designing high performance xds registries/repositories ihe interoperability showcase – himss 2006...
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Designing High Performance XDS Registries/Repositories
IHE Interoperability Showcase – HIMSS 2006
Joe GallantProduct Manager
Presentation Overview
• XDS has the potential to serve as the foundation for aXDS has the potential to serve as the foundation for across-enterprise EHR supporting advanced functionality.cross-enterprise EHR supporting advanced functionality.
• HL7 CDA is central to XDS achieving its potential.HL7 CDA is central to XDS achieving its potential.• HL7 CDA documents are objects.HL7 CDA documents are objects.• Relational technology is ill suited to storing & retrieving objects.Relational technology is ill suited to storing & retrieving objects.• Post relational database technology is ideal for high Post relational database technology is ideal for high
performance, massively scaleable EHR systems.performance, massively scaleable EHR systems.• Modern application integration platform is critical to the success Modern application integration platform is critical to the success
of an advanced function EHR system.of an advanced function EHR system.
XDSCross-Enterprise Document Sharing
Document Consumer
Retrieve Documents
Query Documents
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide&RegisterDocument Set
Register
Document Set
Actors and Transactions
The Case for HL7 CDA … as the “standard” content container for XDS
• CDA facilitates the creation and broadest accessibility of CDA facilitates the creation and broadest accessibility of attested, attested, human-readablehuman-readable, clinical documents., clinical documents.
• CDA accommodates non-standard clinical documents, CDA accommodates non-standard clinical documents, proprietary formats and images.proprietary formats and images.
• CDA provides a framework for the incremental growth in the CDA provides a framework for the incremental growth in the amount and precision of structured, vocabulary-bound amount and precision of structured, vocabulary-bound clinical information exchanged. clinical information exchanged.
– Low barrier to entry; simple things are easy to do.Low barrier to entry; simple things are easy to do.– Promotes longevity of information.Promotes longevity of information.– Enables the finest level of semantic granularity in Enables the finest level of semantic granularity in
standards-based representation of clinical information standards-based representation of clinical information for applications that can support it.for applications that can support it.
An HL7 CDA document …
is a complete information objectCDA characteristics
• Human Readability – Doctor and Patient Friendly• Persistence & Stewardship – Tangible & possessible• Wholeness & Context – Stand alone if necessary• Potential for authentication – Genuine, Signed, Private
as well as encryption and digital rights management
CDA provides an incremental path forward from human-readable documents to computable semantic interoperability
IHE Roadmap: Building upon XDS
XDS is a foundation for cross-enterprise EHR Document Content Integration Profiles defined for a specific domain of care practice: document format, content vocabularies, templates, etc.).
Process Flow Profiles additionally define actors and transactions to support specific processes (ePrescribing, eReferral, eBooking, etc.). These messages should reference XDS managed documents for persistent artifacts.
XDSCross-Enterprise Document Sharing.
Document ContentIntegration Profiles
Workflows MessagingIntegration Profiles(e.g. ePrescription)
Acc
ess
Con
trol
The “Real” Requirements are for an EHR based on HL7 CDA and IHE XDS Framework
• High performance High performance OLTPOLTP application application on aon a massive massive repository of complex objectsrepository of complex objects
– Must support SQL queries for retrieval of individual Must support SQL queries for retrieval of individual documents, as well as OLAP style for researchdocuments, as well as OLAP style for research
• Complex application integration projectComplex application integration project– Messaging: receive, parse, Messaging: receive, parse, persistpersist, transform, transmit, transform, transmit– Business Process Management Business Process Management – Composite ApplicationsComposite Applications– Business Activity Monitoring (BAM)Business Activity Monitoring (BAM)
Requirement
High Performance
High performance On-Line Transaction Processing (OLTP) on a massive repository of complex objects, serving tens of thousands of concurrent users
However...
““Using tables to store objects is Using tables to store objects is like driving your car home and like driving your car home and then disassembling it to put it in then disassembling it to put it in the garage.the garage. It can be assembled It can be assembled again in the morning, but one again in the morning, but one eventually asks whether this is eventually asks whether this is the most efficient way to park a the most efficient way to park a carcar..”” - - Esther DysonEsther Dyson
Objects / Relational Mismatch
UserUserInterfaceInterface LogicLogic TraditionalTraditional
DatabaseDatabase
ObjectsObjects ObjectsObjects TablesTables
Expensive TransformationExpensive TransformationImpedance MismatchImpedance Mismatch
Expensive TransformationExpensive TransformationImpedance MismatchImpedance Mismatch
Objects in the Database
UserUserInterfaceInterface LogicLogic ObjectObject
DatabaseDatabase
ObjectsObjects ObjectsObjects PersistentPersistentObjectsObjects
Consistent Representation End to EndConsistent Representation End to EndConsistent Representation End to EndConsistent Representation End to End
Post Relational Architecture
Multi-DimensionalMulti-DimensionalStorage ManagerStorage ManagerMulti-DimensionalMulti-DimensionalStorage ManagerStorage Manager
ObjectsObjectsObjectsObjectsSQLSQLSQLSQL
Performance& Scalability
ProgrammaticAccess for OLTP
Query & AggregateAnalysis
Post RelationalUnified Data Architecture
Storage ManagerStorage ManagerStorage ManagerStorage Manager
ObjectsObjectsObjectsObjectsSQLSQLSQLSQL
DictionaryDictionaryDictionaryDictionary
• One databaseOne database
• One definition of the dataOne definition of the data
• Two access paths reference Two access paths reference the same definitionthe same definition
Eliminates the overhead ofobject / relational mapping
InterSystems’ CachéObject and Relational Connectivity
Multi-DimensionalMulti-DimensionalStorage ManagerStorage ManagerMulti-DimensionalMulti-DimensionalStorage ManagerStorage Manager
CachéCachéObjectsObjectsCachéCachéObjectsObjects
CachéCachéSQLSQL
CachéCachéSQLSQL
Industry-standardrelational access
High-performanceHigh-performancelinks to all majorlinks to all major
object architecturesobject architectures C++
C++
C++
C++
Java
Java
Java
Java
COM
COM
COM
COM
XML
XML
XML
XML
SOAP
SOAP
SOAP
SOAP
EJB
EJB
EJB
EJB
.Net
.Net
.Net
.Net
Perl
Perl
Perl
Perl
Pyth
onPy
thon
Pyth
onPy
thonODBCODBCODBCODBC JDBCJDBCJDBCJDBC
Single Data DefintionOptimized For High
Performance
Optimized To MinimizeContention
Transactional Bit Map Indexing
Excellent retrieval performance for Excellent retrieval performance for complex queriescomplex queries
Excellent retrieval performance for Excellent retrieval performance for complex queriescomplex queries
Excellent update performance for Excellent update performance for core transaction processing applicationscore transaction processing applications
Excellent update performance for Excellent update performance for core transaction processing applicationscore transaction processing applications
Real-Time AnalyticsReal-Time Analytics
Requirement
Application Integration
• Complex application integration project:Complex application integration project:– Receive, parse, Receive, parse, persistpersist, transform, transmit , transform, transmit XMLXML– Implement cross-enterprise Business Process Implement cross-enterprise Business Process
Management (BPM), also known as workflowManagement (BPM), also known as workflow– Build and run Composite Applications – to Build and run Composite Applications – to
support browser access to heterogeneous datasupport browser access to heterogeneous data– Perform Business Activity Monitoring (BAM) – for Perform Business Activity Monitoring (BAM) – for
policy making and public health management, policy making and public health management, including disease surveillance and bioterrorism including disease surveillance and bioterrorism defensedefense
Integration Models
Composite Composite ApplicationsApplications
DataDataCoordinationCoordination
Business ProcessBusiness Process/ Work Flow/ Work Flow
Business ActivityBusiness ActivityMonitoringMonitoring
Universal Business Integration PlatformUniversal Business Integration Platform
TechnologyTechnologyApplicationApplicationDataData
Convergence
Increasingly projects span integration models …
DataData
Coordi
natio
n
Coordi
natio
n
Compo
site
Compo
site
Applica
tions
Applica
tions
Business
BusinessProcess
ProcessManagement
Management
Business
BusinessActivity
Activity
Monitoring
Monitoring
OneOne ArchitectureArchitecture
StorageStorageM
anag
emen
tM
anag
emen
t
Deve
lopm
ent
Deve
lopm
ent
InterSystems EnsembleUniversal Business Integration Platform
OneOne• AbstractionAbstraction
LayerLayer• ExecutionExecution
EngineEngine• RepositoryRepository• Development Development
EnvironmentEnvironment• Management Management
EnvironmentEnvironment
Convergence
Driving a need for Driving a need for rich platforms that rich platforms that seamlessly combine seamlessly combine application application development and development and integration integration
Analyti
cs
Analyti
cs
Orches
tratio
n
Orches
tratio
nDevelopment
Development
Integration
Integration
See Gartner’s research on Application Platform Servers (APS)
Conclusion
• Realizing the vision of clinical document sharing, and Realizing the vision of clinical document sharing, and patient care process management across multiple unrelated patient care process management across multiple unrelated healthcare provider enterprises encompassing regional or healthcare provider enterprises encompassing regional or national populations will require:national populations will require:
– HL7 CDA as the standard “container” for content,HL7 CDA as the standard “container” for content,– Post relational database technology optimized for OLTP Post relational database technology optimized for OLTP
on complex objects, with support for SQL queries,on complex objects, with support for SQL queries,– Application integration platform middleware supporting:Application integration platform middleware supporting:
• Robust store and forward messagingRobust store and forward messaging• Business Process Management orchestration (i.e. workflow)Business Process Management orchestration (i.e. workflow)• Composite ApplicationsComposite Applications• Business Activity MonitoringBusiness Activity Monitoring
• InterSystems’ Ensemble meets and exceeds InterSystems’ Ensemble meets and exceeds requirements for a high performance, requirements for a high performance, advanced functionality, massively scaleable, advanced functionality, massively scaleable, cross-enterprise EHR.cross-enterprise EHR.
Conclusion
Designing High Performance XDS Registries/Repositories
IHE Interoperability Showcase – HIMSS 2006
Joe GallantProduct Manager