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A Cloud-Based Electronic Health Record Platform

A Cloud-Based Electronic Health Record Platform. Henry Chueh, MD, MS 闕 思 杰 METS 2012 November 11-14, 2012. 30%. Health Care. (n=150) Data from CDW Tracking Poll 2011. What about clinical applications?. Barriers. Security Privacy Compliance. Incentives. Cost Access Consolidation.

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A Cloud-Based Electronic Health Record Platform

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  1. A Cloud-Based Electronic Health Record Platform Henry Chueh, MD, MS 闕 思 杰 METS 2012 November 11-14, 2012

  2. 30% Health Care (n=150) Data from CDW Tracking Poll 2011

  3. What about clinical applications?

  4. Barriers Security Privacy Compliance

  5. Incentives Cost Access Consolidation

  6. Delivery Transition Agility

  7. 1999 Millennium bug Netscape dies, IE thrives HTML 4.01 Emergence of XML

  8. An informatics platform to meet MGH’s clinically-related operational and research needs responsively, effectively, and efficiently Oncall

  9. Be a user-driven platform Support a common clinical record and integrate with existing systems and data Support highly specialized workflow Foster research on its technology and the clinical processes it supports Oncall goals

  10. Oncall Cloud-based Web browser client Service-oriented architecture

  11. CoStAR EMR est. 1978 1981 users 178,037 patients 1,522,879 structured notes

  12. HTML Application Services XML Data Services { private cloud } Oncall CoStAR SQL database bulk M database

  13. Request Flow Data App / Presentation App / Business

  14. Electronic health record (EHR) Discharge Express Apprentice (Handoffs, Signout) iHealthspace TopCare Population Health Clinical Research toolKit Anesthesia Pre-op Professional Billing Cardiac Lab Operations Cardiac Surgery Inpatient Transplant Registries Embryology Lab Obstetrics record Neonatal Bilicurves Surgery Registries, M&M Mobile workflow …and many more Oncall: host to many

  15. Oncall usage growth

  16. Oncall usage growth

  17. Scalability Database External services Sessions Chaining services

  18. Sessions Cookies or database Reduced memory needs Avoid self-blocking

  19. Chaining services Recursion Parallel requests Single server pool 1 3 2

  20. Results Oncall EHR Discharge Express Apprentice iHealthspace

  21. Oncall as EHR Instead of “applications”… …focus on content and workflow

  22. Oncall “brands” Primary Care (IMA/APF/NEHC) Cardiology Cardiac surgery Transplant Program Fertility Obstetrics Reproductive endocrinology Infectious disease Anesthesia Emergency surgery Surgery Vascular Center >5,000,000 documents >1,000,000 patients

  23. Structured Notes <PROBLEM> <CONCEPTID SCHEME=‘ICD9’>401.9</CONCEPTID> <RECORDEDNAME>Hypertension</RECORDEDNAME> <COMMENT> Increase lisinopril for sustained high systolic readings. </COMMENT> ... </PROBLEM> “High blood pressure. Increase lisinopril for sustained high systolic readings.” <PROBLEM> <CONCEPTID SCHEME=‘ICD9’>786.2</CONCEPTID> <RECORDEDNAME>Cough</RECORDEDNAME> <COMMENT>Resolved.</COMMENT> <STATUS>INACTIVE</STATUS> ... </PROBLEM> “Inactivate cough. Resolved.” <VITALSIGNS> <PULSE>75</PULSE> <SYSTOLICBP>156</SYSTOLICBP> <DIASTOLICBP>84</DIASTOLICBP> <WEIGHT>210</WEIGHT> ... </PROBLEM> “Pulse 75, BP 156/84, Weight 210.”

  24. Transcoding Oncall Electronic Health Record Direct Data Entry >75% Clinical Language Understanding Outsourced Transcription “Correctionist”

  25. Concepts by Year SmartDictation Oncall EHR CoStAR EMR

  26. Discharge Express

  27. Apprentice Handoffs Signouts Progress notes 3700 users, 47 groups

  28. Apprentice

  29. Apprentice …and ~1,000,000 daily progress notes in 2012

  30. iHealthspace

  31. iHealthspace

  32. iHealthspace

  33. JSON Application Services XML Data Services { private cloud } Oncall

  34. Acknowledgements Octo Barnett, MD Faculty and Staff, Laboratory of Computer Science

  35. Thank you谢谢

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