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

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Definitions

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

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

EMR Application

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• 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/

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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

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

• Open (big ‘O’) Author-independent

• Open Interface <> Open Source

Open Interface

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

Open Innovation

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• Stands for: Representational State Transfer

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

ReST-ful

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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

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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

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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

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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:

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Business Value

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

Strategic value to HCOs

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• 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

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

Operational Value to HCOs

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• 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

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Existing Efforts

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

Industry examples

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• Microsoft HealthVault • Google Health • Optum Health Cloud

Previous Forays from Tech

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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

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• 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

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*END* Main Presentation