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 ID: 594736
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Slide1
Creating a Flexible
EMR Architecture
Doug Martin, MDSlide2
The Need for InnovationTraditional EMR architectures tend to be monolithic in design, which may limit configurability and extensibilityNovel modular architectures support collaborative EMR development throughBuilt-in extensibility
High level of configurabilityFlexible UISlide3
The CareWeb Framework Slide4
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 developmentSlide5
What It Isn’t
A
standalone application (not an EMR
)
Specific to healthcare
Dependent upon a specific domain
modelSlide6
The Road to CWF
1998 Consortium of VA Hospitals fund
VistAtion
project
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
1999
VistAtion
pilot commences at Atlanta VAMC
2000 VA rejects
VistAtion
concept as
“
too open
”
2001 VistAtion
VueCentric
2002
VueCentric
-based EHR piloted at Crow Indian Hospital
2004 IHS adopts RPMS-EHR as its official EMR
2008 RPMS-EHR deployed in over 120 IHS sites
2009 VueCentric
CareWeb Framework
2010 CareWeb deployed across Indiana HIE
2011 Gopher order entry system begins a new life as Gopher
3Slide7
Rationale for Re-engineeringSoftware platform reaching end of lifeSystems reaching limits of extensibilityDifficulty recruiting engineers with relevant experienceDiminishing compatibility with evolving infrastructureLimited ability to leverage contemporary tools
Complexity of maintaining multiple systemsSlide8
Goals of New PlatformTechnology convergenceWeb-basedLeverage existing open source technologiesExtensible architecture
Modular designEmphasis on component re-useEase of developmentMinimal configurationSupport our research mission!Slide9
What We Already KnewComponent-based frameworks workSeparation of domain from framework is importantGiven the proper tools, users will innovateDon’t design to perceived workflows
Let users adapt software to workflowAbility to share custom layouts is hugeDeployment can be a pain (lots of moving parts)Slide10
ChallengesSpeed, speed, speedScalabilityCross browser supportUI richnessUI consistency
Session interferenceDependency managementVersioningWorkflow supportSlide11
Key TechnologiesJavaSpring FrameworkSpring SecurityZK Framework JQuery
JavaHelpApache ActiveMQ ServerApache TomcatApache MavenCCOWSlide12
ExternalServices
InternalServices
ArchitectureOrder Entry
Chart Search
User Preferences
Web
Resources
Context
Management
Event
Management
Help
Subsystem
Electronic
Signature
Patient
Context
Data
Access
Security
Services
User
Context
Layout
Manager
Theme
Support
Messaging
Services
User
Interface
Layout
Designer
Component
Registration
Plug-in
Widgets
Framework
Services
Plug-in
Services
Framework
Services
Core
Services
Web
Services
Patient
Selection
Electronic
Signature
User
Authentication
Plug-in
Services
SMArt
Plug-in
Clinical
Flowsheet
Rule Authoring
Problem List
Medication List
Allergy ListSlide13
What’s inside the new Gopher?
Data captureOrder entryNote Writing
ObservationsPatient LettersDocument uploader
Electronic signature
Problem list management
Allergy Management
Order Sets
Natural Language Processing
Results display
Recent results
Flowsheet
Clinical abstract
Clinical documents
Encounter display
Order summary
Appointment history
Patient dashboard
Medication summary
Chart search
Clinical Decision support
Alert display
InfoPanel
Rule Authoring
Relevance Adjustment Module
FDB Integration
Setting-specific functionality
Outpatient
Inpatient
Emergency Department
Touch interface
Administrative Tools
User management
Remote troubleshooting
Property management
Concept mapping
Disaster aid support
System integration
McKesson portal
Relay Health portal
Docs4Docs integration
Research
Randomization
Medication adherenceMedication reconciliationMed profile visualization
ResNet study recruitmentSMART plug-ins
CertificationsMeaningful Use
Inpt / OutptNCPDP e-Prescribing
ReportingPopulation searchSlide14
SummaryModular architectures promoteAgile developmentCollaboration within and across organizationsBest-of-breed approachCode re-use
Incremental evolutionSlide15
What’s Next?Ongoing workSMART platform supportClinical abstraction layerEMR adaptors
VistARPMSOpenMRSCommercial systemsOpen sourceCommunity buildingInfrastructure for collaboration