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Жизнь после смерти, или о технологии перехода к новой
медицинской информационной системе с помощью интеграционной платформы
Жизнь после смерти, или о технологии перехода к новой
медицинской информационной системе с помощью интеграционной платформы
М.А.ШифринНИИ Нейрохирургии им. Н.Н.Бурденко РАМН
Москва15 сентября 2009 г.
Симпозиум InterSystems
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Life After Death,or on Technology of Transition
to a New Medical Information System Using Integration Platform
Life After Death,or on Technology of Transition
to a New Medical Information System Using Integration Platform
M.ShifrinN.N.Burdenko Neurosurgical Institute
Moscow15 SEptember, 2009
InterSystems Symposium
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N.N.Burdenko Neurosurgical Institute (R&D)N.N.Burdenko Neurosurgical Institute (R&D)of Russian Academy of Medical Sciencesof Russian Academy of Medical Sciences
•Established in 1932
•Now: new surgical building (1999)
►300 neurosurgery beds
►40 beds in ICU
►14 operating rooms
►Radio surgery department
►Neurorehabilitation department
►Full set of diagnostic and laboratory equipment
►~5500 admissions/year
►Out-patient department
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• 1 workplace ~ 400 • 5 users ~ 600• 1 user function ~ 150, supporting about
90% everyday clinical activity• A single interruption of the work of the system, all critical
functions were running• A single breakdown which halted a system for 24 hours
• 1 workplace ~ 400 • 5 users ~ 600• 1 user function ~ 150, supporting about
90% everyday clinical activity• A single interruption of the work of the system, all critical
functions were running• A single breakdown which halted a system for 24 hours
Electronic Patient Record SysytemElectronic Patient Record Sysytem2000 - 2009
Electronic Patient Record SysytemElectronic Patient Record Sysytem2000 - 2009
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Evolutionary development (1) Evolutionary development (1)
“spatial”“spatial” “functional”“functional”
“cognitive”“cognitive”
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Evolutionary development (2)Evolutionary development (2)
“Spatial” dimension:
• 1 working place ~ 400
• 4 users ~ 600
“Functional” dimension:
• 1 function (admission/discharge) ~ 130
“Cognitive” dimension:
• free text adequate formalization
“Spatial” dimension:
• 1 working place ~ 400
• 4 users ~ 600
“Functional” dimension:
• 1 function (admission/discharge) ~ 130
“Cognitive” dimension:
• free text adequate formalization
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What nextWhat next??What nextWhat next??
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Following Hamburg scoreFollowing Hamburg score……Following Hamburg scoreFollowing Hamburg score……
+Works 24/7
Intuitive interface
"Fine tuning" accordingly to the needs of the hospital
Support – 3 persons
The system is habitual
-Unsatisfied expectations:
•display of diagnostic images•connection with analyzers •connection with financial system•analytical options:
for scientific investigationsfor business and medical administration
• …
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""Inborn defectsInborn defects""""Inborn defectsInborn defects""
e-med – home-made system
•Poor documentation
•Business logic – part of the programme code
•A little supporting team – pluralism of functions
Transition to industrial system Transition to industrial system Transition to industrial system Transition to industrial system
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Objective difficultiesObjective difficultiesObjective difficultiesObjective difficultiesStructural contradictions
•Clinics vs. science: different data models
•Electronic document flow vs. decision support:different information technologies
•Heterogeneity of subject domain:diagnostic and treatment process (CIS)laboratory processes (LIS)obtaining, storing and transfer of images(RIS)administrative processes
IntegrationIntegrationIntegrationIntegration
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Transition DifficultiesTransition DifficultiesTransition DifficultiesTransition Difficulties
"Single step" or step-by-step?
•Large number of users, low level of IT qualification
•Variety of functions
•Variety of running systems
•Impossibility of halting main business processes
Transition platformTransition platformTransition platformTransition platform
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Industrial systemIndustrial system
+ + IntegrationIntegration
+ + Transition platformTransition platform
Industrial systemIndustrial system
+ + IntegrationIntegration
+ + Transition platformTransition platform
Integration platformIntegration platformIntegration platformIntegration platform
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Integration platformIntegration platformIntegration platformIntegration platform
OldOldOldOld Other systemsOther systemsOther systemsOther systems
EPREPREPREPR
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Integration platformIntegration platformIntegration platformIntegration platform
NewNewNewNewOldOldOldOld Other systemsOther systemsOther systemsOther systems
EPREPREPREPR
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Integration platformIntegration platformIntegration platformIntegration platform
NewNewNewNewOldOldOldOld Other systemsOther systemsOther systemsOther systems
EPREPREPREPR
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Integration platformIntegration platformIntegration platformIntegration platform
NewNewNewNew Other systemsOther systemsOther systemsOther systems
EPREPREPREPR
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AdvantagesAdvantagesAdvantagesAdvantages• Smooth transition without halting
business processes
• Permanent development
• "Best of Breed"
• Creating of integrated information environment
• Smooth transition without halting business processes
• Permanent development
• "Best of Breed"
• Creating of integrated information environment
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Last but not leastLast but not leastLast but not leastLast but not least
A hope not to meet transition problem in 10 years –
transition will be permanent
A hope not to meet transition problem in 10 years –
transition will be permanent
Transition to a new integration platform -
the problem for the supplier
Transition to a new integration platform -
the problem for the supplier
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DifficultiesDifficultiesDifficultiesDifficulties
As far as they appear…As far as they appear…
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HUB - MPIHUB - MPIHUB - MPIHUB - MPIe-mede-mede-mede-med
««ParusParus»»««ParusParus»»
LISLISLISLIS HSCHSCHSCHSC
PACSPACSPACSPACS
New services of New services of the EPRthe EPR
New services of New services of the EPRthe EPRPilot projectPilot projectPilot projectPilot project
IS IS ««Radiology Radiology treatmenttreatment»»
IS IS ««Radiology Radiology treatmenttreatment»»
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Pilot project: e-Med – TrakCare LabPilot project: e-Med – TrakCare LabPilot project: e-Med – TrakCare LabPilot project: e-Med – TrakCare Labe-mede-mede-mede-med
Buffer DB (MS SQL)Buffer DB (MS SQL)Buffer DB (MS SQL)Buffer DB (MS SQL)
Orders Results
TrakCare LabTrakCare LabTrakCare LabTrakCare Lab
Laboratory devicesLaboratory devicesLaboratory devicesLaboratory devices
Orders Results
EnsembleEnsembleEnsembleEnsemble
EPR
LIS
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Thank you for your attention!
Thank you for your attention!
[email protected]@nsi.ru