Baptist Health System uses CORBA to facilitate electronic patient record

Baptist Health System uses CORBA to facilitate electronic patient record

Object-oriented interfaces to link up all information systems

Developing an electronic patient record is no easy task. The integration of disparate healthcare information systems, often located at several institutions, can be difficult to achieve. To solve this dilemma, some healthcare institutions are evaluating the use of object-oriented interfaces to facilitate the EPR.

In a partnership with Philips Medical Systems North America of Shelton, CT, the Baptist Health Systems of South Florida in Miami is taking that approach in its Medical Information Retrieval Application for Clinical Enhancement (MIRACLE) electronic patient record development project. The effort, begun in October 1997, will link up four BHSSF hospitals as well as outpatient clinics and physicians' offices to an EPR.

The BHSSF information systems department is working closely on the project with CareFlowNet, a medical transcriptionist firm based in Poolesville, MD, and with Philips, which is providing PACS and the MIRACLE application to the health system. When the MIRACLE project is completed, physicians will be able to access all patient information from a PC or Java-based client, said Michael Spencer, BHS MIRACLE project leader.

A series of tabs on the MIRACLE graphical user interface will allow physicians to access various components of the medical record. Physicians could, for example, click on an images tab and view a list of medical images or reports for that patient, Spencer said.

The MIRACLE team, a partnership among BHS, Philips, and CareFlow Net, is in the final stages of the project's alpha phase, which is targeted for completion on October 1. In this phase, several physicians will evaluate the Java-based MIRACLE software package and provide feedback to the development team.

By October 15, the physician testing group will expand to at least 10 physicians, said Kent Wreder, corporate director of object technology and information technology for BHSSF.

In the alpha project, the software will include patient demographic information, medical images and reports, and laboratory results. Planned additions include patient history and physicals, pharmacy medications, discharge summaries, EKGs, and any other piece of medical information that can be digitized, Spencer said.

Object technology

Integration of healthcare information systems is a tricky concept, fraught with difficulties regarding conformance to standards and the use of several different operating systems and programming languages. To facilitate systems integration, the MIRACLE team turned to an open software standard from the Object Management Group (ORG) called the Common Object Request Broker Architecture (CORBA), which employs Web protocols and Java technology from Inprise of Scotts Valley, CA, and Sun Microsystems of Mountain View, CA.

"The world is always going to be full of operating systems and full of programming languages, but we can all settle on CORBA," Wreder said.

By adding CORBA interfaces to each information system, data can be stored in each one, rather than in a centralized data repository. With BHSSF generating 10 terabytes of medical image data in one year, an EPR driven by a centralized data repository would not be feasible for the health system, Wreder said.

As a result, the team needed to create a client software package that would give users access to data from other information systems without a centralized storage approach, he said. Thanks to the interoperability provided by CORBA interfaces, the MIRACLE client software contacts each information system and retrieves the relevant patient data as they are requested by physicians.

"We believe the EPR should be distributed, and the way to get to information when you need it is to have every information system interoperable with each and every other departmental system with CORBA interfaces," Wreder said.

In addition to supporting a distributed architecture, CORBA also enables flexibility and expandability. As long as the departmental information system is equipped with CORBA interfaces, it can easily be added to MIRACLE at any time, Wreder said. All new information systems purchased at BHSSF must have CORBA interfaces.

In addition to the graphical user interface and the various information systems, the CORBA-based electronic patient record relies on middleware, which handles user work-flow and security issues such as user authentication. It also provides access only to the data that are required by the specific users.

The MIRACLE team, including Philips and CareFlow Net, are active participants in creating standardized CORBA interfaces as part of the healthcare task force of OMG, called CORBAmed.

Preliminary work on the MIRACLE project was presented at the 1998 Healthcare Information Management Systems Society meeting in the Philips booth. The company's Medical Greenhouse Rapid intranet Development (MEDGRiD) healthcare information technology development office is devoting much of its energies to work on the MIRACLE project. Formed in 1997 in Palo Alto, CA, the MEDGRiD office is working to improve integration of various healthcare information systems. It has principally investigated the use of such tools as distributed object technology and Web protocols (PNN 6/98).

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