EHR Implementations:EHR Implementations:Revolutionising Health Information ManagementRevolutionising Health Information Management

Denis TebbuttManaging Director, InterSystems ANZ

Software for Connected Healthcare

Regional /

National EHR

Institutional / Community EPR

Application Level

Ensemble - #1 rated healthcare integration software

HealthShare – #1 health information exchange platform

TrakCare – Advanced Web-based healthcare information system

Caché - #1 database in clinical applications worldwide

National & Regional Sharing of Clinical Information

• Around the world healthcare delivery systems are Around the world healthcare delivery systems are increasingly focused on the creation of an EHRincreasingly focused on the creation of an EHR

– Increases accessibility of important health information Increases accessibility of important health information across the spectrum of careacross the spectrum of care

– Improves the quality of careImproves the quality of care– Reduces the costs of care through elimination of Reduces the costs of care through elimination of

duplicate tests and prescriptionsduplicate tests and prescriptions– In emergency situations can literally save livesIn emergency situations can literally save lives– Facilitates the development of integrated community Facilitates the development of integrated community

based carebased care– Can outreach to health based NGO’sCan outreach to health based NGO’s

The EHR Basics

• Identify the patient across Identify the patient across facilities facilities

• Authentication of the requesting Authentication of the requesting clinician/viewerclinician/viewer

• Consent ManagementConsent Management

• SecuritySecurity

• TerminologyTerminology

• MessagingMessaging

• Leave clinical data at the sourceLeave clinical data at the source

Technology Challenges

• Clinical access through a ‘Portal’Clinical access through a ‘Portal’

• There must be an integrated clinical There must be an integrated clinical application that fits all levels of a application that fits all levels of a facility facility

• A powerful, health focused, A powerful, health focused, integration platform supporting HL7 integration platform supporting HL7 and other IT based standardsand other IT based standards

• A strong standards based approachA strong standards based approach

• Repository and Record Locator Repository and Record Locator ServiceService

• Rapid Application development and Rapid Application development and deployment with incremental and deployment with incremental and massive scalabilitymassive scalability

TrakCareTrakCareClinical Patient RecordClinical Patient Record

TrakCareTrakCareClinical Patient RecordClinical Patient Record

EMPI/RLSEMPI/RLSEMPI/RLSEMPI/RLS

CacheCacheCacheCache

HealthShareHealthShareClinical Viewer & Patient PortalClinical Viewer & Patient Portal

EnsembleEnsemble

HL7/CDA/CCD/DICOM/NCPDP/RLSHL7/CDA/CCD/DICOM/NCPDP/RLS

So What is HealthShare?

• Massively scalable integrated Massively scalable integrated healthcare suite for the deployment of healthcare suite for the deployment of Regional and National Electronic Regional and National Electronic Health Records:Health Records:

– Clinical ViewerClinical Viewer– Enterprise Master Patient IndexEnterprise Master Patient Index– Clinically proven database and Clinically proven database and

applicationapplication– Fully integrated and clinically Fully integrated and clinically

proven integration and proven integration and development platformdevelopment platform

• Harvests the data held in all of the Harvests the data held in all of the repositories that support the operation repositories that support the operation of a healthcare of a healthcare facility/state/region/countryfacility/state/region/country

The Structure of HealthShare?

• The The HealthShare EPRHealthShare EPR is a sophisticated browser- is a sophisticated browser-based Electronic Patient Record that doctors and other based Electronic Patient Record that doctors and other clinicians use to access patient dataclinicians use to access patient data

• The The HealthShare HubHealthShare Hub is a central index of patients and is a central index of patients and providers, it uniquely identifies a patient and specifies providers, it uniquely identifies a patient and specifies which edge Caches maintain data for that patientwhich edge Caches maintain data for that patient

• The The HealthShare Edge Cache RepositoryHealthShare Edge Cache Repository is a clinical is a clinical database that holds all of the data that a provider is database that holds all of the data that a provider is willing to sharewilling to share

• The The HealthShare GatewayHealthShare Gateway is a health integration is a health integration platform optimised for providing multiple provider platform optimised for providing multiple provider organisationsorganisations

Populating the Hub

Locating Patient Records

HealthShare Patient Viewer

Ensemble at the Heart of HealthShare

• OneOne data model data model

• OneOne metadata repository metadata repository

• OneOne development developmentenvironmentenvironment

• OneOne management managementenvironmentenvironment

• OneOne learning learningcurvecurve

HealthCare Deployment ExamplesHealthCare Deployment Examples

Long Island, Rhode Island RHIO’s, Sweden & Netherlands National SystemsLong Island, Rhode Island RHIO’s, Sweden & Netherlands National Systems

Long Island Patient Information eXchange

Mission

• Mission: To create an Mission: To create an achievable, sustainable and achievable, sustainable and replicablereplicable model for integrating clinical information across multiple model for integrating clinical information across multiple health care organizations in order to improve access to patient data at health care organizations in order to improve access to patient data at the point of care; improve health care quality; and reduce the point of care; improve health care quality; and reduce inappropriate utilization and cost.inappropriate utilization and cost.

• Focus on support for the “transitions of care”Focus on support for the “transitions of care”

• Emphasis on infrastructure and Proof of Concept in Phase 1Emphasis on infrastructure and Proof of Concept in Phase 1

Benjamin Stein, MDChief Executive Officer, LIPIXDirector of CIS, North Shore LIJ Health System

Long Island Patient Information eXchange

Scope

• Clinical Data Exchange (CDE)Clinical Data Exchange (CDE)– ““Data of convenience”Data of convenience”– Workflow integrationWorkflow integration

• Need to support “pull” and “push” transactionsNeed to support “pull” and “push” transactions

• Meta - Master Patient Index (M-MPI)– Supports health information exchangeSupports health information exchange– Provides patient identification services to individual member organizationsProvides patient identification services to individual member organizations

• Future growthFuture growth– Public Health modulePublic Health module– E-imagingE-imaging– e-Rxe-Rx– Ambulatory EMRAmbulatory EMR– PHRPHR

Long Island Patient Exchange (LIPIX)

• 5.2 Million Residents 8,000 GP’s (Assoc with NS-LIJ Health System) 5.2 Million Residents 8,000 GP’s (Assoc with NS-LIJ Health System)

• Connecting 15 healthcare organizations on New York’s Long IslandConnecting 15 healthcare organizations on New York’s Long Island• Initial LIPIX DeploymentInitial LIPIX Deployment

4 Hospitals4 Hospitals 2 Physician Practices2 Physician Practices Home Care AgencyHome Care Agency Municipal Health CenterMunicipal Health Center EMS OrganizationEMS Organization Reference LaboratoryReference Laboratory Long Term Care FacilityLong Term Care Facility Public Health DepartmentPublic Health Department

Long Island Patient Information eXchange

Scope

Public Health Surveillance

GIS Reports

LIPIX Independently Provisioned Users

LIPIX HUB (HIE and M-MPI)

Initiate MPI

Intersystems HealthShare Hub

(RLS)

Intersystems HealthShare

Gateway

Eclipsys Sunrise CIS

HealthShare Gateway

NSLIJ E-Gate Interface Engine

Siemens RIS

North Shore University Hospital

Siemens Invision ADT

Eclipsys Sunrise Ambulatory Manager

HealthShare Gateway

NSLIJ E-Gate Interface Engine

NSLIJ Faculty Practice Plan

IDX Flowcast ADT

Cold Spring Hills Center for Nursing and Rehabilitation

HealthShare Gateway

NSLIJ E-Gate Interface Engine

NSLIJ Home Care

McKesson Horizon Home Care

HealthShare Gateway

NSLIJ E-Gate Interface Engine

NSLIJ Center for EMS

Sansio HealthEMS(housed in Seattle?)

Siemens Invision ADT

HealthShare Gateway

NSLIJ E-Gate Interface Engine

NSLIJ Core Laboratory

Siemens Invision ADTs Cerner Millenium

(housed in Kansas City)Siemens

Invision ADTsSiemens Invision ADTs

PICIS PulseCheck

HealthShare Gateway

OpenLink Interface Engine

Southside Hospital

Siemens Invision ADT

HealthShare Gateway

IDX Flowcast

Suffolk County Dept of Health Services

HealthShare Gateway

Med Records Alert Chart

North Shore Staff IPA Practice

Med Records Alert PHR Vault

LIPIX Phase 1

Eclipsys Sunrise CIS

HealthShare Gateway

Eclipsys E-link Interface Engine

Misys RIS

Nassau University Medical Center

Siemens Eagle ADT

Misys LIS

HealthShare Gateway

Cloverleaf Interface Engine

Misys RIS

South Nassau Communities Hospital

Keane Care ADT and CISMisys LIS

LIPIX Vendor Software

Key:

Participant Infrastructure

= existing interfaces

= Interfaces to be built by System Integration Consultants

USA Rhode Island

• Having a useful, usable and used interconnected health Having a useful, usable and used interconnected health information system that:information system that:

• A total of 1.1Million Residents 3,000 GP’sA total of 1.1Million Residents 3,000 GP’s Puts the right information into the hands of Puts the right information into the hands of

clinicians and their patients when and where it is clinicians and their patients when and where it is needed needed

Allows for population health information to be Allows for population health information to be analyzed and used for surveillance, health policy, analyzed and used for surveillance, health policy, and researchand research

• Using InterSystems HealthShare for state-wide master patient Using InterSystems HealthShare for state-wide master patient index and clinical data exchangeindex and clinical data exchange

• Connecting 14 healthcare organizations across the state (85%Connecting 14 healthcare organizations across the state (85%+ of all lab and medication data)+ of all lab and medication data)

• Governor has an Governor has an “Anytime, Anywhere Healthcare”“Anytime, Anywhere Healthcare” agenda agenda

Sweden - National Patient Overview (NPO)

• Population 9 million Population 9 million

• 21 healthcare regions21 healthcare regions

• National EHRNational EHR

• Carelink is Government appointed Carelink is Government appointed group to manage the project. group to manage the project.

• InterSystems in partnership with InterSystems in partnership with Tieto Enator.Tieto Enator.

• Contract signed March 18thContract signed March 18th

Netherlands (NICTIZ)

• National Healthcare Messaging Hub

• National solutions for Access, Identity & Consent

• HL7 V.3 for Health Information Exchange

• Strategy of inclusion for existing suppliers and end-user solutions

• Concept of “well-behaved systems” [GBZ]

• Encouraging utilisation of the infrastructure

EHR Implementations:EHR Implementations:Revolutionising Health Information ManagementRevolutionising Health Information Management

Denis TebbuttManaging Director, InterSystems ANZ