Architectural Design Principles
The key principles of the future architecture direction consider the technology trends in health and are based on international best practice and experience in the health sector. As a key theme underpinning these principles is the sharing of information, alignment with legislation and engagement with the Irish Data Protection Commissioner will play a critical part to ensure successful implementation. The principles are set out below.
Architecture Design Principals
Users should have access to the full local record, and core national record at the point of care delivery
Patients, Clinicians, Care Staff and other Users of healthcare systems in Ireland should have the benefit of access to relevant clinical data at the point of care delivery. The HSE architecture aims to provide a consolidated core national record that contains key demographic and clinical details together with a summary of care and events across all care settings. Implementing this principle will require local systems to integrate with and publish data to core systems.
Solutions should enable integrated, end-to-end care pathways through all phases of care delivery: Prevent, Access, Entry, Diagnose Treat, Evaluate, Transfer, Maintain.
The concept of the “circle of care” is that healthcare is an ongoing continuous process. Patients are initially in a stage of health & wellbeing maintenance (prevent). If a health event occurs, the patient may access care services, enter into a care setting, receive assessment, treatment, transfers before returning to health & wellbeing maintenance. This cycle will repeat many times during the patient’s lifetime. HSE solutions should support this complete cycle of care with appropriate Information Technology solutions. This requires integration between HSE “core systems”, core applications, applications that are local to individual care settings (GP, Acute Hospital, Departmental, Community, Mental Health and others). Integration should enable process level integration, enabling a process (e.g. transfer of care) to be supported with IT across care settings.
There should be a single, consistent identifier for patient, practitioner and location
The Individual Health Identifier (IHI) Bill provides for patient and practitioner identifiers. Identifiers are also required for locations. Identifiers are required as a fundamental enabler of patient care records, to improve data protection through accurate data linking, and improve management through more accurate reporting. The IHI must be applied to all systems that integrate with the HSE architecture, where a patient, practitioner or location is being described.
Access and entitlements should be common and consistently enforced across all systems
User access should be based on a single identity. Entitlements to access functionality and data should be based on consistent rules that are applied across all systems. Entitlements should be based on role and relationship to the patient. This is required to enable efficient entitlement management and audit of access and access rights.
Solutions should enable federated, hybrid or centralised solutions to be implemented in a phased manner, using standardised interfaces
The HSE has a mix of federated, centralised and hybrid (in-between) systems. This architecture will support all of these options now and in the future. To support future solutions, in particular solutions that integrate across systems, it will be necessary for current and future systems to implement standardised interfaces and integrate with the rest of the HSE estate.
Core national components, described by standards, must be identified and built early on.
The national core components are the foundations for all other components which integrate with the core. A stable core is important, as changes to the core in future would have the potential to disturb many systems. The core will define the interfaces for all non-core systems to integrate with, and enable the integration of these other systems.
Point of care systems and system processes integrate and use these core systems
Local and central point of care applications will integrate with core systems to provide functionality and a connected view of information to end users. Additionally, system processes will integrate with and use the core systems to automate and connect processes across multiple care applications and care settings.