Introduction – Who is Teksouth? The Teksouth Corporation is a Small Business (with approximately 135 employees across the US) with 25 years of experience providing cutting-edge data solutions to both corporate and government clients. Teksouth has focused on providing Data Warehouse / BI solutions that support both Logistics, Financial and Healthcare operations. Teksouth has deployed the DoD’s single most successful comprehensive Data Warehouse / BI solution – CRIS. This was done at a fraction of the cost of all contemporary solutions. We are Systems Integrators.

The Teksouth Corporation is a Small Business (with approximately 135 employees across the US) with 25 years of experience providing cutting-edge data solutions to both corporate and government clients.

Teksouth has focused on providing Data Warehouse / BI solutions that support both Logistics, Financial and Healthcare operations.

Teksouth has deployed the DoD’s single most successful comprehensive Data Warehouse / BI solution – CRIS. This was done at a fraction of the cost of all contemporary solutions. We are Systems Integrators.

Teksouth Corporation Locations Teksouth is Headquartered in Birmingham, AL

Teksouth Corporation Partners Microsoft Corporation Cognos / IBM Semantech Inc. Teradata LogiXML Centech CSC Sumaria Systems Sun Microsystems Accenture

Microsoft Corporation

Cognos / IBM

Semantech Inc.

Teradata

LogiXML

Centech

CSC

Sumaria Systems

Sun Microsystems

Accenture

Teksouth Corporation Clients Federal Department of Defense Financial Manufacturing

The “TEC” & Innovation At Teksouth, Innovation is not a mandate, it’s our passion…

What is the TEC ? Teksouth Corporation’s Enterprise Consulting (TEC) group is a professional services organization whose primary focus is delivering comprehensive next generation information technology solutions. These solutions include The “Dynamic Data Warehouse” or “DDW” as well as the Virtual Healthcare Portfolio. Both of these are designed to facilitate enterprise scale integration. The TEC is chartered to update and infuse Teksouth’s Solutions with leading edge technologies and techniques. We have developed a practice methodology based upon Semantic Interoperability which we refer to as the “i-TEC”.

Teksouth Corporation’s Enterprise Consulting (TEC) group is a professional services organization whose primary focus is delivering comprehensive next generation information technology solutions.

These solutions include The “Dynamic Data Warehouse” or “DDW” as well as the Virtual Healthcare Portfolio. Both of these are designed to facilitate enterprise scale integration.

The TEC is chartered to update and infuse Teksouth’s Solutions with leading edge technologies and techniques. We have developed a practice methodology based upon Semantic Interoperability which we refer to as the “i-TEC”.

The TEC Methodology – “i-TEC”

New Ideas Begin with Principles…

Introduction – A Crisis in Healthcare 195,000 people died each year on average in 2000, 2001 and 2002 due to possibly preventable in-hospital errors (HealthGrades, 2004). Despite medical industry and governmental attention to these statistics, including the creation of The Agency for Healthcare Research & Quality (AHRQ), only modest improvements have been realized thusfar and the pace of improvement is slowing (AHRQ Progress Report – 2007). Why? What is responsible for this and other significant problems associated with our Healthcare system? The single most obvious culprit: Information – sometimes too much, other times not enough and often just plain wrong.

195,000 people died each year on average in 2000, 2001 and 2002 due to possibly preventable in-hospital errors (HealthGrades, 2004).

Despite medical industry and governmental attention to these statistics, including the creation of The Agency for Healthcare Research & Quality (AHRQ), only modest improvements have been realized thusfar and the pace of improvement is slowing (AHRQ Progress Report – 2007).

Why? What is responsible for this and other significant problems associated with our Healthcare system? The single most obvious culprit: Information – sometimes too much, other times not enough and often just plain wrong.

Understanding the Problem Space

Complexity, Change & Info Overload The practice of Medicine is a study in complexity. Few other fields of endeavor are changing so rapidly; new medicines, new treatments, new technologies, new research are appearing on a daily basis. How do we cope? Regardless of how much education practitioners receive, aspects of their knowledge will become either obsolete or incomplete almost immediately upon entry into the field. Healthcare practitioners are busy; shortages in key staff and high patient case loads as well as more complex cases often lead to confusion and mistakes. Traditional healthcare is still very much “paper-based.” The systems that do exist tend to be poorly integrated.

The practice of Medicine is a study in complexity. Few other fields of endeavor are changing so rapidly; new medicines, new treatments, new technologies, new research are appearing on a daily basis. How do we cope?

Regardless of how much education practitioners receive, aspects of their knowledge will become either obsolete or incomplete almost immediately upon entry into the field.

Healthcare practitioners are busy; shortages in key staff and high patient case loads as well as more complex cases often lead to confusion and mistakes.

Traditional healthcare is still very much “paper-based.” The systems that do exist tend to be poorly integrated.

Current Healthcare Automation - 1 Electronic Medical / Healthcare Records – EMR / EHR: These are the premier emerging technologies focused on improving patient treatment & outcomes. However, standards and data exchange are still unclear. Laboratory Management & Prescription Management – Some of the earliest examples of integration occurred in the 1990’s with pharmacy management & laboratory tools. Point of Care Systems – A loosely coordinated set of sensors, systems or capabilities available to first providers. Healthcare Informatics / Clinical Decision Support – These systems may or may be built atop Data Warehouses or Marts or even EMRs/EHRs as sources.

Electronic Medical / Healthcare Records – EMR / EHR: These are the premier emerging technologies focused on improving patient treatment & outcomes. However, standards and data exchange are still unclear.

Laboratory Management & Prescription Management – Some of the earliest examples of integration occurred in the 1990’s with pharmacy management & laboratory tools.

Point of Care Systems – A loosely coordinated set of sensors, systems or capabilities available to first providers.

Healthcare Informatics / Clinical Decision Support – These systems may or may be built atop Data Warehouses or Marts or even EMRs/EHRs as sources.

Current Healthcare Automation - 2 Almost all of these solutions are built upon traditional RDBMS platforms. Most of these are ‘systems’ rather than web services or services on a SOA platform. Standards which are supported (like HL7), require hard –coded support (for XML or EDI) within those systems to achieve interoperability with a relatively small subset of other systems. Most of these systems were not built with an “enterprise” or information sharing perspective in mind, thus they represent disconnected “Islands of Information.” Because of their cost and obscure value proposition, EMR / EHRs have not been widely adopted yet.

Almost all of these solutions are built upon traditional RDBMS platforms. Most of these are ‘systems’ rather than web services or services on a SOA platform.

Standards which are supported (like HL7), require hard –coded support (for XML or EDI) within those systems to achieve interoperability with a relatively small subset of other systems.

Most of these systems were not built with an “enterprise” or information sharing perspective in mind, thus they represent disconnected “Islands of Information.”

Because of their cost and obscure value proposition, EMR / EHRs have not been widely adopted yet.

The “Portfolio Metaphor”

The Context Makes a Difference Healthcare represents a set of processes, those processes depend upon information but cannot effectively be patterned around a Relational Database schema. The EMR / EHR is based loosely on the Medical Chart Metaphor. Unfortunately, this does not provide an effective pattern for the true complexity of most Healthcare scenarios and makes comparison of cases difficult. What is needed is something that can represent continuity of care across cases and information sources for individual patients, and across groups of patients as well. This is a dynamic perspective, an enterprise perspective & metaphor. Our context changes the nature of the solution.

Healthcare represents a set of processes, those processes depend upon information but cannot effectively be patterned around a Relational Database schema.

The EMR / EHR is based loosely on the Medical Chart Metaphor. Unfortunately, this does not provide an effective pattern for the true complexity of most Healthcare scenarios and makes comparison of cases difficult.

What is needed is something that can represent continuity of care across cases and information sources for individual patients, and across groups of patients as well. This is a dynamic perspective, an enterprise perspective & metaphor. Our context changes the nature of the solution.

The High Level Architecture

The Virtual Healthcare Portfolio The Healthcare Portfolio architecture & solution is an attempt to avoid reactionary integration by building proactive interoperability in at the start. The Healthcare Portfolio is driven by Semantics, the next generation of enterprise integration, which allows us to integrate through a semantic abstraction layer (using RDF & SPAQRL coupled with a SOA foundation). The Healthcare Portfolio provides role-based web-based access to all stakeholders in all related healthcare processes. The Healthcare Portfolio provides access to unlimited knowledge sources through semantic queries.

The Healthcare Portfolio architecture & solution is an attempt to avoid reactionary integration by building proactive interoperability in at the start.

The Healthcare Portfolio is driven by Semantics, the next generation of enterprise integration, which allows us to integrate through a semantic abstraction layer (using RDF & SPAQRL coupled with a SOA foundation).

The Healthcare Portfolio provides role-based web-based access to all stakeholders in all related healthcare processes.

The Healthcare Portfolio provides access to unlimited knowledge sources through semantic queries.

The Semantic Foundation Semantic Fabric All aspects of any IT infrastructure share a common semantic fabric Occurs when that fabric is managed

Solving Healthcare Integration

Solutions Must Serve, Not be Served Two studies in 2005 (one published in the Journal of the American Medical Association and the other in Pediatrics ) indicated that poorly designed clinical information systems actually can lead to an increase in medical errors. Crounse (2006) While Healthcare Integration is important, and will solve a number of important healthcare issues, making sure that patient outcomes improve is paramount. The key to ensuring that Healthcare Quality improves and that Patient outcomes are successful is to understand the processes and to empower those processes with Technology & Automation.

While Healthcare Integration is important, and will solve a number of important healthcare issues, making sure that patient outcomes improve is paramount.

The key to ensuring that Healthcare Quality improves and that Patient outcomes are successful is to understand the processes and to empower those processes with Technology & Automation.

Continuity of Care – Key to Quality

Exponential Knowledge Expansion The community of Medical practice and knowledge is expanding exponentially. Any attempt to centrally manage all types of medical knowledge in one system’s metadata framework is bound to fail. Part of the true strength of the Healthcare Portfolio solution is its ability to accommodate information not originally anticipated. The implications of this are important, as there is no consistent method of coordinating metadata across multiple metadata sources except through custom interface development or management in most of today’s EHRs. As the scope of custom integrations grows, interface management and integration become mores difficult to control. In other words, those architectures simply are not scalable.

The community of Medical practice and knowledge is expanding exponentially. Any attempt to centrally manage all types of medical knowledge in one system’s metadata framework is bound to fail. Part of the true strength of the Healthcare Portfolio solution is its ability to accommodate information not originally anticipated.

The implications of this are important, as there is no consistent method of coordinating metadata across multiple metadata sources except through custom interface development or management in most of today’s EHRs. As the scope of custom integrations grows, interface management and integration become mores difficult to control. In other words, those architectures simply are not scalable.

Healthcare Portfolio – DoD View

Making Quality Affordable One of the primary drawbacks of many Healthcare systems have been their excessive cost. This is particularly difficult for smaller practices or institutions to bear and is why adoption has been slow. Part of what we are addressing is the core business model underlying Healthcare Information systems. As long as security concerns are met (HIPAA etc.), there is no reason why capability cannot be federated or spread out among providers and subscribers. Smaller organizations do not need to shoulder all of the burden themselves. Becoming an interactive part of a larger community of information & practice has many benefits.

One of the primary drawbacks of many Healthcare systems have been their excessive cost. This is particularly difficult for smaller practices or institutions to bear and is why adoption has been slow.

Part of what we are addressing is the core business model underlying Healthcare Information systems. As long as security concerns are met (HIPAA etc.), there is no reason why capability cannot be federated or spread out among providers and subscribers. Smaller organizations do not need to shoulder all of the burden themselves.

Becoming an interactive part of a larger community of information & practice has many benefits.

Information Access & Cost

Healthcare and SOA Separating systems out from underlying data and knowledge sources and providing them as “services” accomplishes a number of critical goals: It allows that logic to evolve without necessarily requiring recoding of data sources (and vice versa). It allows for the possibility of capability expansion through adoption or interchange with external (web-enabled) services. It allows for coordination of previously disconnected systems within the context of the Healthcare processes being served.

Separating systems out from underlying data and knowledge sources and providing them as “services” accomplishes a number of critical goals:

It allows that logic to evolve without necessarily requiring recoding of data sources (and vice versa).

It allows for the possibility of capability expansion through adoption or interchange with external (web-enabled) services.

It allows for coordination of previously disconnected systems within the context of the Healthcare processes being served.

The Service Inventory View

Semantic Visualization & Healthcare One of the most daunting challenges in healthcare is the ability to quickly distill information and to grasp complex relationships and processes. Knowledge can be mapped through semantics, using Ontologies, Taxonomies, Vocabularies and Rulesets for relationships. A Key capability of the Healthcare Portfolio is the ability to discover information based upon maps and to create them as well to capture new knowledge (e.g. diagnostic algorithms, best practice process improvement etc.). Interoperability with external knowledge is achieve through the ability to represent these ‘maps’ as RDF graphs.

One of the most daunting challenges in healthcare is the ability to quickly distill information and to grasp complex relationships and processes.

Knowledge can be mapped through semantics, using Ontologies, Taxonomies, Vocabularies and Rulesets for relationships.

A Key capability of the Healthcare Portfolio is the ability to discover information based upon maps and to create them as well to capture new knowledge (e.g. diagnostic algorithms, best practice process improvement etc.). Interoperability with external knowledge is achieve through the ability to represent these ‘maps’ as RDF graphs.

Semantic Visualization of Rulesets

Teksouth Contact Information Thank You… For more information, contact: Stephen Lahanas (TEC partner) [email_address] Or Ken Craig [email_address] (937) 554-4673 (800) 842-1470 (toll free) (205) 631-1500