Innovative Approach for Healthcare Integration using IIBfive9.vn/images/categories/main/Innovative...

Innovative Approach for Healthcare Integration Using IBM Integration Bus

Nguyen'Tuan'Khang'|'khangnt@vn.ibm.com/|/0913/008994/Senior/Solu;on/Advisor/IBM/Cloud,/SoDware/Group/

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REDEFINING VALUE AND SUCCESS IN HEALTHCARE

COLLABORATE TO IMPROVE CARE AND OUTCOMES Improve the quality and efficiency of care while cultivating patient centricity through engagement and health and care personalization.

INCREASE ACCESS TO HEALTHCARE Reduce disparities in access and compel individuals to become advocates for their own health.

BUILD SUSTAINABLE HEALTHCARE SYSTEMS

Build an efficient, flexible organization that proactively manages cost and regulatory

requirements and enables greater transparency and accountability.

Evidence-Centric Healthcare

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•  Health Information Exchange (HIE) •  Enterprise, Patient and Clinical Portals •  Health Benefit Exchange (HIX) •  Smarter Commerce for Healthcare / Consumer 360 •  Connected Home Health / Telehealth

•  Enterprise, Patient and Clinical Portals •  Provider Outcome Analytics / Provider Analytics Platform •  Content and Predictive Analytics •  Fraud, Waste & Abuse Management •  Disease Surveillance and Modeling •  Enterprise Forms Management •  eHealth Suite •  Payer Analytics Platform

•  Enrollment and Membership Process Optimization •  ICD-10 Transformation •  Enterprise Service Bus for Healthcare •  Medical Image Storage Archive (Private Cloud) •  Privacy, Security and Business Resilience •  Application Portfolio and Management Services •  Digital Hospital Infrastructure Virtualization and Optimization

IBM HEALTHCARE SOLUTIONS Increase access to healthcare

Collaborate to improve care and outcomes

Build sustainable healthcare systems

Enterprise Analytics

Consumer Services

Business Process Modernization

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HEALTHCARE INTEGRATION?

•  Enterprise'systems'consist'of'many'logical'endpoints'

•  Off<the<shelf'applica=ons,'services,'cloud'apps'(SaaS),'web'apps,'devices,'appliances,'custom'built'soEware''

•  Endpoints'expose'a'set'of'inputs'and'outputs'which'compromise'

•  Protocols'–'e.g.'TCP/IP,'HTTP,'File'System,'FTP,'MQ,'SMTP,'POP3,'etc…'

•  Message'Formats,'Binary'(C/COBOL),'XML,'Industry'(HL7,'EDI),'User<defined'

•  ‘Integra=on’'is'connec=ng'these'endpoints'in'meaningful'ways'to'achieve'interoperability'

•  Route,'Transform,'Enrich,'Filter,'Monitor,'Distribute,'Decompose,'Correlate,'Fire'and'Forget,'Request/Reply,'

Publish/Sucscribe,'Aggrega=on,'Fan<in,'Complex'Event'Processing….'

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HEALTHCARE INTEGRATION CHALLENGES Proprietary*nature*of*technology*!  Most'healthcare'systems'are'closed'systems'and'the'architectures'

and'data'models'are'proprietary'to'different'vendors'

!  Various'healthcare'systems'end'up'becoming'siloes'of'informa=on,'

making'data'exchange'very'complex'

Implementa4on*Concerns*!  Complex'implementa=on'programs'

!  Data'security'challenges'

!  Adop=on'of'messaging'standards'

!  Cost'and'ROI'implica=ons'

Data*Availability*Challenges*!  OEen,'the'necessary'data'is'not'available'in'real<=me'

!  Data'needs'to'be'transformed'as'it'is'not'available'in'the'required'format'

!  Healthcare'interoperability'and'EMR/'EHR'integra=on'are'symbio=c'in'nature'

!  Few'standalone'EMRs'only'contain'pa=ent'demographics'and'the'rest'of'the'clinical'informa=on'is'paper'based,'making'

it'difficult'to'extract'the'en=re'medical'history.'

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HEALTHCARE INTEGRATION TO SUPPORT HIGHER VALUE INITIATIVES

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INTEGRATION TOPOLOGIES

'Bridges •  OEen'used'for'single'point<to<point'connec=ons'•  Usually'cheap'and'quick'to'configure'•  More'difficult'to'scale'to'larger'numbers'of'endpoints'

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cloud

B2B etc.

internet Gateways •  Provides connectivity to

third parties or to a specific class of endpoint

•  For example, internet, cloud, security, DMZ, B2B

•  Combines simplicity of configuration and (commonly) an on-ramp to backend ESB

Enterprise Service Bus (ESB) •  Logical construct that combines data movement

and enrichment •  Scales very well; can integrate small and large

numbers of endpoints, and can be easily distributed

•  Often applied as a backbone for a Service Oriented Architecture (SOA)

•  Solutions can usually also be applied to hub and spoke style architectures

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IBM INTEGRATION ARCHITECTURE FOR HEALTHCARE

Pharmacy

Medical devices

Medical imaging modalities

Medical applications

Clinical repositories

Legacy interface engines

Enterprise Master Patient Index

Laboratory

HL7'Cache'

ODBC'

DICOM' HL7,'

Proprietary,'

RS232'

Web'Services'

HL7v2,'FHIR' HL7'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

IHE'PIX/''

PDQ'HL7'

HL7'

IBM API Gateway Edge

IBM Integration Bus + Healthcare Pack

Mobile Mainframe CICS/IMS

MQ, JMS, MSMQ

ERP / EIS / CRM Files Devices Analytics

Web Services Microsoft Web 2.0 Databases Applications Decision Management / Business Process

Remote patient monitoring Medical insurers Community

Sterling'Connect'

Direct,'HIPAA'

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'

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KEY FEATURES

•  Paeern<based'development'tooling'<'fast'integra=on'

without'detailed'knowledge'of'integra=on'technologies'

•  Makes'use'of'proven'run=me'of'IBM'Integra=on'Bus'

•  Integrates'HL7'based'clinical'repositories'&'applica=ons'

•  Produc=on'ready'paeerns'based'around'HL7'v2.x'•  Paeern'allows'easy'customisa=on'

•  Handles'inbound'and'outbound'MLLP'socket'connec=ons'

•  Message'defini=ons'for'all'chapters'of'the''HL7'v2.x'

specifica=ons'

•  Integrates'DICOM'based'PACS'&'modali=es'

•  Processes'CDA/CCD'documents'

•  Direct'connec=vity'to'medical'equipment'<'monitors,'

infusion'pumps'etc'

•  Healthcare<oriented'opera=onal'views'

•  Single'point'of'visibility'and'control'

Electronic'

Medical'

Records'

Pa=ent'

Administra=on'

System'

PACS'&'

imaging'

Labs'&'

pharmacy'

Medical'

devices'

Remote'

Pa=ent'

Monitoring'

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HL7'Web'Services'

HL7v2,'FHIR'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

IHE'PIX/''

PDQ'HL7'

HL7'

Sterling'Connect'

Direct,'HIPAA'

DICOM'

CONNECTING CLINICAL APPLICATIONS

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Medical devices Legacy

interface engines

HL7'Cache'

ODBC'

HL7,'

Proprietary,'

RS232'

Integration Gateway Edge

Remote patient monitoring Medical insurers Community

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'Medical imaging

modalities Enterprise Master

Patient Index Medical

applications Clinical

repositories Laboratory Pharmacy

In*isola4on,*clinical*technologies*cannot*provide*a*single,*360*degree*view*of*the*pa4ent*•  e<prescribing,'prac=ce'management,'EHRs,'health'informa=on'systems,'clinical'portals,'etc'

Connect*clinical*applica4ons*across*the*enterprise:*•  Enhance*pa4ent*care'–'A'single'view'of'the'pa=ent'supports'more'informed'clinical'decision'making'and'risk'analysis.'

•  Reduce*costs'–'Giving'care'staff'access'to'the'right'informa=on'at'the'point'of'care'supports'the'reduc=on'of'duplicate'

ac=vi=es'(such'as'tests)'and'with'beeer'access'to'data,'your'organiza=on'has'the'opportunity'to'gain'new'insights'and'

make'beeer'business'decisions.'

•  Save*4me'–'Reduce'=me'spent'on'searching'for'relevant'data'and'add'new'applica=ons'as'the'business'has'need'for'them.'

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IHE'PIX/''

PDQ'HL7'

DICOM'

HL7' HL7'

Sterling'Connect'

Direct,'HIPAA'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

Web'Services'

HL7v2,'FHIR'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'Medical devices Legacy

interface engines

HL7'Cache'

ODBC'

HL7,'

Proprietary,'

RS232'

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'Medical

applications

Clinical repositories Pharmacy Laboratory

INTEGRATE WITH AN EMPI

Integration Gateway Edge

Remote patient monitoring Medical insurers Community

Medical imaging modalities

Enterprise Master Patient Index

Challenges*in*crea4ng*a*longitudinal*pa4ent*record*•  Mul=ple'records'may'exist'across'the'enterprise.'Matching'and'linking/merging'records'across'an'enterprise'once'

disparate'systems'are'integrated'can'be'complex'

*By*integra4ng*an*EMPI*you*can:*

•  Iden=fy'the'same'pa=ent'across'disparate'systems'to'link'records'helping'establish'an'accurate'pa=ent'medical'

record'

•  Store,'view,'and'match'data'within'global'languages'in'mul=ple'character'sets'

•  Find,'correct,'and'eliminate'duplica=on'and'other'data'quality'problems'across'systems'and'data'sources'

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DICOM'

HL7'

IHE'PIX/''

PDQ'HL7'

HL7'

Sterling'Connect'

Direct,'HIPAA'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

Web'Services'

HL7v2,'FHIR'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'Medical devices Legacy

interface engines

HL7'Cache'

ODBC'

HL7,'

Proprietary,'

RS232'

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'Medical

applications

Clinical repositories Pharmacy

Enterprise Master Patient Index

Laboratory

INTEGRATING MEDICAL IMAGES

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Integration Gateway Edge

Remote patient monitoring Medical insurers Community

Medical imaging modalities

Why*automate*flow*of*images*between*archives?*•  Provide'access'to'data'held'in'remote'PACS'systems''

*Improving*clinical*process**

•  Engage'external'experts'in'diagnos=c'process'by'rou=ng'image'data''

•  Ensure'latest'pa=ent'informa=on'at'the'clinicians'finger=ps'by'implemen=ng'pre<fetch'of'

studies'on'admission'

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Medical imaging modalities

DICOM'

HL7'

IHE'PIX/''

PDQ'HL7'

HL7'

Sterling'Connect'

Direct,'HIPAA'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

Web'Services'

HL7v2,'FHIR'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'Medical devices Legacy

interface engines

HL7'Cache'

ODBC'

HL7,'

Proprietary,'

RS232'

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'Medical

applications

Clinical repositories Pharmacy

Enterprise Master Patient Index

Laboratory

SHARING DATA BEYOND THE HOSPITAL WALLS

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Integration Gateway Edge

Remote patient monitoring Medical insurers Community

Pa4ents*may*move*between*care*facili4es*for*a*number*of*reasons*•  Without'medical'records'from'previous'visits'in'other'organiza=ons,'clinicians'may'not'be'aware'of'a'pa=ent’s'history'

•  May'lead'to'unnecessary'duplica=on'of'ac=vi=es'(eg.'diagnos=c'tests)'

Integrate*using*‘Integra4ng*the*Healthcare*Enterprise’*profile*for*a*standard*approach*to*sharing*and*receiving*health*related*documents*

•  Increase'efficiency'by'reducing'unnecessary'paperwork'

•  Provide'caregivers'with'clinical'decision'support'tools'for'more'effec=ve'care'

•  Enable'interoperability'among'EHRs'maintained'by'individual'physicians'&'organiza=ons'

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DICOM'

HL7'

IHE'PIX/''

PDQ'HL7'

HL7'

Sterling'Connect'

Direct,'HIPAA'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

Web'Services'

HL7v2,'FHIR'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'

Legacy interface engines

HL7'Cache'

ODBC'

HL7,'

Proprietary,'

RS232'

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'Medical

applications

Clinical repositories Pharmacy

Enterprise Master Patient Index

Laboratory

INTEGRATING MEDICAL DEVICES

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Integration Gateway Edge

Remote patient monitoring Medical insurers Community

Medical imaging modalities

Medical devices

Why*automate*data*capture?*•  Ensure'consistency'in'hospital'records'

•  Single'source'of'truth'for'li=ga=on'

*Remove*need*to*reNkey*data*

•  Free'clinicians'to'deal'with'clinical'tasks'

•  Reduce'errors'

•  Ensure'latest'pa=ent'info'at'the'clinicians'finger=ps'

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DICOM'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'Medical

applications

Clinical repositories

Medical imaging modalities

HL7'

IHE'PIX/''

PDQ'HL7'

HL7'

Sterling'Connect'

Direct,'HIPAA'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

Web'Services'

HL7v2,'FHIR'

Medical devices Legacy

interface engines

HL7'Cache'

ODBC'

HL7,'

Proprietary,'

RS232'

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'

Pharmacy

Enterprise Master Patient Index

Laboratory

HIPAA MESSAGING

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Integration Gateway Edge

Remote patient monitoring Community Medical insurers

Eligibility,*claims*and*payment*reconcilia4on*can*be*a*long*and*complex*process*•  Interac=ons'with'a'pa=ent'must'now,'under'HIPAA,'send'most'billing'claims'for'services'via'electronic'means'

•  Mul=ple'transac=ons'are'needed'to'complete'the'medical'billing'cycle'

Simplify*the*exchange*of*informa4on*between*payers*and*providers*•  Integrate'claims'processing'ac=vi=es'with'medical'applica=ons'on'a'single'plalorm'to'simplify'billing'cycle'and'

receive'faster'reimbursements'

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DICOM'

IHE'XDS,'

CDA/CCD,'

XML,'HL7'Medical

applications

Clinical repositories

Medical imaging modalities

HL7'

IHE'PIX/''

PDQ'HL7'

HL7'

Sterling'Connect'

Direct,'HIPAA'

HL7,'FHIR'

Cache'ODBC'

Web'Services'

Web'Services'

HL7v2,'FHIR'

Medical devices Legacy

interface engines

HL7'Cache'

ODBC'

HL7,'

Proprietary,'

RS232'

Web'Services'

SOAP'HTTP'

MQTT,'Con=nua'

Pharmacy

Enterprise Master Patient Index

Laboratory

REMOTE PATIENT MONITORING

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Integration Gateway Edge

Medical insurers Community

Remote patient monitoring

Care*of*pa4ents*outside*of*tradi4onal*care*ins4tu4ons*•  Post<acute'care,'chronic'condi=on'sufferers'or'pa=ents'who'need'long'term'health'management'(eg.'

weight'management)'

*Intervene*faster*to*resolve*issues*before*reNadmiQance*

•  Support'the'connec=on'and'flow'of'data'from'remote'devices'(medical'devices,'mobile'applica=ons)'

•  Track'success'and'personalise'plans'based'on'the'individual'

•  Look'aEer'all'pa=ents'while'spending'the'=me'with'those'who'really'need'help'

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PUTTING IT ALL TOGETHER…

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MQTT DICOM PACS

Predicting Deciding

Integrating

Imaging*Modality*

Pa4ent*Report*

Monitoring

Electronic*Health*Record*

Alert*Doctor*

ODBC JDBC

SMS

1. An'ambulance'aeends'a'pa=ent'who'has'collapsed'and'

makes'an'ini=al'assessment,'transmieed'via'MQTT.*

2. Monitoring'displays'summary'data'in'a'Web'UI.'

3. The'Integra=on'Bus'looks'up'the'pa=ent’s'history'in'an'EMR.'

4. An'Event'containing'both'the'pa=ent'assessment'and'

their'medical'history'is'sent'to'an'Analy=cs'engine'to'

determine'the'likelihood'of'pa=ent'admission.*

5. Based'on'the'predic=on,'the'Rules'engine'decides'whether'to'alert'a'doctor'in'readiness'for'pa=ent'

arrival.'

6. Before'the'pa=ent'arrives,'the'Integra=on'Bus'gathers'together'their'image'history'from'PACS'systems'(inside'

or'outside'the'care'centre).*

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SHARING BIG DATA IN HEALTHCARE

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MEDIA FILES SHARING TOOLS

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NEW APPROACH TO SHARING BIG DATA WITH IBM

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Texas Health Resources is one of the largest faith-based, nonprofit health care delivery systems in the United States and the largest in North Texas in terms of patients served. The system's primary service area consists of 16 counties in north central Texas, home to more than 6.2 million people. THR has 12 acute-care hospitals and one long-term care hospital that total 3,355 licensed hospital beds, employs more than 18,000 people, and counts more than 3,600 physicians with active staff privileges at its hospitals

TEXAS HEALTH RESOURCES CLIENT SUCCESS STORY

•  Challenges*•  THR'needed'to'migrate'from'their'current'middleware'/''transforma=on'

plalorm'(Sun/Oracle'eGate).'The'soEware'had'become'outdated,'and'

con=nuing'support'from'the'vendor'was'in'ques=on.'

•  Integra4on*in*Ac4on*–  Converted'the'14<hospital'environment'to'the'IBM'Healthcare'Integra=on'

solu=on,'allowing'the'hospital'group'to'integrate'their'disparate'systems'

using'an'open'standards<based'plalorm.'

•  Business*Outcomes*"  The'conversion'allowed'the'sharing'and'standardiza=on'of'both'message'and'

data'from'all'hospitals'within'the'group,'and'standardized'their'development'

plalorm'

"  Func=onality'that'provides'robust'support'for'all'HL7'messaging'and'

heterogeneous'opera=ng'environments'handling'transac=on'volumes'of'

2million+'per'day'

"  More'affordable'and'a'lower'TCO'than'the'compe=ng'solu=ons'

"  Advanced'transac=onal'capabili=es'enabled'the'client'to'implement'only'one'

processor'license'to'support'current'and'future'messaging'transac=on'needs.'

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Dignity Health, headquartered in San Francisco, California, runs 43 hospitals and medical canters in California, Arizona, and Nevada.

Founded in 1986, it is one of the largest not-for-profit providers in California with more than 8,500 physicians providing healthcare services to more than four million people annually.

DIGNITY HEALTH CLIENT SUCCESS STORY

•  Challenges*•  Working'with'IBM,'Dignity'Health'implemented'a'robust'integra=on'plalorm'

to'meet'the'Electronic'Health'Record'(EHR)'mandate'for'health'informa=on'

flows'between'hospitals'based'upon'the'HL7'standard.'

•  Integra4on*in*Ac4on*•  Internally'referred'to'as'ConneXion,'the'solu=on,'built'upon'IBM'Integra=on'

soEware,'was'customized'with'over'2500'integra=ons'to'cater'to'the'EHR'

and'HL7'mandates.'

•  This'took'full'advantage'of'the'core'values'of'IBM’s'messaging'and'ESB'

solu=on,'to'provide'a'reliable,'high<performance'messaging'system'that'is'

easy'to'scale.''

•  Business*Outcomes*"  Robust'Backbone'for'transmiqng'EHR'data'

"  Handles'millions'of'messages'a'day'

"  New'hospitals'can'be'easily'added'to'backbone'"  IT'Standards'&'integrity'retained'as'network'grows'

© 2014 IBM Corporation

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STRENGTHS AND DIFFERENTIATORS

"  Robust'<'Supports'data'integra=on'across'80'plalorms'and'

includes'access'to'a'large'range'of'industry'standard'

databases'and'ERP'systems'

"  High*Performance*–'Scalability'and'throughput'leader'with'support'for'more'than'450'million'messages/day,'and'low'

latency'(up'to'2.25x'faster'than'closest'compe==on)'

"  Simple'–'Minimize'the'need'for'custom'coding'of'interfaces'

and'reduce'design,'buid'and'test'costs'by'40%'to'60%.'

"  Readily*available*skills*<'Extensive'network'of'trained'IBM'

Business'Partners'and'ISVs'with'over'4000'cer=fied'

specialists'worldwide'

"  Close'interac=on'with'a'loyal'and'growing'customer'base'

and'product'development'team'through'Beta*and*Lab*Advocacy*Programs*

"  Developed,'tested'and'supported'from'IBM’s'Hursley'

soEware'development'laboratory'in'the'UK'in'addi=on'to'a'

24*x*7*worldwide*support*organiza4on*

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WHY IBM?

"  Trusted'integra=on'technology,'with'over'15'years'in'the'market'

"  More'than'1000*produc4on*installa4ons*"  More'than'600*installa4ons*at*healthcare*sites**

Forrester:''Case'study'revealed:'•  Open'source'ESB'would'significantly'increase'risk'of'incidents'($700,000'

savings)'

•  Significant'scalability'and'throughput'advantage'($320,000'savings)'

•  More'produc=ve'and'efficient'development'environment'($684,000'

savings)'

•  Wider'range'of'integra=on'op=ons'resul=ng'in'reduced'development'effort'

than'the'open'source'alterna=ve'($150,000'savings)'*

Gartner:''“IBM'is'a'Leader'in'all'three'applica=on'infrastructure'project'markets,'

because'of'the'depth,'breadth,'adop=on'and'maturity'of'its'technology.'[IBM'

Integra=on'Bus'is'a]'technically'proven'and'powerful'product'[with'a]'broad'

install'base'and'partner'ecosystem.”'*

InfoTech:''“Highly'customizable…'wide'range'of'connec=vity…'makes'

integra=on'intui=ve...'well'suited'for'handling'high'message'volumes...'entry<

level'pricing'may'make'it'en=cing'for'smaller'companies.”'

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QUESTIONS AND MORE INFORMATION!

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THANK YOU