Pharmacy one source speed saves lives

Speed Saves LivesKaj Pedersen | Pharmacy OneSource

7.Feb.2011

®Copyright 2010 Gigaspaces Ltd. All Rights Reserved

Pharmacy OneSource by the Numbers

• Healthcare's #1 Software-as-a-Service (SaaS) provider

• More than 44,000 pharmacy professionals are active members of the Pharmacy OneSource community.

• Nine quality healthcare application offerings

• More than 1,300 organizations in the U.S. utilize one or more of our applications


Healthcare’s Big Goals

• Efficiency:– Human Resource Scarcity

– Declining Reimbursement

– Increasing demand and severity

• Effectiveness:– Mortality and costs are too high

– Reimbursement penalties and rewards

– Growing readmission rates

• Preservation: Worsening anti-infectives efficacy


Pharmacy OneSource is Adapting to Market

• We are focused on delivering real-time data-driven analytics optimizing care in quality, cost and compliance

• Every day we process over 4 million messages supporting over 200,000 active patients

• We run 9000 rules against these messages in real-time

• We needed to find a more cost-effective way to support our market need

Q1 08

Q2 08

Q3 08

Q4 08

Q1 09

Q2 09

Q3 09

Q4 09

Q1 10

Q2 10

Q3 10

400000

800000

1200000

1600000

2000000

2400000

2800000

3200000

HL7 Messages Processed per Day


By Ensuring We Adopt Market-leading Solutions, Rather than Building

• Drive Innovation

– Not bleeding edge, but market-driven and competitive

– Technology innovation driven by ease of management and

ubiquity

– Balance Cost, Quality and Speed

• Increase operational efficiencies in the delivery and hosting

of our services and data sources through-out our product

offerings

• Leverage Agile development methodology to increase

quality and consistency in delivery of our product offering


Focusing on Ambitious Goals Aligned with the Business

• By being cost-effective:– Our justification was to leverage existing investments in

infrastructure by doubling capacity– Drive down our cost per hospital to better manage our margins

• By meeting the scalability challenge to support real-time:– Support an architecture that could scale to 10 million messages

and beyond on a daily basis– Enable our rules to process the messages and generate results

back to the client in less than 10-secs, regardless of complexity

• Provide a bridge to the cloud to enable us to move away from the hardware business


Resulting in our Choice for a Spaces-Based Architectural Solution

• In-Memory Data Grids are inherently faster than databases because memory is faster than disk. A recent Stanford University study confirms that In-Memory Data Grids "can provide durable and available storage with 100-1000x the throughput of disk-based systems."

• An In-Memory Data Grid relieves the database bottleneck, which makes it difficult to scale most enterprise applications. It does this by scaling the data layer and sharing the load among numerous machines.

• Databases and file systems have inherently limited latency because they run on magnetic disks. According to a recent Stanford University study, an In-Memory Data Grid has "the potential for extraordinarily low latency ... 5-10 ms."

For an in-depth overview of the In-Memory Data Grid concept and its benefits, see the Stanford article cited above: The Case for RAMClouds: Scalable High-Performance Storage Entirely in DRAM (Ousterhout et. al, 2009)

http://www.gigaspaces.com/files/ramcloud.pdf




This will Address our Need for Speed and Power

• Today we are challenged by physics (or more precisely disk speed) and Scalability

• Disk speed is a massive bottleneck and leads to performance issues that result in:– Messaging traffic backups– List processing delay and timeouts– Resource contention

• As we move away from traditional web-based architectures we need to Scale effectively– Scaling out vs. scaling up– Linear scalability– Cost-effective scaling


Secure Early Wins, While Minimizing Risks in our Actual Approach

• Selection Strategies– Evaluated market-leaders to see which could best serve our needs: GigaSpaces and Terracotta

– RFP sent to finalist vendors

– Piloted finalist before making decision

• We split our project into four phases:– Replace our HL7 ADT messaging

– Replace all HL7 messaging (formulary, lab/microbiology, pharmacy, surgery and radiology feeds)

– Transition our customers to new platform

– Replace our rules processing with Drools rules processing

• Implementation Approach– We use Agile/XP – co-located teams, TDD, Paired-programming, etc

– We established a team dedicated to messaging and another team for rules-processing

– Tackled implementation as an evolutionary replacement defined around four phases shown above

– Separated out the development from actual customer conversion

– Demonstrated success with early wins


Our Journey Has it’s Challenges

• Integration - Code complete is only half-way there, we still need to transition our customers to the new platform

• Resourcing - Finding the right skills to undertake the development and transition knowledge

• Culture - Building a culture around innovation and market-focus

• Learning Curve - With any new technology expect to adjust timelines to support learning with team – ensure the mission is well understood

• Technical - Be prepared to give up old approaches for new capabilities. At the end of the day it is only software and prone to change


Our Initial Results Support Our Projections

• Our initial pilot with GigaSpaces proved out capability

and demonstrated support for our own technical

considerations

• We completed first phase with ADT HL7 feed

replacement– We saw 6x increase in message processing from 25 messages per

second to over 130 messages per second

– We have converted over 150 customers and on track to complete this

by year end

– This has reduced our message load on our legacy architecture by 15%


S7

Messagi

ng – Tgt 3/1

ADT, RDE, ORU (Chemistry & Text MICRO) and Patient Deactivation:Drug Discontinue /RXDC:CRCL:Basic Web Admin

Event

by

Messagi

ng – Tgt 8/1

List Membership / Real-time Rules:•R

ules against QTFI included, not S7D

•Real time alerting

•Excluding new function for 2011

RadiologyBasic Web Admin for new feeds and MIC II

Fut

ure Releases – TBD

Rules against S7DICP Functionality (currently not well defined)OR SchedulingAdditional New FeedsAdvanced Web Admin

Setting us up for the remaining milestones


Our Investment has Tremendous Upside for the Future

• Freeing $20 million from the bottom line!

• Rapid time to market: leveraging market-leader to deliver solution in 18 months

• Deliver processed lists faster than 10-seconds

• Scale to process over 10 million HL7 messages daily

• Bridge to the Cloud – taking us out of the hardware business by scaling via On Demand cloud vendors


SENTRI7 DELIVERY APPLICATION

Import API

XML, CSVADT RDE ORU MFN

PHARMACY ONESOURCE PLATFORM

SQL Server RDBMS

GigaSpaces

iNTERFACEWARE Iguana

Surveillance DocumentationCare

Coordination Notification Reporting

SENTRI7 SERVICES

DELIVERY

Pharmacy OneSource Application Services

Pharmacy OneSource’s Integrated Platform


Pharmacy OneSource and GigaSpaces is the Delivery Platform for our Customers

• Overcome performance challenges by leveraging the In-

Memory Data Grid

• Get to market rapidly by leveraging market-leading solutions

getting us to market rapidly

• Scale without passing the expense burden onto our customers

• A bridge to the Cloud – we will no longer need under-utilized

hardware, but provide On Demand solutions as we add

customers

• We save people’s lives by delivering critical information in real-

time!

Documents

Pharmacy one source speed saves lives