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Oracle SOA Suite for Healthcare Integra4on: the path to Large-‐Scale Produc4on Deployment Session 10096 – Thursday October 29, 2015 – Marrio< Marquis—Salon 1/2/3

Copyright © 2015, Oracle and/or its affiliates. All rights reserved. |

Jim Bole VP, Oracle Service Integra4on Products Kevin MaSngly Integra4on Architect Ascension Health Steve Schenks SOA PlaUorm Architect Ascension Health

Jay M. Jenkins Children’s Hospital of Philadelphia

Copyright © 2015, Oracle and/or its affiliates. All rights reserved.

Safe Harbor Statement The following is intended to outline our general product direc4on. It is intended for informa4on purposes only, and may not be incorporated into any contract. It is not a commitment to deliver any material, code, or func4onality, and should not be relied upon in making purchasing decisions. The development, release, and 4ming of any features or func4onality described for Oracle’s products remains at the sole discre4on of Oracle.

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Program Agenda

What is Oracle SOA Suite for Healthcare

What’s New in Oracle SOA Suite for Healthcare

Customer Case Studies

Q&A

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Program Agenda




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Challenges in Today’s Healthcare Enterprises -‐ Pa4ent-‐centricity requires a new look at integra4on

Pa4ent sa4sfac4on Lack of latest health informa4on online and on mobile devices

Cost Accountable Care Organiza4on (ACO) and Value based Payment (VBP) impac4ng profits

High cost to maintain legacy applica4on

OOTB healthcare applica4on

HIPAA Mandates Meaningful Use

Secure Protected Health Informa4on (PHI)

Payer and Provider Mergers Clinical Integra4on trends are changing

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Customer

Compliance Complexity


Healthcare IT Trends – Emerging Use Cases • Meaningful Use Compliance • Clinical Alarm Systems Compliance •  Seamless Care and Portability • Healthcare Analy4cs • Predic4ve Analy4cs • Gamifica4on, Self-‐monitoring, Apps • Point-‐of-‐Care IT •  Telehealth

• Pandemic and Disease Outbreak Detec4on

• Wearables, Sensors, Smart Devices • Pa4ent Knowledge and Transparency

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IT Innova4on Trends are Enabling Improvements in Pa4ent Care Broader InnovaJon Topic General Enterprise Value Prop Healthcare Applicability

Mobile Ubiquitous access to informa4on Point of care, Self-‐monitoring, Apps

Big Data Rich analy4cs, correla4on, unprecedented informa4on mining techniques

HINs, Disease Registries, Popula4on-‐based care plans, Outbreak detec4on…

IOT Smart devices, M2M, Quan4ta4ve real4me sensing, ….

Capital intensive equipment management/monitoring, pa4ent sensors and tracking, wearables

Predic4ve Analy4cs Trend analysis and forecas4ng…business & ops management

Disease/outbreak detec4on, care plan analysis and refinement, workload management improvements

Enterprise APIs Simplify B2B and partner interop, self-‐service access to secure info…..

Non-‐clinical b2b simplifica4on, easier non-‐H7 integra4on touchpoints

Cloud Capex and Opex improvements, scaleability, elas4city, agility

Capex and Opex improvements, scaleability, elas4city, agility O 8


Healthcare Integra4on Solu4ons -‐ enabled by SOA Suite for Healthcare Integra4on •  SSHI + Stream Explorer: Real4me analy4cs use cases for healthcare clinical and ops, outbreak detec4on

•  SSHI + Data-‐as-‐a-‐Service offerings: Pa4ent popula4on aggrega4on, disease registries •  SSHI + IOT: Capital equipment monitoring, pa4ent monitoring

•  SSHI + CRM: Pa4ent intake and other use non-‐clinical-‐to-‐business ops use cases

•  SSHI + MFT: Managing file-‐based delivery channels

•  SSHI + B2B: Healthcare supply chain •  SSHI + MCS: Tablets at the point of care

•  SSHI + API Manager: Healthcare enterprise api publishing and management

•  SSHI + ICS/SOACS: A2A and Data Integra4on beyond HL7 •  SSHI + ICS/SOACS: Agent technology to securely bridge cloud-‐to-‐on-‐prem integra4on use cases

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Oracle Solu4on – SOA for Healthcare IntegraJon Scenario : Within a Hospital

•  Pa4ent walks in the Registra4on desk of Hospital and give his personal, demographic and health informa4on.

•  A HL7 feed is generated and send to various departments – pharmacy, dietary, radiology, billing so that pa4ent informa4on is available in all those department.

Primary focus:

•  Integra4on across Informa4on Silos

•  Meet SLAs – High throughput, Fast Response Time

ADT (Admission, Discharge, and

Transfer) Clinical

Billing

Planning

Radiology

Oracle SOA for Healthcare allows Hospitals to exchange healthcare message leveraging secure, fast, reliable infrastructure to meet their high demanding SLAs.

SOA for Healthcare


SOA for Healthcare – Integra4on across Hospitals

•  Pa4ent comes to visit Doctor for general check up

•  Doctor recommends some additonal tests and for second opinion to other Clinic in same hospital group

•  Pa4ent finishes the tests in Clinic and the informa4on is sent back to his primary Doctor

Primary focus:

•  Interoperability -‐ Integra4on between Peers •  Avoiding disconnected pa4ent records flow is of most importance

IntegraJon Scenario : Hospital Group

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Hospital A

Hospital C

Laboratory D

Rehab Center E

Oracle SOA for Healthcare allows Hospital groups to exchange healthcare message meeJng their interoperable needs.

Clinic B


SOA for Healthcare – Payer -‐ Provider Interac4ons Scenario : Hospital, Insurance Carriers and CMS communicaJon

•  Pa4ent is diagonsed with Neuorological disorder •  Doctor advises pa4ent to admit in hospital for X-‐Ray , CT Scan and procedure

•  The Doctor‘s Administrator staff sends a query to Pa4ent‘s insurance carrier to understand pa4ent contribu4on, and his year to end remaining amount etc.

Primary focus:

•  A more efficient Healthcare Ecosystem

•  Secure message exchanges

Oracle SOA for Healthcare provides wide variety of secure protocols and message standards support for healthcare message exchange beyond Healthcare Enterprise firewall

Insurance Co.

Govt. Regulatory

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Hospital A

Hospital B


SOA for Healthcare – Financial to Clinical Integra4on

•  Charges and Credits for services and supplies used and generated on the Clinical side of the Enterprise need to be integrated with the billing system and financial on the Business side of the Enterprise

•  Past Due accounts data needs to be integrated from the Business side to the Clinical side of the Enterprise

•  Integra4on may be by file, db, web service, HL7, X12 and typically done in batch

•  Today it can take more than a month, in some cases mul4ple months for all financial account reconcilia4ons to process.

Scenario : Post-‐Discharge Financial IntegraJon

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Oracle SOA Suite with Adapters and MFT allow modeling these Financial to Clinical integraJon use cases


SOA for Healthcare Solu4on – Business Value Proposi4on •  Increase Hospital efficiencies and cost saving •  Increase Pa4ent par4cipa4on in their care

– By leveraging modern technology to access their healthcare informa4on

•  Improve Pa4ent Care and Sa4sfac4on –  by minimizing medical errors

•  Increasing efficiencies of healthcare administrators


SOA for Healthcare Solu4on – Key Highlights •  Supports all the Healthcare Standards – HL7, X12 HIPAA EDI, NCPDP

•  Intui4ve Visual development environment – Integrated user experience to develop healthcare composites

•  End to End visibility to healthcare transac4ons

• Capable of mee4ng most demanding SLAs – High throughput, faster response 4me

• Pre-‐seeded Healthcare documents • Robust Audi4ng and Security • Built in Integra4on – SOA, MFT..

Hospital

Lab

Health Screening

GP / Clinic

Patient Data

Patient Data

Patient Data

Patient Data

Healthcare Informa4on Exchange A unified pa+ent medical summary

(Federated or centralised) to help improve clinical outcomes, increase

healthcare efficiency and reduce costs through primary and secondary uses

PaJent


The Oracle SOA For Healthcare Solu4on

Mobile

Hospital

Radiology

Pharmacy

Lab

Legacy Applica4ons Insurance Carrier

Things

SOA Composite

Healthcare Console

Document Editor

Interface Configuration, Dashboards, Monitor

Route, Transfer, Integrate

Healthcare Message creation, customization,

testing

Healthcare Runtime Engine

Translation, Validation, Sequencing, ACK Handling

MLLP

HLLP

JMS

FILE

WS-‐HTTP

FTP

SFTP

MFT

MDS and

Runtime instance data


Healthcare Console Configuration, Management and Monitoring

§ Designer § Configuration

§ Documents – HL7 v2.x, V3, CCD, CDA, Endpoint Configuration, WSDLs, Callouts,

§ Administration § Alerts, User Provisioning, Admin Setting,

Internal Delivery Channel, Import/Export

§ Dashboard §  System Dashboards, Endpoint Status,

Endpoint Summary, Metrics

§ Reports §  Message Status ,Graphical Message Flow,

Resubmitting, Filtering , Purging


System Dashboard Healthcare Systems status at a glance

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The Oracle Advantage

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•  Modern, Highly Scalable Enterprise solu4on –  Integrated Solu4on build on SOA framework -‐ leveraging B2B and integrated with MFT

–  Suppor4ng cloud, mobile, IOT use cases that posi4on healthcare customers for future

•  Easy to Use –  UI based solu4on with easy drag and drop features –  Pre-‐build healthcare libraries to kick start

•  OOTB Management and monitoring capabili4es –  Dashboards and repor4ng for end to end visibility –  Command line tools for automa4on


Program Agenda with Highlight




Q&A

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•  SSHI onPrem (12.1.3 current release, 12.2.1 End CY 15) – 12.1.3: Integra4on with MFT; Enhanced end to end monitoring; Local Policy Auachment

– 12.2.1: Alta skin, PGP Support, Endpoint cloning, Performance & Resiliency improvements; Addi4onal messaging pauerns such as sync request-‐reply over MLLP and custom acknowledgments for non HL7 messaging over MLLP; Life cycle management enhancements -‐ start up, recovery, resubmit and retry

•  SSHI Cloud Service (Early CY 16) – Hosted, Managed SOA Suite for Healthcare Integra4on Cloud Service – Targe4ng dev/test use cases

What’s New in Oracle SOA Suite for Healthcare Integra4on On Premises and Oracle Public Cloud

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Roadmap Items Subject to Change


Program Agenda




Q&A

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Ascension Information Services Confidential and Proprietary 23

CON10096 - Oracle SOA Suite for Healthcare Integration: the Path to Large-Scale Production Deployment

Presentation by: Steve Schenks Kevin Mattingly


§  Ascension (www.ascension.org) is transforming healthcare by providing the highest quality care to all

§  Ascension is the largest nonprofit health system in the United States and the world’s largest Catholic health system

§  More than 150,000 associates and 40,000 employed and affiliated providers serve in 1,900 sites of care – including 131 hospitals and more than 30 senior care facili4es – in 24 states and the District of Columbia

§  In addi4on to healthcare delivery, Ascension subsidiaries provide a variety of services and solu4ons including physician prac4ce management, venture capital inves4ng, treasury management, biomedical engineering, clinical care management, informa4on services, risk management and contrac4ng through Ascension’s own group purchasing organiza4on.

Ascension – Who We Are


§  As Ascension added hospitals and related health facili4es, siloed IT departments were also added in some cases

§  The majority of the clinical interfaces (2058) and all the PeopleSow human resources, finance, supply chain interfaces (1084) are supported by the Ascension Shared Informa4on Services ("SIS") integra4on team and run in a centralized data center

§  Other interfaces (approximately 1000) are supported by Health Ministries themselves and run locally at the Ministry

Current Environment – Sca<ered Deployments


Moving to Standardization

Orion Rhapsody

v 5.1.0

Oracle Java CAPS

(JCAPS 5.1.3) Sybase eBiz

Impact

eGate 4.5.3

eGate TRE 5.0.1 (Clinical)

eGate SRE

Summit Express

Connect 8

eGate SRE 5.0.5

(Symphony)

Lawson Cloverleaf

Sybase Impact TDM

4.1 / Ebiz 5.5.4

Shared Integration

Shared Integration Stand-Alone Integration


High Level Architecture Overview


 

Environment – Performance Analysis

Date TXN_COUNT AVG_E2E_Time (milliseconds)

27-‐Sep-‐15 71893 3097

28-‐Sep-‐15 184991 4497

29-‐Sep-‐15 189004 4692

30-‐Sep-‐15 191349 4984

1-‐Oct-‐15 201108 7016

2-‐Oct-‐15 156105 5666

3-‐Oct-‐15 74568 5601

5-‐Oct-‐15 193261 5819

6-‐Oct-‐15 182805 5364

TXNS

Des4na4on 160839 Source 88125

Average number of transactions per day

Average Message size for the above dates:

Number of transactions per day and the average end to end time

Message Size in Bytes

OUTBOUND 1790

INBOUND 2481


Performance Tuning has taken place with the help and guidance of Oracle A-‐Team and Development Team Issue diagnosis and resolu4on through My Oracle Support (MOS) Oracle Applica4on Patches Tuning Thread Counts

•  xEngineThreadCount •  inboundThreadCount •  outboundThreadCount

•  The tuning parameters used were a ra4o of inbound + outbound = xEngine

Tuning Cache •  mdsCache •  TPACache •  xEngineCache

•  Mds and TPA cache were based on the total size of ECS files •  xEngineCache was based on the total number of ECS files

Environment – Performance Tuning


  JVM Tuning •  Based on GC analysis awer load tes4ng •  Iden4fied a poten4al issue with the na4ve heap used by xEngine and the Java heap had overlapping

addressing •  Resolu4on was to set the MIN address for the Java heap

  Oracle Service Request •  Ini4ally HCA used a database entry to decide which Managed Server was Primary for MLLP

•  Based on issues, SR was raised and Patch was developed by Oracle to use Coherence as the store for which Managed Server is Primary for MLLP

Updated to latest version of Coherence HCA Console Tuning

•  Lazy loading of results in the Reports tab •  Message Volume portlet of the endpoint point tab on the HCA Dashboard

•  Metrics not upda4ng due to materialized view becoming stale because of high message volume

•  Composite View via HCA Dashboard

Environment – Performance Tuning


IP VirtualizaJon Strategy


Clinical IntegraJon Architecture


Clinical IntegraJon Architecture Interface Sequencing vs. Component Sequencing


Clinical IntegraJon Architecture Use Case: Source Message split into multiple messages for same destination – Transfer (A02) – Discharge (A03), Admit (A01)


Clinical IntegraJon Architecture Use Case: HL7 Message triggers the transfers of an MFT file

Remote FTP to Local FTP

Local FTP to Remote FTP

Local FTP to Remote FTP


Use Cases solved with SSHI Transport Callouts

Use Case SoluJon

File des4na4on endpoint needs to be part of a composite that u4lizes interface sequencing

File Appender

Source applica4on sends mul4ple Posi4onal Flat File (PFF) document types via the same port

PPF Doc Iden4fier

Source applica4on sends standard HL7 delimiters such as ^ and & in the data (e.g. OBX-‐5)

Special Characters Handler

Source applica4on does not send a document version in MSH-‐12 Version ID Handler

CHOP’s EIE Replacement Project SOA Suite for Healthcare Integration

October, 2015

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CHOP – Who We Are

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•  ~ 500 pediatric inpatient beds

•  ~ 28,000 inpatient admissions in FY2013

•  ~ 1,200,000 Outpatient, ED, Day Surgery visits

•  ~ 50 CHOP Care Network Locations

•  ~ 155,000 Patient days

•  “Best in the United States” – US News and World Report prestigious 2012-2013 honor roll

•  Patient Care, Research and Education

CHOP – Integration

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• High Volume • Complex Functions • Data Validation & Enrichment • Data-Driven Actions • Being Ahead of the Curve • Proactive Monitoring –

goal: Complete Error-Checking

Selection Process

• Determined Strategy The strategy was a whole project by itself – outcome: this a key solution in the enterprise, and needs to be future-focused

• Documented Use Cases •  Submitted RFPs • Developed Selection Criteria • Evaluated most of the “healthcare” solutions

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Project Efforts

•  H/W & S/W Design – (driven by Use Cases) • Development • Migration Planning – DEV, TEST*, UAT and PROD can be all

different •  Training – Informal (internal brown-bags) and formal •  Prod-Ready •  Full Steam Ahead! (existing SDLC process)

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Timelines of Projects

• Evaluation began Nov 2011 • Selection by Jul 2013 • System Design & Build Sep’13-Sep’15 • Software Design & Build on-going • Prod-Ready by Dec 2015 • Migration through Dec 2016

Architecture

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Challenges & Solutions

•  System Design – lots of options=lots of choices •  Design patterns - lots of options=lots of choices •  Development Foundation - •  Data Management – journaling, logging and

archiving for support and auditing •  Getting PROD-Ready

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Best Practices

and Lessons Learned

•  Be INNOVATIVE (the challenge from our CEO) •  Re-engineer (rather than “upgrade”) •  Use Cases -> Design Patterns •  Architecture flexibility was daunting. Engaging Oracle and our

implementation partner was key to overcoming this obstacle. •  Thinking differently than we did before. We are more than

traditional healthcare interfaces. We integrate applications •  Bleeding Edge can be bloody •  “a teaching hospital ~ a teaching IS”

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Go-Live Details

• Actively training entire team.

•  Intelligently pick some low hanging fruit.

• Migration of All Existing Interfaces.

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Additional Info

Moving Beyond Traditional Healthcare…

An Enterprise Solution to Address Other Needs –  Device Integration (MDI) to Hadoop, Patient & Provider Master

Indexes, Cardiology, Radiology, Research, Lawson, and Web apps

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Program Agenda with Highlight




Q&A

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