InterSystems IRIS for Health

Technology Brief

FHIR-Based Healthcare Application Development.

Advanced Interoperability.
Unprecedented Speed.
Massive Scale.

IRIS for Health

Introduction
InterSystems IRIS for Health™, a comprehensive, cloud-first data
platform, along with its predecessors, is the basis for healthcare software
that manages over a billion health records globally.
Its use is broad and deep across the healthcare industry, and our own
HealthShare and TrakCare products are based on it. InterSystems IRIS
for Health is at the heart of commercial healthcare solutions such as
Epic’s EMR and 3M’s Encompass 360. Clinical laboratory companies
such as Sonic, Labcorp, and Bioreference have based their internal
management systems on our platform. It’s used by startups and
established healthcare delivery and medical technology organizations,
payers, pharmaceutical companies and others as a foundation for
innovation through its connectivity, interoperability, and application
development capabilities.

The Core of a Smart Data Fabric

Recently, smart data fabrics have emerged as an IT architectural
approach that goes beyond previous designs used to gain access to data
silos across an organization. Smart data fabrics combine technology to
integrate, transform, and harmonize data from disparate sources on
demand, and leverage that data in applications through a wide range of
analytics capabilities.
For an increasing number of organizations and developers, InterSystems
IRIS for Health forms the core of a smart data fabric that includes
analytics and data exploration, business intelligence, natural language
processing, complex business rules, and machine learning. Developers,
researchers, and organizations across the healthcare continuum are
using it to gain new insights from data and power a transformation where
patients are at the center of every service provided.

InterSystems IRIS for Health

InterSystems IRIS for Health provides many of the capabilities required
to implement real-time, smart data fabric architectures in a single
product, eliminating the need to implement, integrate, and maintain
dozens of different technologies. Key components of InterSystems IRIS
for Health include:
• A new approach to data and application integration
• Seamless healthcare interoperability via HL7® FHIR®
and other standards
• Advanced FHIR capabilities
• Embedded advanced analytics tools
• Support for application development
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Data and Application Integration:

A New Approach
Nearly every application today needs to connect to other
systems, whether to simply transfer data, or to offer
new services that aggregate information from multiple
sources, support users with consistent data from different systems,
or build seamless composite end-to-end workflows to automate and
optimize processes.

Connect and Collect

InterSystems IRIS for Health provides a low-code approach to data and
application integration that supports connect and collect approaches.
Connect enables new applications to access information on demand,
without creating additional copies of the data. Of course, data can be
stored within the InterSystems IRIS for Health multi-model, multi-
workload database (collect), and applications can leverage both
approaches for the highest performance and resource efficiency.

High Performance, Multi-Model, Multi-Workload

Database Management
At the core of InterSystems IRIS for Health is an ultra-high performance,
multi-model, multi-workload database management engine that
supports vertical and horizontal scalability. It ingests, processes, and
stores transactional data at high rates while simultaneously processing
high volume analytic workloads involving historical and real-time data
(including ACID-compliant transactions).

Multi-Model
Within the InterSystems IRIS for Health database, data is stored once
and can be accessed as tables, objects, documents, key-value pairs,
or multidimensional arrays without duplicating data or executing
performance-killing mapping between models. All access methods can be
used simultaneously on the same data with full concurrency. This pure
approach to multi-model database management allows developers to use
the most appropriate model types for their applications within a single
environment.

Multi-Workload
InterSystems IRIS for Health is optimized for real-time applications
that require high-throughput data ingestion with high-performance,
concurrent analytics at scale. It is deployed in mission-critical healthcare
applications that must have the capacity to ingest thousands or millions
of records per second while simultaneously querying the incoming data
in real time.

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 Proven Scalability Technology
InterSystems IRIS for Health enables applications to scale efficiently
to meet the needs of your application – horizontally through sharding
and our Enterprise Cache Protocol, and vertically through parallel SQL
queries. Whether it’s high volumes of concurrent users, a massive dataset
to analyze, or both at the same time, InterSystems IRIS for Health scales
out to a distributed architecture on affordable hardware to reduce total
cost of ownership.

Vertical Scalability
Vertical scaling takes advantage of bigger, multicore machines through
the efficient and fully automated use of parallelization, which enables
organizations to right-size infrastructure resources in the cloud to
achieve optimal price-performance ratios. However, big, multicore
machines can quickly become cost prohibitive, both in the cloud and on
premises.

Horizontal Scalability
InterSystems IRIS for Health addresses this “big machine cost” issue
with InterSystems Enterprise Cache Protocol (ECP). ECP enables
horizontal scaling of the number of users by caching data on application
servers. User queries are satisfied from the local application server cache,
if possible, retrieving data from the data server only if necessary. ECP
automatically synchronizes the data and is entirely transparent to users
and applications, providing superior performance and resource efficiency
as workloads increase.
InterSystems IRIS for Health also enables horizontal scaling of data
through sharding — splitting up very large databases onto multiple
machines. Queries are run in parallel on each shard, and the results are
aggregated before being returned to the user.

Sharding and ECP are transparently combined so applications can

handle large volumes of data and high volumes of compute workloads
efficiently and independently.

Flexible Scalability for Your Business

You don’t have to make a large investment in InterSystems IRIS for
Health to get the performance and scalability your business needs.
Flexible licensing and deployment options, and our Smart Health Data
Services in the cloud, enable you to address current requirements with
the technology you need now, and easily scale as your needs change.

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Healthcare Interoperability
In fragmented healthcare systems, data is stored in
+
multiple sources and in a variety of formats and standards,
creating silos that are difficult to integrate. Even when
sources make data available via an API, those APIs
aren’t compatible with one another. To ensure you can leverage all this
data in your solutions, InterSystems IRIS for Health offers extensive
development tooling for healthcare interoperability standards and
templates.
These include:
• HL7® FHIR® (STU3, R4)
• HL7® V2
• IHE Profiles, including XDS.b, XCA, PIX, PDQ, and MHD
• CDA/C-CDA Documents
• DICOM
• X12
An individuals health record typically needs to be brought together from
different systems using different standards, so developers often need to
transform data from one format to another. InterSystems IRIS for Health
provides pre-built extensible data transformations between modern
and legacy data representations. For example, using out-of-the box
InterSystems IRIS for Health features,
you can:
• Transform an HL7 V2 message from one schema version to
another, including HL7 FHIR
• Produce HL7 V2 messages from a CDA document
• Transform a portion of a CDA document into HL7 FHIR
resources

Advanced FHIR Capabilities

InterSystems support for HL7 FHIR is broad and deep.
InterSystems IRIS for Health provides the building
blocks needed to work with FHIR data and develop FHIR applications,
including:
• A base FHIR server supporting standard FHIR REST APIs
• A FHIR resource repository fully supporting the FHIR Standard
• Data access authorization via the standard OAuth protocol
• Built-in data transformations between FHIR and other healthcare
interoperability standards such as HL7 V2 and CDA
• Support for FHIR-based IHE Profiles, including PIXm, PDQm,
and MHD
• Bulk FHIR
• FHIR SQL Builder

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 The InterSystems IRIS for Health FHIR repository offers full read-write
capabilities, receiving or sending FHIR resources or bundles via the
FHIR RESTful API in JSON or XML formats. This allows applications
built on the latest technologies to use FHIR data — new or mapped from
legacy systems — for patient care, quality improvement, research, and
other use cases.

Bulk FHIR
One of the most useful capabilities that have been added to the FHIR
Standard is Bulk FHIR import and export. Bulk FHIR is important for
several reasons:
• Efficiency: Bulk FHIR enables the retrieval of large datasets of
FHIR resources in a single request, which can significantly improve
the efficiency of data exchange and management.
• Population health: Bulk FHIR supports population health use cases
by enabling the analysis of large datasets to identify trends,
patterns, and gaps in care.
• Research: Bulk FHIR supports research use cases by enabling the
retrieval of large volumes of data for analysis and study.
• Reporting: Bulk FHIR supports quality reporting and compliance
use cases by enabling the retrieval of large quantities of data for
reporting purposes.
Executive Summary: • Interoperability: The Bulk FHIR API facilitates interoperability by
enabling the exchange of large quantities of data between different
healthcare systems, which can support care coordination and
continuity of care.
InterSystems FHIR server not only supports Bulk FHIR export but
includes an intuitive Bulk FHIR client for easily exporting FHIR data
from external FHIR servers. For FHIR servers that do not support the
Bulk FHIR API, InterSystems offers pure FHIR fetch, which enables
customers to get data from FHIR servers that support the operator
$everything.

FHIR SQL Builder

FHIR is foundational to health data exchange but is poorly suited to
analytics. FHIR data is represented as a complex directed graph, which
is difficult to model in a relational schema. Nevertheless, business
intelligence tools require a relational representation of data to build
cubes, dashboards, and reports. FHIR data must be transformed,
“projected”, to make this relational representation possible.
Why is FHIR analytics so important in healthcare? Because it is the
foundation of population health management, decision support, and
operational/quality improvement programs. InterSystems IRIS for
Health FHIR SQL Builder transforms the FHIR directed graph into a
relational schema for access by analytics applications.
InterSystems recognizes that there is no one relational projection all
customers would agree on. The IRIS for Health FHIR SQL Builder guides
users toward the optimal projection for each use case.

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The FHIR SQL Builder :

• Analyzes the FHIR graph, and reports on the number of resources,
links between resources, and number of elements for each resource
• Gets user input on what resources, links, and elements are
important for building their schema
• Projects the FHIR data to a relational schema of the customer’s
choice, so there is no need to move the data
• The FHIR SQL Builder takes advantage of the unique capabilty of
InterSystems IRIS for Health FHIR Repositoy
Note: InterSystems IRIS for Health Advanced Server is required

Analytics

Embedded
Java
and Open Analytics
C#/.NET Node.js Python ObjectScript

InterSystems IRIS for Health provides a range of

powerful, built-in analytics capabilities that run against
data stored in its database. Users gain rapid access to insights with the
ability to run a wide variety of analytics directly within applications close
to the data. Because data in FHIR format is by nature nonrelational, we
offer an option — FHIR SQL Builder — that gives data scientists access to
it using SQL. Data managers do not need to translate and move the data
inSources
the FHIR repository into a separate relational
Smartdatabase.
Data Fabric
InterSystems
(Powered by InterSystems)
Solutions
InterSystems IRIS for Health also supports third-party analytics tools,
Message Streams
so data scientists can continue to use whatever
Data worksand
Security, Lineage, best for them.
Semantic Layer
Services Business 360

Databases
Machine
Data Lakes
Learning for SQL Developers
Data Connectivity Integration and Analytics
Reporting and
Customer 360
(Kafka, JMS, JDBC, (BI, Machine
InterSystems IntegratedML® brings the
File, Services) power of machine
Transformation
learning
Learning, etc.) to Visualization
External Data Providers
SQL developers. With three simple SQL statements, users can create Patient 360

and train
Production ML models onData
Applications their data and then use those models
Ingestion Processto make Business User
... (Real Time and Data Pipelining Self Service
predictions
Files
on unseen data in
Batch)SQL-based applications. This turnkey toolAnalytics
Automation Supply Chain 360

dramatically increases the productivity of data teams and enables data

scientists to focus on only the most complex problems, without having to
worry about data access or model deployment.

The Machine Learning Process

Data Data Feature Model Model Parameter Model

Acquisition Preparation Engineering Selection Training Tuning Deployment

Automating the Machine Learning Process With IntegratedML

Data Model
Acquisition InterSystems IntegratedML Deployment

Deep integration with InterSystems IRIS for Health enables applications to seamlessly
execute ML models directly on the data, in response to real-time events and
transactions, without extracting or moving any models or data.
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 Natural Language Processing
Built-in capabilities for NLP and text exploration can deliver insights
from unstructured data directly within applications. NLP is often used
with InterSystems IRIS for Health to create new ML features from text
such as clinical notes, that can in turn be used to develop and train ML
models. InterSystems text exploration technology—also available as
open source—is unique in that it uses a bottom-up approach, discovering
concepts and relationships within the text itself.

Business Intelligence (BI)

InterSystems IRIS for Health provides fully integrated support for
business intelligence modeling, analysis, and end-user dashboards. An
InterSystems IRIS for Health BI model runs directly on transactional
data and any other data that might be needed. InterSystems IRIS for
Health integration capabilities ensure that its database is always up-to-
date, and eliminates the need for extract, transform, and load processing
to bring in data from external sources. Drag and drop analysis editing
enables non-technical users to examine the data at any level, performing
complex queries with ease. InterSystems IRIS for Health dashboards
provide a way to display live business metrics and give users options to
explore and change what is displayed.
InterSystems IRIS for Health BI uses selective Cube Build, which makes
it much faster to add measures and dimensions to a build, without
bringing down the cube. By eliminating the need to rebuild the cube each
time, hours to days of time can be saved depending on the size of the
dataset.
Note: InterSystems IRIS for Health Advanced Server is required

Adaptive Analytics
InterSystems IRIS for Health Adaptive Analytics is an add-on component
that provides business users with self-service analytics capabilities
to visualize, analyze, and interrogate data from multiple sources in a
consistent format. Its semantic layer and drag-and-drop data modeling
capabilities allow business users to interactively explore the data to make
timely and accurate business decisions.
Note: InterSystems IRIS for Health Advanced Server is required

Columnar Storage
Columnar Storage is an option for IRIS for Health SQL tables that offers
order-of-magnitude faster analytical queries compared to traditional row
storage. Such queries typically aggregate data over very large tables and
involve filters and groupings on one or more columns. Through laying
out the table data by column rather than by row (which works best for
transactions on a handful of rows at a time), we can dramatically reduce
the amount of I/O required to run such queries, and exploit modern
chipset-level optimizations called SIMD (Single Instruction Multiple
Data) to further improve performance as part of vectorized query
processing. That means that, in addition to I/O reductions, bottlenecks

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such as unpacking values and memory access no longer constrain

performance, and operations are only bound by the number of CPU cores
the system can access.
If you are implementing a use case where you’re running queries across
large volumes of data in a data warehouse, data lake, or data lakehouse;
or if you’re running analytical queries on live application data (a Hybrid
Transaction-Analytical or Translytical use case), Columnar Storage will
help you achieve excellent query performance.
Note: InterSystems IRIS for Health Advanced Server is required

Reporting
InterSystems IRIS for Health enables the creation of pixel-perfect forms
and reports in a variety of formats. It supports the scheduling, exporting,
and embedding of reports in customer and partner applications.
Note: InterSystems IRIS for Health Advanced Server is required

Application Development Support

Healthcare application developers need to understand
complex regulations and privacy rules, and make sure
the software they create complies with them. Developers
need to keep up with new interoperability standards – like
FHIR – while still managing to historical standards. And dealing with
healthcare data, terminology, and data models requires specialized
knowledge. Using a healthcare-specific data management platform such
as InterSystems IRIS for Health accelerates development.

Your Language. Your Choice.

Java C#/.NET Node.js Python ObjectScript

Unified, Low-Code Development Environment

InterSystems IRIS for Health includes a unified graphical and code-
based environment that streamlines development and maintenance of
sophisticated data- and analytics-intensive
Sources
healthcare
Smart Data Fabricapplications that
InterSystems
(Powered by InterSystems)
connect data and application silos. Solutions
Message Streams
Developers can use graphical and drag-and-drop
Data editors
Security, Lineage, and to design
Semantic Layer
Services Business 360
integration flows and business processes, to incorporate business rules
and human workflow, and to define data and message transformations.
Databases
Customer 360
Data Connectivity Integration and Analytics
DataInterSystems
Lakes IRIS for Health
(Kafka, seamlessly
JMS, JDBC, manages (BI,all Machine
connection Reporting
states, and
Transformation Visualization
File, Services) Learning, etc.)
connection
External Data Providers adapters, message queues, and payloads between itself and Patient 360
external applications
Production Applications Dataand systems.
Ingestion Business User
Process
... (Real Time and Data Pipelining Automation Self Service
Supply Chain 360 9
99
Files Batch) Analytics
 The platform provides a consistent representation of diverse
programming models, programming interfaces, and data formats to
simplify development of applications that access and share data across
the care continuum. Its trace capability enables developers to track and
see the behavior of messages to and from the application, simplifying
debugging and diagnosis, lowering development costs, and accelerating
time to market.

Client-Side Development
InterSystems IRIS for Health supports client-side development using
many popular development technologies, including Java, C#/.NET, Node.
js, Python, and ObjectScript, for the greatest flexibility in supporting
a wide range of developers and existing applications. ObjectScript is a
high-performance, flexible object programming language optimized
for developing complex data- and analytics-intensive applications with
InterSystems IRIS for Health. ObjectScript classes can be exposed
through built-in libraries to Java, .NET, C++, JavaScript, and many other
languages.

Server-Side Development
Server-side development provides the highest performance since
the applications run close to the data. InterSystems IRIS for Health
supports server-side application development with Python and
InterSystems ObjectScript. Developers can build applications in either
or both programming languages, choosing whichever language is best
for the application. Python and ObjectScript code execute within the
InterSystems IRIS for Health kernel on the server for extremely high
performance.

Message Management
Messages are automatically saved and can be easily audited and visually
tracked. This eliminates the need to develop additional application logic
to monitor inbound/outbound traffic, queues, and message volumes;
for persisting historical message content; for message resending,
rerouting, alerting, and event logging; or even for coordinating multiple
simultaneous threads of executing process logic.

Full Life-Cycle API Management

InterSystems IRIS for Health provides full life-cycle API management
capabilities that support discovering, consuming, routing, throttling,
securing, logging, monitoring, and monetizing APIs to support a modern
microservices approach to development.
InterSystems API Manager (IAM) enables organizations to monitor and
control traffic to and from web-based APIs, including FHIR APIs. They
can configure API management using a web-based user interface and API
calls, which simplifies remote deployments. The more distributed the
environment, the more critical it becomes to properly govern and monitor
API traffic. IAM enables all traffic to be routed through a centralized
gateway and forwards API requests to appropriate target nodes.
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This enables organizations to:

• Monitor all of their API traffic in a central spot
• Plan, document, and update the list of APIs they are using and the
servers that provide them
• Identify issues before they become critical
• Control API traffic by throttling throughput, configuring allowed
payload sizes, whitelisting and blacklisting IP addresses and
domains, and quickly taking endpoints into maintenance mode
• Onboard internal and external developers by providing interactive
API documentation through a dedicated and customizable
developer portal
• Secure APIs in a central location

Extensibility
Integration capabilities are flexible and extensible. In addition to
its built-in integration capabilities, InterSystems IRIS supports the
incorporation of existing integration components written in Java, .NET,
and Python, enabling developers to build and integrate custom inbound
and outbound adapters that can be called at runtime and can send
messages to other components.

Flexible Deployment
InterSystems IRIS for Health is available as a managed
service (Data Platform as a Service) and can be deployed
on all major cloud platforms, in private clouds, on
premises, and in multi-cloud and hybrid environments.
It offers the following advantages:
• Eliminates lock-in to a single cloud provider
• Runs on standard hardware to support on-premises, private, and
hybrid deployments, with no custom configurations required
• Seamlessly supports all deployment types through a single API,
without requiring any modifications
• Continuously leverages the optimizations released by cloud
providers and hardware vendors

Smart Health Data Services

InterSystems Smart Health Data Services let you access
much of the power of InterSystems IRIS for Health
database, interoperability, and analytics technology as
smaller, flexible, cloud-centric managed services. See the
table below for a list of services and uses. They are available from major
public cloud marketplaces. major public cloud marketplaces.

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PRODUCT DESCRIPTION BEST FOR

InterSystems IRIS for Health A comprehensive cloud-based Developing intelligent, scalable,

software development platform standards-based health
for data management, with solutions where connectivity
interoperability support for all to a variety of source and
major healthcare standards, destination systems matters
including FHIR, and analytics

InterSystems FHIR Server A smart data service delivering Easily adding FHIR data
an enterprise-grade FHIR storage and management to an
server to provide secure, application
scalable data sharing and
storage for healthcare data

InterSystems FHIR Fully managed, automated cloud Populating a FHIR server from
Transformation Service services to transform HL7 V2 data sources that do not “speak
and CDA messages to FHIR FHIR”

InterSystems Smart Health Data Services

Security
InterSystems IRIS for Health provides a strong, flexible,
consistent, and high-performance security infrastructure
while minimizing its burden on application performance.
This security architecture is based on authentication,
authorization, auditing, and database encryption.
• Authentication: InterSystems supports multiple authentication
mechanisms, including two-factor authentication.
• Authorization: Using our System Management Portal, system
administrators can easily assign and manage role- and application
based resource access privileges.
• Auditing: InterSystems products record all system and application
events in an append-only log, which can be queried using SQL or a
reporting tool.
• Database encryption: InterSystems IRIS for Health encrypts data
at rest and data in motion. To protect entire databases, it offers
block-level encryption.

About InterSystems
Established in 1978, InterSystems is the leading provider of next-
generation solutions for enterprise digital transformations in the
healthcare, finance, manufacturing, and supply chain sectors. Its cloud-
first data platforms solve interoperability, speed, and scalability problems
for large organizations around the globe. InterSystems is committed to
excellence through its award-winning, 24×7 support for customers and
partners in more than 80 countries. Privately held and headquartered in
Cambridge, Massachusetts, InterSystems has 36 offices in 25 countries
worldwide. For more information, please visit InterSystems.com.
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© 2023 InterSystems Corporation. All rights reserved. InterSystems IRIS Data Platform is a trademark of InterSystems Corporation. 060623