Wes Wright, chief information officer at Seattle Children’s Hospital, says a new analytics tool that unobtrusively monitors the performance of his HL7 transactions "gives me peace of mind."
[See also: HL7 makes IP available for EHRs]
Seattle Children's is unique, says Wright, in that it's a "smaller hospital, in terms of bed size," but serves a four-state region: Washington, Alaska, Montana and Idaho. It offers critical, highly-advanced care to a large geographic area.
"We're a tertiary, almost quaternary care hospital," he says. "It's a really specialized pediatric hospital."
[See also: HL7 and Regenstrief Institute connect on standards]
On top of that, Wright is in charge of a 1,200 person research institute – "the fifth leading NIH grant recipient for pediatric research," he says.
Overseeing the IT needs of the primary hospital, three research buildings and 14 affiliated locations in western Washington area is a challenge, to say the least.
"The hardest part of my job is demand management (and) prioritization," he says. "As healthcare becomes more and more digital, more and more of the improvement opportunities and perceived safety problems we have are all – well, not all, but about 85 percent – related to IT," Wright explains. "My folks are always in demand."
Another big challenge, as it is for so many hospitals and health systems, is data exchange and interoperability.
"We are in the throes of standing up our own pediatric health information exchange," says Wright. "We use an InterSystems HealthShare platform for that. In October, we plan to soft launch with our major pediatric provider across the lake" – Pediatric Associates, located in Bellevue, Wash. – "which has about 85 docs.
"So we're going to do a soft launch with them, using a couple of their providers and a couple of ours, to suss out what's there, what's not there, what shouldn't be there," he says. "And then November go with a broader launch with Seattle Children's and the Pediatric Associates docs. And then start bringing on some other clinically integrated network partners that we're forming right now.
"We're right on the cusp of being able to share data the way I think we need to be able to share data," says Wright.
Optimizing HL7 transactions: Epic, Cerner and more
As for exchanging patient information within the walls of the Seattle Children's organization, ensuring that the transactions between systems run smoothly and efficiently is also of critical concern.
Wright has been making use of technology developed by ExtraHop Networks, which aims to offer real-time "operational intelligence" into the quality of HL7 transactions.
The tool helps healthcare organizations map HL7 communications across interfaces, monitor the performance of clinical workflows and, hopefully, gain insights into ways to improve and innovate. ExtraHop's new healthcare-specific edition of its Wire Data Analytics platform is billed as a valuable tool to get heterogeneous, real-time visibility into HL7 transactions.
"Healthcare IT professionals face management and visibility challenges associated with the recent explosion of data in their environments," said Jesse Rothstein, CEO and co-founder of ExtraHop, in a press statement. Analytics tools such as these "enable these teams to more effectively derive valuable intelligence from the massive amounts of data they are currently struggling to manage."
Wright, for one, is a fan. Seattle Children's relationship with ExtraHop goes back to its initial virtual desktop infrastructure implementation, four or five years ago, he says. "When we first stood VDI up, we probably had about 1,000 users or something like that on board. We kept chasing around a ghost in the machine. We couldn't figure out what was causing intermittent performance issues.
"One of my Citrix engineers knew about ExtraHop, so I asked them to come in and do a (demo) for us," he adds. "They set it all up in four hours or so, and actually found the ghost in my machine the second day."
At that time, "ExtraHop was the only performance monitoring tool that had the relationship with Citrix to where they can get into the ICA channel," says Wright. "They could get inside that and figure out what's going on with the traffic. That's why I brought them on board."
ExtraHop's new Open Data Stream technology allows IT teams to stream data sets to a database such as MongoDB – or a search, analytics and data visualization suite, such as the Elasticsearch ELK stack – helping give providers a way to compare and contrast data from multiple sources, company officials say. This offers more control over where patient data is stored and queried, and increases the flexibility of other and analytics tools.
"I'm excited about that," says Wright. By taking that messaging and streaming it into a non-structured database, "then I can use some tools to query that database and find out about pretty much all the parameters that are involved in an HL7 message," he says. "That's pretty powerful stuff right there."
"What's really interesting about (ExtraHop), especially in a medical environment, is that they sit on the wire, so to speak," says Wright. "They get a copy of everything that's sent over your network. And from that information, we can monitor performance."
"A lot of the application performance management tools that are out there, you have to load an agent either onto a server or a desktop or something like that," Wright explains. " a lot of applications, if you put an agent on that application, you might break it."
Before the new healthcare-specific edition came out, Seattle Children's was using ExtraHop "mostly for monitoring our virtual desktop performance," says Wright. "Then we were a beta partner with HL7 folks."
Application interface engineers "historically keep track of their HL7 messaging in their interfaces via a spreadsheet, and really don't have any kind of performance monitoring around what's happening with those interfaces," he explains. "But you put ExtraHop in there, that can now look at HL7 messaging, and determine what interface that is going to and coming from. All of a sudden I can see a clear picture of the performance of that interface."
For instance, Seattle Children's uses both Epic and Cerner technology.
"Epic is our registration and scheduling, and Cerner is our clinicals, so there's an HL7 interface from Epic into Cerner on any registration that we do," he says. "If we have someone come into our ED, somebody comes into out ED they'll get registered in Epic and then show up in Cerner. And if that slows down for some reason then the physician can't do their documentation in Cerner when they need to.
"So now it gives me peace of mind: I can set the parameters on what good performance is," says Wright. "ExtraHop does that for me. It sets my upper control limit, lower control limit and then the mean for this particular HL7 interface transaction, receiving and sending."
"Any time stuff starts to slow down, it sounds an alarm," he adds. "Then I can go look at the interface and not have to wait for someone in the ED to call and say, 'Hey, I registered so-and-so into Epic and it's not flowing over into Cerner.' Before ExtraHop, that's kind of what we had to do."
But the "very cool thing," says Wright, "is that it's super non-intrusive to our production environment. There aren't any agents. It's just sucking the data off of the wire and no one else is aware of it."
