Healthcare Enterprise Architecture for Epidemics and Pandemics

By Dr. Padmavathi Roy, Advisor DXC Technology Office, DXC Technology

Healthcare Enterprise Architecture

In this article, I would like to discuss the critical importance of connected healthcare systems during an epidemic or a pandemic. Everyone benefits from connected healthcare systems; people, families, districts, states, nations.  Leadership from all levels of healthcare authorities is essential, from hospital workers to governments, to global organizations such as the World Health Organization (WHO).

The figure below simplifies the epidemic triangle where the pathogen, host and the environment are involved. An outbreak or an epidemic exists when there are more cases of a disease than expected in each area, or among a specific group of people, over a period.

Wuhan is where the COVID-19 case was first reported. Now 210+ countries and territories around the world are under pandemic. There has been inertia and lack of connectedness among healthcare systems that has contributed to containing the virus that had led to the pandemic of COVID- 19 today. COVID-19 has cost over 285,000 lives globally (as of May 11, 2020), has virtually halted economies of the world, and is stressing healthcare systems globally. Would these outcomes have been reduced by having a connected healthcare system? With a vigilant module embedded, I think so.

So, what does such an epidemic-pandemic module look like?

Drawing from the World Health Organization’s six building blocks of health systems, considering the person at the center of an epidemic, I try to define how such a module could help in a time of crisis.  My focus is on the unfettered flow of necessary information.

An epidemic-pandemic response module must be integrated with other hospital information systems and electronic patient records.  This capability would enable front line workers to alert the WHO and other global epidemic monitoring and alerting organizations.  When a local system gets continuous alerts with similar kind of clinical symptoms from a city, following an incubation period of 7-14 days then the following sequence of messages would be alerting WHO.

1. Electronic Patient Records and connected Hospital Information Systems from a city in single country records similar kind of clinical symptoms for more than 7 days
2. The new symptoms get recorded for more than 7 days in a group of people or groups of people, from a single or multiple cluster
3. Connected healthcare systems can then help alert authorities within 10 days of identification of an Epidemic
4. The World Health Organization can then call for an emergency meeting with Epidemiologists, Physicians and Government health authorities of SAARC, NATO and UN Countries alerting them, and others, for preparation for a probable pandemic
5. The six building blocks identified by the World Health Organization gets alerted as shown in the figure above

And as a result of this we could contain the outbreak, prevent a pandemic, save lives, and prevent economic collapse.

Lessons Learnt from the COVID-19 and How to Prepare for Future

1. Develop the capability of any country to tackle and contain the spread of the virus
   • Adopt preparedness measures at the village, district, state and country level
   • Build crisis management infrastructure and educate others about it in all educational systems.
2. Transmission of alert from the country of genesis to WHO in 1-14 days or with in the incubation period of the virus
3. Supply chain preparedness

• Medicinal supplies (personal protective equipment, ventilators, hospital capacity, etc.)
• Food Supply Chain

4. Closing national and international borders
5. Severely restricting and in case needed shutting down airports and other mass transits
6. Developing the health care-hospital infrastructure
   • Isolation and quarantine wards
   • Personal Protective Equipment (PPE) for front line workers
   • Development of the treatment protocols
   • Preparedness of the ICUs & Ventilators
   • Testing capability
   • Agile clinical trials for swift development of Vaccines

Post COVID-Landscape Changes

Landscape of different domains need to change in Post COVID world. It starts with us as people and to nations entire ecosystem need to change.

As a person we need to improve our innate immunity, by adhering to a systematic lifestyle, diet and physical exercise. Need to maintain personal hygiene and generic social distancing. I would cover immunity development to seasonal and environmental changes in another article in future.

At a region level, improving the cleanliness of our environment. Ban wet markets, as these wet markets trade live animals and they have been implicated in previous outbreaks of coronaviruses for e.g. SARS (Severe Acute Respiratory Syndrome).

Different countries in the world need to be part of the United Nations Climate Change “The Paris Agreement” to a common combat to the climate change and its adverse effects.

Healthcare changes to start with paper less patient health records connected healthcare systems, telemedicine, boundaryless healthcare information flow across the world. More empowered World Health Organization.

There is a dire need for the world to change the way it to day to be more efficient to prevent, contain and spread of epidemics and pandemics in future.