Microservice ecosystems for healthcare

Patients will experience profound positive impacts as the advantages of microservices become better understood by healthcare technology leaders.

Google, Amazon and Soundcloud all have successfully deployed microservices. Let’s modernize healthcare applications with microservices.

Microservice architecture transfers healthcare providers and payers from one large application into smaller applications. These little applications or “micro” applications provide specialization using service-oriented architectures (SOA) by building dependent and flexible components. These micro pieces are not simple CRUD (create, read, update, delete) services — they have responsibilities.

Microservices combine lightweight mechanisms that offer scalability (Netflix supporting 800 different devices and 1 billion calls a day) and can support a range of platforms and interactions (the web, mobile, IoT, wearables).

The world of microservices

There are many reasons why microservices are valuable for healthcare. Before we jump into those reasons, let’s define the ecosystem that makes up the world of micro services.

A dynamic response to changing business conditions

Microservices provide agility and align well with changing business needs that require automation and the ability for functionality to be recomposed. The benefit of intrinsic interoperability with industrywide standards (HTTP and JSON) ensures that your technology is enabling your business to solidify your competitive advantage.

Microservices work off a three-layer system: system APIs (core business capabilities), process APIs (orchestration and choreography of components) and experience APIs (adaptable processes and configurable options). As patient engagement, sustainability, and outcomes prove ever more critical, the ability to micronize your healthcare environment will become a best practice in healthcare. The speed of delivery, accelerating innovation capabilities and new models of care today are prerequisites for a functional and efficient business operation.

Microservices for healthcare enable this vision.

Avoiding the snowball

Monolithic applications like the large electronic health record systems we know and love, eventually snowball into unreasonably large systems. The effect is that problems quickly snowball, out of control. Simple changes need to be made in multiple locations. Various systems across a healthcare ecosystem are running on different versions or service patients using entirely different and unconnected systems. Value is siloed.

What’s our solution to this problem? Our solution is that we build the functionality over and over again. We try to “reuse” components, but for the most part, they are constructed initially by vendors and then modernized — and that means another bill for similar work. Moving away from limited-reuse applications enables organizations to slide move toward the edge of innovation — where the most value occurs.

Microservice providers acknowledge there are tradeoffs when leading initiatives that require scale (multiple location installations), including the following:

  • Service discovery and documentation
  • Fault tolerance
  • Quality of service
  • Security
  • Request traceability
  • Failure triage

Start exploring the value of microservices

It’s always difficult when exploring new areas you’re unfamiliar with. Here are a few steps to help jump-start the journey of incorporating microservices into your healthcare environment.

  1. Identify potential microservices categories where you may find value.
  2. Define the scope of responsibility for the identified microservices.
  3. Consider the type of information that will be transmitted.
  4. Associate business processes with the technical functionality defined.
  5. Link technical processes to the business processes.
  6. Research capabilities that are ahead on the business road map — capabilities  that are not offered today but are desired. The following steps are typically done with tools, not manually.
  7. Design the micro service starting with the API definition and elaborate how the service will be consumed (REST or event-driven)
  8. Develop a service mocking or simulation. This step is also known by isolation, simulation or virtualization. In essence, you’re building something that works as something else.
  9. Deploy the microservice. This is where we transition from deploying to multi-tenant environments like JBoss AS or Tomcat and leverage IaaS automation frameworks such as HashiCorp or Chef and virtualization technology such as Xen or VMware.
  10. Manage container systems. Conflicts and container integration must be proactively managed. Pivotal Cloud Foundry and Mesosphere DCOS have recognized this gap and are evolving to address the need.

Best-of-breed healthcare solutions

This year, your team will identify new technical capabilities. They will assess how these skills will align to the predefined needs of the business. As a healthcare leader, what do you expect out of this analysis? What have we always expected? We expect a recommendation — a single recommendation.

When was the last time your team identified, assessed and presented options and the result was a set of five to eight products that worked together and provided a unified best-of-breed solution? I’d say it probably hasn’t happened in the past 30 days and likely not even within the past year. Whether you’re assessing a healthcare medical record solution or a pure desktop product used by clinicians, everyone wants simplicity.

Unfortunately, in today’s knowledge-rich world, one solution rarely provides all the answers. As a result, we “fit.” We fit our solution into whatever problem hole we find. The solution rarely fits the need perfectly, yet we just cram the solution into the problem space. The action correspondingly has a ton of white space where the solution didn’t solve the intended problem (business or technical).

Delivering the value of simple

The most logical microservices uses are attributable to business processes or transactions. Microservice responsibility goes beyond pushing data. Each service is discrete and encapsulates a set of responsibilities. These responsibilities may relate to a business domain such as claims or billing. However, they also could relate to technical domains such as operating systems or network performance.

The benefit of deploying microservices is the micro scale of functionality that is agonistic to a particular domain or subdomain such as claims reconciliation. The patient name, account number and balance may also be applicable across other business areas such as patient entry, patient discharge or utilization. Microservices begin with business-oriented designs commonly in the form of APIs (business interactions to access information).

Adaptability, loose coupling, autonomy, fault tolerance, composability and discoverability each offer the advantage of reuse — a core principle supporting the value of microservices design. Define the problem first. Savvy healthcare pioneers have already discovered that microservices help solve problems by getting back to simple.

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Peter is a technology executive with over 20 years of experience, dedicated to driving innovation, digital transformation, leadership, and data in business. He helps organizations connect strategy to execution to maximize company performance. He has been recognized for Digital Innovation by CIO 100, MIT Sloan, Computerworld, and the Project Management Institute. As Managing Director at OROCA Innovations, Peter leads the CXO advisory services practice, driving digital strategies. Peter was honored as an MIT Sloan CIO Leadership Award Finalist in 2015 and is a regular contributor to CIO.com on innovation. Peter has led businesses through complex changes, including the adoption of data-first approaches for portfolio management, lean six sigma for operational excellence, departmental transformations, process improvements, maximizing team performance, designing new IT operating models, digitizing platforms, leading large-scale mission-critical technology deployments, product management, agile methodologies, and building high-performance teams. As Chief Information Officer, Peter was responsible for Connecticut’s Health Insurance Exchange’s (HIX) industry-leading digital platform transforming consumerism and retail-oriented services for the health insurance industry. Peter championed the Connecticut marketplace digital implementation with a transformational cloud-based SaaS platform and mobile application recognized as a 2014 PMI Project of the Year Award finalist, CIO 100, and awards for best digital services, API, and platform. He also received a lifetime achievement award for leadership and digital transformation, honored as a 2016 Computerworld Premier 100 IT Leader. Peter is the author of Learning Intelligence: Expand Thinking. Absorb Alternative. Unlock Possibilities (2017), which Marshall Goldsmith, author of the New York Times No. 1 bestseller Triggers, calls "a must-read for any leader wanting to compete in the innovation-powered landscape of today." Peter also authored The Power of Blockchain for Healthcare: How Blockchain Will Ignite The Future of Healthcare (2017), the first book to explore the vast opportunities for blockchain to transform the patient experience. Peter has a B.S. in C.I.S from Bentley University and an MBA from Quinnipiac University, where he graduated Summa Cum Laude. He earned his PMP® in 2001 and is a certified Six Sigma Master Black Belt, Masters in Business Relationship Management (MBRM) and Certified Scrum Master. As a Commercial Rated Aviation Pilot and Master Scuba Diver, Peter understands first hand, how to anticipate change and lead boldly.