Systems Integration: What Works?

In a complex environment like healthcare, systems integration is bound to be high on the information technology agenda. The continuing need to share and incorporate data from disparate systems to produce a useful patient record is a challenge that all health communities are striving to meet.

In addition, experts in systems integration report increasing complexity as healthcare organisations move towards data centre hosted environments.

In this Special Report we have taken the theme ‘What Works’ and brought together some case studies from around the country to show how systems integration is being approached in four leading trusts:

St Mary’s Hospital, Paddington, London

University Hospital of South Manchester NHS Foundation

Plymouth ICT Shared Services

University Hospitals Leicester NHS Foundation Trust

Ringing the integration bell at St. Mary's

A fully CfH-compliant Sun eGate integration interface environment has been implemented by ReStart Consulting – www.restartconsulting.com - for London-based St. Mary’s NHS Trust Paddington, London.

Phil Jones, the trust’s IT director sets the scene: “We had a very disparate set of clinical and management IT applications that just didn’t fit together very well. No doubt they’d been installed historically for the best of reasons, but changing technologies and the drive to bring systems together meant that a robust integration engine was essential.”

“For example, we had Ascribe for A&E, Ciconia for maternity, iSoft for pathology, and so on. We had looked around for a likely integration engine solution – checked out what other trusts were doing, what software they were using and how they were implementing it”. The trust then decided on the Sun eGATE solution.

“We’d considered handling implementation ourselves, but timescales were tight and while we probably had the internal technical knowledge, it seemed more practical and sensible to get experts in. This represented a lower risk – and enabled our own IT resources to carry on with existing IT programmes to which we were committed without undue interruption,” says Jones.

“We wanted to be involved in the work and were looking for a partnership relationship which would facilitate a skills transfer for the new technologies involved. We were also conscious of the fact that actually managing the project was as important as choosing the right technical solution”.

“ReStart were able to step in and take over the reins very authoritatively to develop the interfaces, working very closely as part of our own staff. They grasped the loose ends, pulled the project together, and made sure everything happened progressively and in the right order”.

Key ReStart Consulting attributes contributing to the project’s success – according to St. Mary’s - were high-level project management expertise, product knowledge, excellence of code, and ability to take over from existing, failing outsourced project management.

BT is using the suite to design, deliver and manage the national patient record database and transactional messaging service, at the centre of the NHS Care Records Service (NHS CRS). As the core software for the transactional messaging service initiative, the eGate Integrator and eInsight Business Process Manager will serve as the web services and J2EE-based integration platform for business process management.

Delivery of the personal demographics service module of the NHS CRS is being facilitated by eView Global Identifier. This will act as the basis of the NHS CRS to record and cross-index patient and care information electronically, eliminating duplication of patient files and improving information sharing.

“We could see that the system had already received fairly convincing votes of confidence from key elements of the NHS IT community – and was being widely adopted by trusts,” says Jones. “It was mature, established technology that provided the right solution and was highly scalable. It was also user-friendly and could accommodate very large message volumes, bigger by a huge margin than our actual expected volumes,” says Jones.

South Manchester ‘goes live’ with CfH implementation

The situation

University Hospital of South Manchester NHS Foundation Trust needed a partner to not only integrate its systems to meet ‘go live’ dates set for the Connecting for Health (CfH) programme, but to ensure that a platform was in place for future development plans and locally maintainable support.

High on the requirements list was to ensure the solution not only supported the trust’s clinical needs but the operational and technical requirements, ensuring that IT staff shadowed and understood all stages of the project to become self-supportive now and for the future.

The solution

‘Go live’ dates were on the horizon to meet trust targets and the project needed to address integration of the new local service provider (LSP) application with existing departmental systems, whilst maintaining a clinically safe environment.

The solution introduced SeeBeyond ICAN Suite 5 including an eGate integration engine with interfaces to the new LSP chosen Lorenzo PAS application and the trust’s existing systems, including radiology, pathology and audiology. As a partnership, WCI assisted the trust in developing interfaces that met local needs, conformed to LSP specifications and provided the building blocks for future development plans.

‘Go Live’ preparation began on 29 November 2006 and was successfully completed on 3 December 2006. WCI’s approach combined scaleable, robust and safe technology solutions with a strong focus on process improvement. This achieved the trust’s ambition to simplify administration and management activities whilst improving the quality of services delivered to patients in a safe and controlled environment.

The Benefits

Richard Moulds, head of programme management, IM&T said, "We selected WCI because of their expertise in health application integration, detailed knowledge of the National Programme for IT, track record of successful implementations and value for money."

Plymouth plans for future integration needs

Plymouth ICT Shared Services - which supports over 15,000 users across a large acute trust, a teaching primary care trust and over 50 GP surgeries - announced recently that it was replacing its current integration platform with InterSystems Ensemble.

Plymouth’s director of ICT, Nick Thomas, said: “This investment will enable the community to fully embrace the central integrated solutions provided by the National Programme for IT [NPfIT], while maintaining and enhancing the benefits to clinicians delivered by our local best-of-breed applications.”

Head of technology, Andy Blofield, explained that the trust’s iSoft iPM and iCM would be hosted centrally and other applications would remain local. The local applications number about 16; they include applications for accident and emergency, pathology, oncology and e-prescribing.

Plymouth is one of seven trusts designated under the NPfIT to remain with iSoft even though it is placed geographically in Devon - a county covered by the Fujitsu Alliance’s contract with Cerner.

Blofield explained: “This means we are able to build on the investment we have made in iSoft since 1999.”

He hopes users will see some improvements with the prospect of real time interfaces running more quickly as Ensemble is implemented.

However, the investment is also geared towards the future, providing a system that will meet the Plymouth trusts’ needs three four or five years on.

He said: “InterSystems Ensemble will enable us to work more efficiently to deliver robust, scaleable, maintainable and cost effective integration solutions to our stakeholders. In addition to providing an improved service, by streamlining the development and management processes of our integration architecture, we will have an IT system that’s flexible and scalable enough to support the community in the long-term, while still allowing us to use the most appropriate systems for our needs.”

In addition, the new integration platform has the reputation of being able to support existing interfaces “no matter how old.”

Connecting IT systems at a multi-facility university hospital

University Hospitals of Leicester NHS Trust (UHL) comprises three acute hospitals based in Leicester: Glenfield Hospital, Leicester General Hospital and Leicester Royal Infirmary. The trust is one of the largest acute teaching hospitals in the United Kingdom, with 12,500 staff. As an organisation formed by merging three existing facilities, UHL owned a wide variety of legacy clinical IT systems that were challenging to operate together. In addition UHL was examining replacement IT systems to support cancer care, rheumatology and maternity services.

UHL required all its clinical IT systems to share data more effectively, and needed a system that could easily monitor and control its large number of interfaces. In addition the trust wanted to be able to develop and deploy interfaces more quickly and cost effectively as new IT systems were brought online.

Existing interfacing architecture had reached its limits

By 2003 UHL’s existing interfacing environment was posing a number of challenges. Major problems identified included:

• Many individual point-to-point interfaces that were not centrally controlled;

• Interfaces used proprietary formats

• No automatic alerts when problems occurred;

• Due to staff turnover, many old interfaces were a mystery to current staff;

• Development of new interfaces required many months of work;

• No new ports were available to add new interfaces.

Connecting the organisation

UHL decided that the best architectural/technical solution for its integration needs would be an interface engine because this would offer:

• Central hub for all messaging;

• Ability to administer all interfaces from a single point;

• Ability to add/upgrade new interfaces as necessary;

• Reduce the overall cost of interfacing.

After a selection process involving several different products, UHL chose the Rhapsody Integration Engine from Orion Health because it offered:

• Cost-effectiveness: Rhapsody allows unlimited connections at no extra cost;

• Ease of development through the use of graphical interfaces and industry standard development languages;

• Effective monitoring tools including automated alters and web-based monitoring;

• Platform independence: operating in both Windows and Unix environments.

Benefits in practice

Jason Selby, UHL software architect, comments: “Rhapsody has proved invaluable for managing interfaces at UHL. We now build and maintain interfaces in-house, saving our team valuable time and reducing our reliance on third party vendors to build interfaces for us.”

Alert messages from the engine have proved particularly beneficial, Selby explains: “When a problem with an interface is detected, Rhapsody can send out alter messages automatically to a staff member’s pager or e-mail. Combined with the ability to monitor and manage the engine via the web, this had made life easier for our on-call staff out of hours. Now we can often detect and fix interface problems in production before the error affects end-users.”

Connecting with the National IT Programme

The Rhapsody Integration Engine is being used by UHL as a central component of the trust’s readiness plan for the arrival of National Programme for IT (NPfIT) systems. As NPfIT scope and delivery dates continue to evolve, UHL can deploy Rhapsody as its central integration point with the confidence it will provide the necessary interfaces when NPfIT systems are delivered.