Month: October 2009

Interoperability, SOA and Healthcare

Dr. Lynn, CIO of M.D. Anderson, Houston, Texas had an interesting guest article on HisTalk blog on interoperability and healthcare and how it is an oxymoron given that the Health Information Exchanges are using existing intra-organization architecture as a basis for enabling inter-organization sharing of data.

In summary Lynn highlighted the need for two different architectures for intra-organizational clinical workflows and inter-organization interoperability.  And provided a great  Internet analogy to get a sense what this architecture would look like.  The inter-organization interoperability architecture should not duplicate data collection and should facilitate quick searches of relevant data variety of sources and link data to a unified patient index.

Here is my take on the subject:

To see interoperability architecture in principle and practice you don’t have to look far.  IHE’s XDS architecture framework enables inter-organizational interoperability.   At a high level there are three components, XDS Registry, Repository and Consumer.   XDS registry is a search index of clinical data and XDS repository is a wrapper around existing clinical repository to update the search index(XDS registry).   There is an XDS Consumer- essentially a portal that enables a clinical user to view unified EHR on a patient.   Essentially its a federated architecture that leverages existing clinical data sources and investment and enables interoperability for a HIE.

And IHE XDS is based on SOA framework( to answer RadioGuy) and uses web services for communication between the relevant systems.   For some reason, IHE doesn’t seem to strike a chord with HIT folks in US where as, its not the same in rest of the world.   Is this the reason for HIEs focus or reliant on EMR’s intra-organizational architecture ?

If you want to see IHE XDS based inter-organization interoperability systems live and running, you just have to come to Canada (currently implemented in Diagnostic Imaging). Its being currently implemented in province of Alberta, Quebec and Ontario all using IHE XDS as a framework and funded by Canada Health Infoway ( a Canadian Federal Organization) that funds Canadian equivalent of US HIE’s.

eHealth Ontario announces short-list for Diabetes Registry Project

eHealth Ontario and Infrastructure Ontario have announced the three companies short-listed to submit proposals for a chronic disease management system that will be used initially to establish a Diabetes Registry for Ontarians and an eHealth Portal framework.

The three short-listed companies are:

xwave, a Division of Bell Aliant Regional Communications, LP

•  CGI Information Systems and Management Consultants Inc., and

•  TELUS Health Solutions GP

The short-listed companies will be invited to respond to a request for proposals (RFP) later this fall.

“Diabetes management is one our top clinical priorities since we know that more than 900,000 people in Ontario have diabetes and this number is expected to grow to 1.2 million by next year,” said Rob Devitt, eHealth Ontario’s Interim President and CEO. “I would like to thank the vendors who demonstrated an interest in this project and I look forward to the next stages of this process.”

The online Diabetes Registry is part of Ontario’s Diabetes Strategy to improve health outcomes for the growing number of Ontarians living with diabetes and reduce healthcare costs. It will be an interactive, real-time information system designed to track the care of diabetes patients in Ontario against evidence-based guidelines. It will track the dates of important tests and lab results to help clinicians and patients better manage their care.

The companies responded to a request for qualifications (RFQ) issued this summer. Following a process that involved demonstrations and reviews by evaluation committees, the three short-listed companies were selected.

Infrastructure Ontario is a Crown corporation dedicated to managing some of the province’s larger and more complex infrastructure renewal projects – ensuring they are delivered on time and on budget.

Visit or for more information.

Click to access ShortlistedBidders_DiabetesRegistry.pdf

Healthcare IT Vendors News!

1. IBM inks 3.3 million$ eHealth deal

Here is some niche business that IBM is starting to execute enabling sharing of diagnostic images across jurisdictions using a registry framework based on IHE XDS (Cross Enterprise Document Sharing) framework. Kudos to Quebec to act on it quickly before the Canada Health Infoway money runs out.

2. Cerner has launched healthcare development community

Here is what the PR claims,  “The uDevelop platform, modeled on the principle of open source software development, will allow the more than 2.5 million healthcare professionals who engage with Cerner® solutions to provide direct feedback on solution enhancements and to have a hands-on role in customizing and developing Cerner solutions”

In fine print, you have to be a Cerner client to be part of this community.

Web Services and Healthcare!

HisTalk blog had an article submitted (by Mark Moffitt) on web services and healthcare and how it can bring change to the healthcare industry, although slowly.

Here are few highlights, where Mark was right on about the healthcare lay of the land dominated by heavyweights like GE, Epic, Siemens, Cerner, McKesson, Meditech etc.,

1. Sunk costs of single vendor poses a significant barrier to change for providers who follow a single vendor approach in their IT strategy.

2. That tax is much higher in the US than in other countries (Chart 2). Healthcare cost as a percent of GDP cannot continue at current levels if the USA is to compete against other global economic powerhouses in the 21st century.

3. Agreed,  webservices is better integration approach compared to point to point integration provided by HL7 (V2.X)

All other sections, I have a different opinion and here are my comments below.

1. The article claims that there is not enough competition between healthcare IT vendors. When are major 8 vendors like GE, Epic, Siemens, Meditech, McKesson, Cerner, Eclipsys, Healthland controlling the market share to the tunes of around 80%, I think the competition is healthy.

2. Though best of breed might be a better approach to healthcare, significant integration costs and numerous failed approach to integrations makes single vendor approach attractive from a Total cost of Ownership

3. The big vendors are taking step towards web services in their own product portfolio or through partnerships. GE recently partnerd with InterComponentWare(ICW), a really niche eHealth vendor who has all componets in their eHealth framework to enable interoperability at all levels from with in a provider’s infrastructure to across providers in a jurisdiction.