Creating a Flexible EMR Architecture Doug Martin, MD The Need for Innovation • Traditional EMR architectures tend to be monolithic in design, which may.
Download ReportTranscript Creating a Flexible EMR Architecture Doug Martin, MD The Need for Innovation • Traditional EMR architectures tend to be monolithic in design, which may.
Creating a Flexible EMR Architecture Doug Martin, MD The Need for Innovation • Traditional EMR architectures tend to be monolithic in design, which may limit configurability and extensibility • Novel modular architectures support collaborative EMR development through – Built-in extensibility – High level of configurability – Flexible UI The CareWeb Framework What It Is • A foundation for component-based applications • Highly extensible through plugin modules • Flexible, supporting user-designed layouts • A coordinator of shared functions (events, contexts) • A facilitator of collaborative development What It Isn’t • A standalone application (not an EMR) • Specific to healthcare • Dependent upon a specific domain model The Road to CWF • 1998 Consortium of VA Hospitals fund VistAtion project • • • • • • • • • • • • • • 1999 2000 2001 2002 2004 2008 2009 2010 2011 Integrate commercial note authoring tool into CPRS Monolithic, closed → open, modular, extensible architecture Monopolistic → collaborative development culture Needed a supporting framework (VistAtion Framework) Modularize CPRS → VistAtion components VistAtion pilot commences at Atlanta VAMC VA rejects VistAtion concept as “too open” VistAtion VueCentric VueCentric-based EHR piloted at Crow Indian Hospital IHS adopts RPMS-EHR as its official EMR RPMS-EHR deployed in over 120 IHS sites VueCentric CareWeb Framework CareWeb deployed across Indiana HIE Gopher order entry system begins a new life as Gopher3 Rationale for Re-engineering • Software platform reaching end of life • Systems reaching limits of extensibility • Difficulty recruiting engineers with relevant experience • Diminishing compatibility with evolving infrastructure • Limited ability to leverage contemporary tools • Complexity of maintaining multiple systems Goals of New Platform • • • • • • • • • Technology convergence Web-based Leverage existing open source technologies Extensible architecture Modular design Emphasis on component re-use Ease of development Minimal configuration Support our research mission! What We Already Knew • • • • • • • Component-based frameworks work Separation of domain from framework is important Given the proper tools, users will innovate Don’t design to perceived workflows Let users adapt software to workflow Ability to share custom layouts is huge Deployment can be a pain (lots of moving parts) Challenges • • • • • • • • • Speed, speed, speed Scalability Cross browser support UI richness UI consistency Session interference Dependency management Versioning Workflow support Key Technologies • • • • • • • • • • Java Spring Framework Spring Security ZK Framework JQuery JavaHelp Apache ActiveMQ Server Apache Tomcat Apache Maven CCOW External Services Internal Services User Interface Architecture Order Entry Chart Search Clinical Flowsheet Rule Authoring SMArt Plug-in Plug-in Widgets Patient Selection Problem List Medication List Allergy List Web Resources Plug-in Services Layout Manager Layout Designer User Authentication User Preferences Electronic Signature Framework Services Electronic Signature Patient Context User Context Context Management Event Management Component Registration Help Subsystem Data Access Security Services Messaging Services Web Services Plug-in Services Theme Support Framework Services Core Services What’s inside the new Gopher? • – – – – – – – – – – • • • Recent results Flowsheet Clinical abstract Clinical documents Encounter display Order summary Appointment history Patient dashboard Medication summary Chart search Alert display InfoPanel Rule Authoring Relevance Adjustment Module FDB Integration Setting-specific functionality Randomization Medication adherence Medication reconciliation Med profile visualization ResNet study recruitment SMART plug-ins Certifications – – • McKesson portal Relay Health portal Docs4Docs integration Research – – – – – – • User management Remote troubleshooting Property management Concept mapping Disaster aid support System integration – – – • Outpatient Inpatient Emergency Department Touch interface Administrative Tools – – – – – Clinical Decision support – – – – – • Order entry Note Writing Observations Patient Letters Document uploader Electronic signature Problem list management Allergy Management Order Sets Natural Language Processing Results display – – – – – – – – – – • – – – – Data capture Meaningful Use Inpt / Outpt NCPDP e-Prescribing Reporting – Population search Summary Modular architectures promote – Agile development – Collaboration within and across organizations – Best-of-breed approach – Code re-use – Incremental evolution What’s Next? • Ongoing work – SMART platform support – Clinical abstraction layer – EMR adaptors • • • • VistA RPMS OpenMRS Commercial systems • Open source – Community building – Infrastructure for collaboration