Accelerating and Sustaining EHR Innovations
description
Transcript of Accelerating and Sustaining EHR Innovations
Accelerating andSustaining EHR Innovations
Wednesday, May 7, 2014
Seong K. Mun, PhDPresident and CEOOSEHRA
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Innovation and Ecosystem
“Why great innovations fail: It's all in the Ecosystem”
JASON Report*
“EHRs should not be things that one buys, but rather things that evolve through cultural change aided by technology”
*A Robust Health Data InfrastructureJASON Report: November 2013
Forbes-2012The Wide Lens: A New Strategy for InnovationBy Ron Adner of Dartmouth
Open Source EHR Ecosystem
Community
Software Governance
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“Greatness on your part is not enough. • You are no longer an autonomous innovator. • You are now an actor within a broader innovation
ecosystem. • Success in a connected world requires that you
manage your dependence. • But before you can manage your dependence, you
need to see it and understand it. ”
Innovation Strategy is Organic to OS Operations
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The Wide Lens: A New Strategy for InnovationBy Ron Adner of Dartmouth
Community Governance Software
I. Managing VulnerabilityII. Scheduling ContestIII. Managing Code IV. Product Management & ToolsV. Code TransparencyVI. Sustained Innovation
VistA Innovation Areas
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• M2M Broker Vulnerability discovered by Georgia Tech grad student Doug Mackey on 7/31
• Work under NDA– VA, IHS– DSS, Medsphere, iCare, Oroville
• NDA lifted Mid-October• Coordination with VA for release• Code Convergence Effort• Eventual FOIA Release
I: Managing Vulnerability
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Two Security Models
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Open source operating systems such as Android & Linux offer the ability to implement security policies down to the kernel level.
Complete Controlof Implementation
OPEN SOURCE
Partial Control of Implementation
TRUSTUS
PROPRIETARY
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• Goals:– Knowledge Gathering exercise– Risk reduction for future RFP and
Acquisition• Overview: Two Phases
– Phase 1: Evaluate level of integration and compatibility with open source VistA.
– Phase 2: Evaluate broad features and functionalities
II: VA MASS* Scheduling Contest
*Medical Appointment Scheduling System
• America Competes Act• Identify Solutions to Replace Medical
Scheduling Package – Possibly with Open Source
• OSEHRA Tested Submissions for VistA Interoperability and Open Source Content
• 3 Winners • Future Activity – Under Discussion
Contest Implementation
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VA701-14-I-0147SOURCES SOUGHT
Office of Health Informatics and Analytics (OIA)VistA Evolution Program (VEP)
Challenges with Competition and Prizes
VistA Evolution
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ProprietaryProducts
EcosystemOpen and Proprietary
Open CommunityActivities
OS Products
III: Managing Code
• Managed– Code subject to formal review/certification– Changes reviewed and subject to configuration
management– Examples: FOIA VistA, OSEHRA VistA
• Hosted– Code placed into repository by community– Storage and retrieval only– Could be certified– Could be incorporated into managed code base
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Managed Code Submission Path
VistA Patch
RepositoryApprovalGerrit
ReviewManaged Code Submission
Instrumented VistA Instance
Dashboard
ForumCommunity Notification
OSEHRA Technical Journal
New Code Submission VistA-M
Repository
Automated Tool
OSEHRA VistA Reference Instance
FOIA VistAReference Instance
GithubGithub and Gitorious
Mirrors
Mirrors
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Open Source Software Repositories
Generic Repositories
OSEHRA RepositoriesTools
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• Improves/ensures the quality of Open Source code
• Critical to making code reusable for code intake by the community
• NOT a replacement for acceptance, integration, or regression testing by new user organization
Open Source Software Quality Certification
Usable: Appropriate licensing and documentation
Safe: Individual code units do not cause errors in other components of the system and the code is robust to all code paths and conditions
Compliant: Code meets agreed upon interface specifications and code conventions, and complies with all applicable laws and regulations
Functional: Code has a defined set of requirements that are met when the code executes
Maintainable: Integral unit tests are provided to facilitate regression testing
OSEHRA Certification Standard
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Certification Levels
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Name/ Number Space
Dependency / SAC
Open Source License Documentation Code Review Test
InstallationRegression
TestingFunctional
Testing
Level 1 Pass Pass Apache 2 None Large # Non-critical Issues
Large # Non-critical Issues
Existing Tests Pass
Large # Non-critical Issues
Level 2 Pass Pass Apache 2 Basic Small # Non-critical Issues
Small # Non-critical Issues
Existing + Some
R. Tests
Small # Non-critical Issues
Level 3 Pass Pass Apache 2 Substantial No Issues No IssuesExisting + >=
50% Coverage
No Issues
Level 4 Pass Pass Apache 2 All Required No Issues No IssuesExisting +
>= 90% Coverage
No Issues
• Level 1 is reserved for VistA legacy code. • Levels 2-4 are growing certification compliance. • For new code developed under VA contracts, OESHRA
recommends a minimum certification level of Level 3.
IV: Product Management & Tools
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VIVIANVisualizing VistA and Name Space
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Root view from VIVIAN “Collapse All” option.
Clicking the “VistA” button expands the tree...
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...Now we see several categories of capabilities. (We can scroll down to view the ones that aren’t now visible.)
We’ll select “Provider Services”...
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...and that subtree comes into view.
Now we select “Order & Results Management”...
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...now we see the Order & Results Management capabilities.
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When we click on “Order Entry Results Reporting”...
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We see the namespaces of the M routines and globals that the package uses. (The leading exclamation points designate partial namespaces that are excluded.)
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A “Dependencies & Code View” hyperlink lets us see lists of dependencies, globals, Fileman files and M routines...
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The Dependencies window includes a hyperlink to package documentation in the Vista Documentation Library.
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When we scroll further down the Dependencies window, we see a list of routines. Order Entry Results Reporting has over 1,000 routines!
We can select a routine...
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...to get a screen of routine information and dependencies.
A “Source Code” hyperlink can be clicked...
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...to get a view of the M source code.
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Back on the modal window, an Interfaces frame contains hyperlinks to M APIs, Remote Procedure Calls, Web Service APIs, and HL7 messages.
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The M API link lets us see all of the entry points in M code that have been documented for database integration agreements.
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Here we see the routine names, tags, and additional descriptive information that is displayed for M-language application programmer interfaces.
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We can click a hyperlink to see all of the remote procedure calls that the package provides through the VistA RPC Broker.
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The Remote Procedure Call view shows RPC names, tags, routines, and availability within the VA Enterprise.
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Another hyperlink lets us see all the package’s web services that can be invoked through VA’s MDWS (Medical Domain Web Services).
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The Web Services view lists web service names, facades, parameter and descriptive information.
We can select a web service...
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...to get descriptions and sample syntax for all the operations that the web service supports.
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The last hyperlink in the modal window’s “Interfaces” frame lets us get a list of supported HL7 Version 2 messages.
V: Code Transparency
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Transparency Enables Innovation
ACCE
LERA
TE
ADOPT• Leverage Previous
InvestmentADAPT• Re- Purpose• Re-Architect
INNOVATE• New Solutions• Continuous InnovationComm
unityActors
OS EHR
ACCELERATE
OSEHRA Today• 2,400+ Individual Members around the Globe• 13 Corporate Members, 3 Collaborative Partners• Approximately 15 staff members• Headquartered in Arlington, Virginia• Annual Budget: App. $5 Million
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VistA is Deployed World-Wide
Working Group Roster
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Group Name Type Group Name TypeAcademic Affiliates Work Group Interoperability Work Group
Architecture Work Group M2M Code Intake Open Source Project Group
Certification Work Group MDWS Open Source Project Group
Code Convergence Work Group Open AHLTA Project Group
Open Source Project Group
Development Tools Discussion Group Patient-Centered Care Work Group
Education Work Group Product Management Open Source Project Group
Fileman and Lab Agile Project (FLAP)
Open Source Project Group Reminders VA Work Group
Forum Open Source Project Group VistA Dialects Work Group
Genomics Open Source Project Group VistA Evolution CITE Discussion Group
Imaging Work Group VistA Novo Open Source Project Group
Immunization Open Source Project Group Visualization Open Source Project Group
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Sustaining Innovation
Key Issues OS Approach
I. Vulnerability • Security during collaboration
• Temporary security via NDA until patch available
II. Contest: Scheduling • Evaluation Criteria
• Collaborative definition• of OS code quality• Requirement for Open
APIsIII. Managing Code • Adapt/Adopt
• Contribution• Licensing
• Certification Standard
VI. Product Management
• Architecture • Open APIs• Governance
V. Code Transparency • Finding code• Sharing code
and interfaces
• Communication and Collaboration
• Maximum exposure to submitted code
• OS Licensing
• Industry Feeling Limits in Closed Code – Apple vs Dominance of Android– Closed Systems Embracing OS Methods– Spectacular Success of Netflix
• Main Challenges Today– Ownership vs. Sharing– Control vs. Open Innovation– Community Management
State of Open Source
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Where do we stand among our peers?
Ad Hoc Opinion
Leaders
Single
Moderator
Committee-
Based
Commercial
Support
Members
OnlyClosed
Stro
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Cop
ylef
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Wea
k
Cop
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Non
-
Cop
ylef
tPe
rmis
sive
Lice
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Governance Model (how contributions are managed and accepted)
Linux Kernel
Firefox
Eclipse
Android
OSEHRA
GENIVI
Openstack
The
Foundation
The Apache Foundation
WHO DECIDES?- Courtesy of MARK RADCLIFF
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Open Global CollaborationTotal Transparency in Software
www.osehra.org