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Cloud Computingin Canadian Health Care
Presented by:Dennis GiokasEmerging Technology Group
February 21, 2013Copyright © 2013 Canada Health Infoway
2© 2013 Canada Health Infoway Inc.
Agenda
2
• EHRS Business Architecture
• EHRS Technical Architecture
• Cloud Computing in Health
• Key Messages and Assertions
© 2013 Canada Health Infoway Inc.
© 2013 Canada Health Infoway Inc.
Patient Receives Care Across Care Providers & Settings
Specialist Clinic
Community Care Center
Clinic
Diagnostic
Hospital Emergency
Homecare
Laboratory
Pharmacy
Emergency Services
© 2013 Canada Health Infoway Inc.
Patient Clinical Information is “Shared” Among Care Providers & Settings
Specialist Clinic
Community Care Center
Clinic
Diagnostic
Hospital Emergency
Homecare
Laboratory
Pharmacy
Emergency Services
INTEGRATED VIEW
© 2013 Canada Health Infoway Inc.
Clinician systems “put” relevant data for sharing into interoperable EHR
Specialist Clinic
Community Care Center
Clinic
Diagnostic
Hospital Emergency
Homecare
Laboratory
Pharmacy
Emergency Services
Put
PutINTEGRATED VIEW
© 2013 Canada Health Infoway Inc.
Clinician systems “list” and “get” desired datafrom interoperable EHR for display and use
Specialist Clinic
Community Care Center
Clinic
Diagnostic
Hospital Emergency
Homecare
Laboratory
Pharmacy
Emergency Services
List/Get
List/Get
INTEGRATED VIEW
7© 2013 Canada Health Infoway Inc.
EHR DefinitionAn electronic health record (EHR) provides each individual in Canada with a secure and private lifetime record of their key health history and care within the healthcare system.
The record 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.
© 2013 Canada Health Infoway Inc.
Common Architecture• Common business and technical
architecture accepted by jurisdictions and vendors
• Links local clinical systems with jurisdiction and regional registries and repositories using a data sharing approach
• Must cost effective approach, limiting the number of integration points
• Extensible to support new functions, scalable
• Serves as a reference model for Infoway investments
• Available on the Infoway website
9© 2013 Canada Health Infoway Inc.
EHR Infostructure
9
The EHR Infostructure is a collection of common and reusable components in the support of a diverse set of health information management applications.
It consists of software solutions for the EHR, data definitions for the EHR and messaging standards for the EHR.
© 2010 Canada Health Infoway Inc.
11© 2013 Canada Health Infoway Inc.
Registries Data& Services
EHR Data& Services
Ancillary Data& Services
DataWarehouse
ImmunizationManagement
PHSReporting
HealthInformation
Physician Office EMR
Physician/Provider
BusinessRules
EHRIndex
MessageStructures
TerminologyRepository
NormalizationRules
Longitudinal Record Services
HIALCommunication Bus
Security MgmtData Privacy Data Configuration
ProviderRegistry
LocationRegistry
Common Services
EMR APPLICATIONEMR
Database
ClientRegistry Shared
Health RecordDrug
InformationDiagnostic
Imaging Laboratory
POINT OF SERVICE
JURISDICTIONAL INFOSTRUCTURE
End-User Perspective: EMR Application
12
Standards-based EHR Solutions
© 2006 Canada Health Infoway Inc.
StandardizedArchitecture
StandardizedInterfaces
StandardizedData Structures
StandardizedData Vocabularies
StandardizedFunctional Behavior
14© 2013 Canada Health Infoway Inc.
EHR Infostructure: Standards Based ConnectivityJURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
Hospital, LTC,CCC, EPR
PhysicianOffice EMR EHR Viewer
Physician/Provider
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health Provider
EHR IPEHR IPEHR IPEHR IPEHR IPEHR IPEHR IP
EHR IPEHR IPEHR IPEHR IPEHR IPEHR IPEHR IP
EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP StandardsEHR SCP Standards
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
ImmunizationManagement
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging Laboratory Health
Information
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
HIAL
HIAL HIAL HIAL HIAL HIAL HIALProviderRegistry
LocationRegistry
ClientRegistry H
IAL
HIA
LH
IAL
Security MgmtData Privacy Data Configuration
HIALHIAL
HIALCommunication Bus
Common Services
TerminologyRepository
Longitudinal Record Services
15© 2013 Canada Health Infoway Inc.
Service Oriented Architecture as an Enabler
The HIAL as an Application Abstract Layer• Each jurisdictional HIAL deployed will have different
• Physical deployment model• Some interfaces which are unique to that implementation
• HIAL acts as an abstraction of the EHR such that applications see the EHR in a consistent way across EHR implementations
• Services exposed outside of an EHRi in the form of supported EHR Interoperability Profiles for an entire Infostructure perceived as a single system with transactional services
• Services within an EHR Infostructure to optimize scalability, maintainability and functional flexibility
16© 2013 Canada Health Infoway Inc.
First Type of Abstraction: The EHR as ServicesJURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICEPhysician/Provider
Physician/Provider
Physician/Provider
Public Health Provider
Hospital, LTC,CCC, EPR
PhysicianOffice EMR EHR ViewerLab System
(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
OutbreakManagement
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging Laboratory Health
Information
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security MgmtData Privacy Data Configuration
TerminologyRepository
Longitudinal Record Services
HIALCommunication Bus
Common Services
ClientRegistry
ProviderRegistry
LocationRegistry
EHR SERVICES
Get Client IDResolution
List Laboratory Orders Put Laboratory Result
Get LaboratoryResults
Get Prescription
List Medications
Stream DI Image
List DI Results Get DI ReportPut Immunization Data List CD ReportEvents
Get ProviderInformation
List ServiceDelivery
Locations
List EncounterEvents
Get EncounterSummary
Get ClinicalDashboard
Get ClientDemographic
17© 2013 Canada Health Infoway Inc.
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
OutbreakManagement
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging Laboratory Health
Information
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security MgmtData Privacy Data Configuration
TerminologyRepository
Longitudinal Record Services
HIALCommunication Bus
Common Services
ClientRegistry
ProviderRegistry
LocationRegistry
Second Type of Abstraction: Generic Application
Any Point-of-Service
Application
EHR IP
EHRi SERVICES
CRServices
PRServices
LRServices
TerminologyServices
Detection& Reporting
Services
Shared HealthRecord Services
DrugServices
DIServices
LabServices
NormalizationServices
AssemblyServices
A & AServices
BrokeringServices
ConsentServices
SessionServices
LoggingServices
OutbreakServices
RulesServices
OrchestrationServices
EHR IndexServices
18© 2013 Canada Health Infoway Inc.
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
POINT OF SERVICE
Communication Bus
EHR Infostructure: Communication Bus
COMMUNICATION BUS
MESSAGINGTransformation
ServicesRoutingServices
Encrypt/DecryptServices
En/DecodingServices
ParserServices
SerializationServices
PROTOCOLApp Protocol
ServicesNetwork Protocol
Services
19© 2013 Canada Health Infoway Inc.
EHR Infostructure: Common ServicesJURISDICTIONAL INFOSTRUCTURE
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
POINT OF SERVICE
HIAL
Security MgmtData Privacy Data Configuration
Common Services
COMMON SERVICES
INTEROP
InteroperabilityServices
Search/ResolutionServices
INTEGRATION
Service CatalogueServices
Broker Services
Mapping Services
Queuing Services
CONTEXT
Session MgmtServices
Caching Services
Identity ProtectionServices
Identity MgmtServices
AnonymizationServices
User AuthenticationServices
Consent DirectivesMgmt Services
EncryptionServices
Access ControlServices
Secure AuditingServices
Digital SignatureServices
General SecurityServices
SUBSCRIPTION
Alert/NotificationServices
Pub/SubServices
MANAGEMENT
ManagementServices
ConfigurationServices
GENERAL
AuditingServices
Log MgmtServices
Policy MgmtServices
Exception/ErrorHandling Services
PRIVACY & SECURITY
20© 2013 Canada Health Infoway Inc.
EHR Infostructure: Longitudinal Record ServicesJURISDICTIONAL INFOSTRUCTURE
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
POINT OF SERVICE
HIAL
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
TerminologyRepository
Longitudinal Record Services
LONGITUDINAL RECORD SERVICES
DATA
Key MgmtServices
ETLServices
BUSINESS
Data QualityServices
Domain BusinessComponents
EHR IndexServices
OrchestrationServices
NormalizationServices
Business RulesServices
AssemblyServices
DataServices
ReplicationServices
TerminologyServices
21© 2013 Canada Health Infoway Inc.
EHR Infostructure: EHR ViewerJURISDICTIONAL INFOSTRUCTURE
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
POINT OF SERVICE
HIAL
EHR Viewer
Physician/Provider
EHR VIEWER
EHRi InteroperabilityServices
EHR ViewerBusiness Objects Components
NormalizationServices
End-userNavigation Services
Business RulesServices
End-userDisplay Services
DataServices
23© 2013 Canada Health Infoway Inc.
Research over the past several years has identified the independent evolution of four powerful forces: information, mobile, social and cloud. As a result of consumerization and the ubiquity of connected smart devices, people's behavior has caused a convergence of these forces.
Information is the context for delivering enhanced social and mobile experiences.
Mobile devices are a platform for effective social networking and new ways of work.
Social links people to their work and each other in new and unexpected ways.
Cloud enables delivery of information and functionality to users and systems.
Source: Mobile and the Nexus of Forces: Creating the New Experience, Gartner Research, June 25, 2012
Nexus of forces
The forces of the Nexus are intertwined to create a user-driven ecosystem of modern computing.
Copyright © 2013 Canada Health Infoway 24
“The digital world – the Internet and the cloud and supercomputing and social networking – is breaking medicine out of its cocoon. It’s a super convergence we’ve seen in other walks of life but not in the health and medical sphere.”
Eric Topol, MDquote from Wired MagazineFebruary 2012
Health super convergence
25© 2013 Canada Health Infoway Inc.
Introduction of “Cloud Computing in Health”• The first in the Emerging Technology white
paper series• Designed to address cloud computing from a
Canadian health care perspective• Intended to:
• Scope and provide insight on the potential applicability and utility for this technology
• Provide some context for business opportunities and challenges
• Suggest some possible approaches• Be a call-to-action for further focused conversations on
this topic
26© 2013 Canada Health Infoway Inc.
By the way: our Blueprint….JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
TerminologyRepository
Ancillary Data & ServicesRegistries Data& Services
EHR Data & Services DataWarehouse
ImmunizationManagement
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging Laboratory Health
Information
Hospital, LTC,CCC, EPR
PhysicianOffice EMR
EHR Viewer
Physician/Provider
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security MgmtData Privacy Data Configuration
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health Provider
Longitudinal Record Services
HIALCommunication Bus
Common Services
ClientRegistry
ProviderRegistry
LocationRegistry
27© 2013 Canada Health Infoway Inc.
Can be seen as Software as a Service
POINT OF SERVICE
Hospital, LTC,CCC, EPR
PhysicianOffice EMR
EHR Viewer
Physician/Provider
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health Provider
Jurisdictional EHR Infostructure
28© 2013 Canada Health Infoway Inc.
Possible use scenario
CommunityChronic Disease MgmtCare CollaborationCare Transitione-ReferralScheduling
Health RegionHospital
Home Care LTC
PrivateOperational systemsClinical systemsSpecialized apps
PublicReference InformationClinical Decision SupportSocial Networking(no PHI)
Clinics / FP
29© 2013 Canada Health Infoway Inc.
Key messages• Cloud is one of the top three CIO technology
priorities• Cloud is becoming increasingly visible to the
public and health care providers
30© 2013 Canada Health Infoway Inc.
Key messages (continued)• Cloud and SaaS are necessary computing
models for: • Data anywhere • User anywhere • Use from any device • Access anytime
• This is very aligned with the five Rs of the EHR and digital health: • The right information • About the right client • Available to the right person • In the right place • At the right time
31© 2013 Canada Health Infoway Inc.
Key assertions• There are many opportunities for use of cloud
in health• Greenfield deployments in community settings or at
program levels • A necessary computing model for e-referral, clinical
decision support, PHRs, chronic disease management and remote monitoring
• We need roadmaps and business cases to support the gradual migration of existing infostructures to private or community clouds and to determine how to deliver health care programs in a hybrid environment
32© 2013 Canada Health Infoway Inc.
Privacy and security considerations• All computing models have similar set of
privacy/IT security risks and requirements, such as authorized access to information and information resources (e.g., consent, RBAC), cloud computing is no different
• Privacy and security issues are manageable, but must be “by design” and take into account cloud context
• Key privacy and security differentiators of cloud deployment models • Level of transparency, oversight, governance, and
management of privacy and security controls
33© 2013 Canada Health Infoway Inc.
Cloud as an enabler• The scalability and extensibility made possible
by virtualization and service oriented architecture will be a critical success factors for coping with the proliferation of mobile devices and “apps”
• The pace of cloud adoption in health care is likely to quicken• Financial constraints• Demand for increased agility in response to social and
mobile drivers
34© 2013 Canada Health Infoway Inc.
Health information is the context for delivering enhanced collaborative and coordinated care experiences.
Point of service systems and mobiledevices are the platforms for effective social networking and new ways of work.
The health IT eco-system links people to their work and each other in new and unexpected ways.
Digital health infostructure as Software-as-a-Service in the cloudenables delivery of information and functionality to users and systems.
Nexus of forces in digital health
The forces of the Nexus are intertwined to create a user-driven ecosystem for digital health.
36© 2013 Canada Health Infoway Inc.
Website: www.infoway-inforoute.ca
ETG Resources: https://www.infoway-inforoute.ca/index.php/resources/technical-documents/emerging-technology
E-mail: [email protected]
Blog: http://infowayconnects.infoway-inforoute.ca/
Twitter: @Infoway
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