Systems integration, interoperability

Real-time information sharing is vital to controlling pandemics

The current swine flu outbreak emphasises the global, connected challenges facing today’s healthcare professionals. By June 2009, over 30,000 cases had been identified in 75 countries across the world, all appearing in less than two months, causing the World Health Organisation (WHO) to declare the disease a pandemic.

This is a major change — previous flu outbreaks took months to spread across the world, making them easier to understand and quarantine and giving the authorities time to put defensive strategies in place. Now a more mobile population means that diseases can spread in hours, needing a radically different approach to pandemic control.

Accurate information should be at the heart of this approach. Being able to monitor risk, identify potential carriers and share this information locally, nationally and internationally is at the heart of controlling potential pandemics. And given the speed at which disease can spread, information has to be as near to real time as possible.

The good news is that the growing computerisation of healthcare IT means that information on this scale is increasingly available. Historically, healthcare providers have worked in silos, with data kept on local systems unconnected to the wider world.

The last five years have seen a push for national IT systems, such as The NHS National Programme for IT (NPfIT) run by NHS Connecting for Health (CFH) in the UK, that securely share data, including medical records, to deliver better patient care and increase efficiency.

However, this process is by no means complete across the world, with many healthcare systems still relying on fax and email. But as technology costs have fallen and patient expectations have risen across the world, healthcare has opened up to collaboration — enabling valuable information to be integrated to provide a complete, accurate and timely picture.

Challenges

This information explosion has, however, created three new challenges. Data needs to be integrated between multiple different systems to gain an overall picture, quality needs to be checked and advanced analytics are necessary to ensure that healthcare professionals can track the trends and navigate their way through the potentially millions of records that are now available to them.

In the case of pandemics such as swine flu, integrating different IT infrastructures is complicated by the number of countries, systems and standards involved. It is impossible to expect every healthcare IT system around the world to use the same standards — cost alone would be prohibitive, and the risk would be a generic standard that would meet no-one’s needs adequately. Add in disparate hardware and software configurations, ranging from legacy mainframes to the latest web-based systems and you see the scale of the integration problem.

While it is pretty obvious that neighbouring NHS trusts will need to be able to easily exchange information, sharing information internationally is a new experience for most healthcare professionals. And it is impossible to plan who you will need to integrate with — six months ago no-one would have identified the sharing of medical information between Mexico and the UK as a priority.

Given the speed at which diseases spread, once the need is identified it needs to be met quickly if healthcare professionals and international bodies such as the WHO are to understand, track and ultimately control pandemics.

Therefore hard-wired links between individual systems will not work in providing real time integration. What is needed is a more open approach that can handle all types of data, check information quality and translate it accordingly.

Essentially this should be an information hub that combines built in translators for all common data formats, such as the healthcare messaging language HL7, with a user-friendly way of integrating new formats once they are found. And despite the increase in healthcare IT use, it is vital that unstructured formats such as fax, email and spreadsheets can also be included to provide a complete picture of the healthcare landscape.

Information quality is vital to ensure both that data is complete and that systems are acting consistently. For example, different terms need to be understood, different fields need to be matched and dubious or unclear records flagged automatically. This prevents bad data corrupting the overall picture and aids analysis.

Bringing data together and making it cohesive and consistent provides the ability for healthcare professionals to access the most powerful weapon against pandemics — real time information.

Understanding where swine flu cases are most concentrated, who carriers have recently been in contact with, susceptibility of particular groups and specific ways that diseases are spreading, should put doctors one step ahead of swine flu.

Used correctly, comparisons can be drawn with other countries or outbreaks, providing the ability to predict next steps and take action accordingly. In the case of swine flu, analysis of cases has found that it particularly affects young working age patients, rather than older members of the population.

Best practice

To understand best practice, healthcare IT professionals should look at previous epidemics and how these challenges were met. During the SARS outbreak of 2004, the Hong Kong Hospital Authority implemented a data integration platform from Informatica to bring together information, including front line clinical care data to co-ordinate medical, audit and performance reporting.

This is now being used in the frontline of the current swine flu pandemic, demonstrating the ongoing value that integration brings. Hong Kong recently closed all nurseries and primary schools as part of its response to swine flu.

Before implementing the new system the authority used a fax-based information sharing process. This made it extremely difficult to get a complete and up-to-date patient view across hospitals and clinics.

By replacing a manual, legacy system, the authority is able to bring together data from 30 clinical systems across 43 hospitals and 121 outpatient centres. The integrated data fuels a datawarehouse containing historical data on six million patients — 90% of Hong Kong’s population.

Showing the value of integrated data, during the SARS epidemic this datawarehouse was used to create an external reporting system for sharing SARS-related information with the government’s Department of Health to support contact tracing and quarantine control.

This complete, real-time picture provided sharing of critical information during the SARS epidemic, enabling better focus of efforts to improve patient care and minimise the spread of the disease. In more normal times, doctors are now able to engage in more comprehensive medical investigations for improved care and have a platform for sharing critical information in near real-time.

As the Hong Kong example shows, integration does not just help during epidemics. It provides the infrastructure to share information, analyse statistics and consequently deliver a comprehensive view of the healthcare landscape either geographically, by age group, type of disease or sex. Resources can then be better deployed to ensure the highest standards of patient care.

Conclusions

Swine flu has been declared the first pandemic of the 21st Century and shows no sign of abating, demonstrating that the need for real-time collaboration across the world is accelerating.

With technology increasingly at the heart of healthcare, it is vital that organisations work together and integrate data in order to turn it into useful, actionable and real-time information. This analysis will provide the ability to stay one step ahead of pandemics and ensure understanding to minimise further spread of disease and hopefully minimise potential loss of life.

John Poulter, senior vice president sales EMEA, Informatica.

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