1. March 7, 2007Immunization Forecast Module as a Web Service 1 Utilizing a Web Service for the Validation and Forecasting of Immunizations within a State Massachusetts Department of Public Health Presenters: William Adams, James Daniel, Gillian Haney and Bob Moriarty Co-Authors: Danielle Norton, Dennis Michaud, Susan Lett, Pejman Talebian and Marie O’Donnell

2. March 7, 2007Immunization Forecast Module as a Web Service 2 Agenda Service Oriented Architecture (SOA) Background Why take the SOA Approach? Implementation of Immunization Forecast Module (IMF) as a web-service Partners utilizing IMF Risks/Conclusions

3. March 7, 2007Immunization Forecast Module as a Web Service 3 SOA Background “Core business capabilities are encapsulated within independent software services and these services are leveraged by various front-end applications to fulfill business requirements” Kawamoto, Kensako and Lobach, David “Proposal for fulfilling strategic objectives of the US Roadmap for National Action on Decision Support through a Service-oriented architecture Leveraging HL7 Services” JAMIA 2007:146-155

4. March 7, 2007Immunization Forecast Module as a Web Service 4 SOA Background Message-based interactions “Black-box” implementations Communication over network Platform neutrality Service description Loose coupling between system components

5. March 7, 2007Immunization Forecast Module as a Web Service 5 Original High-Level Architecture

6. March 7, 2007Immunization Forecast Module as a Web Service 6 The MIIS will serve as a central registry available to all health care providers, vaccine distributors, and necessary state personnel. The system will interact with a recommendation web services endpoint to be located within the Massachusetts “Virtual Gateway” for the purposes of generating patient vaccine schedules.

7. March 7, 2007Immunization Forecast Module as a Web Service 7 Updated High-Level Architecture

8. March 7, 2007Immunization Forecast Module as a Web Service 8 Why take the SOA Approach? Immunization Registry Development Costs Flexibility Re-use of Web-Service

9. March 7, 2007Immunization Forecast Module as a Web Service 9 Cost-Savings J2EE Requirements from Commonwealth ITD Existing J2EE Solution for Disease Surveillance (Consilience Software - MAVEN) –PHIN-Compliant Solution Simplified Requirements without Immunization Forecast Module Benefits of shared platform

10. March 7, 2007Immunization Forecast Module as a Web Service 10 Disease Surveillance Demographic Page

11. March 7, 2007Immunization Forecast Module as a Web Service 11 Disease Surveillance TB Clinic Question Package

12. March 7, 2007Immunization Forecast Module as a Web Service 12 Disease Surveillance Workflows

13. March 7, 2007Immunization Forecast Module as a Web Service 13 MIIS Client Demographics Page

14. March 7, 2007Immunization Forecast Module as a Web Service 14 MIIS Client Immunization

15. March 7, 2007Immunization Forecast Module as a Web Service 15 MIIS Client Immunization- Forecast

16. March 7, 2007Immunization Forecast Module as a Web Service 16 Shared-Platform Benefits Shared hosting costs Shared technical resources (DBA,etc.) Potential for single client-index Common look/feel for shared users of Immunization Registry and Disease Surveillance

17. March 7, 2007Immunization Forecast Module as a Web Service 17 Why take the SOA Approach? – Flexibility of the Immunization Forecast Module The MIIS team reviewed five different applications for potential modification as a web service for the Immunization Forecast Module. The Software Partners product was selected for modification using the existing San Diego rules. Software Partners application utilizes a “rules engine” which allows for extensibility and flexibility for changing Business Rules

18. March 7, 2007Immunization Forecast Module as a Web Service 18 Why take the SOA Approach? – Re-use of Web Service Application functionality is surfaced via web service endpoints so it is possible for any number of disparate applications to reuse the Immunization Wizard’s forecasting capabilities. WIC, Medicaid, Personally-Controlled Health Record Allows these groups to focus on core business requirements

19. March 7, 2007Immunization Forecast Module as a Web Service 19 Implementation of IFM as Web Service A web service has been created and a test version has been successfully implemented with the immunization registry application. Web service available for batch files or single file. Existing rules and additional rule sets for new vaccines are being finalized. Standard nomenclature and the XML file format is being negotiated with the intent to limit future change requirements.

20. March 7, 2007Immunization Forecast Module as a Web Service 20 Implementation of IFM as Web Service – XML Message Required Data –Sex –Date of Birth –Immunization History (vaccine group, date) Optional Data –Client Comments (contraindications)

21. March 7, 2007Immunization Forecast Module as a Web Service 21 Tiers Business Tier The business components are primarily responsible for executing the business rules of the application. The Business Tier of this application consists of one component: Vaccine Forecasting Module: The Vaccine Forecasting Module is responsible for validating a client’s current vaccination status and providing forecasts of needed vaccines based upon a patient’s vaccine history. The details of the Vaccine Forecasting Module are described further in the application layer. Integration Tier The integration components provide a means to interface with external systems. In the case of the Immunization Wizard the integration with external systems is inbound from Immunization Wizard service consumers. Web Services Interface: Clients utilize the Web Services Interface in order to access the functionality provided by the Vaccine Forecasting Module.

22. March 7, 2007Immunization Forecast Module as a Web Service 22 Configuration View The figure above depicts the BEA WebLogic Application Server in a Clustered configuration. These two servers will support application failover and load balancing. The Environment is configured behind a firewall to protect the unauthorized access of the application. The XML Gateway and ESB will run on separate servers within the EOHHS Integration Services domain and be used by the Application Servers within the BEA WebLogic cluster. As depicted in the figure above, network connections between the physical servers are required.

23. March 7, 2007Immunization Forecast Module as a Web Service 23 Partners Utilizing IMF Web Service Internal: Medicaid Internal: Women, Infants and Children (WIC) Program External: Personally Controlled Health Record (PCHR) –Boston Children’s Hospital Informatics Program (CHIP)

24. March 7, 2007Immunization Forecast Module as a Web Service 24 Medicaid Use Case Claims data including immunization histories Send limited batch files to IMF web service Allows Medicaid to monitor appropriate vaccinations of clients

25. March 7, 2007Immunization Forecast Module as a Web Service 25 WIC Use Case WIC application stores medical data including immunization histories Limited client record sent to IMF web service WIC can monitor individuals for appropriate vaccinations

26. March 7, 2007Immunization Forecast Module as a Web Service 26 Personally Controlled Health Record (PCHR) Use Case

27. March 7, 2007Immunization Forecast Module as a Web Service 27 Hospitals do not have a history of sharing information H1H2H3 xx Proprietary Perceived competition Privacy Health Insurance Portability and Accountability Act No dedicated resources

28. March 7, 2007Immunization Forecast Module as a Web Service 28 Currently... H1H2H3 xx

29. March 7, 2007Immunization Forecast Module as a Web Service 29 What if we gave patients a tool to request their records electronically and create a personal health record H1H2H3 xx Indivo Server Comprehensive record

30. March 7, 2007Immunization Forecast Module as a Web Service 30 Rely on individual rights Confront privacy head on by exercising individual rights to information The patient is the integrator of his/her own medical record

31. March 7, 2007Immunization Forecast Module as a Web Service 31

32. March 7, 2007Immunization Forecast Module as a Web Service 32 Risks Web service performance Legal requirements and responsibilities associated with forecasting and validation of immunization histories Handling multiple and disparate requirements from different agencies Evolving technology standards

33. March 7, 2007Immunization Forecast Module as a Web Service 33 Conclusions The web services model demonstrates that state health departments can leverage limited resources to deliver IFM services to multiple and disparate parties while maintaining control over the business rules. The web services model allows applications to focus on core business requirements which can lead to cost savings for state health departments

34. March 7, 2007Immunization Forecast Module as a Web Service 34