Download Intersystems HealthShare Information Exchange V1.0

Services Description
GPSoC Service Name
GPSoC Service ID
HealthShare Information Exchange
ISC-HS-HIE
Service Overview
HealthShare Information Exchange is InterSystems’ core service offering
for GPSoC Lot 3.
The HealthShare Information Exchange provides the entire infrastructure to
facilitate comprehensive record sharing at a local level across all parts of the
local health economy/ecosystem.
Figure 1 - HealthShare Information Exchange
The HealthShare Information Exchange facilitates a number of use cases:
Provision of a local health record or shared record service
HealthShare Information Exchange enables the creation of virtual patient
records containing aggregated information from all participants in the care
community. This virtual record is created from information that is fed into
HealthShare as events occur, or is queried from the source systems as
required. The information held from each organisation is then aggregated
to produce a rich record of the patient. The rich patient record represents
information types from all sectors of a typical health economy. It includes
elements familiar to primary or acute settings, such as allergies,
medications, (lab) results, encounters, but it also includes elements such as
social history, care plans and general alerts drawing information from other
sectors of the health economy. Whilst this rich record exists in the
product, it is also an extensible model that can incorporate new information
types.
The HealthShare Information Exchange includes a rich consent model.
This model allows access to a patient record to be layered based on system
wide preferences, facility clinician preferences and individual patient
preferences. By using this consent model it is possible to configure either
opt-in or opt-out models at an information exchange level, but also to
specify that certain types of information is shown or hidden against
individual patients or to clinicians at particular facilities. There is a fine
level of control that allows local projects to accurately reflect local needs.
The aggregated patient record can be viewed directly by clinicians in the
integrated clinician viewer. The clinician viewer provides a web-based
view of the patient record that can be accessed on a wide variety of
devices. The patient record can also be accessed electronically by other
systems and can be rendered into a wide variety of formats; for instance
the record can be rendered into a PDF document that could be used in
community care visits even when network access can be problematic.
Sharing of documents
The Information Exchange can facilitate document sharing. Organisations
in the care community can send documents using the Interoperability
Toolkit (ITK), that are then stored in the IHE Cross Domain Document
Repository and Registry (XDSb) that is integral to HealthShare. An Out of
Hours Surgery can send an encounter summary document, via ITK, to the
document repository. This is stored and registered in the document
registry. Other organisations participating in the Information Exchange
can then search for and retrieve the documents using a configurable set of
metadata items.
Interchange of key documents & Enhanced Workflow (Referral,
Discharge etc.)
A key part of the interoperability landscape involves the sharing of
documents between organisations. Many of these documents have
particular significance within workflows. For instance referral documents
often flow from primary care to secondary care and discharge documents
flow in the opposite direction. In addition to processing and storing these
documents, the clinical messaging capabilities of HealthShare go further
and ensure the notification and routing of key documents to interested
parties. Routing rules can be determined by querying document content, or
based upon the specific patient criteria. Custom workflows can be created
that can take into account local factors via the use of custom business rules.
Creation of local services to better manage ‘at-risk’ patient groups.
The HealthShare Information Exchange supports better management of atrisk patient groups by providing access to and notification of relevant and
timely information. Clinicians can setup and manage relationships with
particular patients. Relationship types can be dynamically created in the
information exchange to accurately represent the roles in use locally. Once
a relationship is setup between a patient and a clinician it can be used to
drive notifications and alerts when key events occur for that patient.
Clinicians can create programs for patient cohorts (chronic condition; drug
abuse; vulnerable children) that can be used for clinical, research, social
care or other purpose. A patient program can be used to drive clinical
messaging and alerting. (For example Alert community nurse if drug user
presents at ED; alert social worker if at-risk child is admitted etc.).
A typical deployment of the HealthShare Information Exchange might
logically appear in Figure 2.
The information exchange consists of one or more Edge Gateways, one or more
Access Gateways, a Registry and a BUS.
Figure 2 - A typical deployment of the HealthShare Information Exchange
The HealthShare registry in the exchange hub holds all configurations and
shared information. The registry continually updates the other components
with configuration changes and can be queried as needed. Edge Gateways
connect to underlying source systems and act in different ways. An edge
gateway may persist a local copy of the data from the operational source.
Another might query the operational source ‘on demand’. Another may adopt a
hybrid caching based approach with timed or event driven flushes of the cache.
Access Gateways provide access to the aggregated patient records, either in the
clinician viewer directly, or via other access mechanisms such as Web Services.
The Access Gateways will first search the registry for the requested patient and
will then request the source information from the relevant edge gateways. The
Bus provides access to the information exchange via the supported
interoperability mechanisms and standards. For instance, receipt of documents
and messages via the ITK will be through the Bus, which will then distribute to
the other logical components as required. Equally the IHE profiles
InterSystems support will be exposed externally via the Bus.
Case Studies
Support
For appropriate case studies please contact InterSystems, or alternatively,
please see InterSystems Website for details of case studies in this service area.
Support Arrangements
Support for the HealthShare packaged services is provided directly by
InterSystems. InterSystems approach to support is based on delivery of
processes and procedures in accordance with Information Technology
Infrastructure Library (ITIL) best practices, a philosophy of “Continuous
Improvement”, and root-cause analysis aimed the aim of reducing the level of
calls to the Service Desk whilst improving customer satisfaction.
Services are provisioned by combining a proactive and reactive approach.
Events are continuously monitored and alerts are automatically generated in
order to avoid potential future problems.
Helpdesk Arrangements
InterSystems Help Desk is staffed by UK based personnel and forms part of the
InterSystems Worldwide Response Centre (WRC), a global network of regional
centres with extensive expertise across the product portfolio. The organisation
is comprised of teams of individuals working together to provide support
services that InterSystems customers require. The Help Desk is located in Eton
at the InterSystems UK headquarters and will serve as the main point of
communication for NHS organisations.
The Service Centre maintains a structured approach to application support
services based upon an ITIL V3 compliant methodology and provides a single
point of contact for the control and management of all issues relating to the
collaborative working applications being supported. The Service Centre is
managed and supported by the appropriate mix of specialists required to
support a managed service operation for customers.
The Worldwide Response Centre (WRC) is available by phone, e-mail, and
online 24x365 to provide product support to HealthShare clients who subscribe
to support services. Guaranteed response is 30 minutes and at least 75% of all
contacts are immediate. Clients determine the priority (Crisis, High or
Medium) and requests are not closed without client permission. Clients rate the
WRC staff 9.8 out of 10 for courtesy and professionalism.
The WRC meets ITIL best practices and provides Incident Management,
Problem Management, Change and Release Management. Specific Service
Level Agreements are determined for clients based on their requirements
contracts.
All incidents, service requests, problems, and change requests, regardless of
which component they affect, are managed using the Service desk application.
When an incident (an event that negatively impacts the service to the user) is
reported to the Service Desk, a new incident ticket is opened and an
investigation triggered. The initial focus of the investigation is always to
resolve the incident and return the portion of the affected system to normal
operation.
In the event an incident requires a deeper level of investigation, a problem
incident may be triggered and a Root Cause Analysis performed. In cases
where a Problem investigation is warranted, the Service Desk application will
again be used to record investigation activity. This allows the customer
visibility into every step of the resolution process. Only when the customer has
confirmed that the problem has been resolved to their satisfaction, will the
Service Desk ticket will be closed. Once closed, the problem record forms part
of a searchable database, to aide in future problem investigations/resolution.
Help Desk Response Time / Incident Fix Times Standard:
Incident
Category
1
2
3
4
Response Time
15 mins
30 mins
2 hours
1 day
Resolution or Provision of
a workaround
2 hours
4 hours
2 days
Next New Version
Table 1 - Help Desk Response Time / Incident Fix Times Standard
Service Availability
Clients that manage their own systems can achieve at least 99% uptime,
excluding planned outages, if they implement our recommended configurations
and follow systems management best practices.
Where selected, InterSystems’ hosted service offering provides a minimum of
99% uptime excluding planned outages that are agreed with the client 30 days
in advance.
Contractual Remedies
Specific Service Level Agreements and related remedies, such as credits for
service failures and termination options, will be included in Call Off contracts
with each client.
Customer Satisfaction
The InterSystems Worldwide Response centre boasts an unrivalled track record
of customer satisfaction, having achieved an average of 98% overall
satisfaction rating since 2001. This has been derived from customer satisfaction
feedback, provided by thousands of InterSystems customers and responded to
by tens of thousands of end users.
A formal governance mechanism for escalation of satisfaction issues will be
agreed and regular management reviews may take place, over and above the
monthly service review meetings.
CLIENT
PRIORITY
Escalation
CRISIS
HIGH
MEDIUM
Immediate
verbal
notification
to all
appropriate
senior
managers by
the director
of client
support.
Immediate
automated
notification to
senior
management.
Immediate
automated
notification to WRC
management.
Table 2 - Escalation Governance
Simple satisfaction surveys are automatically generated for the designated
customer contact upon closure of every incident within the Service Desk
application. The “simple” survey inquires as to whether or not the incident was
resolved to the customer’s satisfaction (Yes/No) and whether or not they have
any additional feedback to share. Comprehensive satisfaction surveys are also
automatically generated on a random selection of incidents. The InterSystems
executive team meets formally on a weekly basis to review customer
satisfaction and address issues of service delivery and/or service support. Low
or “unsatisfied” results automatically trigger instant management alerts that will
result in a detailed internal review and subsequently; a follow up process with
the customer is initiated. More comprehensive satisfaction surveys will be
conducted throughout the service management lifecycle, for the duration of the
contract, as agreed with the customer.
Dependencies
Service Dependencies






Access to data source systems and services (NHS or external) to
establish the Exchange.
Data being collected through the Health Information Exchange from
Data Source Systems is the correct data of sufficient quality in discrete
data fields to produce the expected results.
To ensure successful delivery to a schedule to be agreed with
InterSystems, the customer must ensure that all source system providers
to connect to the HealthShare HIE have empowered and knowledgeable
staff, complete end-point interface documentation and technical staff
able to verify message delivery available as agreed.
Access to N3 or equivalent network for information exchange between
care settings
The customer must make sure that they are staffed fully in accordance
with levels defined by InterSystems and agreed prior to commencement
of the project in order to fulfil its part of the agreed project schedule.
The customer must ensure that all end-point production and test
systems are actively available at all times as required by InterSystems
and mutually agreed.
Third Party Dependencies



The customer shall ensure availability of third party data sources.
Access to external data source systems for data exchange and any
desktop or application level integration to allow access to HIE viewer
from within third party applications.
The customer will secure 3rd party vendors’ co-operation and ensure
their deliveries are made within acceptable timeframes for InterSystems
to meet its commitment. HealthShare HIE validation can only begin

once contracted 3rd party vendors have completed their integration
task.
N3 or equivalent network provision, as required to connect systems and
provide user access (e.g. BT for N3).
Infrastructure Dependencies

The InterSystems HealthShare HIE solution will require the defined
system-software, servers, and storage requirements to be provided for
each individual contract. Two options are available for deployment,
either a client self-hosted solution or an InterSystems hosted solution
within appropriate secure data-centre capacity within the UK.
 In all cases it is anticipated the customer will provide user access
devices (for example desktop/ tablet/ smartphone) with appropriate
network access for all users.
Client Self-Hosted Option
 In a client self-hosted environment a detailed document will be
provided detailing all of the server, storage, and system-software such
but not limited to virtualisation, operating systems, and backup
management. The hardware resource requirements will be determined
based on the expected workload in terms of both processing and storage
requirements.
 The HealthShare solution is supported on a wide variety of platforms
and operating systems. These operating systems include Microsoft
Windows Server, Linux (Red Hat and SUSE), and IBM AIX UNIX.
 Network topology is to be provided by the client to convey network
connectivity options (copper, SFP, SFP+ etc.), network (VLAN)
assignments, DMZ and firewall requirements, and any other established
pertinent network security practices. This information is necessary to
understand the deployment model and determine if there are any
security risks or vulnerabilities.
InterSystems Hosted Option
 In an InterSystems hosted environment, HealthShare will be deployed
onto InterSystems owned and operated equipment as a fully managed
service and will be provisioned to support the contract terms.
InterSystems leverages a completely virtualised architecture providing
elastic resources to be agile and rapidly respond to changing
requirements.
 Network connectivity methods (N3, MPLS, IPSEC VPN, etc.) and
bandwidth requirements will need to be determined along with the
respective demarcation points/addresses to establish WAN connectivity
between the client and InterSystems data centres.
Local Personnel Dependencies


Sub-Contractor(s)
This will be discussed as part of the call off
The customer will provide project sponsorship, project management, as
well as functional and technical resources required by the project.
InterSystems do not expect to sub-contract the delivery of any Catalogue item
or Service. Contract staff may be sourced and used to support and extend the
InterSystems delivery capacity, however contractual responsibility for any
delivery will remain entirely with InterSystems
Pricing Information
Implementation Charges
Below implementation sections are standard for setting up the HealthShare
Health Information Exchange (HIE) package. Depending on the specific
customer requirements, the implementation steps can vary slightly in terms of
man-days as well as in the number of steps. Therefore, the implementation man-
days and number of steps presented below, is indicative.
Standard Setup of HealthShare Infrastructure (17 man-days):
 Install HealthShare and its components with dummy interfaces to make
sure the solution is properly installed, configured, tested and ready to be
connected
Infrastructure (17 man-days):
 Install HealthShare and its components in accordance with the customer
requirements at the disaster recovery centre (if applicable)
Documentation (17 man-days):
 Provide documentation in accordance with the agreed project plan and
deliverables
 Participate to the creation of Interface Technical Design and Mapping
documents. One document per interface is required
 Update the Systems document to reflect components and processes used
for interface(s)
Configuration (51 man-days):
 Configure/tuning of Hardware, Infrastructure & Environments
 Configure the HealthShare platform according to customer
requirements:

Development environment

Integration/Operability tools

dB Management system (Repositories/Registries)

Clinical viewer

Clinical messaging

Consent services

Composite Health Record

Terminology services

Foundation services

Data pipeline services
 Register the external data sources in HealthShare
 Configure a data transformation layer and routing rules for message
transformation as defined in the agreed Systems document
Customisation/Development (average 17 man-days per development area):
 Provide and participate with customisation as required and agreed in
project plan before project commences.

Development of Indexes

HCF Registry setup

HC Professional setup

Index of Medical Devices

Development of classifiers and values sets
management system

Development of external interfaces
systems/applications

EHR browsers (if applicable)
1.
Cloud interface
2.
Information Portal
3.
eGov HS services

Interface Development
Testing (34 man-days):
 Testing in accordance with the agreed project plan
 Address issues logged in InterSystems’ web-based help desk system
 Perform Unit Test

Unit Test Plan

Unit Test Execution
 Support the Pre-Production Test with the customer end users – Using
data supplied by the connecting source systems, the customer reviews
the representation of the data in HealthShare (UAT environment)

Pre-Production Test Plan

Pre-Production Test Execution – Performed by
staff from customer end users

Documented Pre-Production Test Results – Created
by the customer end users
 Support Volume Test in UAT that uses a one to three days sample of
live data

Integrated Test (Live feed from source systems to
HealthShare – real time)
Cutover to Production (34 man-days):
 Create the technical cutover checklist
 Enable data feed flow into the LIVE system
 Assist the customer end users with validation in the LIVE system
 Observe and communicate any issues related to data processing for two
weeks following go live in the production environment
 Transition to InterSystems Support (if applicable)
Training (17 man-days):
 Train the various users in accordance with the agreed project plan
 Train the customer super users on usage of the TRC response centre
application.
The total average implementation of the HealthShare HIE is 157 man-days + 17
man-days per connecting interface.
Service Charges
Charge Description
Service Subscription Fees
The pricing for HealthShare Health
Information Exchange (HIE) is based
on two factors: a base subscription
that provides the underlying software
needed to operate the solution, and a
service subscription proportional to
the overall usage of the solution.
For the initial production instance that
operates HIE we charge a primary
server subscription fee. For
subsequent production instances and
additional systems used for training,
testing, development, or failover, we
offer a secondary server
subscription fee.
Subscriptions include Software
License, Software Update and
Technical Assistance services. A
subscription can be upgraded to larger
capacity at any time. Subscriptions
are available on a month-to-month
basis, with no fixed term, or on a fixed
term basis for up to ten years.
Service subscription fees for
HealthShare HIE are based on the
volume and scope of patient
information handled by the exchange
measured in Health Licensing Units
(HLUs). HLUs can be defined at calloff to reflect the specific nature of the
HealthShare project. Commonly used
measures include organisational
metrics (beds, patient encounters) and
population-based metrics (patients,
population).
Unit Price (exc VAT);
Primary Server Monthly
Subscription = £2,587
Secondary Server Monthly
Subscription = £647
Note: a standard HIE
implementation includes:
1 x Primary Production Server
4 x Secondary Production Servers
3 x Secondary Non-Production
Servers
For population-based service pricing
one HLU is required for every 25,000
people in the defined population
served by the Information Exchange.
Illustrative Licensing Example:
A cross care setting health information
exchange is deployed to serve a
population of 250,000 citizens using
InterSystems HealthShare HIE.
The deployment architecture includes
1 primary production instance and 7
secondary instances of the HIE
software.
Monthly Subscription Pricing:
1 x Primary @ £2,587
7 x Secondary @ £647
10 x HLU license @ £485
Total Monthly Fee = £11,966
HIE can be deployed at an end user
location or remote hosting facility.
These prices do not include hosting or
managed service these are available
from InterSystems and will be
negotiated at call off.
Software Licenses
As an alternative to using HealthShare
on a subscription basis, HealthShare
HIE server capacity is available on a
traditional one-time-charge license
basis.
In this case, Software Update and
Technical Assistance services must be
purchased separately (see below)
Prices for up-front payment of
monthly service subscriptions are
available on request.
HIE can be deployed at an end user
location or remote hosting facility.
These prices do not include hosting or
managed service these are available
from InterSystems and will be
negotiated at call off.
Monthly Service Subscription =
£485 per HLU
Primary Server License = £81,695
Secondary Server License = £20,432
Monthly Service Subscription =
£485 per HLU
Software Update Programme
The Software Update programme
provides free updates to new software
versions. In addition, when switching
computers, the Software Updates
programme provides free transfers in
some cases and trade-in credits in
other cases. Annual Software Update
fees are calculated as a percentage of
the License Fees stated above.
Technical Assistance Programme
Annual Software Update Fees =
15% license list price
The Technical Assistance Programme
provides assistance via telephone, fax,
or email for problem resolution during
normal business hours; emergency
assistance 24 hours/day, 7 days/week;
and problem updates via email.
Annual Technical Assistance Fees =
7 % license list price
Participation in the Software Update
Programme is a prerequisite for
Technical Assistance. On-site
software installation is not included in
Technical Assistance or License Fees.
Annual Technical Assistance fees are
calculated as a percentage of the
License Fees stated above.
HIE can be deployed at an end user
location or remote hosting facility.
These prices do not include hosting or
managed service these are available
from InterSystems and will be
negotiated at call off.
Exit Charges
On termination of a service-based contract, users will no longer have access to
the HealthShare Health Information Exchange software. Where the overall
solution has been provided by InterSystems the necessary steps at termination of
contract might include removing hardware, infrastructure, and software (if
applicable). There may be a requirement to transfer any data stored in the HIE
(if applicable). This is estimated as a 17 man-days project.
A specific Exit Plan would be agreed at call off as appropriate.
The standard rate card would apply.
Invoicing Terms
Payment Terms
Discounts
Resource Based Pricing
Other Pricing Information
HealthShare Service Subscription fees (which include License, Software
Update and Technical Assistance) are invoiced monthly in arrears and are
chargeable from the beginning through to the end of the contract.
HealthShare One-Time-Charge license fees are invoiced upon electronic
delivery of the license key.
For HealthShare One-Time-Charge License fees, associated Software Update
and Technical Assistance fees are invoiced monthly in arrears and the fees are
chargeable from delivery of the license key through to the end of the contract.
Implementation and other agreed professional service fees are invoiced on
delivery of the service or provision of resource (rate card) to the client which
could include milestone payments for implementation services.
Additional Charges
Any travel expenses, wire fees, sales taxes, value added taxes, import duties, or
other government-imposed charges applicable to License and services fees shall
be paid by the Customer. Shipping terms are FOB Destination, unless otherwise
noted on the invoice. The Customer shall pay shipping and handling charges as
detailed on each invoice.
All fees are due 30 days from the date of invoice, unless otherwise agreed in the
Call Off.
None proposed in this submission
InterSystems can offer a range of Implementation and Consulting services,
pricing for these resource based offerings can be found in Schedule 7.1 Annex
C for details of InterSystems Rate Card.
Any change request must be consistent with the scope of the project and not a
substantial change to InterSystems standard products or services, other than the
required configuration for the project.