SlideShare a Scribd company logo
1 of 48
A Tale of 2 Architectures

       CEITA @ ISS
        Peter Tan
       24 Oct 2012

                            1
A happy occasion




                   2
History of me
Organisation                     Key Role                             Work Examples
Education Cluster, NCB           Conceptualise, Evangelise, Pilot     Student & Teacher’s Workbench,

Infrastructure & Technology      Operate and Outsource                Government Internet
Office, GCIO, NCB

Ecommerce Technologies, NCB      Explore & Pilot                      Internet Database Access


Engineering, Operations & ISM,   Product development, EUC             E-auction, E-tender, CRM
SESAMi.com

COO, LatticeKey Solutions        Fundraising, Ops, Sales, Legal       Single sign-on, User provisioning

eGovernment Planning &           Policy, Technical Architecture,      Service-wide Technical Architecture
Management Division, IDA         Funding Evaluation                   (SWTA),

AD, eHealth, MOH                 Project & Programme                  Electronic Medical Records Exchange
                                 Management, IT Governance,           (EMRX), iN2015 Healthcare &
                                 Strategy                             Biomed strategy

Lead Enterprise Architect, MOH   Strategy, Enterprise Architecture,   National Electronic Health Record
Holdings                         RFP, Governance                      Architecture

Principal Architect, IHiS        ??                                   ??

                                                                                                            3
http://sg.linkedin.com/in/petertansg
The Healthcare Ecosystem
         Primary Care                   Acute &               Long-Term Care
                                   Intermediate Care



                                      Community
                                        Hospital

                    Polyclinics                        Nursing Home

    Screening &                      Restructured                      Palliative
    Preventation                       Hospital                          Care

                     General                            Home Care
                   Practitioners
                                       Rehab &
                                       Support
                                       Services




    Public sector                    Private sector                   People sector
                                                                                      4
                                                                                      4
At The 30,000 Feet…



                                                                                     Restructured
                                                                                       Hospital


                                                                                                             CH
                                                                                             Polyclinics                NH
                                                                             Screening &                                           Palliative
                                                                              Prevention                    RH                       Care
                                                                                                                        Home
                                                                                                FPs                     Care
                                                                                                           Rehab &
                                                                                                           support
                                                                                                           services


                                              CH                                                                              CH                                                                   CH
                              Polyclinics                  NH                                                 Polyclinics                NH                                        Polyclinics              NH
                    Screening &                                      Palliative                 Screening &                                          Palliative
                     Prevention              RH                        Care                      Prevention                  RH                        Care
                                                                                                                                                                         Screening &
                                                                                                                                                                          Prevention              RH               Palliative
                                                           Home                                                                           Home                                                                       Care
                                  FPs                      Care
                                                                                                                 FPs                      Care                                                              Home
                                                                                                                                                                                       FPs                  Care
                                            Rehab &                                                                         Rehab &
                                            support                                                                         support                                                              Rehab &
                                            services                                                                        services                                                             support

                                                                                    CH                                                                          CH                               services


                                                                  Polyclinics                   NH
                                                                                                                                                Polyclinics              NH
                                                                                                                                 Screening &                                     Palliative
                                                       Screening &
                                                                                   RH                      Palliative             Prevention                   RH                  Care
                                                        Prevention                                           Care                                                        Home
                                                                                                Home                                               FPs                   Care
                                                                     FPs                        Care
                                                                                                                                                              Rehab &
                                                                                  Rehab &                                                                     support
                                                                                  support                                                                     services
                                                                                  services




                                       General                                                                                                                    Community                                                     Nursing
      Polyclinics
                                     Practitioners                                                                                                                 Hospital                                                      Home
                                                                                                                                                                                                                                          5
                                                                                                                                                                                                                                          5
One Patient One Record Strategy

                       iN2015 Strategic Framework
                                                                                 … a journey summarised by …
            From iN2015 Healthcare and Biomedical Sciences Report

                      To accelerate sectoral transformation through an                                         • Visibility of supply, demand, costs and
                    Infocomm-enabled personalised healthcare delivery                                            care pathways
  Goal               system to achieve high quality clinical care, service               Optimized             • Well populated clinical database
                      excellence, cost-effectiveness and strong clinical                                       • Patients have visibility of their health
                                           research                                                              journey and available options


                                                    Greater         Strong                                     • Manage ‘cases’ across care settings
                     Well-          Cost-
                                                    ability of   clinical and                                    using defined care pathways
                  Integrated      effective
Outcomes            Quality      Healthcare
                                                    public to       health                                     • Enable interconnection of clinicians,
                                                    manage         services              Integrated              carers and patients in support of
                  Healthcare      Services                                                                       integrated care
                                                  their health    research
                                                                                                               • Shared use of common services and
                                                                                                                 effective right-siting
                                                      Enable integration
Strategic             Enable integrated
                                                   between healthcare and                                      • Connection of core health systems to
 Thrusts             healthcare services
                                                   advances in biomedical                                        support electronic transactions initiated
                                                           science                                               across settings
                                                                                         Connected             • For example - PHR / NEHR for access to
                                                                                                                 an individuals common health record,
                       Health
                                          Integrated           Translating                                       eReferrals, or e-Prescriptions
                    Information
                                          Healthcare           Biomedical
                   Exchange - e-
                                       Continuum - e-          Research to
                  Enable seamless
                                            Enable             Healthcare                                      • Adoption of Health Infocomm
Strategies          and secured
                                        processes and           Delivery -                                       technologies across all care settings
                    information
                                       linkages across      integrate clinical            Adopted              • System adopted are core health
                  exchange in the                                                                                systems such as EMR, NEHR, PAS, RADT,
                                       the healthcare        and biomedical
                  healthcare value                                                                               PHR
                                          value chain         research data
                        chain

                                              6
                                                                                                                                                             6
“Fun” Challenges For EA



     Chain of 9
     polyclinics




     Chain of 9
     polyclinics




                          7
                          7
Alternative paths for EA




         ?




                           8
                           8
Our EA Approach




                  9
                  9
Enterprise & Solution Architecture

                                                     Prioritize and plan Architecture activities
                                                     around Programmes initiated by
                                                     management, i.e. develop the EA segment
                                                     by segment


                                                     Aligning architecture domains across the
          Enterprise Architecture                    enterprise. I.e. whilst architecting each
                                                     segment, keep in view the broader
                                                     enterprise considerations for each domain.

                                                     Applying enterprise design patterns and
                                                     standards in each segment architecture



                                                     Guidance to Solution architecture &
              Implementation                         implementation.
        Solution Architecture & Design


Adapted from Chapter 40. Architecture Partitioning
                                                                                                   10
                                                                                                   10
MOHH EA Journey
            3Q        4Q        1Q        2Q          3Q        4Q          1Q        2Q           3Q        4Q        1Q       2Q     3Q    4Q
            ‘08       ’08       ’09       ’09         ’09       ’09         ’10       ‘10          ‘10       ’10       ’11      ’11    ’11   ’11
                                            Value                                        NEHR
               NEHRA             NEHR POC                 NEHR RFP      Value           detailed
                                                                                         design

                                             Value               NHIS                                     Design
               From                 NHISA                       Scoping                                  Assurance
            Strategy to
             Program                                              ESB
               focus         From problem to
                             innovation:                                      Value
NEHR                         Deep dive into a
                                                               Repository

                             tricky problem space                                                                            NEHRA next
                                                                Data/Doc
                             & take opportunity to                                                                            iteration
                             innovate.
                                                            Service Catalog


                                                    IIA        Interop Specs




                                                 Extending to new               CIC & PHM
CIC & PHM                                         Business Areas                Architecture


                      Implementing operation &
                       governance only when                     Tooling: EA        Content
                                                                                                                     Gov & Operation
EA Ops &                     needed.                            Repository        population

Gov

                                                                                                                                                   11
                                                                                                                                                   11
Architecture Bundle Cards (ABC)
Collaborative & Continual Architecture
              Business                                                                    • A means of managing Complexity
               Inputs                                                                       and constant Evolution.

      Group Discussion &                                                                  • Each ABC is a mini segment
                                      Bottom-up ideas from Architects                       architecture
      Joint Development
                                                                                                • Summary cover “card”
                                                                                                • All 4 domains
             Produce                                                                            • Analysis of key options
                                                                                                • Implementation implications
            ABC XYZ
                   Analysis “Vs.                              Architecture Team
  Analysis “Vs.                                                                           • ABCs are “living” documents
 current NEHR”
                      Target
                                          Architect owner      (more than EA)
                   architecture”                                                               • May not be complete
   Integration     New business
                                             for each ABC                                      • Expand and update as more
   analysis of
 current systems
                   services and
                    applications
                                                                                                 architecture “work” gets done


         Go to ABCs                                                     Review &          • Dependencies across ABCs must
           Library                                                       Endorse            be managed

                                                                                          • Each ABC can be used as a
       ABCs Library                                                                         communication pack for a
                                                                                            capability and includes key decision
                                                Harmonise                   Goal State      & recommendation.
                                   Input into                              Architecture
                                                    &         Produce
                                   Goal State
                                                Synthesize




                                                                                                                                   12
The NEHR Goal State
                                                                              Access Channels

                               Patient                                             Clinician                                                    Researcher
                         National Health                        Clinician Portal                      Provider
                                                                                                                                                   BI Tools
                          Portal - PHM                          NEHR Viewer                         EMR Systems


         Business Services                                                                                                                      Integration Partners
             Summary Care Record                                                           Shared Services                                             EMRX
                                                       Primary Care Provider                  Medications Reconciliation                               CMIS
                    Demographics
                                                          Care Coordinator
                                                                                              Problem List Reconciliation                               NIR
               Diagnoses                   Allergies            Investigations
                                                                                                                                                       CHCS
                 Events                  Medications           Referral Events                            Shared CDS
                                                                                                                                                       CLEO
                                                                                                    Shared Care Plan
             Detailed Documents                                                                                                                         IRIS

                 Event                    Radiology             Investigation &           BI Enablement                                               MINDEF
               Summaries                   Images               Procedure Rpts                Audit                   Prog Eval
                                                                                            Scorecards               Scorecards                         PHM
              Referral Docs


         Integration Services

             Provider                                  Integration                    Transformation                Registry                       2nd Data Use
             Gateway                                    Services                         Services                   Services                          Support
                                                                                                                                                      Pseudony-
             Extraction                  Data validation           Message               Terminology                  Patient                          misation
                                                                   Exchange
                                               Data                 Pattern             Communication
            Doc Retrieval                 transformation                                  brokering
                                                                                                                  Care provider                       Extraction

                                                                                             Message
                                         Error Workflow                                    Interception
                                                                                                                     Facilities

                                                                                                                    Relationship
                                         Service Proxy                                 Structure Mapping
                                                                                                                      Service

                                                                                                                      Endpoint
                                              Audit                                                                  resolution



                                                               Clinical                           Registry         Access &
                                                                             Terminology
                                                                Data                               Data              Audit                          Secondary uses
                                                                                                                                                      data replica



         Infrastructure & Technology

                          Interaction & Integration                                                        Operations                               Development
                                    Doc Mgmt &                                         Provider               Clinician
                Portal                                       Reporting                                                            Usage Audit         Standards &            Legend
                                     Workflow                                         On-boarding             Support
                                                                                                                                                       Processes
              App Server            Messaging                  ESB &
               & Batch               & ETL                  Orchestration              Registry              Data Error           User Rights                          Existing functionality
                                                                                                                                                     SDLC Methods
                                                                                       Updates               Resolution             Admin               & Tools
                                    Security                                                                                                                             New functionality
                                   Encryption &                                               System Monitoring & Management                          Environments
            Authentication                                 Audit Logging
                                    Signature
                                                                                                                                                                       Updated functionality
                                                                            Platform & Availability
                Replication,                                           Clustering,
                 Archival
                                           Backup & DR
                                                                     Load Balancing
                                                                                                     Server                       Network             Storage             To be retired




                                                                                                                                                                                                13
Business Architecture:
Healthcare Capability Model

                              The Healthcare Capability
                              Model is used to:
                              • Develop a ‘good practice’
                                goal state architecture
                              • Communicate to
                                Stakeholders
                              • Manage Business and IT
                                Portfolio




                                 Existing
                                 Newly added
                                 To be
                                 extended




                                                            14
                                                            17
Business Architecture:
Capability vs. care settings




                               15
Compositing of services: Referral
                                                                  1. Locating recipient uses both Care
                                                                     Provider and Facility registries
                                                                  2. Referral letter is composed and
                                                                     uploaded to NEHR (note referral letter
                                                                     composition possible via NEHR Portal)
                                                                  3. Referral notification uses notification
                                                            AIC      and care provider comms capability.
            GP                          RH                           Destination is also determined via
                                                             ?       Endpoint resolution service
                   2. Upload                                      4. Recipient retrieves Referral Letter from
                    referral                 3. Referral             NEHR (either through EMR or NEHR
                                                                     Portal)
1. Locate              5. Communicate
                     letter                  notification         5. Recipient uses clinical communication
recipient                 acceptance                                 capability to communicate acceptance
                                                                     (note lightweight manual business
                                                4. Retrieve          process required).
                                                Referral
                                                Letter

            NHIS                        NEHR


Clinical CommunicationsCare Providers
Put referral
Get referral
Notifications
NHIS Facilities  NHIS                    Relationship service


                                                                                                              16
A different Referral example

                                                                Characteristics
 RHS                                                            1. Broker e-referral provides an IT
                                              CH
                                                                   service (e.g. Web service) for
                                                                   referral management

                                         
                                           
                                                                2. An IT module in the CH manages
                                                                   the referral assessment workflow
                                                                   within the CH
                        Broker                                  3. CH referral management module
                                  1   3
                                               2                   provides an IT service (e.g. Web
                     e-Referral           Referral       PMPA      service) to receive referral
                                            mgt
                                                     5
                                                                   information
                                      4
                                                                4. Upon completion of assessment by
                                                                   CH users, the referral management
                                                                   module will update the AIC system
                                                                   on referral status
                                                                5. The module will also create a pre-
                                                                   admit case in the PMPA system,
       Proposed new module.
                                                                   and pre-populate referral data


                                                                                                   17
Enterprise Continuum:
               Goal State EMR
cmp ABC-026-JHS



                                                                                              Cross (cluster) EMR
                                                                                              communication
                                                                            «goal state»                                                                                                                                                                                                          «goal state»
                                                                        out of cluster :EMR                                                                                                                                                                                                          EMR




                                                                                              getOTNotes




                                                                                                                                                                                                                                                                                                                                                                                                            putReconciledMedications
                                                                                          getEDNotes




                                                                                                                                                                                                                                                                                                                                putDischargeSummaryMetadata




                                                                                                                                                                                                                                                                                                                                                                                                                                       putReconciledProblems
                                                                                                                                  getDischargeSummaryMetadata




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           putDispensedMedications
                                                resolveRecordLocation




                                                                                                                                                                                        getReconciledAllergies
                                                                                                                                                                                     getReconciledMedications




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          putOTNotesMetaData
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     putEDNotesMetaData
                                                                                      getDischargeSummary




                                                                                                                                                                                                                                                                                                                                                                                   putReconciledAllergies




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   putOrderedMedications
                                                                                                                                                                                                                                                                                                   getOTNotesMetaData
                                                                                                                                                                getRadiologyReport




                                                                                                                                                                                                                                                                             getEDNotesMetaData
                                                                                                                                                                                                                 getReconciledProblems




                                                                                                                                                                                                                                                                                                                                                                                                                                                               putReferralLetter
                                                                                                                                                                                                                                                                                                                                                              putRadiologyReport
                                                                                                                                           getImmunisations
                              resolveEndpoint




                                                                                                                                                                                                                    getReferralLetter




                                                                                                                                                                                                                                                                                                                                                              addImmunisation




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                putLabResult
                                                                                                                                                                                                                                                  getLabResult
                                                                                                                    sendMessage




                                                                                                                                                                                                                                                                 getEvent




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          putEvent
                                                                                                                                                                                                                                         getSCR
   Used to resolve the                                                           Required to recieve
   address of documents                                                          and deliver
   and document / referral                                                       communications from
   recipients                                                                    other care providers /
                                                                                 systems




                                                                                                                                                                                        NEHR



                                                                                                                                                                                      «OSB»
                                                                                                                                                                                     NEHR-ESB




                                                                               «Initiate»
                                                                                 NHIS


                             Endpoint Resolution
                                  Serv ice                                                                                                                                                                                                                                                                              «HTB»
                                                                                                                                                                                                                                                                                       NEHR-CDR
                                                                                                                                                                                                                                                                            Note: whilst some existing
                                                                                                                                                                                                                                                                            interfaces are shown in black
                                                                                                                                                                                                                                                                            they are not exposed via
                                                                                                                                                                                                                                                                            NEHR-ESB at present - i.e.
                                                                                                                                                                                                                                                                            NEHR portal retrieves the
                                                                                                                                                                                                                                                                            information directly




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               18
Interoperability and Integration
                  Architecture

                                                              Key Questions Answered:
                 Interoperability Specifications
                                                               Interoperability Specifications
                                                                – How can EHR information be understood in a
                                                                  consistent manner?
Administration




                                                               Integration Services
                                                   Security

                          Integration
                          Services                              – What capabilities does the EHR need to
                                                                  provide to support interoperability and
                                                                  integration?
                                                               Security
                         Infrastructure                        Administration
                                                                – How does interoperability impact
                                                                  administration and operations of EHR and EMR
                                                                  systems?
                                                               Infrastructure


                                                                                                                 19
Data – a Wicked Problem




                          20
                          20
EA Repository Meta-Model
                           Example:
                           • Singapore’s
                             – Rising Healthcare Costs are a
                                  Business Driver
                           • which is tackled by the improved
                             – Sharing of clinical information
                                  whose Goal
                           • is supported by the example of
                             improved sharing in the
                             – Imaging - Capability
                           • This capability contains the
                             – resolveRecordLocation -
                                  Application service
                           • Found in the
                             – NHIS - Application
                           • That can be implemented on
                             – Linux - Technology Component




                                                                 21
EA repository – sample content

                                                                                              •Business Data
                                                                                               Inventory
                                 Business Application Data




                                                                                              •Application Inventory
                                            Business
                                       Organization




                                                                                              •Organisation Inventory
       Info flow (appln. srv.) Appln Svs Service




                                                                                              •Business Svs Inv
                                                                                              •Appln Svs Inventory
                  Info Information srv.)
Business Svs vs Appln Svs(appln. Flow




                                                                                              •Information Flow
                                                                                              •Info flow (appln. srv.)
                        flow




                                                                                              •Appln vs Appln Svs
                                                                                              •Business Svs vs Appln
                                                                                               Svs




                                                                                                                     22
Role of IHIS


 Architect of IT Solutions


 Delivery of Business, Clinical
  and Technology management
  Systems

 CIO for Clusters
Changing Healthcare & IT Landscape


Healthcare           Treatment            Disease
                                                              Population Care
                     Outcomes            Outcomes


          SGH                    SGH    SHS         NHG
                                          Poly       Poly
                          TTSH            clinics    clinic
          MOH

   Ttsh         WH
                                 CGH       SOC       SOC




                                         Hospital
    Department            Hospital     SOC, Polyclinic
      Centric             Centric                              Cluster centric
                                          Centric

Healthcare        Interfaced              Integrated
                 Department                                   Fully Integrated
    IT                                 Cluster Systems        National Systems
                   Systems
Landscape for Healthcare Clusters IT
 Integrated information for Better Personalised Care
Today Public Healthcare exchange EMR and Images across any cluster for in- and outpatients

Hospitals:                                            EHR
• Information sensing
• Paperless                       GP                                          CH
• Clinical & Business
  integration
• Advanced Clinical
  Decision support

Intra-Cluster:
• Integrated Workflow
• One EMR
• One Patient
  Relationship
  Management PRM
                                                                                   RH
Cross-Cluster           EMR                                                         EMR
•One E H R
•EMR for Details                       Exchanges of Images, Records (Today)
                                                      EMRX
Federated EA


  Business       Business       Business        Business       Business       Business
Architecture   Architecture   Architecture    Architecture   Architecture   Architecture


                                                             Application    Application
Application Architecture      Application Architecture       Architecture   Architecture


      Information                                                           Information
      Architecture                Information Architecture                  Architecture



                 Technical Architecture
                                             26
Architecture “bricks”
 Each architecture component is subdivided into a set of specific elements or attributes. Each
 technology element is discussed based on industry status and outlook. The status is based on
 availability of standards (e.g., formal or de-facto, vendors and products, both emerging and
 currently deployed)

                           Current           2 years            5 years


                                            Tactical           Strategic
                           Baseline
                                          Deployment           Direction
                                                                                  Introduction to
                                                                                  Environment
                            Retirement
Exit from                                         Mainstream Standards
                              Target
Environment
                                                                 Emerging
                                Containment Targets               Trends




                                  Implications and Dependencies
Technology Obsolescing Roadmap
      Technology                  2011         2012          2013                     Remarks
 Database Server
                                                                    Premier Support Ends 31 Jan 2009
 Oracle 10.1                        M              D          -
                                                                    End of Extended Support 31 Jan 2012
                                                                    Premier Support Ends 31 Jul 2010
 Oracle 10.2                        M             M           D
                                                                    End of Extended Support 31 Jul 2013
                                                                    Premier Support Ends 30 Aug 2012
 Oracle 11.1                         I             I          M
                                                                    End of Extended Support 30 Aug 2015
                                                                    Premier Support Ends 31 Jan 2015
 Oracle 11.2                         I             I          I
                                                                    End of Extended Support 31 Jan 2018
                                                                    Limited to 1CPU, 1GB memory, 4GB
 Oracle 10g Express                 M             M           M
                                                                    database – POC, small dept use only

Legend
: P Pilot
 I   Invest, technology ready for mainstream deployment
 M   Maintain, new implementation not encouraged
 D   Technology reaches End-of-Support, to be discontinued
                                                                       RESTRICTED - IHiS INTERNAL REFERENCE ONLY
Architecture Support Guidance
                                                                                                     Standard/
                          Mission Critical Business Critical              Enterprise
                                                                                                        Dept
Uptime                         99.9%                 99.5%                     99%                      95%
Availability              (equivalent to 43.2    (equivalent to 3.6     (equivalent to 7.2        (equivalent to 1.5
                           min over 30 days)    hours over 30 days)    hours over 30 days)          days over 30
(unplanned downtime
                                                                                                        days)
over a rolling 30 days)
Secondary/DR Site           Mandatory             Mandatory           Recommended                     Optional
                            Active-Active         Active-Passive        site with manual
                          Configuration with    Configuration with           failover
                          automatic failover     manual failover
Recovery Time                  < 1 hr                < 4 hrs                 < 8 hrs                  < 24 hrs
Objective (RTO) –
time to recover system
Recovery Point               < 15 mins             < 15mins                   1 day                    1 week
Objective (RPO) –
amount of data loss




                                                                      RESTRICTED - IHiS INTERNAL REFERENCE ONLY
Healthcare Business Reference Model
                          Biz Areas > Line of Business

Level 0                                 Core Business Areas
 Level 1                                Healthcare Services
      Emergency                                  SOC/                                    Investigation
                       Inpatient Care                            Allied Health
 Level 2 Care                                  Outpatient

      Surgery/                                                   Medication                Health-
                      Step-down Care           Home Care                                  screening
     Procedure                                                    Mgmt
                                    Direct Care                                         Supportive Care



                                    Enabling Business Areas

             Corporate Services                                       Support Services
   Corporate                         Service
                  Legal Affairs                             Medical                          Operations
    Planning                         Quality                              Estate Mgmt
                                                            Admin                              Mgmt
    Corporate
  Communication
                    HR Mgmt          Finance                Nursing
                                                                         Supply Chain
                                                            Admin
   Community      Accreditation &   Information
   Engagement        Licensing      Management      30                           30
Healthcare Business Reference Model
                Biz Areas > Line of Biz > Core Biz Functions
                                                 Core Business Areas
                                                 Core Business Areas

                                                   Healthcare Services
Emergency          Inpatient        SOC /             Surgery /         Step-          Home Care         Investigation
  Care               Care         Outpatient          Procedure         down            Registration
                                                                                                            Registration
Registration       Admission       Registration        Registration     Transfer /         Tele-
                                                                        Admission       Consultation        Investigation
   Triage         Consultation     Consultation         Treatment      Consultation     Investigation
                                                                                           (BP etc)           Billing &
                                                                                                              Payment
Consultation      Investigation    Investigation       Day Surgery /                      Billing &
                                                        Procedure      Investigation                         Discharge/
                                                                                          Payment
                                                                                                            Referral/Apt
Investigation      Treatment        Treatment           Medication                         Admit/
                                                        Dispensing      Treatment        Discharge/
                   Operation/                                                           Referral /Apt
 Treatment                          Procedure                                                            Health Screening
                   Procedure
                                                                        Procedure
Medication         Medication      Medication
                                                                                       Allied Health    Supportive Care
Dispensing         Dispensing      Dispensing                          Medication
                                                                       Dispensing       Registration
  Billing &         Billing &        Billing &           Billing &
  Payment           Payment          Payment             Payment         Billing &
                                                                                         Treatment
                                      Admit/                             Payment
   Admit/                                                 Admit/
                   Discharge/
 Discharge/                         Discharge/          Discharge/      Discharge/        Billing &
                  Referral/Apt
  Referral                         Referral/Apt        Referral/Apt    Referral /Apt      Payment

                                                                                         Discharge/
                                                                                        Referral/Apt
    Med Mgmt                                Direct Care                                     31
Current Application vs Process Map

                                                           Medication
           Consultation      Investigation    Treatment                    Operation      Procedure
                                                           Management
System A                                                                                  
             (EDNotes)                       (EDNotes)                   (EDNotes)      (EDNotes)

System B                          
                               (eOrders)

System C                          
                             (Results Mgmt)

System D                                                        
                                                            (Outpatient)

System E        
              (HIDS)

System F                                                                    Medication managed by
                                                            (Inpatient)      different applications.
System G                                                        
                                                            (Dispensed)

System H        
             (Support)

System I                                                                                   
             (Support)                                                      (Support)     (Support)

System J        


                          Clinical documentations across
                          multiple applications.
Target Application Landscape
Level 0                                         Core Business Areas
 Level 1
                                                 Healthcare Services
                                                                                                                                  Patient
        SAP –
       Patient
       PA/PM
    Relationship
                        EDWeb
                                                            Integrated EMR                                                        Portal
                         CPSS          Dental
      Mgmt. /                                     EndoSys      ENTSys
                         (eRX)         Notes                                           Step-down                Community         Home
        Appt
                         eIMR
                                       CPSS (eHIDs/            OTRS          CDMS         Care                      Care          Care
      Financial                           eMC)
     Counseling
                        eHOR                           Acute Care
      Patient
    Engagement
      Services           CCOE          CCOE       Lab Information          RIS        CliniVi                               Chronic
                        (eOrder        (RM)              Sys               RIS/PACs
                                                                          /PACS  ew                    Blood Bank
                                                                                                                            Disease
      Patient                                                                                                               Registry
    Touchpoints                             Incident                                              Drug Allergy &
                        Pharmacy
                                           Reporting
                                                                    Supportive Care                                         & Marts
                                                                                                  Medical Alerts
    Patient
                         Clinical         Adverse Drug Event                      Monitoring     Clinical Indicator         Clinical
  Engagement            Repository          & Surveillance
                                                                    ECG
                                                                                  & Tracking       & Risk Alerts            Review



                                   Enabling Business Areas
                  Corporate Services                       Support Services
                                                                         Bed          SAP -                                  Queue
  Patient Accounting       Financial                                    Mgmt         Enterprise Scheduling
                                                                                      Appt    OTS   Trendcare               Mgmt Sys
       & Billing          Assistance                                                   SAPEnterprise
                                                                                           -
                                                                          ODS                                   Location Tracking /
                                                                        EDW/BI         MM
                                                                                      Resource Planning            Asset Mgmt.
                                                                                                           33
Current Programme-Data Matrix
                   Data Element




                                                                                                                                                 Program H
                                                                                                                     Program F
                                                                                        Program D
                                                Program A


                                                              Program B


                                                                           Program C




                                                                                                     Program E




                                                                                                                                                                 Program I
                                                                                                                                     Program G
C – Create
R – Read




                                                                                                                         -
U – Update
D – Delete
* – Manual/Forms

Patient Information
Patient & Demographics                         CR *          CR *         CRUD           R          CRU               R          CRU*                  R         R
Family Information                              —            —             —           CRUD*         —               —               —               —       CRUD
Financial Information                           CR           —             —             R           —               —               —               —       CRUD
Healthcare Episodes & Visits
Patient Episode                                 R             R            R             R           —                R              —               —           R
Patient Visit/Encounter                         R             R            R             R           —                R              —               —           R
Patient Appointment                            CRUD          —            CRUD         CRUD          —               —               —           CRUD            —
Payment                                         C            —             C             C           —               —               —               —           —
Healthcare Organisations & Providers
Institution                                     —            —             —            —            —               —               —               —           —
G.P. Clinic                                    CRUD         CRUD           —             R          CRUD         CRUD                —               —           —
Screening
Screening Event                                 —            —             —            —           CRUD             —               —               —           —
Screening Registration                          —            —             —            —           CRUD             —               —               —           —
Screening Result                                —            —             —            —           CRUD             —               —               —           —
Referral
Referral                                       CR*           CR *          —            CR*         CR*          —               —               —           —

Clinical Information
Medical History: Allergies                      R            —             R            —            —               —               —               —           —
Medical History: Surgery History                R            —             R            CR*          —               —               —               —           —
Physical Condition: Vital Signs                 —           CRUD*          —            CR*         CR*              —               —               —           —
Physical Condition: Physical Characteristics                                             R           —               —               —               —           —
Healthcare Delivery: Examination               CR*           CR*          CR*           CR*         CR*               R              —               —           —
Healthcare Delivery: Test Results               R            CR*           R            CR*         CR*               R              —               —           —
Healthcare Delivery: Procedure                  R             R            R            CR*          —                R              —               —           —
Healthcare Delivery: Medication                 R             R            R            CR*          —                R              —               —           —
Discharge Summary                               R            —             R             R           —                R               R              —           —
Medical Conditions                              R            —             —             R           —               —               —               —           —
Integrated Care/Tele-care
Programme                                       —            —             —            —            —            CR                 —               —           —
Call-Scripts                                    —            —             —            —            —           CRUD                —               —           —
Knowledge-base                                  —            —             —            —            —           CRUD                —               —           —
Tasks                                           —            —             —            —            —           CRUD                —               —           —
Communication Logs                              —            —             —            —            —           CRU                 —               —           —
Current Application-Data Matrix
                  Data Element




                                                                                                                       System G
                                                                                                 System E


                                                                                                            System F
  C – Create




                                                                                     System D
                                                                          System C
                                                              System B
                                                  System A
  R – Read
  U – Update
  D – Delete


  Patient Information
  Patient & Demographics                            CR       CRU           R          —          —          R           —
  Family Information                                 —        —           —           —         CRUD        —           —
  Financial Information                             CR        —           —           —         CRUD        —           —
  Healthcare Episodes & Visits
  Patient Episode                                     R       —            R          —          R          R           —
  Patient Visit/Encounter                             R       —            R          —          R          R           —
  Patient Appointment                             CRUD        —           —           —          —          —           —
  Payment                                            —        —           —           —          —          —          CRU
  Healthcare Organisations & Providers
  Institution                                        —        —           —           —          —          —           —

  G.P. Clinic                                     CRUD       CRUD        CRUD         —          —          —           —

  Screening
  Screening Event                                    —       CRUD         —           —          —          —           —
  Screening Registration                             —       CRUD         —           —          —          —           —
  Screening Result                                   —       CRUD         —           —          —          —           —
  Referral
  Referral (IN)                                      —        —           —           —          —          —           —
  Clinical Information
  Medical History: Allergies                         —        —           —           —          —          —           —
  Medical History: Surgery History                   —        —           —           —          —          —           —
  Physical Condition: Vital Signs                    —        CR          —           —          —          —           —
  Physical Condition: Physical Char acteristics      —        —           —           —          —          —           —
  Physical Condition: ADL                            —        —           —           —          —          CR          —
  Healthcare Delivery: Examination                  CR        CR          —           —          —          —           —
  Healthcare Delivery: Test Results                  —        CR           R          —          —          —           —
  Healthcare Delivery: Procedure                     —        —           —           —          —          —           —
  Healthcare Delivery: Medication                    —        —           —           —          —          —           —
  Discharge Summary                                  —        —           —           —          —          —           —
  Medical Conditions                                 —        —           —           —          —          —           —
  Integrated Care/Tele-care
  Programme                                          —        —           CR          —          —          —           —
  Call-Scripts                                       —        —          CRUD         —          —          —           —
  Knowledge -base                                    —        —          CRUD         —          —          —           —
  Tasks                                              —        —          CRUD         —          —          —           —
  Communication Logs                                 —        —          CRU          —          —          —           —
Information Architecture – Gaps &
Opportunities

                    • Lifestyle
New Data Elements   • Family History
                    • Activity of Daily Living *



                    • G.P. Clinic
Sharing of Common   • Lifestyle
       Data         • Activity of Daily Living
                    • Financial Information


 Accessibility to
                    • Electronic clinical documentations
    clinical        • Scanned MRO Case notes
 documentation


Event Management    • Screening, training, and etc. as Events
Target Logical Model
Summary
 Establish Enterprise Standards and Guidelines
 IT Roadmap and Blueprinting
      Jurong Health Services (JHS) cluster
      SingHealth Chronic Disease Programme
      EasternHealth Alliance Integrated Care Programme

 Continual governance, review and project
  involvement
 Communicate, communicate, communicate …


10/22/2012                                                38
EA – Key Success Factors
 Understand that EA is a Journey, not an End-State
    Iterations and Roadmap Reviews

 Cooperation and Willingness from the rest to work
  with architecture team to align to EA
    Seeing the value that EA can bring in the long run

 Competent Architecture team to lead the way
    Knowing what EA is, and options for implementation
    Knowing how to earn and keep client trust
Proud moments…




                 40
A SHORT CHAT
    if we have time …

                        41
An experienced EA’s wisdom
• Jim Heaton, CTO Baker Hughes, How to fast track an EA group
    –   Mentor and develop employee competencies
    –   Create insanely rapid value and business impact.
    –   Generate external recognition as a powerful reinforcements of achievements
    –   Just enough, just in time.
    –   Design for specific immediate demand, but always thinking about the general
        case
    –   Minimize time to value, not time to milestones
    –   Time box architecture efforts, so that EA team can have the capacity for
        breadth of coverage, and avoid the temptation to dive into details
    –   Make sure that everyone else doesn't think that EA is trying to take over the
        world. (politics)
    –   How to manage outsourced partners? Identify good architects in these
        organizations, nurture them, give them credit, get them promoted
    –   Make sure that every piece of work is about Developing the Architect, on top
        of developing the architecture



                                                                                    42
A panel of EA’s point of view
• What are good qualities to look for in an EA
   –   Curiosity
   –   Courageous to ask why
   –   A good sales guy
   –   Not locked in to standard IT way of thinking
   –   Able to foster and grow a team of Subject Matter Experts
   –   Have run a business before

“External consultants can provide methodology and be
evangelists. But the internal team must be one doing the
work.”
                                                                  43
My point of view
• I believe there are 3 “pillars” to becoming a competent EA
• Framework
    – “An architecture framework is a foundational … set of structures…for
      developing … architectures” – TOGAF Intro
• Methodology
    – “… a method for designing a target state of the enterprise …, and for
      showing how the building blocks fit together” – TOGAF Intro
• Practice
    – “Must I complete all the Catalogs, Matrices & Diagrams?”
    – “Must I cover all Domains – Business to Technical?”
    – “Must I strictly follow every single step of the ADM?”
• The practice of EA is the craft of applying of technology1 (TOGAF) to
  solve problems and help master complex environments
• Commonsense should prevail

                                                                              44
Insource or Outsource
Insource                       Outsource
• Contextual knowledge         • Methodology & framework
• Long term view               • Broader experience
• Focus on implementation      • Time-bound discipline
• Ongoing maintenance          • Extra brains & hands
• Politics                     • Politics

If you choose to outsource, make sure that
• Blended team, internal team must be involved in doing work
• Internal team understands and can continue the work
• Matches your EA style and content. See Chap 40.3 Integration
                                                            45
EA is the Glue


  IT Strategies




IT Implementations




                         46
The Art of EA
                         2.
                       Build
       1.         relationships
   Focus on           / trust          5.
    solving                       Evolve from
problems, not                      where you
just delivering                       are
   artefacts            4.
                        Be
                    pragmatic,
      3.               not
    Be a             dogmatic
  servant
    first,
 policeman
   later


                                  47
Go forth and Architect!




                          48

More Related Content

What's hot

Comp1 unit1a lecture_slides
Comp1 unit1a lecture_slidesComp1 unit1a lecture_slides
Comp1 unit1a lecture_slideslingmac
 
Dr rozita halina tun hussein public private intergration in malaysia past and...
Dr rozita halina tun hussein public private intergration in malaysia past and...Dr rozita halina tun hussein public private intergration in malaysia past and...
Dr rozita halina tun hussein public private intergration in malaysia past and...EyesWideOpen2008
 
Aeroscout Canada
Aeroscout CanadaAeroscout Canada
Aeroscout CanadaMarc
 
Intel - eHealth2012
Intel - eHealth2012Intel - eHealth2012
Intel - eHealth2012Agora Group
 
Dr azilina 1 care for ph conference 12july2011 11july 2011
Dr azilina 1 care for ph conference 12july2011 11july 2011Dr azilina 1 care for ph conference 12july2011 11july 2011
Dr azilina 1 care for ph conference 12july2011 11july 2011EyesWideOpen2008
 
Maimunah A.Hamid - 1care1aim
Maimunah A.Hamid - 1care1aimMaimunah A.Hamid - 1care1aim
Maimunah A.Hamid - 1care1aimEyesWideOpen2008
 
EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)
EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)
EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)BenHeublKeynotes
 
Passport overview scrolling
Passport overview   scrollingPassport overview   scrolling
Passport overview scrollingBthornhillPass
 
Healthcare innovation as a key for sustainability of health systems
Healthcare innovation as a key for sustainability of health systemsHealthcare innovation as a key for sustainability of health systems
Healthcare innovation as a key for sustainability of health systemsJose Luis Rocha Castilla
 
7.wild ga partnership for tele health 3.19.2013 savannah,(2)
7.wild ga partnership for tele health  3.19.2013 savannah,(2)7.wild ga partnership for tele health  3.19.2013 savannah,(2)
7.wild ga partnership for tele health 3.19.2013 savannah,(2)Samantha Haas
 
Architectuurcongres 20110623
Architectuurcongres 20110623Architectuurcongres 20110623
Architectuurcongres 20110623Hazelzet
 

What's hot (20)

Comp1 unit1a lecture_slides
Comp1 unit1a lecture_slidesComp1 unit1a lecture_slides
Comp1 unit1a lecture_slides
 
Dr rozita halina tun hussein public private intergration in malaysia past and...
Dr rozita halina tun hussein public private intergration in malaysia past and...Dr rozita halina tun hussein public private intergration in malaysia past and...
Dr rozita halina tun hussein public private intergration in malaysia past and...
 
Dr Abdul Rahim
Dr Abdul RahimDr Abdul Rahim
Dr Abdul Rahim
 
Vision, reality and challenges
Vision, reality and challengesVision, reality and challenges
Vision, reality and challenges
 
Aeroscout Canada
Aeroscout CanadaAeroscout Canada
Aeroscout Canada
 
Intel - eHealth2012
Intel - eHealth2012Intel - eHealth2012
Intel - eHealth2012
 
HISAC- Health Information Strategy Action Committee
HISAC- Health Information Strategy Action CommitteeHISAC- Health Information Strategy Action Committee
HISAC- Health Information Strategy Action Committee
 
Dr azilina 1 care for ph conference 12july2011 11july 2011
Dr azilina 1 care for ph conference 12july2011 11july 2011Dr azilina 1 care for ph conference 12july2011 11july 2011
Dr azilina 1 care for ph conference 12july2011 11july 2011
 
What Does Person Centric Healthcare Mean?
What Does Person Centric Healthcare Mean?What Does Person Centric Healthcare Mean?
What Does Person Centric Healthcare Mean?
 
Maimunah A.Hamid - 1care1aim
Maimunah A.Hamid - 1care1aimMaimunah A.Hamid - 1care1aim
Maimunah A.Hamid - 1care1aim
 
Puskin
PuskinPuskin
Puskin
 
EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)
EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)
EPITAL Keynote presentation by Søren Vingtoft at Health 2.0 CPH (February 6)
 
Health Insurance Brochure
Health Insurance BrochureHealth Insurance Brochure
Health Insurance Brochure
 
Passport overview scrolling
Passport overview   scrollingPassport overview   scrolling
Passport overview scrolling
 
Healthcare innovation as a key for sustainability of health systems
Healthcare innovation as a key for sustainability of health systemsHealthcare innovation as a key for sustainability of health systems
Healthcare innovation as a key for sustainability of health systems
 
R. binks healthcare policy long term conditions experiences of yorkshire
R. binks healthcare policy long term conditions experiences of yorkshireR. binks healthcare policy long term conditions experiences of yorkshire
R. binks healthcare policy long term conditions experiences of yorkshire
 
Road to Telehealth
Road to TelehealthRoad to Telehealth
Road to Telehealth
 
7.wild ga partnership for tele health 3.19.2013 savannah,(2)
7.wild ga partnership for tele health  3.19.2013 savannah,(2)7.wild ga partnership for tele health  3.19.2013 savannah,(2)
7.wild ga partnership for tele health 3.19.2013 savannah,(2)
 
Architectuurcongres 20110623
Architectuurcongres 20110623Architectuurcongres 20110623
Architectuurcongres 20110623
 
Paras Healthcare
Paras HealthcareParas Healthcare
Paras Healthcare
 

Viewers also liked

Business Value Measurements and the Solution Design Framework
Business Value Measurements and the Solution Design FrameworkBusiness Value Measurements and the Solution Design Framework
Business Value Measurements and the Solution Design FrameworkLeo Barella
 
Interoperabilidad en mHEALTH
Interoperabilidad en mHEALTHInteroperabilidad en mHEALTH
Interoperabilidad en mHEALTHCarlos Gallego
 
Presentació homologació app v0.3
Presentació homologació app v0.3Presentació homologació app v0.3
Presentació homologació app v0.3Carlos Gallego
 
My equipment and location
My equipment and locationMy equipment and location
My equipment and locationNana Oppong
 
Awarepoint product showcase aami 2010.06 - gcs
Awarepoint product showcase aami 2010.06 - gcsAwarepoint product showcase aami 2010.06 - gcs
Awarepoint product showcase aami 2010.06 - gcsAwarepoint Corporation
 
RTLS Asset Management at UCSF Medical Center
RTLS Asset Management at UCSF Medical CenterRTLS Asset Management at UCSF Medical Center
RTLS Asset Management at UCSF Medical CenterAwarepoint Corporation
 
Eksamen tn transport projekt
Eksamen tn transport projektEksamen tn transport projekt
Eksamen tn transport projektjeanette89
 
Reference models a case study for healthcare
Reference models a case study for healthcareReference models a case study for healthcare
Reference models a case study for healthcareReal IRM
 
Molina Troux Worldwide Conference 2014
Molina Troux Worldwide Conference 2014Molina Troux Worldwide Conference 2014
Molina Troux Worldwide Conference 2014carybrown
 
Enterprise Architecture and Innovative Healthcare Design
Enterprise Architecture and Innovative Healthcare DesignEnterprise Architecture and Innovative Healthcare Design
Enterprise Architecture and Innovative Healthcare DesignSoftware Park Thailand
 
Healthcare payer medical informatics and analytics
Healthcare payer medical informatics and analyticsHealthcare payer medical informatics and analytics
Healthcare payer medical informatics and analyticsFrank Wang
 
Globalization And A Changing World[1]
Globalization And A Changing World[1]Globalization And A Changing World[1]
Globalization And A Changing World[1]dkiely
 
Outsourcing Manufacturing
Outsourcing ManufacturingOutsourcing Manufacturing
Outsourcing ManufacturingJane keller
 
HRD Challengesand Outsourcing
HRD Challengesand OutsourcingHRD Challengesand Outsourcing
HRD Challengesand OutsourcingRajan Neupane
 
The Pros and Cons of HR Outsourcing
The Pros and Cons of HR Outsourcing The Pros and Cons of HR Outsourcing
The Pros and Cons of HR Outsourcing G&A Partners
 
Connecting the Healthcare Ecosystem - An Architecture for Improved Health
Connecting the Healthcare Ecosystem - An Architecture for Improved HealthConnecting the Healthcare Ecosystem - An Architecture for Improved Health
Connecting the Healthcare Ecosystem - An Architecture for Improved HealthProlifics
 
The Propell Group - ESSEC Business School - Digital Health Innovation
The Propell Group - ESSEC Business School - Digital Health InnovationThe Propell Group - ESSEC Business School - Digital Health Innovation
The Propell Group - ESSEC Business School - Digital Health InnovationJulien de Salaberry
 
Hc Country Wide Architecture Sanitized
Hc Country Wide Architecture SanitizedHc Country Wide Architecture Sanitized
Hc Country Wide Architecture Sanitizedssoliani
 
Using Big Data for Improved Healthcare Operations and Analytics
Using Big Data for Improved Healthcare Operations and AnalyticsUsing Big Data for Improved Healthcare Operations and Analytics
Using Big Data for Improved Healthcare Operations and AnalyticsPerficient, Inc.
 

Viewers also liked (20)

Business Value Measurements and the Solution Design Framework
Business Value Measurements and the Solution Design FrameworkBusiness Value Measurements and the Solution Design Framework
Business Value Measurements and the Solution Design Framework
 
Interoperabilidad en mHEALTH
Interoperabilidad en mHEALTHInteroperabilidad en mHEALTH
Interoperabilidad en mHEALTH
 
Presentació homologació app v0.3
Presentació homologació app v0.3Presentació homologació app v0.3
Presentació homologació app v0.3
 
My equipment and location
My equipment and locationMy equipment and location
My equipment and location
 
Awarepoint product showcase aami 2010.06 - gcs
Awarepoint product showcase aami 2010.06 - gcsAwarepoint product showcase aami 2010.06 - gcs
Awarepoint product showcase aami 2010.06 - gcs
 
RTLS Asset Management at UCSF Medical Center
RTLS Asset Management at UCSF Medical CenterRTLS Asset Management at UCSF Medical Center
RTLS Asset Management at UCSF Medical Center
 
Eksamen tn transport projekt
Eksamen tn transport projektEksamen tn transport projekt
Eksamen tn transport projekt
 
Reference models a case study for healthcare
Reference models a case study for healthcareReference models a case study for healthcare
Reference models a case study for healthcare
 
Molina Troux Worldwide Conference 2014
Molina Troux Worldwide Conference 2014Molina Troux Worldwide Conference 2014
Molina Troux Worldwide Conference 2014
 
Enterprise Architecture and Innovative Healthcare Design
Enterprise Architecture and Innovative Healthcare DesignEnterprise Architecture and Innovative Healthcare Design
Enterprise Architecture and Innovative Healthcare Design
 
Healthcare payer medical informatics and analytics
Healthcare payer medical informatics and analyticsHealthcare payer medical informatics and analytics
Healthcare payer medical informatics and analytics
 
Globalization And A Changing World[1]
Globalization And A Changing World[1]Globalization And A Changing World[1]
Globalization And A Changing World[1]
 
Outsourcing Manufacturing
Outsourcing ManufacturingOutsourcing Manufacturing
Outsourcing Manufacturing
 
HRD Challengesand Outsourcing
HRD Challengesand OutsourcingHRD Challengesand Outsourcing
HRD Challengesand Outsourcing
 
The Pros and Cons of HR Outsourcing
The Pros and Cons of HR Outsourcing The Pros and Cons of HR Outsourcing
The Pros and Cons of HR Outsourcing
 
Connecting the Healthcare Ecosystem - An Architecture for Improved Health
Connecting the Healthcare Ecosystem - An Architecture for Improved HealthConnecting the Healthcare Ecosystem - An Architecture for Improved Health
Connecting the Healthcare Ecosystem - An Architecture for Improved Health
 
The Propell Group - ESSEC Business School - Digital Health Innovation
The Propell Group - ESSEC Business School - Digital Health InnovationThe Propell Group - ESSEC Business School - Digital Health Innovation
The Propell Group - ESSEC Business School - Digital Health Innovation
 
Hc Country Wide Architecture Sanitized
Hc Country Wide Architecture SanitizedHc Country Wide Architecture Sanitized
Hc Country Wide Architecture Sanitized
 
Using Big Data for Improved Healthcare Operations and Analytics
Using Big Data for Improved Healthcare Operations and AnalyticsUsing Big Data for Improved Healthcare Operations and Analytics
Using Big Data for Improved Healthcare Operations and Analytics
 
Hospital planning and designing
Hospital planning and designingHospital planning and designing
Hospital planning and designing
 

Similar to A Tale of 2 Architectures

Sue Page & others: Integration in Cumbria
Sue Page & others: Integration in CumbriaSue Page & others: Integration in Cumbria
Sue Page & others: Integration in CumbriaNuffield Trust
 
Health and care system from April 2013
Health and care system from April 2013 Health and care system from April 2013
Health and care system from April 2013 Department of Health
 
Health IT in Singapore
Health IT in SingaporeHealth IT in Singapore
Health IT in SingaporeInfoPier
 
090312 Sc Uts Presentation Part 1of2(2)
090312 Sc Uts Presentation Part 1of2(2)090312 Sc Uts Presentation Part 1of2(2)
090312 Sc Uts Presentation Part 1of2(2)jiriri
 
Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...
Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...
Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...marcus evans Network
 
The future of market access – the local picture
The future of market access – the local picture The future of market access – the local picture
The future of market access – the local picture PM Society
 
Baylor University Medical Center
Baylor University Medical CenterBaylor University Medical Center
Baylor University Medical Centerthe Health Advocate
 
Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning
Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning
Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning NHSScotlandEvent
 
Josep Roca. Gestión hospitalaria en tiempos de crisis
Josep Roca. Gestión hospitalaria en tiempos de crisisJosep Roca. Gestión hospitalaria en tiempos de crisis
Josep Roca. Gestión hospitalaria en tiempos de crisisANTARES CONSULTING
 
Paperless Hospitals Dr Dev Taneja 3rd June2012
Paperless Hospitals Dr Dev Taneja 3rd June2012Paperless Hospitals Dr Dev Taneja 3rd June2012
Paperless Hospitals Dr Dev Taneja 3rd June2012DrDevTaneja
 
Gary Welch Selling To The Nhs Ukti 31 Mar 2010
Gary Welch   Selling To The Nhs Ukti   31 Mar 2010Gary Welch   Selling To The Nhs Ukti   31 Mar 2010
Gary Welch Selling To The Nhs Ukti 31 Mar 2010GaryWelch
 
Personalised Medicine, a cross-sectoral ambition
Personalised Medicine, a cross-sectoral ambitionPersonalised Medicine, a cross-sectoral ambition
Personalised Medicine, a cross-sectoral ambitionEuroBioForum
 
Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...
Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...
Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...DrDevTaneja
 
Types of committees governing health care teams
Types of committees governing health care teamsTypes of committees governing health care teams
Types of committees governing health care teams Dr.Priyanka Phonde
 
Business Model Innovation in Healthcare by Chris Wasden
Business Model Innovation in Healthcare by Chris WasdenBusiness Model Innovation in Healthcare by Chris Wasden
Business Model Innovation in Healthcare by Chris WasdenMatt Perez
 

Similar to A Tale of 2 Architectures (18)

Sue Page & others: Integration in Cumbria
Sue Page & others: Integration in CumbriaSue Page & others: Integration in Cumbria
Sue Page & others: Integration in Cumbria
 
Nhsla 2
Nhsla 2Nhsla 2
Nhsla 2
 
Health and care system from April 2013
Health and care system from April 2013 Health and care system from April 2013
Health and care system from April 2013
 
Health IT in Singapore
Health IT in SingaporeHealth IT in Singapore
Health IT in Singapore
 
090312 Sc Uts Presentation Part 1of2(2)
090312 Sc Uts Presentation Part 1of2(2)090312 Sc Uts Presentation Part 1of2(2)
090312 Sc Uts Presentation Part 1of2(2)
 
Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...
Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...
Staying Relevant in a High Volume, Commoditized, Medical Device Product Line ...
 
The future of market access – the local picture
The future of market access – the local picture The future of market access – the local picture
The future of market access – the local picture
 
Baylor University Medical Center
Baylor University Medical CenterBaylor University Medical Center
Baylor University Medical Center
 
Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning
Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning
Parallel Session 3.1.4 Emerging Technologies - Horizon Scanning
 
Josep Roca. Gestión hospitalaria en tiempos de crisis
Josep Roca. Gestión hospitalaria en tiempos de crisisJosep Roca. Gestión hospitalaria en tiempos de crisis
Josep Roca. Gestión hospitalaria en tiempos de crisis
 
A. carriazo e health business models for chronic conditions-case of andalusia
A. carriazo e health business models for chronic conditions-case of andalusia A. carriazo e health business models for chronic conditions-case of andalusia
A. carriazo e health business models for chronic conditions-case of andalusia
 
Paperless Hospitals Dr Dev Taneja 3rd June2012
Paperless Hospitals Dr Dev Taneja 3rd June2012Paperless Hospitals Dr Dev Taneja 3rd June2012
Paperless Hospitals Dr Dev Taneja 3rd June2012
 
Gary Welch Selling To The Nhs Ukti 31 Mar 2010
Gary Welch   Selling To The Nhs Ukti   31 Mar 2010Gary Welch   Selling To The Nhs Ukti   31 Mar 2010
Gary Welch Selling To The Nhs Ukti 31 Mar 2010
 
Cathy Grahame - Kaleidoscope Ambulatory Care Program - More than just a clinic
Cathy Grahame - Kaleidoscope Ambulatory Care Program - More than just a clinicCathy Grahame - Kaleidoscope Ambulatory Care Program - More than just a clinic
Cathy Grahame - Kaleidoscope Ambulatory Care Program - More than just a clinic
 
Personalised Medicine, a cross-sectoral ambition
Personalised Medicine, a cross-sectoral ambitionPersonalised Medicine, a cross-sectoral ambition
Personalised Medicine, a cross-sectoral ambition
 
Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...
Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...
Leadership &amp; Human Capital Development In Healthcare­­ People Hosp Orchid...
 
Types of committees governing health care teams
Types of committees governing health care teamsTypes of committees governing health care teams
Types of committees governing health care teams
 
Business Model Innovation in Healthcare by Chris Wasden
Business Model Innovation in Healthcare by Chris WasdenBusiness Model Innovation in Healthcare by Chris Wasden
Business Model Innovation in Healthcare by Chris Wasden
 

Recently uploaded

Benefits Of Flutter Compared To Other Frameworks
Benefits Of Flutter Compared To Other FrameworksBenefits Of Flutter Compared To Other Frameworks
Benefits Of Flutter Compared To Other FrameworksSoftradix Technologies
 
Making_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptx
Making_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptxMaking_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptx
Making_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptxnull - The Open Security Community
 
Maximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptxMaximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptxOnBoard
 
GenCyber Cyber Security Day Presentation
GenCyber Cyber Security Day PresentationGenCyber Cyber Security Day Presentation
GenCyber Cyber Security Day PresentationMichael W. Hawkins
 
Azure Monitor & Application Insight to monitor Infrastructure & Application
Azure Monitor & Application Insight to monitor Infrastructure & ApplicationAzure Monitor & Application Insight to monitor Infrastructure & Application
Azure Monitor & Application Insight to monitor Infrastructure & ApplicationAndikSusilo4
 
Install Stable Diffusion in windows machine
Install Stable Diffusion in windows machineInstall Stable Diffusion in windows machine
Install Stable Diffusion in windows machinePadma Pradeep
 
Snow Chain-Integrated Tire for a Safe Drive on Winter Roads
Snow Chain-Integrated Tire for a Safe Drive on Winter RoadsSnow Chain-Integrated Tire for a Safe Drive on Winter Roads
Snow Chain-Integrated Tire for a Safe Drive on Winter RoadsHyundai Motor Group
 
Integration and Automation in Practice: CI/CD in Mule Integration and Automat...
Integration and Automation in Practice: CI/CD in Mule Integration and Automat...Integration and Automation in Practice: CI/CD in Mule Integration and Automat...
Integration and Automation in Practice: CI/CD in Mule Integration and Automat...Patryk Bandurski
 
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024BookNet Canada
 
Enhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for PartnersEnhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for PartnersThousandEyes
 
Breaking the Kubernetes Kill Chain: Host Path Mount
Breaking the Kubernetes Kill Chain: Host Path MountBreaking the Kubernetes Kill Chain: Host Path Mount
Breaking the Kubernetes Kill Chain: Host Path MountPuma Security, LLC
 
Human Factors of XR: Using Human Factors to Design XR Systems
Human Factors of XR: Using Human Factors to Design XR SystemsHuman Factors of XR: Using Human Factors to Design XR Systems
Human Factors of XR: Using Human Factors to Design XR SystemsMark Billinghurst
 
Beyond Boundaries: Leveraging No-Code Solutions for Industry Innovation
Beyond Boundaries: Leveraging No-Code Solutions for Industry InnovationBeyond Boundaries: Leveraging No-Code Solutions for Industry Innovation
Beyond Boundaries: Leveraging No-Code Solutions for Industry InnovationSafe Software
 
Next-generation AAM aircraft unveiled by Supernal, S-A2
Next-generation AAM aircraft unveiled by Supernal, S-A2Next-generation AAM aircraft unveiled by Supernal, S-A2
Next-generation AAM aircraft unveiled by Supernal, S-A2Hyundai Motor Group
 
IAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI SolutionsIAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI SolutionsEnterprise Knowledge
 
FULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | Delhi
FULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | DelhiFULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | Delhi
FULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | Delhisoniya singh
 
WhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure service
WhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure serviceWhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure service
WhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure servicePooja Nehwal
 
AI as an Interface for Commercial Buildings
AI as an Interface for Commercial BuildingsAI as an Interface for Commercial Buildings
AI as an Interface for Commercial BuildingsMemoori
 

Recently uploaded (20)

Benefits Of Flutter Compared To Other Frameworks
Benefits Of Flutter Compared To Other FrameworksBenefits Of Flutter Compared To Other Frameworks
Benefits Of Flutter Compared To Other Frameworks
 
Making_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptx
Making_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptxMaking_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptx
Making_way_through_DLL_hollowing_inspite_of_CFG_by_Debjeet Banerjee.pptx
 
Maximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptxMaximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptx
 
GenCyber Cyber Security Day Presentation
GenCyber Cyber Security Day PresentationGenCyber Cyber Security Day Presentation
GenCyber Cyber Security Day Presentation
 
Azure Monitor & Application Insight to monitor Infrastructure & Application
Azure Monitor & Application Insight to monitor Infrastructure & ApplicationAzure Monitor & Application Insight to monitor Infrastructure & Application
Azure Monitor & Application Insight to monitor Infrastructure & Application
 
Install Stable Diffusion in windows machine
Install Stable Diffusion in windows machineInstall Stable Diffusion in windows machine
Install Stable Diffusion in windows machine
 
Snow Chain-Integrated Tire for a Safe Drive on Winter Roads
Snow Chain-Integrated Tire for a Safe Drive on Winter RoadsSnow Chain-Integrated Tire for a Safe Drive on Winter Roads
Snow Chain-Integrated Tire for a Safe Drive on Winter Roads
 
Integration and Automation in Practice: CI/CD in Mule Integration and Automat...
Integration and Automation in Practice: CI/CD in Mule Integration and Automat...Integration and Automation in Practice: CI/CD in Mule Integration and Automat...
Integration and Automation in Practice: CI/CD in Mule Integration and Automat...
 
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
 
Enhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for PartnersEnhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for Partners
 
Breaking the Kubernetes Kill Chain: Host Path Mount
Breaking the Kubernetes Kill Chain: Host Path MountBreaking the Kubernetes Kill Chain: Host Path Mount
Breaking the Kubernetes Kill Chain: Host Path Mount
 
Human Factors of XR: Using Human Factors to Design XR Systems
Human Factors of XR: Using Human Factors to Design XR SystemsHuman Factors of XR: Using Human Factors to Design XR Systems
Human Factors of XR: Using Human Factors to Design XR Systems
 
Beyond Boundaries: Leveraging No-Code Solutions for Industry Innovation
Beyond Boundaries: Leveraging No-Code Solutions for Industry InnovationBeyond Boundaries: Leveraging No-Code Solutions for Industry Innovation
Beyond Boundaries: Leveraging No-Code Solutions for Industry Innovation
 
Next-generation AAM aircraft unveiled by Supernal, S-A2
Next-generation AAM aircraft unveiled by Supernal, S-A2Next-generation AAM aircraft unveiled by Supernal, S-A2
Next-generation AAM aircraft unveiled by Supernal, S-A2
 
The transition to renewables in India.pdf
The transition to renewables in India.pdfThe transition to renewables in India.pdf
The transition to renewables in India.pdf
 
IAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI SolutionsIAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI Solutions
 
Vulnerability_Management_GRC_by Sohang Sengupta.pptx
Vulnerability_Management_GRC_by Sohang Sengupta.pptxVulnerability_Management_GRC_by Sohang Sengupta.pptx
Vulnerability_Management_GRC_by Sohang Sengupta.pptx
 
FULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | Delhi
FULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | DelhiFULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | Delhi
FULL ENJOY 🔝 8264348440 🔝 Call Girls in Diplomatic Enclave | Delhi
 
WhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure service
WhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure serviceWhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure service
WhatsApp 9892124323 ✓Call Girls In Kalyan ( Mumbai ) secure service
 
AI as an Interface for Commercial Buildings
AI as an Interface for Commercial BuildingsAI as an Interface for Commercial Buildings
AI as an Interface for Commercial Buildings
 

A Tale of 2 Architectures

  • 1. A Tale of 2 Architectures CEITA @ ISS Peter Tan 24 Oct 2012 1
  • 3. History of me Organisation Key Role Work Examples Education Cluster, NCB Conceptualise, Evangelise, Pilot Student & Teacher’s Workbench, Infrastructure & Technology Operate and Outsource Government Internet Office, GCIO, NCB Ecommerce Technologies, NCB Explore & Pilot Internet Database Access Engineering, Operations & ISM, Product development, EUC E-auction, E-tender, CRM SESAMi.com COO, LatticeKey Solutions Fundraising, Ops, Sales, Legal Single sign-on, User provisioning eGovernment Planning & Policy, Technical Architecture, Service-wide Technical Architecture Management Division, IDA Funding Evaluation (SWTA), AD, eHealth, MOH Project & Programme Electronic Medical Records Exchange Management, IT Governance, (EMRX), iN2015 Healthcare & Strategy Biomed strategy Lead Enterprise Architect, MOH Strategy, Enterprise Architecture, National Electronic Health Record Holdings RFP, Governance Architecture Principal Architect, IHiS ?? ?? 3 http://sg.linkedin.com/in/petertansg
  • 4. The Healthcare Ecosystem Primary Care Acute & Long-Term Care Intermediate Care Community Hospital Polyclinics Nursing Home Screening & Restructured Palliative Preventation Hospital Care General Home Care Practitioners Rehab & Support Services Public sector Private sector People sector 4 4
  • 5. At The 30,000 Feet… Restructured Hospital CH Polyclinics NH Screening & Palliative Prevention RH Care Home FPs Care Rehab & support services CH CH CH Polyclinics NH Polyclinics NH Polyclinics NH Screening & Palliative Screening & Palliative Prevention RH Care Prevention RH Care Screening & Prevention RH Palliative Home Home Care FPs Care FPs Care Home FPs Care Rehab & Rehab & support support Rehab & services services support CH CH services Polyclinics NH Polyclinics NH Screening & Palliative Screening & RH Palliative Prevention RH Care Prevention Care Home Home FPs Care FPs Care Rehab & Rehab & support support services services General Community Nursing Polyclinics Practitioners Hospital Home 5 5
  • 6. One Patient One Record Strategy iN2015 Strategic Framework … a journey summarised by … From iN2015 Healthcare and Biomedical Sciences Report To accelerate sectoral transformation through an • Visibility of supply, demand, costs and Infocomm-enabled personalised healthcare delivery care pathways Goal system to achieve high quality clinical care, service Optimized • Well populated clinical database excellence, cost-effectiveness and strong clinical • Patients have visibility of their health research journey and available options Greater Strong • Manage ‘cases’ across care settings Well- Cost- ability of clinical and using defined care pathways Integrated effective Outcomes Quality Healthcare public to health • Enable interconnection of clinicians, manage services Integrated carers and patients in support of Healthcare Services integrated care their health research • Shared use of common services and effective right-siting Enable integration Strategic Enable integrated between healthcare and • Connection of core health systems to Thrusts healthcare services advances in biomedical support electronic transactions initiated science across settings Connected • For example - PHR / NEHR for access to an individuals common health record, Health Integrated Translating eReferrals, or e-Prescriptions Information Healthcare Biomedical Exchange - e- Continuum - e- Research to Enable seamless Enable Healthcare • Adoption of Health Infocomm Strategies and secured processes and Delivery - technologies across all care settings information linkages across integrate clinical Adopted • System adopted are core health exchange in the systems such as EMR, NEHR, PAS, RADT, the healthcare and biomedical healthcare value PHR value chain research data chain 6 6
  • 7. “Fun” Challenges For EA Chain of 9 polyclinics Chain of 9 polyclinics 7 7
  • 10. Enterprise & Solution Architecture Prioritize and plan Architecture activities around Programmes initiated by management, i.e. develop the EA segment by segment Aligning architecture domains across the Enterprise Architecture enterprise. I.e. whilst architecting each segment, keep in view the broader enterprise considerations for each domain. Applying enterprise design patterns and standards in each segment architecture Guidance to Solution architecture & Implementation implementation. Solution Architecture & Design Adapted from Chapter 40. Architecture Partitioning 10 10
  • 11. MOHH EA Journey 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q ‘08 ’08 ’09 ’09 ’09 ’09 ’10 ‘10 ‘10 ’10 ’11 ’11 ’11 ’11 Value NEHR NEHRA NEHR POC NEHR RFP Value detailed design Value NHIS Design From NHISA Scoping Assurance Strategy to Program ESB focus From problem to innovation: Value NEHR Deep dive into a Repository tricky problem space NEHRA next Data/Doc & take opportunity to iteration innovate. Service Catalog IIA Interop Specs Extending to new CIC & PHM CIC & PHM Business Areas Architecture Implementing operation & governance only when Tooling: EA Content Gov & Operation EA Ops & needed. Repository population Gov 11 11
  • 12. Architecture Bundle Cards (ABC) Collaborative & Continual Architecture Business • A means of managing Complexity Inputs and constant Evolution. Group Discussion & • Each ABC is a mini segment Bottom-up ideas from Architects architecture Joint Development • Summary cover “card” • All 4 domains Produce • Analysis of key options • Implementation implications ABC XYZ Analysis “Vs. Architecture Team Analysis “Vs. • ABCs are “living” documents current NEHR” Target Architect owner (more than EA) architecture” • May not be complete Integration New business for each ABC • Expand and update as more analysis of current systems services and applications architecture “work” gets done Go to ABCs Review & • Dependencies across ABCs must Library Endorse be managed • Each ABC can be used as a ABCs Library communication pack for a capability and includes key decision Harmonise Goal State & recommendation. Input into Architecture & Produce Goal State Synthesize 12
  • 13. The NEHR Goal State Access Channels Patient Clinician Researcher National Health Clinician Portal Provider BI Tools Portal - PHM NEHR Viewer EMR Systems Business Services Integration Partners Summary Care Record Shared Services EMRX Primary Care Provider Medications Reconciliation CMIS Demographics Care Coordinator Problem List Reconciliation NIR Diagnoses Allergies Investigations CHCS Events Medications Referral Events Shared CDS CLEO Shared Care Plan Detailed Documents IRIS Event Radiology Investigation & BI Enablement MINDEF Summaries Images Procedure Rpts Audit Prog Eval Scorecards Scorecards PHM Referral Docs Integration Services Provider Integration Transformation Registry 2nd Data Use Gateway Services Services Services Support Pseudony- Extraction Data validation Message Terminology Patient misation Exchange Data Pattern Communication Doc Retrieval transformation brokering Care provider Extraction Message Error Workflow Interception Facilities Relationship Service Proxy Structure Mapping Service Endpoint Audit resolution Clinical Registry Access & Terminology Data Data Audit Secondary uses data replica Infrastructure & Technology Interaction & Integration Operations Development Doc Mgmt & Provider Clinician Portal Reporting Usage Audit Standards & Legend Workflow On-boarding Support Processes App Server Messaging ESB & & Batch & ETL Orchestration Registry Data Error User Rights Existing functionality SDLC Methods Updates Resolution Admin & Tools Security New functionality Encryption & System Monitoring & Management Environments Authentication Audit Logging Signature Updated functionality Platform & Availability Replication, Clustering, Archival Backup & DR Load Balancing Server Network Storage To be retired 13
  • 14. Business Architecture: Healthcare Capability Model The Healthcare Capability Model is used to: • Develop a ‘good practice’ goal state architecture • Communicate to Stakeholders • Manage Business and IT Portfolio Existing Newly added To be extended 14 17
  • 16. Compositing of services: Referral 1. Locating recipient uses both Care Provider and Facility registries 2. Referral letter is composed and uploaded to NEHR (note referral letter composition possible via NEHR Portal) 3. Referral notification uses notification AIC and care provider comms capability. GP RH Destination is also determined via ? Endpoint resolution service 2. Upload 4. Recipient retrieves Referral Letter from referral 3. Referral NEHR (either through EMR or NEHR Portal) 1. Locate 5. Communicate letter notification 5. Recipient uses clinical communication recipient acceptance capability to communicate acceptance (note lightweight manual business 4. Retrieve process required). Referral Letter NHIS NEHR Clinical CommunicationsCare Providers Put referral Get referral Notifications NHIS Facilities NHIS Relationship service 16
  • 17. A different Referral example Characteristics RHS 1. Broker e-referral provides an IT CH service (e.g. Web service) for referral management     2. An IT module in the CH manages the referral assessment workflow within the CH Broker 3. CH referral management module 1 3 2 provides an IT service (e.g. Web e-Referral Referral PMPA service) to receive referral mgt 5 information 4 4. Upon completion of assessment by CH users, the referral management module will update the AIC system on referral status 5. The module will also create a pre- admit case in the PMPA system, Proposed new module. and pre-populate referral data 17
  • 18. Enterprise Continuum: Goal State EMR cmp ABC-026-JHS Cross (cluster) EMR communication «goal state» «goal state» out of cluster :EMR EMR getOTNotes putReconciledMedications getEDNotes putDischargeSummaryMetadata putReconciledProblems getDischargeSummaryMetadata putDispensedMedications resolveRecordLocation getReconciledAllergies getReconciledMedications putOTNotesMetaData putEDNotesMetaData getDischargeSummary putReconciledAllergies putOrderedMedications getOTNotesMetaData getRadiologyReport getEDNotesMetaData getReconciledProblems putReferralLetter putRadiologyReport getImmunisations resolveEndpoint getReferralLetter addImmunisation putLabResult getLabResult sendMessage getEvent putEvent getSCR Used to resolve the Required to recieve address of documents and deliver and document / referral communications from recipients other care providers / systems NEHR «OSB» NEHR-ESB «Initiate» NHIS Endpoint Resolution Serv ice «HTB» NEHR-CDR Note: whilst some existing interfaces are shown in black they are not exposed via NEHR-ESB at present - i.e. NEHR portal retrieves the information directly 18
  • 19. Interoperability and Integration Architecture Key Questions Answered: Interoperability Specifications  Interoperability Specifications – How can EHR information be understood in a consistent manner? Administration  Integration Services Security Integration Services – What capabilities does the EHR need to provide to support interoperability and integration?  Security Infrastructure  Administration – How does interoperability impact administration and operations of EHR and EMR systems?  Infrastructure 19
  • 20. Data – a Wicked Problem 20 20
  • 21. EA Repository Meta-Model Example: • Singapore’s – Rising Healthcare Costs are a Business Driver • which is tackled by the improved – Sharing of clinical information whose Goal • is supported by the example of improved sharing in the – Imaging - Capability • This capability contains the – resolveRecordLocation - Application service • Found in the – NHIS - Application • That can be implemented on – Linux - Technology Component 21
  • 22. EA repository – sample content •Business Data Inventory Business Application Data •Application Inventory Business Organization •Organisation Inventory Info flow (appln. srv.) Appln Svs Service •Business Svs Inv •Appln Svs Inventory Info Information srv.) Business Svs vs Appln Svs(appln. Flow •Information Flow •Info flow (appln. srv.) flow •Appln vs Appln Svs •Business Svs vs Appln Svs 22
  • 23. Role of IHIS  Architect of IT Solutions  Delivery of Business, Clinical and Technology management Systems  CIO for Clusters
  • 24. Changing Healthcare & IT Landscape Healthcare Treatment Disease Population Care Outcomes Outcomes SGH SGH SHS NHG Poly Poly TTSH clinics clinic MOH Ttsh WH CGH SOC SOC Hospital Department Hospital SOC, Polyclinic Centric Centric Cluster centric Centric Healthcare Interfaced Integrated Department Fully Integrated IT Cluster Systems National Systems Systems
  • 25. Landscape for Healthcare Clusters IT Integrated information for Better Personalised Care Today Public Healthcare exchange EMR and Images across any cluster for in- and outpatients Hospitals: EHR • Information sensing • Paperless GP CH • Clinical & Business integration • Advanced Clinical Decision support Intra-Cluster: • Integrated Workflow • One EMR • One Patient Relationship Management PRM RH Cross-Cluster EMR EMR •One E H R •EMR for Details Exchanges of Images, Records (Today) EMRX
  • 26. Federated EA Business Business Business Business Business Business Architecture Architecture Architecture Architecture Architecture Architecture Application Application Application Architecture Application Architecture Architecture Architecture Information Information Architecture Information Architecture Architecture Technical Architecture 26
  • 27. Architecture “bricks” Each architecture component is subdivided into a set of specific elements or attributes. Each technology element is discussed based on industry status and outlook. The status is based on availability of standards (e.g., formal or de-facto, vendors and products, both emerging and currently deployed) Current 2 years 5 years Tactical Strategic Baseline Deployment Direction Introduction to Environment Retirement Exit from Mainstream Standards Target Environment Emerging Containment Targets Trends Implications and Dependencies
  • 28. Technology Obsolescing Roadmap Technology 2011 2012 2013 Remarks Database Server Premier Support Ends 31 Jan 2009 Oracle 10.1 M D - End of Extended Support 31 Jan 2012 Premier Support Ends 31 Jul 2010 Oracle 10.2 M M D End of Extended Support 31 Jul 2013 Premier Support Ends 30 Aug 2012 Oracle 11.1 I I M End of Extended Support 30 Aug 2015 Premier Support Ends 31 Jan 2015 Oracle 11.2 I I I End of Extended Support 31 Jan 2018 Limited to 1CPU, 1GB memory, 4GB Oracle 10g Express M M M database – POC, small dept use only Legend : P Pilot I Invest, technology ready for mainstream deployment M Maintain, new implementation not encouraged D Technology reaches End-of-Support, to be discontinued RESTRICTED - IHiS INTERNAL REFERENCE ONLY
  • 29. Architecture Support Guidance Standard/ Mission Critical Business Critical Enterprise Dept Uptime 99.9% 99.5% 99% 95% Availability (equivalent to 43.2 (equivalent to 3.6 (equivalent to 7.2 (equivalent to 1.5 min over 30 days) hours over 30 days) hours over 30 days) days over 30 (unplanned downtime days) over a rolling 30 days) Secondary/DR Site Mandatory Mandatory Recommended Optional Active-Active Active-Passive site with manual Configuration with Configuration with failover automatic failover manual failover Recovery Time < 1 hr < 4 hrs < 8 hrs < 24 hrs Objective (RTO) – time to recover system Recovery Point < 15 mins < 15mins 1 day 1 week Objective (RPO) – amount of data loss RESTRICTED - IHiS INTERNAL REFERENCE ONLY
  • 30. Healthcare Business Reference Model Biz Areas > Line of Business Level 0 Core Business Areas Level 1 Healthcare Services Emergency SOC/ Investigation Inpatient Care Allied Health Level 2 Care Outpatient Surgery/ Medication Health- Step-down Care Home Care screening Procedure Mgmt Direct Care Supportive Care Enabling Business Areas Corporate Services Support Services Corporate Service Legal Affairs Medical Operations Planning Quality Estate Mgmt Admin Mgmt Corporate Communication HR Mgmt Finance Nursing Supply Chain Admin Community Accreditation & Information Engagement Licensing Management 30 30
  • 31. Healthcare Business Reference Model Biz Areas > Line of Biz > Core Biz Functions Core Business Areas Core Business Areas Healthcare Services Emergency Inpatient SOC / Surgery / Step- Home Care Investigation Care Care Outpatient Procedure down Registration Registration Registration Admission Registration Registration Transfer / Tele- Admission Consultation Investigation Triage Consultation Consultation Treatment Consultation Investigation (BP etc) Billing & Payment Consultation Investigation Investigation Day Surgery / Billing & Procedure Investigation Discharge/ Payment Referral/Apt Investigation Treatment Treatment Medication Admit/ Dispensing Treatment Discharge/ Operation/ Referral /Apt Treatment Procedure Health Screening Procedure Procedure Medication Medication Medication Allied Health Supportive Care Dispensing Dispensing Dispensing Medication Dispensing Registration Billing & Billing & Billing & Billing & Payment Payment Payment Payment Billing & Treatment Admit/ Payment Admit/ Admit/ Discharge/ Discharge/ Discharge/ Discharge/ Discharge/ Billing & Referral/Apt Referral Referral/Apt Referral/Apt Referral /Apt Payment Discharge/ Referral/Apt Med Mgmt Direct Care 31
  • 32. Current Application vs Process Map Medication Consultation Investigation Treatment Operation Procedure Management System A     (EDNotes)  (EDNotes)  (EDNotes) (EDNotes) System B  (eOrders) System C  (Results Mgmt) System D  (Outpatient) System E  (HIDS) System F  Medication managed by (Inpatient) different applications. System G  (Dispensed) System H  (Support) System I    (Support) (Support) (Support) System J  Clinical documentations across multiple applications.
  • 33. Target Application Landscape Level 0 Core Business Areas Level 1 Healthcare Services Patient SAP – Patient PA/PM Relationship EDWeb Integrated EMR Portal CPSS Dental Mgmt. / EndoSys ENTSys (eRX) Notes Step-down Community Home Appt eIMR CPSS (eHIDs/ OTRS CDMS Care Care Care Financial eMC) Counseling eHOR Acute Care Patient Engagement Services CCOE CCOE Lab Information RIS CliniVi Chronic (eOrder (RM) Sys RIS/PACs /PACS ew Blood Bank Disease Patient Registry Touchpoints Incident Drug Allergy & Pharmacy Reporting Supportive Care & Marts Medical Alerts Patient Clinical Adverse Drug Event Monitoring Clinical Indicator Clinical Engagement Repository & Surveillance ECG & Tracking & Risk Alerts Review Enabling Business Areas Corporate Services Support Services Bed SAP - Queue Patient Accounting Financial Mgmt Enterprise Scheduling Appt OTS Trendcare Mgmt Sys & Billing Assistance SAPEnterprise - ODS Location Tracking / EDW/BI MM Resource Planning Asset Mgmt. 33
  • 34. Current Programme-Data Matrix Data Element Program H Program F Program D Program A Program B Program C Program E Program I Program G C – Create R – Read - U – Update D – Delete * – Manual/Forms Patient Information Patient & Demographics CR * CR * CRUD R CRU R CRU* R R Family Information — — — CRUD* — — — — CRUD Financial Information CR — — R — — — — CRUD Healthcare Episodes & Visits Patient Episode R R R R — R — — R Patient Visit/Encounter R R R R — R — — R Patient Appointment CRUD — CRUD CRUD — — — CRUD — Payment C — C C — — — — — Healthcare Organisations & Providers Institution — — — — — — — — — G.P. Clinic CRUD CRUD — R CRUD CRUD — — — Screening Screening Event — — — — CRUD — — — — Screening Registration — — — — CRUD — — — — Screening Result — — — — CRUD — — — — Referral Referral CR* CR * — CR* CR* — — — — Clinical Information Medical History: Allergies R — R — — — — — — Medical History: Surgery History R — R CR* — — — — — Physical Condition: Vital Signs — CRUD* — CR* CR* — — — — Physical Condition: Physical Characteristics R — — — — — Healthcare Delivery: Examination CR* CR* CR* CR* CR* R — — — Healthcare Delivery: Test Results R CR* R CR* CR* R — — — Healthcare Delivery: Procedure R R R CR* — R — — — Healthcare Delivery: Medication R R R CR* — R — — — Discharge Summary R — R R — R R — — Medical Conditions R — — R — — — — — Integrated Care/Tele-care Programme — — — — — CR — — — Call-Scripts — — — — — CRUD — — — Knowledge-base — — — — — CRUD — — — Tasks — — — — — CRUD — — — Communication Logs — — — — — CRU — — —
  • 35. Current Application-Data Matrix Data Element System G System E System F C – Create System D System C System B System A R – Read U – Update D – Delete Patient Information Patient & Demographics CR CRU R — — R — Family Information — — — — CRUD — — Financial Information CR — — — CRUD — — Healthcare Episodes & Visits Patient Episode R — R — R R — Patient Visit/Encounter R — R — R R — Patient Appointment CRUD — — — — — — Payment — — — — — — CRU Healthcare Organisations & Providers Institution — — — — — — — G.P. Clinic CRUD CRUD CRUD — — — — Screening Screening Event — CRUD — — — — — Screening Registration — CRUD — — — — — Screening Result — CRUD — — — — — Referral Referral (IN) — — — — — — — Clinical Information Medical History: Allergies — — — — — — — Medical History: Surgery History — — — — — — — Physical Condition: Vital Signs — CR — — — — — Physical Condition: Physical Char acteristics — — — — — — — Physical Condition: ADL — — — — — CR — Healthcare Delivery: Examination CR CR — — — — — Healthcare Delivery: Test Results — CR R — — — — Healthcare Delivery: Procedure — — — — — — — Healthcare Delivery: Medication — — — — — — — Discharge Summary — — — — — — — Medical Conditions — — — — — — — Integrated Care/Tele-care Programme — — CR — — — — Call-Scripts — — CRUD — — — — Knowledge -base — — CRUD — — — — Tasks — — CRUD — — — — Communication Logs — — CRU — — — —
  • 36. Information Architecture – Gaps & Opportunities • Lifestyle New Data Elements • Family History • Activity of Daily Living * • G.P. Clinic Sharing of Common • Lifestyle Data • Activity of Daily Living • Financial Information Accessibility to • Electronic clinical documentations clinical • Scanned MRO Case notes documentation Event Management • Screening, training, and etc. as Events
  • 38. Summary  Establish Enterprise Standards and Guidelines  IT Roadmap and Blueprinting  Jurong Health Services (JHS) cluster  SingHealth Chronic Disease Programme  EasternHealth Alliance Integrated Care Programme  Continual governance, review and project involvement  Communicate, communicate, communicate … 10/22/2012 38
  • 39. EA – Key Success Factors  Understand that EA is a Journey, not an End-State  Iterations and Roadmap Reviews  Cooperation and Willingness from the rest to work with architecture team to align to EA  Seeing the value that EA can bring in the long run  Competent Architecture team to lead the way  Knowing what EA is, and options for implementation  Knowing how to earn and keep client trust
  • 41. A SHORT CHAT if we have time … 41
  • 42. An experienced EA’s wisdom • Jim Heaton, CTO Baker Hughes, How to fast track an EA group – Mentor and develop employee competencies – Create insanely rapid value and business impact. – Generate external recognition as a powerful reinforcements of achievements – Just enough, just in time. – Design for specific immediate demand, but always thinking about the general case – Minimize time to value, not time to milestones – Time box architecture efforts, so that EA team can have the capacity for breadth of coverage, and avoid the temptation to dive into details – Make sure that everyone else doesn't think that EA is trying to take over the world. (politics) – How to manage outsourced partners? Identify good architects in these organizations, nurture them, give them credit, get them promoted – Make sure that every piece of work is about Developing the Architect, on top of developing the architecture 42
  • 43. A panel of EA’s point of view • What are good qualities to look for in an EA – Curiosity – Courageous to ask why – A good sales guy – Not locked in to standard IT way of thinking – Able to foster and grow a team of Subject Matter Experts – Have run a business before “External consultants can provide methodology and be evangelists. But the internal team must be one doing the work.” 43
  • 44. My point of view • I believe there are 3 “pillars” to becoming a competent EA • Framework – “An architecture framework is a foundational … set of structures…for developing … architectures” – TOGAF Intro • Methodology – “… a method for designing a target state of the enterprise …, and for showing how the building blocks fit together” – TOGAF Intro • Practice – “Must I complete all the Catalogs, Matrices & Diagrams?” – “Must I cover all Domains – Business to Technical?” – “Must I strictly follow every single step of the ADM?” • The practice of EA is the craft of applying of technology1 (TOGAF) to solve problems and help master complex environments • Commonsense should prevail 44
  • 45. Insource or Outsource Insource Outsource • Contextual knowledge • Methodology & framework • Long term view • Broader experience • Focus on implementation • Time-bound discipline • Ongoing maintenance • Extra brains & hands • Politics • Politics If you choose to outsource, make sure that • Blended team, internal team must be involved in doing work • Internal team understands and can continue the work • Matches your EA style and content. See Chap 40.3 Integration 45
  • 46. EA is the Glue IT Strategies IT Implementations 46
  • 47. The Art of EA 2. Build 1. relationships Focus on / trust 5. solving Evolve from problems, not where you just delivering are artefacts 4. Be pragmatic, 3. not Be a dogmatic servant first, policeman later 47
  • 48. Go forth and Architect! 48