Concierge

Concierge is a suite of health and care integration modules, abstracting and simplifing integrations with underlying health and care systems.

A concierge assists guests. This concierge assists clients to integrate into the local health and care ecosystem.

Background

I built an electronic health record (2007-present day) and found that the most difficult part was integrations with other systems. Unlike many monolithic systems, I wanted to delegate important functionality to a suite of different platform services, so that I could concentrate on creating value.

Unfortunately, I didn't find a suite of effective platform services, but instead I had to write bespoke integrations to many different data and computing services.

This work was a great learning experience.

The core services I needed were:

• terminology - SNOMED-CT.
• reference data - from the NHS "organisational data services"
• demographics - patient identity
• staff identity
• appointments and scheduling
• document repositories

I see these services as foundational; no higher-order clinical data can be interpreted without the context of who, when, why and how.

When I started, there wasn't an off-the-shelf service for terminology or reference data, but they were published via TRUD by NHS Digital. So I originally built these services into the wider EPR, but later realised the importance of spinning them out into their own microservices. You can try out my terminology server.

As an EPR not linked to a single organisation, but instead providing services across organisational and disciplinary boundaries, I wanted to hide the underlying complexity from end-users. After all, the patient they are supporting is the same patient, whether it's via a telephone consultation, a GP surgery in Aberystwyth or an outpatient clinic at the University Hospital of Wales.

So I wrote interfaces to multiple services; the best way to describe this was a "war of attrition" with difficulties such as

• difficulty getting access with lots of discussions and interactions with lots of stakeholders
• seemingly arbitrary rules on access
• no documentation, or out-of-date documentation
• no cohesive structure
• bespoke proprietary web service calls
• sometimes extraordinarily slow response times
• service endpoints that are ephemeral
• no authentication, and authorisation at the level of firewalls
• multiple firewalls, blocking both outgoing and incoming traffic
• logging by the client and not the service
• no way to do development while actually on the network - so develop on laptop, compile and then use a USB stick to transfer for testing
• lack of readily-available on-demand test environments such as docker images / example source code.

These experiences, over many years, highlighted the need for a set of cohesive platform services - as outlined on my personal blog.

Services

Concierge is a new lightweight library and microservice that provides integration services. It is a work-in-progress as I port across my existing (legacy) integrations.

It currently supports the following integrations:

• A wrapper around the NHS Wales' enterprise master patient index (EMPI).
• Staff authentication and lookup via the national directory service (NADEX) to provide staff identity services
• Staff lookup
• Cardiff and Vale Patient Administative System (PAS) integration - for demographics and appointments/scheduling.
• Cardiff and Vale Document Repository service
• Aneurin Bevan PAS integration
• Sending text messages using the gov.uk Notify service.

I have also built standalone libraries (embeddable into larger applications) and microservices to support:

• SNOMED CT - see hermes
• Organisational data services and postcode lookup / geographical data - see clods and nhspd

These individual components are re-combined in my server-side software, with support for a generic service mechanism based on identifiers:

• System/value ("identifier") resolution and mapping for the following:
  • NHS Wales patients via namespace https://fhir.wales.nhs.uk/Id/empi-number and organisational (case record numbers) codes for Cardiff and Vale, Swansea, Aneurin Bevan, Cwm Taf Morgannwg, Hywel Dda and Betsi Cadwaladr health boards
  • NHS Wales practitioners via namespace https://fhir.nhs.uk/Id/cymru-user-id using the live active directory
  • User roles via the NHS England SDS role identifier namespace https://fhir.nhs.uk/STU3/CodeSystem/CareConnect-SDSJobRoleName-1
  • SNOMED CT via namespace http://snomed.info/sct
  • Read V2 and CTV mapping to and from SNOMED via namespaces http://read.info/readv2 and http://read.info/ctv3 respectively

I have integrations with the following systems, that are due to be ported to this new application:

• National document repository service (Welsh Care Records Service)

Future integrations that will be needed will be:

• Welsh Results Reporting Services (WRRS) - although currently permission has not been available to access this service
• Welsh Demographics Service (WDS) - which includes lookup via the NHS England Spine for NHS number tracing
• Read access to national document repository - although it is unclear whether permission will be given to access this service

You can think of concierge as a "socket adaptor" making it possible to plug-in your clinical application into a local ecosystem. Concierge abstracts those integrations into a cohesive set of APIs.

Technical information

This is a clojure re-write of an original golang-based experiment.

It is designed to provide modules that permit integration with a health and care ecosystem, abstracting services mainly using namespaced identifiers and first-class identifier resolution and mapping.

Proxy settings

Proxy settings are managed manually.

There are three options.

1. You could add proxy settings to deps.edn for an application using this library.

For example:

:test/live
           {:extra-paths ["test"]
            :extra-deps  {aero/aero                 {:mvn/version "1.1.6"}
                          com.cognitect/test-runner {:git/url "https://github.com/cognitect-labs/test-runner.git"
                                                     :sha     "b6b3193fcc42659d7e46ecd1884a228993441182"}
                          ch.qos.logback/logback-classic {:mvn/version "1.2.3"}}
            :main-opts   ["-m" "cognitect.test-runner"]
            :jvm-opts ["-Dhttps.proxyHost=137.4.60.101" "-Dhttps.proxyPort=8080"]}

Will use the same proxy for all outgoing https requests.

2. Use specific per-service proxy configuration

Most services take optional :proxy-host and :proxy-port parameters to permit à la carte selection of a proxy for an individual service. An example is shown in the config.edn file in the live tests.

3. Define proxy settings on the command line

For example, using the clojure command line tools you can pass parameters directly to the JRE:

clj -J-Dhttps.proxyHost=192.168.0.1 -J-Dhttps.proxyPort=8080 -M:test/live

Development

Run compilation checks

clj -M:check

Linting

clj -M:lint/eastwood
clj -M:lint/kondo

Run unit tests

clj -M:test/unit

Run integration tests

(You'll need to be running within the NHS Wales network - and have the right network access / firewall permissions)

clj -M:test/live

Building

Build a library jar file:

clj -T:build jar

Install a library jar file into local maven repository:

clj -T:build install

Deploy to clojars:

clj -T:build deploy

Use as a library

Check for the latest release, or build from source code. You could reference using git coordinates if using clojure, or using maven if using java.

e.g. include using deps.edn:

com.eldrix/concierge {:mvn/version "RELEASE"}

e.g. include using pom.xml:

<dependency>
  <groupId>com.eldrix</groupId>
  <artifactId>concierge</artifactId>
  <version>1.0.139</version>
</dependency>