NSW Health Pathology Aided by APIs in Response to COVID-19

Over the past four years, NSW Health Pathology invested heavily in API-led connectivity. With coverage from Justin Hendry, writing for ITnews.com, we learn how this investment has paved the way for them to pivot handily to building public-facing services during the coronavirus pandemic. 

At this year’s MuleSoft CONNECT digital summit, enterprise architect Tim Eckersley spoke about the agency’s rapid response early on in the pandemic, crediting the agency’s “large Library of healthcare microservices.” This library is one of the projects developed over the past four years, designed to allow “seamless Integration between a very broad range of healthcare systems...each wave of delivery built up a groundswell of microservices...the reusable components gradually take a much more dominant posture and provide a really solid launching place to have this rapid response.”

Disclosure: MuleSoft is the parent company of ProgrammableWeb.

The NSW agency is the largest public provider of pathology in Australia. Eckersley leads the agency’s DevOps. He credits their architectural approach with allowing the agency to build out and launch a results-delivery bot in just two weeks. 

Eckersley explains, “In terms of what we’ve been able to achieve with MuleSoft, we’ve used it to integrate our four laboratory information systems, which are our core systems of record in the background, with the greater health system...So that’s the eMRs [electronic medical records] or the eHRs [electronic health records], depending on if you're in Australia or the United States, as well as the outpatients administration systems.”

Eckersley’s team developed their automated, citizen-facing service in the first weeks of the pandemic, working in partnership with AWS, Deloitte, and Microsoft. This group approach shaved off a tremendous amount of work time: Eckersley credits the strategy with returning “5,000 days of effort back to clinical frontline staff.” The service will also work to “tie those [systems] together with our federal systems, so things like the My Health Record and the national cancer screening registry.”

The service is projected to return test results in as little as 24 hours or less - much more quickly than in other parts of the world. This service was initially piloted with a few regional clinics, before rolling out in the rest of the state. The simple, approachable service is easy for participants, Eckersley explains. “All [patients need to do when they go to get a nasal swab taken] is scan a QR code and it immediately pops open a text message of ‘what are my results?’ to our text bot service...and then that text bot requests that [the patient] put in identifying information, as well as the date their collection was taken, and it will instantly give them the results as soon as they become available.”

A key facet of the strategy is focused on collecting fringe cases, with a bot which integrates with a healthcare system (such as Cerna, Auslab, and a Jira service desk, which allows automated ticket creation). This collection enables the service to keep notifications within a three-day window of response time. The four-year process of building a library of microservices is the foundation enabling the agency to hit the ground running with a delivery window of two weeks. 

Eckersley breaks down the more technical elements of their process: “[By] taking an HL7 message, using the MuleSoft HL7 adapters and then connecting it up with cloud infrastructure like Azure service bus for messaging, we’ve been able to make a state-scaled solution really quickly which can pick up the millions of messages that we get running through the state in any given week and handle them in an API-led way...So we take that message in HL7, we convert it to XML, and then we push it through our process API layer...at that point, it is converted into a range of different FHIR [Fast Healthcare Interoperability Resources].”

Converting to FHIR empowers the agencies to use a NoSQL database like Cosmos at hyperscale: information can then be stored, and experience APIs can be presented to agency web and mobile apps (as well as those belonging to their partners). The agency is currently shifting all Mulesoft services piecemeal to Kubernetes, with the idea that a slow shift will reduce risk and allow detailed prioritization of which apps move when. 

Also presenting at the 2020 Mulesoft CONNECT digital event was NWS Health Pathology CIO James Patterson. Patterson praised the strategy of reusing as many components as possible, explaining that it reduced the creation of “technical debt.” Patterson explains: 

“Even where we’ve had things like a billing project that’s using MuleSoft integration to bring data from our legacy systems into our more modern systems, we’ve been able to pick up components of that previous project and reuse them to build these new services. Where we've had legacy, we’ve had to build things from scratch in our modern integration environment, and obviously that takes longer and takes more effort...we're creating a situation where we’re removing technical debt as we go through the crisis, and I think that’s been really centered around our strategy with Mulesoft.

Patterson credits the upheaval of the pandemic with forcing adoption of agile practices, whereas pre-pandemic, agile practices made up just 10% of the work time at NSW Health Pathology. He praises the shift, musing that “I think the opportunity is now there to introduce that way of working into all of our work or most of our work, which will really enhance the experience of our customers internally.” 

Be sure to read the next Microservices article: How Microservices Empowered the UK's DWP to Pivot During COVID-19

Original Article

How APIs helped NSW Health Pathology respond to COVID-19