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A Report on Service Oriented Architecture and its importance in major Electronic clinical Records Projects Oladimeji Farri ISA 302: Health systems and the EMR Dr Guy Bisson and Kerry Johnson 15th July, 2007

A Report on Service Oriented Architecture and its importance in major Electronic clinical Records Projects Introduction In this present age of technological advancement and implementation in major business processes, information technology (IT) departments are saddled with complex portfolios as business needs continue to evolve.1 The business of clinical care is not left out in the evolution of business needs as the emphases on client-centred health care delivery, increased ambulatory services, electronic health records and point-of–need care require easy access and implementation of a wide variety of applications and information systems. The pressure to align IT tools with changing business demands in clinical care has brought about an aspiration for an end-to-end view of complex business processes, in turn necessitating integration of information useful in providing valued added, client-satisfying services.1 With the advent of web services, protocols and standards have been developed for the discovery and publishing of business needs as well as the use of technology in a neutral, standard form to meet these needs.2 Specifically, dynamic applications that improve and automate previously manual clinical records, to realize a consistent view of patient-physician relations and orchestrate electronic clinical record (ECR) processes that comply with both internal authorizations and external regulations, stand to benefit from web services. The net result is a high level of ECR agility necessary for superior health care industry performance. A useful approach to creating dynamic applications from the integration of information systems involved in electronic patient records and making these applications easily accessible to the end-users is the concept behind the use of service oriented architecture (SOA) in major ECR projects.

Definition of SOA Service oriented architecture is a means of integrating across diverse systems using standard protocols and conventional interfaces, usually web services, thereby facilitating access to business logic and information among various services.1

SOA allows underlying service capabilities and interfaces to be composed into new processes. Each new process is exposed through a standardized interface without the limitation of differences in operating systems and communication protocols among individual service providers.

The ultimate goal is a world-wide mesh of collaborative services not just seen from the technology perspective but also the policies, practices and frameworks of ensuring that the right services are provided and consumed. The SOA life cycle

Figure 1: Life cycle of Service Oriented Architecture1 As earlier mentioned, SOA ties together disparate and autonomous information sources. The process by which it does this is by creating new services (“expose”), aggregating these new services into large composite groups (“compose”), and making the output available for consumption by the business user (“consume”), as illustrated in fig 1. The” expose” phase of the SOA approach has to do with the choice of services to be created from underlying applications and electronic health data as well as the implementation of the services thus created. The “compose” phase deals with the combination of various ECR services into complex groups of services, applications or cross-functional business processes. Future adjustments of ECR processes and practices without constraints from the limitations of underlying applications become possible through the new applications, services and processes generated from such combinations. The goal of the “consume” phase is to deliver new, dynamic applications that enable increased productivity and enhanced insight into ECR performance. Users can consume the composed ECR service through a number of avenues, including Web portals, rich clients, Office business applications, and mobile devices. Implementation of SOA in major ECR projects SOA is usually done by software developers and solutions architects. However, it is important that the interest of the stakeholders, mostly physicians, actively drives the design of the SOA solution. While the developer maps the sources of clinical information- health databases, laboratory systems, imaging systems etc- to give the business analyst greater insights into the cost and benefits of IT investments, the analyst is concerned with bringing the IT investments more in line with business strategies. Ultimately, the developers and solution architects are concerned with creating dynamic collaborative applications that meet the goals of the various stakeholders. The SOA enables them to do so in a way that meets the needs of the health care organization as a whole. Before implementing SOA it is important to line up the IT investments with the needs and priorities of the ECR project. There are three approaches commonly used in the implementation of SOA- (a) Top-down(b) bottom-up and(c) Middle-out approaches, the latter being a successful hybrid of the previous two approaches. In the middle-out approach, clear directions and priorities are first set, and then the organization takes steps to build end-to-end capabilities that deliver new, dynamic ECR applications that are used to create business return. In the Ontario paediatric electronic health record project, access to health information in an electronic patient record format is made available to paediatric health professionals in over 50 hospitals and community care centres across various provinces. The paediatric ECR can be improved by specialized paediatric requirements and software applications created through the SOA approach, thus contributing to the goal of a province-wide ECR.3 Other projects that stand to benefit from SOA include the Canada Infoway ECR and Quebec ECR projects. Benefits of SOA SOA solutions: - build essential ECR services required to ensure that the appropriate clinical information systems are accessed by the appropriate users-clinicians - promote stronger connections between physicians and patients - facilitate enhanced clinical decision-making - ensure greater productivity among stakeholders in the health care organization.1

References 1. Learn about Service Oriented Architecture (SOA), Dec 2006, Microsoft BizTalk server: service oriented architecture, Microsoft Corporation. 2. Service Oriented Architecture-overview, 2007, MSDN solution architecture centre; special coverage, Microsoft Corporation. 3. Ontario health initiatives; e-Health Ontario Forum, www.moh.gov.on.ca.

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