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Open Health Tools UI Platform

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Presentation on theme: "Open Health Tools UI Platform"— Presentation transcript:

1 Open Health Tools UI Platform
Approved for Public Release: XXXXX. Distribution Unlimited.

2 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

3 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

4 The OHT UI Team Gail Hamilton
Software Consultant , MITRE Marine Koshkakaryan Web Application Developer, PIIM Mary Greer Software Engineer, MITRE Noah Pedrini Software Engineer, PIIM Ken Rubin Health Enterprise Architect, Hewlett Packard Damian Bendersky Interactive Web Developer, PIIM Yalini Senathirajah Assistant Professor, Department of Medical Informatics SUNY Downstate Medical Center Erik Sax Software Engineer, MITRE

5 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

6 2. Open Health Tools Documentation
UI Problem We are Trying to Solve: Allowing Clinician Access to Full Patient Health Record Phone Siloed Health Data Multiple data sources ‘One size fits all’ User Interface (UI) EHR UIs lack of usability in non- standard EHR user interface design1 Lack of Interoperability between EHRs Components of Health IT stacks Cost to organizations Health IT Budget Significant % of annual IT budgets2 Fax Handhelds EHR(s) EHR EHR Scanned Records Patient They have, on average only 15 minutes to spend with each patient. And have even less face time with a patient. In this time they must access the situation , to diagnose problem and verify that old and new data confirms/ refutes this hypothesis recommend treatment To do this the doctor has to sift through a large amount of information, from various sources some of it not readily available. These sources of information include: VISTA – The system that they will currently be using to store patient records, or using as a messaging system – generally Outlook Fax – for any information that has been faxed from other clinicians or from outside sources Phone – After a phone call, the physician has to write down the salient points of the call And any scanned in records that are generically labeled “outside records”, and ,may include records from AHLTA – The DoD medical system. As a physician put it: “Everyday you need to search all these sources of information for data.” Which leads to this… All this information must be searched through and correlated in the physician’s head. 1. John Halamaka : for-boundless-energy-and-optimism.html?m=1 2. Open Health Tools Documentation

7 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

8 Open Health Tools UI Platform
Enable an adaptable Health IT Infrastructure, through providing an adaptable user interface that is flexible enough to meet the needs of a range of Health IT users as part of a suite of Open Health Tools Provide an Open Source pilot of end to end capability that demonstrates how to lower the barriers to innovation

9

10 Open Health Tools UI Platform Solution
An adaptable framework that enables a user to build a personal view of a patient record, using a palette of widgets, each of which is separable and platform independent allowing for flexibility and system evolution through substitutability.

11 Palette Based User Interface

12 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

13 Planned Approach for OHT UI Platform
Identify through OHT Meetings likely participants Expectations that this would be volunteer activity Set up standing weekly meeting Have frequent MITRE-led code-a-thon sessions where majority of work would take place Develop solution to a OHT UI developed use case Use hingX as a collaboration tool

14 Key Challenges Geographically dispersed participants
Volunteer activity Competing schedules and priorities MITRE: Funding change -> reduced resources

15 What Happened? Had Weekly meetings False starts Help of Ken Rubin
Tried to accommodate too many ideas Help of Ken Rubin Defined key principles of platform Gave everyone a common understanding of UI Platform goals Started building out some use cases Held a 2 day code-a-thon at MITRE Some interests were not aligned Lost some participants

16 OHT UI Approach Bring together interested parties through OHT to tackle aspects of the UI problem that aligned with their self interests MITRE team: Transition work, and ideas and platform outside of MITRE Parson’s Institute : Move HealthBoard from Flex and have back end infrastructure, transition design ideas Yalini Senathirajah: Bring evidence based research to this approach, and bring this approach to a wider audience. All: Finding collaborations to overcome resistance to new UI concepts and design ideas

17 OHT UI Platform Principles
Design to the 80% DO no(or minimal) harm in customization Integrated, adaptable and consistent across modality/ platform Portability of access. Has to across multiple data repositories/ EHRs / products Palette of reusable, easily extensible and complementary components

18 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

19 Two Complimentary Projects
Shared goal of innovating presentation of medical information medCafe - “One size fits all EHRs do not ‘fit all’; I believe in composable interfaces that empower clinicians to lay out information in way that suits them best!” HealthBoard - “Medical data can be presented better; integrating strong information design principles, visualization makes it easier to understand” Similarities: collapsible widgets, tabs, themes; both open- source, available on OSEHRA and GitHub

20 HealthBoard Let me take a moment to introduce our two characters...

21 HealthBoard Developed by Parson’s Institute of Information Mapping (PIIM), funded by TATRC, with design input from Walter Reed Presentation layer for “patient centered medical home” Goal: bridge geographical barriers to medical care via web- based system, increasing interactions and decreasing costs Project consists of patient and provider portal prototypes (Flash/Flex), as well as design assets Adds non-traditional components like messaging system, chat, nutrition manager, custom “trackers” (i.e. smoking cessation) Geared towards military personnel, but could easily be applied to broader healthcare community

22 medCafe

23 medCafe Developed by MITRE, framework for composable EHR system
Provider-focused, allows users to build, modify, customize patient record to their liking Features Customizable client (widgets) and server (repositories) Composable interface, customizations persist across session Support for multiple data repositories (Vista, local db) Demonstrative of how customizability has potential to optimize system reach and adoption Built using Java, jQuery, jQuery UI, OVID (Java OpenVista access)

24 Though they felt complete, they knew there was more...
Main Focus UX and design (front-end heavy) System architecture (back-end heavy) Data/Persistence All data static Changes don’t persist across sessions All data dynamic Changes to data and UI configuration persist Next steps Hook-up to real data Make mobile version Separate into client and server Explore potential as service

25 Two Complimentary Projects, Two Days, 6 People
medCafe Team Began developing query layer for reading/writing FHIR data stored in MongoDB (built w/ Node.js and Backbone.js) FHIR - Emerging standard for representing healthcare concepts in consistent format and allowing access through RESTful interface HealthBoard Team Familiarized ourselves with medCafe architecture Continued building out initial vitals module Updated prototype to load and parse test observation data (vitals) from sample FHIR server

26 Two Complimentary Projects. Two Days, 6 People
medCafe Build out FHIR server, separate into distinct project Add HTTP response codes, sweep for FHIR compliance, validation HealthBoard Mobile Integrate with medCafe’s FHIR server Integrate medCafe, Open Health Tools UI Group principles Widgetize views, make composable/customizable Make responsive, work on variety of devices Parson’s team plans on contributing back to medCafe

27 Epilogue: Since our Meeting
medCafe: Completed FHIR server support for reading/writing observations (vitals), patients and providers HBMobile Reading/writing all in-app vitals (weight, bp, temp, respiratory rate, heart rate) to/from FHIR server User login, signup and profile editing up and running AngularJS javascript framework integrated Working on medications (including FHIR server support) Wrote Python script to convert drugs in RxNorm db to FHIR- formatted flat file

28 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

29 Enable Innovation UI Presentation RESTful Services hData/ GreenCDA
VistA UI Presentation RESTful Services hData/ GreenCDA HL7 Now here is a rather complex slide. So I’ll step through it. First you see that we have two major components, a RESTful web server which is a subset of web server. So the first thing we want to do is connect to an EHR – VistA and bring the data into the system. In this example you see a snippet of medications in the hData document. The system ingests this XML format and through RESTful web services serves up all the pieces in the VISTA as modular web services. The system accesses these web services simply by using the following something like this sample URL, used to access medications. Users never have to see this URL, as this happens behind the scenes. I list a sample of these here including Patient Details, Medications, Alerts, Vital Signs, etc,…That mirror the structure of the medical record itself. The output is in JSON format. JSON doesn’t look very pretty, but for developers this is the holy grail. Because this is the format that javascript understands. So it is easy for web developers to work with. With simple translation tools they can quickly produce HTML, that looks similar to this. But adding javascript enables a whole world of options. The simplest in medCafe being a simple text formatting of the data encased in a widget. Or on the other extreme, displayed within a javascript timeline, showing the whole patient history.

30 Provide Consistent Access to Data Pieces
VistA RESTful Services hData/ GreenCDA HL7 JSON Observations Medications Careplan Conditions Patient Procedures Now here is a rather complex slide. So I’ll step through it. First you see that we have two major components, a RESTful web server which is a subset of web server. So the first thing we want to do is connect to an EHR – VistA and bring the data into the system. In this example you see a snippet of medications in the hData document. The system ingests this XML format and through RESTful web services serves up all the pieces in the VISTA as modular web services. The system accesses these web services simply by using the following something like this sample URL, used to access medications. Users never have to see this URL, as this happens behind the scenes. I list a sample of these here including Patient Details, Medications, Alerts, Vital Signs, etc,…That mirror the structure of the medical record itself. The output is in JSON format. JSON doesn’t look very pretty, but for developers this is the holy grail. Because this is the format that javascript understands. So it is easy for web developers to work with. With simple translation tools they can quickly produce HTML, that looks similar to this. But adding javascript enables a whole world of options. The simplest in medCafe being a simple text formatting of the data encased in a widget. Or on the other extreme, displayed within a javascript timeline, showing the whole patient history.

31 UI Platform: Enable Innovation
Web Server RESTful Services hData/ GreenCDA HL7 HTML AJAX Now here is a rather complex slide. So I’ll step through it. First you see that we have two major components, a RESTful web server which is a subset of web server. So the first thing we want to do is connect to an EHR – VistA and bring the data into the system. In this example you see a snippet of medications in the hData document. The system ingests this XML format and through RESTful web services serves up all the pieces in the VISTA as modular web services. The system accesses these web services simply by using the following something like this sample URL, used to access medications. Users never have to see this URL, as this happens behind the scenes. I list a sample of these here including Patient Details, Medications, Alerts, Vital Signs, etc,…That mirror the structure of the medical record itself. The output is in JSON format. JSON doesn’t look very pretty, but for developers this is the holy grail. Because this is the format that javascript understands. So it is easy for web developers to work with. With simple translation tools they can quickly produce HTML, that looks similar to this. But adding javascript enables a whole world of options. The simplest in medCafe being a simple text formatting of the data encased in a widget. Or on the other extreme, displayed within a javascript timeline, showing the whole patient history.

32 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned

33 User-composable EHRs – Research and Findings
Yalini Senathirajah, PhD SUNY Downstate Medical Center

34 History Developed user-composable EHR (‘MedWISE’) in ~2007, as part of PhD work at Columbia University Real functional system built into New York Presbyterian Hospital existing system Tested with real patient cases and clinicians residents, attendings, physician assistants Selected results: All users able to learn in a short training period and use system for real case review Most (>80%) of users enthusiastic, rated favourably on ease of use, usefulness

35 Findings Reduced repetitious navigation (70% decrease) suggests time savings Support for reduced cognitive load; reduced need to integrate information in mind Some users take advantage of new opportunities to improve system, adapt it to specific needs, fix existing problems Concerns about accuracy, possible errors; small studies show no difference in diagnostic accuracy from conventional system Philosophical issues regarding errors; See: Essential Questions: Accuracy, errors and user perceptions in a drag/drop user-composable Electronic Health Record. Senathirajah Y, Kaufman D, Bakken S. Stud Health Technol Inform. 2013;194:

36 Agenda The Team The Problem The Solution The Approach The Projects
The Architecture Research Findings Lesson’s Learned Next Steps

37 Lesson Learned Adaptable to changing circumstances
Move over new standard quicker Accept that will lose people / groups along the way There will be attrition of groups More face to face meetings and have initial face to face meeting much earlier Collaboration hingX was not well used: primarily as artifact repository Need to work on how to use collaboration tools better Workshop Have sooner or at least 2 Better preparation: transition of ideas/ technology before the workshop Better evaluation of two architectures prior to workshop

38 Next Steps FHIR Integration
Reconcile John Nolen work on FHIRMeteor with NodeOnFHIR Reconcile with efforts underway at MITRE and OSEHRA S/W Integration effort to move medCafe to FHIR Fully transition to Parsons Institute Licensing on FHIR Apache 2 Need more collaborators willing to work with us At an exciting point, with FHIR integration – we don’t want to see the work end now!

39 Open Health Tools UI Platform: How Did We Do?
Enable an adaptable Health IT Infrastructure, through providing an adaptable user interface that is flexible enough to meet the needs of a range of Health IT users as part of a suite of Open Health Tools Provide an Open Source pilot of end to end capability that demonstrates how to lower the barriers to innovation

40 Thank You! Gail Hamilton
Software Consultant , MITRE Marine Koshkakaryan Web Application Developer, PIIM Mary Greer Software Engineer, MITRE Noah Pedrini Software Engineer, PIIM Ken Rubin Health Enterprise Architect, Hewlett Packard Damian Bendersky Interactive Web Developer, PIIM Yalini Senathirajah Assistant Professor, Department of Medical Informatics SUNY Downstate Medical Center Erik Sax Software Engineer, MITRE

41 Questions? For more information .
medCafe Contact : Gail Hamilton : Live demo Login: guest1, Password: guest1 HealthBoard Source code (GIT) https://github.com/medcafe/medCafe OHT UI Platform Collaboration Site

42 Questions

43 Background

44 Palette of reusable, easily extensible and complementary components
Many small, independent pieces that each run ‘standalone’ Easy to deploy and add new capability through adding new widgets User decides which components to use depending upon patient Allows use of ‘Best of Breed’ components Replacing/ upgrading components is easy

45 Integrated, adaptable and consistent across modality/ platform
Javascript framework on top of HL7 Standard Enables widgets to run independent of Platform Consistent display Laptop / Desktop Browser Mobile Device Tablet Device Lowering Barriers to Innovation UI developers only need to have knowledge of Javascript Add new widgets through simple Javascript API

46 Portability of access Has to across multiple data repositories/ EHRs / products
Normalize data to HL7 Standard hData Currently moving to FHIR UI developers only worry about one data format Less time and resources on taking care of underlying data interoperability issues More time can be spent on creating better ways to display the information to enable better and safer patient care Building rapidly deployable FHIR node.js server

47 User Defined Interface
Speed Patient Data Re-Acquisition Use Pre configured Interfaces Components/ Template Template: predefined set of components arranged optimally Default templates are provided to align with common use cases Create/ add new templates as desired User/Clinician Defined Views Customize view for patients Align with patient use cases Per Patient Views Some patients do not ‘fit the mold’ Modify a view for a specific patient and save record view Displays saved view on re-engagement with Patient Speeds re-engagement with a patient


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