| Service Oriented Architecture (SOA) is the latest | | | | represented as a collection of services. Each |
| concept buzzing in software and IT circles. SOA is | | | | service is made available to the entire organization |
| the next evolutionary step in systems | | | | through a standard protocol. All departments that |
| development. Properly implemented, it builds upon | | | | maintain or use the same data use the same |
| existing architecture while it better addresses | | | | service. This makes any redundancies transparent |
| efficient reuse of business functionality inside and | | | | to users. Applications supporting a specific |
| outside the organization. At its core, SOA is about | | | | workflow will reference the same service. Each |
| providing true interoperability that reflects | | | | service communicates with the systems to which |
| real-world use cases. | | | | it is related. Users no longer need to switch |
| Most organizations do not realize the dream of | | | | between systems to complete a workflow. Data |
| enterprise-wide systems, but instead rely upon a | | | | is naturally synchronized between systems. |
| portfolio of independent systems. Often these | | | | Services aligned in this manner enable true |
| systems have duplicate data and functionality. The | | | | interoperability among the healthcare organization's |
| goal of SOA is to select and encapsulate certain | | | | processes and people. |
| pieces of functionality as services that can be | | | | As SOA is further adopted by the healthcare |
| made available across the organization. With this | | | | industry, collections of services, as well as specific |
| being the goal, the organization can shift their | | | | services, will be available for use by a healthcare |
| focus from individual, often file-based interfaces, | | | | organization's internal and external resources. This |
| to creating service-oriented applications. These | | | | is possible because the origin of the service is |
| new applications not only create a truly | | | | transparent. Imagine adding a patient in one |
| interoperable environment, but they also more | | | | application and having that patient synchronized in |
| accurately reflect the actual business functions in | | | | all other systems without specific point-to-point |
| a healthcare environment. | | | | interfaces and files being generated. |
| Most industries, including healthcare, are faced with | | | | Integrating data and interoperability are key |
| the dilemma of providing operational systems, | | | | requirements in evolving healthcare technology, |
| supporting the revenue management and any | | | | and healthcare is behind the curve in adoption and |
| administrative features. For healthcare, the | | | | investing in these technologies. Healthcare adopting |
| operational could be capturing the insurance | | | | these technologies and getting the right |
| payment for a claim as defined by the remittance | | | | information in the right place at the right time can |
| advice. The revenue piece could be the posting of | | | | result in the following benefits: |
| that payment to the proper account and | | | | - Greater claim accuracy |
| recognizing the affect on the aging balance. The | | | | - Reduced medical errors |
| administration piece could be the security that | | | | - More accurate diagnosis |
| makes sure the person entering the transaction | | | | - Increased access for patients |
| has the proper authority to do so. It is not | | | | - Reduced payment cycles |
| unusual, nor is it bad, for this to be done in three | | | | SOA takes on greater significance with the |
| different systems. SOA allows the different | | | | emergence of Healthcare Information Networks |
| systems to know what has happened and to | | | | (HINs). A HIN is collaboration among the |
| interact when changes are made. | | | | government, hospitals, specialty labs and |
| SOA is different from legacy systems integration | | | | pharmacies and payors to provide a network of |
| in that it requires system design and management | | | | data exchange that builds shared information, data |
| principles that support reuse and sharing of | | | | repositories, applications and interfaces. The |
| system resources across the organization. It does | | | | collective applications efficiently and accurately |
| this without requiring re-engineering the existing | | | | exchange key information across a spectrum of |
| systems. With SOA, existing processes are | | | | healthcare. Existing HINs are currently |
| combined with new capabilities to build a library of | | | | accomplishing the following: |
| services. These services then become the | | | | - Exchange of patients' electronic medical record |
| solution. The goal is to create shared services that | | | | between providers to get key information like |
| reflect actual business processes. SOA | | | | medical history, allergies, persistent problems, |
| strengthens interoperability while reducing the | | | | medications and active treatments |
| need to synchronize data between isolated | | | | - Referral exchanges |
| systems. Properly implemented, the organization | | | | - Electronic patient eligibility for a visit or |
| has readily available services regardless of the | | | | procedure |
| originating system, department, location or | | | | - Electronic claim filing and payment |
| desktop. | | | | - Electronic ordering and monitoring of |
| Let's examine a relatively simple transaction and | | | | prescriptions |
| how the SOA approach applies. A clinic has a new | | | | - A consolidated repository of key healthcare |
| patient coming in for a visit. A list of items to be | | | | information for disease control |
| done includes: | | | | - A consolidated repository of data to support |
| - Examining if the patient exist | | | | government-funded programs and benefits of |
| - Verifying patient eligibility | | | | those programs |
| - Adding the patient to the Master Patient Index | | | | - A portal for the patient, providers and payors |
| - Examining the Doctors schedule | | | | accessing patient data |
| - Creating the appointment | | | | There is little debate regarding the benefits of |
| - Accessing public records | | | | implementing HINs. There is debate about the |
| - Creating an EHR visit | | | | cost and the ROI of HIN investment. Part of the |
| We have potentially accessed three to seven | | | | ROI equation is the cost of supporting the legacy |
| different systems depending on the functionality | | | | applications and their participation in the network. |
| of the base applications. Many healthcare | | | | If every time a new hospital, clinic, pharmacy, or |
| environments either do not perform all the | | | | government program was introduced a new |
| functionality or do it with a series of point-to-point | | | | point-to-point interface had to be introduced, it |
| file-based interfaces. Still others do it by entering | | | | would not be feasible to build a HIN that has |
| the data into multiple systems. Manually entering | | | | sustainable momentum. The cost of having to |
| data into multiple systems is essentially | | | | build a sequence of point-to-point interfaces for |
| human-interoperability because it is up to a person | | | | every system involved in the network would be |
| to coordinate and control the interfaces. | | | | unsustainable to all the practices and the software |
| As the number of systems increases, standard | | | | providers who support them. |
| interface formats, such as Health Level 7 (HL7), | | | | When using SOA for HIN integration, the cost of |
| and central data interface engines are adopted by | | | | integration can be reduced significantly and a |
| larger healthcare organizations. Internet-based | | | | sustainable community value is created. To |
| communication allows organizations to exchange | | | | accomplish this goal, SOA services facing the HIN |
| data with external organizations, such as payors. | | | | must accomplish the following: |
| Although data is passed among systems, the file | | | | - Simplify and reduce the interface points to |
| exchange approach falls short of supporting true | | | | create data interoperability in the network |
| data interoperability. File exchanges can work, but | | | | - Address the architecture, infrastructure, |
| they have multiple inherent problems: | | | | software, and related business functions as a |
| - Multiple points of failure - creating the file, | | | | cohesive unit |
| configuring where the file should go, security to | | | | - Have services deployed internally and externally |
| write the file, confirmed delivery of the file, file | | | | to support the needs of the organization and the |
| reader services, configuration of picking up the file | | | | HIN |
| and reading the file are just a sample of the | | | | - Support legacy systems |
| issues that have to be solved. Not that these are | | | | - Support current and evolving data standards |
| not solvable problems, they all are. With each | | | | - Be tested for scalability so larger external |
| point of functionality comes an increased | | | | organization can use it |
| probability that something can break. | | | | SOA is the direction IT is moving. SOA gets our |
| - Increased cost - Using all of the multiple points | | | | focus off of a single application and what it needs |
| of failure mentioned above, each step requires | | | | to do and onto how this application fits into a |
| additional development, testing and maintenance. | | | | bigger world. Whether that world is the |
| All of these combined equals increased cost and | | | | organization or beyond, SOA enables the |
| elongated time lines. | | | | applications key components to become exposed |
| - Finger pointing - Any time a file is create and | | | | to all who need them. Healthcare, which as an |
| security is needed to create the file, we have a | | | | industry has can achieve great benefits from this |
| blending of development teams with infrastructure | | | | kind of interoperability, is behind others in achieving |
| teams. Management never wins when both of | | | | it. Healthcare IT managers, and the software |
| these technical groups are pointing fingers saying | | | | companies that support them, need to evaluate |
| it is the others fault. | | | | how they are incorporating SOA in their design |
| With SOA, IT processing is organized and | | | | plans. |