Upload
peter-tan
View
1.676
Download
2
Embed Size (px)
DESCRIPTION
Presented at iCMG Architecture World, Bangalore, 2011
Citation preview
Architecture World ‘11
Singapore National EHR – Adaptive Architecture for
Transformation and Innovation
Peter Tan, Lead Enterprise ArchitectWong Ming Fai, Senior Architect
MOH Holdings, Singapore
2
First Up, Organization Context - Singapore …
Confidential to MOH Holdings Pte Ltd.
4.99 million people on 710.3 sq km (7,025/km2)
Ethnically diverse: Chinese: 75 per cent Malays: 14 per cent Indians: 9 per cent
It’s Characters: A city state Rich technology foundations Support of the government Will of the people Less legal constraints ‘It will be done’
3
The Healthcare Services
Confidential to MOH Holdings Pte Ltd.
Primary Care Long-Term CareAcute &Intermediate Care
Restructured Hospital
Rehab & Support Services
Community Hospital
Polyclinics
General Practitioners
Screening & Preventation
Nursing Home
Home Care
Palliative Care
Public sector Private sector People sector
35,000+ healthcare workers
11,580 hospital beds
429,744 hospital admissions (2007)
Public sector out-patient visits (2007)– Specialist Outpatient Clinics 3,687,910– A&E 752,122– Polyclinics 3,797,953
4
Secondary Care
At The 30,000 Feet…
Confidential to MOH Holdings Pte Ltd.
Tertiary Care
Primary & Intermediate Long Term Care
A pyramid model, Anchored by Regional
Hospitals
More autonomy in day-to-day operations
own networks of general practitioners
step-down care facility in respective zones.
Community Hospital
General Practitioners
NursingHome
Polyclinics
Restructured Hospital
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
04/09/2023 ©2011 Healthcare Information and Management Systems Society
5
One Patient One Record Strategy
Enable integrated healthcare services
Enable integration between healthcare and advances in biomedical
science
Health Information
Exchange - e-Enable seamless
and secured information
exchange in the healthcare value
chain
Integrated Healthcare
Continuum - e-Enable
processes and linkages across the healthcare
value chain
Translating Biomedical Research to Healthcare Delivery -
integrate clinical and biomedical research data
Well-Integrated
Quality Healthcare
Cost-effective
Healthcare Services
Greater ability of public to manage
their health
Strong clinical and
health services
research
To accelerate sectoral transformation through an Infocomm-enabled personalised healthcare delivery system to achieve high quality clinical care, service
excellence, cost-effectiveness and strong clinical research
Strategic Thrusts
Outcomes
Goal
Strategies
iN2015 Strategic FrameworkFrom iN2015 Healthcare and Biomedical Sciences Report
• Visibility of supply, demand, costs and care pathways
• Well populated clinical database• Patients have visibility of their health
journey and available options
• Manage ‘cases’ across care settings using defined care pathways
• Enable interconnection of clinicians, carers and patients in support of integrated care
• Shared use of common services and effective right-siting
• Connection of core health systems to support electronic transactions initiated across settings
• For example - PHR / NEHR for access to an individuals common health record, eReferrals, or e-Prescriptions
• Adoption of Health Infocomm technologies across all care settings
• System adopted are core health systems such as EMR, NEHR, PAS, RADT, PHR
Integrated
Connected
Adopted
Optimized
… a journey summarised by …
6
Restructured Hospital
Polyclinics
Fun & Challenges For EA
Confidential to MOH Holdings Pte Ltd.
Chain of 9 polyclinics
Chain of 9 polyclinics
Ancillary systems
EMR Systems
Unique “paperless”
system
7
At MOHH, The Alternative paths for Architecture
Confidential to MOH Holdings Pte Ltd.
(1) Top Down StrategyiN2015 Healthcare and Biomedical SciencesReport
?
Focus on Governance
& Control
Develop Artefact Library
Focus on Delivery
Future Planning &Innovation
8
Reflecting back…
Confidential to MOH Holdings Pte Ltd.
Gartner Research, 10 Feb, 2010Case Study: Understanding the Impact of Emergent Strategy on Enterprise Architecture
(1) Top Down StrategyiN2015 Healthcare and Biomedical Sciences Report
NEHR
Future Planning &Innovation
9
Enterprise Architecture – Our Approach
Confidential to MOH Holdings Pte Ltd.
Work Collaboratively
Add value early on
Pragmatic approach
Become part of natural process
It’s always about Delivery
Be supportive
Value breeds demand.
10
Transformation Driven Approach
04/09/2023 ©2011 Healthcare Information and Management Systems Society
11
To Enable Transformation and Innovation
Planned Capabilities
1.0 Support & Educate Patient
1.1 Educate
1.2 Enable Self Management
2.0 Deliver Health Services
2.1 Schedule / Register
2.2 Assess Patient 2.3 Deliver Care
2.4 Transfer of Care
3.0 Plan & Manage the Health System
4.0 Manage Population Health
4.2 Design Programme 4.3 Execute Programme 4.4 Evaluate Programme
1.2.1 Access Screening Data in PHR
2.5 Manage Patient Flow
4.3.1 Extract Data for Programme Evaluation
4.1 Define & Manage Performance Targets
4.1.1 Extract EHR Data for Clinical Audit
1.3 Relationship Management
2.1.1 Enable EHR Access
2.1.2 Manage Patient Demographics
2.1.3 Capture Care Team Details
2.2.1 Review Summary Record
2.2.3 Review Investigation Details
2.2.4 Review Procedure Details
2.2.5 Review Referral Details
2.2.6 Review Care Plans
2.2.2 Review Event Details
2.2.7 Review Notifications
2.3.1 Episode of Care Planning
2.3.2 Reconcile Medications
2.3.3 Reconcile Problem List
2.3.4 Update Allergy / ADR
2.4.1 Create / Manage Referral
2.4.2 Create Event Summary
2.4.3 Create Discharge Summary
Legend
1.4 Personal Health Record Management
1.2.5 Self-Assessment Support
1.2.2 Personal Health Risks Assessment, Care Plan and Monitoring
1.2.4 Health Peer Support
1.2.3 Health Advice
1.2.6 Personal Health Care Scheduling
1.2.7 Personal Medications Management
1.2.8 Personal Chronic Health Care Management
1.2.9 Home Monitoring and Therapy
1.2.10 Immunization Access and Management
1.2.11 Health Research Programs
1.3.1 Patient Relationship Coordination
1.1.1 Health Education Information
1.1.2 Health Promotion Programs
1.1.3 Health Management Tools
1.1.4 Outreach Programs
1.4.1 Personal Health History
1.4.2 Health Record Consent Management
1.4.3 NEHR Access and Update (Patient)
3.1 Manage Logistics
3.2 Manage Finances
3.3 Manage Legal & Commercial
3.4 Manage HR 3.5 Manage IT 3.7 Manage Quality
3.6 Manage Policy
3.1.1 Manage Facility Information
3.4.1 Manage Clinician Information
3.5.1 Manage EHR Operations
2.3.5 Care Results Sharing
2.4.4 Health System and Provider Capacity Identification
2.4.5 Care Transfer Planning
2.5.1 HealthCare Options Assessment
2.5.2 Case Management
2.5.3 Length of Stay Management
2.5.4 Resource Usage Monitoring and Management
2.5.6 Care Outcomes Evaluation
2.5.6 Health Finances Management
2.5.7 Demand Management
3.7.1 Care Quality Monitoring and Management
3.8 Manage Partners3.8.1 External Service Provider Management
3.8.2 Provider Relationship Coordination
3.8.3 Clinical Networking Support
4.2.1 Integrated Care Pathways Design
Not impacted by programsEHR functionality = post P1EHR and CIC functionalityEHR-related functionalityPHM-related functionalityCIC-related functionalityLevel Two business capabilityLevel One business capability
2.0.1 School Health Services
2.2.8 Care Requirement Assessment
2.5.8 NEHR Access and Update
Planned Components
Developed Reusable Components Services catalog Inter-operability &
Integration National Service Bus
Architecture Data & Data repository
Architecture National Health Identity
Service Capabilities Catalog
12
Conceptual View of the NEHR
Confidential to MOH Holdings Pte Ltd.
Event Summary, Referral & Screening Documents
EHR Summary Record
NameNRIC No.
Primary Care ProviderCare Coordinator
Allergies
DiagnosesCurrent Medications Procedures
Recent EventsRecent Referrals
Care Plan
Date of BirthGender
Detailed Reports / Images
Shared Services / Functionality
Business Intelligence
Data Warehouse
National Scorecard
Programme Scorecard
Link
Share Data
DA / ADR Module
Immunisation
Medications Reconciliation
Problem List Reconciliation
Shared Care Plan
Care Team Details
Personal Health Record (PHR)
Referral Processing
Laboratory Reports
Procedure Reports
Radiology Reports / Images
Drill DownDrill Down
School Screening
Fit for Instruction
SOC Referralto GP
AIC / ILTC Referral
Community Hosp Disch. Summ.
Referral to SOCSOC Event Summary
Inpatient Disch. Summ.
GP Event Summary
ED Event Summary
Investigations
Immunisations
Applications that are not a part of the EHR solution, but will be integrated with the EHR
04/09/2023 ©2011 Healthcare Information and Management Systems Society
13
Source Data Characteristics
Service Catalogue: Organisation
5 Domains: EHR, Identify and Access Mgmt, Terminology, National Health Identification Service, Integration
x 461
x 82
x 24
x 5
A Peek into the Service Catalogue
Domain
Functional Area
Service Name
Service Name Description
Service Operation
Service Operation Description
Service Input
Service Output
EHR 1. Summary Care Record
PatientManages the services to register patients.
AddPatient
Registers a new patient with the EHR based on inputs from the source systems
Patient Particulars; e.g. Last Name, First Name, etc
Success or failure indicator
EHR 1. Summary Care Record DeletePatient
De Registers the patient from the EHR based on the source systems
PIDSuccess or failure indicator
Key Questions Answered:
Interoperability Specifications– How can EHR information be understood in
a consistent manner? Integration Services
– What capabilities does the EHR need to provide to support interoperability and integration?
Security Administration
– How does interoperability impact administration and operations of EHR and EMR systems?
Infrastructure
Interoperability Specifications
Infrastructure
Ad
min
istr
ati
on
Sec
urity
Integration Services
Interoperability and Integration Architecture
Information Exchange Requirements
Benefit: Establish Common Understanding
Linkage to Standards
S/N
Name Purpose Integration Standards
Semantic Standards
5 Doc – Request EMRX
Request source system for a specific document.
Leverages on EMRX’s GetDoc functionality.
Web Service EMRX XML
Linkage to Service Catalogue
Domain Functional Area Service Name Service OperationService Operation Description
EHR 1. Summary Care Record Medication UpdatePatientMedic
ation
Update medication(s) on the patient medication list.
20
3Q ‘08
4Q ’08
1Q ’09
2Q ’09
3Q ’09
4Q ’09
1Q ’10
2Q ‘10
3Q ‘10
4Q ’10
1Q ’11
2Q ’11
3Q ’11
4Q ’11
NEHR
CIC & PHM
EA Ops & Gov
“Operationalise” the EA practice
Confidential to MOH Holdings Pte Ltd.
CIC & PHMArchitecture
Extending to new Business Areas
Tooling: EA Repository
Gov & OperationContent
population
Implementing operation & governance only when
needed.
NHISA
NEHRA
ESB
Service Catalog
IIA
From Strategy to Program
focus From problem to innovation:Deep dive into a tricky problem space & take opportunity to innovate.
ValueValue
Value
Value
NEHR POC NEHR RFP
NHIS Scoping
NEHR detailed design
Repository
Data/Doc
Interop Specs
Design Assurance
21
Collaborative EA Gov & Processes
Confidential to MOH Holdings Pte Ltd.
Architecture & Solution Governace
EA –Project Engagement
(Interaction Points)
EA Repository & Content Mgmt System
Architecture Office
Implementation Projects
PrincipalEnterprise Architect
ArchitectureChange
Management
Architects (Enterprise & Domain)
Guidance
Architecture &Solutions BlocksProcesses IT RoadmapArchitecture
Decisions
Inception
Elaboration
Realization
ARB
SimplifiedInteraction
An Accessible Reference Library
Senior Management Stewardship
1
6
3
4
2
5
7
Current state of application
22
EA Tool & Repository
Confidential to MOH Holdings Pte Ltd.
1
23
4
23
EA Repository Meta Model
Confidential to MOH Holdings Pte Ltd.
Data Architecture Technology ArchitectureBusiness Architecture Application Architecture
Alfabet Content Meta ModelD
Architecture Principles, Vision & Requirements
Other References
Adapted from TOGAF 9
Architecture Principles
D
Architecture Requirements RepositoryRequirements | Constraints | Assumptions | Gaps
D Architecture VisionBusiness strategy | Business Principles Objectives & Drivers | Stakeholders | Technology Strategy
D
Deliverable's PARCI
D
ProcessesD
Architecture Decision Log
D Staff Contact list
DToolkits
DSpecifications?
DArchitecture Position Statement
D
Enterprise’s Architecture landscape (Baseline and to-be)supported Business Domains/Organizations (Business Support) - which IT systems provides which Capabilities to which Organizations.
A
Program/Project’s Architecture landscape (Implementation Programs/projects )View of affected Architecture components and/or architecture Components dependencies/overlap
A
OrganizationA
CapabilityA
Process*(Attachment)
A
ApplicationA
ApplicationReleases
AServices
A
Information FlowA
Business Object (LIM)
A
Business Data (Physical)
A
Components / Standard
Components
A
A
Standard Platform
A
GlossaryA
ComponentModule
A
Managed in a Directory repository
DManaged in Alfabet repository
A
Overview of EA Repository’s Meta Model
25
3Q ‘08
4Q ’08
1Q ’09
2Q ’09
3Q ’09
4Q ’09
1Q ’10
2Q ‘10
3Q ‘10
4Q ’10
1Q ’11
2Q ’11
3Q ’11
4Q ’11
NEHR
CIC & PHM
EA Ops & Gov
“Operationalise” the EA practice
Confidential to MOH Holdings Pte Ltd.
CIC & PHMArchitecture
Extending to new Business Areas
Tooling: EA Repository
Gov & OperationContent
population
Implementing operation & governance only when
needed.
NHISA
NEHRA
ESB
Service Catalog
IIA
From Strategy to Program
focus From problem to innovation:Deep dive into a tricky problem space & take opportunity to innovate.
ValueValue
Value
Value
NEHR POC NEHR RFP
NHIS Scoping
NEHR detailed design
Repository
Data/Doc
Interop Specs
Design Assurance
NHRA next iteration
NEHR Architecture Refresh Approach
Gap analysis of current NEHR system
Gap analysis of current NEHR system
Items from current target architecture
Items from current target architecture
Integration analysis of current systems
Integration analysis of current systems
New business services and applications
New business services and applications
Goal state architectureGoal state architecture
Options analysis
27
Solidifying EA Process
Confidential to MOH Holdings Pte Ltd.
1
23
4
04/09/2023 ©2011 Healthcare Information and Management Systems Society
28
What We’ve Learned
1.Focus on solving
problems, not just delivering
artefacts
2.Build
relationships / trust
3.Be a
servant first,
policeman later
5.Evolve from where you
are
4. Be
pragmatic, not
dogmatic
Revolutionaries make
Good Martyrs!
Health and MedicalPractice Insurance Pte Ltd
Thank you