5/15/2007 10:22 AM
© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 1
Архитектура за Електронно Здравеопазване
Иля ФъртуновSenior ArchitectMicrosoft EMEA Public Sector
Представяне – Иля Фъртунов
• Над 28 години в информационната индустрия като консултант, разработчик и архитект в Европа, Северна Америка, Австралия и Азия
• В Microsoft от 1993 г. като консултант и водещ архитект на сложни разпределени системи (финанси, търговия, обществен сектор) – вкл. UK Government Gateway, NHS
• Автор на публикации на Microsoft по архитектура на информационни системи (MSDN Patterns & Practices Guides)
• Водещ автор на Connected Government Framework (CGF) и Connected Health Framework (CHF)
2Microsoft Connected Health Framework
Ролята на Microsoft в Здравеопазването
Трансформиране на предоставянето на здравни услуги чрез новаторско прилагане на информационни технологии и партньорства които подпомагат развитието накоито подпомагат развитието на здравеопазването чрез интеграция на грижите за гражданите, подобряване качеството и безопасността на услугите и намаляване на разходите за здравеопазване
3Connected Health Framework
Use
rs Clinical Records
Clinical Management
Outcomes Reporting
Disease Surveillance
Delivery Transformation
Seamless Health Delivery
Patient SafetyTimely Data
Reduce Transcription Errors
Increase Clinical Governance
Трансформиране на Здравеопазването чрез Технологии
По-добри Резултати за Пациентите, Медиците и Държавата
Electronic Medical Records
HealthcarePortals
Health I f i
HealthcareAnalytics
Compliance& Reporting
Financials
Bio-Surveillance
Vaccination &Immunization
Tracking
Diseaseя за
Здр
авеопазването
CaseManagement
ElectronicReferrals
Long Term C di i
PatientSelf-Service
Remote Care& Learning
Consumer
TimeIncrease AutomationReduce Input Burden
Negate Systems TrainingConnected Health Platform
Solution Platform INFORMATION, Business & Clinical Intelligence and Reporting
Organizational Productivity INTERACTION Collaboration, Mobility, Real-Time Data, CUIINTEGRATION Interoperability,
Core Infrastructure INFRASTRUCTURE, Systems Management ,DR, IDENTITY, Access Control,
InformationNetworks
PACsSystems
Clinical DecisionSupport
ConsumerEvidence
Tracking
EmergencyResponseNetworks
Polic
yИнф
раструктура
При
ложен
и я ConditionManagement
CaregiverCollaboration
Consumer Health Channels
HomeDevices
Contain CostsReduce DuplicationFund on OutcomesMinimize unneeded
admissions
BlueprintRoadmapReusable IPReferences
Privacy Accessibility
Usability Security Standards Interop
Архитектура за Електронно Здравеопазване (Connected Health Framework) VisionДефиниране на общоприложима архитектура за системи в здравеопазването– Съвети за изграждане на сервизно‐ориентирани системи за интегрирана здравна информация и
йвзаимодействие между участниците• Приложима на ниво звено (GP, клиника), регион и страна• Ефективно използване на ресурсите с по‐голям ефект• Основана на наложили се стандарти и протоколи
– Изграждане на екосистема от съвместими решения• Постигане на краен ефект по‐бързо и по‐евтино• Референтна рамка за решения от различни партньори• По‐лесно интегриране между отделните подсистеми
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Екосистема на Здравеопазването
Медици
Достнвчици на
МедицинскаНаука
ГражданиПациенти
Услуги
СтратегияЗакониПравила
Спонсори и Застрахо‐ватели
Наука
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 2
Здравеопазването е Сложна Система
• Здравеопазването се различава от други сложни системи:– Работните процеси силно варират и често се променят– Множество резултати, трудни за предвиждане– Използването на системите зависи от предпочитанията
бна потребителите и съществуващата практика– Системите трябва да се адаптират към реалните условия и постоянно променящата се среда
• Connected Health Framework отчита тези проблеми и ги решава чрез:– Отделяне на по‐динамичната част от системата (работни процеси и начини за ползване) от стабилната част (основни функции и структура на данните)
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Connected Health FrameworkBusiness Framework
• Използва сервизно‐ориентиран подход за да:– Дефинира функционалните (бизнес) компоненти и основните обекти за даннитеПредлага набор от “услуги” (services) които могат– Предлага набор от услуги (services) които могат да се комплектоват в различни набори да поддържат променящите се работни процеси
– Използва максимално съществуващите източници на информация и функции
• Предлага Business Pattern for Health
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Business Framework
9Microsoft Connected Health Framework
Connected Health FrameworkTechnical Framework
• Анализира вариантите за решаване на общите архитектурни проблеми:– Множественост на услугите, източниците на данни и интегрирани системи
– Идентификация и управление на пациентите и медицинския персонал
– Интегриране на разнообразни системи и платформи– Гъвкавост и настройване към промените– Безопасност и сигурност– Мащабиране, капацитет и надеждност
• Предлага Reference Architecture for Health
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Technical FrameworkCommunication
Operations Management
Security
Collaboration, Presentation and Point of Access, Identity Management, Privacy and
Security Services
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Security Services
Service Publication and Location
Shared Services
System Management Services
Communication Services
Data Services
Connected Health Services HubIntegration Services
Connected Health Framework ArchitectureCommunication
Operations Management
Security
Collaboration Services
Presentation and Point of Access Services
Identity Management Services
Privacy and Security ServicesUser Processes AGILEAGILE
Service Publication and Location
Shared Services
System Management Services
Communication Services
Data Services
Business Processes
Connected Health Services HubIntegration Services
Business Components
Service Component Interface
Data Access Logic ComponentsSTABLESTABLE
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 3
Основни Принципи на Архитектурата
• Сервизно‐Ориентирана (Service Oriented Architecture)– Позволява модулен подход и независимост– Използва стандартни интерфейси и протоколи– Фокус на основната рамка и функции, с последващо разширяване
• Мрежа за данни– Потребителските интерфейси като надстройкар рф р
• Федерация на данните– Първоначално фокус на минимален набор критични данни– Стопанисването на данните остава непроменено
• Федеративна идентификация– Оставя сложностите по идентифициране, управление на потребителите, ролите и правата им в периферните системи
• Надеждна– Безопасност, защита на личните данни, винаги достъпна…
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Варианти за Съхранение на Здравни Данни
• Преди всичко въпрос на политика и закони• Централизиран модел
– Пълна здравна история в централна база данни– Clinical Data Exchange (CDX) Gateway публикува данните и управлява синхронизирането
• Федеративен моделЦ б– Централната база не съдържа лични данни – само индекси къде има данни за съответния пациент
– CDX Gateway публикува сигнали за различни епизоди и временно съхранява пълната история получена по заявка от различни източници
• Хибриден (смесен) модел– Централната база съдържа само извлечение– CDX Gateway публикува извлечението и временно съхранява пълната история
– Може да бъде на мното нива и бази данни
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Проблеми на Интегрирането
• Варианти за интегриране– Директно, на база стандартни интерфейси
• Това е идеалният случай към който се стремим• Предполага съгласувани интерфейси• SOA поддържа директно интегриране• SOA поддържа директно интегриране
– Чрез адаптери• Централни• Разпределени
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Интегриране Чрез Адаптери• Без промени в съществуващите системи• Различни протоколи• Трудно за реализиране през WAN• Сложно за растеж
A
B
• Включването на нови системи изисква промени в центъра
HubB
C
D
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Интегриране Чрез Дистанционни Адаптери• Всяка система се интегрира до съгласувания стандартен интерфейс
• Промени във всеки възел ( x N ) • Един WAN протокол
A
B
X
X
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HubB
C
D
X
X
X
• Използва обща база завсяко конкретно интегриране
• Разработват се само уникалните елементи
Authentication Challenges• Scale (e.g. >1M employed by NHS in UK)• Organisational structures and practices• Authentication and access for users outside of the organization– Other organisations (e g social services)
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Other organisations (e.g. social services)– Citizens
• Non‐standard authorisation requirements – Role‐based– “Legitimate Relationship” aspect– Emergency override – “Sealed Envelopes” – explicit consent required
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 4
Pluggable Authentication Model
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Authentication Challenges• Scale (e.g. >1M employed by NHS in UK)• Organisational structures and practices• Authentication and access for users outside of the organization– Other organisations (e g social services)
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Other organisations (e.g. social services)– Citizens
• Non‐standard authorisation requirements – Role‐based– “Legitimate Relationship” aspect– Emergency override – “Sealed Envelopes” – explicit consent required
Microsoft Connected Health Framework
Core Models for Authentication
Single Realmfor users and resources
Separate Realms
ResourceResourceUserUser
DirectoryDirectory
Acct. Info
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Account info replicated between realms
FederationNo shared account infoUser presents federation claims with the request
UserUser
FSFS--AA
ResourceResource
FSFS--RR
Fed. Trust
UserUser ResourceResource
Microsoft Connected Health Framework
Federated Web SSO with a Portal
ActiveActiveDirectoryDirectory
FederationFederationSTSSTS
FederationFederationSTSSTS
SIDsSIDsFederationFederationClaimsClaims
ApplicationApplicationClaimsClaims
Health ApplicationHealth Application
Medical Medical InformationInformationPortalPortal
1. User accesses VZP Medical Information Portal to request some medical info
Healthcare SystemHealthcare SystemVZP InsuranceVZP Insurance
2. User redirected to VZP STS• Seamlessly authenticated using Active Directory & Windows integrated
authentication (Kerberos security token)3. User obtains SAML security token from VZP STS for Healtcare STS
• Federation claims per VZP and Healthcare business agreement 4. User obtains SAML security token from Health STS for the Health application
• Claims in the token (role, etc.) are specific to VZP5. User accesses seamlessly the Health application in the Healthcare system
Federation and Distributed Authorization
SIDs/AttribsSIDs/Attribs
Federation RealmFederation RealmFederationFederationClaimsClaims
ApplicationApplicationClaimsClaims
FederationFederationFederationFederation
Roles-based Access Control with Federated Web SSO
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AzMan (RBAC)AzMan (RBAC)RolesRoles
Resource RealmAccount Realm
Web ServerWeb Server
FederationFederationSTSSTSActiveActive
DirectoryDirectory
FederationFederationSTSSTS
Microsoft Connected Health Framework
Advantages of the Federated SSO Model
• Superset incorporating other models• Allows more flexibility long‐term• Maps easier to existing org. structures• Distributed user management
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Distributed user management • Easier to scale• Aligned with broader eGovernment services strategy (e.g. Government Gateway in the UK and other countries)
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 5
Federated Authentication Model
• Federated Authentication– Supports existing identity models from independent trust domains
– Authentication occurs in “home” domain
25
– Resources/Services accessed in “target” domains– Trust established between participating domains– Supported by industry web service standards:
• WS‐Federation, WS‐Trust, WS‐Security• Active Directory Federation Services (ADFS) implements WS‐Federation in Windows Server 2003 R2
Microsoft Connected Health Framework
An e‐Health Services Hub
• Common infrastructure that addresses the common architecture challenges identified earlier
• The Hub logically provides the required set of services – May be physically realized through a federation of hubs,
h idi b t f th i d ieach providing some subset of the required services• The Hub plays two roles:
– Provider of services to various types of consumers across a number of access channels
– Consumer of services provided by other systems or hubs
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An e‐Health Services Hub –Client and Provider Interactions
27Microsoft Connected Health Framework
Основни Услуги
• Високопроизводителен Индекс на Здравните Данни (Record Locator Service)– Подобно на DNS – може да е разпределен и дублеран– Не съдържа защитени лични данни
• Архив с медицински данни В зависимост от съответните закони правила и– В зависимост от съответните закони, правила и избраната архитектура
• Регистър на пациентите и идентифициране– Главен индекс при системи на много нива
• Услуги за сигурност и защита– Управление на федеративни данни и функции– Процедури за акредитиране на участниците (хора, системи, приложения, методи за идентификация,...)
– Права за достъп, контролни записи (logging), проверки28Microsoft Connected Health Framework
Допълнителни Услуги
• Предлагане на услуги от общ център (Hosting)– За малки и отдалечени участници с ограничени ресурси– Може да осигури висока надежност с малко разходи
• Обобщаване на данните за отчети и изследвания• Справочници и регистри за термини, к ас ф ка а оз екарс е сре с акласификации, диагнози, лекарствени средства
• Публикуване и получаване на информация по зададени критерии (“абонамент”)– Очистени от лични данни, за епидемиологични и други изследвания и мониторинг
– Независимо от обмена на на медицински данни• Информация за подпомагане на клиничните решения, лечение на база резултати
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Варианти на Топологии
• Generic hub as described can be deployed across a number of topologies:– Едно централно ядро– Слой за външно интегриране– Равностойни партньори– Йерархия
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 6
Централно ядро
• Services published by providers and consumed by clients from a single physical d l tdeployment
31Microsoft Connected Health Framework
Legacy Integration Hub
• Wraps, consolidates and publishes legacy services to e‐Health Hub
• Custom integration built on a common base
Hub
A
B
C
D
X
X
X
X
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Равностойни Партньори
• Federation of hubs based on separation of service
ibilitresponsibility, geographic, or performance constraints
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Йерархия
• Further federation of hubs based on the specific requirements and
t i tconstraints
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Interoperability
• Service Oriented Architecture– Detailed business collaboration specifications
• Core messaging and connectivity ‐ Web Services– Based on broadly accepted and adopted standards such as SOAP, WSDL
– Protocol or message security based on HTTPS tunnelingProtocol or message security based on HTTPS, tunneling protocol or WS‐Security 1.0/1.1
• Security federation– WS‐Trust family of specifications
• Agnostic to message payload– Clinical Data Exchange based on limited, normalized set of standards: HL7 v2.x, HL7 CDA, ASTM CCR, NCPDP SCRIPT, DICOM (?), HIPAA TS…
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Communication
Operations Management
Security
Collaboration Services
Presentation and Point of Access Services
Identity Management Services
Privacy and Security Services
Service Publication and Location
User Processes
B i P
CHF Ecosystem – Who does what?
Customer Specific(MS provides Guidelines,
Platform Products, Assistance)
SI Partner Provided(MS provides Reference Architecture
and SDKs)
Shared Services
System Management Services
Communication Services
Data Services
Business Processes
Connected Health Services HubIntegration Services
Business Components
Service Component Interface
Data Access Logic Components
36Microsoft Connected Health Framework
ISV Provided(MS provides Business Pattern – Component and Service Definitions)
MS or SI Partner Provided
SI Partner Provided(MS provides Reference Architecture and SDKs)
ISV or SI Partner Provided(MS provides platform and guidance)
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 7
Communication
Operations Management
Security
Collaboration Services
Presentation and Point of Access Services
Identity Management Services
Privacy and Security ServicesUser Processes
Microsoft’s Connected Health Platform
Office System
Office System, LiveMeeting,Exchange,
Windows Server System
Windows Mobile
Service Publication and Location
Shared Services
System Management Services
Communication Services
Data Services
Business Processes
Connected Health Services HubIntegration Services
Business Components
Service Component Interface
Data Access Logic Components
Visual Studio, .NET Framework
BizTalk Server, .NET Framework
Operations Manager, System Center
SQL Server
CHF in Context
38Microsoft Connected Health Framework
Building Solutions using the CHF
• Key scenarios depending on the role:– Customer ‐ Formulating Requirements (RFP)– Vendor/Systems Integrator ‐ Meeting Requirements (Responding to an RFP)
– Software Vendor ‐ Aligning an ISV Application with the g g ppCHF
– Infrastructure provider ‐ Establishing the Environment• CHF (Part 4) provides guidance for each, e.g.:
– Understanding Scope & Boundaries– Understanding the Required Features– Deriving the Architecture – Defining the Solution
39Microsoft Connected Health Framework
MSDN Health Industry Center
• Намира се на http://msdn.microsoft.com/health• Стартова страница, води до всички материали за разработчици и софтуерни архитекти в областта на здравеопазването
Връзки до всички други ресурси– Връзки до всички други ресурси• Полезна информация за:
– Доставчици на здравни услуги– Правителствени органи на различни нива, отговорни за здравето и социалните грижи
– Национални инициативи за електронно здравеопазване
Next Steps
• Connected Health Framework Architecture and Design Blueprint е публикуван и достъпен– Кратко обобщение http://www.microsoft.com/industry/healthcare/businessvalue/chframework.mspx
– Пълна документация на http://solshare.net , форуми иПълна документация на http://solshare.net , форуми и дискусии
– Контакт с местното представителство на Microsoft или [email protected]
• Think service oriented business and technical architectures– Използвайте богатите функции на платформата на Microsoft за сигурност, съвместна работа и обмен на данни, управление и интеграция…
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© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and
Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.
5/15/2007 10:22 AM
© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 8
CHF – from Requirements to Solution• Top 10 issues to address:
– How to create a Patient Health Record – How to build a lifelong health history for a patient from information held in multiple, diverse systems
– How to manage Identity and Authorities– How to identify a patient (or a healthcare professional) uniquely and reliablyuniquely and reliably.
– How to enable the creation of composite applications from different systems on different platforms
– How to interconnect diverse systems and how to make them interoperate
– How to communicate with remote systems– How to reuse legacy systems and applications– How to achieve organizational flexibility and agility– How to achieve performance and scalability
43Connected Health Framework - Part 1
Microsoft Healthcare Standards Strategy
Standards and Policy Strategy
• Microsoft’s engagement is driven (mostly) by:– Intent to implement the standard– Impact on industry, customer and partner’s ability to adopt key technologies
– Strategic engagement and thought leadership opportunity• Objective: drive the adoption of horizontal standards by profiling their use for health scenarios
• Approach– Improve Microsoft’s platform support for the standard or policy
– Help the organization leverage horizontal standards such as XML and Web Services
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Levels of Engagement
None Monitoring Engaging Driving• No engagement other than knowing the organization exists
g• Scanning newsletters and distribution lists
• Gauging customer’s interest on the activities of the organization.
g g g• Actively participating in discussions and the decision making process by exercising voting rights.
g• Writing specifications or policies and seeing them through the development process.
46Microsoft Connected Health Framework
Example: U.S. SDO and Policy Microsoft Engagement (CY06)
Solid Border: SDO; Dashed Border: Policy
47Microsoft Connected Health Framework
Health Level Seven (HL7)
• Healthcare SDO founded in 1987• 3,000+ members representing 1,000+ organizations from around the world– Providers, health plans, pharma companies, vendors, government agencies…
– 90% of largest healthcare ISVs WW• 30+ international affiliates
– Many have adopted HL7 as a government standard• Many liaisons with other healthcare SDO
– DICOM, CDISC, OMG, SNOMED, X12N (HIPAA)…
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 9
Microsoft and HL7
• Microsoft is Benefactor member of HL7 since 2000– Highest level of membership
• Participated to the HL7 Interoperability Demo in 2002‐2004– Showcase of HL7 standards
• Submitted Web Services proposal in Sept 2003– Now an official HL7 standard
• Submitted Web Services profiles for security and reliable messaging in Sept 2004
• Sponsor many projects and activities– Business Collaboration Framework (BCF) POC– HL7/CDISC Single Source Data Capture POC
• Released BizTalk Accelerator for HL7 in Feb 2004• Demonstrated Office support for HL7 standards
– InfoPath, Word, SharePoint
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HL7 Web Services Profiles
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Support for XML standards
• .NET Framework: developers’ framework• Office System 2003/2007
– Create and consume standard XML using familiar Office tools: InfoPath, Word, Excel
– Manage document repositories and document life cycle• BizTalk Server 2004/2006
– Messaging, Business Process Management, Business Activity Monitoring, Rules Engine
• SQL Server 2005– Store raw XML with schema support
51Microsoft Connected Health Framework
Conclusion on Standards
• Microsoft is committed to standards in healthcare and across the industry
• Microsoft unique approach– Ease of implementation– Better integration among platform components– Achieve better results faster (ROI)– Developed Partner Ecosystem
• BizTalk is the cornerstone of our Business Process Integration and Workflow strategy
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Connected Health Platform Accelerators
• MSDN Health Industry Center• Health Connection Engine• Common UI Effort
MSDN Health Industry Center
• Reach it at http://msdn.microsoft.com/health• One‐stop‐shop for all content for developers and software architects– Additional links to other resources
• Relevant to– Healthcare provider organizations– State and local government, federal Health and Human Services agencies
– National healthcare initiatives
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© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 10
Health Connection EngineCommunication
Operations Management
Security
Collaboration Services
Presentation and Point of Access Services
Identity Management Services
Privacy and Security ServicesUser Processes
HCE Services and Service Publication and Location
Shared Services
System Management Services
Communication Services
Data Services
Business Processes
Connected Health Services HubIntegration Services
Business Components
Service Component Interface
Data Access Logic Components
HCE Services and Registries
Messaging Management Services
Adapters
Messaging Management Services
Health Connection Engine (HCE)
• Open source project on http://www.CodePlex.com/hce
• Accelerates the development and deployment of connected solutions– Adapters SDKStandard set of Web Services– Standard set of Web Services
• Based on BizTalk, SQL Server and the .NET Framework
• First reference implementation in line with the Connected Health Framework – Architecture and Design Blueprint
• Developed in partnership with the New Zealand Health Cluster
Connected Health AcceleratorCommon User Interface
Common User InterfaceCommunication
Operations Management
Security
Collaboration Services
Presentation and Point of Access Services
Identity Management Services
Privacy and Security ServicesUser Processes
User Interface Components
User Interface Components
Service Publication and Location
Shared Services
System Management Services
Communication Services
Data Services
Business Processes
Connected Health Services HubIntegration Services
Business Components
Service Component Interface
Data Access Logic Components
Medical Research and Reference Services
Medical Research Services
5/15/2007 10:22 AM
© 2005 Microsoft Corporation. All rights reserved.This presentation is for informational purposes only. Microsoft makes no warranties, express or implied, in this summary. 11
Clinical Application ‐ Demonstrator
Clinical Application ‐ Design Guidance Medications Overview – Top Patient Safety Risks
• Clear, consistent display of medication information
• Unambiguous dose information• Clear distinction between items to be administered and items that are still clinicallyadministered and items that are still clinically relevant
• Clear indication of alerts associated with medication items
• Clear indication of ALL medications in the active medications list
• Provision of appropriate ‘summary’ indicators
Medications Overview ‐ Summary GuidanceThe same rules apply regardless of the form of the display
Medications Overview ‐ Summary Guidance
• Prioritise the display of drug or item name –spatially and stylistically
• Use dm+d term
• Use generic name (all lowercase) unless there is a specific requirement otherwise
• DO NOT use frequency abbreviations
• Separate dose from item name with at least 2 spaces
• DO NOT abbreviate the item name
• DO NOT truncate the item name
• Avoid wrapping the item name
abbreviations
• Always use labels where the value could be associated with more than one attribute
• Use useful forms of data (today) to increase clarity