Slide Deck from Gene Dragotta and Sachin Agarwal's Cloud Expo Presentation: A Peek into the Future of Mobile-Enabled Health Care

While unprecedented technological advances have been made in healthcare in areas such as genomics, digital imaging and Health Information Systems, access to this information has not been easy for both the healthcare provider and the patient themselves. Regulatory compliance and controls, information lock-in in proprietary Electronic Health Record systems and security concerns have made it difficult to share data across health care providers.

The opportunities inherent in mobile technology are dramatically changing the way healthcare business gets done. Healthcare provider professionals are adopting mobile devices and tablets as an alternative to desktops/laptops and using mobile applications to augment gaps in existing patient management system capabilities. Developing mobile applications for the healthcare industry has some unique challenges, particularly protecting your backend data services while making them available to mobile application frameworks and SDKs.

Mobile applications utilize messaging patterns similar to the client/server and AJAX patterns, however unlike desktop clients, mobile devices have to minimize client side processing to maximize battery life and also keep network chatter to a basic minimum. This is achieved by using RESTful APIs with machine-readable formats like JSON. The availability, reliability and performance of these API-based services are critical to the successful deployment and operating of your application.  Now add some healthcare domain requirements (encryption, security, etc.,) to this environment and there is a lot of work to do in addition to the actual coding of your mobile application.  An API management system will simplify exposing and consuming backend healthcare services through a variety of different channels. To successfully implement an API, you will need a tool that will enable simple enforcement of API controls, continuous monitoring capabilities, performance management, and assurance of high availability.

An API management system will typically provide capabilities for creating and registering service as follows:

• Secure API Services
• Manage API Lifecycles
• Mediate and Virtualize Services
• Govern Access to Services
• Integrate Services and their Data
• Support Authentication and Authorization for all APIs and Services, including OAuth, OpenID, SAML, Kerberos, WS-Security, LDAP and XACML
• Support for all Major Security Standards, including WS*and WS-I

The focus of this article is to discuss how a unified API management and SOA governance platform can accelerate your organization's ability to deliver reliable, scalable and secure mobile applications for healthcare providers. First we will begin with the major technical challenges encountered when deploying healthcare-based mobile applications. Then we will discuss API management and governance platform expectations that can help you overcome these challenges such as the following:

• Data Encryption
• Access Control - Role and Application-based Access
• Integration / Orchestration of data from Multiple Provider Systems
• Mediation
• Quality of Service Control
• Usage Analytics / Event Management

Security - Encryption, Authentication and Authorization
A PKI facilitates users, applications and systems to exchange insecure data safely by encrypting it prior to transmission. Unlike traditional cryptography that uses private keys also known as symmetric cryptography, the public key infrastructure utilizes public key cryptography or asymmetric cryptography. This is used to authenticate a user or manage message encryption.

With asymmetrical cryptography, a public and private key are created simultaneously using the same algorithm (such as RSA) by the certificate authority. The private key is given to the requesting party and the public key is made publicly available (embedded within the certificate) in a location that all parties can access. The private key is used to decrypt text that has been encrypted with the public key. The certificate is used to authenticate the user.

Typically a PKI provides:

• A certificate authority (CA) who issues and verifies the digital certificate. A certificate includes the public key or information about the public key
• A registration authority (RA) acts as the verifier for the certificate authority before a digital certificate is issued to a requestor
• Persistent storage of the certificates and keys
• A certificate management system (creation, import, export, revocation, etc.)

In addition to authenticating with a validated digital certificate, using SAML, an SSO token, basic HTTP authentication, an X.509 certificate, an application token or a third-party IAM system are all popular approaches that can be used to securely connect your mobile application to back-end systems and data services residing with the HIE enterprise.

When health provider personnel authenticate themselves on systems that access patient health records; it's likely that different employees will require and qualify for various levels of data access based on their job description. For this reason, a role-based authentication / authorization framework is recommended. For example, the front office personnel may only have a need to see basic information such as patient demographics, insurance and medication information and a nurse might be required to have access to the entire patient's medical record. Having a framework for implementing role-based access will easily help filter and mask patient data attributes from un-authorized use.

Mediation and Service Orchestration
Where are your patient's medical records, how many sources of data needed to be aggregated, transformed and merged to assemble them, what formats of data do these sources of patient record fragments support etc.? Architects and developers typically face these questions when working with multiple systems both internally and externally to assemble a patient's holistic and contiguous health history or continuity of care document (HL7 CCD). Often developer are using integration engines such as Rhapsody, Mirth, etc., to transform HL7 messages, legacy EDI messages, database data, along with other source of patient information into in XML and usually exposed via a SOAP service.

Most mobile UX frameworks support some form of a model-view-controller runtime design pattern or at a minimum provide a way to perform an XMLHttpRequest to retrieve data. Whether using an MVC pattern or a lower-level URL request, REST is the preferred method (over SOAP) primarily for the simplicity of setting up the request. A SOAP service will return an XML document. When using a JavaScript-based framework such as Sencha Touch, using JSON for data objects is usually preferred. The mobile app framework's data store component prefers the use of a REST service and the data it returns to be in JSON format. With this approach, the integration engine is providing a SOAP/XML service, unless we re-write and convert the SOAP service to a REST service, the mobile application will need to mediate between the SOAP and REST protocols and XML and JSON object formats.

In addition to mediation, service orchestration and the creation of compound services are a common requirement for health care oriented mobile applications. As an example, in order to create a patient's HL7 CCD, patient data usually resides within multiple systems, data service requests (primitives) to these systems will need to be orchestrated to form the resulting CCD dataset. In some cases, data returned from some of the primitive service requests may require some transformation or may be used as input to a subsequent request. Encapsulating and abstracting multiple primitive requests and any associated logic into a single composite service operation will reduce overall mobile application implementation complexity and message traffic between the mobile device and the HIE data center.

Policy-based Governance Controls for API Services
In most cases, we probably want different licenses with different levels of service (and access) to the backend APIs that enable our mobile applications. The levels of service could be measured in throughput, the bandwidth consumed over time, concurrency and availability.

Within the realm of health care you might want to have some specific controls or governance policies regarding the use of the HIE's back-end system services or APIs. Below are some QoS and SLA examples.

• Allow APIs to be called no more than 10 times per minute per device
• Allow devices to consume no more than 100MB per hour
• Prevent devices from outside the trusted country list (user-defined)
• Allow devices with this IP address range x.x.x.x-x.x.x.x to access the service layer
• Prevent Denial-of-Service attacks with quota management and white/blacklisting
• Only allow certain APIs to be called by specific user roles

The back-end services within the HEI should be deployed within an infrastructure that can provide a similar level of API governance.

Usage Analytics
In order to understand how your HEI back-end service layer is performing and being utilized by its application consumers, the API management platform should provide access to real-time API usage statistics, API status and event and SLA violation monitoring. These analytics can be used for troubleshooting, performance tuning, threat detection and various usage reports.

Most enterprises utilize a dashboard and reporting system that ingests telemetry data from a variety of systems within the enterprise. Data from these systems are combined to create a complete picture of enterprise system activity. Therefore it may become important to have a capability that can export or publish API management system telemetry data to an enterprise activity monitoring system or reporting data warehouse.

Conclusion
Healthcare-focused mobile applications contain complex use cases and have strict operational requirements. Security models, message protocol mediation services, service usage statistic collection, data transformations and service orchestration functions are all features that can easily be added to your mobile application by leveraging and integrating an API management and governance system with your service oriented architecture.