One of the biggest hurdles the healthcare industry has faced in its march toward increased efficiency is interoperability – interoperability in sharing patient data between provider offices and hospitals and interoperability in tying together related services required for patient care.
For Misys Plc., whose healthcare division had grown through acquisition, the problem of healthcare interoperability was initially an internal problem of how to better connect its acquisitions and enable them to act collaboratively. But healthcare’s interoperability problem is much larger than one company; and Misys quickly realized that the efficiency advantages of an interoperability solution could grow exponentially with a wider view of addressing the problem.
“There was a need to serve a community that was traditionally proprietary and not outward-looking; and the last thing the community needed was a black box solution,” said Tim Elwell, vice president of Misys Open Source Solutions (MOSS).
The Misys Connect Exchange was developed by Misys Open Source Solutions (MOSS), which is dedicated to using open source principles and open standards to create lower-cost interoperability solutions for the healthcare industry. Misys Connect Exchange uses the open standards and protocols introduced by the Integrating the Healthcare Enterprise (IHE), an initiative created by the healthcare industry that is dedicated to improving the way healthcare systems share information. In true open source fashion, Misys Connect Exchange’s development also involved input from partners and customers.
MOSS is embracing the open source business model in addition to open standards. In a big departure for a company that had been in the business of creating and selling proprietary technology for over 30 years, MOSS is providing the underlying Misys Connect Exchange platform for free. And, it’s charging a subscription fee for value-added components, which are essentially services.
“The first question many customers ask is ‘how do you make a sustainable business case to your boss?’” said Elwell. “Even if the only thing I was able to monetize was the open source stack, I think there is a viable business model around supporting and servicing that core infrastructure, but that is not where we stop. On top of that core infrastructure, we have created what we call a mashable platform that is a services-based architecture. If you as a provider need to order lab tests or medications, or send information securely to another provider, all these things become part and parcel of the chargeable components associated with our solution, all built on top of the open source stack.”
The “mashable” environment means that value-added application portlets can be joined together to create new applications. In fact, MOSS envisions an open source development environment where providers and developers co-create components that address specific needs, and healthcare providers can access customized solutions by assembling different components.
The first implementation of Misys Connect Exchange went live in October of 2010 with Hartford Hospital in Connecticut as the primary client. Hartford Hospital and its CIO, Steve O’Neill, have attracted the interest of other hospitals in the area to support the concept of an exchange consortium. Hartford Hospital encountered Misys Connect Exchange when MOSS was demonstrating a patient identification component of the exchange at the IHE’s Connectathon conference, a week-long testing event for standards-based interoperability. Hartford Hospital, which had done a lot of open source work internally and had begun looking for an open source exchange, has served as both a client and a partner to Misys Connect Exchange. It has contributed toward the development of the Misys Connect Exchange components, and has worked on creating additional components within its enterprise that tie into Misys Connect Exchange.
“It was a perfect storm type of situation, where we were looking for a partner and we found a hospital that has great technical understanding and true operational expertise,” said Elwell.
The platform, as well as the deployment at Hartford Hospital, uses several parts of Red Hat’s portfolio, including Red Hat Enterprise Linux, JBoss ESB, and JBoss Enterprise Web Server.
Already MOSS employs cloud computing to link to various partners for services in which external vendors have expertise.
“We have a starter set of e-prescriptions, clinical care document viewers, radiological viewers, laboratory orders, laboratory routing capabilities, and secure messaging referrals, which are basic services,” said Elwell. “In some cases we have created the services, and in other cases our partners have created the services. We can invoke these services and deploy them truly as cloud applications.”
For example, for e-prescriptions, Misys Connect Exchange connects to a partner for the service. Single sign-on, and provider identification and verification are securely transferred to the e-prescription service partner. In the case of e-prescriptions, the request is then sent to a second partner, a clearinghouse of sorts, that collaborates with the e-prescription partner to gather data. The second partner gathers information and sends it back to the e-prescription partner, which does a drug-drug and a drug-allergy query and sends the prescription information to the pharmacy. In other words, the process essentially involves the interaction of several different clouds.
The users see tabs on their portals for the different services to which they have subscribed. While in some cases services are built by MOSS, in others MOSS essentially serves as a realtor, leasing space to other services.
Technologically, MOSS will continue to monitor the standards in this emerging and evolving space and manage the upgrades or expansions by the exchange to new technology, according to Konda Mullapudi, Moss director of development.
“Right now, we are using a pretty typical set of standards, but they are expanding and evolving and there are some new domains they are evolving into,” said Mullapudi. “We will expand [into these domains] as well when we see the need.”
Looking forward from a services standpoint, MOSS plans to focus on incorporating new services to the platform by both adding more services from external partners and building more solutions to solve specific business issues. One area that might be a candidate for future services is “Medical Home,” an approach to patient care that has been gaining attention according to Elwell. Medical Home involves the provider taking on risk. To accept this risk, more aggregated information from various sources, including from the patient him/herself, will become necessary. MOSS has already integrated devices from the patient’s home into his/her portal; therefore, real-time information will become available to the provider at any time. “There is real value in combining information from the hospital, the provider’s office, and the patient’s home,” said Elwell. “We believe this is where the HIE market is moving and we are excited to be a leader in this migration.”
“We have also had conversations about how we can liberate the exchange to automate some of the pain points in the community, and offer these efficiencies as services on top of the platform,” said Mullapudi. “There are still a lot of manual processes that go into the workflow for the continuum of care. We can explore how to liberate the exchange to address many of these issues.”
