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

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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

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

Key Stats

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

How can you do that?

System Overview

KeyFeatures

• XDCR

• Views (on 2nd cluster)

• Views with custom reduce functions

• Atomic counters

• Binary storage

• Expiring documents

• Memcached buckets

Outputs

Live Counters for Important Indicators

Outputs

Real-time Data Flow Maps

Outputs

Charts, Histograms, Tables…

Outputs

Personal Health Portal

Outputs

Mobile and Tablet Apps

Outputs

Wearables and Mobile Health Devices

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.

Thank you!

Mehmet Zahid Ercan

[email protected]