HL7 UK Advantages and Disadvantages of Middleware Solutions

1. Tony Mottram – Indigo 4 Systems Co-chair HL7 UK Lab Sub-group HL7 UK Advantages and Disadvantages of Middleware Solutions

2. What is Middleware? • Integration Engine? • Interface Engine? • System Emulator? • Everyone has a different concept. • There is no single definition of middleware. It varies depending upon what the individual wants it to mean.

3. What is Middleware? • It may emulate another system. • It may be an Integration Engine. • It may transform structured messages. • It may be all of these and more beside.

4. What is Middleware? A Design Authority Viewpoint Transformation Interface Communication Problem Black Box What does it do? That’s your problem! It’s a Black Box! Problem Solved!

5. What is Middleware? Another Viewpoint PAS Trust Pharmacy Pathology HL7 EDIFACT Integration Engine XML Anything else I might want Free Text High Street Optician GP Practice High Street Pharmacy

6. What is Middleware? A Middleware Viewpoint Trust Pharmacy PAS Pathology Prescribing/Dispensing? Update/Reference? Ordering/Reporting? Middleware ???????? Local Takeaway EHR/Results/Requests? ETP/POCT? Cataract/Glaucoma? GP Practice High Street Optician High Street Pharmacy

7. What is Middleware? • It interfaces Applications and Systems. • It’s more and less than an Integration Engine. • It’s not just an on-the-fly message translator. • It stores individual message entities for re-assembly, grouping and routing. • It provides pseudo-interfaces to other systems - aiding cross-discipline comprehension and accommodation of differing terminologies. • It provides controls for each domain by using rules and protocols tailored by users within the domain.

8. Unusual Example Requirement Local Takeaway -> Pathology Request. Destination – Anytown Hospital pathology lab Demographics – name, address and phone no. Test Request – Quality test on No. 23 (fried rice) Sample type – Rice Location – white bag in store Sample Container – 7548 - plastic microwavable box Diagnosis – Customer feels very ill Recent History – Same problem last week Fasting – not by choice Responsible Person – Health Inspector

9. Unusual Example Requirement Pathology Report Destination – Local Takeaway Demographics – sender name, address and phone no. Sample type – Rice Location – white bin in store Observation – abnormally high Na and Cl Observation – Patna not Basmati Comments – excess salt likely to cause vomiting. Responsible Person – Mr. Chempath

10. Is the Communication Understood? • Safe coding transforms – which is the safest - the code or the rubric – “No. 23” or “fried rice” • Transform discipline specific jargon to terms which others can understand – Na? Cl? does “salt” have the same meaning? • Does the message transport method impact upon the safe communication of the data? • How can I be sure that what you think I said is exactly what I meant?

11. Advantages of Middleware? • Service not System Orientated Architecture. • Allows each discipline to retain control of its own data and ensure appropriate presentation. • Offers bi-directional human to human, human to machine and machine to machine communication. • Offers different human interfaces to accommodate different user bases. • Enables end-to-end communication between disparate systems. • Aids rationalisation/harmonisation existing processes. • It can act as a messaging endpoint for systems which cannot directly support structured messaging.

12. Disadvantages of Middleware? • May increase processing overhead when compared with direct end-to-end messaging. • Needs collaboration between all stakeholders to establish requirements – understanding every viewpoint can be difficult. • Rationalising existing processes without jeopardising the outcome may not be possible. The Middleware may have to accommodate them. • There is no single plug-and-play solution for all existing systems and services – each one will have its own specific quirks.

13. Issues for Consideration • Theoretical Solution – Redesign all Systems and Applications to fully support every structured and unstructured messaging protocol – Green field approach • Clinical and administrative systems have had significant investment in their design and implementation over long periods – Experience is a important factor • Processes have been optimised according to local patient requirements and local service facilities – One size does not fit all. • Reluctance to change something which appears to work effectively - Inertia

14. Why Is Middleware Still Used? • It’s a well tried and tested methodology. • It doesn’t have a major impact upon working practices. • It’s versatile and forgiving of local anomalies. • Big bang replacement of existing systems with ones which all speak the same language is not an easy option and has significant clinical risks, huge financial implications and steep learning curves. • Middleware offers a migration approach which is clinically safer, more cost effective and less disruptive. • End-to-end messaging is the best solution but it is still a long way off.

15. Middleware – You Decide • Questions?