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2016 iHT2 San Diego Health IT Summit
1. iHT2 Conference
January 19, 2016
Stanley M. Huff, MD
stan.huff@imail.org
T H E H E A L T H C A R E I N N O V A T I O N E C O S Y S T E M
The Healthcare Services Platform
Consortium: A New Ecosystem for
Sharing Knowledge and Applications
2. 2
Intermountain Healthcare Profile
An Integrated Health System
1975 1983 1994
• 22 hospitals
• 33,000 employees
• 600,000 members
• 25% market share
• 200 clinics
• 1,000 employed
physicians
3. What is the Healthcare
Services Platform Consortium
(HSPC)?
3
5. Essential Functions of the Consortium
Select the standards for interoperable services
Standards for models, terminology, security, authorization, context sharing, transport
protocols, etc.
Modeling: SNOMED, LOINC, RxNorm – FHIR Profiles – do it together
Provide testing, conformance evaluation, and
certification of software
Gold Standard Reference Architecture and its Implementation
We will work with an established company to provide this service
Implementation of the standard services by
vendors against their database and infrastructure
Everyone does not have to do every service
There must be a core set of services that enable a marketplace
5
6. HSPC History
HSPC was incorporated as a not-for-profit corporation on August 22,
2014
Meetings
May 2013 Salt Lake City
August 2013 in Phoenix
January 2014 Salt Lake City
May 2014 in Phoenix
July 2014 Salt Lake (Technical modeling meeting)
August 21-22 2014, Washington DC, hosted by IBM
February 4-6, New Orleans, Louisiana, hosted by LSU
June 17-19, Washington DC
August 10-13, Salt Lake City
September 28-30, Phoenix
January 20-22, New Orleans, Louisiana, hosted by LSU
6
8. Homer Warner and HELP
Intermountain can only
provide the highest
quality, lowest cost
health care with the use
of advanced clinical
decision support
systems integrated into
frontline clinical
workflow
Dr. Homer Warner
8
10. Core Assumptions
‘The complexity of modern medicine exceeds
the inherent limitations of the unaided
human mind.’
~ David M. Eddy, MD, Ph.D.
‘... man is not perfectible. There are limits to
man’s capabilities as an information
processor that assure the occurrence of
random errors in his activities.’
~ Clement J. McDonald, MD
1
11. Clinical System Approach
Intermountain can only provide
the highest quality, lowest cost
health care with the use of
advanced clinical decision
support systems integrated into
frontline workflow
11
16. Decision Support Modules
Antibiotic Assistant
Ventilator weaning
ARDS protocols
Nosocomial infection
monitoring
MRSA monitoring and
control
Prevention of Deep Venous
Thrombosis
Infectious disease reporting
to public health
Diabetic care
Pre-op antibiotics
ICU glucose protocols
Ventilator disconnect
Infusion pump errors
Lab alerts
Blood ordering
Order sets
Patient worksheets
Post MI discharge meds
16
17. We can’t keep up!
We have ~150 decision support rules or
modules
We have picked the low hanging fruit
There is a need to have 5,000+ decision
support rules or modules
There is no path from 150 to get to 5,000
unless we fundamentally change the
ecosystem
17
18. The cost of medical software
Becker’s Health IT & CIO Review
Partners HealthCare: $1.2 billion
Boston-based Partners HealthCare is one of more recent implementations, going live the first
week of June to the tune of $1.2 billion. This is the health system's biggest investment to date.
The implementation process took approximately three years, and in that time, the initial price tag
of $600 million doubled.
Intermountain Medical Center $550 million
18
19. More Reasons
Every useful piece of software has to be created
in each EHR system
As a society, we pay the cost of creating all of those
copies of useful programs
Agile development
Usability of software, creativity, innovation
19
24. Apps that address specific focused problems…
Provider-facing services
Focused decision support
Visualization
Disease management
Specialty workflows
National Shared Services
Genomic testing & CDS
Pharmacogenomic screening
CDC Ebola screening?
CDC immunization forecaster
Prior Authorization / Appropriateness
App 1
EHR
App 2 App 3
Like Google Maps…
24
25. Apps that enable data sharing…
Next-gen Interoperability
Population Health integration
HIE integration
Data capture for research
Clinical Trial recruiting
Quality Repositories
EHR
2
App 1
EHR
3
EHR
1
ACOs and Registries
25
26. Apps that empower patients / consumers…
Apps as Prescriptions
Chronic disease
management
Pt-Provider
Communication
Remote monitoring
Outcome capture & Clinical
Effectiveness Monitoring
SMART
Phone App
Pop
Health
EHR
Like ???? …
26
28. SAGE Project
HL7 Working Group Meeting
April-May 2003
Guy Mansfield, Ph.D.
Health Informatics, IDX Systems
A collaborative project to
develop a universal framework
for encoding and disseminating
electronic clinical guidelines
“ “
28
29. SAGE Project
Feedback
Author
Encode
Publish
Import
Install
In Practice
Evaluate
o Guidelines would be
routinely encoded in
a standard,
computable format,
and would be widely
available for
downloading.
o Healthcare
organizations would
be able to import
proven guidelines,
and execute them via
their local clinical
information systems.
Research, meta
analysis,
“crafting the
guideline”
Disambiguation
,
encoding,
testing
Guidelines.net?
Guidelines-R-
Us.com?
Download to local
care delivery organization
Clinical editing,
guideline set up
Guidelines active
in local CIS
Outcomes
research
Consolidated
feedback
29
30. Old Strategy Problems
1. The application had to be
imported and compiled for each
platform/facility/version
2. Local installation of knowledge
resources
3. Small hospitals lack support
4. Disagreement
30
31. Knowledge Sharing via Executable Apps
Decision Support
ApplicationTrigger Event
EHR
System
Standardized
FHIR APIs
31
32. The New Way
1. One copy can service many requests
2. Logic only needs to be installed in one place
3. No need to import the decision module to the local EHR
4. If standard FHIR APIs are implemented by vendors, the
module can be used by any EHR
5. The decision support language does not need to be
standardized, just the APIs for interactions
32
33. Characteristics of a new
Ecosystem
Consistent and unambiguous data collection
Data stored and accessed through truly semantically
interoperable services
Sharing of data for direct patient care, population
based analytics, and research
Sharing of applications, executable clinical decision
support and knowledge
33
34. What are the Challenges?
Enlisting the large EHR vendors to support
standards based services and architecture
Everyone currently has their own library of services
Vendors are developing their own “app stores”
Uniform implementation of truly interoperable
services
The vendors have FHIR libraries and development
environments, but they are not truly interoperable
35. The Business Case for Vendors
They aren’t keeping up with demand
Happier customers because they have higher quality,
lower cost applications
New source of revenue for testing HSPC approved
applications with their platform
New revenue for providing standards based services
36. “True” Interoperability is Hard!
Standard HL7 FHIR services
Standard FHIR profiles
Observation Hematocrit (for example)
Choice of the correct LOINC and SNOMED CT codes
The HL7 Clinical Information Modeling Initiative
OAuth2 plus standard configuration for authorization
SMART strategy for EHR integration
41. What Is Needed to Enable a New
Ecosystem?
Standard set of detailed clinical data models
coupled with…
Standard coded terminology (SNOMED CT,
LOINC, RxNorm, others)
Standard query language
Standard API’s (Application Programmer
Interfaces) for healthcare related services
Open sharing of models, coded terms, and API’s
Sharing of decision logic and applications
41
43. Essential Functions of the Consortium
Select the standards for interoperable services
Standards for models, terminology, security, authorization, context sharing, transport
protocols, etc.
Modeling: SNOMED, LOINC, RxNorm – FHIR Profiles – do it together
Publish the models, and development instructions openly, licensed free-for-use
Provide testing, conformance evaluation, and certification of software
Gold Standard Reference Architecture and its Implementation
We will work with an established company to provide this service
Fees that off set the cost of certification will be charged to those who certify
their software
Implementation of the standard services by vendors against their
database and infrastructure
Everyone does not have to do every service
There must be a core set of services that enable a marketplace
43
44. Other Functions of the Consortium
Participation in “other” functions is optional for a given
member
Enable development “sandboxes”
Could be provided by companies or universities
Could be open source or for-profit
Set up a vendor neutral and provider neutral “App Store”
Many companies and provider organizaitons already have their own app stores
Vendor certification that a given application can be safely used in their system
Accommodate small companies or individuals that won’t have their own app store
Create a business framework to support collaborative
development
Pre-agree on IP, ownership, co-investment, allocation of revenue
Try to avoid unique contracts for each development project
Provide a way for people to invest (Venture capital)
44
46. SOA Services Layers
46
• Support common UI Standards
• Provide services for imbedding application in existing EMR/EHR frameworks
UI
• Implement a multi-layered services architecture (SOA)
• Support common Decision Support models (BPMN2/Drools)
• Support common workflow models (BPMN2)
• Data and vocabulary transformation Services
• Context management services
• Master Data Management Services
• Identity Management Services
Orchestration of Services and Busines Layer
• Support FHIR/Restful Services models that support launch and forget
applications and applications that support a full SOA services stack
• Deploy FHIR profiles in collaboration with Argonaut, the VA, Intermountain,
Regenstrief, Mayo/ASU and LSU.
Data Virtualization
47. SOA Guiding Principles
47
Three tiered services model
Maintain atomic services that are consistent in performance
and behavior
Can be administered once in a framework
Can be orchestrated under a true SOA governance
Can be consumed by anyone implementing the HSPC
reference architecture
Can be addressed by synchronous and asynchronous service
requests
Are implementable out of the box
Are supportable and documented to a standard
Provide HSPC supported services as open source
50. Argonauts
Don’t know for sure
A call is planned to discuss the relationship
Work together on HIMSS demonstrations?
Work together to create industry wide consensus for
profiles to be used for “true” interoperability?
51. HL7
HSPC will use HL7 FHIR for data services
CIMI plans to become a part of HL7
HSPC will use HL7 as the forum for creating industry
wide agreement about:
Detailed profiles for true interoperability
Consensus of professional and clinical bodies about data
that needs to be collected and shared (workflow or
process interoperability)
52. SMART
HSPC will use SMART as a EHR integration strategy
HSPC will work together with SMART on all activities of
mutual interest
We will create a written document (MOU?) to describe
the relationship between the two organizations
53. Center for Medical Interoperability
Work for support of CIMI and HSPC as part of C4MI
technical programs
Possible activities
Host a vendor and provider neutral app store
Create a reference implementation of HSPC services
Host a development sandbox
Logistic support
Meetings, websites, publicity
Host a model repository (and other knowledge artifacts)
Support online terminology services
Tool development
Conformance testing and certification
55. OUR VISION
Be a provider-led organization that accelerates the
delivery of innovative healthcare applications that improve
health and healthcare.
56. OUR GOAL
Our goal is to create an open marketplace featuring the
industry’s first vendor-neutral Healthcare App Store and
to foster a vibrant entrepreneurial community to deliver
the best solutions quickly, easily and seamlessly to
improve the quality of today’s accountable care.
Achieving the gold standard of true semantic
interoperability, our services platform seeks to
dramatically augment today’s standards efforts by
providing a ground-breaking collaborative platform and
real world laboratory to advance the native interoperability
of healthcare applications.
57. ABOUT HSPC
The Healthcare Services Platform Consortium (HSPC) is
a provider-driven organization of leading healthcare
organizations, IT vendors, systems integrators, and
venture firms dedicated to unlocking the power of
entrepreneurial innovation to improve healthcare
outcomes.
Through HSPC’s open marketplace and services
platform, we seek to foster a new level of provider-
vendor collaboration and innovation to meet one of the
industries’ greatest needs -- accelerating the creation,
sharing and delivery of promising software applications
at the point of care.
58. OUR MEMBERS
HSPC’s founding members are established leaders in shaping
the course of healthcare.
Intermountain Healthcare
Department of Veterans Affairs
LSU Health
Regenstrief Institute
Harris Corporation
They are joined by a growing membership of forward thinking
providers, vendors, technology providers, researchers and
venture firms, all committed to creating a new and open,
market-based paradigm to drive innovation at the point of
patient care.
59. HOW WE’LL DO IT
Collaborate with members to create a specification (based
on existing industry standards where possible)
Truly semantically interoperable data access specification
Security standard for clinical applications and data access.
Authorization, Authentication, Application Launch Context, etc.
Clinical Care Pathways
Coordinated Care across multiple providers
Proactively seek new members
Provide a development sandbox representative of a real
world hospital system.
Host an App Store