Enterprise Wide Meta Data Archive

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Version: 30.10.2012 Dokument/Ersteller:

Version: E. Flamme

A individual Story how to handle Big Data

Klinikum Wels-Grieskirchen / Austria

01.11.2012

Healthcare World Oslo

E. Flamme Strategic CIO

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Version: E. Flamme Seite 2

Where ist Wels located ?

Population County Districts Wels / Grieskirchen = 300.000 Population Upper Austria Federal State = 1.400.000 Population Austria = 8.000.000

Center of Austria

Linz

Wels

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Facts about Klinikum Fraternity Kreuzschwestern

and Klinikum Wels Grieskirchen

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Fraternity „Kreuzschwestern“ / Partner Enterprises

Healthcare Public and Private

Healthcare Education / Prevention

Nursing Homes / Kindergarten

Technical Hospital Services

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Hospital Grieskirchen Location Grieskirchen

• Since January 2008: One hospital on four sites • 1000 bed Hospital in Wels merged with 260 bed

Hospital in Grieskirchen and 60 bed Psychiatric Hospital in Wels

• 1.349 beds with over 80.000 inpatients per year • 37 departments, 26 different specialities

• 37 outpatient departments with approx. 290.000 outpatient visits /yr

• 30.000 operations and 2.600 births per year • Number of staff is 3.800 (including 500 doctors

and 1200 nurses)

• Budget: approx. 288 million Euro

The largest Convent Hospital in Austria

5th largest Hospital in Austria

Facts about Klinikum Wels – Grieskirchen

A Cooperation of Fraternities Kreuzschwestern / Franziskanerinnen

Private Clinic PKA Location Wels

Psychiatric Clinic

Location Wels Main Clinic Wels-Grieskirchen Location Wels

Main Clinic

Wels-Grieskirchen Location Grieskirchen

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Version: 30.10.2012 E. Flamme Seite 6

•

Since 2003 Developing Partnership with Siemens

• SOARIAN Clinical Beta Side

• SOARIAN Physician Letter / Emergency Department Moduls

•

Evaluating, Improving and Developing Healthcare Solutions together

with X-tention and other Partners (HDS, CISCO)

• eMEDIC (Medication Documentation and Reconciliation Tool) • MDES (CISCO Tiani IHE compatible eHealth Solution

• eMIND – Healthcare Meta Data Archive as HCR with HDS

• Pilot Site for Public Healthcare Solutions

• eMedication Austria / epSOS

• Integration in the Upper Austrian eHealth Infrastructure (Pre National Pilot)

Klinikum Wels – Grieskirchen / XT Partnership – Sucsess

in Healthcare IT

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Version: E. Flamme Seite 7

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Three data centers

• One high availability data center (200qm) / Second with 180qm) – 80qm separated and dedicated for X-tention and X-tention customers.

• Backup Location (inside) and 60 miles away.

•

2.500 Clients

• >100 Mobile Devices (iPAD on to clinical Tablets)

•

> 500 servers (60% virtualized)

• VMWare Products (Vsphere, LabManager, ….)

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Network Environment

• CISCO SAN / LAN / WLAN

•

HDS Enterprise Storage Environment

• Hitachi Enterprise Solutions (Storage and Solutions)

• NEXSAN S-ATA / SAS Beast (Dual Vendor Strategy Low Cost) • Falconstore VTL / Deduplication

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Challenges for Healthcare IT

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Healthcare Challenges for the next decades

Data out of Admin or HIS Systems Data out of Modalities and other

Healthcare-provider Additional Information Personal Training Life Science Wellness Detailed (Genetic) and Epidemical and

Forensically correlations Information about health related quality

of life

Treatment

Maintenance of

good

Healthiness

Healing

E. Flamme

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Challenges for Healthcare IT in Austria in the next years

Government's Expectations: • Cutting Costs

• Centralization of IT Services and Providers

• Collaboration between the different Health Care Providers User / Clinician / Healthcare Professionals Expectations:

• Data Exchange and Collaboration Support for Clinical • Integration of new User Interfaces and new Devices

including new integrations Strategies (BYOD / CLOUD ) ) • Integration of new Software Platforms / User Interfaces

similar to „Apps“ / similar to Social Networks • Decision Support and integrated Knowledge

Management

• Medical Platforms similar to social Networks as

(personal) PHR assentivs or part of a CRM Strategy

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The World of Heathcare Data is growing up ………

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From a large Number of Data

only a few documents are important

in a specific Situation

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Essential: “Data Suppliers” meets “Content Consumers”

•

Main Data Suppliers in Healthcare are GP, Hospitals, Nursing Homes

and HomeCare

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Main Consumers of Healthcare Information's are Healthcare Providers,

Insurances, Science and Research

•

Every Healthcare Employees and every Healthcare Consumer needs

Application and Devices which offers him information:

•

At the right time

•

At the right place

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In the right context

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At the right role

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An NEW: The Patient himself will be OWNER and CONSUMER of

relevant Healthcare Data (PHR)

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Starting thinking about a (clinical) Meta Data

Repository

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• Status Quo: Starting with PACS and a non DICOM Archive we needed additional archive solutions for SAP Digital Receipt Management, eHealth Repository, Email, Share Portal Server …..

• CEO Order: Look for a vendor who supports most of the our requirements !

• Considerations: Which vendor delivers most of our requirements and can help migrate from our previous archives?

We decided not to do so !

Looking for Solutions

What happens in five years ?

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Version: 30.10.2012 Dokument/Ersteller: Elmar Flamme

1. Challenge: Avoiding Data Overload

Slide 16

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Accessing and Presenting data in

different context cases for patient

treatment, science and education

•

Considering Commercial interests

(prevention rather than cure /

medical trial evaluations /

managerial decisions)

•

Prepared to Support decision

support systems with data

Meta Data Repository - A base for semantic networks solutions offering information for all Users in the right time, the right place and in the right context (Clinical / Administration / Business)

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2. Challenge: Stop Data Grave Yard

Version: 30.10.2012 Dokument/Ersteller: Elmar Flamme Slide 17

An Archive or Repository should not become a graveyard for data, information and knowledge

• Consolidation of the different

archives, archive technologies, archiv

vendors

• Content archiving in one plattform for

common access

• Avoiding permanent Data Migration

producing or losing Data and

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3. Challenge: Delivering Data

• Compliance with meetings legal retention

periods for data

• IHE compliance for health portals and

health data exchange

• Data “Independence” – avoid migrations,

yet easy to access

• Readiness for a “digital memory” of a

hospital and a regional healthcare record

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From „Vision“ to „Reality“

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Our Vision

Adm. / ERP System (HR, FI, CO, DW, MM) eHealth GP Port al Home Care Portal Upper Austria n eHealt h Conne ct Clinicals / Scheduling Clinical Information Systems EHR / CPOE / PoC / ED

PACS Laboratory 3rd Party Departmental’ / Subsystems Self- develop-ment products Medication Coding

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Version: 30.10.2012 Dokument/Ersteller: Elmar Flamme

What we understand under “Content” Services ?

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The knowledge to convert information into Standards and structured

Information (like CDA).

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The knowledge to extract (Custom) Meta Data from structured

Information.

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The knowledge to offer Custom Meta Data to Applications like “Snomed”

or “.Dr. Watson” to display information in individualized views based on

roles, events and different point of care.

•

The knowledge to offer “Patient Safety Systems ” like Medication

reconciliation Applications additional information.

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The possibilities to combine every object information under a knew

Question.

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If you are Master of the Data (like a regional IHE repositories) you have under restriction of law and data privacy a lot of possibilities to develop Services around Content

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A clinical meta data repository needs high-availablity,

flexible storage and content-based Platforms that are…..

“Open” for

Standards

• HL7

• CDA

• DICOM

• PDF (PDF-A)

• HTML

• XML

• XLS

“Open” for

Access

• Enterprise

Search

Engine

• API-free

Ingest from

Multiple

Sources

“Open” for

Data

• Object

Oriented

• System Meta

Data

• Custom Meta

Data

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Our Concept

“Meta Data Robot” analyzes and prepares data Source systems exports data via standard interfaces

Hitachi Content Platform Automatic extraction and adding meta data information Storing as Object (HL7 message / PDF-A, DICOM, CDA) API delivers result back to the Apps. Target system inbound

Using API for Query Source systems or Semantic Network Applications

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• Meta Data Structure

• Analyzing all enterprise document types (clinical/ office documents)

• Analyzing the content of all documents • Analyzing the possible different levels for

information (equal content / different content)

Preparing Meta Data

Applications

• Chose application which provides

extracting Meta Data otherwhile use the HCP Standard Features

Classification

• Defining document categories • Defining rules and regulations

• Choosing standards for automatic classification of documents types and automatic content filtering

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How we did it

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Example: Defining CDA Level 2 Document

Custom Meta Daten:

Department / Speciality

Information

Custom Meta Data

Sections

Custom Meta Daten:

Diagnosis / Coding

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Example: RIS / PACS – DICOM / DICOM Header

Custom Meta Daten:

DICOM Header + RIS

Result Text

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Clinicals / Scheduling Clinical Information Systems EHR / CPOE / PoC / ED

Clinical User

Other Source Systems

Output

Input

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One Repository for All (Meta) Data

eMind

Master Index Specialised Indices

PACS

Kernel

Documents

IHE

HCP Lucene IHE-Registry AIM Metadata PACS-MD DICOM-Header-Data eMind-Metadata IHE-Metadata Documents PACS-Application IHE-Application KIS ISH AIM HDDS Standard Connectors S p e c ia lis e d C o n n e c to rs Whatever Ward Application Whatever ˅

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Version: 30.10.2012 Dokument/Ersteller: HIS EHR Portal

Syndedra View Microbiology Radiology

User View

Pathology …………..

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Version: 30.10.2012 Dokument/Ersteller Elmar Flamme:

Search result

via Meta Data on

CDA Level 2

GP Portal View

IHE Application

Slide 32

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Example: Phrase Search: „Duodenalschleimhautbiopsien“

Expected Result: Pathology Results / Documents

CDA Level 2 Pathology Document

D o c u m e n ts w it h t h is P h ra s e Search

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eMIND / HCR Document / Project Status

15 diff. Source Systems

500 diff. Documenttypes

1.2 Mill Documents / Objects

expected End of 2012

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Summary

Content Search / Forensic Search

- Search over all (Custom) Meta Data (not on Object / Document) - Search for Phrases / Expressions

- Including Objects (Pictures) which includes Expression and Phrases as Custom Meta Data

Clinical Search

- Real Time Search (depends from Transfer Time) - Search over PID (all Documents)

- Including Merges

- Custom Meta Data Changes

- (including SAP Patient Reciepts PID) Administrative Search

- SAP ERP / HR Documents - (later: Email)

- (later: SharePoint) - (later: FileServer)

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Summary

Storing

- Every (TextBased) Information is stored as CDA Level 2 Document - Every Information is stored as Orignal Information (HL7, TXT, …..) - Every (TextBased Information is stored as PDF-A

- Meta Data can be changed / updated (without impact to orginal object)

Display

- Every Stored Information can be displayed by - XML Viewer (CDA-L2)

- DICOM / NonDICOM Picture Viewer - PDF Viewer

Restoring

- Every Information which is needed for Restoring is saved inside the Custom Meta Data

- No DataBase is needed – Only XML Tools for Reading Custom Meta Data (TXT)

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Long Term Project (5 – 10 – 15 years)

• Building an enterprise-wide meta data repository needs a lot of preparation inside the enterprise organizations (Document Management, Standardization).

• Consider short-term requirements: A meta data repository can not substitute archive application solutions and most of the existing clinical and administration software is simply not ready for meta data yet.

• IHE is a key feature for improving patient treatment with the standardization based on IHE Profiles, CDA – clinical document architecture etc. With standardization you can extract META DATA Information.

• Greater flexibility and cost effectiveness: Having stored data in a generic way you are independent from migration timelines and costs. Change applications as and when needed for user acceptance and improving your processes.

• Implementing a Qualitiy Process for Data (similar to “Data Analyst”)

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Version: 30.10.2012 Dokument/Ersteller: Contact

Strategic CIO

E. Flamme

Klinikum Wels – Grieskirchen A-4600 Wels, Grieskirchner Straße 42 Tel: + 43 / (0) 7242 / 415 – 9 - 3220, Fax: DW – 3774 / Mobil: + 43 / (0) 699 / 14163220 E-Mail: [email protected] Homepage: www.klinikum-wegr.at