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Joe Gallant Product Manager. Designing High Performance XDS Registries/Repositories. IHE Interoperability Showcase – HIMSS 2006. Presentation Overview. XDS has the potential to serve as the foundation for a cross-enterprise EHR supporting advanced functionality.
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Joe Gallant Product Manager Designing High Performance XDS Registries/Repositories IHE Interoperability Showcase – HIMSS 2006
Presentation Overview • XDS has the potential to serve as the foundation for across-enterprise EHR supporting advanced functionality. • HL7 CDA is central to XDS achieving its potential. • HL7 CDA documents are objects. • Relational technology is ill suited to storing & retrieving objects. • Post relational database technology is ideal for high performance, massively scaleable EHR systems. • Modern application integration platform is critical to the success of an advanced function EHR system.
XDSCross-Enterprise Document Sharing Provide&Register Document Set Patient Identity Source Actors and Transactions Patient Identity Feed Query Documents Document Document Consumer Registry Register Document Set Retrieve Documents Document Document Repository Source
The Case for HL7 CDA … as the “standard” content container for XDS • CDA facilitates the creation and broadest accessibility of attested, human-readable, clinical documents. • CDA accommodates non-standard clinical documents, proprietary formats and images. • CDA provides a framework for the incremental growth in the amount and precision of structured, vocabulary-bound clinical information exchanged. • Low barrier to entry; simple things are easy to do. • Promotes longevity of information. • Enables the finest level of semantic granularity in standards-based representation of clinical information for applications that can support it.
Human Readability – Doctor and Patient Friendly • Persistence & Stewardship– Tangible & possessible • Wholeness & Context– Stand alone if necessary • Potential for authentication– Genuine, Signed, Private as well as encryption and digital rights management An HL7 CDA document … is a complete information object CDA characteristics CDA provides an incremental path forward from human-readable documents to computable semantic interoperability
IHE Roadmap: Building upon XDS Document Content Integration Profiles Workflows MessagingIntegration Profiles(e.g. ePrescription) Access Control XDSCross-Enterprise Document Sharing. • XDS is a foundation for cross-enterprise EHR • Document Content Integration Profiles defined for a specific domain of care practice: document format, content vocabularies, templates, etc.). • Process Flow Profiles additionally define actors and transactions to support specific processes (ePrescribing, eReferral, eBooking, etc.). These messages should reference XDS managed documents for persistent artifacts.
The “Real” Requirements are for an EHR based on HL7 CDA and IHE XDS Framework • High performance OLTP application on amassive repository of complex objects • Must support SQL queries for retrieval of individual documents, as well as OLAP style for research • Complex application integration project • Messaging: receive, parse, persist, transform, transmit • Business Process Management • Composite Applications • Business Activity Monitoring (BAM)
RequirementHigh Performance High performance On-Line Transaction Processing (OLTP) on a massive repository of complex objects, serving tens of thousands of concurrent users
However... “Using tables to store objects is like driving your car home and then disassembling it to put it in the garage.It can be assembled again in the morning, but one eventually asks whether this is the most efficient way to park a car.” - Esther Dyson
Objects / Relational Mismatch UserInterface Traditional Database Logic Objects Objects Tables Expensive Transformation Impedance Mismatch
Objects in the Database UserInterface ObjectDatabase Logic Objects Objects PersistentObjects Consistent Representation End to End
Query & AggregateAnalysis ProgrammaticAccess for OLTP SQL Objects Multi-DimensionalStorage Manager Performance& Scalability Post Relational Architecture
SQL Objects Dictionary Storage Manager Post RelationalUnified Data Architecture • One database • One definition of the data • Two access paths reference the same definition Eliminates the overhead ofobject / relational mapping
High-performancelinks to all majorobject architectures XML SOAP COM EJB Java .Net C++ Perl Python ODBC JDBC Industry-standard relational access InterSystems’ CachéObject and Relational Connectivity CachéSQL CachéObjects Single Data Defintion Multi-DimensionalStorage Manager Optimized For High Performance Optimized To MinimizeContention
Real-Time Analytics Transactional Bit Map Indexing Excellent retrieval performance for complex queries Excellent update performance for core transaction processing applications
RequirementApplication Integration • Complex application integration project: • Receive, parse, persist, transform, transmit XML • Implement cross-enterprise Business Process Management (BPM), also known as workflow • Build and run Composite Applications – to support browser access to heterogeneous data • Perform Business Activity Monitoring (BAM) – for policy making and public health management, including disease surveillance and bioterrorism defense
Integration Models DataCoordination Business Process / Work Flow Composite Applications Business ActivityMonitoring Universal Business Integration Platform Data Technology Application
Composite Applications Business Process Management Business Activity Monitoring Data Coordination Convergence Increasingly projects span integration models …
OneArchitecture InterSystems EnsembleUniversal Business Integration Platform • One • AbstractionLayer • ExecutionEngine • Repository • Development Environment • Management Environment Development Management Storage
Convergence Driving a need for rich platforms that seamlessly combine application development and integration Orchestration Development Integration Analytics See Gartner’s research on Application Platform Servers (APS)
Conclusion • Realizing the vision of clinical document sharing, and patient care process management across multiple unrelated healthcare provider enterprises encompassing regional or national populations will require: • HL7 CDA as the standard “container” for content, • Post relational database technology optimized for OLTP on complex objects, with support for SQL queries, • Application integration platform middleware supporting: • Robust store and forward messaging • Business Process Management orchestration (i.e. workflow) • Composite Applications • Business Activity Monitoring
Conclusion • InterSystems’ Ensemble meets and exceeds requirements for a high performance, advanced functionality, massively scaleable, cross-enterprise EHR.
Joe Gallant Product Manager Designing High Performance XDS Registries/Repositories IHE Interoperability Showcase – HIMSS 2006