We have used Intersystems Ensemble and Cache to design, develop and implement the following technologies:
With 17 years of laboratory IT experience using Intersystem technologies, we have developed software, features and functions inspired by the need of over 500 hospitals and commercial laboratories throughout the country. From an intuitive web based lab ordering system, to remote laboratory printing functionality, digital alert dashboards to monitor interfaces and mobile applications to keep important critical laboratory data in a physician’s iPhone or Android device. We’ve listened to our customers and have developed world class cloud based applications that can help any laboratory succeed. Below are some examples of the range of functions we’ve provided.
Using ColdFusion, a rapid commercial deployment web platform, a laboratory ordering system that allows fully laboratory complaint orders to be placed. Over the years we’ve added functionality required and request by laboratories of all kinds. Features such as medical necessity checking at order entry, ask at order questions to complete an order, order routing based on insurance carrier or test code, automatic requisition splitting to their respective laboratory based on specific rules. The ability to add-on test to correspond with an already assigned LIS accession number. Other features for couriers and physician office staff such as Manifest List to assure specimens leaving the facility are fully accounted for. Pending order report to display testing that takes longer incubation time. An easy shopping cart style supply ordering module for clients to place their own orders with routes to the laboratory supply desk. A feature for physician to add specific patient encounters notes that follow the patient’s record. Trending and cumulative graph reporting for specific analytes or an entire report with enough data elements. A longitudinal view of patient’s entire blood history with the ability to follow trends when titrating medication. Insurance member code validation based on character recognition by carrier.
Custom alerting to both SMS text and mobile application push for critical values. The ability to consume HL7 either from an existing feed with no disruption or vendor involvement to creating a full HL7 TCP interface from a flat file drop to our secure file transfer mechanisms. The ability to print our laboratory standardized requisition at the time of order entry even when placing an order on a foreign EMR. The same for advanced beneficiary notices. Administrative access control functionality to restrict usage by personnel when off-hours. On screen Result Status Bar that includes, Critical Values, Stat orders, and specific physician alerts such as a Copy To from another ordering physician. A full test compendium list that includes all necessary order information such as container type, temperature requirements, volume requirements or any special collection requirements. A quick order feature that saves typical ordering requirement fields such as test, ICD10 code, Insurance information that allows for single click ordering.
The ability to print reports with no user intervention at the physician’s office. It can be configured to send Final Reports Only or Partials when requested. Ability to configure commonly ordered test and diagnosis codes on ordering screen for ease of ordering. IOS/Android compatible mobile application allowing physician to view reports, print and act when critical values need immediate attention. The ability to not only create custom reports to the laboratory specification, but also the ability to send the custom report as an embedded PDF in HL7 to any EMR accepting of PDF reports. For hospital outreach programs, the ability to view both inpatient and outpatient laboratory reports. Physician and user access to only designated physicians. Only users can view their physicians’ reports. Additional physicians can be added as needed per user. Ability to add local Medicare review policy database. Automatic uploading at scheduled times of new order codes added by the laboratory. The ability to print container ready barcodes to identify patient and test ordered. Instrument ready barcodes can be configured with the LIS system supports it. An extensive audit trail to track all usage of the portal to adhere to HIPAA compliance.
Using Ensemble, we’ve created a fully management cloud based engine that services over 500 hospitals, over 10,000 interface instances and millions of transactions daily. Features include a full operation dashboard console to quickly view stalled, stopped and active interfaces with an easy to read color coded displayed. Ability to view raw HL7 inbound and outbound messages from EMR/LIS/HIE or any sources. The ability to resend messages to intended interface system Customizable alerts to notify staff of interfaces that have crossed a set threshold. Alerts such as no data received, connection lost. Alerts to email or SMS text. Created multi-interface connections to HIS, LIS, Billing systems in a multi-hospital setting all using different LIS/HIS and Billing systems. We normalize the data feed and send to their respective systems in the format they expect.
Developed on both IOS and Android mobile platforms, the application gives physicians and office staff to view results just as they were on a PC. Print to any compatible Air Print printer. Filter by report status (Final, Partial, Stat, Critical). Full patient contact information including phone when an immediate call is required.
Is one of the main protocols of the Internet protocol suite. It originated in the initial network implementation in which it complemented the Internet Protocol (IP). Therefore, the entire suite is commonly referred to as TCP/IP. TCP provides reliable, ordered, and error-checked delivery of a stream of octets between applications running on hosts communicating by an IP network.
SFTP is a command-line interface client program to transfer files using the SSH File Transfer Protocol (SFTP) as implemented by the sftp-server command by the OpenSSH project, which runs inside the encrypted Secure Shell connection.It provides an interactive interface similar to that of traditional FTP clients.
HTTPS (also called HTTP over Transport Layer Security [TLS] HTTP over SSL, and HTTP Secure) is a communications protocol for secure communication over a computer network which is widely used on the Internet. HTTPS consists of communication over Hypertext Transfer Protocol (HTTP) within a connection encrypted by Transport Layer Security, or its predecessor, Secure Sockets Layer. The main motivation for HTTPS is authentication of the visited website and protection of the privacy and integrity of the exchanged data.
In its popular deployment on the internet, HTTPS provides authentication of the website and associated web server with which one is communicating, which protects against man-in-the-middle attacks. Additionally, it provides bidirectional encryption of communications between a client and server, which protects against eavesdropping and tampering with or forging the contents of the communication.
Simple Mail Transfer Protocol (SMTP) is an Internet standard for electronic mail (email) transmission. First defined by RFC 821 in 1982, it was last updated in 2008 with Extended SMTP additions by RFC 5321, which is the protocol in widespread use today.
Although electronic mail servers and other mail transfer agents use SMTP to send and receive mail messages, user-level client mail applications typically use SMTP only for sending messages to a mail server for relaying. For retrieving messages, client applications usually use either IMAP or POP3.
Representational state transfer (REST) or RESTful web services is a way of providing interoperability between computer systems on the Internet. REST-compliant Web services allow requesting systems to access and manipulate textual representations of Web resources using a uniform and predefined set of stateless operations. Other forms of Web services exist, which expose their own arbitrary sets of operations such as WSDL and SOAP.
SOAP (originally Simple Object Access Protocol) is a protocol specification for exchanging structured information in the implementation of web services in computer networks. Its purpose is to induce extensibility, neutrality and independence. It uses XML Information Set for its message format, and relies on application layer protocols, most often Hypertext Transfer Protocol (HTTP) or Simple Mail Transfer Protocol (SMTP), for message negotiation and transmission.
SOAP allows processes running on disparate operating systems (such as Windows and Linux) to communicate using Extensible Markup Language (XML). Since Web protocols like HTTP are installed and running on all operating systems, SOAP allows clients to invoke web services and receive responses independent of language and platforms.
An application programming interface (API) is a set of subroutine definitions, protocols, and tools for building application software. In general terms, it is a set of clearly defined methods of communication between various software components. A good API makes it easier to develop a computer program by providing all the building blocks, which are then put together by the programmer. An API may be for a web-based system, operating system, database system, computer hardware or software library. An API specification can take many forms, but often includes specifications for routines, data structures, object classes, variables or remote calls. POSIX, Microsoft Windows API, the C++ Standard Template Library and Java APIs are examples of different forms of APIs.
A web service is a service offered by an electronic device to another electronic device, communicating with each other via the World Wide Web. In a Web service, Web technology such as HTTP, originally designed for human-to-machine communication, is utilized for machine-to-machine communication, more specifically for transferring machine-readable file formats such as XML and JSON. In practice, the web service typically provides an object-oriented web-based interface to a database server, utilized for example by another web server, or by a mobile application, that provides a user interface to the end user. Another common application offered to the end user may be a mashup, where a web server consumes several web services at different machines, and compiles the content into one user interface.
Cloud File Storage Handling
A distributed file system for cloud is a file system that allows many clients to have access to data and supports operations (create, delete, modify, read, write) on that data. Each data file may be partitioned into several parts called chunks. Each chunk may be stored on different remote machines, facilitating the parallel execution of applications. Typically, data is stored in files in a hierarchical tree, where the nodes represent directories. There are several ways to share files in a distributed architecture: each solution must be suitable for a certain type of application, depending on how complex the application is. Meanwhile, the security of the system must be ensured. Confidentiality, availability and integrity are the main keys for a secure system.
Users can share computing resources through the Internet thanks to cloud computing which is typically characterized by scalable and elastic resources – such as physical servers, applications and any services that are virtualized and allocated dynamically. Synchronization is required to make sure that all devices are up-to-date.
Distributed file systems enable many big, medium, and small enterprises to store and access their remote data as they do local data, facilitating the use of variable resources.
- Content-Based Router
- Message Filter
- Dynamic Router
- Recipient List
- Composed Message Processor
- Routing Slip
- Process Manager
- Message Broker
Message Transformations Middleware (MOM)
Is software or hardware infrastructure supporting sending and receiving messages between distributed systems. MOM allows application modules to be distributed over heterogeneous platforms and reduces the complexity of developing applications that span multiple operating systems and network protocols. The middleware creates a distributed communications layer that insulates the application developer from the details of the various operating systems and network interfaces. APIs that extend across diverse platforms and networks are typically provided by MOM
Enterprise Service Bus
An enterprise service bus (ESB) implements a communication system between mutually interacting software applications in a service-oriented architecture (SOA). It implements a software architecture as depicted on the right. As it implements a distributed computing architecture, it implements a special variant of the more general client-server model, wherein, in general, any application using ESB can behave as server or client in turns. ESB promotes agility and flexibility with regard to high-level protocol communication between applications. The primary goal of the high-level protocol communication is enterprise application integration (EAI) of heterogeneous and complex service or application landscapes (a view from the network level).
Advanced detection and alerting on conditions such as overheating, processor and disk failure.
Network monitoring services usually have a number of servers around the globe - for example in America, Europe, Asia, Australia and other locations. By having multiple servers in different geographic locations, a monitoring service can determine if a Web server is available across different networks worldwide. The more the locations used, the more complete is the picture on network availability.
When monitoring a web server for potential problems, an external web monitoring service checks a number of parameters. First of all, it monitors for a proper HTTP return code. By HTTP specifications RFC 2616, any web server returns several HTTP codes. Analysis of the HTTP codes is the fastest way to determine the current status of the monitored web server. Third-party application performance monitoring tools provide additional web server monitoring, alerting and reporting capabilities.
As the information brought by web server monitoring services is in most cases urgent and may be of crucial importance, various notification methods may be used: e-mail, land-line and cell phones, messengers, SMS, fax, pagers, etc.
Data analysis, also known as analysis of data or data analytics, is a process of inspecting, cleansing, transforming, and modeling data with the goal of discovering useful information, suggesting conclusions, and supporting decision-making. Data integration is a precursor to data analysis, and data analysis is closely linked to data visualization and data dissemination. The term data analysis is sometimes used as a synonym for data modeling.
Health Level-7 or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. These standards focus on the application layer, which is "layer 7" in the OSI model. The HL7 standards are produced by the Health Level Seven International, an international standards organization, and are adopted by other standards issuing bodies such as American National Standards Institute and International Organization for Standardization.
Hospitals and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should communicate with each other (or "interface") when they receive new information, or when they wish to retrieve information, but not all do so.
CDA specifies the syntax and supplies a framework for specifying the full semantics of a clinical document, defined by six characteristics:
- Potential for authentication
- Human readability
CDA can hold any kind of clinical information that would be included in a patient's medical record; examples include:
- Discharge summary (following inpatient care)
- History & physical
- Specialist reports, such as those for medical imaging or pathology
The Portable Document Format (PDF) is a file format used to present documents in a manner independent of application software, hardware, and operating systems. Each PDF file encapsulates a complete description of a fixed-layout flat document, including the text, fonts, graphics, and other information needed to display it.
Fast Healthcare Interoperability Resources (FHIR, pronounced "fire") is a draft standard describing data formats and elements (known as "resources") and an application programming interface (API) for exchanging electronic health records. The standard was created by the Health Level Seven International (HL7) health-care standards organization.
FHIR builds on previous data format standards from HL7, like HL7 version 2.x and HL7 version 3.x. But it is easier to implement because it uses a modern web-based suite of API technology, including a HTTP-based RESTful protocol, HTML and Cascading Style Sheets for user interface integration, a choice of JSON or XML for data representation, and Atom for results. One of its goals is to facilitate interoperation between legacy health care systems, to make it easy to provide health care information to health care providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical applications which can be easily integrated into existing systems.
FHIR provides an alternative to document-centric approaches by directly exposing discrete data elements as services. For example, basic elements of healthcare like patients, admissions, diagnostic reports and medications can each be retrieved and manipulated via their own resource URLs. FHIR was supported at an American Medical Informatics Association meeting by companies like Cerner which value its open and extensible nature.
Extensible Markup Language (XML) is a markup language that defines a set of rules for encoding documents in a format that is both human-readable and machine-readable. The W3C's XML 1.0 Specification and several other related specifications—all of them free open standards—define XML.
The design goals of XML emphasize simplicity, generality, and usability across the Internet. It is a textual data format with strong support via Unicode for different human languages. Although the design of XML focuses on documents, the language is widely used for the representation of arbitrary data structures such as those used in web services.
Several schema systems exist to aid in the definition of XML-based languages, while programmers have developed many application programming interfaces (APIs) to aid the processing of XML data.
An open-standard file format that uses human-readable text to transmit data objects consisting of attribute–value pairs and array data types (or any other serializable value). It is a very common data format used for asynchronous browser–server communication, including as a replacement for XML in some AJAX-style systems.
Originally the JSON format in the early 2000s; two competing standards, RFC 7159 and ECMA-404, defined it in 2013. The ECMA standard describes only the allowed syntax, whereas the RFC covers some security and interoperability considerations.
A restricted profile of JSON, known as I-JSON (short for "Internet JSON"), seeks to overcome some of the interoperability problems with JSON. It is defined in RFC 7493.