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© 2011 IBM Corporation

IBM’s Enterprise Service Bus for Healthcare /

WebSphere Message Broker Connectivity Pack

for Healthcare

© 2011 IBM Corporation2

ESB for Healthcare/Connectivity Pack for Healthcare -Agenda

ESBs in Healthcare Technical Architecture and Hospital Solutions Proven solution that is healthcare specific WebSphere Message Broker: the core of IBM’s premiere Enterprise Service Bus Functionality Highlights Connectivity Pack for Healthcare Software Components Document type support Building Blocks Functionality examples Clinical Documentation, IHE and Dicom Support Patterns High Availability Security Delivery Path Migration


IBM Healthcare Technical Architecture

Clinical Pathway Management – Emergency, Oncology etc

Corporate Applications

Billing – Payroll - HR

Clinical ApplicationsPAS – Orders – Pharmacy – Maternity – Pathology – ER

EnterpriseDataWarehouse

Analytics and ReportingClinical and Corporate

JCAPSRhapsodyeGateInterSystems

ExistingHospitalIntegrationEngine

ElectronicMasterPatientIndex

Electronic Forms -Discharge Form etc

Portal

IBM Remote Medical Device Aggregator

Hospital Medical Devices

Home/Telehealth Medical Devices

Non-Trust Applications

Web Services

Web Services

Web Services

Web Services

XML

ODBC, JDBC, SQL XML, IDOC, Proprietary XML, HL72, HL73, Cache ODBC, Web Services Proprietary

HL72 HL72, HL73

ClinicalDocumentSharing

XML, SOAP, Web Services, ebRIM

Integration Engine - ESB

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ebXMLITKProprietary

Integration Engine – WebSphere Message Broker

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Web Services


In production since 2005 Full use of all components (queues, flows, monitoring) Currently deployed to all 40+ hospitals in their network Over 9 million transactions per day

Many Health Plan institutions around the country All HIPAA transactions, claims pre and post adjudication Easy to create, modify, enhance

World-wide, proven solution that is healthcare specific

… As well as many others!

Toronto, CA - In production Full use of all components (queues, flows, monitoring) About 2 million transactions per week Special flows created for Meditech (MUMPS/Cache app)

In production across all of Kaiser Full use of all components including Process Choreography

(WPS) About 20 million transactions per day at peak Special workflows created for Epic


Business IssueThis very large hospital group in the Western U.S. needed to migrate from their legacy middleware/transformation platform. The software had become outdated, and was not able to handle the integration of the many hospitals in the group.

SolutionConverted the 42-hospital environment from Sybase-Neon platform to the Enterprise Service Bus for Healthcare.

The conversion allowed the hospital group to integrate their disparate systems using an open standards-based platform

Expand the usage to all other hospitals in the group. Introduced a "Common Information Model", or "CIM". The CIM

provided a common definition of information for services around a Service Oriented Architecture (SOA) with regard to common data structures, both HL7 and non-HL7.

Over 9 million transactions per day More than 1400 interfaces migrated by IBM, Independent

Services Contractors (CSC) and CHW personnel.

Results Very successful project for CHW. Allowed the sharing of data from all hospitals within the group, and standardized their ESB platform.

Catholic Healthcare West (CHW)


Business IssueThis large hospital group in Dallas is migrating from their current middleware transformation platform. Their software had become outdated, and continuing support from Oracle is ending in 2012.

SolutionConverted the 14-hospital environment from the SUN eGate platform to the Enterprise Service Bus for Healthcare:

The conversion allows the hospital group to integrate their disparate systems (Epic, Cerner, Siemens) using our open standards platform

Expanding the usage to all other hospitals in the group. Re-used the "Common Information Model", or "CIM". The CIM

provides a common definition of information for services developed at CHW – reducing cost and risk to THR.

Results:On-going project that has gone very well. Continued use of the ESB and expansion into other hospital needs is being scoped now:

Devices Data aggregation Data Warehousing

Texas Health Resources


– A new production ready pattern based around HL7 MLLP v2.x– Pattern allows easy customisation in service engagements

Operational monitoring of clinical applications– Enhancements to the Message Broker Explorer

ESB for Healthcare/Connectivity Pack for Healthcare


ESB for Healthcare/Connectivity Pack for Healthcare Highlights Universal Connectivity

– Simplify application connectivity to provide a flexible and dynamic infrastructure

Routes and transforms messages FROM anywhere, TO anywhere– Supports a wide range of protocols

• MQ, JMS 1.1, HTTP(S), Web Services, File, EIS (Oracle, Siebel…), TCP/IP, MLLP, User Defined

– Supports a broad range of data formats• Binary (C/COBOL), XML, Industry (HL7, EDI, HIPAA…), User Defined

– Interactions and Operations• Route, Filter, Transform, Enrich, Monitor, Distribute, Decompose, Correlate, Detect…

Simple programming– Message Flows to describe application connectivity– Message Nodes which encapsulate required integration logic which operate on…– Message Tree which describes the data in a format independent manner– Transformation options include Graphical mapping, Java, ESQL, XSL and WTX

Operational Management and Performance– Extensive Administration and Systems Management facilities for developed solutions– Wide range of operating system and hardware platforms supported


YESEclipse Open-Standard ToolingYESInitiate/eMPI SupportYESAnalytics supportYESAssured Delivery

YESCommon Interface SpecificationsYESHTTP/SOAPYESMQ/JMS supportYESWeb Services

YESSupport for HL7 v2, v3, CDA, CCRYESDatabase Reads/Writes/UpdatesYESAPIs for external applicationsYESCommon Development RoutinesYESCommon Error handlingYESCommon Information ModelYESHealthcare Patterns

All development platforms supported through Nodes

OthersYESeSQLYESJAVA

Development Methods

YESDrag and Drop interfaceESB for HealthcareFunctionality

ESB for Healthcare/Connectivity Pack for Healthcare Highlights


Document types supported

PineStarPower Scribe

Cerner Millennium FUJIGE IDX

McKessonMeditech (ADT, ORU)EPIC (ADT, ORU, ORM, MDM)

MedTrack (ADT) Midas (ADT) Omnicell (ADT)

Cerner RadNet (ADT, ORM, ORU) Millbrook (ORU) DOMINATOR (ORM)

RehabManager (ADT) BEDTRACKING (ADT) APOLLO (ADT)

Xtend (ADT) GE Logician (ADT, SIU) IMS (different custom transcriptions)

Cerner Pathnet (ADT, ORM, ORU) PCN (ADT, SIU) Emtek (ADT, ORU, ORM)

Chartlinc (ADT, BAR, ORU) IMPAC IntelliLab (ADT) Siemens Invision (ADT, BAR, ORU)

Examples of HIPAA document types in the ESB (all are supported):

Clinical Applications Coded and Sample Documents Types:

834: Enrollment835: HealthCare Claim Payment Advice 837: Claims submission

278: Health Care Service Review Information

277: Health Care Claim Status Notification

276: Claim status inquiry

271: Eligibility and Benefits Response 270: Eligibility and Benefits Inquiry 820: Health Care Payment Order


The Healthcare Connectivity Pack framework has been specifically architected to handle the needs of a healthcare entity, providing the communications paths needed for source and destination applications, as well as:

WebSphere Message Broker V7(Required)

Provides HIPAA EDI transaction mapping

WebSphere Transformation Extender For HIPAA (Optional)

Internal WMB flows Journaling

Multiple error queues

Message state

Easy development and system monitoring is possible in the Connectivity Pack for Healthcare:

– A new production ready pattern based around HL7 MLLP v2.x

– Operational monitoring of clinical applications through enhancements to the Message Broker Explorer

Connectivity Pack for Healthcare (Required)

ESB for Healthcare/Connectivity Pack for Healthcare:Building Blocks


ESB for Healthcare/Connectivity Pack for Healthcare:Functionality Examples


Web Service connectivity and requests are handled by the following:

1. Java Connectivity adapters connect to the IP-based systems, and handle routing to and from the Message Broker and MQ

2. Message Broker can also directly receive Services requests through its HTTP nodes

Wrap an HL7 TCPIP connection with a web service= On-ramp for SOA services (Example: Kaiser Permanente)


Property controls can be set to indicate whether the update to the database is committed immediately, or deferred until the message flow completes, at which time the update is committed or rolled back, according to the overall completion status of the message flow.

Specialized forms of this node are available to:

The Database node is used to interact with a database in a specified ODBC data source. The type of interaction is defined by coding ESQL statements that specify the data from the input message, transform it in some way (if needed), and assign the result to a database table.

Update values within a database table (the DataUpdate node)

Insert rows into a database table (the DataInsert node)

Delete rows from a database table (the DataDelete node)

Store the message, or parts of the message, in a warehouse (the Warehouse node)

Call to external databases – query/ retrieve and updateJDBC, ODBC – DB2, SQL Server, Cache, Oracle, Flat File= Connectivity Pack for Healthcare is a key On-ramp for Health Analytics


Benefits of the CIM Creates a standard mapping of

elements from disparate systems

Maintains speed through the use of the Message Broker transformation engine

Is XML-schema based, allowing further refinements as more hospitals and different message types come on board

Provides a solid base for transitions into future states of the CIM

The Common Information Model (CIM) is a canonical data model that assists in the reuse of broker components and allows for standardization of the data. It is fully compliant with all HL7 2.x versions and can be extended to any RIM of HL7 V3.

Supports all current HL7 versions, and V3 CDA, Continuity of Care Record

Visualization (at a Segment level ) of ADT_A01 Mapping from Invision to Pathnet Classic, through destination, via CIM

* Number of defined Fields in parentheses . All Source segment field counts include a “Remainder” field

** All CIM segment field counts are based on the HL7 Messaging Standard , v2.4 (source is DTD)

Source DestinationCIM

MSH (21)*

UB1 (19)ZG1 (77)ZG2 (8)ZK1 (34)ZPV (69)

ACC (7)ZI1 (8)

ZIN (71)IN3 (26)IN2 (73)IN1 (50)GT1 (52)PR1 (16)DG1 (16)AL1 (5)DB1 (9)PV2 (38)PV1 (52)NK1 (38)MRG (5)PD1 (13)PID (29)EVN (6)

ZMC (11)ZP1 (45)

ZVS (25)

ZVI (5)ZCR (12)

MSH (21)**

EVN (7)

PID (38)

. . .

NTE

MRG (7)

NK1 (37)

PV1 (52)

PV2 (47)

AL1 (6)

ZP1 (46?)

. . .

. . .

NonHL7 IndustryFacility-Unique

MSH (12)

ZP1 (7)AL1 (6)PV2 (37)PV1 (50)NK1 (41)NTE (3)PID (19)EVN (2)

Legend

HL7 Standard

HL7-format Extension

Industry-standard NonHL7

Facility-Unique information


ESB for Healthcare/Connectivity Pack for Healthcare:Clinical Documentation, IHE and Dicom Support


A Clinical Document Architecture (CDA) document is a defined and complete information object that can exist outside of a message. In addition to text, it can include images, sounds, and other multimedia content. The CDA is a three-level architecture with each higher level (2, 3) adding an extra section (more specificity to the mark-up) of the document.

Clinical Document Architecture and the ESB

The XML parser in Message Broker can validate and transform any XML message.

Through the use of a ‘Message Set,’ Message Broker can store the CDA schema and greatly accelerate the processing of these complicated XML messages.

The Connectivity Pack for Healthcare and WebSphere Message Broker)fully supports all versions of HL7 and, more specifically, the CDA.


The Connectivity Pack for Healthcare provides full support for the latest versions of:•Digital Imaging and Communication in Medicine standard (DICOM)•Integrating the Health Enterprise (IHE) •Cross Enterprise Document Sharing (XDS)

Connectivity Pack for Healthcare: DICOM, IHE and XDS Support


New production ready pattern based on HL7 MLLP v2.x

Mediates between HL7 clinical applications (1:1 and 1:many)

– Focus on ADT, ORU and ORM messages from HL7 standard

Easy to extend with custom transformation logic

Pattern has excellent multi-threaded performance characteristics

– Sender and receiver message flows decoupled by WebSphere MQ queues

Supports message validation, duplicate detection, sequencing, and retry

ESB for Healthcare/Connectivity Pack for Healthcare - Patterns


Patterns for Simplified Development Creates top-down, parameterized connectivity

solutions Reduces common problems in flow development Communicates best practices to the Broker

community Complements existing bottom-up construction for

bespoke connectivity Reduces time-to-value for solution development


Pattern Generation


New nodes encapsulate the MLLP protocol and HL7 message parsing– Nodes handle de-duplication, validation, acknowledgments and

timeout handling– Easy to use nodes enable new HL7 message processing scenarios– Examples include HL7 to data warehouse and HL7 device aggregator

integration

HL7 MLLP Nodes


Getting Started using Healthcare PatternsPattern includes resources to get you started quickly:

– Comprehensive set of HL7 messages, test flows and an HL7 message set

– Test flows simulate a source and destination(s) HL7 clinical applications– Unit test client files configured to send ADT, ORM and ORU messages


Customizing the HL7 Pattern Customisation points for every destination and source system

– Allows for data-enrichment and application specific logic

Use XPath and extended functions to manipulate data


ESB for Healthcare/Connectivity Pack for Healthcare:Journaling and Monitoring


Journaling Journaling writes a copy of every inbound HL7 message to a

queue


Enhancements provide insight into the healthcare environment

– How many HL7 MLLP messages have been processed?

– Are my clinical applications connected and working?

– What status messages have been sent from my medical devices?

– When were the TCP/IP connections last created and dropped?

– Visual warnings when queues approach limits and applications disconnect

Monitoring Clinical Applications


Monitoring Clinical Applications

Displays the current state of all clinical application connections–Warning visuals highlight when connectivity is lost to a clinical

application–Monitoring automatically updates when new pattern instances

are deployed


ESB for Healthcare/Connectivity Pack for Healthcare:High Availability, Security, Delivery Path and Migration


WMB and WMQ clustering provide an effective means of failover support, and processing load balancing between two or more servers.

There are two methods of doing this, Hot or active and cold or backup Hot or active and hot and active

Recommended: hot / hot or active / active solution.

This solution provides for better continued availability.

Plus World Class Hursley Lab Support

High availability, load balancing, disaster recovery options= Ready for demanding Healthcare needs

Network

Qmgr Cluster

Content switch to manage and direct IP addresses

IP1 IP2

Virtual IP Address 1 Virtual IP Address 2

AIX Machine 1

Broker 1BrokerQmgr 1

Adapter Qmgr 1

Failover Support

AdpI-1

AdpI-3

AdpI-5

AdpI-n

Execution Group 1Flow 1

Flow 2

Flow 3

AdpO-1

AdpO-3

AdpO-5

AdpO-n


Flow 5

Flow 6

AIX Machine 2

Broker 2BrokerQmgr 2

Adapter Qmgr 2

Failover Support


Flow 2

Flow 3


Flow 5

Flow 6

AdpI-2

AdpI-4

AdpI-6

AdpI-n

AdpO-2

AdpO-4

AdpO-6

AdpO-n

Shared Storage

Adapter Qmgr 1

Queues and Logs

Symbol for a Queue

Red Interface 1 Data Lavender Interface 2 Data

Orange Interface 3 Data Blue Interface 4 Data

Purple Interface 5 Data Black Interface 6 Data

Process Software Process InstanceGreen indicates Active

Broker 1 instance files and logs Broker 2 instance files and logs

Adapter Qmgr 2

Queues and Logs

Broker Qmgr 1

Queues and Logs

Broker Qmgr 2

Queues and Logs


Safeguarding data and access to that data is an important function of the solution. AuthenticationAuthentication is the process of proving your identity, i.e., who are you. Authentication can take many forms such as userid/password, RSA token, digital certificate and biometrics. authentication can be structured as follows:

Servers Software Data Access

Authorization MQ Authorization Message Broker Authorization

ConfidentialityConfidentiality is supported by the process of protecting data from unauthorized disclosure.

Data IntegrityData Integrity is supported by the process of protecting data from unauthorized modification. The data integrity service in WMQ detects whether there has been unauthorized modification of data. There are two ways in which data might be altered: accidentally, through hardware and transmission errors, or because of a deliberate attack. The purpose of the MQ data integrity service is to detect a deliberate attack.

WebSphere Message Broker Security built in= All HIPAA regulations are supported.


Migration from a current Interface Engine platforms such as eGate/JCAPS to WebSphere Message Broker involves information gathering and developing strategy on achieving not only the migration, but improving both the functionality and user experience. • The Connectivity Pack for Healthcare is built

on WebSphere’s Message Broker platform. Introduced in 1997, this application has consistently been in Gartner’s Magic Quadrant for performance and scalability.

• IBM provides proven and tested code for over 30 clinical applications, including Epic, Cerner, McKesson, Meditech, and many others.

• And while the Connectivity Pack for Healthcare provides support for all current data transformation requirements, it also provides comprehensive tooling for Web Services, integration to Initiate and Master Data Management systems, and much more.

Why Customers choose the Connectivity Pack for Healthcare: A solid and proven delivery path


Connectivity Pack for Healthcare – MigrationThe ESB for Healthcare provides a simple and effective migration path:

Interface Specifications

Standard templates are used during the requirements gathering phase to carefully document all the transformation and functional needs of the source and destination applications.

Common Information Model

The CIM creates a standard mapping of elements from the disparate systems in the application environment. It is XML-schema based, allowing further refinements as more systems and different message types come on board


ESB for Healthcare/Connectivity Pack for Healthcare

Questions?

Contact:

Chris KellerIndustry Architect, Healthcare and Life SciencesCertified IT Architect - Application ArchitectureOpen Group Certified - Master IT ArchitectIBM Software [email protected]