A Tale of Two Architectures Software AG Partner Summit 2 June 2014 Peter Tan Principal Architect National Architecture Office
My Journey in Health IT Policy Development Provide Funding Strategic Planning Systems Coordination Facilitate Collaboration Synergise Economies of Scale 1 3 Architects Delivers CIO for clusters http://sg.linkedin.com/in/petertansg 2 2
MOH Holdings Information Systems Division (ISD) Provides leadership in setting strategic direction for Singapore s national health informatics strategy MOH Holdings Master HIT Planning Organization Specific IT Capabilities Strategic Alignment National EHR & Related Integrative Projects HIT master planning supports the national agenda for an Electronic Health Record by facilitating strategic alignment at various Levels of the Healthcare System
Our Healthcare Ecosystem Primary Acute and Intermediate Long-term 35,000+ healthcare workers Community Hospital 11,580 Polyclinics hospital beds Nursing Home 429,744 hospital admissions (2007) Screening & Preventation Restructured Hospital Palliative General Public Home Practitioners sector out-patient visits (2007) Rehab & Public sector Specialist Outpatient Clinics 3,687,910 Support A&E Services 752,122 Private sector Polyclinics 3,797,953 People sector
Vision: Integrated Healthcare System What does it mean when we say our population will be older? It means there will be more demand on healthcare because older people are sick more often. But this also means it is a different pattern of healthcare So we have to respond to this by putting in more resources into our hospital system, building new hospitals. get the whole system to be structured properly so that it will be adapted to cater for the ageing population. To structure it properly means we need step-down care. Picture taken from asiaone.com And one key thing we must do with this step-down care is to link up our acute hospitals [ ] with community hospitals, so that you can have the best of both worlds. Prime Minister Lee Hsien Loong National Day Rally 2009
Goal State: The Big Picture 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 Screening & Prevention Polyclinics FPs CH RH Rehab & support services NH Home Screening & Prevention Palliative Screening & Prevention Polyclinics FPs Tertiary Secondary Polyclinics FPs CH RH Rehab & support services Screening & Prevention NH Home CH RH Rehab & support services Polyclinics FPs Palliative NH Home CH RH Rehab & support services Palliative NH Home Screening & Prevention Polyclinics FPs Palliative CH RH Rehab & support services Screening & Prevention NH Home Polyclinics FPs Palliative CH RH Rehab & support services NH Palliative Home Primary and Intermediate Long Term Polyclinics General Practitioners Community Hospital Nursing Home
One Patient One Record Strategy Goal Outcomes 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 Well- Integrated Quality Healthcare Costeffective Healthcare Services Greater ability of public to manage their health Strong clinical and health services research Health Information Exchange e-enable seamless and secured information exchange in the healthcare value chain Strategic Thrusts Enable integrated healthcare services Enable integration between healthcare and advances in biomedical science NEHR Strategies 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 Integrated Healthcare Continuum - e-enable processes and linkages across the healthcare value chain in2015 Strategic Framework From in2015 Healthcare and Biomedical Sciences Report
Adaptive Architecture (1) Top Down Strategy in2015 Healthcare and Biomedical Sciences Report Focus on Governance & Control Develop Artefact Library? Focus on Delivery Future Planning & Innovation
Solution and Architecture Services Work collaboratively Add value early on Enterprise Architecture Take a pragmatic approach Become part of natural process It s always about delivery Be supportive Value breeds demand Implementation Solution Architecture & Design Adapted from TOGAF v9
Envision for each Stakeholder Vision: The EHR in Singapore will revolutionise the timely and accurate communication of clinical information, which will help promote a healthier population. No Singaporean will have their clinical care compromised by lack of access to clinical information Vision of Patients Vision of Clinicians Vision of Health Administrators Trust that clinicians have information required to deliver the best possible care Streamlined interaction with high calibre providers across the healthcare sector Encouragement to seek answers to clinical questions Empowerment delivered by selfmanagement capabilities Minimise inconvenience from unplanned encounters with the health system Confidence that personal data is protected Reputation for providing outstanding service to patients & families Culture of wanting to share clinical information with partners in care delivery Support to deliver the highest level of clinical care outcomes Streamlined transfer of care More time for direct patient care due to less manual / paper based processes Trust in data analysis and entry of other clinicians Confidence in the quality of data Exceeded expectations of consumers & staff Value for investment meets / exceeds the promise Pre-eminence in Health IT and clinical research Innovative, evidence based systems Satisfaction from the knowledge that the health system is sustainable Belief that the future population will be healthier than before Able to attract, develop and retain high quality clinicians Confidence that health policy is based on decisions and insights from robust operational data
To Enable Transformation and Innovation Planned Components
Solving wicked problems: Source Data and Operations
Architecture journey over the years 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 Work Packages NEHRA From Strategy to Program focus NEHR POC NHISA Value Value From problem to innovation: Deep dive into a tricky problem space & take opportunity to innovate. NEHR RFP NHIS Scoping ESB Repository Data/Doc Value Service Catalog Value NEHR detailed design Design Assurance NEHR Live NEHRA next iteration IIA Interop Specs Extending to new Business Areas CIC & PHM Architecture EA Ops & Gov Implementing operation & governance only when needed. Tooling: EA Repository Content population Gov & Operation
Extended: Healthcare Capability Model The Healthcare Capability Model is used to: Develop a good practice goal state architecture Communicate to Stakeholders Manage Business and IT Portfolio Existing Newly added To be extended
Reference Architecture example: Goal State EMR cmp ABC-026-JHS Used to resolve the address of documents and document / referral recipients resolveendpoint resolverecordlocation Cross (cluster) EMR communication «goal state» out of cluster :EMR getotnotes getednotes getdischargesummary Required to recieve and deliver communications from other care providers / systems sendmessage getdischargesummarymetadata getimmunisations getradiologyreport getreconciledallergies getreconciledmedications getreconciledproblems getreferralletter getscr getlabresult getevent getednotesmetadata «goal state» EMR getotnotesmetadata putdischargesummarymetadata addimmunisation putradiologyreport putreconciledallergies putreconciledmedications putreconciledproblems putreferralletter putorderedmedications putdispensedmedications putlabresult putevent putednotesmetadata putotnotesmetadata A conceptual goal state EMR system has been modeled to add context to the application architecture and integration pattern. The conceptual goal state EMR s capabilities are: Integration NEHR «OSB» NEHR-ESB Clinical data sharing Reconciliation «Initiate» NHIS Endpoint Resolution Serv ice «HTB» NEHR-CDR Note: whilst some existing interfaces are shown in black they are not exposed via NEHR-ESB at present - i.e. NEHR portal retrieves the information directly
planningit repository Meta-Model Example: Singapore s Rising Healthcare Costs are a Business Driver which is tackled by the improved sharing of clinical information whose Goal is supported by the example of improved sharing in the Imaging - Capability This capability contains the resolverecordlocation - Application Service Found in the NHIS - Application That can be implemented on Linux - Technology Component
Business Info Svs flow vs Appln (appln. Info Information flow Svs srv.) (appln. Appln Business Flow srv.) Svs Organization Service Application Business Data Goal State Architecture operationalized in planningit alfabet repository manages indexes of the major entities, physical and logical, within the MOHH enterprise. Business Data Inventory Application Inventory Organisation Inventory Business Svs Inventory Appln Svs Inventory Information Flow Info flow (appln. srv.) Appln vs Appln Svs Business Svs vs Appln Svs
Integrated Health Information Services Architect of IT Solutions Delivery of Business, Clinical and Technology management Systems CIO for Clusters Copyright 2013, Integrated Health Information Systems Pte Ltd.
Changing Healthcare & IT Landscape Healthcare Treatment Outcomes Disease Outcomes Population SGH SGH SHS NHG Ttsh MOH WH TTSH CGH Poly clinics SOC Poly clinic SOC Department Centric Hospital Centric Hospital SOC, Polyclinic Centric Cluster centric Healthcare IT Interfaced Department Systems Integrated Cluster Systems Fully Integrated National Systems Copyright 2013, Integrated Health Information Systems Pte Ltd.
Landscape for Healthcare Clusters IT Integrated information for Better Personalised Today Public Healthcare exchange EMR and Images across any cluster for in- and outpatients Hospitals: Information sensing Paperless Clinical & Business integration Advanced Clinical Decision support GP NEHR CH Intra-Cluster: Integrated Workflow One EMR One Patient Relationship Management PRM Cross-Cluster One E H R EMR for Details EMR RH EMR Exchanges of Images, Records (Today) EMRX Copyright 2013, Integrated Health Information Systems Pte Ltd.
IHIS EA focuses on supporting CIOs and IHIS mgmt to serve our customers better Enterprise Architecture is Business Analytics & Decision Support for the CIO Organise information about information assets for the CIO Analyse options with longer-term consideration for the enterprise, beyond short-term project needs Recommend IT initiatives aligned with enterprise strategy Support IT planning, portfolio mgmt & governance processes EA is Integrated for Enterprise IT! Copyright 2013, Integrated Health Information Systems Pte Ltd.
Well maintained EA info will help us practice IT in an evidence-based manner Our IT landscape is too complex to fit inside any single person s head! Copyright 2013, Integrated Health Information Systems Pte Ltd.
Federated Enterprise Architecture Business Architecture Business Architecture Business Architecture Business Architecture Business Architecture Business Architecture Application Architecture Application Architecture Application Architecture Application Architecture Information Architecture Information Architecture Information Architecture Technical Architecture Copyright 2013, Integrated Health Information Systems Pte Ltd.
Integration With a variety of operating models, consolidation may not be the best option Coordination Integrated Unification H Cloud Shared Apps Tech Mgmt Diversification Regional Health Systems Replication New Buildings FMCs Standardisation Four Operating Models [Source: Jeanne Ross et al, Enterprise Architecture as Strategy] Copyright 2013, Integrated Health Information Systems Pte Ltd.
Healthcare Business Reference Model Biz Areas > Line of Business Level 0 Level 1 Core Business Areas Healthcare Services Emergency Level 2 Inpatient SOC/ Outpatient Allied Health Investigation Surgery/ Procedure Step-down Home Medication Mgmt Healthscreening Direct Supportive Corporate Planning Corporate Communication Community Engagement Corporate Services Legal Affairs HR Mgmt Accreditation & Licensing Enabling Business Areas Service Quality Finance Information Management Medical Admin Nursing Admin Support Services Estate Mgmt Supply Chain 25 25 Operations Mgmt Copyright 2013, Integrated Health Information Systems Pte Ltd.
Healthcare Business Reference Model Biz Areas > Line of Biz > Core Biz Functions Core Business Areas Healthcare Services Emergency Registration Inpatient Admission SOC / Outpatient Registration Surgery / Procedure Registration Step-down Transfer / Admission Home Registration Tele- Consultation Investigation Registration Investigation Triage Consultation Investigation Treatment Medication Dispensing Billing & Payment Admit/ Discharge/ Referral Consultation Investigation Treatment Operation/ Procedure Medication Dispensing Billing & Payment Discharge/ Referral/Apt Consultation Investigation Treatment Procedure Medication Dispensing Billing & Payment Admit/ Discharge/ Referral/Apt Treatment Day Surgery / Procedure Medication Dispensing Billing & Payment Admit/ Discharge/ Referral/Apt Consultation Investigation Treatment Procedure Medication Dispensing Billing & Payment Discharge/ Referral /Apt Investigation (BP etc) Billing & Payment Admit/ Discharge/ Referral /Apt Allied Health Registration Treatment Billing & Payment Billing & Payment Discharge/ Referral/Apt Health Screening Supportive Med Mgmt Direct Discharge/ Referral/Apt 26 Copyright 2013, Integrated Health Information Systems Pte Ltd.
Current Application vs Process Map System A System B System C System D System E System F System G System H System I Consultation Investigation Treatment (EDNotes) (HIDS) (Support) (Support) (eorders) (Results Mgmt) (EDNotes) Medication Management (Outpatient) (Inpatient) (Dispensed) Operation (EDNotes) Procedure (EDNotes) Medication managed by different applications. (Support) (Support) System J Clinical documentations across multiple applications. Copyright 2013, Integrated Health Information Systems Pte Ltd.
Target Application Landscape Level 0 Level 1 SAP PA/PM Patient Relationship Mgmt. / Appt Financial Counseling Patient Engagement Services Patient Touchpoints Patient Engagement EDWeb CPSS (erx) eimr ehor CCOE (eorder Pharmacy Clinical Repository Dental Notes CPSS (ehids/ emc) CCOE (RM) Incident Reporting Core Business Areas Healthcare Services EndoSys ENTSy s OTRS Acute Lab Information Sys Adverse Drug Event & Surveillance Integrated EMR RIS /PAC S CDMS Supportive ECG Step-down CliniVi ew RIS/PACs Monitoring & Tracking Blood Bank Drug Allergy & Medical Alerts Clinical Indicator & Risk Alerts Community Chronic Disease Registry & Marts Clinical Review Patient Portal Home Enabling Business Areas Patient Accounting & Billing Corporate Services Financial Assistance Bed Mgmt EDW/BI ODS Support Services SAP - Enterprise Trendcare Appt OTS Scheduling SAP - MM Enterprise Resource Planning 28 Queue Mgmt Sys Location Tracking / Asset Mgmt. Copyright 2013, Integrated Health Information Systems Pte Ltd.
System A System B System C System D System E System F System G Application - Data Matrix C Create R Read U Update D Delete Data Element Patient Information Patient & Demographics CR CRU R R Family Information CRUD Financial Information CR CRUD Healthcare Episodes & Visits Patient Episode R R R R Patient Visit /Encounter R R R R Patient Appointment CRUD Payment CRU Healthcare Organisations & Providers Institution G.P. Clinic CRUD CRUD CRUD Screening Screening Event CRUD Screening Registration CRUD Screening Result CRUD Referral Referral (IN) Clinical Information Medical History: Allergies Medical History: Surgery History Physical Condition: Vital Signs CR Physical Condition: Physical Char acteristics Physical Condition: ADL CR Healthcare Delivery: Examination CR CR Healthcare Delivery: Test Results CR R Healthcare Delivery: Procedure Healthcare Delivery: Medication Disch arge Summary Medical Conditions Integrated /Tele - care Programme CR Call - Scripts CRUD Knowledge - base CRUD Tasks CRUD Communication Logs CRU Copyright 2013, Integrated Health Information Systems Pte Ltd.
EA is never complete. EA efforts must be run as time-boxed agile projects to realise relevant value Integration Architecture for one of the clusters 10 week agile sprint from Dec - Feb, focused on new Core IT system & high priority RFPs Virtual team of Site, EA, Integration, MOHH architect Options analysis of 6 priority topics Diagram based on 114 interfaces maintained in a spreadsheet Springboard to ongoing EA work in FY2013 IA1018 EPIC EPIC Radiant EPIC Beaker EPIC Beacon EPIC OpTime WMS Portering RMS Housekeeping EPIC Bridges Legend Dated: Feb 2013 New Systems / P1K Integration / Exchange Engine EPIC Cadence EPIC Willow EPIC Bedtime EPIC ClinDoc Existing Systems Repository EPIC ASAP EPIC Epicare Building Systems External Systems IA1039, IA1040 IA1017 IA1016 CSSD SAP IA1002 Devices & Equipment IA1034 IA1014 SAP FICO SAP MM SAP HRIS CC IA1001 VMS IA1034, IA1035 IA1012 IA1003 IA1014 IA1037 IA1011 IA1019 RTLS AMS SAP ISH IA1005, IA1006, IA1008 IA1037 IA1013 EPIC Info Flows IA0053 SAP ISH Info Flows IA0045, IA0046, IA0047, IA0048 IA0054 IA0059 IA0019, IA0020, IA0021, IA0022 IA0054 IA0059 IA0061 IA0062 IA0013 IA0051 IA0030 IA1004, IA1007, IA1010 IA1015 UC IA0032 IA0035 IA0036 QMS SMS Gateway DSS HMS IA0037 IA0038 ipas IA0001 IA0050 IA0005 IA0002 PACs NHG External Gateway IA0007 IA0006 IA0067, IA0068, IA0069, IA0071, IA0072 IA1036 IA1027 IA1028 IA1024 VisuaPAC efc MRS IA0012 IA0011 IA0010 IA0009 IA1026 IA0050 HCLL IA1009 IA0013 IA0035 IA1026 FAAST IA0014 IA0034 Share Drive QDX IA0030 IA0032 IA0066 IA1027 IA0001 IA0034 IA0064 IA0016 IA0033 DMS CMS IA0012 IA0045, IA0046, IA0047, IA0048 IA0019, IA0020, IA0021, IA0022 IA0002 IA0016 IA0062 IA1033 IA1023 IA0063 IA0065 IA0010 IA0069, IA0072 CPRS IA0011 IA0023 IA0065 IA0067, IA0068 Cluster Repository ODS TRS C&P IA1038 IA0066 IA0064 IA0005 IA0009 IA0051 IA0025 IA0063 IA0006 CCDR PASS IRIS IA0033 CMIS IA0017 IPharm IA0061 IA0071 IA0007 4DCIS/ Xcelera Radio Therapy Xcelera Cardio emos Lab Eqiupment Trendcare Cobasit PXYIS Dragger IA0039 IA0040 IA0041 IA0042 IA0043 IA0044 IA0060 IA1029 IA1029 PES MOH (MediNet Means Testing, OMIS, Medifund...) IA0070 IA0070, IA0073 ESB RAD Equipment AIC ereferral Connexall NC CaseMIX CSSD Eqiupment IA0011 IA0070, IA0073 IA0039 IA0040 IA0041 IA0042 IA0043 IA0044 IA0060 IA0070 IA1032 IA0011 ibms ADEAS MRMS NHIS NEHR 30 Copyright 2013, Integrated Health Information Systems Pte Ltd.
31 Copyright 2013, Integrated Health Information Systems Pte Ltd.
What We ve Learned 01. Focus on solving problems, not just delivering artefacts 02. Build relationships/ trust 03. Be a servant first, policeman later 04. Be pragmatic, not dogmatic 05. Evolve from where you are Revolutionaries make good Martyrs!
What Next
THANK YOU Peter Tan peter.tan@ihis.com.sg