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Servicio Andaluz de Salud (SAS)The Andalusia Public Health System manages a service network that guarantees citizens’ access to healthcare and an equitable distribution of resources. This network consists of 1,514 Primary Care Centers and 29 hospitals distributed throughout the Andalusia region that will one day all be able to contribute information to the Single Andalusia Medical Record for every citizen.

Key Benefits

  • SOA Implementation
  • Rapid Deployment
  • BP and Alerts Management


The extensive and often intense operational workload that the network supports, together with the development of applications needed for its operation demands a comprehensive IT system with an architecture capable of guaranteeing its scalability, sustainability and effectiveness.

To meet this need Everis, a multinational business solutions consultancy, selected the InterSystems Ensemble® seamless integration and development platform to implement an Enterprise Service Bus (ESB) for the Andalusia Health Service (SAS). The project provides the Andalusia public health with guaranteed security and traceability of messages between applications running on an enterprise service bus. It also forms the basis of a Service Oriented Architecture (SOA) for the whole Diraya electronic patient medical record system. This robust and extensible infrastructure enables the integration of all of the different modules in the Andalusia Public Health System.

Servicio Andaluz de Salud (SAS)A comprehensive health service network

The Andalusia Health Service (SAS – Servicio Andaluz de Salud) has over 7.9 million records with clinical data. In addition, 3,500 pharmacies and over 17,000 medical professionals connect to its IT system. In 2010, the Andalusia Health Service registered 95 million consultations scheduled through Diraya , which comprised of 39.7 million Primary Care consultation sheets, and 3 million hospital emergency episodes. 272 Primary Health Care centers also use a MPA (Módulo de Pruebas Analíticas – Analytic Tests Module) supported by 10 hospitals laboratories, and are currently in the process of extending their use to the whole system.

The SAS rely on 14 corporate applications and 104 available services that provide:

  • Functional:
    • Administrative: Appointments, admissions, discharges and transfers.
    • Healthcare Services: Medical records updates, discharge notifications, drug prescription and medical record queries.
  • System:
    • Updates to master tables and synchronization of catalogues.

A powerful combination

The Everis project proposal was successful in the bidding procedure implemented through Red.es, a public business agency, supported by the Secretariat of State for Telecommunications and for the Information Society, of the Ministry of Industry, Tourism and Trade (MITYC).

According to José Román Fernández Engo, head of the Interoperability Technical Office of the Technology and Information Services Sub-management of the SAS:

Ensemble is now the pillar, at hospital level, of the interoperability strategy that enables a distributed architecture of integration buses at each hospital that work together as one centralized system. This simultaneously enables the deployment of a number of services throughout Andalusia, while maintaining a single citizen reference, at each hospital, at administrative and clinical, as well as application level.

The choice of Everis and Ensemble together perfectly addressed the requirements established for the Administration’s integration platform.

These requirements included the following:

  • Multi-platform capability, because Ensemble can be implemented on the largest range of commonly available computer Operating Systems.
  • The connectivity, based on the management of messages; service guarantees; interoperability between applications; and technology and data sources available in the Andalusia health network. This is achieved using Ensemble’s inbuilt adapters and interfaces to facilitate the connection with the widest range of devices and servers with support for health industry standards that include HL7 and DICOM. Ensemble also enables the easy, rapid development of new custom adapters using its object-orientated technology.
  • The integrated storage capacity, another key element of the platform, provides the message persistence, recovery of transactional information, registration, message traceability, and messages and data recovery for analysis.
  • The orchestration provided by Ensemble defines and manages business processes that extend services to include external applications, with access to existing applications using the ESB application programming interfaces (APIs) and SOA model.

Minimum operational impact during implementation

The SAS wanted an integration platform that would have a minimum impact on its hospitals during the implementation as well as its subsequent management and administration. Another important factor was that the Ensemble-based solution did not need additional functional modules or products to obtain the features specified by the Andalusia Administration for the project. The project includes the implementation of the integration platform, configuring and adapting it to the technology infrastructure available from Everis at each hospital center.

Ensemble is now the pillar, athospital level, of the interoperability strategy that enables a distributed architecture of integration buses at each hospital that work together as one centralized system.

José Román Fernández Engo, Chief of Interoperability
SAS

Servicio Andaluz de Salud (SAS)
Figure 1. The Ensemble-based hospital ESBs supporting a regional service oriented architecture

The project’s first phase will provide integration mechanisms between the system’s different components for the implementation in 29 hospital areas of the new version of Diraya, the Hospital Management Module, and the Hospitalization Module of the Diraya Electronic Medical Record project. Services will be published through the SOA architecture for use by applications external to the hospital as well as by the regions centralized health service applications.

Complete Electronic Medical Record available to the professional

The benefit to the healthcare professionals and patients is the ability for any authorized SAS health professional to have immediate and full access to the complete patient Medical Record. By using the ESB at each hospital to integrate all of the local and regional management modules that form the Electronic Medical Record, hospital professionals can access both the data of the patient’s current hospital episode as well as other data about their medical record previously generated at other facilities whether in primary care or in emergency department. Therefore, all of the important information for a patient is assembled in a single electronic health record; including emergency episodes, outside consultation episodes, primary consultations, general health data (health problems, allergies and antecedents); diagnosis tests performed; and pharmacological treatment.

At the same time, management also benefit from being able see the consolidated operational management information as regards the provision and use of the healthcare services. As José Román Fernández explains:

At management and administrative level, that entire communication circuit will instantly produce a series of indicators which will provide reliable information about how the system is working at business level: how much revenue there has been, how the patient has been handled in hospital, what procedures and care protocols were used, among other data.

Evolving with the future

Andalusia first established its Electronic Medical Record in the year 2000. Since then it has and will continue to develop and adapt its systems to make best use of the technology solutions available as demanded by reality of its evolving business needs. This new, flexible IT framework based on InterSystems Ensemble now provides them with the robust foundation they need for continuous innovation and service enhancement in a rapid, cost effective and practical manner.