Western Australian Emergency Medicine Research Online WAEMRO Dis-integrating healthcare information systems Professor Peter Sprivulis MBBS PhD FACEM FACHI 1

WAEMRO Our health care information systems are disintegrating Circa 1992, Fremantle Hospital Board resigned over failed hospital IT integration project Most big name ‘Health’ systems (evolved from acute hospital billing harvesting systems) are very old and can’t flow information to where it is needed by modern care models Most offer ‘all or none’ ‘integration’ 2

WAEMRO We are still waiting for the sun to rise on shared information clinical nirvana….. 3

WAEMRO And waiting….. 4

WAEMRO And waiting….. 5

WAEMRO 6 And it never will…..

WAEMRO Why? Every large health software company needs to be recapitalised every 7-10 years or so The business model is broken  Build at one site – OK  Build at many sites – go broke! Each site is different Manhours ++ consumed in just getting systems alive and communicating with legacy systems Every site upgrade is a ‘new build’ with the same problems as the first build The innovation path is glacially slow 7

WAEMRO What Google apps teaches us There is a business model for offering services across the web rather than installing and integrating a system upon site With clear benefits for the innovation path, costs of maintenance and scalability 8

WAEMRO But what about privacy? A major issue for any healthcare service delivered over the web is security and privacy No security/privacy framework or implementation is perfect Health consumers have every right to expect that their sensitive and private information is not put at risk 9

WAEMRO Two basic rules about the web and privacy If you want to keep something private….  Don’t put it on the web If you want the world to see it….  Put it on the web! 10

WAEMRO WAEMRO’s privacy model Strict separation of private and non-private information  Non-identification rather than de-identification or identity encryption Organisation and user handles confidentiality and privacy considerations of their records  WAEMRO content composed only ‘at the glass’ with organisation’s content  WAEMRO shares with, and organisation retains, a unique pointer to WAEMRO’s record system WAEMRO never sees nor stores private information or private identifiers 11

WAEMRO Highly technical diagram….. 12 WAEMRO Healthcare organisation security systems & firewall Healthcare organisation Technically speaking: The healthcare organisation and WAEMRO share a unique alphanumeric pointer to allow non-identified WAEMRO records to be linked by the organisation to private identified information, within the confines of the organisation’s security and privacy framework/systems.

WAEMRO We don’t have the full piano…yet The current model implies no ‘smart’ integration with decision support with early releases  Early services will need minimal duplicate data entry Eg age, gender, (but not much more) for acute coronary syndrome risk stratification Later  The pointer could be used to send more comprehensive data out to WAEMRO services and back Eg summary health profile records for medications decision support Lab data for disease management decision support All without the need for shared identifiers 13

WAEMRO The benefits of the model Clinicians can rapidly design and deploy clinical decision support tools and documentation templates THEMSELVES using readily available open source web based tools  Data may be downloaded and used for audit/quality improvement/research Time critical clinical information can be shared irrespective of clinician location, without the need to build new infrastructure or supply new/additional devices Scalability – design once, use again and again Persistent patient privacy controls can be built into the model 14

WAEMRO Privacy Example: CISAM A clinician obtains a clinical image using their smart phone, with the patient’s verbal consent The clinician uploads the image to the WAEMRO Clinical Image Sharing and Management service (CISAM) via in order to facilitate sharing with another clinician for clinical purposes The clinician must print out and hand to the patient the hyperlink to the clinical image file permissions page so that at any time in the future, the patient may change the permissions, before the clinician themselves can use or share the image 15

WAEMRO Take home message No identified information is required in order to build shared, clinical systems accessed across the web! 16