Kevin Miller

1
National Infrastructure for eHealth
Considerations for Decision Support
Thomas M Jones, MD Vice President and Chief
Medical Officer
2
A Simple Case

• NC, a 38 year old businessman
• 2/14 donates blood in Munich hematocrit 45
• 2/21 visits GP in Cologne obtains prescription
  for Sulindac
• 4/21 travels to Toronto
• 4/25 travels to Frankfurt
• visits infectious disease screening clinic
• hematocrit is 40

3
Using a model without a CDR
Any clinician, with appropriate authorization
from the patient and permissions from the system,
can view clinical documents that are held in any
local system.
Viewing Application
MPI, Encounter Directory, Message Location,
Retrieval Of Documents
Clinical Document Hub
LocalSystems
4
Using a model without a CDR
Assuming that Dr Falke is aware that NC has been
seen in the Frankfurt Airport ID screening
clinic, he may wish to view the records of that
visit. He initiates a request to see the records
of that visit.
Viewing Application
Consent
MPI, Encounter Directory, Message Location,
Retrieval Of Documents
Clinical Document Hub
?
X
LocalSystems
5
Using a model with a CDR
Any clinician, with appropriate authorization
from the patient and permissions from the system,
can view clinical data
Viewing Application
Notification
Rules Engine
?
R
E
A
L D A T A

• Master person Index
• Message Processing
• Terminology Management
• Security, authentication
• Encounter Directory

CentralizedDataRepository
CDR
LocalSystems
6
Using a model with a CDR
Dr Falke reviews NCs clinical data (possibly
because of a notification alert from a Rules
Engine)
Viewing Application
Notification
R
E
A
L D A T A

• Message Processing
• Master Person Index
• Terminology Management
• Security, authentication
• Encounter Directory

CentralizedDataRepository
CDR
LocalSystems
7
Summary

• If the infrastructure cannot support a simple
  case, how can we expect it to support complex
  cases?
• Transactional and retrospective decision support
  activities depend on data, not documents
• Modern technology allows patient privacy to be
  honored in a partitioned data base environment
• The citizen owns access to his/her data

8
Current Picture
Gradual evolution
Region 2
Region 1
Tier 1
A
B
B
B
A
A
B
C
Acute
Acute
A
B
C
C
A
B
B
C
Community
Community
Tier 2
A
B
B
C
A
A
B
B
Primary Care
Primary Care
A
B
C
A
A
B
C
A
Misc.
Tier 3
Misc.
9
Stage 1
Gradual evolution
Region 1
Region 2
Tier 1
A
B
B
B
A
A
B
C
Acute
Acute
A
B
C
C
A
B
B
C
Community
Community
Tier 2
A
B
B
C
A
A
B
B
Primary Care
Primary Care
A
B
C
A
A
B
C
A
Misc.
Tier 3
Misc.
10
Stage 2
Gradual evolution
A
B
B
B
A
A
A
B
C
Acute
Acute
A
B
C
C
B
A
B
B
C
Community
Community
Tier 2
A
B
B
C
C
A
A
B
B
Primary Care
Primary Care
A
B
C
A
A
B
C
A
Misc.
Tier 3
Misc.
11
Stage 3
Gradual evolution
New Pan-Com. Apps
New Pan-Com. Apps
E
E
Core Region 1
Core Region 2
Tier 1
A
B
B
B
A
A
A
B
C
Acute
Acute
A
B
C
C
B
A
B
B
C
Community
Community
Tier 2
A
B
B
C
C
Primary Care
A
B
C
A
A
B
C
A
Misc.
Tier 3
Misc.
12
Stage 4
Gradual evolution
New Tier 1 Apps
New Tier 1 Apps
E
E
Core Region 1
Core Region 2
Tier 1
A
B
B
B
A
A
A
B
C
Acute
Acute
A
B
C
C
B
A
B
B
C
Community
Community
Tier 2
A
B
C
A
A
B
C
A
Misc.
Tier 3
Misc.
13
Stage 5
Gradual evolution
A
B
C
D
E
B
C
E
E
Core Region 1
Core Region 2
Core Region 3
A
A
B
C
A
A
B
C
A
A
B
B
C
Tiers 1- 3
A
B
B
A
B
C
A