Enabling a Multi-Vendor EHRS Using Document Storage and Interchangeable Apps - PowerPoint PPT Presentation

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Enabling a Multi-Vendor EHRS Using Document Storage and Interchangeable Apps

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The KIS Architectural Framework Gordon Raup, CTO Datuit, LLC Started from a business need Build software to make the PCMH work Found cross provider collaboration is ... – PowerPoint PPT presentation

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Title: Enabling a Multi-Vendor EHRS Using Document Storage and Interchangeable Apps


1
Enabling a Multi-Vendor EHRSUsing Document
Storage andInterchangeable Apps
  • The KIS Architectural Framework

Gordon Raup, CTO Datuit, LLC
2
Introduction
  • Started from a business need
  • Build software to make the PCMH work
  • Found cross provider collaboration is difficult,
    time-consuming and expensive with current
    technology
  • Goals
  • A single Electronic Chart for the Patient that
    all vendors use
  • Allow provider to modify EHRS without vendor
    assistance
  • Current Status
  • Provisional Business Process Patent was filed May
    2010
  • Changed companies to accelerate progress
  • Currently working on the prototype and finalizing
    the patent

3
The current HIT Database ModelThe Hairball
4
Consequencesof the Database Model
  • Data is stored in Silos
  • No single database schema can meet all needs
  • Databases dont scale up well for large volumes
    of data
  • Provider is dependent on the Vendor
  • Only the Vendor can change the system
  • Very expensive to change Vendors
  • Innovation is expensive
  • Must either be done by or coordinated with the
    vendor or done in a different silo

5
More Consequencesof the Database Model
  • Interfaces required to link silos
  • Requires agreement between two vendors and the
    provider
  • Fragile and expensive
  • Cross-Provider collaboration is difficult
  • Data from different providers must be viewed
    separately or translated
  • Translation is expensive and risky
  • Vendors pursuing a winner take all strategy
  • Health Reform Difficult with Database Model
  • Accountable Care Organizations and Medical Homes
    require high level of cross-provider
    collaboration

6
The KIS Framework, part 1The Document Model
7
Document Model
  • All permanent storage is done in documents
  • Context always kept with data
  • Use only published standards for which
    conformance can be tested
  • Continuity of Care Document (CCD)
  • Clinical Document Architecture (CDA)
  • Use only documents conformant with the HL7
    Reference Information Model (RIM)
  • Use Logic Apps to extract and combine data from
    multiple documents

8
Data Keeps Gate Servers
  • Store Documents in Specially designed data
    centers Data Keeps
  • Every patient has Primary Data Keep where all
    Documents are stored, regardless of vendor.
  • Multi-level storage Permanent layer,
    BigTable-like layer, RAM layer
  • Fierce Protective Shield Gate Server
  • Patient identification, User ID Role
    authentication, validation of User Permissions,
    Session Authentication and Termination,
  • Encryption and decryption.
  • Document Masking per Patient Consent.

9
Interchangeable Logic Apps
  • Accelerator Apps inside Gate Server
  • Tightly integrated with the BigTable layer
  • Purpose is to have data end user needs before it
    is asked for
  • Predictive modeling based on knowledge of health
    system, patient health status and user past
    practices.
  • Interchangeable Diabetes Center may want
    different Accelerator than Cardiac Rehab
  • Data Agents outside Gate Server
  • Viewer Agent, Communication Agent, Logic Agent
  • Tightly integrated with end user browser session
  • Purpose is to prepare new screens before browser
    action generates request for them

10
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11
The KIS Framework, part 2The Assembly Line
12
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13
Interchangeable UI Apps
  • Apps are Nested
  • Four types of Primitives Action Elements, List
    Elements, Data Widgets, Page Definitions
  • Four Levels of Nesting Page Sets, Solution
    Sets, Packages, and Applications
  • Tightly integrated with Viewer Agent
  • Apps have Defined Roles and Services
  • Med List App must be able to supply meds in a
    standard format for other apps to use.
  • Office Visit App must have all of the required
    elements of an Office Visit
  • Requirements are usually a constraint on
    underlying document standard

14
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15
Advantages of KIS
  • Single Electronic Chart for each Patient
  • All Data for the patient in one place No
    interoperability required. EPC instead of EHR
  • Avoids the cost, speed delays, and translation
    risk of HIE
  • The tight care coordination needed for Medical
    Homes and Accountable Care Organizations wont be
    realized unless each provider can see all of the
    data quickly, whenever they want it.
  • Allows all Providers to be in the same silo
  • Because all documents must conform to published
    industry standards all vendors can reliably read
    and interpret the data.
  • Documents posted by one provider are immediately
    available and usable by other providers and
    their Data Agents.

16
More Advantages of KIS
  • Fosters innovation in care delivery
  • Technically-aware healthcare providers or their
    IT departments can create their own page sets,
    data widgets, and KIS packages without technical
    training by using KIS BUILDER
  • Such innovators can sell their IP with little
    effort and investment and automatically have
    proceeds deposited in their bank account each
    month.
  • Reduces Health IT costs substantially
  • By allowing provider organizations to compete
    with vendors, overall IP costs will be reduced
  • By using simple interchangeable parts, the system
    will be cheaper to maintain and adjust
  • By moving to a Utility Computing model health IT
    infrastructure costs will be substantially
    reduced.

17
Still More Advantages of KIS
  • Supports Open Source without the challenges
  • Developer organizations can provide KIS apps to
    others at no charge or for a small fee.
  • KIS Organization will ensure system reliability
    and enhancements.
  • Makes FDA Quality Standards Practical
  • KIS breaks software apps into small chunks that
    can be separately tested to higher standards.
  • Allows true Provider-Patient Collaboration
  • Different KIS apps tailored to consumers can
    display the same data as recorded by healthcare
    providers no importing.
  • Patients can add data to the EPC just like any
    other provider

18
Technical Challenges
  • Response Time
  • Database technology was developed to improve
    response time, but is not scalable.
  • KIS will use small independent distributed Data
    Agents to provide real time data and services to
    end users
  • Data Agents will use in-memory fast-response data
    structures such as NOSQL, and modern search
    algorithms such as web crawlers and predictive
    modeling to provide fast response time.
  • It is anticipated that when fully built out,
    response times will be better than comparable
    database response times.

19
Technical Challenges
  • Choosing Document Standards
  • Not all types of documents have published
    standards that are widely accepted.
  • Different document standards will be required in
    different countries and in different industry
    segment
  • Industry is now rapidly coalescing around
    preferred standards
  • A common marketplace of supported standards as
    implemented in the KIS platform will accelerate
    this process
  • Ensuring Privacy and Security
  • Robust Identity Management and Privacy Consent
    Management will be critical to widespread
    adoption.
  • The Health IT industry has struggled with both of
    these electronic management challenges. Both are
    substantially easier to lock down with a
    consistent system.
  • KIS provides vendors such a consistent system
    while providing a level playing field on which
    to compete.

20
Thank you!
  • Gordon Raup, CTO
  • Datuit, LLC
  • graup_at_datuit.com
  • www.datuit.com
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