Comprehensive patient view, communication and data sharing, and population health management are key components

Federal agencies have been incenting healthcare providers to leverage their electronic health records (EHRs) to get patients involved in the management of their care. Most organizations, however, haven’t moved beyond patient engagement as an item to be checked off in order to receive meaningful use incentive funding.

Typically, providers rely on patient portal functionality that healthcare IT vendors package with their EHR products. While fulfilling requirements of meaningful use, thes

A business case for the transition from eGate to InterSystems EnsembleÆ From interface engine to integration platform Healthcare IT is evolving so rapidly that the term "HL7 interface engine" may soon become extinct. Forces driving this evolution include:

• Government and markets pushing hospitals and integrated delivery networks (IDNs) toward broad-based health information sharing, within and between organizations
• Clinical and administrative staffs needing more information, faster, to improve patient care and control costs
• The need for real-time business intelligence capability to measure progress

Abstract

A benchmark of a real-world application, which loads data into a data warehouse for subsequent analysis, was performed. To conduct the benchmark, one module of the Oracle-based application was replicated in Caché ObjectScript. Only about 40 person-hours of work was required to duplicate the functionality of the original module in Caché.

The time required to complete certain tasks was measured running the Caché-based module, and was compared to existing data. The Caché application was five times faster, taking only 286 minutes to complete the data loading and filtering tasks that took 14

Introduction

With the growing popularity of smart phones and tablet computers, consumers are coming to expect that software solutions will be presented as "apps" on their mobile devices. The challenge for most application developers is to find ways to make their existing solutions run on modern mobile platforms without incurring the delay and cost of a complete rewrite.

This paper will describe the approach taken by HAPO Community Credit Union when they adapted their online banking application, developed on InterSystems' high performance object database system called Caché, for use with mobile d

Executive Summary

For twenty years or more, large financial institutions have been locked in a battle between the need for extremely high performance transaction processing and the demands of downstream applications that can deliver competitive advantage if they can get real time access to this transactional data. When individual database servers could no longer handle simultaneous transaction and query workloads, many firms turned to replication, offloading data access onto read-only copies of production databases. While this strategy worked well for smaller volumes, greater data volumes (year

Executive Overview

The healthcare software market offers exciting and significant growth opportunities. Yet, while some healthcare software companies enjoy incredible growth, others under-perform, languish, or even fail. There are many criteria for success in this market, but two are particularly critical:

• Breakthrough solutions: In every part of the world, healthcare buyers are demanding broad and deep new capabilities that eliminate cumbersome processes, deliver breakthrough results, and advance the missions of their rganizations.

• Connected care capabilities: the future of healthcare depends on

InterSystems Caché 2015.1 soars from 6 million to more than 21 million end-user database accesses per second on the Intel® Xeon® processor E7 v2 family compared to Caché 2013.1 on the Intel® Xeon® processor E5 family

Overview

With data volumes soaring and the opportunities to derive value from data rising, database scalability has become a crucial challenge for a wide range of industries. In healthcare, the rising demands for healthcare services and significant changes in the regulatory and business climates can make the challenges particularly acute. How can organizations scale their databases

Introduction

Australia's recent launch of the Personally Controlled Electronic Health Record (PCEHR) - a significant step towards establishing a national e-Health infrastructure - has simultaneously provided a boost to shared Electronic Patient Record (EPR) projects and delivered a wake-up call to healthcare providers about their readiness for connected care initiatives. In countries around the world, the era of connected care is here.

The PCEHR has increased both the push and pull factors that will lead to widespread shared EPR adoption. Some organisations - such as state health departments - w

Introduction

Impedance mismatch is a term commonly used to describe the problem of an object-oriented (OO) application housing its data in legacy relational databases (RDBMS). C++ programmers have dealt with it for years, and it is now a familiar problem to Java and other OO programmers.

Impedance mismatch arises from the inherent lack of affinity between the object and relational models. Problems associated with the impedance mismatch include class hierarchies binding to relational schemas (mapping object classes to relational tables), ID generation, concurrency, as well as other problems descr

Introduction

In healthcare, information accessibility can impact the outcome of a medical decision, or the success of a bundled payment initiative. To ensure that the right information is available at the right place and time, healthcare organizations typically have used HL7® interface engines to share data among clinical applications. But the demands on healthcare information technology are changing so rapidly that these simple engines are no longer sufficient.

• New data sharing and interoperability standards and protocols arise and evolve continuously
• The volume, variety, and velocity of data —

Introduction

In today's world, an ever-increasing number of purchases and payments are being made by credit card. Although merchants and service providers who accept credit cards have an obligation to protect customers' sensitive information, the software solutions they use may not support "best practices" for securing credit card information. To help combat this issue, a security standard for credit card information has been developed and is being widely adopted.The Payment Card Industry (PCI) Data Security Standard (DSS) is a set of guidelines for securely handling credit card information.

Executive Summary

An accountable care organization (ACO) is a group of providers that are collectively responsible for the total cost and quality of care provided to a specific population of patients. Together, the group assumes risk and shares rewards. As with high-performing organizations in other industries, the hallmarks of ACOs are quality measurement and continuous improvement.

Like other care models that are experiencing changing reimbursement structures, ACOs require new competencies to coordinate the delivery of care, and to manage populations, finances and risk. Issues of governance, l

Introduction

Software services, in a service-oriented architecture (SOA), can be used again and again in many different business processes, making for a very flexible, efficient, and vibrant business and information technology infrastructure. Providing, of course, that IT has the right platform in place for modeling business processes and implementing the SOA. Using the InterSystems Ensemble product as an example, this paper examines two key technologies that are absolutely essential for successful SOA implementation, but missing from most SOA development platforms. Abstraction and Data Persist

Introduction

Tying quality of care to reimbursements has been proposed in the last few years as a solution to increase the efficiency and quality of care and replace the costly and ineffective fee-for-service model. Provisions within the Affordable Care Act of 2010 have given accountable care organizations (ACOs) the foundation upon which to build real-world, value based care models. As a result, healthcare organizations across the country are exploring what they must do in terms of restructuring and realigning their operations in order to manage costs efficiently, and to improve outcomes and o

Changes in reimbursement approaches in healthcare are unleashing unprecedented business forces in the industry. As a result, providers are consolidating into larger integrated delivery networks, hoping to achieve economies of scale and operating efficiency.

But it’s difficult to truly integrate organizations, and that’s particularly true when it comes to getting disparate information systems to work together. Overall, consolidation has become more difficult because providers now have a variety of IT systems in place. Because these IT systems have become mission critical for healthcare organizat

Introduction

To overcome the performance limitations of traditional relational databases, applications - ranging from those running on a single machine to large, interconnected grids - often use in-memory databases to accelerate data access. While in-memory databases and caching products increase throughput, they suffer from a number of limitations including lack of support for large data sets, excessive hardware requirements, and limits on scalability.

InterSystems Caché is a high-performance object database with a unique architecture that makes it suitable for applications that typically u

Introduction

This document is intended to provide a survey of various High Availability (HA) strategies that can be used in conjunction with InterSystems Caché, Ensemble, and HealthShare Foundation. This document also provides an overview of the various types of system outages that can occur, as well as how each strategy would handle a given outage, with the goal of helping you choose the right strategy for your specific deployment.

The strategies surveyed in this document are based on three different HA technologies:

• Operating System Failover Clusters
• Virtualization-Based HA
• Caché Database Mirrori

Introduction

With the maturation and wide acceptance of Java, object-oriented programming has moved to the foreground of the application development landscape. Because of their rich data models and support for productivity-enhancing concepts such as encapsulation, inheritance, and polymorphism, object technologies like Java, C++, and COM, are favored by today's application developers.

However, much of the world's data still resides in relational databases. Developers of database applications (that is, any application that accesses stored data) often find themselves fighting impedance mismatch: t

Introduction

If the administrators responsible for securing applications had their way, passwords would be long complex strings of random symbols, and users would memorize different passwords for every application they use. But in the real world, few people are capable of such prodigious feats of memory. The typical user can only remember a handful of relatively short passwords.

That’s why an increasing number of applications are requiring two-factor authentication. In addition to asking for a password (something the user knows), applications can be configured to ask for a supplementary password

Introduction

In healthcare, the outcome of a life-or-death decision can depend on the available information. To help deliver the right information at the right time and place, healthcare organizations traditionally have used HL7 interface engines to share data among clinical applications.

But the world of healthcare information technology is changing so rapidly thatHL7 interface engines are no longer sufficient. The technology landscape now includes new protocols and architectures, and the business environment has changed as well. Health information is being shared across broader populations of

Using Intel® Advanced Encryption Standard New Instructions with InterSystems Caché Substantially Improves Encryption Performance and Reduces Computational Overhead

Executive Summary

Financial services companies have an ever-growing need to encrypt databases containing sensitive customer and trade data. However, using encryption on these databases can require significant computational resources, potentially impacting trading latencies. Intel® Advanced Encryption Standard New Instructions (Intel® AES-NI), included in the Intel® Xeon® processor 5600 and E5 product families (and more recent Inte

Executive Summary

InterSystems HealthShareÆ and InterSystems EnsembleÆ both provide a rapid integration and development platform with built-in capabilities for the high-speed processing of HL7 messages. For the purposes of HL7 v2 message routing the two products are equivalent in performance. For brevity, this document will just say Ensemble in many places but it should be taken to apply equally to both products.

We have recently completed a performance and scalability benchmark of Ensemble version 2015.1, focusing on HL7 version 2 messaging. This document describes the observed characteristics,

Business Transformation for Application Providers

Introduction

InterSystems regards the enterprise service bus (ESB) as a business transformation engine for application providers.

Why the emphasis on transformation? For many application providers meeting today’s customer demands will require a change in business model. Customers are looking for unified solutions instead of application portfolios from vendors. They want these solutions delivered on their device of choice, from desktop to mobile. Above all, these solutions must be focused on the user experience. Data, functionality, and insight mus

Abstract

In a recent benchmark test of an application based on InterSystems Caché, a sustainable rate of 8.9million database accesses/second, with peaks of 16.9 million database accesses/second, was achieved. These results were from a test performed on a connected system of eight applications servers, using Intel Xeon 5570 processors, and running Linux as the operating system. This benchmark shows that:

1. Caché can achieve unheard of levels of performance for an object database. It provides full persistence of data at speeds that are normally only reached by in-memory databases.
2. Caché demonstrates

Featuring the results of the HIMSS Analytics Interoperability Study

Introduction

Interoperability - the ability of health information systems to exchange, transform and interpret shared data across multiple systems and devices, and across organizational boundaries, in order to advance the health status of, and the effective delivery of healthcare for, individuals and communities - gained widespread attention in the United States when President Bush called for interoperable electronic health records (EHRs) in his 2004 State of the Union Address. This vision began to be executed in 2011 when the C

Customers who switch to Caché from relational databases report that their average performance is up to 20 time faster, running on the same hardware, with no changes to the application. What is it about Caché that lets applications run so fast?

Introduction

The lack of visibility across data silos — data sources that are not integrated with enterprise systems — is a threat to business efficiency and profits in many industries. In financial services, front-office silos may develop where operations are segregated by product and region without coordination on data model design. Mergers and acquisitions may result in additional disparate silos, or regulations may require that data in one arm of the firm be inaccessible to another. When risk managers and compliance officers in financial services firms cannot see how activities in one silo

Abstract

The European Space Agency (ESA) has chosen InterSystems Caché as the database technology for the AGIS astrometric solution that will be used to analyze the celestial data captured by the Gaia satellite.

The Gaia mission is to create an accurate phase-map of about a billion celestial objects. During the mission, the AGIS solution will iteratively refine the accuracy of Gaia's spatial observations, ultimately achieving accuracies that are on the order of 20 microarcseconds.

In preparation of the extreme data requirements for this project, InterSystems recently engaged in a proof-of-c