Building a Sound Integration Architecture – a Challenging
Journey at KFSH&RC
Hamad Al-Daig, BS, MBA and Enam UL Hoque, BS, MBA, PMP, CPHIMS
King Faisal Specialist Hospital & Research Centre (KFSH&RC) is a 1200 Plus bed multi-site tertiary care hospital and one of the leading healthcare institutions in the Kingdom of Saudi Arabia. Corporate entity of KFSH&RC and its main site is in Riyadh, the capital city of Saudi Arabia with a branch site is in Jeddah, the other major city within the Kingdom.
Its mission is to provide the citizens of Saudi Arabia with the highest level of patient care as well as to provide distinguished patients with a full range of medical and clinical services equal to the best available in other leading hospitals around the world with similar settings. The Hospital has more than 11,000 employees from 78 different countries.
In many fields of medical science, KFSH&RC is highly recognized as the leader in the Middle East. It has been a pioneer in numerous medical programs since it became operational back in 1975. KFSH&RC has accreditation by Joint Commission on International Accreditation (JCIA) for its highest international standard of Health Care delivery. It is also accredited by the College of American Pathologist (CAP) for the pathology and laboratory medicine department since 1982. KFSH&RC receives an average annual patient referral of over 44,000 patients, over 60% of which get accepted for treated at the hospital. Following table will illustrate the magnitude of medical and clinical capacity and load of in two sites of KFSH&RC.
Beds (Inpatient) 1046
Day Beds 231
Patients Accepted 26,751
Inpatient Admission (excl. newborns) 32,909
Discharges (excl. newborns) 32,783
Average Length of Stay 10.6
Average Daily Census 889
Bed Occupancy Rate 89%
Outpatient Clinic Visits 920,547
Emergency Department Visits 89,212
Operating Room Procedures 18,107
Day Surgery Procedures 6,650
Laboratory Tests 9,090,021
Radiology Procedures 270,491
KSH&RC is the first hospital in the Middle East to recognize by HIMSS as Stage 6 hospital for its EMR adoption level. For the enriched contents and services provided through the web portal of KFSH&RC, the hospital received “Digital Excellence Award” of 2011, ranking first within Healthcare Information Technology, from the Ministry of Communications and Technology organization of Saudi Arabia. Also, in 2011, KFSH&RC achieved ISO 27001 Information Security Management certification.
Hospital IT infrastructure supports network that accommodates more than 16,000 nodes and with 9000 plus active computer users. In addition, the Hospital hosts integrated packaged solutions and numerous homegrown applications in various platforms involving different databases and programming languages.
The two main pillar application systems of KFSH&RC Information Technology are Integrated Clinical Information System (ICIS) from Cerner Corporation and Enterprise Resource Planning (ERP) System from Oracle.
Integrated Clinical Information System (ICIS) is built based on packaged applications purchased from Cerner Corporation of USA (HNA Millennium suits). Hospital has implemented all major components of HNA Millennium suits:
o Person Management o Scheduling
o Radiology o Laboratory
o Order Management (CPOE) o Pharmacy
o Surgery (Operating Room) o Emergency Medicine o Medical Records
The system has around 5,000 oracle database tables, capturing patients, orders, and results information.
Hospital had fully implemented ERP solutions purchased from Oracle Corporation to electronically manage its HR, finance, supply chain and administration operations. Oracle Integrated ERP solutions include: o HRMS o Payroll o Inventory o Purchasing o Order Management o General Ledger o Accounts Payable o Fixed Assets o iProcurement o iSupplier
Oracle Integrated ERP solution has more than 10,000 database tables, capturing HRMS, supply chain and financial information.
To support medical and clinical operation through technology, KFSH&RC’s strategic direction is to unify solutions within integrated clinical system from Cerner Corporation. However, Cerner HNA Millennium suits lack some department specific solutions. Similarly, Oracle’s integrated ERP platform does not address all the non-clinical software need of our hospital. For that, there are still some stand-alone systems exist at the hospital to cater for department specific needs. Stand-alone packages and home grown applications are listed below:
Medical Systems Non-Medical Systems
Picture Archival and Communication System (PACS) Cardiovascular Solution (Apollo CardioStar)
Nursing Scheduling System (One-Staff) Dictation and Transcription (CBay) Food and Nutrition (CBord) Patient Acceptance & Eligibility On-Call System
Tumor-Registry (C/Net) Infection Control
Medication Dispensing (Pyxis & ScriptPro)
Patient Billing System
Document Management (EMC) Contact Centre System Housing
Quality Assurance Social Services
In support of KFSH&RC’s vast operations, tremendous amount of data are being collected using ICIS and ERP as well through all of those systems and applications stated above. To transform those collected data into decision making information, KFSH&RC is one of the pioneer organizations to build a data warehouse as shown in the diagram below. To share KFSH&RC’s knowledge and experience of Data Warehouse, we co-authored a book “Developing a Data Warehouse for the Healthcare Enterprise – Lessons from the Trenches” published by HIMSS, USA (ISBN 0-9777903-6-3) in 2007. Currently, we are working on the 2nd edition of the book, which is
expected to be out towards the end of 2012.
Interoperability and data integration are rather daunting challenges for any healthcare organization. It is no different for KFSH&RC with its diverse application software, hardware platform and databases.
To overcome the reality of diversity challenges, KFSH&RC is using Quovadx Cloverleaf interface engine to manage data integration among disperse systems. Diagram below depicts high level data integration architecture of KFSH&RC for all systems and applications that require interoperability:
Integrated Clinical Information System (ICIS) and all other department specific stand-alone medical related systems at KFSH&RC are HL7 compliant.
In fact, it is a mandate KFSH&RC imposes during the process of acquiring any package solution from vendor. We also mandate the same for in-house development of applications around medical related application.
KFSH&RC installed Picture Archival and Communication system (PACS) solutions from three vendors. Radiology department of Riyadh uses GE PACS and Dental department uses Carestream Dental PACS solutions. Jeddah Branch uses Agfa PACS solution in their Radiology department. PACS solutions from these vendors are DICOM compliant for integration with diagnostic modalities. PACS also have integration with ICIS through HL7 interface.
Cloverleaf interface engine is used since 1993 at KFSH&RC for data integration. Initially, it was used to integrate data among legacy systems existed at that time. Since the implementation of ICIS in 2002 at KFSH&RC, Cloverleaf is being used to integrate data of ICIS to all medical related departmental systems and vice versa as depicted in the diagram below.
Through Extraction, Transformation and Loading (ETL) process, ICIS data are loaded directly into data warehouse to produce decision making reports. PACS, Pixys for medication dispensing, Cbay dictation and transcription system, are bi-directional interface. Remaining departmental systems stated above are uni-directional interface, receiving data from ICIS.
PACS receives HL7 ADT information from ICIS and sends back HL7 ORU and ORM messages to ICIS. CBay dictation and transcription system receives HL7 ADT messages from ICIS and sends back HL7 MDM information to ICIS. Pyxis inpatient medication dispensing system receives HL7 ADT messages from ICIS and sends back HL7 DFT messages to reflect the utilization of supply and quantities on hand. CardioStart system receives HL7 ADT message from ICIS and sends back HL7 MDM messages to ICIS. Patient Billing system receives HL7 ADT and DFT messages from ICIS.
Except ERP, all the other departmental systems listed above, receives HL7 ADT messages from ICIS.
ERP system sends personnel information to ICIS, particularly for newly joined as well as resigned and terminated employees’ information.
Integration between ERP and other systems that need HR and finance information from ERP is shown in the diagram below.
Cloverleaf interface engine is used for integration between ERP and ICIS. All other system has direct homegrown application interfaces to extract data from ERP systems and in the case of One-Staff sends employee leaves and over-time related data to ERP system.
Data integration among systems at KFSH&RC is helping our users tremendously avoiding duplicate entries as well as transmitting data accurately from ICIS and ERP to all other systems as needed.
Real-time interface through cloverleaf engine makes relevant data entered in ICIS and ERP available instantaneously to other systems that need those data. Similarly, data captured in PACS, CBay, Pyxis and One-Staff systems get updated in ICIS and ERP instantaneously.
Integration is not only transporting data seamlessly among systems, but also increasing the inter-operability of all systems used in KFSH&RC. Data integration is also helping care provider at KFSH&RC to be more responsive to our patients, having information available in a timely manner to enhance care delivery.
=========================================================== Hamad Al-Daig is the CIO of King Faisal Specialist Hospital and Research Centre and can be reached via e-mail hamad@kfshrc.edu.sa.
Enam UL Hoque is a Senior Strategic Health Information Consultant, working in the Information Technology Affairs of KFSH&RC. He can be reached via e-mail enam@kfshrc.edu.sa.
