King's College Hospital Integrates with Red Hat JBoss Fuse

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February 17, 2014

King’s College Hospital (KCH) NHS Foundation Trust needed a new middleware platform that would allow over 50 hospital systems to exchange critical patient information quickly and reliably.

Customer: King's College Hospital NHS Foundation Trust

“In a critical healthcare environment, where messaging concerns the diagnosis and treatment of patients, reliability, speed, and integrity are non-negotiable requirements.” - Patrick Johnson, change leader in the strategy department, King’s College Hospital NHS Foundation Trust

Industry: Healthcare
Geography: EMEA
Country: United Kingdom

Business Challenge:

With time running out for its aging integration hub, King’s College Hospital (KCH) NHS Foundation Trust needed a new middleware platform that would allow over 50 hospital systems to exchange critical patient information quickly and reliably.


With timing and budgetary constraints, they reached out to Red Hat partner Answer Consulting and implemented an integration hub based on Red Hat JBoss Fuse that offers better reliability, speed, and manageability than its predecessor.


King’s College Hospital NHS Foundation Trust supports one of the UK’s largest and busiest teaching hospitals, with nearly 7,000 staff providing around 1 million patient contacts a year. The organization has a unique profile, with a full range of local hospital services for people in the London boroughs of Lambeth and Southwark, as well as specialist services to patients from further away. It also plays a key role in the training and education of medical, nursing, and dental students with its academic partner, King’s College London (KCL). Answer is a creator of business solutions for some of the world’s leading companies. Delivering innovation to generate bottom-line benefits for big and small organizations in every market sector. From award winning financial trading platforms to mobile workforce apps, Answer understands the art to designing the possible.

Business Challenge:

Fast, reliable transfer of medical information essential for high-quality patient care

In 2012, IT staff at King’s College Hospital (KCH) NHS Foundation Trust faced an urgent situation. For 15 years, the hospital had relied on the same integration solution to handle messaging between over 50 clinical systems and to underpin electronic patient records, but the license for this solution was due to expire at the end of March 2013. The team had less than one year to implement a new integration hub capable of handling large volumes of messages between enterprise systems, transferring and transforming them at high speeds, and ensuring that the integrity of messages was preserved in transit.

“In a critical healthcare environment, where messaging concerns the diagnosis and treatment of patients, reliability, speed, and integrity are non-negotiable requirements,” said Patrick Johnson, change leader in the strategy department at KCH.


Red Hat JBoss Fuse: The scalable, open source integration solution

The team at KCH evaluated a range of integration hubs and ran several proof-of-concepts (POCs) before deciding that an open source approach would best suit its requirements.

“We felt that an open source solution would not only be more cost-effective, bearing in mind the limited budget available for the project, but would also give the integration team the flexibility to build out the integration hub over time and expand its use in line with future hospital needs,” said Johnson.

KCH needed a robust, enterprise-class open source solution that came with a full range of professional, 24x7 support and services. This, according to Johnson, was essential in giving the team at KCH the confidence to deploy technology that would be used to integrate mission-critical hospital systems. A busy hospital cannot stop admitting and treating patients because an IT system link has failed or the IT staff member who knows how to fix it is off-duty or moves to another job.

These requirements led the team to Fuse ESB, FuseSource’s supported distribution of the open source enterprise service bus (ESB) Apache ServiceMix. This product was chosen because of its strong track record in high-volume messaging and ESB environments. FuseSource was subsequently acquired by Red Hat in June 2012, bringing Red Hat’s world-class support to the product and renaming Fuse ESB to Red Hat JBoss Fuse.

KCH recognized that to switch a core system from proprietary to open source software against a pressing timeline required expert assistance and sought out Leeds-based Answer Consulting. In only a few days Answer had proposed an architecture for the solution and a plan for the combined team to deliver within a tight timeline and budget.

However, KCH had also to develop the in-house programming skills it would need to get the ESB implemented and to incorporate new message types and end-point systems in the future. The team implemented a training plan to help staff understand various technologies on which ServiceMix relies, including Spring application development framework for enterprise Java programming, the Apache Camel integration framework for routing, transformation and mediation, and the ActiveMQ message broker. The five-person integration team welcomed this training, as it represented an opportunity for them to work with new technologies and expand their professional skills base. It was delivered via a mix of on-site training from Answer and virtual sessions conducted by video conference, a method which is also available through Red Hat Training.

Meanwhile, consultants from implementation partner Answer assisted in mapping out the complex network of traffic flows and data dependencies that run between the hospital’s various systems. Especially important are those that underpin vital, time-critical operations such as Accident & Emergency and the Pathology department.

With over 50 systems of varying size, complexity, and criticality to be migrated to the new hub, an incremental implementation plan was formed. Larger hospital systems were integrated first, followed by smaller groups of dependent systems. Before the go-live date­­ — on which a system was disconnected from the old integration hub and permanently plugged into the new one — extensive testing was carried out to ensure that all messages running to and from that system met required levels of speed, reliability, and data integrity.

“Answer was able to accelerate our project by providing the right level of training and advice on critical architecture decisions. We didn’t want someone to come up and do everything; we needed a partner that would work with us so that the in-house team could support the product once it had gone live,” said Clive Stringer, deputy IT director at KCH.

Despite the complexity of the project and the limited time available to complete it, the introduction of Red Hat JBoss Fuse was achieved with no impact on the users of these systems throughout the hospital’s wards, departments, and offices and involved no changes in working practice for them, according to Johnson. Today, it is used by the majority of hospital systems at KCH that need to exchange data with other systems.


Seamless messaging and integration support consistent care for patients

“The efficient working of any large hospital is highly dependent on different systems being able to ‘talk’ to each other,” said Johnson. “From the moment a patient enters the hospital’s care, and throughout their treatment, data about them is being entered by both administrative and clinical staff into a wide range of multidisciplinary systems, so a fast and reliable integration hub is essential to consistency and continuity of care for patients.”

As a result of implementing Red Hat JBoss Fuse, King’s College Hospital NHS Foundation Trust now has a faster, more reliable integration hub capable of seamlessly integrating different hospital enterprise systems. The open source technologies at its core are reliable, high-performing, and cost-effective. At the same time, because of Red Hat’s subscription model, KCH staff has round-the-clock access to service, support, and software upgrades and updates.

“We’re aware of other hospitals working on similar integration projects, but because they’re using proprietary technologies, they’re spending a lot more money than we did, and their projects are typically expected to last several years,” said Johnson. “At first, open source technologies seemed like a gamble, but with proper and careful analysis upfront, the decision to use open source really paid off for us.”

In terms of the IT team managing the technology, the new hub is better documented than its predecessor and, because more people were involved in its implementation, there is a wider understanding of the technology involved. That means that KCH has a good supply of in-house maintenance expertise, plus easy access to out-of-hours cover to tackle any problems. And, because the integration hub is developed using non-proprietary Java technology, recruitment of new staff with the skills needed to maintain and develop it further will be easy.

Simple text files are used in the configuration of the hub’s core—for example, memory allocation and error logging—and in the configuration of routes. This makes trouble-shooting and overall maintenance a great deal simpler for the team to perform. In addition, integrations based on Apache Camel are easier and quicker to develop, deploy, and maintain. Apache Camel provides a robust, proven, and easy-to-use integration framework based on the commonly used enterprise integration patterns.

In terms of performance, the new integration hub wins hands-down. The old integration hub was frequently overwhelmed by the number of routes it was expected to handle, taking up to an hour to reboot. The new hub rarely chokes and can reboot in under two minutes. Its processing capabilities represent a vast improvement. Recently, when a third-party end-point system was rebooted after four hours of downtime, the integration hub was able to process the backlog in five minutes, demonstrating a fast and reliable platform.

For King’s College Hospital NHS Foundation Trust as a whole, the new integration hub provides a degree of future-proofing that its predecessor couldn’t guarantee. “We looked at where we wanted to go as an organization,” said Johnson, “which systems we’d need to integrate in future, and what new projects that we had in mind. We knew that our previous integration hub simply wouldn’t allow us to meet our goals. With Red Hat JBoss Fuse, we’re now well-equipped for the journey ahead.”

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