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. Among the first is improving

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.

The CIO Perspective

Executive Summary

Addressing the challenge of reducing hospital readmissions using manual processes is not a viable long-term solution. With other IT mandates demanding time and attention, your readmissions initiatives may suffer. However, with the right health information technology (HIT) platform, you can sustain efforts to reduce readmission rates and make processes more efficient and effective. Enabling interoperability and access to real-time data is key. Organizations that integrate real-time data from disparate sources for analysis can proactively reduce readmissions a

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.

Efficient data exchange increases the need for fast, scalable data persistence. Financial services applications

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.

To foster this collaboration and engagement, payer organizations must make critical deci

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

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.

Patients are increasingly relying on multiple specialists and healthcare organisations for treatment, due to the complexity of their medical conditions

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. They've also tried to implement consistent and manageable application

Overview

Integrated Delivery networks (IDNs) face complex challenges in getting the right data into the right hands, at the right time, with the goal of more informed decision-making and improved clinical and financial performance.

In many cases today, even with the use of traditional business intelligence tools and an enterprise data warehouse, important data often remains hard to access and difficult to aggregate and present to healthcare providers in a useful, unified format. It executives and their staffs currently devote extensive resources to plugging together multiple disparate systems in

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.

Automating text analysis is not eas

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