INTEGRATION PORTALS

Portals to an Integrated Future

An underlying Web architecture can enable system consolidation, scalability and interoperability.

by Deborah Kohn

August 2002 - Healthcare Informatics

Who doesn't remember the hype and enthusiasm of the early 1990s when the idea of the clinical workstation took hold? The concept was evangelized to assist healthcare provider organizations in the integration of multiple, disparate information systems /applications. Because each application came with a unique user interface, used different data nomenclature, and took limited advantage of data standards, integrating information from the separate systems was difficult. Also, users found learning and interacting with the different systems arduous.

The clinical workstation approach espoused a single point of access to all the structured (and sometimes unstructured) data in the organization's data repository or to the disparate systems/applications feeding the data into the repository. This single point of access was deployed at the clinician's workstation, or desktop, and included a common user interface to view information from the various applications as well as launch the applications.

At the heyday of the clinical workstation concept, Redmond, Wash.-based Microsoft's Windows operating system products became nearly universal at PC client workstations. Consequently, the Windows graphical user interface, presenting file folders and documents within those folders in a directory tree, was commonly deployed at clinical workstations. However, with the widespread acceptance of the Internet and its derived technologies in the late 1990s, the Web browser, which presented content categories as hyperlinks on a Web page, became the user interface of choice.

In addition to its ease of use for access and presentation of data stored within host databases, a simple Web browser provided the requisite "view only" functionality to the healthcare organization's applications. Without altering any existing information systems, it was layered on top of the current infrastructure. The only requirement was that the viewer be browser-independent so end users could select the Internet browser of their choice.

Today, the term "clinical workstation" is still used to describe the presentation of healthcare data and launching of applications in the most effective way for healthcare providers. However, the concept of the clinical workstation is being replaced by the Web browser-based "clinical portal." As organizations continue to grapple with integration of redundant and disparate databases, multiple data types, proliferating and complex processes for creating and maintaining data, and multiple platforms and operating environments, the portal concept offers more than just central access and a presentation layer. A portal can be viewed as a strategic framework for an organization's information systems, providing a sound, underlying architecture that enables system consolidation, scalability and interoperability.

The birth of portals
Web portals began in the consumer market with the large, public, online Internet service provider Web sites, such as AOL and CompuServe. Portals offered end users fast, centralized access to Internet services and information found on those Web sites. In an effort to ensure that visitors would return to sites, the large public directory and search engine Web sites, such as Yahoo and Lycos, began to offer customized and personalized interaction with the Web. Customized interaction allows Web site visitors to create customized, relevant views of the Web site at the role and individual levels. Personalized interaction provides Web site sponsors a means to filter information to meet the unique needs of users based on their roles and preferences.

At about the same time, private organizations began to deploy intranets to address internal business needs within secure environments. The intranets became analogous to internal, private "Internets" by restricting access to authorized users. Soon, portals were recognized as a way to provide easy access to private organizations' internal information, offering a central aggregation point or gateway to the data via a Web browser. And the portals became analogous to internal, private "Webs" by restricting access to authorized users. Portals quickly evolved into an effective medium for also providing secure access to an organization's applications, including links to many different applications and systems utilized by diverse, disconnected participants in various locations.

Portals vs. dashboards
Typically, dashboards are associated with the visual representation of a portal. They do not provide the depth of functionality of a full-fledged portal, which includes a variety of enabling technologies or services. For example, portals have at least one search engine that scans e-mail, file and Web servers, and databases. Also, portals provide customization and personalization capabilities.

A portal can serve as a dashboard, but most dashboards cannot serve as a full-fledged portal. Dashboard technology is closer to that of the clinical workstation.

Clinical portals
Like clinical workstations, clinical portals began as a way for clinicians to easily access (via a Web browser) an organization's multiple sources of structured and unstructured data from any network-connected device. They quickly evolved into an effective medium for providing access to multiple applications, both internal and external.

However, unlike clinical workstations, clinical portals became "private Webs," restricting user access to the data and applications contained within the portal. This capability was crucial to protect the integrity of decisions made by healthcare providers and to ensure confidentiality of patient information.

More important, clinical portals began to provide more functionality than clinical workstations. For example, they included customization capabilities and simplified, automated methods of creating taxonomies or categories of data. Similar to how consumer portals, such as Yahoo.com, organize files and data into such categories as food, fashion, and travel, clinical portals may classify files and data by test results, dictations, and patients.

Enterprise portals
Enterprise portals appeared in the workplace as an efficient way to organize all the information (structured, such as relational data, and unstructured, such as emails, Web pages, and text documents) that employees needed to access routinely. They grew to offer enabling technologies or services that provided general functionality across the organization--not just to a single type of user, such as a clinician.

These enabling technologies included the security and access management, customization, search, and taxonomy capabilities that are the foundation of clinical portals, plus single sign-on, personalization, document and Web content management, proactive delivery of data, and metadata management. All these technologies, heretofore thought to be interesting and discrete, turned out to be essential to creation of a successful enterprise portal.

Enterprise portal frameworks
Enterprise portal frameworks can be thought of as organizational infrastructures that include built-in data and application integration technologies to facilitate system consolidation and scalability. Today, every major platform vendor has made moves to establish an enterprise portal framework position. It's no longer just about the desktop. It's about integrating enterprisewide applications that have to work together.

Some of today's leading companies' enterprise portal framework products are San Jose, Calif.-based BEA Systems' WebLogic; Armonk, N.Y.-based IBM Corp.'s WebSphere; Microsoft's SharePoint; Redwood Shores, Calif.-based Oracle Corp.'s 9iAS; and Mountain View, Calif.-based Sun Microsystems' SunONE (formerly iPlanet) portal servers. Also, leading vendors in the enterprise resource planning market, such as Newton Square, Pa.-based SAP America and Pleasanton, Calif.-based PeopleSoft Inc., are offering enterprise portal frameworks. And some companies specialize in portal frameworks only, such as Epicentric Inc., San Francisco, with its Foundation Builder server, and Plumtree Software Inc., San Francisco, with its Corporate Portal server.

Typically, the ability to present and post data to and from applications and launch or view other applications within the portal is achieved by providing application programming interfaces to commonly used enterprise applications. These usually are based on off-the-shelf, commercially available application servers and nonproprietary middleware-type software solutions. Through partnerships or self-development, these portal framework products are refined to include the enabling technologies or services that augment the enterprise- specific applications.

The engines that drive and integrate the organization's applications lie beneath this. These engines support multiple server and client operating environments. They include eXtensible Markup Language (XML), allowing data interchange without the need for translation, and Sun's Java 2 Enterprise Edition (J2EE) compliance, ensuring interoperability or Microsoft's .NET compliance.

Portal solutions and business strategies
Like the major platform vendors, major healthcare information system vendors have moved to establish a clinical and/or healthcare enterprise portal framework position. For example, Alpharetta, Ga.-based McKesson Information Solutions has deployed its Horizon Foundation at Memorial Health in Savannah, Ga., and Irving, Texas-based HEALTHvision (a company created through the 1999 merger of Delray Beach, Fla.-based Eclipsys Corp. and Irving, Texas-based VHA Inc.) has deployed its COMMUNITYvision and CAREvision at multiple sites in the St. Joseph Health System, headquartered in Orange, Calif.

Currently, most of these vendors rely on the healthcare organization's existing third-party infrastructure solutions and provide support with combinations of various portal-enabling technologies or services, such as Web content management or single sign-on. Other vendors base their portal positions on deploying one of the framework products mentioned.

Healthcare information system vendors realize that the greatest opportunity exists in developing applications that are not just transaction processing based, and they are developing new content and contextual applications. Therefore, healthcare IT decision-makers should not ignore the connection between these portal technology solutions and their organizational and IT business strategies and planning processes. They should think of their portals as robust and scalable architectures that feature integrated solutions to the challenges of healthcare user diversity and technology evolution.

Deborah Kohn, R.H.I.A., C.H.E., C.P.H.I.M.S., is principal, Dak Systems Consulting, San Mateo, Calif.