The NCTS service is responsible for managing, developing, and distributing national clinical terminologies and related tools and services to support the digital health requirements of the Australian healthcare community. The Australian Digital Health Agency will discuss how they are using AWS to support health practitioners, including an exploration of innovation and cost reductions that have been achieved using AWS. Presenter: Dion McMurtrie, Director, Australian Digital Health Agency

1. P U B L I C S E C T O R
S U M M I T
Canberra, ACT

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Use of AWS Services to Support the National
Clinical Terminology Service
Dion McMurtrie
Director, Clinical Terminology Tooling
Australian Digital Health Agency

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Agenda
What is digital health and terminology?
Why create the National Clinical Terminology Service (NCTS)?
Overview of the NCTS AWS implementation
NCTS 2.0 innovation and cost reduction

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What is digital health and terminology?
Digital health
Digital health is about electronically connecting up
the points of care so that health information can be
shared securely, to ultimately help deliver safer,
better quality healthcare.
Terminology
Terminology is the basis of shared meaning between
different systems.
Information structures (messages, documents) are the
containers, but terminology defines what goes in
them.
Terminology and structured data are the key to interoperability
and analytics required to deliver the benefits of digital health.

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Why create the NCTS?
Complex data and documentation
with steep learning curves
Variability in implementation of
specifications
Slow update cycle
Content required from many
sources
!#{?!

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Why create the NCTS?
Centralise content
Provide APIs and software
that codify complex rules into
best practice
Provide endpoints for
automated updates
CTSA
NCTS
:-)

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“With the NCTS, they can leave the
hard stuff to the specialists and just
focus on making their applications
work well with terminology.”
Grahame Grieve
FHIR® Product Director

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National Clinical Terminology Service
More than a website
FHIR® Terminology Service
endpoint
Free licences to run FHIR®
terminology services locally
for use in Australian
healthcare
W3C Atom Syndication of
terminology content
OAuth2 and SMART on
FHIR

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Current NCTS AWS implementation
Microservice application architecture
Based in Docker containers using Docker Compose on Amazon EC2
instances
AWS used as infrastructure as a service
Infrastructure as code using AWS CloudFormation, AWS OpsWorks, and
AWS OpsWorks for Chef Automate
AWS hosted Atlassian Bamboo build and deploy

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Reasons for change
Simplification
The current system has many moving parts, and is cumbersome to deploy
Cost
Financial costs of hosting and operation can be much lower
Ongoing staffing costs are high
Risk
Security must be managed manually – ongoing complicated IRAP assessments
High availability not intrinsic in the design
Platform for future services
More demanded features, more code systems to support, FHIR R4…the backlog is long

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NCTS 2.0 build
Partnered with an AWS Advanced Consulting Partner via the AWS Marketplace
AWS Serverless approach
Makes more use of the AWS Shared Responsibility Model
Reduces hosting and operational costs – testing shows ~90% reduction in hosting
costs
Implemented using AWS services in scope of the compliance program
Identity moved to AWS Cognito
Codebase and deployment moved to AWS CodeCommit and AWS CodePipeline

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What next?
Complete final testing
Re-engineer operations and deployment procedures
Penetration testing, IRAP assessment
Clinical safety assessment
Migration and cut-over …then move on to more functionality

20. Thank you!
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Dion McMurtrie
help@digitalhealth.gov.au
www.digitalhealth.gov.au
twitter.com/AuDigitalHealth
healthterminologies.gov.au
developer.digitalhealth.gov.au
github.com/audigitalhealth

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