Cloud 2.0 integrations in eHealth Canada

The first main challenges we’re setting out to address in the ‘Cloud VDI for Healthcare‘ project is nicely illustrated by this graphic of Healthcare privacy domains.

I.e. For point-of-care delivery you need an IT environment that can enable users to easily span across multiple legacy systems, not just one EHR database. This requires VDI infrastructure to deliver the app to the device and you also need to address aspects like Cloud Identity as a keystone for securing this, as well as some kind of business process layer pulling from these sources.

Indeed it’s always more about a rolling process rather than static data, and it always requires collaboration and ‘process hand-offs’ in between all the many staff involved in medical treatment.

We’re not quite flipping data blocks across touch screen interfaces a la Tom Cruise in Minority Report, however there is increasing use of iPads et al and also better integration between different systems.

However this is only in some cases, in others there are still manual paper-based workflows and other impediments, and as Theory of Constraint planners will know, it doesn’t matter how souped up some parts of the process are, if other parts are still cart and donkey, then your overall speed will be cart and donkey.

For example last year I wrote a blog that highlighted how Canada is slipping behind the USA in terms of EHR adoption, and in that news piece a doctor was quoted that illustrates exactly this:

“So far, Dr Michael Freeman, a cardiologist at St. Michael’s explained, an individual hospitals records are limited in their connectivity to family doctors and local pharmacies. When a patient is discharged, we will provide an electronic letter to the family doctor and a typed out letter to the pharmacy. Those healthcare practitioners would not be able to directly update the patient’s record so that they are in synch with St. Michael’s records.”

While process improvement can be applied to some parts of the process, unless it is end-to-end then much of the desired transformation benefit won’t be realized.

TrackHealth – RM&R from the Cloud

It’s this type of gap filling that the Cloud is ideal for. Indeed rather than always thinking in terms of ‘moving our app into the Cloud’, it should be more about ‘connecting my app to the Cloud‘.

Getting inter-connected with the Cloud is more about agreeing to data interoperation standards, rather than virtualization and hosting, although ultimately the trend is about the combination of these two.

In Canadian healthcare there are a number of popular EMR tools already installed, and so rather than the focus being running more EMR but from Cloud providers, the focus is more about “Cloud SOA”, I.e. in what way will the Cloud act as a business process brokering service function for legacy apps like EMRs?

This type of focus highlights the various open standards projects underway oriented towards mapping traditional SOA models on to Cloud scenarios. For example the JTC 1/SC 38 standards program from the ISO, which focuses on Cloud, Web services, SOA (Service Oriented Architecture) and distributed systems. A similar group is the SOA tc at OASIS.

Implementing these on SaaS platforms will offer customers like Healthcare organizations with ‘Cloud Gateway Services’, meaning they can offer to connect up your existing on-site legacy apps in such a way that they offer integrated workflows with key local partners, like eReferral workflows.

This is most synonymous with the ‘HIAL‘ concept in Canadian eHealth referring to the shared information model defined by Health Infoway for inter-operation across the Canadian eHealth ecosystem. This is then translated into business process level solutions via programs like the eHealth Ontario RM&R process: Resoure Matching and Referral.

Canadian Cloud providers that adopt the software that implements these standards and gateway features can then offer the ideal mix of managed IT services and specialized vertical industry solutions, without having to become fully in-depth involved with the sector.

Small businesses can’t afford that level of specialism however hosting providers are ideal local support organizations for IT at a local level. GPs, smaller hospitals, et al, are all ideally served by locally run Cloud service providers; the Cloud doesn’t always have to mean the big central Amazon in the sky.

This type of software set could be packaged up as something like ‘TrackHealth SaaS’, and with suitable endorsement from the authorities involved, provide the ideal catalyst for ICT supplier development at this level, with these valuable solutions.

Cloud as ‘Overlay Architecture’

Leveraging the Cloud as an integrating layer more so than an operational platform can be thought of as an “overlay architecture” approach to business transformation, and there is more than SOA as available toolsets for achieving this.

It is of course an important one, and if you check out vendors like Fiorana you can get a taste for some well thought out approaches to blending Cloud and Service Oriented Architecture.

However it`s not the only one, and the other two I can think of and put forward as your Cloud 2.0 staples are:

• Open Data Warehousing - By using providers like Socrata, governments can build portals that aggregates all of their back-end data, i.e. a data warehousing approach, and then makes it available via an Open Data API.
• Enterprise Search Connectors - Utilizing software like Microsoft FAST, you can interrogate your back-end systems via a Search engine.

At one level all of these models enable you to modernize and extend the value of your existing legacy systems without replacing them, by building another layer of apps on top that use the underlying data.

Also in all cases developers can build on top of APIs, so it`s an ecosystem-enablement process too; where you then differentiate between them is the type and goals of that specific project, as each lends itself to scenarios for apps sharing data or for people searching for data, and permutations thereof.

If you consider our starting scenario of the healthcare worker at the point of care, then what they need is a ‘blended’ delivery of information – Some transactional like the patients name and other personal data, but also knowledge like the latest peer reviews of the best treatments for certain specialized illnesses.

Ideally and what `smart systems`will deliver is proactive matching of this data so it`s there at the point they need it, automatically. Hence why enterprises are going to want to abstract their legacy data via these main tool-sets, with Cloud providers being the ideal places to host and source them from.