Web services project protects healthcare provider

Providence, a system of hospitals, clinics and assisted-living complexes in the Northwest with 606,000 members, is in the second phase of a multi-step Web services project that will make medical and other records, which are spread across disparate system

Two years and several Web services projects later, Providence Health System is systematically using the nascent technology to craft a network of reusable components that likely will save it more than $1 million per year, lead to better patient care and potentially save lives.

Providence, a 606,000-member system of hospitals, clinics and assisted-living complexes in the Northwest, is in the second phase of a multi-step Web services project. The project will make medical and other records, which are spread across disparate systems, accessible to patients and physicians through portal-based applications.

Two years ago, the Seattle healthcare company got its first taste of Web services with a project that created profiles that made it easier for patients to interact over the Web with the healthcare provider, a nonprofit that the Sisters of Providence ministries established in 1859 (see our earlier story on Providence).

The latest project is a Web service that pulls together in no more than 3 seconds all the electronic medical records a patient’s primary care physician has stored, the company says.

If a patient walks into a Providence emergency room in the evening, the staff could look up his name and discover his primary care physician earlier that day had performed a particular test or procedure. The staff could access the results and avoid the cost of a repeat procedure.

The system aggregates data from 27 physician offices. Those offices operate within Providence and store their data in back-end billing, clinical, laboratory and ambulatory care record systems in 10 Oracle databases Providence maintains on its network.

“This is more of a business-based ROI based on what this new technology will allow physicians to do,” says Mike Reagin, director of research and development. “It is significant to say that potentially making this technology available to physicians can save us $700,000 per year.” That’s in addition to savings Providence gets with its Profile Manager Web service introduced two years ago.

As its Web services effort has evolved, Providence has created its version of a service-oriented architecture (SOA) built on a component collection that provides simple and reusable interfaces for incorporating patient data into an application.

“We feel we have achieved an SOA by being able to use the same integration across different lines of business and different customers internally,” Reagin says. “It’s the first time that has happened with our integration.”

He says the SOA is defined on his network and in the application development process.

The Infravio Ensemble Web services management suite orchestrates data extraction and display on the portal. Infravio and the Physician Web service sit on a pair of Compaq 700 MHz servers that run Microsoft’s Windows 2000 Server and Internet Information Server. That package is load-balanced by a Cisco Content Services Switch 11000 and runs over a 100M bit/sec Ethernet backbone.

Infravio secures access by only letting authorized applications running on authorized servers access the Web services.

“Infravio manages security at the application layer rather than a higher layer, so it helped us provision and manage security” Reagin says. The Physician Web service also uses digital certificates so only an authenticated user can request information through the portal. He says security is made easier because the whole system runs within its firewalls.

The overall security architecture meets Health Insurance Portability and Accountability Act regulations, which require securing access to patient data.

On the development side, Providence uses Microsoft’s Visual Studio .Net to build services that live on the network and can be accessed through standard interfaces based on XML and the Simple Object Access Protocol.

“Part of the problem was getting the information in a semi-real-time fashion from these different systems and aggregating it together and then doing the search and displaying it back in the portal. It’s pretty difficult,” Reagin says. “I think it could have been done in the past, but it would have been a lot more development.”

The reusable Web service cuts an average of 30% off the development time for new applications that need to incorporate patient data, he says.

While the Web service makes patient records available in near real time to ER doctors, it also lets physicians see what sort of diagnosis, tests and treatments a patient has received from other primary care doctors. Providence plans to use the Web service as part of a patient service that would allow access to lab tests through a secure messaging system based on Web services developed by Kryptiq.

Despite the progress Reagin has seen, he knows there is more to come.

“We haven’t used the full power because we use Web services only internally and in a very limited external fashion,” he says. He says he hopes other organizations will adopt Web services and foster more business-to-business interactions. “The true power of this is going to be realized when we can have other businesses and healthcare organizations working together using Web services technology,” he says.