From time to time, it is a good idea to re-evaluate potential IT architectures especially with the cost reduction pressures in healthcare IT. The growth in maturity of several key players in the open source software arena is gaining the attention and respect of healthcare IT decision-makers and worth evaluation as a lower cost alternative. The ability to set-up a complete top to bottom architectural stack is getting very close to a reality in open source and the only challenge will be an organization that will be able to integrate that open source stack. What are these maturing key components of an open source stack for healthcare? Here are the candidates from the bottom of the stack to the top: Mirth for HL7 integration, Drools for a business rules engine, Mule for SOA, Pentaho for business intelligence, and Liferay for portal.
Mirth for HL7 message integration
Starting with the integration layer, Mirth Connect has developed into the cost effective alternative at a time when commercial HL7 integration engines are charging by the number of interfaces and driving up costs. Mirth is specifically designed from the ground up for healthcare HL7 message integration and provides the necessary tools for developing, testing, deploying, and monitoring interfaces. Mirth products address one of the most difficult problems in healthcare – interoperability. With some hospitals using nearly 200 applications each, the applications integration challenges can be complex and numerous. Mirth is a comprehensive integration solution that can handle the work to transform and route healthcare data, and here is the real plus – because it is open source, a healthcare organization can share and reuse your interfaces with other organizations.
One key new offering from Mirth is Mirth Appliances. The Mirth Appliance provides a ready-to-run healthcare messaging platform that is stable, secure, and scalable. With the need to create Health Information Exchanges at many larger healthcare organizations, the Mirth Appliance installed at each individual hospital or large physician practice can make interoperability more affordable with full commercial support and a simple management control panel. There are no per-interface fees or per-message charges on a Mirth Appliance to assist in keeping down IT costs.
Drools for a Business Rules Engine
To assist in transforming healthcare messages and support business rules is the open source product called “Drools.” No, it isn’t about leaking saliva, but is a fast maturing business rules engine at a time when healthcare needs to separate business logic from reams of old legacy source code, especially to meet changing performance measurements or calculating metrics for Meaningful Use. According to Wikipedia, Drools is a business rule management system (BRMS) with a forward chaining inference based rules engine, more correctly known as a production rule system, using an enhanced implementation of the Rete algorithm. The Drools business rules engine supports the JSR-94 standard for its business rule engine and enterprise framework for the construction, maintenance, and enforcement of business policies in an organization, application, or service. Drools is a key component for implementing a flexible Service Oriented Architecture (SOA). JBoss Rules is the commercial version of the open source Drools project.
The key improvement in maturity of this open source business rules engine is the addition of a business rules manager called Drools Guvnor which is a centralized repository for creating knowledge bases. In addition, Drools Fusion provides for complex event processing including time-based decision-making, also a key need for healthcare environments. One example of the use of a Drools business rules engine would be a clinical event monitoring system to provide proactive alerts when messages indicate a need for human intervention in a business process.
Mule for a Service Oriented Architecture
While all of the major commercial software vendors have SOA offerings, the cost to install, implement and maintain SOA environments is out of reach for a typical healthcare IT budget. A fast growing community is implementing the open source SOA Enterprise Service Bus product called Mule from Mulesoft. Mule is used for SOA by many of the Fortune 500 companies and is a real alternative for cash-strapped healthcare IT needing to move to a message-based architecture. Mule ESB is a lightweight Java-based enterprise service bus (ESB) and integration platform that allows developers to connect applications together quickly and easily, enabling them to exchange data. Mule ESB enables easy integration of existing systems, regardless of the different technologies that the applications use, including JMS, Web Services, JDBC, HTTP, and more. Combined with the Mirth Appliance, Mule is capable of supporting the HIE needs of a healthcare integrated delivery network. Mule is also a strong SOA alternative to the current state of hub and spoke, single point of failure, integration engines used in healthcare today.
Mule has excellent scalability for large healthcare organizations with complex enterprise integration needs. Mule’s stage event-driven architecture (SEDA) makes it highly scalable and a major airline processes over 10,000 business transactions per second with Mule while H&R Block uses 13,000 Mule servers to support their highly distributed SOA environment. Clearly, this open source solution has matured and gained widespread acceptance, but Mulesoft isn’t resting on its success and is developing a SOA repository management solution for its Enterprise version.
Pentaho for Business Intelligence
With the very high level of interest in business intelligence and performance metrics in healthcare due to Meaningful Use and Accountable Care, the next open source stack component to review is Pentaho. What is interesting about Pentaho is how they describe themselves: “Pentaho was born out of the desire to achieve positive, disruptive change in the business analytics market, dominated by bureaucratic mega vendors offering eye-wateringly expensive heavy-weight products built on outdated technology platforms, and who had become focused on integration with the rest of their enterprise application suites – at the expense of innovation of their BI capabilities.” The maturity level of Pentaho is demonstrated by their recent inclusion as a strong vendor with the richest functionality and most extensive integration with Hadoop for big data by Forrester.
Pentaho as an open source solution has compelling capabilities for the healthcare environment. One of the more important ones is that Pentaho provides the option to take data in-memory to speed up your analytics. For quick near real-time analytics for clinical decision-making, this feature is important. The challenge with other BI solution sets is that they may require a customer to bring all data in memory before analysis resulting in memory challenges on the hardware platform. Pentaho supports capabilities to manage in-memory analytics with very large data sets.
Pentaho is a BI solution that can also provide persistent caching for improving the speed of advanced analytics. A typical healthcare organization will not want to load reference data and prime the cache every time the analytics server restarts. This may take a long time depending on the size of the data set, creating significant delays in making the system available to end users. Reference data and some master data loaded in memory or persistent cache can really speed queries in a healthcare setting, especially with by facility or physician views of detailed information. Pentaho uses a distributive caching system to scale out and distributes the queries to a pool of shared memory for meeting concurrency requirements and avoiding cache bottlenecks.
Liferay for the Portal
Last, but definitely not least, is the open source portal software called Liferay. Liferay has matured in recent years to become a complete portal solution that includes:
- • Content & Document Management with Microsoft Office® integration
- • Web Publishing and Shared Workspaces
- • Enterprise Collaboration
- • Social Networking and Mash-ups
- • Enterprise Portals and Identity Management
For healthcare, portals are the key information delivery mechanism including patient portals, physician portals, intranets and project management portals. Liferay is an independent portal vendor that doesn’t insist on controlling the architectural stack of architectural components in order to work. For large healthcare organizations with thousands of employees, Liferay has strength in developing self-service portals that include knowledge sharing workspaces and Web 2.0 capabilities.
Consider Integrating the Stack
In summary, the big building blocks of an open source architecture are available today and are reaching a level of maturity that is worthy of consideration by large healthcare organizations. It is important to note that open source software is not free and requires staff commitment to succeed, generally with good to excellent Java skills. The commercial versions of the open source products are usually well documented and have excellent product support.
One key aspect of these open source products is that they are excellent for developing proof of concept (POC) projects before committing to purchasing the full commercial versions. This POC approach can allow for testing not only the functionality of these architectural components but evaluating them in your existing IT environments. If your IT team hasn’t taken a recent look at open source, you might be surprised at what big organizations are adopting it and how much money it could save your organization.