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© 2013 The MITRE Corporation. All rights Reserved. Open Health Tools UI Platform Approved for Public Release: XXXXX. Distribution Unlimited.

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Presentation on theme: "© 2013 The MITRE Corporation. All rights Reserved. Open Health Tools UI Platform Approved for Public Release: XXXXX. Distribution Unlimited."— Presentation transcript:

1 © 2013 The MITRE Corporation. All rights Reserved. Open Health Tools UI Platform Approved for Public Release: XXXXX. Distribution Unlimited.

2 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

3 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

4 © 2013 The MITRE Corporation. All rights Reserved. The OHT UI Team Noah Pedrini Software Engineer, PIIM Marine Koshkakaryan Web Application Developer, PIIM Ken Rubin Health Enterprise Architect, Hewlett Packard Yalini Senathirajah Assistant Professor, Department of Medical Informatics SUNY Downstate Medical Center Gail Hamilton Software Consultant, MITRE Mary Greer Software Engineer, MITRE Erik Sax Software Engineer, MITRE Damian Bendersky Interactive Web Developer, PIIM

5 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

6 © 2013 The MITRE Corporation. All rights Reserved. UI Problem We are Trying to Solve: Allowing Clinician Access to Full Patient Health Record EHR(s) Fax Scanned Records Phone Handhelds Patient EHR Siloed Health Data Multiple data sources ‘One size fits all’ User Interface (UI) EHR UIs lack of usability in non- standard EHR user interface design 1 Lack of Interoperability between EHRs Components of Health IT stacks Cost to organizations Health IT Budget Significant % of annual IT budgets 2 2. Open Health Tools Documentation 1. John Halamaka : for-boundless-energy-and-optimism.html?m=1

7 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

8 © 2013 The MITRE Corporation. All rights Reserved. Open Health Tools UI Platform 8 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 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. Palette Based User Interface

12 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

13 © 2013 The MITRE Corporation. All rights Reserved. Planned Approach for OHT UI Platform 13 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 © 2013 The MITRE Corporation. All rights Reserved. Key Challenges 14 Geographically dispersed participants Volunteer activity Competing schedules and priorities MITRE: Funding change -> reduced resources

15 © 2013 The MITRE Corporation. All rights Reserved. What Happened? 15 Had Weekly meetings False starts 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 © 2013 The MITRE Corporation. All rights Reserved. OHT UI Approach 16 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 © 2013 The MITRE Corporation. All rights Reserved. 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 17

18 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

19 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. HealthBoard

21 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. medCafe

23 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. 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 Two Complimentary Projects, Two Days, 6 People

26 © 2013 The MITRE Corporation. All rights Reserved. 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 Two Complimentary Projects. Two Days, 6 People

27 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

29 © 2013 The MITRE Corporation. All rights Reserved. RESTful Services UI Presentation Enable Innovation VistA HL7

30 © 2013 The MITRE Corporation. All rights Reserved. Observations Medications Careplan Conditions Patient Procedures RESTful Services Provide Consistent Access to Data Pieces VistA HL7

31 © 2013 The MITRE Corporation. All rights Reserved. RESTful Services Web Server UI Platform: Enable Innovation HL7

32 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned

33 © 2013 The MITRE Corporation. All rights Reserved. User-composable EHRs – Research and Findings Yalini Senathirajah, PhD SUNY Downstate Medical Center

34 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. Agenda The Team The Problem The Solution The Approach The Projects The Architecture Research Findings Lesson’s Learned Next Steps

37 © 2013 The MITRE Corporation. All rights Reserved. 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 37

38 © 2013 The MITRE Corporation. All rights Reserved. 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! 38

39 © 2013 The MITRE Corporation. All rights Reserved. Open Health Tools UI Platform: How Did We Do? 39 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 © 2013 The MITRE Corporation. All rights Reserved. Thank You! Noah Pedrini Software Engineer, PIIM Marine Koshkakaryan Web Application Developer, PIIM Yalini Senathirajah Assistant Professor, Department of Medical Informatics SUNY Downstate Medical Center Gail Hamilton Software Consultant, MITRE Mary Greer Software Engineer, MITRE Erik Sax Software Engineer, MITRE Damian Bendersky Interactive Web Developer, PIIM Ken Rubin Health Enterprise Architect, Hewlett Packard

41 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. Questions 42

43 © 2013 The MITRE Corporation. All rights Reserved. Background 43

44 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. 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 © 2013 The MITRE Corporation. All rights Reserved. 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 46

47 © 2013 The MITRE Corporation. All rights Reserved. User Defined Interface 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 Speed Patient Data Re-Acquisition


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