Canada Cloud Network Feb 21 2013 v3 · 2/21/2013 · It consists of software solutions for the EHR, ... • Cloud and SaaS are necessary computing ... Canada Cloud Network Feb 21

Cloud Computingin Canadian Health Care

Presented by:Dennis GiokasEmerging Technology Group

February 21, 2013Copyright © 2013 Canada Health Infoway

2© 2013 Canada Health Infoway Inc.

Agenda

2

• EHRS Business Architecture

• EHRS Technical Architecture

• Cloud Computing in Health

• Key Messages and Assertions

© 2013 Canada Health Infoway Inc.


Patient Receives Care Across Care Providers & Settings

Specialist Clinic

Community Care Center

Clinic

Diagnostic

Hospital Emergency

Homecare

Laboratory

Pharmacy

Emergency Services


Patient Clinical Information is “Shared” Among Care Providers & Settings

Specialist Clinic


Clinic

Diagnostic

Hospital Emergency

Homecare

Laboratory

Pharmacy

Emergency Services

INTEGRATED VIEW


Clinician systems “put” relevant data for sharing into interoperable EHR

Specialist Clinic


Clinic

Diagnostic

Hospital Emergency

Homecare

Laboratory

Pharmacy

Emergency Services

Put

PutINTEGRATED VIEW


Clinician systems “list” and “get” desired datafrom interoperable EHR for display and use

Specialist Clinic


Clinic

Diagnostic

Hospital Emergency

Homecare

Laboratory

Pharmacy

Emergency Services

List/Get

List/Get

INTEGRATED VIEW


EHR DefinitionAn electronic health record (EHR) provides each individual in Canada with a secure and private lifetime record of their key health history and care within the healthcare system.

The record is available electronically to authorized healthcare providers and the individual anywhere, anytime in support of high quality care.

This record is designed to facilitate the sharing of data across the continuum of care, across healthcare delivery organizations and across geographies.


Common Architecture• Common business and technical

architecture accepted by jurisdictions and vendors

• Links local clinical systems with jurisdiction and regional registries and repositories using a data sharing approach

• Must cost effective approach, limiting the number of integration points

• Extensible to support new functions, scalable

• Serves as a reference model for Infoway investments

• Available on the Infoway website


EHR Infostructure

9

The EHR Infostructure is a collection of common and reusable components in the support of a diverse set of health information management applications.

It consists of software solutions for the EHR, data definitions for the EHR and messaging standards for the EHR.




Registries Data& Services

EHR Data& Services

Ancillary Data& Services

DataWarehouse

ImmunizationManagement

PHSReporting

HealthInformation

Physician Office EMR

Physician/Provider

BusinessRules

EHRIndex

MessageStructures

TerminologyRepository

NormalizationRules

Longitudinal Record Services

HIALCommunication Bus

Security MgmtData Privacy Data Configuration

ProviderRegistry

LocationRegistry

Common Services

EMR APPLICATIONEMR

Database

ClientRegistry Shared

Health RecordDrug

InformationDiagnostic

Imaging Laboratory

POINT OF SERVICE

JURISDICTIONAL INFOSTRUCTURE

End-User Perspective: EMR Application

12

Standards-based EHR Solutions


StandardizedArchitecture

StandardizedInterfaces

StandardizedData Structures

StandardizedData Vocabularies

StandardizedFunctional Behavior

13

The Blueprint:A Services-Oriented Architecture (SOA)



EHR Infostructure: Standards Based ConnectivityJURISDICTIONAL INFOSTRUCTURE

POINT OF SERVICE

Hospital, LTC,CCC, EPR

PhysicianOffice EMR EHR Viewer

Physician/Provider

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist

Public HealthServices

Public Health Provider

EHR IPEHR IPEHR IPEHR IPEHR IPEHR IPEHR IP

EHR IPEHR IPEHR IPEHR IPEHR IPEHR IPEHR IP

EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP StandardsEHR SCP Standards



EHR Data& Services

DataWarehouse


PHSReporting

SharedHealth Record

DrugInformation

DiagnosticImaging Laboratory Health

Information

BusinessRules

EHRIndex

MessageStructures

NormalizationRules

HIAL

HIAL HIAL HIAL HIAL HIAL HIALProviderRegistry

LocationRegistry

ClientRegistry H

IAL

HIA

LH

IAL


HIALHIAL


Common Services




Service Oriented Architecture as an Enabler

The HIAL as an Application Abstract Layer• Each jurisdictional HIAL deployed will have different

• Physical deployment model• Some interfaces which are unique to that implementation

• HIAL acts as an abstraction of the EHR such that applications see the EHR in a consistent way across EHR implementations

• Services exposed outside of an EHRi in the form of supported EHR Interoperability Profiles for an entire Infostructure perceived as a single system with transactional services

• Services within an EHR Infostructure to optimize scalability, maintainability and functional flexibility


First Type of Abstraction: The EHR as ServicesJURISDICTIONAL INFOSTRUCTURE

POINT OF SERVICEPhysician/Provider

Physician/Provider

Physician/Provider



PhysicianOffice EMR EHR ViewerLab System

(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist




EHR Data& Services

DataWarehouse

OutbreakManagement

PHSReporting

SharedHealth Record

DrugInformation


Information

BusinessRules

EHRIndex

MessageStructures

NormalizationRules





Common Services

ClientRegistry

ProviderRegistry

LocationRegistry

EHR SERVICES

Get Client IDResolution

List Laboratory Orders Put Laboratory Result

Get LaboratoryResults

Get Prescription

List Medications

Stream DI Image

List DI Results Get DI ReportPut Immunization Data List CD ReportEvents

Get ProviderInformation

List ServiceDelivery

Locations

List EncounterEvents

Get EncounterSummary

Get ClinicalDashboard

Get ClientDemographic



POINT OF SERVICE



EHR Data& Services

DataWarehouse

OutbreakManagement

PHSReporting

SharedHealth Record

DrugInformation


Information

BusinessRules

EHRIndex

MessageStructures

NormalizationRules





Common Services

ClientRegistry

ProviderRegistry

LocationRegistry

Second Type of Abstraction: Generic Application

Any Point-of-Service

Application

EHR IP

EHRi SERVICES

CRServices

PRServices

LRServices

TerminologyServices

Detection& Reporting

Services

Shared HealthRecord Services

DrugServices

DIServices

LabServices

NormalizationServices

AssemblyServices

A & AServices

BrokeringServices

ConsentServices

SessionServices

LoggingServices

OutbreakServices

RulesServices

OrchestrationServices

EHR IndexServices





EHR Data& Services

DataWarehouse

POINT OF SERVICE

Communication Bus

EHR Infostructure: Communication Bus

COMMUNICATION BUS

MESSAGINGTransformation

ServicesRoutingServices

Encrypt/DecryptServices

En/DecodingServices

ParserServices

SerializationServices

PROTOCOLApp Protocol

ServicesNetwork Protocol

Services


EHR Infostructure: Common ServicesJURISDICTIONAL INFOSTRUCTURE



EHR Data& Services

DataWarehouse

POINT OF SERVICE

HIAL


Common Services

COMMON SERVICES

INTEROP

InteroperabilityServices

Search/ResolutionServices

INTEGRATION

Service CatalogueServices

Broker Services

Mapping Services

Queuing Services

CONTEXT

Session MgmtServices

Caching Services

Identity ProtectionServices

Identity MgmtServices

AnonymizationServices

User AuthenticationServices

Consent DirectivesMgmt Services

EncryptionServices

Access ControlServices

Secure AuditingServices

Digital SignatureServices

General SecurityServices

SUBSCRIPTION

Alert/NotificationServices

Pub/SubServices

MANAGEMENT

ManagementServices

ConfigurationServices

GENERAL

AuditingServices

Log MgmtServices

Policy MgmtServices

Exception/ErrorHandling Services

PRIVACY & SECURITY


EHR Infostructure: Longitudinal Record ServicesJURISDICTIONAL INFOSTRUCTURE



EHR Data& Services

DataWarehouse

POINT OF SERVICE

HIAL

BusinessRules

EHRIndex

MessageStructures

NormalizationRules



LONGITUDINAL RECORD SERVICES

DATA

Key MgmtServices

ETLServices

BUSINESS

Data QualityServices

Domain BusinessComponents

EHR IndexServices

OrchestrationServices


Business RulesServices

AssemblyServices

DataServices

ReplicationServices

TerminologyServices


EHR Infostructure: EHR ViewerJURISDICTIONAL INFOSTRUCTURE



EHR Data& Services

DataWarehouse

POINT OF SERVICE

HIAL

EHR Viewer

Physician/Provider

EHR VIEWER

EHRi InteroperabilityServices

EHR ViewerBusiness Objects Components


End-userNavigation Services

Business RulesServices

End-userDisplay Services

DataServices

Cloud Computingin Canadian Health Care

Copyright © 2013 Canada Health Infoway


Research over the past several years has identified the independent evolution of four powerful forces: information, mobile, social and cloud. As a result of consumerization and the ubiquity of connected smart devices, people's behavior has caused a convergence of these forces.

Information is the context for delivering enhanced social and mobile experiences.

Mobile devices are a platform for effective social networking and new ways of work.

Social links people to their work and each other in new and unexpected ways.

Cloud enables delivery of information and functionality to users and systems.

Source: Mobile and the Nexus of Forces: Creating the New Experience, Gartner Research, June 25, 2012

Nexus of forces

The forces of the Nexus are intertwined to create a user-driven ecosystem of modern computing.

Copyright © 2013 Canada Health Infoway 24

“The digital world – the Internet and the cloud and supercomputing and social networking – is breaking medicine out of its cocoon. It’s a super convergence we’ve seen in other walks of life but not in the health and medical sphere.”

Eric Topol, MDquote from Wired MagazineFebruary 2012

Health super convergence


Introduction of “Cloud Computing in Health”• The first in the Emerging Technology white

paper series• Designed to address cloud computing from a

Canadian health care perspective• Intended to:

• Scope and provide insight on the potential applicability and utility for this technology

• Provide some context for business opportunities and challenges

• Suggest some possible approaches• Be a call-to-action for further focused conversations on

this topic


By the way: our Blueprint….JURISDICTIONAL INFOSTRUCTURE

POINT OF SERVICE


Ancillary Data & ServicesRegistries Data& Services

EHR Data & Services DataWarehouse


PHSReporting

SharedHealth Record

DrugInformation


Information


PhysicianOffice EMR

EHR Viewer

Physician/Provider

BusinessRules

EHRIndex

MessageStructures

NormalizationRules


Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist





Common Services

ClientRegistry

ProviderRegistry

LocationRegistry


Can be seen as Software as a Service

POINT OF SERVICE


PhysicianOffice EMR

EHR Viewer

Physician/Provider

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist



Jurisdictional EHR Infostructure


Possible use scenario

CommunityChronic Disease MgmtCare CollaborationCare Transitione-ReferralScheduling

Health RegionHospital

Home Care LTC

PrivateOperational systemsClinical systemsSpecialized apps

PublicReference InformationClinical Decision SupportSocial Networking(no PHI)

Clinics / FP


Key messages• Cloud is one of the top three CIO technology

priorities• Cloud is becoming increasingly visible to the

public and health care providers


Key messages (continued)• Cloud and SaaS are necessary computing

models for: • Data anywhere • User anywhere • Use from any device • Access anytime

• This is very aligned with the five Rs of the EHR and digital health: • The right information • About the right client • Available to the right person • In the right place • At the right time


Key assertions• There are many opportunities for use of cloud

in health• Greenfield deployments in community settings or at

program levels • A necessary computing model for e-referral, clinical

decision support, PHRs, chronic disease management and remote monitoring

• We need roadmaps and business cases to support the gradual migration of existing infostructures to private or community clouds and to determine how to deliver health care programs in a hybrid environment


Privacy and security considerations• All computing models have similar set of

privacy/IT security risks and requirements, such as authorized access to information and information resources (e.g., consent, RBAC), cloud computing is no different

• Privacy and security issues are manageable, but must be “by design” and take into account cloud context

• Key privacy and security differentiators of cloud deployment models • Level of transparency, oversight, governance, and

management of privacy and security controls


Cloud as an enabler• The scalability and extensibility made possible

by virtualization and service oriented architecture will be a critical success factors for coping with the proliferation of mobile devices and “apps”

• The pace of cloud adoption in health care is likely to quicken• Financial constraints• Demand for increased agility in response to social and

mobile drivers


Health information is the context for delivering enhanced collaborative and coordinated care experiences.

Point of service systems and mobiledevices are the platforms for effective social networking and new ways of work.

The health IT eco-system links people to their work and each other in new and unexpected ways.

Digital health infostructure as Software-as-a-Service in the cloudenables delivery of information and functionality to users and systems.

Nexus of forces in digital health

The forces of the Nexus are intertwined to create a user-driven ecosystem for digital health.


Questions?


Website: www.infoway-inforoute.ca

ETG Resources: https://www.infoway-inforoute.ca/index.php/resources/technical-documents/emerging-technology

E-mail: [email protected]

Blog: http://infowayconnects.infoway-inforoute.ca/

Twitter: @Infoway

Thank you

Documents

Canada Cloud Network Feb 21 2013 v3 · 2/21/2013 · It consists of software solutions for the EHR, ... • Cloud and SaaS are necessary computing ... Canada Cloud Network Feb 21