OHIOlympic Healthcare Interoperability Initiative

Advancing the seamless exchange and use of health information throughout the Olympic community

Wednesday February 22nd ● 1:30-2:30pm ● Interoperability Showcase Theatre

OHI

Agenda

• The OHI Initiative - background, description and

context

• Technology Infrastructure at the Rio2016 Games

• Designing and building an Interoperable

Healthcare IT infrastructure

• Questions and Discussion

2

OHIIntroducing the OHI Team

3

Michael Nusbaum, BASc, MHSA, FHIMSSBusiness Management

•Executive Liaison

•Stakeholder Relations

Flavia Dias Moreira, BBA, PMPProgram Management

•Planning and Governance

•Management Framework definition and communications

Todd Cooper, BATechnical Management

•Collaboration with vendors and health organizations

•Technical implementation leadership

• Healthcare Management Consultant

• International Expert: interoperability & standards

• Strategist, Visionary, Project Leader

• Board member: HIMSS & IHE

• Vancouver2010 Games volunteer: alpine events

• Extensive contacts in healthcare informatics industry

• Healthcare Management Consultant & Head of PMO

• Leadership Role in Rio2016 Games (5 yrs) - General

Manager and TOC Director

• Expert in Programme Leadership & knowledge management

• Relevant experience and knowledge in the Brazilian Public

and Private Healthcare system

• Healthcare Technology Consultant

• International Expert: trusted interoperable healthcare

systems & medical devices

• Expert in Interoperability standards, testing & certification

• Board member: IHE, HL7 FHIR Foundation

• Chair, US Delegation to ISO/TC215 Health Informatics

• Extensive contacts with Asia Pacific healthcare and

government leadership

OHI

The Imperative• Every two years, people from around the world converge

on a community to compete in Olympic Games

• Celebration of athletic excellence and inspiring the world to

strive to excel in every endeavor

• Providing the world's best healthcare services ecosystem

to all participants attending the Games - from athletes to

volunteers to spectators… supported by state-of-the-art

healthcare IT!

• The Olympic Healthcare Interoperability (OHI) initiative

seeks to advance the seamless exchange and use of

health information throughout the Olympic community,

before, during and after the games

4

OHI

Our MissionAdvancing the seamless exchange and use of health information,

using established international standards, to support an integrated

medical services infrastructure at each Olympic Games site.

The OHI network connects pre-Games person-specific healthcare

information with information generated at Games time by Olympic and

Host City service providers

5

OHI

Objective of the OHI Initiative• Increase the efficiency and effectiveness of the Olympic Medical Services functional

program through the integration of interoperable healthcare information technology

• Demonstrate to the world that the international adoption and implementation of

standards-based interoperable healthcare information technology directly impacts:

– Better health of the “Olympic Population” (athletes, coaches, volunteers, spectators)

– Improved health outcomes through availability of, and secure access to, appropriate information at

the right place, audience and time

– Reduction of total time for diagnosis and treatment

– Reduction of waste of human and system resources

– Improved care coordination, quality, safety, efficiency, population health

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OHI

What is Healthcare Interoperability?

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• The ability of different information technology systems and software

applications to communicate, exchange data, and use the information that

has been exchanged.

• Interoperable health information systems work together within and across

organizational and geographic boundaries, in order to advance the effective

delivery of healthcare for individuals and communities.

• Interoperability ensures that appropriate, accurate and complete

information is securely available to clinicians at any point of service,

at the time it is needed to facilitate diagnosis and treatment.

OHI

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The Current Healthcare IT Infrastructure

NOCs and their

own athletes

health records

“Polyclinics”

Host City Tertiary

Referral

Hospital(s)

Local EHR

Accredited

laboratories

Pharmacy

patient

records

“clinics” at venues Patient transport

records

OCOG Medical

Encounters (EHR)

Separate Systems

Separate Vendors

No integration

Digital

imaging

OHI

Future Interoperable Healthcare IT Model

9

NOCs and their

own athletes

health records

“Polyclinics” Host City Tertiary

Referral Hospitals

Accredited

laboratories

Pharmacy

patient

records

“clinics” at venues

Patient transport

records

OCOG Medical

Encounters (EHR)

Digital

imaging

Local EHR

Interoperability occurs here

And in here too!

OHI

The Olympic Opportunity

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• An integrated, multi-national, multi-disciplinary healthcare environment

• A multi-national patient population

Athletes(10,000’s)

Olympic “family”

(10,000’s)

Spectators

(1,000,000’s)

Target Populations

Volunteers

(100,000’s)

Olympics by the Numbers London 2012

# people per day using medical facilities 500

% of cases minor illness/injury 95%

# sports medicine doctors 46

# specialist physicians on call 80

% of athletes reporting injuries 11%

# blood & urine tests performed 6000

Prevalence of doping (reported/tested) 6.8%/0.81%

OHIValue Proposition

11

Monitor and better respond

to public health

outbreaks

Track athlete health, perhaps

trended over some longer time periods

Promote an Olympic class Longitudinal

Electronic Health Record

to support a patient through

the full Care Continuum

Clinical data can be anonymized

and made available to

IOC/OCOG for Analytics &

Planning

Demonstrate commitment

to innovation, to facilitate

welcoming the world

Facilitate the retention of the

medical and pharmacy patient records after the games, according

to national law and industry best

practice

Ensured that prohibited or

contra-indicated medications are not

inadvertently administered by the

OCOG medical team.

Enhance the quality and

efficiency of care provided to all participants

[reduced costs, increased safety,

etc.]

OHIValue Proposition

• Automatic alerts to the authorities (WHO and OCOG Public Health). e.g: Zica in Rio2016 http://www.mirror.co.uk/news/world-news/rio-2016-olympic-games-test-8144360

• Access to patient history and previous exams reduces medical errors, eliminates care delays, eliminates redundant procedures. e.g: Rio2016 incidents http://www.mirror.co.uk/sport/other-sports/most-dangerous-olympics-ever-horrific-8587095

• Easy and fast identification of an Olympic Family member involved in a car crash. e.g: Germany canoe coach in Rio2016 http://www.abc.net.au/news/2016-08-16/german-canoe-coach-dies-car-crash-rio-2016/7746580

• Alerts for prohibited and contra-indicated medications during prescribing. e.g: asthma treatment https://www.sciencedaily.com/releases/2012/04/120424210526.htm

• Preventive Care for patients with preexisting diseases. e.g: the case of the French physiotherapist in Rio2016 http://www.smh.com.au/sport/olympics/rio-2016/olympics-off-the-field/french-olympic-tennis-team-physiotherapist-dies-in-rio-20160813-gqrxp0.html

12

OHIIndustry Support

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• Well-Supported by the International Health Informatics Industry

• Industry (non-commercial) sponsors have been eager to come on-board, either to “endorse” the initiative, or to provide support during the start-up phase

Healthcare Information and

Management Systems SocietyHIMSS is a global, cause-based, not-

for-profit organization focused on

better health through information

technology (IT). Recognized as the

premier worldwide industry

association representing clinicians,

users and vendors of healthcare IT.

SNOMED InternationalGlobal leadership in healthcare

terminology, ensuring that SNOMED

CT is accepted as the common

language for health terms

worldwide.

OHIInternational Healthcare SDO Support

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• ISO/TC215 – Worldwide standards for Health Informatics

• Joint Initiative Council – collaborative of international health IT SDO’s

• IHE International – world leader in healthcare interoperability standards

• HL7 - standards for the exchange, integration, sharing, and retrieval of electronic health information

• GS1 – world leader in identification standards

* Standards Development Organization

OHI

Rio2016 Technology

15

OHI

Rio Technology Structure

16

OHI

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Program Management

Projects and programmes

588

Policies and procedures

460

Contracts

60

Headcount

Paid staff

412

Contractors

5509

Volunteers

1341

Operational

readinessTest events

43 venues

2yrs to go

Technical rehearsals 1 and 2

24 venues

6 and 3mths to go

OHI

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NOCs/NPCs

Press

Broadcasters

IFs

Athletes

Olympic and Paralympic

Family

T&S and OVR (e.g.

scoreboard, TVG)

INFO Diffusion

(e.g. INFO, CIS, IDF)

CATV

GMS

Internet infrastructure

Technology equipment

Reprographics

IT security

Spectators

Fixed and mobile

telephony

Call centre infrastructure

Mobile and internet

applications

Data network

Trunk radio

Frequency spectrum

WorkforceAudio and video systems

Intercom

Omega

AtoS

Panasonic

Samsung

Embratel/Claro

Symantec

Computer and Reprography

Suppliers

Cisco

Trunk radio suppliers

Intercom supplier

Anatel

Facilities

(e.g. TOC, EDC)PartnersCabling

ClientsServicesProviders

217+160

5962

+500 TVs

28

15636

+50000 vol

54

3.5 Bi

172000 park

+10000

OHI

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SecurityHardware and SoftwareSystems and applications

60Desktops

6307Laptops

8833Reprographic equipment

1980

CRM

Records transferred to IOC

2.43 million

Ticketing 1.5 million

Push notification 0.6 million

Workforce 0.3 million

Newsletter 0.1 million

Security events

12 BillionSecurity incidents

2000Impact

0Website and Mobile app

Threats (blocked attacks)

30 Million

OHIInfrastructureServers

66 Admin

72 Games

LAN Ports

Installed 94776

Activated 62000

Email and

SW licensesEmail accounts

17674Software Licenses

13872

20

Service deskTickets in August 2016 (Games Time)

29739Tickets in July 2016

(Bump In)

28385Tickets in June 2016

(Bump In)

20966

OHI

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Telecommunications

Mobile phones

25000

Landlines

6800

Radios

12600

Frequencies

32531

Shared

15396

Dedicated

17135

Wi-Fi APs 3267

BoH 1800

FoH 1187

Buses 280

OHI

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WebsiteUnique users

47 million

Page views

468 million

Hits

9,1 billion

Downloads

7,4 million

Screen views

1,1 billion

Hits

11,3 billion

Mobile App

OHI

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Video AudioMainframes 43

Operator panels 318

Annoucer panels 131

Beltpacks 430

Headsets 748

Analogue radios 383

FM announcer 28

Intercom

TVs

13400

M2 LED

1886

Venue PA systems 48

Mag&bag PA systems 33

Tech tables 43

Medals ceremonies 43

Mixed zone 40

Conference 34

VTO PA systems 40

Interpretation

systemBooths 41

Interpreter panels 41

Headphones 3000

IR radiators 20

IR modulators 8

Conference rooms 8

Language channels upto10

OHI

24

ResultsT & S Equipment

450 tons

Incoming ODF messages 1.7 million

ODF messages sent to customers 109 million

ODF customers 58 RAC, 11 internal

ODF support e-mail messages sent 6.888

PRD messages sent16.000

Print jobs 161.933

myInfo+ used accounts

9071

Info+ kiosks

577

OHI

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CompetitionVenues

OperationsCenter

Broadcasters

Press

OlympicNetwork

ODF

On-venue Results

Athletes

Spectators

Internet

Generalpublic

Olympicand Paralympic Family

Technical infrastructure at Olympic games is a world-class challenge!

OHIDesigning and building an Interoperable Healthcare IT infrastructure

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Bringing the OHI vision of

seamless interoperability

to an extensive, complex,

and dynamic technical

infrastructure

OHIOHI will not reinvent the wheel!

Leverage established international

standards

Leverage “connectathon” & other

testing events

Focus on Olympic use cases

across entire Olympic community

Include technical, semantic &

functional interoperability

“Future proof” OHI implementation

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OHIAn Interoperable Healthcare Ecosystem

Interoperability across Care Continuum

Interoperability is a fundamental

component of today’s modern

healthcare ecosystem

Interoperability allows health

information to flow seamlessly across

the continuum of care

Interoperability can be expressed as

functional, semantic, technical:

Interoperability across

Geography

Interoperability allows health

information to be available

across geographical

boundaries (cities, states,

countries)

System

A(Vendor

A)

System

B(Vendor

B)

System

A(Vendor

A)

System

B(Vendor

B)

UserQuery

Response

Direct

Infrastructure

Interoperability Architectures

Based on international

standards

Example Implementation Architecture

International standards in this example include: Transport: ISO 28380, IHE

XDS.b, XDM Content: IHE XDS-MS, HL7

IPS, CDA, HL7v2, HL7 FHIR Semantic: SNOMED CT Functional: IHE XDW, IHE

GAO Security/Privacy: ISO

27799, IHE BPPC, ATNA

Patient Identity Source

Document Registry

Document Repository

Document Source

Document Consumer

Patient Identity Feed

[ITI-8]

Patient Identity Feed

HL7v3 [ITI-44]

Provide&Register

Document Set-b [ITI-41]

Retrieve Document

Set [ITI-43]

Registry Stored

Query [ITI-18]

Register Document

Set-b [ITI-42]

OHI

Phased Implementation Approach• Proof of Concept

– OHI concepts have been socialized since 2011, to vendors, OCOG’s, NOC’s, SDO’s and

other organizations, consistently meeting with enthusiastic support from all areas to move the

initiative forward.

• Demonstration & Pilot

– Use OHI as a means to demonstrate the power of open standards-based interoperability in a

controlled, international environment – the Olympics!

– Begin phasing-in components to the Games

• Program Implementation

– The long-term vision is to see OHI implemented as integral part of the Olympic Medical

Services Functional Program, with every NOC eventually participating and every host city’s

healthcare infrastructure connected.

29

OHI

Next Olympic games …

30(Source: www.olympic.org/olympic-games)

… each bringing unique opportunities and challenges

OHI

Questions & Discussion

31

Michael Nusbaum

michael@mhnusbaum.com

Flavia Dias

flaviadias_br@icloud.com

Todd Cooper

toddcooperafc@gmail.com

Advancing the seamless exchange

and use of health information

throughout the Olympic community.