TrakCare Solution Guide

LAB Applications

Over 100 of the most common and latest analyser interfaces are already available, offering uni- and bi-directional capabilities with barcode reader functionality and direct TCP/IP interface connections via dedicated instrument terminal servers, utilising the ASTM or supplier/analyserspecific protocols. Interfaces are already available for new “black-box” analysers, such as Roche PSM and Roche Modular.

TrakCare LAB supports the needs of laboratory professionals to process and analyse results. It also provides caregivers access to those results in formats that they understand. Physicians have been able to use their mobile devices to access and review results in several hospitals. Some of the specific TrakCare LAB modules that can be used to address specific departmental needs are illustrated below:

• Daybook provides departmental control for registration of specimens, allowing automatic retrieval for inclusion in reports. Through this module users can allocate specimens, procedures, and stains to specimens, and enable the printing of specimen-specific labels for slides, blocks, and cassette writers, either in batch mode or on an ad-hoc basis. Users can create custom screens that are consistent with their department’s workflow.
• Worksheets incorporates multiple tests with defined turnaround times. A dedicated worksheet module allows users to enter results on a screen that mirrors the layout of the printed worksheet, significantly improving the time of result entry for manual assays when interfacing is not available.
• Reports allows report templates to be defined by the user and customised to suit the laboratory’s report types and formats. TrakCare LAB includes a significant number of reports that satisfy the requirements of even the most complex laboratory. In addition, TrakCare’s underlying technology is fully ODBC-compliant, allowing users to use third-party reporting tools such as Business Objects Crystal Reports to create custom reports on an ad-hoc basis.
• Electronic Claims creates electronic claim files suitable for exporting to other accounting system packages.
• Quality Control incorporates a fully integrated quality control module for manual assays and interfaced instruments, including Levy-Jennings and Youden Plot graphing capabilities, as well as inter- and intra-laboratory analyser quality control comparisons.
• Interfaces provides for both uni- and bi-directional analyser interfaces, including barcode reading functionality. For other interfacing requirements, TrakCare LAB uses PIT, HL7, and/or UN/EDIFACT formats. TrakCare LAB has also been configured to interface with external systems using client-specific proprietary formats.
• Specimen Storage includes a dedicated specimen storage module in TrakCare LAB (Version L64). Configuration of storage locations, including building, refrigerators, and the individual storage containers, can be configured entirely by users, ensuring accurate identification and retrieval of stored samples for further testing.

Section 3: TrakCare System Architecture and Technology

Unlike other systems, TrakCare was built from the ground up as a Web-based, patient-centric solution. It uses the most advanced technologies available in the market and is the first hospital information system to be built on an integration platform instead of a rigid database structure. This architecture facilitates the FastTrak to EPR and allows TrakCare to serve as the EPR while you implement new functionality over time.

TrakCare uses the browser as the client front end and requires little in the way of bandwidth or power at the desktop. The use of the browser enables the system to be used with full functionality over low-speed lines such as ISDN or dial-up without the need for expensive “thin client” technologies. This gives ubiquitous but secure access to appropriate information wherever and whenever it is needed via the Internet.

TrakCare is built on InterSystems Ensemble®, a rapid integration platform. Designed with today’s Web and service-oriented architectures in mind, TrakCare excels at quickly building and deploying new solutions that leverage the functionality of existing applications, orchestrating new business processes, and integrating data from across the entire hospital, outsourced service providers, and community health services.

3.1 TrakCare Technical Features

TrakCare supports a number of technical features that differentiate it from many competitive systems, including:

• Mobile Computing features offerings that differ substantially in both capability and flexibility. The capabilities of the applications on the various platforms will be directly related to the capabilities of the device. TrakCare has been developed to utilise the latest technology, with minimal or no modifications to the software. In broad terms, it can be accessed from any device that runs Internet Explorer Version 5.5 or higher. In the hospital environment, this allows pen-based tablets and laptop computers connected in a wireless network to be used to deliver patient information at the bedside. When staff work away from the hospital, such as in a community environment, TrakCare provides remote access to patient information.
• Security allows the hospital to establish its own desired security levels, departments, and roles in the system and to determine which functions and screens should be secured and at what security level. TrakCare also provides full data security, tied to user log-in names and associated passwords that limit access to the database.
• TrakCare allows for log-on security to be integrated with Windows log-on authentication, utilising pass-through authentication of the Windows log-on. This reduces the time it takes for users to get into the application and the need to have multiple log-ons for both Windows and TrakCare.
  
  Specific security features available include the following:
  • Access to TrakCare is user-name and password protected.
  • Restrictions can be placed on the actions a user can perform.
  • Users can be forced to change their passwords on a regular basis.
  • Access to TrakCare workflows that is restricted by the role the user is assigned (in addition to password protection).

TrakCare has additional safeguards to maintain the confidentiality of the data by associating patient records with treating doctors on a “need to know” basis. Only the treating doctor, or other doctors permitted by the treating doctor, can access such records.

• Reporting provides users with extensive facilities to manipulate data in a quick and easy manner. Since hospitals are dynamic environments, the information needs of clinicians vary considerably. TrakCare supports this requirement with the following features:
  • Each module of TrakCare comes with a number of standard reports for operational, managerial, and statistical purposes. Users can control the selection and sort criteria of these reports. These reports can also be modified by the hospital.
  • The hospital can develop its own ad-hoc reports using ODBC-compatible reporting tools.
  • TrakCare can be linked to business intelligence tools, allowing users to make their own ad-hoc queries on the TrakCare database (i.e., a user can make a query on the Patient Master Index to identify patients who are male, over 65 years old, and currently admitted).
    
    Reports may be viewed on-screen, printed, or imported to other office automation products, including Microsoft Excel and Word and e-mail systems. TrakCare can provide a seamless interface between its database and these products. TrakCare provides an interface to all Microsoft and open-system-compliant desktop packages.
• Auditing includes the following facilities:
  • Audit Trails keeps a record of all changes made to a patient’s record including the date, time of change, user making the change, and details of the change. Features include:
    • Configurable
    • Detail of changes made to the database
    • Time and date stamp
  • Audit Footprint keeps a record of any user who has accessed the patient’s record even if no changes were made. Features include:
    • Configurable
    • Detail of who views patient record
    • Time and date stamp
  • Code Table Audit keeps a record of all changes made to code table records including the date, time of change, user making the change, and details of the change.
  • Security Violations keeps a record of any security violation attempt.

3.2 Application Architecture

TrakCare implementations are created with the philosophy that you must use the right tool for the job. Solutions are built using a unique Component Framework, enabling rapid Web application development, extraordinary transaction processing speed, and massive scalability with minimal maintenance requirements, resulting in a high-performance, highly flexible EPR application.

The TrakCare component model enables rapid application development, a consistent user interface, a consistent and inherent model for system tailoring, and considerable reuse of system components.

TrakCare can be quickly and easily tailored to your requirements without the expense, delay, complexity, or risk of custom development. The system can optionally be tailored across some or all modules through configurable workflows and configurable views of data to best serve differing needs within organisations, groups, and even individuals.

TrakCare provides support for a range of secure multiple agency configurations. Solutions can be configured to meet specific requirements.

Typical model configurations include:

• Multiple instances of the application on a single server
• A single database with multiple hospitals in a multihospital configuration
• A multihospital configuration with independent databases and a single EPR summary
• A multiregion, multihospital, central EPR configuration with effective replication of the EPR with the patient’s home EPR

3.3 Operating System Environments

TrakCare applications are certified to run on a range of commodity operating system environments, including but not limited to Microsoft Windows NT 4 (SP4, SP5, SP6), Microsoft Windows 2000 (SP3, SP4), Microsoft Windows XP (SP1, SP2), Microsoft Windows Server 2003, Microsoft Windows Vista, and a range of Unix platforms including Solaris, Tru64 Unix, HP-UX and AIX (Web components require Microsoft Internet Information Services). TrakCare can run in a mixed-platform environment.

3.4 Logical Model

TrakCare is logically designed as a multi-tier system. The components in the different tiers are responsible for different tasks and can be logically grouped based on the type of work they perform. These tiers may be physically configured across one or more servers to provide scalability and resilience.

The four logical tiers are:

• Data Tier
• Application Tier
• Web Tier/File and Print Tier
• Client Tier

Data Tier

3.4.1 Data Tier

The Data Tier is made up of a database containing TrakCare transaction data and database schema. Typically both a primary and a secondary database server are active at all times. The primary database server is used for back-end transactions. The secondary (shadow) database is a mirror image of the primary database, which is kept current by copying transaction journals from the primary database and replaying the journals into the shadow database. The advantage of the shadow database is that it can be used for ad-hoc queries and reporting that would otherwise impact the performance of the primary database. Multiple shadow servers may be configured to suit reporting requirements and provide redundancy to enhance corporate disaster recovery plans.

Data Tier

Shadow Database

Application and Data Tiers communicate over standard TCP/IP network configurations.

3.4.2 Application Tier

The Application Tier is the workhorse of the TrakCare application, containing TrakCare application programs and data.

It is responsible for dynamically generating TrakCare application Web pages in response to client requests. One or more Web Tier servers connect to the Application Tier via a Web gateway. The application server constructs an HTML representation of the data, which is passed back to the Web server via the gateway.

Application Tier

Depending on your geographical requirements, the application servers can be located remotely from the Data Tier server, in which case they may also contain high-use static data, accessing the database server only when dynamic transaction data is required.

When the Application Server needs to access a remote data server, a protocol is used to access the remote database and cache data on the application server so future related data requests can often be satisfied without using network resources.

3.4.3 Web Tier/File and Print Tier

The Web Tier/File and Print Tier typically integrates with your existing infrastructure.

TrakCare utilises the Trak Reporting Model, which supports both centralised (system) printing and distributed (client preview) printing models.

Trak Print Service (TPS) supports a centralised queued model to manage system-generated printing, faxing, and e-mailing. TPS uses the worldleading Business Objects Crystal Reports RDC print engine. Multiple print services can be run simultaneously, with each instance aware of the total number of print processes currently running to effectively control licensing costs.

TrakCare can also integrate with Business Objects Crystal Reports Application Server for Web-based client previewing requirements. The reports are generated as dynamic HTML or HTML, or via an ActiveX viewer. The preview mechanism offers the flexibility to print to a locally defined printer and the functionality to export reports in various formats.

The Web Tier serves TrakCare application Web pages ? created dynamically by the Application Tier ? to client PCs and returns client transactions back to the Application Tier.

InterSystems Ensemble® utilises Cache Server Pages (CSP) technology from InterSystems Corporation, which allows the building and deployment of high-performance, highly scalable Web applications. CSP enables Web pages to be generated dynamically at runtime on the application server, allowing content (HTML, XML, style sheets, images, and other types) to be served dynamically.

The client connects to the Web server via a Web browser using standard HTTP protocol. The HTTP client (the Web browser) requests a page from the Web Tier using HTTP. The Web server recognises this as a CSP request and forwards it to the Application Tier using a fast server application programming interface. The CSP Server in the Application Tier processes the request and returns a page to the Web Tier, which in turn sends it to the browser. CSP manages communications between the Web Tier and Application Tier and invokes application code to generate the page.

CSP supports HTML, XML, WML, and other Web-oriented mark-up languages. CSP uses a dynamic server page technology based on the Document Object Model.

Web Tier

3.4.4 Client Tier

The Client Tier is the only part of the TrakCare system that end users interact with directly. This tier can be any low-maintenance, light-footprint client device that supports Microsoft Internet Explorer 5.5 or higher, and provides the single interface between the user and the components of TrakCare, including PAS, CIS, system administration, and viewing reports, and non-TrakCare applications.

In addition to the server-side code that executes on the Application Tier, some code, typically JavaScript, is run on the client browser, usually to support advanced functionality such as data validation, reformatting, or invoking serverside code. ActiveX and Java controls are also used to execute client-side applets to preview complex images and standard reports and to modify TrakCare page layouts. Use of the capabilities can be restricted to specific users or groups of users and may be subject to license restrictions.

3.4.5 Standards and Protocols

The TrakCare solution utilises the latest standards and protocols to enable connectivity and extensibility with other systems. Key technologies and standards are indicated (but not limited to) those illustrated below.

3.5 System Architecture Configurations

The innovative design of the TrakCare application using logical tiers results in considerable flexibility to tailor a solution to your organisation’s geographical and technological requirements. Multi-tier, multiserver solutions have the added advantage of providing outstanding performance, massive scalability, real-time data analytics, and robust reliability. Your solution can be designed to accommodate several hundred users or many thousands, in a single location or over many sites. An entry-level configuration can be extended to support additional users as your organisation’s use of TrakCare grows without the need to rebuild or redesign from scratch.

3.5.1 Single-Server Configuration

In the simplest configuration, a single server is used for all the logical tiers. This type of configuration can service a limited number of clients ? typically up to 200 concurrent users ? but can be extended to approximately 1,000 depending on the platform and TrakCare modules used.

The entry-level option is designed for deployment at a single site or for a limited implementation of TrakCare. Although the singleserver configuration does not immediately provide the necessary infrastructure to support future growth, additional servers can be added as your needs change.

A high-availability environment is possible by adding additional hardware. For example, a clustered or multi-tiered configuration would require at least one more server.

The preferred operating system for a singleserver configuration is Microsoft Windows 2003 Server.

3.5.2 Multi-Tier Configuration

The multi-tier, multiserver configuration uses distributed database communications to make it possible for a higher system capacity and greater system redundancy, allowing far more clients to connect to the system through the use of multiple application servers.

For sites requiring high capacity and high availability, it is recommended that the TrakCare Application and Database Tiers be distributed across multiple servers. The Web Tier should also be a separate tier. In addition, report services may be on separate servers depending on the reporting requirements.

In the simplest multi-tier setup, two or more systems, acting as Application Tier servers, are placed between the central Data Tier server and the Web Tier servers. In this configuration, the Application Tier servers host processes that perform work for the client's benefit, off-loading the CPU load from the database server. This type of configuration scales best for Web applications such as TrakCare, which offers a significant level of data read access. More complex configurations, with multiple data servers as well as data stored on application server machines, are also possible.

Typically sites use multi-tier configurations for scaling as well as for providing high availability, with application servers serving as hotstandby systems.

For entry-level high availability, only a duplicate system with the same specifications as the database server is required. Shadow and failover database servers are similarly sized.

3.5.3 Scalability and High Availability

A multi-tier architecture allows the system components to be spread across two or more data centres connected by high-capacity network connections.

The architecture does not alter significantly when scaling up, although the capacity of the components can be increased as additional sites and modules are brought online.

Acceptance, system testing, and training environments are located on their own pool of servers.

Multi-tier, multiserver system architecture is characterised by:

• Individual servers for the database and application servers
• Windows servers for the Web Tier/File and Print Tier
• High-availability clustering of the database servers
• Redundant Web, print, and file servers
• Disaster tolerance through geographically separate data centres and remote mirroring
• Private gigabit network between servers
• Use of SAN storage for all disk requirements (except operating system and system booting if required)

It is designed to scale through the addition of:

• Additional application servers
• Additional Web servers
• Scaled increments of hardware (memory, CPUs)

Unix systems are preferred for database and application servers for larger installations. However, Microsoft Windows Servers can be used in multi-tier configurations.

The following table compares single-server configuration and multi-tier configuration.

Table: Comparison of Different Options

	Option One Single-Server Configuration	Option Two Multi-Tier Configuration
Hardware Costs	Lower start-up hardware costs	Higher start-up hardware costs
Hardware Efficiency	Seldom-used redundant hardware if high availability is employed	All [multiple] application servers for high availability are fully utilised
Scalability	Limited, and would require significant downtime to upgrade to a multi-tier environment	No interruption to services as additional server hardware can dynamically be brought online

3.5.4 Client Architecture

The recommended minimum hardware and software configuration of PCs to be used as client workstations are:

Client	Operating System	Processor	Memory	Disk	Monitor
Minimum	Windows 2000 with Internet Explorer 5.5 SP2	Pentium (133 MHz)	128MB	2GB	15” CRT (800 x 600)
Recommended	Windows XP	Pentium 4 (1 GHz+)	256MB	20GB	17” (1,024 x 768)
Recommended	Windows Vista	Pentium 4 (1 GHz+)	1GB	40GB	17” (1,024 x 768)

The main client application used in the TrakCare solution is Internet Explorer 5.5 or higher with Microsoft or Sun’s Java Virtual Machine (VM).

For report preview and the ability to customise the application components, the “local intranet” security zone in Internet Explorer must be configured to allow signed and unassigned ActiveX controls.

The additional software components required for application maintenance or configuration include:

• Visual Basic application for code table maintenance
• Limited Ensemble client installation and ActiveX control for editing layouts
• Full Ensemble client

Where Microsoft Word integration capabilities are required, Microsoft Word must be available to the client PC in addition to ODBC. Typical uses are clinical summaries and results reporting. However, alternate mechanisms are available through the TrakCare application such as creation of PDFs (which requires client installation of Adobe Acrobat Reader).

Users who wish to develop or maintain Business Objects Crystal Reports will also need Crystal Reports Designer and an Ensemble ODBC driver.

Required hard disk space on the client workstation for each additional component includes:

InterSystems certifies these environments with the TrakCare solution

3.6 Other Architecture Requirements

Several environments should be maintained as part of the entire healthcare information system infrastructure. It is expected that there will be several TrakCare instances on the servers supporting different versions of the TrakCare system.

3.6.1 Production

The production system used for live system activity.

3.6.2 System Test

An environment for vendors to place and run initial quality assurance tests. This environment can also be used for:

• Performance and stress testing
• Investigating the effect of alternative or emerging infrastructure components on application performance or availability
• Other testing (e.g., start-up, shutdown, backup, and recovery)

3.6.3 Training

Generally this is a copy of production (in functionality) but could be ahead if training is required for a new release. During planned training sessions, the database may be refreshed prior to commencement. The training environment is often used to acceptance-test latest releases prior to their deployment into the production system.

Server hardware for acceptance testing ideally would be the pre-production equipment. In large installations it may be necessary to maintain a replica of the production systems for the purpose of continual acceptance testing, however, this would be rare. Disk requirements may be scaled down to suit the expectation of the level of acceptance testing.

3.7 Additional Peripherals Supported

The TrakCare solution has the capability to support a broad range of commodity peripherals including tablet PCs, mobile devices, scanners, and barcode readers.

3.7.1 Tablet PCs

TrakCare supports the use of wireless tablet devices for deployment; these provide the full functionality of the desktop environment.

3.7.2 Scanners

TWAIN-compatible scanners can be interfaced into the TrakCare application. The interface is only limited by the TWAIN driver, however, the client must have an associated TWAIN driver. The interface is called using an ActiveX control via the browser.

3.7.3 Barcode Readers

The solution supports rapid and error-free search and selection through the use of barcode scanners. Typical uses include laboratory specimens and medical records.

 

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InterSystems TrakCare is a trademark of InterSystems Corporation. Other product names are trademarks of their respective vendors.
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