Clinical Messaging in a Services Oriented Architecture

Approaching "the EHR" in Steps

Integration is complex, costly, and time-consuming. Excessive time is often spent on the “wiring” of integration solutions rather than bringing out business value. With such lengthy implementation cycles, it is easy for an organization to lose sight of a project’s business level objectives; more importantly, it is easy for an organization to lose the funding necessary to achieve a completely integrated system. In healthcare, the long term goal of achieving an Electronic Medical Record (EMR) can be easily lost, while near term goals – such as utilizing Business Activity Monitoring – are often put on hold.

Having previously architected and implemented complex, linear-based clinical integration solutions on the BizTalk Server platform, Visiphor has identified the following related challenges:

• Complex design cycles
• Tightly coupled solutions (interdependencies between schemas, maps and orchestrations) requiring longer un-deploy/re-deploy cycles, translating to extended downtimes
• Business Logic, Routing Logic and Transformation Logic coupled within a linear flow
• Statically defined end points, leading to increased management issues

An ideal clinical integration solution provides the ability to rapidly connect systems while using a range of communication protocols (such as MLLP) and a combination of messaging standards (such as HL7 v2.x to HL7 v3.0). Additionally, the solution must be loosely coupled, with a specific understanding of the individually supported applications held away from the core messaging engine.

An ideal solution is also dynamic, and the business processing steps discrete and easily composable into required orders through a non-technical interface. Changes to the schemas, business logic, and transformations are possible while the engine runs, thereby eliminating the need for any service interruptions.

Visiphor's work has shown that the BizTalk Server 2006 platform – hosting both the Enterprise Service Bus (ESB) Toolkit and the Health Connection Engine (HCE) – provides a decoupled and manageable solution enabling organizations to concentrate on their core clinical and business value activities. Additionally, by providing specific adapters for healthcare applications, Visiphor’s solution will reduce a large portion of the “wiring” issues by allowing discrete services to be composed together as a pathway via the use of itineraries.

By providing a Clinical Services Platform, Visiphor will help health organizations realize the extensive benefits of a services-based integration broker, in addition to providing detailed reporting capabilities based on clinical and supporting data. Visiphor’s solution will move clinical organizations towards a fully integrated Electronic Medical Record.