Improving patient care and medical research through SOA
The University of Chicago Medical Center (UCMC) is a not-for-profit corporation based in Hyde Park on the campus of the University of Chicago. The Medical Center offers the full range of specialty and primary care services for adults and children, as well as serving as the training center for the Pritzker School of Medicine, a private professional school within the University's academic division of the Biological Sciences that is one of the nation's premier medical schools.
UCMC by the Numbers
- Founded in 1927
- 700+ physicians
- 596 beds in service
- 26,933 admissions
- 174,995 patient Days
- Two functions: both a neighborhood healthcare provider and a world-class research institute
- Six divisions: in & outpatient; women’s & children’s hospitals; physician offices and the Pritzker School of Medicine
UCMC physicians are not only members of the University of Chicago Physicians Group (UCPG), which includes more than 700 physicians and covers the full array of medical and surgical specialties, but also faculty members of the Pritzker School of Medicine.
The Biomedical IT group at UCMC provides traditional IT services (including database services, Web development, integration and Web services/SOA implementations, among others) for both the Hospital-based clinical faculty and University-based research faculty. They were tasked with finding a way to improve the efficiency of the hospital’s outpatient services, as well as the delivery of the results of those services to researchers.
On the clinical side, UCMC chose the hospital’s mammography service for their first test case. To improve efficiency here, they needed to find a way to automate radiology ordering by the physician, appointment booking by the clinic, results delivery from the clinic to the requesting physician, as well as patient notification – all the while ensuring patient data remained secure.
To improve efficiency on the research side, UCMC wanted to automate the input, collation and querying of radiology patient information. Once the data was ready for use, to ensure Quality of Service (QoS), research queries needed to be restricted (and that restriction strictly enforced in real time) in order to limit the amount of data that could be returned.
Additionally, with a timeline of just three months for the first clinical service to go live, and a six-month timeline for the complimentary solution on the researcher side, coupled with budget constraints overall, there was a pressing need to be able to reuse any solution created. Although the IT team at UCMC had never worked with Web services before, they understood that creating a Service Oriented Architecture (SOA) would allow them to re-use the same project infrastructure for both the clinical and R&D deployments without significant new investment.
Clinics entered their data into the system using the Health Level 7 (HL7) standard for healthcare-oriented information exchange. For UCMC’s purposes, HL7 was needlessly complex, and would raise costs by requiring them to purchase an HL7 engine. Instead, UCMC decided to spend their budget dollars on a Layer 7 SecureSpan Gateway, which provided not only a transformation engine that converted HL7 to Plain Old XML (POX), but also ensured against unauthorized access to secure patient information, enforced QoS by filtering malformed queries, and encrypted data over the wire using Public Key Infrastructure (PKI) to ensure data security. Key to the Layer 7 value proposition was the SecureSpan XML VPN Client (XVC), which allowed UCMC to meet their aggressive project timelines by speeding deployment. Once installed on the desktops of the clinic and research staff, the XVC automatically negotiated policy with the SecureSpan SOA Gateway, eliminating the need to code security, compliance and SLA requirements into UCMC’s client applications.
With the Layer 7 SecureSpan SOA Gateway in place to ensure HIPAA compliance by properly authorizing and authenticating users of the system, physicians can log on and order mammography tests for their patients. Once the tests have been run, the HL7 data feed from the radiology clinic is normalized to a standard SOAP-based XML data stream and input into the mammography service. This conversion process has the added benefit of making it easier to trigger workflow to ensure results are streamlined through the system and passed back to the requesting physician, and a follow-up notification is sent in a timely manner to the patient.
For the university researchers, UCMC built an “Honest Broker” application that strips out specific patient details (for HIPAA compliance) to ensure patient data remains confidential. Once a researcher registers with Honest Broker they can obtain pathology results using the same services that generate results for the requesting doctor. Here, the Layer 7 SOA Gateway ensures QoS by rejecting bad queries, and/or throttling datasets by enforcing limitations on data query size to prevent the system from being overwhelmed.
Overall, the quality of clinic care has measurably improved, while the time to process patient records and make them available for research has dramatically decreased.
By automating their mammography service, the clinic is now able to process more patients in the same amount of time, increasing patient satisfaction by decreasing wait times. Automating the input of patient and radiology data has reduced error rates by 30-40%, providing researchers with far more accurate data.
Finally, UCMC was able to deliver the project on time and within budget by reusing the same IT infrastructure for both their clinical and research divisions.