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Les Lenert, NCPHI, CDC kenote speech slides for PHI2008, Seattle, WA, USA
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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
Inte
rnal
Aud
it
Hos
pita
l & L
ab
Serv
ices
Man
agem
ent
Serv
ices
Med
ical
Ser
vice
s
Nur
sing
Ser
vice
s
Hum
an R
esou
rces
for
Hea
lth
Fina
ncia
l Res
ourc
es
Dis
ease
Con
trol
&
Prev
entio
n
Dru
g &
Med
ical
Su
pplie
s
Supp
ort S
ervi
ces
Plan
ning
&
Info
rmat
ion
Prim
ary
Hea
lth C
are
Governorate SouthGovernorate WestGovernorate North Governorate East
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Just
ice
Tour
ism
and
Cul
ture
Tran
spor
tati
on
Mar
ine
Reso
urce
s
Soci
al W
elfa
re
Labo
r
Ener
gy a
nd P
ower
Trad
e &
Indu
stry
Inte
rnal
Aff
airs
Loca
l Gov
ernm
ent
Land
s
Publ
ic W
orks
-Hou
sing
Publ
ic A
ffai
rs
Agr
icul
ture
Hea
lth
Nat
ural
Res
ourc
es
Info
rmat
ion
& M
edia
Fore
ign
Aff
airs
Fina
nce
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
Inte
rnal
Aud
it
Hos
pita
l & L
ab
Serv
ices
Man
agem
ent
Serv
ices
Med
ical
Ser
vice
s
Nur
sing
Ser
vice
s
Hum
an R
esou
rces
for
Hea
lth
Fina
ncia
l Res
ourc
es
Dis
ease
Con
trol
&
Prev
entio
n
Dru
g &
Med
ical
Su
pplie
s
Supp
ort S
ervi
ces
Plan
ning
&
Info
rmat
ion
Prim
ary
Hea
lth C
are
Governorate SouthGovernorate WestGovernorate North Governorate East
Dis
tric
t N1
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tric
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tric
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tric
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tric
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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
12
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
Aud
it
Hos
pita
l & L
ab
Serv
ices
Man
agem
ent
Serv
ices
Med
ical
Ser
vice
s
Nur
sing
Ser
vice
s
Hum
an R
esou
rces
for
Hea
lth
Fina
ncia
l Res
ourc
es
Dis
ease
Con
trol
&
Prev
entio
n
Dru
g &
Med
ical
Su
pplie
s
Supp
ort S
ervi
ces
Plan
ning
&
Info
rmat
ion
Prim
ary
Hea
lth C
are
Governorate SouthGovernorate WestGovernorate North Governorate East
Dis
tric
t N1
Dis
tric
t N2
Dis
tric
t N3
Dis
tric
t N4
Dis
tric
t E1
Dis
tric
t E2
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tric
t E3
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tric
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tric
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tric
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tric
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tric
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tric
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tric
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A National Health System
Design and Build Open Source Components Based on EA Map
10/21/08
33
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 ….