This is the third of a three-part article looking at the area of interoperability and health information exchange (HIE) in the healthcare industry. In the first part, I intended to clearly articulate the key challenges and barriers to adoption faced by those looking to engage in HIE. Part 2 examined an architectural approach to address those challenges as well as some technology enablers to realize a vision for high quality HIE. In this last part, I will share with you a success story from industry where this approach was put to the test.
Our first story takes us to Shanghai, to a government-led initiative to enable the sharing of electronic medical records between 23 of the top state-owned hospitals in and around Shanghai. In an initial phase, a solution was put in place to enable each hospital to collect medical record data from its Hospital Information System (HIS) at a predetermined time.Each night, synchronization from the hospital to the datacenter would take place, giving doctors in each of the 23 hospitals access to a consolidated historical medical record for each and every patient in hospital network.
Their pre-existing solution was based on JMS and suffered from both network and compute performance problems. On average, each hospital was required to upload about 900K patient records using the queue-based architecture over a four-hour window, which created enormous network overhead and required massive amounts of centralized data processing. In addition to these performance problems, the queuing system was not very reliable and lacked manageability hooks for alarming, alerting, etc.It soon became clear that the project needed a new solution that could handle the large message sizes and high performance workflow required for patient data sharing.
A new solution put in place in the most recent phase replaced each edge server as well as the central JMS-broker with Intel® SOA Expressway for Healthcare "soft appliances".In this new architecture, the queuing system instantly benefited from a high-performance, highly reliable software runtime. The integration function, which was previously handled entirely centrally, was subsequently distributed more evenly across the health network.Each soft appliance at the edge was responsible for orchestrating a workflow comprised of database queries, XML conversion and message creation and distribution. By applying the SOA network model design pattern combined with the breakthrough XML processing and manageability capabilities of Intel® SOA Expressway, the Shanghai hospital network was able to lower their support costs, improve reliability and reduce each hospitals 900k record load time by half.
Our second example takes us to Latin America, where a research institution was chartered by the governmentto demonstrate the feasibility of a healthcare data interoperability solution for rapid development and deployment of a virtual patient record system. As part of their strict attention to facilitating low TCO, the team restricted their consideration to configuration-oriented COTS products, rather than a custom-code solution. Their specific end goal was to enable a health information exchange to underpin a government-sponsored portal to give patients a more complete view of their health records.
Four geographically dispersed health regions were identified as source systems for EMR information. Each of these systems of origin were responsible forpreparing and sending patient data over a network to a centralized patient service, which handled a series of orchestrations to update a database and deliver data to the portal application. Intel's® SOA Expressway for Healthcare "soft appliance" was evaluated as it met requirements across a number of categories like performance, reliability, scalability, security and message processing and routing.Specific attention was given to the Intel product's configuration-centric capabilities compared to a more conventional hand-coded solution.
Two architecture models were developed for two phases of this solution:phase one was based on a conventional, centralized architecture that delivered high-performance and scalable HIE from the distributed source systems to centralized virtual patient record service. A second phase evolved the architecture from a centralized to a hybrid model, similar to that described in the Shanghaistory. This called for deploying soft appliances at key source systems to accommodate future use cases like bi-directional patient record synchronization and federated record location. This second model will enable deployment of a fully standards-based, canonical information busand reap the myriad of benefits touched on in the previous post.
But the most compelling feature of this success story was how quickly the team in Latin America were able to light up this architecture.In less than one week and with only a single systems analyst to setup and configure workflows using the codeless Service Designer of SOA Expressway , the benefitsbecame clear.The reduced development and maintenance costs along with reduced complexity in configuring and extending the solution greatly enhanced the research team's ability to realize value very quickly and affordably, what we call "time-to-value".
Intel® SOA Expressway for Healthcare is a specific implementation of a new product category called a SOA "soft appliance", which delivers a breakthrough in simplicity, cost and scalability for enabling high-quality health information exchange.