Implementing SOA in Healthcare Systems

Implementing SOA in Healthcare Systems[EXTRACT]
Service Oriented Architecture (SOA) is the latest concept buzzing in software and IT circles. SOA is the next evolutionary step in systems development. Properly implemented, it builds upon existing architecture while it better addresses efficient reuse of business functionality inside and outside the organization. At its core, SOA is about providing true interoperability that reflects real-world use cases.Most organizations do not realize the dream of enterprise-wide systems, but instead rely upon a portfolio of independent systems. Often these systems have duplicate data and functionality. The goal of SOA is to select and encapsulate certain pieces of functionality as services that can be made available across the organization. With this being the goal, the organization can shift their focus from individual, often file-based interfaces, to creating service-oriented applications. These new applications not only create a truly interoperable environment, but they also more accurately reflect the actual business functions in a healthcare environment.Most industries, including healthcare, are faced with the dilemma of providing operational systems, supporting the revenue management and any administrative features. For healthcare, the operational could be capturing the insurance payment for a claim as defined by the remittance advice. The revenue piece could be the posting of that payment to the proper account and recognizing the affect on the aging balance. The administration piece could be the security that makes sure the person entering the transaction has the proper authority to do so. It is not unusual, nor is it bad, for this to be done in three different systems. SOA allows the different systems to know what has happened and to interact when changes are made.SOA is different from legacy systems integration in that it requires system design and management principles that support reuse and sharing of system resources across the organization. It does this without requiring re-engineering the existing systems. With SOA, existing processes are combined with new capabilities to build a library of services. These services then become the solution. The goal is to create shared services that reflect actual business processes. SOA strengthens interoperability while reducing the need to synchronize data between isolated systems. Properly implemented, the organization has readily available services regardless of the originating system, department, location or desktop.

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Let’s examine a relatively simple transaction and how the SOA approach applies. A clinic has a new patient coming in for a visit. A list of items to be done includes:
Examining if the patient exist
Verifying patient eligibility
Adding the patient to the Master Patient Index
Examining the Doctors schedule
Creating the appointment
Accessing public records
Creating an EHR visit
We have potentially accessed three to seven different systems depending on the functionality of the base applications. Many healthcare environments either do not perform all the functionality or do it with a series of point-to-point file-based interfaces. Still others do it by entering the data into multiple systems. Manually entering data into multiple systems is essentially human-interoperability because it is up to a person to coordinate and control the interfaces.As the number of systems increases, standard interface formats, such as Health Level 7 (HL7), and central data interface engines are adopted by larger healthcare organizations. Internet-based communication allows organizations to exchange data with external organizations, such as payors.Although data is passed among systems, the file exchange approach falls short of supporting true data interoperability. File exchanges can work, but they have multiple inherent problems:
Multiple points of failure – creating the file, configuring where the file should go, security to write the file, confirmed delivery of the file, file reader services, configuration of picking up the file and reading the file are just a sample of the issues that have to be solved. Not that these are not solvable problems, they all are. With each point of functionality comes an increased probability that something can break.
Increased cost – Using all of the multiple points of failure mentioned above, each step requires additional development, testing and maintenance. All of these combined equals increased cost and elongated time lines.
Finger pointing – Any time a file is create and security is needed to create the file, we have a blending of development teams with infrastructure teams. Management never wins when both of these technical groups are pointing fingers saying it is the others fault.

With SOA, IT processing is organized and represented as a collection of services. Each service is made available to the entire organization through a standard protocol. All departments that maintain or use the same data use the same service. This makes any redundancies transparent to users. Applications supporting a specific workflow will reference the same service. Each service communicates with the systems to which it is related. Users no longer need to switch between systems to complete a workflow. Data is naturally synchronized between systems. Services aligned in this manner enable true interoperability among the healthcare organization’s processes and people.As SOA is further adopted by the healthcare industry, collections of services, as well as specific services, will be available for use by a healthcare organization’s internal and external resources. This is possible because the origin of the service is transparent. Imagine adding a patient in one application and having that patient synchronized in all other systems without specific point-to-point interfaces and files being generated.Integrating data and interoperability are key requirements in evolving healthcare technology, and healthcare is behind the curve in adoption and investing in these technologies. Healthcare adopting these technologies and getting the right information in the right place at the right time can result in the following benefits:
Greater claim accuracy
Reduced medical errors
More accurate diagnosis
Increased access for patients
Reduced payment cycles
SOA takes on greater significance with the emergence of Healthcare Information Networks (HINs). A HIN is collaboration among the government, hospitals, specialty labs and pharmacies and payors to provide a network of data exchange that builds shared information, data repositories, applications and interfaces. The collective applications efficiently and accurately exchange key information across a spectrum of healthcare. Existing HINs are currently accomplishing the following:
Exchange of patients’ electronic medical record between providers to get key information like medical history, allergies, persistent problems, medications and active treatments
Referral exchanges
Electronic patient eligibility for a visit or procedure
Electronic claim filing and payment
Electronic ordering and monitoring of prescriptions
A consolidated repository of key healthcare information for disease control
A consolidated repository of data to support government-funded programs and benefits of those programs
A portal for the patient, providers and payors accessing patient data

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There is little debate regarding the benefits of implementing HINs. There is debate about the cost and the ROI of HIN investment. Part of the ROI equation is the cost of supporting the legacy applications and their participation in the network. If every time a new hospital, clinic, pharmacy, or government program was introduced a new point-to-point interface had to be introduced, it would not be feasible to build a HIN that has sustainable momentum. The cost of having to build a sequence of point-to-point interfaces for every system involved in the network would be unsustainable to all the practices and the software providers who support them.When using SOA for HIN integration, the cost of integration can be reduced significantly and a sustainable community value is created. To accomplish this goal, SOA services facing the HIN must accomplish the following:
Simplify and reduce the interface points to create data interoperability in the network
Address the architecture, infrastructure, software, and related business functions as a cohesive unit
Have services deployed internally and externally to support the needs of the organization and the HIN
Support legacy systems
Support current and evolving data standards
Be tested for scalability so larger external organization can use it
SOA is the direction IT is moving. SOA gets our focus off of a single application and what it needs to do and onto how this application fits into a bigger world. Whether that world is the organization or beyond, SOA enables the applications key components to become exposed to all who need them. Healthcare, which as an industry has can achieve great benefits from this kind of interoperability, is behind others in achieving it. Healthcare IT managers, and the software companies that support them, need to evaluate how they are incorporating SOA in their design plans.

Recession and Healthcare System in the US – Sustainable?

Recession and Healthcare System in the US – Sustainable?[EXTRACT]
The Health care system in the US, despite its glaring drawbacks, has managed so far to provide its patients with a reasonable quality or treatment. Of course, this is subject to a lot of qualifications. Yes, there were treatments that were denied that would have saved the lives. Yes, there were pressures on the doctors not to refer too many patients to the specialists. Yes, the insurance premiums were high. Yes, the doctors were charging proportionately high fees (read astronomical fees) for procedures and surgeries in Hospitals. So it will go on as usual. Or will it?The wild card factor has been created by the Recession. Simply put, there is no money with the patients. People are cutting down in every aspect. And health care is one aspect that people spend big on. But, if there is not enough money to keep the gas tank of the car full all the time, how and where are the customers going to get money for the elective surgeries? Or the pre-existing condition surgeries? Or those that have been denied?

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Medical Tourism could be on a upsurge. Those surgeries that cost an arm and a leg if performed in the USA, will cost about 75% less if done abroad by Medical Tourism. Compared to the price of a simple Knee Replacement in the US at about $38,000 or so, it would cost $7,000 or thereabouts abroad. Fertility Treatment is not covered under many plans, and the savings there are proportionate. Cosmetic treatment is another aspect which is not covered by any health plan. So is that the trend for the future, go offshore?It is not quite as simple. First off, Americans and people form the West in general are usually distrustful of foreign treatment, and some of it with good reason. Secondly, who would want to travel 8 hours by plane to get treatment?But in the different scenario where money is scarce, this actually could work. Checking the hospital to make sure it is of the right quality, taking testimonials from past patients, checking the qualifications of the Doctors: all these add up to somewhere near getting confidence to make that trip. And after shelling out monthly premiums of supplemental insurance, if the cost of a treatment is about $7000 or thereabouts, it could be a worthwhile bet. Only time will get in the final word! Contact me at

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Why the Healthcare System is Letting You Down

Why the Healthcare System is Letting You Down[EXTRACT]
As a practicing nutritionist, I’m used to clients visiting me with a common scenario: they have had some awareness of ‘eating healthy’ and have paid some, or often no, attention to this. Their health has gradually or suddenly deteriorated and they have sought the help of a medical professional. At some point, they have decided to seek ‘complementary’ assistance from me, either as well as or instead of the medication their doctors have prescribed.It is this reliance on the healthcare system that plays a huge role in the high number of diseases prevalent in Western cultures, in my opinion. Many people ignore guidelines about eating right, using supplements and exercising frequently, until their health begins to fail. Then they place their trust in a healthcare system that is understaffed, underfunded and grossly underperforming.While this attitude towards health will allow a person to enjoy extra hamburgers or soft drinks, often for decades, it is one that will ultimately cost a person their most valuable asset: their health.Arthritis is a good example. By the age of 60, nine out of ten people will suffer from arthritis, an agonisingly painful health problem that drastically reduces a person’s quality of life. The key to easing arthritis is to reduce inflammation, and there are safe, natural products that can achieve this. The healthcare system, however, will recommend anti-inflammatory drugs for arthritis sufferers, and these drugs will successfully reduce the pain and swelling. So, if a drug achieves the same result, why should a person put in the effort to find a natural alternative?

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Especially in the UK, where the NHS offers subsidised and often even free of charge medical prescriptions, where is the incentive to spend money on natural alternatives? Well, the anti-inflammatory drugs (both steroidal and non-steroidal classes) actually speed up the progression of the person’s arthritis, leading to non-steroidal anti-inflammatory drugs becoming a $30 billion industry in the US – $17 billion for the drugs themselves and $13 billion for treating the side effects caused by the drugs.If this is the best your healthcare system can offer you if you develop arthritis, do you really want to place them in sole control of maintaining or restoring your health?Arthritis isn’t a one off. Breast cancer, for example, is still accounting for a third of all female cancers and leading to around 12,000 deaths each year. And yet we are led to believe that the survival rate has increased over the last thirty years. The truth is that science has improved and it is possible to diagnose cancer earlier. Cancer sufferers are not living any longer, we are just aware of the disease at an earlier stage. In fact, many experts have found that breast cancer is occurring not only more frequently, but earlier in many women’s lives than it did twenty years ago.And what causes cancer? Dr John Lee, a medical expert, believes the major cause of breast cancer is excessive oestrogen that the body fails to balance with progesterone. This situation can be caused by stress, which raises levels of cortisol, a hormone which competes with progesterone. It can also be caused by xenoestrogens, which are commonly found in the environment in sources such as pesticides and plastics. Even more worrying given many people’s diets, it can be caused by insulin resistance, which is the result of a diet high in sugar and refined carbohydrates.

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Yet another reason why following a healthy diet is a good idea. But say you decided to head towards insulin resistance and excessive oestrogen led to a breast cancer diagnosis in the future – you could rely on the doctors, right? Well, the healthcare system continued to prescribe unopposed oestrogen to women on HRT for decades despite very clear evidence of the risks of doing so!Get smart. Take responsibility for your own health right now. Use the healthcare system as the last resort it’s intended to be, not an insurance policy to eat as you like.PS – Please, don’t fall into the trap of believing that if you have no symptoms of ill health, you are healthy. Cancer cells take between 5-30 years to grow in the body before they can be detected. It is never too early to take responsibility for your health.

The Healthcare System in France

The Healthcare System in France[EXTRACT]
The healthcare programme in France is bolstered by an insurance policy established in 1945 and provides cover for 80% of the population. It was originally created to cover those in employment to provide “sécurité sociale” or social security but has since been expanded to cover all citizens under the principle of “couverture maladie universelle” or universal health coverage.An overview of the healthcare infrastructure in FranceThe health care system in France is totally subsidized by the government by virtue of a fund and is therefore free. The fund is injected with personal income taxes from income earned by the working population and allows for the lack of income, the effects of wage changes and strives to offer all citizens the opportunity of having access to medical treatment when the need arises.Role of the StateThe state ensures that people have access to the health insurance scheme, the types of health care eligible for funding and oversees the role of entities involved. Public safety is the state’s priority and so is planning for the number of hospitals and sizes as well as the provision of specialized wards.

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Hospitals availableThere are two types of hospitals – the public sector hospitals and the private hospitals. The first category hospitals provide 65% of available beds. Because they are public, these hospitals are charged with the supply of continuous care for patients as well as being responsible for ongoing tutoring and training of both patients and staff. The second category or private hospitals are motivated by profit and they focus attention mainly on income earning activities such as surgery. They levy a charge for their services in order to obtain and augment their finances.Health professionalsDoctors and physicians are employed in the public and private sector hospitals and 97% abide by the provisions of the “Tarif de convention” or tariff references which set the amount of costs involved for the kind of medical treatment rendered. Health professionals as well as clinics and hospitals that choose not to conform to the tariffs, are required to display their prices, so people can decide whether or not to avail themselves to treatment.
In France, there are 3.37 doctors per 1,000 people.
Healthcare procedureInitially, the patient approaches the medicin traitant or general practitioner who has been registered as the physician responsible to coordinate the patient’s treatment. Should for any reason, the physician or substitute is another doctor may be consulted by the patient after consulting the cause d’assurance or staff at the register. The patient is at liberty to change his/her physician and in the process, retains the entitlement for reimbursement for the type of treatment given.

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Funding the healthcare schemeFunds for the healthcare system in France is obtained from the income of the working population with the following percentages:

An employee’s contribution towards his/her healthcare compensation is 21% made up of 12.5% contributed by the employer and 0.75% by the employee. The balance is obtained from a social security tax collected from the employee.

The contribution by the employer and employee along with the social security tax make up 60% of the health care fund remitted to government.

The balance of the fund is obtained from indirect taxes on alcohol and tobacco.

Can Care Management Software Solutions Save the US Healthcare System?

Can Care Management Software Solutions Save the US Healthcare System?[EXTRACT]
Healthcare innovation companies are just beginning to understand technology challenges that come with engaging patients with chronic diseases in care management and care transition. Many of healthcare IT vendors assumed that a simple access to portals with half-baked information and fragmented medical records will do the trick. Boy… were they wrong!For the past twenty years, the HIT industry has focused on developing software solutions exclusively for healthcare providers. These companies understand where the money comes from. HIT executives can tell you that patients will not spend a dime on their products. The great Google Health flop was testimonial to this hypothesis. Google, and in some extent Microsoft, naively assumed that patients are indeed interested in managing their own health data. The executives in these brilliant companies sat around large tables in large conference rooms and brainstormed about a population they didn’t know much about. They made some very false assumptions.For example, what patient wouldn’t like to access his/her data? Wouldn’t it be great if patients could have all their data in one place? Why wouldn’t we put patients in charge of managing their own data? How about making patients the custodians of their own information? These questions were logical but uninformed. Google, and again in some extent Microsoft, ignored some fundamental behavioral traits of the patient population.

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Under pressure from CMS and private insurers, healthcare organizations are being gently ushered out of the fee-for-service model into the pay-for-performance system which rewards providers for keeping patients healthy and out of hospitals. Finally, after all these years, the concept of patient-centered care model is gaining ground. Patient engagement is big contributing factor to the success of the patient-centered care model. Patient engagement means different things to different people. But whatever your definition of patient engagement might be, one thing is for certain: without patient participation, there is no patient engagement.Facing stage 2 Meaningful Use compliancy, ICD-10 and HIPAA 5010 requirements, healthcare organizations began to put pressure on their HIT vendors to come up with patient engagement solutions. Healthcare organizations needed solutions that would enable patients to access information online. This was a disaster waiting to happen. So, the executives in these HIT companies sat around large tables in large conference rooms and brainstormed about a population they didn’t know much about. And as a result, patient portals were adopted as the solution to the patient engagement problem. They made the same false assumptions that Google made. For example, why don’t we create patient portals and connect them to our own EMR and PM systems and allow patients to access their medical records, see their lab results, make appointments online, request refills and access patient education materials? Wouldn’t that be greater? We even throw in a mobile app.Well, here is the problem: small number of patients has access to computers and Internet. Many of these patients will not login to portals. Patients who are computer savvy require the least amount of engagement and intervention. Computer literate patients take good care of themselves, take their medications on time, make their appointments and stay out of hospitals.Patient portals leave behind those who need engagement the most. Elderly and low-income patients with chronic diseases have the highest rate of hospital readmissions. This patient population will not touch patient portals. They do not use gadgets, do not have access to smart phones, do not have internet and do not own computers. The same is true for many behavioral health patients. If accessing information through patient portals is our only solution to patient engagement, then shame on us.

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Elderly and low-income patients are the most venerable and often left behind when it comes to the use of technology in healthcare. As HIT innovators, it is our outmost responsibility to design products that especially accommodate this patient population. We need to walk away from the concept of accessing information and start thinking about ways to deliver information and education to patients. In addition to patient portals, we must develop products that are simple, cost effective, holistic and easily available to elderly and the low-income patients. We must develop multifaceted technology solutions that connect with patients based on the best method of communication available to the patient. Our patient engagement strategy must be built on patients’ requirements, not ours. The success of the patient-centered care model on the technology side depends heavily on availability of solutions that cover patients from all walks of life without any unintentional favoritism towards certain race, gender, income and age.