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A View into Services Architecture in Healthcare

A View into Services Architecture in Healthcare. Kenneth S. Rubin Enterprise Architect, EDS ken.rubin@eds.com. Presentation Overview. Common Services: A Reference Model Common Services within VHA HL7.org and Common Services. Common Services: A Reference Model. Why common services?*.

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A View into Services Architecture in Healthcare

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  1. A View into Services Architecture in Healthcare Kenneth S. Rubin Enterprise Architect, EDS ken.rubin@eds.com

  2. Presentation Overview • Common Services: A Reference Model • Common Services within VHA • HL7.org and Common Services

  3. Common Services: A Reference Model

  4. Why common services?* • A common practice in healthcare, just not yet in healthcare IT • Many key products use them but do not expose interfaces • Ensures functional consistency across applications • Accepted industry best practice • Furthers authoritative sources of data • Minimizes duplication across applications, reuse *slide adapted from 2004 ITC Presentation on VHA Common Services

  5. ISO Layers: Sufficient? Application Presentation Session Transport Network Data Link Physical Platform

  6. ISO Layers: Insufficient! Dynamic (Extensible) Stds-based Semantics Dynamic (Extensible) Semantics Static (closed community) Semantics Middleware, Dynamic-Discovery, Stds Based Middleware, Static-binding, Stds Based Custom/Proprietary Interfaces Application Presentation Session Transport Network Data Link Physical Platform

  7. Pyramid of Interoperability High Semantic Interop Standards- Computable w/ based Middleware Ability to Interoperate extensibility mechanism Middleware Proprietary Low Information Computational View View Applications Computable Data Proprietary APIs Proprietary Semantics MetaData Exchange Interface Engine/Msg Routing Msg Interface, Std Structure, Pt2Pt Data Interchange Msg Interface Pt-2-Pt Proprietary Data Duplication / Re-Keying File Exchange (FTP, flat files...)

  8. Scaling the Pyramid: Examples Semantic Interop Standards- Computable w/ based Middleware extensibility mechanism Middleware Computable Data Proprietary Proprietary APIs Proprietary Semantics MetaData Exchange Interface Engine/Msg Routing Msg Interface, Std Structure, Pt2Pt Data Interchange Msg Interface Pt-2-Pt Proprietary Data Duplication / Re-Keying File Exchange (FTP, flat files...) HL7 HDF Services McKesson Person ID Service (PIDS) XYZ's Web Service HL7 3.0 Msgs Medici Data API HL7 2.x XML HL7 2.x University Hospital's DataExtract

  9. Common Services within the Veterans Health Administration (VHA)

  10. Business View 158 hospitals/medical centers 854 outpatient clinics 132 long-term care facilities 42 rehabilitation facilities Affiliated with 107 of 125 medical schools in the US Healthcare Statistics (2003) 7.2M beneficiaries enrolled 4.8M treated 49.8M outpatient visits Operational View 180k VHA employees 13k physicians, 49k nurses 85k health professionals trained annually USD $29.1B Budget for 2004 Technical View VistA (EHR) for over 20 years Software portfolio exceeds 140 applications Reengineering effort is based upon a services architecture First, a little about VHA* *statistics taken from May 2004 Fact Sheet, U.S. Dept of Veterans Affairs

  11. Relevant Context • VHA is among several (U.S.) Federal healthcare organizations (DoD, IHS, HHS, CDC, FDA to name a few) • National Coordinator for Health IT has been appointed • US NHII – Public/Private involving regional and local pilots • Four focus areas: • Bring technology to points of care • Interconnect clinics • Patients as informed • Support population health consumers • Approach is for government to lead and not mandate • VHA has related efforts to address information semantics

  12. VHA’s Service Architecture Objectives PlugIT PlugIT PlugIT PlugIT PlugIT = stated objective PlugIT = implied objective PlugIT • Minimize duplication and inconsistency of implementation • Position VHA to support significant platform changes, isolate from middleware technology • Allow for flexible deployment approaches without changing client applications • Support multiple concurrent middleware technologies • Facilitate integration with external systems, off-the-shelf products • Minimize maintenance burden • Establish services as authoritative sources of data

  13. VHA’s Road to Service Architecture Performance Tuning Removal of M systems Re-hosting of VistA Applications Data standardization Site Preparation & Training CAIP Person Lookup Person Identity Management HDR prototype Data Cleanup Data Aggregation & Migration Systems of Interest Dynamic Routing Service NEW PERSON enumeration Naming / Directory Service Messaging Service HL7 Builder Utility Standard Data Service Patient Lookup, Patient Service Person Demographics Delivery Service Web Apps. Hardware design, procurement and deployment Planning HealtheVet VistA

  14. VHA Service Architecture: Conceptual view

  15. VHA Lessons Learned with Common Services • Alternative Triple-constraint: idealism , practicality, timeliness • Establish agreed-upon architectural principles • Need for architectural vision to integrate with project teams • Need for a solid migration strategy (technology and staff) • Don’t overlook cultural maturation issues • Sequence planning is essential • Managing organizational trust • Need to differentiate “infrastructure” from “business” services • All-compassing requirements management

  16. Services Architecture within HL7.org

  17. HL7: The Services “Climate” Today • HL7 has several service-oriented efforts (CCOW, CTS, Java, ITS) • Each has considered itself outside the mainstream of HL7 Activities • The methodology and approach to each effort has been “unique” • Informal “Services Birds-of-a-Feather” community has maintained steady interest • Most of HL7 remains message focused

  18. Emerging Areas • MDF to HDF transformation • More than messaging • Support for multiple ITS specifications • More rigorous alignment to UML • Tooling Task Force • Off-the-shelf • Requirements-driven, organizational priorities • HL7 Organization Review Committee

  19. What about the Services BOF… • “Why isn’t it a formal committee?” • Informal group meeting for several years • Regular meetings with average of 20 attendees • Offered formal sponsorship under EHR TC • Possibility of “Going SIG”

  20. The climate is changing… • The HL7 HDF nears deployment • Interest and sponsorship by EHR TC • HL7 EHR Functional Standard adopted May 2004 • EHR TC sees services as the next step • HL7 is responding to national interests • HL7 Canada, HL7 UK, HL7 Australia exploring solutions involving services • US NHII initiative appears to be influencing the HL7 Board of Directors • Joint meetings with OMG have begun

  21. What needs to be done… • HL7 International Affiliates continue to push, inform HL7 Board of the importance and interest in services • Services BOF must be either chartered as a committee or (preferably) incorporated in the HDF • Support and promote HL7 partnership with SDOs focused in the services space • HL7 should recognize the strengths and weaknesses of its membership volunteers

  22. References • VHA Website: • http://www.va.gov • VHA HIA Website: • http://www.va.gov/vha-ita/ita-p.html • HL7 Website: • http://www.hl7.org • NHII Information: • www.hhs.gov/onchit/

  23. Acknowledgements and Thanks To… • VHA Health Information Architecture Office • VHA Common Services Team (for their review of this presentation for technical accuracy, and permissions to use and adapt several of their presentation slides) • PlugIT, the University of Kuopio, and HL7 Finland (for the opportunity and sponsorship) • Juha Mykkanen • Mikko Korpela

  24. eds.com

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