Data warehousing, medical identifiers and untapped intelligence

Richard Corbridge, HSE



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8 December 2015 | 0

The Health Service Executive (HSE) has 17 years of prescription data in the Primary Care Reimbursement Service (PCRS) ready to be mined, while An Post’s data warehouse is now producing insights in minutes.

Both the HSE and An Post are long standing Oracle customers with long usage histories and were speaking at the recent OpenWorld event in California.

Richard Corbridge, CIO, HSE, explained that the PCRS has been on Oracle infrastructure from the very beginning. Inside, he said, there is 17 years’ worth of prescription information that is, as yet, untapped but ready to be mined for insights.

“It is literally a store of data, nothing more,” said Corbridge.

No tech barriers
This might seem an unusual resource not to be exploited, but when it comes to data, technology and health, it is rarely the technology that stands in the way.

Corbridge explains that a major development for the HSE, and delivering healthcare in Ireland, is the Individual Health Identifier (IHI). This is a system for a unique identifier for each person within the health system to allow for individual patient records to be reconciled across all branches, from GP care to hospital referrals, and treatment and prescription histories that would be invaluable for the likes of accident and emergency clinicians.

At the end of last year, Corbridge explains, the decision was taken that when the IHI is created, it would be created inside the PCRS infrastructure. As of 1 September, that technology stack is the responsibility of the HSE CIO office.

IHI standards
“Through this year, we’ve been working to create the design standards for what the IHI is, how it would work and how it would be exposed, make sure all of the legislation is in place and kick off the privacy impact assessment, and get ready for creating the IHI,” said Corbridge.

“There was a real desire to do that before the end of the summer, to make it live and prove the concept of what it was to have an IHI in Ireland and to use it in different ways. We worked with Oracle on how it would fit inside the PCRS infrastructure and the technology stack and some of the web services that come with that. It just lends itself perfectly.”

There was even a useful precedent for the HSE, on a much larger scale.

“It’s been done in Brazil already on the same solution, so there are lessons to be learnt from there, and building on them,” he said.

But with the technology there, and proven in other jurisdictions, it was a legislative issue that needed addressing.

The IHI Act was passed at the end of 2013. Corbridge explains that elements had to be extracted from the Health Information Bill, which has been long in waiting, and put through specifically to facilitate the IHI.

“Because you are creating an identifier for everyone in Ireland, using public sector data to be used in the public and private sector, legislation had to be passed to link those databases,” he reports.

“Frustratingly, whilst the legislation has been enacted to create the IHI, it has not yet been created to allow us to look at the IHI.”

“That is the next big piece of work,” said Corbridge.

NI integration
However, progress has been made and the facility now exists for just under 5 million patients. There is even the facility to integrate with Northern Irish NHS systems, and further into European data infrastructures said Corbridge.

Corbridge said that there are some world leading centres of excellence within the Irish health system, citing the epilepsy electronic health record, which can be leveraged to provide a basis for the likes of full electronic health records, but that recent low investment levels in IT in healthcare means that Ireland is some way off the likes of the UK and many of our European partners in the area.

However, success in systems such eReferrals for GPs have been such that the arguments for funding are becoming easier.

“We’ve gone from nothing to nearly 50% of hospitals accepting eReferrals from GPs. They will have the IHI on them so that when you’ve got the referral and then the discharge note with the IHI, matching those two will be a machine capable process, rather than a human one. A rough estimate says that 45 minutes per day is spent matching referrals to discharge notes, and with less accuracy. The saving could be quite phenomenal,” said Corbridge.

Centralised information
An Post has gone from a situation 5 years ago which consisted of distributed, uncoordinated information in spreadsheets, to a centralised highly connected data warehouse that facilitates dashboards and analytics and near real-time insights to guide the business, reports John Cronin, CIO.

With various Oracle installations through the business, there was already a level of familiarity and comfort, reports Cronin, but when the decision was made to look for a data warehouse solution, there was a still competitive process.

Oracle was chosen after six months of discussion, said Cronin. There had been Oracle databases in An Post for many years, he says, running systems and services such as the state savings bank system, and the fixed penalty notice system with the Gardaí.

The Oracle GoldenGate system was chosen and implemented. GoldenGate is a comprehensive software package for real-time data integration and replication in heterogeneous IT environments.

Small test
Mail operations were included in the first phase roll out, followed by payroll in phase two. For an organisation of some 1,130 post offices, 2,000 service outlets and more than 10,000 employees, this was no small test of the system.

Cronin reports that there were immediate results with efficiencies around mail route planning, working hours, sorting for efficient delivery etc., that allowed An Post to make the best of the resources available.

Labour and input for the system has reduced by 17%, while it has facilitated next day delivery rates going from 72% to in excess of 98%.

There are also significant savings when considering total cost of ownership. The dedicated Oracle infrastructure saw two ExaData boxes replace 20 traditional servers. Between licensing, hardware and operational considerations, the savings run to around €1.2 million per year.

There are also predictive analytics capabilities now available to the users of the system and Cronin said that functions such as budget forecasting have improved dramatically.

“The information that is needed to run the business will be available quicker,” said Cronin. “It will transform the way we run our business.”


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