2. Disclaimer
The information shared here does not
represent the official opinions of my
current employer (MOH Holdings).
2
@Copyright 2012 Health InterConnect
3. Brief Introduction of myself
Organisation
Key Role
Key Responsibilities
MOH Holdings Pte Ltd
Senior Enterprise Architect
National Architecture Office
Healthe Solutions
Chief Software Architect
Oversee, manage and lead EHR
product development and solution
implementation
Savi Technology
System Architect
Lead architecture design and
development of real-time supply
chain tracking and optimization
product
IBM Singapore
Software Development
Lead
Lead IBM Production eProcurement development
HL7 Singapore
TC member
HL7 Interoperability Standards such
as HL7v2, HL7 CDA, HL7 FHIR etc
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4. Topics
• SOA reality check
• The challenges & complexities
• The solution
• Adoption strategy
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5. Is SOA still relevant today?
Source: Gartner Ross Altman
A fundamental shift from monolithic application centric
design to service centric design
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6. SOA has become increasingly
relevant and important
• Information
• Mobile
Internet of Things
Contextualized
Information
Seamless user
experience
Multi-access
channels
App becomes
more
specialized
Social
interactions and
Collaboration
Infrastructure
Platform
Software
• Social
• Cloud
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7. Design for the unknown
• Design for the known is in the past
– Design the application to manage the known &
limited information
– Design the application for the specific access
channel, information storage
• Embrace for the unknown
– Aggregation of external information to deliver
contextualized information
– Application is no longer tied to the fixed UI, must
be service-ready to enable the consumption &
collaboration with different kinds of external
applications
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8. Challenges & Complexities in
Healthcare IT
• Many diversified IT systems within and across
healthcare settings
• Different information models across different
IT systems
• Lack of standardization
• Fragmented and inaccessible information
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9. Healthcare IT Overview
Electronic Medical Record
(EMR): A computerized
medical record created in
an organization that
delivers care, such as a
hospital or physician’s
office, usually part of a local
health information system
that allows storage, retrieval
and modification of records.
Health Information
Exchange (HIE): The
mobilization of
healthcare information
electronically across
organizations within a
region, community or
hospital system.
Electronic Health Record
(EHR): A systematic
collection of electronic
health information about
individual patients or
populations in digital format
and capable of being
shared across different
healthcare settings.
Healthcare IT: The umbrella framework to describe the
comprehensive management of health information
across computerized systems and its secure exchange
between consumers, providers, government and quality
entities, and insurers
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10. Healthcare Landscape of Future
Strategic vision of patients moving seamlessly across
the healthcare system, receiving coordinated patientcentric care at the most appropriate settings.
Communit
y Hospital
Polyclinic/
Family Medicine
Clinic
Home
Screening &
Prevention
Family
Physician
supported by
CHCs
Medical
Centres
Restructur
ed
Hospital
Communit
y Hospital
Polyclinic/
Family Medicine
Clinic
Home
Screening &
Prevention
Family
Physician
supported by
CHCs
Medical
Centres
Restructur
ed
Hospital
Nursing
Homes
Palliative
Care
Rehab
Centres
Communit
y Hospital
Nursing
Homes
Polyclinic/
Family Medicine
Clinic
Palliative
Care
Home
Screening &
Prevention
Family
Physician
supported by
CHCs
Rehab
Centres
Medical
Centres
Restructur
ed
Hospital
Communit
y Hospital
Nursing
Homes
Home
Screening &
Prevention
Family
Physician
supported by
CHCs
Medical
Centres
Source: HIMSS 2012
Restructur
ed
Hospital
Home
Screening &
Prevention
Rehab
Centres
Family
Physician
supported by
CHCs
Medical
Centres
Communit
y Hospital
Polyclinic/
Family Medicine
Clinic
Polyclinic/
Family Medicine
Clinic
Palliative
Care
Communit
y Hospital
Nursing
Homes
Polyclinic/
Family Medicine
Clinic
Palliative
Care
Rehab
Centres
Home
Screening &
Prevention
Family
Physician
supported by
CHCs
Medical
Centres
Restructur
ed
Hospital
Nursing
Homes
Palliative
Care
Rehab
Centres
@Copyright 2012 Health InterConnect
Restructur
ed
Hospital
Nursing
Homes
Palliative
Care
Rehab
Centres
11. Vision of Future Healthcare Landscape
- enabled by the Regional Health Systems (RHS)
Screening
&
Prevention
Polyclinic/
Family
Medicine
Clinic
Community
Hospital
Nursing
Homes
Home
Palliative
Care
Family
Physician
supported
by CHCs
Rehab
Centres
Restructured
Hospital
Medical
Centres
Strategic vision
of patients
moving
seamlessly
across the
healthcare
system, receiving
coordinated
patient-centric
care at the most
appropriate
settings.
Organisation of the RHS, where Home is the central location for care, with primary care delivering personcentric care integrated with the rest of the care spectrum for both physical and mental healthcare
Source: HIMSS 2012
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12. A patient journey within a setting
Patient arrives
at hospital
Consultation
Investigation
Treatment
Patient
discharged
Claim & Billing
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13. Different IT systems along the patient
journey
Lab Order
Patient
Arrives at
Hospital
Patient
Admission
Rad Order
Consultation
Lab Result
Rad Result
Investigation
Clinical
Documentation
Medical Procedure
Surgical
Procedure
Patient
Discharged
Treatment
Discharge
Summary
Medication Prescription
Medication Dispense
Billing &
Claim
Mgmt
Medication Administration
Insurance &
MediClaim
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Casemix &
Subvention
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14. Different information models
Heterogeneity in naming, syntax, representation and structure
Data Source1
Data Source2
Data Source3
e.g., “Severe osteoarthritis of the left knee ”
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15. Lack of standardisation
Code
Y
N
Code
X
Value
Code
1
0
Resident
Non Resident
Code
R
N
P
Value
Resident
Non-resident
PR/Residential
Status Code
A
C
P
U
Value
Resident
Non-Resident
Value
RESIDENT
NON-RESIDENT
PERMANENT RESIDENT
Description
Alien
Citizen
PR
Unknown
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16. Fragmented Information
Input - Output
Process
Clinical Desicions
Information
Medical
operational
Society
objective
subjective
Assesment
Planning
Workflow
Action
Community
Isolated information
Complex desicions
Fragmented information
Lack of training
Not accessable information
Changing knowledge
Diference in structure and clinical meaning
Medical errors
Too much information
Inefficient workflow
Bad information presentation
Understaffing
Only clinical data is kept (no knowledge)
No operational information
Some information is not computer usable (free
text, image features, (genome in the future))
No infrastructure information
No common language
No feed back to medical community and society
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17. WHAT IS THE SOLUTION
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18. Multichannel enabled architecture
• From ‘PC first’ to “Mobile first’
• Embrace ‘multi-channel enabled
architecture’
– It drives the underlying shared service
design principle
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19. Data driven service enablement
• Do we understand why ‘SOA != Web Services’?
• Adopt SOA to enable data sharing & re-use
instead of moving data across
• What’s the fundamental benefits of SOA
service enablement?
– A paradigm shift from ‘move’ data across towards
‘share & reuse’ data across
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20. An analogy on ‘share’ instead of ‘move’
• Do we copy and paste the external content into our
site page, or we simply use URL link to reference the
external content when we build a web site?
• Why it is important?
– Prevent information proliferation, and avoid obsolete
information
– Promote self-discovery, requester can ‘follow’ the path to
navigate to the needed information
– Promote decoupling between requester and provider
– Each app can focus on managing its own information, and
relies on reference to build up network of information aggregation
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21. Master Data Management
• Adopt SOA to share instead of duplicate
Master Data
• Data Entities
– Patient
– Care Provider
– Healthcare Organisation/Services
– Terminologies such as medication and
procedure
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22. Standard-based Info Exchange
• Leverage on international standards –
HL7
– Reduce long time integration cost
– Support of wider development community
• Provides unified info access layer to
hide the underlying diversity and
complexity
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23. Unified Info Access Layer
• Provides consistent
API to access
diversified
information
• Transparent data
access control and
privacy
enforcement
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24. A unified information layer provides
the foundation for RAD
• Information consumers
– Higher level business
services
– Presentation layer
components
– External partners information
consumers
Presentation
External
Business
Presentation
External
partner
Business
Service
Presentation
External
partner
Business
Service
Presentation
External
partner
Business
Service
Presentation
External
partner
Business
Service
Presentation
External
partner
Business
Service
Presentation
External
partner
Service
partner
• Minimize the potential
changes to information
consumers
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Information Layer
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25. Standards Based Reference Design
Messaging and Document
based Integration
Lightweight
Restful Service
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27. SOA Adoption Strategy
1/2
• Start from infrastructure IT-driven
service
– E.g. Common authentication service
• Share and reuse existing IT assets
• Consolidate redundant business
functionality into fewer moving parts
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28. SOA Adoption Strategy
2/2
• Establish common standards and
integration patterns
• Publish services to encourage reuse
• Remember, SOA is a journey of
business & IT transformation
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