Overview of

eHR Development

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•Hospital Authority
‣ 8 million patient records
‣800 million laboratory results
‣340 million prescribed drugs
‣34 million Xray images
‣3 million transactions per day
•Department of Health
‣essential health data, e.g.
vaccination
‣preparing for eHR
Where are we today?
•Private hospitals
‣mainly billing and financial
systems
‣electronic record lacks sharing
capability
•Private clinics
‣mostly paper-based record
‣electronic record lacks sharing
capability
•Private laboratories
/ allied health providers
‣not connected
 Guiding principles of eHR Development

• Government-led model for development

• Compelling but not compulsory record sharing

• Data privacy and security of paramount

importance

• Open technical standards for private participation

• Building block approach

 Core Components & Dev. Phases

• 3 Core Components
– eHR Sharing Infrastructure
– CMS Adaptation and On-ramp
– Standards definition and Interface Pilot

• 2 Phases for Development

– Phase 1 (2009/10 to 2013/14)
– Phase 2 (2014/15 to 2019/20)
Overview of eHR Development
& Implementation

Security & Audit Clinical

PPI
Systems

Shared

Standards
services
ePR
PMI

PMI
& Other
Information
Repositories
ePR
Shared
Services Architecture
DW
Management

DW
 Architectural Components

Web Layer Application Layer Data Layer

eHR Access Web Layer Application Framework eHR Sharable
Layer Portal Service Data Store
Core Application
PMI
Presentation
Services Service Pool
eHR
Shared Services CDR
Requests

SOA Governance DW

Clinical Information Architecture Management

Terminology Data
Portal Standards and Terminology Definition

Messaging Backbone
Compliance Verification
Framework Provider
Framework
Message / System
Messaging Backbone Standards Integration Infrastructure Registries

Security Policy Security Risk Defense in

Assurance
& Standards Management depth Consent Identity
Registry Management
Security & Audit Infrastructure

IT Infrastructure

Slide - 7 Hospital Authority - electronic Health Record

 eHR Sharable Data Set

Department Private
Hospital
of Health A

eHR • Each institution maintains

Group Sharable own complete set of
Practice operational data
X
Data
• Contributes sharable data
Set to eHR
Clinic
Hospital • eHR Sharable Data Store
1 keeps & shares for all
Authority
Clinic
2
 eHR Sharable Data Store

Department Private
Hospital • Facilitate a lifelong
of Health A longitudinal view of
people’s electronic health
records
eHR • Data to survive beyond
the life span of people and
Group Sharable systems
Practice
X
Data • Available 7days x 24hours
Store • Aim for a single version of
Clinic truth
1
Hospital
Authority • Stored in a secured
Clinic
manner
2
 eHR Sharable Data Store

• Key sharable data sets:

– Person Master Index
– eHR Clinical Data Repository
– Data Warehouse
– Patient Consent Registry
– Provider Registry
– System Registry
– Clinical Terminology Repository

Hospital Authority - electronic Health Record

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 Information Architecture
Management Framework
• Function
• To support the development, collaboration, implementation and on-going
maintenance of the Information Model

• Information Model
• Gives meaning to the captured
clinical data to ensure consistent
eHR Sharable
semantics and to allow flexible and eHR
Access
Web Layer
Portal Service
Application Framework Data Store

meaningful presentation of clinical Layer

Core
Application
PMI

data to healthcare practitioners Presentation

Services
Service Pool
eHR
Shared Services CDR
Requests

DW
SOA Governance
• Key Components Clinical
Clinical Terminology
Information Architecture Management
Terminology Data

Reference Terminology Repository

Data
Portal
Standards
Standardsand Terminology
and Terminology Definition
• Portal
Definition

(HK Clinical Terminology Repository) Compliance

Framework
Verification
Framework
Messaging Backbone

Message

• Reference Terminology Engine Messaging Backbone Standards Integration Infrastructure

• Terminology Services Security

Policy &
Standards
Security Risk
Management
Defense in
depth
Assurance
Consent Identity
Registry Management

• Clinical Terminology Portal Security & Audit Infrastructure

IT Infrastructure

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 Application Framework

• Functions
• Provide a central, secured gateway for real-time, synchronous communication with partner
EMR systems
• Host the eHR Core application logics for data or service requests processing

• Components
• Portal Services eHR Web
WebLayer
Layer Application Framework eHR Sharable
Data Store
Access
Core Application Services
Portal
Portal Service
Service

• Layer Core
Application PMI
Technical Services pool Service Pool
Core Application

• Presentation
Presentation
Services
Services

eHR
Shared
Shared Services
Services CDR
Requests
Requests

SOA Governance DW

• Development Approach & Information Architecture Management

Platform Clinical
Terminology
Portal Standards and Terminology
Data
Definition

• Building blocks approach Compliance

Framework
Verification
Framework
Messaging Backbone
Provider
/ System
Message
Integration Infrastructure
Service Oriented Architecture (SOA)
Registries
Standards
• Messaging Backbone

Security
Security Risk Defense in
Policy & Assurance
Management depth
Standards Consent Identity
Registry Management
Security & Audit Infrastructure

IT Infrastructure

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 Integration Infrastructure

• Functions
• Provide a standard integration platform for information interchange

• Components
• Message Standards Catalogue and
Standards portal
• Compliance assessment and message eHR Web Layer Application Framework eHR Sharable
Data Store
Access
standards verification platform
Portal Service
Layer
Core PMI
Application
Service Pool
• Registries of providers and systems
Presentation
Services
eHR
Shared Services CDR
Requests

• Message backbone SOA Governance DW

• Integration services Information Architecture Management

Data
Standards and Terminology Definition

Verification
Messaging Backbone
Compliance
Framework Framework Provider
/ System
Message
Messaging Backbone Standards Integration Infrastructure Registries

Security
Security Risk Defense in
Policy & Assurance
Management depth
Standards Consent Identity
Registry Management
Security & Audit Infrastructure

IT Infrastructure

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 Security and Audit Infrastructure
Security and Audit

• Functions
• Establish a standard and consistent
set of security policy and protocols
for the eHR and partner IT projects
• Define a proactive, protective &
defensive security framework and
toolsets to protect the eHR data eHR Web Layer eHR Sharable
Application Framework Data Store
Access
• Specify the on-going security and
Portal Service
Layer
Core PMI

audit measures
Application
Presentation
Services
Service Pool
eHR
Shared Services
CDR
Requests

DW
SOA Governance

Clinical Information Architecture Management

Terminology Data
Portal Standards and Terminology Definition

Messaging Backbone
Compliance Verification
Framework Framework

Tender issued for an external consultant

Message
Messaging Backbone Standards Integration Infrastructure

to review and advise on a Security

Security Policy &
Policy
Standards
Standards
&
Security
Management
Management
Risk
Security Risk Defense in
Defense in depth
depth
Assurance
Assurance
Consent
Consent Identity
Identity

comprehensive security and audit Registry Management

Management
Registry
Security & Audit Infrastructure
framework for eHR
IT Infrastructure

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 Approach on CMS Extension

• Leverage key HA CMS III functionalities

• With eHR standards, inter-operability, and security control
• Built with private healthcare sector participation
CMS Adaptation (for private hospitals and group practice)
• Developed as a series of modules
• Deployed by Compliant Service Provider (CSP)/Hospital or Clinic IT
CMS On-ramp (for private clinics)
• Open source
• Deployment by Compliant Service Provider (CSP)

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 Implementation Strategy
- Support and Training to Private Sectors

 Technical Specifications
 User guide
 Deployment/installation guide
 Interface specifications
 Trainings (Technical and Application)
 Skill transfers or “train-the-trainer” approach
 Compliant Service Provider (CSP) establishment
 On deployment, installation, user training, and on-going user
support
 On-going support for Compliant Service Provider (CSP)
 Major upgrade on policy implementation and bug fix

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 CMS Adaptation
Building blocks approach

Approach Description Target users

Integrate some of the Those already have their own
CMS Adaptation clinical systems and interest in
modules into the some of the CMS Adaptation
existing clinical modules
Building systems
Blocks (Private hospitals, group practice)
(include eHR
standards & inter-
operability, and
security control)

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CMS Adaptation Module
 Potential CMS Adaption Modules

• Allergy/Alert • Investigation request

• Discharge Summary • Immunization
• Medication Order • E-Referral
Entry (MOE) • Integration with eHR
• Diagnosis and • Nursing Assessment
Procedure Coding • Charting/Chronic
• Hospital ePR Drug List
• Person Master Index • Scanning
• Pharmacy System
 CMS Adaptation
Development Strategy
Interfaces
Compliant with eHR
Service
Provider Existing Systems Core
Health Care
Service Secured
Provider A Provider A Modules Adapters WAN

Adaptation Modules Optional:

Hospital-
Hospital-
based ePR
Interfaces
with eHR
Core eHR Core

Health Care
Service Secured
Provider B Provider B Existing Systems WAN

Optional
Hospital-
Hospital-
based ePR

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 CMS On-ramp
Objectives

• To develop an open-source clinical application

for private clinics

• Aim to support basic operation in private clinics

• Conform to eHR data standard for sharing

CMS On-ramp Prototype
 CMS On-ramp
Function List

•Patient Registration
•Appointment Booking
•Structured Allergy and Alert
•Consultation and Prescription
•Drug Dispensing
•Drug Inventory Management
•Basic Billing
•Reports
 CMS On-ramp Project Plan

Modules 2010 2011 2012 2013

Focus group meetings for users requirement

collection

Prototype development

Prototype testing by private practitioners

Final Product Development

Product Release
 CMS On-ramp
Deployment Strategy
Interfaces
eHR CMS On-ramp with eHR
(Open Source) Core
Health Care
Service
Secured
Provider A
WAN

Compliant
Service
Provider
Health Care Interfaces
Service
Provider B with eHR eHR Core
3rd Party Vendors Core
Clinical Systems
Secured
WAN
Health Care
Service
Provider C
 Standardisation & Interface

• Develop technical standards for different IT systems to

interoperate & interconnect through eHR Sharing
Infrastructure
• Clinical Related Standards
– Data content, Coding, Terminology, etc.
• IT Related Standards
– Interface, Messaging etc.
• Validation Platform
– Validation & Certification of IT systems against
standards
 Thank you

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