Singapore’s National EHR - Adaptive Architecture for Transformation and Innovation
1. Singapore’s National EHR
Adaptive Architecture for Transformation and Innovation
Peter Tan Lead Enterprise Architect
pIT X – Berlin
15 November 2011
v
15/11/2011 1v
3. Context
Singapore
• 4.99 million people on 710.3 sq km
• Ethnically diverse:
• Chinese: 75 per cent
Singapore
• Malays: 14 per cent
• Indians: 9 per cent
• Characteristics:
• A city state • will of the people
• Rich technology foundations • less legal constraints
• Support of the Government • ‘it will be done’
15/11/2011 3
4. Context
National Infocomm Initiatives
3G & Free Island-wide
Wireless Hotspot
National BroadBand rollout
– Fiber Optic
2015 is Singapore’s
6th National IT
Masterplan, launched in
National 2 Factor Authentication 2006, http://in2015.sg
Cloud infrastructure
15/11/2011 4
5. Context
Our Healthcare Ecosystem
Primary Care Acute and Long-term Care
Intermediate Care
• 35,000+ healthcare workers
Community
Hospital
• 11,580 hospital beds
Polyclinics Nursing Home
Palliative
• 429,744 hospitalRestructured
Screening &
Preventation admissions (2007)
Hospital Care
General
• Public sector out-patient visits Care
Practitioners
Home (2007)
Public sector • Specialist Outpatient Clinics
Rehab & 3,687,910
Support
• A&E Services 752,122
Private sector
• Polyclinics 3,797,953
People sector
15/11/2011 5
6. Context
Transform
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
Picture taken from asiaone.com
So we have to respond to this by putting in more resources into
our hospital system, building new hospitals. “ And one key thing we must to
with this step-down care is
do
link up our acute hospitals […]
… get the whole system to be structured properly so that it will with community hospitals, so
be adapted to cater for the ageing population. To structure that you can have the best of
it properly means we need step-down care.” both worlds.
”
Prime Minister Lee Hsien Loong
National Day Rally 2009
15/11/2011 6
7. Context
Transform
Goal State: The Big Picture
• A pyramid model
• Anchored by regional Tertiary
hospitals Care
• More autonomy in day-
to-day operations Secondary Care
• Own networks of Screening &
Prevention
Polyclinics
CH
RH
NH
Palliative
Care
general practitioners
Home
FPs Care
Rehab &
support
services
CH CH CH
Polyclinics NH Polyclinics NH
• Step-down care facility
Polyclinics NH
Screening & Palliative Screening & Palliative
Prevention RH Care Prevention RH Care
Screening &
Prevention RH Palliative
Home Home Care
FPs Care
FPs Care Home
FPs Care
Rehab & Rehab &
support support Rehab &
services services support
CH
in respective zones
services
CH
Polyclinics NH
Polyclinics NH
Screening & Palliative
Screening &
Prevention RH Palliative Prevention RH Care
Care Home
Home FPs Care
FPs Care
Rehab &
Rehab & support
support services
services
Primary and Intermediate Long Term Care
General Community Nursing
Polyclinics
Practitioners Hospital Home
15/11/2011 7
8. Context
Transform
One Patient One Record Strategy
To accelerate sectoral transformation through an
Infocomm-enabled personalised healthcare delivery
Goal system to achieve high quality clinical care, service Health Information Exchange –
excellence, cost-effectiveness and strong clinical
research e-Enable seamless and secured
Greater Strong
information exchange in the
Well- Cost-
Integrated effective
ability of clinical and healthcare value chain
Outcomes Quality Healthcare
public to health
manage services
Healthcare Services
their health research
Strategic Enable integrated
Enable integration
between healthcare and
NEHR
Thrusts healthcare services
advances in biomedical
science
Health
Integrated Translating
Information
Exchange - e-
Healthcare Biomedical Integrated Healthcare Continuum -
Continuum – Research to
Strategies
Enable seamless
and secured
e-Enable Healthcare e-Enable processes and linkages
processes and Delivery -
information
exchange in the
linkages across integrate clinical across the healthcare value chain
the healthcare and biomedical
healthcare value
value chain research data
chain
iN2015 Strategic Framework
From iN2015 Healthcare and Biomedical Sciences Report
15/11/2011 8
9. Context
Transform
Adaptive Architecture Approach
(1) Top Down Strategy Focus on Develop
iN2015 Healthcare Governance Artefact
and Biomedical & Control Library
Sciences Report
?
Future
Focus on Planning &
Delivery Innovation
15/11/2011 9
10. Context
Transform
Proactive Vs. Passive Architecture Approach
Passive Architecture Proactive Architecture
Build the EA Balancing Goals and Objectives
Organization
Build the Principles Passion Meaningful & Explore Involvement
and Blue Prints Credible
Business “The Art of Excite and
Analysts, Architecture Possible” Encourage
Develop Gover-
Solution Analysis
nance Blue Prints
Architects,
Enterprise
Mandate Architects
Uptake
Committees and You may make a mistake, but don’t make the
Boards same mistake twice
15/11/2011 10
11. Context
Transform
Solution and Architecture Services Approach
• 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
15/11/2011 11
12. Context
Transform
Envision for each Stakeholder Approach
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 • Reputation for providing • Exceeded expectations of
information required to deliver outstanding service to patients & consumers & staff
the best possible care families • Value for investment meets /
• Streamlined interaction with high • Culture of wanting to share clinical exceeds the promise
calibre providers across the information with partners in care • Pre-eminence in Health IT and
healthcare sector delivery clinical research
• Encouragement to seek answers • Support to deliver the highest level • Innovative, evidence based systems
to clinical questions of clinical care outcomes • Satisfaction from the knowledge that
• Empowerment delivered by self- • Streamlined transfer of care the health system is sustainable
management capabilities • More time for direct patient care • Belief that the future population will
• Minimise inconvenience from due to less manual / paper based be healthier than before
unplanned encounters with the processes • Able to attract, develop and retain
health system • Trust in data analysis and entry of high quality clinicians
• Confidence that personal data is other clinicians • Confidence that health policy is
protected • Confidence in the quality of data based on decisions and insights from
robust operational data
15/11/2011 12
13. Context
To Enable Transformation Transform
Approach
and Innovation
Planned Components
15/11/2011 13
14. Context
Solving wicked problems: Transform
Approach
Source Data and Operations Current
15/11/2011 14
15. Context
Transform
In the last 3 years Approach
Current
3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
‘08 ’08 ’09 ’09 ’09 ’09 ’10 ‘10 ‘10 ’10 ’11 ’11 ’11 ’11
Value Value NEHR
NEHRA NEHR POC NEHR RFP detailed
design
NEHR
Value NHIS Design Live
From NHISA Scoping Assurance
Strategy to
Program ESB
focus From problem to
innovation: Value
Work Deep dive into a
Repository
Packages tricky problem space NEHRA
& take opportunity to Data/Doc next iteration
innovate.
Service Catalog
IIA Interop Specs
Extending to new CIC & PHM
Business Areas Architecture
EA Ops & Implementing operation
Tooling: EA Content
& governance only Gov & Operation
Repository population
Gov when needed.
15/11/2011 15
16. Context
Transform
Continue to Leverage and Extend Approach
Current
Gap analysis Look at Current
of current vs Goal State
NEHR system
Integration Identify new
analysis of business services
current systems and capabilities
Options analysis
Goal state architecture
15/11/2011 16
17. Context
Transform
Extended: Healthcare Capability Model Approach
Current
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
15/11/2011 17
18. Context
Reference Architecture example: Transform
Approach
Goal State EMR Current
cmp ABC-026-JHS
Cross (cluster) EMR
communication
«goal state» «goal state»
out of cluster :EMR EMR
A conceptual goal state EMR
system has been modeled to
add context to the application
getOTNotes
architecture and integration
putReconciledMedications
getEDNotes
putDischargeSummaryMetadata
putReconciledProblems
getDischargeSummaryMetadata
putDispensedMedications
resolveRecordLocation
getReconciledAllergies
getReconciledMedications
pattern.
putOTNotesMetaData
putEDNotesMetaData
getDischargeSummary
putReconciledAllergies
putOrderedMedications
getOTNotesMetaData
getRadiologyReport
getEDNotesMetaData
getReconciledProblems
putReferralLetter
putRadiologyReport
getImmunisations
resolveEndpoint
getReferralLetter
addImmunisation
putLabResult
getLabResult
sendMessage
getEvent
putEvent
getSCR
Used to resolve the Required to recieve
The conceptual goal state
address of documents
and document / referral
and deliver
communications from EMR’s capabilities are:
recipients other care providers /
• Integration
systems
NEHR
• Clinical data sharing
«OSB»
• Reconciliation
NEHR-ESB
«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
15/11/2011 18
19. Context
Transform
planningIT repository Meta-Model Approach
Current
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
15/11/2011 19
20. Context
Goal State Architecture Transform
Approach
operationalized in planningIT Current
Business Application Data
alfabet repository manages
indexes of the major entities,
Business
physical and logical, within the
MOHH enterprise.
Organization
Info flow (appln. srv.) Appln Svs Service
• Business Data Inventory
• Application Inventory
Info Information srv.)
Business Svs vs Appln Svs(appln. Flow
• Organisation Inventory
• Business Svs Inventory
• Appln Svs Inventory
• Information Flow
flow
• Info flow (appln. srv.)
• Appln vs Appln Svs
• Business Svs vs Appln Svs
15/11/2011 20
21. What We’ve Learned
01.
Focus on solving 02.
problems, not Build
just delivering relationships/ 05.
artefacts trust
Evolve from
where
you are
04.
03. Be pragmatic,
Be a servant not dogmatic
first,
policeman
later Revolutionaries
make
good Martyrs!
15/11/2011 21
23. Thank you!
Peter Tan
peter.tan@mohh.com.sg
15/11/2011 23 23
Notes de l'éditeur
- small country, but big city- but even in this small place, we have great diversityAnd I think the greatest advantage that Singapore has is “It will be done”
As for the Health care services, - we have the full spectrum of health sectors: Primary, acute & intermediate, and Long term care. moreover, in each sector, the ownership is divided between numerous independent institutionsThusthe challesges for EA, What we have is quite a fragmented IT landscape - For example Multiple EMR systems in place at Hospitals, Polyclinics and Specialist Clinics , Minimal EMRs at GP and across Community Hospitals We have regional hospital partnering step down care institution,
At present, Singapore is organized into a 3 tiers pyramid With Tertiary Care be supported by the two local university, NUS, and Duke NUS..At the secondary care, each of the 4 zone, West, east, North and central will be anchored by a regional hospital, …A new model being employed in the recent time… 4 region….And finally at the Primary care , it is supported by Polyclinics, GPs, Community hospital and nursing home.This is where our jobs become interesting. For example, when KTPH was build, and under the new regional hub model, KTPH has a choice, and the path they choose is a mix from both cluster….And as we look across there are some interesting development… for example the paperless system uniquely developed….So as the healthcare eco-system and the model of care evolve, EA will face a bigger challenges with the 4 hubs continuous to evolve and the expected silver tsunami and still support the national driver to manage cost and information exchange between hospitals.
Singapore do have an over arching strategy going back to 2006, …
Adaptive Architecture – is this an oxymoron? Some will say that architecture does not adapt, technology does. However our experience is that architecting with an ‘ability to adapt’ mind set brings different principles to the fore that influences the nature of the final architecture deliverable.
We’ve introduced a passionate architecting style outside of the comfort zone of traditional enterprise architects. There is an art to mixing passion and architectural analytics skills to produce meaningful and credible results. The passionate style is also useful when engaging stakeholders, being able to vocalize and sell “the art of the possible” excites people, encouraging them to be involved and have a say.By it’s very nature innovation attracts risk. To address this we try to continue to evolve an environment that tolerates high risk, accepts the potential impacts of taking on risk and encourages brave decision making.
Our architecture team extends from one providing traditional architecting services into a more hybrid model that provides the skills needed to understand and create business transformation, innovation and strategy, and integrate them into architecture.
Our architecture team extends from one providing traditional architecting services into a more hybrid model that provides the skills needed to understand and create business transformation, innovation and strategy, and integrate them into architecture.
Our objective has been to provide meaningful supporting infrastructure and services that enable transformation and innovation.
Solving Wicked ProblemsWe have entered a ‘VUCA’ world: Volatility, Uncertainty, Complexity and Ambiguity, and it’s becoming the norm for highly complex integrated eHealth programs. In response, we have actively established “problem solving” working groups, bringing together those who rise to the challenge of solving wicked problems.We strive to not only solve the EHR problem, but also consider the broader national connectivity, workflow and access problems that must be solved to enable true integrated health care.
The primary objective was never to develop a single, comprehensive target goal state – but to address future vulnerability and be adaptable to future requirements.
Going forward we will continue to leverage on and extend the foundations delivered with NEHR phase 1. As I am presenting this, our teams in Singapore are planning future phases of NEHR implementation focusing on business intelligence, research, personalized healthcare and the extension of integrated care. Building a national information exchange capability that ensures access anywhere anytime in a flexible way to support changing models of care continues to be paramount.
We will be ‘brave’ going forward supporting innovative initiatives that make our clinicians lives easier, provide better outcomes for patients, continuously ensuring Singapore is at the forefront of eHealth.