1. Bethesda Medical Center, Haiti
High Level Technology Architecture – Framing the Vision

2. Background
Bethesda Medical Center will be a private, not-for-profit specialty teaching hospital in Port‐au‐Prince that will provide emergency and
inpatient and outpatient specialty consultative services for patients referred from locations throughout Haiti.
The hospital development, implementation and operations will be based on a strong North American-Haiti partnership as
demonstrated both by the hospital governance structure and the teaching faculty consisting of North Americans and Haitians.
Note 1: Digicel covers 95% of Haiti http://www.digicelhaiti.com/en/coverage_roaming/coverage_map

3. Haiti Technology Architectural Principles
Architectural principles help inform technology decisions. When technology does not meet one or more architectural principles there
needs to be a conscious decision to move forward and how will the decision impact the overall technology ecosystem.
• Reduce Technology Complexity as Much as Possible
• Low cost
• Simple
• Minimal Local Infrastructure
• Bandwidth Sparing
• Use Commodity Platforms and Open Source Whenever Possible
• Leverage cell phones and cellular infrastructure1
• Standardize data exchange formats
• Build in Security
Note 1: Digicel covers 95% of Haiti http://www.digicelhaiti.com/en/coverage_roaming/coverage_map

4. M
D
High-Level Technology Architectural
Data exchange and teleheatlh between sites is necessary to provide appropriate care. In some cases telehealth may be as low tech as
voice or email. The amount of technology reduces as you move away from the hospital, where local sites may have very little
technology. Leverage smart phones, apps, and cellular as much as possible to reduce local infrastructure need.
Hospital
Regional
Center
Local
Local
Local
Regional
Center
US
Consult
Sites
M
D
M
D
M
D
M
D
Technology RequirementLO HI
Data Exchange
& Tele-health
Data Exchange
& Tele-health
Data Exchange
& Tele-health

5. Principles
 Light infrastructure required at local sites
 Rapid provisioning
 Leverage existing cellular and/or network infrastructure
 Encrypted data on devices and between sites
Summary
• Cellular connected smartphones provide a very light
infrastructure that requires no local facility upgrades
• Wired or WiFi connected devices could also be used, but
they require additional local infrastructure
• Obtain an app that can be used to help local providers
triage patients. If an app does not exist use a code-a-
thon to develop a prototype
• Obtain an app for tele-health video consults. Ideally the
app would have virtual waiting room capability. Minimal
requirements might be voice, still pictures, and sending
appropriate patient data.
• Determine relevant sensor (eg. SpO2, BP, etc.) data
needed to make clinical decisions and look for devices
and solutions that can capture the data with API
(application interfaces). Consumer devise may be
adequate for screening.
• Local sites will be able to communicate with the hospital
to schedule transport if needed.
Local Technology Architectural
Local technology is optimized to use a minimum of infrastructure possibly using cellular enabled smart phones and/or tablets which
can be provisioned quickly.
Regional
Center
Local
Local
Local
Smart Phone
• Triage App
• Tele-health
Smart Phone
• Triage App
• Tele-health

6. Principles
 Minimal or no changes to Regional Centers, use existing
infrastructure
 Regional Centers provide data in common formats
 Encrypted data is exchanged between between sites
Summary
• Regional Centers can collect more diagnostic data than
local sites
• Less critical cases are handled directly at Regionals
Centers
• Regional Centers preform additional triage and connect
to the Hospital when needed
• Regional centers can exchange clinically relevant data
with both local sites and the hospital as needed
Regional Center Technology Architectural
Regional Centers are networked and have the ability of digitally capturing and forwarding appropriate clinical data. Local sites can
connect to Regional Centers or directly to the hospital.
Digital Capture
of clinical
information
Regional
Center
Regional
Center
Data Exchange
& Tele-health
Biomedical
Sensor Data
Digital Data
Store including
EMR and
Images
Telehealth
• Voice & Still Image (min)
• Video & Data Exchange

7. Principles
 Critical systems are available in disaster
 Non-critical systems utilize cloud to reduce local
infrastructure
 Leverage WiFi to reduce wired infrastructure for
stationary and mobile computers
 Tele-consult infrastructure is as vendor agnostic as
possible (might leverage WebRTC)
Summary
• Integration between EMR, Lab, Rx, and Imaging
• Critical systems are hosted locally
• High availability power is available if utility power is
interrupted
• High bandwidth connection to the Internet to support
tele-consults with Local, Regional Centers, and US
Specialists
• Location services (RFID) is used to keep babies safe
(HUGS), track expensive assets.
• Barcodes are used for wrist bands, medications, lab, etc.
to reduce errors
• VoIP phones
• Intel Windows & Linux Systems
• Charting computer location decisions effects
infrastructure (in room, nursing stations, mobile)
Hospital Technology Architectural
The Hospital is technologically advanced and can operated as a standalone facility in a disaster. Physical and technology security is
built-in. Communication infrastructure supports data exchange and tele-health including video.
Digital Capture
and Access of
information
Hospital
Data Exchange
& Tele-health
Digital Data Store
including EMR,
Lab, Pharmacy
and Images
Systems
• EMR, Lab, Pharmacy, Imaging, Nurse Call
• Accounting, Email, Scheduling, Materials Mgt
• Physical Security, Surveillance, Newborn
• Staffing & Visiting Staff Scheduling
• Fire & Safety & Building Systems
US
MDs
Mix of Local &
Cloud
Computing
Commercial
Grade
Biomedical
Systems
WiFi & Wired
Network

8. Local sites
participate in
the program
Local sites
collects data
Biomedical
Sensors
Intermediate
data cache
Data
Validation
EMR
Analytics
Provider
Tele-health Monitoring Technology Architecture
In the future automated monitoring of high risk patients could be added. Local sites collect data and send it to the hospital where the
data is validated and analytics notify providers of potential risks facilitating early intervention.
Principles
 Cache data centrally for intermediate processing
 Validate/scrub data before loading it into the EMR
 Alert for both downward trending & reaching critical thresholds
Summary
 Local sites collect data regularly
 Data is validated before it is included in the EMR
 Analytics scan data and alert providers when needed
 Providers initiate early intervention