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ISS TOGAF 2012

The document discusses two different architectures - the current architecture and a goal state architecture. The current architecture lacks integration between different care settings. The goal state architecture aims to improve integration through a shared patient record, standardized clinical data exchange, and defined care pathways that can manage patient cases across different care settings. It outlines strategies like enabling integrated healthcare services, adopting health infocomm technologies, and connecting core health systems to support the goal state architecture.

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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

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ISS TOGAF 2012

  • 1.
    A Tale of2 Architectures CEITA @ ISS Peter Tan 24 Oct 2012 1
  • 2.
  • 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 30,000Feet… 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 OneRecord 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 ForEA Chain of 9 polyclinics Chain of 9 polyclinics 7 7
  • 8.
  • 9.
  • 10.
    Enterprise & SolutionArchitecture 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 GoalState 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 CapabilityModel 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
  • 15.
  • 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 Referralexample 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 – aWicked 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 HealthcareClusters 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” Eacharchitecture 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 ReferenceModel 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 ReferenceModel 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 vsProcess 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 Level0 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
  • 37.
  • 38.
    Summary  Establish EnterpriseStandards 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 – KeySuccess 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
  • 40.
  • 41.
    A SHORT CHAT if we have time … 41
  • 42.
    An experienced EA’swisdom • 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 ofEA’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 ofview • 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 theGlue IT Strategies IT Implementations 46
  • 47.
    The Art ofEA 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 andArchitect! 48