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Johnny Ma
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Many health organisations now use the Healthcare Information and Management Systems Society’s (HIMSS) EMR Adoption Model (EMRAM) to set the strategy for their path to adoption of electronic medical records (EMR). This eight-stage (0-7) model measures a hospital’s implementation and utilisation of information technology applications, providing logical and progressively sophisticated steps for full EMR adoption. However, as they progress towards this goal, many physicians and managers remain confused as to how they can simultaneously manage two important needs for content management. One need is to identify appropriate IT solutions to manage the increasing volume and variety of EMR content. The other need is to ensure seamless interoperation among healthcare applications and databases.
To help health organisations in Asia Pacific effectively and confidently move towards full EMR adoption, Hitachi Data Systems has created the industry’s first medical content management requirements to match the HIMSS EMR Adoption Model. The result is a valuable blueprint that organisations can use to confidently plan their IT and fully optimise their IT investments.
The following table shows how medical content management requirements correspond to each stage of EMR adoption.
Based on the blueprint created by HDS for HIMSS EMRAM, we can identify which IT applications and solutions can be used to meet the specific medical content management requirements of each stage.
| Medical Content Management Requirements for EMRAM | ||
| Stage | HIMSS Analysis Asia Pacific EMR Adoption Model Cumulative Capabilities | Medical content management requirements |
| Stage 7 | Complete EMR; CCD transactions to share data; data warehousing; data continuity with ED, ambulatory, OP | Deliver 100 per cent availability and security to ensure non-stop operation
Extraordinary flexibility and scalability to support growth |
| Stage 6 | Physician documentation (structured templates); full CDSS (variance and compliance); closed loop medication administration | Enable rapid content retrieval for all clinical systems
High flexibility and scalability to support information growth Stringent business recovery plan, acquiring solutions like real-time replication, snapshots and cloning |
| Stage 5 | Full R-PACS | Upgrade to an enterprise-class content management platform
Enable real-time access and fast retrieval of medical information Enhance private cloud, storage virtualisation and unified content storage Further enhance the business continuity plan |
| Stage 4 | CPOE; Clinical Decision Support (clinical protocols) | Provide higher levels of information sharing and collaboration
Optimise performance, security and availability for applications and content management Adopt cloud and storage virtualisation to support increasing applications and workloads Improve the business continuity plan |
| Stage 3 | Nursing/clinical documentation (flow sheets); CDSS (error checking); PACS available outside Radiology | Enhance scalability, compatibility and cost-savings for future development
Improve RTO and RPO with improved data protection and long-term archiving The intention to adopt cloud becomes apparent |
| Stage 2 | CDR; controlled medical vocabulary; CDS; possible document imaging; HIE-capable | Unified content management and business continuity become equally important
Empower more sharing and reviews of medical content Consider to implement cloud to enhance efficiency, reduce costs and enable mobility in the future |
| Stage 1 | Ancillaries – Lad, Rad, Pharmacy – all installed | Unified management of all types of content, including files and images
Content protection is a must to meet regulatory requirements Disaster recovery plan for data protection |
Unified content management
Health organisations must now deal with an ever-increasing volume of content-intensive clinical data, medical images and files. The cornerstone of full EMR adoption is to implement a unified content management system that can handle all types of data, including files, images and block data. By simplifying the management of all data types, health organisations can store, share, and retrieve files and images from a single system with greater simplicity, reduced costs and lower risks. Since IT requirements will be added in accordance with the progression of the EMRAM, the chosen solution should not only meet the organisation’s current needs, but also lay the groundwork for future expansion. The solution must be highly scalable and flexible to allow the organisation to grow. For example, it should be easily scalable from a few terabytes to tens ofpetabytes, and enable users to effortlessly add functions like dynamic provisioning, dynamic load balancing, auto-tiering and replication tools. As EMR is critical for daily operation, the content management system should also support SLAs, data integrity and availability.
Business continuity
Business continuity and disaster recovery plans are essential for all businesses today. In the healthcare sector, where reliability can literally be a matter of life and death, it is vital to ensure the non-stop running of health applications and information delivery. That’s why the disaster recovery plan should be prepared at an early stage of EMR adoption. Both the recovery time objective (RTO) and recovery point objective (RPO) should be well-defined, with an appropriate business continuity system. Health organisations should also choose a content management solution that can dynamically provide exceptional flexibility and expandability in terms of functionality, scalability, reliability and performance. The most important criterion is whether it can provide 100 per cent data availability to protect overall, organisation-wide data. This is necessary because EMR implementation will ultimately reach stage 7 (full EMR adoption) where 100 per cent data availability is a must.
Virtualisation and cloud computing
Enterprise-class management system
To support progressive EMR adoption and top-of-the-line, complete EMR operation, HIMSS and HDS recommend deploying an enterprise-class management system in the later EMRAM stages. When a health organisation develops its EMR in these final stages, it is preparing to operate in a fully-digital, paperless environment (namely, the full EMR adoption of stage 7).
At this stage, only an enterprise-class management system can provide the high-end, cutting-edge capabilities and functionalities that are required, such as dynamic tiering, storage virtualisation and leading performance, as well as 100 per cent data availability to guarantee uninterrupted operation. An enterprise-class platform can also help reduce the capex and opex of overall data management.
These medical content requirements provide practical guidelines to help health organisations of all sizes to meet their operational needs today and tomorrow. This blueprint creates a solid foundation to ensure guaranteed sustainability on a health organisation’s journey to EMR, while also protecting its IT investments.