Monday, December 12, 2011

Building Foundation going beyond EHR

Last Month I attended 3rd Annual Electronic Health Records (EHR) Asia 2011, during pre-conference workshop, I shared my experience in building adaptive enterprise foundation that goes beyond the current EHR capabilities. Below I summarized the key challenges we faced and the approaches of tackling these issues so that EHR scales up progressively to meet ongoing business needs.

1. Plan and design enterprise architecture with business capability centric view to support end-to-end care giving.

The boundary between EMR and summary care record EHR becomes increasingly fuzzy. Traditionally we plan IT systems from care setting perspective, however due to the fact that healthcare delivery is undergoing transformation to support patient centric care giving from primary care, inpatient acute care and the step-down care, there is increasing need for more efficient information flow to support seamless integration of care giving and transfer.

Just like Service Oriented Architecture design, enterprise architecture planning needs to be driven with "SOA style" - Business capability as Service, care setting is the context of the service, care provider/giver and patient are the consumer of the service.

2. Articulate the business benefits and value proposition from the perspective of the entire healthcare ecosystem.

The benefits of EHR is not equally shared by different stakeholders within the healthcare ecosystem, also the time of realizing these business benefits by different stakeholders are not synchronized. For example, in order to provide quality clinical analytic, we need to improve data quality at the point of data entry, however this will incur additional cost of system upgrading and might still increase the workload of data entry giving the current technology limitations and constraints. The additional workload during data entry might lead to time saving at another step of entire care giving process, also improved data quality and thus patient safety as whole.

However those benefits might not be realized immediately, thus at early planning stage, we need to highlight business value with the view from the entire care delivery perspective instead of individual setting perspective, also lays a foundation to allow different stakeholders to realize business benefits as early as possibly to drive up the adoption and at the same time progressively move up the IT capability ladder to enjoy more business benefits.

3. Role of different healthcare interoperability standards/specification

One of the question asked during the workshop is "What standard shall I use? e.g HL7v2, HL7v3, ISO13606, IHE" .

The common mistake in the current healthcare interoperability space is the notion of "all or nothing". To decide what interoperability standards to use, firstly we need to be clear that the above mentioned standards or specifications play different roles in healthcare interoperability, they are not equal, neither exclusive, they are complementary to each other to play its intended role in the entire software development life cycle.

Secondly we should define an architecture framework esp SOA reference architecture to position each respective standard/specification's role in the reference architecture to guide the overall solution design and implementation.

More detail can be found at EHR conference 2011.


  1. Additional comment for last point - The relationship between HL7 and IHE can be described as the two sides of the same coin. HL7 produces standards, IHE builds upon HL7 to standardize the system interaction termed as "integration profile", whereas HITSP defines the interoperability requirements and the realization of the requirements with IHE and HL7.

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