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.

Strategic Interoperability

Executive Overview

This white paper discusses the critical requirements for the U.S. Departments of Defense (DoD) and Veterans Affairs (VA) to share Service members’ medical records – including real-time access to a complete composite health record – and it proposes an immediate solution via implementation of a health informatics platform. This approach will provide significant and clearly visible results in a matter of months, while positioning the Departments for strategic improvements in the years ahead.

Introduction

As healthcare providers face increasing pressures to lower costs and reduce readmissions, they're rapidly shifting towards accountable?care organizations (ACOs) and other coordinated, quality-based reimbursement systems. However, most providers have historically?organized their data and workflows in ways that best fi t the fee-for-service payment model. Now that so many providers are sharing?risks and rewards, they must also share and coordinate information by adopting more streamlined health information technology?solutions.

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.

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.

What is Integration

Integration of enterprise applications and data to simplify and automate business processes has become an important focus for many CIOs. It refers to both the tasks of integrating data and applications, as well as to software products that provide integration frameworks and associated tools. Integration enables the sharing of data and business functions across applications.Integration has become popular because most traditional enterprise applications were custom built to address a specific business need.

InterSystems encourages the adoption of a flexible, practical approach to application development, rather than strict adherence to one of the prevalent development theories. This paper offers advice based upon our experience. However needs, attitudes, and styles vary; we recommend that each programmer choose the development approach that works best for them. Caché supports a wide range of development methodologies, not just those recommended here.

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.

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.

Strategic interoperability —The key to connected care

Introduction

The aging population and increasing incidence of chronic diseases are putting unmanageable pressures on healthcare services, not just in Europe, but worldwide. The current models of healthcare are unsustainable in the face of increased demand for services and rising costs. This was evident even before the financial crisis led to severe cuts in healthcare budgets in many countries.

Lessons from Aviation

Introduction

Despite rapid advances in information technology and medical devices, most healthcare organizations have not achieved the same high reliability and safety as other industries, such as aviation, where mistakes can have catastrophic results. Executives and physicians alike are dissatisfied with costs and outcomes, and patients are rightfully fearful of medical errors, infections and miscommunication.

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.

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.

Introduction

Running the business efficiently and delivering solid value to customers have always been hallmarks of successful companies. However, today's companies have to cope with much more. For example, over the past few years it has become increasingly important for U.S. organizations to devote appropriate resources to the issues of corporate governance and regulatory compliance. Organizations of all types have tightened internal controls as a result of new regulations and increased investor focus on corporate oversight.

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.

Goals of the project

North Shore-LIJ is a health system serving the needs of over seven million people through 17 hospitals, 400 ambulatory practices, and three skilled nursing facilities as well as home and hospice care. Our healthcare system, including its CareConnect insurance company, is at the forefront of payment reform and population health management.

With our rapid and ongoing growth, the operational complexity of being so large and diverse, and the changes driven by accountable care reforms such as bundled payment, we’ve had to overcome several challenges.

Executive Overview

Accountable care and value-based reimbursement models are causing a seismic shift in the medical device industry. In the new medical device market, the value of the device and data alone will not drive sales. instead, it will be solutions that bundle device, data, and real-time analytics that clinicians, health systems, and payers will want to buy. For improved decision-making and outcomes, they need these solutions to deliver actionable information into existing electronic medical record systems and health information exchanges.

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.

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.

The Business Case for InterSystems Ensemble

This document presents a business case for replacement of older interface engine software with our next-generation rapid integration product, Ensemble. To illustrate the business case, our primary example will be an InterSystems customer (Metro Health Corporation) that replaced its SeeBeyond eGate (now Sun SeeBeyond) interface engine with Ensemble. Other organizations also will comment on reasons for switching to Ensemble.

Executive Summary

The best way to compare the performance of database products is in a head-to-head test using a real application, preferably one of your own. This is especially true when evaluating Caché's post-relational technology, because "standard" transaction processing benchmarking methodologies assume the restrictive "row and columns" format of a relational database. They cannot accurately predict the performance of real applications, which often use complex data models.

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.

Introduction

Experts estimate that 85% of all data exists in unstructured formats – held in e-mails, documents (contracts, memos, clinical notes, legal briefs), social media feeds, etc. Where structured data typically accounts for quantitative facts, the more interesting and potentially more valuable expert opinions and conclusions are often hidden in these unstructured formats. And with massive volumes of text being generated at unprecedented speed, there’s very little chance this information can be made useful without some process of synthesis or automation.

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.

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.

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.

Information Sharing Enables Health Plans to Leverage Data and Analytical Assets to Deliver Sustained Value

Executive Summary

The shared-risk payment models that are central to health reform all require tight coordination among payers, providers, and patients if they are to succeed. As payers and providers enter into more and more such agreements, they need to enhance success by communicating and collaborating more effectively with their partners and actively engaging, supporting, and empowering their members.

Introduction

By now, anybody working in the technology sector will have heard of Cloud computing. But the concept is increasingly being paid attention to outside of IT departments, with growing recognition among boardlevel executives of the potential of this range of innovations. Frequently, senior personnel are hearing stories about how the Cloud helps organizations reduce costs, boost efficiency and expand their operations, so they’ll be excited about what the Cloud can do for them.

As a result, Cloud is one of the fastest-growing parts of the IT industry.

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.