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.
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.
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.
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:
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:
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
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.
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.
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.
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.
