Oracle HIE

Brazilian Ministry of Health:National Health Information Exchange Solution Dr. Augusto Cesar Gadelha CIO DATASUS/ Ministry of Health - BrazilLuiz Paulo Ribeiro Manager Middleware Platforms - CDSKumar Sivaraman Director, Product Strategy Oracle America

Healthcare system in BrazilHealth is a social right under the terms of this constitution 6th art. Constitution of 1988. (section)

225th largest country in the world. (7,682,300 Km2)5th largest population. (201 million) (2013)7th largest economy (GDP 2.2 trillion USD) (2013)Young democracy (Constitution from 1988)Political stabilityNational Federation5 Regions26 states + DF (Federal District)5,569 Cities (Municipalities)3Brazil: Facts and Data

Brazil is the only country with more than 100 million people which took the challenge of having an universal and free public healthcare system. In August 2013, Brazil had a total resident population of 201,032,714.

3More than 90 million people connected to the Internet100% of income tax forms are sent via Internet Electronic Voting System: a system with 135 million voters with election results in 4 hours35 billion electronic bank transactions in 2012We feel confortable about IT technologiesIntense use of social networks by internet users4Brazil: Facts and DataBrazil is the only country with more than 100 million people which took the challenge of having an universal and free public healthcare system. In August 2013, Brazil had a total resident population of 201,032,714.

4At the end of 80s, the Constitution of 1988 defined that it is a duty of the State to ensure the health of the population.To comply with this requirement, SUS was created ( Sistema nico de Sade Unified Health System) in order to provide universal healthcare access.DATASUS is the Ministry of Health Department responsible to provide necessary IT resources to the Ministry.5Healthcare system in BrazilBrazil is the only country with more than 100 million people which took the challenge of having an universal and free public healthcare system. In August 2013, Brazil had a total resident population of 201,032,714.

56About SUSUniversal healthcare accessThe health is a rightHealth is a right of all and a duty of the StateMore than 160 million citizens depend on SUSUniversal coverage, for freeIn all services and proceduresPrinciple of SUS:Equality of accessUniversality of servicesIntegrity in attentionFinance and Shared ManagementBy Federal, State and Municipal levelsThere are private healthcare insurance for those who can afford1.400+ healthcare insurances that provide coverage for more than 40M peopleThe ANS (National Supplemental Healthcare Agency) is responsible to regulate the health insurance sector.Brazil is the only country with more than 100 million people which took the challenge of having an universal and free public healthcare system. In August 2013, Brazil had a total resident population of 201,032,714.

67About SUS: NumbersServicesCount (2011)Month AverageAmount Paid per Year (2011)ProceduresHospital Admissions11.1 mi0.9 miR$ 11.2 bi112 miHigh Complex Procedures717.7 mi59.8 miR$ 5.8 bi3,600 miAmbulatory3,524.0 mi293.7 miR$ 15.2 bi3,524 miTotal4,252.8 mi354.4 miR$ 32.2 bi ~US$16 bi7,236 mi1 BRL 2 USD (2011)Brazil is the only country with more than 100 million people which took the challenge of having an universal and free public healthcare system. In August 2013, Brazil had a total resident population of 201,032,714.

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78About SUS: NumbersHealthcare providersPublicPrivatePhilanthropicSUS Providers65,33317,3314,812Non-SUS Providers168,150Brazil is the only country with more than 100 million people which took the challenge of having an universal and free public healthcare system. In August 2013, Brazil had a total resident population of 201,032,714.

8ObjectivesTo promote correct identification and individualization of health informationTo provide demographic information to support decision making of healthcare policiesTo provide access to electronic health record To promote interoperability between health IT systems with the national database (CADSUS).9National Healthcare CardIt identifies a SUS user (patient), allowing to create a link between the patient, healthcare professionals and providers where the healthcare services actions were taken.

(CNS)910National Healthcare Card The five is10Health Resources and Services AdministrationU.S. Department of Health and Human ServicesHealth information exchange (HIE) is the electronic movement of health-related information among organizations according to nationally recognized standards. The goal of health information exchange is to facilitate access to and retrieval of clinical data to provide safer, timelier, efficient, effective, equitable, patient-centered care.What is Health Information Exchange?Copyright 2014 Oracle and/or its affiliates. All rights reserved. | #DocumentRepositoryDocumentRegistryDocumentConsumerPatient Identity ManagerDocumentSourcePatient Identity Feed ITI-8 ; ITI-44 Provide and Register Document Set ITI-41 Registry Stored Query ITI-18 Retrieve Document Set ITI-43 Register Document Set ITI-42 Patient Demographic Query ITI-21; ITI-47 Patient Demographic Query ITI-21; ITI-47 Patient Identity SourcePatient Identity SourcePatient Identity SourcePatient Identity SourceDocumentRepositoryDocumentRepositoryDocumentSourceDocumentSourceDocumentConsumerDocumentConsumerTransaction FlowCross-Enterprise Document SharingCopyright 2014 Oracle and/or its affiliates. All rights reserved. | #12Transaction FlowDocumentRepositoryDocumentRegistryDocumentConsumerPatient Identity ManagerDocumentSourcePatient Identity Feed ITI-8 ; ITI-44 Provide and Register Document Set ITI-41 Registry Stored Query ITI-18 Retrieve Document Set ITI-43 Register Document Set ITI-42 Patient Demographic Query ITI-21; ITI-47 Patient Demographic Query ITI-21; ITI-47 Patient Identity SourceOracle Healthcare Data RepositoryOracle Health Sciences Information ManagerOracle Healthcare Master Person IndexCross-Enterprise Document SharingCopyright 2014 Oracle and/or its affiliates. All rights reserved. | #13Oracle Exalogic / Oracle Weblogic ServerOracle Exadata / Oracle DatabaseOrchestrated Integration Message-based Web Services Java APIHealth Information SystemsPublic Health SystemsClinical Information SystemsLaboratory Information SystemsDiagnostic Imaging SystemsPharmacy SystemsHealthcarePortalsOther Health Information SystemsStandards-Based Integration IHE Profiles IHE Web Services eHealth Exchange Direct/CONNECTOracle Healthcare Master Person IndexOracle Healthcare Data RepositoryOracle Health Sciences Information ManagerOracle Health Sciences Information GatewayOracle Healthcare Data ModelOracle Identity and Access ManagementOracle SOA Suite for Healthcare IntegrationOracle Health Information ExchangeCopyright 2014 Oracle and/or its affiliates. All rights reserved. | #14Supported IHE ProfilesPatient Identifier Cross Referencing (PIX) Patient Identifier Cross Referencing (PIX) V3Patient Demographics Query (PDQ)Patient Demographics Query (PDQ) v3Cross-Enterprise Document Sharing (XDS.b Document Registry)Cross-Enterprise Document Sharing (XDS.b Document Repository)Multi-Patient Queries (MPQ)Document Metadata Subscription (DSUB)Cross-Community Access (XCA)Cross-Community Patient Discovery (XCPD)Patient Administration Management (PAM Patient Identity Management PIM)Patient Administration Management (PAM Patient Encounter Management PEM) XAD-Patient Identity Change Management (XPID)Consistent Time (CT)Audit Trail and Node Authentication (ATNA)Oracle Health Information ExchangeSupported IHE ProfilesCopyright 2014 Oracle and/or its affiliates. All rights reserved. | #15Oracle HIE provides person de-identification, document indexing and national repository servicesPerson Index - to de-deduplicate multiple person identities and cross-reference all identifiers Document Index - provides access to participating individuals records from a range of repositories Document Repository - for storing health records and terminology services

SolutionsOracle Health Sciences Information ManagerOracle Healthcare Data Repository Oracle Healthcare Master Person IndexOracle Identity ManagementOracle WebLogic SuiteOracle SOA SuiteOracle Database

ResultsNational infrastructure for e-health records to realize one patient one health record goal Information available at point of care in support of key clinical decisions that can avoid delays in treatmentImprove quality of healthcare, lower costs of services, and promote effective health policiesOracle HIE Nationwide Implementations Copyright 2014 Oracle and/or its affiliates. All rights reserved. | #16OHMPI allows CADSUS to support multiple source systems, identify duplicates, and merge/unmerge recordsFull history of transactionsUse of Oracle Text for phonetic searchHosted in Oracle Exadata and Exalogic platformUse of Oracle SOA products for integration

17CADSUS Cadastro Nacional de Usurios do SUSPlatform responsible to promote interoperability and access to National Healthcare Card database. CADSUS Web is a web system that provide easy access to patient informationIt is available to any SUS healthcare provider to locate and add new patients The solution is design to assist those providers that dont have IT resources to maintain patient recordsCADSUS Service leverages OHMPI for patient identification 18CADSUS Cadastro Nacional de Usurios do SUSPlatform responsible to promote interoperability and access to National Healthcare Card database.

19CADSUS 5.0

1920CADSUS IntegrationsGeneral Vision21CADSUS Interoperability ModelInteroperability standards are regulated by an official directive: MS 2.073/2011Web Services and Security: SOAP and WS-*Document Coding: XMLDocument Registry and Repository: XDS.bPatient Identification: IHE PIXv3 and PDQv3TerminologiesLab Coding: LOINC (Logical Obs. Identifiers, Names and Code)Clinical Terms: SNOMEDImage coding: DICOMInternational Standards2122National EHRInformation and Business modelsInteroperability architecture (Service bus): deployed 2012Citizens Health Portal (PHR):deployed 2013Security and Privacy policy (and enabling tools)Technical architecture and infrastructureGovernance

2223National EHR - Interoperability

2324How to store data from this message

25 to this MoH MPI model ?

26IHE Profile on CADSUS PIXv3/ PDQv3The PIX and PDQ built using OHMPI IHE Profile frameworkIt maps the MoH MPI model to IHE ModelThe PIXManager and PDQSupplier web services interface were published to service bus in less than 3 weeksUse of OHMPI plugins for customized merge logic and CNS number generationOracle Service Bus compositions for reuse and orchestration with OHMPI IHE Profile

2627CADSUS IHE PIX/PDQ Solution Design

2728PIX Feed Flow

28Oracle Healthcare Master Person IndexOracle ExadataOracle ExalogicOracle WebLogic ServerOracle JVM JRockitOracle Access ManagerOracle Virtual DirectoryOracle Data IntegrationOracle SOA SuiteOracle Service BusOracle BPM SuiteOracle HTTP ServerOracle API GatewayOracle Enterprise Manager Grid Control 12cOracle Enterprise RepositoryOracle Service RegistryOracle Virtual MachineOracle LinuxOracle BIEEOracle Identity ManagerOracle Traffic Director

29Deployed Oracle Products 29Main ChallengesClear e-Health consensus and policies stillin developmentNeed to commit Healthcare Professionals and Providers (program is, so far, IT driven!)Complex governance system;Regional and economical diversity;Diversity of technical solutions (in use and in development);Limitations in connectivity and ICT infrastructure (specially outside large and medium urban areas);Lack of required expertise;Bureaucracies at public sector administrative processes Quick wins vs. strategic developments balance30Brazilian National e-Health Strategy

31Q&A

Thank you!Augusto Cesar Gadelha CIO DATASUS/SGEP/MS - augusto.gadelha@saude.gov.br Luiz Paulo Ribeiro Manager Middleware Plaforms - luiz.ribeiro@cds.com.brKumar Sivaraman Director, Product Strategy Oracle America - kumar.sivaraman@oracle.com

Data

Oracle Service Bus

OHMPI

Auxiliary EJBs

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cadsus.v5r0.wsdl

usuariosus.v5r0.xsd

BAM

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