Rockefeller Foundation

BellagioWorkshop

Week One:EnterprisePublic Health Informatics

(and Pathway to Interoperability)

What was this all about?

• Place • People• Mission• Ideas and ideals• Expected obstacles• Unexpected innovations drive novel

solutions• The way(s) forward

Bellagio: On hill above a lake and a picture-perfect hill-country town

National Health System in Context

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A National Goverment

October 21, 2008

People that would benefit from technology often have a difficult time imaging how a technology might change what they do,

Scott Adams captured it brilliantly…

Enterprise Architecture (The Open Group Architecture Framework)

Industry ConsortiumMembership LeadOutputs Approved by

MembersUses Industry StandardsContributes to StandardsArchitect Certification Program8 Versions in 12 Years

Background

www.opengroup.org

The National Health System as an Enterprise

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A National Health System

Are These initial Building Blocks Directionally Correct for an Appropriate

Architecture?

1. Health Services2. Laboratory3. Pharmacy4. Human Resources5. Environmental Monitoring6. Decision Support7. Health Finance

10/21/08 11

What Common Architecture Building Blocks are Needed First?

10/21/08

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Common HIS Architecture

65431 2

12111097 8

National HIS Architecture

1 1172

National HIS Solutions

B BAA

HIS Solutions

AAAAA A

BBBBB B

Goal

• Common set of interchangeable products• Modular approach to development• Open source approach

– Different groups spearhead modules of greatest interest to them

Data Sources Integrated Health Information System

Policies, Resources and Processes

Routine and Non-RoutineData Collection Activities

Conceptual Model of an Architecture

Extractand

IntegrateData

NCPHI: Health Protection Framework

Data

Inform-ation

KnowledgeDecisions

Plans

Actions

HEALTH THREAT

• Supply chain management

• Outbreak Management System• Countermeasure Tracking• HAN

• Biosense Integrator• PHIN Messaging• PHIN Vocabulary

• Nationally Notifiable Disease Surveillance System (NEDSS)

• Biosense

• Biointelligence Center• Epi-X

• Simulation

Health Protection Framework Foundation

EDUCATION

POLICY

EVALUATION

RESEARCH

APPLICATIONS & SERVICES

STANDARDS

Actions

Plans

Decisions Knowledge

Information

Data

HEALTH THREAT

Changing the Rules: IBM NHIN Prototype Architecture

Clinical Document Architecture

EA in Service Oriented Architecture Model

• Systems– Agile development– Combine functions if needed across categories to tailor

to workflow within county

• Services support systems– Vocabulary modeling– Document, patient and encounter identifiers– Storage and retrieval– User authentication– Population summarization– Data exchange

An SOA Enterprise Architecture

Patient ID Document ID

Encounter IDUser authenticationand security

Vocabulary modelingand cross mapping

Storageand retrieval

Population summarization

Data entry

DecisionSupport

Work flow management

Collaborationtools

Health services Laboratory Pharmacy

Finance Planning Environmental Monitoring

Real World Intrudes…

• Segment architecture complexity• Workforce and informatics capacity• Program specific information needs and

funding

Complexities of Segment Architectures

• Segments discussed– Laboratory– Pharmacy– Disaster response– Acute and chronic care– Vital statistics– Others

Lab System Complexity

Pharmaceutical Management

Pharmaceutical Care is Disease Specific

Emergency Response and Emerging Methods

Workforce and Capacity Issues

• What workforce– How can we (national governments) pay

these guys enough to keep them?

• What capacity?– Sierra Leone

Silo Oriented Funding Issues

Unexpected Innovations

• Mobile phone and text messaging for EMR access in Kenya

• San Paulo comprehensive public health system– EMR. Lab, Billing, and population health

management using an SOA framework

Moving Onward and Upward

• Country specific enterprise architecture

• Organized opportunism (SOA model)

• Collaboration to demonstrate benefits of integration

Commitment to address the Issue

• WHO Country EA efforts• NCPHI WHO Collaborating Center and

International Health Informatics Office• Rockefeller ?• Gates ?• Government led efforts disease specific

programs (USA and others) ?

The National Health System

Inte

rnal

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lth C

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Governorate SouthGovernorate WestGovernorate North Governorate East

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A National Health System

Design and Build Open Source Components Based on EA Map

10/21/08

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Common HIS Architecture

65431 2

12111097 8

National HIS Architecture

1 1172

National HIS Solutions

B BAA

HIS Solutions

AAAAA A

BBBBB B

Design and Build the Components Needed to for Country Applications and Systems

Patient ID Document ID

Encounter IDUser authenticationand security

Vocabulary modelingand cross mapping

Storageand retrieval

Population summarization

Data entry

DecisionSupport

Work flow management

Collaborationtools

Health services Laboratory Pharmacy

Finance Planning Environmental Monitoring

Tailor Comprehensive Systems to Program NeedsCore Comprehensive System

(San Paulo)

V1 tailored for HIV

V2 tailored for immunizations

V3 Tailored for malaria

SynergiesAnd healthbenefits

SynergiesAnd healthbenefits

Incremental expansionto a national system

Concluding Remarks From An Architect

Daniel Burnham

“Make no little plans; they have no magic to stir men's blood and probably will themselves not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will not die.”

(1846-1912)

Thanks to

And to PHI ….