Enterprise Services Integration Transforming Features into Services The complexity of information systems for health sector organizations is a global challenge that results in an exponential increase in liabilities and costs. The information systems/applications framework in this sector is a topic that should be properly assessed and planned. There are solutions that helps managers to address this challenge without disrupting the operational service of such organizations. Bruno Santiago Correia bruno.correia @ lisboncg.com (Manager LCG) Framework The rapid evolution of business models in the health sector in Portugal in combination with the developments in other business sectors requires agility and efficiency in the use of Information Technology in a constant improvement process. The use of information is a critical success factor for any organization, both internally as well as for customers, partners and suppliers. In the health sector, the strategic alignment with market developments, with regulators and with the introduction of best practices by the competent entities increasingly becomes a major concern. The complexity and evolution of the clinical and non-clinical activities of hospitals have been accompanied by technology suppliers in the health sector, market that is already quite vast with numerous applications developed for various purposes. It is not uncommon to find hospitals with an application architecture that is composed of dozens of different applications, that includes exclusive clinical utility, resource management applications - financial, logistic and human resources - applications addressing areas of research and which act as decision support tools, among others. The range of applications is not only large in number but also heterogeneous with regard to their nature, purpose and technical support. This range of needs creates numerous projects and initiatives, on the one hand through their urgency, on the other hand through their simplicity or features that help to terminate isolated initiatives that results in information silos and functionalities in the architecture of information systems of an organization, adding complexity to cross operational activities. The isolation of information creates complexity in the application framework and causes redundancy, data inconsistency, duplication of effort and paper usage promotion within processes, which creates difficulties in the integrated view and consequent obstacles to the work of health professionals. This serious challenge directs hospitals to plan an evolution to an application integration architecture that addresses these constraints and ensures low impact in the introduction of new systems on the existing architecture while maintaining continued provision of services. An integrated and consolidated architecture will enable the resolution of problems such as existence of errors, duplication of information and data inconsistency. The application integration also facilitates the exchange of information processes and that enablings management information while becomes a more comprehensive, reliable and easy task. The new challenges in the health sector create opportunities in order to continue generating new systems and applications that contribute more and more to an increase in the quality of provided services by hospitals. 2013 LGC 1
Current Situation in Portugal Nowadays, and in order to address these challenges, Portuguese hospitals normally use HIS (Hospital Information System) solutions with the prospect of having a centralized platform that responds appropriately to all hospital management needs. Clínica A Clínica B This notion of "one size fits all", i.e. a single solution for all needs, is represented by some of HIS vertical solutions that we find in use in Portugal for example SONHO, HOSIX or SINUS systems. Given that this one technology platform approach to match the challenges that arise in the complexity of a hospital is never enough, these have to be, over time, addressed with other applications and solutions, which acquisition and implementation will lead to an exponential increase of complexity in managing and maintaining the application framework replicating the previously mentioned problems. Hospital IT departments should aim to establish a model of application integration that enables them to prepare and respond to changing demands in a flexible manner and with reduced and controlled impact. Subsequently, they shall develop a plan for implementation of the adopted model. This reality is evident in this sector, because in general terms, there is a lack of standardization of information and its formats, for clinical as well as for administrative areas. Difficulties in extracting information from these systems becomes obvious and critical. To summarize, it appears that the need for a universal model of application integration is a common problem for hospitals, fostered by the diversity of information to support clinical and administrative activities, systems, and other support applications, which leads to greater vertical integration of products developed by suppliers. The hospitals face a situation that makes them technology and suppliers hostages, whose responsiveness is rarely the necessary to meet the most diverse demands. Existing applications easily create complex and distinct environments and difficulties in obtaining information from the hospital activity processes. The set of point-to-point applications integration, is complex, vast (it just needs a small calculation of possible combinations in order to realize its size), and hardly reusable in new situations because of their specificity. This complexity has demonstrated by itself to have huge maintenance costs, whether we are considering correction or development costs or overall architecture management costs as a whole. In addition, this state of affairs requires the manual implementation of information transfer mechanisms between systems with all the risks that this operation entails, in particular the likelihood of errors, loss of information, dubious data quality, information security, among others. Outras s Adm. X HIS To summarize, this situation is characterized by: 1. A disturbing complexity in applications management, which increases exponentially whenever a new application is included in the technological infrastructure. 2. Information Redundancy caused by the existence of the same data in different systems that creates inconsistency and duplication of effort problems. Just imagine how many systems would be updated within a hospital just to change the personal address of a patient. Has nothing been forgotten? Was the address written in the same way in all systems? Weren t there errors in data entry? 3. Errors in information due to incorrect entry, as described in the previous point, in case of manual input of the same information among different systems. 4. With the increase of the application framework complexity, the effort of including and/or integrating new applications increase, require more effort and consequently higher costs. 5. Despite technological advances, the hospital environment is one of the sectors where there is a greater resistance to paperless processes. 6. Strong dependency on external suppliers, in particular the HIS platform supplier and its technological know-how which is based on key administrative hospital activities. 7. Dependency on the HIS platform availability that centralizes most of the required functionality in a platform / single infrastructure. 8. Resistance to change of health professionals on the introduction of new information systems to support the activity or changes to the existing systems. 9. Trade-off between the approach "off-the-shelf" (one size fits all) and the flexibility and agility of the systems. 10. Efficiency and quality orientation that require organizational changes highly dependent on an information systems platform that is agile, robust and simple. Adm. Y Clínica C 11. Infrastructure reorganization through application integration and openness for users data transfer and accountability 2013 LGC 2
lication Integration If properly planned and executed there are mechanisms that allow to overcome these challenges and reduce system complexity. The transformation of each application in cross and accessible services is the ideal medium for overcoming the challenges highlighted above, which is achieved by creating a Virtual Services Repository (VSR) solution. To do this one should useadditional concepts such as those described below. The integration application, known as EAI (Enterprise lication Integration) ensures systems full integration with each other and with external ones information portals, public transactions, intranets and clinical systems among others and reduces the redundancy and inconsistencies risk in systems databases. It also allows the publication of all available services according to the established business rules. The EAI gives organizations greater information systems utility that start to respond faster and in a more agile fashion, which is a critical factor for change. The application integration allows to: Reduce costs Eliminate information asymmetries Ensure higher productivity and greater accessibility Generate a source of knowledge and decision support Ensure equity in strategic alignment In addition, the information systems that are structured in an architecture that ensures data integrity and consistency also allow, on one hand, the use of credible, accurate and auditable management information,, and on the other hand the elimination of paper work and less dependency on bureaucratics. Briefly, the implementation of an integrated application framework in accordance with good practice EAI, gives organizations the following advantages: Maintaining legacy applications useful, providing them with flexibility Integration of new applications with minimum effort Future cost savings related to technology upgrades Increased productivity in the organization Elimination of redundant or inconsistent data Elimination of data granularity and functional silos Involvement of users, partners and suppliers in the processes Reduced dependence on suppliers, technologies and systems Reduced paper use and manual work input / updated information Quality of service and interactions between systems monitoring, whose exchanges of information act as a analytical tool An application integration project should not be a disruptive one, but be implemented in a phased manner while creating conditions to evolve in a progressive and planned manner. This type of project requires some care by its nature and lack of standard methods for application integration projects (which is still a reality). Besides that, handling different Legacy (specific proprietary systems considered obsolete but still in use) systems can be a very complex task, associated with high levels of stress if the systems have no external interfaces. Also the cross nature of these initiatives should be considered because of the inherent risk that must be managed as it will require an agile communication and coordination between different functional units in the organization. The careful and meticulous planning is also one of the factors taken into account in the implementation of an EAI project. All these challenges must be put into practice with the involvement of the organization top management to ensure alignment with the ongoing strategy. The main aspects to consider in order to ensure the success of a change project like this are: The Organization and People (responsibilities, culture, monitoring) Processes and Rules (assets life cycle, reengineering and optimization) Technologies and Tools (standards creation, applicationmiddleware) Through the EAI practices it is created a mediation mechanism of transactions between applications called ESB (Enterprise Service Bus) that allow the rationalization and standardization of integration mechanisms. The ESB is an abstraction layer that centralizes the various integrations to ensure the consolidation and re-mediation of the integration processes, eliminating point-to-point dependencies and ensuring transformations associated with information exchange. This component provides the necessary general and independent nature of any architectural application integration. In summary, the main functions of an ESB are: Virtualize the location and identity of the participating systems Convert the different types of protocols used by the participating systems Transform message formats in universal formats Manage the quality of service of the various interactions Distribute information and events between participating systems 2013 LGC 3
Service-Oriented Architecture (SOA) After having solved the problems of inconsistency and redundancy, the next challenge is to transform the applications features in services. That s the role of the Service Oriented Architecture (SOA). A SOA architecture is a layer of abstraction between the information systems and their clients which transforms decentralized and difficult to access features in shared central services, syntactically clear and easily accessible. A services oriented architecture gives an organization the agility, reusability, dynamics and the consequent cost reductions needed to respond to the challenges of change and adaptation, allowing, at the same time to capitalize on previous investments in information systems. SOA increases responsiveness, as well as the the autonomy degree regarding support system development. These changes require a new approach for organizations changing the drive from features to processes. In this sense it is important to realize that critical processes extend within the value chain and out of the organization which requires greater agility and dynamism. Enterprise Services Integration (EAI + SOA) In summary, the benefits of an integration model to make features of information systems available as services, are the following: > Change without disruption: stepwise change without disruption to a new fully flexible paradigm in a controlled environment and without significant third party dependencies; > Functional Scalability: ability to add features that are not implemented in the central HIS and make them accessible regardless of location, technology or supplier; > Centralized Information: Creating a single location (e.g. in an Intranet Portal) with access to all information and services; > Integrity: ensuring data integrity, eliminating redundant information repositories, eliminating effort duplication in data recording and decreased errors likelihood ; > Connect to external entities: ease of integration with new functional Health Units and Health Centers promoting clinical referral criteria in patients circulation. s Clínicas s Administ. Outras s Repositório Virtual de Serviços S S S S S S S S S S S S Sistemas de Informação HIS 2013 LGC 4
Methodology To implement a project of this complexity LCG follows a very strict methodology based on careful planning and constant attention to change management (including high focused risk management). Phase I: Assessment Phase II: Roadmap Phase III: Monitoring Organization strategic alignment identification ; Organizational and Technological Information Assessment; Requirement assessment on Information and Key Processes Information Sources Information Storage Duplication Cases Information Usefulness Existing integrations Future Needs Mapping lications / Processes Mapping Users / Processes; Current lication Architecture Assessment; Ongoing Projects Identification; Integration Requirements and Associated Risks Identification. Deliverables Listing existing technological resources; Current lication Architecture Diagram; Targets Identification ; Future and Integrated Vision Definition and Design; Procedural and Technological Recommendations; Major Initiatives Definition and Impact Analysis ; Action Plan Elaboration which identifies efforts, priorities, precedence and risks; Deliverables Future Architectural lication Design; Communication Plan; Recommendations List; Transformation Program. Projects and Initiatives Requirements Defininition; Solutions and Providers Evaluation and Selection; Implementation Monitoring - Project Management and Change Management; Implementation Definition and Rule Management; Supplier and contracts management. Deliverables lication Integration Solution; Next Steps: Platform integration KPIs Definition; Scorecard creation for performance of application integration monitoring and evaluating. Conclusion This new fully integrated and available architecture will allow to develop and maintain structured cross projects such as (i) clinical procedures; (ii) electronical clinical processes (ii) an alarm / notification system (for example to notify a doctor that an examination is ready); (iii) a prescription system and / or electronical requisition amongst other initiatives with incomparably lower costs and speed of implementation. Definitions EAI (Enterprise lication Integration): planning, methodology and tools aimed at modernizing, consolidating and coordinating company applications, determining the role that each of these applications has in the integrated architecture. SOA (Service-Oriented Architecture) framework / platform to support communications between related services of information systems. The SOA defines how several applications must interact in order to share services with each other. ESB (Enterprise Service Bus) oriented web services that support intelligent communication between different application components. 2013 LGC 5
Meet some of our solutions and services: Consulting - Support multi-criteria decision: Support the release and evaluation of public tender proposals. Identification of requirements and preparation of contract documents. Multi-criteria evaluation processes (high complexity and conflicts of interests) and assessment models requirements. Analysis and classification of suppliers and proposals. Support decision-making. Consulting - Operation: Design and re-engineering of processes. Design and implementation of operating performance and evaluation systems - Metrics, Balanced Scorecard, Reporting, Operations Management Optimization - Logistical planning, activities sequencing, production management, warehouse and procurement. Consulting - Human Capital Integrated Management Model: Performance evaluation management skills and models. Definition of compensation and incentive systems. Monitoring careers, succession planning and attracting and retaining talent. Assiduity management.. Technology - Design, Implementation and Maintenance of SAP solutions: Supporting the hiring and monitoring of IS projects. Transformation programs and SAP implementations. Integration / interconnection with other SAP applications and maintenance. Models of application maintenance. 2013 LGC 6 LCG Pólo Tecnológico de Lisboa Edifício Empresarial EE3 Sala 218 Estrada do Paço do Lumiar, Lote 3 1600-546 Lisboa Tel: (+351) 217 101 633 Email: geral@lisboncg.com www.lisboncg.com