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The Oracle HTB
Designed for Healthcare
Baltic IT&T 2005 – Riga, April 8
Thomas M Jones, MD
Vice President and Chief Medical Officer ®
Healthcare challenges
Challenge Requirement
Manage across the Comprehensive patient
continuum of care centric record
Assure data re-use for Standards-based data
multiple purposes management
Protect patient privacy Access control, de-
and adhere to identification, reverse
legislative mandates notification
Leverage existing Transform and integrate
investments data from any source
Healthcare activity
Member
(Covered) Costs
Economic Medical
selects Outcomes Outcomes
Benefit Plan Citizen Caregiver
(Coverage)
administers
manages
Account
(Receivable) Problem
(Condition) Is a part of
exhibits
Plan Administrator
(Arbitrator) Encounte Epicrisis
r (Problem Occurrence)
(Event)
Symptom
(Sign) schedules
Visit
is a Task (Appointment) Order
Staff
Lab Resource (Offered Service) (Directive)
specifies
(Means)
tracks
is a
has
Facility
Pharmacy
(Area) records
has
Provider Result
Service Care plan
Radiology (Organization) (Measurement)
Equipment (Catalog) (Chart)
The importance of infrastructure
It is important to note that the provision of
infrastructure services is an enabling
mechanism.
The infrastructure itself will deliver some
benefits, but the main outcomes will be
achieved by the provision of additional
applications and services.
As with any infrastructure, information
technology infrastructure enables other
systems that do yield business benefits.
Implementing Information for Health - Denis Protti
A lifetime of care
GP Hospital
Dental Pathology
Physiotherapy
Birth
Current IT practice
Building silos
A standards based platform
Healthcare Transaction
Base
A Standard Information Model
Health Level 7 RIM
One place to store everything – and to
retrieve it for re-use
Healthcare Transaction
Base
Creating a single person record
GP 32561 F HOSP 2345
PHY 4562 LG
DEN9001
Person
Services
A10001
Healthcare Transaction
12324
Base
Single Identifier
Patient: 123456
Integrating information HL7 version 2.X
Delaminated File
HL7 Version 3 Interface
Engine
XML
Person Message
Services Services
Flat File
Healthcare Transaction Bespoke Standard
Base
Single Record
Patient: 123456
HL7 Version 3.0
Integration is more than just data
exchange
HL7 Mission Statement:
“Develop specifications that support
interoperability in healthcare, i.e.
“computer systems exchanging information
in the healthcare space will predictably
compute on the exchanged information
based on an agreed upon set of
specifications defining the structure and
meaning of the exchanged information.”
More on interoperability
Syntactic interoperability
– Structures are exchangeable but there is no
guarantee that meaning will be consistent across
system boundaries
Semantic interoperability
– The exchange of meaning between systems
Computable semantic interoperability
– The exchange of consistent and unambiguous
meaning between two or more machines
HL 7 affiliates
Members include Argentina, Australia,
Brazil, Canada, China, Croatia, Czech
Republic, Denmark, Finland, Germany,
Greece, India, Ireland, Italy, Japan,
Lithuania, Mexico, Netherlands, New
Zealand, Poland, South Africa, South
Korea, Spain, Switzerland, Taiwan,
United Kingdom, and USA
Why HL 7 works – many brains
RIM Harmonization Meeting
Allergy RMIM
Adding to and reading the EHR
Person Message
Services Services
Healthcare Transaction
Base
Single Record
Patient: 123456
The ability to unify terminologies
Dental SNOMED
ICD 10 Code Code
Code
Local
Code
LOINC
Person Message Terminology
Services Services Services
ICD 9 Code
Healthcare Transaction
Base
Normalised Data
SNOMED: 123456789
Incorporating rules
Person: John Smith MRN 12345
Diagnosis: Carcinoma Colon
Procedures: Colonoscopy
Rule Processing
Recent Results
Sodium: 137 mm/l 01 January 2004
Potassium: 4 mEq/l 01 January 2004
Snomed (Pre-RT) Code Snomed (Pre-RT) Code
Colonoscopy Sodium
SNM 198/P1-57710 SNM198/C 15500
Display Term - Colonoscopy
Display Term - Sodium
CPT 4 ICD 10 OPCS
Colonoscopy Colonoscopy Colonoscopy CPT 4 LOINC HCPCS
CPT 45355 ICD91/45.24 H22.9 Sodium - serum Sodium, ser/plas Sodium
CPT 45355 LNC1.0N 2951-2 84295
Protecting patient privacy
Support for evolving
technologies
Security Auditing
Service Service
Healthcare Transaction
Base
Single Source of
Truth
Enhancing decision support
Star Schema Drill to Detail Analytic Workspace
Business
Intelligence
Healthcare Transaction
Base
Single Source of
Truth
Rapid application development
Application Programming Interface
Healthcare Transaction
Base
Single Source of
Truth
Supporting new healthcare
applications and processes
Remote Monitoring
New Applications
Application Programming Interface
Healthcare Transaction
Base
Single Source of
Truth
Existing Applications
Healthcare Transaction Base
Interoperability Framework
Third Party Applications
• Application Flow • Proprietary Data Elements
• User Interface • Content (e.g. Protocols)
Interoperability Platform
• Data Repository • Security Services
• Messaging Services • Auditing Services
• Terminology Services • Person Services
• Configuration Services • Business Process API
Core Technology
• Database • Workflow Engine
• Application Server • Platform Security
• Data Warehouse • Wireless Support
Current HTB projects - USA
District of Columbia Department of Health
Los Angeles County Public Health System
National Cancer Institute
US Military Health Service
– RITPO
– Madigan Army
CMS
Louisiana Department of Health and Hospitals
Municipal Public Health
Healthcare Local Health Federal
Researchers
Workers Agencies Authorities
Data Capture
Internet
Applications
Encounter Results Incident Data Alert
Summary Access Reports Mining Notifications
Healthcare Transaction Base Data Warehouse
• Messaging Services
• Person Services Clinical
• Terminology Management Data
• Security and Auditing Repository
iHUB
Facility ADT & Clinical Systems
National Disease Surveillance
Clinical and Public
Healthcare Applications Reporting & Analysis
Health Systems
Application Programming Data Warehouse
Messaging
Interface
Services HL7 V3 Reference
OracleAS • Person Services
Integration • Information Model
Terminology Management
• Security and Auditing
• Business Process Support
Healthcare Data
Model
Enterprise Data Model
EHR – Public Health Interoperability
System Scenario
Clinical Care Public Health Surveillance
Hospital of Birth
ADT – Newborn
Birth Record Screening
HL7 2.4 HL7 3.0 Registry
Newborn
Screening HL7 3.0 Hearing
HL7 3.0
Screening
OracleAS Registry
HL7 3.0
Hearing Integration HL7 2.4
Screening
HL7 3.0 Immunization
Registry
Immunization HL7 2.4 HL7 3.0
Administration
Communicable
Disease
J2EE Registry
External
API
Laboratory HTB API
J2EE
Healthcare
Transaction
Viewer
Metropolitan integration
Centralized decision support – Los Angeles
County Executives Managers Researchers
Internet
Executive Operational Encounter
Cost Analysis Historical Clinical
Information Day-to-Day Lifecycle
System Reports Reports Trending Monitoring Outcomes
Healthcare Transaction Base Data Warehouse
• Messaging Services
Interface
• Person Services Clinical
Engine
• Terminology Management Data
• Security and Auditing Repository
Business
Process Data
Warehouse
ADT & Clinical Systems Financial Systems
Metropolitan integration
Results Review- Metropolitan
National Network
Staff Community Care
Patients
Physicians Physicians Providers
Internet
Organization Staff
Scheduling
Management Management
Healthcare Transaction Base
• Messaging Services
Interface • Person Services Clinical
Engine • Terminology Management Data
• Security and Auditing Repository
ADT & Clinical Systems
Staff Management
Current HTB projects - Europe
Groupe Hospitalier du Havre
Creteil et Montreuil
Finsiel (Modena, Busto, Careggi)
CSC Scandihealth
Son Llatzer
Stockholm County
Cronos (Antwerp)
Biobank
Integrated healthcare information
Groupe Hospital du Havre
Legacy Applications New Applications Analysis and Reporting
J2EE
Healthcare Transaction Base Data Warehouse
• Messaging Services
• Person Services Clinical
• Terminology Management Data
• Security and Auditing Repository
HIS Integration
Engine
External Data
Warehouse
ADT LIS
CIS
Summary The Healthcare Transaction
Base is a standards based
solution that:
– is based on proven
scalable technology
– integrates healthcare data
across single or multiple
enterprises
– provides a rapid
Application Programming Interface
application development
environment for
healthcare solutions
– protects the IT
Healthcare Transaction Base
investments of
purchasers, partners, and
end users
– offers a unique service for
citizens/patients world
wide
Thank you – tom.jones@oracle.com
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