5/26/2016 4:08 AM EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation. EDS is an equal opportunity employer and values the diversity of its people. © 2004 Electronic Data Systems Corporation. All rights reserved. A View into Services Architecture in Healthcare Kenneth S. Rubin Enterprise Architect, EDS Kenneth S. Rubin Enterprise Architect, EDS

Page 2 © 2004 Electronic Data Systems Corporation. All rights reserved. Presentation Overview Common Services: A Reference Model Common Services within VHA HL7.org and Common Services

Page 3 © 2004 Electronic Data Systems Corporation. All rights reserved. Common Services: A Reference Model

Page 4 © 2004 Electronic Data Systems Corporation. All rights reserved. Why common services?* A common practice in healthcare, just not yet in healthcare IT Many key products use them but do not expose interfaces Ensures functional consistency across applications Accepted industry best practice Furthers authoritative sources of data Minimizes duplication across applications, reuse *slide adapted from 2004 ITC Presentation on VHA Common Services

Page 5 © 2004 Electronic Data Systems Corporation. All rights reserved. ISO Layers: Sufficient? Application Presentation Session Transport Network Data Link Physical Platform

Page 6 © 2004 Electronic Data Systems Corporation. All rights reserved. ISO Layers: Insufficient! Application Presentation Session Transport Network Data Link Physical Platform Middleware, Static-binding, Stds Based Custom/Proprietary Interfaces Dynamic (Extensible) Semantics Static (closed community) Semantics Middleware, Dynamic-Discovery, Stds Based Dynamic (Extensible) Stds-based Semantics

Page 7 © 2004 Electronic Data Systems Corporation. All rights reserved. Pyramid of Interoperability Ability to Interoperate High Low

Page 8 © 2004 Electronic Data Systems Corporation. All rights reserved. Scaling the Pyramid: Examples

Page 9 © 2004 Electronic Data Systems Corporation. All rights reserved. Common Services within the Veterans Health Administration (VHA)

Page 10 © 2004 Electronic Data Systems Corporation. All rights reserved. First, a little about VHA* Business View –158 hospitals/medical centers –854 outpatient clinics –132 long-term care facilities –42 rehabilitation facilities –Affiliated with 107 of 125 medical schools in the US Healthcare Statistics (2003) –7.2M beneficiaries enrolled –4.8M treated –49.8M outpatient visits Operational View –180k VHA employees –13k physicians, 49k nurses –85k health professionals trained annually –USD $29.1B Budget for 2004 Technical View –VistA (EHR) for over 20 years –Software portfolio exceeds 140 applications –Reengineering effort is based upon a services architecture *statistics taken from May 2004 Fact Sheet, U.S. Dept of Veterans Affairs

Page 11 © 2004 Electronic Data Systems Corporation. All rights reserved. Relevant Context VHA is among several (U.S.) Federal healthcare organizations (DoD, IHS, HHS, CDC, FDA to name a few) National Coordinator for Health IT has been appointed –US NHII – Public/Private involving regional and local pilots –Four focus areas: Bring technology to points of care Interconnect clinics Patients as informed Support population health consumers Approach is for government to lead and not mandate VHA has related efforts to address information semantics

Page 12 © 2004 Electronic Data Systems Corporation. All rights reserved. VHA’s Service Architecture Objectives Minimize duplication and inconsistency of implementation Position VHA to support significant platform changes, isolate from middleware technology Allow for flexible deployment approaches without changing client applications Support multiple concurrent middleware technologies Facilitate integration with external systems, off-the-shelf products Minimize maintenance burden Establish services as authoritative sources of data = implied objective = stated objective

Page 13 © 2004 Electronic Data Systems Corporation. All rights reserved. VHA’s Road to Service Architecture HealtheVet VistA Planning Web Apps. Patient Lookup, Patient Service Hardware design, procurement and deployment Person Demographics NEW PERSON enumeration HDR prototype Standard Data Service CAIP Delivery Service Systems of Interest Naming / Directory Service Messaging Service HL7 Builder Utility Person Lookup Data standardization Data Cleanup Dynamic Routing Service Data Aggregation & Migration Site Preparation & Training Re-hosting of VistA Applications Removal of M systems Performance Tuning Person Identity Management

Page 14 © 2004 Electronic Data Systems Corporation. All rights reserved. VHA Service Architecture: Conceptual view

Page 15 © 2004 Electronic Data Systems Corporation. All rights reserved. VHA Lessons Learned with Common Services Alternative Triple-constraint: idealism, practicality, timeliness Establish agreed-upon architectural principles Need for architectural vision to integrate with project teams Need for a solid migration strategy (technology and staff) –Don’t overlook cultural maturation issues –Sequence planning is essential –Managing organizational trust Need to differentiate “infrastructure” from “business” services All-compassing requirements management

Page 16 © 2004 Electronic Data Systems Corporation. All rights reserved. Services Architecture within HL7.org

Page 17 © 2004 Electronic Data Systems Corporation. All rights reserved. HL7: The Services “Climate” Today HL7 has several service-oriented efforts (CCOW, CTS, Java, ITS) Each has considered itself outside the mainstream of HL7 Activities The methodology and approach to each effort has been “unique” Informal “Services Birds-of-a-Feather” community has maintained steady interest Most of HL7 remains message focused

Page 18 © 2004 Electronic Data Systems Corporation. All rights reserved. Emerging Areas MDF to HDF transformation –More than messaging –Support for multiple ITS specifications –More rigorous alignment to UML Tooling Task Force –Off-the-shelf –Requirements-driven, organizational priorities HL7 Organization Review Committee

Page 19 © 2004 Electronic Data Systems Corporation. All rights reserved. What about the Services BOF… “Why isn’t it a formal committee?” Informal group meeting for several years Regular meetings with average of 20 attendees Offered formal sponsorship under EHR TC Possibility of “Going SIG”

Page 20 © 2004 Electronic Data Systems Corporation. All rights reserved. The climate is changing… The HL7 HDF nears deployment Interest and sponsorship by EHR TC –HL7 EHR Functional Standard adopted May 2004 –EHR TC sees services as the next step HL7 is responding to national interests –HL7 Canada, HL7 UK, HL7 Australia exploring solutions involving services –US NHII initiative appears to be influencing the HL7 Board of Directors Joint meetings with OMG have begun

Page 21 © 2004 Electronic Data Systems Corporation. All rights reserved. What needs to be done… HL7 International Affiliates continue to push, inform HL7 Board of the importance and interest in services Services BOF must be either chartered as a committee or (preferably) incorporated in the HDF Support and promote HL7 partnership with SDOs focused in the services space HL7 should recognize the strengths and weaknesses of its membership volunteers

Page 22 © 2004 Electronic Data Systems Corporation. All rights reserved. References VHA Website: VHA HIA Website: HL7 Website: NHII Information:

Page 23 © 2004 Electronic Data Systems Corporation. All rights reserved. Acknowledgements and Thanks To… VHA Health Information Architecture Office VHA Common Services Team (for their review of this presentation for technical accuracy, and permissions to use and adapt several of their presentation slides) PlugIT, the University of Kuopio, and HL7 Finland (for the opportunity and sponsorship) Juha Mykkanen Mikko Korpela

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