Partners Healthcare uses InterSystems Ensemble to integrate internal and external EMRs
Partners HealthCare System:
Ensemble在设计和实行大规模分配业务系统的使用
随 着一系列的兼并，Partners HealthCare System已然成为一家具有几十亿美元横跨整个马萨诸塞州的医疗保健提供者，它由两家享誉世界的医疗机构：波士顿Brigham and Women's医院和马萨诸塞州总医院共同组建而成，并且它毗邻著名的哈佛大学医学院。Partners拥有15家为公众提供一整套高质量医疗保健服务的 机构。
项目简述 :
Partners HealthCare System最早应用InterSystems的技术是Bringham and Women's医院的BICS 。这是在美国首次应用电脑化医嘱录入 (CPOE) ，已有 20 年的历史。现如今，Partners HealthCare System 包括EMPI, CPOE, LMR和CDR在内有一百多个应用系统都是在InterSystems的技术上建立起来的。
InterSystems的技术在这些运用中是一种基础结构，起到了核心作用，服务于35000个终端用户和5000 个多机终端用户。
Partners HealthCare要求从InterSystems那儿获得最高可靠性、最佳性能和可扩展性的产品，该公司的首席技术官Steve Flammini说：“这三方面容不得讨价还价。”
项目的技术细节 :
35000个工作站中的一半使用了浏览器，整个网络由6台InterSystems的数据库服务器和11台应用服务器组成，每一台服务器都运行Windows2000 。
InterSystems 的企业缓存协议（ECP）作为17台服务器之间的网间协议。 ECP支持载荷最大的服务器，凡是任何符合TCP协议的连接都可分享应用代码和数据。从数据 /Cache同步化，服务器死机的恢复到可靠的网络业务，ECP都提供了一系列的有力保证。
InterSystems 和合作伙伴自有技术相结合使这些应用程序享有100%的正常运行时间。这通过一个抽象层向服务器发送来自客户应用系统的各种要求，该抽象层运用建立在系统 可用性和系统活动的算法来决定哪一台应用服务器最能解决客户遇到的问题。用户和应用之间的每一个要求都被完全记述下来，任何一个应用服务器能够处理任何用 户的问题。如果其中一台服务器瘫痪了，那么它的要求会被发送到一台新的服务器上而不会使用户的工作出现停顿。
平时，Partners每天合计要处理大约40亿次数据库访问。举一个很罕见的例子，Partners有次一天受理了 240亿次的访问而没有发生任何服务质量下降。
尽管使用了如此大规模的多台多站点服务器，整个网络只需四个全职的数据库管理人员进行维护。
实施的时间和地点:
时间 : 1985 年
地点 : 美国马里兰州，波士顿市
Partners HealthCare, based in Boston, Massachusetts, is an innovative integrated healthcare network that includes multiple major hospitals with more than 7,000 physicians attending to four million outpatient visits and 160,000 admissions per year.
Partners’ institutions, including Massachusetts General Hospital and Brigham and Women’s Hospital, consistently rank among the best hospitals in the United States, according to U.S. News and World Report. To maintain its leadership status, Partners establishes enterprise-wide, CEO-supported corporate initiatives under the banner of “High-Performance Medicine.”
One of these initiatives includes electronic medical record (EMR) adoption by all community physician practices in the Partners system. To achieve this goal, Partners offers these physicians full, Web-based access to its internal EMR. But first, Partners must rapidly create interfaces (programs that handle data translation and transmission between systems) to the community physicians’ practice management and scheduling systems, and integrate that data into its EMR. The initiative also gives participating physicians access to more than three terabytes of data in Partners’ clinical data repository (CDR). InterSystems Ensemble is a key enabling technology for this initiative.
High-performance HL7 messaging and data transformation
In this application, Partners uses Ensemble as a hub to integrate and coordinate the flow of patient information between community-based medical practices and the Partners EMR and CDR systems. Ensemble also integrates this information with Partners’ enterprise master patient index application to ensure consistent identification of patients between the external and internal medical record systems.
Ensemble accepts HL7 “ADT” (patient administration), and “SCH” (schedule) message types from the community physicians’ practice management systems. It then determines which type of message was received, and transforms the message, if necessary, to the Partners standard HL7 message formats. Ensemble also validates the content of the ADT messages before passing the information on to the master patient index system. If a message does not pass validation, it is rejected and Ensemble sends an email alert to the appropriate resource. The transformed SCH messages are sent on to the Partners EMR.
The Ensemble application also processes HL7 “LAB” messages from vendors used by the community-based medical practices. Based on message content, Ensemble breaks these messages into laboratory, microbiology, and pathology components. Ensemble transforms the components into the standard CDR HL7 formats, and then transmits the messages to Partners’ CDR.
Partners now has more than 320 community physicians online and integrated with its EMR, submitting tens of thousands of ADT, SCH, and LAB messages per day, using several different practice management systems. “This project would have taken much longer without Ensemble’s rich HL7 support,” says Partners CTO Steve Flammini. “Ensemble has given us tremendous flexibility with data transformations, and made us much more agile in delivering on this type of integration.”
Rapid and flexible interface development
Partners uses Ensemble’s graphical Business Process Language (BPL) editor to quickly build the business logic of its interfaces to community-physician practice management systems and third-party laboratory systems. The logic includes integration of this “external” patient information with Partners’ enterprise master patient index and EMR, and complex data transformations. Explains Flammini, “Ensemble’s visual data transformation editor enables us to create complex, XML-based transformations in a matter of hours. This is key as most of the work in creating interfaces involves changing one vendor’s data formats into another’s.”
Once the interface to a system has been created it becomes like any other native object in Ensemble’s object-oriented development environment. It can be easily “sub-classed” and modified for connection to new practice management or laboratory systems, instead of developers having to write each new interface from scratch.
In practice, it’s frequently necessary to modify interfaces, while they are in use, to add or alter transaction codes and to add new data mappings. Partners leverages Ensemble’s architecture and flexibility to enable interface analysts, instead of developers, to perform these modifications via a browser-based user interface. The modifications are applied immediately to the running system. This has freed time for developers to focus on rapidly integrating new physician practice management systems with Partners’ EMR, and to meet the organization’s aggressive goals for EMR adoption levels. “Ensemble has helped propel this entire effort,” says Cindy Bero, chief information officer at Partners Community Healthcare, Inc. “Ensemble enables quick development of integration points with the small physician practices, and has drastically shortened the time it takes to bring these practices online.”
Ready for growth with high performance and scalability
Since this Ensemble project integrated its first community-physician practice management system in August 2005, there has been no unplanned downtime, and no data integrity issues. “Uptime and reliability of Ensemble has been superb,” says Flammini. “Based on our experience so far, and on our experience with InterSystems products throughout our organization, we expect this Ensemble platform to easily accommodate rising message volumes as we bring more medical practices onboard.”