Hospitals Implement Unified Intelligence System to Aggregate and Share Health Information

Overview “There hasn‟t been one thing we have asked for, that Country or Region: United States Industry: Healthcare Amalga wasn‟t able to deliver to the client. WHIE clinicians can easily create custom views using data Customer Profile elements contained in a base view, or edit one of the Novant Health is a not-for-profit organization in North and South Carolina. H. Lee Moffitt existing templates.” Cancer Center & Research Institute is a Dr. Edward Barthell, President, National Institute of Medical Informatics National Cancer Institute Comprehensive Cancer Center in Tampa, Florida. The Wisconsin Health Information Exchange is a Efficient healthcare delivery is a priority for governments, health information exchange project in healthcare facilities, caregivers, and patients. The exchange of southeastern Wisconsin. electronic healthcare information among institutions and Business Situation individuals that provide health services is a key enabler of patient- To provide patient-centric care, healthcare facilities needed an easier way to aggregate centric care, but it remains a challenge for the entire industry. data from their health systems so clinicians, Microsoft released Microsoft® Amalga™, the Unified Intelligence administrators, and researchers can make better decisions. System, to answer this challenge. Early adopters are taking advantage of the layered architecture and unique database design Solution Healthcare facilities deployed Microsoft® of Amalga to integrate health information from disparate systems Amalga™, the Unified Intelligence System and deliver the data to end users. With Amalga, IT departments can that integrates clinical, administrative, research, and financial data, and delivers it support the information needs of their institutions. Instead of to users through customizable user searching for information among many systems, clinicians and interfaces. other users can use Amalga to gain self serve access to the data Benefits they need from one place to improve patient care.  Shared data improves patient care

 Better healthcare reporting  Empowered clinical staff  Low cost electronic data exchange

 Improved reporting services from IT staff

“With the ability to Situation information among hospital departments is The healthcare IT ecosystem has evolved just as great as the need to share information coordinate data from over the years into a fragmented, complex across enterprise boundaries in regional disparate systems, environment, with a plethora of incompatible health information exchanges. In fact, it‟s a Amalga can improve the systems, data silos, and data formats. The prerequisite to coordinated, patient-centric patient is at the center of the vast amounts of care.” efficiency of healthcare clinical, administrative, and financial data providers while that reside within the healthcare IT Unfortunately, for many healthcare ecosystem. Unfortunately, as patients move organizations it isn‟t easy to efficiently and supporting better through the healthcare system, receiving economically create a single integrated decision making and different levels of care at different facilities, system that contains all the information a ultimately better care.” the data they generate does not always flow doctor may require to treat a patient. Rich with them. Separate clinical, financial, and McKnight, Senior Vice President and Chief Dr. Stephen Wallenhaupt, Executive Vice pharmaceutical records are kept wherever Information Officer at Novant Health, President and Chief Medical Officer, Novant patients interact with the system, at describes a familiar problem, “At Novant Health hospitals, physicians‟ offices, clinics, Health, our physicians have to remember outpatient units, pharmacies, labs, and multiple passwords and navigate different health insurance companies. systems to access the entire range of information on a patient that is stored at the Hospitals and health facilities capture patient hospital, from lab results to doctors‟ notes to information in many different data formats, prescriptions. And the more complicated depending on their health solutions. For someone‟s medical situation is, the more example, it can be difficult to share radiology information from different sources is required images with another facility that uses a to provide optimal care. We wanted to reduce different medical imaging system. This the amount of time spent gathering situation is frustrating for the patient, who is information to increase the amount of time forced to provide the same information every spent on providing care.” time he or she interacts with a new care provider. It is also frustrating for the clinicians The situation is exacerbated when a patient and care givers, who are unable to access a appears at an emergency department with no complete, up-to-date history of the patient. previous admissions on his or her record. In According to the Wisconsin Health this situation, instant access to key Information Exchange (WHIE), a regional components of that patient‟s medical history health information exchange project in could mean the difference between life and southeastern Wisconsin, doctors spend death. “Yet there wasn‟t a single technology between 20 and 30 percent of their time solution that we could use to build a health searching for information and the lack of information exchange that would immediate access to patient information is electronically move health and medical the source of thousands of medical errors information securely between doctors, every year. hospitals, and other healthcare providers when it‟s needed for direct patient care,” “We all talk about patient-centric care, but it says Barthell. will remain a hoped-for goal until we can find a way to share health information,” says Dr. Similarly, clinicians, scientists, and Edward Barthell, President of the National researchers need unfettered access to Institute of Medical Informatics, the funding clinical data stored in disparate health body behind WHIE. “The need to share information systems and epidemiological

data to conduct their research. The H. Lee also affects the industry‟s financial health Moffitt Cancer Center & Research Institute is and operational efficiencies. Health facilities developing a personalized cancer care need a consolidated view of clinical, financial, delivery system called Total Cancer Care and operational information to improve the (TCC). Researchers are investigating new receipt of reimbursement fees for services, to ways to provide personalized cancer care assess performance against benchmarks of based on identifying disease-specific bio- excellence, and to comply with the Joint markers. To support their research, Moffitt Commission on Accreditation of Healthcare built a strategic data warehouse that Organizations and other quality and safety aggregates clinical, research, and financial performance measures. data from several operational systems. But Moffitt scientists did not have a tool they Despite recent improvements and could use to explore this data by themselves investments in the field of healthcare in a way that facilitated their research. The informatics, health facilities and care tool needed to support disparate data types providers were still waiting for a technology ranging from clinical data, lab results, that could economically and efficiently prescriptions, surgery, and financial data to integrate digital data from different sources images, including CT scans, MRIs, and X-ray. and then provide customizable access to that data for self-serve analysis. “Our researchers were constantly requesting data (via queries) from the IT department with minor changes in every iteration of the Solution query,” says Srivaths Srinivasan, Director of When the Microsoft® Health Solutions Group Total Cancer Care Systems at H. Lee Moffitt (HSG) acquired a technology developed at Cancer Center & Research Institute. “For the Washington Hospital Center called Microsoft researchers, it was always a struggle to Amalga™, the Unified Intelligence System, all combine in one view different types of clinical that changed. Amalga is based on Microsoft and epidemiological data from multiple .NET connection software and the Windows source systems. It wasn‟t possible for us to Server® 2003 operating system. Healthcare hire enough IT data analysts and report IT staffs can use Amalga to consolidate their builders to support our 300 researchers‟ clinical, administrative, and financial information needs. We needed an efficient information into a unique, metadata-tagged self-service tool that would support data store layered on multiple instances of customizable data exploration.” the Microsoft SQL Server® 2005 database. Clinicians and other hospital staffers now can The same pain points underlie these different use one source to access information from scenarios—sharing and accessing aggregate numerous systems. And they can take health data among departments in a hospital, advantage of the Amalga optimized user among hospitals, and within research interface to combine the data in customized institutions—and they resonate across the views for on-the-fly data analysis. HSG is entire healthcare ecosystem, where partnering with select early adopters to refine hospitals, healthcare facilities, insurance the product and develop its potential. plans, specialists, and patients all interact in a web of interconnections with little or no Creating a Partnership for Development overall coordination. The disconnection One member of the healthcare IT ecosystem between disparate healthcare systems not to partner with Microsoft is Novant Health. “At only affects the quality of patient care, but it Novant, we had talked about trying to achieve

data stored within an organization with little or no impact on the existing systems and minimal effort on the part of the hospital IT staff. Different raw data feeds come into Amalga from a multitude of systems across the hospital: clinical, financial, and administrative. Amalga is agnostic to the type of information that it captures and accepts highly structured standard formats such as HL7 Messaging v2.x (a healthcare focused messaging and text communications protocol) or DICOM, an international communications protocol standard for representing and transmitting radiology and other image-based data. Amalga also accepts unstructured data such as dictation reports and scanned documents.

All of the transactions and data feeds received are stored in their original format in the historical archive so IT staffers can Figure 1. The data structure and this level of data integration in-house, but conduct a full replay of an arbitrary set of information flow within Microsoft realized we weren‟t ready to invest the time historical (archived) messages to recreate Amalga, the Unified Intelligence and money to get this done,” says McKnight. portions of the Amalga data core, or the System, were specifically “So when Microsoft approached us with entire core itself. Thus, the data model designed to get the most value information about Amalga, we were evolves as the additional data feeds are from constantly changing data. interested in the opportunity to participate in brought in, or as additional uses for Amalga a pilot rollout.” are explored, or the needs of the organization change. The acquired data is then parsed Others partnering with Microsoft are WHIE into the individual data elements tagged with and H. Lee Moffitt Cancer Center & Research metadata and stored in the Amalga data Institute, as well as 21 different hospitals at core. (See Figure 1.) academic medical centers such as John Hopkins Health System, St. Joseph Health The high level of parallelism in the System, and New York Presbyterian Hospital, architecture of the Amalga data acquisition and large health systems such as MedStar subsystem allows the system to scale by Health, a six-hospital system based in adding additional queues and parsers Columbia, Maryland. While each facility has a without compromising the performance of the unique IT environment and slightly different entire application. Similarly, the different use-case scenarios for its Amalga rollout, all components maintain a high degree of cited the product‟s layered architecture and isolation to minimize interdependencies and uniquely flexible and manageable database lower the cost of change. The Amalga data technology as key reasons for their interest. core is optimized for ease and speed of access in order to present information to the Using Layered Architecture user in a timely manner. All of the information Amalga has the ability to rapidly bring needed is typically available in a few seconds, together all the structured or unstructured no more than a couple clicks away.

Finally, Amalga allows users, depending on Health. “With Amalga, you can change the their role and access privileges, to view the database structure at any time without being data that‟s stored in the system—everything penalized for decisions that were taken early from the most high-level view to the details of in the design phases. In reality, Amalga is the machine that acquired a specific CT-scan. built for change and it will evolve as we learn The powerful Amalga client allows users to more about the incoming data and how we interactively explore the information and intend to use it.” analyze it on the fly without requiring assistance from the IT staff. Users can see all IT staffers can use the flexible parsing engine the data in logical cohorts, customized to suit to adapt to multiple data standards to each individual‟s particular workflow. implement tasks such as de-identification, geospatial mapping, vocabulary Users can also export the data to Microsoft reconciliation, and others. “The ability to write Office Excel® spreadsheet software, generate and modify parsing scripts to accommodate custom reports, activate alerts, and perform a any new data was very appealing to us,” says multitude of other functions that enable them Srinivasan. “The extract transfer load “Amalga is integral to to be more productive and to customize their functionality of the parsing engine is flexible the success of our user experience independent of IT. Amalga and my team has become pretty proficient at also provides a full audit trail for privacy and writing new scripts.” research program security purposes. because it supports Gaining Flexible Data Views Utilizing Flexible Data Capture Because Amalga was built with the end user scalable data delivery All the early adopters partnering with in mind, the system‟s design takes a different and data exploration, Microsoft were keen to take advantage of the slant to the more common transaction without involving IT.” flexible data capture found in Amalga. processing concept. Amalga is focused on the Designers of Amalga anticipated the fact that presentation of data, so that the clinician or Srivaths Srinivasan, Director of Total Cancer no two hospitals are alike and every hospital researcher has access to every piece of Care Systems, H. Lee Moffitt Cancer Center & Research Institute will have its own custom feeds that it will information available in an organized way. want to send to the message queue. The “Other healthcare solutions are designed to

Amalga data acquisition and storage register, process, and store data generated subsystems are both flexible and scalable. as patients go through their treatment, but In a traditional scenario, project managers Amalga is designed first and foremost for will spend a significant amount of their time data presentation,” confirms McKnight. “The designing a database structure that would flexibility end users have for displaying accommodate all the data that the system is information is amazing, with customizable expected to store. Invariably decisions taken screen designs that fit into an individual‟s early into the project fail to consider a workflow.” number of issues, incurring extensive restructuring and extra expense to re-acquire Application consultants can take their the data from the original systems. understanding of the data that doctors or other user groups want to see and create any “Amalga solves this problem by taking into number of SQL Views from the data tables— consideration that things will change, new essentially picking and choosing from the data will be added, and the structure of the data elements and rearranging them so that database will have to be modified,” says Dr. they are ready to be delivered to end users in Stephen Wallenhaupt, Executive Vice just the way they want. “There hasn‟t been President and Chief Medical Officer at Novant one thing we have asked for, that Amalga

wasn‟t able to deliver to the client,” says architecture should give IT staffers peace of Barthell. “WHIE clinicians can easily create mind,” says Ostrowski. custom views using data elements contained in a base view, or edit one of the existing Srinivasan sees this as a benefit from a templates.” scalability perspective. “Amalga is horizontally scalable, so if there is a “Amalga is different from other health requirement for additional capacity, you add systems for its ability to ask questions of the more servers. This is much easier to do than data without having a separate analytical tool vertical scalability.” sitting on top of the other application that houses the data,” says Steven Ostrowski, Project Manager at SysLogic, the partner Benefits working with the Amalga implementation at Healthcare facilities participating in the WHIE. development of Amalga are already experiencing its benefits. As the new, Unified Achieving a Manageable Enterprise Solution Intelligence System for healthcare, Amalga Amalga is designed for simple deployment has the potential to fundamentally change and is easily managed in the enterprise. Built information management within the on familiar and supported Microsoft products, healthcare IT ecosystem. The benefits of a Amalga requires minimal training and manageable enterprise solution that provides integrates easily into a hospital‟s IT flexible data capture and flexible data views environment. “For health facilities, it‟s a lot are applicable to health institutions easier and less expensive to find people everywhere. The unique ability to break down comfortable with the Microsoft Visual C# barriers between data silos and facilitate development environment, as opposed to information exchange to build a unified someone well versed in MUMPS,” says database is the Amalga core value Ostrowski. “During the training sessions we proposition, leading to improved patient care held for WHIE, two emergency physicians and an IT department newly empowered to quickly learned how to write parsing scripts, deliver a powerful health intelligence solution which says a lot for how intuitive the to the organization. technology is.” Shared Data Improves Patient Care Amalga is also designed with built-in Aggregating healthcare data from siloed redundancy and makes disaster recovery less systems into a unified integrated system has of a concern for IT staffers. Three data been the major stumbling block in creating servers use SQL Server 2005 peer-to-peer coordinated patient healthcare IT ecosystems replication. If one goes down, the two and it‟s the first thing that Amalga solves. remaining will still function. One is allocated for writing transactions, one is allocated to At Novant Health, Amalga is being rolled out application-level reading, and one is allocated first in one of its community hospital‟s for report reading. This arrangement isolates emergency departments, where doctors can the read/write input/output operations. Also, use it to access information from different the message queues live on their own systems within the hospital. “Imagine the database, and the data acquisition and time saved when doctors have all the distribution engine and the parsers each live information they need to make decisions in on their own set of clustered servers. “This the emergency department within a single level of redundancy built into the Amalga application,” says Wallenhaupt. “Doctors no

longer have to switch between systems to operational systems for information for the find lab results, radiology images, or previous following question, „Find Caucasian females emergency department records; it‟s all who have breast cancer, have received either available through customized views from one chemotherapy or radiation, and the number place. Various medical specialists prefer of tissue samples we have,‟ they can get the different ways to review patient data, but answer themselves through Amalga. Amalga Amalga is flexible enough to deliver the data is integral to the success of our research that the doctor wants to see, in the right program because it supports scalable data format, as defined by the nature of the delivery and data exploration, without encounter.” involving IT.”

At Moffitt, researchers are enjoying the same Electronic Data Exchange at Low Cost benefits of selecting the data they need from Because Amalga is designed to integrate with different systems. They will use this flexibility a hospital‟s existing health systems, there is to build up iterative “what-if scenarios” that no need to rip and replace solutions to are integral to the research process. And at achieve the benefits of data aggregation and WHIE, IT staff is using Amalga to provide the improved reporting. “We look at Amalga as a foundation for an unprecedented level of way to provide electronic medical record electronic data access between health functionality on a grand scale, without going facilities. “We are starting with cleaned data through a long and expensive process of from a proprietary cable-based batch format replacing our different systems,” says from the vendor of the Medicaid claims data McKnight. “Instead, Amalga works to help us system in Wisconsin, and real-time HL7 data reap the value of our existing data and IT feeds from the registration systems of all the investments.” emergency departments of participating hospitals in the exchange,” says Barthell. “At Another cost saving for hospitals that deploy WHIE, Amalga provides the architecture that Amalga lies in the area of change we require to fulfill any information needs management. In the rapidly evolving world of that we may have.” healthcare, end-user information needs are constantly changing. “With other products Providing Better Reporting Services that have a static database structure, Using Amalga, IT staffers can provide better customers have to go back to the vendor to reporting services for doctors and clinicians, make changes,” says Ostrowski. “With thereby supporting their ability to provide Amalga, customers are empowered to add better care. And once Amalga is deployed, any data they want, at any time. They just those clinicians and care providers can have to write the parsing scripts. In that continue to use it with little or no input from sense, a DBA [database administrator] has the IT staff. For budget conscious CIOs, this is much more control over the data that he or a valuable benefit. she can make available to the end user compared to a closed proprietary system. At “We are loading data from Cerner, Tissue the same time, this saves money on Tracker, Galvanon, and OnCore among other expensive engagements with a vendor.” systems, into the Amalga database,” says Srinivasan. “Currently, we will have about half Amalga is flexible enough to answer an a terabyte of data available for our almost universal challenge in healthcare— researchers. So instead of making multiple collecting and sharing data. This is evidenced requests to the IT department to look in the by the success of its early adopters that are

For More Information deploying the solution in slightly different Microsoft Amalga For more information about Microsoft scenarios. But the overriding benefit of Microsoft Amalga offers a new way to products and services, call the Microsoft seamless access to unified health capture, store, and present information, Sales Information Center at (800) 426- information has implications for everyone enabling health systems to unlock data 9400. In Canada, call the Microsoft that comes in touch with the healthcare sitting in clinical, financial, and administrative Canada Information Centre at (877) 568- system. silos across organizations. Amalga helps 2495. Customers who are deaf or hard-of- provide clinicians, administrators, financial hearing can reach Microsoft text telephone Wallenhaupt concludes, “Amalga has great managers, and researchers with instant (TTY/TDD) services at (800) 892-5234 in potential, even beyond the delivery of access to the data they need, when they the United States or (905) 568-9641 in healthcare information to the clinician. With need it. Without replacing any current Canada. Outside the 50 United States and the ability to coordinate data from disparate systems, Amalga helps bring together patient Canada, please contact your local systems, Amalga can improve the efficiency data from hundreds of different sources. Microsoft subsidiary. To access information of healthcare providers while supporting Amalga turns data into role-based using the World Wide Web, go to: better decision making and ultimately better information and health critical knowledge. www.microsoft.com care.” Microsoft in Healthcare For more information about Novant Health At Microsoft we have a simple vision services visit the Web site at: statement: To improve health, around the www.novanthealth.org world. To achieve that vision, we are developing innovative solutions on both the For more information about H. Lee Moffitt enterprise and consumer sides of the Cancer Center & Research Institute healthcare equation-because healthcare is hospital, research, and services visit the too complicated to be solved with a single Web site at: approach. We are proud to be engaged in the www.moffitt.org creation of a business that can do well by doing good. Microsoft has a history of For more information about Wisconsin innovation, and we continue to make an Health Information Exchange services visit annual investment of more than $7 billion in the Web site at: R&D. Ten years ago, we recognized the need www.whie.org to invest in the health industry. Today, it represents one of Microsoft's largest vertical markets-one that is growing rapidly.

For more information about Amalga and other Microsoft solutions for the healthcare industry, go to: www.microsoft.com/amalga

Software and Services  Microsoft Server Product Portfolio  Microsoft Amalga − Microsoft SQL Server 2005  Microsoft Office  Windows Server 2003 Standard Edition − Microsoft Office Excel 2007

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.

Document published June 2008

0608 Part No. 098-109291