Enterprise Wide Meta Data Archiveweb.idg.no/app/web/online/Event/hw/2012/presentasjoner/Flamme.pdf · • VMWare Products (Vsphere, LabManager, ….) • Network Environment ... •

Version: 30.10.2012 Dokument/Ersteller: Version: E. Flamme

A individual Story how to handle Big DataKlinikum Wels-Grieskirchen / Austria

01.11.2012Healthcare World Oslo

E. FlammeStrategic CIO

Enterprise Wide Meta Data Archive

Version: 30.10.2012 Dokument/Ersteller: Version: E. Flamme Seite 2

Where ist Wels located ?

Population County Districts Wels / Grieskirchen = 300.000Population Upper Austria Federal State = 1.400.000Population Austria = 8.000.000

Center of Austria

LinzWels

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Facts about Klinikum Fraternity Kreuzschwestern and Klinikum Wels Grieskirchen

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Fraternity „Kreuzschwestern“ / Partner Enterprises

Healthcare Public and PrivateHealthcare Education / Prevention

Nursing Homes / KindergartenTechnical Hospital Services

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Hospital GrieskirchenLocation Grieskirchen

• Since January 2008: One hospital on four sites• 1000 bed Hospital in Wels merged with 260 bed

Hospital in Grieskirchen and 60 bed Psychiatric Hospital in Wels

• 1.349 beds with over 80.000 inpatients per year• 37 departments, 26 different specialities

• 37 outpatient departments with approx. 290.000 outpatient visits /yr

• 30.000 operations and 2.600 births per year• Number of staff is 3.800 (including 500 doctors

and 1200 nurses)• Budget: approx. 288 million Euro

The largest Convent Hospital in Austria5th largest Hospital in Austria

Facts about Klinikum Wels – GrieskirchenA Cooperation of Fraternities Kreuzschwestern / Fran ziskanerinnen

Private Clinic PKALocation Wels

Psychiatric ClinicLocation Wels

Main Clinic Wels-GrieskirchenLocation Wels

Main ClinicWels-GrieskirchenLocation Grieskirchen

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• Since 2003 Developing Partnership with Siemens• SOARIAN Clinical Beta Side• SOARIAN Physician Letter / Emergency Department Moduls

• Evaluating, Improving and Developing Healthcare Sol utions together with X-tention and other Partners (HDS, CISCO)• eMEDIC (Medication Documentation and Reconciliation Tool)• MDES (CISCO Tiani IHE compatible eHealth Solution• eMIND – Healthcare Meta Data Archive as HCR with HDS

• Pilot Site for Public Healthcare Solutions• eMedication Austria / epSOS• Integration in the Upper Austrian eHealth Infrastructure (Pre National Pilot)

Klinikum Wels – Grieskirchen / XT Partnership – Sucse ss in Healthcare IT


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• Three data centers • One high availability data center (200qm) / Second with 180qm) – 80qm

separated and dedicated for X-tention and X-tention customers. • Backup Location (inside) and 60 miles away.

• 2.500 Clients• >100 Mobile Devices (iPAD on to clinical Tablets)

• > 500 servers (60% virtualized)• VMWare Products (Vsphere, LabManager, ….)

• Network Environment• CISCO SAN / LAN / WLAN

• HDS Enterprise Storage Environment• Hitachi Enterprise Solutions (Storage and Solutions)• NEXSAN S-ATA / SAS Beast (Dual Vendor Strategy Low Cost)• Falconstore VTL / Deduplication

Klinikum Wels Grieskirchen Infrastructure


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Challenges for Healthcare IT

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Healthcare Challenges for the next decades

Data out of Admin or HIS Systems

Data out of Modalities and other Healthcare-

provider

Additional Information Personal Training

Life ScienceWellness

Detailed (Genetic) and Epidemical and

Forensically correlations

Information about health related quality

of life

Treatment

Maintenance ofgoodHealthiness

Healing

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Challenges for Healthcare IT in Austria in the next years

Government's Expectations:• Cutting Costs• Centralization of IT Services and Providers • Collaboration between the different Health Care Providers

User / Clinician / Healthcare Professionals Expecta tions:• Data Exchange and Collaboration Support for Clinical • Integration of new User Interfaces and new Devices

including new integrations Strategies (BYOD / CLOUD ) )• Integration of new Software Platforms / User Interfaces

similar to „Apps“ / similar to Social Networks• Decision Support and integrated Knowledge

Management• Medical Platforms similar to social Networks as

(personal) PHR assentivs or part of a CRM Strategy

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The World of Heathcare Data is growing up ………………

from „birth“ to „death“


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From a large Number of Data

only a few documents are important

in a specific Situation

Our Challenge: Presenting Information


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Essential: “Data Suppliers” meets “Content Consumers”

• Main Data Suppliers in Healthcare are GP, Hospitals, Nursing Homes and HomeCare

• Main Consumers of Healthcare Information's are Healthcare Providers, Insurances, Science and Research

• Every Healthcare Employees and every Healthcare Consumer needs Application and Devices which offers him information:

• At the right time• At the right place• In the right context• At the right role

• An NEW: The Patient himself will be OWNER and CONSU MER of relevant Healthcare Data (PHR)

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Starting thinking about a (clinical) Meta Data Repository

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• Status Quo : Starting with PACS and a non DICOM Archive we needed additional archive solutions for SAP Digital Receipt Management, eHealth Repository, Email, Share Portal Server …..

• CEO Order: Look for a vendor who supports most of the our requirements !

• Considerations: Which vendor delivers most of our requirements and can help migrate from our previous archives?

We decided not to do so !

Looking for Solutions

What happens in five years ? Will we do this again, again and again ?

Version: 30.10.2012 Dokument/Ersteller: Elmar Flamme

1. Challenge: Avoiding Data Overload

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• Accessing and Presenting data in different context cases for patient treatment, science and education

• Considering Commercial interests (prevention rather than cure / medical trial evaluations / managerial decisions)

• Prepared to Support decision support systems with data

Meta Data Repository - A base for semantic networks solution soffering information for all Users in the right time, the rig ht placeand in the right context (Clinical / Administration / Busine ss)

2. Challenge: Stop Data Grave Yard

Version: 30.10.2012 Dokument/Ersteller: Elmar Flamme Slide 17

An Archive or Repository should not become a graveyard for da ta, information andknowledge

• Consolidation of the different archives, archive technologies, archivvendors

• Content archiving in one plattform forcommon access

• Avoiding permanent Data Migration producing or losing Data andInformation

3. Challenge: Delivering Data

• Compliance with meetings legal retention periods for data

• IHE compliance for health portals and health data exchange

• Data “Independence” – avoid migrations, yet easy to access

• Readiness for a “digital memory” of a hospital and a regional healthcare record


From “unstructered Data” to “structured Information


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From „Vision“ to „Reality“

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Our Vision

Adm. / ERP

System(HR, FI, CO, DW,

MM)

eHealth

GP Portal

Home Care Portal

Upper Austria

n eHealt

h Conne

ct

Clinicals / SchedulingClinical Information Systems

EHR / CPOE / PoC / ED

PACSLaboratory 3rd Party Departmental’ / Subsystems

Self-develop-

mentproducts

MedicationCoding

Displaying Information / Content in new Context

Version: 30.10.2012 Dokument/Ersteller: Elmar Flamme

What we understand under “Content” Services ?

• The knowledge to convert information into Standards and structured Information (like CDA).

• The knowledge to extract (Custom) Meta Data from structured Information.

• The knowledge to offer Custom Meta Data to Applications like “Snomed” or “.Dr. Watson” to display information in individualized views based on roles, events and different point of care.

• The knowledge to offer “Patient Safety Systems ” like Medication reconciliation Applications additional information.

• The possibilities to combine every object information under a knew Question.

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If you are Master of the Data (like a regional IHE repositories) you have under restriction of law and data privacy a lot of possibilities to develop Services around Content


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A clinical meta data repository needs high-availabl ity, flexible storage and content-based Platforms that a re…..

“Open” for Standards

• HL7• CDA• DICOM• PDF (PDF-A)• HTML• XML• XLS

“Open” for Access

• Enterprise Search Engine

• API-free Ingest from Multiple Sources

“Open” for Data

• Object Oriented

• System Meta Data

• Custom Meta Data


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Our Concept

“Meta Data Robot” analyzes and prepares data

Source systems exports data via standard interfaces

Hitachi Content Platform

Automaticextraction

and adding meta data information

Storing as Object (HL7 message /

PDF-A, DICOM, CDA)

API delivers result back to the Apps.

Target system inbound

Using API for Query

Source systems or Semantic Network Applications

• Meta Data Structure• Analyzing all enterprise document types (clinical/

office documents)• Analyzing the content of all documents• Analyzing the possible different levels for

information (equal content / different content)

Preparing Meta Data

Applications• Chose application which provides

extracting Meta Data � otherwhile usethe HCP Standard Features

Classification• Defining document categories• Defining rules and regulations• Choosing standards for automatic

classification of documents types and automatic content filtering

Consider your enterprise Architecture


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How we did it

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Example: Defining CDA Level 2 Document

Custom Meta Daten:Department / SpecialityInformation

Custom Meta DataSections

Custom Meta Daten:Diagnosis / Coding


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Example: RIS / PACS – DICOM / DICOM Header

Custom Meta Daten:DICOM Header + RIS Result Text


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Clinicals / SchedulingClinical Information Systems

EHR / CPOE / PoC / ED

Clinical User

Other Source Systems

Output Input

Access and Display via HIS System / Special Viewer Software


One Repository for All (Meta) Data


eMind

Master Index Specialised Indices

PACS

Kernel

Documents

IHE

HCP Lucene IHE-RegistryAIM

MetadataPACS-MD

DICOM-Header-Data

eMind-Metadata

IHE-Metadata

Documents

PACS-ApplicationIHE-

ApplicationKIS ISH

AIM

HDDS

StandardConnectors

Spe

cial

ised

Con

nect

ors

Whatever

WardApplication

Whatever˅


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HIS EHR Portal

Syndedra View

Microbiology

Radiology

User View

Pathology

…………..


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One Archiv, One Viewer for diff. Sources, diff. Appl.

Version: 30.10.2012 Dokument/Ersteller Elmar Flamme:

Search resultvia Meta Data on CDA Level 2

GP Portal ViewIHE Application

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Different Applications – Common View – One Archive


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Example: Phrase Search: „Duodenalschleimhautbiopsien“Expected Result: Pathology Results / Documents

CDA Level 2 Pathology DocumentDoc

umen

ts w

ith th

is P

hras

e

Search

Example for eMIND


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eMIND / HCR Document / Project Status

15 diff. Source Systems

500 diff. Documenttypes1.2 Mill Documents / Objectsexpected End of 2012….Physician Letter, LIS, Assesments, ECG ….


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Summary

Content Search / Forensic Search- Search over all (Custom) Meta Data (not on Object / Document)- Search for Phrases / Expressions- Including Objects (Pictures) which includes Expression and Phrases as

Custom Meta Data

Clinical Search- Real Time Search (depends from Transfer Time)- Search over PID (all Documents)

- Including Merges- Custom Meta Data Changes

- (including SAP Patient Reciepts � PID)

Administrative Search- SAP ERP / HR Documents- (later: Email)- (later: SharePoint)- (later: FileServer)


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Summary

Storing- Every (TextBased) Information is stored as CDA Level 2 Document- Every Information is stored as Orignal Information (HL7, TXT, …..)- Every (TextBased Information is stored as PDF-A- Meta Data can be changed / updated (without impact to orginal object)

Display- Every Stored Information can be displayed by

- XML Viewer (CDA-L2)- DICOM / NonDICOM Picture Viewer- PDF Viewer

Restoring- Every Information which is needed for Restoring is saved inside the Custom

Meta Data- No DataBase is needed – Only XML Tools for Reading Custom Meta Data

(TXT)

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Long Term Project (5 – 10 – 15 years)

• Building an enterprise-wide meta data repository needs a lot of preparation inside the enterprise organizations (Document Management, Standardization).

• Consider short-term requirements: A meta data repository can not substitute archive application solutions and most of the existing clinical and administration software is simply not ready for meta data yet.

• IHE is a key feature for improving patient treatment with the standardization based on IHE Profiles, CDA – clinical document architecture etc. With standardization you can extract META DATA Information.

• Greater flexibility and cost effectiveness: Having stored data in a generic way you are independent from migration timelines and costs. Change applications as and when needed for user acceptance and improving your processes.

• Implementing a Qualitiy Process for Data (similar to “Data Analyst”)

Version: 30.10.2012 Dokument/Ersteller: Version: 30.10.2012 Dokument/Ersteller: Elmar Flamme Slide 37


Contact

Strategic CIOE. FlammeKlinikum Wels – Grieskirchen A-4600 Wels, Grieskirchner Straße 42

Tel: + 43 / (0) 7242 / 415 – 9 - 3220, Fax: DW – 3774 / Mobil: + 43 / (0) 699 / 14163220

E-Mail: [email protected]: www.klinikum-wegr.at