Futrend SOA Cloud Computing Symposium 2011 - Object [PDF]

Toward A Universally Connected Healthcare Network By Jian (Jeff) Zhong Chief Technology Officer (Acting) Chief Architect for SOA & Cloud Computing FUTREND Technology Inc.

Agenda    

Healthcare In the United States of America Service Oriented Architecture after the 2008 Financial Crisis National Institutes of Health SOA Case Study Research on Published SOA Case Studies      

Federal Health Architecture Connect Open Source Harvard Pilgrim Health Harvard Medical School University of Pittsburgh Medical Center Medical Imaging at University of Chicago Hospitals MEDICUS for 200+ Sites at Children’s Oncology Group

 The Vision of Universally Connected Health

More expenditure does not mean better quality

HEALTHCARE IN THE UNITED STATES OF AMERICA

Healthcare in the United States of America     

Total spending: $2.5 trillion in 2009 Per person: $8047 in 2009 17% of GDP in 2009 Medical causes were cited by 50%+ bankruptcy filings Medical adverse events:  3rd leading cause of death in USA  Direct economic cost of over 53 billion a year  Medical tourism: in 2007, 750000 Americans traveled to other countries for medical care  Healthcare quality not the best, behind England, Taiwan and many others Source: http://en.wikipedia.org/wiki/Health_care_in_the_United_States

Top 10 Healthcare Systems by Revenue 2008 (in millions)

2011 Market Cap

1. U.S. Veterans Affairs Dept

$40,686.5

Government

2. HCA, Inc. (HCA)

$28,374.0

17.84 Billions

3. Ascension Health

$12,720.6

Private

4. Community Health Systems

$10,840.1

Private

5. NY Presbyterian Healthcare Sys

$8,458.3

Private

6. Tenet Healthcare Corp. (THC)

$8,348.0

3.14 Billions

7. Catholic Health Initiatives

$7,817.1

Private

8. Catholic Healthcare West

$7,596.2

Private

9. Sutter Health

$6,874.0

Private

10. Mayo Clinic

$6,143.5

Private

Top Ten’s Cumulative Revenue:

$137,858.3

Source: http://www.darkdaily.com/nations-list-of-top-ten-largest-healthcare-systems-include-some-surprises-113

EMR Adoption ModelSM Q3 2010 – 2010 Final Stage 7

Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP

1.0%

Stage 6

Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS

3.2%

Stage 5

Closed loop medication administration

4.5%

Stage 4

CPOE, Clinical Decision Support (clinical protocols)

10.5%

Stage 3

Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology

49.0%

CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable

14.6%

Stage 2 Stage 1

Ancillaries – Lab, Rad, Pharmacy – All Installed

7.1%

Stage 0

All Three Ancillaries Not Installed

10.1%

Data from HIMSS AnalyticsTM Database N = 5,281 2011 HIMSS Analytics

TOP VENDORS OF ENTERPRISE EMR SYSTEMS Vendor Name

Total Installations

Percent of Installations

• Meditech

1212

25.5%

• Cerner

606

12.8%

• McKesson

573

12.1%

• Epic Systems

413

8.7%

• Siemens Healthcare

397

8.4%

• CPSI

392

8.3%

• Healthcare Management Systems

347

7.3%

• Self-developed

273

5.8%

• Healthland

223

4.7%

• Eclipsys (Bought by Allscripts)

185

3.9%

Source: http://www.darkdaily.com/ranking-top-10-hospital-emr-vendors-by-number-of-installed-systems-32511

What does Wall Street expect from Healthcare IT?  

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CERNER Corp Founded in 1979, headquartered in North Kansas City, Missouri Over 8000 employees Industry: Healthcare Information Services, second largest EMR vendor Mission: transforming health care by eliminating error, variance and waste for health care providers and consumers around the world Stock price $0.4 in 1990 and now is about $120 Total market cap about 10 billion

Source: Yahoo! Finance

The American Recovery and Reinvestment Act (ARRA)  

ARRA: Public Law 111-5 and was signed on February 17, 2009 by President Barack Obama Title XIII of ARRA: Health Information Technology for Economic and Clinical Health Act (HITECH) –

– – – – –

$20.819 billion in incentives through the Medicare and Medicaid reimbursement systems to assist providers and organizations in the adoption of electronic health records. $4.7 billion for National Telecommunications and Information Administration’s Broadband Technology Opportunities Program. $2.5 billion for the U.S. Department of Agriculture’s Distance Learning, Telemedicine, and Broadband Program. $2 billion for the Office of the National Coordinator (ONC). $1.5 billion for construction, renovation, and equipment for health centers through the Health Resources and Services Administration. $1.1 billion for comparative effectiveness research within the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS).

Source: http://www.ahima.org/advocacy/arrahitech.aspx Image Source: The Economist

Resurrection after the financial crisis

SERVICE ORIENTED ARCHITECTURE

Service Oriented Architecture         

A new paradigm of distributed computing About 8 design principles and numerous design patterns Pronounced dead in 2009 Resurrected after financial crisis Become more business driven and agile RESTful services into mainstream Complement with Cloud Computing Infrastructure, Platform, Software as Services Better integration and improved interoperability

Architecture – From Abstract Design to Concrete Results The Great Architect Oscar Niemeyer

Source: Wikipedia, the free encyclopedia

Designed public buildings in the city of Brasília, and the United Nations Headquarters in New York City

The Medical SOA Analogy  SOA as Food or Medicine  Fully tested for efficacy and safety  Prototype and Pilot before mission critical usage  No one-size-fit-all panacea, specific solutions for specific problems A medicine can be used/reused for patients with similar problems Source: NIH web site image bank

SOA reduced cost, improved quality and streamlined business

NIH BUSINESS SYSTEM SOA CASE STUDY

National Institutes of Health (NIH)  World’s foremost medical research organization  Begun as a one-room Laboratory of Hygiene in 1887  Annual grants of more than $25 billion (US)  Supports 325,000+ research personnel at 3,000+ institutions located in 90+ countries  More than 130 researchers funded by NIH received Nobel Prizes

Source: NIH FY 2011 Director Perspective

Source: NIH web site image bank

NIH Clinical Center  Largest hospital devoted to clinical research in the United States  Located in Bethesda, Maryland, USA  6,000 inpatient admissions annually  95,000 outpatient visits annually  Some 1,200 credentialed physicians, dentists, PhD researchers; 620 nurses  Patients travel from the United States and around the world for care

Source: NIH Clinical Center 2011 Profile

Source: NIH web site image bank

Four years and Five Successful SOA projects at NBS 



NBS SOA Overview: 

Started SOA implementation in 2007



NBS program holistic approach for entire enterprise-level integrations



Followed NIH enterprise architecture (EA) and SOA guiding principles

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Utilized the existing NIH CIT/ISC and NBS infrastructures

Successful NBS SOA Implementations:    

Travel – the first successful SOA implementation in eTravel among all Federal agencies (average 8,000 transactions/month) Federal Acquisition (two contracts) – the first NBS SOA implementation (average 20,000 transactions/month) NIH annual grant commitments and obligations (average $20-25 billion US/year) Clinical Center – Expense reimbursement system integration (average 3,000 transactions/month)

Major Milestones of NBS SOA Implementation 

2004: NBS conducted a 90-day study on how to integrate with Federal eTravel services and developed a prototype using Apache Axis software



2007: NIH CIO adopted SOA; NIH Integration Service Center (ISC) announced initial availability of SOA hardware, software and governance based on TIBCO



2007: NBS developed integration architecture for all future integration projects, and decided to use ISC TIBCO and NBS Oracle products

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2007: NBS Requisition service went live with one Institute

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2008: NBS eTravel phase I went live with Purchase Order, Voucher services

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2009: NBS eTravel phase II went live with more Institutes and Centers (ICs)

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2009: NBS Requisition service enhanced and usage expanded to 26 ICs

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2010: NBS Grant Integration went live with enhanced Funds Check service

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2010: NBS Clinical Center Patient Expense Module went live with significant reuse of Purchase Order, Voucher, and Funds Check services

NIH Enterprise Architecture and Governance for SOA  

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Adopted SOA and Integration vision Established NIH Integration Service Center Created NIH strategic SOA initiatives  Increase level of integration with and between Enterprise Systems  SOA as standard software architecture

 

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Conducted SOA assessment and workshops Assessed service design against service design principles Managed NIH Enterprise Architecture Repository (NEAR) for service metadata

Source: NIH Chief Architect Office presentation

Applying SOA Principles to Formulate a Solution  Understand strategic goals and analyze business needs

Analyze strategic goals and business needs

Update/add to reusable services framework

Baseline design for a servicesbased project

Leverage existing or build new services

Reuse or create design patterns

Develop appropriate test plans

Identify options, risks, tradeoffs

Factor in non-functional requirements

Implement to production

 Make decisions based upon SOA principles

 Embed principles into the design patterns  Reuse and iteratively enhance SOA framework  Be flexible and agile with SOA principles

Service Reuse – Funds Check 

Problem: Funds control requires that funds availability be checked before transaction is submitted to the financial system. How does a source system use funds check/control that are available in financial system?



Solution Options:  

  

Data warehouse can generate daily or hourly funds availability reports The financial system real-time funds check web service can be called by the source system software before submitting and committing financial transactions

Apply SOA principle: Service reuse SOA Design Pattern: Single source of data and real-time web service lookup. Results: 



Fewer manual corrections on any failed financial transactions End users get real-time funds check result instead of waiting hours for batch consolidation results

Reduced Costs and Increased Service Quality 

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Reduced Time to Services and Development Costs 

Reduce development time Patient Module - A web-based solution completed within 12 weeks from requirements to deployment



Reduced duplicated systems and data inconsistencies

Reduced Development and Maintenance Costs 

Projected savings: ~ $2.18M over five years for Patient Module service fees



Purchase Order Module avoids double data entry, saves an estimated $1M annually and won 2010 HHS Innovation award

Increased Service Quality 

99% accurate first-time transaction processing resulting in a reduction of service desk tickets



Avoided manual data consolidation from batch processes

Streamlined Traveler Profile Management NIH Automated Process 1. Profile automatically synchronized via web services 2. User accounts automatically generated when profile is created 3. Single sign-on automatically configured when account is created 4. User logs into NIH portal, clicks a link and goes directly to eTravel service

Non-NIH Manual Process 1. Administrator creates user profile 2. User self-registers and creates Login ID and password 3. Administrator provides the user an account token 4. User logs in, links the self-created user account with the administrator-created profile via account token 5. User configures challenge questions 6. Now user can login to eTravel Service

Who else is doing SOA?

RESEARCH ON PUBLISHED SOA CASE STUDIES

Federal Health Architecture Connect       

Federal Government developed open source software Based on Service Oriented Architecture principles and Web Services Platform independent, tested on Windows XP, Solaris and Linux Uses EJBs and Open Enterprise Service Bus Runs on GlassFish Enterprise Server MySQL Community RDBMS 5.1 Adopted by:     

Department of Veterans Affairs Social Security Administration Kaiser Permanente MedVirginia Many federal and state government agencies

Harvard Medical School   

Google key words: John Halamka, geekdoctor, Joe Kvedar, connectedhealth, Blackford Middleton, Adam Wright, CDSC, SANDS Halamka about Service Oriented Architecture for Healthcare Halamka 4 reasons for Online Medical records    

  

Issues with storage Compliance benefits Patient access Better sense of community

Middleton about Clinical Decision Support Wright about SANDS (Service-oriented Architecture for NHIN Decision Support) Kvedar: Founder and Director of the Center for Connected Health  

Diabetes Remote Monitoring Connected Medical Devices

Harvard Pilgrim Health Care 

Harvard Pilgrim Health Care – The oldest nonprofit health plan in New England – 800,000 members – 22,000 doctors and 130 hospitals

 Similar Technology Stack as NIH Business System  Tibco SOA Platform  Extensive use of Oracle Infrastructure, platform and applications software



SOA Benefits – better service, fewer claims rejections, and significant cost savings for both providers and the health plan – Improved quality and timeliness of data for providers reduces errors and speeds service – improving customer satisfaction for Harvard Pilgrim plan members

Source: harvard-pilgrim-health-care.pdf from Dell Case Study and ss-harvardpilgrim_tcm8-757.pdf Tibco Case Study

University of Pittsburgh Medical Center (UPMC) 

University of Pittsburgh Medical Center (UPMC) – 40,000 employees and 4,000 doctors – 19 hospitals and 400 smaller sites throughout western Pennsylvania – Over 200 clinical systems

 Technology Stack  IBM servers  dbMotion SOA based solution



SOA Benefits – Integrated and aggregated data from more than 25 major clinical systems – Connected to best-of-breed systems such as Cerner, Epic, McKesson, MEDITECH, Siemens, Misys, Quest Diagnostics, HBOC Star, Dictaphone, and Spheris – Project finished in 8 months

Source: http://www.dbmotion.com/UPMC.aspx

Medical Imaging and Computing for Unified Information Sharing (MEDICUS)       

Google key words: Stephan Erberich, SOA, MEDICUS Open Source Funded by NIH Support collaboration and data exchange among multiple clinical trial centers Expanded to Children’s Oncology Group of more than 200 facilities to link to Image Data Center at the University of Southern California (USC). MEDICUS created an abstract layer between data, meta-data and users linking DICOM storage service providers and registries. Federation of DICOM medical imaging devices into healthcare Grids Patient-centric authorization will use X509 SAML assertions

More SOA Case Studies      

Implementing SOA at Duke University Health System by Boyd Carlson The CDC Public Health Grid by Joseph D. Rogers The National Cancel Institute caBig SOA Case Study by Ken Buetow Impact of SOA Initiatives on Business-IT Alignment and Business Agility by BlueCross BlueShield Using Service Oriented Architecture to Support Meaningful Use at DOD Military Health System by Chuck Campbell SOA in Medical Imaging at University of Chicago Hospitals by Paul Chang

SOA and Cloud Computing Enabled Healthcare IT

TOWARD A UNIVERSALLY CONNECTED HEALTH NETWORK

The Wisdom of Connected Patients  

Jane Sarashon-kahn researched Healthcare and Social Media for California Healthcare Foundation Healthcare and Social media    



Patientslikeme.com – the power of collective wisdom Thehealthcarescoop.com – patients reviews from people like you, by BlueCross and BlueShield Sermo.com – forum to share medical insights for physicians Doximity.com – linking medical minds

Healthcare Cloud   

Google Health Microsoft Health Vault Carestream Health: billion PACS images in Cloud

From SOA Integration to Universally Connected Health 

SOA Integration   



Prefer System Integration over Consolidation Prefer Evolution over revolution No one-size-fits-all solution

A Better Connected World       

Connected Doctors Connected Patients Connected Hospitals Connected Medical Diagnosis Devices Connected Patient Embedded Devices Connected Medical Home Connected Health Information Systems

Acknowledgements 

This presentation was reviewed and commented by : 

Charles Singleton, Director of NIH Business System Program



Thomas Murphy, NIH Acting CIO

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Thomas Erl, Editor of the SOA Magazine

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John Halamka, CIO of Harvard Medical School and Beth Israel Deaconess Medical Center

Some slides were presented to NIH EATS in February 2011, the 4th International SOA Symposium and the 3rd Cloud Computing Symposium in April 2011 and NIH CIT Service Seminar Series in June 2011

Disclaimer: All authoring and reviewing efforts are personal. Some content may be sanitized or incomplete. Content usage is granted but no usability is claimed.

References 

Federal Health Architecture Connect Open Source http://www.connectopensource.org

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NIH Enabling National Networking of Scientists and Resource Discovery http://www.vivoweb.org

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NIH Semantic SOA Grid https://cabig.nci.nih.gov/

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US Federal Cloud Computing Initiative http://apps.gov

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A Case Study on SOA and Process: Integrating E-Gov Travel Services with Federal Agency Financial Systems (Part II) http://soamag.com/I33/1009-4.php

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A Case Study on SOA and Process: Integrating E-Gov Travel Services with Federal Agency Financial Systems (Part I) http://soamag.com/I32/0909-1.php

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Health Care IT Collaboration in Massachusetts by Halamka et al. J Am Med Inform Assoc. 2005;12:596–601. DOI 10.1197/jamia.M1866

Contact

Thanks! Jeff Zhong Email: [email protected] http://www.linkedin.com/in/jeffzhong Website: http://www.futrend.com