Cosmic Technical Spec

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					        Cambio COSMIC
Technical Overview
TABLE OF CONTENTS


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Product overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

The Spider architecture . . . . . . . . . . . . . . . . . . . . . . . . . . 6

COSMIC system set-up . . . . . . . . . . . . . . . . . . . . . . . . . 10

System requirements and recommendations . . . . . . 13

Example case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
                                                                                                                INTRODUCTION




About this document

PURPOSE, TARGET GROUP
The purpose of this document is to provide a comprehensive introduction to the technical architecture
of Cambio’s products. It is intended for the technical staff of healthcare organisations, system integrators,
and sales and implementation partners.

TERMINOLOGY
Cambio = Cambio AB
COSMIC = Cambio COSMIC, the product name of the system
Spider = Cambio Spider, COSMIC’s service platform
CDK = Cosmic Development Kit, a development package for Cambio’s customers and partners




                                                                                                                           3
PRODUCT OVERVIEW




           Product Overview
           CAMBIO COSMIC
           Cambio COSMIC (Compliant Open Solutions for Modern Integrated Care) is a complete systems con-
           cept with a wide range of applications within the healthcare sector.

           Cambio COSMIC provides comprehensive support for a range of diverse needs. The Patient Administration
           System (PAS) parts handle resource planning, everyday administration, pricing and billing, scheduling,
           etc. The Clinical Care Support parts handle medication, referrals and tests, and medical records. Cambio
           COSMIC provides tools for incident management, and statistics (data warehouse). All Cambio COSMIC
           applications have a firm footing in the reality of healthcare provision, with a focus upon efficiency, open-
           ness, security and user-friendliness.




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4
                                                                                                   PRODUCT OVERVIEW




Cambio COSMIC supports handling of very large volumes of healthcare information. It is possible to
audit, analyse and follow up events, clinically, administratively or qualitatively. This enables the hospital
to analyse clinical and operational data in order to improve the planning and management.

Cambio COSMIC is developed in Java, which is the most modern and stable software development
technology available today. It is also considered specifically to be the market-leading technology for
information systems development, with a huge market penetration both in the commercial and open
source arena. Our products are also founded on architectures and standards such as J2EE, CORBA,
Web Services, applications servers and relational database applications.

Cambio COSMIC enables easy and cost-efficient integration with message interfaces to e.g. Laboratory,
Pharmacy, Radiology, and other external systems such as the National Insurance System.



CAMBIO SPIDER
Cambio Spider, the business logic framework for COSMIC, is an open and flexible service platform.
Cambio Spider is multi-layered, component-based and builds on modern and stable software technology
with architecture such as a J2EE-compliant application server, CORBA, Web Services, and modern rela-
tional databases. Cambio Spider is an object-oriented middleware platform. Cambio Spider enables per-
sistent storage, and offers an API for implementing end-user applications and for system integration to
various external systems: lab systems, other health care centres etc.

Adaptability is one of the main design principles in Spider’s architecture. Spider is adaptible towards:
          • Demands for new applications
          • Large amounts of data
          • Complex organizations
          • Underlying software and hardware
          • The varying needs of the end-user organizations

Cambio Spider is built so that it can be integrated and work together with virtually any other existing
system. The technical strategy involves making use of standard products already in the market, and con-
centrating our own efforts on building the best healthcare system on these foundations. The integration
APIs are today based on J2EE/Corba communication protocols, to some extent depending on the choice
of application server that the system is hosted on. Some specific extensions has been made to expose the
business logic over Web Services/SOAP (for example the Swedish National Patient Overview/NPÖ).
Integrations with external systems are usually done with the help of an integration engine, such as the
SeeBeyond® ICAN™ Suite or similar products.

Cambio Spider complies with the European pre standard HISA (Healthcare Information System
Architecture), which means that Cambio Spider is a service platform based on open standards from a
technical as well as a healthcare oriented perspective.




                                                                                                                  5
THE SPIDER ARCHITECTURE




             The Spider architecture

             THREE-LAYER ARCHITECTURE
             Spider is based on a three-layer architecture: presentation layer, domain layer (business logic) and data
             storage. The layers communicate with the application server over TCP/IP.

             The presentation layer, business logic and storage are separated from each other, where Cambio Spider
             together with our applications makes up the middle layer. This means that the system as a whole achieves
             a high degree of flexibility and provides a foundation with good performance, scalability and availability.



                          PRESENTATION LAYER

                                                                              Cosmic
                                          PDA                                  Client
                                                              Web
                                                              Client


                                          RMI/CORBA/SOAP

                          DOMAIN (BUSINESS LOGIC)




                                                Application Services

                                                    Spider Services

                                             J2EE Application Server



                                          JDBC/ODBC/LDAP

                          DATA STORAGE




                                                      DBM                         Directory
                                    DBM                               DBM




6
                                                                                            THE SPIDER ARCHITECTURE




The presentation layer is usually a fat Java client which can be deployed in different ways. A complete
thin client based only on a web browser is currently under development but has not yet reached the per-
formance of the fat client solution.

The business logic is based on Java with a choice of J2EE-compliant application servers: JBoss, Sybase EA
server, or Weblogic. The business logic is organized into different common services and application
modules. The business logic layer is described in more detail in section 3.2 below.

For the data storage, various SQL-compliant database systems can be used. The major providers are
Oracle and Microsoft SQL server.



THE BUSINESS LOGIC IN SPIDER
The business logic of Spider is concentrated around a number of powerful services providing the modules
(packages of applications) with the basic building blocks of a healthcare information system. This means
that when developing new applications and while Cambio is extending the existing applications, we do that
based on a framework with consistent rules, classes and a common logical way of building our products.

The picture below outlines the components in the business logic layer in Spider.



                                          APPLICATION SERVICES




                                                            Patient Administration System



                                                                Clinical Care Support


                                                                  External Modules
DOMAIN (BUSINESS LOGIC)




                Application Services
                                          SPIDER SERVICES

                   Spider Services
                                                             Process Model Service Layer
             J2EE Application Server
                                             Settings and             Authent-
                                             Configuration             ication                 Logging


                                                             Access                 Commun-
                                                                                     ication


                                                Patient                Activities              Concepts


                                                                                   Healthcare
                                                          Resources              Characteristics

                                                                   Storage Service




                                                                                                                  7
THE SPIDER ARCHITECTURE




             OPEN AND MODULARIZED ARCHITECTURE
             Spider’s multi-layered architecture offers an unlimited potential for adaptation, development and expan-
             sion. It also means that COSMIC has a a virtually unlimited length of life. The open architecture offers
             unique possibilities of adding new applications on any level in the system. These applications may range
             from thin clients with customized user interfaces, to large-scale third-party applications utilizing the ser-
             vice platform. Cambio Spider’s open and well-defined interfaces also simplifies the integration of existing
             IT systems in the infrastructure.

             Cambio Spider is entirely component-based. A component is an application with well-defined functio-
             nality and a specified interface. In component-based systems, components can be re-used to allow
             system developers focus on coding tasks that create a truly enhanced value. Well-tested components will
             work reliably the next time they are used, with no extensive further verification. Each component can be
             exchanged or developed, without affecting other parts of the system. This provides for a modern system
             with high stability and maximum performance.



             HEALTHCARE STANDARD COMPLIANCES

             HISA
             Cambio Spider is based on the European prestandard HISA (Healthcare Information Systems
             Architecture), which involves a generic set of clinical processes applicable in all healthcare sectors and
             environments. Spider is a fully operational deployment of the original HISA architecture. It also inclu-
             des a common underlying healthcare-process model used by all Cambio’s applications. This is part of the
             new HISA standard EN 12967-1, Part 1: Healthcare middleware layer. Cambio has been leading the
             development of the second generation of EN 12967 parts 1 – 3 to become a full European standard in 2006.

             This generation is based on the ISO 10746 Open Distributing Processing Architecture and uses the
             international and European most recent developments for information models for healthcare, based on
             the HL7 version 3 RIM and the derived General purpose components EN 14822-1,2 and 3 published
             in 2005 as European and French standards.

             Other healthcare standards
             Cambio also complies with many other standards which provide frameworks for clinical and administra-
             tive information systems, whether the standards are published, or subject to work in progress.

             Two examples from the Security area are EN 13608 parts 1 – 3 Security for Healthcare communication
             (ENV 12388 Digital signature algorithm for healthcare), and the new ISO 17090 work on Health
             Informatics – Public Key Infrastructure. The latter was developed under the leadership of Cambio.
             Among other recent work from ISO worth mentioning is the ISO/TR 22221, “Health informatics –
             Principles and practices for a clinical data warehouse”.

             Cambio has also been actively contributing to the development of the new CEN/ISO work prEN 13606
             Health informatics – Electronic Health Record Communication series which we intend to implement in
             future releases and see as the major direction in a long-term perspective for the exchange of health
             records between independent systems from different manufacturers.




8
                                                                                          THE SPIDER ARCHITECTURE




ACCESS AND SECURITY

User authorisation
Cambio Spider contains an all-embracing and well-integrated system for user authorization control that
meets the strict requirements of the healthcare sector. The user’s identity is ascertained via password
and/or PKI, depending on the client’s infrastructure. The possibility of multidimensional control also
allows a system where the user’s information authorisation can be restricted to, for example, an organisa-
tional unit and a particular role. Cambio Spider also gives you the option to decide which services and
functions a particular user can access. The access rights system in COSMIC supports both negative per-
mission (”access for all units except A and B”) and functional permissions (”authorised to read and
write”, ”read not write” etc.). COSMIC also supports auditing of events, for example, authorized and
unauthorized attempts by users to access information.

Approach to security
• Integrated access system, can be integrated with existing solutions
• User authentication: Out-of-the-box password authentication, Biometric authentication available
• Single sign-on implemented at a number of customer sites

Security model within the system
• Network: SSL-based encryption
• Data: Spider ensures integrity through total control of storage and integrity checking
• Users Access: controlled by Spider’s access service
• Physical: access to application servers and database should be restricted. Data can be encrypted on storage
level depending on choice of relational database.



STORAGE AND LOGGING
In addition to the application services, the Spider platform provides a number of support services for
logging, software version handling, server/client settings, import/export, data structures etc.

Spider’s underlying storage handling isolates the services from product-specific aspects like SQL syntax,
communication protocols etc. The storage handling also enables distribution of services. The distribu-
tion may be based for example on the services’ different performance requirements, which allows a par-
ticularly demanding service to run exclusively on a specified server.

All information is version-handled in Spider, and each user access is logged. For each update in the data-
base, the change and/or access attempt is logged with user and time stamp. Thus, it is possible to re-cre-
ate the exact information stored in the system back at a given time, or to log unauthorized attempts to
access information.




                                                                                                                9
C O S M I C S Y S T E M S E T- U P




                      COSMIC system set-up

                      PHYSICAL SET-UP
                      The picture below outlines a physical view of the COSMIC system.




                               Monitoring and
                                Management                                     End user
                                                                                                                  Linked
                                                                                                                 Systems


                                                                 Terminal                   Desktop
                                                                  Server




                                          Dataware                Application Server Cluster                     Integration
                                         House Server                                                              Engine



                                          Cosmic Intelligence   Cambio Spider & Cosmic Application Servers



                                                                                                               Secondary database
                                                                Database                         Database      System (Cluster/log-
                                                                 Server                           Server       shipping) for high
                                                                                Cluster/                       availability
                                                                              logshipping

                                                 Disk System     8CPU/32Gb                         8CPU/32Gb   Disk System




10
                                                                                               C O S M I C S Y S T E M S E T- U P




SCALABILITY AND PERFORMANCE
The system is both scalable and robust. The application servers run in parallel and the environment can
easily be scaled by adding more servers as the number of users of the system increase. By having multiple
application servers (redundancy), the stability of the system is not depending on a single server. Clients
are distributed among the J2EE servers for load sharing and for system adaptability – if a server goes
down, the current clients are switched to another server. All servers have identical Spider installations.
There is no direct communication between the servers-no additional overhead when more servers are
added to the system.

For the major relational databases (SQL Server 2005 and Oracle 10.x), the database tier can be configu-
red in different setups to achieve both high availability (clusters and read-only copies). For Oracle, load
balancing can be achieved by using the Oracle RAC features, that is, allowing a cluster of less powerful
servers to provide the computing power needed for the database tier.

Cambio has performed extensive load testing using Load Runner. Our technical partners are market-lea-
ding vernors such as Microsoft, HP (Tests performed at HP’s European performance center) and Oracle.
The Cambio COSMIC system is deployed at sites with 11 000 users, and simulations have been done
with up to 100 000 users.



INTEGRATION POSSIBILITIES
Cambio has a rich experience of integration projects with third-party systems and suppliers. Different
standards have been used as required. For external message handling, a third-party integration engine is
usually selected, e.g. the SeeBeyond® ICAN™ Suite. Plug-ins already exist for a number of external
registers, and new plug-ins can easily be implemented.

Integration examples
Some examples of successful integrations with other systems carried out by Cambio:
• In Sweden and Denmark: Implementations based on European standards for e.g. Electronic transfer of
prescriptions (ENV 13607: Health informatics - Messages for the exchange of information on medicine
prescriptions and for orders and responses of laboratory investigations, ENV 1613 - Messages for
Exchange of Laboratory Information, and NF EN 14720-1 Health informatics - Service request and
report messages - Part 1: Basic services including referral and discharge).

• In Denmark: ENV 12538:1997 Medical informatics - Messages for patient referral and discharge.

• For communication with PACS systems we have implemented parts of DICOM that is now also for-
mally endorsed as a European and AFNOR standard EN 12052: 2004 Health informatics - Digital ima-
ging - Communication, workflow and data management.

• In the United Kingdom: The NHS-required new messages based on the HL7 v3 methodology but with
special English information content requirements.




                                                                                                                               11
C O S M I C S Y S T E M S E T- U P




                      System integration techniques
                      Cambio provides a toolbox for software development, enabling efficient development on top of Spider
                      for our partners and customers in integration projects. Currently, the toolbox primarily focuses on deve-
                      lopment of Java-based client applications. However, our offerings in this area will expand continuously
                      in accordance with the requirements of partners and customers.

                      Server side integration
                      • External API exposed through web services technology
                      • Messaging system
                      • Batch/bulk load/export of registers (e.g. code registers)
                      • Plug-in repository (server side) and one united way of adding and using plugins

                      Client side integration
                      • Standard based client-client integration software
                      • Plug-in repository (client side) and one united way of adding and using plug-ins




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                                                            S Y S T E M R E Q U I R E M E N T S A N D R E C O M M E N D AT I O N S




System requirements and recommendations
(Note: The hardware examples below should be seen as guidelines, not as strict requirements.)


DESKTOP

Client hardware (fat client)
Typical configuration:
• Intel® Pentium® 4 Processor 2.8GHz
• Internal memory 512MB. There should be at least 128MB free memory for the COSMIC application.
• 40GB (7,200 rpm) IDE Hard Drive

Desktop hardware (thin client)
Example:
• HP Compac t5525 for Linux

Client software
• COSMIC modules as required
• Java Runtime Environment 5.0 update 6 (platform used to run Java programs)
• Visual basic runtime, Visual Basic 6.0
• Crystal Report Runtime, version 11 (handles report print-outs)
• Windows operating system (XP is the recommended version, 2000 and NTare also supported)
• Acrobat Reader, 6 or later (required for templates)
• Microsoft Word, 97 or later (required for Word/Medical record integration)
• Font (supplied by Cambio, required for bar-code print-outs)
• JacoZoom (supplied by Cambio, required for integration of Word and Digital dictation)



APPLICATION SERVER

Application server hardware
Typical configuration:
• Dual Intel® Xeon processor 2.4GHz with 512K cache
• 2GB DDR SDRAM
• DVD-ROM
• Recommended minimum 40 GB storage
Comments: A minimum of three application servers are recommended for high availability. With increasing
workload, additional application servers can be added to the cluster, thus allowing scaling of the solution over time.




                                                                                                                                13
S Y S T E M R E Q U I R E M E N T S A N D R E C O M M E N D AT I O N S




                      APPLICATION SERVER SOFTWARE

                      JBoss:
                      • JBoss 4.0.3 SP1
                      • Microsoft Windows 2003 server

                      Sybase:
                      • Microsoft Windows 2000 or 2003 server
                      • Enterprise Application server 5.2

                      Oracle:
                      • Microsoft Windows 2000 or 2003 server
                      • OC4J 10.1.3.x.x

                      WebLogic:
                      • Microsoft Windows 2000 or 2003 server
                      • WebLogic server 8.1



                      DATABASE SERVER

                      Database server hardware
                      Typical configuration as follows:
                      • 4 Intel® Xeon processor 3.2GHz with >=1MB cache
                      • Internal memory16-32GB
                      • DVD-ROM
                      • 2 x 72GB 15krpm (OS and database software)
                      • 24-40 x 36GB 15krpm RAID 10 (data files). Preferably in a SAN.
                      • At least two NIC:s (one for application access and one for backups)
                      Comments: Either a stand-by solution and/or a cluster can be used to achieve high availability.

                      Database server software
                      • Microsoft Windows 2003 enterprise edition
                      • Microsoft SQL Server 2000/2005
                      • Oracle Enterprise 10.1 or 10.2




14
                                                                                                     EXAMPLE CASE




Example case
This example describes the current use of COSMIC in a county in Sweden. In this county, all COSMIC
modules are used.

PRODUCTION DATABASE
Database size: approx. 900 GB.
Configuration: Tempdb, logfile and datafile on three volumes with RAID 10.
Back-up: The backup of the production instance is performed on-line.



NUMBER OF USERS
Approximately 10 000 registered users, 1 100 simultaneous users.



DATABASE SERVER HARDWARE
One primary database server, one secondary server stand-by (cold).

                          PRIMARY                                                SECONDARY
Model                     HP RX86xx                                              RX68xx
Internal memory RAM       64 Gb                                                  64 Gb
Processor                 Itanium2                                               Itanium2
No. Of processors         16, 4 MB cache                                         16
Internal disks            4 mirrored hard disks
Network card              2 cards – 1 Gbit, error tolerant Team
                          2 cards – 2 Gbit HBA
Operating system          Windows Server 2003 Datacenter Edition for 64bit Sp1
Database                  SQL2005 (as of August 2006)




DISK SYSTEM (SAN)
One primary SAN and one secondary SAN. Replication with CA.

Model                     HP EVA 8000
Disk                      72 Gb
Total memory size         7 000 GB




APPLICATION SERVERS

Number of servers         16 (11 end user, 1 CI, 1 install/export, 3 debug)
Internal memory RAM       4 Gb
Number of processors      2 Intel XEON, 2 Mb cache
Internal disks            2
Network card              2, 1 Gbit each, error tolerant Team
Operating system          Windows Server 2003
Application server        JBoss (as of August 2006)




                                                                                                                15
EXAMPLE CASE




               INTEGRATIONS

               So far, 11 integrations have been implemented in this installation of COSMIC. Some examples:
               • Apoteket (support for ePrescriptions towards the National Swedish Pharmacy company)
               • INFOMEDIX (Integration of administrative patient system)
               • KOVIS (scanning of paper-based medical records)
               • Agresso (economy)
               • Flexlab and Immunologi (lab analysis production system)




16
17
                                                       Cambio Healthcare Systems, with Cambio COSMIC, offer
                                                       a comprehensive healthcare administration system
                                                       which has been developed from the needs and wishes of
                                                       people working in the healthcare sector. Today Cambio
                                                       COSMIC is used by about 40,000 doctors, nurses and
                                                       administrators in healthcare sectors around Europe on a
                                                       daily basis. We are currently employing about 120 people
                                                       and 65 consultants at offices in Sweden, United Kingdom
                                                       and France.




                                                          Cambio Healthcare Systems AB can be contacted at:                              Cambio Healthcare Systems AB partners can be contacted at:
                                                          SWEDEN                                                                         DENMARK
                                                          Office in Linköping: Ågatan 40, 582 22 Linköping. Phone +46 13 20 03 00.       WM-data A/S Frichshuset, Hermodsvej 22, 8230 Åbyhöj, Denmark.
                                                          Office in Stockholm: Ringvägen 100, 118 60 Stockholm. Phone +46 8 691 49 00.   Phone +45 87 44 44 44.
Cambio COSMIC® and Cambio SPIDER® are registered
trademarks owned and controlled by Cambio Healthcare      UNITED KINGDOM
Systems AB.                                               1 Hammersmith Grove, London W6 OBN. Phone +44 020 300 88 298.

                                                          FRANCE
                                                          19, boulevard Malesherbes. 75008 Paris. Phone +33 155 273 666.

                                                          info@cambio.se | www.cambio.se

				
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