Most healthcare organizations today operate with multiple pools of information maintained in separate

organizational silos on often incompatible platforms. More effective data sharing could generate

insights that would dramatically improve the industry’s productivity and ability to serve its mission.

Today, the sector faces significant challenges:

- Spiraling costs of healthcare delivery are forcing all players to pay closer attention to the bottom line.

- In a post-9/11 world, pressure is increasing to mobilize as a proactive defense against bioterrorism.

Watching costs while increasing vigilance makes the need to share and effectively communicate

information— inside and outside organizational walls—more urgent than ever. The stakes have never

been greater.

A recent Rand Health study revealed that effective use of IT could dramatically reduce costs while better

coordinating care delivery. According to the study, the U.S. healthcare industry could save $81 billion

annually if 90 percent of physicians and hospitals successfully adopted health information technology.

The savings would materialize from shorter hospital stays; reduced administrative overhead; more

effective use of medications, laboratory, and radiology services; and fewer errors.

The Rand study pointed to a critical shortcoming in healthcare: Outside of billing systems, few providers

have effectively automated their operations. Although healthcare isn’t the only industry that can benefit

from better automation and integration of information flows and processes, it faces unique challenges.

First, the industry has many unique data formats, languages and protocols, such as Health Level 7 (HL7)

for electronic data interchange and M (or MUMPS), a programming language developed for maintaining

medical records. Most healthcare institutions haven’t standardized on technology implementations,

with each department often running its own systems. The industry is also highly diverse, consisting of

care delivery networks, small clinics and independent practitioners, clinical laboratories, pharmacies,

payer organizations, and many types of public health agencies.

Mobilizing to meet current economic pressures and security concerns requires the ability to integrate

and assimilate vast streams of information from highly diverse sources, based on a series of events that

may not always be foreseen. Healthcare organizations must piece together information arriving in a

wide variety of formats and communicated using a wide range of protocols. Sharing data requires

integration technology that supports interoperability, while reducing the complexity of dealing with

heterogeneous system environments.

To encourage data sharing, healthcare organizations must be prepared to shoulder the burden of

standardizing data that originates from different technical and organizational domains themselves,

rather than expect external sources to bear the cost and inconvenience of altering their own IT

environments.

Digesting information to get the big picture will require automated, event-driven, orchestrated

processes that receive, transform, and aggregate diverse streams of data, generating reports and

visualizations that are automatically communicated to the right decision-makers—while the information

remains actionable. To attain this goal, the integration industry has developed technology approaches

such as Event-Driven Architectures (EDAs), Service-Oriented Architectures (SOAs), and Enterprise Service

Busses (ESBs).

Operational Intelligence:

The Healthcare Opportunity

For healthcare organizations, the challenges of piecing together the big picture are immense. Inside the

typical metropolitan hospital are numerous islands of information captured in IT systems and medical

devices. There’s a wide range of platforms, ranging from Electronic Data Interchange (EDI) supplier and

payer links to back-office legacy systems for billing, human resources, and scheduling. Various

applications and transaction protocols consume information that resides in formats such as database

records, flat files, delimited documents, and spreadsheets.

At the operational level, information is highly fragmented. Some diagnostic devices may store their own

test results in proprietary file formats, while others communicate test results to applications via highly

localized departmental networks. In some cases, test results, which may originate from third-party

clinical laboratories, are communicated through proprietary networks and message structures.

Additional requirements may exist for sharing test data with affiliate physicians with admitting

privileges.

Then there are formal and informal observations recorded through physician notes. The hospital, and its

affiliates in a larger network, may record this data, but in disparate systems and file structures that

prohibit sharing.

Without the ability to integrate siloed data, healthcare providers have trouble optimizing inventories

and negotiating with suppliers. Staff utilization may be poor because employee labor tracking systems

remain out of sync with patient care scheduling. Because physicians must often rely on informal

communications among colleagues, they’re often unable to see the big picture when it comes to

outcomes and care delivery.

The stakes are even higher when it comes to public health. Public health authorities must make

decisions to prevent outbreaks from becoming epidemics. The margin of error in identifying outbreaks is

thin. Jumping to false or late conclusions could cause major havoc to regional and national economies,

place lives at risk, and waste millions of dollars, while revealing new vulnerabilities in the nation’s civil

defenses. Even worse, not recognizing an outbreak that can be contained before it spreads could lead to

a massive loss of life.

In the wake of the 9/11 attacks and the subsequent outbreaks of anthrax, the Centers for Disease

Control (CDC) chartered the National Electronic Disease Surveillance System (NEDSS), a $1 billion

program providing seed money for creating bioterrorism response centers. The goal of NEDSS is to

promote the use of data and information system standards to make bioterrorism surveillance

interoperable through all levels of the public health system. One of its requirements is the use of HL7

documents for communication with the CDC.

The New York City Department of Health received its wake-up call following the attacks of 9/11 and the

anthrax outbreaks that occurred shortly thereafter. At that time, it accelerated plans to build a

syndromic surveillance system with the goal of spotting the advance symptoms of disease before they

could turn into widespread outbreaks. The goal was to spot emerging patterns of symptoms, rather than

diseases themselves, to assess if an outbreak had started or was imminent.

Putting such a system together is a massive integration challenge. For starters, there’s the challenge of

keeping costs contained while accepting data from outside systems under scenarios that may be outside

the agency’s or institution’s control. Then there’s the need to have the ability to receive data from

hundreds or thousands of independent organizations, each with its own technologies and formats for

storing the required data in short timeframes. The system must have the ability to capture events from

a dizzying array of listener protocols, parse messages on the fly, convert them into a standard format,

and then, using intelligent routing, push the data to the appropriate target so in-time analyses can be

conducted to transform the constant streams of raw data to actionable information public health

professionals can use to make smart decisions.

Admittedly, the nature of the challenge healthcare institutions face in optimizing care delivery, and that

of public health authorities in their defense against bioterrorism appear initially as completely different

problems.

For instance, when guarding against bioterrorism, public health organizations may need to decipher

trends in as little as a few hours. By contrast, a hospital system allocating resources, or a physician

deciding care, may require a different degree of immediacy.

However, while lead-time requirements may vary, the nature of the integration challenge and the

benefits of gaining reporting capabilities for information deemed current apply to both private

healthcare providers and public health agencies.

In both scenarios, the organizations are dealing with multiple streams of highly varied message syntaxes

and semantics. Sources can include structured SQL databases, Excel spreadsheets, e-mails, comma or

tab-delimited files, XML flat files, hierarchical non-relational data files, standard HL7 messages, and

more. Message communication protocols may include MQ, JMS, MSMQ, HTTP(S), FTP, SMTP, AS2,

ebXML, and many more. Interoperability is the key ingredient in creating a common, integrated view of

information shared across systems and organizations.

In both cases, there’s a value add for integrating data and presenting reports highlighting trends while

the results are actionable. For instance:

- A physician checking the results of an individual patient’s regimen of tests makes smarter decisions

when able to view all the results at once. Practitioners can optimize the decision regarding diagnosis or

care delivery if they have access to reports providing comparisons with past or current trends.

- A hospital optimizing staff utilization and supplies may benefit from checking trends from current

intakes.

- A public health agency checks trends in the manifestation of specific symptoms, comparing trends over

the past month and past 24 hours.

Making Intelligence Operative

In an era where healthcare delivery organizations of all kinds face new operational pressures and

requirements, success requires the ability to proactively respond to events, both expected and

unforeseen, by transforming and routing information so it can be aggregated, reported and acted on

within tight time constraints.

Designing an integrated healthcare solution for sharing information involves several principles. It should:

- Be standards-based, preventing reliance on a single vendor platform

- Have the ability to interoperate with all existing IT investments, regardless of platform

- Be flexible, supporting the ability to change requirements in a timely, cost-effective manner, using

common visual tools for key design and management tasks.

EDA, SOA and ESBs have recently received plenty of attention. For healthcare organizations, they can

provide cost-effective, flexible approaches to integrating data in varied, dynamic environments.

An EDA is a best practice for capturing information in real-time. The events of EDAs are messages,

defined by set interface structures that are emitted from an application through a communications

protocol. EDA implementations take advantage of SOA by relying on services—self-contained stateless

units of functionality that reuse functionality from existing systems.

EDAs are especially applicable for public health agencies seeking to predict regional outbreaks or

bioterrorism. They’re far more suitable than batch or manual processes because of their ability to apply

process automation to transform and route the information as it happens, rather than afterward.

When incoming data arrives, process automation logic applies policies and rules to identify events of

interest while filtering out the static. When such an event occurs, a service is called, which triggers an

action, such as calling on applications, databases, or various legacy systems.

Services isolate consuming applications from the details and complexity of the systems whose

functionality they leverage. Consequently, resources with less specialized skillsets can design processes

that incorporate existing systems. By focusing on processes and information, rather than worrying about

the nuances and complexities of the underlying applications, services make organizations far more agile.

This is especially critical for healthcare organizations, which tend to have few IT experts on staff.

ESBs capitalize on the advantages of EDAs and SOAs by providing the “glue” to enable events and

services to connect in a loosely coupled manner. ESBs enable a scalable, lightweight architecture for

highly distributed environments. They route events and manage services, determining the proper

services to call, based on business rules and the content of each received event message.

There are many ESBs and SOA-and EDA-enabling tools, coming onto the market. Many of the offerings

deliver excellent support for emerging Web Services standards and popular enterprise messaging

formats such as MQSeries or Java Messaging Service (JMS) messages. However, many of the services-

oriented integration products available today lack support for many of the unique formats and protocols

that remain common in the healthcare sector. So, when selecting an integration technology, public and

private healthcare organizations must exercise care that the technology facilitates sharing and fully

leverages existing investments.

Summary

The healthcare sector has always faced unique challenges when it comes to managing information. The

proliferation of unique formats and the reality that most healthcare institutions operate with islands of

automation has rendered it difficult to get the big picture on care delivery or public health.

The economic pressures impacting all types of healthcare delivery organizations, and post-9/11 security

concerns impacting public health agencies, are driving the need for the healthcare sector to take a huge

leap forward in their capabilities. Advances in event-driven SOAs and the emergence of ESB technology

offer promises for resolving the integration bottleneck. Together, they can be harnessed to deliver the

kind of operable intelligence that can make a difference.

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