Why can you achieve Interoperability through deployment of a SOA corporative strategy. Andalusian Healthcare Service, a case of use. Achieve a viable pathway to the evolution of systems existing in autonomic environments of wingspan to a business model based on the paradigm SOA. Determine the current state of the habitual environment itself; cases of legacy systems, projects underway, State of the master data and define the necessary lines of work carried out achieve SOA model: architecture, tools and resources, and governance.

1. Towards
Interoperability
enabling SOA strategy
José R. Fernández Engo – Charge of IOP – SOA Strategy at Andalusian
Healthcare Ministry – IT Division.
jose.fernandez.engo.sspa@juntadeandalucia.es
http://es.linkedin.com/pub/jos%C3%A9-rom%C3%A1n-fern%C3%A1ndez-engo/11/3a0/30

2. Target:
To establish the relationship between the development of a strategy oriented
to services and the achievement of the interoperability
secondary objectives:
achieve a viable pathway to the evolution of systems existing in autonomic
environments of wingspan to a business model based on the paradigm
SOA
determine the current state of the habitual environment itself; cases of
legacy systems, projects underway, State of the master data.
Define the necessary lines of work carried out achieve SOA model:
architecture, tools and resources, governance

3. We are going to talk
about:
• ITC in large healthcare systems - situation.
• Interoperability
• SOA in Healthcare
• SOA: a way to interoperability.
• Pathway approach.
• Impact of the model.
• Case of use: Andalusian Healthcare Service

4. ITC at Healthcare Systems
At Public Healthcare Systems:
• Lack of ITC vision, i.e. technology and
INFORMATION
• Lack of decision-making capacity in organizations
• Usually systems badly equipped
• Lack of knowledge about the business
• 2 costumers in the value-chain:
o professionals: their technologists
o citizens: public employees
• We‟re in the world… and it‟s moving on:
o SNS
o epSOS

5. And Spain is a reference…

6. ITC at Healthcare Systems
N1 N2 Fecha, cie9
FTP
AP Sin formato
AP
1 2
N,cie10
N3
FTP AP
AP
4
dblink 9
chino N,a,d
N6
AP1 jdbc
XMLs
0 HL7 2.3
Loinc, sc
AP
AP1 7
Fecha,d
5 odbc AP
deutsch 6
D, date FTP
Datum, monate
AP
a,d 8
N4
d
N5 Id,d
Business?

7. ITC at Healthcare Systems
Technology:
• Uncoordinated providers, vendors and developments.
• developed systems without a project.
• Strong dependencies with political decisions without
strategies.
• Very strong legacies systems
• No procedures, no methodologies
• No interoperability through systems into the organization
As result of the patterns of evolution reflected above we
suffer the not provided and forced coexistence of many
technologies but some not supported, some obsolete,
some incompatible,…

8. ITC at Healthcare Systems
Information:
• Systems don‟t share master data
• Strongly coupled subsystems – high dependence
• No scalability strategy neither vertical nor horizontal
• Uncontrolled replica
• No global vision about systems -> wheel reinvented
usually
• No common way to share EHR though different clinical
environments (GP, hospital, ambulatory, etc.)

9. ITC at Healthcare Systems
Volume:
 No strategy or prevision for systems concurrence
 No strategy to historical data transition neither
functional nor technical
 No volume optimization queries in applications
 Not prevision about evolution of the data repositories
 No finished EHR treatment in clinicians view

10. IOP: what’s that?
Integration: technical solution for the exchange of
data between the two applications.
Interoperability: The interoperability is the condition
whereby heterogeneous systems can exchange
processes or data, automatically, keeping the
meaning in both ends. Example: speak 2 languages

11. interoperability
IOP level Scope General
Healthcare Policies Vision and strategy
Structures, processes, incentives
Sustainable legal and socio-economic framework
Privacy and confidentiality
Tools, process, professionals and systems certification
Organizational Organizational culture
Suppliers/vendors Processes of internal and external services
ofservices Management of change
Process reingeniering
Semantic Terminologies, clasifications and onthologies scalability
Translations sustainability
Development and deployment of sustainable
architectures
Syntactic Messaging
Technical Technical standards
Hardware and software connectivity
Security
User interface

12. interoperability between
organizations
Achieving interoperability involves achieving the same
at all levels and these levels are interdependent.
Unable to establish interoperable policies between
organizations if the processes are not defined. These
can not be if the significance of the information is not.
Unable to achieve semantic interoperability if the way
to management information and semantic is not
interoperable and it is no use to achieve the above if
the transmission layer technology fails to
communicate both organizations.

13. SOA in Healthcare
environment:
a chip change
• Legacy systems are the kernel of business. We‟re going to find situations
with no possible or not profitable evolution/change.
• No vendor is the best in every business. Although we‟ve a solid and
complete normative framework we‟ll need interoperability with no
anticipated systems.
• Healthcare business is always on the road, with a very high rate of
change both clinical and managerial so it requires a innovative and solid
framework that facilitate a quick reaction with high quality, no impact in
business and a consistent clinical information.

14. SOA -> IOP
SOA model deployment achieve interoperability
through entire organization in all its levels thanks to:
• Structured policies
• Global application of norms and standards
• Consolidate a strong model of governance
• A sustainable cycle of life
• A deep knowledge of business, its needs and
evolutions derived from a complete process model.

15. Detailed
IOP needs:
A change in development model
Knowledge, knowledge, knowledge
Normalization, standards, common masters tables,
business,…
productivity, low costs, scalability, …
SOA

16. Semantic interoperability
SOA architecture
g g g
o s o s o
N N N
v e v e v
O O O
e r e r e
R R R
r v r v r
M M M
n i n i n
S S S
a c a c a
n e n e n
- - -
c s c s c
e e e

17. Strategy
• Take a model scalable, sustainable and consistent
• Become experts in our own business.
• Set and extend a framework of rules and standards
• Adoption of a technology model that allows ->
governance, integration, modeling, reuse
• Convergence of the systems to the new model
project to project in the context of a macro-global
project.
• Establish responsibilities for information

18. Pathway
o Adoption of the strategy for the organization
o Modeling the business. Requires participation and time.
o Define the business model and government.
o Define technology and governance model.
o Set of rules and standards, policies and procedures. Semantic.
o Define master data of the Organization. How to share.
o Convergence of the systems to the new model, project by project, as part
of an overall macro-project, ensuring coexistence with the existing. Define
the projects. Define the measurement.

19. Launch Plan
o Business Modeling SOA
o Acquisition and implementation of physical architecture.
o Implementation of SOA office. Where to look. Dissemination.
o Location of the organization's master data
o Selection, adoption and dissemination of standards. Certification.
o What we have and what we don‟t have -> prioritization
o Development and adaptation of services designed and / or existing.
o Decoupling applications.

20. Model impact
• Impact on recruitment
o Uniformity of support
o Uniformity of technology
o Consistency of performance
o Ease in developing specifications
o Use of certifications
• Development impact
o Reference documents
o Centralized Support
o Availability of infrastructure
• Impact on knowledge management
o It internalizes business knowledge
o It spreads business knowledge

21. Model impact
• Improvement internal control projects. Knowledge
inside the organization.
• Decoupling between applications.
• Ensures interoperability of the organization both
internally and externally
• Ensures scalability and sustainability
• Technologies upper level independent of platforms
and languages
• Ensures reuse. „Snowball„ effect.

22. Conclusions I
• The deployment of an SOA strategy enables and
strengthens the conditions necessary to achieve
interoperability both internally and externally at all
levels by:
o The adoption of a strategy and a defined policy information (policy IOP)
o The definition, modeling and consolidation processes of the organization
(organizational IOP)
o The launch of the services that establish and unify the interpretation of the
information in the organization (IOP semantics)
o The adoption of a syntax-based communication standards common to all
systems (IOP syntactic)
o The deployment of a physical architecture information management and
communications standards-based technology, which ensures the
exchange of information at the physical (technological IOP)

23. Conclusions II
• They share the same needs for clear governance,
methodological and understood by the organization to
ensure scalability and sustainability.
• In organizations “on the road” the recommended
pathway of an approach that combines vision top -
down and bottom - up since it is not feasible delete the
non interoperable legacy systems immediately .
• These should be isolated as soon as possible by services -
facade to undertake its evolution with guarantees.
• The impact on the organization model is extensive and
undeniable but must be prioritized actions to
consolidate developments.

24. future: Electronical
continuity of care

25. future: BAM on process

26. S.S.P.A.: an approach
• Population: 8,3 M
• Professional> 80 k
• Nº GP centers: 1.500
• Hospitals: 29 + 25 CHARES
• GP concurrent users: >9000
• Nº appointment: 400M
• Nº EHR: 8,8 M
• Electronic prescription and dispensation use: 58%

27. S.S.P.A. original project:
Diábaco Base de Datos de MTI: Usuarios, Citas,
Explotación
(Indicadores) Explotación Urgencias
Salud Responde Navegador Hª
Registros Garantías Citación y Peticiones RIS
InterS@s u Pruebas Analíticas (2) tools COMUNES tools
Receta XXI Prescripción
PACS
Vacunas
U C HOSPITALIZACIÓN (1)
P R O
R G N
I E S MEDICINA ENFERMERÍA
M
A
N U Estaciones
C L
AGD R I T REGISTRO ADMVO Clínicas
I A A
A S S
(1) En desarrollo Subsystems
OPERADORES BDU ESTRUCTURA
(2) En pilotaje Estructurales

28. S.S.P.A. reality 2009:
Diábaco (PKI) Base de Datos de MTI: Usuarios,
Explotación Citas, Urgencias
Salud Responde Navegador Hª
Citación y Peticiones RIS
 A monolit with: 
Registros
SQL Server
Garantías
InterS@s
 W2000
u Pruebas Analíticas (2)

tools COMUNES
Informix
Receta XXI Prescripción
 Oracle 8, 10, 11 Vacunas  Weblogic PACS
 Visual Basic, VB.NET U C
 IIS
HOSPITALIZACIÓN (1)
 Clipper P
R
R
G
O  Java…
N
 Dbase I
M
E
N
S
U
MEDICINA ENFERMERÍA
 W2003
AGD
A
R
C
I
L
T REGISTRO ADMVO
I A A
A S S
OPERADORES BDU ESTRUCTURA

29. S.S.P.A. steep 1
Logical model
BUSINESS: PROCESS AND FUNCTIONAL SERVICES
Standard modelling (BPML,…) External
modelling services
Internal and provider t
external s e
consumers c
Standard Messaging (HL7…) h
Routing
Audit n
service Service Compose
service
service
ext. Authentication/Authorizat ESB o
ion
l
o
E T L
master Org. g
Own Commerci
data Data
Legacy al Legacy y
Standard data modelling– directory, terminologies, ontologies, etc. (CEN – CIE - SNOME

30. S.S.P.A. steep 2
business architecture
BAM: business process monitoring
G
O
V
BPM: Business process modeling
E
S
R
O
N
A
ESB C A
N
C
ESB h1 ESB h2 ESB h3 ESB hn E

31. S.S.P.A. steep 3
physical architecture

32. S.S.P.A. steep 4
documentation
• Functional profile
o Business definition and modelling
o Cases of use
• Operative profile: deployment
• Compose services
• Atomic services
• Master Data tables
• Norms and standards
• Map of systems: SOA view
• Map of process
• Use of services contracts
• Procedures

33. S.S.P.A. steep 5
methodology
resources Personal Users Prescriptions
Evolution
resources Personal Users Prescriptions
Diraya, Receta XXI, BDU, MACO, estructura,
etc

34. S.S.P.A.: launched - DAE
HOSPITAL
BDU BDU AGD
DAE
C. Externas y Urgencias
(EG,EM,….)
MACO Estructura MACO Estructura
Concepto Inicial

35. S.S.P.A.: launched - DAE
ADM
External Medical
EHR HIS
ESB CENTRAL ESB HOSPITAL
RIS Nursering Farmacy ….

36. S.S.P.A.: achieved
• Deployment of the Technical Office of interoperability
• Acquisition and extension of architecture based on
federated ESB systems
• Home care circuits modeling
• Launching methodology to detect services based on
modeling
• DAE Project Extension to 21 hospitals in two years with
incidences ratio <15/month
• Extension of the model to other far-reaching corporate
systems (MPA - Corporate LIS, Logistic, etc.)
• Launching a website to disseminate the strategy
• Commissioning of all sectors of documentation
• Starting the master table model
• General reuse services

37. Thanks
jose.fernandez.engo.sspa@juntadeandalucia.es
http://es.linkedin.com/pub/jos%C3%A9-rom%C3%A1n-fern%C3%A1ndez-
engo/11/3a0/30