The EMC OSA (Open Systems Architecture)

The EMC OSA (Open Systems Architecture)

The EMC Collaborative
Healthcare Solution at SaintPierre University Hospital,
Brussels, Belgium
TRANSFORMATION GATEWAY
Agenda
• Introducing Saint-Pierre University Hospital
• I.T. Strategy and Landscape
• Electronic Health Record and Clinical Documents
• Collaborative Healthcare Medical Image Sharing and
Management
Project in Saint-Pierre
• (Preliminary) conclusions
Saint-Pierre University Hospital, Brussels
• 600-beds University Hospital
• 1,700 employees
• Member of the IRIS public hospitals network of the Brussels
Region
• 20+ medical specialties
Saint-Pierre’s I.T. Strategy
• Long term partnership with suppliers
• Integration
– Intra-muros – Ensemble middleware
– within IRIS network – dbMotion platform
– within Brussels regional healthcare network
• Virtualization
–
–
–
–
Storage layer
Server layer
Client layer
Patient layer
Current I.T. Landscape
• Mostly vertical applications, in many functional
domains
–
–
–
–
–
Patient administration, scheduling, billing
Medico-Technical departments : lab, medical imaging, …
Real-time support : intensive care, surgery
Computerized patient records, global and per specialty
Logistics : pharmacy, transportation, catering, ...
• Multiple platforms
– Operating systems : Windows, Solaris, Linux
– Databases : Oracle, Informix, Microsoft SQLServer
• 200+ Servers
Medical Data aggregation in Saint-Pierre
Business Intelligence
Unified Patient Information Aggregation
Middleware
Application Modules
Digitalized
documents
General
Clinical
Data.
Specific
Clinical
data
Medical
Imaging
Analogical
Data
Web
Pages
Clinical
Biology &
Anapath
Other
MedTech
Medical Data aggregation (cont’d)
Clinical Data Repository
Document Cache Repository:
Medical document collector
Content of local node
Patients demographic data &
encounters
Structured clinical data : medications,
diagnosis, immunizations, allergies
DCR
CDR
Clinical Documents Indexes
LOCAL
LOCAL
NODE
NODE
Images indexes
Aggregation Layer
Middleware Ensemble
Data consultation platform
Applicative Layer
Admin.
Archives
Independent
storage
Clinical
Data
Departmental
data
Imaging
Analogical
Data
Production
Servers
Web
Pages
Labs
data
Other
M/T
Medical Data aggregation (cont’d)
Clinical Data Repository
Document Cache Repository:
Medical document collector
Content of cache
All documents stored in a repository (oracle
database) and converted in PDF.
A WebService allows retrieval and display of
documents when requested by the user
DCR
CDR
LOCAL
LOCAL
NODE
NODE
Aggregation Layer
Middleware Ensemble
Data consultation platform
Applicative Layer
Admin.
Archives
Independent
storage
Clinical
Data
Departmental
data
Imaging
Analogical
Data
Production
Servers
Web
Pages
Labs
data
Other
M/T
Data aggregation in the IRIS network
Integration in the ABruMeT Brussels Healthcare Network
and in the Belgian’s eHealth HUB-METAHUB Network
ABruMeT
IRIS Network
CoCoeur
dbMotion
CoSite
APPLIC
RELAIS
DCR
kmehr
MetaHub e-Health
Flanders
RSW
Topology of the eHealth HUB-MetaHUB Project
Electronic Health Record
“The electronic health record is a repository of information
regarding the health status of a subject of care in computer
processable form, stored and transmitted securely, and
accessible by multiple authorised users. It has a standardised
or commonly agreed logical information model which is
independent of EHR systems. Its primary purpose is the
support of continuing, efficient and quality integrated health
care and it contains information which is retrospective,
concurrent, and prospective”
ISO/TR 20514
Key capabilities of an EHR
Institute of Medecine, 2003
Health information and data
Immediate access to key information improve ability to
make sound clinical decision
Result management
Access to new and past results by all caregivers […] improve
patient safety and effectiveness of care
Order management
[…] enhance legibility, reduce duplication, and improve the
speed with which orders are executed
Decision support
[…] improve compliance with best clinical practices, ensure
regular screenings and other preventive practices, identify
possible drug interactions […]
Electronic communication and
connectivity
[…] improve the continuity of care, increase the timeliness
of diagnoses and treatments, and reduce the frequency of
adverse events
Patient support
[…] improve control of chronic conditions
Administrative processes
[…] improve hospitals' and clinics' efficiency […]
Reporting
[…] enable health care organizations to respond more
quickly to federal, state, and private reporting requirements
[…]
Content of the Electronic Health Record
• Demographic Data
– Patient ID, name, birthdate, gender
– Address(es), contact persons, …
– Health insurances, …
• Orders, Results, Observations
–
–
–
–
Biometric data, vital signs, clinical biology, …
Treatments : pharmacy, physiotherapy, …
Technical procedures and imaging : ECG, EEG, X-Ray, NMR, …
Progress notes
• Problem lists, alerts, allergy, risk factors,
• Documents
– Results, discharge letters, …
Documents in the EHR
• Documents are mostly snapshot s of a (small) subset of the
EHR, for communication and/or archiving purposes
• Legal status
• Generaly NOT structured
• Emerging standards like CDA and KMEHR
• Multiple formats : TIFF (…), PDF, Microsoft Word, …
• Basic part of minimalistic integration pattern for 3rd-party
software :
– Get patient ID and demographics from Master Patient Index
– Get patient contacts from ADT system
– Put examination report
• Metadata for indexing/classification purposes
Documents Registry and the Virtual Patient Record
Documents Registry
Saint-Pierre’s documents repositories
• Multiple sources, but mostly
– Digitalization of hand-written notes, reports, documents from external
institutions, … in the medical archives facility
– Electronic reports
• Huge and rapidly growing number
– 10+ Mio clinical reports (TIFF, PDF, Word, …) - 2 Tb
– 60+ Mio DICOM images from the PACS - 20 Tb
• Multiple storage
– Proprietary
– Oracle DB
– PACS
→ Looking for a strong partnership and for an all-in-one,
hospital-wide archiving solution with DICOM integration
EMC Proposal
EMC Collaborative Healthcare - Medical Image Sharing and
Management Solution
• Including EPA suite from DocByte
• Medical archive integrated into patient information system
• Vendor-neutral PACS archive
• Clinical information lifecycle management
• Cost-effective virtualized infrastructure
• J4Care zero-footprint DICOM viewer on Medical Image Sharing
archive device
Medical Image Sharing and Management Project at
Saint-Pierre:
Architecture before starting the project:
CD-Import
Application layer
PACS Viewer
DCR
PACS
XX.x
Medical Image Sharing and Management Project at
Saint-Pierre
Proof of Concept
• DCR – Documentum interface
– Define metadata
– Store PDF
– Retrieve PDF
• PACS – Document interface
– Via HealthCare Connector (HCC)
– Store all patient series for small subset of patients
– Store large mammography images
Medical Image Sharing and Management at Saint-Pierre
Proof of Concept
CD-Import
Application layer
PACS Viewer
J4Care
DCR
HCC (Health Care
Connector)
EMC²
Documentum
PACS
XX.x
Target architecture at Saint-Pierre
CD-Import
DBMOTION
J4Care
DCR
Radiology
HCC (Health Care
Connector)
PACS
EMC²
Documentum
Archive retrieval
(store&remember)
Medical Image Sharing and Management at Saint-Pierre
A view of tomorrow
CD-Import
Hospital A
EPR
J4Care
Radiology
DCR
PACS
HCC (Health Care
Connector)
EMC²
Documentum
Other
E-Mail
Doc
Multi
Media
Preliminary Conclusions
• Achieve robust enterprise storage & archive
– Enterprise documents
– Enterprise DICOM images
• Move away from vendor lock-in
• Avoid long and custom migrations in the future
• Healthcare-oriented Content Management platform
– Standards-based (Clinical Document Architecture, XDS
profiles, …)
– Full-text indexing
THANK YOU
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