The transition from Island Healthcare Information Systems to integrated Care Record Systems

Christopher Varian

Kodak Health Imaging

European spend on ICT as a % of healthcare budget

• ICT Health budget and status of integration

1990 2000 2010

6%

5%

4%

3%

2%

1%

Isolated

applications

Communication

between

applications

Ad Hoc

Integration

Regional

Integration

EU / Global

Integration

• EU Acceleration of ICT spend

• UK NHS ICT Budget 2%

• EU Industry ICT spend 7%

Healthcare budget spend -HCIT

The challenge for ICT in healthcare

• Providing appropriate clinical information at the point of care to improve efficiency and quality

– Complexity of the healthcare process and the interdependences between the departments, hospitals and clinicians

– Legacy Information systems need to be integrated to provide the clinical pathway

– Validation of patient identification and the migration of data in island systems

– Security and authorisation of access to data – Cost of implementation and overall complexity of the integration

of island departmental systems due to different architectures – Lack of investment in ICT in health

The solution

• A system that will automate clinical information at the point of care

– Simplify the Complexity of the healthcare process by providing a longitudinal healthcare record

– Enable Legacy Information systems to be integrated to provide a clinical data repository

– Ensure an appropriate unique patient identifier is the starting point in for the master patient index.

– Reduce costs by Enterprise Information Management by consolidation and simplification

– Use existing industry standards IHE DICOM HL7 XML FTP …….

Radiology Cardiology ..ologies Other applications

Archive Storage BackupArchive

• DICOM archive• 50MB files• First generation

obsolete• “Closed” archives• Archive dedicated

to each PACS

• DICOM or non-DICOM

• Little or no archiving (DVD)

• 500MB/1GB files• Dedicated archive

• Non-DICOM• Little or no

archiving• Small files• Dedicated

storage

• Non-DICOM• Backup and

archiving• Small to very

large files• Dedicated tape

libraries

• Different vendors, isolated archives• No sharing of infrastructure• No sharing of information base• May be located at different sites

• Different vendors, isolated archives• No sharing of infrastructure• No sharing of information base• May be located at different sites

Standard Hospital environment Today

MPI & PAS

Hospital general storage content

Radiology Cardiology ..ologiesOther

applications

• 75% is fixed content• Storage volumes mainly in imaging• Exponential storage growth in the next

3 years

• 75% is fixed content• Storage volumes mainly in imaging• Exponential storage growth in the next

3 years

Data volume

Enterprise Information management Solution

Radiology Cardiology ..ologies

Archiving function

• Enhance IT productivity • Ease architecture evolution

• Ease Obsolescence Management

• Ease long term information management

• Globalize data protection

• Consolidate information

• Share the infrastructure • Optimize investment

• Ease information sharing

• Enhance information security

Main Advantages

Other applications

Nationally built locallyImplemented

Locally configured and locally implemented

Sample Set of Generic Processes

Flexible Toolkit to Support Range of Data and Viewing Requirement

Range of Care Settings

Resource scheduling

Bed Management

Ambulatory Care Management

Mental Health Act Administration

Domiciliary Care Management

Casenote and Film tracking

E-booking

Clinical Noting

Integrated Care Pathways

Screening

Management Information

Clinical Correspondence/Summary

Image Management

Clinical Decision Support

Master Patient Index (eMPI)

Order Entry

Confidentiality

Graphical Analysis

Authentication

Results

E-prescribing

Reporting

Cardiology Anaesthesiology

Intensive Care

Diabetes Theatres

Radiology

Pathology

MaternityOld Age Psychiatry

Radiotherapy

Child Health Screening

Trauma Rehabilitation

Respite Care

Palliative CareColposcopy

Nephrology

Endoscopy

DTCsACADs

GeneralPractise

AcuteHospital

CommunityNursing

HospitalPsychiatry

Therapies(OT/PT)

CommunityMental Health

DiagnosticDepartments

Home

TertiaryCare

NHS PrisonSocialCare

HospicesPrivateHealth

AmbulanceWalk-InCentres

MPIDemographics

E-booking

Electronic Transfer

of prescriptions

CommonServices

INT

EG

RA

TE

D C

AR

E R

EC

OR

D S

ER

VIC

E

Scope of LSP Responsibility

Overall Requirements for a national system

Kodak HCIS as part of a national record CRS

• Simplified system architecture and flexible workflow

– Both presentation (pull) and routing (push) models are supported

– Data moves from modalities to system RAID and is distributed from there

• Optimized use of distributed storage

– Central database manages all image storage components

– Centralized or physically distributed storage, including workstation storage

• Global view of all studies with sophisticated worklists

– Customized worklists based on filtered views of global database at any

workstation or client in the enterprise

• Enhanced system scalability and availability

– Software components are easily replicated across multiple hosts

– High-availability clustered server configurations

• Supports and uses DICOM 3.0 HL7 & IHE standards

– Integrates into CIS systems by agreed international standards

– Will support XDS and HL7v 3 when finalised

Kodak Enterprise archiving model

Archive

Viewing/diagnosticViewing/diagnostic capabilities

An enterprise wide Clinical data repository, accessible to every authorised users

Rad

iolo

gy

Other clinical applications

Epidemiology, research,…

Card

iolo

gy

Lab

orato

ries

Neu

rolo

gy

Ph

armacy

Orth

op

edic

Clinical Data Repository - CDR

Electronic Medical record

…

Long term data management

(media conversion, format conversion, …)

•Searching and viewing•Statistics•Reports…

Kodak VIParchive enterprise archive management view

VIP archive key features

• Multi source/Open archive– DICOM/Non DICOM, ”ology” and IT sources– Patient data consolidation– Makes use of IHE HL7 DICOM and future XDS standards

• Enhanced lifecycle management, clinical based – Adapt performance to content– Adapt preservation/retention to content

• Transparent access across multi sites – All data available from anywhere– With standard interface to End User tools

• Built in disaster recovery– Local or remote– From manual to automatic recovery

• Media technology and storage vendor neutral– All storage technologies supported (disk, tape, DVD…)– Management of obsolescence

• Scalability by design– Same software from small to large enterprise systems – Incremental architecture

Thank you&

Questions