couchbase live europe 2015: turkish ministry of health: electronic healthcare records
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1200+ Hospitals and 20K+ Family Practitioners:
National Integrated PC-EHRSystem with
Couchbase
Mehmet Zahid Ercan
CEO
Agenda • Who we are
• What is PC-EHR?
• Why NoSQL & Why Couchbase?
• Use Case Overview
• Key Stats
• System Overview
• Key Features & Outputs
• Future Direction
• Expectations from Couchbase
CompanyOverview
• Established in 2012, Istanbul -Turkey
• Provide
o consultancy,
o training,
o system analysis,
o project management and
o software development services
Company Overview
Project name:
«Saglik Yonetim Sistemi»
(Health Management System)
A Turk Telekom Company
What isPC-EHR?
• What is PC-EHR?o An electronic health record (EHR) is broadly
defined as a collection of patients’ health related
information
o Lifetime
o Central/National
o PC (Personally Controlled) EHR provides
individuals with contro l over access to and sharing
of their health records
o Manage EHR sharing and adjust level of privacy
using a web portal
What isPC-EHR?
• Why it is important?
o EHR systems offer significant benefits to
healthcare systems
o Facilitating healthcare information exchange
by allowing access to health records from
multiple locations
o Contributes to accuracy and timeliness of
care
o Improves the quality of healthcare delivery
WhyNoSQL?
• Storing healthcare records has become
the bottleneck for healthcare systems as
the structure and size of the healthcare
data have changed over the time.
• EHR systems require high-availability,
100% uptime
• Fast access to information is a MUST for
timely decision making
• Hardware costs and database license
fees are huge!
WhyCouchbase?
• Document-oriented
• Flexible –schemaless data model
• Great Windows Support
• Easy-to-use, intuitive admin interface
• Excellent .NET SDK
• XDCR, Views,….
Use Case • 1200+ Public and Private Hospitals
• Various EMR Vendors
• 20K+ Family Practitioners
• 1000s of individual practitioners and
health providers
• Real-time integration using web services
• One database to unite them all!
Use Case
Personal Health Portal
IndividualPractitioners
HospitalsFamily
Practitioners
PatientsPatients
Health SystemManagers
Document Structure
• Admission Details
• Basic Demographic Information
• Procedures, Laboratory Tests, etc.
• Laboratory Test Results
• Diagnosis and related information
• Vaccinations
• Prescriptions
• Financial Details
• Performance Details for Practitioners
• Discharge Details.
• …
Privacy • Patient identifiers in separate clusters
• No IDs in EHR documents
• No direct relation between patient
identifier documents and EHR
documents
• Hashing AND encryption
• Separate locations
Key Stats • 77 million citizens (plus other patients)
• 130M+ EHRs since December 2014
• 1.5 TB total document size
• Time-based 11-character keys
• 1.4 billion messages processed
• 20M+ messages / day
• 1750 incoming messages per second
• <20ms response time
Key Stats • Couchbase 3.0.1
• 35 nodes in 4 clusters
• 96GB RAM, 8-core 2 CPUs per node
• 400GBx2 SSDs for data on each node
• Bare metal
• Turk Telekom Data Centre
KeyFeatures
• XDCR
• Views (on 2nd cluster)
• Views with custom reduce functions
• Atomic counters
• Binary storage
• Expiring documents
• Memcached buckets
KeyBenefits
• Allow real-time data flow
• Live stats, early warning systems
• Better flexibility
• Better scaling
• Lower costs
• Always on
• Live feedback to health providers about
their data
Tips • Sizing matters!
• Monitor performance and stats
• Do not move your data
• 1 GbE not enough
• SSDs
FutureDirection
• Meaning behind the data
• Chronic disease management
• Control over prescriptions
• Promote healthy lifestyle and well-being
• Detect early symptoms and risks basedon analysis
• Patient participation
• Lower costs and less burden on healthsystem
Expectations from
Couchbase
• Re-consider 20MB value size limitation
• Better documentation about some
under-the-hood details (such as
indexer_max_doc_size)
• Solid enterprise backup tool
• A way of faster initiation of XDCR
MoreInformation& References
• Video on e-Nabız Project (﴾Health Portal for Citizens):
http://ow.ly/Kpnsj
• Cartoon from: komikaze.net
• Electronic Health Records and NoSQLo Ercan, Mehmet Zahid, and Michael Lane. "An evaluation of NoSQL
databases for EHR systems." Proceedings of the 25th Australasian
Conference on Information Systems. Auckland University of Techno logy,
School of Business Information Systems, 2014.
o Narayan, S, Gagne, M & Safavi-Naini, R 2010, 'Privacy preserving EHR system
using attribute-based infrastructure', proceedings of the 2010 ACM workshop
on Cloud computing security workshop ACM, Chicago, Illino is, USA, pp. 47-
52.
o Lobach, DF & Detmer, DE 2007, 'Research challenges for electronic health
records', American journal of preventive medicine, vol. 32, no. 5, pp. S104-
S11.
o Jin, Y, Deyu, T & Xianrong , Z 2011, 'Research on the distributed electronic
medical records storage model', proceedings of the IT in Medicine and
Education (ITME), 2011 International Symposium on IEEE, pp. 288-92.
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