This document summarizes an upcoming meeting of the Association of Enterprise Architects Delhi Chapter. The meeting agenda includes updates on the chapter and EA field, a presentation by Mr. Kumar Satyam from Philips on healthcare interoperability, feedback/Q&A, and future plans. The chapter aims to advance EA excellence in Delhi/NCR. The healthcare interoperability talk will discuss challenges like standards, data sharing, and regulations, and opportunities like APIs and initiatives like NDHM and IHE profiles.

1. AEA Delhi Chapter Meeting
Monthly Meeting /Knowledge Session on
“HealthCare interoperability. Mr. Kumar Satyam “
Senior Architect interoperability Philips
Association of Enterprise Architects Delhi Chapter

2. AEA Delhi Chapter Meeting
Agenda
Topics Time
1 Delhi Chapter 6:00 to 6:02
2 What's happening in EA space 6:02-6:10
3 “ Session Topic name and speaker HealthCare interoperability. Mr. Kumar
Satyam
6:10 to 6:45
4 Feedback /Q&A 6:45 to 7:00
5 AEA Delhi Chapter Future Plans 7:00 to 7:05
6 Vote of Thanks 7:05 to 7:10

3. Who We Are…
The Association of Enterprise Architects is the definitive professional organization
for Enterprise Architects Delhi Chapter
❑ President Dr Pallab Saha
AEA India
❑ Board Member AEA India Tarun Gupta
❑ Advisory Board Prof Arpan Kar (IIT Delhi)
❑ Chair Delhi Chapter Chander Shekher
❑ Vice Chair Delhi Chapter Aurobind Upadhyaya
❑ Treasurer Sandeep Singh

4. AEA Delhi Chapter Meeting
AEA Delhi Chapter
•Aim
The AEA Delhi Chapter aims to advance the professional excellence and status of Enterprise
Architecture and at the Delhi/NCR
•Mission
To enable and encourage the highest standard of enterprise architecture practice by
members.

5. Healthcare Interoperability

6. Healthcare is Communication

7. Healthy living Prevention Diagnosis Treatment Home care
Interoperability connects the care pathways
Philips Healthcare Continuum Model
Healthcare Continuum

8. Excerpt from Principles of Health Interoperability SNOMED CT, HL7 and FHIR
Towards patient-centered healthcare model

9. The ultimate measure by which to judge the quality of a medical effort is whether it
helps patients (and their families) as they see it. Anything done in healthcare that does
not help a patient or family is, by definition, waste whether or not the professions and
their associations traditionally hallow it (Berwick 1997)
Information consumes the attention of its recipients; a wealth of information creates a
poverty of attention and a need to allocate that attention amongst the overabundance
of information sources that might consume it (Simon 1971)

10. Interoperability is ability of two or more systems or components to exchange
information and to use the information that has been exchanged (IEEE 1990)
- Most frequently used definition of Interoperability
What is Interoperability

11. Standard
Combinatorial Explosion
2 nodes – 1 link
6 nodes – 15 links
100 nodes – 4950 links
Formula
Links = n(n-1)/2
n= number of nodes
Interoperability –Standards

12. Technical Interoperability - Technology layer
Semantic Interoperability - Data Layer
Process & Clinical Interoperability - Human Layer
The Institutional layer - culture, education, regulations ,incentives etc.
Healthcare Interoperability

13. Stakeholders Benefits
Patient Care continuity, elimination of redundant testing, improved outcomes, longitudinal records,
Wearables, better privacy & security
Clinicians Faster and more accurate diagnosis, decision support tools, access to information as needed
Hospitals Administrative efficiency, eliminate paper & delays, disease registries , Clinical trials and research,
avoid vendor lock in
Insurance/pay
er
Faster settlement, improved efficiency , fraud detection, Risk profiling
State Population health surveillance, Public health policy, strategic planning.
Vendors Standard interfaces, innovation in product, cost efficiency, level playing field exchange and repurpose
health data for innovative services
Some benefits of Interoperability

14. Identification of patients, providers and other stakeholders
No silver bullet Standard
Security , privacy & consent management
Volume & variety of data from multiple sources
Legacy systems
In medicine, as in art, the value of information is often related to its rarity. The
key to medical decision-making is Bayes law, which is based on how much a new
piece of information changes the prior probabilities.
Technical Challenges

15. IHTSDO
IETF
….. Many more
Healthcare standards

16. Perception that data-sharing is bad for business.
Interoperability pays in the long run. Justification of cost in near term.
Access to skilled resources.
Fear of workflow disruption/productivity drop.
Financial/business/Trust challenges

17. Lack of regulations promoting Data sharing.
Compliance overheads.
National vs state regulations.
Regulatory & administrative Challenges

18. APIs the future of Healthcare
Overcoming Technical challenges

20. https://content.datica.com/hubfs/2020%20Open%20APIs%20in%20Healthcare%20-%20Datica%20excerpt.pdf
APIs in Healthcare

21. https://365.himss.org/sites/himss365/files/365/handouts/552739129/handout-219_FINAL.pdf
• Rise of APIs in Healthcare
• Opening up of Patient data access
• Enabled New business models
• Enabled SMART
• Wearables & IOTs data into EHRs.
• Fast & easy integration cycles.
• A big community of developers &
implementers.
APIs in Healthcare

22. • New exchange standard from HL7.
• Latest released version is R4.
• Resources are the basic building blocks
• Interfacing paradigms supported by FHIR
• Restful API, Messaging, Documents & Services
• Standard for Agile world
Specification:- https://www.hl7.org/fhir
FHIR – Open Healthcare API
F-Fast
H-Healthcare
I-Interoperability
R-Resources

23. http://hl7.org/fhir/summary.html#2.17.3
Get All Patients
http://yourfhirserver/fhir/Patient
Search for a specific patient
http://yourfhirserver/fhir/Patient?nam
e=Eva
http://yourfhirserver/fhir/Patient?nam
e=eva&birthdate=1983-12-30
FHIR – Open Healthcare API

24. Focus on Implementers
Target support for common scenarios (80/20)
Leverage cross-industry web technologies(XML/JSON/REST)
Require human readability as base level of interoperability
Make content freely available
Support multiple paradigms & architectures
Demonstrate best practice governance
FHIR – Principles

25. ◼ HL7, DICOM, SNOMED, LOINC, etc.
cover the messaging, format, and
vocabulary space well – in their
own space
◼ But workflow descriptions limited
to simple cases using 1 or maybe
2 standards
◼ Needed profiling of significant use
cases using multiple standards
Workflow
Messaging
Format
Vocabulary
Profile
Yellow = gaps in individual standards
IHE – A technical framework to solve workflows

26. 26
images
stored
patient
information
RIS
examination orders
images
retrieved
HIS
PACS
procedure
scheduled
Prefetch any relevant
prior studies
modality
worklist
report
report
Registration
Orders Placed
Orders Filled
Film
Film
Folder
Image Manager
& Archive
Film
Lightbox
report
Report
Repository
Diagnostic
Workstation
Modality
acquisition
in-progress
acquisition
completed
acquisition
completed
images
printed
Acquisition
Modality
HL7
DICOM
IHE –Example Scheduled Workflow

27. GP
System
Clinic
Hospital B
EMR/CIS
Hospital
System
Hospital A
EMR/CIS
Hospital
System
Patient
Identity
Manager
XDS
Document
Registry
HIE Infrastructure
XDS Document
Repository
XDS Document
Repository
ATNA Audit
Server
CT Time
Server
1
Register New Patient--
Local Patient ID Feed (HL7 2.5)
2
Regional Patient ID Feed (HL7
2.5)
3
Event summary is
made available in the
local repository for
sharing
4
Register Document
5
PIX Query
(Have local Patient ID, need
Regional Patient ID) 6
Patient exists, respond
with Regional Patient
ID
7
Get List of Documents
for Regional Patient ID
8 HTTP GET
Document
9
A new event summary
is made available in the
local repository for
sharing 10 Register
Document
11
PDQ Query
(Have Patient demographics,
need Regional Patient ID)
IHE – Cross enterprise document exchange
workflow

28. NDHM – Providing key building blocks

29. https://ndhm.gov.in/home/proposed_architecture
NDHM – Architecture

30. Approach Interoperability initiative as change initiative.
Set overall accountability. Break the silos.
Go for Open standards, restrain the temptation of building proprietary point to point
interfaces.
Have a robust certification mechanism to certify for adherence to chosen standards
Have Business plan, financial viability.
Regulatory Clarity & Push
Overcoming Interoperability Challenges

31. Questions /Feedback
31

32. Questions?
32
THANK YOU!
AEA Delhi Chapter
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Email : chair.del@aeaindia.org
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