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1、Amazon Web Services Accelerating Innovation in Healthcare 1 Accelerating Innovation in Healthcare The benefits of unlocking EHR data with AWS October 2020 Amazon Web Services Accelerating Innovation in Healthcare 2 Notices Customers are responsible for making their own independent assessment of the

2、information in this document.This document:(a)is for informational purposes only,(b)represents current AWS product offerings and practices,which are subject to change without notice,and(c)does not create any commitments or assurances from AWS and its affiliates,suppliers or licensors.AWS products or

3、 services are provided“as is”without warranties,representations,or conditions of any kind,whether express or implied.The responsibilities and liabilities of AWS to its customers are controlled by AWS agreements,and this document is not part of,nor does it modify,any agreement between AWS and its cus

4、tomers.2020 Amazon Web Services,Inc.or its affiliates.All rights reserved.Amazon Web Services Accelerating Innovation in Healthcare 3 Introduction.5 Innovation on AWS.5 Putting Data to Work.5 Improving the Healthcare Experience.7 Patient Experience.7 Clinician Experience.9 Employee Experience.9 Migr

5、ating to AWS.10 Conclusion.11 Contributors.11 Document Revisions.11 Amazon Web Services Accelerating Innovation in Healthcare 4 Abstract Migrating Electronic Health Record(EHR)environments to AWS offers advantages that go well beyond infrastructure.Organizations can radically enhance their clinician

6、,patient,and employee experiences by leveraging the broad portfolio of AWS services.This paper describes a pragmatic process for organizations to accelerate innovation by migrating their EHR environments to AWS.Amazon Web Services Accelerating Innovation in Healthcare 5 Introduction Hospitals have i

7、mplemented Electronic Health Record(EHR)applications for a variety of reasons,such as enhancing clinician and patient experiences,improving workflows,and care coordination.For hospitals,the EHR is at the core of clinical and business operations.It is essential that infrastructure powering a hospital

8、s EHR is not only reliable,secure,and provides the ability to keep Protected Health Information(PHI)private.It should also provide tools for healthcare organizations to transform their organization beyond the EHR.AWS has significantly more services,and more features within those services,than any ot

9、her cloud provider.AWS works with EHR vendors around the globe to regularly validate deployment architectures so healthcare provider organizations have the latest recommendations.Doing so allows healthcare organizations to migrate their environments to AWS to gain advantages from AWS.Innovation on A

10、WS Healthcare organizations generate tremendous amounts of data.In fact,the average hospital has 10-15 connected medical devices per bed1.These medical devices generate data that can be used for activities like predicting patient outcomes,creating better care plans,monitoring patients,managing suppl

11、ies,or identifying trends among the patient population.Today,many of these systems operate in silos where data is stored in different formats and databases.Data Interoperability,or the ability of systems to exchange healthcare data while understanding the context and meaning of the data,is key to un

12、locking this data to gain more intelligent insights.Putting Data to Work Healthcare organizations own their data whether they run their EHR system on-premises or on AWS.Data can also be accessed outside the EHR.For historical data,all major EHR vendors offer tools for exporting,migrating,and transfo

13、rming data to other locations.For real-time data,EHR vendors typically offer a service of SOAP and REST API calls.While FHIR server endpoints(using the standard HL7 FHIR protocol)are becoming more commonly supported across EHR vendors,there are also some EHRs that have custom SOAP and REST APIs that

14、 offer immediate access to application-specific data(such as department wait times).Because these services vary depending on the EHR,organizations should consult their vendors documentation related to data exporting and interoperability services.When accessing real-time data,start within your DEV en

15、vironment and use your vendors documentation to research all available API endpoints.From there,have a Subject Matter Expert(SME)from your EHRs application team work closely with your developers to test API calls in your DEV environment.It is important to have an EHR application team member work clo

16、sely with your dev team,as they may need to login to the DEV EHR environment to create test data.For example,when testing something like wait times,someone will need to check in fake patients,move them through departments,discharge them,and repeat,while the dev team tests API calls and code.Your org

17、anizations SMEs can also help to identify the correct places to pull data from.For example,allergy or Amazon Web Services Accelerating Innovation in Healthcare 6 current medications are common datasets and can normally be pulled through FHIR or custom EHR APIs.Customers should follow their vendors g

18、uidance for migrating code changes to each environment and deploying your application.There will be specific requirements when making API calls,so review your vendors documentation for the latest requirements.If assistance is needed during this process,reach out to your organizations AWS account tea

19、m and EHR vendor.The end result is that your data will be accessible,secure,and in compliance with applicable laws and guidelines,so that you can move forward with creating ancillary applications in your environment.Utilizing data lakes in a secure and compliant way is a primary use case we see cust

20、omers interested in.A data lake is a centralized,curated,and secured repository that stores all your data,both in its original form and prepared for analysis.A data lake lets you to break down data silos and combine different types of analytics to gain insights and guide better business decisions.Da

21、ta lakes also democratize your data by removing bottlenecks and expediting access while allowing granular security controls around permissions.By using AWS Lake Formation,a service that makes it easy to set up a secure data lake in days,a healthcare organization can enable access to data not only fr

22、om their EHR,but also all other applications in one central place.Figure 1 AWS Lake Formation makes it easy to combine your data Amazon Web Services Accelerating Innovation in Healthcare 7 Combining data from the multitude of applications in a healthcare environment opens up a new world of insights

23、into your organization.Patient falls can be researched by combining medical histories with building maintenance logs.Supply usage can be optimized.Patient population data can be studied and combined with organizational and environmental data.AWS Data Exchange,a service for subscribing to anonymized

24、and de-identified datasets,can be used to enrich data for even more insights.Healthcare organizations can even publish their own data to AWS Data Exchange,either for free or using private pricing,so that other healthcare organizations can exchange data for medical research.The list of clinical and b

25、usiness insights from an organizational data lake are virtually unlimited.Improving the Healthcare Experience With your EHR environment and data accessible from AWS,organizations can imagine new ways to use the growing number of AWS HIPAA-eligible services to transform everyones experiences in healt

26、hcare.Patient Experience Patients are the core of everything in healthcare,and their experience is vital to the success of any healthcare organization.Patients today expect the latest technology in their care,including voice,mobile,digital assistants,AI/ML predictions,and ease of access to their own

27、 healthcare data.Amazon and AWS have been at the forefront of this innovation,and our services are used in many cutting-edge solutions that patients already use and have come to expect in their daily lives.For patients,the beginning of their experience with an organization is at the digital front do

28、or.The digital front door is a strategy for engaging patients at every touchpoint of their journey.Amazon Connect(an omnichannel cloud contact center for voice and chat)and Amazon Lex(a service for building conversational interfaces into any application using voice and text)are services customers tu

29、rn to for creating a digital front door experience.These services allow customers to call,text,and chat with a bot that can help automate and assist providers with addressing patient queries,requests,and then directing them to the next best action.This becomes even more powerful when you query the E

30、HR directly for information.For example,if a patient asks about an upcoming appointment,Amazon Lex can query the EHR to get information and reply with the answer using Amazon Polly,a text-to-speech engine.Improving search capabilities for patients is another challenge that organizations are regularl

31、y tasked with.Healthcare environments are complex and contain numerous data repositories.Amazon Kendra,a highly accurate and easy to use enterprise search service powered by machine learning,can curate information from a multitude of data sources and provide answers to patients.By using Amazon Kendr

32、a,healthcare organizations can add search capabilities to data such as office locations and hours,clinician availability,physician biographies,clinic directions,and other elements,to create powerful organizational searches that provide the most accurate information.Amazon Web Services Accelerating I

33、nnovation in Healthcare 8 When patients receive care,the EHR contains a vast amount of data that can be used to update patient families.Amazon Simple Notification Service(Amazon SNS),a fully managed messaging service,can be used to build notifications based on patient events.For example,SMS messages

34、 can be used as patient movement notifications for patients undergoing procedures.Amazon Chime,a communications service,can allow family and patients to connect through video calls.For digital assistants and patient entertainment,healthcare organizations with an Amazon Alexa BAA can build HIPAA-elig

35、ible skills to create custom interactions,games,or enhance patient education using Alexa.Both Amazon Alexa and Amazon Lex can use AWS Lambda,a service that lets you run code without managing servers,to query data from any backend system using API calls.Hospitals can even create augmented reality gam

36、es for patients using Amazon Sumerian.The same functionality for building logic can be used across solutions with AWS services.Healthcare organizations can use Amazon Connect,Amazon Lex,and Amazon Alexa to use shared logic for reading data from any backend system.At a very high level,the architectur

37、e would look similar to the following voice architecture:Figure 2 Patients can use voice or chat to interact with their health record To engage patients outside of a clinical setting,Amazon Pinpoint,an inbound and outbound marketing communications service,can be configured to engage patients at crit

38、ical care points with data from an EHR.With Amazon Pinpoint,organizations can create different segments based on diagnoses or surgical data(e.g.diabetic patients,pediatric versus adult patients,transplant recipients,international patients,pre-or post-operative patients).These segments can then be se

39、nt meaningful information using email,SMS,or push notifications.This allows for more granular and relevant information to be communicated to patients.Amazon Web Services Accelerating Innovation in Healthcare 9 Another area where weve seen interest is telemedicine.Amazon Chime is being used in telehe

40、alth solutions for connecting patients to providers.By querying scheduling and appointment data in real-time,healthcare organizations can have standalone and highly scalable video communication and calling solutions in their resilient and secure AWS environment.Clinician Experience Clinicians need s

41、olutions that offer the most up-to-date information and latest technology.These solutions need to be integrated within their workflows so that everything is convenient and easy to use.With over 100 HIPAA-eligible services available to build with,AWS offers services that can be used to create solutio

42、ns for any clinical use case.Customers can use these services to transform and customize the clinicians experience within their organization.Some EHR vendors even support embedding custom web applications directly so functionality can be built and integrated in a clinicians workflow.For innovation t

43、eams and clinician builders,an environment can be secured with appropriate guardrails so that members can rapidly innovate and create solutions.For AI/ML work,having clinical data on AWS makes it easy and cost-effective to analyze tremendous amounts of data.Amazon SageMaker and the growing number of

44、 AWS AI/ML services can be used to improve patient care or enhance business and clinical operations.For reporting and clinical research,Amazon QuickSight,a fully managed business intelligence service,allows clinicians to build their own dashboards that can be shared with colleagues or embedded withi

45、n applications.Clinicians often ask about image and video tools.Amazon Rekognition can train models to look for skin abnormalities,cancer,text within referrals,objects,or even analyzing a patients mood.Medical images can also be de-identified using Amazon Comprehend Medical and Amazon Rekognition2.F

46、or simulations,healthcare simulation centers can use Amazon Sumerian to create augmented and virtual environments for training.Voice is one of the most requested areas that clinicians regularly ask AWS about.At a high level,the architecture is similar to the patient voice architecture shown in figur

47、e 2.Amazon Lex can fulfill voice commands.AWS Lambda can then be called to execute APIs on a backend system or interact with other AWS services.For example,Amazon Comprehend Medical can receive unstructured text and identify medical conditions,medication,dosage,and medical ontologies like ICD-10-CM

48、or RxNorm.Text from speech can also be sent to Amazon Translate for high-quality language translations,or to Amazon Kendra to create an enterprise voice and text search across medical documentation,procedures,unstructured documents,or other data sources.Employee Experience From clinical to business

49、staff,the complexity of maintaining a hospital environment can be stressful and time consuming.Interestingly,the five pillars of an AWS Well-Architected Framework3 are similar to what healthcare employees work towards:operational excellence,security,reliability,performance efficiency,and cost optimi

50、zation.For hospital staff,AWS provides robust capabilities to deploy Amazon Web Services Accelerating Innovation in Healthcare 10 infrastructure as code,automate resource management,improve disaster recovery,and enhance security and monitoring.AWS also provides access to the latest technologies for

51、clinical and business applications.In other words,resilient architectures can be created so that support staff isnt alerted at 3:00 AM that a server has run out of memory.When it comes to enabling a remote and mobile workforce,Amazon WorkSpaces,a fully managed and secure Desktop-as-a-Service solutio

52、n,can provide all employees with access to their desktops from any device or location.This allows clinicians access to not only the EHR,but all other applications and documentation they use for clinical care.An organizations entire staff can support,build,and innovate without being tied to a physica

53、l machine.Because it can be configured to access resources in the AWS environment with ease,employees can use their own devices to securely access any application they need for their job on Amazon WorkSpaces.Improving the employee experience does not stop at devices.Voice is another area we see busi

54、nesses investing in.Alexa for Business can be used to schedule conference rooms,join meetings,set reminders,take notes,and access other backend applications through API calls.For example,staff can ask about upcoming appointments or staffing questions for a department.AWS offers the tools to build th

55、ese interactions securely and reliably.Organizations that run on AWS can also tap into expertise from the AWS Partner Network.We are customer-obsessed,and 90%of what we build comes from customer requests.We offer a plethora of documentation,training,AWS Quick Starts,and other solutions to accelerate

56、 your objectives.Today,more than 90%of Fortune 100 companies and the majority of Fortune 500 companies use AWS Partner solutions and services in their organizations.Migrating to AWS To migrate to AWS,your organization should first reach out to its AWS account team.Your account team will assess your

57、current environment to provide the best options for migration.AWS has a variety of reference architectures,from hybrid to full cloud deployments,and your situation depends on how your organization prefers to manage your EHR.AWS can also provide various disaster recovery and single versus multi-Regio

58、n architectures.Because migrating to AWS offers cost savings,security,and high reliability,customers are encouraged to consider their other ancillary applications(from billing to PACS)when migrating to AWS.This can extend benefits to all areas that touch an EHR environment.Many companies that provid

59、e solutions to healthcare organizations are already building on AWS or are in the AWS Partner Network.Your organization has complete control over how you choose to migrate your environment or build solutions.Customers can choose to work on their own,with AWS Professional Services,or with an AWS Part

60、ner who specializes in building on AWS.Your AWS account team will work with you,your EHR vendor,and the migration team to ensure that your environment is optimized,follows the AWS Well-Amazon Web Services Accelerating Innovation in Healthcare 11 Architected Framework,and complies with your EHR vendo

61、rs recommendations.Migrating to AWS does not stop at infrastructure;it opens up a world of possibilities for innovation to reimagine how healthcare is delivered.Conclusion Migrating to AWS is the first step in a long journey to a healthcare organizations digital transformation.As AWS continues to in

62、novate on behalf of customers,the number of HIPAA-and HITRUST-eligible services offered expands.While no one can predict the future,you can be prepared for it by creating a framework and structure to exceed patient demands,deliver superior patient experience,and support providers in new ways.Healthc

63、are organizations can leverage AWS,the cloud provider with the most operational experience,to run their EHR and IT environments so they can focus on improving clinical outcomes and building better patient,clinician,and employee experiences in healthcare.Contributors Contributors to this document include:Brian Warwick,Senior Partner Solutions Architect,AWS Healthcare and Life Sciences Document Revisions Date Description October 2020 First publication 1 https:/ 2 https:/ https:/