The Oracle HTB Designed for Healthcare Baltic ITT

The Oracle HTB Designed for Healthcare Baltic IT&T 2005 – Riga, April 8 Thomas M Jones, MD Vice President and Chief Medical Officer ®

Healthcare challenges Challenge Requirement Manage across the continuum of care Comprehensive patient centric record Assure data re-use for multiple purposes Standards-based data management Protect patient privacy and adhere to legislative mandates Access control, deidentification, reverse notification Leverage existing investments Transform and integrate data from any source

Healthcare activity Member (Covered) Costs s es pay Citizen manages ex pe administers Problem (Condition) Is a part of exhibits Plan Administrator (Arbitrator) Encounter (Event) Symptom (Sign) specifies es Facility (Area) um Pharmacy Resource (Means) Task (Offered Service) ns is a co Lab schedules has Staff Epicrisis (Problem Occurrence) Visit (Appointment) tra ck s tracks Account (Receivable) Medical Outcomes Caregiver rie Benefit Plan (Coverage) Economic Outcomes nc selects s ck tra Order (Directive) records has Radiology Equipment Provider (Organization) Service (Catalog) Care plan (Chart) Result (Measurement)

The importance of infrastructure Ÿ It is important to note that the provision of infrastructure services is an enabling mechanism. Ÿ The infrastructure itself will deliver some benefits, but the main outcomes will be achieved by the provision of additional applications and services. Ÿ As with any infrastructure, information technology infrastructure enables other systems that do yield business benefits. Implementing Information for Health - Denis Protti

A lifetime of care GP Dental Hospital Pathology Physiotherapy Birth

Current IT practice Building silos

A standards based platform Healthcare Transaction Base A Standard Information Model Health Level 7 RIM

One place to store everything – and to retrieve it for re-use Healthcare Transaction Base

Creating a single person record GP 32561 F HOSP 2345 PHY 4562 LG DEN 9001 Person Services A 10001 12324 Healthcare Transaction Base Single Identifier Patient: 123456

Integrating information HL 7 version 2. X Delaminated File HL 7 Version 3 Interface Engine XML Person Services Message Services Flat File Healthcare Transaction Base Bespoke Standard Single Record Patient: 123456 HL 7 Version 3. 0

Integration is more than just data exchange Ÿ HL 7 Mission Statement: “Develop specifications that support interoperability in healthcare, i. e. “computer systems exchanging information in the healthcare space will predictably compute on the exchanged information based on an agreed upon set of specifications defining the structure and meaning of the exchanged information. ”

More on interoperability Ÿ Syntactic interoperability – Structures are exchangeable but there is no guarantee that meaning will be consistent across system boundaries Ÿ Semantic interoperability – The exchange of meaning between systems Ÿ Computable semantic interoperability – The exchange of consistent and unambiguous meaning between two or more machines

HL 7 affiliates Ÿ Members include Argentina, Australia, Brazil, Canada, China, Croatia, Czech Republic, Denmark, Finland, Germany, Greece, India, Ireland, Italy, Japan, Lithuania, Mexico, Netherlands, New Zealand, Poland, South Africa, South Korea, Spain, Switzerland, Taiwan, United Kingdom, and USA

Why HL 7 works – many brains RIM Harmonization Meeting

Allergy RMIM

Adding to and reading the EHR Person Services Message Services Healthcare Transaction Base Single Record Patient: 123456

The ability to unify terminologies Dental Code ICD 10 Code Local Code LOINC Person Services Message Services SNOMED Code Terminology Services ICD 9 Code Healthcare Transaction Base Normalised Data SNOMED: 123456789

Incorporating rules Person: John Smith MRN 12345 Diagnosis: Carcinoma Colon Rule Processing Procedures: Colonoscopy Recent Results Sodium: 137 mm/l Potassium: 4 m. Eq/l 01 January 2004

Protecting patient privacy Support for evolving technologies Security Service Auditing Service Healthcare Transaction Base Single Source of Truth

Enhancing decision support Star Schema Drill to Detail Business Intelligence Healthcare Transaction Base Single Source of Truth Analytic Workspace

Rapid application development Application Programming Interface Healthcare Transaction Base Single Source of Truth

Supporting new healthcare applications and processes Remote Monitoring New Applications Application Programming Interface Healthcare Transaction Base Single Source of Truth Existing Applications

Healthcare Transaction Base Interoperability Framework Third Party Applications • Application Flow • User Interface • Proprietary Data Elements • Content (e. g. Protocols) Interoperability Platform • • Data Repository Messaging Services Terminology Services Configuration Services • • Security Services Auditing Services Person Services Business Process API Core Technology • Database • Application Server • Data Warehouse • Workflow Engine • Platform Security • Wireless Support

Current HTB projects - USA ŸDistrict of Columbia Department of Health ŸLos Angeles County Public Health System ŸNational Cancer Institute ŸUS Military Health Service – – RITPO Madigan Army ŸCMS ŸLouisiana Department of Health and Hospitals

Municipal Public Healthcare Workers Local Health Agencies Data Capture Applications Federal Authorities Internet Encounter Summary Results Access Incident Reports Healthcare Transaction Base i. HUB Researchers • • Messaging Services Person Services Terminology Management Security and Auditing Clinical Data Repository Facility ADT & Clinical Systems Data Mining Alert Notifications Data Warehouse

National Disease Surveillance Clinical and Public Health Systems Messaging Services Oracle. AS Integration • • Healthcare Applications Reporting & Analysis Application Programming Interface Data Warehouse HL 7 V 3 Reference Person Services Information Model Terminology Management Security and Auditing Business Process Support Healthcare Data Model Enterprise Data Model

EHR – Public Health Interoperability System Scenario Public Health Surveillance Clinical Care Hospital of Birth ADT – Birth Record Newborn Screening HL 7 2. 4 HL 7 3. 0 Oracle. AS Hearing Screening HL 7 3. 0 Integration Immunization Registry HL 7 2. 4 HL 7 3. 0 J 2 EE HTB API External Laboratory Hearing Screening Registry HL 7 2. 4 HL 7 3. 0 Immunization Administration Newborn Screening Registry Communicable Disease Registry J 2 EE Healthcare Transaction Viewer

Metropolitan integration Centralized decision support – Los Angeles County Executives Managers Researchers Internet Executive Information System Operational Day-to-Day Reports Cost Analysis Reports Historical Trending Encounter Lifecycle Monitoring Healthcare Transaction Base Interface Engine • • Messaging Services Person Services Terminology Management Security and Auditing Clinical Outcomes Data Warehouse Clinical Data Repository Business Process Data Warehouse ADT & Clinical Systems Financial Systems

Metropolitan integration

Results Review- Metropolitan

National Network Staff Physicians Community Physicians Patients Care Providers Internet Scheduling Organization Management Staff Management Healthcare Transaction Base Interface Engine • • Messaging Services Person Services Terminology Management Security and Auditing Clinical Data Repository ADT & Clinical Systems

Staff Management

Current HTB projects - Europe ŸGroupe Hospitalier du Havre ŸCreteil et Montreuil ŸFinsiel (Modena, Busto, Careggi) ŸCSC Scandihealth ŸSon Llatzer ŸStockholm County ŸCronos (Antwerp) ŸBiobank

Integrated healthcare information Groupe Hospital du Havre New Applications Legacy Applications Analysis and Reporting J 2 EE Healthcare Transaction Base • • HIS Messaging Services Person Services Terminology Management Security and Auditing Data Warehouse Clinical Data Repository Integration Engine External Data Warehouse ADT LIS CIS

Summary Ÿ The Healthcare Transaction Base is a standards based solution that: – is based on proven scalable technology – integrates healthcare data across single or multiple enterprises – provides a rapid application development environment for healthcare solutions – protects the IT investments of purchasers, partners, and end users – offers a unique service for citizens/patients world wide Application Programming Interface Healthcare Transaction Base

Thank you – tom. jones@oracle. com