Connected Healthcare

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Connected Healthcare
Kerry Stratton

• June 2008

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InterSystems Products
World Leading Health Information System
Premier platform for building, running and
connecting healthcare applications worldwide
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Intersystems Vantage Point
Hospitals, Clinics, Laboratories, HMOs,
100,000 systems,4,000,000 users
Packaged Applications
Custom Applications
100s of applicationpartners
Database Application Development
Most successfulhealthcare database
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Connected Healthcare
Connectingclinicians,organizationsand
patientsacross thecontinuum of care
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Terminology

• Electronic Patient Record (EPR) Computer based
  patient records within the scope of a single
  provider organisation.
• Electronic Health Record (EHR) The contents of
  a (possibly virtual) repository of summary
  medical information about a person. Designed to
  serve a large number of provider organisations
  and facilitate interoperability of EPR systems to
  improve the continuity of care given to patients.
• Electronic Case Record (ECR)
• The contents of a (possibly virtual) repository
  of all Clinical information related to a Specific
  Case i.e. Diabetes. Designed to serve a large
  number of provider organisations and facilitate
  interoperability of EPR systems to improve the
  continuity of care given to patients.

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FastTrak EPR
Practice Management System
Hospital PAS
Clinical Viewer Including Order Communications
Stage 1 Clinical Viewer Order Comms. Lab
Radiology
Stage 2 Order Comms. 2nd level. E-Prescribing

• Ensemble

FastTrak to EPR
Stage 3 Decision Support Discharge Summary
Radiology
Path Lab
ICU
Pharmacy
A E
Theatres
Cardio Lab
Replace ICu
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Worldwide Healthcare Spending
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HealthShare What Is It?
Hospital/CHC
CIS
RIS
HIS
Etc.
Healthshare Hub
EMPI
EMR
LIS
Physician's Practice
Laboratory
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Regional National EHR
GP 1
Viewer
RAD
EMPI
Point of Care
LAB
GP 2
EMPI HUB
Hospital
PAS
Edge Gateway
GP 3
Gateway
OPR
Edge Gateway
A E
Clinic
Repository
I C U
Edge Gateway
Edge Gateway
Clinical Repository
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HealthShare Standards
HL7 v2
Health Language 7 version 2
HL7 v3
Health Language 7 version 3
CDA
Clinical Document Architecture
CCR
Continuity of Care Record
CCD
Clinical Care Record encapsulated in CDA
DICOM
Digital Imaging and Communications in Medicine
NCPDP
National Council for Prescription Drug Programs
RLS
Connecting for Health Common Framework
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International Projects

• Australia
• Belgium
• Brazil
• Chile
• China
• Italy
• Netherlands
• Russia
• South Africa
• Sweden
• Switzerland
• USA

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Regional System Brasilia

• Regional Project
• 17 Hospitals
• 134 Health Clinics
• 3 Diagnostic Laboratories
• 20 Emergency Units
• 3 Specialist Diagnostic Units
• Home Care
• More than 5.000 health professionals using just
  one Electronic Health Record

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Regional Care In Brasilia

• Healthcare Centers and Regional Hospital 134
• Single patient information and EHR
• Shared scheduling of doctors visits, tests and
  procedures
• Control of references and counter-references
• Seamless admittance and pre-admittance scheduling
• Pharmacies 134 15 Regional 2 Central
• Shared information and single EHR
• Control of prescription issuing
• Control of medication issuing
• Integration between Regional Hospitals 17
• Shared information and single EHR
• Bed management, with a full view of the network,
  by specialties
• Laboratories 20, of which 3 are central
• Emergency Care 20
• Integration with legacy systems SES
• SES-DF DATASUS GRCA SINAM SINAM/MS
  DIPAS/SAS/SES SIM SINASC SIA SIAB SISVAN
  SISCOLO SISPRENATAL SISCOM SI PNI SICLON
  FCES CARTÃO SUS SALA SITUAÇÃO SIS PPI HOSPUB
  SIGAB

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Brasilia Citizens Portal
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China Shenzhen Region

• Shenzhen Region 13million people located about 1
  hour drive from Hong Kong. Brings in more Export
  revenue than any other city in China each year.
• Hospitals 87
• Community Health Center 490
• Number of beds 17,600
• Doctor18,500
• Nurse17,500
• Outpatient cases (year) 41,585,708
• Inpatient cases (year) 581,047
• Average hospitalization 8.8 days
• Emergency cases (year) 4,513,291
• Busiest outpatient hospital daily cases
  7,000
• Ambulance209

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Sweden National System

• Population 9 million 21 healthcare regions
• National EHR
• Carelink is Government appointed group to manage
  the project.
• ISC in partnership with Tieto Enator.
• Visited GDF Brazil December 2007.
• Project started March 2008

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HealthShare The Components
One shared resource for the exchange. Primarily
responsible for managing identifiers (EMPI)
Hub
Many distributed resources across the
exchange Primarily responsible for managing data
collection caching
Edge Gateway

• Many distributed resources across the exchange
• Provider portal for querying the exchange and
  viewing results

Access Gateway
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HealthShare The Components
The Hub
Hub
MPI Database Native or Initiate or Quadramed
Access Gateway
Edge Gateway
Edge Gateways send demographic updates to the
Hub in SDA (XML) format using Web Services
Access Gateway
Edge Gateway
Access Gateways send demographic search requests
to the Hub in SDA (XML) format using Web Services
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HealthShare The Components
The Edge Gateway
Clinical repository for each Edge Gateway. The
incoming clinical data is converted to SDA and
fed into TrakCare
Hub
Edge Gateway
TrakCare Database
Demographic updates to the Hub using Web Services
3rd Party Apps.
3rd Party Apps.
3rd Party Apps.
3rd Party Apps.
3rd Party Apps.
Access Gateway
3rd party apps send information to the Edge
Gateway (or the Edge Gateway pulls it from the
applications)
Access Gateway
Access Gateways send requests for patient
information to the Gateway and receive SDA (XML)
response using Web Services
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HealthShare The Components
The Access Gateway
The results of the patient search are shown on
the web page
Access Gateway
Hub
Access Gateways send demographic search requests
to the Hub in SDA (XML) format using Web Services
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HealthShare The Components
The Access Gateway
The patient information requested from the Edge
Gateways is stored in the Access Gateways
clinical repository (TrakCare) where the record
is transient
Access Gateway
The Clinical Viewer (TrakCare) is used to inspect
the patient record stored in the Access Gateways
Clinical Repository
TrakCare Database
TrakCare Database
Edge Gateway
Access Gateways send patient requests to the Edge
Gateway. in SDA (XML) format using Web Services
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HealthShare The Components
The Full Picture
Hub
MPI Database Native or Initiate or Quadramed
Edge Gateway
TrakCare Database
Edge Gateway
TrakCare Database
Edge Gateway
Edge Gateway
TrakCare Database
Access Gateway
3rd Party Apps.
Access Gateway
3rd Party Apps.
Access Gateway
3rd Party Apps.
Access Gateway
3rd Party Apps.
3rd Party Apps.
TrakCare Database
TrakCare Database
TrakCare Database
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Worldwide Update USA Rhode Island

• Having a useful, usable and used interconnected
  health information system that
• A total of 1.1Million Residents 3,000 GPs
• Puts the right information into the hands of
  clinicians and their patients when and where it
  is needed
• Allows for population health information to be
  analyzed and used for surveillance, health
  policy, and research
• Using InterSystems HealthShare for state-wide
  master patient index and clinical data exchange
• Connecting 14 healthcare organizations across the
  state (85 of all lab and medication data)
• Governor has an Anytime, Anywhere Healthcare
  agenda

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Worldwide Update USA (LIPIX)

• Long Island Patient Information Exchange
• 5.2Million Residents 8,000 GPs (Assoc with
  NS-LIJ Health System)  
• Using InterSystems HealthShare for master patient
  index and clinical data exchange.
• Connecting 15 healthcare organizations
  on New Yorks
  Long Island
• Initial LIPIX Deployment
• 4 Hospitals
• 2 Physician Practices
• Home Care Agency
• Municipal Health Center
• EMS Organization
• Reference Laboratory
• Long Term Care Facility
• Public Health Department

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Questions?