Giving patients the best possible care is never easy
when details of their symptoms, diagnoses and treatment lie
scattered across a myriad of diverse paper-based documents and
disconnected applications that cannot 'talk' to each
other.
It is a struggle faced by many healthcare providers, but it is
one that Beaumont Hospital,
one of the busiest general hospitals in Ireland, has begun to
address using a
service oriented architecture (SOA).
"The hospital's IT infrastructure has been assembled over the
course of the last 18 years, with multiple stovepipe applications
and no single application model," says Tony Kenny, the hospital's
IT project manager. "As a result, we had a fragmented view of our
patients, clinical information, administrative systems, and other
critical systems."
A major problem, he adds, was the sheer volume of paper-based
information the hospital kept on patients. This included vast
amounts of handwritten clinicians' notes, conforming to no
particular format or style, and a range of charts that nurses
filled in by hand.
Patient files one-inch thick were not uncommon and it was
extremely difficult for medical staff to locate specific pieces of
patient information within the files. The paper records also made
it difficult to share patient details securely with external
parties, such as referring GPs and consultants based in other
hospitals.
To tackle both problems - paper-based records and disconnected
applications - the Beaumont Hospital's IT team saw an SOA as the
way forward.
The team hoped the architecture would let it integrate new
applications to eliminate the need for paper with existing legacy
applications that continued to provide a valuable range of
functions. Not only that, says Kenny, but an SOA would enable
integrations to be introduced in a controlled fashion and in such
as way as to increase the productivity of IT resources.
The first project along these lines was set up for the
hospital's epilepsy department, which needed an integrated system
to record all encounters with a patient, provide a consolidated
view of care, and support vital research work.
The first move was to standardise on BEA Systems'
WebLogic platform in order to loosely couple two disparate
applications: an electronic health records system, which provided
document management, security and auditing of patient records and
an epilepsy disease management system, which captured all
encounters with a patient, implemented clinical workflow and
handled clinic scheduling, administration and reporting.
Having executed that integration, WebLogic now provides the
foundation for an SOA in which both applications are linked to
Beaumont's main hospital information system.
Basically, the electronic health records repository offers a
range of re-usable web services for maintaining core elements of a
patient's record. The web service can retrieve patient demographic
information but hide from the calling application the detail of
where the information is stored or comes from. This single,
aggregated access point to patient information does away with the
need for information replication across different applications.
The SOA has transformed the value of Beaumont Hospital's HP9000
mainframe environment. The web services have allowed the mainframe
to become a 'heritage' system that will deliver even more value as
joined-up services are introduced, says Kenny. It also reduces the
risks of future migrations and upgrades.
"This best-of-breed application infrastructure platform blends
both integration and development, allowing us to extend the
lifespan of existing applications as well as serving as a
foundation for new applications on our SOA," says Kenny.
Although initially deployed in the epilepsy department, the
approach provides a re-usable template for other disease types,
Kenny says. And all participants in the care processes, including
hospital staff, GPs and community-based care workers, can log onto
a clinical portal to gain a consolidated, real-time view of a
patient's health record.
"We are steadily creating a hospital without walls," says
Kenny.
What you need for a successful SOA >>
Layman's guide to web services >>
IT in the NHS >>