Much homework and hard footwork is needed to drive a compelling case for a service-oriented architecture (SOA) project, but some organizations in the health care sector are forging ahead despite severe budgetary constraints.
A major project is in the planning stages at SIMS, the shared information management services provider for Toronto-based University Health Network (UHN), which serves three major downtown hospitals and seven community care facilities.
“We’ve created the business case outlines needed for the interoperability layer that supports integration,” says Jim Forbes, CTO at SIMS. “And we have some initiatives under way to demonstrate the advantages of having a common infrastructure. Some of the early deliverables are slated for completion within six to 18 months.”
UHN is a major health care hub in Ontario, receiving patients with specialized needs from across the province. As its IT provider, SIMS is well placed to demonstrate the savings and efficiency made possible with SOA. “Many health care organizations can’t afford to have the in-depth knowledge that SIMS brings. We believe if we can demo SOA’s potential, it will ripple through Ontario and help other organizations look at the opportunities,” says Forbes.
The business case centers on showing the savings by using SOA for integration across multiple organizations versus other methods such as point-to-point interfaces. “If we make a strong case, hopefully it’ll attract the dollars needed to make it happen,” he says.
Where to start a SOA project is often a stumbling point in government circles. At SIMS, the strategy is to start with a universal service required across all health care organizations: linking patient IDs. This aligns with the province’s broader business objectives to improve the circle of care. “We’ve developed several applications, like providing patient results online and for emergency room (ER) notifications.”
A key component in all of these is Ontario’s Enterprise Master Patient Index (EMPI), which contains more than 43 million records and is the largest patient registry in Canada. Recently developed by the province, the EMPI is a major component in the evolution of an electronic health record (EHR). “We’re hoping to be early adopters of the EMPI for other purposes, such as using it to establish uniqueness,” Forbes says.
At present, every organization stores patient data according to its internal ID: UHN has one number, Mount Sinai Hospital another, and so on. “The trick in using the EMPI is to have a tool that does the linkage,” explains Slaven Rackic, senior technical project manager at UHN. “We can then use it to find out what activities happened to patients at other sites.”
Establishing those linkages is possible without SOA, but would require duplication of information across multiple sites and complicated queries to map them to one ID, which increases development costs significantly, says Forbes. “Instead of writing separate interfaces for each application, we have one, which is where the savings come in.”
He acknowledges that the project would have been a harder sell were restructuring under Local Health Integration Networks (LHINs) not under way in Ontario. “If there were no EHR ambitions and LHINs didn’t exist, it would be harder to get momentum. People wouldn’t already be at the table, and we would have to get them there.”
Another success factor is that the project also doesn’t involve rewriting legacy code to make it SOA-compliant. “All the stuff we’re doing is new: we’re not looking into retroactively adjusting legacy interfaces. With greenfield projects, it’s easier to move on the SOA agenda.”
Canada Health Infoway’s standards are useful in applying SOA to health care systems, he says. “There are advantages if everyone works from one blueprint. But it’s the commonality that’s attractive – there’s nothing significantly different in Infoway’s model compared to Ontario’s generic SOA model.”
Some industry observers suggest government strategists need to push the SOA agenda, not CIOs. But at UHN, the CIO’s efforts in forging alliances and brokering agreement were instrumental in getting the project going, says Forbes. “Our CIO, Matt Anderson, didn’t wait – he went out and formed voluntary partnerships with other organizations, and that’s what created the business driver.”
This is where the case for SOA is most compelling, he says. “In our view, SOA has huge value when you want to share data across external organizations. Most sites are fine with their own systems, but we can’t continue with this copying of data and pushing stuff around when we want to talk externally.”
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