healthcare integration with iib

© 2014 IBM Corporation

1149Healthcare Integration with IBM Integration Bus

Ben Thompson <[email protected]>

Please Note

IBM’s statements regarding its plans, directions, and intent are subject to change or withdrawal without notice at IBM’s sole discretion.

Information regarding potential future products is intended to outline our general product direction and it should not be relied on in making a purchasing decision.

The information mentioned regarding potential future products is not a commitment, promise, or legal obligation to deliver any material, code or functionality. Information about potential future products may not be incorporated into any contract. The development, release, and timing of any future features or functionality described for our products remains at our sole discretion.

Performance is based on measurements and projections using standard IBM benchmarks in a controlled environment. The actual throughput or performance that any user will experience will vary depending upon many factors, including considerations such as the amount of multiprogramming in the user’s job stream, the I/O configuration, the storage configuration, and the workload processed. Therefore, no assurance can be given that an individual user will achieve results similar to those stated here.

IBM Integration Bus Industry Packs

Each pack is a fully supported software product, independently delivered from IBM Integration Bus

The purpose of an IIB Industry Pack is to provide industry-specific development accelerators which solve common industry integration problems

Help users to deploy working integration solutions in literally a few clicks of the mouse.

IIB Industry Pack content is structured around three delivery pillars:

ConnectorsData Definitions

ConnectorsData Definitions

Integration PatternsIntegration Patterns MonitoringMonitoring

Association for Retail Technology Standards

Open Applications Group

Data Format Description Language

Open Grid Forum

Health Level 7

Digital Imaging and Communication in Medicine

Association for Retail Technology Standards

Open Applications Group

Data Format Description Language

Open Grid Forum

Health Level 7

Digital Imaging and Communication in Medicine

IIB Healthcare Pack Landscape

4

Web ServicesHTTP / JSON

Web ServicesHTTP / JSON

SCAWeb Services

SOAP XML

SCAWeb Services

SOAP XML

IBM Integration Bus + Healthcare Pack

DICOMDICOM

IDOC, BAPIProprietary XML

IDOC, BAPIProprietary XML

Corporate ApplicationsBilling, Payroll, ERP, CRMCorporate Applications

Billing, Payroll, ERP, CRM

Web ServicesSOAP, XML

Web ServicesSOAP, XML

ODBC, JDBC,SQL

ODBC, JDBC,SQL

Medical ImagingModalities

Medical ImagingModalities

Clinical RepositoriesClinical Repositories

Web ServicesSOAP HTTP

MQTTContinua

Web ServicesSOAP HTTP

MQTTContinua

HL7v2Proprietary

RS232

HL7v2Proprietary

RS232

SterlingConnect

DirectHIPAA

SterlingConnect

DirectHIPAA

PharmacyPharmacy

HL7v2NCPDPHL7v2NCPDP

Medical DeviceIntegration

Medical DeviceIntegration

HL7v2Cache ODBCWeb Services

HL7v2Cache ODBCWeb Services

Electronic MasterPatient Index

Electronic MasterPatient Index

Web ServicesHL7v2

PIX / PDQ

Web ServicesHL7v2

PIX / PDQ

Web ServicesSOAP XML

Web ServicesSOAP XML

HL7v2Cache ODBC

HL7v2Cache ODBC

HL7v3CDA CCD

HL7v3CDA CCD

Home Health DevicesHome Health DevicesMedical InsurersMedical Insurers

Medical ApplicationsMedical Applications

LegacyHospital Interface Engines

LegacyHospital Interface EnginesAnalyticsAnalytics Business ProcessesBusiness Processes

Clinical Mobile ApplicationsClinical Mobile Applications

Decision ManagementDecision Management

Portal, Web Applications, Electronic Forms

Portal, Web Applications, Electronic Forms

DynamicsSiebel

SAP

DynamicsSiebel

SAP

Roadmap

IBM's plans, directions, and intent are subject

to change or withdrawal

Q4 2011

WMB 8.0.0.0

Q1 2014

IIB Healthcare Pack 3.0Integration Improvements (Error Handling, DFDL)

Web User Interface

Home Health Pattern

Integration Improvements (Error Handling, DFDL)

Web User Interface

Home Health Pattern

Q1 2013

WMB 8.0.0.2

Q4 2013

IIB 9.0.0.1

Q2 2012

WMB Healthcare Pack 7FP2

Medical Device Input Node

Pattern HL7 Reports

Pattern Medical Device to EMR


Pattern HL7 Reports

Pattern Medical Device to EMR

Q1 2013

WMB Healthcare Pack 8ATNA Audit & DICOM nodes

HL7 DFDL Model

Patterns: DICOM, HL7

CDA Data Analysis

ATNA Audit & DICOM nodes

HL7 DFDL Model

Patterns: DICOM, HL7

CDA Data Analysis

IIB vNext

*The first WMB Healthcare Pack (v7) was released in May 2011*The first WMB Healthcare Pack (v7) was released in May 2011

Key Features

Pattern-based development tooling - fast integration without detailed knowledge of integration technologiesMakes use of proven runtime of IBM Integration BusIntegrates HL7 based clinical repositories & applications

• Production ready patterns based around HL7 v2.x• Pattern allows easy customisation• Handles inbound and outbound MLLP socket connections• Message definitions for all chapters of the HL7 v2.x specifications

Integrates DICOM based PACS & modalitiesProcesses CDA/CCD documentsDirect connectivity to medical equipment - monitors, infusion pumps etcHealthcare-oriented operational views

• Single point of visibility and control

ElectronicMedicalRecords


PatientAdministration

System


SystemPACS &imagingPACS &imaging

Labs &pharmacy

Labs &pharmacy

Medicaldevices

Medicaldevices

Remote PatientMonitoring


StandardsSTANDARD SUPPORT NOTES

HL7 v2.xV2.2 up to v2.7 (inclusive)JAXB bindings providedData Analysis profile provided2

HL7 v3 Supported directly by IBM Integration Bus

HL7 CDA

CDA / CDTContinuity of Care Documents (CCD)Consolidated CDA (C-CDA)HITSP (C32 / C83)

Data Analysis profile provided2

DICOM

C-STORE3 SCU and SCPC-FIND SCUC-MOVE SCU

Data Analysis profile provided

IHE Profiles

PIX ManagerPDQ SupplierATNA Secure Node2013 European Connectathon in Turkey alongside IBM Initiate

1 HIPAA and NCPDP supported by IBM Integration Bus with WebSphere Transformation Extender (WTX)2 CDA and HL7 v2 Data Analysis profiles are integrated with the LOINC terminology code system3 DICOM C-STORE SCP (DICOMInput node) is fully configurable with the target presentation contexts

Putting it all together

MQTT DICOMPACS

Predicting Deciding

Integrating

ImagingModalityImagingModality

PatientReportPatientReport

Monitoring

ElectronicMedical Record

ElectronicMedical Record

AlertDoctorAlert

Doctor

ODBCJDBC

SMS

What’s new in the IIB Healthcare PackIIB Healthcare Pack v3.0 released in March 2014

• 3rd release building on top of existing functions including HL7 connectivity, DICOM, ATNA, MedicalDevice connectivity and Data Analysis Profiles

New Web User Interface• Clinical Application monitoring• Operational views to understand flow activity

HL7 Transformation Pattern• Generates graphical data maps for creation of

HL7 messages from scratch• Assigns for individual fields in the MSH

HL7 Error handling enhancments

Home Health Pattern• Generates message flows to support a WAN interface• SOAP/HTTP interface using the IHE industry standard

“CommunicatePCDData” WSDL• Security PEP node for SAML Token security (with external STS)• Mapping solution for all 3 forms of acknowledgement

Clinical Application Integration

PAS


System


SystemLabs &

pharmacyLabs &

pharmacy



Integrate EMR and clinical applications such as PAS, Pharmacy, Labs

HL7 v2.x predominant standard but wide variations in application implementation

Pack provides connectors, schemas (HL7, DICOM, ATNA, Data Devices, Data Analysis profiles for CDA and CCD) and development patterns for easy integration

Uses many features of IIB including Graphical Mapping tools

RequestingApplication

ReceiverFlow

DestinationApplication

SenderFlowFilter Transform

AckAckAckAck

HL7 to HL7 DFDL Pattern• MLLP over TCP/IP, Message Validation and Parsing

• Journaling

• Duplicate checking and Sequencing

• Exception Handling

• Transformation to canonical XML format

• Message & Segment Filtering

• Message Distribution

Pattern: HL7 TransformationHL7 messages typically contain many data segments. For example the commonly used ADT_A01 message gives you information about a patient admission:

• 23 segments• 2 substructures (contain +6 segments)

Each segment can also contain large numbers (tens or hundreds) of individual fields.

In total it would not be uncommon for for an HL7 message to contain hundreds of individual fields

Creating this message tree structure hierarchy in a flow can be time-consuming, even when you use a graphical mapping tool.


System


SystemLabs &

pharmacyLabs &

pharmacy



Pattern: HL7 TransformationPatient

AdministrationSystem


SystemLabs &

pharmacyLabs &

pharmacy




System


SystemLabs &

pharmacyLabs &

pharmacy



Web User Interface

IIB Healthcare pack provides its own Context RootUses internal HTTP server to serve dataCan reconfigure to listen on user port or disableSSL connector configured via mqsichangepropertiesDisplays built upon REST API queries exchanged with IIB nodeClinical Application Monitoring (specific view for HL7 to HL7 patterns)Operational Monitoring (relevant to all patterns involving flows)

http://localhost:4414/healthcare

Web User InterfaceConnected Clinical Applications

X Ray

Maternity

Admissions

Out Patients

PAS Hospital West WingOut Patients

PASX Ray West WingX Ray

Pattern InstanceHospital_West_Wing

Pattern InstanceXRay_West_Wing

Built-in Healthcare Data Test Tools

The Continua AllianceRemote Patient

MonitoringRemote Patient

Monitoring

Defined actors:• Application Hosting Device (AHD)

• WAN Interface

Associated Standards:• IHE CommunicatePCDData

• HL7v2.6

Home Health Pattern

Points of variability in the pattern control:• URL fragment to which WAN requests are sent• Support for SAML Token Authorization and Authentication



Home Health PatternRemote Patient

MonitoringRemote Patient

Monitoring


IIB HCP provides connectors integration patterns to capture data from bedside medical devices and route observations

Medicaldevices

Medicaldevices



For example, you could use a MedicalDeviceInput in an integration flow to connect to a group of heart rate monitors and transfer the observations to a data warehouse, EMR, or dashboard for remote viewing

Why Automate data capture?• Ensure consistency, single source of truth for litigations, reduce errors

• Speed data collection, free up clinicians for clinical tasks(!)

Each MedicalDeviceInput node gathers readings from one or more physical device and presents the data in a consistent logical format.

Medical Device - Input Node

One to one relationship between a MedicalDeviceInput node and its configurable service

Configurable Services relate “Device Connections” and “Measurement Sets”

Medicaldevices

Medicaldevices



Medical Device Configurable Service

Device ConnectionDeviceID_001



Measurement SetMeasurementSet_001

Measurement SetMeasurementSet_002

Medical Device - Configurable ServiceMedicaldevices

Medicaldevices



Medical Device – Device ConnectionMedicaldevices

Medicaldevices



Medical Device – Measurement SetMedicaldevices

Medicaldevices



Medical Device – Supported Devices

The Medical Device Input node currently supports connections from:• Patient Monitors (GE, Philips, Somanetics, Tyco)• Anaesthesia Workstations (Draeger)• Infusion Pumps (Cardinal Health)• Ventilators (Draeger)

Medicaldevices

Medicaldevices



Alaris Asena CC Draeger CiceroEM GE Dash 4000 Medical Virtual Monitor 3 Philips IntelliVue MP90 Siemens SC9000

Alaris Asena GH Draeger Evita GE Eagle Medical Virtual Ventilator Philips Viridia 24 Siemens Vista

Alaris Asena GS Draeger Evita2 GE Eagle 3000 Medical Virtual Ventilator 2 Philips Viridia 26 Siemens Vista XL

Alaris Asena TIVA Draeger Evita4 Dura2 GE Eagle 4000 Nellcore NPB-190 Siemens Delta Somanetics Invos

Datex Ohmeda AS/3 Draeger Julian GE Eagle 4000N Nellcore NPB-195 Siemens Delta XL

Datex Ohmeda Cardiocap/5 Draeger PM8014 GE Solar 7000 Nellcore NPB-395 Siemens Gamma

Datex Ohmeda CS/3 Draeger PM8030 GE Solar 8000 Philips CMS Siemens Gamma X XL

Datex Ohmeda CS/3 Compact Draeger PM8040 GE Solar 8000N Philips IntelliVue MP20 Siemens Gamma XL

Datex Ohmeda S/5 Draeger Sulla GE Solar 9500 Philips IntelliVue MP30 Siemens Kappa

Draeger 8000 Draeger Vitara GE Tramscope 12 Philips IntelliVue MP40 Siemens Kappa XLT

Draeger 8000IC Draeger Evita Capnostat GE Tramscope 12C Philips IntelliVue MP5 Siemens SC 6002 XL

Draeger 8004 Draeger Savina Medical Virtual Device Philips IntelliVue MP50 Siemens SC 6802 XL

Draeger Cato GE Dash 2000 Medical Virtual Monitor 1 Philips IntelliVue MP60 Siemens SC7000

Draeger Cicero GE Dash 3000 Medical Virtual Monitor 2 Philips IntelliVue MP70 Siemens SC8000

Pattern: Medical Device to EMR

Production ready pattern to integrate medical devices with an EMR• Converts device measurements into HL7 observation results (ORU R01)• Supports alerts, discrete variables and waveforms (continuous sampling)• Observation results are easily customised for different HL7 destinations

Standard set of connectivity options for the outbound HL7 MLLP• Transport options including leading/trailing bytes, port number and timeout• Acknowledgments, automated retry and journaling (audit)• Source feed provided either direct to queue, or published to topic

Medicaldevices

Medicaldevices



DICOM Nodes

Provides flow of image and supporting data between medical image archives and modalities

Both inside & between care establishments

Support for common DICOM commands including MOVE, FIND and STORE

Images are routed as XML messages and stored on the file system

PACS &imagingPACS &imaging

PACS PACS

DICOM nodes:• IBM Integration Bus can act as both a client

(SCU) and server (SCP)• Metadata for DICOM images are propagated

through IBM Integration Bus as XML messages• Message does not contain the pixel data (this

is stored on the file system!)• Shared file system locations (NFS) supported

DICOM Pattern provided for WebService

DICOM Test Application

Example DICOM ScenarioCollect Studies for Patient Admission

PACS &imagingPACS &imaging

IBM Integration Bus Healthcare Pack

Data Analysis

Recursive nature of CDAs makes working from the schema very difficult• component, section, entry and entryRelationship to mention just a few!• Great flexibility in representing and modelling rich clinical statements

IIB Data Analysis helps you to rapidly understanding the structure of clinical documentsAnalyze a set of sample documents according to their data contentThe Healthcare Connectivity Pack provides four built-in Data Analysis Profiles for HL7v2, HL7 CDA, HL7v2 (ORU), and DICOM.It is pre-configured with CDA, C-CDA, CCD, HITSP (C32 and C83) template IDs and set up for use with a LOINC gloddary of terms to make clinical codes more readily understandable.

Clinical Document Data AnalysisUnderstanding your clinical documents is the vital first step

• Recursive nature of CDAs makes working from the schema very difficult• component, section, entry and entryRelationship to mention just a few!• Great flexibility in representing and modelling rich clinical statements

The Healthcare Connectivity Pack understands clinical documents• IBM Integration Bus is configured with a CDA Data Analysis Profile• Load example documents representing your implementation guide(s)• Pre-configured with CDA, C-CDA, CCD, HITSP (C32 and C83) template IDs• A glossary of LOINC terms is built-in so that codes are understandable

Import your source documents into a Data Analysis project – the summary page shows you how many documents were loaded,

validation issues, and information about missing LOINC codes

Navigating Documents

The Data Analysis project shows you

the meaning of different parts of your documents

Search for clinical concepts across all

your source documents

See where the relevant

information is actually stored in your documents

Data Analysis Profile identifies key sections in the clinical document• Navigate easily from the logical model to your source documents

• Multiple example documents can be loaded into your Data Analysis project

• Cardinality of the clinical data can be explored across the document set

Target Model

The target model represents the information you want extracted• The goal is to identify and map out the relevant clinical information

• The Data Analysis Profile creates an XML schema for the target model

• Typically large amounts of the clinical document is not relevant

Simply drag-and-drop your clinical data onto the target model• By default all attributes and elements are assumed to be required

• Refine the target model by removing unnecessary data and renaming elements

• Often this refinement means removing structural attributes like classCode

The target model contains just the information you want to extract

from the source documents – the tooling creates an XML schema to

represent this simplified model

Generation

Generate the map, XSD, XSLT and subflow from the target model• The XSD defines a schema for the data specified in the target model

• The map (MSL) extracts data in CDAs into the target model

• As with XML schemas, maps can be deployed direct to IBM Integration Bus

The XPATH expression shows what has been mapped automatically• Clearly building this kind of expression by hand would be tedious (at best!)

Questions and More Information!

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healthcare integration with iib

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