A Cloud-Based Electronic Health Record Platform
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Transcript of A Cloud-Based Electronic Health Record Platform
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A Cloud-Based Electronic Health Record Platform
Henry Chueh, MD, MS闕 思 杰METS 2012
November 11-14, 2012
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Health Care30%
(n=150) Data from CDW Tracking Poll 2011
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What about clinical applications?
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BarriersSecurityPrivacy
Compliance
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IncentivesCost
AccessConsolidation
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Delivery
Transition
Agility
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1999
Millennium bug
Emergence of XML
Netscape dies, IE thrives
HTML 4.01
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OncallAn informatics platform to meet MGH’s clinically-related operational and research needs responsively, effectively, and efficiently
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Oncall goalsBe a user-driven platform
Support a common clinical record and integrate with existing systems and data
Support highly specialized workflow
Foster research on its technology and the clinical processes it supports
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OncallCloud-based
Web browser clientService-oriented architecture
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CoStAR EMRest. 1978
1981 users
178,037 patients
1,522,879 structured notes
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CoStAROncall
Data Services
Application ServicesXML
{ private cloud }
HTML
M database
SQL database
bulk
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App / Presentation
App / Business
Data
Request Flow
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Oncall: host to manyElectronic health record (EHR)
Discharge ExpressApprentice (Handoffs,
Signout)iHealthspace
TopCare Population HealthClinical Research toolKit
Anesthesia Pre-opProfessional Billing
Cardiac Lab OperationsCardiac Surgery Inpatient
Transplant Registries
Embryology LabObstetrics record
Neonatal BilicurvesSurgery Registries, M&M
Mobile workflow
…and many more
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Oncall usage growth
2006 2007 2008 2009 2010 20110
20000000
40000000
60000000
80000000
100000000
120000000
140000000
160000000
Volume
Page
hit
s
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Oncall usage growth
2007 2008 2009 2010 2011 20120
20
40
60
80
100
120
140
Concurrency
Hit
s / s
ec (
peak
)
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ScalabilityDatabase
External servicesSessions
Chaining services
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SessionsCookies or databaseReduced memory needsAvoid self-blocking
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1
RecursionParallel requestsSingle server pool
2
Chaining services
3
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ResultsOncall EHR
Discharge Express
Apprentice
iHealthspace
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Instead of “applications”…
…focus on content and workflow
Oncall as EHR
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Oncall “brands”Primary Care (IMA/APF/NEHC)
CardiologyCardiac surgery
Transplant ProgramFertility
ObstetricsReproductive endocrinology
Infectious diseaseAnesthesia
Emergency surgerySurgery
Vascular Center
>5,000,000 documents>1,000,000 patients
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Structured Notes“High blood pressure. Increase lisinopril for sustained high
systolic readings.”
“Inactivate cough. Resolved.”
“Pulse 75, BP 156/84, Weight 210.”
<PROBLEM> <CONCEPTID SCHEME=‘ICD9’>401.9</CONCEPTID> <RECORDEDNAME>Hypertension</RECORDEDNAME> <COMMENT> Increase lisinopril for sustained high systolic readings. </COMMENT> ...</PROBLEM><PROBLEM> <CONCEPTID SCHEME=‘ICD9’>786.2</CONCEPTID> <RECORDEDNAME>Cough</RECORDEDNAME> <COMMENT>Resolved.</COMMENT> <STATUS>INACTIVE</STATUS> ...</PROBLEM><VITALSIGNS> <PULSE>75</PULSE> <SYSTOLICBP>156</SYSTOLICBP> <DIASTOLICBP>84</DIASTOLICBP> <WEIGHT>210</WEIGHT> ...</PROBLEM>
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ElectronicHealthRecord
Direct Data Entry
Clinical LanguageUnderstanding
OutsourcedTranscription
Transcoding
“Correctionist”
>75%
Oncall
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Concepts by Year
SmartDictationOncall EHR
CoStAR EMR
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Discharge Express
2005 2006 2007 2008 2009 20100
10000
20000
30000
40000
50000
60000Dictation Online
Dis
char
ge S
umm
arie
s (t
otal
)
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ApprenticeHandoffs
Signouts
Progress notes
3700 users, 47 groups
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Apprentice
2007 2008 2009 2010 2011 20120
200
400
600
800
1000
1200
Daily Tasks
Task
s cr
eate
d / d
ay (
avg)
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Apprentice
…and ~1,000,000 daily progress notes in 20122008 2009 2010 2011 2012
0
10000
20000
30000
40000
50000
60000
70000
80000
Signout NotesSi
gnou
t no
tes
/ mon
th
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iHealthspace
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iHealthspace
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iHealthspace
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Oncall
Data Services
Application ServicesXML
{ private cloud }
JSON
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Acknowledgements
Octo Barnett, MD
Faculty and Staff,Laboratory of Computer Science
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Thank you谢谢