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The military's battle plan for using SOA in health care

The U.S. Military Health System is migrating its EHR system to a service-oriented architecture model. In the process, the system's CIO said, private providers can see how to make SOA in health care a reality.

ARLINGTON, VA. -- If you think migrating your hospital's network infrastructure, on the fly, from a traditional, application-based model to a service-oriented architecture (SOA) model looks like a project too big to tackle, try doing it for millions of soldiers and their families. If that's not a tall-enough order, the president is a patient in the system too.

Speaking at the SOA in Healthcare conference, Chuck Campbell, CIO of the U.S. Military Health System (MHS), shared some insights about his team's SOA implementation for its electronic health record (EHR) system, as well as his agency's objectives for using the new architecture to make its health care more nimble once the implementation is complete.

Ideally the SOA model will let MHS port more patient services to the Web, regionalize its health information databases for soldiers and their families (who typically move every two to three years), and more proactively analyze population symptom data to pinpoint patients who might be vulnerable to particular medical conditions. That last function is particularly important: Soldiers might be showing early symptoms of kidney disease because of exposure to chemical warfare agents, for example, or patients sick with H1N1 influenza can be isolated in days instead of weeks, preventing wide swaths of patients from contracting the virus.

An EHR system that serves millions

Counting patients in the U.S., abroad and on 25 ships at sea, a typical week's work for the MHS includes 19,600 inpatient admissions, 1.8 million outpatient visits, 103,400 dental visits, 3.5 million claims processed, more than 2.2 million prescriptions and 2,100 births, according to Campbell.

Migrating the MHS to a SOA model will help meld that data into a standard whole, Campbell said, as well as offer better EHR access to patients, many of whom use a mix of public and private health care providers.

The military first fleshed out its concept for an EHR system in 1979, and built it slowly to the point where it incorporated computerized physician order entry, or CPOE, in 1996. In 2006, an integrated data repository went online; health data now pours in from around the world in real time to a single data center, Campbell said. The system works well for patients who use a military facility. Nevertheless, getting data in from -- and out to -- private health care providers is the MHS's biggest challenge.

"There's a lot of care done outside [military facilities]. Right now, the challenge is how we get the information into our system," Campbell said. Equally demanding is the need to standardize data from public and private providers in the system to serve both individual patients and public-health leaders looking at whole-population data.

Forward, march to SOA model, meaningful use

The MHS is in the midst of a five-year SOA implementation -- likely the most massive SOA infrastructure project in health care -- chunking up processes to fit the "mobile theater" flavor of its EHR system. It shares the philosophy used by soldiers on the battlefield, and it is more nimble than the current system. It fits for everyday health care, Campbell said, because the problems it solves are some of the same ones CIOs are dealing with at private hospitals. Data is entered locally on a number of devices, which may or may not have a strong wireless signal. The devices then are set up to sync with the servers immediately, or later if bad connectivity requires deferral.

IT is a team sport. It's going to take a lot to make this happen, especially in something as large as the military health system, which then can be used in a lot of other places, too.

Chuck Campbell, CIO, U.S. Military Health System

SOA strategies also help the MHS address meaningful use and Health Insurance Portability and Accountability Act (HIPAA) compliance, Campbell said. For example, MHS is piloting a personal health record (PHR) system using Google Health and Microsoft HealthVault, in which those private companies can access records from the MHS central data repository. (Testing the ability to exchange clinical information electronically is a meaningful use requirement.) In order to participate, both Google Inc. and Microsoft had to make concessions -- one of which was to pledge that military patient data be stored within the continental U.S. -- to satisfy both military and HIPAA security concerns.

Using the SOA model  is enabling the MHS to deploy health services more rapidly, Campbell concluded. Instead of taking seven years to develop and roll out software -- a process that includes testing software on every system and device to make sure it functions, as well as testing for conflicts with other apps -- simpler, more modular SOA applications go online more rapidly because they don't knock over as many dominoes.

Campbell hopes private health care providers can use the MHS's SOA model as an example and apply some of the principles -- and lessons learned -- in their own EHR deployments.

"IT is a team sport," Campbell said. "It going to take a lot to make this happen, especially in something as large as the military health system, which then can be used in a lot of other places, too."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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