workflow process management and enterprise application integration in healthcare
DESCRIPTION
Amit Sheth, Keynote Address at HEALTHCOM99, Sydney, Australia, Jan.11, 1999.TRANSCRIPT
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Large Scale Distributed Information Systems Labat University of Georgia
http://lsdis.cs.uga.edu
Requirements, Applications, Technology and ResearchRequirements, Applications, Technology and Research
Amit ShethAmit Sheth
Keynote AddressKeynote Address
HEALTHCOM99HEALTHCOM99Sydney, AU Jan.11, 1999Sydney, AU Jan.11, 1999
Thanks: > Krys Kochut, John Miller and METEOR Team> NIST-ATP, IONA Technologies, Informix, ...
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Introduction
Comprehensive Healthcare IT solutions require Comprehensive Healthcare IT solutions require broad variety of process management broad variety of process management
applications, and applications, and enterprise application integration enterprise application integration
in a rapidly changing, distributed, and in a rapidly changing, distributed, and heterogeneous computing environments.heterogeneous computing environments.
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Reprsentative Healthcare Applicationsfor which the METEOR EAppS has been used
Application• NeoNatal Clinical
PathWays• Genome
Sequencing
• Eligibility-Referral• Immunization
Tracking
Key Characteristics• Clinical, single site/server• Non-medical, multiple user
organizations, two servers• Administrative, two
participating organizations• Clinical and Administrative,
multiple servers, multiple organizations
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Neonatal Clinical Pathways
Server
Nurse Nurse Coordinator Neonatologist
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Neonatal Clinical Pathways
• Multiple inter-related clinical pathways or treatment plans for premature, underweight babies (head ultrasound, metabolic screen, nutrition, immunizations, etc.)
• Alert on test to be ordered, enter tests and review results, update database, print reports
• Users: nurse coordinator, nurse, neonatologist• single server, Web-based clients
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Head Ultrasound Workflow
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Multi-institutional Genome Sequencing
SolarisServer
Users in different labs worldwide
SGIServer
Legacy App Legacy App
Georgia
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Data Analysis in a Multi-institution Genome Sequencing Enterprise
Raw output fromDNA sequencing machinesfrom multiple institutions
Fully sequencedand annotated genome
Task 1 Task 2 Task i
...
Automatic and human-computerdata analysis tasks running on heterogeneous servers
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Characteristics of Data Analysis Tasks
• Many existing legacy data analysis applications and new applications running
• different servers (SGI and Solaris)
• Each human-computer task performed by an expert who specializes in that task; experts are located at different institutions throughout the world
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Eligibility and Referral
Sending organization
Receivingorganization
Insurancecompany
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Eligibility and Referral(i.e., “patient dumping”)
• Sending Organization -- Receiving Organization -- (optionally insurance company and ambulance services)
• Two independent workflows with interoperability, optionally EDI with other organizations
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Sending Organization
Receiving Organization
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An Example of Mission-criticalEnterprise Application
Developed using METEOR EAppS
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CLINICAL SUBSYSTEM
Generates:• Alerts to identify
patient’s needs.• Contraindications to
caution providers.
SDOH andCHREF maintaindatabases,support EDI transactions
Hospitals and clinics update centraldatabases after encounters
Health providers can obtain up-to-dateclinical and eligibility information
TRACKING SUBSYSTEM
State and HMO’s can update patient’s eligibility data
Health agencies canuse reports generated to trackpopulation’s needs
CT
Hospitals andcase workerscan reach out to the population
HMOs can keep track of performance
Reports to state
Reminders to parents
Schematic of Immunization Tracking
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CORBADBMS
ImmunizationDatabase
Web Server
(Solaris)
Administrator Case Worker AdmitClerk
TriageNurse
Doctor/NP
Maternity Ward
(Solaris)Encounter DatabaseHospita
lCHREF
AdmitClerk
TriageNurse
Doctor/NP Encounter
Files/Databases
Office PracticeMgmt System
ClinicCHREF/SDOH
Insurance Eligibility Database
(Solaris)
Implementation Testbed: Immunization Tracking Demo
ask us for a demo
EDI
(Solaris)
MPI MEI Web Server
Web ServerDBMS
DBMS
(Windows NT)Hospital
Info System
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Web-based Implementation
Start. . . . Start
PULL
CGI
NN
NN
NN
NN
NN
CGI
CGI
CGI
CGICGI CGI
Enter PatientGenerate
Alerts
Update PersonalData
Check Eligibility
Update Local Database
HTTP
WorklistFile
Generate TriageNurse’s Page
Display Worklist
NN
EnterPatient Info.
GenerateAlerts
Enter PatientInfo.
Update PersonalData
Check Eligibility
Update LocalDatabase
Stop
Implementation
Triage Nurse Task
Submit Button
Alert Results EligibilityResults
Admit Clerk Task
Workflow Design
Mac
hin
e B
ou
nd
ary
CollectVitals
Add toWorklist
Web Page
DBMS
Updated Results
WORKLISTHANDLER
NN
EnterPatient Info.
Verify patient eligibility
Generate medical alerts
Insert into clinic/hospitalEncounter database
NN
EnterPatient Info.
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Start. . . . Start
PULL
CGI
NN
NN
NN
NN
CGI
CGI
CGI
CGICGI CGI
Enter PatientGenerate
Alerts
Update PersonalData
Check Eligibility
Update Local Database
HTTP
Generate TriageNurse’s Page
Display Worklist
NN
EnterPatient Info.
GenerateAlerts
Enter PatientInfo.
Update PersonalData
Check Eligibility
Update LocalDatabase
Stop
Implementation
Triage Nurse Task
Submit Button
Alert Results EligibilityResults
Admit Clerk Task
Workflow Design
Mac
hin
e B
ou
nd
ary
CollectVitals
Add toWorklist
Web Page
DBMS
Updated Results
NN
WorklistFile
WORKLISTHANDLER
NN
WorklistFile
WORKLISTHANDLER
NN
WorklistFile
WORKLISTHANDLER
Web-based Implementation
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Provider Interface:Immunization Reco’s
List of overdue vaccinations
Link to contraindication info obtained from the Internet
Clinical update to “administer vaccination”
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CORBA-based Implementation
Check Eligibility
. . . .
Workflow DesignGenerate
AlertsEnter Patient
Info.
Update PersonalData
Check Eligibility
Update LocalDatabase
Start Stop
Triage Nurse Task
Start
Admit Clerk Task
CollectVitals
Enter PatientGenerate
Alerts
UpdatePersonal
Data
Check Eligibility
UpdateLocal
Database
HTTP
Worklist Handler
Enter Patient Info.
Implementation
Submit Button
Alert Results Eligibility Results
Mac
hin
e B
ou
nd
ary
CORBA CORBA
CORBA
CORBA
CORBANN
Add toWorklist
NN Web Page
DBMS
Updated Results
NN
NNNN
CORBA
Patient Data (CORBA)
Control Flow
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Requirements of mission-critical healthcare applications
that METEOR supports
Some of the important requirements for this application include:
Support for a distributed architecture in a heterogeneous computing environment. At the level of any user of the system, this distribution should be transparent
Support for inter- and intra-enterprise wide coordination of tasks
Provision of a standard user-friendly interface to all users of the system
Support for a variety of tasks: transactional and non-transactional, user and application
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Requirements of mission-critical healthcare applications
that METEOR supports
Capability of using existing DBMS infrastructure and databases across organizations
Low cost of system for the providers and user organizations
Ease of modification (re-design), scalability, extensibility and fast design-to-implementation
Open architecture, use of standards (e.g., CORBA, CORBAmed, OMG WF, WfMC, SWAP) and middleware (JDBC)
Security authorization for users and secure communication (required as patient data is typically confidential)
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Adaptive Workflow Example 1
If initial exam identifies needs for additional procedure in the blood test, the task/subprocess component is obtained from the repository and added to the subprocess
get blood
standard test
write report
WorkflowComponent
Repos.
special test
This example is from Han et al.
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Adaptive Workflow Example 2
• Comorbidity: new lab result identifies previously unknown illness or health condition that requires additional health management in addition to the current condition.
• New related workflow (or subworkflow) is kicked off.
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State of the art technology, products and research
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Market Approaches to Workflow
document mgmt.workgroup/collaborative
imaging
Internet ORB
databaseTP-monitoring
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Key conclusion from DocuLab’s workflow product comparison study
Products that allow development of complex applications, provide flexibility and support integration are very hard to use, take too long and require experience programmers (and are still not quite comprehensive)
Easy to use products are too restrictive --and are useful for small or standard applications only
METEOR’s objective is to avoid significant compromise.
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What is lacking from state of the art in Workflow Technology
• Primarily centralized, client/server architectures• Difficulty in integrating with existing applications
and databases, not meant for heterogeneous, multi-server environments
• Static workflows that can be fully defined before enactment starts
• Focus on repetitive processes
Most products are, however, suitable for many office automation and other human oriented processes.
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Research Disciplines Contributing to to Workflow Management
Quantitative andFormal Methods/Modeling
Software Engineering,HCI, etc.
OrganizationalScience
CSCW
Database Management/Information Systems Distributed
Computing/Systems
MIS/Reengineering/Methodology
Software Process
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Enterprise Application Integration [EAI]
• The average Fortune 2000 company relies on 49 enterprise-level applications to run its business and spends 25 to 33 percent of its IT budget just to get tem to talk to each other [Dan Sholler, Meta Group]
• Systems integration costs in many cases amount of 40 percent of IT costs
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Messaging/PersistentQueue Middleware
DistributedObject Management
(ORB)
EnterpriseJava Beans
DCOM
Publish/Subscribe;event-based messaging
PackagedApp
Broker
METEORComponent
HOST 1
HOST 2HOST 3
HOST 4
ApplicationDatabase Transaction
EDI
UserTask
UserTask
METEORComponent
METEORComponent
METEORComponent
METEORComponent
Services and Business Objects
Message/Data Tools/Architectureof current EAI products/solutions
Business Object/Process Tool/Architectureof the METEOR Enterprise Application Development & Integration
Adapter
Adapter
Adapter
Adapter
App
App
LegacyApp
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METEOR Architecture
Builder REPOSITORY
AUTOMATIC CODE GENERATION
MONITOR
AND
TASKTASK TASK
TASKWEB /
CORBA
DB
TASKMgr.
TASKMgr.
TASKMgr.
TASKMgr.
Application
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METEOR2 EAppS [Enterprise Application Suite of Tools and Services]
End Users
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METEOR Model
• Integral support for human and application tasks– transactional and non-transactional tasks– human tasks: forms, collaborative tasks– automated tasks: database access, legacy
applications
• Complex control and data dependencies• much more
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METEOR Workflow Builder Service
Comprehensive set of Comprehensive set of graphical tools for graphical tools for building workflow building workflow process applicationsprocess applications
Map DesignerMap Designer Data DesignerData Designer Task DesignerTask Designer Web Form DesignerWeb Form Designer Exception DesignerException Designer
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WebWork Application Development
WorkflowDesigner
TaskCustomizer
WorkflowGenerator
ApplicationPrototype
PageCustomizer
Specification
Customizer
WorkflowApplication
.wil .spec
source
.spec.html.cc
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Web Enabled and Web Based Engines
Web Enabled
WebBased
Centralized Distributed
Vendor1 Vendor2 Vendor3 OzWeb Endeavors WebWork
DistributedScheduling
Error handlingRecovery
(Transactional Support)
CGI Tcl, Java, XML
Front End Enactment, monitoring, administration
EJB
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Workflow MonitorGRM
Object Request Broker(CORBA)
TTM
LRM
LPS
ApplicationTask
Web Server
GPS
Web
WorkflowAdministrator
Database Task
User Task
DBMS
Host E
Host D
Host C
Host A Host B
UTM
LPS
LPS
LRM
NtTMGPS Global Persistence StoreGRM Global Recovery ManagerLPS Local Persistence StoreLRM Local Recovery ManagerNtTM Non-transactional Task ManagerTM Task ManagerTTM Transactional Task MangerUTM User Task Manager
Cleanup Task
Watchdog
Data Object Activate Message
LRM
OVERVIEW
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ORBWork Enactment Service
Designed to address a variety of shortcomings found in today’s component middleware, enterprise integration, and workflow process management systems, it supports the following capabilities:Integration of application components and databases
on disparate distributed and heterogeneous computing environments across enterprise intranet and extranet boundaries
A fully distributed and highly scalable enterprise application process enactment system capable of supporting dynamic business processes
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ORBWork (continued)
Utilization of open and industry standards such as CORBA/IIOP, Java, JDBC, HTTP, and OMG Workflow Facility for developing open, distributed, object-based, interoperable enterprise applications
Support for cross-platform portability of tasks in business processes (by exclusively developing them in Java)
Provision for a browser-based Web user interface for the end-users and the administrators.
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ORBWork’s fully distributed scheduling and flexible placement
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Achieving Scalability
• Use of a fully distributed scheduler.• Component task schedulers “mirror” the
workflow map design.• Natural distribution of scheduling and task
activation functions among participating hosts.
• Task schedulers can be replicated to increase the load handling potential.
• Task managers can be distributed among many hosts to balance the load.
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Dynamic Changes
Dynamic changes both to the enterprise application or workflow process schema and to the individual workflow process instances.
Administrator can easily modify the schema at runtime by acquiring the new information from the repository, or even by modifying the specification by HTTP-based direct interaction with the scheduler.
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ORBWork implementation:
Utilizing ORBIX’s features
Feature Application
Dynamic ObjectActivation
Allows for automatic activation and deactivation ofORBWork components, reducing the load on the hostsystem(s)
Dynamic InvocationInterface (DII)
Only object references are transferred; data object areaccessed dynamically, according to their interfaces
Object Loaders Data objects, task schedulers, and other ORBWorkcomponents use loaders to automatically save/restorestate
Naming Service Task schedulers are located with the use of the NameService; this allows for flexible and transparentplacement of the schedulers and their possiblemigration at runtime
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Features, capabilities and benefits Graphical building of complexapplications
Ability to visualize all application components; reducedneeds for expert developers; rapid deployment
Support for heterogeneous,distributed computingenvironment, open-systemsarchitecture
Seamless deployment over networked heterogeneous(Solaris and NT) server platforms; ease of integration oflegacy/existing applications
Automatic code generation Significantly reduced coding and corresponding savings indevelopment cost; reduced need for expert developers;rapid deployment
Integration of human andautomated activities, includingtransactions
Natural modeling of complex business activities/proesses
Fully distributed scheduling High scalability and performance, minimal single point offailure,
Dynamic changed Rapidly adapt to changes in business processes
Exception-handling andrecovery, survivability
Mission-critical, robust applications
Traditional security, multi-levelsecurity
Support for roles, security on open Internetworking;commercial to defense applications
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Summary
Enterprise Healthcare applications need more than what most workflow products and “consultantware” systems have to offer.
METEOR EAppS uses CORBA, Web, and Java offers unique solutions to realize the promise of recent advances in distributed computing infrastructure, middleware and Web, by quickly integrating applications and information systems, to support complex and dynamic business process management.
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Additional information
http://lsdis.cs.uga.edu(METEOR Research)
Infocosm, Inc. http://infocosm.com
METEOREAppS(Technology/Product Licensing)