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MongoDB in the Healthcare Enterprise

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Presented by Radu Craioveanu, Director of Software Development, Clinical Systems, Fresenius Medical Care at MongoDB Evenings New England 2017.

resenius is a large healthcare enterprise, specializing in dialysis care. Fresenius' 40,000 clinicians and physicians deliver over 100,000 dialysis treatments per day, across 8 time zones. There is significant pressure to improve treatment outcomes, lower costs, expand the patient coverage, and overall become a Value Based Services provider, sharing the risk with the payers, the insurance companies. This pressures requires Fresenius to adapt, change, and leverage technologies and processes that can enable a rapid transformation to Value Based Care. </br></br>Using technologies and partnerships with players such as MongoDB, Red Hat, and others with a similar, open source innovative approach to progress, Fresenius has been able to implement a healthcare platform that is the foundation onto which the business can transform itself.

MongoDB has enabled Fresenius to achieve high availability of systems across multiple data centers, a data lake concept used for predictive analytics and reporting, enhanced messaging capabilities, fast, effective and distributed archiving, rapid application development via MEAN stacks, and Red Hat Open Shift Docker Container ready-to-use persistence.

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MongoDB in the Healthcare Enterprise

  1. 1. FOR INTERNAL PURPOSES ONLY. Why & When to Use MongoDB The use case for Mongo DB in some key applications at Fresenius Radu Craioveanu Director Software Development Clinical Systems, ITG, FMCNA
  2. 2. FOR INTERNAL PURPOSES ONLY. 1. Operational Data Store (ODS) 2. Enterprise Data Service 3. Datamart/Cache 4. Master Data Distribution 5. Single Operational View System of Record System of Engagement MongoDB Architectural Patterns Single View Internet of Things Mobile Real-Time Analytics Treatment Sheet Archive PANELS Clinical Record View Patient Portal Care Coordination dabbling dabbling FHIR Lake Machine Data Audit Catalog Personalization Content Management n/a Doctors Corner Patient Portal n/a
  3. 3. FOR INTERNAL PURPOSES ONLY.
  4. 4. FOR INTERNAL PURPOSES ONLY. HIE Fresenius External Apps… Data Layer DATA WAREHOUSE APPLICATION DATABASES Integration - ETL DATA ACQUISITION CONFORMANCE & INTEGRATIONS - PUBLISH... PERIMETER SECURITY  Nephrologists  Other Providers  Ancillary Services  Hospitals  Nursing Homes  SNIFs  Health Plans  CMS  Regulatory Agencies  Social & Community Services EXTERNAL SOURCES EMPI OTHER FRESENIUS LINES OF BUSINESS Spectra Labs Fresenius Rx Vascular Care Urgent Care Physicians Groups FRESENIUS KIDNEY CARE Shared Services Security, ERP, HR,… Hosted Locally Oh wait… ours is a typical healthcare enterprise multiplied by 100  Clinical Services EMR, PHR Hosted Locally Financial Services Admissions, Billing Hosted Locally Portal Services Content Hosted Locally Fresenius healthcare enterprise
  5. 5. FOR INTERNAL PURPOSES ONLY. Fresenius Chairside – world’s largest healthcare deployment up to 100k Tx/day 8 Timezones
  6. 6. FOR INTERNAL PURPOSES ONLY. Chairside application – goal of moving 70 million patient treatment documents from Oracle to MongoDB via the Treatment Sheet App for CS 2x and 1x treatments minimizing the Operational DB to handle 60 days of data only in Oracle DB Current Challenges Desired Outcomes Large anticipated growth from 2015- 2020  Easily scalable applications Long dev cycles  Fast, iterative dev cycles Can’t incorporate diverse data, new sources coming in from acquisitions  Easy to incorporate any data High DB spend  Lower TCO Must meet PHI requirements for HIPPA  Compliance Single View - 1st MongoDB project at Fresenius 2013-2014
  7. 7. FOR INTERNAL PURPOSES ONLY. Ideal when reads >> writes – retrieve entire document with one read, no joins Agility and flexibility Data model supports business change Rapidly iterate to meet new requirements Intuitive, natural data representation Eliminates ORM layer Developers are more productive Reduces the need for joins, disk seeks Programming is more simple Performance delivered at scale { customer_id : 1, first_name : "Mark", last_name : "Smith", city : "San Francisco", phones: [ { number : “1-212-777-1212”, dnc : true, type : “home” }, number : “1-212-777-1213”, type : “cell” }] } Single View - MongoDB as perfect companion to a Document Model App
  8. 8. FOR INTERNAL PURPOSES ONLY. Single View – began with ‘Create a searchable treatment record archive’ • Opportunity • Evaluation Many large system acquisitions with many different data format 70 million records to loaded 40 million records per year Searchable, printable, auditable Looked at MongoDB and MarkLogic MongoDB prevailed
  9. 9. FOR INTERNAL PURPOSES ONLY. Single View – began with ‘Create a searchable treatment record archive’ • Justification for MongoDB • Introduction and adoption challenges • Final agreements Faster Development Forward/Backward Compatibility Cheaper Development Cheaper Licensing No DBA support Fortune 500 ?? Healthcare needs ACID Dev will co-own with DBA Limit the scope to Treatment Sheet Archive
  10. 10. FOR INTERNAL PURPOSES ONLY. Single View - Initial deployment footprint (2014)
  11. 11. FOR INTERNAL PURPOSES ONLY. Single View Application to Single View First and Operational Data Store
  12. 12. FOR INTERNAL PURPOSES ONLY. • Treatment Sheet Archive • Clinical Record View CRV • Acumen Live Patient View • PANELS Live Patient View, Historical Patient View • CNU Live Treatment View for CNU enrolled patients • Patient Trak Live NoShow indication to Sales Force • AIM Alert Interface Module, support for any source any destination • PANELS 2.0 • AUDIT service for applications Single View Read Centric – Proliferation of MongoDB 2014-2015 aimdb            12.760GB asbdb            18.765GB auditdb          48.352GB config            0.001GB epocdb            0.120GB evrtdb            0.000GB panelsdb          1.523GB patientportaldb   0.079GB quicklinksdb      0.155GB rxDomainDb        4.565GB rxWorkflowDb      6.819GB hepcdb 0.001GB ptifdb   1309.119GB
  13. 13. FOR INTERNAL PURPOSES ONLY. Patient Portal – goal of supporting 20,000 home patients Making self treatment and self charting at home a possibility With Zero downtime Current Challenges Desired Outcomes Several data sources and systems are involved in the home or in clinic dialysis  Use an event driven architecture to create a real time synchronization of all workflows involved in home or in clinic treatment Systems have downtime at night or on weekends  Provide a zero downtime environment No current write capability into some systems, or slower, batch mode capability into some other systems  Allow patients/clinicians to write and read data from systems in real time Single View leads the way to the Operational Data Store 2015-2017 Care Coordination – goal of supporting 40,000 clinicians coordinate care for 300,000 patients Making self treatment and self charting at home a possibility With Zero downtime
  14. 14. FOR INTERNAL PURPOSES ONLY. F5 Liferay Portal Oracle DB Steel App F5 Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers MongoDB Replica 3 OpenLink eCC SQL DB A, B, C eCC A, B, C MongoDB Replica 1 2 Steel App AD LDS HL7 writeSQL read Boston Waltham JSON writeJSON read Active-Active Active-Active Active-Active FHIR DSTU-2 Replica set Fabric Single View Dual Write – Patient Portal
  15. 15. FOR INTERNAL PURPOSES ONLY. F5 Liferay Portal Oracle DB Steel App F5 Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers Jboss Fuse Fabric8 Containers MongoDB Replica 3 OpenLink eCC SQL DB A, B, C eCC A, B, C Mongo Replica 1 2 Steel App AD LDS HL7 write Boston Waltham JSON writeJSON read Active-Active Active-Active Active-Active FHIR DSTU-2 Replica set Storage array DR needs to be fleshed out Single View Dual Write – Patient Portal
  16. 16. FOR INTERNAL PURPOSES ONLY. Single View First – Fabric Operational Data Store - Live Data and APIs FHIR FABRIC Applications Enterprise Applications Web-based Applications {External & Local} Business Intelligence Reporting & Analytics Portal Services Applications Enterprise Applications Web-based Applications {External & Local} Business Intelligence Reporting & Analytics Portal Services DATA Fresenius Kidney Partners Spectra & Shiel Fresenius Vascular Care National Cardio- vascular Partners FMCNA Lines of Business Fresenius Rx Fresenius Health Care Medspring Sound Physicians FMCNA Lines of Business FHIR Server Precision Nephrology Data Transformation Services (Restful, FHIR, API…) Orchestration Development Platform Clinical Financial Pharmacy others Security Workflow Engine Healthcare Enterprise Data
  17. 17. FOR INTERNAL PURPOSES ONLY. Single View First – Fabric manifestation – The Platform and API 17 FABRIC eCC eCFFHIR BPM ESB MS SQL MS SQL EAP, SPING BOOT HL7 FHIR API STU-3 JBOSS FUSE INTEGRATION JBOSS BPM SUITE COMPONENTS Security Audit Cache Pharm Rx MS SQL KCNG KC EMPIOPEN SOURCE Clinical Allergies Conditions Procedure Clinical Impression Assessment … Administration Patients Practitioner Related Person Organization Healthcare Service … Diagnostics Observation Diagnostic Report Specimen Imaging Study …. Medications Medication MedicationOrder MedicationAdmin Immunization …. Financial Coverage Eligibility Enrollment Claim EOB …. Workflow Encounter Appointment Schedule SupplyRequest SupplyDelivery …. MongoDB
  18. 18. FOR INTERNAL PURPOSES ONLY. Single View First – Fabric manifestation – The Applications 18 FABRIC eCC eCFFHIR BPM ESB MS SQL MS SQL EAP, SPING BOOT HL7 FHIR API STU-3 JBOSS FUSE INTEGRATION JBOSS BPM SUITE COMPONENTS Security Audit Cache Pharm Rx MS SQL KCNG KC EMPIOPEN SOURCE WorkflowComplexity ePOC Patient Portal SOS PANELS Patient Trak for Rx CNU Chairside eAccess User Provisioning Patient Trak for FC DAMA Acumen Compass P&T Automation hepC HCP on Healthcloud Planned/In Progress Completed MongoDB
  19. 19. FOR INTERNAL PURPOSES ONLY. SMART DATA CLINICAL PRECISION Dual Data Center HA Active-Active on FABRIC Outputs FHIR based Decision Support and Clinical Quality Measures Inputs FKC Data and Rules, CMS Data and Rules Intelligent Compute Engine R Server executing on top of Apache Spark SMART ID (OpenID Connect OAuth2) Guidance Response, Measure, Measure Report CARECOORDINATION Spring Boot Container SPA SPA Servic e Jboss EAP Container MPA Financial Admissions Point of Care EHR ASP .NET Container MPA Clinical EHR Jboss EAP Container MPA Real Time Reporting WebApp FKCFVC …… MPA or SPA SMART on FHIR Connector APACHE SPARK APACHE SPARK National Provider Directory R Server CMS, other sources SPA SPA Servic e Care Coordination Spring Boot Container DATA WAREHOUSE APACHE SPARK Patient, Physician Clinician Portal Single View First and Real Time Predictive, Descriptive Analytics
  20. 20. FOR INTERNAL PURPOSES ONLY. SMART DATA CLINICAL PRECISION Dual Data Center HA Active-Active on FABRIC Outputs FHIR based Decision Support and Clinical Quality Measures Inputs FKC Data and Rules, CMS Data and Rules Intelligent Compute Engine R Server executing on top of Apache Spark R Server Single View First and Real Time Predictive, Descriptive Analytics SparkR JavaSpark DATA WAREHOUSE Data Lake F A B R I C
  21. 21. FOR INTERNAL PURPOSES ONLY. • Patient Portal High Availability FHIR Operational Store • FHIR AUDIT service for FHIR stack(s) • ePOC FHIR Operational Store • hepC FHIR Operational Store Current Uses and Successes with MongoDB at Fresenius • Treatment Sheet Archive • Clinical Record View CRV • Acumen Live Patient View • PANELS Live Patient View, Historical Patient View • CNU Live Treatment View for CNU enrolled patients • Patient Trak Live NoShow indication to SalesForce • AIM Alert Interface Module, support for any source any destination • PANELS 2.0 • AUDIT service for applications
  22. 22. FOR INTERNAL PURPOSES ONLY. aimdb            12.760GB asbdb            18.765GB auditdb          48.352GB config            0.001GB epocdb            0.120GB evrtdb            0.000GB panelsdb          1.523GB patientportaldb   0.079GB quicklinksdb      0.155GB rxDomainDb        4.565GB rxWorkflowDb      6.819GB hepcdb 0.001GB ptifdb   1309.119GB Current Uses and Successes with MongoDB at Fresenius

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