic Patient Record (EPR) Demographics OP visits Tests & results IP stays Treatments Surgery Notes Palliative care e...
 
 
 
Most of the rest of the NHS <ul><li>Very few advanced Electronic Patient Record developments </li></ul><ul><li>Proliferati...
National Spine GPs Guys & St Thomas Royal Marsden Epsom & St Helier Staff Records Web site Choose & Book  Demographics www...
How can NPfIT help? <ul><li>National NHS Network (N3) </li></ul><ul><li>Choose & Book </li></ul><ul><li>PACS </li></ul><ul...
LPfIT Acute solution from Cerner ** ** **   Not relevant to the Royal Marsden
Where do we want to be? <ul><li>To benefit where appropriate from NPfIT </li></ul><ul><ul><li>Engagement with Connecting f...
The Royal Marsden Hospital Information System Cherylin Fletcher Deputy Director of ICT
Agenda:  Part II <ul><li>Caché at the RMH </li></ul><ul><ul><li>Building a successful IT  infrastructure to support  heath...
RMH IT – History (80s) <ul><li>Department formed in early 1980s </li></ul><ul><ul><li>General hospital IT </li></ul></ul><...
RMH IT – History (80s) <ul><li>First applications – the basics </li></ul><ul><ul><li>Patient Master Index </li></ul></ul><...
RMH IT – History (90s) <ul><li>Seduced by cost/performance of RISC based architecture </li></ul><ul><ul><li>Migrate from V...
RMH IT – History (00s) <ul><li>Turbulent times ahead </li></ul><ul><ul><li>National Programs on the horizon </li></ul></ul...
RMH IT – Architecture <ul><li>1980s: Terminal based applications </li></ul><ul><ul><li>Serial lines to server </li></ul></...
RMH IT – Architecture <ul><li>2000s: Migrating to the Web </li></ul><ul><ul><li>All workstations networked (TCP) </li></ul...
RMH IT – Development <ul><li>Early systems </li></ul><ul><ul><li>Hand-crafted M code </li></ul></ul><ul><ul><li>Needed to ...
ETHOS: HOS Component <ul><li>What is it? </li></ul><ul><ul><li>Mathematically verified Functional Programming Environment ...
ETHOS: HOS Component <ul><li>Benefits? </li></ul><ul><ul><li>Integrity of tree structures checked for self consistency and...
ETHOS <ul><li>Higher Order Software </li></ul><ul><li>Some Examples </li></ul>
ETHOS tree: Calculate Age
ETHOS tree: Embedded SQL
ETHOS tree: Embedded SQL
ETHOS tree: Recursion
ETHOS tree: Using Libraries
ETHOS: SQL/RDBMS Component <ul><li>What is it? </li></ul><ul><ul><li>SQL with extensions </li></ul></ul><ul><ul><ul><li>ET...
ETHOS: SQL/RDBMS Component <ul><li>Benefits? </li></ul><ul><ul><li>High level of abstraction </li></ul></ul><ul><ul><ul><l...
ETHOS <ul><li>SQL and Data Model </li></ul><ul><li>Some Examples of Entity Definitions </li></ul>
ETHOS Entity: PATIENT <ul><li>Base Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, PAT-NAM, ADDRESS, D-REG, T-REG, D...
ETHOS Entity: DATE <ul><li>Superclass of all attributes of type ‘DATE’ </li></ul><ul><li>Base Table: Primary View </li></u...
ETHOS Entity: ADMISSION <ul><li>Base Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, D-ADM, T-ADM, WARD </li></ul><u...
ETHOS Entity: DIAGNOSTICS <ul><li>Base Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, D-TEST, T-TEST, TEST-ID, RESU...
ETHOS Entity: EVENTS <ul><li>Derived Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, D-EVENT, T-EVENT, KEYS, EVENT-T...
ETHOS Entity: EVENTS (1) <ul><li>Derived Table: Secondary View 1 (Contribution from PATIENT) </li></ul><ul><li>SELECT PAT-...
ETHOS Entity: EVENTS (2) <ul><li>Derived Table: Secondary View 2 (Contribution from ADMISSION) </li></ul><ul><li>SELECT PA...
ETHOS Entity: EVENTS (3) <ul><li>Derived Table: Secondary View 3 (Contribution from DIAGNOSTICS) </li></ul><ul><li>SELECT ...
ETHOS SQL: Sequences <ul><li>“ Get all diagnostic tests performed for a patient between 9:00 on 1/9/07 and 12:00 the follo...
RMH IT/ETHOS – Why Caché? <ul><li>High Performance </li></ul><ul><li>Rapid Application Development </li></ul><ul><li>Massi...
RMH IT/ETHOS – Why Caché? <ul><li>High performance? </li></ul><ul><ul><li>Undoubtedly true </li></ul></ul><ul><ul><ul><li>...
RMH IT/ETHOS – Why Caché? <ul><li>Rapid Application Development? </li></ul><ul><ul><li>Undoubtedly true </li></ul></ul><ul...
RMH IT/ETHOS – Why Caché? <ul><li>Massive scalability? </li></ul><ul><ul><li>Undoubtedly true </li></ul></ul><ul><ul><ul><...
Free Alternatives <ul><li>OpenSource, FSF, Freeware etc … </li></ul><ul><li>Will it really take over the world? </li></ul>...
Free Alternatives <ul><li>OpenSource, FSF, Freeware etc … </li></ul><ul><li>Will it really take over the world? </li></ul>...
Traditional Project Lifecycle <ul><li>Analysis of requirements </li></ul><ul><li>Design data-model </li></ul><ul><ul><li>K...
Systems Development <ul><li>May not want to implement something as big as ETHOS but … </li></ul><ul><li>The case for havin...
HTTP <ul><li>SOAP, REST, MEST, [2008 version] etc … are transported by HTTP and … </li></ul><ul><li>The case for having a ...
Caché in Healthcare IT <ul><li>High Performance </li></ul><ul><li>Rapid Application Development </li></ul><ul><li>Massive ...
The state of play in NHS IT Chris Munt Cherylin Fletcher Royal Marsden NHS Trust
Upcoming SlideShare
Loading in...5
×

Chris Munt Cherylin Fletcher State Of Play In Nhs

914

Published on

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
914
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
19
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Chris Munt Cherylin Fletcher State Of Play In Nhs"

  1. 1. The state of play in NHS IT Chris Munt Cherylin Fletcher Royal Marsden NHS Trust
  2. 2. Agenda: Part I <ul><li>Healthcare IT </li></ul><ul><li>A local view </li></ul><ul><ul><li>IT at the RMH </li></ul></ul><ul><ul><li>Cherylin Fletcher </li></ul></ul><ul><ul><li>(Deputy Director of IT at RMH) </li></ul></ul>
  3. 3. Cherylin Fletcher Deputy Director of ICT The Royal Marsden Hospital Information System The State of Play in NHS IT
  4. 4. Electronic Patient Record (EPR) Demographics OP visits Tests & results IP stays Treatments Surgery Notes Palliative care etc Additional Specialised Data Critical Care Unit Diatetics Massage Physio BASO equivalent Genetics research etc Per patient Clinical Workstation Clinical Research Referrals Registration OP IP Case notes Biochemistry Haematology Histopathology Cytology Radiology Radiotherapy Theatres Pharmacy Transport Re-hab Private patients etc Hospital # Staff/System Data Manpower (HR) System Admin Service Agreements etc Trust-wide Hospital Information System (HIS) Management Information
  5. 8. Most of the rest of the NHS <ul><li>Very few advanced Electronic Patient Record developments </li></ul><ul><li>Proliferation of separate departmental/niche systems </li></ul><ul><li>Lack of integration </li></ul><ul><li>Inadequate management information </li></ul><ul><li>Value for money? </li></ul>
  6. 9. National Spine GPs Guys & St Thomas Royal Marsden Epsom & St Helier Staff Records Web site Choose & Book Demographics www.royalmarsden.nhs.uk NHS Net Digital Dictation Intranet e-Mail Interfaces & Other Systems Non-clinical Finance Human resources Occupational health Access control Charity donations Complaints management Catering Drug Stock Control Micro-biology Picture Archiving Hospital Information System (HIS) Demographics OP visits Tests & results IP stays Treatments Surgery Notes Palliative care etc MRI scanners Patients HR Publications X-ray machines
  7. 10. How can NPfIT help? <ul><li>National NHS Network (N3) </li></ul><ul><li>Choose & Book </li></ul><ul><li>PACS </li></ul><ul><li>National Care Records Service (Spine) </li></ul><ul><li>Additional Services </li></ul><ul><li>Enterprise Wide Agreements </li></ul><ul><li>Regional and Implementation Focus (LPfIT) </li></ul>
  8. 11. LPfIT Acute solution from Cerner ** ** ** Not relevant to the Royal Marsden
  9. 12. Where do we want to be? <ul><li>To benefit where appropriate from NPfIT </li></ul><ul><ul><li>Engagement with Connecting for Health/BT </li></ul></ul><ul><li>Move to paperless medical records </li></ul><ul><ul><li>Nursing documents, order comms, drug prescribing, hand-held wireless devices & disaster recovery </li></ul></ul><ul><li>Refresh core in-house applications </li></ul><ul><ul><li>EPR, Casenotes & PAS (Referrals, Registration, Outpatients, Inpatients) </li></ul></ul><ul><li>Reduce surface area of in-house systems </li></ul><ul><ul><li>Replace departmental systems (eg. Radiology & Labs) with best-of-breed third party systems interfaced to the EPR </li></ul></ul>
  10. 13. The Royal Marsden Hospital Information System Cherylin Fletcher Deputy Director of ICT
  11. 14. Agenda: Part II <ul><li>Caché at the RMH </li></ul><ul><ul><li>Building a successful IT infrastructure to support heathcare applications </li></ul></ul><ul><ul><li>Chris Munt </li></ul></ul>
  12. 15. RMH IT – History (80s) <ul><li>Department formed in early 1980s </li></ul><ul><ul><li>General hospital IT </li></ul></ul><ul><ul><li>Research </li></ul></ul><ul><li>One of the first UK customers for DSM </li></ul><ul><ul><li>DEC PDPs </li></ul></ul><ul><li>Moved to M11+ and MVX in mid 80s </li></ul><ul><ul><li>Operational Systems </li></ul></ul><ul><ul><ul><li>DEC PDPs – 11/70, 11/44 </li></ul></ul></ul><ul><ul><li>Research system (epidemiology, analysis) </li></ul></ul><ul><ul><ul><li>DEC VAX 11/750 </li></ul></ul></ul>
  13. 16. RMH IT – History (80s) <ul><li>First applications – the basics </li></ul><ul><ul><li>Patient Master Index </li></ul></ul><ul><ul><li>Basic pathology (Chemistry, Haematology) </li></ul></ul><ul><ul><li>Admissions and Outpatients </li></ul></ul><ul><ul><li>Third party pharmacy system </li></ul></ul><ul><ul><li>Clinical Research System (CRS) </li></ul></ul><ul><li>Significant hardware upgrade late 80s </li></ul><ul><ul><li>VAX 8530 </li></ul></ul>
  14. 17. RMH IT – History (90s) <ul><li>Seduced by cost/performance of RISC based architecture </li></ul><ul><ul><li>Migrate from VAX/VMS to HPUX on HP hardware </li></ul></ul><ul><ul><li>Switched to Micronetics MUMPS (MSM) </li></ul></ul><ul><ul><li>Later switched back to InterSystems M (ISM) </li></ul></ul><ul><li>Further applications </li></ul><ul><ul><li>Towards a complete PAS and HIS </li></ul></ul><ul><ul><li>Radiology and other clinical systems </li></ul></ul>
  15. 18. RMH IT – History (00s) <ul><li>Turbulent times ahead </li></ul><ul><ul><li>National Programs on the horizon </li></ul></ul><ul><ul><li>Poor image of M-based systems in NHS </li></ul></ul><ul><ul><ul><li>Despite the fact that they delivered (and many are still doing so now!) </li></ul></ul></ul><ul><ul><li>Experimented with various standard RDBMS </li></ul></ul><ul><ul><li>Further third party departmental systems introduced </li></ul></ul><ul><li>Standardized core on InterSystems Caché </li></ul><ul><ul><li>Natural ‘best fit’ successor to our M-based systems. </li></ul></ul><ul><ul><li>Caché 5 on IBM AIX </li></ul></ul><ul><ul><ul><li>Development machine </li></ul></ul></ul><ul><ul><ul><li>Operational machine + Shadow </li></ul></ul></ul>
  16. 19. RMH IT – Architecture <ul><li>1980s: Terminal based applications </li></ul><ul><ul><li>Serial lines to server </li></ul></ul><ul><li>1990s: Migrating to Windows/GUI </li></ul><ul><ul><li>Terminals replaced with PC workstations </li></ul></ul><ul><ul><li>Workstations networked (LAT then TCP) </li></ul></ul><ul><ul><li>VB applications </li></ul></ul><ul><ul><ul><li>Using an adaptor to M (developed in-house) </li></ul></ul></ul><ul><ul><ul><ul><li>Used telnet to M and TCP sockets when they became available </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Likely to be one of the first service oriented (non-ODBC) connectors between VB and M </li></ul></ul></ul></ul><ul><ul><ul><li>Later applications used HTTP over WebLink </li></ul></ul></ul>
  17. 20. RMH IT – Architecture <ul><li>2000s: Migrating to the Web </li></ul><ul><ul><li>All workstations networked (TCP) </li></ul></ul><ul><ul><li>Visual InterDev with VB </li></ul></ul><ul><ul><li>ASP.Net </li></ul></ul><ul><ul><ul><li>Using WebLink and CSP as the transport </li></ul></ul></ul><ul><ul><ul><ul><li>Web services in CSP </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Proprietary protocols over HTTP </li></ul></ul></ul></ul>
  18. 21. RMH IT – Development <ul><li>Early systems </li></ul><ul><ul><li>Hand-crafted M code </li></ul></ul><ul><ul><li>Needed to improve quality, resilience and maintainability </li></ul></ul><ul><ul><li>Various experiments with code generators </li></ul></ul><ul><ul><ul><li>Tools for screen design </li></ul></ul></ul><ul><li>Developed ETHOS toolkit </li></ul><ul><ul><li>E x T ended H igher O rder S oftware </li></ul></ul><ul><ul><li>HOS (Higher Order Software) + SQL/RDBMS </li></ul></ul><ul><ul><ul><li>HOS: Programming environment </li></ul></ul></ul><ul><ul><ul><li>SQL/RDBMS: Added to the HOS environment to make ETHOS in mid-80s </li></ul></ul></ul><ul><ul><ul><ul><li>Likely to be first SQL implementation for M </li></ul></ul></ul></ul>
  19. 22. ETHOS: HOS Component <ul><li>What is it? </li></ul><ul><ul><li>Mathematically verified Functional Programming Environment </li></ul></ul><ul><ul><ul><li>Underlying Mathematics by Margaret Hamilton and Saydean Zeldin </li></ul></ul></ul><ul><ul><ul><li>A Methodology for Defining Software </li></ul></ul></ul><ul><ul><ul><li>Developed for the Apollo and Skylab programs </li></ul></ul></ul><ul><ul><li>Graphical tree-based representation of functions </li></ul></ul><ul><ul><li>Partial functions with plug-in points </li></ul></ul><ul><ul><ul><li>Defined Structures </li></ul></ul></ul>
  20. 23. ETHOS: HOS Component <ul><li>Benefits? </li></ul><ul><ul><li>Integrity of tree structures checked for self consistency and correctness </li></ul></ul><ul><ul><ul><li>Interfaces verified </li></ul></ul></ul><ul><ul><ul><li>Referential transparency </li></ul></ul></ul><ul><ul><li>Self documenting </li></ul></ul><ul><ul><ul><li>Tree nodes separate the ‘what’ from the ‘how’ of an operation </li></ul></ul></ul><ul><ul><li>Generates bug-free code </li></ul></ul>
  21. 24. ETHOS <ul><li>Higher Order Software </li></ul><ul><li>Some Examples </li></ul>
  22. 25. ETHOS tree: Calculate Age
  23. 26. ETHOS tree: Embedded SQL
  24. 27. ETHOS tree: Embedded SQL
  25. 28. ETHOS tree: Recursion
  26. 29. ETHOS tree: Using Libraries
  27. 30. ETHOS: SQL/RDBMS Component <ul><li>What is it? </li></ul><ul><ul><li>SQL with extensions </li></ul></ul><ul><ul><ul><li>ETHOS functions can be embedded in SQL and vice versa </li></ul></ul></ul><ul><ul><ul><li>Sequences </li></ul></ul></ul><ul><ul><ul><li>Complex derivations </li></ul></ul></ul><ul><ul><ul><li>Best of Caché incorporated (e.g. pattern match) </li></ul></ul></ul><ul><ul><li>Comprehensive Data Model </li></ul></ul><ul><ul><ul><li>Definition of Entities (tables/classes) and Attributes (fields/properties) </li></ul></ul></ul><ul><ul><ul><li>ETHOS Entity == RDBMS Table == Caché class </li></ul></ul></ul><ul><ul><ul><li>Derived attributes and tables </li></ul></ul></ul><ul><ul><ul><li>Inheritance and polymorphism </li></ul></ul></ul><ul><ul><ul><li>Full referential actions (e.g. maintenance of referential integrity) </li></ul></ul></ul>
  28. 31. ETHOS: SQL/RDBMS Component <ul><li>Benefits? </li></ul><ul><ul><li>High level of abstraction </li></ul></ul><ul><ul><ul><li>Object-relational characteristics </li></ul></ul></ul><ul><ul><li>Derived supersets maintained in real time </li></ul></ul><ul><ul><ul><li>Data warehouse </li></ul></ul></ul><ul><ul><li>Rich environment for data analysis </li></ul></ul><ul><ul><ul><li>Support for research </li></ul></ul></ul><ul><ul><li>Multiple access paths to same data </li></ul></ul><ul><ul><ul><li>SQL accessible Cache classes maintained in parallel </li></ul></ul></ul><ul><ul><ul><ul><li>ETHOS SQL </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Caché SQL </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Caché Objects </li></ul></ul></ul></ul><ul><ul><ul><ul><li>M Globals </li></ul></ul></ul></ul>
  29. 32. ETHOS <ul><li>SQL and Data Model </li></ul><ul><li>Some Examples of Entity Definitions </li></ul>
  30. 33. ETHOS Entity: PATIENT <ul><li>Base Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, PAT-NAM, ADDRESS, D-REG, T-REG, D-BIRTH, AGE, </li></ul><ul><li>D-LAST-ADM </li></ul><ul><li>FROM [BASE-TABLE] </li></ul><ul><li>DECLARE PAT-NUM ::= BT ; </li></ul><ul><li>DECLARE PAT-NAM ::= BT ; </li></ul><ul><li>DECLARE ADDRESS ::= BT ; </li></ul><ul><li>DECLARE D-REG ::= BT <- DATE.VALUE ; </li></ul><ul><li>DECLARE T-REG ::= BT <- TIME.VALUE ; </li></ul><ul><li>DECLARE D-BIRTH ::= BT <- DATE.VALUE ; </li></ul><ul><li>DECLARE AGE ::= SV <= AGE:LX(D-BIRTH) ; </li></ul><ul><li>DECLARE D-LAST-ADM ::= HV <= GET_LAST_ADM_DATE:LX( </li></ul><ul><li>F:ADMISSION, </li></ul><ul><li>PAT-NUM) </li></ul><ul><li><- DATE.VALUE ; </li></ul>
  31. 34. ETHOS Entity: DATE <ul><li>Superclass of all attributes of type ‘DATE’ </li></ul><ul><li>Base Table: Primary View </li></ul><ul><li>SELECT VALUE, ENCODE, DECODE </li></ul><ul><li>FROM [BASE-TABLE] </li></ul><ul><li>DECLARE VALUE ::= SV ; </li></ul><ul><li>DECLARE ENCODE ::= SV <= ENCODE_DATE:LX(:DECODED-DATE) ; </li></ul><ul><li>DECLARE DECODE ::= SV <= DECODE_DATE:LX(:ENCODED-DATE) ; </li></ul>
  32. 35. ETHOS Entity: ADMISSION <ul><li>Base Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, D-ADM, T-ADM, WARD </li></ul><ul><li>FROM [BASE-TABLE] </li></ul><ul><li>DECLARE PAT-NUM ::= BT ; </li></ul><ul><li>DECLARE D-ADM ::= BT <- DATE.VALUE ; </li></ul><ul><li>DECLARE T-ADM ::= BT <- TIME.VALUE ; </li></ul><ul><li>DECLARE WARD ::= BT <- WARD.WARD-ID ; </li></ul>
  33. 36. ETHOS Entity: DIAGNOSTICS <ul><li>Base Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, D-TEST, T-TEST, TEST-ID, RESULT </li></ul><ul><li>FROM [BASE-TABLE] </li></ul><ul><li>DECLARE PAT-NUM ::= BT ; </li></ul><ul><li>DECLARE D-TEST ::= BT <- DATE.VALUE ; </li></ul><ul><li>DECLARE T-TEST ::= BT <- TIME.VALUE ; </li></ul><ul><li>DECLARE TEST-ID ::= BT <- LAB-TEST.TEST-ID ; </li></ul><ul><li>DECLARE RESULT ::= BT ; </li></ul>
  34. 37. ETHOS Entity: EVENTS <ul><li>Derived Table: Primary View </li></ul><ul><li>SELECT PAT-NUM, D-EVENT, T-EVENT, KEYS, EVENT-TYPE </li></ul><ul><li>FROM [BASE-TABLE] </li></ul><ul><li>DECLARE PAT-NUM ::= BT ; </li></ul><ul><li>DECLARE D-EVENT ::= BT <- DATE.VALUE ; </li></ul><ul><li>DECLARE T-EVENT ::= BT <- TIME.VALUE ; </li></ul><ul><li>DECLARE KEYS ::= BT ; </li></ul><ul><li>DECLARE EVENT-TYPE ::= BT ; </li></ul>
  35. 38. ETHOS Entity: EVENTS (1) <ul><li>Derived Table: Secondary View 1 (Contribution from PATIENT) </li></ul><ul><li>SELECT PAT-NUM, D-EVENT, T-EVENT, KEYS, EVENT-TYPE </li></ul><ul><li>FROM PATIENT </li></ul><ul><li>DECLARE PAT-NUM ::= HV <= PATIENT.PAT-NUM ; </li></ul><ul><li>DECLARE D-EVENT ::= HV <= PATIENT.D-REG ; </li></ul><ul><li>DECLARE T-EVENT ::= HV <= PATIENT.T-REG ; </li></ul><ul><li>DECLARE KEYS ::= HV <= K:PATIENT ; </li></ul><ul><li>DECLARE EVENT-TYPE ::= HV <= &quot;REGISTRATION&quot; ; </li></ul>
  36. 39. ETHOS Entity: EVENTS (2) <ul><li>Derived Table: Secondary View 2 (Contribution from ADMISSION) </li></ul><ul><li>SELECT PAT-NUM, D-EVENT, T-EVENT, KEYS, EVENT-TYPE </li></ul><ul><li>FROM ADMISSION </li></ul><ul><li>DECLARE PAT-NUM ::= HV <= ADMISSION.PAT-NUM ; </li></ul><ul><li>DECLARE D-EVENT ::= HV <= ADMISSION.D-ADM ; </li></ul><ul><li>DECLARE T-EVENT ::= HV <= ADMISSION.T-ADM ; </li></ul><ul><li>DECLARE KEYS ::= HV <= K:ADMISSION ; </li></ul><ul><li>DECLARE EVENT-TYPE ::= HV <= &quot;ADMISSION&quot; ; </li></ul>
  37. 40. ETHOS Entity: EVENTS (3) <ul><li>Derived Table: Secondary View 3 (Contribution from DIAGNOSTICS) </li></ul><ul><li>SELECT PAT-NUM, D-EVENT, T-EVENT, KEYS, EVENT-TYPE </li></ul><ul><li>FROM DIAGNOSTICS </li></ul><ul><li>DECLARE PAT-NUM ::= HV <= DIAGNOSTICS.PAT-NUM ; </li></ul><ul><li>DECLARE D-EVENT ::= HV <= DIAGNOSTICS.D-TEST ; </li></ul><ul><li>DECLARE T-EVENT ::= HV <= DIAGNOSTICS.T-TEST ; </li></ul><ul><li>DECLARE KEYS ::= HV <= K:DIAGNOSTICS ; </li></ul><ul><li>DECLARE EVENT-TYPE ::= HV <= &quot;DIAGNOSTICS&quot; ; </li></ul>
  38. 41. ETHOS SQL: Sequences <ul><li>“ Get all diagnostic tests performed for a patient between 9:00 on 1/9/07 and 12:00 the following day” </li></ul><ul><li>SELECT * </li></ul><ul><li>FROM DIAGNOSTICS A:SEQUENCE(PAT-NUM, D-TEST, T-TEST) </li></ul><ul><li>WHERE A AFTER :PAT-NUM, “1/9/07”, “9:00” </li></ul><ul><li>AND A BEFORE :PAT-NUM, “2/9/07”, “12:00” </li></ul>
  39. 42. RMH IT/ETHOS – Why Caché? <ul><li>High Performance </li></ul><ul><li>Rapid Application Development </li></ul><ul><li>Massive Scalability </li></ul>
  40. 43. RMH IT/ETHOS – Why Caché? <ul><li>High performance? </li></ul><ul><ul><li>Undoubtedly true </li></ul></ul><ul><ul><ul><li>Fastest high-end database that we’ve used </li></ul></ul></ul><ul><ul><li>Low hardware costs </li></ul></ul><ul><ul><ul><li>Small investment can make a ‘slow’ DBMS perform well </li></ul></ul></ul><ul><ul><li>Free alternatives </li></ul></ul><ul><ul><ul><li>Many will put up with a non-optimal solution if it is free. </li></ul></ul></ul>
  41. 44. RMH IT/ETHOS – Why Caché? <ul><li>Rapid Application Development? </li></ul><ul><ul><li>Undoubtedly true </li></ul></ul><ul><ul><li>Others make the same claim </li></ul></ul><ul><ul><li>Free alternatives </li></ul></ul><ul><ul><ul><li>Many will put up with a non-optimal solution if it is free. </li></ul></ul></ul>
  42. 45. RMH IT/ETHOS – Why Caché? <ul><li>Massive scalability? </li></ul><ul><ul><li>Undoubtedly true </li></ul></ul><ul><ul><ul><li>We’ve migrated systems from PDP 11s to high end IBM/AIX servers to PCs </li></ul></ul></ul><ul><ul><ul><ul><li>Low administrative costs </li></ul></ul></ul></ul><ul><ul><ul><li>Well abstracted environment </li></ul></ul></ul><ul><ul><li>Low hardware costs </li></ul></ul><ul><ul><li>Modern networking </li></ul></ul><ul><ul><ul><li>Clustered and/or distributed environments </li></ul></ul></ul><ul><ul><ul><li>Load balancing solutions </li></ul></ul></ul>
  43. 46. Free Alternatives <ul><li>OpenSource, FSF, Freeware etc … </li></ul><ul><li>Will it really take over the world? </li></ul><ul><li>What drives development? </li></ul><ul><ul><li>Research initiatives </li></ul></ul><ul><ul><li>Outsource support </li></ul></ul><ul><ul><li>Consulting based marketing model </li></ul></ul>
  44. 47. Free Alternatives <ul><li>OpenSource, FSF, Freeware etc … </li></ul><ul><li>Will it really take over the world? </li></ul><ul><li>What drives development? </li></ul><ul><ul><li>Research initiatives </li></ul></ul><ul><ul><li>Outsource support </li></ul></ul><ul><ul><li>Consulting based marketing model </li></ul></ul><ul><ul><li>The presence of a ‘Bogeyman’ as a motivator </li></ul></ul><ul><ul><ul><li>The bigger the better </li></ul></ul></ul><ul><ul><ul><li>Free software thrives on a healthy commercial sector </li></ul></ul></ul>
  45. 48. Traditional Project Lifecycle <ul><li>Analysis of requirements </li></ul><ul><li>Design data-model </li></ul><ul><ul><li>Know requirements in advance </li></ul></ul><ul><ul><li>Design model with reports in mind </li></ul></ul><ul><li>Create application </li></ul><ul><li>Maintenance and compromise </li></ul><ul><ul><li>De-normalize database to make it perform </li></ul></ul>
  46. 49. Systems Development <ul><li>May not want to implement something as big as ETHOS but … </li></ul><ul><li>The case for having a more flexible environment than is usually provided by a conventional DBMS is compelling </li></ul><ul><ul><li>Never know requirements in advance </li></ul></ul><ul><ul><li>Web culture demands flexibility </li></ul></ul><ul><ul><ul><li>ever changing requirements </li></ul></ul></ul><ul><ul><li>Higher expectations </li></ul></ul><ul><li>Applications need to adapt and evolve </li></ul><ul><ul><li>Without driving up costs and complexity </li></ul></ul>
  47. 50. HTTP <ul><li>SOAP, REST, MEST, [2008 version] etc … are transported by HTTP and … </li></ul><ul><li>The case for having a comprehensive development environment for serving protocols carried over HTTP is compelling </li></ul><ul><ul><li>Ajax allows web applications to distribute processing to clients </li></ul></ul><ul><ul><ul><li>Not available to the infrastructure for data communication/distribution </li></ul></ul></ul><ul><ul><li>Higher expectations for integration/sharing </li></ul></ul><ul><ul><li>Complex functionality behind services </li></ul></ul><ul><li>Applications need to reach out and be available to foreign systems </li></ul><ul><ul><li>Without driving up costs and complexity </li></ul></ul>
  48. 51. Caché in Healthcare IT <ul><li>High Performance </li></ul><ul><li>Rapid Application Development </li></ul><ul><li>Massive Scalability </li></ul><ul><li>Excellent Systems Prototyping and Development Environment </li></ul><ul><li>Excellent back-end processor for HTTP </li></ul>
  49. 52. The state of play in NHS IT Chris Munt Cherylin Fletcher Royal Marsden NHS Trust
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×