Connecting a digital platform to a complex IT portfolio across organizations Case from the Norwegian healthcare sector IN5320 26.10.20 Kristoffer Fossum
Theme Content of lecture: • Provide you with an example of emerging complexity when a software platform is to be established as part of a large existing IT portfolio across organizations • What does it take to connect the platform • What happens with good platform characteristics when it is connected Q&A: • Interactive session on zoom 26th of October
A platform A large portfolio of IT systems, organizations, routines etc. App App Is going to be connected to APIs – standards - policies Core
The Norwegian healthcare sector • About 17 000 autonomous enterprises • Each enterprise is responsible for quality and safety of healthcare • According to Norwegian laws, each enterprise has their own responsibility in establishing a patient journal system • Procurement of IT systems is the enterprise’s responsibility • An enterprise is free to establish, choose and adopt standards • Decades of implementation of IT systems has led to a plethora of systems that are not well integrated with each other • High variation in all types of standards in the systems • Example: • The Norwegian South-East Health Region currently has more than 5700 IT systems to support hospital operations
Hospital 1 Hospital 2 Hospital 3 The challenge “In a hospital in our health region, an elderly woman got a potentially fatal allergic reaction to muscle-relaxing medicine during prefaces of anesthesia, but was saved by skilled personnel. The same woman was later undergoing surgery at another hospital in the same health region. There, she received the same medicine, and experienced the same adverse reaction to it. The same happened again when she needed emergency surgery at our [the third] hospital” • Why did this happen? • Lack of information about what had happened with the patient in the first hospital at the others – lack of information flow • Can’t we just solve the problem? • Of course! However…
Information emerges in a lot of different places, and needs to be accessed in a lot of places Patient received medication and got a severe reaction Patient received medication and got a severe reaction Allergy info used in org 1 Allergy info emerges in org 1 Allergy info emerges in org 2 Allergy info used in org 2 Allergy info emerges in org 3 Allergy info emerges in org 4 Patient received Allergy info used in org 3 medication and got a severe reaction
Information flow requirements within each system User interface/ Admission report decision support A User interface/ Radiology decision support B referral • The information needs to User interface/ Surgery decision support C planning reach all the way to the User interface/ Electronic user interfaces users use decision support D messages naturally in their work User interface/ Prescriptions decision support E User interface/ Message to decision support F municipality User interface/ Care summary decision support G report
Hospital 1 Hospital 2 Hospital 3 The challenge “In a hospital in our health region, an elderly woman got a potentially fatal allergic reaction to muscle-relaxing medicine during prefaces of anesthesia, but was saved by skilled personnel. The same woman was later undergoing surgery at another hospital in the same health region. There, she received the same medicine, and experienced the same adverse reaction to it. The same happened again when she needed emergency surgery at our [the third] hospital” • Why did this happen? • Lack of information about what had happened with the patient in the first hospital at the others – lack of information flow • Can’t we just solve the problem? • Of course! However…
Case • Introduction of a national care summary record to improve accessibility of so-called «alert information» among healthcare professionals in hospitals in the Norwegian South-East health region. • Planning and design of the care summary record • Legislation and politics • Development of information standards • Implementation in hospitals • There are many IT systems dealing with the same information already (more than 100 identified in the health region). How to deal with these when the platform is to be introduced? • Healthcare professionals (tens of thousands in the health region) are used to do things in one way, how to make them change what they do and how they think?
Alert information is Information about a patient that in a healthcare provision setting may change planned and best practice procedures, and that may save patients’ lives or prevent severe harm to patients • Allergies • Ongoing treatment and implants • Changes in procedures • Complications from anesthesia • Contagion • Medical conditions
Care summary record as a solution for access to information Care summary record Allergy info used in org 1 Allergy info emerges in org 1 Allergy info emerges in org 2 Allergy info used in org 2 Allergy info emerges in org 3 Allergy info emerges in org 4 Allergy info used in org 3
Developing the concept «care summary record» Around year 2000, approximately 15 years before the care summary record was introduced one of those who worked with the initiation said: • «With the continuous local introduction of electronic patient journal systems now, I foresee a messy future. We now need some common national components that function across enterprises in the healthcare sector» 18 years later the same person said: • « Within this sector, development does not advance as quickly as the pessimists think » • The concept of a solution was established in y 2000, and was continuously developed as a concept the next 10 years • In competition with other types of information flow solutions – messages • Legislation in Norway did not allow a national solution containing patient data • However, gained gradual foothold through national policy documents during the 2000’s • Reports and planning were developed
Planning and design • Need for change in laws regulating patient data • Parallel processes: • Data definitions had to be included in the law texts before it was decided which data the solution should contain • Making a a new law was done in parallel with development of solution • Process to define «alert information» in the national care summary record as a national standard • Exspert group from the sector • «We were lucky. We had managed to include what the expert group found necessary in the law before the group initiated its work to define standards» • Assessment of potential standards existing in Norway and in other countries • Consultative round with more than 40 «main actors» and interests organizations • Was implemented in the solution
Implementation of the care summary record in hospitals • A button in the main patient journal system • Clinicians need to log in even though they are already logged in to the patient journal system • Takes around 30 seconds to log in • Manual transferring of information between the patient journal system and the care summary record • Alert information has different definitions among all systems – makes it difficult to transfer information correctly • In practice, vast amounts of information is not transferred to the care summary record – only about 2,5% of what is produced in the hospitals • How can it be improved?
Need for solutions • Automatic log-in via the local patient journal systems • Automation of data transfer between patient journal systems and the care summary record. Needs: • Standardization of content • Technical integrations • Commmon understanding of what data means across all enterprises that use and produce data from and to the care summary record
A hospital
Many different patients
IT systems support many functions
Many IT systems exist for the same functions PAS/EPJ RIS/PACS LAB- LAB- LAB - LAB- Kurve og Multi- Medika- Ambulanse- Føde- Medisinsk Mikro- Patologi Blodbank medikasjon media mentell kreft- journal journal biokjemi biologi behandling Oslo PasDoc Siemens Flexlab Swisslab DocuLive Prosang MetaVision Diverse Cyto- Cyto- Papir universitets- Patologi dose dose DocuLive Swisslab sykehus Papir Obstetrix Agfa Sectra Unilab Unilab Akershus DIPS Siemens Analytix Analytix DocuLive LabCraft MetaVision Diverse Cytodose Partus universitets- Patologi sykehus DIPS Sunnaas DIPS DIPS Papir Diverse sykehus Lab Vestre Viken DIPS Carestream Flexlab Miclis Sympathy LabCraft Diverse Papir Mobimed Partus (flere DIPS installasjoner) Papir Siemens Analytix Prosang Sykehuset DIPS Siemens Analytix Analytix Sympathy LabCraft Papir Diverse Cytodose Partus Innlandet Papir Sykehuset DIPS Sectra Netlab Miclis Sympathy Prosang Papir Diverse Papir Partus Østfold Sykehuset i DIPS Sectra Unilab Miclis DocuLive Prosang PICIS Diverse Papir Partus Vestfold Patologi PAPS PAPS Papir Sykehuset IMx Agfa Flexlab Sympathy LabCraft Papir Diverse Cytodose Partus Telemark Sørlandet DIPS DIPS Sectra Unilab Miclis Sympathy Prosang Papir Diverse Papir Partus (flere sykehus RIS installasjoner)
Many IT systems in hospitals • 5700 in the south east health region • More than 100 IT systems containing alert information across hospitals in the health region
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