Platform Architecture and Deployment Options

Three Tier

The MedCommons Platform is a three tier web application with two available (optional) extensions:

• A DDL component that runs typically inside a personal computer or server to service local imaging modalities and DICOM workstations
  
• A perpetual backup storage component that runs on public and/or private storage clouds including EC2/S3 and EMC/Atmos

MedCommons applications written in HTML5/Javascript/Ajax and Objective-C for Apple iPhones are also available that adapt and extend the desktop UI for mobile use.

ePHI Primary Storage

MedCommons instances can be configured using a variety of SAN or NAS storage for patient documents and records (ePHI - electronic Protected Health Information). The capabilities of the chosen storage for allocation, resizing/up-scaling, migration, etc. can be used to flexibly manage storage used for patient records. MedCommons appliances can inter-operate with storage based CDP, backup/archive, and snapshot services to persist patient records.

Perpetual Backup Storage

MedCommons provides an optional continuous archiving service that saves all patient records and documents to external storage. It provides support for both AWS/S3 and EMC/Atmos storage clouds. It automatically replicates records to the selected storage cloud as they’re received and retrieves records from the storage cloud as required. This allows the local instance storage to be managed as a records cache and the instance to access unlimited amounts of storage for patient records (cache storage management is automatic if the archiving service is configured).

Database

Appliances

MedCommons is a highly scalable three tier web application that allows large numbers of appliances to be connected behind a load balancer and share a separate, common database server and ePHI repository in a multi-appliance configuration. Service nodes host application services only in this configuration. Individual appliances can be added, removed and/or fail without impacting the availability of the service.

On elastic processor clouds (Amazon EC2), appliances can be provisioned as required to handle load. Additional nodes can be added during peak load hours and immediately retired which yields cost savings relative to static provisioning against peak load requirements.

The MedCommons system consists of several distinct (logically separate) services the most important of which is the MedCommons Gateway Server (``the Gateway’’). It handles all ePHI processing and storage, manages the sandboxed MedCommons account and support merging of incoming messages, fax, DICOM, emails. The Gateway manages the relationship between user identities, applications and ePHI storage.

The Gateway stores ePHI in a records repository local to the instance (in a local file system on a single-appliance instance; on network-shared storage in a Flex clustered configuration). It can replicate ePHI to remote archival storage (e.g. AWS/S3) and manage available local storage as a cache (see above) .

Capabilities

Users can load DICOM images to different Workstations and Viewers and vice/versa, the MedCommons enabled OSIRIX workstation being the first example.

Fax records are fully supported as an ePHI format by MedCommons. An account holder can select a template and print a cover sheet containing a bar code that will route faxes to their MedCommons Account as PDFs wrapped in a CCR. An incoming fax for an account will be merged into the current CCR as an attachment with the name of the template as its title.

CXP is a family of SOAP and REST based APIs for manipulating CCRs, creating accounts, and performing other useful MedCommons functions under remote control. Every CXP call is logged by MedCommons for future forensic or billing purposes.

Orders are instructions or requests for service that may live for a long time. The order is a complex CCR that represents an Order from a Requesting Organization that is augmented and 'filled' by one or more Providing Organizations . There is a special Order-oriented CCR Edit form for Concierge applications.

DDL

User Interfaces