At Your Service: Will Service Oriented Architecture Add Interoperability to Imaging?

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Service Oriented Architecture (SOA) is not a new concept, but the medical field has been slow to adopt it. This could change as more and more radiologists, administrators and IT leaders recognize its value in a field that is requiring a greater degree of interoperability.

While service-oriented architecture may be the “flavor of the month” among radiologists, says Paul Chang, MD, medical director of enterprise imaging and SOA infrastructure at the University of Chicago Hospitals, it’s based on a concept that’s been around for years. As we often lament, healthcare tends to lag behind nearly every other business when it comes to implementing information technology, and SOA is no exception, according to Chang. But, he believes SOA is a concept whose time has come.

“In medicine, we need to be able to support a complex workflow,” says Chang. “And in order to achieve that, we need information from various kinds of systems and databases. I need to look at images from PACS, clinical information from EMRs, pathology reports. I have to talk to billing systems. So, in order to support that complex workflow, we need access to information from systems that don’t natively talk to each other. SOA does that. SOA attempts to address interoperability.”

Chang’s favorite example of SOA success is Amazon. During a single customer transaction of just a few minutes, Amazon’s backend interacts with dozens of different databases—warehouses, banks, delivery companies, he notes. It is seamlessly interoperable—and lightening quick to the user.
But, Chang adds, if Amazon operated the way most PACS do, a customer transaction wouldn’t be so seamless, and would require the customer to log in and out of systems in order to buy the correct book, access the funds necessary to purchase the book, and make the necessary arrangements to ship the product.

From a business perspective, the results for Amazon would be catastrophic, Chang notes, but in radiology, “that’s what we do every day, hundreds of times a day. But when we go to Amazon, it’s all done seamlessly. What’s the difference? It’s SOA.”

In health IT today, the only way to consume information is to use specific applications. “So, if I want to look at images, I have to look at the PACS application,” he points out. SOA adds a level of sophistication and interoperability through “loose coupling.”

“We disengage the relationship between the content—which is the valuable stuff—and the presentation or display of the content,” says Chang. “That is decoupled, so now instead of only being able to access the content through a specific application, you create a middle layer—a SOA layer called an enterprise service bus—that can talk to various databases, gets the content, and creates it in a form that’s universally useable.”

Here’s how SOA works at the University of Chicago. A physician, for example, may look at images on a PACS and at the same time wonder whether the patient is exhibiting a fever. In most cases, that would require the physician to log in separately into the EMR. In this case, Chang can, with a click of a button, get that patient information, namely the patient’s recent temperature, to come up automatically within his PACS applications.

“It’s the same content as the EMR,” says Chang, “but it’s orchestrated to my appropriately idiosyncratic requirements where I don’t have to be the integration agent. SOA does the integration for me and that’s a big advantage.”

In addition to the advantage SOA provides as far as patient quality care and workflow efficiency are concerned, Chang also makes a business case for SOA.

“Patients are no longer passive health consumers,” he says. “They shop around. If, God forbid, a patient has cancer, he wants a one-stop shop. He doesn’t want the traditional routine where he gets a CT exam one day and because there is a delay in delivery he has to come back the next day to see an oncologist. A radiology, department that can offer same-day service adds value and has given itself a competitive business advantage,” says Chang.

To do this, the first step is a “really intelligent” PACS worklist, says Chang. A radiology information system only knows what is being scheduled to be imaged, he explains, and the location from where it was ordered, but it doesn’t know whether a patient has been scheduled to be seen by another scheduling system.

“But all we had to do was build a SOA scheduling service that basically says that for every patient who is scheduled to be seen,