NORTHERN HEALTH AUTHORITY, BC

Provincial Lab Information System Integration with Northern Health Authority, BC

Business Situation

The Provincial Laboratory Information Solution (PLIS) of the province of BC provides consolidated diagnostic laboratory test results to authorized persons across British Columbia. PLIS also enables the collection of laboratory information for the purpose of analyzing and managing chronic diseases in BC. The PLIS and interoperable Electronic Health Record (iEHR) projects are two key complements of the e-Health provincial and federal program.

In 2009, Provincial Health Services Authority, BC (PHSA) integrated with PLIS by providing test orders and results. Alianz’s consultants have led the technical design, implementation, and testing of all PHSA outbound ORM and ORU HL7 interfaces, as well as interfaces to the data remediation system.

Successful PLIS integration with PHSA Lab information systems has established the foundation for PLIS onboarding of other regional Health Authorities and private labs.

The Northern Health Authority (NHA) of BC was mandated to integrate with PLIS in 2010. NHA has selected Alianz Development Inc. to manage the implementation of PLIS interfaces based on the following three primary factors:

– Clinical domain expertise and a strong portfolio of integrating applications based on HL7 standards
– Proven ability to deliver PLIS interface to specification, on time and on budget
– Exceptional knowledge of the NHA integration platform — Microsoft BizTalk 2006/10 and correspondent HL7 accelerator

This case study outlines the ways Alianz has helped NHA and the PLIS team to manage project risks of delivering PLIS interfaces. We also describe how NHA’s collaboration with Alianz, in the context of the PLIS project, has helped NHA to improve their integration capabilities at the enterprise level.

Key Project Risks and Mitigation

Described below are major risks that NHA had to manage for successful integration with PLIS.

Cost overrun and resource availability

PLIS integration is a typical enterprise project that requires strong coordination of deliverables from several major parties: a PLIS vendor (Oracle), a project sponsor (Ministry of Health/PHSA), a lab data provider (NHA), a system integrator (Alianz), an owner of a data remediation system (PHSA) and providers of registry services. As a result, the NHA had to manage the risks of project cost overrun caused by the following factors:

– In case one party could not to deliver its task or provide issue resolution on time, it could significantly impede project time lines, decrease availability of resources from other parties, and increase substantially overall project cost.

– The system integrator should provide dedicated resources over the course of all project stages. At the same time, resources should be available as needed, that is, not on a full-time basis at all project stages, to avoid linear dependency between project cost and project duration.

Compliance to the Enterprise Integration Architecture

The NHA integration layer (IL) is responsible for processing and distributing clinical information between internal and external clinical applications.

The key business goals of integration architecture are as follows:

– To lower cost and technical risks, to decrease “time-to-market,” and to increase the quality of interfaces by reusing proven design decisions and pre-build components
– To accommodate new requirements and to develop interfaces without requiring extensive infrastructure development
– To ensure that clinical information, provided by the NHA lab, is delivered to all downstream applications on a real-time basis, even if one of the downstream applications is temporarily unavailable due to operational or change management reasons

NHA had to ensure that the design of the PLIS clinical interfaces is compliant with these architectural requirements.

Support and manageability of PLIS interfaces

At the beginning of the project, the NHA technical team had limited experience in developing enterprise-level HL7 interfaces and managing correspondent infrastructure of their integration platform, Microsoft BizTalk Server. At the same time, NHA needed to ensure that their internal team could support PLIS interfaces and manage correspondent changes.

Therefore, the system integrator was required to transfer knowledge and to train the internal team in the context of developing and supporting HL7 interfaces, implemented on the Microsoft BizTalk Server integration platform.

Deliverables

Managing cost overrun risk

Alianz & NHA developed a contract with an unambiguous scope, a milestone schedule, a deliverables listing, and clear acceptance criteria. As a result, Alianz has agreed to deliver a PLIS-integrated solution for NHA based on time and materials, with cap contractual principles. Such a commercial approach has minimized NHA’s risk of cost overrun for the integration part of the project, while ensuring availability of resources at all project stages.

Developing the NHA Enterprise Integration Architecture

Core business requirements for the NHA enterprise integration architecture have been translated into the following several principle technical requirements for the integration layer (IL):

– Interoperability of clinical interfaces for application and transport protocols
– Reliable delivery of outbound messages and tractability/auditing information of message processing
– Decoupling interfaces from operational, code, and change management stand points
– Uninterrupted deployment/upgrades, i.e., the IL should guarantee that no outbound messages are lost while one of its receiving applications is temporary offline
– The IL must scale to accommodate the processing of an increasing number of messages
– The IL performance of processing and delivering clinical information must be acceptable for NHA businesses
– Maintainability and simplicity – the IL must be manageable by an operational team based on standard procedures applicable for all interfaces
– Manageability, i.e., core business logic, such as message routing, filtering, content validation, business exception handling, etc., must be managed via configuration
– Security: The IL must secure interfaces at communication and message levels as per PIA standards and per the capability of the receiving application

Alianz has designed, implemented, and integrated PLIS to address all these architectural requirements. The resulting solution also has provided patterns of how other clinical interfaces should be implemented to comply with requirements of Enterprise Integration Architecture (EIA).

Alianz has led NHA efforts for documenting, analyzing, and base-lining EIA for integrating clinical applications.

Domain knowledge transfer and technical training

Comprehensive documentation, training, and knowledge transfer for developing and supporting HL7 BizTalk interfaces were our key project deliverables. As result, the NHA internal integration team was able to support PLIS interfaces and develop a new HL7 clinical interface based on proven patterns and design decisions that the PLIS integrated solution has provided.

Conclusion

Alianz has delivered NHA Lab integration with PLIS on time, to specification, and under budget.

By April 2012, all six Health Authorities of British Columbia have been integrated with the Provincial Lab Information System. This provides one of the foundational components within the provincial and pan-Canadian e-Health program.

We are proud to have contributed to governmental, healthcare-related programs in a cost-efficient and quality-driven manner.