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Couchbase Live Europe 2015: Turkish Ministry of Health: Electronic Healthcare Records

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Turkish Ministry of Health introduced the next generation National Integrated Personally Controlled Electronic Healthcare Records System powered by Couchbase Server. The system processes more than 1750 complex incoming messages per second, consisting of diagnosis, medical history, laboratory results, prescriptions and more from 1200 hospitals and 20,000+ family practitioners.

Presented by: Mehmet Ercan, Big Data Labs

Published in: Software
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Couchbase Live Europe 2015: Turkish Ministry of Health: Electronic Healthcare Records

  1. 1. 1200+ Hospitals and 20K+ Family Practitioners: National Integrated PC-EHRSystem with Couchbase Mehmet Zahid Ercan CEO
  2. 2. Agenda • Who we are • What is PC-EHR? • Why NoSQL &Why Couchbase? • Use Case Overview • Key Stats • System Overview • Key Features &Outputs • Future Direction • Expectations from Couchbase
  3. 3. Company Overview • Established in 2012, Istanbul -Turkey • Provide o consultancy, o training, o system analysis, o project management and o software development services
  4. 4. Company Overview Project name: «Saglik Yonetim Sistemi» (Health Management System) A Turk Telekom Company
  5. 5. What is PC-EHR? • What is PC-EHR? o An electronic health record (EHR) is broadly defined as a collection of patients’ health related information o Lifetime o Central/National o PC (Personally Controlled) EHR provides individuals with control over access to and sharing of their health records o Manage EHR sharing and adjust level of privacy using a web portal
  6. 6. What is PC-EHR? • Why it is important? o EHR systems offer significant benefits to healthcare systems o Facilitating healthcare information exchange by allowing access to health records from multiple locations o Contributes to accuracy and timeliness of care o Improves the quality of healthcare delivery
  7. 7. Why NoSQL? • Storing healthcare records has become the bottleneck for healthcare systems as the structure and size of the healthcare data have changed over the time. • EHR systems require high-availability, 100% uptime • Fast access to information is a MUST for timely decision making • Hardware costs and database license fees are huge!
  8. 8. Why Couchbase? • Document-oriented • Flexible –schemaless data model • Great Windows Support • Easy-to-use, intuitive admin interface • Excellent .NETSDK • XDCR, Views,….
  9. 9. Use Case • 1200+ Public and Private Hospitals • Various EMR Vendors • 20K+ Family Practitioners • 1000s of individual practitioners and health providers • Real-time integration using web services • One database to unite them all!
  10. 10. Use Case Personal Health Portal Individual Practitioners Hospitals Family Practitioners Patients Patients Health System Managers
  11. 11. Document Structure
  12. 12. Document Structure • Admission Details • Basic Demographic Information • Procedures, Laboratory Tests, etc. • Laboratory Test Results • Diagnosis and related information • Vaccinations • Prescriptions • Financial Details • Performance Details for Practitioners • Discharge Details. • …
  13. 13. Privacy • Patient identifiers in separate clusters • No IDs in EHR documents • No direct relation between patient identifier documents and EHR documents • Hashing AND encryption • Separate locations
  14. 14. Key Stats • 77 million citizens (plus other patients) • 130M+ EHRs since December 2014 • 1.5 TB total document size • Time-based 11-character keys • 1.4 billion messages processed • 20M+ messages / day • 1750 incoming messages per second • <20ms response time
  15. 15. Key Stats
  16. 16. Key Stats
  17. 17. Key Stats • Couchbase 3.0.1 • 35 nodes in 4 clusters • 96GB RAM, 8-core 2 CPUs per node • 400GBx2 SSDs for data on each node • Bare metal • Turk Telekom Data Centre
  18. 18. How can you do that?
  19. 19. System Overview
  20. 20. Key Features • XDCR • Views (on 2nd cluster) • Views with custom reduce functions • Atomic counters • Binary storage • Expiring documents • Memcached buckets
  21. 21. Outputs Live Counters for Important Indicators
  22. 22. Outputs Real-time Data Flow Maps
  23. 23. Outputs Charts, Histograms, Tables…
  24. 24. Outputs Personal Health Portal
  25. 25. Outputs Mobile and Tablet Apps
  26. 26. Outputs Wearables and Mobile Health Devices
  27. 27. Key Benefits • Allow real-time data flow • Live stats, early warning systems • Better flexibility • Better scaling • Lower costs • Always on • Live feedback to health providers about their data
  28. 28. Tips • Sizing matters! • Monitor performance and stats • Do not move your data • 1 GbE not enough • SSDs
  29. 29. Future Direction • Meaning behind the data • Chronic disease management • Control over prescriptions • Promote healthy lifestyle and well-being • Detect early symptoms and risks based on analysis • Patient participation • Lower costs and less burden on health system
  30. 30. Expectations from Couchbase • Re-consider 20MB value size limitation • Better documentation about some under-the-hood details (such as indexer_max_doc_size) • Solid enterprise backup tool • A way of faster initiation of XDCR
  31. 31. More Information & References • Video on e-Nabız Project (﴾Health Portal for Citizens): http://ow.ly/Kpnsj • Cartoon from: komikaze.net • Electronic Health Records and NoSQL o Ercan, Mehmet Zahid, and Michael Lane. "An evaluation of NoSQL databases for EHR systems." Proceedings of the 25th Australasian Conference on Information Systems. Auckland University of Technology, School of Business Information Systems, 2014. o Narayan, S, Gagne, M & Safavi-Naini, R 2010, 'Privacy preserving EHR system using attribute-based infrastructure', proceedings of the 2010 ACM workshop on Cloud computing security workshop ACM, Chicago, Illinois, USA, pp. 47- 52. o Lobach, DF & Detmer, DE 2007, 'Research challenges for electronic health records', American journal of preventive medicine, vol. 32, no. 5, pp. S104- S11. o Jin, Y, Deyu, T & Xianrong, Z 2011, 'Research on the distributed electronic medical records storage model', proceedings of the IT in Medicine and Education (ITME), 2011 International Symposium on IEEE, pp. 288-92.
  32. 32. Thank you! Mehmet Zahid Ercan mehmet@bigdatalabs.com.tr

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