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Healthcare service bus

With the aim to provide a solution to the growing need for integrating the healthcare sector, Parsek developed a standard-based solution called Healthcare Service Bus (HSB) to address these needs.


Aim

Over the last few decades we witnessed the digitalization of healthcare system. Hospitals and medical institutions no longer rely on paper trail but on information systems. As independent systems have emerged rapidly, we are now facing the need to integrate them in order to allow data exchange. Even when systems are able to exchange data, it is necessary to control data flows, manage messages centrally, process complex events, and organize and control data structure and methods through data governance. 

Parsek has over ten years of experience in the field of integration. regarding project implementation, we rely on enterprise grade open-‌source technologies, which allow us to meet the needs of our customers and our own. Parsek provides a complete HSB solution for medium and large medical institutions.

Central Connectivity Solution

Using enterprise service bus and business process modelling we are able to simplify connections between systems. HSB provides the following benefits:

  • Improving the quality of care by providing instant access to clinical information, inside and outside the healthcare institution.
  • Improving efficiency in care processes, saving time (instant access) and cost (time, transport).
  • Securing relationships with clinical organization by providing a highly-valued information system which supports organizational workflows.
  • Patient-centric information access to demonstrate to your patients that care professionals spend their time caring about them and not chasing information.

All of this and more can only be achieved by using an appropriately configured HSB solution.

Routing of Messages

HSB provides one important aspect of service integration, namely, intelligent routing of messages.

It is important to understand that HSB does not purely route the messages from point A to point B. It is able to understand the meaning and actions according to the message, document meta-data or even content of a structured document.

Messages can be routed and mangled to accommodate different business rules, aspects and infrastructure requirements. This functionality is especially important for the following needs:

  • Implementation data and Service Oriented Architecture (SOA) governance;
  • Implementation of cross-system data access security;
  • Centralization of service and content knowledge base.

Data governance, including management of metadata descriptions, is the key to knowing which piece of data is the right one to return for a specific business process requestor. Another aspect of data governance is data quality monitoring. Data quality is of extreme importance to every business process and to a company's overall success.

One of major advantages of HSB is the possibility of defining custom routing services and connecting specific inputs to specific outputs. Everything is manageable by a system administrator and can change rapidly based on organizational requirements without any software supplier involvement.

IHE Infrastructure

The HSB core has been designed to be completely IHE compliant, which was confirmed at the 2012 and 2013 IHE Connectathons. HSB is able to route the following internal and external infrastructural IHE profiles.

Internal IHE Profiles

  • [ATNA] Audit Trail and Node Authentication Basic security through (a) functional access controls, (b) defined security audit logging, and (c) secure network communications.
  • [BPPC] Basic Patient Privacy Consents method for recording a patient's privacy consent acknowledgement to be used for enforcing basic privacy appropriate to the use.
  • [CT] Consistent Time enables system clocks and time stamps of computers in a network to be synchronized (median error less than 1 second).
  • [XDS] Cross Enterprise Document Sharing; to share and discover electronic health record documents between healthcare enterprises, physician offices, clinics, acute care in-patient facilities, and personal health records.
  • [XDR] Cross-enterprise Document Reliable Interchange exchanges health documents between health enterprises using a web-service based point-to-point push network communication.
  • [XDS-I.b] Cross-enterprise Document Sharing for Imaging.b Update extends XDS to share images, diagnostic reports and related information across a group of care sites.
  • [XUA] Cross-Enterprise User Assertion communicates claims about the identity of an authenticated principal (user, application, system...) across enterprise boundaries - Federated Identity.
  • [MPQ] Multi-Patient Queries enables aggregated queries to a Document Registry for data analysis such as provider accreditation, clinical research trial data collection or population health monitoring.
  • [PDQ] Patient Demographics Query lets applications query by patient demographics for patient identity from a central patient information server.
  • [PIX] Patient Identifier Cross Referencing lets applications query for patient identity cross-references between hospitals, sites, health information exchange networks, etc.
  • [PWP] Personnel White Pages provides basic directory information on human workforce members within an organization.
  • [DSUB] Document Metadata Subscription describes the use of subscription and notification mechanism for use within an XDS Affinity Domain and across communities.
  • [SVS] Sharing Value Sets distributes centrally managed common, uniform nomenclatures.

External IHE profiles

Data Model

Being primarily a message router, HSB itself is focused mostly on headers and meta-data and not so much on the actual content of the messages. However, having some context does allow additional processing based on understanding of the message. HSB is able to parse and understand RIM structured patient data, CDA, and EpSOS.

Master Patient Index

Implementing information infrastructure in healthcare organization is always a complex process and not a simple on/off switch. Therefore, many systems are installed during this conversion. Most of the time, each one will have its own notion of patient, even if provided by the same software vendor or if they are based on the same database infrastructure (e.g. HL7 RIM). Even systems based on the same data model (e.g. OpenEHR) may need a way to interconnect and exchange data.

A crucial component for these systems to cooperate successfully is a Master Patient Index (MPI). MPI holds unique patient identifiers from different systems and is responsible for joining the patients even when some information has been omitted or when typing errors have been introduced.

Parsek’s HSB solution comes with an embedded MPI server which is based on standard IHE PIX/PDQ (v2 and v3) profiles. It is able to merge patients from different patient domains based on custom-defined set of rules. The administrator can therefore define merging rules based on:

  • full patient data match;
  • fuzzy patient data match (e.g. typos in demographical data, transposition errors in numerical data etc.);
  • phonetic algorithm to match homophones.

The system provides an administrative interface which allows the administrator to merge (or decline the mergence) of patient details based on certain “match percentage” cut-off. The system also enables the administrator to define a basic set of rules which allows the merging process to be more efficient. These rules are locale-dependent and usually include synonyms (e.g. “Bill” vs. “William” and “Will”) or transliteration rules (e.g. rewriting “š” to “s” or “sh”, “ä” and “ae” to “a”, changing Cyrillic script to Latin etc.)

Document Management

Some of the most important things in any institution are appropriate storage, access, and processing of documents. This is even more important in healthcare institutions, as medical decisions rely on correct and timely data. IHE defines two distinct systems that manage documents, namely, a document registry (usually one per organization) and a document repository (there could be more of them). Document registry is responsible for storing meta-data about the documents and keeping an index of all files within the organization. Document repository, on the other hand, stores documents itself. HSB offers both components and they cooperate together with the MPI, to keep an up-to-date link between patients and documents.

Repositories and registries can be the most basic read-only types, or they can offer advanced features. Parsek’s registry and repository offers advanced features, such as:

  • Multi patient queries; the ability to query a registry for multiple patients simultaneously.
  • Folder management; possibility to arrange documents in folders.
  • Replacing and deleting an existing document.
  • Supporting the same version of a document in different languages.
  • Dynamic and on-demand documents.
  • Additional custom meta-data.

All documents are easily accessible through the administrative interface (HSB portal) which allows querying and manipulation of document management content.

HSB also provides additional extensions, the so-called cross-community profiles. These include functionalities, such as cross-community access (XCA) and cross-community fetch (XCF). They are used for querying and fetching the documents from another medical institution, region or country.

Auditing and Monitoring

Parsek’s HSB integration middleware includes ATNA logging server and system monitoring tool. ATNA has been standardized within IHE organisation and covers local auditing requirements and regulations. It is a crucial component within any organization and can be used with either OpenEHR-, HL7 RIM-based, or custom grown solutions.

HSB portal allows the administrator to view modifications and access patient’s data and systems. The service comes with all the benefits of HSB itself: scalability, reliability, and fail-over.

If an institution uses an existing ATNA logging server, HSB can be used as a proxy to provide reliability and scalability for it.

Support OF legacy systems

It is a fact that informatics has been used in the healthcare industry for over twenty years. During this time, many systems have been implemented, some have been replaced, but the legacy still remains.

HSB provides an out-of-the-box solution for the integration of existing and new information systems which are based on IHE and HL7 standards, but on the other hand, it does not neglect the systems that are not. HSB has lower lever connectors which are available to third party protocols; this enables a connection to almost any legacy system. For example, if you have an old HL7v2 consumer, you can feed our system and access to data from HL7v3 consumer. 

Technologies

Technologies which are used inside the HSB have been chosen in order to provide optimal relation between high performance, stability, and security, not neglecting the need for flexibility. HSB used only those components that have been proven in the field and have an active user community. This allows our customers and us to keep the total cost of ownership (TCO) relatively low, while still guaranteeing further development and upgrades.

Parsek has been using open source solutions for over ten years in different mission-critical information systems. HSB core technologies are Java EE6 and jBoss, which provide the application server and Enterprise Service Bus (ESB). For virtualization we use VMware vSphere; HSB is data base independent solution.

Operating systems

  • Red Hat Enterprise Linux and CentOS;
  • Microsoft Windows Server.

Database support

  • PostgreSQL;
  • MySQL;
  • Oracle database;
  • Microsoft SQL Server;
  • IBM DB2;
  • Progress.

Calculate Key Performance Indicators

Key Performance Indicators (KPIs) allow business executives to access key information of their company at a single glance. Based on implemented business processes in Enterprise Service Bus (ESB), a lot of key performance indicators can be calculated. Routing messages through HSB can show average, minimum, or maximum execution time for a specific business process as well as detect bottlenecks. When weighted with monetary data, specific process cost can be calculated automatically and suboptimal activities improved.

Use Cases

The solution is implemented in various projects. For basic understanding we are providing typical use cases which are described below.

Enterprise-wide

The first project use case; HSB is implemented as a central connectivity point inside a hospital. HSB is used to reduce connectivity costs, connect legacy systems, and route messages from external systems to XDS repository. HSB offers local XDS registry and repository services through different front-ends (e.g. XDS.b and XCA).
 

Cross-enterprise

The second project use case; HSB is implemented to bring together different enterprise-wide MPIs and implement an eMPI solution. Over 10 local MPI solutions are integrated; some of them are available over HL7 v3 and PIX/PDQ v3, while others use a custom HL7 v2 transport.
 

Nation-wide

The third project use case; HSB is implemented to work out an international cross-border cooperation. In this scenario, HSB is used as a “central aggregator point” at the national level and provides health services to local medical institutions and other national and regional integration infrastructures. IHE profiles implemented at this level include amongst others, XCPD, XCA, XUA, ATNA, and CT.

HSB as integration middleware is used in projects across four European countries (Germany, Austria, Italy, and Slovenia).

Back to References
Operating systems
Red Hat Enterprise Linux and CentOS
Microsoft Windows Server
Database support
PostgreSQL
MySQL
Oracle database
Microsoft SQL Server
IBM DB2
Progress

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