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InterSystems

Achieving the Vision of Connected Healthcare

InterSystems software products are being used by leading healthcare institutions around the world to turn the vision of “connected healthcare” into reality, improving patient care and safety while reducing costs. Our innovative technologies offer the fastest way to create and integrate electronic health records (EHRs). By enabling connected healthcare, our software makes it possible for test results and other critical clinical information to be delivered instantaneously to healthcare professionals at every point of care. Doctors are able to send electronic prescriptions to pharmacies, and connected systems can flag potentially harmful drug interactions and provide clinical guidelines.

Doctors

InterSystems software for connected healthcare eliminates the duplication of laboratory tests and other redundancies, expedites billing and payment, and maximizes bed utilization. Connected healthcare makes every process more efficient and reliable.

InterSystems products offer the reliability, scalability, ease of use, and performance required to create connected healthcare environments. Our products include:


“Poorly integrated healthcare IT systems harm or kill more patients every year than do medications and medical devices.”

Asif Ahma
CIO
Duke University Health System

InterSystems Ensemble

As the #1 interface engine in healthcare, and a recognized leader in composite application development, Ensemble makes it easier for individual hospitals to rapidly connect their applications, processes, and healthcare professionals to share vital information. Here are two examples of how our clients are improving care and cost efficiency with Ensemble:

Working with your existing development platforms and IT standards, Ensemble enables you to rapidly enhance existing applications with the new features required to address your most pressing challenges, including:

Easily Create Connectable Applications

Ensemble is the easiest and most efficient integration software to use because it’s not a stitched-together suite of separate parts. We created it as a single, architecturally consistent technology stack. Ensemble seamlessly combines a rapid application development environment with messaging, integration, business process orchestration (BPO), and business activity monitoring (BAM) capabilities. Designed with service-oriented and event-driven architectures in mind, Ensemble excels at quickly building and deploying connectable applications – healthcare solutions that leverage the functionality of existing applications, orchestrate new business processes, and integrate data from across the enterprise.

Ensemble offers unmatched performance because its technology stack includes InterSystems Caché, the leading database in clinical applications worldwide. Ensemble provides all the technology needed to create composite applications or to share data among disparate systems, without having to first integrate multiple development and integration platforms. This fusion of previously independent technologies has only a single, rapid learning curve and dramatically reduces time-to-deployment and costs. At the same time, it lowers management overhead by enabling you to rapidly tailor integrated systems, without coding, using business process definitions, business rules, workflows, and other configuration settings.

Ensemble technology lets you rapidly enhance applications and systems with:

Ensemble’s Innovations in Developer and Administrator Productivity

Developer productivity: Ensemble’s advanced abstraction technology provides a consistent, internal object representation of the diverse programming models, programming interfaces, and data formats in an integrated system. This enables the use of Ensemble’s single development environment across all aspects of projects – from messaging to composition to process orchestration to BAM. This unified graphical, XML, and code-based development environment simplifies and accelerates modeling and automating of business processes, and it enables extremely rapid service-oriented development of composite applications.

Unlike products that are focused on a particular infrastructure such as J2EE or .NET, Ensemble provides equal support for both and is easily extensible for new object models and technology frameworks to protect your investments well into the future.

Messaging/ESB: Rapid time-to-deployment, high performance, reliability of deployed solutions, and management efficiencies are the hallmarks of the Ensemble ESB. In demanding healthcare environments, Ensemble customers report that application integration projects are completed nearly three times faster than with other products, and that message processing is twice as fast.

Composite applications: When used for projects that incorporate multiple systems based on different development and integration technologies, Ensemble’s advantages become even more apparent. Ensemble’s object technology and repository provide a consistent, unified view of the diverse systems, applications, and services in the solution. This simplifies composite application development by applying Ensemble messaging, business rules processing, workflow, alerting, and real-time BAM consistently across all the disparate systems involved.

Business rules: Interface specialists and support personnel can use Ensemble’s rules engine to configure and change message routing and filtering rules in a matter of minutes. This reduces the cost of making such changes, and it frees programmers to focus instead on new projects – reducing backlogs and delivering value sooner.

SOA: Ensemble can produce and consume Web services. As a producer, Ensemble can present any of the functions represented in its repository as a Web service. As a consumer, Ensemble identifies external Web services and stores their object representations in its repository, where they can be managed and incorporated into solutions as easily as local functionality.

End-to-end management: Ensemble’s built-in, persistent message repository, rules engine, and a well-designed, browser-based management portal reduce administration and maintenance costs and are the foundation for:


Grow with Ensemble

Start simple with Ensemble as your interface engine, and complete messaging projects faster than ever. Then move on to use the additional power of Ensemble. Create composite applications and enhanced business processes that coordinate workflow, deliver vital information in the right form exactly when and where needed, and provide data for business intelligence and management insights. Ensemble is the ideal platform for growing healthcare enterprises.

Case Studies

Case Study: Stanford Hospital and Clinics, United States

Stanford Hospital and Clinics Switches to Ensemble for a Healthcare SOA Foundation

Stanford Hospital and Clinics has secured a place on U.S. News & World Report magazine’s “America’s Best Hospitals” honor roll for each of the past eight years. “The quality of our medical staff is the main reason we so consistently rank high in the U.S. News & World Report list,” says Anita Brewer, Stanford Hospital’s director of IT architecture and innovation. “But our IT innovations also are key. The timely access to accurate information that our applications provide is critical to clinical safety and success.”

Stanford’s long-term clinical information strategy calls for seamless integration and communication among multiple applications and data repositories. To execute on this strategy, the Stanford IT group chose the Ensemble rapid integration and development platform. “Ensemble will help us maintain and improve our level of care,” Brewer notes, “and keep us on the Best Hospitals list for years to come.”

Key factors for Stanford in its choice of Ensemble included:

Transparent information flow with Ensemble
“We are pursuing a more service-oriented architecture,” Brewer explains, “so it’s easier to extend our data and to exchange information and communicate much more efficiently and rapidly.” Ensemble is the centerpiece of this transition.

The first task for Ensemble is to create the interfaces from legacy departmental systems to a new installation of the Epic Systems Corporation suite of EMR applications. Unlike the technology Ensemble replaced, these new interfaces will not require a team of specialists, each understanding the complexities of the specific languages needed for individual application-to-application communication.“Ensemble will let us enlarge our focus to information exchange and sharing, instead of just ‘interfacing,’” says Brewer. “It is a new paradigm for us that puts the emphasis on transparent information flow. We’ll be able to automate manual processes, capture data as it flows through the organization, repurpose it, use it in data warehouse applications, and have one central location for its control.”


“Ensemble is so visual and easily understandable
that our team of IT architects quickly perceived
how it would work in each of our integration scenarios.
Ensemble provides exceptional capabilities
for rapid integration and development.”

Anita Brewer,
director of IT architecture and innovation
Stanford Hospital and Clinics

Case Study: National IT Institute for Healthcare, Netherlands

Netherlands Counts on Ensemble as Core Technology for its National EHR

In 2005, the Netherlands’ National IT Institute for Healthcare (NICTIZ) moved boldly, on behalf of the national health community, to establish an infrastructure for nationwide electronic sharing of patient information among healthcare providers. Like similar efforts elsewhere, the goal is to improve the quality of care and the efficiency of healthcare delivery and to drive down costs. The difference between the Netherlands’ effort and other similar projects is how quickly they have achieved technical milestones. Ensemble rapid integration software is a major reason for this success.

In October 2005, the project’s system integrator, Computer Sciences Corporation (CSC), chose Ensemble as the technology for the core National SwitchPoint (NSP) system. The NSP maintains a central index pointing to all locations of records for each patient and a registry of associated clinical systems, handles authentication and authorization of system users, and logs all transactions for auditing. In only four months, the CSC team was trained on Ensemble, completed requirements gathering and analysis, and developed, tested, and deployed the NSP software. “Our architects designing the system and creating specifications were hard-pressed to keep up with the developers implementing those specifications,” says Hans Rietveld, NSP developer at CSC. “Development is that fast with Ensemble.”

Ensemble was chosen for the NSP project because of:

“With Ensemble, we could run as fast as we needed
on a straightforward and easy-to-manage configuration.”

Bob Schat
solution architect
CSC

“With Ensemble, we could run as fast as we needed on a straightforward and easy-to-manage configuration, supporting the performance and scalability demands of the NSP,” says Bob Schat, solution architect at CSC. “Ensemble is simply doing more for NICTIZ, faster, and with greater manageability and less expense.”

Case Study: Cedars-Sinai Medical Center, United States

Cedars-Sinai medical Center Uses Ensemble Software for Rapid Integration and Fast Development

Following an extensive evaluation of leading integration products, Los Angeles based Cedars-Sinai Medical Center replaced its legacy integration platform with Ensemble software.

Cedars-Sinai is one of the largest non-profit academic medical centers in the Western United States. Approximately 1,800 physicians in virtually all medical specialties serve Cedars-Sinai’s patient population. Known throughout healthcare as a leader in advanced technology and ranked as a national leader in quality healthcare delivery, 10 of Cedars-Sinai’s specialties ranked among the nation’s best in U.S. News & World Report’s 2007 “America’s Best Hospitals” guide. Cedars-Sinai also has received the “Most Wired Hospital” designation from Hospitals & Networks Magazine.

“Ensemble provides the extensibility, speed-to-deployment, and wide choice of adapters needed to replace the current integration engine, and is critical to implementing our organization’s IT strategic vision.”

Darren Dworkin
CIO
Cedars-Sinai Medical Center

Ensemble provides Cedars-Sinai with a rapid development environment for creating interfaces and composite applications that leverage existing data and functionality. Tightly integrated with all of Ensemble’s messaging and business process optimization functionality, the development environment enables Cedars-Sinai to address the entire range of its IT requirements. “We currently have more than 500 interfaces running on production systems where Ensemble is replacing the legacy integration technology,” says Darren Dworkin, CIO at Cedars-Sinai. “Ensemble is the foundation software for advanced integration work as we move forward.”

“InterSystems is a proven leader in healthcare and shares our strong commitment to advancing healthcare technology standards,” Dworkin continues. “Our long-term strategy is aimed at building a single integration environment for our clinical IT platform. Ensemble provides the extensibility, speed-to-deployment, and wide choice of adapters needed to replace the current integration engine, and is critical to implementing our organization’s IT strategic vision.”

Case Study: Vimercate Hospital, Italy

Vimercate Hospital Creates Regional EHR in Just Three Months with Ensemble

Vimercate Hospital near Milan leads a public trust of seven hospitals within the Lombardy region in northern Italy. In support of a government program that includes smart cards for each citizen and a central repository of healthcare information, Vimercate used Ensemble rapid integration software to implement a regional EHR among all of its member hospitals.

The trusts’ hospitals run different healthcare applications based on a variety of databases, including Caché and Oracle. Vimercate faced a decision to either mandate the move to a single EHR solution for use in all its hospitals, eliminating the existing systems, or leave the hospitals’ current systems in place and integrate their data into a virtual EHR.

Vimercate’s CIO, Giovanni Delgrossi, chose to create a virtual EHR using Ensemble. This EHR taps information stored in the hospitals’ various systems, individual citizen’s smart cards and the Lombardy region’s central repository.“We could have solved our data complexity issues by mandating a single electronic records solution,” Delgrossi says, “but we decided to leverage our prior investments and to offer integration of data and processes through Ensemble. Ensemble allowed us to develop a system, in just three months, that fits the regional requirements and gives us tighter control and better management of our data, information, and company.”

While the EHR was being developed, hospital personnel continued to use the existing applications, avoiding disruption of their work. The hospital’s applications now communicate with Ensemble to identify patients and retrieve their medical records.

Vimercate Hospital saw immediate benefits from its Ensemble-based EHR implementation. “The main result,” says Delgrossi, “is that our doctors now have complete and clearly presented patient information always at hand, which makes it easier to make good diagnoses and decisions. Our objective was to improve the quality of treatment, while also improving the overall efficiency of healthcare delivery, and Ensemble has helped us get there.”


“We could have solved our data complexity issues by mandating a single electronic records solution, but we decided to leverage our prior investments and to offer integration of data and processes through Ensemble.”

Giovanni Delgrossi
CIO
Vimercate Hospital

Case Study: Barts and the London NHS Trust, United Kingdom

Barts and the London NHS Trust Eases Integration of Internal Systems and Connection to National EHR with Ensemble

“Our first experience using Ensemble has confirmed for us that we now have the means to connect our applications across the entire continuum of care.”

Mike Eagles,
head of software development
Barts and the London NHS Trust

Barts and the London NHS Trust, comprised of St. Bartholomew’s Hospital, the Royal London Hospital, and the London Chest Hospital, is one of the largest and most respected teaching hospital trusts in Britain. The trust offers 1,000 hospital beds and cares for more than 500,000 patients annually in the London area.

Over the years, Barts has developed and deployed a set of clinical and administrative applications integrated through many point-to-point connections. With plans to build a new hospital, an initiative to improve clinical processes through modernized information systems, and the advent of Britain’s nationwide EHR (the Care Records Service, or CRS), Barts selected the comprehensive capabilities of Ensemble to address these challenges.

The first phase of the trust’s modernization used Ensemble to integrate a new radiology information system (iSOFT’s RadCenter) into the trust’s existing physician order entry (POE) system. Orders for radiology come into Ensemble from the POE, and Ensemble communicates the request, with some transformation of data formats, to RadCenter. RadCenter then returns the results, including the radiologist’s observation report, to Ensemble using HL7 messaging. This receipt of results triggers Ensemble to communicate reports back to the POE system and to transform the HL7-formatted results and observation report into Barts’ locally implemented structures for electronic communication to the patient’s personal physician.

“Our first experience using Ensemble has confirmed for us that we now have the means to connect our applications across the entire continuum of care,” says Mike Eagles, head of software development at Barts and the London NHS Trust, “and to quickly adapt to any changes that come our way.”

Now rolling straight toward Barts is the National Health Service’s CRS. “When the software for the CRS is implemented,” explains Eagles, “we’ll be ready with Ensemble to integrate those services with our existing systems. We’ll be able to keep the best of what works for us now and still get the benefits of a nationwide electronic health record.”

Case Study:
Massachusetts Institute of Technology, United States

MIT Medical Reports on Live Clinical Data with Ensemble, Improving Quality of Care

MIT Medical meets the healthcare needs of the Massachusetts Institute of Technology community and family members. With 90 clinicians in all medical specialties and its own health plans, a small hospital, and pharmacy, laboratory, and radiology services, MIT Medical serves a population of 30,000, registering approximately 130,000 outpatient visits per year.

A reporting challenge
“We have many disparate applications and databases that have to be interfaced one way for our business functions, and other ways to create useful management data,” says Alison Grice Knott, MIT Medical’s manager of information security and integration. Before adopting Ensemble, analysts extracted data from these varied sources and then entered it into Access databases and Excel spreadsheets for analysis. “But the data was always retrospective,” Knott explains, “not information the medical staff could use to impact their work or patient care in a timely way.” In 2007, increasing demand for improved management information drove the search for a new reporting solution. After a successful proof-of-concept project, MIT Medical chose the InterSystems Ensemble rapid integration and development platform.

Rapid development and a fast path to higher quality of care
Using Ensemble, MIT Medical created several Web-based dashboards that present live data, rolled up into summary statistics, drawn from various applications and data sources. Each dashboard targets a different area of interest, such as diabetes patients, or visit statistics. “Once we’ve done one dashboard,” says Terry McNatt, an MIT Medical consultant, “it’s very easy to tweak it for use in the next project.” Ensemble business rules give the dashboards a “set and forget” capability. “We set the rules,” explains McNatt, “and Ensemble goes and gets the pieces of data we want, when we want it, so our users are always seeing fresh information.” Ensemble business activity monitoring keeps an eye on the data and sends alerts when key performance indicators pass certain thresholds.

“Ensemble has made a big difference for us,” Knott says. “It knits all the information together without the management challenges of a data warehouse.” Knott continues, “Now we can look at productivity in terms of increasing quality of care, and keep an eye on costs. We can get answers to questions like, ‘Are we managing our diabetic patients well?’ ‘Are we meeting the standards set for wellness?’”

With the data freed from static reports, any authorized user with a Web browser can drill into the summary numbers and explore their origin. “Our users trust the data now,” says Knott, “and have confidence in using it to guide management decision making.”


“Ensemble has made a big difference for us. It knits all the information together without the management challenges of a data warehouse.”

Alison Grice Knott
manager of information security and integration
MIT Medical

Case Study:
New York City Health and Hospitals Corporation, United States

Ensemble Helps Win Race Against Disease Outbreak

The New York City Health and Hospitals Corporation (HHC) is the largest municipal hospital and health care system in the United States. It serves 1.3 million people with 11 acute care hospitals (7,407 beds), four skilled nursing facilities, 6 large diagnostic and treatment centers, and more than 80 community based clinics.

In 2007, when a dangerous salmonella outbreak occurred among children eating a popular snack food in another part of the country, the New York City Department of Health (DOH) didn’t want to wait for New York’s kids to get sick before taking action. Instead, it used an information system built on the InterSystems Ensemble rapid integration platform to quickly identify 200 children between the ages of 1 and 4 who could be at risk. The Ensemble-based system draws live data from the healthcare information systems in use at the HHC hospitals and many of its community clinics.

Ensemble enabled quick identification of 200 children who could be at risk.

Within hours of asking HHC to identify kids at risk, the New York City Department of Health had the information it needed to contact the families and make sure that these children were checked for salmonella poisoning.

Ensemble builds a single view of patient data
To enable easy access to system-wide data for the Department of Health, HHC needed a solution that could reliably store, process, aggregate, and share patient data coming from all its hospitals, diagnostic centers, and community health centers. HHC chose Ensemble, and turned to J2 Interactive, an InterSystems Implementation Partner in Charlestown, Massachusetts, to design an Ensemble-based system to meet the immediate need for data sharing with the DOH and to address broader needs for data access and analysis.

In the resulting system, ADT (admission, discharge, transfer) events at HHC facilities trigger HL7 messages in existing message routers. Ensemble continuously analyzes those messages, aggregates them into patient-centric data structures, and stores them in its embedded, high-performance object database. DOH uses this data for its real-time bio-surveillance efforts, and HHC uses a Web browser interface for system-wide ad hoc reporting and analysis.

 

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