The Healthcare IT Blog

Today we are announcing two new great additions to the growing Amalga customer base: University of Washington and Seattle’s Children Hospital!

• University of Washington will focus on clinical and translational research by basically providing researches with better access to data that was previously scattered across multiple systems and the tools to investigate and
• Seattle’s Children Hospital while keeping a more clinical focus, will also address clinical research and hospital operations

Read the full press releases to get the entire story.

This brings the number of announced Amalga customers to eleven:

While looking at my past posts on the topic, I realized I never gave out the link to the download for the HL7 Schema Generation Tools that I discussed waaaaay back.

Hopefully the most entrepreneurial readers will have found it, for the rest of us, here it is with a small description from the download page:

http://www.microsoft.com/downloads/details.aspx?familyid=94877261-1F04-40B7-8C6D-CF92F38D09A3&displaylang=en

This is the same tool that the BizTalk team uses internally to generate the schemas that ship with Microsoft BizTalk Accelerator for HL7 v2.0. The tool takes the HL7 message definition from the database that HL7 publishes on their web site and generates schemas in a format that the BizTalk HL7 parser can understand. These schemas are used by the parser in the process of translating from the flat file format of HL7 v2.x to XML.
The HL7 message definitions are stored in a Microsoft Access database and include definitions for all the approved versions (2.1, 2.2, 2.3, 2.3.1, 2.4 and 2.5). The HL7 message definition database will not ship with the Accelerator as it is part of the HL7 standard and has to be acquired separately from the HL7 standards organization.
By customizing the database and the generated schema namespace, you will be able to create your own library of message definitions for your own integration purposes or for versions of HL7 that we do not include in the Accelerator for HL7.
The Schema Generation Tool also comes with full source code. That way it can be adapted to generate the schemas from *any* repository or from tools such as the HL7 Messaging Workbench.
The objective of the Schema Generation Tool is to make it easier to manage libraries of HL7 message definitions by working at the model level instead of dealing with schema customization. Every time you need to generate a custom message or segment, you can modify the repository (or a copy of it) and generate new schemas.

Just to be clear, you need to have your own HL7 definition database. You can get the “vanilla” version from the HL7 web site. To get it, go to the HL7 Bookstore, scroll down to the section “Access Databases Versions of the HL7 Standards” and click on the “more info” button.

The most interesting aspect of the tool is that it allows you to generate schemas from your own HL7 message definition. So, if you have a national HL7 v2 standard (most countries do) and you can put that definition in an easy to maintain database, then generating the BizTalk schemas for any particular HL7 dialect becomes much easier.

Another interesting route to explore, and the reason why we’re including the source code, is to adapt the tool to generate the schemas directly from other tools or repositories such as the HL7 Messaging Workbench.

Today we announced a new customer added to the growing list of organization that are adopting Amalga to gather better insight on their care delivery, operations and performance.

El Camino Hospital today announced that it has selected Microsoft Amalga, the unified intelligence system, as its data platform to aggregate all of its information, which currently resides in disparate, transaction-based systems, and integrate it into a single system that will allow the hospital to better evaluate and improve quality of care. The investment is part of an aggressive three-year initiative aimed at helping El Camino Hospital achieve a top 5 percent ranking among U.S. hospitals across all of its service lines.

We are very proud of the customers that have adopted Amalga so far and El Camino adds another big name to the growing list and today brings the number of announced customers to nine:

• Medstar (July 2006)
• New York Presbyterian Hospital (March 2007)
• Johns Hopkins (April 2007)
• Wisconsin Health Information Exchange (August 2007)
• Novant (August 2007)
• Moffitt (September 2007)
• St. Joseph Health System (November 2007)
• DC RHIO (June 2008)
• El Camino (September 2008)

The team in the UK is doing a great job with the Microsoft Common User Interface (MSCUI). Head over to http://www.mscui.net to check for the new version that was just posted.

New in this release:

1. Publication of new and updated Design Guidance:
   1. New Micro Patient Banner guidance
   2. New Displaying Graphs and Tables guidance
   3. Updated Time Display guidance
   4. Updated Date and Time Input guidance
2. Publication of 6 new Controls for Silverlight 2 and WPF:
   1. New Silverlight and WPF PatientBanner controls
   2. New Silverlight and WPF AddressLabel controls
   3. New Silverlight and WPF ContactLabel controls
   4. New Silverlight and WPF GenderLabel controls
   5. New Silverlight and WPF IdentifierLabel controls
   6. New Silverlight and WPF NameLabel controls
3. Updates to the Patient Journey Demonstrator which showcases CUI design guidelines, controls and future UI concepts in a Silverlight 2 application.
4. Publication of the new Team Blog.

Yes, I know, it’s been a while since I posted and I know that I have probably lost a lot of readers. Fare enough! I hope to start posting more regularly and bring you more news from the Amalga family of products, the Health Solutions Group and Microsoft in Healthcare in general.

In the meantime, Ilia posted the following on the SolShare.Net healthcare forums:

Since it was published almost two years ago, Connected Health Framework Architecture and Design Blueprint has gained popularity and has been used successfully to shape eHealth strategy and guide projects at enterprise, regional and national level in many countries.  While the key principles and guidance remain valid, we recognize the need to refresh and improve the content, and make it more relevant and useful.

This is your chance to provide input and participate in the creation of version 2 of the Connected Health Framework Architecture Blueprint.  We want to hear you success stories, what works for you and your customers (and what doesn’t), what is missing, how to make it better. Please post your suggestions ASAP, so that they can be considered for v2 – which we plan to release in 2009.

If you have ideas, suggestion or comments, please head over there and let your opinion be heard!

Today we are announcing Microsoft Amalga, the new family of Health Enterprise Systems. You can read the full press release on the microsoft.com web site.

The products included in the Amalga family are:

• Microsoft Amalga. The new version of the product formerly known as Azyxxi, Amalga is part of a new software category called Unified Intelligence Systems that allows hospital enterprises to unlock the power of all their data sitting in isolated clinical, financial and administrative systems. Without replacing current systems, it offers an innovative way to capture, consolidate, store, access and quickly present data in meaningful ways for use by clinicians and executives of leading-edge institutions. Amalga is designed for hospitals and health systems that have invested in a diverse set of IT solutions.
• Microsoft Amalga Hospital Information System (HIS). The new version of the product previously named Hospital 2000, Amalga HIS is a state-of-the-art, fully integrated hospital information system designed for developing and emerging markets. Amalga HIS is built around an electronic medical record (EMR) with complete patient and bed management, laboratory, pharmacy, radiology information system and picture archiving and communication system (RIS/PACS), pathology, financial accounting, materials management, and human resource systems.
• Microsoft Amalga RIS/PACS. The new version of the product formerly known as GCS Amalga is now available as a stand-alone system as well as an integrated component of Amalga HIS. The integrated architecture means that a radiologist can use a single application to manipulate and study images and access the patient medical record. The workstation interface is optimized for radiologist workflow, including support for predefined templates, an intuitive report editor and voice recognition capabilities.

Today we are also launching a revamped HSG web site and a new Amalga web site that contains detailed information about the three products.

This was a tremendous team effort leading up to HIMSS in a couple of weeks where you will be able to see all three products live in the Microsoft booth #2247. If you wondered where I was since the last time I blogged, well now you have a clue ;-)

The products included in the family are new versions of the products that we acquired over the last couple of years:

• Azyxxi --> Microsoft Amalga
• Global Care Solutions Hospital 2000 --> Amalga HIS
• Global Care Solutions Amalga RIS/PACS --> Amalga RIS/PACS

If you're coming to HIMSS, stop by the booth and say Hi, I will be there the entire week :-)

As promised the GOLD version of the IHE XDS.b Reference Implementation is now posted on CodePlex [direct link]

It is official, after a week of testing in Chicago at the IHE Connectathon, the Microsoft IHE XDS.b Reference Implementation has passed and received the GREEN LIGHT from the Connectathon staff:

You can expect the final drop of the code to be posted to the Codeplex web site in about a week.

Kudos to the entire Microsoft team, SIMPL and the partners that helped us testing!

It’s been about a month now since we released HealthVault and we heard a lot of great feedback from the industry. Pretty much everyone in Health has an opinion on HealthVault :-)

I also saw some interesting debate regarding how HealthVault addresses the big elephant in the room: compliance with existing standards.

I have been involved in the standards community in healthcare for a long time and contributed first hand to several of the standards that are adopted today, including the ASTM CCR, HL7 and the IHE Interoperability Profiles. We have demonstrated in the past strong support for standards in healthcare and we are committed to the idea of interoperability based on standard protocols and data formats.

I talked to Sean Nolan, our Chief Architect for HealthVault, about the philosophy behind the data model design and I asked him to give a brief explanation. Here is what he had to say:

Wherever possible, we are using existing standards both for interchange in and out of HealthVault as well as within it. Many of our data types draw directly from standards such as the ASTM CCR, the IndivoHealth project and soon the HL7 CDA/CCD.

Some of the data types we needed in order to support our partners’ applications where not readily available in the standards community. In those cases, for example for the “aerobic exercise” data type, we have worked in concert with clinical and application partners to make sure that we capture the right information. We are not the domain experts – our partners are, and we are leveraging their expertise to help us build up the dictionary of HealthVault types.

Our decisions around data type definitions are driven by four key principles:

1. Interoperable. When designing our information model, we try to do our best to make our data types interoperable with industry standards in actual use. Each individual data type generally represents a superset of the correspondent industry standards data type. This way we enable our partners to more easily take the information stored in HealthVault and populate a standard ASTM CCR or HL7 CDA XML document or to take an existing ASTM CCR or HL7 CDA XML document and populate the atomic HealthVault data.

2. Inclusive. When designing the HealthVault data model we had to strike a balance between fully structured data and unstructured information. This is in line with a number of the industry standards that allow, for example, dates to be represented as the string “when I was a kid”. Our types are designed to be as inclusive as possible - with the ability to capture structure when it is available, but still take in the data when structure is missing. Our use of “coded values” is one example - we allow simple text strings for things like lab results, but if LOINC codes or similar are available we handle them as well. This does make life somewhat harder for application developers - but ultimately we believe it is well worth the added complexity. This philosophy is also expressed in other parts of the system - for example, we support the ability for people to fax information into their records. An image of your immunization history isn’t as good as structured data - but it sure is better than not having it at all.

3. Just in Time. If the data types you see in the HealthVault today seem a bit arbitrary, it is due to how we approached their design with our early partners. Our data model is growing as we work with partners fluent in various domains. For example, we got help on our fitness types from Polar, and learned a great deal from J&J Lifescan when it came to blood glucose measurements.

4. Independent. As much as possible, we have tried to keep application development simple by eliminating relationships across data items. For example, for medication we store the information on the prescribing physician in the data item rather than as a pointer to another data item describing the physician. Managing data integrity across partners would be a huge problem if we had a real normalized schema behind the HealthVault system. Our goal has been to allow expression of those connections but never rely on their existence for data integrity.

Our types also allow each vendor to add “extensions” of their own making to item data – so to the extent that we are missing certain fields, they can be added – and the industry can rally around those extensions if it makes sense. We’re also working on a process for partners to submit these extensions for inclusion in the HealthVault base types.

We appreciate the richness of the clinical formats developed by the standards community. This is the reason that when we take data from external sources, we keep the original available as a single package that can be shared and managed just as any other type can be. In addition to this, we support through our API the ability to extract of the component pieces of those items and - when appropriate -store them into more discrete types.

I strongly suggest you download our SDK from the HealthVault MSDN Developer Center and have a look at the data types. Also, if you spend enough time looking at the SDK, you’ll see “traces” :-) of how we support ASTM CCR and HL7 CDA CCD:

And

I hope this helps explain our thinking and some of the principles behind the design HealthVault, please keep providing us with precious feedback!

I have seen some posts about the BizTalk Accelerator for HL7 v2.0 not supporting Windows Server 2003 SP2. That seemed very odd to me so I asked the product teams and in fact there was a typo in the Known Issues where something from a previous release of the documentation was left.

Friday we posted an updated version of the documentation where the typo has been corrected.

The BizTalk Accelerator for HL7 v2.0 *is* supported on Windows Server 2003 SP2, the *minimum* requirement is SP1. 

If you're in Farmington, CT on November 5th, I strongly suggest you attend the (first?):

Microsoft Health and Life Sciences Industry Council

Healthcare 2.0 Perspectives & Industry Impact - Blogs, Wikis, podcasts, social networking, mashups, and RSS have become mainstream. Yet, the overall business value and viability of the viral movement is largely unrealized within the Healthcare Industry.  This interactive session will showcase current and future state themes, trends, and what Microsoft is doing to help turn vision and potential into reality.

Sorry for the short notice, but I did not see this until today. All the people presenting have a very deep background in Health and development: Allan, Ben, Hong, David...

Now, how come I did not get an invite ;-)

After a long gestation period we have finally published the HL7 v3 and BizTalk whitepaper:

Getting Started with HL7 v3 and BizTalk Server 2006

This paper provides developers with an overview of HL7 version 3 Messaging (HL7 v3) concepts, how to build HL7 v3 solutions with Microsoft® BizTalk® Server 2006, and how to convert message format from HL7 v3 to HL7 Version 2 Messaging (HL7 v2).

Given all the different nuances of HL7 v3, it is somewhat difficult for Microsoft to build a "product", but we're definitely committed to supporting the development of solutions based on HL7 v3 messaging standard on the Microsoft platform. Over the past years we worked very closely with HL7 to make sure that XML best practices and Web Services were included in the development of the standard and at the same time that the Microsoft platform would support HL7's artifacts.

The whitepaper analyzes a typical workflow and the steps that are required to make everything work like it should. We have many customers and partners that contributed to the experience that led to the development of this paper. While the paper is by no means meant to be all-encompassing, it definitely gives a good idea and starting point.

The scenario that we selected for HL7 v2/v3 interop is based on the IHE ITI Patient Identity Feed transactions for HL7 v2 and HL7 v3.

This whitepaper comes with sample code for BizTalk 2006 R2 and the version 2.0 of the BizTalk Accelerator for HL7.

If you have not seen it, there is a nice complement to this paper that examines the development of HL7 v2 solutions (although based on v1.3 of the Accelerator for HL7).

Last night we made another announcement that further demonstrates Microsoft's commitment to the Health industry worldwide.

Collaborative alliance with Bumrungrad International Hospital in Bangkok will help bring enterprise-class health information system solutions to market around the world.

Have a look at the web site and the video we have there to get a better understanding of what GCS provides:

• http://www.hospital2000.com/
• Download the GCS video (11MB, right-click and save)

At the same time we're also launching a minor update to the Azyxxi web site, so this is a good time to go check it out again :-)

We have just published a whitepaper on the use of Office Open XML in Health at the address below:

Using Office Open XML Formats to Support Electronic Health Records Portability and Health Industry Standards

Abstract: Empowering patients and consumers to exchange Electronic Health Records securely is a big debate in the health industry across the globe. Learn how to use Office Open XML Formats and custom XML formats to exchange data securely. This particular scenario shows the use of Health Level Seven (HL7) Clinical Document Architecture (CDA) to represent the Electronic Health Record in an industry standard format. It also shows how to include the data in a secured document, based on Office Open XML Formats, for portability across multiple care providers.

The paper comes with sample code that is very easy to install and test with minimal requirements on the machine to help illustrate the concept outlined in the whitepaper.

I also want to point out an entry on Oliver Bell's blog about a similar topic.

Starting today I am joining Microsoft's Health Solution Group as a Senior Product Manager for Azyxxi.

After seven years working as a Technical Strategist for our healthcare team (U.S. Healthcare and Life Sciences first, then Worldwide Public Sector) I have enjoyed spending time with a lot of folks in the Microsoft field, in standard development organizations like HL7, IHE and ASTM, and with Microsoft customers and partners.

It is time to take it to the next level, as a Product Manager in HSG I will be responsible for product strategy for one of the most innovative solutions in Healthcare WW. That includes bringing the product to market and making sure that our roadmap is aligned to our customer's objectives (plus a few other things :-)

This blog is here to stay and I appreciate your continued support.

Btw, we're hiring a replacement ;-) The position should be posted soon.