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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.

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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.

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Providing a reliable infrastructure for rapid, unattended, automated failover

Technology Overview

Traditional availability and replication solutions often require substantial capital investments in infrastructure, deployment, configuration, software licensing, and planning. Caché Database Mirroring (Mirroring) is designed to provide an economical solution for rapid, reliable, robust, automatic failover between two Caché systems, making mirroring the ideal automatic failover high-availability solution for the enterprise.

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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:

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Providing a reliable infrastructure for rapid, unattended, automated failover

Technology Overview

Traditional availability and replication solutions often require substantial capital investments in infrastructure, deployment, configuration, software licensing, and planning. Caché Database Mirroring (Mirroring) is designed to provide an economical solution for rapid, reliable, robust, automatic failover between two Caché systems, making mirroring the ideal automatic failover high-availability solution for the enterprise.

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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.

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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.

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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?

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Introduction

Because of increasing business and governmental pressures to integrate their operations, the financial services industry is developing a number of standards for data exchange and other common functions. Standards such as XBRL, FpML, MDDL, RIXML, and FIXML are all specialized dialects of XML (Extensible Markup Language). Any financial services application with good support for XML will be able to communicate effectively using one or more of the emerging industry standards.

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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.

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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.

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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.

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Introduction

Application integration at its simplest is often just one application sending a message to another to notify it of some change. Perhaps when a patient arrives at a hospital, the registration system will send a message to clinical systems so they have all demographic data ready to use. Of perhaps it is just a nightly file transfer from the sales system to the accounting system.

But modern application integration platforms or suites can do a lot more than this to help applications work together and add real value to the enterprise.

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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:

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Introduction

HL7 V2 message routing solutions often have hundreds of business services, processes and operations. Inevitably things will go wrong and you have to monitor the production to be able to react quickly and resolve any problems before they can become serious issues.

Ensemble includes some powerful alerting capabilities that can help, but if you aren't careful you will be inundated with alerts and your inbox more or less becomes a copy of the event log defeating the object of the exercise.

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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.

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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.

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