can fhir be a national standard in russia? how we build ......companies, cnews 2017 18/85 21%...
TRANSCRIPT
devDays
November 19, 2020
Andrey Dyukov
Can FHIR be a National Standard in Russia?
How we build Russia’s regional information systems based on FHIR.
N3.Healthcare
Just another normal day in Russia
146,8M PATIENTS
>2M MEDICAL STAFF
>59K HEALTH INSTITUTIONS
Just another day in Russian healthcare
Free to all residents through compulsory medical insurance.
Three levels of healthcare management:- Federal government- Regional government- Healthcare facility
* Data source https://rosstat.gov.ru/free_doc/doc_2019/rusfig/rus19.pdf
* See here for more info https://www.euro.who.int/__data/assets/pdf_file/0006/157092/HiT-Russia_EN_web-with-links.pdf
National E-Health initiative: Goals by 2024
• 38M people (25% population) will be using centralized online E-Health services
• 100% of public health institutions will be using EHRs
• Continuity of care will be provided by 100% health institutions
* Data sourcehttps://static-0.minzdrav.gov.ru/system/attachments/attaches/000/046/712/original/FP_Cifrovoj_kontur_zdravooxraneniya.pdf?1565344851
▪ How we use FHIR to contribute to National E-Health initiative goals
▪ What kind of FHIR-based services we’ve implemented in Russia based on FHIR
… and finally сan FHIR be a national standard in Russia?
In this session:
A private Russian software development company.
A leading expert in systems integration for business and the public sector.
10years of experiencein developing healthcare IT solutions
1450 healthcare institutions are interconnected
Next to 100%of Russian E-health software vendors are integrated with the N3.Healthcare platform –more than 75 information systems, including HIS / EHR, LIS, RIS and PACS.
AWARD WINNER
ITM contest and 2020 organized with the support of the Ministry of Healthcare.
▪ Best Solution for Healthcare 2016 ▪ Best Solution for Healthcare 2020
Top 5 E-healthcare software development companies, Cnews 2017
18/85 21% Russian regionshave implemented N3.Healthcare on the regional level
30/146 MMN3.Healthcare connectshealthcare institution informationsystems that serve over30 million out of146 million people in Russia (20%)
KEY PRINCIPLES: ▪ Regions can choose the approach they implement: integrational approach with different EHR vendors or
one-vendor approach.
▪ Exchange with the federal level is based on CDA and national APIs.
▪ Regional information exchange is based on FHIR and CDA.
How we do it : 3 connected levels
N3.Healthcare
Other
ministries and
public offices
Ministry of Healthcare of the Russian
Federation Information Systems
National citizen
portal
Private clinicsPublic
healthcare
institutions
Laboratories Diagnostic
medical
equipment
CDA and
national APIs
FHIR and CDA APIs
CDA and national APIs
Federal level
Regional level
Healthcare Institutions level
MPI (Master Patient Index) Medical staff Monitoring
Terminology Access provider Audit
Business Functional Components
Auxiliary Components
A custom API FHIR-based In transition to FHIR
Appointment scheduling
Referralmanagemen
t
Laboratory results
exchange
PACS results exchange
Telemedicine
Registry platform
Consolidated EHR
BI
Main components based on
Legend:
N3.Healthcare integration platform
CASE 1Electronic doctor appointment
scheduling
BEFORE Electronic Doctor Appointment scheduling the clinics sometimes looked like this
And this …
The challenge
Netrika has developed a regional Electronic Appointment scheduling service.The service is a single point of access for all information systems involved in appointment booking:
― hospital information systems, ― call center software, ― mobile apps ― online portals.
A 4 in 1 service where you can book a primary care appointment, a referral visit, a regular check-up or a telemedicine session.The oldest service up&running since 2011 - now being moved to FHIR.
What we have doneNow with N3.Healthcare doctor appointment scheduling looks like this:
With N3.Healthcare
▪ Patients can book doctor appointments online, in a mobile app or via call-center, and cancel or re-schedule their appointment on the patient portal.
▪ No more queues or double bookings.
▪ Reduced no-shows.
▪ Increased patient satisfaction.
Up to 75% of doctor appointments in St.Petersburg are now booked remotely.
*Data source: https://spbmiac.ru/specialistam/zhivye-grafiki/
How that helped The management can monitor healthcare accessibility KPIs and take action to fix problems.
CASE 2Laboratory information
exchange
To exchange lab test orders and results, clinics and laboratories used multiple local point-to-point
integrations. In St.Petersburg, 19 information systems were exchanging laboratory data.
Scaling such point-to-point integration was impossible. Data could not be consolidated, since the HIS and
LIS used different coding systems and data exchange standards.
The challenge was to create a centralized service that would provide a paperless workflow between HIS
and LIS.
This would eliminate double data entry and excessive paperwork, improve data quality and reduce
waiting time for laboratory reports.
The challenge
N3.Laboratory information exchange service
N3.Laboratory information exchange
service
N3.Terminology
▪ Semantic interoperability (LOINC®).
▪ 2014 true FHIR service
▪ 3 iterations of redesign
What we have done
1 day600 000 20%
PROJECT RESULTS 2015 - 2019
Decrease in double or unnecessary tests
compared to decentralized and paper-based workflow
Is the average waiting time for the test
result compared to 3-7 with paper-based
workflow
Tests orders per day are delivered via the
N3.Laboratory information exchange
service
How that helped
CASE 3The Consolidated EHR
Problem
Medical documents were stored on paper or in autonomous silos in hospital information
systems.
Patient information could not be found easily – some patient entries contained misprints
and mistakes and could not be correctly attributed to patients.
Different types of information –medical history, medications, lab tests, radiology images,
and other – were stored in different information systems and not liked to single patient
profile.
Patients had to store and carry paper versions of their files. There was little feedback
from specialized facilities to primary care. Continuity of care was lacking.
The challenge
N3.Consolidated EHR
Provides continuity of care across healthcare institutions,
facilitates access to medical information.
▪ Regulatory limitation– medical document
▪ FHIRproxy gives FHIR-based APIs for data taken by regional-
made API
What we have done
Hospital
Emergency care
Clinical laboratory
Private clinicUniversity hospital
Health center
N3.MPI identifies which patient an entry must be attributed to
based on a complex automated analysis algorithm.
How that helped
With N3.Healthcare
▪ Electronic health records can be accessed
online at doctor and patient portals and in
HIS. We store different types of documents,
including doctor notes, lab tests and links to
diagnostic imaging.
▪ Ambulance workers have access to patient
data.
▪ Continuity of care is provided across the
healthcare continuum.
▪ Access rights management system
establishes access policies and rules.
▪ Data is structured in a meaningful way that
helps find relevant information easily.
CASE 4Business Intelligence
Data from multiple healthcare information systems were separated and could not be used together in a meaningful way.
Analytical reports took a few weeks to be developed and processed.
Reporting was based on fixed forms and could not be drilled down to a specific case or medical record.
Analytical reports could highlight a problem, but there were no drill-down tools that could shed light on what caused the issue.
The challenge
We have developed a BI system that provides
analytical reports and statistics based on data from
multiple sources. It is optimized for processing big
data and is based on open-source software.
▪ Data transformation procedures that enhance
data integrity, consistency and credibility.
▪ Multifactor analysis with any level of detail.
▪ Report constructor: build reports on the go,
no programming skills needed.
▪ A variety of visualization options: graphs,
diagrams, spreadsheets.
Data sources Raw data
repository
Report constructor and
visualizationAnalytical
database
Information systems: HIS, LIS, EHR,
insurance, patient registries.
Regional services and patient population
management systems
Supporting services: terminology and
patient index
What we have done
How that helped Together with our clients, we’ve created reports based on the data that was already there in regional information systems. Some examples:
COVID-19 Monitoring
1
Example: Why patients leave healthcare facility,cardiology
Disease specific reportsExample: Number of patients with lab results values above normal, by healthcare facility
MPI (Master Patient Index) Medical staff Monitoring
Business Functional Components
Auxiliary Components
Terminology Access provider Audit
Appointment scheduling
Referralmanagement
Laboratory results
exchange
PACS results exchange
TelemedicineRegistry platform
Consolidated EHR
BI
N3.Healthcare building blocks
▪ Use existing blocks
▪ Unifications through FHIR
▪ Normalization through reference data
The integration approach focuses on theprocesses of interaction and management.
Taking a new task or a new business process
3 connected levels
N3.Healthcare
Other
ministries and
public offices
Ministry of Healthcare of the Russian Federation
Information Systems
National citizen
portal
Private clinicsPublic
healthcare
institutions
Laboratories Diagnostic
medical
equipment
Federal level
Regional level
Level ofmedical organizations
▪ Federal Research Institute for Health
Organization and Informatics of Ministry of
Health of the Russian Federation.
▪ Trying to convert CDA to FHIR for lab med
document.
▪ Legal foundations – signed medical document.
3 MAIN ISSUES:
1. Validation.
2. Format-logical control.
3. Visualization tools.
And these 3 are followed by № 4
4. Signature – snapshot.
FHIR in Russia
