Establishing an EMR Application Ecosystem

Establishing an EMR Application Ecosystem

November 2013

Presented by: Keith M. Toussaint, Executive Director, Collaborative Development, Global Business Solutions Ken Bobis PhD, Administrator, Chief Technology Office Mayo Clinic

Track category - Session #

An Open Interface Approach

Slide 1

Keith M. Toussaint & Kenneth G. Bobis

Have no real or apparent

conflicts of interest to report.

Conflict of Interest Disclosure

Slide 2

Agenda

• Definitions • The problem • Solution vision • Business value • An example • Further research

Slide 3

Definitions

• EMR Application • Interface / API/ Protocols • Ecosystem • Open Interface • Open Innovation • ReST-ful

Slide 4

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

EMR Application

Slide 5

• A point where two systems, subjects, organizations, etc., meet and interact Application Program (API) or Web Services

(WS) Interface • Establishes the contract between two

systems

Interface

Source: http://toni.org/2007/01/30/open-source-vs-open-apis/

Slide 6

Ecosystem

• A biological community of interacting organisms and their physical environment

• A set of businesses functioning as a unit

and interacting with a shared market for software and services, together with relationships among them Software Ecosystem, Messerschmitt. D.G & Szyperski,

C., 2005

Slide 7

• open (small ‘o’) May be used by others Control retained by the author

• Open (big ‘O’) Author-independent

• Open Interface <> Open Source

Open Interface

Slide 8

• Using the market rather internal hierarchies to source and commercialize innovations

Open Innovation

Slide 9

• Stands for: Representational State Transfer

• Layered System • Client-Server • Stateless Interfaces • Uniform Interfaces

ReST-ful

Slide 10

The Problem

• Practice functionality needs are huge More than a single HCO 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

Slide 11 Slide 11

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, Mayo Managed HCO provided and managed

Slide 12

Solution Vision • Open Innovation via Open APIs • Public Interfaces Author-neutral interfaces

• Common infrastructure Available to all – but not required

• Layered architecture Separating application, platform and storage functionality

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

Slide 13 Slide 13

Future State

Data Storage and Computing Infrastructure

Core Clinical Informatics Functionality

User Interface

EH

R

PoC Tool 1

Vendor 1

Legend: Vendor provided and managed HCO provided and managed

Vendor 2

HCO 1 Vendor 3

PoC Tool 2 PoC Tool 3

Open; ReSTful:

Open; ReSTful:

Slide 14

Business Value

Slide 15

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

Strategic value to HCOs

Slide 16

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

analytics • Cost savings through shared physical

infrastructure

Financial value to HCOs

Slide 17

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

Operational Value to HCOs

Slide 18

• 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

Value to newcomers

Slide 20

Existing Efforts

Slide 21

• CommonWell Alliance • Smart Platforms.org • Continua Health Alliance • OpenEHR • OpenMRS

Industry examples

Slide 22

• Microsoft HealthVault • Google Health • Optum Health Cloud

Previous Forays from Tech

Slide 23

Further Research

• Cloud-based deployment architecture • Catalog of required of services • Flesh out business value • Operational policies & procedures for

member HCOs • Protocols for EMR & Ecosystem

interactions • Common local & public architecture

requirements

Slide 24

• Current State is sub-optimal • Loosely-coupled architecture • Open APIs • Now possible to make a shift • Can be driven by providers • Opinions invited on how to proceed

Wrap up/Summary

Slide 25

*END* Main Presentation