Rialto makes clinical information exchange and storage networks simple, easy and affordable by solving the many barriers that exist today. Designed with a scalable, open architecture, Rialto’s services are organized in stack formation and are deployed in several different ways. The services combine to form a comprehensive out-of-the-box toolkit of building blocks that establish the clinical information exchange and storage network. These building blocks simplify the participation of systems and manage the associated complexity of establishing interoperability between information systems, data formats, and terminologies.

Rialto services are grouped into two categories for ease of implementation:

• Common services provide the intelligent routing, advanced transformation and security services essential to most implementations;
• Communication Services provide the core additional functions required to establish the interoperability at each point of care. During implementation, vendors can deploy required common services only, but can easily add additional services later on to accommodate future growth.

The Rialto services stack

In addition to the Common and Communication Rialto services outlined below, the Rialto stack can also accommodate 3rd party services. The Rialto Java-based open architecture extends the capabilities and scalability of the clinical information exchange and storage network.

Communication Services

Document Consumer

The Document Consumer

Imaging Document Source

The Imaging Document Source allows Rialto to store complete published imaging documents. Rialto enables the creation of a federated network in which participants can publish clinical data and images, but prefer Rialto to assume responsibility for discovery and retrieval processes.

This service enhances the capabilities of an existing PACS system by allowing legacy systems to publish imaging information to the exchange network, increasing performance and mitigating existing legacy PACS capabilities.

Document Repository

Rialto’s Document Repository supports the storage of XDS documents, as specified by the IHE Technical Framework. Rialto supports HL7 CDA, PDF, plain text, and image formats, making information accessible to the exchange network that would otherwise be unavailable to other healthcare providers. The Document Repository is used to complement existing repositories where needed.

Document Registry

Rialto’s Document Registry establishes an index of all patient records and clinical information published by a participant. Rialto stores metadata regarding each document, and assumes responsibility for discovery services. For example, when another consumer searches the exchange network for a patient’s records, each Rialto Document Registry service consults its index to determine search results. Rialto forwards retrieval requests to the participant who published the document, allowing a federated network model where participants can publish documents, support the retrieval process, but prefer Rialto to assume responsibility for the discovery process.

Patient Registry

Rialto’s Patient Registry service develops links between patient identifiers sourced from different domains. For example, Patient Registry can link the local PID codes from the HIS or PACS to a master PID for a patient. When participants publish documents into Rialto, Rialto indexes the documents using the cross-reference capabilities of the Patient Registry. When another consumer uses Rialto to discover documents in the network for this patient, all patient documents known to the clinical exchange network are available for retrieval, regardless of the published origin.

Provider Registry

Rialto’s Provider Registry establishes a basic information directory of all human workforce members within an enterprise. The Provider Registry supplies user identities according to the IHE Personnel White Pages  (PWP) and Enterprise User Authentication (EUA) integration profile.

Audit Repository

Rialto’s Audit Repository tracks and reports all access to all patient’ personal health information throughout the entire clinical information exchange and storage network. Auditing logs are searchable, allowing powerful audit tracking and governance.

Common Services

Routing

Rialto’s intelligent routing service is a network-aware request processor that determines the most appropriate service provider based on the requestor’s location within the exchange network. For example, if a clinician places a retrieve request for a patient’s lab result report, Rialto intercepts and routes the request to the service provider(s) that can best serve up the result.

Transformation

Rialto’s sophisticated Transformation service provides for conversion of data formats. Rialto supports DICOM, HL7 V2, HL7 V3 and ebXML data formats out of the box and can easily be extended to support other formats as required. Rialto’s Transformation service also provides for mapping between the various identifier and terminology domains present in a clinical information exchange network. As clinical data is published to the network, Rialto can map local patient identifiers, provider identifiers and terminologies to cross-enterprise values. In addition, as consumers discover and retrieve data, Rialto will map those cross-enterprise identifiers and terminologies back to local values that the consumer understands, allowing legacy systems to fully participate in the network as sources and consumers of data.

Security

Rialto’s Security service performs several functions. Foremost, the Security service ensures that all information is exchanged reliably and securely. Rialto maintains a record of all transactions involving Protected Health Information (PHI), providing a complete audit trail of access to information. Rialto supports patient privacy concerns and confidentiality in accordance with the US Health Insurance Portability and Accountability Act (HIPAA), EU directive 95/45/EC Protection of Personal Data and Personal Information Protection and Electronic Documents Act (PEPIDA).

In addition, the Security service captures patient consent and governs the healthcare providers that can access a patient’s records. Patient consent is captured and stored electronically, ensuring consistent enforcement of privacy policies. The Security service also handles data encryption and decryption to securely communicate information in the network. In addition for all PHI transactions audit record logs are created that can be later used by the Audit Repository for reporting.

Deployment

For ease of implementation, and for maximum flexibility, Rialto can be deployed in the following ways:

• On server appliances -The Rialto platform can be deployed on server appliances or server clusters, providing Rialto services to a number of participants in the exchange network;
• On advanced router technology (such as Cisco’s AXP Router), in effect pushing the complexity into the network;
• Embedded within the participants on the network, such as an Clinical Applications, Diagnostic Imaging workstation, etc.

For ease of administration, Rialto provides web-based tools for configuration and system monitoring. Smart configuration tools capture detailed information about the entire clinical exchange network, ensuring that Rialto is network-aware of configured capabilities of all other Rialto instances. For additional simplicity, all Rialto instances share configuration information to greatly reduce deployment effort and increase scalability of the exchange network.

Platform

For maximum portability, Rialto is implemented in Java. All server applications are based on the Java 2 Enterprise Edition (J2EE) standard and web-based client applications are based on the Java Server Faces (JSF) standard.

Rialto has been validated on the following:

• Operating Systems: LINUX, Solaris, Microsoft Windows Server
• Application Servers: JBoss
• DMBS: Oracle, Microsoft SQL Server, MySQL, Hypersonic
• Hardware: Dell, HP, IBM, Sun, Cisco AXP