Open Platforms for Healthcare Applications

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Today's Electronic Health Record (EHR) offerings inhibit the ability to develop the next generation of clinical applications for providers to provide the best possible care and patients to become more engaged. Such offerings are designed as monolithic silos of storage and end-user experience that use proprietary methods for accessing key functionality. While large health care providers typically have physical control over their data, they lack in having functional control. This barrier makes it virtually impossible for data to be easily accessed by other applications without very costly and time-consuming migration strategies. As a result, the pace of innovation is greatly stymied by closed systems that appear to be all-too-prevalent in the healthcare industry. This session presents a strategy of vendor-neutral, public, open Application Programming Interfaces (APIs) and advocates for their use in developing open platforms for healthcare applications.

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HIMSS MN Presents:

Open Platforms for Healthcare Applications

Thursday, August 21, 2014

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HIMSS MN 2014-2015 Event CalendarMonth FormatAugust 21st Webinar – Open Platforms for Healthcare ApplicationsSeptember WebinarOctober Expert PanelNovember Midwest Fall Technology Conference (Chicago)December WebinarJanuary Advocacy EventFebruary WebinarMarch Networking EventApril HIMSS National Chapter Reception (Chicago)May 14th Annual Spring ConferenceJune 3rd Annual Charity Golf TournamentJune Twin Cities Summer SocialJuly SE Minnesota Summer SocialAugust Webinar

Today’s Speakers

Keith ToussaintExecutive Director

Collaborative DevelopmentMayo Clinic

Ken BobisAdministrator

Chief Technology OfficeMayo Clinic

Open Platforms for Health Care Applications

An Open Interface Approach

Presented to HIMSS MNAugust 21, 2014Keith M. ToussaintKen G. Bobis, PhD

Agenda

Definitions The problem Solution vision Business value An example Further research

Definitions

Health Care Organization (HCO) EMR Application Interface / API / Messaging Standard Ecosystem Open Interface

EMR Application

Application that is integral to the delivery of patient care, but not found in the institution’s core Electronic Medical Record

◦ Document Viewer, EMR Viewer, Pt. Itinerary, smartplatforms.org

Interface / API / Messaging Standard Interface

◦ A point where two systems, subjects, organizations, etc., meet and interact Tape data transfer; interface engine

API◦ Application Program (API) or Web Services (WS) Interface

A callable program interface ValidatePatientNumber, ValidateDate

Messaging Standard◦ Rules by which an interface is maintained◦ An agreed upon message format

HL7, FHIR

Ecosystem

(biological) A biological community of interacting organisms and their physical environment◦Rain Forest, Prairie, Coral Reef

(software) A set of businesses functioning as a unit and interacting with a shared market for software and services, together with relationships among them◦Wintel, iOS, Android, Java

Biological Ecosystem

Software Ecosystem

http://subprint.com/blog/it%27s-the-ecosystem,-stupid

Open Source Software Ecosystem

Open Interface

open (small ‘o’)◦May be used by others◦Control retained by the author◦Traditional view of “open”

Open (big ‘O’)◦Author-independent◦Emerging view of “Open”

Open Interface <> Open Source

The Problem Practice functionality needs are huge

◦ More than a single provider organization can satisfy◦ Years to implement workflows in existing products◦ New capabilities removed from “The Gemba”

Closed architectures◦ No access to data sources and business logic

Product lock-in◦ Product B may be more conducive but … switching

costs are prohibitively high

Current State

Data Storage and Computing Infrastructure

Core Clinical Informatics Functionality

User Interface

EH

R X

Monolith

Y

Viewer 1

Tool 1

Viewer 2

Tool 2

Legend:

Vendor provided, HCO Managed HCO provided and managed

Solution Vision Embrace Open APIs

◦ Author-neutral interfaces ◦ Reduce product lock-in

Layered architecture◦ Separating application, platform and storage functionality

New Value Network◦ New problems require new solutions◦ New business models with new value network

participants Common infrastructure

◦ Available to all – but not required

Future State

Data Storage and Computing Infrastructure

Core Clinical Informatics Functionality

User Interface

EH

R

PoC Tool 1

Vendor 1

LegendVendor provided and

managedHCO provided and managed

Vendor 2

HCO 1 Vendor 3

PoC Tool 2 PoC Tool 3

Open interfaces

Open interfaces

Business Value

Strategic value to HCOs

Leverage common core capabilities Minimize capital expenditures Enable rich collaboration Focus on differentiating technology Reduce vendor “lock-in”

Financial value to HCOs

Common platform to meet MU Establish common application frameworks Improved Innovation on reporting and

analytics Cost savings through shared physical

infrastructure

Operational value to HCOs

Enabling Pay-as-you-go tools Minimal up-front costs Same quality tools for all

Value to Newcomers

Enable new value network of application innovation◦Shared core functionality◦New capabilities on existing ‘stack’◦Enabling consistent tools across the spectrum

of care Reduce innovation friction

Existing Efforts

Industry Examples

FHIR HealthKit CommonWell Alliance Smart Platforms.org Continua Health Alliance OpenEHR OpenMRS

HL7 Fast Health Interoperability Resources Fast and easy to implement Implementation libraries Free for use Interoperability out-of-the-box Path from HL7 Version 2 and CDA Web standards compatible Support for ReSTful architectures Human-readable message formats

About FHIR

http://www.hl7.org/implement/standards/fhir/summary.html

Is it big “O” open? Yes!◦ Non-proprietary standards◦ Enables local extension of the standard◦ Well-defined process for evolving the standard

What is missing?◦ Definition of layered architecture◦ Clear description of “separation of concerns”◦ Example of such an architecture:

A Robust Health Data Infrastructure prepared by JASON for ONC: http://healthit.gov/sites/default/files/ptp13-700hhs_white.pdf

FHIR considered

JASON interoperability architecture

Data Storage and Computing Infrastructure

Core Clinical Informatics Functionality

User Interface

Previous Forays from Tech

Microsoft HealthVault Google Health Optum Health Cloud

Further Research

Cloud-based deployment architectureCatalog of required of servicesFlesh out business valueOperational policies & procedures for

member HCOsProtocols for EMR & Ecosystem

interactionsCommon local & public architecture

requirements

Wrap up / Summary

Current State is sub-optimal Loosely-coupled architecture Open APIs

◦Understanding the difference between small ‘o’ and big ‘O’

Now possible to make a shift Can be driven by providers Opinions invited on how to proceed

Today’s Speakers

Keith ToussaintExecutive Director

Collaborative DevelopmentMayo Clinic

toussaint.keith@mayo.edu

Ken BobisAdministrator

Chief Technology OfficeMayo Clinic

bobis.kenneth@mayo.edu

Open Platforms for Health Care Applications

An Open Interface Approach

Presented to HIMSS MNAugust 21, 2014Keith M. ToussaintKen G. Bobis ,PhD

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