1. Designing High Performance XDS Registries/Repositories IHE Interoperability Showcase – HIMSS 2006 Joe Gallant Product Manager

2. Presentation Overview XDS has the potential to serve as the foundation for a cross-enterprise EHR supporting advanced functionality. XDS has the potential to serve as the foundation for a cross-enterprise EHR supporting advanced functionality. HL7 CDA is central to XDS achieving its potential. HL7 CDA is central to XDS achieving its potential. HL7 CDA documents are objects. HL7 CDA documents are objects. Relational technology is ill suited to storing & retrieving objects. Relational technology is ill suited to storing & retrieving objects. Post relational database technology is ideal for high performance, massively scaleable EHR systems. 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. Modern application integration platform is critical to the success of an advanced function EHR system.

3. XDS Cross-Enterprise Document Sharing Document Consumer Retrieve Documents Query Documents Patient Identity Source Patient Identity Feed Document Source Document Registry Document Repository Provide&Register Document Set Register Document Set Actors and Transactions

4. 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 facilitates the creation and broadest accessibility of attested, human-readable, clinical documents. CDA accommodates non-standard clinical documents, proprietary formats and images. 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. 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.

5. An HL7 CDA document … is a complete information object CDA characteristics 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 CDA provides an incremental path forward from human-readable documents to computable semantic interoperability

6. IHE Roadmap: Building upon XDS 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. XDS Cross-Enterprise Document Sharing. Document Content Integration Profiles Workflows Messaging Integration Profiles (e.g. ePrescription) Access Control

7. The Real Requirements are for an EHR based on HL7 CDA and IHE XDS Framework High performance OLTP application on a massive repository of complex objects High performance OLTP application on a massive repository of complex objects –Must support SQL queries for retrieval of individual documents, as well as OLAP style for research Complex application integration project Complex application integration project –Messaging: receive, parse, persist, transform, transmit –Business Process Management –Composite Applications –Business Activity Monitoring (BAM)

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

9. 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 - Esther Dyson

10. Objects / Relational Mismatch User Interface Logic TraditionalDatabase ObjectsObjectsTables Expensive Transformation Impedance Mismatch Expensive Transformation Impedance Mismatch

11. Objects in the Database User Interface Logic Object Database ObjectsObjects Persistent Objects Consistent Representation End to End

12. Post Relational Architecture Multi-Dimensional Storage Manager ObjectsObjectsSQLSQL Performance & Scalability Programmatic Access for OLTP Query & Aggregate Analysis

13. Post Relational Unified Data Architecture Storage Manager ObjectsObjectsSQLSQL DictionaryDictionary One database One database One definition of the data One definition of the data Two access paths reference the same definition Two access paths reference the same definition Eliminates the overhead of object / relational mapping

14. InterSystems Caché Object and Relational Connectivity Multi-Dimensional Storage Manager Caché Objects Caché SQL Industry-standard relational access High-performance links to all major object architectures C++C++ JavaJava COMCOM XMLXML SOAPSOAP EJBEJB.Net.Net PerlPerlPythonPython ODBCODBCJDBCJDBC Single Data Defintion Optimized For High Performance Optimized To Minimize Contention

15. Transactional Bit Map Indexing Excellent retrieval performance for complex queries Excellent update performance for core transaction processing applications Real-Time Analytics

16. Requirement Application Integration Complex application integration project: 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

17. Integration Models Composite Applications Data Coordination Business Process / Work Flow Business Activity Monitoring Universal Business Integration Platform Technology Application Data

18. Convergence Increasingly projects span integration models … DataCoordination CompositeApplications BusinessProcessManagement BusinessActivityMonitoring

19. One Architecture Storage ManagementDevelopment InterSystems Ensemble Universal Business Integration Platform One Abstraction Layer Abstraction Layer Execution Engine Execution Engine Repository Repository Development Environment Development Environment Management Environment Management Environment

20. Convergence Driving a need for rich platforms that seamlessly combine application development and integration Analytics Orchestration Development Integration See Gartner s research on Application Platform Servers (APS)

21. 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: 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 messagingRobust store and forward messaging Business Process Management orchestration (i.e. workflow)Business Process Management orchestration (i.e. workflow) Composite ApplicationsComposite Applications Business Activity MonitoringBusiness Activity Monitoring

22. InterSystems Ensemble meets and exceeds requirements for a high performance, advanced functionality, massively scaleable, cross-enterprise EHR. InterSystems Ensemble meets and exceeds requirements for a high performance, advanced functionality, massively scaleable, cross-enterprise EHR. Conclusion

23. Designing High Performance XDS Registries/Repositories IHE Interoperability Showcase – HIMSS 2006 Joe Gallant Product Manager