Healthcare software solutions giant Dedalus has released extra capabilities in its Digital Connect 4 Health (DC4H) interoperability platform, released to the Australian and New Zealand markets late last year.
The DC4H platform brings together a number of technologies developed over the years by Dedalus in Europe but also under its former corporate guise with DXC Technology.
The platform includes an enterprise master patient index and an integration engine, Dedalus interoperability lead for the ANZ region, Marcus Shirrefs. said.
“There are also some underlying pieces of an interoperability layer around consent management, policy management, so you can control the access levels and everything else, as well as a health provider directory,” he said.
“Ultimately, it brings together a repository that can hold a broad view of data from what would be otherwise in silos in different systems. And we’ve got an element we call Patient Synoptic Viewer, which is a browser-based view that gives users the window into the broad patient record.”
The company has also set up a new CTO group for the Asia Pacific region led by former NEHTA CIO and chief security officer Steve Burmester, which brings together the company’s expertise in architecture, cloud, security and interoperability.
Mr Burmester said the company had set up a single architecture practice that oversees products, solutions and services. “Part of the CTO group’s charter is to lead the transformation away from our traditional roots of being a product-based business, to being a services-based business,” he said.
“We are looking at how we can allow our customers to consume our applications and our products as services in a different way.”
For cloud, the company works with managed IT services firm LAB3 in the Asia Pacific region. “We partnered with them to accelerate the build of our Azure platform using their automated deployment solution called Bedrock, and it is secured with LAB3 Insight,” he said.
“We also utilise LAB’s 24×7 security operation centre (SOC) leveraging AI and automation for rapid threat detection and response, and their cloud managed services.”
The company also integrates with AWS, Mr Burmester said. “Our strategy is very much a hybrid, multi-cloud environment.”
Security is the third element of the CTO group’s key capability, which Mr Burmester personally oversees, and it has also set up an interoperability practice, headed by Mr Shirrefs.
“That’s everything from our processes and our methods for how we do it, but it also extends to the tooling,” Mr Burmester said. “And that is also the home where DC4H lives.”
DC4H as the glue
Dedalus’ senior principal for digital healthcare strategy Byron Phillips describes DC4H as sitting in the middle of the health journey between the hospital and beyond, with the Patient Synoptic Viewer sitting on top of the various layers.
“This positions DC4H as that glue to open up the underlying systems to the broader journey of healthcare,” Mr Phillips said.
DC4H has six pillars – Integrate, Ingest, Index, Insight, Inform, Intervene – which Dedalus says provides organisations with the ability to integrate and ingest data across disparate applications, to link datasets, to gain evidence-based insights about populations, and to support clinical workflows across organisations.
These capabilities allow organisations to share data across organisations to participate in a Health Information Exchange (HIE), Mr Phillips said. Together, it provides a comprehensive platform for innovation and modernisation to support an integrated health system.
Dedalus’ solutions architect Chris Royle said those new to the platform think initially it is an integration engine or an integration component. “But integration is just the first pillar of the six,” Mr Royle said. “As you move [through the pillars] the value increases through standardisation of the schema and terminologies.”
That is being done using FHIR APIs, with terminology services such as CSIRO’s FHIR-based Ontoserver, widely used in Australia and New Zealand, and now in the UK, being harnessed.
“FHIR R4 is under the covers of our longitudinal care record, but sitting on top of that longitudinal care record is the Patient Synoptic Viewer, which is a way of viewing that rich data,” Mr Royle said. “Between those two layers is the consent module, the policy engine to make sure that the user that’s using that application only sees the data they’re authorised to see.
“Anything that sits on top of that longitudinal care record has the same controls, like the API management layer. Whether our customers use our mobile apps or their own developed apps, they still go through those same controls, still get audited in the same way.
“And then there’s visualisation of the data. There’s AI algorithms that you can insert and because we’ve standardised the format using FHIR, we can then add algorithms such as the CSIRO readmission risk algorithm to determine risk factors.”
The Inform and Intervene pillars relate to how information is provided back to the clinician or to the business user, he said.
Mr Phillips said the DC4H platform promises simple management and configuration thanks to its unified self-service platform control centre, as well as simple set-up and configuration thanks to widgets and pre-defined use cases.
In the field
Dedalus is up to its third release of DC4H but it has been in use in the field for some time. It is being used at the Parkville Precinct in Victoria, providing integration between the i.PM patient administration system and the Epic EMR.
The largest implementation globally is the six hospital New York Presbyterian group, which initially started out as a project to replace a legacy integration engine. “They had six different organisations coming together and each of them had a different EMR,” Mr Royle said. “They had this massive piece of work in trying to bring them all together.
“They also wanted to bring their EMRs together as a single patient appointment view for their patients, regardless of which hospital they went to. So we tapped those messages, they came in, converted them to FHIR resources on the fly, and then they themselves developed an application off the back of those FHIR APIs to visualise appointments.”
In the NHS, Dedalus has worked with North Staffordshire NHS Trust in the UK on child mental health referrals, routing referrals for child mental health services to the appropriate service based on particular needs. “We’re using pieces of DC4H to enable that effective routing back into those systems of record, whether it be one of our own or a competitor’s product,” Mr Royle said.
Closer to home, Dedalus last year spent eight weeks with Whanganui DHB working on telehealth capability, creating an interface through to Microsoft Teams using DC4H. There was also a similar piece of work for the former Waikato DHB, allowing the organisation to ingest data that’s in its integrated care record.
Mr Shirrefs said these projects were now able to be stood up in a matter of weeks rather than the months or years previously experienced. The Whanganui project, for example, took just eight weeks.
“It was hectic, it was at the height of COVID and they weren’t able to continue Outpatients appointments so they did telehealth,” he said. “But the ability to adopt cloud and take it as a managed service from us … they don’t have to think of infrastructure, servers, storage, capacity planning. It was simply a connection through to our cloud service.
“We were able to have a test and then a production environment spun up really, really quickly for them and then into production with them in the space of eight weeks.”
Mr Burmester said the power of the cloud was obvious. “The work that we’re doing with LAB3 in that space leveraging their Bedrock platform and application blueprints where ‘everything is code’ is all about shortening the time to value for our customers.
“We now have applications we can deliver as a managed service, and what used to be weeks to months of engagement is now 16 minutes to deploy.”