1. HIPAA-strength Enterprise Portals Examples and Architecture Steve Flammini Chief Technology Officer Partners HealthCare Boston, MA

2. Overview Who is Partners HealthCare? Approach Enterprise Portal Examples Architecture Conclusions

3. Partners HealthCare System Created in 1994 through affiliation of Massachusetts General and Brigham & Women’s Hospitals Patient care –Two academic medical centers –Four community hospitals and two specialty hospitals –Joint cancer care venture with Dana Farber –Mental health network –Non-acute care network –Network of more than 1000 primary care physicians and 1200 community specialists –Total of more than 5000 physicians serving 2.2 million patients in Eastern Massachusetts

4. Partners HealthCare System Research –Largest non-university based non-profit private medical research enterprise in United States Education –Principal teaching affiliate of Harvard Medical School Revenue –$4.0 billion –$760 million in research expenses

5. Kensington, NH Hampton Falls, NH Seabrook, NH Hampton, NH PCHI Regional Organization Primary Service Area Currently No Coverage Secondary Service Area Revised 9-00 Dorchester Hyde Park West Roxbury Chestnut Hill Brookline Jamaica Plain Roxbury Brighton Allston Watertown Belmont Cambridge Somerville Charlestown East Boston Chelsea Woburn Saugus Melrose Stoneham North End South End West End South Boston Back Bay ‘east’ Back Bay ‘west’ Revere Malden Rockport Gloucester Ipswich EssexHamilton ManchesterBeverly Marblehead Salem Danvers Nahant Swampscott Peabody Lynn North Andover Boxford Topsfield Middleton Hull Wenham Cohasset Scituate Marshfield Hingham Norwell Weymouth Braintree Dorchester Milton Duxbury Plymouth Kingston Carver Plympton Halifax Middleboro Bridgewater East Bridgewater West Bridgewater Pembroke Hanover Rockland Abington Hanson Whitman Brockton Holbrook Avon Randolph Easton WarehamRochester Freetown Acushnet Lakeville Taunton Raynham Norton Dighton Berkley Seekonk Rehoboth Attleboro North Attleboro Mansfield Swansea Somerset Fall River Westport New Bedford DartmouthFairhaven Mattapoisett Marion Falmouth Bourne Sandwich Mashpee Gay Head Chilmark West Tisbury Edgartown Oak Bluffs Tisbury Nantucket BarnstableYarmouth Dennis Harwich Chatham Brewster Orleans Eastham Wellfleet Truro Provincetown Foxboro Plainville Wrentham Bellingham Franklin Norfolk Sharon Walpole Stoughton Canton Norwood Medway Millis Medfield DoverSherborn Holliston Hopkinton Ashland Natick Framingham Southborough Westwood Dedham Needham Weston Wayland Westborough Northborough Marlborough Berlin Hudson BoltonStow Maynard Boxborough ActonConcord Lincoln BedfordLancaster Harvard Lunenburg ShirleyAyer Groton Littleton Westford Carlisle Billeric a ChelmsfordTewksbury Waltham Lexington Burlington Wilmington North Reading Wakefield Lynnfield Andover Dunstable Tyngsboro Dracut Lawrence Lowell Portsmouth, RI Quincy Mattapan Sudbury Winthrop Warren, RI Bristol, RI Little Compton RI Tiverton, RI Reading Medford Winchester Everett Arlington Merrimac Valley Rte 2 West Metro West Neponset Valley Boston South South Shore Tri County North Bristol Plymouth Cape & Islands Fall River New Bedford Partners - BWH Metro North Partners - MGH North Shore Cape Ann Regional Service Organizations: North Central Near North Cambridge/Somerville Newton-Wellesley Newton Northeast Wellesley Greater Lowell Georgetown West Newbury Rowley Newbury Groveland Methuen Haverhill Newburyport Amesbury Salisbury Merrimack Plaistow, NH East Kingston, NH

6. Approach Internal Development of Enterprise-Class Systems Enterprise Apps must be ‘portalized’ Multi-Tier Architecture, Emphasizing Abstraction between data, presentation, and logic. (Loose Coupling) Increasing role of XML / Web Services in Service-Oriented Architecture Back-End Integration / Aggregation of Legacy Systems Foundational Enterprise Elements: Directories, EMPI, CDR, CPR

7. Approach Extranet Security Architecture –HTTPS –Multiple Authentication Factors –Roles-based access structures –Audit Trails

19. Enterprise Portal Architecture PCHInet Email Provider RPDR Medical References CPMQM EMPI eConsultReferral View Images 4-NextLMR Order Entry Labs Clinical Data Repository Directories LMR Data Clinical Images IDX NSMCPCHI McLean DFCI MGHBWHNWH Faulkner Spaulding IDXMeditechPCISBICSSMSHomecare PHC GSVNA

20. Example: CPR / PACS interoperability CPR Database servers App Servers Web Servers Image servers Radiology App Servers XML query/response Radiology Web Servers Computerized Patient Record

21. Simplified Application Platform Overview Database Server Tier Application Server Tier (MiddleWare Services) Presentation Tier (GUI)

22. Multi-Tier App Environment DB Servers / Legacy Platforms App Servers Presentation Web Servers Content Switches CISCO CS11050 HTTPS, TCP/IP IP / VLAN ISAPI, IP, XML XML, pooled IP, proprietary

23. Conclusions Agile, multi-tier architecture is essential for portalization. Enterprise Portals consist of only web- enabled apps. Portals will deliver to multiple classes of end user devices. Robust Architecture for Secure Extranet Access. Emphasis on Integration Elements: Directories, CDR, EMPI, CPR