Friday, October 28, 2011

Combining IHE transactions : Orchestration or Choreography?

Integrating the Healthcare Enterprise (IHE) has gained tremendous momentum in the past few years. Started as a Healthcare Information and Management Systems Society (HIMSS) and Radiological Society of North America (RSNA) workshop in October 1998 with only 15 participants including AGFA, Cerner, Fuji, GE, HP, Philips, Siemens, the IHE initiative has more than 400 members worldwide. It is composed of healthcare professional associations, government agencies, Health Information Exchanges (HIE), healthcare providers, IT and consulting companies, trade, educational, standard and research organizations. IHE provides a standards based-interoperable framework to share and exchange information between healthcare organizations across networks.

Combined with the latest technology and well established standards (HL7, DICOM, IDC9/10, LOINC, W3C), clinical data can then be securely and privately accessed and transmitted locally between network endpoints (e.g. within the same hospital between the practices and a lab). IHE profiles can also be used across Health Information Exchanges (HIE) of Regional Health Information Organization (RHIO), or a state level (e.g. an individual state in the US, Canada or Europe), or at the federal level (e.g. the US Nationwide Health Information Network or NwHIN). As a result, there is a strong need to integrate and combine individual IHE profiles end-points to form “hub of hubs” or “network of networks” to support health information exchange between the participating nodes entities.

Because IHE transactions are most likely to be offered as web services, combining those transactions can be done following Service Oriented Architecture (SOA) and Service Oriented Computing (SOC) principles.

Conventional middleware distributed system infrastructures (e.g. JMS) are generally not sufficient or flexible enough to mediate, transform, federate and route messages from and to web services.

Enterprise Application Integration (EAI) goes one step ahead, trying to separate the applications from the web services end-points. EAI usually employs a centralize service broker for this, a set of connectors and an independent data model. Services can then send and subscribe to receive messages to and from the broker. However, this very centralized approach requires a large amount of up front development and business process design for the connectors, as well as high cost of maintenance in general. Enterprise Service Buses (ESB) is an infrastructure that leverages EAI principles.


Like EAI, orchestration uses a centralized approach. Web services orchestration is realized through Business Process Execution Language (BPEL) that describe the collaboration and interaction between the web service participants.

Business workflows, states, actions, events, control flows and exception handling can be specified. Messages can be received and sent directly from and to WSDL ports. Results received asynchronously from web services can be combined to create new messages. Usually BPEL workflows are created and updated with visual design tools.

There is often an overlap between orchestration engines and Enterprise Services Buses (ESB). Vendors now also offer BPEL design on top of more generic EAI mechanisms enabling true orchestration for ESBs.


Choreography is more distributed and collaborative in nature and uses the Web Service Choreography Interface (WSCI) specification and the WSDL description files to represent the flow of messages exchanged between the Web services involved.

Choreography seems more flexible than orchestration since it does not rely on a central element that could become a bottle neck and seems to offer more complex interaction potential between web services. However, choreography has some drawbacks including the necessity for all web services to be aware of overall business process workflow. WSCI itself does not specify the definition and the implementation of the mechanism to implement the message exchange.

In addition to this, performance can be an issue if high volume message transactions between the end-points peers are not handled properly.

Moreover, there is no clear responsibility for the overall workflow leading to legal issues related to monitoring and maintenance.

Orchestration vs Choreography

Orchestration also has the advantage to be a much more mature integration technology than choreography. For these reasons, most of the state-wide health information exchange networks in the US employ a Service-Oriented Architectural (SOA) model that is implemented through an Enterprise Service Bus (ESB) orchestration.

In addition to this, web service orchestration offers much more than just technical benefits:
  • Organizational: standardization, narrow gap between business analysts and developers;
  • Managerial: risk reduction, lower costs, more flexibility;
  • Strategic: IT resilience, delivery time reduction, less technology lock-in;
  • Technical: portability, reuse, interoperability of tools, less complex code, better maintainability;
  • Operational: efficiency, automation, higher level tasks management.
When deployed on high performance platforms such as SOA software appliances, orchestration solutions are easy to test, extend and maintain.

  • More on this topic to be published as part of the following paper: Andry F., Wan L., HEALTH INFORMATION EXCHANGE NETWORK INTEROPERABILITY THROUGH IHE TRANSACTIONS ORCHESTRATION, 5th International Conference on Health Informatics (HEALTHINF 2012).