Transcript Innovation and Ecosystem

Accelerating and
Sustaining EHR
Innovations
Seong K. Mun, PhD
President and CEO
OSEHRA
Wednesday, May 7, 2014
Innovation and Ecosystem
“Why great innovations fail:
It's all in the Ecosystem”
Forbes-2012
The Wide Lens: A New Strategy for Innovation
By Ron Adner of Dartmouth
JASON Report*
“EHRs should not be things that one buys,
but rather things that evolve through
cultural change aided by technology”
*A Robust Health Data Infrastructure
JASON Report: November 2013
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Open Source EHR Ecosystem
Community
Software
Governance
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Innovation Strategy is
Organic to OS Operations
Community
Governance
Software
“Greatness on your part is not enough.
• You are no longer an autonomous innovator.
• You are now an actor within a broader innovation
ecosystem.
• Success in a connected world requires that you
manage your dependence.
• But before you can manage your dependence, you
need to see it and understand it. ”
The Wide Lens:
A New Strategy for Innovation
By Ron Adner of Dartmouth
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VistA Innovation Areas
I.
II.
III.
IV.
V.
VI.
Managing Vulnerability
Scheduling Contest
Managing Code
Product Management & Tools
Code Transparency
Sustained Innovation
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I: Managing Vulnerability
• M2M Broker Vulnerability discovered by
Georgia Tech grad student Doug Mackey
on 7/31
• Work under NDA
– VA, IHS
– DSS, Medsphere, iCare, Oroville
•
•
•
•
NDA lifted Mid-October
Coordination with VA for release
Code Convergence Effort
Eventual FOIA Release
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Two Security Models
OPEN SOURCE
PROPRIETARY
TRUST
US
Complete Control
of Implementation
Partial Control of
Implementation
Open source operating systems such as Android & Linux offer the
ability to implement security policies down to the kernel level.
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II: VA MASS* Scheduling Contest
• Goals:
– Knowledge Gathering exercise
– Risk reduction for future RFP and
Acquisition
• Overview: Two Phases
– Phase 1: Evaluate level of integration and
compatibility with open source VistA.
– Phase 2: Evaluate broad features and
functionalities
*Medical Appointment Scheduling System
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Contest Implementation
• America Competes Act
• Identify Solutions to Replace Medical
Scheduling Package – Possibly with
Open Source
• OSEHRA Tested Submissions for VistA
Interoperability and Open Source Content
• 3 Winners
• Future Activity – Under Discussion
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VistA Evolution
VA701-14-I-0147
SOURCES SOUGHT
Office of Health Informatics and Analytics (OIA)
VistA Evolution Program (VEP)
Challenges with Competition and Prizes
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Ecosystem
Open and Proprietary
OS Products
Open
Community
Activities
Proprietary
Products
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III: Managing Code
•
Managed
–
–
–
•
Code subject to formal review/certification
Changes reviewed and subject to configuration
management
Examples: FOIA VistA, OSEHRA VistA
Hosted
–
–
–
–
Code placed into repository by community
Storage and retrieval only
Could be certified
Could be incorporated into managed code base
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Managed Code Submission Path
Dashboard
Forum
Community
Notification
Instrumented VistA
Instance
Managed Code
Submission
Gerrit
Review
Approval
VistA
Patch
Repositor
y
Mirrors
M
i
r
r
o
r
s
Automated
Tool
New Code
Submission
OSEHRA
Technical
Journal
Github
Github and
Gitorious
FOIA VistA
Reference Instance
VistA-M
Repository
OSEHRA VistA
Reference Instance
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Open Source Software Repositories
OSEHRA Repositories
Tools
Generic Repositories
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Open Source Software Quality Certification
• Improves/ensures the quality of Open
Source code
• Critical to making code reusable for
code intake by the community
• NOT a replacement for acceptance,
integration, or regression testing by
new user organization
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OSEHRA Certification Standard
Usable: Appropriate licensing and
documentation
Safe: Individual code units do not
cause errors in other components of
the system and the code is robust to
all code paths and conditions
Compliant: Code meets agreed
upon interface specifications and
code conventions, and complies with
all applicable laws and regulations
Functional: Code has a defined set
of requirements that are met when
the code executes
Maintainable: Integral unit tests are
provided to facilitate regression
testing
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Certification Levels
Level 1
Name/ Number
Space
Dependency /
SAC
Open Source
License
Documentation
Code Review
Test
Installation
Regression
Testing
Functional
Testing
Pass
Pass
Apache 2
None
Large # Noncritical Issues
Large # Noncritical Issues
Existing Tests
Pass
Large # Noncritical Issues
Small # Noncritical Issues
Existing +
Some
R. Tests
Small # Noncritical Issues
No Issues
Existing + >=
50%
Coverage
No Issues
No Issues
Existing +
>= 90%
Coverage
No Issues
Level 2
Pass
Pass
Apache 2
Basic
Small # Noncritical Issues
Level 3
Pass
Pass
Apache 2
Substantial
No Issues
Level 4
Pass
Pass
Apache 2
All Required
No Issues
• Level 1 is reserved for VistA legacy code.
• Levels 2-4 are growing certification compliance.
• For new code developed under VA contracts, OESHRA
recommends a minimum certification level of Level 3.
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IV: Product Management & Tools
VIVIAN
Visualizing VistA and Name Space
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Root view from VIVIAN
“Collapse All” option.
Clicking the “VistA”
button expands the
tree...
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...Now we see several
categories of capabilities.
(We can scroll down to
view the ones that aren’t
now visible.)
We’ll select
“Provider Services”...
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...and that subtree
comes into view.
Now we select
“Order &
Results
Management”...
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...now we see the
Order & Results
Management
capabilities.
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When we click
on “Order
Entry Results
Reporting”...
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We see the namespaces
of the M routines and
globals that the
package uses. (The
leading exclamation
points designate partial
namespaces that are
excluded.)
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A “Dependencies & Code
View” hyperlink lets us
see lists of
dependencies, globals,
Fileman files and M
routines...
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The Dependencies window
includes a hyperlink to
package documentation in the
Vista Documentation Library.
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When we scroll further down the
Dependencies window, we see a list
of routines. Order Entry Results
Reporting has over 1,000 routines!
We can
select a
routine...
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...to get a screen of
routine information and
dependencies.
A “Source Code”
hyperlink can be clicked...
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...to get a view of the M
source code.
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Back on the modal
window, an Interfaces
frame contains
hyperlinks to M APIs,
Remote Procedure Calls,
Web Service APIs, and
HL7 messages.
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The M API link lets us
see all of the entry
points in M code that
have been documented
for database
integration agreements.
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Here we see the routine names, tags, and
additional descriptive information that is
displayed for M-language application
programmer interfaces.
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We can click a hyperlink
to see all of the remote
procedure calls that the
package provides
through the VistA RPC
Broker.
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The Remote Procedure Call view shows RPC
names, tags, routines, and availability
within the VA Enterprise.
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Another hyperlink lets
us see all the package’s
web services that can
be invoked through VA’s
MDWS (Medical Domain
Web Services).
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The Web Services view lists web service
names, facades, parameter and descriptive
information.
We can
select a
web
service...
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...to get descriptions and sample syntax
for all the operations that the web service
supports.
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The last hyperlink in the
modal window’s
“Interfaces” frame lets
us get a list of supported
HL7 Version 2 messages.
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V: Code Transparency
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ADOPT
• Leverage Previous
Investment
ADAPT
• Re- Purpose
• Re-Architect
INNOVATE
• New Solutions
• Continuous Innovation
ACCELERATE
ACCELERATE
Transparency Enables Innovation
Community
Actors
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OSEHRA Today
•
•
•
•
•
2,400+ Individual Members around the Globe
13 Corporate Members, 3 Collaborative Partners
Approximately 15 staff members
Headquartered in Arlington, Virginia
Annual Budget: App. $5 Million
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VistA is Deployed World-Wide
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Working Group Roster
Group Name
Type
Group Name
Type
Academic Affiliates
Work Group
Interoperability
Work Group
Architecture
Work Group
M2M Code Intake
Open Source Project
Group
Certification
Work Group
MDWS
Open Source Project
Group
Code Convergence
Work Group
Open AHLTA Project
Group
Open Source Project
Group
Development Tools
Discussion Group
Patient-Centered Care
Work Group
Education
Work Group
Product Management
Open Source Project
Group
Fileman and Lab
Agile Project (FLAP)
Open Source Project Group
Reminders VA
Work Group
Forum
Open Source Project Group
VistA Dialects
Work Group
Genomics
Open Source Project Group
VistA Evolution CITE
Discussion Group
Imaging
Work Group
VistA Novo
Open Source Project
Group
Immunization
Open Source Project Group
Visualization
Open Source Project
Group
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Sustaining Innovation
Key Issues
OS Approach
I. Vulnerability
•
Security
during
collaboration
•
Temporary security via
NDA until patch
available
II. Contest: Scheduling
•
Evaluation
Criteria
•
•
•
Collaborative definition
of OS code quality
Requirement for Open
APIs
III. Managing Code
•
•
•
Adapt/Adopt
Contribution
Licensing
•
Certification Standard
VI. Product
Management
•
Architecture
•
•
Open APIs
Governance
V. Code Transparency
•
•
Finding code
Sharing code
and interfaces
•
Communication and
Collaboration
Maximum exposure to
submitted code
OS Licensing
•
•
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State of Open Source
• Industry Feeling Limits in Closed Code
– Apple vs Dominance of Android
– Closed Systems Embracing OS Methods
– Spectacular Success of Netflix
• Main Challenges Today
– Ownership vs. Sharing
– Control vs. Open Innovation
– Community Management
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Where do we stand among
our peers?
Foundation
Weak
Copyleft
Linux Kernel
Openstack
Firefox
NonCopyleft
The Apache Foundation
GENIVI
Eclipse
Permissive
License
Strong
Copyleft
The
OSEHRA
Android
Ad Hoc
Opinion
Leaders
Single
Moderator
CommitteeBased
Commercial
Support
Governance Model (how contributions are managed and accepted)
- Courtesy of MARK RADCLIFF
Members
Only
Closed
WHO DECIDES?
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Open Global Collaboration
Total Transparency in Software
www.osehra.org
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