Hospital IT infrastructures form a complex transactional environment in which pulling applications and information together can be not just mission-critical, but also a matter of life and death.
Entrenched proprietary systems store patients' clinical, radiological, demographic and billing information as text, images and voice-annotated reports. That information must be dealt with in accordance with strict clinical priorities and federal regulations. An increasing number of health care organisations are using Web services and service-oriented architectures to make critical connections in their information systems.
"We are building SOAs and Web services that will not only integrate different systems, but also take care of the hospital's rules -- a heart operation cannot be performed on the second floor, or anesthesia equipment cannot be located in the cafeteria, for example," says Furrukh Khan, director of the Collaborative for Applied Software Technology at Ohio State University Medical Center in Columbus.
Khan and his staff have developed a Microsoft .Net-based SOA that includes Web services for connecting hospital monitoring equipment to back-end databases. Since .Net licenses were already in place, the Web services were developed for very little cost, Khan explains.
Using Microsoft Indigo and Microsoft Web Services Enhancements for .Net, which provide standards-based security and other features to the Visual Studio .Net and .Net frameworks, Khan and his staff have linked anesthesia systems with the hospital's location services, which are stored in a McKesson hospital information system. As a result, physicians and other authorised users can view a patient's picture and vital signs remotely on a Web browser, says Khan.
Without Web services, the task of integrating patient data in the clinical and departmental systems scattered throughout hospital facilities has been monumental, say hospital CIOs.
"I have clinical software from 17 vendors. All you're really trying to do is service the organization and doctors, but it's a terrible struggle to get information between the different electronic environments," says John Wade, vice president and CIO at Saint Luke's Health System.
Saint Luke's uses systems from multiple hospital software vendors, and even with in-house programming staff and funds at his disposal for integration projects, Wade says it's still very difficult to get information from one electronic environment to another.
For example, the hospital has developed a custom XML-based application for its Web portal. Called Post-It Note, the application translates Dictaphone voice into data to allow physicians to view and annotate a radiologist's voice-based report on a Web browser. The patient data resides in a system from San Francisco-based McKesson. The use of XML has made the application a service that's accessible to a variety of systems, says Wade.
Part of the difficulty in making information available to multiple systems has been the need to comply with entrenched hospital data-transaction standards such as the Health Level 7 protocol. HL7 is used for interdepartmental patient-data transactions among clinical systems, including hospital information systems and radiology, laboratory and cardiology systems. However, custom programming has often been required to integrate hospital systems that use HL7 with systems that don't use the protocol -- essentially any software that's not health-care-specific, including reporting and billing applications. As a result, hospitals can have hundreds of HL7 interfaces among systems that trade basic patient data, according to hospital IT officials.
Hospital enterprise application vendors have had to provide interfaces and consulting services to their customers to ensure that all systems work together. However, this is cumbersome and isn't achieving true integration, according to Barry Runyon, an analyst at Gartner Inc. in Stamford, Conn.
"Hospitals are a heterogeneous environment with regard to platforms and applications, and by passing around HL7 to 10 different systems, they don't integrate; they interface," says Runyon. "Integration is far more intimate and requires knowledge of workflow, as well as a security model and other specifications."
More difficulty has arisen because vendors have been slow to relinquish their captured customer bases by making their applications easier to integrate with competing systems. Even when two systems support HL7, IT staffers have had to create custom interfaces to make them work together.
"Hospital system vendors don't play well with others," says Ken Thomson, chief architect at the University of North Carolina Health Care System in Chapel Hill. "If you want to integrate their software with lots of other systems, you're out of luck. We developed our own XML-based facades to their applications. They're starting to realise they're never going to own the space. In the end, the customer will be the 800-pound gorilla that changes this, because they need direct access to those applications."
At Boston-based CareGroup Healthcare System, Web services technology has provided an efficient means of making diverse systems work together, says John Halamka, CIO of the four-hospital network. Using development products that were already in place, Halamka's staff built an XML-based application called CareWeb to link 12,000 users on 146 internal clinical information systems -- including laboratory, radiology and pharmacy systems -- across the organisation.
"Web services are the glue that you can use to create a virtual system," says Halamka, who's also a Computerworld columnist. "If you want to achieve seamless data integration, you can make your infrastructure one gigantic system or, cheaper and faster, you can use Web services."
Health care has lagged behind other industries in implementing SOAs, for both budgetary and historic reasons. IT budgets in the sector are a fraction of those in other industries. To make matters worse, HL7 didn't include XML support until this past May. Moreover, the industry groups behind Integrating the Healthcare Enterprise (IHE), a 7-year-old project of the Healthcare Information and Management Systems Society and the Radiology Society of North America, are just now planning to include XML schemas in the framework.