Insurance companies, state health care systems, and HMOs need to manage the health of customers and provide medical decisions. There are 4 parts of such a system, which is often referred to as an MMIS system. The key components of an MMIS system are as follows:
- Provider – enrollment, management, credentials, services enrollment
- Consumer – enrollment, service application, healthcare management
- Transactions, billing, and service approvals
- Patient health data, big data, health analysis, and analytics
Each of these systems are integrated and each requires its own event-driven architecture (EDA). Standards in the health industry include HL-7 for the message format and coding. Important standards to be supported in any system include HL-7, EHR standards, ICD coding standards, and numerous other changing specifications. Systems need to support strong privacy, authentication, and security to protect individuals privacy.
Let’s look at one particular type of healthcare transaction; the enrollment process for patients in an insurance service.
When a patient requests to enroll in a medical insurance company or system they typically make an application in one form or another. To facilitate this numerous ways are provided for the applicant to submit the information. As a best practice, this application uses an ESB to mediate and transform whatever application source is used. Mobile applications, for instance, can talk directly to the ESB. Once an application has been received it needs to be reliably stored and a business process initiated to process the application. Typically, the patient’s past data will have to be obtained from existing medical systems as well as history of transactions, payments, providers, etc. so that a profile can be created to determine if the application should be approved.
Over time, new information coming into the system may undermine an applicant’s eligibility to participate in a certain plan. Hence, the system has to continue to ingest data from various data sources including information on the applicants living address, medical conditions, and behaviors. A CEP engine can detect events that may trigger a business process to review an applicant’s status.
WSO2 offers a full suite of open source components for both EDA and Web services architectures to implement highly scalable and reliable enterprise grade solutions. It is typical to use both architectures in today’s enterprises. WSO2 is one of the only vendors that can deliver all components of both architectures. WSO2 is also open source and built to be enterprise grade throughout.
In the architecture described by the above diagram, health care organizations have integrated event driven capabilities. A Data Services Server helps collect raw information that can be processed by analytics tools for learning and detection of anomalous conditions. Healthcare privacy is a key requirement and the architecture above provides the security required.