Useful and Interesting Health IT Links from the Last Week – 11/11/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

Five ways to roll out SOA

Big name companies from Comcast to United Airlines are jumping into Services Orientated Architecture (SOA) , changing the way organizations plan, develop, and deploy enterprise applications

Galen Gruman (InfoWorld) 06/11/2007 10:15:14

Back when SOA first started getting traction, the goal was simply to make application functionality available as a shared service. Companies made up their architectures as they went along -- and of course, they're still doing that. The difference today is that, in the last couple of years, the business side has a better sense of the strategic value of IT, while IT has learned more about the competitive pressures business must endure. As a result, SOA now offers the possibility of greater alignment between IT and business than ever before.

What business needs is an array of services that can be recombined, resulting in new business processes that support new products or services. Publishing those services and providing a coherent framework within which they can be governed and orchestrated into applications is what SOA is all about. Although many SOA initiatives remain an early phase, the promise of increased business responsiveness is real. And we're seeing an increasing number of enterprises that are pushing toward advanced deployments. The case studies here are prime examples.

Comcast builds its SOA on domain expertise

It's tempting to start buying ESB, registries, and other tools when you decide to adopt the SOA approach. But that misses the key value of SOA, which is to have a way to align the applications you create and deploy to the business processes they execute, says Tom Adler, senior manager of application architecture and IT governance at Comcast. And starting with the architecture can help ensure you have the right framework to do that -- both now and as needs change over time, he says.

"When we started this effort 18 months ago, we resisted the temptation of bringing in vendors. We brought in subject matter experts instead and figured out what we needed first," Adler says. "All the vendors just wanted to sell us an ESB." The architecture effort does more than set the framework, he notes: It also begins identifying where you already have redundancies, both in business processes and in applications. That's key to getting business buy-in, Adler says, because it shows in very real terms where there are opportunities for savings that will help justify the eventual SOA infrastructure and tool investment, as well as show where the use of common services should help reduce maintenance and integration complexities, allowing more responsive development efforts in the future. "It's the target that lets us eliminate redundant services," he says.

After developing the architecture -- what Adler calls the common domain model -- Comcast's next step was to develop the governance framework for the service development and deployment. "Services need to go through the governance gate," he says, "otherwise no one will know that the services exist or follow the right policies and procedures." Only services that pass the governance gate are added to the service registry and thus made available for others to reuse.

One governance challenge that came up quickly was deciding who owned the services. Comcast is fairly decentralized, so the culture naturally supported having the service originators own the services in their domains, Adler says. Common services, such as single sign on, reside with IT -- their natural domain, he adds.

One step that Adler now realizes Comcast missed was developing a common data service model after defining the architecture. By not having standard data services to access corporate information and manage interactions across systems, developers have ended up designing their services to get the job done in different ways, leading to inconsistencies that break the SOA promise of allowing an easy mix and match of service components. "We underestimated the value up front," Adler says, and the price has been reworking some services to impose that model after that fact.

The architectural focus of Comcast's SOA effort has helped the concept be applied more widely than if viewed merely as a technology issue, Adler believes. For example, because Comcast didn't start with the view that SOA means the use of Web services, the company has applied the SOA concept to all its efforts, not just those that are obviously Web-enabled. "A Web service is just one way to expose a service -- it's just an implementation detail," he says. One result is that much of the initial internal SOA efforts were in fact directed at the legacy applications, reducing the integration points both within and outside the company (such as with billing vendors), a major pain point for the business.

Developers use a variety of tools and programming languages, for example, as best fit their knowledge and the application they are creating. By standardizing processes and policies instead of specific tools and technical methods, Adler says developers can better adhere to the architecture's intent rather than trying to shoehorn each effort into the limitations or assumptions of a specific tool or technology. There's also a practical reason to allow technological heterogeneity under the common architecture, he notes: In a 9,000-person company, it would be unrealistic to get everyone on the same methodology."

A company of that scale must also adjust to changing business needs and technology opportunities, Adler says. It's important to revisit the reference architecture periodically so it doesn't become a straitjacket or a document that everyone ignores; either way, you would lose the benefits of SOA. Adler revisits the architecture each month, though it is changed less often than that.

Continue reading here to hear about the other four examples:

http://www.computerworld.com.au/index.php/id;904732282;fp;4194304;fpid;1

NEHTA is very keen on the use of SOA and these examples are worthwhile to see the range of approaches commerce is using to try and obtain the various advantages.

Second we have:

Abbott health project disappears

Karen Dearne | November 06, 2007

SPENDING on e-health crashed during 2006-07, with $41.5 million allocated to national projects left unspent out of a budgeted $79 million.

Local industry observers said Tony Abbott had abandoned HealthConnect

As a result, $40 million of the unspent $41.5 million was rolled over into the 2007-08 budget, forming the total allocation for e-health programs in the current year, the Health Department's annual report reveals.

The move halved the federal Government's funding commitment to health technology reform.

E-health specialist and blogger David More said the situation was farcical, and only half of the available federal funding had been spent.

"With lack of investment being a key blocker to improved e-health, it does not look like Health Minister Tony Abbott is serious about making progress in this area, in spite of his recent rhetoric and mea culpa," Dr More said.

"Even worse, there is no apparent increase being planned."

In comparison, Canada recorded a huge rise in e-health expenditure in 2006-07, with its national co-ordinator, Health Infoway, approving investments of more than $C520 million in joint state-federal projects, Dr More said.

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22709617-15306,00.html

It is always nice to get a reference in the mainstream press!. The points made in this article are all valid. The Government persisting with the fiction of HealthConnect being a viable strategy which is being implemented is just laughable.

Third we have:

Draft PHR Standard Ready for a Vote

HDM Breaking News, November 5, 2007

Standards development organization Health Level Seven has sent to ballot its Personal Health Record System Functional Model. Members and nonmembers of Ann Arbor, Mich.-based HL7 can vote through Dec. 1 on whether the model should become a draft standard for trial use.

The model defines a set of functions and security features that may be present in PHR systems and offers guidance to facilitate data exchange among PHRs or with electronic health records systems. The model is designed to help consumers compare PHRs and select one appropriate for their needs.

Continue reading the details here:

http://www.healthdatamanagement.com/news/standards_PHRs_consumers25130-1.html

The PHR functional model specification is available at hl7.org/ehr.

This is an important step forward in terms of developing standards for Personal Health Records. Given NEHTA is supporting HL7 Standards this standard may have directed relevance in Australia.

Fourth we have:

RHIOs aren't working, new report says

By Diana Manos, Senior Editor 11/05/07

WASHINGTON--The development of regional health information organizations may not be effective in advancing healthcare information technology, a new report by the Information Technology and Innovation Foundation contends.

"The strategy of building the network from the bottom up by establishing many RHIOs throughout the country is not working," ITIF's report said. "More than 100 RHIOs have been established across the country, but the majority are financially unsustainable. In the absence of clear national standards for sharing medical data, achieving system interoperability for RHIOs has been difficult."

The 23-page report, titled "Improving Health Care: Why a Dose of IT May Be Just What the Doctor Ordered" calls for a renewed national strategy for advancing healthcare IT.

…..

The report recommends that Congress take immediate actions to help advance healthcare IT, including:

*Pass legislation to promote the use of electronic health records and national health data standards;

*Create a legal framework for health record data banks;

*Leverage federal resources to ensure access to health record data banks;

*Require medical practices to disclose patient health information electronically upon request.

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8075

The report can be downloaded from the following URL:

http://www.itif.org/files/HealthIT.pdf

This is an interesting review of where one author thinks the US is presently situated and what strategies may be applicable to have things move forward. Well worth a download.

Lastly we have:

CCHIT certifies six EHRs for hospitals

By Eric Wicklund, Managing Editor 11/05/07

CHICAGO – Six vendors, or roughly one out of every four, offering electronic health record products for acute care hospitals have now been certified by the Certification Commission for Healthcare Information Technology.

CCHIT officials announced today that products offered by the six vendors certified have demonstrated compliance with the certification commission’s published criteria. Four of the products have been deemed fully certified:

• Computer Programs and Systems, Inc. ’s CPSI System 15,

• Eclipsys Corp. ’s Sunrise Acute Care 4.5 SP4,

• Epic Systems’ EpicCare Inpatient Spring 2007

• Healthcare Management Systems, Inc. ’s Healthcare Management Systems 7.0.

Two others – Prognosis Health Information Systems’ ChartAccess 1.0 and Siemens Medical Solutions’ Soarian Clinicals 2.0C5 with Siemens Pharmacy and Medication Administration Check 24.0 – have been ruled pre-market, conditionally CCHIT certified, meaning the products will be fully certified once their operational use in a hospital has been verified.

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8108

This is further evidence that the CCHIT is progressing a sensible agenda of identifying and certifying capable Health IT System which can reasonably be expected to work well when implemented. This certification could be of some use to Australian States that are planning major Hospital system purchases over the next few years. Would be good to see both incumbent Australian Vendors - Cerner and IBA/ iSoft submit their products to certification via this system.

All in all some interesting material for the week!

More next week.

David.