1. HL7 Roadshow 2009 Connected Healthcare HL7 Roadshow 2009 Connected Healthcare Jose Sueiras, March 2009

2. Integration solutions using Ensemble HealthShare. – –Building an EHR CSC - TIE – –Trust Integration Engine Implementing Spine Compliance – –i.e. TrakCare

3. InterSystems Integration TechnologyCacheCache EnsembleEnsemble HL7HL7 HL7 Features –Schemas. Virtual documents. Message Router (Rules). Integration platform. – Adapters, BPM, Data transformation. –Management, Monitoring.. Database / Application Server OO. –SOAP,XML,EJB,COM… –ODBC, JDBC

4. HealthShare. Architecture EMPI Physician's Practice Hospital/CHC Laboratory EMR LIS CIS RIS HIS Etc. ECR Healthshare Gateway ECR Healthshare Gateway ECR Healthshare Gateway Healthshare Hub

5. Regional & National EHR RAD PAS Viewer LAB OPR A & E I C U GP 3 Clinic GP 2 GP 1 EMPI Gateway Point of Care Edge Gateway Hospital Repository Clinical Repository EMPI HUB

6. HealthShare – The Components Hub Many distributed resources across the exchange Provider portal for querying the exchange and viewing results One shared resource for the exchange. Primarily responsible for managing identifiers (EMPI) Many distributed resources across the exchange Primarily responsible for managing data collection & caching Edge Gateway Access Gateway

7. Main Features Patient Identity Management –Identity Hub as clinical record locator –Identity Policy and Service most commonly centralised. Fuzzy logic algorithms. –Use of (existing) national numbers (Social Security Number / NHS number) User Provisioning & Consent –User Access and Consent policy and service is typically centralised –Access/Consent policy not typically defined / controlled by those who need to use the systems –Clinicians may perform different roles at different times in different facilities. –Time-based nature of “legitimate user relationship” & “consent” –Integration of Smartcards and biometrics –Requirement for tamper-proof audit and governance databases / message archives Data aggregation / normalization Data aggregation / normalization –Variable quality of data source systems Data Capture – push/pullData Capture – push/pull Structured & Unstructured dataStructured & Unstructured data –Coded / Non-Coded data – differing coding regimes & purposes –Numerous (converging) Standards for Normalisation CCR, CDA, CCDCCR, CDA, CCD

8. InterSystems Ensemble Trust Integration Engine (TIE) Connecting applications in the Trust with the applications supplied by CSC Integrate applications within the Trust. (Upgrade)

9. TIE CSC Data Message Architecture Spine Message Hub Message Hub Central Trust DB Messages Data

10. TIE CSC Data Message Architecture Spine Message Hub Message Hub Central Trust DB Messages Data EnsembleEnsemble EnsembleEnsemble EnsembleEnsembleEnsembleEnsembleEnsembleEnsembleEnsembleEnsembleEnsembleEnsembleEnsembleEnsemble

11. TIE. Ensemble Production HL7 Business Processes HL7 Business Operations HL7 Inbound Adapter HL7 Outbound Adapter External Applications HL7 Business Services Client Applications HL7 Message

12. Plymouth Hospitals NHS Trust EnsembleEnsemble

13. Basic Connectivity (N3) NPfIT services. Firewalls/routers Patient Demographics Service (PDS) Access/Update “PDS Compliance” patient demographics NHS Number EBXML/HL7V3/MIM Transaction Messaging (TMS) Access Control Framework (SDS, SSB) “IG Compliance” Authentication. Authorization “Spine Compliant”. CFH Definition

14. “Spine Compliant” CFH Definition. PDS/IG Compliance (PDS = NPFIT-FNT-TO-TIN-1023, IG = NPFIT-FNT-TO-TIN-1031) Choose and Book (CAB) NPFIT-FNT-TO-TIN-1032 Electronic Prescriptions NPFIT-FNT-TO-TIN-1050 GP2GP Transfer NPFIT-FNT-TO-TIN-0402 Summary Record NPFIT-FNT-TO-TIN-0830 GP System Choose and Book (CAB) NPFIT-FNT-TO-TIN-1032 NHS Acute/ Community/ Mental Health or ISTC EPR/PAS Electronic Prescriptions NPFIT-FNT-TO-TIN-1050 Community Pharmacy Summary Record NPFIT-FNT-TO-TIN-0830 Urgent Care

15. “Spine Compliant”. CFH facts It takes about 9 – 12 months to “become compliant” from scratch “Compliance” is specific to a functionality, spine version and supplier software version – not a general status Spine Compliance must be maintained – it is not static

16. Ensemble. Spine FW Web services and ebXML toolkit. XML – Object mapping BPM capabilities – –Message patterns – –Alert generation. Error handling workflow Data transformation. – –HL7 2.x schemas. Hl7 v3 Storage – –Guarantee message delivery. – –SDS Cache Monitoring. Management

17. Ensemble based solution for TrakCare PDS and C&B compliance. Authentication and authorization process integrated in a single sign on architecture. – –Smart cards TrakCare is easily configurable to interact with other systems using HL7 v2.x messages Use Ensemble to implement a MHS that will talk to TRAK using HL7 v2.4

18. Ensemble based solution for TrakCare TRAKCare ebXML W.S. Spine HL7 Version 3 Routing SDS Cache WF Errors DTL BPM TCP HL72.4 Ensemble. MHS

19. Spine. Iteration example TRAKEnsemble MHSIntermediary MHS PRSC_IN080000UK07 / ebXML Persist MCCI_IN010000UK13 / ebXML ACK Message Processing 2.4 SQM_S25 / TCP 2.4 SQR_S25 / TCP Persist PRSC_IN090000UK09/ ebXML MCCI_IN010000UK13 / ebXML ACK Persist Request Available Slots Respond Available Slots

20. Conclusions Ensemble is a versatile integration platform Unified development environment that promotes rapid development Especially suited for healthcare – –HL7 and other standards High performance solutions at different scales

21. Questions? Questions?? jose.sueiras@interSystems.com www.intersystems.co.uk/TIE