The Long Tail of Legacy

The Long Tail of Legacy: An additional value of embracing FHIRCasey Helfrich, Chief Architect, UPMC Enterprises2016.11.16 - FHIR Dev Days

Who Am I?

Name: Casey HelfrichCompany: UPMC EnterprisesBackground:

Education/Degrees in Physics and CompSci (Carnegie Mellon)10 years as a Research Engineer @ Intel Switched to Healthcare 7 years ago @ UPMCImplementer! Director Of Engineering Chief ArchitectFocus on Data Driven solutions

(abstraction == goodness)(flexibility > current quality of implementation)

1) Provider

2) Payer

3) Other Stuff

UPMC Factoids

$13 billion integrated global health enterprise

More than 20 academic, community, and regional

hospitals 5,000+ licensed beds

UPMC Health Plan: over 3 million total

members; network of 125+ hospitals, 11,500+

physicians

Affiliated with the University of Pittsburgh

285,000+ inpatient admissions

185,000 surgeries performed annually

3.9 million+ outpatient visits

710,000 emergency visits

$1.5 billion invested in technology over the past

five years

Western PA’s largest employer:65,000 employees

UPMC EnterprisesValue-based care and IDFS development (Population Health)

Cost management (Business Services & Infrastructure)

Risk adjustment(Population Health)

Neurocognitive/concussion assessment (Clinical Tools)

Online mental health wellness tool (Consumer)

Clinical decision support and data acquisition (Clinical Tools)

Automated clinical interpretation of genomes (Clinical Tools)

Cognitive supply chain (Business Services & Infrastructure)

Revenue cycle services (Business Services & Infrastructure)

Supply chain efficiency (Business Services & Infrastructure)

Clinical decision support for cancer(Clinical Tools)

Remote patient monitoring (Population Health)

UPMC (Clinical) Data Sources Inventory

Fundamental challenge

• FHIR provides a solid framework for data liquidity with a higher than 0% chance of reuse

• Most production systems do not actually provide a FHIR interface today

• Most Legacy systems will NEVER natively provide a FHIR interface

• I have application developers who want to write apps today with the hope for minimal work in the future

• We want to use the apps in production

Solution – must be a strategy, not a deliverable

• REDA – Real-time Enterprise Data Abstraction

• Philosophically aligned with FHIR

• There is unavoidable work – do it once

• Provide a framework for contribution with quality – implement opportunistically

• Open Source(ish)

REDA – high level view

1. Take a FHIR request from a client2. Make the corresponding call(s) in the source

system3. Take the returned data and map it to FHIR

resources4. Return the FHIR data back to the client

REDA – simple example

REDA General Requirements

Secure andCompliant Resilient Cost Effective

Federal Regulations

Data Governance

Full Traceability of all Data movement

Make the easy thing the good thing

Elastic Microservices Operational Cost

Development Cost

REDA – asset management

Deploy REDA to Project System

Updates integrated in deliverables

• One implementation per system, multiple instantiations

• Develop source adapters to meet applications requirements

• Submit code back for incorporation into the community

• Updated REDA distributed as a microservice

• App team and core team deploys REDA to their environment

REDA – technologies

• Java – using Maven or Gradle

• Spring Framework

• Docker all the things

• Kubernetes/VMware

• GitLab, Confluence, Jira

REDA – other considerations and extension

• Phase 1: Started as a POC and getting to know FHIR

• Phase 2: Hit real (dev) systems and had a real use case

• Phase 3: HIPAA compliance and production use• API Metrics and Instrumentation (optional)• Code quality, framework, repeatability, empowerment• High availability via Docker/Kubernetes

REDA – result

• 5 Production workloads and one company thus far

• Success == independent team used the framework, developed their own REDA adapter, and contributed it back

• Goal is to become the defacto approach to systems integration @ UPMC (and then beyond).

A Message

• Get lost in the technology…

A Message

• Get lost in the technology…

• But take a chance to come up for air.

A Message

• Get lost in the technology…

• But take a chance to come up for air.

• This is important

Thank you