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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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designing high performance xds registries repositories

Joe Gallant

Product Manager

Designing High Performance XDS Registries/Repositories

IHE Interoperability Showcase – HIMSS 2006

presentation overview
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.
xds cross enterprise document sharing
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
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.
an hl7 cda document is a complete information object

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
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
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)
requirement high performance
RequirementHigh Performance

High performance On-Line Transaction Processing (OLTP) on a massive repository of complex objects, serving tens of thousands of concurrent users

however
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
Objects / Relational Mismatch

UserInterface

Traditional

Database

Logic

Objects

Objects

Tables

Expensive Transformation

Impedance Mismatch

objects in the database
Objects in the Database

UserInterface

ObjectDatabase

Logic

Objects

Objects

PersistentObjects

Consistent Representation End to End

post relational architecture

Query & AggregateAnalysis

ProgrammaticAccess for OLTP

SQL

Objects

Multi-DimensionalStorage Manager

Performance& Scalability

Post Relational Architecture
post relational unified data 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

intersystems cach object and relational connectivity

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

transactional bit map indexing

Real-Time Analytics

Transactional Bit Map Indexing

Excellent retrieval performance for complex queries

Excellent update performance for core transaction processing applications

requirement application integration
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
Integration Models

DataCoordination

Business Process

/ Work Flow

Composite Applications

Business ActivityMonitoring

Universal Business Integration Platform

Data

Technology

Application

convergence

Composite

Applications

Business

Process

Management

Business

Activity

Monitoring

Data

Coordination

Convergence

Increasingly projects span integration models …

intersystems ensemble universal business integration platform

OneArchitecture

InterSystems EnsembleUniversal Business Integration Platform
  • One
  • AbstractionLayer
  • ExecutionEngine
  • Repository
  • Development Environment
  • Management Environment

Development

Management

Storage

convergence1
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
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
conclusion1
Conclusion
  • InterSystems’ Ensemble meets and exceeds requirements for a high performance, advanced functionality, massively scaleable, cross-enterprise EHR.
designing high performance xds registries repositories1

Joe Gallant

Product Manager

Designing High Performance XDS Registries/Repositories

IHE Interoperability Showcase – HIMSS 2006