Designing High Performance XDS Registries/Repositories

IHE Interoperability Showcase – HIMSS 2006

Joe GallantProduct Manager

Presentation Overview

• XDS has the potential to serve as the foundation for aXDS has the potential to serve as the foundation for across-enterprise EHR supporting advanced functionality.cross-enterprise EHR supporting advanced functionality.

• HL7 CDA is central to XDS achieving its potential.HL7 CDA is central to XDS achieving its potential.• HL7 CDA documents are objects.HL7 CDA documents are objects.• Relational technology is ill suited to storing & retrieving objects.Relational technology is ill suited to storing & retrieving objects.• Post relational database technology is ideal for high Post relational database technology is ideal for high

performance, massively scaleable EHR systems.performance, massively scaleable EHR systems.• Modern application integration platform is critical to the success Modern application integration platform is critical to the success

of an advanced function EHR system.of an advanced function EHR system.

XDSCross-Enterprise Document Sharing

Document Consumer

Retrieve Documents

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide&RegisterDocument Set

Register

Document Set

Actors and Transactions

The Case for HL7 CDA … as the “standard” content container for XDS

• CDA facilitates the creation and broadest accessibility of CDA facilitates the creation and broadest accessibility of attested, attested, human-readablehuman-readable, clinical documents., clinical documents.

• CDA accommodates non-standard clinical documents, CDA accommodates non-standard clinical documents, proprietary formats and images.proprietary formats and images.

• CDA provides a framework for the incremental growth in the CDA provides a framework for the incremental growth in the amount and precision of structured, vocabulary-bound amount and precision of structured, vocabulary-bound clinical information exchanged. clinical information exchanged.

– Low barrier to entry; simple things are easy to do.Low barrier to entry; simple things are easy to do.– Promotes longevity of information.Promotes longevity of information.– Enables the finest level of semantic granularity in Enables the finest level of semantic granularity in

standards-based representation of clinical information standards-based representation of clinical information for applications that can support it.for applications that can support it.

An HL7 CDA document …

is a complete information objectCDA characteristics

• Human Readability – Doctor and Patient Friendly• Persistence & Stewardship – Tangible & possessible• Wholeness & Context – Stand alone if necessary• Potential for authentication – Genuine, Signed, Private

as well as encryption and digital rights management

CDA provides an incremental path forward from human-readable documents to computable semantic interoperability

IHE Roadmap: Building upon XDS

XDS is a foundation for cross-enterprise EHR Document Content Integration Profiles defined for a specific domain of care practice: document format, content vocabularies, templates, etc.).

Process Flow Profiles additionally define actors and transactions to support specific processes (ePrescribing, eReferral, eBooking, etc.). These messages should reference XDS managed documents for persistent artifacts.

XDSCross-Enterprise Document Sharing.

Document ContentIntegration Profiles

Workflows MessagingIntegration Profiles(e.g. ePrescription)

Acc

ess

Con

trol

The “Real” Requirements are for an EHR based on HL7 CDA and IHE XDS Framework

• High performance High performance OLTPOLTP application application on aon a massive massive repository of complex objectsrepository of complex objects

– Must support SQL queries for retrieval of individual Must support SQL queries for retrieval of individual documents, as well as OLAP style for researchdocuments, as well as OLAP style for research

• Complex application integration projectComplex application integration project– Messaging: receive, parse, Messaging: receive, parse, persistpersist, transform, transmit, transform, transmit– Business Process Management Business Process Management – Composite ApplicationsComposite Applications– Business Activity Monitoring (BAM)Business Activity Monitoring (BAM)

Requirement

High Performance

High performance On-Line Transaction Processing (OLTP) on a massive repository of complex objects, serving tens of thousands of concurrent users

However...

““Using tables to store objects is Using tables to store objects is like driving your car home and like driving your car home and then disassembling it to put it in then disassembling it to put it in the garage.the garage. It can be assembled It can be assembled again in the morning, but one again in the morning, but one eventually asks whether this is eventually asks whether this is the most efficient way to park a the most efficient way to park a carcar..”” - - Esther DysonEsther Dyson

Objects / Relational Mismatch

UserUserInterfaceInterface LogicLogic TraditionalTraditional

DatabaseDatabase

ObjectsObjects ObjectsObjects TablesTables

Expensive TransformationExpensive TransformationImpedance MismatchImpedance Mismatch

Expensive TransformationExpensive TransformationImpedance MismatchImpedance Mismatch

Objects in the Database

UserUserInterfaceInterface LogicLogic ObjectObject

DatabaseDatabase

ObjectsObjects ObjectsObjects PersistentPersistentObjectsObjects

Consistent Representation End to EndConsistent Representation End to EndConsistent Representation End to EndConsistent Representation End to End

Post Relational Architecture

Multi-DimensionalMulti-DimensionalStorage ManagerStorage ManagerMulti-DimensionalMulti-DimensionalStorage ManagerStorage Manager

ObjectsObjectsObjectsObjectsSQLSQLSQLSQL

Performance& Scalability

ProgrammaticAccess for OLTP

Query & AggregateAnalysis

Post RelationalUnified Data Architecture

Storage ManagerStorage ManagerStorage ManagerStorage Manager

ObjectsObjectsObjectsObjectsSQLSQLSQLSQL

DictionaryDictionaryDictionaryDictionary

• One databaseOne database

• One definition of the dataOne definition of the data

• Two access paths reference Two access paths reference the same definitionthe same definition

Eliminates the overhead ofobject / relational mapping

InterSystems’ CachéObject and Relational Connectivity

Multi-DimensionalMulti-DimensionalStorage ManagerStorage ManagerMulti-DimensionalMulti-DimensionalStorage ManagerStorage Manager

CachéCachéObjectsObjectsCachéCachéObjectsObjects

CachéCachéSQLSQL

CachéCachéSQLSQL

Industry-standardrelational access

High-performanceHigh-performancelinks to all majorlinks to all major

object architecturesobject architectures C++

C++

C++

C++

Java

Java

Java

Java

COM

COM

COM

COM

XML

XML

XML

XML

SOAP

SOAP

SOAP

SOAP

EJB

EJB

EJB

EJB

.Net

.Net

.Net

.Net

Perl

Perl

Perl

Perl

Pyth

onPy

thon

Pyth

onPy

thonODBCODBCODBCODBC JDBCJDBCJDBCJDBC

Single Data DefintionOptimized For High

Performance

Optimized To MinimizeContention

Transactional Bit Map Indexing

Excellent retrieval performance for Excellent retrieval performance for complex queriescomplex queries

Excellent retrieval performance for Excellent retrieval performance for complex queriescomplex queries

Excellent update performance for Excellent update performance for core transaction processing applicationscore transaction processing applications

Excellent update performance for Excellent update performance for core transaction processing applicationscore transaction processing applications

Real-Time AnalyticsReal-Time Analytics

Requirement

Application Integration

• Complex application integration project:Complex application integration project:– Receive, parse, Receive, parse, persistpersist, transform, transmit , transform, transmit XMLXML– Implement cross-enterprise Business Process Implement cross-enterprise Business Process

Management (BPM), also known as workflowManagement (BPM), also known as workflow– Build and run Composite Applications – to Build and run Composite Applications – to

support browser access to heterogeneous datasupport browser access to heterogeneous data– Perform Business Activity Monitoring (BAM) – for Perform Business Activity Monitoring (BAM) – for

policy making and public health management, policy making and public health management, including disease surveillance and bioterrorism including disease surveillance and bioterrorism defensedefense

Integration Models

Composite Composite ApplicationsApplications

DataDataCoordinationCoordination

Business ProcessBusiness Process/ Work Flow/ Work Flow

Business ActivityBusiness ActivityMonitoringMonitoring

Universal Business Integration PlatformUniversal Business Integration Platform

TechnologyTechnologyApplicationApplicationDataData

Convergence

Increasingly projects span integration models …

DataData

Coordi

natio

n

Coordi

natio

n

Compo

site

Compo

site

Applica

tions

Applica

tions

Business

BusinessProcess

ProcessManagement

Management

Business

BusinessActivity

Activity

Monitoring

Monitoring

OneOne ArchitectureArchitecture

StorageStorageM

anag

emen

tM

anag

emen

t

Deve

lopm

ent

Deve

lopm

ent

InterSystems EnsembleUniversal Business Integration Platform

OneOne• AbstractionAbstraction

LayerLayer• ExecutionExecution

EngineEngine• RepositoryRepository• Development Development

EnvironmentEnvironment• Management Management

EnvironmentEnvironment

Convergence

Driving a need for Driving a need for rich platforms that rich platforms that seamlessly combine seamlessly combine application application development and development and integration integration

Analyti

cs

Analyti

cs

Orches

tratio

n

Orches

tratio

nDevelopment

Development

Integration

Integration

See Gartner’s research on Application Platform Servers (APS)

Conclusion

• Realizing the vision of clinical document sharing, and Realizing the vision of clinical document sharing, and patient care process management across multiple unrelated patient care process management across multiple unrelated healthcare provider enterprises encompassing regional or healthcare provider enterprises encompassing regional or national populations will require:national populations will require:

– HL7 CDA as the standard “container” for content,HL7 CDA as the standard “container” for content,– Post relational database technology optimized for OLTP Post relational database technology optimized for OLTP

on complex objects, with support for SQL queries,on complex objects, with support for SQL queries,– Application integration platform middleware supporting:Application integration platform middleware supporting:

• Robust store and forward messagingRobust store and forward messaging• Business Process Management orchestration (i.e. workflow)Business Process Management orchestration (i.e. workflow)• Composite ApplicationsComposite Applications• Business Activity MonitoringBusiness Activity Monitoring

• InterSystems’ Ensemble meets and exceeds InterSystems’ Ensemble meets and exceeds requirements for a high performance, requirements for a high performance, advanced functionality, massively scaleable, advanced functionality, massively scaleable, cross-enterprise EHR.cross-enterprise EHR.

Conclusion

Designing High Performance XDS Registries/Repositories

IHE Interoperability Showcase – HIMSS 2006

Joe GallantProduct Manager