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The realities of Healthcare Enterprise Data Interoperability and Integration

The realities of Healthcare Enterprise Data Interoperability and Integration

Presented at 2015 OSEHRA Summit.
Background:
* Many enterprise apps are being built these days, most are designed to work as a stand alone system similar to consumer apps
* Healthcare-specific software engineering and integration tools are going to do more harm than good (industry-neutral is better).

Takeaways:
* Any enterprise app which acts like a consumer app that doesn’t integrate well into hospital or ambulatory systems and workflows is doomed
* There’s nothing unique about health IT data that justifies complex, expensive, or special technology.
* There’s a lot unique about healthcare workflows that require common technologies to be adapted properly.

Shahid N. Shah

July 29, 2015
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Transcript

  1. The No BS Guide to Developing an Enterprise
    Integration Strategy for your Digital Health Product
    Stop dreaming about interoperability and focus on
    tactical enterprise integration
    By Shahid N. Shah, CEO

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  2. NETSPECTIVE
    www.netspective.com 3
    Who is Shahid?
    Chairman, OSEHRA Strategic Board of
    Advisors
    • 20+ years of software engineering and multi-
    discipline complex IT implementations (Gov.,
    defense, health, finance, insurance)
    • 12+ years of healthcare IT and medical
    devices experience (blog at
    http://healthcareguy.com)
    • 15+ years of technology management
    experience (government, non-profit,
    commercial)
    Author of Chapter 13, “You’re
    the CIO of your Own Office”

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  3. NETSPECTIVE
    www.netspective.com 4
    What’s this talk about?
    Background
    • Many enterprise apps are being built
    these days, most are designed to
    work as a stand alone system similar
    to consumer apps
    • Healthcare-specific software
    engineering and integration tools
    are going to do more harm than
    good (industry-neutral is better).
    Key takeaways
    • Any enterprise app which acts like
    a consumer app that doesn’t
    integrate well into hospital or
    ambulatory systems and workflows
    is doomed
    • There’s nothing unique about health
    IT data that justifies complex,
    expensive, or special technology.
    • There’s a lot unique about
    healthcare workflows that require
    common technologies to be
    adapted properly.

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  4. www.netspective.com 5
    There is no interoperability
    crisis in healthcare.
    Even if there was, there’s nothing you can do about it so stop complaining.
    There is, however, a vendor management
    and incentives alignment crisis.

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  5. NETSPECTIVE
    www.netspective.com 6
    This practical view is possible today

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  6. www.netspective.com 7
    A Sustainable Business Model for Health
    Information Exchange Platforms: The
    Solution to Interoperability in Health Care IT
    By: Niam Yaraghi
    To address the interoperability problem,
    Yaraghi proposes a business model in which
    economic incentives of different entities in
    the health care market would lead them to
    actively engage in exchanging heath
    information. In the paper, Yaraghi outlines a
    business environment in which health
    information exchange platforms can generate
    substantial revenue from two sources: (1)
    real-time data services to different health care
    providers and (2) asynchronous data analytics
    and customized reports. The revenue
    generated from these sources would be used
    to finance the operational costs of an
    interoperable heath information network.
    http://www.brookings.edu/research/papers/2015/01/30-sustainable-business-model-health-information-exchange-yaraghi

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  7. www.netspective.com 8
    http://blog.syntelinc.com/it-healthcare-data-transmission-standards-health-information-exchange/
    • EDI (Electronic Data Interchange): EDI
    is primarily used for interactions
    between care providers and health
    insurers.
    • HL7 (Health Level Seven): HL7 is similar
    to EDI; it is mainly used for transmitting
    data for all events that occur within a
    hospital.
    • DICOM (Digital Imaging and
    Communications in
    Medicine): Medical Images (X-Ray,
    MRI, etc.) are
    stored/transmitted/printed in a PACS
    (picture archiving and communication
    system) system using DICOM.
    • CCR/CCD (Continuity of Care Record /
    Document): CCD/CCR is a compact
    form with Patient’s health status
    summary. Under Meaningful Use a new
    format—CDA—which is a combination
    of the best features of CCD and CCR, is
    proposed.
    • NCPDP (National Council for
    Prescription Drug Programs): Family of
    pharmacy data standards
    • HITSP (Healthcare Information
    Technology Standards Panel): Related
    to transmission of immunization data,
    bio surveillance, clinical research, etc.

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  8. www.netspective.com 9
    Source: http://jimenezconsulting.com/industries/healthcare/regulatory/hipaa5010

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  9. www.netspective.com 10
    Interoperability without job stories, use
    cases, and incentives is just arm waving.
    Specialization is key.
    Take lessons from SureScripts, IHE, and
    S&I Framework

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  10. www.netspective.com 11

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  11. www.netspective.com 12
    http://cris.cc.nih.gov/about/overview.html

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  12. www.netspective.com 13
    Why do health IT systems
    integrate poorly?

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  13. www.netspective.com 14
    Because customers don’t know how
    to effectively punish vendors that
    don’t integrate well.
    But, that’s changing. Slowly.

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  14. www.netspective.com 15
    Because app developers don’t have
    a systems engineering culture where
    we think of data integration as a
    discipline our customers will buy.
    But, that’s easy to fix. Be disciplined.

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  15. www.netspective.com 16
    Because we want to wait for others
    to create a new standard or magical
    API that makes integration
    problems disappear.
    But, that’s easy to fix. Follow what other industries are doing.

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  16. NETSPECTIVE
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    The tactical issues
    • We don't support shared
    identities, single sign on (SSO),
    and industry-neutral
    authentication and authorization
    • We're too focused on "structured
    data integration" instead of
    "practical app integration" in our
    early project phases
    • We focus more on "pushing"
    versus "pulling" data than is
    warranted early in projects
    • We have “Inside out”
    architecture, not “Outside in”
    • We're too focused on
    heavyweight industry-specific
    formats instead of lightweight or
    micro formats
    • Data emitted is not tagged using
    semantic markup, so it's not
    securable or searchable by
    default
    • When health IT systems produce
    HTML, CSS, JavaScript, JSON,
    and other common outputs, it's
    not done in a security- and
    integration-friendly manner

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  17. So what do we do?
    And now…

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  18. NETSPECTIVE
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    Legacy integration
    Application A
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Copy features and enhance (everything is separate)
    Application A
    Data
    Functionality
    Presentation
    Feature Z
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Connect directly to existing data, but copy features and enhance

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  19. NETSPECTIVE
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    Services
    Modern integration
    Application A
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Create API between applications, integrate data, create new data
    Application A
    Data
    Functionality
    Presentation
    Feature Z
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Create common services and have all applications use them
    REST
    SOAP, RMI
    SOA
    ETL
    WOA
    APIs

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  20. www.netspective.com 21
    Start cataloging and
    formalizing use of
    enterprise integration
    patterns.
    You’re not the first (or second) to see
    these problems. Read. Hire experts.

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  21. www.netspective.com 22
    Learn about MDM, ESB, ETL, and
    BPM – grab open source or
    commercial implementations and
    build around them.
    Don’t hand code things.

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  22. www.netspective.com 23
    Create a formal Enterprise
    Integration Group (EIG).
    Even get a cool logo and team mascot.

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  23. NETSPECTIVE
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    Popular cloud data exchange approach
    DHP Protected Environment
    CDO’s Protected Environment *
    Practice’s
    Systems
    Filter for
    DHP Patients
    Encrypt
    and
    Transmit
    DHPSB
    DHPSB
    DHP
    Data Repository
    (DHPDR)
    Encrypt
    and
    Transmit
    * EHR could be a standalone or hosted by a service provider
    DHP = Digital Health Product
    DHPSB = Digital Health Product Service Bus

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  24. NETSPECTIVE
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    In cloud, data filter strategy is crucial
    Encrypt and Transmit
    Filter using
    CDO’s rules
    Customize to send only
    filtered data
    Send data for all CDO’s
    patients
    Preferred Option
    Send all data and let
    the DHP Gateway
    perform the filter
    Alternate Option
    Pre-filter data from
    each practice system
    before it reaches DHP
    Gateway
    Alternate option requires more work
    on the CDO’s part; the preferred
    option requires more work on the
    DHP’s part
    Encrypt and Transmit
    DHP
    Protected
    Environment

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  25. NETSPECTIVE
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    Data architecture questions to pose
    1. Kinds of data to collect (e.g. demographics, medications, labs, physician
    notes, etc.) - we need this in excruciating, painful detail. Lots of arguments will
    emerge here and that's really good. This means we give specific field names,
    field types, data lengths, etc. as part of the requirements.
    2. Frequency of data to collect (e.g. real-time, hourly, daily, etc.)
    3. Data code types (e.g. LOINC, CPT, ICD9, ICD10, etc.)
    4. Discrete and structured data standards (e.g. CCR, CCD, BB+, etc.)
    5. Directionality (unidirectional from EHR to DHP
    , bidirectional between both
    EHR and DHP)
    6. File types and transport types (HL7, CSV, etc.)
    7. Broad source types (BlueButton, BlueButton+, Ambulatory EHR, Health
    System EHR, Private HIE, Public HIE, etc.)
    8. Specific sources (e.g. named customers, named EHRs, named HIE, etc.)

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  26. NETSPECTIVE
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    Healthcare integration RACI
    • Name the EHR or HIE (or any other source named in #7/#8
    above)
    • Coordinate with the legal and executive team to ensure that you
    have legal rights to the data
    • Coordinate with the IT team at the system owner at the client
    (usually a covered entity but could be a systems integration firm
    or consulting outfit)
    • Coordinate with the EHR or HIE vendor see how cooperative they
    are
    • Send the EHR or HIE vendor the Enterprise Integration document
    and have them fill that out in collaboration with your team
    • Get physical access to the vendor’s database or system

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  27. www.netspective.com 28
    Create a
    technical profile
    questionnaire
    and checklist.
    Be disciplined, use tools like
    Caristix to document
    requirements and visualize
    interfaces.

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  28. www.netspective.com 29
    Lets see what all
    of this looks like in
    practice.
    You can do this in less than 40 man-
    hours of work.

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  29. NETSPECTIVE
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    Ambulatory MU2 Market Share (2014)
    http://www.policymed.com/2014/05/2014-electronic-health-records-market-share.html

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  30. NETSPECTIVE
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    Inpatient MU2 Market Share (2014)
    http://www.policymed.com/2014/05/2014-electronic-health-records-market-share.html

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  31. NETSPECTIVE
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    Healthcare fears open source
    • Only the government spends more per
    user on antiquated software than we do
    in healthcare.
    • There is a general fear that open source
    means unsupported software or lower
    quality solutions or unwanted security
    breaches.
    Open source can save health IT
    • Other industries save billions by using
    open source.
    • Commercial vendors give better pricing,
    service, and support when they know
    they are competing with open source.
    • Open source is sometimes more secure,
    higher quality, and better supported
    than commercial equivalents.
    • Don’t dismiss open source, consider it
    the default choice and select commercial
    alternatives when they are known to be
    better.
    Rely first on open source, then proprietary
    “Free” is not as important as open source, you should pay for software but require openness

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  32. Thank You
    Visit
    http://www.netspective.com
    http://www.healthcareguy.com
    E-mail [email protected]
    Follow @ShahidNShah
    Call 202-713-5409
    Need to develop an enterprise integration
    strategy for your digital health product?
    Call or write to us.

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