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Creating a new NHS England: Health Education England, NHS Digital and NHS England have merged. More about the merger.

Care Integration and Orchestration

Care Integration and Orchestration (CIAO) is an open source, flexible middleware solution with a library of free open source pre-built and tested care integration patterns of health and social care components for NHS systems and standards. That are installable in the platform for specific routing, transformation and workflow tasks. It can be deployed locally within health and social care organisations to "join up" data between local, regional and national systems.

Care Integration and Orchestration (CIAO) is no longer being developed.  It is still available for others to use if they wish, but there are no current plans to develop it any further.

Further information is available from the CIAO archive page.  

CIAO was developed as part of the HSCIC innovation hub.  It was created to connect and share care information between and from multiple care providers and provide a need for system integration or middleware technology to connect different care providers together.  It aimed to share time and skill barriers by using commercial and open source middleware products and frameworks. 

The first CIAO integration developed was the eDischarge community of practice. This supported the transfer of care initiative. 

This work took information from the my eDischarge system and send it to the GP electronically. It aimed to give timely information to improve patient care for patients who have had been in hospital. 

A diagram of how the CIAO integration works

The CIAO integration is a discharge summary document generated from a local clinical system.  The ciao-docs-parser CIP can pick these documents up, parse out any content that can be sensibly and safely extracted. If necessary “enrich” that information with other information (either static information about the local trust or department, or information from other local data sources and in future national sources such as PDS). Then convert the information into a structured CDA document (in line with nationally defined “transfer of care” standards), and send the generated document to the GP via the Spine (or other routes such as ITK web services).

CIAO goals and milestones

CIAO aimed to 

  • accelerate by being a(n)
    • package as a product and appliance
    • easy install, configuration and management
    • out of the box common CIPs
    • development kit for new CIPs
    • publishing reference implementation
  • commoditise by being a(n)
    • free open source platform and CIPs
    • community support for use and development
    • enterprise class resilience and scalability
    • SME opportunities for run, support and development
  • Evolve by:
    • moving from integration technology to integration patterns
    • moving from static to dynamic integration behaviours
    • building, seeding and curating a care integration ecology
    • supporting national interoperability standards. 

build by

  • using Java under an Apache 2.0 license
  • all code published on Github and made available via Maven Central
  • core “ESB” functionality provided by Apache Camel
  • message queueing using Apache Active MQ
  • use of Docker to allow individual CIPs to be deployed as microservices
  • monitoring of running CIPs using Hawtio
  • also support deployment of CIPs into an OSGi container (Apache Service Mix). 

Further information


Last edited: 28 September 2023 8:32 am