OpenESB

Healthcare Opportunities
innova@vico.org
201306 white paper
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

Interoperability Challenges
Global view of patient healthcare
Health information systems
are increasingly facing
interoperability challenges to
achieve the goal of sharing
patient infor mation in a
common domain, in order to
have a global view of patient
healthcare, and change a
fragmented and passive care
provision for a global and active
continuity of care.
There are some
o rg a n i z at i o n s wo rk i n g o n
healthcare interoperability
standards, such as Health Level
Seven (HL7) [1] or Integrating
the Healthcare Enterprise (IHE)
[ 2 ] . H L 7 i s a n o n - p ro fi t
organization involved in the
development of international
healthcare informatics
interoperability standards to
Provide a framework (and
related standards) for the
exchange, integration, sharing,
and retrieval of electronic health
information. IHE is an initiative
by healthcare professionals and
industry to improve the way
computer systems in healthcare
share information, it defines IHE
Integration Profiles [3] that
describe a clinical information
need or work-flow scenario, and
document how to use established
standards (e.g. HL7, DICOM
[4], LOINC [5], SNOMED CT
[6] ...) to accomplish it .
These two organizations,
and other health-related
standards such as CEN EN
13606 [7], are using XML as a
technical representation of
interchanged information, and
are proposing a Service Oriented
Architecture [8] for
implementing interoperability
scenarios ([9], [10]). Some
interesting efforts are:
Healthcare Services
Specification Program (HSSP)
[11], an initiative arising from
OMG [12] and HL7, or HL7
Services Aware Interoperability
Fr a m e w o r k ( S A I F ) [ 9 ] a
framework for building service-
oriented health integration
services.
OpenESB [13] offers a
service-oriented platform, where
information is exchanged using
XML and it's orchestrated using
the BPEL language. These
characteristics: Services, XML,
orchestration, fits OpenESB with
standards introduced, and
become it an ideal tool to
implement integration solutions
that adopt them.

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 innova@vico.org

Document goals
and content
201306 white paper

The main goal of this

document is to introduce how to
adopt Healthcare standards like
HL7, IHE and DICOM using
Open ESB. First a general
OpenESB Standards adoptions
is introduced, and then, a more
concrete chapter for each
standard is developed. In each
chapter you will find a general
description of the standard and
its relations with OpenESB, a
main benefits and target scenario
list and a conceptual diagram.
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

Content is organized into the following chapters:

1. HEALTHCARE STANDARDS ADOPTION

2. HL7 CDA R2
3. HL7 VERSION 2.x
4. HL7 VERSION 3
5. IHE PROFILES
6. DICOM FEATURES
7. HEALTH INTEROPERABILITY CLUSTER

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Purus, in consectetuer Proin in sapien. Donec
feugiat tempor libero. Fusce urna
magna,neque eget lacus. Maecenas felis nunc,
aliquam ac, consequat vitae.

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 1. Healthcare Standards Adoption
with OpenESB
innova@vico.org

Standards adoption by an organization are
not "Run Set-up" projects, and requires
adjustments on current information structures to
adapt to the needs of the standard, and in many
cases, opening its architectures to service-oriented
ones.
There are two alternatives for facing this kind
of projects: the first one is to rebuild all existing
201306 white paper
• Avoid point to point integrations scenarios and
centralize them in a single component.
• Expose your integration functionalities as
contractual well defined web services, and
replace them for new versions without
impacting the rest of your installation.

systems to fit standard needs, and the second one, Target Scenarios
use a software component that adapts to the
current system and deliver the interoperability • HL7 Patient Management Message routing
services expected. (V2.X [14] and V3 [15]) for maintaining
OpenESB is an Enterprise Service Bus that coherence between different systems in a
fits perfectly in the second option, allowing to common domain.
solve different interoperability projects both in • HL7 Results receiving (like laboratory,
bounded time and human resources, using it radiology) and integration on a current HIS.
connecting components to existing data sources
and it capacity to communicate with external • Transform you current clinical reports to HL7
CDA [16] and share them in a common
components using established standards. All of
repository.
these, minimizing the impact of projects on the
current information system. • Receive HL7 CDA Documents an parse
information to store it into the HIS.
Main Benefits • Implement IHE patient query profiles to allow
systems in a common domain query patient
• Easy adoption of healthcare standards.
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

demographics.
• Time and resource bounded interoperability
• Implement IHE PIX and XDS profiles to
projects.
implement a common CDA Shared Clinical
• Minimal impact on current information Documents Repository.
systems.
• Generate DVD Media DICOM DIR from your
• Easy integration with current systems by using existing studies to share them; or import
well known communication strategies (File , external DICOM DIR from other systems to
mail, Http, Web Services, JDBC, Ftp) your PACS.

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 2. HL7 CDA R2
with OpenESB
innova@vico.org

Clinical reports, like Discharge Summary, • Work directly with HL7 CDA data types when
Medical Orders or Continuity of Care Record, creating or parsing CDA.
are ones of the most important clinical documents
• Expose your information in a well known
in an electronic health record system EHR-S [17], standard with minimal impact to your current
especially to share their content among all HIS.
professionals involved in the patient healthcare.
HL7 CDA (Clinical Document Architecture), is a
201306 white paper

broad used international standard to share clinical Target Scenarios

reports. The capacity to build HL7 CDA
documents from the current HIS clinical reports • Transform your current Clinical report to HL7
and including in it extra structured information, CDA in order to share them in a common
or the capacity to receive HL7 CDA documents domain repository.
from other sources and parse included • Receive HL7 CDA reports as a fulfillment of
information to update internal databases, clinical orders, inform your professional of it
significantly increases the capacity to share and existence, and advise of abnormal results.
retrieve relevant clinical information.
• Generate reports as an Snapshot of your patient
health situation and analyze later retrospectively.
Main Benefits
• Offer clinical decisions support services base on
• Map your current reports an structured existing CDA information.
information to HL7 CDA.
• Receive HL7 CDA an parse it structured
information in order to update your current
information systems or trigger events to your
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

work-flows.

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 3. HL7 messaging v2.x
with OpenESB
innova@vico.org

Health Care organizations, choice different • Parse messages and store information on your
vendors information systems to fulfill needs of current database or trigger events to work-flows.
each department or service. Infor mation
• Reduce cost of plugging new components as not
consistence and communication between this implementing a point to point solution.
software pieces, involves a great challenge. HL7
v2.x is the world broad used standard for • HL7 MLLP direct connection to the BUS.
electronic data interchange in a common
healthcare organizations domains. Having an
Enterprise Services Bus that manage and route all Target Scenarios
201306 white paper

this message allows consistency of patient • Maintain consistence of patient information

information between different vendors, an reduce between all actors in a common domain.
cost of plugging new components as integrations
are not implemented using point to point • Patient demographics query from different
departmental software.
solutions.
• Order management with a laboratory system,
sending orders and receiving results in an on-
going process.
Main Benefits
• Manage medication orders to allow pharmacy
• Manage all your message in a single component department revision and medication
and route them the expected consumers.
dispensation.
• Send message independent of communication
protocol: MLLP, HTTTP, FileSystem, FTP,
WebServices.
• Map your current information to HL7 V2.x
message segment attributes.
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

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 4. HL7 messaging v3
with OpenESB
innova@vico.org

The level of interoperability between systems
implied on patient healthcare is getting higher and
complex, and requires a higher semantic
interoperability level [18].
To fulfill this target, it is necessary to share
information through models that reduce semantic
ambiguity and promote the use of controlled
vocabularies. Furthermore, the use of SOA
(Service Oriented Architecture), is becoming the
201306 white paper
• Directly manipulation of HL7 RIM data types
for message parsing and generation, or for RIM
Based Application Architecture [20] .
• Interoperability scenarios as services, like
terminology services [21] or RLUS [22].
• Easy implementing HL7 Domains Storyboards
[15].

best approach to reduce technological and

platform dependences on systems interoperability. Target Scenarios
Releasing v3, HL7 has not just evolve its • The same in v2.x plus...
message model, but it also provides a new
interoperability framework based on a Reference • Transform v2.x messages to v3 and vice-versa in
a shared domain.
Information Model (RIM) [19], that reduce
semantic ambiguity and promote the use of • Implement HL7 Common Terminology (CTS)
controlled vocabularies. Besides, it also begins to or Retrieve Locate and Update (RLUS)
introduce “services” as a paradigm for Services.
implementing interoperability scenarios [9].

Main Benefits
• SOA and XML oriented interoperability
scenarios fits perfectly with Open ESB
architecture.
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

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 5. IHE Profiles
with OpenESB
innova@vico.org

Interoperability scenarios increasingly involve
more actors and require coordination between
them with a well defined functional specification
profile. IHE Profiles organize and leverage the
integration capabilities that can be achieved by
coordinated implementation of communication
standards, such as DICOM, HL7 or W3C and
201306 white paper
• Service oriented architecture used in some IHE
profiles, it's easy implementable with Open
ESB.
Target Scenarios
• IT Infrastructure profiles: Patient Identifier

security standards. They provide precise Cross-referencing (PIX), Patient Demographics

definitions of how standards can be implemented Query (PDQ), Cross-Enterprise Document
to meet specific clinical needs. Some IHE profiles Sharing (XDS).
(like XDS) are using a SOA approach for
implementing the described scenarios, and IHE • Patient Care Coordination profiles: Cross-
also releases a document on how to take Enterprise Sharing of Medical Summaries 465
advantage of IHE profiles on SOA architectures (XDS-MS) , Exchange of Personal Health
[10]. Service orchestration is one of the main Record Content (XPHR).
futures of OpenESB, so it's a perfect tool for • Radiology Technical Framework profiles:
implementing IHE profiles. Cross-Enterprise Document Sharing for
Imaging (XDS-I.B), Portable Data for Imaging,
Simple Image and Numeric Report (SINR).
Main Benefits • Laboratory Technical Framework profiles:
Sharing Laboratory Reports (XD-LAB).
• Service orchestration to achieve IHE profiles
requirements.
• IHE proposed standards are supported on
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

OpenESB: HL7 CDA, HL7 v2.x, v3 messages,

DICOM, W3C.

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 6. DICOM Features
with OpenESB
innova@vico.org

Digital imaging has become a key piece in

healthcare information system, and with DICOM
adoption, it sharing and work-flow becomes
standardized. But it can not be view as an isolate
piece of patient healthcare, and in some scenarios,
e.g. when sharing radiological report between
different organizations, it's important not to share
only DICOM image, it's also important to share
201306 white paper
Target Scenarios
• Generate DVD/USB Media that includes
DICOM images, CDA reports and additional
information.
• Import external DICOM results received on
some media (DVD/CD/USB) into your

additional extra clinical information like Clinical
records records (allergies) or Clinical Documents
(order results or patient summarizes). With easy
external tool integration (like DCMTK [23] or
dcm4che [24]) is so easy to add DICOM
communication to Open ESB, an integrated your
DICOM PACS in your business process.
information system, saving images in your
PACS and extra clinical content in your HIS.
• Generate anonymous images packages for
academic study purpose.
• Generate DICOM Structured report, and if
necessary, transform it to HL7 CDA an vice-
versa.

Main Benefits
• Expose DICOM PACS communication as a
service.
• If your PACS is WADO [25] enabled, integrate
it directly into the service bus.
• Integrated DICOM nodes in business work-
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

flows.

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 7. Health Interoperability Cluster
with OpenESB
innova@vico.org

Health Interoperability Cluster (HIC) is an

alliance of interconnected businesses, suppliers,
and associated institutions in the healthcare
domain focused with the implementation of an
Interoperability Development Framework.
Clusters are considered to increase the
productivity with which companies can compete,
nationally and globally [26]. HIC have the
potential to affect competition in three ways: by
201306 white paper

increasing the productivity of the companies in the

cluster, by driving innovation in the healthcare
information domains, and by stimulating new
businesses in the field. According to Porter [27], in
the modern global economy clusters emerge where
enough resources and competences amass reach a
critical threshold, giving it a key position in a given
economic branch of activity, and with a decisive
sustainable competitive advantage over other
business models.

White Paper Editors

Martí Pàmies Solà
Paul Perez
Josep Vilalta Marzo
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

Healthcare Interoperability Cluster

• vico open modeling (Spain)

• Pymma Consulting (UK)
• C3 Technology (Mexico)

[28] HL7 international open standards

9
 More information?
about OpenESB
innova@vico.org

This White Paper is an executive summary on

how to use OpenESB for implementing an
interoperability development framework using
well established standards. If you want a more
detailed explanation please contact vico open
m o d e l i n g ( i n n ova @ v i c o. o rg ) o r P y m m a
Consulting (contact@pymma.com). Video tutorial
201306 white paper

series are available to explain how to achieve

success integrating challenges using OpenESB.

References 15: Health Level Seven Version 3 Normative

Edition , http://www.hl7.org/implement/
0: HL7 CDA Builder Workflow - CDA ShowCase, standards/product_brief.cfm?product_id=186
http://www.vico.org/HL7_CDAshowCase/ 16: HL7 Version 3 Clinical Document
CDA_BUILDEReng.pdf/ Architecture , http://www.hl7.org/implement/
1: Health Level Seven International , http:// standards/product_brief.cfm?product_id=7
www.hl7.org/ 17: HL7 Electronic Health Record-System ,
2: Integrating the Healthcare Enterprise , http:// http://www.hl7.org/implement/standards/
www.ihe.net/ product_brief.cfm?product_id=18
3: IHE Profiles , http://www.ihe.net/profiles/ 18: Semantic interoperability , http://
index.cfm en.wikipedia.org/wiki/Semantic_interoperability
Copyright  2103  -­‐  vico  open  modeling  &  Pymma  Consul<ng  (2013).  OpenESB:  Healthcare  Opportuni<es  White  Paper                                            

4: Digital Imaging and Communications in
Medicine , http://medical.nema.org/
5: Logical Observation Identifiers Names and
Codes , http://loinc.org/
6: SNOMED Clinical Terms , http://
www.ihtsdo.org/snomed-ct/
7: CEN/ISO EN13606 standard , http://
www.en13606.org/
8: Service-oriented architecture , http://
en.wikipedia.org/wiki/Service-
oriented_architecture
9: HL7 Services-Aware Interoperability
Framework , http://wiki.hl7.org/index.php?
title=Product_SAIF
10: A Service-Oriented Architecture (SOA) View
of IHE Profiles , http://www.ihe.net/
Technical_Framework/upload/
IHE_ITI_TF_WhitePaper_A-Service-Oriented-
Architecture_SOA_2009-09-28.pdf
11: Healthcare Services Specification Program ,
http://hssp.wikispaces.com/
12: Object Management Group , http://
www.omg.org/
13: OpenESB , http://www.open-esb.net/
14: HL7’s Version 2.x messaging standard ,
http://www.hl7.org/implement/standards/
product_brief.cfm?product_id=185
19: HL7 Reference Information Model , http://
www.hl7.org/implement/standards/rim.cfm
20: RIM Based Application Architecture , http://
www.hl7.org/Special/committees/java/index.cfm
21: HL7 Version 3 Standard: Common
Terminology Services , http://www.hl7.org/
implement/standards/product_brief.cfm?
product_id=10
22: HL7 Version 3 Standard: Retrieve, Locate,
and Update Service , http://www.hl7.org/
implement/standards/product_brief.cfm?
product_id=89
23: DCMTK - DICOM Toolkit , http://
dicom.offis.de/dcmtk.php.en
24: dcm4che2 DICOM Toolkit , http://
www.dcm4che.org/confluence/display/d2/
dcm4che2+DICOM+Toolkit
25: Web Access to DICOM Persistent Objects ,
http://medical.nema.org/Dicom/
2011/11_18pu.pdf
26: Business Cluster https://en.wikipedia.org/
wiki/Business_cluster
27: Porter Global Economy Comparative
Advantage https://en.wikipedia.org/wiki/
Comparative_advantage
28: HL7 International Open Standards http://
w w w. v i c o . o r g / h l 7 / A b o u t H L 7 /
HL7_RepEstandares.pdf

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