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.

Still, the complete replacement of existing systems isn't

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.

Improved Access to Clinical Data Across Hospitals and Systems Helps Pharmaceutical Companies Reduce Delays and the Costs Associated With Bringing New Treatments to Market

Executive Summary

The pharmaceutical and life sciences industry has a strategic imperative to accelerate clinical research in order to reduce overall R&D costs while delivering innovative treatments.1 Yet virtually all pharmaceutical manufacturers and contract research organizations (CROs) recognize that the limited quantity and quality of available patient data are fundamental problems that have led to escalating costs and

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.

In addition to providing an availability solution for unplanned downtime, mir

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. And they need them to provide the efficacy and

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.

Because of contractual prohibitions imposed by well-known database vendors, there is very little published data from "

Executive Overview

One way financial services firms can improve their operational efficiency is to revamp their data management infrastructure. Creating a central repository for data that is used by multiple applications can ensure data consistency and quality across the enterprise, ease integration bottlenecks, and lower the number of failed trades.However, different applications have different database usage patterns. To satisfy them all, any central data repository must:

• Support a large number of transactions with high performance
• Provide fast response to queries, using up-to-date information
• P

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. Gartner forecasts that by 2016, this

InterSystems has implemented a broad set of MultiValue extensions for its Caché multidimensional database. These extensions enable the migration of MultiValue applications to Caché and bring the full range of Caché object and SQL development technologies to MultiValue developers. The result: your existing MultiValue investments are preserved, you gain a broad spectrum of highly scalable deployment options, and your developers can combine the best of MultiValue, object, relational, and technologies to extend existing applications and build new ones.

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. The Institute of Medicine estimated in 1998 that medical errors cause as many as 98,000 deaths per year, and recent reassessments indicate that roughly 15 percent of

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