Singapore s National Electronic Health Record

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1 Singapore s National Electronic Health Record The Roadmap to 2010 Dr Sarah Christine Muttitt Chief Information Officer Information Systems Division 17 th July, 2009

2 Taking the Next Step (MSM April 2008) 1. Singapore requires a national integrated electronic health information system based on a common enterprise architecture, data standards and privacy and security guidelines. 2. A shared electronic health record (EHR) can be delivered by Broad stakeholder engagement is needed. The EHR is not an IT project but a business and clinical transformation project. 4. Governance and accountability is necessary to align strategic intent with implementation. National strategy and implementation plan Funding mechanisms to encourage consistent, coordinated and continuous investment in health IT Skilled resource capacity 5. Measuring of success of the national EHR with regards to health care quality, safety, and productivity. This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 2

3 Electronic Records - EMR vs. EHR EMR Specific to an facility (institution, private office); the equivalent of its paper predecessor and includes everything that is recorded by that organization about a given patient. It has depth but lacks breadth. EHR Specific to an individual; captures a key subset of health information from multiple point of service systems. It 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. This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 3

4 Our Approach Evaluation & Audit with a focus on international benchmarking Clinical Strategy & Prioritization Over-arching Informatics Roadmap Technical Architecture & Data Standards Common Enterprise Architecture IT Delivery guided by Project Management best practice Directed Funding based on Multiyear Business Plan, EAcompliance This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 4

5 Our Goal to bring together clinicians, emerging leaders & process-owners owners to discuss Health IT strategic priorities & jointly identify clinical focus areas where IT-enabled transformation can have the highest impact. This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 5

6 Clinical Engagement Clinical Engagement Clinical Informatics Roadmap The Roadmap articulates Clinical Focus Areas, Objectives and corresponding Health IT capabilities (illustrative) Continuity of Care Support continuity of care during care transitions Summary Facilitate patient care record access to relevant care, and patient E-referrals care coordinator & referral relationships triage Case Improve management efficiency of tools care coordination for large patient cohorts, disease management Medication Management Active medication list Support initiatives to reduce medication error Harmonized drug nomenclature & codes Increase effectiveness of adverse event surveillance Drug dispensing data Diagnostics Support patient safety initiatives Shared image repositories Enhance operational efficiencies for diagnostics Harmonized lab nomenclature & codes services EHR & Extensions Secondary Data Use Improve data comparability, reliability and timeliness Interoperability framework for clinical data Support data analysis across cycle of care for core repositories & disease registries measures This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 6

7 What you told us you wanted.. Longitudinal summary health care profiles Consolidated view of patient s current problems Consolidated view of patient s current medications Ability to share critical patient information across all providers involved in patients clinical care journey Patient information accessible at the point of care to support clinical decision making. This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 7

8 EHR - Summary Care Record (Dashboard Dashboard) Illustrative Sample Only This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 8

9 Plus our Architectural Principles. Portal based with additional toolsets to support targeted clinical capabilities Iterative and phased implementation targeting key clinical capabilities Role based to support clinical access requirements in a secure and authorized way Loosely coupled to support flexibility and extensibility over time Hybrid central repository summary health care information, access to detailed reports / images via record locator service Service orientated based approach integration layer to support interoperability and provision of registry and identification services Leverage existing systems and investments where possible This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 9

10 EHR Architecture Overview Users & Access Patient National Health Portal Clinicians Clinician Portal 1 EMR Researcher BI Tool Name Date of Birth Primary Care Provider NRIC Gender Care Coordinator No. Allergies Alerts Diagnoses Current Recent Medications Investigations Recent Recent Events Referrals Care Plan On-line Analytical Statistical Dashboards Processing Analysis Technology Infrastructure Validation/ Quality Services Data Mining Business Capabilities Clinical Systems Clinical Support National Systems 11 Shared Services 2 Multiple EMRs Laboratory EMRX Medication Reconciliation Moderation/ Reconciliation 2 Medication Problem List/Dx 4 EHR Infrastructure EHR Summary Data 5 Analytic Environment Summary Care Shared Record Services Detailed Business Reports/Images Intelligence Event Summaries & Referrals Radiology CMIS Problem List/Dx Reconciliation Pharmacy NIR Shared CDS Patient Admin Care Plan Mgmt. OT Registry Services 7 Transformation Terminology Service Service Access 8 Management Data Extracts Notification 3 Services 13 Data Repository Interaction & Security Operations Data & Availability Platform Development Integration Management Environment Portal App Server & Authentication Application Replication, Standards & 9 Server Batch Management Archival Processes Doc Mgmt, Messaging Encryption & Signatures 10 System Backup SDLC Methods Network Workflow & ETL Management & DR &Tools Clustering, Reporting ESB & Audit Logging Orchestration Failover Storage Environments EHR Usage 1. Clinician Access Channels 2. EHR Enabled Capabilities 3. Event Notification Electronic Health Record 4. EHR Configuration 5. Information Model and Standards Integration 6. Data Exchange Registries 7. Patient, Clinician and Facility Identification Security 8. Access Management 9. User Authentication 10. Encryption and Signatures National Systems 11. Leveraging Existing Systems 12. EHR/PHR Data Exchange Analytic Environment 13. Business Intelligence Enablement This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission Integration / Data Exchange: Enterprise Service Bus (ESB) / Messaging / Document Exchange

11 The EHR raises new challenges Beyond the EMRX, EHR is envisaged to Cover the entire healthcare continuum Ministry of Health has fewer controls over private sector & Voluntary Welfare Organisations Cover the entire populace including non-resident foreigners Capture the full data complement Including sensitive health information e.g. STD, mental health indications Support secondary uses National health planning & resource allocation Quality assurance Public health regulation Health research etc This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 11

12 Timeline Overview 2008 Timeline Overview 2008 Integration of Workstreams This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 12

13 Clinical Informatics Roadmap Organization Specific IT Capabilities Strategic Alignment National EHR & Related Integrative Projects The Clinical Informatics Roadmap will support the national agenda for an Electronic Health Record by 2010 by facilitating strategic alignment at various Levels of the Healthcare System This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 13

14 Timeline Overview 2009 This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 14

15 MOHH ISD CIO Communications Contract/Vendor Management Programmes Planning & Portfolio Management Clinical Transformation Services Business Intelligence Knowledge Management EHR Programme Risk Management Medical Informatics Community & Integrated Care Quality Assurance Change Management Enterprise Architecture Project Management Benefits Realization Standards Identity & Security Services This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 15

16 Thank You MOH Holdings T: F:

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