Overcoming interoperability barriers to deliver healthcare across the continuum


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Cloud Asia Singapore 15 May 2013

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Overcoming interoperability barriers to deliver healthcare across the continuum

  1. 1. 1Cloud Computing: OvercomingInteroperability Barriers to DeliverHealthcare Across the ContinuumAssoc Prof.Dr. Adam CHEEChief Advocacy Officer15 May 2013
  2. 2. 2Conflict of Interest DisclosureAssoc Prof.Dr. Adam CHEE,Dr.IndTech, FACHI, MSc, MPH (WIP), MBA (WIP), PgD MedInfo, SpD InfoSec, BCom IT, CPHIMS, CITPM,CSSGB, CSP, MCSE,MCSA,MCDBA etc etc… does it really matter?Faculty (Health Informatics) with IHLs (Practice-Based Researcher)SME / Consultant / Advisor / Trainer with Health and Solution Providers, Consulting FirmsChief Advocacy Officer of binaryHealthCareNote: List of conferences presented & media mentions can be found at www.binaryHealthCare.com
  3. 3. Agenda• My topic for today is “Cloud Computing: OvercomingInteroperability Barriers to Deliver Healthcare Across theContinuum” and we will be examining• Deployment of mobile applications for mhealth (wellness throughconsumer health)• Effective health information exchange, ensuring semantic datainteroperability• Secondary use of clinical data for clinical trials and analytics• How can the infrastructure in Asia Pacific be utilized to serve as anenabler for the above?3
  4. 4. Concept Clarification:EMR vs EHR• Electronic Medical Record (EMR)• Medical records that is facility centric• E.g. All of Patient A’s medical records in Hospital A• Draws data from clinical information systems within the facility• Electronic Health Record (EHR)• Medical records that is patient centric• E.g. All of Patient A’s medical records in the hospital cluster / group• Draws data from all EMRs across the healthcare enterprise /Continuum of Care4
  5. 5. Concept Clarification:Continuum of Care• Continuum of Care• A concept involving an integrated system of care that guides andtracks patient over time through a comprehensive array of healthservices across all levels health care.5Acute CareCommunity /ExtendedCareAssistedLiving / HomeCareAmbulatoryCarePrimary CarePrevention &WellnessPalliativeCareHealthcare System (Simplistic)
  6. 6. The Current Burden6Acute CareCommunity /ExtendedCareAssistedLiving / HomeCareAmbulatoryCarePrimary CarePrevention &WellnessPalliativeCare
  7. 7. The Current Burden (cont.)7Acute CareCommunity /ExtendedCareAssistedLiving / HomeCareAmbulatoryCarePrimary CarePrevention &WellnessPalliativeCareFitnessChronicConditionsAgingIndependent12Areas of care that can be ‘offloaded’ from the acute care settings includes;• Remote Patient Monitoring• Provision of (certain) Healthcare Services• Chronic Disease Management• Self-Care3ConsumerHealthInformaticsmHealth TeleHealth Apps
  8. 8. Information Sharing acrossthe Continuum of Care8Sharing of Patient’s InformationAcute CareCommunity /ExtendedCareAssistedLiving / HomeCareAmbulatoryCarePrimary CarePrevention &WellnessPalliativeCare
  9. 9. Health Information Exchange• Health Information Exchange (HIE)• Automates the transfer of health related information that is typicallystored in multiple organizations, while maintaining the context andintegrity of the information being exchanged.• Provides access to and retrieval of patient information to authorizedusers in order to provide safe, efficient, effective and timely patientcare.9
  10. 10. Levels of HIE10Source: National Institute of Standards and Technology
  11. 11. HIMSS EMR Adoption Model11Source: HIMSS Analytics Asia Pacific
  12. 12. Interoperability• Interoperability (in this context) refers to information exchangebetween healthcare professionals and providers.• Physical Interoperability• Medium of connectivity or the physical connections• E.g. Ethernet cable, a Thumb Drive or wireless network• Syntactic Interoperability• The standard formatting adopted to enable machine-to-machineexchange of data• Semantic Interoperability• The ubiquitous use of standardized vocabularies so data can beexchanged and the meaning kept intact12
  13. 13. Interoperability (cont.)13• To quote Charles Mead;• “syntactic interoperability guarantees the exchange of the structure ofthe data, but carries no assurance that the meaning will beinterpreted identically by all parties”• With Structured Data across the care continuum,• Big Data, Analytics• Utilize these data to run Clinical Trials *
  14. 14. Big Assumptionon Interoperability14Acute CareCommunity /ExtendedCareAssistedLiving / HomeCareAmbulatoryCarePrimary CarePrevention &WellnessPalliativeCare• There is one major (and common) assumption• We assume we are able to achieve interoperability across theContinuum of Care – it is NOT that easy• Physical (Silos) and Semantic (Different Standards)Health Information ExchangeEMREMREMREMREMREMRPHR
  15. 15. Clinical DataStakeholders’ ParadigmDiagram is for illustrative purposes only (not to ratio)15EpidemiologyPopulationPrimary CareCommunityAcute CarePatientsObtains data. Requires SemanticInteroperability for AnalyticsProduces Data. Can make do withSyntactic Interoperability for dailywork
  16. 16. Clinical DataStakeholders’ Dilemma• The key investments (current state) for implementation of EMRs,HIE are mainly Acute Hospitals.• Level of Interoperability achieved (current state)• Usually Syntactic Interoperability• Physical Interoperability• Relatively easy if it is for a single ‘entity’• Semantic Interoperability• The physicians / healthcare professionals serve as the conduit tointerpreting the data exchanged• Humans are (much) better at interpreting semantics• But the epidemiologist needs semantic data!(And Prevention is better than Cure!)16
  17. 17. The Common Approach• In a bid to achieve semantic interoperability, healthcare institutesand governments across the world embarks on massive eHealthprojects• However, key investments• Still remains in acute hospitals• Attempts a ‘big bang’ approach (to achieve semantic interoperability)• Troubled by delays due to the complexity (compounded by the scale)• Leading to frustrated stakeholders, fulfilling data requirements forother users’ needs• Not a win-win situation• Ouch!17
  18. 18. Lets Recap the Problems• Ideal state to fulfill desired needs (continuum of care)• Achieving semantic interoperability• Perform analytics / trending / preventive care• Current state and current needs (not ideal needs) of healthcareproviders (patient facing)• Can make do with syntactic interoperability• Able to achieve syntactic interoperability if they can bridge the gapsfor physical interoperability (geographic distances & silos)• So is there a solution to bridge the gaps for current needs?18
  19. 19. Cloud Based HIE?19Acute CareCommunity /ExtendedCareAssistedLiving / HomeCareAmbulatoryCarePrimary CarePrevention &WellnessPalliativeCareEMREMREMREMREMREMRPHRIn APAC?
  20. 20. Infrastructure in APAC20
  21. 21. Infrastructure in APAC (cont.)21
  22. 22. Lets examine theNeeds & Solution• A Cloud based HIE, utilizing 3G to bridge Physical Interoperabilityacross the Continuum of Care is not only possible today but alsorelatively affordable.• Once Physical Interoperability is achieved, SyntacticInteroperability can be easily achieved through adoption ofexisting transaction standards (e.g. HL7)• While establishing a Cloud Based Care HIE in Asia Pacific is nota walk in the park, it isn’t exactly climbing a mountain.(Key Decision Makers – Are you listening to this?)22
  23. 23. Final Points• We need Semantic interoperability in order to effectively utilizeeHealth across the Continuum of Care (no doubt about it)• For analytics, trending and achieving preventive care• But it cannot be a big bang approach• This has been tried and failed many times• If we take a step back,• Take the time to understand the different levels of interoperability• Relook at the problem to be solved (fix problems, not symptoms)• Take an incremental approach (solve Physical, achieve fullSyntactic, then work towards Semantic)• Then we might obtain better success / results23
  24. 24. Current Needs withPractical Technology…Today24Acute CareCommunity /ExtendedCareAssistedLiving / HomeCareAmbulatoryCarePrimary CarePrevention &WellnessPalliativeCareEMREMREMREMREMREMRPHR
  25. 25. binaryHealthCare, a ‘purpose-driven’ (social enterprise) boutique consultingfirm offering training, technical and marketing strategy solutions / advisory,specifically addressing the eHealth domains within (but not limited to) theASEAN region while serving to “Bridge the eHealth Divide” by empoweringstakeholders in both developed & LAMI counties on effective, sustainableadoption of Health IT as an enabler for “better patient care at lower cost”For further information, please contact;Name Dr. Adam CHEEEmail adamchee@binaryhealthcare.comThoughtLeadershipEducation Consultancy CollaborationContent, Conferences,Awareness Raising &Media EngagementsOnline, Onsite &Collaboration towardscourses in eHealthConsultancy as aService, SME as aService, ConsultingWorkshopsOptimization byeliminating replication.Striving for a win-winresolution for allbinaryHealthCareBridging the eHealth Divide