Download - Brazilian Ministry of Health :

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 Brazil

“Health is a social right under the terms of this constitution” – 6th art. Constitution of 1988. (section)

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5th 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)

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Brazil: Facts and Data

More 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 users

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Brazil: Facts and Data

At the end of 80’s, 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 Único de Saúde – 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.

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Healthcare system in Brazil

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About SUSUniversal healthcare access

The health is a right Health is a right of all and a duty of the State More than 160 million citizens depend on SUS

Universal coverage, for free

In all services and procedures

Principle of SUS: Equality of access Universality of services Integrity in attention

Finance and Shared Management By Federal, State and Municipal levels

There are private healthcare insurance for those who can afford

1.400+ healthcare insurances that provide coverage for more than 40M people

The ANS (National Supplemental Healthcare Agency) is responsible to regulate the health insurance sector.

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About SUS: Numbers

Services Count (2011) Month Average

Amount Paid per Year (2011) Procedures

Hospital Admissions 11.1 mi 0.9 mi R$ 11.2 bi 112 mi

High Complex Procedures 717.7 mi 59.8 mi R$ 5.8 bi 3,600 mi

Ambulatory3,524.0 mi 293.7 mi R$ 15.2 bi 3,524 mi

Total 4,252.8 mi 354.4 mi R$ 32.2 bi ~US$16 bi 7,236 mi

1 BRL 2 USD (2011)

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About SUS: Numbers

Healthcare providers Public Private Philanthropic

SUS Providers 65,333 17,331 4,812

Non-SUS Providers 168,150

ObjectivesTo 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).

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National 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)

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National Healthcare Card – The five i’s

Identification

Interoperability

IntegrationInfrastructure

Information

Copyright © 2014 Oracle and/or its affiliates. All rights reserved. | 11

Health Resources and Services AdministrationU.S. Department of Health and Human Services

“Health 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?


DocumentRepository

DocumentRegistry

DocumentConsumer

Patient Identity Manager

DocumentSource

Patient 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 Identity SourcePatient Identity

SourcePatient Identity SourcePatient Identity

Source

DocumentRepositoryDocument

Repository

DocumentSourceDocument

Source

DocumentConsumerDocument

Consumer

Transaction FlowCross-Enterprise Document Sharing


Transaction Flow

DocumentRepository

DocumentRegistry

DocumentConsumer

Patient Identity Manager

DocumentSource

Patient 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 Identity Source

Oracle Healthcare Data Repository

Oracle Health Sciences Information

Manager

Oracle Healthcare Master Person Index

Cross-Enterprise Document Sharing


Oracle Exalogic / Oracle Weblogic ServerOracle Exadata / Oracle Database

Orchestrated Integration

• Message-based• Web Services• Java API

Health Information Systems

Public Health Systems

Clinical Information Systems

Laboratory Information Systems

Diagnostic Imaging Systems

Pharmacy Systems

HealthcarePortals

Other Health Information Systems

Standards-Based Integration

• IHE Profiles• IHE Web Services• eHealth Exchange• Direct/CONNECT

Oracle Healthcare Master Person Index

Oracle Healthcare Data Repository

Oracle Health Sciences Information Manager

Oracle Health Sciences Information Gateway

Oracle Healthcare Data Model

Ora

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SOA

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Oracle Health Information Exchange


Supported IHE ProfilesPatient Identifier Cross Referencing (PIX)

Patient Identifier Cross Referencing (PIX) V3

Patient Demographics Query (PDQ)

Patient Demographics Query (PDQ) v3

Cross-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 Profiles


• Oracle HIE provides person de-identification, document indexing and national repository services• Person Index - to de-deduplicate multiple person identities and cross-reference all identifiers • Document Index - provides access to participating individual’s records from a range of repositories• Document Repository - for storing health records and terminology services

Solutions• Oracle Health Sciences Information Manager• Oracle Healthcare Data Repository• Oracle Healthcare Master Person Index• Oracle Identity Management• Oracle WebLogic Suite• Oracle SOA Suite• Oracle Database

Results• National 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 treatment• Improve quality of healthcare, lower costs of services, and promote effective health policies

Oracle HIE – Nationwide Implementations

OHMPI 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

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CADSUS – Cadastro Nacional de Usuários 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 information It is available to any SUS’ healthcare

provider to locate and add new patients

The solution is design to assist those providers that don’t have IT resources to maintain patient records

CADSUS Service leverages OHMPI for patient identification

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CADSUS – Cadastro Nacional de Usuários do SUSPlatform responsible to promote interoperability and access to National Healthcare Card database.

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CADSUS 5.0

Oracle Service Bus

merge.v5r0.wsdlusuariosus.v5r0.xsd

OHMPI

CADSUSService

PrintCNSCard

cadsus.v5r0.wsdl

usuariosus.v5r0.xsdJMS Queue

Transform

MergeService

BAM

usuariosus.v5r0.xsd

`Auxiliary

EJBs

Oracle DBExadata

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CADSUS – IntegrationsGeneral Vision

Service Bus for

Healthcare

CADSUS• SCPA• SINASC• SIM

CNES

SISRCA• SIA, SIH, BPA,

APAC

SAMU

Farmácia Popular•HORUS

RESe-SUS

Hospitalar

e-SUS AB

SISREG

Others systems

SIM

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CADSUS Interoperability Model

Interoperability standards are regulated by an official directive: MS 2.073/2011 Web Services and Security: SOAP and WS-* Document Coding: XML Document Registry and Repository: XDS.b Patient Identification: IHE – PIXv3 and PDQv3 Terminologies

▫ Lab Coding: LOINC (Logical Obs. Identifiers, Names and Code)▫ Clinical Terms: SNOMED

Image coding: DICOM

International Standards

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National EHR - Interoperability

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How to store data from this message …

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… to this MoH MPI model ?

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IHE Profile on CADSUS – PIXv3/ PDQv3

The PIX and PDQ built using OHMPI IHE Profile framework It maps the MoH MPI model to IHE Model The 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

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CADSUS IHE – PIX/PDQ Solution Design

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PIX Feed Flow

Oracle Healthcare Master Person IndexOracle ExadataOracle ExalogicOracle WebLogic ServerOracle JVM JRockitOracle Access ManagerOracle Virtual DirectoryOracle Data IntegrationOracle SOA SuiteOracle Service BusOracle BPM Suite

Oracle HTTP ServerOracle API GatewayOracle Enterprise Manager Grid Control 12cOracle Enterprise RepositoryOracle Service RegistryOracle Virtual MachineOracle LinuxOracle BIEEOracle Identity ManagerOracle Traffic Director

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Deployed Oracle Products

Main Challenges Clear e-Health consensus and policies still

in development Need 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 balance

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Brazilian National e-Health Strategy

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Q&A

Thank you!Augusto Cesar Gadelha – CIO – DATASUS/SGEP/MS - [email protected] Luiz Paulo Ribeiro – Manager – Middleware Plaforms - [email protected] Sivaraman – Director, Product Strategy – Oracle America - [email protected]

mailto:[email protected]

