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

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.

Whereas in the past the frontier of healthcare it was providin

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. As enterprises have grown, and the need to share information across de

An introduction to virtual documents

Ensemble virtual documents enable your productions to work with large and complex documents with little overhead.

What is a virtual document?

A virtual document is a special kind of Ensemble message, for use with Electronic Data Interchange (EDI) messages and with XML documents.

How are virtual documents different from standard messages?

The body of any Ensemble message is represented by a persistent class that has one property for each value that the message is intended to carry. In addition to carrying these values, the properties enable users to easily search

The Business Processing Language - for orchestration and long-running business processes.

Ensemble can orchestrate calls to external systems. Very often this is done to implement or automate a long-running business process - that is, real business processes where people interact with a series of different systems to complete complex tasks. BPL (the Business Processing Language) provides a graphical way to create these orchestrations.

How do you balance the need to achieve an early success with SOA against the requirement for an architecture that will deliver long term success? You don't want to get bogged down in architectural committees for three years, but you don't want to make short term decisions that will be roadblocks to long term success.

If your first project is to deploy a small number of reusable services in a matter of months but you know that four years from now you might have hundreds of services, an enterprise SOA infrastructure and specialized governance technology you have a dilemma. How do you move forward

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.

Lots of terms have come into use over the years to des

Are you new to Ensemble? InterSystems provides several tools to learn the basics of Ensemble and get on your way to becoming an expert in the technology. Before installing Ensemble, take a look at the Ensemble Technology Overview and Getting Started with Ensemble in documentation. Respectively, these documents explain features and major components of Ensemble as well as how to install the software.

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.

These notes are based on experience of other customers who have set up alerting and will hopefully

Introduction

This paper describes how Ensemble behaves after a system crash or similar uncontrolled shutdown or failover. Ensemble is normally configured to start processing messages automatically when the operating system restarts or when the system has failed over to a cluster member or mirror member. No manual intervention is required. But, in order for your system to robustly handle system failure and restart, you must understand how Ensemble handles these conditions and develop your productions using the rules and guidelines in this document.

The behavior in the event of a restart is very d

Ensemble is based on message flow, and a data transformation is a way to convert from one message type to another. DTL (Data Transformation Language) adds a layer to this - it provides a graphical way to do the conversion. This is really helpful because most of the time, people with domain-specific knowledge may not have extensive coding skills. However, you always have the ability to do some coding, so if you need or want to, this is available.

DTL has several components: the data transformation engine, the language itself, and the DTL editor.