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SOA Best Practices: Case Study

Support Real Healthcare Reform: Start Using HL7 v3

Dutch Healthcare uses HL7 v3 to build Health Information Exchange

Health Care at Cloud Expo

We all know that technology is key to reducing health care costs, eliminating dangerous errors, and eventually providing coverage for all.  I like learning from others, so while we consider ourselves innovative, there is no point in repeating mistakes made by others.  Here's a fact motivating the Dutch -- one of the leading nations in using modern technology (SOA, XML. HL7v3, Schematrons, Virtualization, Cloud computing) for solving their heath care problems:

"Currently some 90.000 people (out of a population of 16 million) are hospitalized yearly due to wrong medication." 

Fourth Grade Math shows that we, in the US, may be hospitalizing (300/16 x 90,000) over 1.6 Million individuals due to wrong medication.

A review of the Dutch Health Care Initiative that has evolved for almost a decade shows that they are on the leading edge of deploying a useful Health Information Broker (HIB) deployment.  They have weathered major political headwinds in developing a visionary HIB and have used Health Level 7 v3  (HL7 v3) - an ANSI health care standard modeling clinical, administrative, pharmacy, medical devices and imaging domains - as a cornerstone of their message exhange strategy.

The Dutch government's aggressive health care initiative in building a nationwide Health Information Broker (HIB) can serve as a good model for the current US Administration that is focused on transforming US health care through nationwide electronic medical records (EMR) as one of its key policy initiatives.  There's is much to learnt from the Dutch initiative beyond what motivates them to build there healthcare technology platform.  One successful choice that they have made is of aggressively adopting XML/SOAP based models hosted in a Cloud computing environments.  Whereas we are still working with EDI centric HL7 v2, the Dutch are deploying XML-based HL7 v3 using Cloud based models where a health care entity can tie into the HIB using XML/SOAP. 

This article give a flavor for technology artifacts being deployed by the Dutch, including HL7 v3 messages using Schematrons.

In the Dutch health care technology infrastructure - based on Web Services enabled HL7 v3 specification - message exchanges take place between Health Information Systems via a HIB that maintains the necessary relationships between health care parties. The HIB is an intelligent message intermediary between entities involved in health care including providers, payers and pharmacies. The HIB ensures high quality and validity of health care information that reduces errors caused by manual information processing. Crosscheck Networks SOAPSimulator (a Cloud-Service Simulation Product) and SOAPSonar(a SOA Testing Product) are an integral part of the HIB to the extent that health care parties can only tie into the HIB if they meet message viability requirements set and enforced by Crosscheck SOAPSimulator at the HIB.

The HL7 v3 message exchange criteria is set at the semantic level as well as the transmission level. With sophisticated use of standards such as WS-I Basic Profiles and Schematrons, custom health care semantic requirements and message transmission requirements are addressed. Schematron assertions and rules provide a flexible way of capturing business domain specific rules that a message must meet for the message to be valid. This improves message interoperability between health care parties. Schmatrons enable business rules that can then be enforced on the HL7 v3 messages flowing through the Dutch HIB. SOAPSimulator is deployed as the message validity enforcer for HL7 v3 messages. As new health care parities get ready to integrate with the Dutch HIB, they must first satisfy the rules set in SOAPSimulator via Schematrons that check the correctness and validity of the HL7 v3 request and responses. Such checks serve as a pre-requsite for production-level integration and reduce interoperability issues between health care parties. 

Figure 1: Configuring Schematron 1.5 Criteria Rules for HL7 v3 in SOAPSimulator

 Figure 1: Configuring Schematron1.5 Criteria Rules for HL7 v3 in SOAPSimulator

Figure 2: Configuring ISO Schematron Criteria Rules for HL7 v3 in SOAPSimulator

Figure 2: Configuring ISO Schematron Criteria Rules for HL7 v3 in SOAPSimulator

In addition to checking against SOAPSimulator checks against a number of additional criteria to ensure that the right identity and security constructs are being used in the message requests.

Conclusion

Building a Health Information Broker is crucial at state and national level.  An on-ramp methodology for tieing in clinics, pharmacies, insurance companies, and diagnostic laboratories to a central HIB requires a strict way of ensuring that the messages being sent to the HIB are standards compliant.  Such compliance is far more deterministic and cost effective through XML/SOAP, WS-I and Schematrons using XML/SOAP-based messaging over HTTP-type protocols, than through point-to-point, proprietary EDI-based networks (VANs) that cannot scale with increasing demands.  Health care ecosystem should be significantly incentivize to adopt HL7 v3.  HIBs based on flexible, interoperable and manageable standards should be developed leveraging cloud-based environments for both ease of integration across many partners and dynamic scaling that keeps up with national health care processing demands.

References
1) Implementing Web Services in Dutch Health

2) Electronic Medical Records and Obama's Economic Plan

3) http://www.hl7.org/

4) Web Service Enablement of HL7 v3

5) An Introduction to Schematron

6) Crosscheck Networks SOAPSonar and SOAPSimulator

 

 

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Mamoon Yunus is an industry-honored CEO and visionary in Web Services-based technologies. As the founder of Forum Systems, he pioneered XML Security Gateways & Firewalls and was granted a patent for XML Gateway Appliances. He has spearheaded Forum's direction and strategy for eight generations of award-winning XML Security products. Prior to Forum Systems, Yunus was a Global Systems Engineer for webMethods (NASD: WEBM) where he developed XML-based business integration and architecture plans for Global 2000 companies such as GE, Pepsi, Siemens, and Mass Mutual. He has held various high-level executive positions at Informix (acquired by IBM) and Cambridge Technology Group.

He holds two Graduate Degrees in Engineering from MIT and a BSME from Georgia Institute of Technology. InfoWorld recognized Yunus as one of four "Up and coming CTOs to watch in 2004." He is a sought-after speaker at industry conferences such as RSA, Gartner, Web Services Edge, CSI, Network Interop, and Microsoft TechEd. Yunus has the distinction of showcasing Forum Systems' entrepreneurial leadership as a case study at the MIT Sloan School of Management. He has also been featured on CNBC as Terry Bradshaw's "Pick of the Week."